Clinical Sports Medicine

729 Pages·2006·35.13 MB·English

by  Darren Johnson

MOSBY
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CLINICAL SPORTS MEDICINE
ISBN-13: 978-0-323-02588-1
ISBN-IO: 0-323-02588-9
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To my girls—Donna, Lindsay, Hailey, Kiley, and Jaycie. I can’t wait for your next soccer game.
—SDM
To my patients, medical students, residents, fellows, athletic trainers, physical therapists, and
colleagues for all they have taught me; they have made this profession an honor and a privilege
to be a part of. With love to my wife Nancy, son Brandon, and daughters Kelsey and Lauren
for making my life complete.
—DLJ
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Contributors
J. Winslow Alford MD Philip E. BlazarMD Adam C. CrowlMD
West Bay Orthopaedics, Warwick, RI. Assistant Professor of Orthopaedic Surgery, Harvard Attending Physician, Orthopedic Spine Surgery,
Rotator Cuff Disorders Medical School; Assistant Professor of Orthopaedic Advanced Orthopedic Centers, Richmond,
Surgery, Brigham and Women’s Hospital, Boston, VA.
Answorth A. Allen MD MA. Cervical Spine
Hospital for Special Surgery, New York, NY. Wrist Soft-Tissue Injuries
Knee: Graft Choices in Ligament Surgery Lisa T. DeGnoreMD
Michael R. BolandMBChB, FRCS, FRACS Volunteer Faculty, Department of Orthopaedic
David R. Anderson MD Assistant Professor, University of Kentucky; Chief, Surgery, University of Kentucky, Lexington,
Orthopedic Surgeon, Minnesota Sports Medicine, Orthopaedic Hand and Upper Extremity Surgery, KY.
Minneapolis, MN. University of Kentucky Medical Center, Veterans Forefoot and Toes
Superior Labrum Anterior to Posterior Lesions Administration Hospital, Lexington, KY.
Wrist and Hand: Physical Examination and Christopher C. DodsonMD
Robert B. Anderson MD Evaluation Resident, Department of Orthopaedic Surgery,
Chief, Foot and Ankle Service, Department of Hospital for Special Surgery, New York, NY.
Orthopaedic Surgery, Carolinas Medical Center; Craig R. BottoniLTC, MD Traumatic Shoulder Muscle Ruptures
Co-Director, Foot and Ankle Fellowship Chief, Sports Medicine, Orthopaedic Surgery Service,
OrthoCarolina, Charlotte, NC. Tripler Army Medical Center; Assistant Clinical Jeffrey R. DugasMD
Ankle Ligament Injury and Instability Professor, Department of Surgery, John A. Burns Fellowship Director, American Sports Medicine
School of Medicine, University of Hawaii, Institute, Birmingham, AL.
Thomas D. Armsey MD Honolulu HI; Assistant Professor of Surgery, Elbow: Instability and Arthroscopy
Associate Professor; Director Sports Medicine Department of Surgery, F. E. Edward Hébert
Fellowship, Palmetto Health Family Practice School of Medicine, Uniformed Services University R. Matthew DumiganMD
Center, Columbia, SC. of the Health Sciences, Bethesda, MD. Fellow, Steadman-Hawkins Clinic, Vail, CO.
On-Field Emergencies and Preparedness Shoulder: Anterior Instability Ankle Intra-articular Injury
Bernard R. Bach, Jr.MD Jeff C. Brand, Jr.MD T. Bradley EdwardsMD
The Claude Lambert-Susan Thomson Professor of Alexandria Orthopaedics and Sports Medicine, Clinical Instructor, Department of Orthopedic
Orthopedic Surgery; Rush University Medical Alexandria, MN. Surgery, University of Texas at Houston; Shoulder
Center, Chicago, IL. Knee: Tendon Ruptures Surgeon, Fondren Orthopedic Group, Texas
Complex Issues in Anterior Cruciate Ligament Orthopedic Hospital, Houston, TX.
Reconstruction Stephen F. BrockmeierMD Pediatric Shoulder
Chief Resident, Department of Orthopaedics,
Champ L. Baker, Jr.MD Georgetown University, Washington, DC. Hussein ElkousyMD
Clinical Assistant Professor, Department of Knee: Overuse Injuries Volunteer Faculty, University of Texas Health Sciences
Orthopaedics, Medical College of Georgia, Center, Houston, TX.
