In the first quarter of today's game, Dallas Cowboys Quarterback, Tony Romo was knocked out of the game with a right hand injury.  He is on the sideline with a tight wrap.  Pictures show a highly swollen hand.  Will he play next week?

ANATOMY

The hand is made up of 27 bones.  In each finger there are 3 phalanges, whereas the thumb has 2.  In the palm of the hand, corresponding to each finger is a metacarpal.  In the wrist there are an additional 8 bones.  These bones work in concert to allow motion and stability to the hand. 

Michael Vick reportedly is suffering from a “hand” fracture.  It is unclear which exact bone is injured, however the fact that a CT scan is being ordered suggests that the base of one of the metacarpals, or perhaps one of the wrist bones was fractured. 

CAUSES

A fracture of the hand is usually caused by a trauma.  This can be in the form of sporting activities where something or someone crushes the hand or drops or twists on the hand. A punch, a fall on an outstretched hand, or even a gunshot can lead to a fracture of the hand. 

SYMPTOMS

Individuals who break their hand will have pain, swelling, loss of motion, and bruising. Depending on the location and position of the break, the finger may turn one way or the other when the fingers are flexed.  This is one of the reasons for surgery. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken hand, you should seek medical attention within a week of the injury, A physical exam and x-rays are usually performed. A CT scan at times may be needed.

TREATMENT

Many hand fractures can be treated without surgery.  If one metacarpal is fractured, oftentimes a removable brace or splint can be worn for about 4 weeks.  If two or more metacarpals are fractured, but are located in the correct position, a short arm cast can be worn for 4 to 8 weeks. 

Surgery is considered if multiple metacarpals are broken, if the break is in the base of the metacarpal where it interacts with the wrist bones, if there is shortening of the metacarpal bone, or if one of the wrist bones is fractured.  Surgery can be as simple as the placement of 1 or 2 wires into the bone, holding it where it belongs, to placing plates and screws on the bone.  In any of these surgical situations, pressure is usually not allowed through the hand for 4 to 8 weeks.

OUTCOMES

Most athletes with a hand fracture have no long lasting issues.

RETURN TO ACTIVITIES

From the current reports, it is unclear of the nature of Romo's injury.  Given that this is his dominant, throwing hand, if a metacarpal is fractured it could be a big deal. A CT scan may be needed to evaluate the injury further.  If broken, he could be out next week.

VIDEO/ANIMATIONS

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

The Houston Texan have faced another blow at the quarterback position.  Matt Leinart injured his left collarbone on Sunday and is out for the season. 

ANATOMY

The shoulder is made up of three bones: the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone).   The clavicle is a long, skinny bone, which is shaped as an “s”, as it travels from the sternum (breast bone) to the shoulder. 

CAUSES

Clavicle fractures are common, occurring usually in children and athletes.  The clavicle can break with a direct blow to the bone. This can occur from a blow to the front or outer part of the clavicle.

SYMPTOMS

Individuals with a broken collarbone will have immediate pain swelling and perhaps a black and blue mark.  The shoulder and arm will be difficult to move.  There may be an abnormal bump in the location where the bone is broken.   An x-ray is usually needed to get a better idea of the location and “shift” (displacement) of the break.  A good physical exam will be needed to ensure that the blood vessels and nerves that travel near the clavicle are not damaged. 

TREATMENTS

Depending on the location of the break, the clavicle can be treated with or without surgery.  In the non surgical option, the arm is kept in a sling, in order to rest the shoulder. The patient is allowed to come out of the sling every few hours to do some basic range of motion exercises and keep the shoulder from stiffening.  The bone will take 8 to 10 weeks to heal.  Surgery is selected if: the bone is pushing up too much on the skin, the broken area of bone is very tender, or in the case of an athlete.  There are a variety of ways to treat clavicle fractures with surgery, including the application of a plate and screws or a screw or device that goes in the center of the bone and stabilizes the break. The advantage of surgery is that physical therapy and exercises can begin more quickly. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you have sustained a clavicle fracture or break of your collarbone, you should seek medical attention within a few hours to days.

RETURN TO ACTIVITIES/OUTCOMES

Most throwing athletes treated without surgery will be out of throwing activities for 8 to 10 weeks.  With surgery, this can be shortened to 6 to 8 weeks.

VIDEO/ANIMATION

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

Jay Cutler, quarterback for the Chicago Bears, underwent surgery today for a Bennet’s fracture or break on his throwing thumb.  What is this injury?  Can he make it back to play this season?

