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Sports Medicine Archive Questions

Below are Dr. Dreese-left’s answers to Sports Medicine questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 71.

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Q : 1

I have recently injured my knee during running. After double visit at my local clinic and examination by, unfortunately, an usual doctor (not sports medicine), he stated that my cartillage is damaged in some degree. That also inflicts on me some minor pain during excessive knee movements in the inner part of the left knee. Squats, quick u-turns and similair activity). USG has also indicated ganglion situated in left gastrocnemius. The doctor prescribed me some medications (glucosamine-based supplement with some extra content) and advised 3 month rest. Despite being a very active person (bad luck that the insufficient amount of rest has caused the injury), I have to stop lower body activity during rehabilitation period. However, I am curious about one exercise. Can I perform double leg calf raises. Is it going to deteriorate my cartilage rebuilding process?

Low impact activities limit the stress on the cartilage of the weight-bearing surfaces in the knees. If you continue to have persistent pain and MRI of your knee may be helpful in differentiating between cartilage damage (arthritis) and a meniscus tear.

Q : 2

I recently pulled a hamstring. It's getting better slowly but surely, still swollen and I can't put any pressure on it. But it does seem like every morning I've been able to progress in walking. My question is: 1) When should I switch from ice to heat? Or should I? 2) When should I start stretching and doing small exercises? 3)Are there any tips or certain stretches I can do to eensure this won't happen again? This is going to set me back a while and I'd like to make sure I'm overly cautious.

Generally speaking, allow the injury to heal for a week or two before doing any stretching. Otherwise, you are breaking up the early scar tissue that is an important part of the healing response. Working with physical therapy may also help expedite your recovery.

Q : 3

I have no cartilage in my left knee. I am looking for alternatives to surgery (replacement) like regenerating or growing cartilage to fill the gap. Does such an option exist?

The body does not have the potential to regrow cartilage, except potentially in very young individuals (likely < 6 years of age). You may consider medications like glucosamine and chondroitin sulfate, but there is no good evidence to suggest that you can heal a cartilage injury with this. Otherwise, your options are surgical and involve a number of different options to regrow a cartilage-like surface in the knee.

Q : 4

I believe that I have "golfer's elbow." Is there a particular type of brace that you recommend?

The cho-pat strap (counterforce brace) is most appropriate. Physical therapy can be very helpful as well.

Q : 5

I am 34, but since the age of 7, I've had bicep pain when throwing a baseball. I have taken 10 years off from throwing with no success. Would I be a candidate for bicep tenodesis surgery?

First, you need to have an accurate diagnosis. You will need to get an MRI arthrogram of your shoulder to look at the labral structures, which are typically the source of pain in throwing athletes. In addition, you need to see an orthopaedic surgeon board-certified in sports medicine for further evaluation and development of a treatment plan.

Q : 6

I have ruptured my quadriceps muscle. Can this be repaired by arthroscopic surgery? I really don't want a large scar.

Ruptures of the quadriceps tendon from the patella should be surgically repaired. The results of non-surgical treatment are loss of knee extension strength, making it difficult to climb steps and walk up inclines. Return of strength and function can be expected following repair. The quadriceps tendon can be repaired through an incision approximately 4 inches long on the top of the kneecap. The tendon cannot be reliably repaired using arthroscopy.

Q : 7

My 8-year-old daughter is an athlete. For the past two weeks, she has complained about her knee. One knee has more fluid around the knee cap then the other and she complains that it is stiff and she doesn't have full range of motion. Should she be evaluated?

Swelling in or around the knee is always a concern in young athletes. It can be the result of multiple injuries, but warrants further attention to determine its source. She should not participate in sports while she has swelling.

Q : 8

How long is too long to wait for surgery to repair a torn hamstring?

If the hamstring is completely torn from the ischial tuberosity, surgery is generally recommended. Within the first 3-4 months these hamstring tears are generally repairable. However, past that point the tendon can become retracted and atrophy, making repair much less beneficial. However, some chronic tears don't have a lot of retraction and/or atrophy and remain good candidates for repair. In general, mid-substance and distal injuries of the hamstring are not likely to benefit from surgery.

