Penn Orthopaedics

Penn Orthopaedics

Thursday, July 2, 2015

Why Pitchers Have Tommy John Surgery

When it comes to throwing a ball, most think the magic is in the arm or the shoulder. It’s not.

The secret sauce is body mechanics.

G. Russell Huffman, MD
“In reality, about seventy percent of the velocity of say, a fastball pitch, actually comes from the pitcher’s leg and torso,” explains G. Russell Huffman, MD, Director of the Shoulder and Elbow Fellowship Program at the Penn Musculoskeletal Center.

“The shoulder, elbow and hand are really for ball control more so than velocity,” he adds.

When a pitcher develops poor mechanics during prolonged use, Dr. Huffman says, “it can ultimately lead to shoulder or elbow injuries.”

The Surgical Solution

Elbow injuries are a common problem for pitchers, whether they play professionally or at an amateur level.

A common fix is Tommy John surgery.

The surgery, named after the Los Angeles Dodgers player who first had the procedure in 1974, fixes tears in the ulnar collateral ligament (UCL) of the elbow. This ligament connects the forearm bone (ulna) and the upper arm bone (humerus).

Where Pitching Problems Start

At the root of elbow injuries is poor mechanics. But that’s not the only problem.

Dr. Huffman cites overuse as another key factor. And when you’re good at what you do, the problem gets compounded.

ulnar collateral ligament (UCL) reconstructionAlso, younger athletes who participate in multiple leagues may end up pitching year-round. This prevents their bodies from fully resting and recovering.

Ensuring that the body recovers is critical, considering the severe nature of pitching.

“When you release the ball, it’s a pretty violent act,” explains Dr. Huffman. “Just the act of throwing and using all that stored energy in your body to transmit that into a moving object creates some damage that your body can handle.”

But if you don’t take time to rest during and after games, stretch, and let the muscles recuperate, “then the damage keeps building up,” he adds. “You start to lose motion through your shoulder, and then that translates down the arm into the elbow.”

Tommy John: The Repair Job

In Tommy John surgery, a tendon from another part of the body—usually the wrist—is used to reconstruct the damaged UCL in the elbow. The fairly quick procedure takes about 90 minutes.

Traditional Tommy John surgery requires the surgeon to drill a hole in the ulna and humerus bones, and thread the ligament through the bone.

The surgeons at Penn refined their surgical technique, which allows athletes to perform on a higher level.

“We’ve developed a very reliable technique for doing both Tommy John and first-time revision surgery. It’s a little bit of a smaller incision and preserves a little more bone than the traditional fix,” says Dr. Huffman.

Recovery, no matter which technique is used, usually takes up to 18 months.

Why Pitchers Feel They’re Better Than Before

Dr. Huffman says there’s a perception among players that the surgery makes pitchers better.

That’s because it does.

Players understand good mechanics. So, they shift their focus to prevent re-injury.

“The first step is building up leg and core strength,” says Dr. Huffman. Then, it’s about consistent shoulder stretching and helping athletes become better advocates for themselves by letting coaches know when they need rest.”

When pitchers prepare to go back for their first full season, Dr. Huffman applies the rehab approach for golfers: short, quality outings.

“They have high-quality outings with a lot of strikes, so no one gets discouraged, and they’re not overutilized,” Dr. Huffman says. “I think that’s a smarter way to go back, rather than trying for a complete game the first day out.” In part two of this series, we look at why repeat Tommy John surgeries are on the rise and how to prevent them.



Sunday, June 21, 2015

On the Move: The Health Benefits of Running

Whether it's a 5K, 10K, Color Run, Tough Mudder or Marathon, it seems as though everyone is out for a run. Once reserved only for die-hards, more and more people are running for the experience and the fun than ever before. Many also see it as a way to relieve stress after a busy day, an opportunity to get a group of friends together or to simply help out a good cause.

Regardless of the reasons or motivations, there are many health benefits for those that pick up the sport.

Kate E. Temme, MD,
"Running has numerous proven health benefits including cardiopulmonary fitness, weight management, stress relief and emotional well-being," says Kate E. Temme, MD, Assistant Professor of Clinical Physical Medicine and Rehabilitation.

