Share Your Story: Meet Marley

Share Your Story: Meet Marley

by | May 1, 2023 | Scoliosis & Spine

Meet Marley, a patient who is seen by our team of scoliosis and spine experts. She also appears in some of our new advertisements! Learn more about her journey below.

Blog written by Marley.

I first learned that I might have scoliosis when I was at my 7-year-old annual checkup with my pediatrician. I didn’t think that I had any symptoms, but when the doctor checked my back, they told my parents I had a curve. My pediatrician referred us to Scottish Rite because they are the experts in helping kids who have scoliosis! 

When we got to the Frisco location, I recognized the crayon logo from going to a park by the Dallas hospital. I’ve now been a patient at Scottish Rite for four years, and I see Dr. Ramo for my scoliosis treatment. On my first appointment, we learned that my curve was large for my age, since I hadn’t had my growth spurt yet. Dr. Ramo told us that as I grew, the curve might get worse, and I could end up having to have surgery. I started wearing a brace, and over the past four years, my curve has actually decreased, and I will most likely not need surgery if I continue on this path!

Dr. Ramo makes me feel like he knows me as a person and not just a patient. He always asks me about how I’m doing in the different sports I play, and he remembers things about my hobbies and interests. I also really enjoy talking to Kelsey, who makes my brace and works on it when I grow. Whenever she has to make me a new brace, she lets me pick out my design. The last time I had to get a new brace, she even helped track down the special pattern I wanted for my brace. 

My favorite thing about Scottish Rite are the volunteers. They are always at the front entrance, and I feel comfortable when they welcome me. I love when they give me stickers, books or popcorn. My entire experience has been great because everyone cares about me and wants to help me improve.

Favorite dessert?
Sugar cookies and vanilla ice cream with rainbow sprinkles. 

Favorite color?
My favorite color is metallic gold because it’s sparkly and shiny.

Favorite book?
My favorite book is The Vanderbeekers of 141st Street. 

What do you want to be when you grow up?
When I grow up, I want to be a marine biologist because I love the water, I love science and I love animals.

Do you have a favorite hobby/sport/interest? 
My favorite sports are swimming and kung fu. I also love to play the piano. 

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

Four Tips to Prevent Injuries in Youth Lacrosse

Four Tips to Prevent Injuries in Youth Lacrosse

by | Apr 28, 2023 | Sports Medicine

Lacrosse is one of the oldest sports in North America and is also one of the fastest growing sports in the United States. In 2021, there were more than 40,000 collegiate and more than 450,000 youth lacrosse players. Boys’ and girls’ lacrosse follow different rules and require different equipment, which may impact the types of injuries seen in these young athletes.

“Lacrosse is an intense and demanding sport,” orthopedic surgeon John E. Arvesen, M.D., says. “Athletes who are prepared can dramatically reduce the risk of injury.” Coaches and parents can use these tips to guide young athletes in the right direction.

FOUR WAYS TO REDUCE INJURY RISK IN LACROSSE

Wear proper equipment. Protective gear that meets standards and fits correctly will provide the most benefit. Poor-fitting equipment may not offer the same protection or support.

Perform a dynamic warm-up. This involves continuous movement to raise the body’s core temperature in preparation for training or competition. Perform this before each practice or game to increase elasticity in the muscles, tendons and ligaments around the joints.

Learn and implement effective hydration strategies. Mild dehydration can worsen performance. Ideally, players should drink water every 15 to 20 minutes. Add a sports drink during intense activities lasting longer than one hour or in very hot environments to replace electrolytes lost through sweat.

Plan for rest and cross-training. Early sport specialization increases an athlete’s risk of injury and inhibits their athletic development. Focusing on one sport at an early age may lead to movement imbalances, an increased risk of injury and overtraining. A one- or two-month break between seasons and a day or two of rest each week in-season is recommended.

Some injuries in lacrosse are more difficult to prevent, such as those that occur from sticks, collisions and falls. Non-contact injuries are considered to be more preventable. As a sports physical therapist and youth lacrosse parent and coach, Michael Losito teaches young athletes the importance of learning fundamental movements to prepare their bodies for non-contact injuries. “When an athlete has control over the trunk and lower extremities, he or she can produce more power, which may help to protect the joints from minor and serious injuries,” Losito says.