ANATOMY

The human hand is composed of 27 bones.   These bones are grouped into categories:  the carpal, metacarpal, and phalanges.  The human hand has five metacarpals. 

A Bennett’s fracture is a break at the base of the metacarpal of the thumb.  

This injury is usually accompanied by a dislocation or a subluxation (partial dislocation) of the thumb.  This injury makes the thumb unstable, particularly for gripping activities, such as holding a football.

There are a number of strong ligaments and tendons that attach to the smaller piece of bone that is broken. 

CAUSES

The most common causes of Bennett’s fractures are: a punch or a direct blow against a football helmet or skull, or a fall, particularly while holding a handle bar of a bike or motorcycle.

SYMPTOMS

Athletes with a Bennett’s fracture will have pain at the base of the thumb.  There will be instability of the thumb with gripping or pinching motions.   There will be weakness with these activities as well. There will be pain, swelling and bruising around the base of the thumb.

TREATMENTS

Athletes with a Bennett’s fracture will require surgery.  Surgery can be performed in a variety of manners:  with small incisions and screws, with screws and plates, or with pins alone.  If the smaller piece is very small and not out of place, a “thumb” spica cast can be placed for non surgical treatment.  Whether surgical or non surgical treatment is performed, a cast for 4-6 weeks is needed.

WHEN TO SEEK MEDICAL CARE

If you suspect that you have a Bennett’s fracture, you should seek medical care within hours of the injury.  A good physical exam, x-rays, and perhaps a CT scan or MRI may be needed to evaluate the hand.

RETURN TO ACTIVITIES/OUTCOMES

Regardless of the type of treatment, a cast is needed for 4-6 weeks.  Thereafter, physical therapy and rehabilitation is required.  It is usually 6 to 8 weeks before throwing activities can be started without pain.

If lucky, Cutler may be able to return late this season, especially if the Bears make is deep into the playoffs. 

Dr. P

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

Sunday, during the win over the Tampa Bay Buccaneers, the Houston Texan quarterback, Matt Schaub, injured his foot.  Today it was discovered that he sustained a Lisfranc injury.  What is the Lisfranc injury and why will Schaub be out for the entire remaining season?

Oakland Raiders quarterback, Jason Campbell broke his right collarbone on Sunday against the Cleveland Browns.  What does this mean for his season?

ANATOMY

The shoulder is made up of three bones: the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone).   The clavicle is a long, skinny bone, which is shaped as an “s”, as it travels from the sternum (breast bone) to the shoulder. 

CAUSE

Clavicle fractures are common, occurring usually in children and athletes.  The clavicle can break with a direct blow to the bone. This can occur from a blow to the front or outer part of the clavicle.

SYMPTOMS

Individuals with a broken collarbone will have immediate pain swelling and perhaps a black and blue mark.  The shoulder and arm will be difficult to move.  There may be an abnormal bump in the location where the bone is broken.   An x-ray is usually needed to get a better idea of the location and “shift” (displacement) of the break.  A good physical exam will be needed to ensure that the blood vessels and nerves that travel near the clavicle are not damaged. 

TREATMENTS

Depending on the location of the break, the clavicle can be treated with or without surgery.  In the non surgical option, the arm is kept in a sling, in order to rest the shoulder. The patient is allowed to come out of the sling every few hours to do some basic range of motion exercises and keep the shoulder from stiffening.  The bone will take 8 to 10 weeks to heal.  Surgery is selected if: the bone is pushing up too much on the skin, the broken area of bone is very tender, or in the case of an athlete.  There are a variety of ways to treat clavicle fractures with surgery, including the application of a plate and screws or a screw or device that goes in the center of the bone and stabilizes the break. The advantage of surgery is that physical therapy and exercises can begin more quickly. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you have sustained a clavicle fracture or break of your collarbone, you should seek medical attention within a few hours to days.

RETURN TO ACTIVITIES/OUTCOMES

Most throwing athletes treated without surgery will be out of throwing activities for 8 to 10 weeks.  With surgery, this can be shortened to 6 to 8 weeks.  For a quarterback the concern is whether the bone has healed enough to endure the force of throwing and tackles.  Campbell is likely out for the rest of the season.

VIDEO/ANIMATION

Dr. P

All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

The third week of the NFL continues to bring drama to the field due to injuries.  Week 2 saw Michael Vick exit the game from a concussion. Today, he left the game because of a broken right hand.  Will he play next week?

