The Art of Sports Medicine

upper extremity sports medicine Most of us have heard of the phrase – “The art of medicine”. That refers to the unique interaction between a physician and their patient, taking into account all of the particular and individual nuances that make up one patient’s problem(s). The same treatment will not work universally for every patient. A physician draws upon their experiences and their fund of knowledge to customize the care provided to each individual patient. That, in essence, is the art of medicine.

I am fortunate enough to have expertise in something similar – “The Art of Sports Medicine.” I credit this experience largely to my full year of subspecialty advanced fellowship training in orthopedic sports medicine – A year that was spent at the American Sports Medicine Institute in Birmingham Alabama. Dr. James Andrews, and his partners, have created the eminent sports medicine mecca in this country where athletes of professional, collegiate, and high school ranks frequently travel to to seek their expertise.

The skills gained and the experience earned during this year were invaluable. We took care of MVP running backs in the NFL, World Series winning pitchers in major league baseball, national championship winning football players from both Alabama and Auburn. And yet, nobody got the same identical treatment. Everybody got the same technical expertise and effort during surgery, but the conversations, relationships, and individualized care and attention were unique to each patient athlete.

In my orthopedic practice, I have extracted the same principles. Every patient of mine gets an individualized treatment plan and thought assessment from me personally. In particular, my athletes – regardless of level and including our weekend warriors – will get a customized and thorough evaluation as well as treatment recommendations from me.

One of my passions is care of the upper extremity in the athlete – from the shoulder down to the fingers. I have the privilege of treating many baseball players and serve as the team physician for the Houston Astros single-A affiliate, the Holly Springs Salamanders, as well as Campbell University and the University of Mount Olive. Care of the athlete’s shoulder and elbow is a very special situation, particularly as it relates to baseball or softball.

There is a growing epidemic regarding injuries to the ulnar collateral ligament (UCL) of the elbow – a problem which is frequently treated with what is commonly known as Tommy John surgery. Other treatment options exist, such as platelet rich plasma (PRP) injections, periods of rest without throwing, and a dedicated return to throwing program.

Each athlete gets a treatment plan tailored to their needs. I take into account many variables – the patient’s age, current level of competition, future ambitions within the sport, and also the time of year during which they are hurt. Different treatment options exist for the baseball player hurt in February versus August, in my opinion.

Together, we can come up with the right treatment plan for you or your family member for their upper extremity and sports medicine needs.
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When To Consider Tommy John UCL Surgery

baseball player throwing athlete elbow injuryOne of the most interesting yet challenging aspects of taking care of baseball players are discussions regarding injuries to the ulnar collateral ligament. This condition, which is extremely common, causes medial or inner elbow pain in overhead athletes. It can be seen in baseball or softball players, volleyball players, football players, or track and field athletes. It is certainly extremely common in the sport of baseball.

This condition is diagnosed with a proper history and physical exam, as well as input from x-rays and an MRI.

As is often the case, there are a spectrum of injuries and a lot of terminology that is thrown around. Sometimes this can be confusing for the patient and their families. It is my job to help to sort it out. Words like sprain, tear, complete versus incomplete, partial, etc. can often be used. This can create confusion and anxiety, but a good sports medicine physician can help you sort things out.

For baseball players with a complete detachment of the ligament from their elbow, Tommy John surgery is unequivocally recommended. This has an excellent track record and a very favorable return to pre-injury activity levels. For patients with pain, loss of velocity, or inability to compete at the proper level with a complete or full thickness tear of the ligament, this treatment approach works well and typically should be followed.

Decisions exist and uncertainty arises when there are partial or incomplete tears of the ligaments. Some people will be candidates for nonsurgical options – most commonly, this refers to treatment with an injection of the patient’s own blood, called platelet rich plasma, or PRP. PRP uses a centrifuge machine to spin down a sample of blood from the patient, to inject a specific layer of the blood that is rich in growth factors, platelets and cytokines-elements which helps stimulate a healing response. In some instances, we believe that the PRP can help the athlete’s native tissue to heal on its own without surgery. This is not always the case, however.

Not everybody is a candidate for PRP. There are certain things which come into play that need to be discussed with your physician. Briefly, this includes the time of the year during which the athlete is being seen, the prior history of injuries or lack thereof about the elbow, and the specific characteristics of the ligament that we can see on the MRI, among other things. Some candidates have true potential to heal the ligaments with PRP and time. Others, unfortunately, will be unable to heal a ligament that is highly disorganized, stretched out, or badly injured, even if it is not completely torn off the bone.

When working on this problem together with you or your family member, we can come up with the best approach that makes sense, taking all of these variables into consideration. Indeed, it is a complex subject, but I and my team can help you sort it out.

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Dr. Kuremsky Co-Authors Article in Journal of Shoulder and Elbow Surgery

An article entitled “Interobserver and intraobserver reliability of radiographic classification of acromioclavicular joint dislocations” was recently published in the Journal of Shoulder and Elbow Surgery, co-authored by Dr. Kuremsky and five colleagues. The article describes a study involving 200 patients with AC joint dislocations. Please see the article summary online for details.
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Free Educational Seminar – Tommy John Injuries in Baseball

Dr. Kuremsky will be providing a free educational seminar on Saturday, February 10, at the Brier Creek office of Emerge Ortho in Raleigh NC.

He will be joined by Physical Therapist Alan Tomczykowski, DPT, SCS, CSCS, HKC. Alan will share his Sports Medicine expertise.

The seminar is free and open to the public! Those interested would include Parents, Coaches, Athletic Trainers, Therapists, Sports Medicine Providers.

Spaces are limited – so please RSVP by February 6 to (919) 281-1820 or via email at Brandon.Sherrell@EmergeOrtho.com.
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Ulnar Collateral Ligament Injuries and Treatment

The phrase “Tommy John” refers to injury sustained to the athlete’s elbow, specifically the ulnar collateral ligament or UCL. Surgical treatment of this injury is known as Tommy John reconstructive surgery, whereby a new ligament is recreated to replace the function of the injured one.

Tommy John himself was a successful baseball player in the 1970s and 80s for the Los Angeles Dodgers and the New York Yankees. His fame truly derives from the fact that his career appeared to be in jeopardy when he sustained an injury to his inner elbow at the UCL. At that time, no professional major-league baseball pitcher had ever returned to play after having sustained this significant injury.

Behind the treatment and pioneering work of Dr Frank Jobe, John had surgery and ultimately returned to continue playing baseball – and had several more exceptional years. From here, other players also began to have this surgery and henceforth the procedure known as “Tommy John” refers to elbow ligament reconstruction in athletes.

The incidence of Tommy John injuries is rising. Of even greater concern is the fact that injuries are happening not only more frequently but to younger athletes. It is estimated that more than 55% of all pictures in the major and minor leagues have had Tommy John surgery.

Research has provided insight into the mechanism of injury. These include some of the following: year-round throwing, failure to adhere to established pitch counts and pitch limits, initiating curveballs at an early age or before mastery of fastballs and breaking balls, poor throwing mechanics, and others.

Throwing athletes of all ages should see a sports medicine elbow specialist if they are having elbow pain or a decrease in velocity when throwing. An experienced physician can help sort out the diagnosis as well as provide next steps for treatments or rehabilitation.
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