Augusta; Chair, Sports Medicine Fellowship Amy Bullens-BorrowMD Principles of Shoulder Arthroscopy
Program, The Hughston Clinic, Columbus, Georgia Sports Orthopedic Specialists, Gainesville,
GA. GA. Ivan Encalada-DiazMD
Elbow: Physical Examination and Evaluation Elbow: Instability and Arthroscopy Associate Clinical Professor of Orthopedic Surgery,
National Autonomous University of Mexico;
George K. BalMD, FACS J.W. Thomas ByrdMD Attending Orthopedic Surgeon, Arthroscopy and
Assistant Professor, Sports Medicine and Shoulder Nashville Sports Medicine and Orthopaedic Center, Sports Medicine Service, Institute of Orthopedics,
Reconstructive Surgery, Department of Nashville, TN. National Center for Rehabilitation, Mexico City,
Orthopaedics, West Virginia University, Hip Joint Mexico.
Morgantown, WV. Meniscal Injury
Clavicle Fractures and Sternoclavicular Injuries E. Lyle Cain, Jr.MD
Fellowship Director, American Sports Medicine Kyle R. FlikMD
R. Shane BartonMD Institute; Orthopaedic Surgeon, Alabama Sports Attending Surgeon, Sports Medicine, Northeast
Assistant Professor, Department of Orthopaedic Medicine and Orthopaedic Center, Birmingham, Orthopaedics, LLP, Albany, NY.
Surgery, Louisiana State University Health AL. Knee: Articular Cartilage
Sciences Center; Medical Director, Sports Internal Impingement
Medicine, Willis Knighton Hospital System, Philip C. Forno
Shreveport, LA. Kenneth Cayce IV Orthopaedic Resident, University of South Cardina,
Shoulder: Nerve Injuries Cincinnati Sports Medicine and Orthopaedics Center, Columbia, SC.
Cincinnati, OH. Shoulder: Overuse Injuries
Carl J. BasamaniaMD, FACS The Preparticipation Physical Examination
Division of Orthopaedic Surgery, Duke University Stephen FrenchMD
Medical Center, Durham, NC. Constantine CharogluMD Big Thunder Orthopedics, Thunder Bay, Ontario,
Clavicle Fractures and Sternoclavicular Injuries Southern Bone and Joint Specialists, PA, Hattiesburg, Canada.
MS. Knee: Arthritis in the Athlete
Frank H. Bassett IIIMD Hand and Wrist Rehabilitation
Sports Medicine Service, Duke University Medical Freddie H. FuMD
Center, Durham, NC. Kevin CharronMD Department of Orthopaedic Surgery, University of
The Role of the Team Physician Chief Resident, Department of Orthopaedic Surgery, Pittsburgh School of Medicine; Chief, Department
Boston University Medical Center, Boston, MA. of Orthopaedic Surgery, UPMC Presbyterian
Todd C. BattagliaMD, MS Patellofemoral Instability Hospitals, Pittsburgh, PA.
Clinical Instructor, Department of Orthopaedics, Anterior Cruciate Ligament
Tufts University School of Medicine; Michael J. CoenMD
Fellow, Sports Medicine and Arthroscopic Department of Orthopaedic Surgery, Loma Linda James R. GardinerMD
Surgery, New England Baptist Hospital, Boston, University, East Campus, Loma Linda, CA. Pacific Sports Medicine at Multicare, Tacoma, WA.
MA. Thigh and Leg Multiligament Knee Injuries
Posterior Cruciate Ligament
Brian J. ColeMD Gary GartsmanMD
Nathalee S. BelserMPA Associate Professor, Department of Orthopaedic Clinical Professor, Department of Orthopaedics,
Department of Orthopaedic Surgery, University of Surgery, Section Head, Cartilage Restoration Center, University of Texas Health Sciences Center; Texas
Louisville School of Medicine, Louisville, KY. Rush University Medical Center, Chicago, IL. Orthopedic Hospital, Houston, TX.
