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Progression from “Pop” Back to Pitching

Progression from “Pop” Back to Pitching

by | Oct 20, 2023 | Sports Medicine

A young baseball player hears a pop and immediately feels pain in his throwing elbow while playing club baseball. At his first visit to Scottish Rite for Children’s Fracture Clinic, Parker and his family were told that surgery was necessary to reattach a separated piece of bone in his elbow. That was tough news for this young pitcher nearing his 12th birthday.

A Note About Sport-Related Overuse Injuries in the Elbow in Baseball

Though a completely displaced fracture in this area is uncommon, pain and injury on the middle side of the elbow is common in young throwers. There are immense stresses placed on the elbow during throwing.

Many pitchers and others perform many throws during practice, private training and year-round games and tournaments, and the damage continues and worsens. For many young athletes, early recognition and rest can prevent the condition from worsening to the point of an acute injury, like a medial epicondyle avulsion fracture, that needs surgery. Learn more about preventing elbow overuse injuries in young athletes in this article, Injury Prevention Tips for Young Baseball Players and Parents.

“This area of the elbow is weak in young throwing athletes around Parker’s age, he was 11 at the time of this injury,” occupational therapist Savana Ashton says. The area is an epiphysis, a growth center, where the bone fragment is connected to the humerus by cartilage that will become bone when growth is complete. With or without a history of overuse, a sudden and forceful injury causes the muscle tendon attached to the fragment to pull it off the humerus completely, this is called an avulsion fracture. Like Parker, an athlete often describes hearing a “pop” and instantly feeling severe pain with this injury.

Parker was in good hands. Pediatric hand surgeon, Chris Stutz, M.D., performed the ORIF surgery where he used a screw to reattach the piece of bone. The procedure is called an open reduction and internal fixation (ORIF) of the medial epicondyle. After surgery to secure the bone fragment back in place, patients require intensive rehabilitation to return to activities and sports that are meaningful to them. In occupational therapy (OT), Ashton provided many therapeutic interventions including skin care and scar management as well as exercises to regain motion in the elbow and strength in the entire arm.

“From the beginning of Parker’s journey, he was eager to return to baseball, so a strategic path through postsurgical rehabilitation including safely reintroducing throwing was critical,” Ashton says. “Once Dr. Stutz cleared him for throwing, I advanced Parker’s plan to include evidence-based throwing programs, which include general baseball strengthening exercises and a multiphase guide to gradually return-to-pitching.”

Similar to other young athletes recovering from a serious sport-related injury, Parker was ready to be discharged from formal rehabilitation, but he was not quite ready to return to full activity, including baseball. In September, Parker transitioned from OT to the Bridge Program, a group training option offered by our Therapy Services team at Scottish Rite for Children. The program provides athletes like Parker a safe “bridge” to maintain progress made in therapy and continue strengthening in the previously injured area. Simultaneously, the coaches emphasize proper body mechanics and total body strength and conditioning, which will likely help reduce the risk of reinjury. “We were grateful Scottish Rite had an environment for him to continue his recovery,” Parker’s mom, Michele, says. She has entrusted Scottish Rite to care for several of her children now.

The program is not baseball-specific, but it is beneficial for baseball players and many others. Certified strength and conditioning coach Justin Haser, M.S., CSCS, says, “The kids that consistently come in, give a good effort and are coachable see great improvements in their movement economy and improvements in their overall strength outputs.” When athletes enroll in the Bridge Program or Athlete Development Program, they can attend up to three times each week.

In pediatric orthopedics, follow-up visits are particularly important when a growth area was involved in the treatment. Complications with this treatment are rare, but monitoring periodically and confirming recovery is on the right path ensures there won’t be surprises later.

Parker is now 13 and has been happily back on the mound and hitting home runs. “Parker is thrilled to be back playing baseball after his full recovery from surgery,” Michele says. To help other young throwers like himself have a safe season, Parker helped us create instructions for evidence-based exercises for all throwers. These are designed to be performed before practice or a game and can help to reduce elbow injuries.

