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NEWSLETTER OF THE AMERICAN ORTHOPAEDIC SOCIETY FOR SPORTS MEDICINE
MAY/JUNE 2008
Copyright Laws—
What You Need
to Know
Grants Awarded
2008 Annual
Meeting
WRIST
AND HAND
INJURIES
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CO-EDITORS
MAY/JUNE 2008
EDITOR
Barry P. Boden MD
EDITOR
Wayne J. Sebastianelli MD
Lisa Weisenberger
MANAGING EDITOR
PUBLICATIONS COMMITTEE
Barry P. Boden MD, Chair
John D. Campbell MD
Grant L. Jones MD
Richard G. Levine MD
William N. Levine MD
Daniel E. Matthews MD
Albert W. Pearsall IV, MD
Wayne J. Sebastianelli MD
Daniel J. Solomon MD
Kevin Wilk PT, DPT
Brian R. Wolf MD, MS
BOARD OF DIRECTORS
PRESIDENT
Bernard R. Bach Jr., MD
PRESIDENT-ELECT
VICE PRESIDENT
Freddie H. Fu MD
James R. Andrews MD
SECRETARY
Robert A. Stanton MD
TREASURER
Carol C. Teitz MD
MEMBER-AT-LARGE
Michael J. Stuart MD
MEMBER-AT-LARGE
Eric C. McCarty MD
MEMBER-AT-LARGE
Col. Thomas M. DeBerardino MD
PAST PRESIDENT
William A. Grana MD, MPH
PAST PRESIDENT
Champ L. Baker Jr., MD
MEMBER EX OFFICIO
Rick D. Wilkerson DO
JOURNAL EDITOR, MEMBER EX OFFICIO
Bruce Reider MD
MEMBER EX OFFICIO (COMMUNICATIONS)
2
Scott A. Rodeo MD
Team Physician’s Corner
MEMBER EX OFFICIO (EDUCATION)
Michael G. Ciccotti MD
Injuries to the Hand and Wrist
AOSSM STAFF
EXECUTIVE DIRECTOR
Irvin Bomberger
MANAGING DIRECTOR
Camille Petrick
DIRECTOR OF COMMUNICATIONS
1
Barry P. Boden MD
MEMBER EX OFFICIO (RESEARCH)
President’s Message
10 Copyright Laws
13 Research News
15 Society News
15 Specialty Day Recap
17 Names in the News
17 Fus Make $1 Million Gift
Lisa Weisenberger
DIRECTOR OF RESEARCH
Bart Mann
DIRECTOR OF EDUCATION
Janisse Selan
DIRECTOR OF ENDURING CME
Kathy Stack
18 2008 Annual Meeting
in Orlando, Florida
ASSISTANT DIRECTOR FOR MEMBER SERVICES
20 Upcoming Meetings
and Courses
EXHIBITS AND ADMINISTRATIVE COORDINATOR
EDUCATION AND ENDURING CME COORDINATOR
EDUCATION AND MEETINGS COORDINATOR
Kara Vasilakos
Laura Bell
Patricia Kovach
Michelle Schaffer
ADMINISTRATIVE AND PROGRAM COORDINATOR
Debbie Turkowski
SPORTS MEDICINE UPDATE is a bimonthly publication of the American Orthopaedic Society for Sports Medicine (AOSSM). The American
Orthopaedic Society for Sports Medicine—a world leader in sports medicine education, research, communication, and fellowship—is a national
organization of orthopaedic sports medicine specialists, including national and international sports medicine leaders. AOSSM works closely with many
other sports medicine specialists and clinicians, including family physicians, emergency physicians, pediatricians, athletic trainers, and physical
therapists, to improve the identification, prevention, treatment, and rehabilitation of sports injuries.
This newsletter is also available on the Society’s Web site at www.sportsmed.org.
TO CONTACT THE SOCIETY: American Orthopaedic Society for Sports Medicine, 6300 North River Road, Suite 500, Rosemont, IL 60018, Phone:
847/292-4900, Fax: 847/292-4905.