Pediatric Knee Knee: Articular Cartilage Principles of Shoulder Arthroscopy
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Contributors
C. David Geier, Jr.MD James D. Kang MD Walter R. LoweMD
Assistant Professor, Orthopaedic Surgery; Chief, Associate Professor of Orthopaedic and Neurological Associate Professor, Baylor College of Medicine;
Sports Medicine Service, Medical University of Surgery, University of PittsburghSchool of Chief, Sports Medicine Section, Department of
South Carolina, Charleston, SC. Medicine; University of Pittsburgh Medical Center, Orthopedic Surgery, Baylor College of Medicine,
Pediatric Elbow Pittsburgh, PA. Houston, TX.
Cervical Spine Superior Labrum Anterior to Posterior Lesions
Thomas J. GillMD
Assistant Professor of Orthopaedic Surgery, Harvard Richard W. KangBS Scott D. MairMD
Medical School; Sports Medicine Service, Research Coordinator, Rush University Medical Associate Professor, Department of Orthopaedic
Department of Orthopedic Surgery, Massachusetts Center, Chicago, IL. Surgery; University of Kentucky, Lexington, KY.
General Hospital, Boston, MA. Knee: Articular Cartilage Shoulder: Posterior Instability
Shoulder: Nerve Injuries
Spero G. KarasMD Terry MalonePT, EdD, ATC
Jennifer A. GrahamMD Assistant Professor of Orthopaedic Surgery, Emory Professor of Physical Therapy, University of Kentucky,
Resident, Harvard Combined Orthopaedic Surgery University School of Medicine, Atlanta, GA. Lexington, KY.
Program, Boston, MA. Shoulder: Multidirectional Instability Knee Rehabilitation
Wrist Soft-Tissue Injuries
James KercherMD Todd C. MalveyDO, CAQSM
Letha Y. GriffinMD, PhD Department of Orthopaedics, Emory University Physician, Moncrief Army Community Hospital, Fort
Team Physician, Adjunct Professor, Department of School of Medicine, Atlanta, GA. Jackson, SC.
Kinesiology and Health, Georgia State University; The Female Athlete On-Field Emergencies and Preparedness
Partner, Peachtree Orthopaedic Clinic, Atlanta,
GA. John J. KlimkiewiczMD Bert R. MandelbaumMD
The Female Athlete Assistant Professor, Department of Orthopedic Santa Monica Orthopaedic Surgery and Sports
Surgery, Georgetown University Hospital– Medicine Group, Orange, CA.
Kevin M. GuskiewiczPhD, ATC MEDSTARHealth; Head Team Physician, Abdomen and Pelvis
Professor and Chair, Department of Exercise and Sport Georgetown Hoyas, Washington, DC.
Science; Professor, Department of Orthopaedics, Knee: Overuse Injuries Steven D. MaschkeMD
University of North Carolina, Chapel Hill, NC. Department of Orthopaedic Surgery, Cleveland
Head Injuries Mininder KocherMD, MPH Clinic Foundation, Cleveland, OH.
Assistant Professor, Department of Orthopaedic Carpal Fractures
Jeffrey A. GuyMD Surgery, Harvard Medical School; Associate
Assistant Professor, Director, Sports Medicine Center, Director, Division of Sports Medicine, Children’s Elizabeth G. MatzkinMD
Medical Director, University of South Carolina; Hospital, Boston, MA. Foundry Sports Medicine, Providence, RI.
Orthopedic Surgeon, Palmetto Health Richland, The Pediatric Athlete Clavicle Fractures and Sternoclavicular Injuries
Columbia, SC.
Shoulder: Overuse Injuries Sumant G. KrishnanMD Craig S. MauroMD
Clinical Assistant Professor, Department of Resident, Department of Orthopaedic Surgery,
Christopher D. HarnerMD Orthopaedic Surgery, University of Texas University of Pittsburgh Medical Center, Pittsburgh,
Blue Cross of Western Pennsylvania Professor, Southwestern; Attending Orthopedic Surgeon, PA.
University of Pittsburgh; Medical Director, Shoulder and Elbow Service, The Carrell Clinic, Safety Issues for Musculoskeletal Allografts; The Stiff
UPMC Center for Sports Medicine, Pittsburgh, Dallas, TX. Knee
PA. Shoulder: Physical Examination and Evaluation
Safety Issues for Musculoskeletal Allografts; The Stiff Knee David MaymanMD
John E. KuhnMS, MD Department of Orthopedic Surgery, Hospital for
Richard J. HawkinsMD Associate Professor, Department of Orthopaedics Special Surgery, New York, NY.
