As if the Colts secondary has not been tormented by enough injuries this season, we recently learned that safety Bob Sanders will be out with a distal biceps tendon rupture at the elbow which will require season-ending surgery. The surgery was performed by the renowned orthopaedist Dr. James Andrews earlier this week.
The biceps muscle is an important muscle in the upper arm. The distal tendon of the biceps muscle transmits all of the forces of the muscle to the forearm at its insertion (radial or bicipital tuberosity), thereby contributing to an athlete's ability to forcefully flex the elbow as well as rotate their forearm in turning the palm upward (supination).
The distal biceps tendon can tear, preventing the transmission of forces from the muscle to the forearm bones. While it can happen from repetitive injury in athletes, it more commonly results from a single traumatic event in which the flexed elbow is resisted or even traumatically extended as in Sander's case. The event is usually accompanied by a "popping sensation" and sense of sharp tearing around the elbow crease.
Once a distal biceps tendon is ruptured, it unfortunately will not heal on its own. Rather, the tendon will continue to retract away from the bone and slide up the arm as the muscle contracts without resistance. Over time, the tendon will be come stiff and scarred as well. This loss of biceps muscle function results in a loss of elbow flexion (bending the elbow) and forearm rotation strength.
Usually the presentation of a distal biceps tendon is not subtle in the athlete. When compared to the normal arm, the tendon can no longer be palpated at the elbow flexion crease. Frequently, there is swelling and bruising around the elbow flexion crease.
The diagnosis can be made by taking a history from the patient and performing a physical exam. An MRI often can confirm a complete tear of the tendon as well as to assess any potential retraction of the tendon. Over the past few years, surgical techniques and implants have improved, which, when combined with people trying to stay more active, has led to an increasing number of distal bicep tendon repairs being performed.
In the past, 2 incisions were typically needed to repair the tendon whereas now 1 is often used. Patients are protected in a brace for the first 6 weeks after surgery after which they progressively work on strengthening exercises before returning to sports. The best results are achieved when surgery is done within three weeks of the initial injury.
Showing posts with label Orthopedy and traumatology. Show all posts
Showing posts with label Orthopedy and traumatology. Show all posts
Sunday, November 15, 2009
Tuesday, August 18, 2009
Ibuprofen is best for kids with broken arms
Kids with a broken arm do better on a simple over-the-counter painkiller than on a more powerful prescription combination that includes a narcotic, a surprising study finds.
It tested ibuprofen, sold as Advil, Motrin and other brands, against acetaminophen plus codeine — a combo called Tylenol No. 3 that is also sold in generic form.
The children on ibuprofen did better, said the study leader, Dr. Amy Drendel of the Medical College of Wisconsin in suburban Milwaukee.
"They were more likely to play, they ate better and they had fewer adverse effects," she said.
Results were published online Tuesday by the Annals of Emergency Medicine. Experts praised the study as one of the few to compare medicines that have been long used in children based on how they work in adults.
"We want to start with what's effective and less likely to cause problems," and in this case, it turned out to be a cheap, over-the-counter drug, said Dr. Knox Todd, an emergency medicine pain researcher at Beth Israel Medical Center in New York and a member of the American Pain Society's board of directors.
The results do not mean that ibuprofen beats acetaminophen for everyday pain relief in children or anyone else, though. The study tested a specific use — pain in the first three days after a broken arm — and the acetaminophen was combined with the narcotic codeine, not tested alone.
Still, it shows the best way to treat a very common problem: As many as one out of five kids will break a bone before age 10 — often, an arm.
Researchers randomly assigned 336 children ages 4 to 18 to go home with liquid versions of either ibuprofen or the acetaminophen-codeine combo after being treated for a broken arm at Children's Hospital of Wisconsin. Neither the children, parents nor the doctors knew who received what treatment until the study ended.
Full results were available on 244 children. The portion who failed to get relief from their assigned medicine was roughly the same.
However, half of those on the combo medicine reported side effects — mostly nausea and drowsiness that can occur with narcotics like codeine — versus 30 percent of those given ibuprofen.
The ibuprofen users also had fewer problems eating, playing, going to school or sleeping. They and their parents reported more satisfaction with the treatment.
"A lot of emergency medicine physicians are afraid to give kids narcotics and a lot of parents are uncomfortable with narcotic medicine," so finding an effective alternative is good news, Drendel said.
The hospital and medical school paid for the study, and a hospital-related charity paid for $10 Toys R Us gift certificates for each participant.
The study has nothing to do with limits on Tylenol for adults that were recently proposed by an advisory panel to the federal Food and Drug Administration, said Todd, who is a member of that panel.
"Acetaminophen when taken as directed is a very safe drug. The problem is people taking too much," or its inclusion in drugs that people might not be aware of, he explained.
It tested ibuprofen, sold as Advil, Motrin and other brands, against acetaminophen plus codeine — a combo called Tylenol No. 3 that is also sold in generic form.
