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Jammed Finger? Early Treatment Can Improve Outcomes

Jammed Finger? Early Treatment Can Improve Outcomes

by | Dec 4, 2024 | Sports Medicine, Therapy Services

When an injury occurs to a young athlete’s bones, ligaments and muscles in their hand, an evaluation is needed. A properly treated hand injury will most likely heal without complications.

In basketball and volleyball, fingers are at an increased risk of injury due to a variety of causes. Some children may snag their finger on a jersey, or others may hang on the rim or net. When an athlete says they have “jammed” their finger, there is concern for a volar plate injury.

 

What is the volar plate?

The volar plate is a thick ligament, located on the palm side of the finger. It connects two bones in the finger and stabilizes the middle joint of the finger, known as the proximal interphalangeal, which prevents the finger from bending backwards.

 

What is a volar plate injury?

A volar plate injury occurs when the finger is hyperextended or bent backwards, damaging the ligament. It is also commonly known as a sprained or jammed finger.

In some cases, the volar plate can be stretched and torn, pulling off a small piece of bone. This results in a fracture in the area called an avulsion fracture. With severe injuries, the joint may also be dislocated.

 

What are the symptoms in the injured finger?

  • Bruising
  • Immediate pain in the middle joint
  • Swelling of the middle joint
  • Decreased range of motion

 

What is the treatment for a volar plate injury?

Fracture Clinic provider Gerad Montgomery, M.S.N., FNP-C, sees and treats volar plate injuries frequently at Scottish Rite for Children Orthopedics and Sports Medicine Center in Frisco. “Treatment for a volar plate injury depends on the severity and can range from a short period of immobilization to surgery,” Gerad says.

With more than 15 years in providing pediatric orthopedic care, Montgomery has learned to warn families of the risks associated with not properly treating this injury. It’s important for families and young athletes to understand that volar plate injuries can worsen to the point of needing surgery without evaluation or treatment from an expert.

 

When should an athlete return to sports after a volar plate injury?

After a clinical provider has released the athlete to begin exercises, gentle range of motion progressing to strengthening exercises may be recommended. Some athletes may need guided exercise with an occupational therapist. “Before returning to sports, the hand and finger should have full strength and range of motion,” certified hand therapist Lindsey Williams says. “Otherwise, there is a risk of injury to the same or other joints nearby.”

Not sure what to do if your child gets a finger injury? Learn about our Fracture Clinic and Sports Medicine Clinic.

Emily Claire’s Transformation: A Pain-Free Knee and a New Life Path

Emily Claire’s Transformation: A Pain-Free Knee and a New Life Path

by | Nov 7, 2024 | Sports Medicine, Therapy Services

Cover story previously published in Rite Up, 2024 – Issue 3.

by Kristi Shewmaker

Emily Claire, of Plano, spends most of her time raising two pigs — Dolly and Kenny, named after Dolly Parton and Kenny Rogers. Like the country legends, Dolly and Kenny are not related. Every morning and evening, the 17-year-old drives to the barn to take care of them where they show their affection for her in different ways. “Dolly gets the zoomies,” Emily Claire says. “She’ll run laps in her pen, but Kenny just sits there with puppy dog eyes looking at me. He also likes to cuddle. Dolly, not so much, but Kenny will lay across my lap.”

Emily Claire is president of the FFA Plano chapter and secretary of Area V’s District VII for the state of Texas, which is part of the National FFA Organization, historically known as Future Farmers of America. She recently attended the Texas FFA State Convention in Houston. “It’s a lot more than just showing animals or being a farmer,” she says. Through FFA, she has engaged in leadership and career development events that will serve her throughout her senior year of high school and beyond.