Attending Physician, Steadman-Hawkins Clinic of the and Rehabilitation, Vanderbilt University Medical Shoulder: Nerve Injuries
Carolinas, Spartanburg, SC. School; Chief of Shoulder Surgery, Team Physician,
Shoulder: Physical Examination and Evaluation Vanderbilt University and Nashville Sounds L. Pearce McCarty IIIMD
Baseball Club, Vanderbilt Sports Medicine, Sports and Orthopaedic Specialists, P.A., Edina, MN.
Robert HoseyMD Nashville, TN. Complex Issues in Anterior Cruciate Ligament
Associate Professor, Department of Family Medicine Scapulothoracic Disorders Reconstruction
and Orthopaedics, Director, Primary Care Sports
Medicine Fellowship, University of Kentucky, Laurence LaudicinaMD Ryan C. MeisMD
Lexington, KY. Orthopaedic Surgeon, Steadmans-Hawkins Fellow, Center for Neurosciences, Orthopaedics, and Spine,
The Preparticipation Physical Examination Florida Sports Medicine Institute, St. Augustine, FL. Dakota Dunes, SD.
Elbow: Overuse Injuries, Tendinosis, and Nerve Internal Impingement
Joel HurtMD Compression
Orthopedic Surgeon, Texas Bone and Joint Sports William C. MeyersMD
Medicine Institute, Austin, TX. Steven J. LawrenceMD Professor and Chairman, Department of Surgery;
Ankle and Foot: Physical Examination and Evaluation Head, Foot and Ankle Section, University of Senior Associate Dean for Clinical Affairs, Drexel
Kentucky; Associate Professor of Orthopedics, A.B. University College of Medicine, Philadelphia, PA.
Peter IndelicatoMD Chandler Medical Center, University of Kentucky, Abdomen and Pelvis
Professor, Shands Healthcare, University of Florida, Lexington, KY.
Gainesville, FL. Midfoot and Hindfoot Mark D. MillerMD
Knee: Medial Collateral Ligament Professor of Orthopedic Surgery, Head of Division of
Jeffrey N. LawtonMD Sports Medicine, University of Virginia,
William M. IsbellMD Hand and Upper Extremity Surgeon, Department of Charlottesville; Team Physician, James Madison
Raleigh Orthopaedic Clinic, Raleigh, NC. Orthopaedic Surgery, Cleveland Clinic Foundation, University, Harrisonburg, VA.
Elbow: Tendon Ruptures Cleveland, OH. Posterior Cruciate Ligament
Carpal Fractures
Darren L. JohnsonMD Peter J. MilletMD
Professor and Chair, Department of Orthopaedic Paul LewisMS Steadman-Hawkins Clinic, Vail, CO.
Surgery; Director of Sports Medicine, Rush University Medical Center, Chicago, IL. Shoulder: Nerve Injuries
University of Kentucky School of Medicine, Knee: Articular Cartilage
Lexington, KY. Amir R. MoinfarMD
Multiligament Knee Injuries Robert LitchfieldMD, FRCS(C) Chesapeake Orthopedics, Glen Burnie, MD.
Associate Professor, Department of Surgery, Fowler Knee: Posterolateral Corner
Grant L. JonesMD Kennedy Sports Medicine Center, University of
Assistant Professor, Department of Orthopaedic Western Ontario, London, Ontario, Canada. Claude T. Moorman IIIMD
Surgery, Ohio State University College of Knee: Arthritis in the Athlete Associate Professor, Department of Orthopaedic
Medicine; Vice Chair, Department of Surgery; Director, Sports Medicine, Duke Medical
Orthopaedics, Ohio State University Medical Daniel S. LorenzPT, ATC, CSCS Center; Head Team Physician, Duke Athletics;
Center, Main Campus; Ohio State University Department of Sports Medicine, Duke University, Durham, NC.
