On The Move: Unstoppable

On The Move: Unstoppable

by | Sep 26, 2022 | Hand Conditions

Article previously published in Rite Up, 2022 – Issue 2.

It is not uncommon to see Michael, of Redmond, Washington, posing like his favorite superheroes. He loves playing Minecraft™, riding his bike, swimming, wearing costumes, acting, dancing and singing. In January 2021, this highly active and vivacious young man had a life-changing surgery performed on his left forearm by pediatric orthopedic experts from our hand and limb lengthening and reconstruction teams at Scottish Rite for Children.

“I have no words to describe the blessing it has been for Michael and myself,” Berenice, Michael’s mother, says. “Scottish Rite is simply amazing.”

Michael was born premature at 23 weeks and stayed in the NICU for four months. At 3-months-old, the family realized he had a bump on his left arm and worked with Michael’s doctors to investigate the issue. Following a biopsy, it was determined that Michael had congenital pseudoarthrosis, which caused a deformity in the bones in his left forearm.There are very few teams that could successfully manage the complexities and intricacies of Michael’s treatment, but Scottish Rite for Children could. “To me Scottish Rite is a place where miracles happen, where the prayers of many parents come true,” Berenice says. “The doctors really care, and all the staff understand you and want to help in any way they can. Somehow you know your child is in the best hands, and you trust they are going to be okay.”

 

Watch Michael’s Story and learn more about Scottish Rite’s extraordinary care.

Read the enitre issue.

D CEO: Ask the Experts

D CEO: Ask the Experts

by | Sep 26, 2022 | Press Coverage

Previously shared in D CEO Magaizine.

How early will a child show signs of having an orthopedic issue that may need medical attention?

DR. DANIEL SUCATO: Orthopedic issues can present as congenital abnormalities of the bones, meaning the bones were not completely or normally formed in utero. This can occur in the spine or the upper and lower extremities. Often these patients do not require treatment early, or sometimes ever, but they should be evaluated to see if treatment is necessary.

DR. PHILIP WILSON: As a pediatric cartilage and ligament surgeon, we often see children with congenital meniscus or cartilage conditions within the knee. Sometimes these can present as early as toddler age, but more often young school-age with a loss of full extension or occasional limp.

What should I expect at our first visit to a pediatric orthopedic specialist?

DR. DANIEL SUCATO: At the initial visit, the family and patient will first meet with the provider to discuss the concerns and note any family history regarding the issue. A physical and orthopedic examination will evaluate the areas of concern. If necessary, appropriate imaging studies, such as ultrasound, plain radiograph, CT or MRI scan, will follow. Let your child know the imaging studies, if necessary, will not hurt.

DR. PHILIP WILSON: We also make sure the child is directly involved in the discussion. As kids get older, the perception and magnitude may be different for parents than it is for the child. Prior to the visit, parents can help by letting them know we are just going to check their muscles-no shots.

What are common issues in children that fall under the category of “pediatric orthopedics?”

DR. DANIEL SUCATO: Pediatric orthopedics involves anything related to children’s muscles, joints or bones, so that would be conditions like clubfoot, scoliosis, developmental hip dysplasia, and even traumatic or sports injuries. We also have subspecialties in spine, upper and lower extremities, foot and ankle, sports injuries, and fractures.

DR. PHILIP WILSON: Within pediatric sports medicine, conditions involving the cartilage or instability of the joint or injuries affecting the tissues around the joint are common reasons for treatment.

Do all orthopedic issues require surgery? What are other forms of treatment?

DR. DANIEL SUCATO: Most can be treated without surgery. Physical therapy can improve range of motion, strength, and flexibilit. Other treatments include bracing, casting, and anti-inflammatory medications.

DR. PHILIP WILSON: We always reserve surgery for use when other options are not available. In addition to what Dr. Sucato mentioned, sometimes simple reassurance to the family that the orthopedic condition is normal or will improve with age may be all that is required.

Current Concepts: Management of Acute Shoulder Instability in Young Athletes

by | Sep 26, 2022 | Sports Medicine

Watch the full lecture.

Our latest presentation from Coffee, Kids and Sports Medicine covers the management of acute shoulder instability in young athletes. Sports medicine physician assistant Ben Johnson, P.A.-C., dives into the differences in instability patterns between the skeletally immature and skeletally mature shoulder, on-field/acute management of shoulder dislocation and evidence-based recommendations for treatment of first-time shoulder dislocation.
 
Johnson begins the presentation by discussing the epidemiology of shoulder dislocations in high school and collegiate athletes in the United States and explains why it matters. He then shares important insight in how children and adolescents differ from adults physically, especially in relation to the capsular elasticity, a smaller anterior-inferior recess and more. Johnson shows the changes that occur in the shoulder as an adolescent enters puberty, and he discusses how this affects shoulder injuries.
 
Next up, Johnson teaches on-field and acute management of shoulder dislocations in pediatric patients and what medical providers need to know. Acute management includes taking a brief history, initial assessment and considering sport-specific factors. He breaks down when and how on-field reductions should be performed, sharing the benefits of early reductions and red flags to consider.
 
Johnson provides an evidence-based review of external and internal immobilization compliance and outcomes, along with the pros and cons of each method. He then answers questions about operative versus nonoperative treatment, breaking down the consequences of each.
 
To wrap up the presentation, Johnson provides a summary on pediatric glenohumeral dislocation and the steps that should be taken when assessing treatment strategies, as well as sharing a treatment algorithm. The presentation is crucial for sports medicine physicians and other medical professionals who treat young athletes, especially those at a high risk for shoulder injuries.