Download the Thrower’s Program PDF (English | Spanish)

Prenatal Care for Clubfoot – What Expecting Moms Need to Know

Prenatal Care for Clubfoot – What Expecting Moms Need to Know

by | Oct 19, 2023 | Clubfoot & Foot Disorders

Discovering that your unborn child appears to have a physical difference during an ultrasound can be scary. The news is often unexpected and can lead to thousands of questions about how it will affect your baby. One thing that is commonly identified during the anatomy ultrasound scans is clubfoot, a condition that causes one or both feet to turn inward and downward. While the condition does require treatment, it often can be corrected without surgical intervention.

Our team in the Center for Excellence in Foot led by Anthony I. Riccio, M.D., meets with parents whose babies are diagnosed with clubfoot prenatally and begins treating these children quickly after they are born, beginning interventions within one to two weeks of birth. Learn more about what to expect during the clubfoot treatment process below.

What is clubfoot?

Clubfoot is a congenital (from birth) disorder in which the foot points down instead of straight and turns in, pointing toward the opposite leg. Clubfoot is one of the most common pediatric musculoskeletal conditions that requires treatment by a pediatric orthopedic surgeon.

A clubfoot is not a normal foot that is just twisted and turned into an abnormal position. The outward deformity is created by structural differences inside the foot. The method of treatment for clubfoot cannot alter the structural differences inside the foot. The treatment method takes the structurally abnormal foot that is in an abnormal position and puts it into a series of casts, which slowly turns the foot until it is in a normal position.

If left untreated, clubfoot will make shoe wear problematic and can lead to serious problems, severely limiting activities and even causing difficulty walking.

Prenatal Clubfoot Care: 20 weeks to 40 weeks gestation

Clubfoot can be diagnosed in unborn babies during the mother’s 20-week ultrasound in which the obstetrician or maternal fetal medicine physician reviews anatomy. During this ultrasound, if one or both feet appear to be abnormal, the doctor will refer the mother to visit with an orthopedic specialist to discuss treatment options.

The first appointment with our clubfoot expert Anthony I. Riccio, M.D., consists of a one-on-one conversation about clubfoot and how it is treated. In this appointment, Riccio answers questions that parents have about the condition and educates them on what to expect. This can greatly help a family feel less anxious about the future of their baby and assuage fears about any future disability.

Newborn Clubfoot Care: 1 to 2 weeks old to 2 months old

Riccio encourages families to spend a few days at home enjoying their newborn and then calling Scottish Rite for Children for an evaluation. Ideally, treatment for clubfoot will begin with the first couple of weeks of the baby’s life.

Typical treatment for clubfoot in newborns consists of the Ponseti method, which uses a series of casts and then braces to correct a baby’s clubfoot and prevent its recurrence. In newborns, the first step is to determine the severity of the condition and begin casting.

In serial casting, a cast is applied to the foot or feet once a week for three to five weeks. This brings the foot from upside down and turned inward position to a right side up and turned outward position. In some cases, a simple procedure under local anesthetic is performed to release tightness in the Achilles tendon and bring the foot into a normal position. After three to five weeks of progressive casting, a final cast is applied to hold the foot in the normal position for three weeks.

Infant Clubfoot Care: 2 months old to 7 to 12-months-old

After serial casting is completed, the next phase in clubfoot treatment is bracing to maintain the correction that was achieved through casting. Babies will wear a brace called a boot and bar brace consisting of soft silicone lined shoes with soft suede straps. These shoes are connected to each other by a bar to keep the feet turned outward.

Scottish Rite follows the protocol set by the International Clubfoot Congress of wearing the brace for 23 hours a day until the baby is beginning to pull up to stand, which usually happens between 7 to 12 months of age. Bracing does not interfere with the baby’s ability to reach developmental milestones, such as rolling over, sitting independently or crawling.

Toddler Clubfoot Care: 7 to 12 months old to 4 years old

After the baby begins pulling up to stand, wearing of the boot and bar brace is transitioned to nighttime only until the child reaches age 4. If bracing is not done in its entirety, the risk of clubfoot recurrence approaches 100%.

