Adventure and high-risk sports is thrilling and exciting. It’s a sport that attracts adventure enthusiasts like Richard Branson and the Secretary of State, John Kerry.

Doctors, presidents, CEO’s actors, and people who love the thrill of an adventure sport, kiteboarding offers “big air” as they fly above the water while maneuvering a giant wave.

It should be no surprise that there is an element of danger and injury in this sport; and although injury studies have not reached a scientific level, there are common injuries that have occurred. … read more

The Tommy John Surgery and Little Leaguer’s Elbow

With a 13-3 record during the spring and summer of 1974, Los Angeles Dodgers pitcher Tommy John was having an incredible year. Then, mid way through the season, the left-handed sinkerball thrower significantly tore through the ulnar collateral ligament (UCL) on his throwing arm. The UCL, located on the inside aspect of the elbow, comes under extreme stress during the throwing motions and it is impossible to pitch at the major league level without it intact.

The season was over for Tommy John. In fact, up until that point it could have been assumed that his entire career was over. But on September 25, 1974, Tommy became the first person to undergo reconstructive surgery that would allow him to return to the playing field for the 1976 season.

The surgery, now commonly known as Tommy John surgery, replaced the damaged ligament with a tendon from his non-throwing forearm. These days, orthopedic surgeons can take a tendon from a variety of locations, including the hamstring or Achilles tendons. Although the rehabilitation process is lengthy at about one year, athletes have a good chance of recovery. Close to 85% of throwers will be able to achieve the same level of competitiveness once the process is complete.

Tommy John surgery is performed mainly on high level throwing athletes; however, injuries to the same area can plague the younger players as well. On the other end of the spectrum is little leaguer’s elbow. This is also an injury caused by repeated stress to the ulnar collateral ligament, but the difference here is that the force of a child or adolescent pitching a baseball does not cause the ligament to break. Here, the stress leads to an uneven growth between the inside and outside aspects of the elbow. This abnormal bone development may result in cubital tunnel syndrome, which is a compression of the ulnar nerve (funny bone) as it passes through the elbow. This can in turn cause numbness, tingling, or weakness in the elbow or hand.

In some cases of little leaguer’s elbow, there may even be a stress fracture where the UCL attaches.3 The young athlete will have pain with throwing a baseball, and may be tender to the touch over the inside of the elbow. Little league baseball mitigates the risk of this condition developing by setting rest requirements and pitch count limits. All coaches and league officials should follow these regulations. If your child is a little league pitcher, you should make sure that he does not exceed the recommended limits for his age group.

Year round baseball play may also increase the risk of little leaguer’s elbow. In Seattle of course, weather does not permit youth baseball to continue year round, but some pitchers aspiring to improve their skills may seek indoor facilities to continue their practice. In this case, players should follow the guidance of the USA Baseball Medical and Safety Advisory Committee, which states that pitchers should not play for more than nine months total per year.

Pitchers certainly are at risk for arm and hand injuries, but the rest of the team is not immune from getting hurt either. Fractures to the hand may result from getting struck by a pitch while gripping a bat or sliding into a base. Diagnosing a fracture in the hand is usually done with X-ray. Treatment for simple fractures is casting for 6-8 weeks, although surgical fixation may be required for more complex breaks.

One final injury worth discussing is mallet finger, also called baseball finger. This injury is a tearing of the tendon that straightens the most distal joint of the finger. The injury mechanism is usually a “jammed finger”, either from sliding into a base or being struck on the top of the finger with a ball. The inability to fully straighten the finger will usually send the player to a physician, who can make the diagnosis through clinical presentation.

Treatment for this injury usually involves splinting the finger for several weeks. If adequate function has not been restored after splinting or if there was a bone fracture or joint misalignment during the original injury, then surgical repair may be necessary. This could consist of tendon grafting to the damaged finger, or using small pins or screws to fix bone fragments.

Wayne Mitchell Weil, MD, specializes in the surgical and non-surgical treatment of hand and elbow disorders. Dr. Weil uses the latest surgical techniques, including minimally invasive carpal and cubital tunnel releases. Those suffering from pain or reduced functional use of their hand or elbow should contact Dr. Weil for a consultation.