Dr. Henry B. Ellis

As a young teen, Emily Claire had her heart set on playing softball. She played for school and select teams and had dreamed of playing at the collegiate level. But, she started experiencing pain in her knee, leading to multiple incidents of partial dislocation. The first time, she was crossing the street. “My kneecap slipped out, and I fell to the ground, literally in the middle of the street,” she says. “It was embarrassing.” The second time, she fell at softball practice, but each time, her kneecap went back into place. Then, in the fall of 2021 during her freshman year of high school, her kneecap fully dislocated at catcher practice. “I was in my squat throwing down to second base, and I popped up to throw, and my kneecap just locked out,” she says. “I couldn’t move it. I didn’t know what was happening, and I was freaking out.”

TREATING KNEECAP INSTABILITY
An established patient at Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Emily Claire was initially treated with a brace and a specific exercise program. Unfortunately, she experienced increasing episodes of instability in her kneecap, or patella. Recurrent episodes of patellar instability often require surgery. Henry B. Ellis, M.D. — pediatric sports medicine surgeon, sports medicine fellowship director and medical director of clinical research — performed medial patellofemoral ligament (MPFL) reconstruction surgery on Emily Claire’s left knee.

“MPFL reconstruction is common for us in pediatric sports and those that take care of kids because kneecap instability is very common in kids,” Dr. Ellis says. “In our practice at Scottish Rite, it is one of the most common conditions that we treat.”

When Emily Claire’s kneecap dislocated, it tore an important ligament that holds the patella in place. In surgery, Dr. Ellis replaced the torn ligament with a new one to give her kneecap stability. However, patellofemoral instability is complicated. Sometimes, it requires more than simply replacing a ligament. At the end of the femur, or thigh bone, is a groove called the trochlear groove. The patella fits into this groove, and when the knee bends or straightens, the patella slides up and down in the groove. Emily Claire’s kneecap was not aligned in the groove because of the position of her tibial tubercle, the bony bump on the upper part of the shin where the patellar tendon attaches. “Her kneecap was living off to the side,” Dr. Ellis says. To mitigate this problem, he performed a procedure to shift Emily Claire’s tibial tubercle, which aligned her kneecap in the groove and ensured that it would track and glide correctly.

REHABILITATING BODY, MIND AND SPIRIT
MPFL surgery stabilized and corrected Emily Claire’s kneecap. What came next would change the direction of her life. Her knee injury and rehabilitation served as a catalyst that led her to discover her dream career. Throughout her care journey, she received treatment from Dr. Ellis and a multidisciplinary team, including physician assistant Ben Johnson, registered nurse Tammy Norris, physical therapist Katie Sloma, child life specialists, psychologists and athletic trainers, among others.

After surgery, Emily Claire met physical therapist Katie Sloma for a physical therapy evaluation. “I remember talking to Katie and asking her questions,” Emily Claire says. “I was really curious about her job.” For weeks, Emily Claire was on crutches, wore a brace and could not bear weight on her leg. “I got a really good tan line at the softball field with stripes going across my leg,” she says. “It was very humbling having two different size quads.”

Katie worked with Emily Claire on quad strengthening, range of motion and mobility through manual therapeutic exercises and aquatic therapy.

“Emily Claire always came in with a smile and ready to work,” Katie says. “She was curious about the process and liked to remain informed, which was cool for us to see.”

For several months, Emily Claire could not play softball. Then, slowly, she was reintroduced to the game part time, but ultimately, her team broke up during her sophomore year. “I was like, ‘OK, I don’t know what I’m supposed to do now,’” she says. She recalls trying out for other teams, but her knee had not fully recovered. “I wasn’t getting called back,” she says. “It was like nobody wanted me, and that was really degrading, and I was like, ‘Am I even supposed to play softball anymore?’”

Things began to change in 2023 when Emily Claire attended the FFA Collin County show. “Everybody there was just so nice and comforting. It felt like a place that I belonged,” she says. “So, I went home and cried about it a lot, and I was like, ‘I just don’t think softball’s for me.’”

