cte, dui, second opinions…3 dot

Saturday, September 23, 2017

Thoughts from the week. More three dot …

CTE may not be as chronic as the name implies. Changes of chronic traumatic encephalopathy were found in the brain of Aaron Hernandez, a former NFL player, who committed suicide while in jail after being convicted of murder…The disease, which can only be diagnosed by autopsy is thought to be a consequence of concussion. Tau proteins are deposited in the brain and eventually are thought to affect cognition, and cause mood swings and depression. The theory suggests that the NFL puts players at high risk because of repeated concussions, but with CTE found in brains of high school and college students, it may be that NFL players have a higher incidence of CTE because they are studied more frequently and that their brains were damaged at a much earlier age…Boston University researchers found that those who participated in youth football before the age of 12 had a twofold risk of problems with behavioral regulation, apathy and executive function and a threefold risk of clinically elevated depression scores. The average age of subjects was 51 and included high school, college and NFL players.

Viking quarterback Sam Bradford, he of two knee ACL reconstructions, developed knee swelling as the NFL season began and after missing another game, it has been reported that he has sought a second opinion regarding potential treatments (presumably surgery) from Dr. James Andrews, one of the country’s leading orthopedic experts…Some might wonder why the Viking team doctor isn’t good enough to treat a star player, but to Mr. Bradford’s credit, another opinion is never a bad decision. In medicine, there are always different ways of doing things and if there is time to consider options, the wise patient should seek those out…The second opinion opportunity isn’t limited to pro athletes, but available to almost all. When it comes to deciding about an operation, a surgeon should welcome the request for a second option, and then help arrange it, providing names of reputable colleagues to review records and examine the patient…It should raise a red flag when a surgeon refuses or appears insulted.

Attributed to either William Gladstone or Willian Penn, “Justice delayed is justice denied” was taken to hear by the British court system in convicting and sentencing Wayne Rooney in a drunk driving case this past week…After being arrested in the wee hours of September 1, the British international soccer star, pled guilty to the charges of driving drunk. On September 18, his driving privileges were revoked for 2 years and he was sentenced to 100 hours of unpaid work as part of a 12-month community service order. He could have been sentenced to 6-months prison for his first offence…British courts have been cracking down on this behavior in light of an average of 940 deaths a year in England and Wales…By comparison, 10,000 victims die every year in the US…And Wisconsin considers a first offence DUI as a misdemeanor and 448,000 drivers have at least one DUI.

Greg Olsen, Carolina Panthers tight end, broke his foot and required surgery to insert a screw into the 5th metatarsal. He knew that something was wrong as he walked off the field…  Cleveland Browns receiver, fell awkwardly and hurt his hand but it was a day later that the broken bones were confirmed…David Johnson of the Arizona Cardinals had a dislocated wrist but continued to play. Just three examples that just because you can walk on it or move it, doesn’t mean that it isn’t broken. All it means is that the muscles and tendons that are associated with the area are working just fine. Walking stops when a bone or joint is deformed and cannot tolerate any movement, cannot support the weight of the body or the muscle/tendon is torn and cannot move a joint.

And a couple definition reminders:

  • A break, fracture, crack all describe the same injury,
  • a stretched or torn tendon is called a strain
  • a stretched or torn ligament is called a sprain. By definition an ACL tear is a sprained knee.
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broken fingers

Tuesday, September 20, 2016

Injuries happen in football. Whether a player can return to play quickly or perhaps needs weeks of rehab depends on the injured body part and the player’s position. Demarcus Ware, a Denver Bronco lineman might play within 4-5 weeks after a forearm fracture but the Bears’ quarterback Jay Cutler may have a season ending injury because of an injured thumb on his throwing hand. The hand is a complicated machine with tendons and pulleys manipulating multiple joints to allow precise, minute movements…or the ability roughly grasp a football and be able to throw a spiral.

The language of medicine has allowed many hand injuries to be described with colorful terms or eponyms that can be confusing when the general public tries to understand what might actually be wrong.

Gamekeeper’s Thumb

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Gamekeeper’s or skier’s thumb described a torn ulnar collateral ligament. This is the ligament that attached the thumb to the rest of the hand and if it is damaged, the ability to grasp with power is lost. The damage occurs during a fall on an outstretched hand where the thumb splays away from the rest of the hand. The ligament needs to heal and this may be allowed to occur naturally by keeping the thumb and hand casted for weeks. Otherwise, surgery is an option to reattach the torn ends. Occasionally, a piece of bone gets torn off where the ligament attaches and potentially makes surgery more of an option.

Bennett Fracture

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The metacarpals are the long bones of the hand that attach the carpal bones to the digits (thumb and fingers). The first metacarpal is the long bone just proximal to the thumb. Should the thumb be flexed just as a fall occurs, the base of the first metacarpal can break (fracture, crack mean the same thing) and potentially become unstable. As well, if the bone does not heal well, the joint between it and the carpal bone can become arthritis and cause chronic pain and weakness with grasp. Surgery is often required to wire the bones into good alignment and hopefully produce a normally functioning hand.

Mallet Finger

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If the tip of a finger is hit by a ball and is forcibly flexed, it can tear the extensor tendon off the distal phalanx (the tip of the finger where the nail is located). The last joint in the finger, the distal interphalangeal joint (DIP), cannot extend and the fingertip droops. While not a terrible injury, a droopy finger gets in the way when the hand tries to grasp or if one tries to put their hand in a pocket. The finger can be splinted for a few weeks and the tendon often reattaches. Surgery is an alternative to reattach the tendon or if a significant chunk of bone gets pulled of the distal phalanx when the injury occurred.

Boutonniere Deformity

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The proximal interphalangeal joint (PIP) is a construction wonder, since tendons have to attach to move it while at the same time allow other tendons to span the joint and get to the DIP joint. It’s a complicated engineering feat and includes tendons that slide on each side of the joint with a central hood that then protects the PIP. If the finger is forcibly flexed or dislocated, this central slip can be torn, the tendons displaced and the joint gets pushed through the central slip. The joint gets stuck and leads to the deformity. Hand function may or may not be affected but the finger but looks weird. Chronic pain and arthritis may develop, like in any other joint injury. Splinting or surgery may or may not work to fix the problem.

Boxer’s Fracture

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This seems simple enough. If one were to hit a wall, or some other immoveable object, bones in the hand can break. A Boxer’s fracture describes a broken fifth metacarpal head, the bone just proximal to the little finger and the metacarpophalageal joint. If the fracture does not involve the joint, then the body can tolerate significant amount of angulation and still have a normally functioning hand. Attempts to manipulate and cast this injury usually fail and the bone tends to heal but the bone remains misshapen but does not affect how the hand moves, grasps or looks.

 

Just a Bruise

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And sometimes, the hand just doesn’t break but can look bad. Viking quarterback, Sam Bradford, had the back of his hand smack up against a defensive player and had immediate swelling. The dorsum of the hand (the side opposite of the palm) has little padding and if one of the prominent veins breaks, there can be significant bleeding. The skin is loose and there is nothing to tamponade or place pressure on the broken vein to make the blood clot quickly. It is sometimes hard to tell whether the bleeding is due to just that or a broken bone underneath. Bradford’s x-rays were negative and al that ugly swelling was no more than a bad bruise. There is no eponym for that yet.

 

 

 

 

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