ANATOMY

The hand is made up of 27 bones.  In each finger there are 3 phalanges, whereas the thumb has 2.  In the palm of the hand, corresponding to each finger is a metacarpal.  In the wrist there are an additional 8 bones.  These bones work in concert to allow motion and stability to the hand. 

Michael Vick reportedly is suffering from a “hand” fracture.  It is unclear which exact bone is injured, however the fact that a CT scan is being ordered suggests that the base of one of the metacarpals, or perhaps one of the wrist bones was fractured. 

CAUSES

A fracture of the hand is usually caused by a trauma.  This can be in the form of sporting activities where something or someone crushes the hand or drops or twists on the hand. A punch, a fall on an outstretched hand, or even a gunshot can lead to a fracture of the hand. 

SYMPTOMS

Individuals who break their hand will have pain, swelling, loss of motion, and bruising.  Depending on the location and position of the break, the finger may turn one way or the other when the fingers are flexed.  This is one of the reasons for surgery. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you are suffering from a broken hand, you should seek medical attention within a week of the injury, A physical exam and x-rays are usually performed. A CT scan at times may be needed.

TREATMENT

Many hand fractures can be treated without surgery.  If one metacarpal is fractured, oftentimes a removable brace or splint can be worn for about 4 weeks.  If two or more metacarpals are fractured, but are located in the correct position, a short arm cast can be worn for 4 to 8 weeks. 

Surgery is considered if multiple metacarpals are broken, if the break is in the base of the metacarpal where it interacts with the wrist bones, if there is shortening of the metacarpal bone, or if one of the wrist bones is fractured.  Surgery can be as simple as the placement of 1 or 2 wires into the bone, holding it where it belongs, to placing plates and screws on the bone.  In any of these surgical situations, pressure is usually not allowed through the hand for 4 to 8 weeks.

OUTCOMES

Most athletes with a hand fracture have no long lasting issues.

RETURN TO ACTIVITIES

From the current reports, it is unclear of the nature of Vick’s injury.  Given that this is his non-dominant, non-throwing hand, if a metacarpal is fractured he should be able to play next week.  A special cast may be made for him to protect the hand during play.  However, if one of his wrist bones is fractured, he could be out of action for 6-8 weeks.  The CT scan that he is scheduled to get on Monday should give us a lot of insight into the nature of his injury and the time to return to play.

VIDEO/ANIMATIONS

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

America’s Team’s quarterback, Tony Romo, was taken out of Sunday’s game for a broken rib.  Remarkably, he was able to return to play in the second half.  Today we learned that he had punctured a lung, a condition known as a pneumothorax.  What is this and how long will he be out?

ANATOMY

The rib cage is made up of the ribs, collar bone (clavicle), and breast plate (sternum) of the chest.  These bones and the tendons, muscles, and ligaments that connect them serve to protect the internal organs of the chest.  These organs include the lungs, heart, esophagus (a tube running from the mouth to the stomach), and trachea (the tube running from the mouth to the lungs).  There are 12 ribs on either side of the sternum.

CAUSES

Rib breaks or fractures are usually due to a blunt trauma, as with Romo, or a sharp trauma, such as with a gunshot wound.    A break of the ribs can potentially cause damage to the underlying organs.  If the force is great enough, the broken bone can be plunged into the lungs.  The air that was in the lungs now escapes and enters the space between the ribs and the lungs.  This is known as a pneumothorax.    The pneumothorax can be small.  In this case, the puncture usually seals itself and the body removes the air over time.  In a large pneumothorax, the air pressure can build up to the point that the trachea starts to close down.  This is life threatening and can lead to death.

SYMPTOMS

Individuals with a rib break will experience pain, difficulty with deep breathing, coughing, sneezing or even swallowing.  There will be pain when pushing on the rib.  If a pneumothorax develops, the individual may suffer from shortness of breath, difficulty with breathing, difficulty with swallowing, and see a shift of the trachea in the neck.

WHEN TO SEEK MEDICAL CARE

If you suspect that a rib fracture or pneumothorax, you should seek immediate medical attention.  A physical exam and x-rays are usually performed.

TREATMENT

Most rib fractures are treated without surgery.  These breaks usually do not penetrate the underlying organs but are painful.  Pain medications, anti-inflammatories, a brace, ice, rest, and activity modifications are usually enough to treat these injuries.

