Category Archives: Orthopedics & Spine

Sports Medicine Expert on Concussion Symptoms and Dangers

Posted on: October 14, 2014

Concussion Management. Assessing the Symptoms.

By Dr. Eric Small

While a headache is among the best-known and first symptoms of a concussion, there are often delayed symptoms that indicate ongoing mild brain damage and require treatment. Ten percent of symptoms don’t present for a week or more.

For this reason, it is essential that parents and teachers as well as emergency room physicians and pediatricians recognize the need to monitor a young injured athlete for the full spectrum of possible symptoms. In my experience, when the athlete gets over the initial headache, or perhaps never experiences this symptom, parents and youngster often push for a quick return to all activities. But that can put a young person at serious risk.

Today’s best concussion management involves assessing all symptoms – early and late, including many that can seem unrelated to the injury — to determine the proper timing of an athlete’s return to play and also to learning, that is, the resumption of a full academic load.

Often-overlooked symptoms of a concussion include sleep disturbances and personality changes, in which, for example, a very sociable teen becomes quiet. It’s also important to know that post-injury cognitive impairment often causes academic difficulties to emerge over time. For example, an A student in math becomes, two or three months later, a B student. I particularly advise parents to keep an eye on their child’s performance in math and foreign language. As both subjects require doing multiple mental tasks simultaneously, and rely heavily on memory, they are usually the most affected. When I see a young athlete who appears fine after a concussion, I ask two targeted questions: First, “How are you sleeping?” And always – “Are you having problems with math?”

Be aware that cognitive symptoms may not surface until triggered by a heavy cognitive stress, such as back-to-back tests in school – and that this delay in symptoms can lead to dangerously delayed treatment. A little-known fact about this type of injury is that an untreated concussion can keep getting worse.

Another surprising fact to most people is that a broken nose or broken tooth suffered during sports can also cause head trauma, causing the same set of often-delayed symptoms. This is why I strongly advise that even a symptom-free child see a doctor within 48 hours of the injury, and that visits continue as the child is watched for late-arriving symptoms.

It is now recognized that proper concussion rehabilitation often involves not only physical rest and rehabilitative therapies – but rest and rehab for the brain. Ideally, a physician prescribes personalized guidelines for modifying physical and mental activities. The guidelines typically encompass texting and computer screen time, both of which can add visual over-stimulation to the stress of cognitive processing.

For day one post-concussion, I typically recommend that the student go to school a few hours late. If they tolerate that, day two is a full day. But during non-core classes, such as gym and music, I recommend they rest in the nurse’s office. And no tests. Similarly, a return to play might start the student off with a little jogging, then add push-ups. What you don’t want is the old method of rehab where the athlete stays out of school for a period of time and then returns to a full regimen. A gradual progression is a must.

Editor’s Note: Dr. Eric Small is a past chairman of the AAP committee on Sports Medicine and is active in creating national policy regarding children and sports. He has been named Sports Medicine Best Doctor in New York Magazine and Westchester Magazine  since 2007, and has over 20 years of experience with athletes.

For more information on concussions, visit www.cdc.gov/concussion

 

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Foot and Ankle Surgeon Discusses Flat Feet

Posted on: May 28, 2014

Feet That Go Flat

By Dr. Kurt Voellmicke,

A00173F02_foot_MedRezThere are aspects of getting older that are simply no fun. For example: In some people — mainly women over 40 — the feet will just give out. More specifically, they get adult-acquired flat foot, says. (Men get it too, by the way.)

People usually recognize something’s wrong when they start to experience pain on the inner side of the ankle. Continue reading

New York Spine Surgeon describes the O-Arm CAT Scanner

Posted on: December 19, 2013

Meet the O-Arm:  New technology in the OR

By John Abrahams, MD, FAANS, Chief of Neurosurgery, Co-Director of Spine Surgery, Orthopedic and Spine Institute

Dr. John Abrahams Northern Westchester HospitalThe Orthopedic & Spine Institute of Northern Westchester Hospital recently brought new technology into the operating room – the O-Arm from Medtronic.

The O-Arm is an intra-operative CAT Scanner with Image Guidance used to make placement of spinal instrumentation more accurate and safer. 

Typically, the O-Arm would be mainly used for patients undergoing spine surgery that need instrumentation placed such as rods and screws.  During these procedures, patients are put to sleep with general anesthesia and prepped for surgery.  An incision is made over the surgical site and then the O-Arm is brought in to obtain a CAT Scan with three-dimensional imaging. Continue reading

New York Orthopedic Specialist Discusses Ankle Sprains

Posted on: June 24, 2013

The Pain of Ankle Sprains

By – Dr. Kurt Voellmicke, Director of Foot and Ankle Section for the Orthopedic and Spine Institute, Northern Westchester Hospital.

foot-swarm As a doctor I find that it is common for many to be confused over what constitutes a sprained ankle.  What is a sprain, and what should you do if you have one? You’ll be happy to know that the answers are pretty straightforward.

 The Definition

A sprain is defined as a stretched or torn ligament — the tough, fibrous tissue that connects one bone to another and supports your joints. By far the most common type of sprain is in the ankle.  Typically people roll their ankle outward and damage the ligaments on the outside of the ankle. Basketball and volleyball players are the most susceptible to sprains, followed by soccer and lacrosse players. Jumping and then landing unevenly or on the side of another player’s foot is the typical cause of a sprain.  Ankle sprains can also occur sliding into a base or running on an uneven surface. Having high arches can put you at higher risk of a sprain: The foot is like a tripod. The higher one’s arch, the more the tripod tends to tilt to the side.  Other risk factors include weakness of the supporting leg muscles or poor balance.

Continue reading

Common Sports Injuries: What you should know

Posted on: May 10, 2013

Although they rank among the most common sports-related injuries, anterior cruciate ligament (ACL), medial collateral ligament (MCL), and meniscus injuries are often misdiagnosed and/or perpetuated.

To understand the issues around diagnosis, we sat down with Victor Khabie, M.D. , FAAOS, FACS, Chief of the Department of Surgery, Co-Director of the Orthopedic and Spine Institute and Chief of Sports Medicine at Northern Westchester Hospital…

new york orthopedistTo achieve timely diagnosis and treatment, Dr. Khabie stresses the importance of physicians and athletic coaches recognizing the signs of each injury and knowing when it is appropriate to refer to a specialist.

According to Dr. Khabie, the signature characteristic of an ACL injury is an audible pop in the knee accompanied by swelling, difficulty walking and an inability to continue certain activities. While MCL and meniscus injuries also result in swelling and pain, athletes may still be able to move and participate, albeit in a diminished capacity. Patients may attempt to treat these injuries at home with propping and icing; however, many find their injuries do not improve. Continue reading