Common Injuries in Lacrosse

Despite efforts to reduce the risk of injury, some accidents are going to happen. Make sure you recognize and respond to injuries promptly. Many conditions can be treated with rest and a short round of rehabilitation if they are recognized early.

SPORT-RELATED CONCUSSIONS
Concussions in girls’ lacrosse players are often the result of stick contact, or a blow with a stick to the head. Boys’ lacrosse has a higher risk for concussion due to player-to-player contact. An athlete with any concussion symptoms, including change in behavior, thinking or performance after a collision or a blow to the head, neck or body, should be removed from play immediately and not return to play the same day. A medical professional with experience managing concussions should determine when it is safe to return to play.

KNEE AND ANKLE INJURIES
Sudden changes in direction, stopping and jumping can place a lot of stress on the knee.  This can stretch and tear ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament (MCL). A swollen knee is a sign of a joint injury that needs to be evaluated.

In lacrosse, sudden direction changes, stepping on another player’s foot or landing from a jump can result in an ankle injury. Ankle sprains and injuries to the growth plate are common in growing athletes and should be evaluated to optimize treatment and return to sport.

BACK AND CHEST INJURIES
Player-to-player collisions or falls may cause back injuries. Powerful and repetitive rotation while running, cradling, shooting and passing is more likely to cause activity-related pain in lacrosse. Overuse injuries, such as stress fractures (spondylolysis), are also common in young athletes. Persistent back pain from overuse injuries needs to be evaluated by a medical professional. The equipment and high-speed movements in lacrosse increase the risk of a rare injury from a direct blow to the chest from the ball, a stick or player collisions. The condition, called commotio cordis, can be life-threatening. Chest protectors may reduce the impact and risk of this injury.

ARM INJURIES
The design of lacrosse protective gear allows the arm to move freely but leaves the shoulder open to injury. Clavicle (collar bone) fractures and ligament injuries, or “separated shoulders,” may occur. A change in the appearance of the shoulder, pain, swelling or limited motion after a collision or fall should be evaluated.
Body checks, stick checks and slashing may cause hand and wrist injuries. Soft tissue injuries such as ligament sprains may heal with rest and ice. Others may need a brace or other treatment.

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Modern Luxury: Champions for Change

Modern Luxury: Champions for Change

by | Apr 26, 2023 | Press Coverage, Psychology

Scottish Rite for Children is leading the charge to ensure that children’s mental health is top of mind.

By. Abra Garrett

In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association joined together to declare a national state of emergency in children’s mental health. Drawing on data from the National Survey of Children’s Health, 2022 showed children in the United States to be experiencing unprecedented rates of depression and anxiety. Scottish Rite for Children (tsrclegacyprd.wpenginepowered.com) has worked extensively treating kids with orthopedic conditions and researching how these disorders impact their mental health. To be seen by their in-house psychologists, a child needs to be an orthopedic patient at Scottish Rite; however, their expertise is useful for all parents, teachers and caregivers.

Dr. Jill M. West, the director of psychological services at Scottish Rite for Children and a licensed pediatric psychologist, as well as the parent of two young children, understands the importance of talking about mental and behavioral health, both personally and professionally. “The rates of mental and behavioral health needs of children and adolescents have steadily increased since 2011,” West explains. She says this change corresponds with the growing availability of smartphones and daily usage becoming a ubiquitous part of being an American youth.

“COVID-19 undoubtedly exacerbated an already building problem,” West says. “It’s not all bad, though—kids and teens appear to feel more comfortable sharing what they are experiencing and reaching out for help.” She says this helps to decrease stigma around mental and behavioral health needs and is serving as a catalyst for efforts to attempt improving access to care.

“Unfortunately, the demand for mental and behavioral health services presently has outpaced the number of clinicians available to offer support in most places, yielding long waiting lists and sometimes leaving parents feeling helpless,” West says. Tools like the Stress Management Workbook, created by the staff at Scottish Rite for Children, give families access to strategies they can begin to implement on their own.

For additional help, West had suggestions for healthy ways for parents and children to interact with digital media together. “Another one of my favorite strategies is the idea of co-using screens with your kids,” she says. “For instance, if your child loves TikTok or loves playing Minecraft, make a point to view it with them for 15 or 20 minutes per day.” She explains this gesture can take an activity that is usually done independently and make it an activity that becomes more social. “Spending time engaging with your child in something they enjoy is important, and it may naturally spark conversation or interest in what they are doing,” West says.

