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5 Common Types of Scoliosis: Which Form Does Your Child Have?

5 Common Types of Scoliosis: Which Form Does Your Child Have?

by | Dec 3, 2023 | Scoliosis & Spine

Scoliosis is a common orthopedic condition that affects between 2% to 3% of the population. This abnormal sideways curvature of the spine can range from mild to severe, with varying health impacts. Scoliosis must be monitored until children stop growing, and moderate to severe curves will need corrective treatment. However, different types of scoliosis have different prognoses and may require different types of treatment.

What Is Scoliosis?

Prior to learning about the different forms of scoliosis, it helps to first understand what this condition is and how any form of the disease can affect a child.

Scoliosis happens when a child’s spine curves sideways. Normally, the spine is straight or has a slight S-curve when you look at it from the side — the top of a child’s back may curve out a little bit, and their lower back may curve in slightly.

In children with scoliosis, the spine curves or twists in an S- or C-shape. Mild cases may only limit a child’s flexibility, but severe cases can cause deformities and serious health problems, such as:

  • Arthritis
  • Back pain
  • Breathing problems or other lung issues
  • Heart problems
  • Paralysis
  • Problems walking, standing or doing other physical activities

Whether mild or severe, the form of scoliosis your child has can also play a role in its long-term impacts. Below are five common types of scoliosis.

Idiopathic Scoliosis

Idiopathic scoliosis, also called adolescent idiopathic scoliosis, is the most common type of scoliosis, affecting around 80% of children with scoliosis. It typically shows up at age 10 or later and has no known cause, although there is a genetic connection. About 30% of children with idiopathic scoliosis have a family history of scoliosis.

Despite what many parents or kids may think, carrying a heavy backpack or slouching will not cause scoliosis.
Treatment for this type of scoliosis depends on the severity of your child’s spinal curve, defined as:

  • Mild, less than 20 degrees
  • Moderate, between 25 degrees and 40 degrees
  • Severe, greater than 50 degrees

Regardless of severity, many children with scoliosis benefit from physical therapy (PT). PT helps reduce pain and improve breathing, while also preventing a curve from getting worse.

Children with mild curves may simply need monitoring every six to 12 months to ensure a curve is not getting worse.

Moderate curves may require a child to wear an orthotic back brace daily for months or even years. Braces are usually successful in stopping the curve from progressing to a point of needing surgery.

Severe curves or moderate curves that do not get better with bracing may require spinal surgery. Spinal fusion is the most common type of surgery for severe adolescent idiopathic scoliosis, but some patients may benefit from a newer technique, vertebral body tethering (VBT).

Congenital Scoliosis

Congenital scoliosis is a form of the condition that exists when a child is born. A rare birth defect, congenital scoliosis occurs in only 1 in 10,000 children.

There are several different types of congenital scoliosis, each affecting how the spine curves abnormally in different ways. All can cause serious problems in children’s growth.

Many children with congenital scoliosis are not diagnosed until the problem becomes noticeable later in childhood or during the teenage years.

Unlike idiopathic scoliosis, congenital scoliosis usually cannot be helped by bracing. Children with mild curves will still likely only need monitoring, but those with moderate to severe curves may need surgery.

Neuromuscular Scoliosis

Neuromuscular scoliosis is caused by medical conditions that impact the muscular or neurological systems. These conditions can affect a child’s muscle balance or how the body controls the muscles that support the spine.
Common neuromuscular conditions that lead to scoliosis include:

  • Cerebral palsy
  • Friedreich ataxia
  • Muscular dystrophy, especially Duchenne
  • Myelodysplasia
  • Spina bifida
  • Spinal muscle atrophy
  • Spinal trauma, especially that causing paralysis

These conditions may require children with scoliosis to be in wheelchairs. For those children, wheelchair seats can be modified to improve balance.

Bracing may also help many patients with neuromuscular scoliosis, but it will not stop the progression of curves. Surgery may be an option, depending on the underlying medical condition and other factors.

Early-Onset Scoliosis

Early-onset scoliosis develops before age 10. In most cases, early-onset scoliosis is idiopathic. Treatment is crucial for preventing breathing problems or deformities later in life.

Infants and children younger than age 2 who have early-onset scoliosis may need to wear a cast for two to three months at a time. In children this young, casting is often easier than bracing.