OPTIMIZING CARE THROUGH EXPERT TEAMWORK
Emily Claire continued to gain strength and increase athletic conditioning by working with athletic trainers while participating in Scottish Rite’s Bridge Program.
“In our care of any youth athlete, one of the biggest advantages that we have at Scottish Rite is the ability to work together,” Dr. Ellis says. “When someone presents a problem, we offer solutions, but we do it not just as a physician to patient, but as Scottish Rite as a whole.”

Physician assistant Ben Johnson agrees. “The care we provide is a team-based approach with all team members focused on a singular goal of getting patients like Emily Claire back to doing what they love to do without limitations,” he says. The exceptional dynamic of Scottish Rite’s continuum of care results in optimal outcomes for patients. “The key to Emily Claire’s success is the fact that she had an opportunity to work with our team together,” Dr. Ellis says.

Emily Claire liked the team she worked with so much she decided to join it. Over the summer, she interned at the Frisco campus’ Movement Science Lab, processing data for a neurocognitive research study. “I have received so much at Scottish Rite — and not just care,” she says. “Everybody here is so kind and loving, and they want to help you not just get better and achieve your goals, but they’re willing to help you learn.”

Emily Claire’s time at Scottish Rite has inspired her to become a physical therapist. “Instead of something that I had to go to, physical therapy became something that I looked forward to,” she says. “Everyone was there for me.” Katie shares that Emily Claire’s interest in the field of physical therapy was rewarding to her as a provider. “It shows that her time at Scottish Rite made a positive impact on her even when things got hard,” Katie says.

Upon reflection, Emily Claire explains that her care journey also changed her mental health. “It showed me that I was more unhappy than I was happy playing softball, and that softball wasn’t for me,” she says. “I thought I was going to let so many people down
if I didn’t play, but it opened my eyes and showed me that I like doing FFA a lot more.”

Recently, Emily Claire received the news that she was accepted to her college of choice, Tarleton State University, where she will pursue a degree in kinesiology. Upon graduation, she plans to attend physical therapy school. But for now, she is enjoying her senior year, beginning this fall, when she shows her superstars, Dolly and Kenny, at the State Fair of Texas.

Read the full issue.

Strength and Conditioning Training: It Is Not Just About Getting Strong

by | Oct 10, 2023 | Therapy Services

What is strength and conditioning?
Strength and conditioning may better be referred to as “physical preparation.” An athlete needs to be physically capable of accomplishing the goals set by the coach to compete in the game. Benefits of strength training go beyond just getting an athlete bigger, stronger and faster. Proper training improves an athlete’s resiliency and confidence in their performance as well. Though preventing injuries may not be directly related to movement and strength training, there are studies that suggest that overuse injuries may be reduced by as much as one-half with appropriate training.

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Ideally, an athlete participating in a strength and conditioning program is:

  • At a developmentally appropriate level.
  • At a physically appropriate level.
  • Receiving proper instruction and supervision.
  • In a setting with equipment that is appropriate for both the athlete and the sport.

KEISER YOUTH TRAINING CLASSES KE 0000000 D 10 10 45 St PB 48KG. A group of young boys squatting in a gym

What is training age?
An athlete’s training age may vary across skills or activity. The “training age” is typically much lower than the chronological age. A soccer player may have started playing soccer at age 4 but didn’t start resistance training until age 12. Therefore, that athlete should not begin a strength and condition program at the level of an athlete with five years of resistance training who may be lifting weights and using other forms of resistance.

How should goals be set for a young athlete?
The goals of the program should also be individualized and progress should be tracked. Measures for strength, power, endurance and speed are commonly used. More importantly, an assessment of movement quality should be integrated in the progression. Proper form in fundamental movements should always precede increased resistance or other challenging elements of an exercise.

Younger athletes should learn that “bulking up” is not an appropriate goal for them. These changes will not occur until developmental stages where hormones are present to create those visual changes. What is more likely to occur with movement and strength training in this population are neurological changes that lead to improved neuromuscular control, which is believed to reduce the risk of knee and ankle injuries common in young athletes.

