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Health & Wellness
Presented by Barnes Jewish Hospital & Washington University Physicians

With professional athletes as our biggest investment, it's important to have doctors and physicians we can count on. It's because of that principle that the Blues work with doctors from Washington University and Barnes Jewish Hospital. Below, you'll find video and articles from one of our team physicians about common athlete injuries, how they can be treated and how well these injuries can heal. [ TEAM PHYSICIAN INDEX ]

  Rick Wright, MD
Professor of Orthopaedic Surgery
Washington University School of Medicine

Dr. Wright is the head team physician for the St. Louis Blues. He is a Washington University orthopaedic surgeon who specializes in sports medicine. Dr. Wright practices at Barnes-Jewish Hospital & the Washington University Outpatient Orthopedic Center in Chesterfield, Missouri as well as at the Washington University Medical Center.

VIDEO: ACL injuries | Dislocated Shoulder | Common Injuries


ROTATOR CUFF REPAIR
The rotator cuff consists of four muscles that surround the ball and socket joint in the shoulder. Their role is to initiate shoulder movement and to stabilize the joint by compressing the ball against the socket when larger muscles such as the deltoid, trapezius, and latissimus are recruited to perform heavy lifting or overhead activities such as those in tennis or baseball. Overuse and acute traumatic injuries can cause a tear in one or more of the tendons that attach the rotator cuff muscles to the bone on the ball of the shoulder. This is a common injury seen in orthopedic sports medicine clinics. The patient that presents with a rotator cuff tear typically will describe pain or inability to use their arm away from their body. This includes reaching overhead, reaching away from their body and reaching behind the back. Physical examination will often demonstrate weakness in muscle testing of the rotator cuff. X-rays are most often normal. An MRI or an ultrasound test can be used to determine if a rotator cuff tear is present.

Once a tear is identified, the patient and the physician will determine if the patient is a candidate for a trial of conservative treatment including physical therapy, ice and NSAIDs or if they need to consider surgical repair. Rotator cuff tears that are complete will not heal on their own without intervention. However, rotator cuff tears can frequently be handled with conservative management especially if the injury was gradual and due to overuse. Acute injuries, on the other hand, often need to be dealt with by surgery performed within a relatively short period of time after the injury.

Surgical repair performed at Washington University involves a minimally invasive approach. This includes arthroscopy and 3 to 4 puncture wounds to allow instruments to be advanced into the shoulder and reattach the tendon to the ball (humeral head). This is typically performed by placing anchors into the humeral head that have sutures attached to them. These sutures are weaved through the tendon and tied down to reattach it to the bone. The body will then finish the process by healing the tendon to the bone over time. Patients are typically maintained in a sling for 4 to 6 weeks. Physical therapy will consist of range of motion exercises and strengthening once the tendon has been allowed to heal back to the bone. Once strength is regained, patients can return to their usual activities including sports and recreational endeavors.


IMPINGEMENT
The rotator cuff consists of four muscles that surround the ball and socket joint in the shoulder. Their role is to initiate shoulder movement and to stabilize the joint by compressing the ball against the socket when larger muscles such as the deltoid, trapezius, and latissimus are recruited to perform heavy lifting or overhead activities such as those in tennis or baseball. Overuse or acute injuries can cause pain in the rotator cuff. This is commonly referred to as rotator cuff tendinitis, impingement, or bursitis.

Patients present with complaints of pain with use of their arm overhead, away from their body or behind their back. This typically has gradual onset but may develop after an injury. Quite commonly this progresses to the point that they will have symptoms at night that may awaken them or make it difficult to fall asleep. Pain typically originates at the shoulder joint and will radiate down the arm. Numbness or tingling is usually not associated unless there is nerve irritation in the neck in conjunction with the shoulder pain. Patients may note some stiffness in the shoulder especially reaching behind their back. X-rays are typically normal and if an MRI is obtained it may show some mild fraying of the rotator cuff but no complete tear.

Treatment typically consists of conservative management initially. This will include physical therapy for strengthening of the rotator cuff and anti-inflammatory medications. In addition, if they have lost range of motion, joint stretching will also be included. Most of the time, this regimen will eliminate the pain and allow the patient to return to their usual activities. Occasionally if the patient is slow to recover or has significant symptoms a cortisone injection may be added. Patients that have worked on conservative management for several months without complete relief of their pain may want to consider a surgical approach.

This consists of an arthroscopic procedure to evaluate the rotator cuff and to remove inflamed tissue surrounding the rotator cuff. This typically is an outpatient surgery utilizing a minimally invasive approach with 2 to 3 puncture wounds for the surgery. Patients will remain in a sling for a short time (7-10 days). Physical therapy is started to regain range of motion and improve strength. Return to sports and recreational activity usually occurs at 6 to 12 weeks. Results of this procedure have been demonstrated to be in the 85-95% good and excellent range.


MENISCUS DEBRIDEMENT
The meniscus is the soft rubbery bumper cushion that sits between the thigh bone and the leg bone. There are two menisci in the knee; a medial (inside) and a lateral (outside) meniscus. These structures act as shock absorbers that decrease the stress seen by the articular cartilage found on the end of the thigh bone and leg bone. Meniscus injuries are quite common and occur in patients of all ages. An injury can occur as a result of squatting, turning or twisting during almost any activity. Once the meniscus is torn, symptoms like locking, clicking, and catching may occur. In addition, patients will frequently notice swelling in the knee. The pain will be localized along the joint line on the inside or the outside of the knee depending on the tear. The diagnosis is made based upon a history and physical exam and frequently special tests. X-rays are usually normal. If there is some question regarding the diagnosis, an MRI can be obtained to confirm a tear. Most tears remain symptomatic and will ultimately require treatment if they interfere with activities of daily living or sports and recreation activities.

Ninety-percent of the time, the appropriate treatment is arthroscopy to remove the torn fragments. Often the meniscus cannot be repaired due to the lack of blood supply, which prevents healing factors from getting to the area of injury even when repaired by stitches. Arthroscopic meniscal debridement is one of the most common procedures performed in orthopedics. It is typically very successful in decreasing symptoms and allowing patients to return to their normal activities. The fact that the patient has torn the meniscus increases their risk of arthritis over the next 15 to 20 years. Removing the torn fragments does not increase this risk, but merely decreases the symptoms from the tear.

Recovery from an arthroscopy to remove the torn meniscus is relatively short. It is a minimally invasive outpatient surgery with typically 2 to 3 small puncture wounds to perform the surgery. The patient will typically be weight bearing as tolerated, but he/she may need to use crutches for a few days following the surgery. Swelling typically improves during the first week. Patients with sedentary jobs can return within one to two days. More physical laborers may take longer to recover. Patients typically return to sports or exercise by 4 to 6 weeks following a short period of physical therapy.

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