Q : 9

I am a middle aged man who is in good health and works out regularly. I want to participate in a basketball league, but I am concerned about the risk of injury given my age. Is it a good idea to wear knee and ankle supports or braces and similar aids as a preventative measure?

Knee supports have never been definitively proven to prevent injuries. Ankle braces, however, have been shown to successfully reduce the incidence of lateral ankle sprains, particularly in individuals who have suffered sprains in the past.

Q : 10

At the end of July I had a lateral meniscus tear surgery on my right knee (scope). My doctor said the tear was big so now there isn't much meniscus there and its making my bone bruise. I was cleared for light activity, but after three weeks of jogging, my knee is very swollen and I'm having some pain again. My doctor recommended meniscus replacement, but said I wouldn't be able to play sports afterward. Is this accurate?

Lateral meniscus deficiency can be a source of persistent disability, ultimately leading to lateral compartment cartilage wear (arthritis). If you have had more than 50 percent of your lateral meniscus removed, you may be a candidate for meniscus transplantation. Cadaveric meniscus transplantation has been shown to be effective at reducing symptoms, but returning to competitive pivoting sports is not recommended in light of the higher failure rates with return to these activities. I recommend you get another opinion from a sports medicine specialist near you.

Q : 11

My husband has a complete PCL tear. He has been told by his orthopedic surgeon that surgery is not a good option and recommended physical therapy. From what I'm reading, a level III complete tear requires surgery in order to to be stable. What's your advice?

Isolated PCL tears (no injury to the ACL, MCL, or LCL) are generally treated with physical therapy initially. Sometimes if those patients continue to have pain (typically behind the kneecap or on the inner side of the knee), PCL reconstruction may be necessary. However, if an injury to the ACL, MCL, or LCL are also present with the initial injury, then surgical reconstruction would be recommended.

Q : 12

My son was kicked in the calf during a soccer game. Since then, he has iced, used heat and done a lot of stretching. The muscle is still tight most of the time and it's hard for him to walk and bend his ankle. It also appears that there is a knot at top of calf. Should we be worried ?

Traumatic injuries to the muscle will often develop some tightness or scar tissue as part of the healing response. Your son may benefit from working with a physical therapist to alleviate the discomfort he is experiencing.

Q : 13

Which MRI procedure (open or closed) is better when viewing injured shoulder (possible rotary cuff)? And if a open is used is the face under the machine? Thanks.

Closed MRI is more effective at evaluating for a possible rotator cuff tear. Your head is inside the machine for a closed MRI. I recommend that patients get a closed MRI whenever possible to give the best possible diagnostic information in making treatment decisions. You can wear headphones in the MRI machine which may help you relax while you close your eyes in the machine. Most closed MRI's take approximately 45 minutes to complete.

Q : 14

Three months ago, I dislocated my knee cap while running on the treadmill. I have had ultrasounds and X-rays taken of my knee, but they were all normal. My knee still randomly "locks" at times and sometimes I feel pain similar to growth pains around the same knee. I am a runner and I wish to start running again. I wear a knee brace while running and even have orthotics in my shoes. Though I don't feel any pain while I run, my knee feels heavy afterward. Is a minor knee dislocation supposed to take this long to heal or is this something else? Can I continue running?

When you dislocated your kneecap, you tore the ligament (medial patellofemoral ligament) that centers the kneecap in the center of the knee. This typically results in a lot of swelling for a few weeks. Physical therapy is indicated for a first-time dislocation to improve tracking of the patella and strength of the quad muscles. Studies show that about half of first time dislocations do well with physical therapy alone, but half continue to have symptoms and pain. These patients eventually require surgery to reconstruct the torn ligament. Results of surgery are excellent. I have many patients with this problem and they almost all are able to return to full activity. The other problem with kneecap instability is that it can cause cartilage damage to the kneecap or femur from the excessive translation of the kneecap. I always get an MRI to look for these cartilage changes, and if they are present recommend reconstruction sooner in an effort to prevent further cartilage damage.

Q : 15

If a quad has been separated from the patella for about 4 months, with surgery can you have normal use of that knee?

You may still be a candidate for direct repair, but if the tendon is badly retracted, augmentation with a tendon graft may be necessary.

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