If a very young child’s scoliosis is severe, they may need a special type of surgery that involves attaching a magnetic rod to the spine. The rod can be lengthened as the child gets older, at which point they usually have spinal fusion surgery.

Syndromic Scoliosis

This type of scoliosis is very rare and develops as part of another condition, such as:

  • A connective tissue disorder, such as Marfan or Ehlers-Danlos syndrome
  • Beale’s syndrome
  • Down syndrome
  • Prader-Willi syndrome
  • Rett syndrome

Treatment options for syndromic scoliosis depend on the severity and the other health conditions involved.

Could Your Child Have Scoliosis?

Children are usually screened for scoliosis during their annual wellness exams, and they may be screened at other times, such as during school health screenings.

However, children grow quickly, so it’s important for parents to know the symptoms of scoliosis. Be on the lookout for signs such as:

  • Back pain
  • One shoulder blade that sticks out more than the other
  • One shoulder, hip bone or rib cage that seems higher than the other
  • Rounded shoulders
  • The sense that your child’s head is no longer directly centered above the pelvis
  • A sunken chest

Call your child’s pediatrician if your child experiences any of these symptoms or if you notice an unusual spinal curve when your child bends forward to touch their toes. Getting treatment early, no matter which type of scoliosis your child has, often leads to more successful outcomes.

If your child has been diagnosed with scoliosis, the Scottish Rite Center for Excellence in Spine is here to help. Schedule an appointment to discuss scoliosis care.

Recognizing Developmental Dysplasia of the Hip in Your Baby

Recognizing Developmental Dysplasia of the Hip in Your Baby

by | Nov 27, 2023 | Hip Disorders

Developmental dysplasia of the hip (DDH) occurs when a baby’s hip joint doesn’t form properly. In most cases, the problem is present at birth, but DDH can also develop as a child grows. It’s essential for parents to know the signs of DDH. The earlier a specialist treats the condition, the better a child’s chances of appropriate development and living without hip problems later in life. DDH occurs in about one in 100 infants.

Defining DDH

The hip is a ball-and-socket joint. The ball, called the femoral head, sits at the upper end of the thighbone and fits snugly into a socket in the large pelvis bone. This ball moves around but always stays inside the hip socket, allowing the hip to move backward, forward and side-to-side while supporting body weight.

When a child has DDH, the ball is not fully covered in the socket or the socket is shallow, which can easily lead to a dislocated hip. Or the hip may already be dislocated or completely or partially out of the socket. Without treatment, the hip joint will not grow properly. As a child gets older, he or she might have pain when walking or develop arthritis at a young age.

Babies at Higher Risk of DDH

While any baby can have DDH, the risk is higher in babies who:

  • Are female
  • Are the first-born child
  • Have a family history of DDH
  • Were born in the breech position (buttocks first instead of head first)

In rare cases, babies can develop DDH after birth. For example, swaddling a baby with the legs straight and tight together can increase the risk of DDH. To help prevent this, talk to your provider about how to use sleep sacks and how to swaddle your infant correctly.

“There’s a lot of importance in how we take care of our babies’ hips after they’re born,” said hip specialist and pediatric orthopedic surgeon William Z. Morris, M.D. “Swaddling the legs in a forced extension can cause the hips to develop incorrectly. The ball and the socket are almost like moldable pieces of clay when you are young, so letting the hips and legs move into a flexed and separated position helps keep the ball tucked up in the socket and makes the socket deeper and the ball rounder.”

When swaddling your baby, focus on wrapping the arms and upper torso only, allowing the hips and legs to move without constriction.

Know the Signs

Babies with DDH do not have pain from the condition. However, parents may notice:

  • A clicking or popping in the hip that you can hear or feel
  • Differences in leg length (one leg being shorter than the other)
  • One leg or hip is not moving the same as the other
  • Skin folds under the buttocks do not line up
  • A limp when the child starts to walk

If you notice your baby has any of these symptoms, immediately make an appointment with your pediatrician.

Doctors usually find signs of DDH during a child’s annual checkup. If symptoms are present or the child has risk factors, the doctor will likely order tests to confirm a diagnosis. These might include:

  • Ultrasound: This imaging test uses sound waves to create pictures of the hip joint. Ultrasound works best with babies younger than 6 months old because the hip joint is mostly cartilage at this age and doesn’t show up on an X-ray.
  • X-ray: In babies older than 6 months, bones have formed well enough to appear on X-ray images.