If a small pneumothorax is present, chest xrays are obtained every day to make sure that the air is going away.  If it enlarges, a chest tube may be needed.  A chest tube is a device that is placed through the skin and between the ribs.  The tube is placed into the space between the lungs and the ribs.  It serves to rest the lungs and get rid of the air between the ribs and the lungs. Very rarely is surgery needed.

If a large pneumothorax is present, a chest tube is needed.  Very rarely is surgery needed.

OUTCOMES

Most athletes with a simple rib fracture can return to all activities within a few days, as long as the pain is being managed well.  For those with a small pneumothorax, they are able to return to sports within 1-2 weeks. For those with a large pneumothorax, they are able to return to sports within 4-6 weeks.

RETURN TO ACTIVITIES

From the current reports, as long as Romo’s pneumothorax stays small, and if his pain is well controlled, he will be able to play this weekend.  However, he will likely be wearing extra protection around his ribs.

VIDEO/ANIMATIONS

None

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics

On opening night of the NFL, one of the most decorated quarterbacks in the history of the league is recovering from cervical spinal surgery.  His third surgery in about 1.5 years, Peyton Manning underwent a single level fusion in the cervical (neck) area of his spine.  The biggest questions on everyone’s minds are will he return and will this end his career?

ANATOMY

The spine is made up of vertebral bodies that make the vertebral column.  In the neck (cervical) region, there are 7 bones, in the back (thorax) region, there are 12 bones, and in the lower back (lumbar) region there are 5 bones. 

Each bone interacts in a complex manner with the bone above and beneath it.  Furthermore, the spinal canal is home to the spinal cord.  Throughout the length of the spinal cord, nerves (known as nerve roots) come off the cord to provide function to that level of the body. 

In addition, between the bones are cushioned disks, known as vertebral discs, which act as shock absorbers along the length of the vertebral column.  Finally a series of ligaments and muscles attach to the bones to provide stability and flexibility to the spine.

In the neck, the first two vertebral bodies are known as the atlas and axis bones.  The next 5 bones are known as C3, C4, C5, C6, and C7.  The spinal canal is largest in this area.   

CAUSES

Repetitive motions in the neck, trauma to the neck, or genetic predispositions can lead one to develop arthritis in the joint in and around the vertebral column and spinal cord or a herniation of a disc.  With arthritis, bone spurs can develop.  The bone spurs can push on the spinal cord itself or on the nerve roots.  This can cause nerve or neurologic type symptoms. 

 A disc can also bulge and lead to the same symptoms.

SYMPTOMS

Individuals can have symptoms of pain with motion of the neck, pain with motion of the body that the nerve root supplies, numbness, tingling, loss of strength and motion. 

WHEN TO SEEK MEDICAL CARE

If you suspect that you have a cervical spine issue, you should seek medical attention within a few days of the onset of symptoms, especially if the symptoms are not improving.  A physical exam and x-rays are usually performed, however often times an MRI or CT scan may be needed to evaluate the spine.

TREATMENT

Treatment varies depending on the severity of the pain and the nature of the underlying cause of pain, i.e. arthritis or a herniated disc.  Initial treatment may include a neck brace, anti-inflammatories, physical therapy, neck injections with steroids and numbing medications.  If this fails, surgery may be required to remove the disc that is pushing on the cord, remove the bone spurs that are pushing on the cord or fuse the joint between two vertebral bodies.  The fusion can be done from the front or back of the neck. 

Manning underwent an anterior cervical fusion of one joint.  He likely had a discectomy (where the intervertebral disc is removed) with the fusion.  A bone graft is usually placed where the disc used to be.  This helps to maintain the height of the vertebral column.  Plates and screws are normally placed in the bones to stabilize the area of fusion.  Once the fusion occurs, this hardware is no longer functional.  

OUTCOMES

Most patients with cervical spine pain improve with conservative care.  If this fails, surgery can improve symptoms and functional losses.   

RETURN TO ACTIVITIES

Peyton Manning has undergone a cervical spine fusion.  The bone usually takes 12 weeks to fuse.  At times, this can heal faster, but should not be expected.  After fusion, a prolonged course of therapy will be needed to regain some of the loss of function, mobility, and strength from the underlying disease and the surgery.  Given this, I would be very surprised if Peyton returned this season, even if the Colts make it deep into the play-offs.

VIDEO/ANIMATIONS

 Animated videos can be seen below:

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.   For more information on the North Carolina Orthopaedic Clinic, go to: http://www.ncorthoclinic.com/  For more information on Duke Orthopaedics, go to: http://www.dukehealth.org/orthopaedics