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Frequently Asked Questions

Edward O'Mara, MD

Q: What are overuse sports injuries and as a coach how do I prevent them?

A: Overuse injuries occur over time due to stress a young athlete places on muscles, joints, ligaments and particularly the growth plate regions of bones without allowing the proper time to recover and heal. Overtraining and single sport specialization can lead to overuse injuries. Ensure your athletes have adequate breaks between practices and games. Encourage natural cross training which occurs from playing a variety of sports. If one of your players develops symptoms that persist or affects their performance, they should be examined by an orthopedic surgeon. A young athlete should never be allowed or expected to "work through the pain."

Q: What happens to your knee when you injure your ACL and/or meniscus? How is it treated?

A:
ACL (Anterior Cruciate Ligament) and meniscus (cartilage) are important structures that help to create stability and absorb shock in the knee. Injuries to the ACL and meniscus occur most often when the body is in motion, the foot is planted on the ground, and the lower portion of the leg stops while the upper portion keeps moving. This scenario can result in a sprain (stretching) or, in worst cases, a tearing of the ACL and/or the meniscus.

For minor sprains, bracing of the knee along with physical therapy may resolve the injury, but in many cases, surgical repair of the ACL and/or meniscus is necessary.

Surgery to repair the ACL usually involves a tissue graft being used to replace the torn section of the ACL. The meniscus can sometimes be repaired using stitches to anchor it back in place; occasionally, a small portion of it needs to be removed. With both types of surgeries, after initial healing has taken place, physical therapy can be a crucial part of a successful recovery.

William Cook, MD

Q: I am in my early 40's and have pain in my knees, what can I do to keep it from getting worse?

A: There are many causes for knee pain in this age group. These include early degenerative changes, overuse injuries of the soft tissues, trauma or infection. Most often the pain is caused by strain of the muscles, tendons or ligaments around the knee; but in cases of previous trauma or athletic injuries, the pain can be due to developing arthritis.

Overuse injuries, such as tendonitis or ligament strain can be relieved or prevented by cross training so that one particular structure is not excessively stressed and the exercise program is spread over the entire knee joint. Excessively high impact training, such as marathon training, can also cause breakdown of the cartilage which may lead to pain caused by arthritis. If this occurs, one should reevaluate continuing that sort of high impact program. An evaluation by a board certified orthopedist, including a physical exam and appropriate imaging studies will provide the most specific treatment program.

Q: How is a reverse total shoulder replacement different from a traditional total shoulder replacement?

A: For decades, sufferers of severe shoulder arthritis have relied on traditional total shoulder replacement as a proven solution. But for individuals with more complex shoulder issues, such as a torn rotator cuff, this was not the best option. In recent years, a new shoulder replacement option called reverse total shoulder replacement has offered relief from pain and lack of mobility to those with more difficult shoulder problems.

In a traditional shoulder replacement, a plastic socket is placed in the shoulder and a metal ball and stem are inserted into the upper arm bone; the two fit together to form the new artificial joint. This solution still relies on a patient's rotator cuff to move the arm.

Conversely, in a reverse total should replacement, the plastic socket is fitted into the arm bone and the metal ball is attached to the shoulder bone instead. This configuration is better for people with damaged rotator cuffs because the new joint does not rely on this muscle for movement of the arm. Instead, the deltoid muscle is used to move the arm.


Raj Yalamanchili, MD

Q: What can advancements in hip arthroscopic surgery offer to people suffering from hip and groin pain?

A: Our ability to diagnose and treat hip problems causing significant pain and progressive joint damage has improved tremendously in the last decade. Advances in instruments and techniques have made minimally invasive hip arthroscopic surgery a better option than open hip surgery as it results in less scarring and a quicker return to an active lifestyle.

Hip arthroscopy, which is usually an outpatient procedure, can be used to remove bone spurs and repair torn cartilage to restore normal anatomy in an effort to preserve the natural hip joint. This is performed through two small incisions using a fiber optic camera and arthroscopic instruments. The best candidate for this type of surgery is an individual with a clearly defined area of damage in the hip and no arthritis. Patients with hip deformities, a cartilage tear in an inaccessible area or arthritis are best treated with open hip surgery or hip replacement. Most patients with localized cartilage tears respond well to physical therapy and x-ray guided injections. Hip arthroscopy is reserved for patients that fail to respond and have persistent pain and disability.

Derek McCoy, MD

Q: What are the symptoms of a concussion? If my child sustains an injury to the head, what should I do?

A: The symptoms of a concussion can be profound enough to be easily recognized, but are often more subtle and therefore difficult to distinguish. The most common symptom is a headache. Other symptoms include; dizziness, nausea and vomiting, temporary memory loss or memory problems, fatigue, trouble sleeping, trouble concentrating, mood changes, sensitivity to light and noise and balance problems .

For youth athletes, it is extremely helpful to do a pre-injury baseline cognitive test, which then can be compared to a cognitive test performed after the injury. More schools are encouraging athletes to have a cognitive test done prior to participating in contact sports.

It is important to correctly diagnosis and treat concussions, especially in athletes, because the consequences of sustaining another concussion can be catastrophic and permanent. Therefore, if your child sustains a head injury from any activity, not just sports, you should have them evaluated immediately by a physician regardless of whether they are complaining of symptoms or not.

Benjamin Diffenderfer, PA-C

Q: Why do I need to stretch before I exercise and what should I do?

A: Stretching is important because it makes the muscles more flexible and therefore less prone to injury during exercise. It will increase circulation in the body and reduce the amount of soreness you might feel as a result of your workout. Before stretching, you must warm up your muscles. A brisk 5 minute walk can do this. Then start your stretch routine slowly, hold each stretch to the count of 10 and don't bounce the stretch. It is important NOT to push your muscle to the point of pain. This will only result in injury to the muscle. It is just as important, and some say more important to stretch after exercising. Repeat your stretch routine again after your cool down. You can find many simple, fun and effective stretch routines on the Internet.

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