If your child has DDH, your pediatrician will refer you to a pediatric orthopedic surgeon. The surgeon will choose the best treatment to hold the hip in place and help the ball stay in the socket so the hip joint will grow normally and not cause problems as your child gets older. Early intervention with DDH is important.

“Parents should know that DDH caught early is treated very successfully,” Morris said. “And the vast majority of the time we can do so without surgery.”

Treatment options for developmental dysplasia of the hip include:

  • Bracing: This is the most common treatment for babies younger than 6 months old. The soft fabric brace, called a Pavlik harness, is a shoulder harness with attached foot stirrups. The brace puts the baby’s legs in a “frog-like” position that allows the ball of the hip joint to fit into the socket properly. This treatment usually lasts about six to 12 weeks. Many babies don’t need additional treatment. Even severe cases, where the hip is fully dislocated, are treatable with a harness or brace more than 80% of the time.
  • Closed reduction and spica casting: If bracing does not correct the problem or the child is older than 6 months at the time of diagnosis, the surgeon might do a closed reduction procedure. The surgeon will inject contrast dye into the hip joint to see the cartilage and gently move the thighbone, guiding the ball of the joint into the socket. The baby will then wear a special cast, called a hip spica cast, for two to four months. The cast will hold the hip joint in place.
  • Open reduction: This is a type of surgery done if a closed reduction is unsuccessful or when the child is older than 18 months at the start of treatment. During the surgery, the surgeon moves muscles to see the hip joint and puts the ball properly in place. An open reduction also requires a hip spica cast to hold the hip joint in place.

When doctors find DDH early, your child will likely benefit more from nonsurgical treatment and may not need surgery. If you have any concerns about your child’s hips, talk to your pediatrician about a referral to a pediatric orthopedic specialist.

Is your baby showing signs of developmental dysplasia of the hip? Schedule an appointment with a specialist at the Scottish Rite for Children.

Get to Know our Staff: Carlos Monroig-Rivera, Medical Student Research Fellow

Get to Know our Staff: Carlos Monroig-Rivera, Medical Student Research Fellow

by | Nov 22, 2023 | Spotlight

Scottish Rite for Children offers a Medical Student Research Fellowship (MSRF) for medical students interested in gaining experience in clinical research. MSRF fellows work with a lead faculty mentor throughout the year and several project supervisors who are pediatric orthopedic faculty at Scottish Rite. They work as a crucial part of the research teams in various centers for excellence at Scottish Rite and are responsible for a variety of research projects.
 
What inspired you to apply for the MSRF position?
What inspired me to apply for the MSRF position was my passion for pediatric orthopedic research. Since meeting Dr. Norm Ramirez, a former pediatric orthopaedic fellow at Scottish Rite, I’ve always been interested in how orthopedic research plays a role in advancing orthopedic knowledge and making a difference in children’s lives.

Have you always been interested in medicine and/or research?
Yes, I am a recent medical doctor graduate from Puerto Rico aspiring to improve pediatric patient care while following my dream of becoming an orthopedic surgeon.
 
 
What is it like working at Scottish Rite for Children?
Working at Scottish Rite for Children has been incredible. The institution’s diverse leadership and commitment to staff and employees make you feel like you belong. Their commitment to the well-being of children is truly inspiring. Scottish Rite for Children’s supportive environment has provided me with invaluable learning opportunities that I will hone to become an ethical and competent orthopedic surgeon.

Can you share a few sentences about someone at Scottish Rite who has been a mentor to you and how they have impacted your experience? What project are you working on with that mentor?
One of my mentors at Scottish Rite has been Jaysson T. Brooks, M.D., a renowned pediatric orthopedic surgeon. Dr. Brooks has had a profound impact on my experience by guiding me through my orthopedic residency application and several research projects related to pediatric spine deformity. One of the projects we are working on together is looking at the effect that a T1 Upper Instrumented Vertebrae has on Proximal Junctional Kyphosis Risk in Adolescent Idiopathic Scoliosis Patients.
                                                                                              
 
How do you think this experience will impact your career path?
This opportunity helps me explore the academic aspects of orthopedics, dive into pediatric orthopedic research and collaborate with renowned experts in the field. This experience reinforced my commitment to becoming an orthopedic surgeon, providing me with the understanding and discipline to excel at my job.
 