Hospital East, Columbus, OH. Durham, NC. The Role of the Team Physician; Knee: Posterolateral
Elbow: Physical Examination and Evaluation Knee: Posterolateral Corner Corner
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Contributors
Steve A. MoraMD Arthur C. RettigMD Dale S. SneadMD
Active Staff, Orthopedic Department, St. Joseph Clinical Instructor, Orthopedic Surgery, Wishard Partner, Methodist Sports Medicine Center,
Hospital, Orange, CA. Memorial Hospital; Clinical Assistant Professor, Indianapolis, IN.
Abdomen and Pelvis Orthopedic Surgery, Indiana University Medical Hand Injuries
Center; Adjunct Professor, Butler University,
Kevin J. MulhallMB, MCh, FRCSI Indianapolis; Adjunct Professor, Purdue University, Jeffrey T. SpangMD
Consultant Orthopaedic Surgeon, Department of West Lafayette; Orthopedic Surgeon and Partner, Chief Resident, Department of Orthopaedics,
Orthopaedic Surgery, Dublin, Ireland. Methodist Sports Medicine Center, Indianapolis, University of North Carolina, Chapel Hill,
Posterior Cruciate Ligament IN. NC.
Hand Injuries Shoulder: Multidirectional Instability
Gregory NicholsonMD
Department of Orthopedics, Division of Shoulder Lance A. RettigMD Tracy Spigelman Med, ATC
and Sports Medicine, Rush University, Chicago, IL. Volunteer Clinical Assistant Professor of Orthopedics, Doctoral Student and Graduate Assistant, University
Rotator Cuff Disorders Indiana University; Staff Orthopedic Surgeon, of Kentucky, Lexington, KY.
Methodist Sports Medicine Center, Indianapolis, Shoulder Rehabilitation
Thomas NoonanMD IN.
Partner, Steadman-Hawkins Clinic–Denver, Hand Injuries J. Richard SteadmanMD
Greenwood Village; Medical Director, Colorado Steadman-Hawkins Clinic; Steadman-Hawkins
Rockies Baseball Club, Denver, CO. John C. RichmondMD Research Foundation, Vail, CO.
Elbow: Overuse Injuries, Tendinosis, and Nerve Professor, Orthopedic Surgery, Tufts University Psychological Aspects of Healing the Injured Athlete
Compression School of Medicine; Chair, Department of
Orthopaedic Surgery, New England Baptist William I. SterettMD
James NunleyMD Hospital, Boston, MA. Steadman-Hawkins Clinic; Steadman-Hawkins
J. Leonard Goldner Professor of Surgery; Chief of Meniscal Injury Research Foundation, Vail, CO.
Orthopedics, Duke University Medical Center, Ankle Intra-articular Injury
Durham, NC. Jeffrey A. RihnMD
Ankle Tendon Disorders and Ruptures Resident Physician, Department of Orthopaedic Steven J. SvobodaMD
Surgery, University of Pittsburgh Medical Center, Orthopedic Surgery Service, Brooke Army Medical
John NylandEdD, PT, SCS, ATC, CSCS, FACSM Pittsburgh, PA. Center, Fort Sam Houston, TX.
Assistant Professor, Department of Orthopaedic Safety Issues for Musculoskeletal Allografts Muscle Injuries
Sugery, Division of Sports Medicine, University of
Louisville; Consultant, Sports Health Program, Craig S. RobertsMD Dean C. TaylorMD
Norton Hospital, Louisville, KY. Professor, Residency Program Director, Department of Orthopaedic Surgery, University of
Foot and Ankle Rehabilitation Department of Orthopaedic Surgery, School Minnesota, Minneapolis, MN.
of Medicine, University of Louisville, Louisville, Muscle Injuries
Adam C. OlsenMPT, ATC KY.
Rehabilitation Coordinator, St. Louis Cardinals, Pediatric Knee John M. TokishMD, USAF MC
St. Louis, MO. Head Team Physician, U.S. Airforce Academy,
Principles of Rehabilitation Richard RodenbergMD Colorado Springs, CO.
Assistant Professor, Department of Family Medicine, Physical Examination and Evaluation
George A. Paletta, Jr.MD Program Director, Sports Medicine Fellowship,
Orthopedic Center of St. Louis, St. Louis, MO. Grant Medical Center, Columbus, OH; Assistant Rachael TuckerMBChB, BHB
Pediatric Elbow Professor, Department of Family Medicine, Research Assistant, Clinical Effectiveness Unit,
Lexington, KY. Children’s Hospital, Boston, MA.
