For someone who enjoys playing and watching tennis as much as I do, this is a perfect time of year to find your racquet and join a friend on the court. It’s also a good time to fine-tune your mechanics and prepare your body for the challenge to avoid injuries
 
Over the years, I have treated many recreational athletes and tennis pros alike at Methodist Sports Medicine / The Orthopedic Specialists. I had the great pleasure of serving as the orthopedic consultant for the Indy Tennis Championships (formerly the RCA Championships) for 13 years until it recently moved to Atlanta. The professional players sustain injuries that are primarily related to the extreme exertion they sustain over a season that now stretches over the entire year. Recreational players, on the other hand, sustain injuries that are primarily related to poor stroke mechanics, improper equipment, and suboptimal conditioning. Many common injuries can be prevented and that’s why we recently created three educational YouTube videos at the Five Seasons Family Sports Club in Indianapolis. The videos cover proper tennis mechanics, common tennis injuries and the benefits of youth tennis.

The Five Seasons tennis pros demonstrate some of the common mistakes made by recreational players that can lead to injury. They discuss the importance of footwork and balance as essential elements of putting the player into position to hit the ball properly. Additionally they emphasize the importance of the connection of the right and left sides of the body in producing smooth effortless strokes.

In the YouTube video about common tennis injuries, we explain the basic care of acute minor injuries following the R.I.C.E. (Rest, Ice, Compression and Elevation) treatment formula. Injuries which don’t resolve in a few days with the basic care may require the attention of a sports medicine physician.
 
Youth tennis is another important topic. I encourage parents to teach your children tennis at a young age because it’s one of the safer sports for them to play. In addition, there are long-term health benefits for children who start playing at a young age and continue playing as an adult. We discuss those positives and other benefits in the third YouTube video.
 
Visit our YouTube channel to watch the videos and tell us what you think in the comments section.

http://www.youtube.com/user/MethodistsSports?feature=watch
Read Dr. Sallay’s “Healthy Tennis” article in Midwest Tennis magazine.

http://www.methodistsports.com/physicians/peter_sallay/documents/Dr.SallayTennis_Articles.pdf

Typically a person can identify a wrist fracture if they feel wrist pain, have swelling of the wrist or if their wrist appears to look deformed.  If this occurs then immediate medical attention is required.

At the emergency room, a doctor will perform x-rays to confirm if a fracture has occurred and to determine the position of the fracture and to assess the stability of the bone fragments. Commonly a broken wrist is treated in a cast or a splint. However, in some situations surgery may be required. An orthopedic surgeon considers the following factors when determining if a patient requires surgery for a broken wrist:

• Age and physical demands of the patient: If a patient is young and active, a physician may choose to perform surgery to ensure that they do not suffer future complications. However, if a patient is older or doesn’t require heavy demands of the wrist, perfect restoration of the wrist bones may not be necessary.

• Location of the fracture: If a fracture involves the joint of the wrist surgery may be necessary to restore the surface of the joint. This is vital in terms of wrist function.

• Displacement of the fracture: If the bones are severely misaligned, then surgery may be performed to properly position the bone fragments. Typically repositioning is done without surgery but in situations where muscles or tendons may become entrapped and block the resetting, surgery may be required. Surgery may also be required if a fracture does not stay in position with a cast or splint.

As I mentioned, surgery is not usually necessary to treat a broken wrist but it may be considered in some situations, during the first two weeks of a fracture. If surgery is performed, there are several treatment options available. Your orthopedic hand specialists will discuss these options with you and help you determine the best course of treatment for your individual situation.

Different forms of arthritis affect the hands in different ways. For example, psoriatic arthritis, a type of arthritis related to the skin condition psoriasis, is most likely to cause pain in the joints closest to the finger nails, while osteoarthritis causes the cartilage to wear down in all the joints in the fingers and thumb.

Although each form of arthritis has its unique characteristics, there are some general signs that a person can look for to help determine if they might be suffering from a form of hand arthritis. Those include:

• Pain in the hands and fingers, especially after firmly holding an object
• Stiffness and pain that are more noticeable in the morning
• Swollen or disfigured joints
• A feeling of warmth in the joints or red and swollen hands
• A feeling that the bones in the joints are rubbing together, or that a joint is “loose”
• Cysts near the joints at the end of the fingers
• Difficulty with motions that require gripping and twisting

Unlike some orthopedic conditions, the progression of hand arthritis can be measured. People with rheumatoid arthritis and psoriatic arthritis lose bone density, which can be measured with bone-density scanning.  People that might be suffering from osteoarthritis experience joint damage, which can usually be seen on X-rays.