There are, though, risks that go along with this sport. Runners are at a high risk for injury, especially those affecting the lower extremities. Knee injuries make up approximately 40% of running injuries, with runner's knee (patellofemoral pain syndrome) being the most common knee complaint.

With that being said, there are some tips that beginners (or those that have taken an extended break from the sport) should follow to ensure a safe and enjoyable experience.

If you are recovering from an injury or have an existing health condition, check with your doctor to make sure running is the right activity for you. If you've run in the past, but haven't been active in a while, build up your level slowly, before returning to your previous routine. Do a warm up for a few minutes each time and add a few minutes or some distance on to your run every few days.

Penn Medicine Sports Medicine
It is also important to focus on hip and core muscle development, as well as strength and flexibility of the muscles/structures directly surrounding the knee (quadriceps, hamstrings, iliotibial band). These muscles are important because they help to provide stability to the knee while you run. Since running occurs only in the frontal/forward plane, it is recommended that cross training include activities in the lateral/side plane to address hip strengthening for knee injury prevention.

Some believe that the more you run, the less susceptible you are to injury. This is not the case, though, as the repetitive nature of running increases the risk of overuse injuries. Lower extremity injuries are especially common in those who run more than 40 miles per week. Distance runners have the highest rates of stress fractures among athletes, with women being more susceptible than men. Training errors as well as nutritional deficits, among other things, increase the risk of injury to bone.

Given that stress fracture treatment may require a lengthy absence from running, prevention becomes an important goal. Shin splints (medial tibial stress syndrome) may lead to stress fractures and should be addressed with appropriate activity modification to prevent progression.

"Slowly increasing your mileage and intensity, avoiding abrupt changes in running surfaces, replacing shoes every six months or 300-400 miles, incorporating rest days into your training schedule and maximizing your calcium and vitamin D intake are all important for stress fracture prevention," said Dr. Temme. "Most importantly, ensuring that you are eating enough to fuel your body AND your sport is paramount for bone health. Seeking expert advice from a Sports Physician or Sports Dietitian can help ensure you are meeting your unique nutritional needs for safe training and competition."

Penn Orthopaedics
Regardless of the distance you decide to run, the number of times per week you do so, know that you are taking a step in the right direction for your health. Set small goals for yourself and fight that mental battle to achieve them. Join running groups, get your friends involved, whatever you need to do to stay inspired. As long as you are moving, you are achieving.

"Running is a convenient, economical and portable sport with many physical and emotional benefits," says Dr. Temme. "When introduced gradually, and with adequate attention to injury prevention, running can be enjoyed safely for years to come."

If The Shoe Fits…Run!

Daniel C. Farber, MD, Foot and Ankle Surgeon, discusses the importance of picking the proper running shoe and offers advice while going through the selection process. 

To avid runners, there is much more to the sport than simply lacing up any type of running shoe. They know that selecting the proper shoe is an incredibly important part of preparing for any type of competition.

Running Shoe Selection
Daniel C. Farber, MD
If you're wearing a shoe that doesn't fit your feet properly, you have a better chance of developing an improper gait or poor biomechanics. This added pressure on the heel or ball of the foot could lead to pain, plantar fasciitis, stress fractures, hallux valgus, (bunions) and lesser toe deformities.

When you're standing in the shoe store, most running shoes feel comfortable. Still, the true test doesn't come until you've pounded the pavement for several miles.

"Not all shoes are the same. Make sure you choose a shoe that fits your foot shape and running style," Dr. Farber recommends. "Remember that the most expensive shoe is not necessarily the best. The midrange shoes often have the more proven technology without the trendy price."

