Dr. Wolf has extensive training and experience in the management of sports-related injuries and optimal surgical treatment of the athlete. He always believes the least invasive methods of treatment should be exhausted before proceeding with surgical intervention. Dr. Wolf is fellowship-trained in orthopaedic sports medicine and arthroscopic surgery, has about 25 years of hands-on surgical experience in the management of complex sports injuries, and has treated athletes on every level of competition, from youth sports to professional athletes to the aging athlete. Articles by Dr. Wolf discussing sports-related topics including ankle and elbow injuries, baseball prep, orthopaedic exercise, and hand/wrist pain among other topics are linked to this blog under the “Archives” section. Using his extensive knowledge, combined with the most modern technological tools, Dr Wolf can diagnose the issue with your sports injury with amazing accuracy and develop a custom plan for your immediate recovery. Call his office today and schedule your consultation with him at 205-271-6503.
By Dr Wolf
Fall is here and youth sports are going full throttle. With the increased specialization and focused intensity that has occurred over the past 20 years in amateur athletics, injuries have also increased, particularly over-use injuries. Approximately 30 million children participate in organized sports, with about 1/3 sustaining injuries requiring medical treatment. According to one recent study, football, wrestling, basketball and gymnastics have the highest annual injury rates among high school sports, at between 30 to 46%. Volleyball, baseball, cross country/track, and softball come in at 7 to 18%. What youth sports produce the most injuries? Which ones are the “most dangerous”?
The answer to this question depends on a number of variables. Depending on how statistics are collected and analyzed, different conclusions may be drawn. The number of kids involved in a given sport in a given area, the hours devoted to that activity, the injury prevention protocols utilized, and the quality of supervision all impact injury rates and severity. Over-use injuries in cross country runners are very common, with an incidence of 10-20% for stress fractures, but rarely require long term treatment or surgical intervention. Cervical spine fractures resulting in neurological injury are relatively rare in football (327 reported between 1977 and 2012) considering the number of participants and hours devoted to practice and game, but when they do occur the results are devastating.
In the region surrounding my practice, located in Birmingham, Alabama, youth sports participation is highly encouraged. The youth sports from which I see the most significant injuries on a daily basis are football, soccer, basketball, gymnastics/cheerleading, and wrestling. This is probably due to the high rates of participation and potential for collision in these sports. Lacrosse is a sport with increasing popularity and propensity for injury, and other sports such as cross country/track, tennis, swimming, and volleyball also produce a large number of orthopaedic injuries. In most cases, these are relatively minor issues: tendonitis (Achilles/patellar tendon/rotator cuff), sprains and strains (hamstring pulls, wrist and ankle sprains) , over-use injuries such as stress fractures of the wrist (gymnastics), shoulder (baseball), foot (cross country), lumbar spine (football/weightlifting/gymnastics), and other issues which are treated non-operatively with appropriate activity modification, exercise, and staged return to sport.
When considering more serious injuries requiring more significant interventions, fractures of the wrist and ankle are the most common injuries seen, occur in all cutting/pivoting/collision sports, and usually can be treated with either casting or surgical correction with a high likelihood of full return to activity without long-term dysfunction. The most common knee injuries requiring surgery are meniscus tears, patellar dislocations, and ACL injuries, and these are most likely to occur in contact sports as mentioned above or sports requiring rapid/repetitive cutting/pivoting/jumping/landing, such as cheerleading/gymnastics, tennis, and volleyball. In youth sports, recurrent shoulder dislocations/instability are the most common shoulder injury requiring surgical intervention, with most of these being seen in football and wrestling (traumatic) and any overhead sport requiring repetitive abduction/external rotation (throwing motion) such as baseball, volleyball, swimming, and tennis. While none of these injuries are particularly “dangerous”, they can all result in significant down time from your child’s sport of choice and potential long-term musculoskeletal functional issues. Appropriate prevention measures such as a good pre-sport participation physical to identify any predispositions to specific injury, bracing and rehab exercises for patients with history of injury, and preventative workouts directed at avoiding tendon strains (stretching), ACL tears (jumping/landing technique), and throwers injuries (biomechanics evaluation/modification) can help avoid some of these problems. Optimizing training programs to avoid excess loading of the developing musculoskeletal system of a child is key to avoiding stress injuries of the shoulder/elbow (baseball/tennis/swimming), spine (strength sports), wrist (gymnastics), and foot/hip (long distance running). Abiding by pitch counts in baseball is a good example of appropriate oversight here, as is avoiding the type of powerlifting routine in a child that you would employ in an 18-yr-old.