Parenting-related stress is an important variable to attend to as well. “You may be feeling as though every time you look at social media, there is another recommendation about how to be a ‘better’ parent,” West says. “That can be overwhelming and confusing when you know you are already doing your best.” She recommends setting aside some time each day that is screen-free, for you and your children, to give everyone a chance to reset and focus on real-life connections. “Remember that your pediatrician’s office is also a good place to bring up concerns about your child’s mental or behavioral health,” she says. “Primary care practices increasingly have access to embedded or co-located behavioral health services and can make a referral for services.”

Meanwhile, in Houston, Texas Children’s Hospital (texaschildrens.org) announced in December of 2022 the implementation of a communitybased approach to the rising pediatric behavioral crisis. One of the nation’s largest children’s hospitals, Texas Children’s raised over $11 million to launch several behavioral and mental health initiatives, which include the following priorities: training frontline pediatricians on behavioral healthcare, embedding psychiatrists and psychologists in Texas Children’s Pediatrics clinics, building an intensive outpatient program, increasing emergency center staff and safe treatment spaces, and implementing specially designed programs to help employees identify warning signs of suicide and tools for navigating these challenging situations. “These services are desperately needed, and we are committed to providing them because we believe that the behavioral and developmental health of children, adolescents and teens is just as important as their physical well-being,” says Dr. Kirti Saxena, chief of psychiatry at Texas Children’s Hospital and associate professor of psychiatry and behavioral sciences at Baylor College of Medicine.

While the statistics can be daunting, if not downright discouraging, it is vital to note that some of the most celebrated experts in the state have made it their mission to address head-on the issues that our children, teens and young adults are facing today. With their commitment to normalize the conversation and proactively address the challenges that have accompanied the last decade plus, parents and caregivers will have access to guidance and expertise to help navigate these unprecedented times.

Read the full issue.

Does a Discoid Meniscus Injury Need Surgery?

Does a Discoid Meniscus Injury Need Surgery?

by | Apr 25, 2023 | Sports Medicine

A discoid meniscus is an abnormally shaped piece of cartilage found in the knee joint, and due to its shape, twisting knee movements can sometimes cause it to tear. When determining whether treatment for this injury is necessary, it is important to consider why, when and how the condition was discovered.

What is a meniscus?
The round end of the femur (thigh bone) sits on the flat top of the tibia (shin bone) to make up the knee joint. The femur is supported by the meniscus, which is composed of two soft “c” shaped cartilage structures. They act like soft cushions that help support the knee joint. The one that sits on the inner side is called the medial meniscus, and the one on the outer side is called the lateral meniscus.

What is a discoid meniscus?
Instead of having the typical “c” shape, a discoid meniscus forms as a solid piece, like a disc or a Frisbee®. The tissue grows thicker and larger than a normal meniscus and also has an abnormal texture, which makes it more likely to cause problems.

What causes a discoid meniscus?
A discoid meniscus is a congenital (at birth) defect and does not grow into the normal shape. This defect is not caused by trauma (i.e., an accident) or an injury. One to two out of every 100 children have a discoid meniscus. The condition is found more often in boys.

A discoid meniscus cannot be prevented. As the child grows, injuries and/or changes in the alignment of the hip, knee and ankle may cause symptoms.

What are the symptoms?
A discoid meniscus does not always cause symptoms. It may go unnoticed until symptoms begin. Symptoms can include pain, popping or snapping, limping, inability to bear weight (stand or walk) and inability to straighten the knee.

How is a discoid meniscus diagnosed?
A thorough history and physical examination are used to diagnose a discoid meniscus. Common findings on the outside of the knee (lateral joint line) include a bulge that can be seen or a “snap” that can be felt and heard.
X-rays are used to look at the alignment of the bones in the knee and leg. Other imaging, such as an MRI, may be used to look at the condition of the meniscus and other tissues in the knee.

What is the treatment?
For children who do not have symptoms or if they have a “clunk” when they move their knee, yet do not experience pain or difficulty conducting daily activities, no treatment is needed.