So, how do you sift through the many different brands and styles to ensure your feet stay happy and you stay pain-free?
  • Try on all shoes. Sizes among shoe brands and styles tend to vary. Don’t select shoes by the size marked inside the shoe. Judge the shoe by how it fits on your foot.
  • Select a shoe that conforms as nearly as possible to the shape of your foot.
  • Have your feet measured regularly. The size of your feet changes with age. For women, it may change during pregnancy.
  • Have BOTH feet measured. Most people have one foot larger than the other. Always fit to the larger foot.
  • Get fitted at the end of the day. The best time to measure your feet is at the end of the day when your feet are largest.
  • Stand during the fitting process. Standing allows you to check that there is adequate space (3/8" to 1/2") for your longest toe at the end of each shoe.
  • Comfort is important. Make sure the ball of the foot fits comfortably into the widest part (ball pocket) of the shoe.
  • Don’t expect them to stretch. Avoid purchasing shoes that feel too tight, expecting them to “stretch” to fit.
  • Minimize slippage. Your heel should fit comfortably in the shoe with a minimum amount of slippage.
  • Take a stroll. Walk in the shoes to make sure they fit and feel right.
Finally, remember that knowing when to replace your running shoes is just as important as picking the proper pair. Dr. Farber recommends that running shoes should be replaced every 3-6 months (or 300-500 miles) as they show signs of wear.

"With less activity, once a year is adequate Dr. Farber said. "If a shoe is in good condition, but has lost the cushioning of its insole, you can oftentimes simply rehab it with an over-the-counter insert."

"However, if the shoe looks and feels worn and doesn't support your foot well, replace it no matter what the age."


Highly skilled and highly specialized, Penn physicians treat each joint condition, spinal disorder or sports injury with a personalized approach.
Schedule an appointment today.

Wednesday, April 22, 2015

When Shoulder Pain Disrupts Sleep

Peaceful, undisturbed sleep.

Andrew F. Kuntz, MD
Isn’t that what we’re all looking for?

Unfortunately for many, shoulder pain and the nagging discomfort that accompanies it have led to countless sleepless nights.

Sleep is a critical component to good health. Tossing and turning throughout the night can cause you to be less active and mentally exhausted during the day. It can even reduce the time it takes your body to recovery from injuries.

One of the most common shoulder injuries, a torn rotator cuff is often the source of intense pain and restlessness. The rotator cuff is a group of tendons and muscles that connect the upper arm to the shoulder blade. You may have gotten this from wear and tear over time or from some type of quick motion that led to a tear.

It’s Time to Get Your Zzz’s

The good news is that there are things you can do on your own and with your doctor to break the cycle. With changes to your lifestyle – and possibly medication – you should be able to get back to enjoying a good night’s rest.

trouble sleeping"Depending on the type of injury, adjustments in sleeping posture, anti-inflammatory medication, heating pads and ice packs can all help to relax a painful shoulder," said Andrew F. Kuntz, MD, shoulder surgeon at Penn Orthopaedics. "However, if those non-operative treatments are unsuccessful, it’s time to seek medical atten
tion."

If you have shoulder problems, the Penn Shoulder Service provides comprehensive care and surgery. Surgery is typically recommended if:

Symptoms last more than six to 12 months
  • Your tendon tear is bigger than three centimeters
  • You experience significant weakness/ loss of function
  • Your tendon tear was caused by a traumatic injury 
The team will work with you to customize a treatment plan to help you feel better and sleep better.

"If you're tired of the pain and wakefulness, the specialists at Penn Medicine can help,” said Dr. Kuntz. "Our nationally and internationally recognized orthopaedic specialists create and use the latest advances in shoulder diagnosis, treatment, surgery and rehabilitation to get you back to living pain-free."

Ready to start a pain-free, restful life? 
Schedule an appointment today.


Tuesday, April 7, 2015

Penn Orthopaedics Welcomes Dr. Lyons and Dr. Manta

Penn Orthopaedics is excited to welcome Christopher J. Lyons, MD and John P. Manta, MD. Specializing in fracture care, knee and hip replacement, and shoulder arthroscopy, as well as injuries that apply to the athletic patient, Dr. Lyons and Dr. Manta have more than 40 years of combined experience and serve all patients from pediatric to geriatric.

Dr. Lyons and Dr. Manta proudly serve all of Chester County, including: Exton, West Grove, West Chester, Downingtown, Kennett Square, Chadds Ford, Malvern, Frazer, and Chester Springs. Both operate at Penn Medicine Chester County.