If symptoms of arthritis are starting to trouble you and are beginning to impact your everyday activities, you should speak with an orthopedic hand surgeon. One way your doctor may recommend managing your arthritis is with regular physical activity.  It’s important to not let the pain force you to give us physical activities you enjoy such as exercise and gardening.  It is these activities that will allow you to maintain strength and flexibility.

Don’t let hand arthritis become a road block to your physical happiness.

The most common injury is known as gymnast wrist or distal radial epiphysitis, which impacts approximate 40 percent of young gymnasts at some point in their athletic career. This injury is caused by placing repetitive stress on the growth plate at the end of the forearm bone, which can lead to inflammation and irritation of the actual growth plate.  If left untreated, gymnast wrist can lead to premature closure of the growth plate, causing asymmetry in the length of the two forearm bones, which can lead to chronic pain, stiffness and difficulty competing in gymnastics.

Treatment of gymnast wrist includes a rest period from impact activities to remove the stress from the growth plate, allowing it to heal. An athlete’s orthopedic surgeon may also recommend icing the area to help reduce inflammation.  When the inflammation and pain has subsided, a gymnast can gradually return to impact activities but if the pain returns further evaluation and more intense medical treatment may be required.

There are several precautions that a gymnast can take to help avoid this type of wrist injury.

• Stay strong: An athlete can avoid many different injuries by increasing muscle strength and flexibility.  It’s harder to overuse wrist, hand and arm muscles if they are kept strong.

• Avoid flexing and twisting: The natural wrist position is when the palm of the hand is at a 30 to 40 degree angle. Keep that position whenever possible. Flexing and twisting of the wrist causes all the tendons and nerves to rub over leverage points at the joints, which can cause an injury.

• Do not train with pain: Pain is a sign of injury, stress or overuse. Rest is required to allow time for the injured area to heal. The sooner an injury is identified, the sooner proper treatment can begin.  The result is shorter healing time and faster return to the tumbling mats.

• Warm-up: Before beginning training or a new gymnastics routine, warm-up muscles with light aerobic exercises such as jumping jacks or running in place.  This will help to loosen muscles, making them more flexible and less prone to injury.

The most important thing to remember is that if a gymnast does suffer from pain or experiences a sudden injury, it’s important to seek immediate medical attention.  Failure to do so can result in longer rest periods and possibly more extensive treatment, including surgery.

As it appeared in the Indianapolis Star

Ask the Doctor: MD for those who make TDs

By: Shari Rudavsky

Dr. Art Rettig is an orthopedic surgeon who is team physician for North Central High School football.

Most of the people inducted into the Indiana Football Hall of Fame are, as you would suspect, players and coaches. But this year, the group of new inductees included Dr. Art Rettig, an orthopedic surgeon with Methodist Sports Medicine/The Orthopedic Specialists. He joined a handful of other doctors honored for their volunteering efforts. Friday nights in the fall mean football for Rettig, who has worked with various Indianapolis- area teams since the early 1980s.

Q: What led you to start this volunteer work?
A: I have been a great sports fan all my life. I started with Decatur Central and then was with Cathedral. I’ve been with North Central for the past 15 years. We’re on the sidelines at all the games, home and away. If we can’t make it, we have one of our partners or a fellow cover it.

Q: Do most teams have people like you working with them?
A: Pretty much every Indiana high school team has a trainer. Not everyone has a physician, but certainly in the metropolitan Indianapolis area, most have physicians there for the game. The home team is required to have a team physician.

Q: How often do you administer care?
A: Usually you have people getting injured every game, just by the nature of football. Sprained ankles, tendonitis, abrasions, contusions — you see something just about every game.

Q: Are there often more serious injuries?
A: Probably there’s one significant injury for every three games that you see. It’s not life-threatening, but it might require surgery.