The Seattle Times reported from the Mariners Clubhouse that, “Montero has a tear of the meniscus in his left knee and will undergo surgery next week. He is expected to miss four to six weeks.” It is unclear at this point what caused this specific injury.

Although a meniscus tear is painful and will require surgery in this case, there is hope for a great outcome.

Dr. Charles Peterson II commented on this specific case saying, “While Jesus Montero has been having his challenges this year at (and behind) the plate, his meniscus-tear surgery should go fairly smoothly. In most cases of isolated meniscus tears, we can have athletes back to full sports about 6 weeks after surgery. Now, whether this will improve his OBP remains to be seen!”

Below are some symptoms and treatment that may come with a torn meniscus from our Meniscal Tear Article: … read more

Anatomy
The patellar tendon attaches the lower pole of the kneecap (patella) to the lower leg bone (tibia). The quadriceps muscle attaches to the upper pole of the kneecap and pulls through the kneecap and patellar tendon to allow one to straighten out ones leg or to support ones weight while squatting.

When the patellar tendon is torn, one cannot support their weight when the knee is bent, such as getting up from a chair or going down the stairs.

Injury Mechanism
The patellar tendon is usually injured with a sudden high force across the tendon, such as landing from a jump. The patellar tendon can be injured by a direct blow or a sharp laceration across the tendon.

Symptoms
Patellar tendon injuries present as significant pain across the front of the knee and immediate weakness in supporting ones weight while squatting. Patients usually cannot straighten their knee out fully with a complete tear of the patellar tendon. Rapid swelling occurs. Often, one can feel a gap under their kneecap at the site of the rupture.

Diagnosis
The physician’s work-up will start with a careful history and exam. The physician can often feel the defect in the patellar tendon and can appreciate the weakness on trying to straighten out the knee against resistance.

X-rays reveal a very high riding patella, since the pull of the quadriceps is no longer opposed by the tethering effect of an intact patellar tendon.

An MRI scan is often obtained to confirm the diagnosis, especially if the physician is concerned that the injury may be just a partial tear that may be able to heal without surgical repair. Plain x-rays show the bones of the knee, while MRI scans reveal the soft tissues around the knee including the ligaments, menisci, muscles and tendons.

Treatment
Your physician will discuss treatment options with you. Treatment decisions are based on whether the injury is a complete tear or a partial tear. Partial tears may be able to be treated with a brace. The brace is initially locked out completely straight to take all of the pressure off of the injured tendon.

As healing occurs, the hinges are unlocked and motion and strengthening are initiated. With complete tears, surgery is almost always recommended. Surgery involves sewing the two ends of the tendon together with strong suture material. If the tendon has pulled directly off of the bone, drill holes are made into the bone to repair the tendon directly to the bone. Risks and benefits of surgery are discussed thoroughly with the patient.

What to expect after surgery
Patellar tendon surgery is usually performed as an outpatient procedure. Patients are sent home with crutches and a knee brace with the knee fully straightened to protect the repair. Depending on the strength of the repair, patients start gentle range of motion and progressive weight bearing over 6-8 weeks.

Patients are using a stationary bike by 2 months, and an elliptical or stair climber shortly thereafter. Jogging is restricted until 4 months following surgery and full sports activities are not resumed until 6 months after surgery. Most patients can return to full activities, with no restrictions and no bracing at the 6th month point.

Photo Via WNBA.com

As ESPN recently reported, Sue Bird, “The Seattle Storm star point guard is recovering from recent left knee surgery, which will sideline her for the entire summer season that began this weekend and runs through August.” Bird underwent knee surgery earlier this May to repair a cyst. She is hopeful that she will be able to play this fall when the team plays against Russia. In addition, she is optimistic that she will be back next spring.

In an interview, Bird said, “I’m doing well, I’m about almost two weeks post-op and had my follow-up appointment, everything’s good. It’s a waiting game now.” … read more