The children on ibuprofen did better, said the study leader, Dr. Amy Drendel of the Medical College of Wisconsin in suburban Milwaukee.
"They were more likely to play, they ate better and they had fewer adverse effects," she said.
Results were published online Tuesday by the Annals of Emergency Medicine. Experts praised the study as one of the few to compare medicines that have been long used in children based on how they work in adults.
"We want to start with what's effective and less likely to cause problems," and in this case, it turned out to be a cheap, over-the-counter drug, said Dr. Knox Todd, an emergency medicine pain researcher at Beth Israel Medical Center in New York and a member of the American Pain Society's board of directors.
The results do not mean that ibuprofen beats acetaminophen for everyday pain relief in children or anyone else, though. The study tested a specific use — pain in the first three days after a broken arm — and the acetaminophen was combined with the narcotic codeine, not tested alone.
Still, it shows the best way to treat a very common problem: As many as one out of five kids will break a bone before age 10 — often, an arm.
Researchers randomly assigned 336 children ages 4 to 18 to go home with liquid versions of either ibuprofen or the acetaminophen-codeine combo after being treated for a broken arm at Children's Hospital of Wisconsin. Neither the children, parents nor the doctors knew who received what treatment until the study ended.
Full results were available on 244 children. The portion who failed to get relief from their assigned medicine was roughly the same.
However, half of those on the combo medicine reported side effects — mostly nausea and drowsiness that can occur with narcotics like codeine — versus 30 percent of those given ibuprofen.
The ibuprofen users also had fewer problems eating, playing, going to school or sleeping. They and their parents reported more satisfaction with the treatment.
"A lot of emergency medicine physicians are afraid to give kids narcotics and a lot of parents are uncomfortable with narcotic medicine," so finding an effective alternative is good news, Drendel said.
The hospital and medical school paid for the study, and a hospital-related charity paid for $10 Toys R Us gift certificates for each participant.
The study has nothing to do with limits on Tylenol for adults that were recently proposed by an advisory panel to the federal Food and Drug Administration, said Todd, who is a member of that panel.
"Acetaminophen when taken as directed is a very safe drug. The problem is people taking too much," or its inclusion in drugs that people might not be aware of, he explained.
Thursday, July 23, 2009
Atlanta Sports Medicine Doctor Spero Karas Wins 'Atlanta's Top Doctors' Honor Again
Spero G. Karas M.D. has again been profiled in Atlanta Magazine's Top Doctors issue within the Orthopedic Surgery category. One of only five Orthopedic Surgeons listed in the July 2009 exclusive, Dr. Karas retains this distinction from the magazine's previous Top Doctors list compiled in July 2007.
Atlanta Magazine compiles its biennial list of "Atlanta's most trusted physicians" based on the results of the highly-regarded Castle Connolly Top Doctors survey. Castle Connolly's physician-led research team follows a rigorous screening process in which board-certified physicians and medical leaders identify particular doctors they feel best embody the ideal of excellence in patient care.
In essence, Dr. Karas and others selected for the Top Doctors list represent those to whom the nominating physicians would send their own families. It is important to note that doctors do not and cannot pay to be profiled as Castle Connolly Top Doctors. Selections are entirely peer-based and randomly sampled. Hence, the results of the vigorous screening process truly identify the most respected doctors in America, subdivided by fields of practice and geographical region.
Dr. Karas was specifically cited for his special expertise in elbow reconstruction, knee reconstruction, shoulder reconstruction, and sports medicine in the Atlanta metro area.
In addition to having been distinguished twice by Atlanta Magazine for being the city's "Most Trusted Sports Medicine Specialist," Dr. Karas was recently included in Castle Connolly's "Best Orthopedic Surgeons in America" list. He was featured last year in Women's Health Magazine's "America's Top Doctors for Women" and Men's Health Magazine's "Top Sports Medicine Specialists."
Dr. Karas specializes in providing comprehensive care to people of all ages with shoulder pain, knee pain, and upper extremity conditions related to traumatic, degenerative, sports and work-related injuries.
As Director of Emory University's Orthopaedic Sports Medicine Fellowship Program, Dr. Karas is a recognized expert in the field of shoulder surgery, knee surgery, arthroscopy, and sports medicine. He has been inducted into the prestigious American Shoulder and Elbow Society, one of only five other physician members in the state of Georgia. In addition to Dr. Karas' role as director of Emory Orthopaedic Sports Medicine, he currently serves as a consulting team physician for Georgia Tech University, Emory University Athletics, and Lakeside High School.
For more information about Dr. Spero Karas or the Emory Sports Medicine Center, contact Dawn Ulloa or visit atlantashoulder.com.
About Emory Sports Medicine Center:
The Emory Sports Medicine Center is a global leader in providing advanced treatments for patients with sports and orthopaedic injuries. Patients treated there range from professional athletes and world leaders to those who enjoy active lifestyles and want to ensure the best possible recovery from injuries.
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