EXECUTIVE ASSISTANT
Susan Serpico
ADMINISTRATIVE ASSISTANT
Mary Mucciante
AOSSM MEDICAL PUBLISHING GROUP
EDITOR
Bruce Reider MD
AJSM EDITOR
Bruce Reider MD
AJSM EDITORIAL & PRODUCTION MANAGER
Donna Tilton
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PRESIDENT’S MESSAGE
THE AOSSM BOARD OF Directors and AOSSM Medical
Publishing Board met this spring to discuss a variety of important issues
for the profession. I will highlight a few items that are of special interest
to our members.
First, the Board approved the development
of a Youth Sports Safety Initiative. Members
encounter on a near daily basis adolescents
who have significant and potentially lifelong
injuries resulting from unhealthy levels of
physical activity and stress on their developing bodies. We believe our profession has
a perspective, authority, and responsibility to help educate the
public so that youth can develop both a competitive edge and a
lifelong love of physical activity and sport. As part of the initiative, we are commissioning a special committee with representatives from our youth sports, education, research, publications,
and public relations committees and the council of delegates to
work with a public relations firm to develop a comprehensive
program. This project will include interactive materials and
activities that will allow the members both collectively and
independently to serve as advocates for youth sports safety.
A second important decision by the Board was to re-constitute
a fellowship match. The National Residency Matching Program
formally dissolved the sports medicine match in 2005 due to a
lack of participation by programs. When program directors met
in San Francisco earlier this spring, there was a clear consensus
that a match was imperative for the profession to provide a more
orderly process for selecting fellows and training programs. The
Board reviewed a variety of options for strengthening the match
so as not to repeat previous problems, including a shorter and
clearer selection process, incentives to participate, significant
penalties for programs and applicants that pull out of the match,
and a clear commitment of the AOSSM Board to ensure that
the match is fully supported and enforced. We will be formally
circulating the sports medicine match program details to program
directors this spring, meeting with them at the Annual Meeting
to address any questions and concerns, and then proceeding
with implementing the match for the next selection cycle.
A third decision by the AOSSM leadership was to “freshenup” the AOSSM logo. The AOSSM logo has been a part of
the Society’s identity since 1972, and it has remained virtually
untouched for the past 36 years. We are making a number of
design changes that seek to preserve elements of the logo, while
making it more appropriate for the different mediums it is
used in today. This SMU introduces the new logo and solicits
your thoughts and feedback before it is formally adopted later
this year.
Finally, the AOSSM Annual Meeting is fast approaching,
and by now you have received the preliminary program in the
mail. I’m excited both with the strength of the program and
the social activities available to participants. Be sure to register
now so you have the best choice in instructional courses,
activities, and lodging.
BE RNARD R. BACH, J R., M D
May/June 2008 SPORTS MEDICINE UPDATE
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TEAM PHYSICIAN’S CORNER
INJURIES TO THE HAND
AND WRIST
DAN MATTHEWS, MD
Bayside Orthopaedic Sports
Medicine & Rehabilitation
Fairhope, Alabama
Injuries to the hand and wrist are very
common in athletics and have the potential to limit an athlete’s
ability to participate. With proper evaluation and treatment most
injuries will heal without any significant long-term disability.
However, many injuries, if not managed appropriately, can
cause significant loss of participation time and potentially lead
to long-term problems. Understanding the injury, as well as the
particular sport and specific demands of the player’s position
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SPORTS MEDICINE UPDATE May/June 2008
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can help the team physician safely return
the athlete to play without jeopardizing
long-term outcomes. This edition of Team
Physician’s Corner will review some of the
most common injuries encountered and
offer recommendations for appropriate
treatment options.
The pressures on the team physician
always seem to be focused around the
question “When can we get him or her back
to play?” The sports medicine specialist
must always be the patient’s advocate and
ensure that the pressure of returning to
play does not put the athlete in a situation
that may lead to long-term problems. Every
team physician has been in a situation
where the pressure to return to play (RTP)
from various sources, including the coach,
trainer, parents, and the athletes themselves,
has had significant influence on the treatment options available. While this situation
is not unique to hand and wrist injuries,
it becomes very apparent when watching
an athletic event and observing how often
one can see tape, wraps, splints, or casts
on players hands and wrists. It behooves
the team physician to develop a standard
for returning athletes to the field of play.