According to research at Scottish Rite, 70-80% of children will not require further treatment after the Ponseti method. Unfortunately, because clubfoot is a structural, congenital difference, approximately 20% of children will relapse and need further treatment, despite the medical providers and families doing everything correctly.

While clubfoot care may seem daunting, it is a safe and pain-free process that will give your baby the best outcome and prevent them from having difficulties later in life. Our team in the Center for Excellence in Foot stay with our patients and families every step of the way.

Learn more about clubfoot.

Get to Know our Staff: Dachia Kearby, Center for Dyslexia

Get to Know our Staff: Dachia Kearby, Center for Dyslexia

by | Oct 18, 2023 | Dyslexia & Learning Disorders

What is your job title/your role at Scottish Rite for Children?
My job title is dyslexia therapist.

What do you do on a daily basis or what sort of duties do you have at work?
As a part of the Education Team at the Luke Waites Center for Dyslexia and Learning Disorders, there are several duties that I may be doing at any given time. I could be teaching patients in our lab school, training teachers in one of our four curricula, troubleshooting technology questions for our customers or working with Karen Avrit and our team with curriculum development.
 
What was your first job? What path did you take to get here or what led you to Scottish Rite? How long have you worked here?
My very first job was at a store named Perry Bros. For the younger staff, that was a nickel and dime type of store that sold everything from candy to fabric to small animals, such as birds and mice. And yes, part of my job was to clean the bird cages, which is why, to this day, I have never had a pet bird.
 
I worked in the public school system for 15 years as an English, Reading and Language Arts teacher. I was a part of the research study for using Rite Flight in public schools when it first came out and was trained here at Scottish Rite. Working closely with my campus dyslexia teacher and with students that struggled with reading and comprehension for most of my career led me to taking over the dyslexia position at my school when it became available. After a year of therapist training here at Scottish Rite, I was offered a job to teach in the dyslexia lab and finish the technology component of our curriculum, Take Flight. This summer, I celebrated eight years at Scottish Rite.

What do you enjoy most about Scottish Rite?
Being here at Scottish Rite is an amazing place to be. I really enjoy that on any day, I could be walking down the hall and witness a first for a child … taking a first step on a new prosthesis, learning to bounce on a halo and giggling with delight, or getting a diagnosis to explain how amazingly smart the child is but that he or she just learns differently. And no matter where you go within the hospital, there is always a smiling face to greet you.

Tell us something about your job that others might not already know?
I am not afraid of technology and have successfully integrated it into all our curricula. Our team helps teachers from all around Texas, and our curriculum (Take Flight) is being used in 42 states and eight countries.

Where is the most interesting place you’ve been?
Jamaica is the most interesting and beautiful place I’ve ever been. I went there for a friend’s wedding. Between the blue, clear ocean, the hiking trails, the friendly people, and the majestic waterfalls, it was a trip I will never forget.

If you could go back in time, what year would you travel to?
I would travel back to 1999, my first year of teaching. My career started in Fort Bend ISD in Sugarland, Texas. I taught sixth grade English at Dulles Middle School. It was such an amazing year with great mentors, incredible friendships and remarkable students.

If you could only eat one meal for the rest of your life, what would it be?
If I could only eat one meal for the rest of my life, it would be a really good cheeseburger, sweet potato fries and a strawberry shake.

What is your favorite Halloween costume that you have worn?
My favorite Halloween costume was many years ago when I was a schoolteacher, and my team dressed up as the characters from The Wizard of Oz. We all worked for several weeks to create our costumes. I was the Wicked Witch, with the green skin and all.

What’s one fun fact about yourself?
I worked in a florist shop in college. Learning to create floral arrangements, corsages, wedding bouquets and homecoming mums was so much fun and a great creative outlet for me. I still enjoy creating them when the occasion calls for it.