What progress have you made toward your career goal since beginning the program?
Since beginning the program, I have contributed to several research projects and developed a better understanding of the complexities in pediatric orthopedics. I’ve also had the privilege of presenting my work at a resident symposium and published research papers in orthopedic journals.
 
What is your favorite project that you are currently working on or have worked on at Scottish Rite?
My favorite project at Scottish Rite has been investigating compliance rates and patients reported outcomes for each type of brace prescribed to treat spinal deformity. It is a challenging and meaningful project that could impact patient care and quality of life. Having the opportunity to work alongside a supportive and knowledgeable team has made me discover a passion for the pursuit of knowledge and the process of curiosity, making me feel fulfilled at work by enjoying the process and making a difference in the lives of children.

What advice do you have for future MSRF participants?
For future MSRF participants, I would advise them to work hard, be proactive and make the most of the resources available at Scottish Rite for Children. Don’t be afraid to ask for help, don’t be discouraged by setbacks or slow progress and stay committed to your goal. Never forget to sharpen the saw. As you step into this journey, continue renewing and improving yourself. Take care of yourself along the way, and take simple steps to sustain your personal growth.

What is one thing most people don’t know about you?
One thing most people don’t know about me is that I’m a fantasy basketball enthusiast and analyst. I’ve always been interested in the strategic components of the game, and this passion always takes me to study the secret world of statistics and strategies when the NBA season begins. I spend nights looking over player statistics, studying trends and predicting breakout performances. I’ve even won a few friendly leagues. The best part is that my love for fantasy basketball has improved my real-life understanding of the game. Fantasy basketball has taught me the art of decision-making, risk assessment, player roles and team strategies. So, if you ever see me with my laptop during the NBA season, don’t assume I’m just catching up on work. I might be fine-tuning my fantasy basketball lineup.

Anything else you would like to add?
In closing, I’m grateful for the chance to be a part of the MSRF program at Scottish Rite for Children, and I look forward to continuing my journey of becoming an orthopedic surgeon with the knowledge and experiences gained throughout my time here.

We’re recruiting Medical Student Research Fellows for 2023! If you are a third-year medical student looking to take a gap year before applying to residency, take advantage of this unique opportunity! Only three positions are available for 2024.

Learn more and apply here on our Careers page.

Share Your Story: Finding Hope and Staying the Course Through Perthes Treatment

Share Your Story: Finding Hope and Staying the Course Through Perthes Treatment

by | Nov 20, 2023 | Hip Disorders

Blog written by Megan, Garrett’s mom

In June 2022, Garrett developed a limp and complained about his right knee hurting. We went to his pediatrician for an X-ray after a few weeks of not getting any relief. He had just attended a basketball camp and is active in many sports.The knee X-ray in June showed no damage, sowe started some chiropractic care to stretch and see if we could determine what was causing his pain. After 6 weeks, nothing changed. Garrett would say that his hip was “tight,” but he said there was no pain.

Garrett had an MRI in August so we could determine the next course of action. It was in the MRI that it was discovered his femoral head was quickly deteriorating, and he had Legg-Calvé-Perthes disease. We went to a local hospital for a consultation, and my son was told not to walk on his own without the help of crutches. The word “nonweightbearing” was seared into our brains.

He started school four days later, and we had to urgently contact his school’s administration to discuss accommodations for him.  There was so much anxiety about attending school on crutches and being asked questions. Garrett didn’t want to tell anyone what was going on, and I dreaded the school year knowing this was going to be the most challenging thing he’d ever faced.

While our local health care options are great, we wanted to get a second opinion since this was such a devastating diagnosis for such an active and energetic kid. I started reading everything I could on Perthes disease. I was up late one night researching the disease, and I found some videos featuring Dr. Harry Kim with Scottish Rite for Children. He just seemed to be the expert in this condition, and I wanted nothing but the best care for my son. 