This standard must apply across the board
for all sports regardless of the pressures
presented. This standard is also not limited
to hand and wrist injuries, but should also
be applied to all situations when RTP
questions arise. One technique that may
be helpful to the team physician is to ask
the three key questions that will apply the
most appropriate care while addressing
the issue of the earliest possible RTP.
Three Questions About RTP
1. Is there a significant increased risk
of short-term damage by returning
to play?
2. Is there a significant increased risk
of long-term damage by returning
to play?
3. Can the athlete functionally perform
activities related to their sport?
Most team physicians would agree that
the answer to the first two questions must
be no, if considering returning the athlete
to participate in their sport. The third
question invokes the “team” concept into
the decision. The athlete may be able to
return to play with a protective device
on their hand without leading to any significant increased risk of both short-term
or long-term damage, but is unable to
functionally perform specific tasks of the
sport. For example, a quarterback would
not be able to handle the ball and play
quarterback while wearing a cast to protect
a metacarpal fracture, but he might be able
to play another position while wearing
this protective device.
Athletic hand and wrist injuries essentially fall into two main categories: trauma
and overuse.
Common Traumatic Injuries
to the Hand and Wrist in Athletes
Phalangeal fractures
TFCC injuries
Metacarpal fractures
Scapho-lunate ligament injuries
PIP joint fracture/dislocations
Hamate hook fracture
Fractures at the base of thumb
Scaphoid fracture
Skier’s thumb
Nail bed injuries
Central slip injury
Jersey finger
Sagittal band injury
Mallet finger
Common Overuse Injuries
of the Hand and Wrist in Athletes
De Quervain’s Syndrome
Intersection Syndrome
Volar/dorsal ganglion
FCR tendonitis
Distal Radial Stress Syndrome
ECU tendonitis
ECU subluxation
FCU tendonitis
Ulnar Tunnel Syndrome
Hypothenar Hammer Syndrome
Traumatic Injuries
Phalangeal and Metacarpal Fractures
Fractures of the metacarpal and phalanx
bones are the most common fractures that
occur in the athletic population. Of the
fractures in the hand, the distal phalanx
accounts for 45 percent of all fractures.
Metacarpal fractures make up 30 percent,
with proximal and middle phalanx fractures accounting for 15 and 10 percent,
respectively. The goal of treatment in hand
fractures is stable reduction and early range
of motion. Most of these fractures can
be treated non-operatively. The proper
treatment is very important, as described
by renown hand surgeon, Dr. Swanson,
“Deformity follows under-treatment, stiffness follows over-treatment, and deformity
and stiffness follows poor treatment.”
Most phalangeal injuries are treated by
closed means with splinting and/or buddy
taping. It is recommended that if at all
possible, the finger should not be completely immobilized for longer than three
weeks. Some form of motion protection
under the guidance of a skilled professional
is critical to maintaining proper finger
function. In some instances to maintain
this motion, operative fixation may be
indicated. Other indications for operative
fixation of phalanx fractures include
unstable fractures, irreducible fractures,
intra-articular fractures, open fractures,
fractures with segmental loss, fractures with
malrotation, or poly-trauma requiring a
weight bearing hand. At times a particular
fracture may have a history of a prolonged
healing time and therefore may require
internal fixation. Internal fixation may
also at times
aid in earlier
return to sport.
(See Figure 1.)
Any degree of
malrotation is
unacceptable in
Figure 1. J.G. distal
phalanx fractures
phalanx fracture
and angulation
of >10 degrees in any plane is indication
for reduction and possible fixation. Many
different means of fixation are available
to the surgeon, including transcutaneous
pinning, interosseous wires, external
fixation, and open reduction and internal
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May/June 2008 SPORTS MEDICINE UPDATE
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fixation (ORIF)
with screws and
plates. ORIF
may also be the
best choice in
some fractures
in the athletic
Figure 2.
population, as
Percutaneous pinning
it may provide
for a more rigid fixation thus allowing
for an earlier RTP. (See Figure 2.)