Christopher J. Lyons, MD
Christopher J. Lyons, MD
Christopher J. Lyons, MD
Christopher J. Lyons, MD, joins the department of orthopaedic surgery as a Clinical Assistant Professor of Orthopaedic Surgery.  After receiving his medical degree from the Temple University School of Medicine, he subsequently completed his residency in orthopaedics at the Temple University Hospital.

Dr. Lyons treats a wide range of orthopaedic conditions from arthritis to fractures. He performs minimally invasive total knee and total hip replacements, in addition to having extensive experience as an orthopaedic trauma surgeon.



John P. Manta, MD
John P. Manta, MD
John P. Manta, MD, joins the department of orthopaedic surgery as a Clinical Assistant Professor of Orthopaedic Surgery. He completed medical school, a general surgery internship, and an Orthopaedic residency at Temple University in Philadelphia. Dr. Manta continued his training with a fellowship in sports medicine at Georgetown University, where he worked with some of the leaders in the sports medicine field.

Dr. Manta specializes in sports medicine and arthroscopic knee and shoulder surgery. In addition, Dr. Manta has extensive expertise in arthroscopic rotator cuff and instability repair of the shoulder and meniscus surgery of the knee.

To schedule an appointment with Dr. Lyons or Dr. Manta, visit pennmedicine.org/orthopaedics.

Friday, February 13, 2015

Penn Sports Medicine Teams Up With Philadelphia Love Run

Last year, despite buckets of rain falling down on the city, more than 10,000 runners ventured out to take part in the first-ever Love Run Philadelphia. Called “The Race That Loves You Back”, this 13.1-mile race is scheduled for Sunday, March 29 and expected to surpass last year’s number of runners.

Penn Sports Medicine
Rahul Kapur, MD
Members from Penn Sports Medicine were asked to serve as the Official Medical Team for the 2015 Love Run.

“We are proud to be part of the Philadelphia Love Run”, says Rahul Kapur, MD, head medical team physician for Penn Athletics and Penn Sports. “Although we hope nobody needs our services, our medical team is well equipped to assist those in need. We wish all the runners the best of luck and look forward to cheering everyone on in this great community event.”

Penn Sports Medicine physicians will supervise medical staff at mobile medical tents along the course and finish line. The Penn team will also provide training to the nurses, paramedics, EMTs and athletic training volunteers who will be staffing the half marathon on race day.

About the Philadelphia Love Run

Join thousands from the Philadelphia region and around the nation for an unforgettable weekend in Philadelphia. This half marathon offers runners a combination of competing in a world-class event with thousands of others and an opportunity to experience all the great sights and sounds of Philadelphia.

The course, which will take you through Center City, is also walker-friendly.

From free Phillies ticket, to vanity bibs, to team challenges, to incredible Philadelphia-themed finish food, this is one race that loves you back!

Event Details:
When: March 29, 2015, 8:00 am
Where: Philadelphia, Pennsylvania
Art Museum, Eakins Oval
Register Now

About Penn Sports Medicine

The specialists at Penn Sports Medicine treat everyone from the weekend warrior to the professional athlete--providing comprehensive care for athletes of all ages and abilities.
Sports medicine services are provided to those who receive injuries from sport, recreation and exercise activities. The goal is to develop individualized care plans to help patients return to normal activities as quickly as possible with the most appropriate diagnosis, treatment and rehabilitation for their particular sports injury.

Suffering from a specific condition, the experts at Penn Sports Medicine can help.