I requested an appointment online, and we were contacted the next day. Although we live nine hours away, we jumped at the chance to travel to Dallas and get a second opinion. I wanted to talk to a nurse to make sure we really should travel to see Dr. Kim. Despite some doubts, something kept gnawing on me to keep pushing. Dr. Kim’s nurse, Kristen, called me a few days later, and we talked about the situation. She asked me to get the X-ray and MRI files to her for Dr. Kim to review. Soon after, she called me and said Garrett had an advanced stage of necrosis, and he needed to be seen as soon as possible. She set an appointment, and we cleared our calendars to make it to Dallas for a perfusion MRI and consultation with Dr. Kim. 

Dr. Kim reviewed his MRI. Garrett’s femoral head had completely collapsed in a period of about four months. He was a more challenging case, but Dr. Kim felt like we could, with treatment and surgery, get the best outcome if we stayed the course. On our drive home, I remember telling my husband that any guilt I had for seeking additional opinions was gone the moment Dr. Kim started explaining the treatment options. He was both conservative in his explanation but also gave me a sense of hope, too. He was clear that Garrett would end up in a wheelchair for a while, and he would need surgery. He wanted to do a tenotomy and a bone-marrow drilling to relieve some of the inflammation and tightness and then apply a Petrie cast to keep the hip in a certain placement as the first step. I clearly remember crying with Garrett at the thought of this massive contraption on my child. Dr. Kim had an opening for surgery in one week, and we jumped at the chance to get started. 

The first surgery went as planned. Nothing can prepare a child for waking up and being in a double-leg cast. However, the care team at Scottish Rite was amazing from the beginning. The Child Life staff brought in a mobile game console pre-surgery, and Garrett played some video games to take his mind off of the surgery. The day after his surgery, Child Life took him to the playroom area with games, toys, art projects, etc., for a few hours, and it was a blessing for me to get some rest.

Dr. Kim checked on him, and Garrett felt like a VIP by ordering his meals via the phone. As we prepared to leave after a few days, the Occupational Therapy and Physical Therapy staff took great care to show us how to get Garrett in and out of our car and worked with us to get to the bathroom, use the new (and massive) wheelchair, and prepare ourselves to go home and manage this new lifestyle for the next six weeks. 

Garrett couldn’t go to school normally during that first casting. The classroom doors were not wide enough to accommodate the platform that his legs had to rest on in the wheelchair. Every time we had to move him, we had to pick him up, take off the platform, push the wheelchair through the door, reinstall the platform, and then put him back in the wheelchair. It really is as daunting as it sounds. My husband Chad and I were very worried about the social toll this would take on Garrett. His teacher and the school administration were helpful and even had some home-tutoring set up. Garrett went to school for about four hours on a Tuesday each week to get in math and reading instruction.

The six weeks passed relatively quickly, and we didn’t stay inside and stay home. Our family is busy, and that’s an understatement. We run a small business, we work at lots of festivals and events, and we were not going to let this disease just stop us in our tracks. We were determined to make sure Garrett still interacted with people and was part of our lives as always. We took him to events, and he ran the cash register. He went fishing with his cousins. We hosted a video game birthday party with his friends where we just let them take over the living room and stay up as late as they could binging on junk food.His first cast came off in mid-November. It was joyous, and he was able to stay cast-free through the holidays.

We traveled back to Scottish Rite in early January and met with Dr. Kim. Unfortunately, Garrett had developed some stiffness and inflammation, and we couldn’t do an osteotomy as soon as we hoped. After correcting some issues with his brace, Garrett was cleared for his osteotomy soon after. He had to have a triple hip osteotomy instead of a femoral osteotomy. It’s more invasive and requires two doctors to work together to perform the surgery. Dr. Kim’s amazing staff was looking at scheduling for us in advance and noticed there was one appointment available with both doctors … the next week. So, we made another quick trip home and prepared for surgery. 

Because the surgeons knew the danger of falling and damaging the work they were about to do, Garrett would have a spica cast that would encompass his right leg and entire torso. I thought Garrett was going to jump through the ceiling. I calmed him down and promised to get him to a Dallas Mavericks game eventually, if he would just understand that the doctors needed to do this casting to give his hip the best chance of recovery without damage. The surgery went well, and Garrett actually went to school five days a week for five weeks in his spica cast without issues.