Thumb Fracture Q&A

Thumb Fracture Q&A

by | Sep 23, 2022 | Hand Conditions

Thumb injuries are common, especially in young athletes, and can occur from direct hits, falls on outstretched hands or hyperextensions. We see them often in football, basketball, baseball and soccer.

Pediatric nurse practitioner Courtney Schneidau, P.A.-C., shares information about thumb fractures and how to handle these types of injuries in young athletes.

Anatomy of the thumb
The thumb is made up of two major bones — the distal phalanx and the proximal phalanx. The distal phalanx starts at the tip of the thumb, underneath the fingernail and extends to the knuckle. The proximal phalanx runs from the knuckle to the base of the thumb, where it connects to the hand. 
 
How do thumb fractures typically occur? 
A thumb fracture can occur anywhere in the thumb and is generally caused by a direct trauma, like from a fall or a hit to the hand. For example, if a player hits his hand/thumb on the helmet of another player while playing football.  
 
What are the main symptoms of a thumb fracture? How do you know if the injury needs medical attention? 
Symptoms can include: 
–    severe pain
–    swelling and tenderness
–    limited motion or inability to move the thumb
–    visible deformity or deformed appearance
–    a numb sensation or coldness in the thumb 

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You should seek medical attention if you are experiencing pain, bruising or swelling. It is important for a professional to examine the injury to determine the best course of treatment.

How is a thumb fracture diagnosed and treated?
Your provider will take a detailed history, including the activity that caused the injury, as well as perform a physical exam. X-rays of the hand and injured thumb will be performed to better evaluate the injury and rule out other injuries.

A fractured thumb can be treated through casting or the use of splints, which limit movement while the bones heal. Surgery is sometimes needed, depending on the location of the break. There are different techniques that are used to hold the bones in place, including the use of pins, plates or screws. Following surgery, a splint or cast is worn to ensure proper healing.

What is the outcome following a thumb fracture? 
Thumb fractures generally have good outcomes, following proper treatment and rehabilitation. Once the fracture has healed, hand therapy may be required to help restore motion.

Should you see a pediatric orthopedic specialist for a potential thumb fracture? 
Scottish Rite for Children treats children who need complex reconstruction following trauma or have hand disorders related to neurological conditions or nerve injuries. That includes fractures (shoulder to fingers), nerve injuries, tendon injuries and complex injuries. Our Sports Medicine team treats the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts. Learn more about our centers for excellence in Sports Medicine and Hand and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other specialists work side-by-side with each patient and their parents to develop the best game plan for treatment, rehabilitation and safe return to sport.

Learn more about our Facture Clinic.

Shoes for Different Orthopedic Needs

Shoes for Different Orthopedic Needs

by | Sep 21, 2022 | Uncategorized

At Scottish Rite for Children, many of our patients are treated for conditions affecting the lower extremities, such as the legs or feet. Some of these treatments can make it challenging for parents to find the right shoes for their child, so we have some tips and tricks to help navigate shoe shopping and ensure a proper fit.

When Buying Shoes
Most braces are built to fit in athletic shoes. They may also fit in hiking boots or lace-up dress shoes. Sometimes it can still be difficult to find properly fitting shoes. When buying shoes, always fit the shoes to the child with the brace on. Each brand and style of shoe fits differently. With a brace, most children will need wide shoes. Also, shoes with tongues that extend closer to the toe will fit braces more easily.

Shoes from Orthotics
When fitting a new leg brace, Scottish Rite for Children may provide one pair of athletic shoes. This allows us to see how the brace works and will allow your child to start wearing the brace immediately. These will not be replaced when they wear out.

Shoe Lifts or Wedges
Most children like to have several different pairs of shoes to wear, therefore you may want to have multiple pairs adjusted. A shoe lift or wedge can be added to shoes that you provide. For these buildups, drop off or mail the shoes to the Orthotics department. It may take several days to complete the work. Some shoes with silicone or gum rubber soles cannot be modified.

Modifying Shoes to Fit Braces
Certain shoes can be modified to allow them to fit better with a brace. It is important to make sure that the shoe comes close to fitting, before deciding to modify it.

  • Remove the insole.
  • Cut the tongue longer.
  • If the shoe is made of leather, a shoe repair shop can stretch the shoe.

Differently Sized Feet
Most children who wear a single brace, or have different sized feet, can wear the same sized shoes on both feet. Buy shoes to fit the larger. If the shoe is too loose on the smaller foot, try modifying that shoe.

  • Add an additional insole.
  • Pack the toe section of the shoe with cotton balls.
  • Put a dancer’s toe pad in the toe of the shoe.
  • Have your child wear two socks on the small side.

These modifications may not always work. If your child’s feet differ by at least two full sizes, you may need mismatched shoes. The easiest way to do this is to buy two pairs of shoes and discard the unneeded shoes. See the other side for additional resources.

Shoe Stores
A full-service shoe store can help fit your child with shoes.

Mismatched Shoes
If your child’s feet differ by at least two sizes, he or she may need mismatched shoes. Companies that sell single or mismatched shoes:

Services to share shoes between individuals with the opposite shoe concerns:

  • National Odd Shoe Exchange
  • Shoewap
  • Odd Shoe Finder

Special Shoes
Most children are able to wear standard shoes with their braces. However, you may need to special order an extra-wide style. Some models include:

  • BILLY Footwear (toe zippers)
  • Saucony Kids
  • Stride Rite
  • Piedro
  • Plae
  • Apis Mt. Emey
  • Nike FLYEASE (heel zippers)

Download the PDF.