Q: How critical is it to have doctors on hand?
A: I think that the administrators certainly feel more comfortable. Trainers can handle 90 percent of injuries, and they do. But it’s good to have a physician there as a backup, to make final decisions about patients, to talk with parents about what the injury is and how to monitor it.

Q: Has there ever been an injury that made you thankful you were there?
A: The things that you worry about are head and neck injuries, and we have had to take two or three players (to the emergency room) over the years. . . . Fortunately, it turned out that they were OK.

Q: Could other sports use a doctor on hand?
A: Football is really a contact sport. There are more collisions per game than in a basketball game. With hockey, soccer, lacrosse, rugby, basketball, it would be nice to have a physician at all of them, but there just are not that many doctors to go around.

Even though golf is a low-risk sport, injuries can occur. According to the Academy of Orthopaedic Surgeons, more than 100,000 golf-related injuries are treated each year.  Shoulder, wrist and elbow injuries occur most often in golf. Most shoulder injuries are due to overuse, while wrist and elbow injuries most likely occur due to improper swing or holding the clubs the wrong way.

Dr. Arthur Rettig recommends some simple ways you can prevent an injury from sidelining you from the links:

• Warm Up and Strengthen Your Muscles – Warm up your muscles to prevent strain. Also, by strengthening your forearm and shoulder muscles, it will help decrease shock in the arm when hitting the ball and reduce the risk of tendonitis or “golfer’s elbow.”

• Learn the Correct Technique and Practice Gradually – By learning the proper way to swing, you will put less strain on your muscles and joints.  Tendonitis or tears of the rotator cuff can occur with poor backswing or overuse. Lessons from a golf instructor will help ensure the correct form.

• Use Correct Equipment – Using clubs that are too heavy or light may increase the risk of shoulder strain. It is important to use the correct equipment for your body type. Also, replace club handle grips as needed and get larger, softer grips to decrease wrist injuries.

• Wear the Proper Clothing – Wearing comfortable clothing protects you from the elements and wearing shoes such as cleats help your feet grip the ground, allowing for a more stable swing.
If you experience pain for more than seven days, visit an orthopedic surgeon to determine the extent of your injury and treatment options. While most injuries are not severe, more extensive injuries such as a torn rotator cuff or carpal tunnel syndrome may require surgery.  A delay in treatment could cause further damage and keep you off the course when the greens beckon.

From baseball to soccer to football, everyday millions of children and young adults participate in sports activities. These activities teach children team work and improve their physical fitness, coordination and self-discipline.  It also increases their chance of experiencing sports-related injuries such as concussions, sprains, fractures, muscle tears, and back and neck injuries. However, there are measures that can be taken to help prevent these types of injuries, such as:
• Undergoing medical exams prior to the sport’s season, which should include concussion screenings and physical evaluations;
• Using proper protective gear, such as shin guards for soccer and helmets for football and baseball;
• Staying hydrated and always warming up before practice or a game;
• Never playing through pain or an injury.

If an athlete does experience an injury it is important that it is not ignored or taken lightly.
Sports-related injuries in children are of great concern because their bones, muscles, tendons and ligaments are still growing. To avoid long-term damage, young athletes should seek immediate care for any minor or serious injury.

Following are several signs to help determine if immediate care is needed:
• Inability to play following a sudden injury;
• Decreased ability to play due to a chronic or long-term complication following an injury;
• Visible deformity of the athlete’s arms or legs;
• Severe pain from a sudden injury, which may prevent the use of an arm or leg.

Sometimes, sports-related injuries occur after office hours or on the weekends.  If and when this happens I recommend that my patients visit the emergency room or an orthopedic walk-in clinic like the one we have at Methodist Sports Medicine / The Orthopedic Specialists. One of our fellowship-trained orthopedic surgeons is available to treat patients with sudden or recent sports or active lifestyle-related injuries.  Patients can visit our Avon or Greenwood locations Monday through Friday from 8 a.m. to 10 a.m., or our Carmel location Monday through Saturday from 8 a.m. to 10 a.m. For more information, please visit www.methodistsports.com or call 317-817-1200.

Hand, wrist and finger injuries are common among basketball players. In fact, according to the American Academy of Orthopaedic Surgeons, there are approximately 481,000 basketball-related injuries each year.