Now, we are in the “waiting phase” of this dreadful disease. We hope the surgeries are done. We’re just waiting to see progress and bone growth. We hope surgery and casting is over, but we will follow Dr. Kim’s lead and trust his judgement. We pray every day for strength, patience, guidance and healing. We know this is out of our hands, and we are not in control, but we have picked the best team and talent to help us manage this difficult period. We can’t wait to return to the activities he loves. I know I will cry buckets of tears the day he steps back on the basketball court. As another Perthes mom told me, “This is a disease you never knew about and never thought you’d deal with, but here we are, and at least there are people surrounding you to help.” 

This past summer, Garrett went to Camp Perthes in Minnesota! He got to meet others with Perthes and spend five days at camp doing kid things. The camp was started by Earl Cole, the winner of Survivor: Fiji. Earl Cole had Perthes as a child and used some of his winnings to start Perthes camp. He’s an example of someone who went through this disease, and he wants to help others do the same. And Earl Cole was raised in Kansas City, Kan—-small world! Garrett had a wonderful time spending time with other Perthes kids, enjoying activities like canoeing and rope courses.

Garrett started beekeeping with his dad during the pandemic.  He was in first grade, and he has his own Facebook page where he captured his beekeeping adventures.  We plan to get back to his Itty Bitty Beekeeper page and keep chronicling his adventures when he is released from treatment. His page is here: https://www.facebook.com/ittybittybeekeeper. 

Right now, with Perthes disease, we allow him way more video game time than we want. However, it keeps him social and interacting with kids on the weekends when he would normally be at a sports practice or outing.  Once we get released from treatment, we will encourage him to return to his beloved sports.  He told him that his focus, when healed, is to become the best basketball player he can be.

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Bouncing Back From UCL Injury Scarlette Soars Higher Than Ever

Bouncing Back From UCL Injury Scarlette Soars Higher Than Ever

by | Nov 15, 2023 | Sports Medicine

Published in Rite Up, 2023 – Issue 3. 

by Kristi Shewmaker
 
It was a nail-biting week for Scarlette, of Coppell, during the fall semester of her high school senior year. She was waiting for a phone call from the head coach of the gymnastics team at Rutgers®. She hoped the coach would invite her to join the team. Years before, she had set her sights on going to Rutgers and competing there as a gymnast.
 
In competitive gymnastics, recruitment for joining a college team begins around an athlete’s sophomore year of high school. During that time, Scarlette visited the campus, attended gymnastics camps and participated in an official visit to get to know the coaches and student gymnasts. All that was left for her to do was wait for “the call” to let her know if her college dreams were coming true.
 
Born and raised in Oahu, Hawaii, Scarlette started gymnastics when she was 4. “She had tons of energy in preschool,” says Bryan, her father. “She was always hanging from the monkey bars and bouncing around.” Her parents enrolled her in a recreational gymnastics class to burn off energy. “We knew nothing about the sport, apart from what we saw in the Olympics,” Bryan says. But, the coaches picked up on Scarlette’s innate ability, and she excelled quickly. At her first gym, they suggested that she try out for a team. “That was the start of my gymnastics career,” Scarlette says. “I was 6 or 7 years old in my first competition.” And in that early competition, she won. Throughout the years, Scarlette kept winning.

By the age of 14, she rapidly advanced to level 10, the highest level in the USA Gymnastics Development Program. During her first year as a level 10, she made it to the national competition in Indiana, an incredible feat for her age. To ensure that Scarlette and her younger sister, who is also a gymnast, could get exposure and compete in bigger, more prestigious tournaments on the mainland, the family packed up and moved to Texas, specifically for the program at Texas Dreams Gymnastics in Coppell.
 
During her sophomore year, Scarlette tripped as she was running into a tumbling pass and rolled her ankle, landing on her arm. “In Hawaii, we have several hospitals but only one main hospital for children,” Bryan says. “In Texas, we didn’t know where to go, but her coaches and other gymnasts’ parents said, ‘You have to go to Scottish Rite for Children.’” At Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Scarlette learned that she had not only sprained her ankle but also would need care for a more complex injury to her ulnar collateral ligament (UCL) in her left elbow. Assistant Chief of Staff and Director of the Center for Excellence in Sports Medicine Philip L. Wilson, M.D., evaluated Scarlette and consulted with her and her family regarding her individualized treatment options.
 