What happens after an injury?
After proper diagnosis, a transition to a supervised strength and conditioning program is ideal only after treatment and rehabilitation for a musculoskeletal injury. An athlete often completes formal physical or occupational therapy before they are ready to return to sport. Therefore, a continued progression of sport-related and other activities help the athlete to complete recovery and prepare for realistic sport environments. Complex movements and distractions that are common during competitions can be integrated into training sessions where variables are controlled.
People squatting in front of a matrix squat rack | HEME 10 45 S 17 18 13 14 15 ᏣᏃ Ec A Ec 16 16 MATRIX 18 14 10 SCOTTISH RITE FOR CHILDREN PORTS MEDICINE Jasirs 处

In a recent program for medical professionals, strength and conditioning coach Justin Haser, M.S., CSCS, and physical therapist Daniel Stokes, P.T., D.P.T., CSCS., explained how strength and conditioning is integrated in the continuum of care for healthy and injured athletes. Watch now on YouTube.

Get to Know our Staff: Madelyn White, Therapy Services

Get to Know our Staff: Madelyn White, Therapy Services

by | Jan 13, 2023 | Therapy Services

What is your job title/your role at Scottish Rite for Children?  
I’m a sports physical therapist at our Frisco campus.
 
What do you do on a daily basis or what sort of duties do you have at work?
I work with youth athletes with various injuries to get them back to their sports safely. My job consists of examining and assessing athletes and coming up with a plan to get them back to their sports. I spend most of the day in our sports therapy gym, leading patients through exercises tailored to their injury and their sport. 
 
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?
Prior to becoming a physical therapist, I worked at an ice rink teaching young kids how to skate and play hockey. 
 
My first job as a physical therapist was here! I was a student physical therapist at Scottish Rite for Children for my final clinical rotation, and I started working as a full-time physical therapist about a year later in March 2021. 
 
My family lives in this area, and I remember seeing the Frisco facility being built. I thought it was really unique to have such a specialized clinic for youth sports, and I knew I wanted to be a part of it. After having my clinical rotation here, I couldn’t imagine working anywhere else. I feel very lucky to get to work in such a great facility.
 
What do you enjoy most about Scottish Rite?
The people! Whether it’s my patients or my colleagues, it’s always fun to be here. We have such a great staff in the Therapy Services department and beyond, and my patients always brighten my day!
 
Tell us something about your job that others might not already know?
I think most people don’t know how hard physical therapy (PT) sessions are for patients. A lot of people think PT is just massages and stretching, but most patients spend the majority of sessions lifting weights, running and jumping. There is a lot more strength and conditioning involved than people expect.
 
Where is the most interesting place you’ve been?
I went to Europe for the first time last summer and loved it. Paris was the most beautiful place I’ve ever seen. 
 
What is your favorite game or sport to watch and play?
Ice hockey! I grew up in a hockey family, and I played and/or coached ice hockey until I went to college. I’m a big Dallas Stars fan and go to (almost) all the home games.
 
I also had a brief stint as a gymnast/cheerleader, and I ran track throughout high school. 
 
If you could only eat one meal for the rest of your life, what would it be?
Any kind of sushi.
 
What’s one fun fact about yourself?
I am currently on a daily running streak and have run at least one mile a day for more than 450 days in a row. I haven’t missed a day!

Get to Know our Staff: Lindsey Ham, Therapy Services

Get to Know our Staff: Lindsey Ham, Therapy Services

by | Dec 13, 2021 | Therapy Services

What is your job title/your role at Scottish Rite for Children?  
I am an occupational therapist and certified hand therapist working primarily at the Frisco campus. 

