Sports Medicine Workshop

Presented by:
Drew Thomas, MD
George Biltz, MD
Steve Elias, MD

2008-2009 Schedule:

• September 17, 2008
• November 12, 2008
• April 2009 TBA
• June 2009 TBA

All sessions are from 1:30 pm - 4:30 pm in the Harrison Conference Room (PWB 13-204/6)

Session 1 - September 17, 2008

Suggested Readings: Session 1

• "Running injuries in children and adolescents"
  Katy Lilly, Teri Metcalf McCambridge, MD
  Contemporary Pediatrics July 1, 2008
• Ankle Sprains in Young Athletes: Part I & Part II
  Dilip R. Patel, MD; Carrie Janiski, BS
  Contempory Pediatrics Vol 22 No 12 December 2005

Other Optional Readings: Session 1

• "Persistent Pain after Ankle Sprain"
  Hugh L. Bassewitz, MD; Matthew S. Shaprio, MD
  The Physician and Sports Medicine Vol 25 No 12 December 1997
• "Overuse Injuries in Children And Adolescents"
  John P. DiFiori, M.D.
  The Physician and Sports Medicine Vol 27 No 1 January 1999
• "Managing Common Stress Fractures"
  Peter Brukner, MBBS; Chris Bradshaw, MBBS; Kim Bennell, PhD
  The Physician and Sports Medicine Vol 26 No 8 August 1998
• "Exercises Induced Leg Pain"
  Michael Korkola, MD; Annunziato Amendola, MD
  The Physician and Sports Medicine Vol 29 No 6 June 2001
• "Foot Injuries of the Recreational Athlete"
  Stephen M. Simons, MD
  The Physician and Sports Medicine Vol 27 No 1 January 1999

Study Questions: Session 1
Please review and complete all study questions prior to the session.

1. What is the most common type of ankle sprain, and why is this so from a biomechanical perspective?
2. The Anterior Drawer Test is used to test the integrity of which ankle ligament?
3. Describe a 1st, 2nd and 3rd degree lateral ankle sprain in terms of the lateral ankle ligaments.
4. What is the function of the Syndesmosis?
5. What are the Ottawa Ankle Rules?
6. What does the mnemonic PRICEMMM stand for?
7. What is an apophysis?  Name the two most common sites of apophysitis in the lower extremity.
8. Discuss 5 factors which can contribute to lower extremity overuse injury.
9. Discuss 4 historical and physical parameters which would lead you to suspect a stress fracture in a patient.
10. What parameters would you like to see fulfilled before you allow an athlete with a grade one ankle sprain return to practice and competition?
11. Your patient has just recovered from an overuse injury. What would you advise the patient so that the injury not recur?

Session 2 -November 12, 2008

Suggested Readings: Session 2

• "Patellofemoral Syndrome"
  Michele LaBotz, MD
  The Physician and Sports Medicine Vol 32 No 7 July 2004
• "Managing Collateral Ligament Tears of the Knee"
  Robert J. Meislin, MD
  The Physician and Sports Medicine Vol 24 No 3 March 1996
• "Osgood-Schlatter Disease: Practical Treatment for a Self-Limiting Condition"
  Eric J. Wall, MD
  The Physician and Sports Medicine Vol 26 No 3 March 1998
• "The Ottawa Knee Rule"
  Paul J. Nugent, DO
  The Physician and Sports Medicine Vol 32 No 5 May 2004
• "Acute Knee Injuries"
  Robert F. LaPrade, MD; Fred Wentorf, MS
  The Physician and Sports Medicine Vol 27 No 10 October 1999
• "A Complete Approach to Groin Pain"
  Vincent J. Lacroix, MD
  The Physician and Sports Medicine Vol 28 No 1 January 2000
• "When Groin Pain Is More than 'Just a Strain': Navigating a Broad Differential"
  Joseph J. Ruane, DO; Thomas A. Rossi, MD
  The Physician and Sports Medicine, Vol 26 No 4 April 1998
• "Your guide to a dreaded injury: The ACL tear"
  Richard E. Rodenberg, MD; Kenneth Cayce IV, MD; Scott Hall, MD Contemporary Pediatrics, July 1, 2006
• "A guide to ACL injury: Treatment, rehabilitation, prevention"
  Richard E. Rodenberg, MD; Kenneth Cayce IV, MD; Scott Hall, MD Contemporary Pediatrics, August 1, 2006

Study Questions: Session 2
Please review and complete all study questions prior to the session.