When considering the most devastating injuries we see in youth sports, spine and closed head injuries, collision sports and any sport involving the combination of speed and heights (extreme sports/motocross/cheerleader flyers/ etc) are higher risk than other more controlled sports. Appropriate adult supervision, protective equipment, and common sense in training and competition choices help mitigate these risks. Like everything we do in medicine, weighing risk and benefit with appropriate parental discernment is the best protection. Sports are a great tool to developing the attributes of discipline, teamwork, patience, endurance, and perseverance, which can benefit your child in all aspects of life. Most youth sports injuries are minor, without long-term consequences. My advice is to encourage your child’s participation, but be involved in their training, and take the right steps to avoid overtraining and unsafe activities.
Good luck and God bless. As always, I invite you to contact my office if we can help you or schedule your evaluation. My team and I look forward to meeting you. 205-271-6503
Ankle Sprains : Initial Evaluation and When to Seek Medical Referral
Ankle sprains are one of the most common injuries seen in athletic competition. What is the best initial management in terms of protection and return to play, and when is medical consultation necessary?
“Sprain” is a term that refers to an injury to a ligament, which is the soft tissue structure connecting bones together. Examples of ligaments include the ACL and MCL in the knee, the UCL in the elbow, and the glenohumeral ligaments of the shoulder. These structures prevent excessive translation of joints (dislocation), and can be torn (sprained) when a joint is injured. Ankle sprains most commonly occur when an inversion injury occurs where the foot and ankle are turned inward and under the leg. This results in injury to the lateral ankle ligaments, usually the anterior talofibular and calcaneofibular ligaments (ATFL and CFL), which are on the outside part of your ankle, on the same side as your small toe. 90% of ankle sprains are of this type, causing swelling, pain, and ecchymosis (bruising) on the lateral side of the foot and ankle. Other less common types of ankle sprains involve the deltoid ligament on the medial (inside) part of the ankle, and the syndesmosis ligaments, which connect the tibia and fibula together above your ankle joint – a “high ankle sprain.” These sprains usually result from an eversion or external rotation injury, where the foot is turned outward.
Initial treatment for all of these injuries involves RICE – rest, ice, compression, and elevation – to control the initial pain and swelling from the ligament tear, Compression with an ace wrap along with intermittent icing for at least the first 48 hours, elevation to decrease swelling, and protection from re-injury is standard care. Crutches may be used for ambulation if pain is excessive, and anti-inflammatory medicine such as ibuprofen or naproxen are usually adequate for pain. Lateral ankle sprains are treated functionally – meaning return to normal activities including sports as soon as symptoms allow. This may be as soon as a day or as long as 4-6 weeks, depending on the injury and the patient. Immobilization in a cast or boot is generally not necessary, and may slow recovery. Protection with a functional brace, usually a lace-up type that provides structural support to the ankle during activities, and exercises to strengthen the peroneal muscles, which support the lateral structures, decrease the risk for re-injury. High ankle sprains are the exception here, and may require immobilization for up to 6 weeks to avoid long-term dysfunction.
90% of lateral ankle sprains have no long term functional issues and can be treated as above. When pain and swelling persist or worsen for more than 2-4 weeks, recurrent instability occurs, or mechanical symptoms such as locking and catching are present, medical evaluation is appropriate. Also, anytime primary symptoms are present in other areas of the foot and ankle, or in patients who are skeletally immature (kids), X-ray evaluation is necessary. Children may have growth plate fractures that require cast or boot protection to avoid future growth issues, and fractures of the foot or ankle may require immobilization or surgical treatment. X-rays and evaluation by an orthopaedic surgeon are usually adequate to definitively determine appropriate initial treatment in these situations. MRI evaluation is necessary when mechanical symptoms persist to rule out a cartilage injury that may require surgical treatment.
For patients with mechanical symptoms or recurrent instability as above, surgical treatment including ankle arthroscopy to remove or repair loose cartilage fragments and ligament reconstruction to eliminate instability are appropriate. 90% of patients with recurrent lateral instability are effectively treated with ATFL/CFL repair and can return to sports with a stable ankle. Down time from sports is generally 4 months when this is necessary, and recent refinements to the traditional surgical technique may enhance stability. More extensive reconstructions involving tendon transfers from other parts of the ankle are rarely needed, and usually only for patients who have recurrent instability after previous
I hope this information has been helpful. If you or your family member needs to be evaluated for a significant ankle injury, feel free to call me at 271-6503 and I would be happy to help you.