Injuries to the distal phalanx may
include crush injuries that involve injuries
to the nail bed matrix. These injuries may
require immediate attention. If the subungual hematoma is small (less than 50 percent), the hematoma may be relieved by
drilling the nail plate. If the hematoma
involves more than 50 percent of the nail,
significant nail bed injury is likely present
and nail removal with repair of the nail bed
is indicated. In this case the best results
are in those patients with an acute repair
(less than 24 hours).
Metacarpal Neck
Metacarpal neck fractures are most commonly treated closed, in both the athlete
and non-athlete. One should be reminded
that the collateral ligaments are under
tension in flexion (intrinsic plus position)
and are lax in extension. When immobilizing the MCPJ it should be done in
flexion to ensure that contracture does
not occur. Malunion in the angular plane
is very common in metacarpal neck fractures and may be acceptable, even in the
athletic population, without any findings
of functional deficit.
Acceptable angulations for metacarpal
neck fractures:
Index and Middle
< 20 degrees
Ring
< 40 degrees
Small
< 70 degrees
Some angulation deformity of
metacarpal shaft fractures is also acceptable
with 10 degrees in the index and long finger and as much as 30 degrees acceptable in
the ring and small fingers. No malrotation
is acceptable, as this will lead to overlapping
fingers and functional deficit. As little
as 5 degrees for malrotation can lead to
1.5 cm of overlap. Up to 5mm of shortening is acceptable, but it should be noted
that every 2mm of shortening leads to
7 degrees of extension lag.
Fractures of the first metacarpal at the
base of the thumb may require operative
treatment and therefore require further
evaluation and discussion of the specific
injury pattern.
RTP for these fractures follows the
“three question standard.” As long as the
fracture can be protected from further
injury the athlete can be returned to play.
The sport and position will determine
if the athlete can return to their regular
position. This decision will weigh heavily
upon the input of the trainer and coaches.
Figure 3 demonstrates a very functional, protective
“glove” cast
for a treatment
of a metacarpal
fracture. This
athlete was able
to return to play
Figure 3. Glove cast
for defensive player
as a linebacker
with metacarpal fracture within ten days
of his injury. Any hard cast must be
appropriately padded as determined by
the local governing athletic commission.
Phalanx Dislocations
Most dislocations occur at the PIP joint
(PIPJ) and are in the dorsal direction. The
middle phalanx is dorsally displaced on the
proximal phalanx. Most every team physician has had to deal with one of these on
the sidelines. Simple closed dorsal dislocations are easily reduced, buddy taped, and
allow for early range of motion. Some controversy exists with regards to same game
RTP without radiographic evaluation.
However, personal communication with
most team physicians and personal experience reveals that the standard approach
of same day return must include having a
smooth reduction, without any crepitance
and a painless range of motion while
buddy taped. Radiographic evaluation the
following day in the office may be helpful.
If there is a bony avulsion on the volar
surface, these joints are at increased risk
of developing a flexion contracture and
may need additional attention.
Volar dislocations of the PIPJ are less
common, but may represent a central slip
disruption and may also be unstable after
reduction. In the case of instability of the
joint, it should be reduced and then pinned
for three weeks to prevent a Boutonniere
deformity. In a stable joint after reduction,
these fingers should all be treated for six
weeks in extension to prevent developing
a Boutonniere deformity. Due to the risk
of this deformity, RTP will be guided by
accommodations for treatment.
Dislocations that cannot be reduced on
the sidelines or have crepitance or grinding
on reduction may represent a fracture
associated with a dislocation and therefore
require radiographic evaluation. These
injuries carry a significant risk of long-term
disability and potential impairment. RTP
in these athletes is delayed until after further evaluation has determined the extent
of the injury. Evaluations should not be
delayed as potential devastating outcomes
can occur in injuries involving the articular
surface of the PIPJ.