Kyle ParishMD Environmental Stressors The Pediatric Athlete
Assistant Professor, Departments of Family and
Community Medicine and Sports Medicine, Mark W. RodoskyMD Tim UhlPhD, ATC, PTC
University of Kentucky, Lexington, KY. Center for Sports Medicine, University of Pittsburgh Associate Professor, Department of Rehabilitation
Environmental Stressors Medical Center, Pittsburgh, PA. Sciences, Division of Athletic Training; Director of
Biceps Tendon Disorders Musculoskeletal Laboratory, University of Kentucky,
Andrew D. PearleMD Lexington, KY.
Instructor of Orthopedic Surgery, Cornell University Anthony R. RomeoMD Shoulder Rehabilitation
New York Hospital; Assistant Attending Department of Orthopedics, Division of Shoulder
Orthopedic Surgeon, Hospital for Special Surgery, and Sports Medicine, Rush University, Chicago, William P. UrbanMD
New York, NY. IL. Clinical Associate Professor; Chair, Orthopaedics and
Knee: Graft Choices in Ligament Surgery Rotator Cuff Disorders Rehabilitation, SUNY Downstate Medical Center,
Brooklyn, NY.
George C. PhillipsMD Greg SassmannshausenMD Principles of Knee Arthroscopy
Clinical Assistant Professor of Pediatrics, Children’s Clinical Faculty, Fort Wayne Medical Education
Hospital of Iowa, University of Iowa Carver Program Fort Wayne, IN. Armando F. VidalMD
College of Medicine, Iowa City, IA. The Older Athlete Blue Sky Orthopedics and Sports Medicine, Brighton,
Medications, Supplements, and Ergogenic Drugs CO.
Anthony SchepsisMD Anterior Cruciate Ligament
James C. PufferMD Professor, Department of Orthopaedic Surgery;
Professor, Department of Family and Community Director, Department of Sports Medicine, Boston K. Mathew WarnockMD
Medicine, University of Kentucky School of University Medical Center, Boston, MA. Fondren Orthopedic Group; Texas Orthopedic
Medicine; President and Chief Executive Office, Patellofemoral Instability Hospital, Houston, TX.
American Board of Family Medicine, Lexington, KY. Pediatric Shoulder
Cardiac Problems and Sudden Death Theodore F. SchlegelMD
Assistant Professor, Department of Orthopedic Robert G. WatkinsMD
Matthew Alan RappéMD Surgery, University of Colorado–Denver; Team Professor of Clinical Orthopaedic Surgery, University
Resident Physician, University of Florida, Gainesville, Physician, Denver Broncos and Colorado Rockies; of Southern California; Orthopaedic Surgeon; Los
FL. Consultant, Steadman-Hawkins Clinic–Denver, Angeles Spine Surgery Institute at St. Vincent
Knee: Medial Collateral Ligament Denver CO. Medical Center, Los Angeles, CA.
Disorders of the Acromioclavicular Joint Lumbar Spine
Fred ReifsteckMD
Clinical Assistant Professor, Medical College of Jeffrey B. SelbyMD Daniel E. WeilandMD
Georgia, Augusta; Head Team Physician, University University of Kentucky; VA Medical Center, Orthopaedic and Sports Medicine Center, Trumball,
of Georgia, Athens, GA. Lexington, KY. CT.
The Female Athlete Ankle Fractures and Syndesmosis Injuries Biceps Tendon Disorders
Michael M. ReinoldPT, DPT Patrick SiparskyBS Kevin E. Wilk PT, DPT
Adjunct Faculty, Department of Physical Therapy, University of Colorado Health Sciences Center, Clinical Director, Champion Sports Medicine and
Northeastern University; Assistant Athletic Trainer, Denver, CO. Rehabilitation Center; Vice President of Education,
Boston Red Sox, Boston, MA. Disorders of the Acromioclavicular Joint; The Pediatric Benchmark Medical, Birmingham, AL.
Principles of Rehabilitation Athlete Principles of Rehabilitation
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Contributors
Jeffrey D. WillersMD Sharrona WilliamsMD
Staff, Orthopaedic Surgery, Baptist Hospital and Southern Orthopaedic Specialists, Atlanta, GA.