Monday, December 22, 2014

Advances in Throwing: Latest on Injury Treatment and Performance Optimization

Join us for a one-day conference at Penn Medicine to learn about the latest tools and techniques to optimize performance for the throwing athlete – including pitchers and quarterbacks. This dynamic program, intended for athletic trainers, coaches, physical therapists and physicians, will feature specialists from Penn Medicine and beyond who will share their expertise on the latest methods to manage the throwing athlete:

Register Now

  • Proper biomechanical principles to evaluate the kinetic chain
  • Sound treatment for common injuries
  • Optimize training for peak performance
  • Updates on the latest surgical techniques – including Tommy John surgery

Event Details

Date: Saturday, January 31, 2015 
Time: 7:00 a.m. - 5:00 p.m
Location: Scheie Auditorium
               Penn Presbyterian Medical Center
               51 N. 39th St.
               Philadelphia, PA
Need help getting to the event? Find driving directions or other visitor information

Keynote Speakers


Superior Labral Anterior-Posterior (SLAP) and Posterior Instability in Throwers
James P. Bradley, MD, Burke and Bradley Orthopedics – Pittsburgh, PA
Dr. Bradley is Head Team Orthopedic Surgeon of the Pittsburgh Steelers and has been named as one of the Top 19 Sports Medicine Specialists in the U.S.



The Disabled Throwing Shoulder - What I've learned in 30 years
Craig D. Morgan, MD, Morgan Kalman Clinic – Wilmington, DE
Dr. Morgan has cared for Major League Baseball pitchers, Olympic-level athletes and golfers on the LPGA.



Schedule

7:00 a.m. - Check in and breakfast
7:45 a.m. - Opening Remarks
8:00 a.m. - Throwing Center Overview
John Kelly, MD
Penn Orthopaedics

8:15 a.m. - Surgical Anatomy of the Shoulder
Brian Sennett, MD
Penn Orthopaedics

8:30 a.m. - Pathomechanics of the Throwers Shoulder
Steve Thomas, Athletic Trainer

8:45 a.m. - Evaluation of Movement Dysfunction and Injury Prevention for the Throwing Athlete
Mark Miller, Athletic Trainer

9:00 a.m. - Non-Operative Rehab of Shoulder Injuries
Brian Leggin, Physical Therapist

9:15 a.m. - Deceleration, Throwing a 5 oz. Baseball
Jim Davidson, Strength Coach
9:30 a.m. - Coffee and Fellowship
10:00 a.m. - Labral Injuries: Evaluation and Treatment
Jim Carey, MD
Penn Orthopaedics

10:15 a.m. - Rotator Cuff Injury in the Throwing Athlete
Miltiadis Zgonis, MD
Penn Orthopaedics

10:30 a.m. - Postoperative Instability/SLAP repair rehabilitation in the Throwing Athlete
Marty Kelley, Physical Therapist

10:45 a.m. - Return to Play Algorithms for the Overhead Athlete
Marisa Pontillo, Physical Therapist

11:00 a.m. - SLAP's and Posterior Instability in Throwers
James P. Bradley, MD
11:45 a.m. - Lunch
12:45 p.m. - Valgus Extension Overload at the Elbow
Russell Huffman, MD
Penn Orthopaedics

1:00 p.m. - UCL Reconstruction
Russell Huffman, MD
Penn Orthopaedics

1:15 p.m. - Eccentric strengthening for quicker return to Play
Chris McKenzie, Physical Therapist
1:30 p.m. - Break
1:50 p.m. - Case Based Surgical Approaches to Rotator Cuff and Labral Injuries
Panel Discussion Moderated by: 
John Kelly, MD
Penn Orthopaedics

2:30 p.m. - Elbow, Prevention and Treatment of UCL Injuries
Panel Discussion Moderated by: 
John Kelly, MD
Penn Orthopaedics

3:15 p.m. - Performance Optimization, a closer look at GIRD, Scapular Dyskenisis and Strengthening Techniques
Panel Discussion Moderated by: 
John Kelly, MD
Penn Orthopaedics

4:00 p.m. - The Disabled Throwing Shoulder - What I've learned in 30 years
Craig D. Morgan, MD
4:45 p.m. - Closing Remarks

Continuing Education Units

Attendees are eligible for eight (8) Continuing Education Units for athletic training.

Who Should Attend

This program is intended for athletic trainers, coaches, physical therapists and physicians. Registration fee includes breakfast and lunch:
  • Athletic Trainers/Coaches: $100
  • Physical Therapists: $150
  • Physicians: $200
Total available tickets: 150

Register Now