Some of the most common injuries include:

Mallet finger: A player can suffer an injury when a ball or other object strikes the tip of the finger or thumb. The force of this action can damage the thin tendon that straightens the finger and may even cause a piece of the bone to pull away from the tendon. One indication a player has suffered a mallet finger is if they are unable to straighten their injured thumb or finger. If this occurs, the player should apply ice immediately and seek medical attention. The majority of mallet finger injuries do not require surgery; however a doctor is the only one qualified to determine the extent of this type of injury.

Fractured finger: Jammed fingers and falls are common in basketball and often result in broken fingers. Symptoms may include swelling, tenderness, bruising and the inability to move the injured finger completely. A player should seek immediate medical attention to determine the extent of their injury. A medical evaluation will help determine if surgical or non-surgical treatments can be used. Once a doctor has determined that it is okay to move the injured finger, the player should begin rehabilitation exercises to reduce the finger’s stiffness and swelling.

Sprained thumb: If a player overextends the main ligament in their thumb it can become sprained, which can diminish the hand’s ability to grasp items between the thumb and index finger. There may or may not be immediate pain but having a doctor assess the injury will ensure there will not be long-term weakness and instability. If the ligament is only partially torn the thumb joint should be immobilized with a splint or cast until it heals. However, if it is completely torn, surgery may be required.

Wrist sprains/fractures: If a player falls on the palm of their hand they may suffer a wrist sprain, which occurs when the ligaments that connect bone to bone within the joint are stretched and perhaps torn. Most wrist sprains can usually be treated at home with rest, ice, compression, elevation and splinting. Severe sprains may require more extensive treatment, including surgery to repair a fully torn ligament. Fractures may occur in the wrist. One particular fracture involves a bone in the wrist called the scaphoid or navicular, which athletes often believe to be just a sprain. If an athlete suffers this type of fracture the best treatment is surgical intervention.

Finger sprains/dislocations: These injuries are most commonly seen in athletes who play ball-handling sports such as basketball. This injury is often referred to as the “coach’s finger,” due to the feeling that the injury is not very serious. However, these injuries can range from a fracture to a dislocation to a sprain, and can be debilitating. A dislocation occurs when a player jams their finger attempting to catch a ball or block a shot. This may cause the finger to bend too far to the side and the ligaments to tear from the bone. If this occurs the finger may appear swollen or deformed. Depending on the extent of the injury, surgery may be required to fix the joint.

It can be difficult to prevent hand injuries during basketball and athletic activities but the use of proper equipment and technique can reduce a player’s risk of injury. However, if an injury does occur it is important seek medical attention within 24 to 48 hours to determine the severity of the damage and assess treatment options.

Bowling is one of America’s favorite pastimes.  According to the United States Bowling Congress, more than 66 million people in the United States bowl during a year, with over six million bowlers joining leagues and other competitions.  It’s definitely a great way to spend time with family and friends.  It’s also a sport that can be enjoyed by people of all ages and abilities and in any kind of weather. 

But like any other sport, bowling can cause painful injuries – especially to your hands and wrist.  That’s why it’s important to know the common injuries and seek medical attention when necessary to keep the fun in your bowling game. 

Tendonitis is a very common injury and often targets the wrist of a bowler. It is a swelling and irritation of tendons and ligaments and occurs as a result of the repetitive motion of bowling.  Tendonitis can cause a dull ache or sharp pain every time you try to swing a bowling ball. The injury can take anywhere from a couple of days to a few weeks, or in extreme cases, months to heal properly.  Many bowlers wait too long to treat tendonitis.

Another common injury known as bowler’s thumb occurs when there is a pinched nerve at the base of the thumb.  It results from direct pressure on the nerve from the thumb hole of a bowling ball.  This constant pressure eventually can lead to scar tissue that wraps itself around the nerve to cause the ultimate in bowler’s thumb.  Symptoms include numbness and tingling. 

Choosing the right bowling ball is the first step to successful bowling without injury. Your ball shouldn’t be too heavy or too light, and should fit comfortably and naturally on your fingers.  Also, you should stretch before and after bowling to reduce chances of tendonitis.  If you injure yourself, see your doctor or an orthopedic specialist as soon as possible. Ignoring the warning signs will only result in more intense pain and discomfort, and possibly, permanent damage.