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Physicians Update


Physicians Update

Fall 2012: Men's Health

Appropriate Treatment Key to Avoid Reinjury

Young male athletes are at increase risk for injuryMillions of Americans of all ages sustain sports and recreational injuries every year, but some sports present a greater risk for injuries than others. Men, for example, have higher rates of participation in contact sports like football, basketball and hockey, activities that involve contact or collisions. As a result, young male athletes are at greater risk for severe injuries than females. Without appropriate evaluation and treatment, these injuries may prevent young men from continuing to participate in sports and other beneficial physical activities or result in reinjury.

"Some patients are only advised to take anti-inflammatories and rest after an injury," says UCLA sports-medicine specialist John Di Fiori, M.D., president-elect of the American Medical Society for Sports Medicine and UCLA team physician. "For many patients with sports-related injuries, that advice is generally not sufficient to return them to their previous level of activity and avoid reinjury."

Chronic injuries, such as patellofemoral pain (runner's knee) or medial tibial stress syndrome (shin splint) most often result from overuse and may not resolve on their own without treatment. Acute injuries, which happen suddenly during exercise or play, may be accompanied by abrupt and severe pain, swelling, tenderness, weakness, inability to support weight or a visibly dislocated bone or joint. These injuries, or others in which the diagnosis is unclear, may benefit from referral to a sports-medicine specialist for evaluation, Dr. Di Fiori says.

"We see patients of all ages, ranging from young athletes competing at all skill levels, including highly competitive club teams, to adult athletes participating in golf, tennis or triathlons," he says. Sports injuries are most common among children and adolescents and middle-aged athletes. "The patients in our clinic see the same physicians and receive the same level of care as UCLA's top athletes, and our goal is to help them maintain their strength, independence and passion for sports," Dr. Di Fiori says.

Reaching an accurate diagnosis is critical to producing the best short- and long-term outcomes. Utilizing high-tech noninvasive tools, such as portable ultrasound, in a comprehensive manner sometimes represents the best diagnostic approach when additional imaging beyond X-ray is required, according to Dr. Di Fiori.

"In some cases, particularly when diagnosing soft-tissue injuries, ultrasound can be utilized in place of MRI," he explains. "Ultrasound is dynamic, which means we can ask the patient where it hurts during the exam, place the transducer there and then have them move the joint to assess the anatomic area of injury."

UCLA patients receive same level of care as UCLA's athletesBeyond diagnosis, ultrasound can be employed to precisely guide corticosteroid injections for soft-tissue injuries, as well as for shoulder, knee, trigger finger and hip problems (such as bursitis around the hip). Compared to palpation-guided injections, ultrasound can improve accuracy in shoulder- and knee-joint injections from 70 to over 90 percent and significantly reduce pain. In addition, ultrasound-guided office procedures may help patients avoid surgery for certain conditions, such as calcific tendinopathy of the shoulder, chronic Achilles tendinopathy or lateral epicondylitis (tennis elbow).

"In many cases we jointly develop a treatment plan because the problems that we see and treat are not always isolated to a single medical or surgical problem," says David McAllister, M.D., chief of the sports-medicine service in the UCLA Department of Orthopaedic Surgery.

UCLA orthopaedic surgeons often see patients who were initially misdiagnosed or who were diagnosed appropriately but the first line of treatment failed, Dr. McAllister says. Anterior cruciate ligament (ACL) injuries, for example, which are common in high school and young adult football and basketball players, sometimes fail to heal properly after an operation. UCLA surgeons frequently perform redo surgeries to address problems not resolved by previous operations. These problems include revision or complex cases involving the knee, shoulder and hip. Most procedures are performed using minimally invasive techniques, which result in smaller incisions, less postoperative pain and faster overall recovery.

"There really isn't any athletic injury or medical problem that we can't handle either medically or surgically," Dr. McAllister says. "We have a dedicated, multidisciplinary team of experts at UCLA whose careers are committed to helping get injured athletes back to what they want to do."

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