What do you do on a daily basis or what sort of duties do you have at work? 
My primary role is an outpatient occupational therapist, specializing in pediatric hand conditions. While this sounds like a small subset, I assess and treat a wide range of diagnoses, including upper limb and hand differences, traumatic injuries and sport-related injuries involving hand, wrist, elbow and/or shoulder. In addition, I also see patients with cerebral palsy, arthrogryposis, arthritis and brachial plexus injuries. My job is to figure out what deficits are limiting their participation and independence with daily activities, such as dressing, bathing, toileting, school participation, sports and leisure participation and play. I then address these deficits through meaningful activities to get them back to doing what they love. Since we see all ages from newborn and up, every hour of my day looks different, ranging from playing a game of Connect 4 or Mancala to bear walks, push-ups and weight machines. We also fabricate custom orthoses (splints) for children who have fractures or surgeries that require immobilization.

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 first job was as a certified nursing assistant at a hospital while I was in college. I always knew that I wanted to be in the medical field. My high school had an amazing health careers program where we were able to shadow many different jobs across the medical field. It was then that I was able to shadow an OT and fell in love with the career! I have been an OT for 13 years and at Scottish Rite for almost three years. I moved from Nashville to Dallas just to work at Scottish Rite, and it was one of the best decisions I’ve made! 

What do you enjoy most about Scottish Rite?
I love the atmosphere and team here! It is such a positive place to work. I love the collaborative approach to treat every patient. There is an open line of communication between therapists and physicians and that creates great outcomes for our patients. I love that everyone here has the same mission — to give kids back their childhood. 

Tell us something about your job that others might not already know. 
Your hand strength is important! This is something that I preach daily. People know to go to the gym and workout, but no one really focuses on hand strengthening. So, grab a stress ball and keep your hands strong! 

What was the best vacation you ever took and why?
I love traveling, so it is hard to pick just one. I would have to say my favorite was the cruise I took to the Bahamas last month because I got engaged!!  

Do you collect anything? How did you start?
Shoes and sunglasses — I guess not a true collection, but I have a lot of both! 

Do you play any sports or instruments?
I was a competitive cheerleader in high school and then coached through college. My sister owns a cheer and tumbling gym, so I am still surrounded by it. I also belong to a kickboxing gym and love it. 

Get to Know our Staff: Rushi Patel, Therapy Services

Get to Know our Staff: Rushi Patel, Therapy Services

by | Nov 15, 2021 | Therapy Services

What is your job title/your role at Scottish Rite for Children?  
I am a sports physical therapist. 

What do you do on a daily basis or what sort of duties do you have at work?
As a sports physical therapist, I help rehabilitate patients following a wide variety of sports injuries — everything from overuse injuries of the shoulder, spine and knee to post-operative care. 

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?
Following physical therapy school, my first job was an orthopedic physical therapist. Once I developed my passion of specializing in sports rehab, I completed a sports physical therapy residency at Baylor Scott & White at The Star, where I was able to sharpen my skills. As soon as I heard about a job opening at Scottish Rite and saw the facility, I immediately knew that this is what I wanted. I have been here for about one year. 

What do you enjoy most about Scottish Rite?
I enjoy the collaborative approach to care. Being able to have a close relationship with a patient’s health care team plus the open lines of communication are key when providing quality care that best suits the complexities and needs of each individual child. 

Tell us something about your job that others might not already know. 
I would want others to know how important recovery and lifestyle are for good physical therapy outcomes. I always provide education on the importance of sleep and good nutrition to each family. It is always humbling to accept the fact that exercises will only go so far. Proper sleep and diet are important to optimize recovery between physical therapy sessions. 

What was the last thing you read?
The Science and Practice of Strength Training. It’s always good to reinforce the science behind what we do on a daily basis. 

What was the best vacation you ever took and why?
Tulum, Mexico. Long story short: I went scuba diving with stingrays.  

Do you collect anything? How did you start?
Starbucks traveler mugs. I started randomly one day at the Seattle airport, and I have been collecting them when I travel to a different city ever since. 

Do you play any sports or instruments?
I try my best to practice what I preach in the sports rehab setting. I love staying active by working out in the weight room so that I can still enjoy playing recreational flag football and basketball as an adult.