1. Define the difference between a Sprain and a Strain.
2. List three traumatic conditions that commonly cause significant, acute swelling of the knee.
3. What is the primary function of the ACL?
4. Describe the difference between the Lachman Test and the Anterior Drawer Test.  Which is the most reliable?
5. You are seeing a patient for suspected Patellofemoral Pain Syndrome.  Name at least three physical parameters to evaluate before you examine the knee.
6. Explain the role of quadriceps strengthening and flexibility training in the treatment of Patellofemoral Pain Syndrome.
7. What muscles originate from the following bony landmarks on the pelvis?  Anterior Superior Iliac Spine, Anterior Inferior Iliac Spine, Ischial Tuberosity.  How would you test for avulsion injury to the aforementioned muscles?
8. What would you tell the parents of a child with Osgood Schlatters Condition who wants to continue to play soccer even though there is some discomfort?
9. What is the treatment for a grade I MCL sprain?
10. What is Osteochondritis Dissecans?  Where is it most likely to present in the pediatric knee and what is the best x-ray view to order to see it?

Session 3 - April 2009

Suggested Readings: Session 3

• "Common Acute Upper Extremity Injuries in Sports"
  Holly J. Benjamin, MD, FAACP, FACSM and Brian T. Hang, MD, MS
  Clinical Pediatric Emergency Medicine Vol 8 Issue 1 March 2007
• "Don’t let Little League shoulder or elbow sideline your patient permanently"
  Kevin D. Walker, MD, Joseph A. Congeni, MD
  Contemporary Pediatrics Vol 21 No 9 September 2004
• "Serious, Often Subtle, Finger Injurie: Avoiding Diagnosis and Treatment Pitfalls"
  James R. Lairmore, MD; William D. Engber, MD
  The Physician and Sports Medicine Vol 26 No 6 June 1998

Study Questions: Session 3
Please review and complete all study questions prior to the session.

1. Name the 4 muscles that comprise the rotator cuff and describe each muscle's action and/or function with regard to shoulder movement/stabilization.
2. What is shoulder impingement? Name some sports activities in which this is likely to occur.
3. Pain with apprehension testing relieved by a relocation test would be suggestive of what shoulder problem?
4. List the 6 secondary ossification centers of the elbow and their general age of appearance. (Hint: Come Read My Tale Of Love)
5. Describe the "Valgus Overload" syndrome of elbow overuse.
6. Match up the following:

     7. How is a patient likely to present with a mallet finger injury?  How is it treated?
     8. How would you splint a volar plate injury?

Session 4 - June 2009

Suggested Readings: Session 4

Concussion:

• "Managing concussion in a young athlete"
  Dilip  R. Patel, MD
  Contemporary Pediatrics Vol 23 No 11
• "Pediatric Sport-Related Concussion: A Review of the Clinical Management of an Oft-Neglected Population"
  Michael W. Kirkwood, PhD, Keith Owen Yeates, PhD and Pamela E. Wilson, MD
  Pediatrics Vol 117  No 4 April 2006
• "Return to Play following sports-related concussion"
  Mark Lovell, PhD, Micky Collins, PhD, James Bradley, MD
  Clinics in Sports Medicine Vol 23 No 3 July 2004

Back Pain:

• "Back Pain in Children and Adolescents"
  William K. Payne III, MD and James W. Ogilvie, MD
  Pediatric Clinics of North America Vol 43 No 4 August 1996
• "Treating back pain in young athlete"
  Jason Kronberg, DO and Eric Small, MD
  Contemporary Pediatrics Vol 22 No 11 Nov 2005

Burners and Stingers:

• "Burner Syndrome: Recognition and Rehabilitation"
  Susan J. Nissen, MD; Edward R. Laskowski, MD; Thomas D. Rizzo, Jr, MD
  The Physician and Sportsmedicine Vol 24 No 6 June 1996

Study Questions: Session 4
Please review and complete all study questions prior to the session.

1. True or False:  Children who engage in sports and present with back pain are more likely than adults to have an identifiable cause for their pain.
2. Regarding spondylolysis, what sports have a high incidence of this condition, and why are participants in these sports at high risk?
3. How might you differentiate back pain from a pars articularis stress fracture from lumbar disc herniation on history and physical exam?
4. How is spondylolistheses graded?  Is sport participation contraindicated in Grades I and II?  If not, how would you monitor the patient?
5. You have an 8 year old child with Down Syndrome in your practice.  Special Olympics requires testing for Atlantoaxial Instability.  What x-ray views are you going to order?
6. You are attending a soccer game where a 13 year old player has a head injury.  There was no loss of consciousness or amnesia, but the player was momentarily stunned and dazed.  Now, 20 minutes later the player reports no symptoms and wishes to return to play.  How will you handle the situation at this point?
7. Contrast the two most prevalent concussion grading systems in use i.e. The American Academy of Neurology and The Colorado Medical Society grading scales.
8. In a patient with a burner or stinger, how would you test for motor and sensory function of the Axillary Nerve?  The Musculocutaneous Nerve?
9. What is Second Impact Syndrome?  When are players at risk?
10. You strongly suspect your patient has a pars articularis stress fracture but plain films including obliques are negative.  Where do you go from there?
11. What would you recommend to the parents of a 16 Y.O. hockey player who had a grade II cerebral concussion 2 days ago, has a posttraumatic headache that is 80% gone, and a normal neuro exam?