The UCL is a band of tissue that runs along the inside of the elbow and works to stabilize the elbow joint during overhead movements. Baseball players, gymnasts and, occasionally, quarterbacks sustain this injury. “It has to do with the way you use your elbow, either for weightbearing or throwing,” Dr. Wilson says. Baseball players sustain the injury from repetitive throwing, bringing the elbow back at a certain angle repeatedly, causing stress on the ligament. “For gymnasts, it’s a weightbearing issue,” Dr. Wilson says. “We all have a little bit of an angle in our elbow called valgus. Gymnasts develop more of that angle as they grow due to repetitive weightbearing from a young age.” The force of a gymnast landing on her hands over and over causes repetitive stress on the ligament.

For most people, the treatment plan for a UCL injury is nonoperative with a recommendation of rest and physical therapy (PT). For athletes like baseball players or gymnasts, the plan could include surgery, depending on their injuries and their goals. “When we consulted with Dr. Wilson, part of Scarlette’s treatment plan depended on whether she wanted to stay at the competitive level or just do gymnastics for fun,” Bryan says. The direction she chose would determine the aggressiveness of the treatment.
 
“It is always challenging for the family to make a decision about what to do,” Dr. Wilson says. Ligament reconstruction surgery requires a long commitment to rehabilitation, and often takes a year for the athlete to get back to the competitive level. “An important part of our job is to partner with the family, provide quality counseling time and ensure that they have all of the information they need to make the best decision,” he says.
 
In their initial consultation, Bryan said that it was the first time he heard Scarlette say that she wanted to do gymnastics just to enjoy it. “A few months before my UCL injury, I had been struggling a lot in the gym,” Scarlette says, “and when I got hurt, I was like, ‘Is this a sign? Is this telling me to just be done?’” Bryan explained that Scarlette had hit a plateau in her skillset, which is common for competitive gymnasts, and in her mind, the injury was a setback.
 
Scarlette decided to take the nonoperative route, and Dr. Wilson recommended PT twice a week at Scottish Rite. After seven months, Scarlette was back in the gym when she injured her elbow again. “I was doing a release on the uneven bars, but I missed the bar and landed on my hands and knees,” she says. “The pain shot up my whole arm.”

After the reinjury, Scarlette decided to pursue surgery. “I was getting my skills back, and I think I just needed to take a step back and rest my body,” she says. “I was able to think.” The light at the end of the tunnel, Bryan said, was that she would get a new ligament in her elbow, and she would be much stronger.
 
Scarlette underwent surgery the summer before her junior year. Wearing a brace, she started range of motion exercises and began PT within the first week. Over many months, her therapy goals included regaining mobility of her joint and then progressing toward strengthening, endurance and power production. At six months, she went back to the gym while continuing PT, and at eight months, she resumed training but not at full skill level. Finally, the summer before her senior year, she was given the all clear to train without restriction and to fully return to gymnastics that fall.

 

“I learned a lot about myself during my recovery,” Scarlette says. “I had to build my way back up. The basics I received to get my skills back really helped my confidence and my performance. I trusted my care team, their process and everything they did.”

 

“I have massive respect for the program at Scottish Rite,” Bryan says. “Dr. Wilson gave Scarlette the option to do what she wanted to do. He didn’t go right to surgery. The professionalism of him to offer PT first, that he even took that into consideration, is a big deal. For any parent considering a facility for their child’s orthopedic needs, it’s a no-brainer. There’s no reason to go anywhere else.”
 
In the 2023 gymnastics season, Scarlette finally got to compete in all four events — vault, uneven bars, balance beam and floor exercise. “After all that she had been through, it was enlightening to see her compete,” Bryan says. “Her demeanor changed. She was driven and confident, not too deep in thought. She just went out there and did her thing, and let it be in the judges’ hands.”
 
After more than a year and a half of injuries, surgery and recovery, Scarlette said that waiting to hear from Rutgers felt like forever. But, the phone finally rang. She was officially offered a position on the team. And, her answer was, of course, yes!

“I’m excited for a whole new chapter,” Scarlette says. “I get to experience college life as a student athlete and compete on a much bigger stage. I can’t wait to experience that whole new world!”

Read the full issue.