Getting Back to Action: The 6 Stages of Concussion Recovery

Getting Back to Action: The 6 Stages of Concussion Recovery

by | Oct 18, 2023 | Sports Medicine

If your child sustained a concussion in a recent game or practice, recovery won’t happen overnight. There are six stages of concussion recovery necessary before returning to action.

A young athlete might think of a concussion as simply a sports injury, but because it involves the brain, a concussion is more complex. A concussion is a traumatic brain injury that occurs after a blow to the head or a hit to the body causes the brain to move back and forth within the skull. 

While a concussion can occur during any type of activity or simply when you bump your head on a bathroom cabinet, it’s more likely to happen when playing sports, such as football and soccer. These contact sports pose a high risk of physical injury, which, unfortunately, can involve your child’s head.

Recovering After a Concussion

After a concussion, your child may want to get back to the court or field quickly, but it’s essential to be patient throughout the full recovery process. Prioritize rest and quality sleep during this time since both will help your child’s brain while they recover.

As your young athlete begins feeling better and symptoms, such as headache and sensitivity to lights or sounds, disappear, a medical provider may recommend a gradual return to normal activities. Encourage your child to listen to his or her body and resume activities as able but not to overdo it. 

If your child’s concussion symptoms linger or get worse, it’s important to talk with a medical provider. Physical and mental symptoms that don’t go away can be a sign of post-concussion syndrome, which can last for weeks or even months. 

When will your child be ready to get back in the sports action? Full recovery isn’t always obvious, and working with your child’s doctor, coach and an athletic trainer, if one is available, is crucial to ensuring your child returns to sports safely.

Generally, concussion recovery follows these six stages.

Stage 1: Back to Regular Activities

In the initial days after a concussion, your child should not return to sports. Normal activities, such as work or school, may be OK, if your child’s medical provider says so. Your child may only tolerate a few hours of school, so keep an eye out for symptoms. 

Stage 2: Light Aerobic Activity

After a few days without symptoms, your child may receive clearance to participate in brief bursts of gentle physical activity to increase his or her heart rate, such as short walks. Avoid weight-lifting at this stage.

Stage 3: Moderate Activity

The next step for recovering from a concussion is progressing to moderate activities that increase your child’s heart rate and involve body and head movement. Activities may include jogging or slow running, along with moderate-intensity weight training.

Stage 4: Heavy, Noncontact Activity

At this point of your child’s concussion recovery, your child’s provider may say it’s acceptable to participate in activities, such as sprinting, weightlifting or noncontact, sport-specific workouts. 

Stage 5: Practice and Full Contact

If your child has progressed through the first four stages without a return of symptoms, his or her provider may give the all clear to participate in contact activities in a practice setting.

Stage 6: Competition

Once your child has participated in sports practices without a return of symptoms, he or she may be approved to return to actual competition. Be careful, though. Having one concussion makes your young athlete more susceptible to future concussions, so talk with the team’s coach or athletic trainer or your child’s provider about precautions your child should take to prevent another head injury.

The Bottom Line on Concussion Recovery

Returning to sports isn’t as simple after a concussion as after a sprained ankle, for example. Head injuries need to fully heal before your child returns to activities, and you should work closely with a health care provider to determine when to move through each recovery phase.

As your child recovers after a concussion, carefully follow the treatment plan outlined by your medical provider. If your child progresses and then his or her symptoms return or new ones develop, hit the pause button and seek medical attention.

After a concussion — and even if your child has never had one — take precautions to protect your athlete’s head and avoid future concussions. Be sure your child uses the required sport-specific protective gear, including a well-fitting helmet. If your child damages his or her helmet during a game or practice, replace it. A helmet that’s cracked or broken can be ineffective.

Baseline testing before your child’s sports season can be another helpful step to discuss with your child’s pediatrician or coach. This type of evaluation provides valuable information that can be used to determine the extent of a head injury if one occurs.

It’s also a good idea to familiarize yourself with the signs of concussion and to talk through them with your child. A medical provider should promptly check out any symptoms after a hit to the head.

Is your young athlete recovering after a concussion? Call 469-515-7100 to discuss your child’s care.