Early symptoms, such as swelling and pain, can be managed by resting, elevating the leg and other common strategies for knee injuries, such as ice and anti-inflammatory medications.

Surgical treatment is needed if there is a concern regarding the development of the knee with a large discoid or when symptoms begin to interrupt daily activities.

A knee arthroscopy, a type of minimally invasive surgery, may be recommended. The goal of surgery is to improve the shape of the meniscus and remove any loose or extra tissue that may cause the joint to become stuck. Rehabilitation and a slow return to sports may be necessary after surgery to change the shape of the meniscus.

A discoid meniscus increases the risk of a meniscal tear, and therefore, the condition is often found when evaluating an MRI of the knee after an injury. In these cases, treatment may be recommended to improve the shape of the meniscus. This can be done at the same time as surgery for other problems diagnosed in the knee.
What is the long-term outlook?

A discoid meniscus should not prevent normal daily activities or participation in sports. Diagnosis and management of symptoms can reduce the risk of further damage in the knee joint and prevent long-term problems. Regular follow-up to monitor the growth and health of the developing joint is very important after diagnosis, even if treatment is not needed in the early stages.

An important initiative of the Center for Excellence in Sports Medicine team at Scottish Rite for Children is a quality improvement registry designed to learn about the care and outcomes of treatment for discoid meniscus, among other conditions. This multi-center collection of data is led by pediatric orthopedic surgeon and director of clinical research Henry B. Ellis, M.D., is called the Sports Cohort Outcomes Registry (SCORE).

“This large collection of data allows us to compare surgery findings and outcomes across different age groups. The data set is unlike any other and will help to define care for this condition and many others. Early results were shared at the Pediatric Research in Sports Medicine annual meeting in 2022 and have already shaped more studies and better patient care.”        
– Henry B. Ellis, M.D.

Each institution in the SCORE group may take care of a handful of patients with this condition each year. The compiled data, reviewing nearly 300 patients and their outcomes helps to provide better education to patient-families, improve surgical decision-making and setting better expectations for outcomes.

Differences in the appearance of the meniscus as well as the ability for the meniscus to be repaired were apparent. In younger patients, the meniscus:

  • Is larger and covers more of the bone.
  • May have loose, unstable edges.
  • Is more likely able to be repaired.

These early findings help pediatric orthopedic surgeons know what to expect and how to counsel parents about who may or may not need surgery. Ultimately, the registry will be able to provide standard outcome expectations which will further improve the patient experience and outcomes.

Pain-free and Positioned for Speed

Pain-free and Positioned for Speed

by | Apr 24, 2023 | Rheumatology

Published in Rite Up, 2023 – Issue 1. 

“When I’m on the snow, I’m not really thinking, I’m just skiing,” says 15-year-old Banks, of Beaver Creek, Colorado. “I like to go fast!”

Banks is an alpine ski racer. He skis for Ski & Snowboard Club Vail and attends high school at Vail Ski & Snowboard Academy where he trains and competes in races across the nation and internationally. Banks started skiing when he was 4. At age 6, he told his dad he had found his sport. In a typical year, he skis in alpine events, including slalom, giant slalom, super-G and downhill.

When Banks was in 4th grade, he started having hip pain. “I would wake up in pain and not want to go skiing,” he says. “In class, I had pain in my tailbone from sitting in a chair.” Doctors in Denver diagnosed him with juvenile idiopathic arthritis (JIA). Banks’ parents, who are from North Texas, decided to seek a second opinion from Scottish Rite for Children.

At Scottish Rite, rheumatology experts confirmed JIA as well as a diagnosis of bilateral sacroiliitis, an inflammation of the sacroiliac joints that connect the spine to the pelvis. The team prescribed weekly injections, and after getting his medication just right, they were able to manage his condition.

“The last time I had pain was in 5th grade, and I was on crutches,” Banks says. “Now, I almost forget that I have JIA.” His mother, Brandi, says that his care has been handled so well that his diagnosis has not held him back from accomplishing what he wants to do. “I want to make the U.S. Ski Team,” Banks says, “and my ultimate goal is to ski in the World Cup.”

“Without Scottish Rite, I wouldn’t be able to ski,” he says. “They not only care about how you are doing as a patient, they care about your life.”

Read the full issue.