St. Thomas Hospital, Nashville, TN. Ankle Tendon Disorders and Ruptures
Ankle Ligament Injury and Instability
Timothy C. WilsonMD
Riley J. Williams IIIMD Central Kentucky Orthopaedics, Georgetown,
Associate Professor, Weill Cornell Medical College; KY.
Attending Orthopaedic Surgeon, Hospital for Knee: Physical Examination and Evaluation
Special Surgery, New York, NY.
Traumatic Shoulder Muscle Ruptures
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Preface
“It’s what you learn after you know it all that counts.”— goal of presenting step-by-step instructions, but rather the
John Wooden rationale for surgical intervention, general principles, and tips
based on experiences, good and bad.
Sports medicine is an ever-expanding and changing field, but
Athletes seem to be getting both younger and older at the
the primary goal remains the same as it was decades ago—
same time. As children strive to become the next Michael
to allow the injured athlete to return safely to participation
Jordan or Mia Hamm, the number of pediatric injuries (par-
and perform to the best of his or her ability. Clinical Sports
ticularly those related to overuse) has risen dramatically. Four
Medicine presents, in a concise manner, the latest techniques
chapters are devoted to prevention and treatment of pediatric
for achieving this goal. Emphasis is placed on summary
injuries. On the other end of the spectrum, “weekend warriors”
boxes, illustrations, and algorithms in order to provide an easy
participate into their retirement years, and chapters addressing
reference to commonly seen medical problems and injuries.
the older athlete and arthritis in the athlete are included.
All chapters are written with the treatment of the athlete
Chapters are organized for easy reference. Each starts with a
in mind. The resultant text is a useful reference to all members
section titled “In This Chapter” to emphasize what is covered.
of the sports medicine team—trainers, therapists, physicians,
This is followed by an introductory summary box of the most
and even coaches and parents. The authors were selected
important concepts. The general outline follows with clinical
based on their specific areas of expertise, and were asked
features and evaluation, relevant anatomy, treatment options,
to cover essential material and pearls based on their personal
surgery, rehabilitation, criteria for return to sports, results and
experience.
outcomes, and potential complications. We hope that the text
The first 15 chapters cover general principles and medical
is an easy-to-read reference that helps those who treat athletes
issues. The remainder of the book is divided by anatomic areas.
to achieve the preceding goals. We wish to thank all of the
Emphasis is placed on physical examination and evaluation of
authors for all of their work in organizing the material in a
the injured athlete because the key to proper treatment almost
concise and interesting format.
always starts with an accurate diagnosis. Also emphasized is
appropriate rehabilitation, with five chapters devoted solely to Scott D. Mair
this topic, and further mention made in each chapter address-
ing specific types of injuries. Surgery is addressed, not with the Darren L. Johnson
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Foreword
It has been several years since a comprehensive book on the The remainder of the book is broken down into sections
medical aspects of clinical sports medicine has been published. dealing with various anatomic regions. Each chapter is written
In the early 1990s, books by The Hughston Clinic, Drs. Fu and by an expert in the field, often with assistance from their
Stone, and Drs. Drez and DeLee made important contributions younger partners. Each chapter has a well-identified introduc-
to the sports medicine literature. Since that time, the sports tion. Tables throughout the book are easily readable and are
medicine subspecialty has come a long way. quite helpful as short, quick studies for the chapter.
The American Board of Orthopaedic Surgery has recognized The authors are orthopaedic surgeons, family physicians,
sports medicine as a clinical subspecialty. A test leading to a cer- internists, physical therapists, and athletic trainers. Their com-
tificate of subspecialization in sports medicine is presently being bined experience is overwhelming, and their writing style is very
written and will be offered in 2007. Indeed, we have come a compatible.
long way from the old concept of “orthopaedics for people with Sports medicine has a separate specialized core curriculum,
numbers.” and this book encompasses the aspects of that curriculum. It
Clinical Sports Medicine is an excellent representation of should be included in the library of all residency and fellowship
where sports medicine is in the early 21st century. Chapters programs and should be valued as a reference for practicing
dealing with the role of the team physician; preparticipation orthopaedists regardless of their training level or expertise. Drs.