Skier’s Thumb (Ulnar Collateral
Ligament Tears of the 1st MCPJ)
Acute injuries to the ulnar collateral
ligament (UCL) of the 1st MCPJ can
be immediately managed on the sideline
or the ski slope with immobilization and
return to play the same day or same ski
trip. Further evaluation is needed to determine if the injury represents a partial or
complete tear of the UCL. Determination
of whether the injury is a complete or
partial tear is important in that this has
significant impact on long-term outcomes.
Incomplete ruptures can be treated with
a thumb spica cast for four weeks and
then a protective splint for three weeks.
RTP is allowed in this protective device,
as soon as tolerated.
A complete UCL tear may require
operative treatment. It has been well
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Deformity follows under-treatment, stiffness follows overtreatment, and deformity and stiffness follows poor treatment.
— Dr. Swanson
documented that in complete ruptures
of the UCL, the ligament may be trapped
by the adductor aponeurosis and therefore
will not heal with an appropriately stable
joint. This is commonly known as a
Stener lesion. Because a competent UCL
is critical for an effective pinch, it is critical to be able to determine whether the
lesion is partial or complete. Evaluation
can be performed with physical examination (complete tear = >35 degrees laxity
or >15 degrees side to side difference),
stress X-rays (>35 degrees = complete
tear), ultrasound, or with MRI. MRI is
currently the most definitive test. Because
Stener lesions occur in up to 80 percent
of complete tears, most surgeons agree
that operative treatment is the best
choice for complete tears. (See Figures 4,
5, and 6 below.)
Figure 4. Stener lesion in soccer player
Figure 5. Surgical incision
Figure 6. Thumb spica cast
RTP after operative repair is allowed in
the appropriate protective immobilization,
which is required for four to six weeks.
Skier’s thumb injuries that involve a bony
lesion may be treated non-operatively, if the
fragment is non-displaced. If the fragment
is displaced, ORIF should be performed.
*Note to physicians: standard X-rays should
be viewed before performing stress views,
as this dynamic examination may displace
a previously non-displaced fragment.
Mallet Finger
A direct blow to the end of an extended
digit can lead to an injury known as a
mallet finger. This soft tissue injury is
caused by direct force acting on the end
of the digit forcing flexion against the
active pull of the extensor tendon. This
injury is often caused by a ball hitting the
end of a digit that is held in full extension.
This force can cause a rupture of the
extensor tendon off the base of the distal
phalanx. Physical examination will reveal
tenderness dorsally at the base of the distal
phalanx and the inability to extend the
DIPJ. This digit may present with the DIPJ
held in flexion. X-rays may be helpful as
a small percentage of these injuries will
involve a small boney fragment (boney
mallet). While this injury seems quite
benign, it is important to properly treat
it in a timely fashion to prevent long-term
deformity that
can be difficult
to correct. A
chronic mallet
can lead to
a swan neck
deformity.
Figure 7. Splinting
of mallet
Surgical treatment of swan neck deformity is difficult
and carries a high complication rate. The
best treatment of mallet finger therefore
is to recognize this injury early and to
initiate early splinting. (See Figure 7.)
Splinting of the DIPJ in slight hyperextension needs to be continuous for six
weeks and then splinted only at night for
four to six weeks. If at any time during
the initial six weeks the finger is allowed
to drop into flexion, the six weeks begins
again. There are a variety of splints that
can be used for treatment of this injury.
Athletes can return to play in the splint
as soon as tolerated. Choosing a particular
splint may depend on the sport and position the athlete plays. For example, the
team physician may choose a stack splint
or another volar-based splint for a soccer
player or an offensive lineman who does
not have to handle a ball, while choosing
a dorsal based
splint for
player who
has to handle
a ball. (See
Figure 8.) As
Figure 8. Dorsal mallet
splint
long as the
digit is protected and held in extension,
the player can return to competition.