physicals; on-field emergencies and preparedness; as well as Johnson and Mair should be commended for their success in
specialized chapters on the pediatric, female, and older athlete, gathering together so many well-respected physicians to share
ensure full coverage of the ever-widening spectrum of sports their knowledge in this exciting book on sports medicine.
medicine. There is even a chapter on the psychology of the
Congratulations to you both.
injured athlete that deals with how injury affects the athlete’s
well-being. Champ L. Baker, Jr., MD
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CHAPTER
1
The Role of the Team Physician
Claude T. Moorman III and Frank H. Bassett III
In This Chapter minimal number of subspecialty providers available. The various
different governing bodies in sports medicine, including the
Responsibilities of the team physician American Orthopaedic Society for Sports Medicine (AOSSM),
Preparticipation clearance the American Academy of Family Physicians, the American
In-season coverage Academy of Pediatrics, the American College of Sports Medi-
Game coverage cine, the American Medical Society for Sports Medicine, and
the American Osteopathic Academy of Sports Medicine have
come together with a consensus document for what is required
INTRODUCTION
for preparticipation physical examinations (John Bergfeld, per-
sonal communication, 1996).
• The defining role for physicians in sports medicine is to serve
At the collegiate and professional levels, oftentimes more
as team physician.
sophisticated measures and a more comprehensive array of con-
• The role of the physician in a sports medicine environment sulting physicians are available to assist with the screening. In
may at times require responsibility for the surgical, medical, many scenarios, electrocardiograms and echocardiograms are a
emotional, and even spiritual well-being of the athlete. common part of the screening. The goal is to rule out conditions
such as hypertrophic cardiomyopathy, which may predispose the
• Specific responsibilities for the team physician can be broken
participating athlete to significant risk or even death. The team
down into roles that evolve over the course of the athlete’s
physician’s responsibility to the athlete generally begins with this
season. At different times in the year, the physician will be
preparticipation clearance. (Please see Chapter 2 for additional
responsible for preparticipation clearance, practice and game
detail.)
injury evaluation, treatment of practice and game injuries,
coordination and implementation of postseason medical and
surgical treatment, and the continuing education of both him- In-Season Coverage
or herself and the rest of the health care team. During the athlete’s season, the physician’s role varies consider-
ably depending on the sport and the setting. The majority of
team physicians are involved, at some point in time, in coverage
RESPONSIBILITIES OF THE TEAM of contact sports, particularly football. The majority of the
PHYSICIAN following discussion centers on football with the realization that
lower risk sports will generally require less frequent on-site pres-
ence of the team physician. In the majority of situations, the
The responsibilities facing the team physician are considerable,
physicians are involved in game coverage with a more limited role
and all of them have ethical and legal ramifications. This creates
in the practice setting. At our institution, the standard has been
some potential conflicts that need to be resolved in order to care
to cover both home and away games, with training room presence
safely and effectively for the athlete. The intention of this chapter
of the attending team physician at the heavy contact practice
is to outline the specific roles and responsibilities of the team
during the week as well. In the collegiate environment, Tuesday
physician. We also discuss potential sociopolitical conflicts and
strategies for managing these conflicts.1Several of the great team practice tends to be the heaviest contact day, and this is the day
that we have selected as the most important for physician pres-
physicians of the past generation are featured in an attempt to
ence. In our setting, this translates into the physician arriving
further understand the role of the team physician and the many
toward the end of the practice setting with involvement in
subtleties that exemplify a successful sports medicine team.
running a clinic in the training room following that practice. We
Preparticipation Clearance have found this to be the highest yield in terms of determining
The team physician is responsible for the overall process through the significant injuries that require physician attention.
which athletes are cleared to play. This requires coordination of It is also important to make a distinction between a true team
the various subspecialists who often assist in these evaluations physician and the “office arthroscopist.”3 With the increasing
as well as determining the setting and facility requirements to financial pressures in the health care market today, there is
implement this important portion of the athlete’s evaluation increasing pressure for the team physician to play a decreasing
(Box 1-1).2At different levels of participation, the requirements role in the true environment of the athlete. This represents a
vary, as does the sophistication of the testing measures insti- substantive threat to the team physician’s persona as it has been
tuted. In the high school environment, the evaluations are often reflected through the ages. Now more than ever before, the
carried out in the school gymnasium, usually with a relatively team physician needs to recognize work in the training room as
3