Central Slip Injuries
A blow to the dorsal aspect of any finger
can lead to an injury to the central slip of
the finger. This athlete will have tenderness
at the dorsum of the PIPJ and pain with
resistance to extension. While this injury
may appear quite minimal, if not recognized
and treated appropriately, it can lead to a
Boutonniere deformity. The Boutonniere
deformity occurs as the triangular ligament
attenuates, allowing the lateral bands to
migrate volarly. Early treatment with
extension splinting of the PIPJ for six
weeks is the treatment of choice. The
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Overuse injuries in the hand and wrist may not cause the potential long-term
disabilities that can occur with some traumatic injuries. However, these injuries can cause
significant performance issues for the athlete and in some instances can lead to the need
for operative treatment.
athlete may return to play as tolerated in
the splint. The player’s sport and position
will dictate their ability to compete with
the finger immobilized.
Jersey Finger
Similar to the mallet finger, albeit on the
flexor side, the jersey finger is an avulsion
of the flexor tendon off its attachment site
at the distal phalanx. This is caused by an
overwhelming eccentric force against the
tendon under tension. The jersey finger got
its name from how it occurs — a player
grabs another player’s jersey and as the
player pulls away, the force leads to an
avulsion of the flexor tendon from the
base of the distal phalanx. The ring finger
is by far the most common finger involved.
Like the mallet finger this can involve just
the tendon or a small fragment of bone.
Unlike the mallet finger, operative repair
of this tendon is the treatment of choice.
It is important to recognize this injury
in a timely fashion as delay in operative
treatment can lead to a poor result. The
level of tendon retraction is important in
determining the timing of surgical repair.
Physical examination will reveal that the
player is unable to flex the DIPJ with the
PIPJ held in full extension. If the flexor
digitorum profundus (FDP) has retracted
to the palm, the best results are found after
repair within 10 days. If the tendon is
retracted only to the level of the A2 pulley,
the tendon has remained within the fibroosseous sheath and the vincula are most
likely intact. Therefore good results can be
obtained with repair performed as late as
six weeks. If a boney fragment is present
with the tendon caught at the A4 pulley,
ORIF of the bone fragment with restora-
tion of the tendon attachment is indicated.
Ultrasound or MRI may be helpful in
determining the level of tendon retraction.
RTP should be restricted until the tendon
has been repaired and has fully healed, and
the athlete has regained full, functional
range of motion. Early RTP places the
athlete at risk of long-term problems
with finger motion and function.
Sagittal Band Injury
Rupture of the sagittal band to the extensor tendon most commonly occurs in the
long finger. This injury will present with
ulnar subluxation of the extensor tendon
with active extension of the finger. There
may also be an extensor lag and deviation
of the affected finger. In an acute injury,
treatment can consist of extension splinting
for four to six weeks. Buddy taping the
finger to the adjacent finger may also help
keep the tendon centrally located during
this period. Acute repair may also be indicated in the athlete where high demand
activity is expected. Repair or reconstruction is certainly indicated in the subacute
or chronic presentation. RTP is allowed in
a protective extension splint, if the athlete
is capable. Buddy taping the long finger
to the index while in the splint and for
four weeks after splinting provides added
protection. RTP after operative repair or
reconstruction is allowed in four to six
weeks with buddy taping.
Triangular Fibro-Cartilage Complex
The triangular fibro-cartilage complex
(TFCC) is the primary stabilizer of the
distal radial ulnar joint and provides for
20 percent of the weight bearing surface
of the wrist joint with 80 percent received
through the distal radius. Injuries are not
uncommon and present with ulna sided
wrist pain that continues despite standard
treatment modalities such as ice, rest, taping, splinting, and exercises. Injuries can
occur through a fall on an outstretched
hand or from an impact like what may
occur in golf when grounding the club
forcefully during a swing. While physical
examination findings are very helpful, an
MRI arthrogram scan evaluation can be
diagnostic. Published reports have demonstrated that the arthroscope has the highest
sensitivity for detecting TFCC tears. There
are two types of tears: traumatic and
degenerative. The traumatic tears are classified by the location of the tear. Much like
the meniscus in the knee, the blood supply
is richest in the periphery and provides for
an opportunity to heal with a suture repair.
Central traumatic tears have poor blood
supply and therefore are more amenable
to debridement. This becomes important
with RTP because much like meniscus
repair in the knee, a suture repair of a
peripheral TFCC tear will need to be protected and will limit early return to play.
After debridement of a central tear the athlete can return to play as soon as they have
regained full range of motion and strength,
or possibly sooner in a protective splint.
These injuries often present late with
complaints of a “sprained wrist that just
won’t get better.” The best treatment
results for acute injuries appear to include
arthroscopic repair within three months
of the injury.
Carpal Ligament Tears
The etiology of tears of the carpal ligaments
can range from high velocity trauma to low
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energy events. These injuries can present
after an acute athletic injury or with
subtle instability patterns that can be the
result of attenuation of a chronic injury.
Diagnosis remains a complex chore as
ligament injuries may be implied by gross
radiographic findings. However, these
instability patterns often will only present
after some time has elapsed. Physical
examination using well-established tests,
radiographic analysis, and even dynamic
testing with arthroscopy are all important
in diagnosing these instability patterns.
While these injuries remain difficult to
diagnosis, they can cause significant longterm disability and impairment and need
to be fully evaluated and treated.
Tears of the scapholunate ligament
(SLL) represent one of the most common
carpal ligament tears. Athletes may present
with the vague wrist pain, weakness, and
possibly loss of wrist motion. On physical
examination they may have dorsal tenderness over the scapholunate joint (SLJ) and
may have a positive Watson’s test. The
examiner needs to evaluate the normal
wrist as well, to compare for the athlete’s
normal wrist laxity.
X-rays may reveal a widened SLJ
(increased with a clinched fist view), and a
cortical ring sign on the PA view. A dorsal
intercalated segmental instability (DISI)
pattern may be seen on the lateral view.
Treatment of these injuries is very complex and beyond the scope of this article.
However, it is important for the team
physician to understand that a wrist sprain
may be a significant injury and needs
evaluation and reevaluation as the season
progresses looking for signs of instability
patterns. Most serious carpal ligament
injuries result in some loss of range of
motion, regardless of the method of treatment. However, appropriate and effective
treatment can limit the amount of disability an athlete may develop. Protective
splinting may be appropriate for RTP,
but only after consideration for the particular long-term issues associated with the
specific instability pattern are identified.
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in the cast (for non-operative treatment)
or as soon as the wound has healed and
swelling has resolved.
Overuse Injuries
Overuse injuries in the hand and wrist may
not cause the potential long-term disabilities that can occur with some traumatic
injuries. However, these injuries can cause
significant performance issues for the
athlete and in some instances can lead
to the need for operative treatment.
Carpel Fractures
The most common carpal fracture is
of the scaphoid bone. The mechanism of
injury usually involves axial load with the
wrist in extension and radial deviation.
Seventy to 80 percent of scaphoid fractures
occur at the waist with 20 to 30 percent
occurring at the proximal pole. The team
physician must have a high index of suspicion anytime there is wrist trauma and
point tenderness in the “snuff box.” The
scaphoid is best palpated with the wrist
moving from neutral to ulnar deviation. If
clinical suspicion is high, the athlete should
not return to play until appropriate X-rays
are taken. Plain radiography carries only
64 percent sensitivity, and therefore MRI
or CT evaluation may be warranted, if
there is high index of suspicions and plain
X-rays are negative. If suspicion remains
high in light of initial negative X-rays
and further radiographic studies are not
immediately available, it is best to immobilize the wrist in a short arm thumb spica
splint or cast for two to three weeks and
then repeat X-rays. Treatment and union
rates are dependent on location of the
fracture and the amount of displacement
present. Union rates are also dependent
on timeliness of treatment. If treatment
is initiated within 28 days of injury, the
union rate is 95 percent. If there is a delay
in treatment greater than 28 days, the
union rate drops to 55 percent. Timely
non-operative treatment with a thumb
spica cast for non-displaced fractures of
the scaphoid have an overall union rate
of 95 percent. Indications for operative
fixation include displaced fractures greater
than 1mm, fractures of the proximal pole
(poor blood supply), and the presence of
any angulation. Both non-operative and
operative treatment options can allow
athletes to return to play in a short arm
thumb spica cast. Athletes should not
return to play without protection until
there is clear evidence of fracture union.
This may require a CT scan to confirm.
Some authors suggest that percutaneous
compression screw fixation may allow
for earlier RTP without protection, for
some athletes in skill positions.
Hook of Hamate Fractures
Hook of the hamate fractures may be the
source of pain for those athletes presenting
with vague ulnar/palmar pain and have
tenderness over the hamate. This injury is
most commonly found in racquet sports,
baseball, and golf. The best radiographic
evaluation is with a carpal tunnel view
on plain X-ray or with axial cuts on a CT
scan. In acute injuries the athlete can be
placed in a short arm cast for six weeks.
In chronic cases, surgical excision of the
fragment is the treatment of choice. In
athletes where six weeks in a cast would be
detrimental to RTP, a decision for earlier
excision can be considered. ORIF has
not had favorable results. In those treated
with excision, athletes can return-to-play
Tenosynovitis (De Quervain’s and
Intersection Syndrome)
Stenosing tenosynovitis of the first dorsal
compartment was first described by
De Quervain in 1895. This condition most
often involves inflammation in the tendon
sheaths of the abductor pollicis longus
and the extensor pollicis brevis tendons.
Physical findings of tenderness and swelling
over the extensor retinaculum of the
first dorsal compartment and a positive
Finklelstein test can confirm the diagnosis.
Intersection Syndrome may be present
with acute bursitis over the crossing tendons
in the second dorsal compartment. This
can produce a classic crepitance with wrist
motion and significant tenderness over
this area. This injury is most commonly
found in rowers and golfers. Both of these
overuse injuries are treated with NSAIDs,
activity modification, ice, immobilization
in a thumb spica splint, and often an
injection with corticosteroid. In recalcitrant
cases, failed non-operative treatment for
more than three months may indicate surgical intervention. Decompression of the
first dorsal compartment is the treatment
of choice for De Quervain’s Syndrome.
Debridement of the bursa and decompression of the second dorsal compartment
is the surgical treatment of choice for
Intersection Syndrome. It is uncommon
for either of these conditions to lead to
loss of the ability to play and athletes will
return to play as tolerated. Most team
physicians will consider an injection if
symptoms warrant, in order to allow for
an earlier pain-free athletic activity.
Continued on page 9
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SPORTS MEDICINE UPDATE May/June 2008
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Ulnar Side Overuse Injuries
Ulnar side wrist pain in the athlete from
overuse can be caused by many things.
The differential diagnosis includes tendonitis of the flexor and extensor tendons,
subluxation of the extensor carpi ulnaris
(ECU), Ulnar Tunnel Syndrome, and
Hypothenar Hammer Syndrome. Tendonitis
of the ECU is most commonly seen in
racquet sports and baseball players.
Tendonitis of the flexor carpi ulnaris is
less common. Both of these conditions
usually respond to NSAIDs and application of a resting splint. Corticosteroid
injections may be helpful if symptoms
do not abate. An MRI in recalcitrant cases
may reveal an increased signal within the
tendon which may represent a split in
the tendon. Surgical debridement of the
tendon sheath or repair of a split tendon
is rarely indicated. Athletes can RTP after
the diagnosis, as tolerated. The symptoms
usually resolve without further issues.
Subluxation of the ECU
Subluxation of the ECU tendon occurs
from a hypersupination/ulnar deviation
injury to the tendon sheath. Most commonly seen in tennis players, the athlete
will present with pain over the ECU tendon and a painful snap with subluxation
of the tendon out of the tunnel with
supination/ulnar deviation. Acute injuries
should be treated in a long arm cast in
slight radial deviation. RTP is allowed, as
tolerated, in a cast. Chronic injuries will
require a direct repair most often with
a radial based sling of the retinaculum.
Because 50 percent are associated with
peripheral TFCC tears diagnostic wrist
arthroscopy
is also recommended. (See
Figure 9.) After
surgical treatment RTP is
not allowed
Figure 9. Operative
repair of ECU luxation
until the repair
has fully healed and the athlete has regained
full motion and strength.
Ulnar Nerve Syndrome
Entrapment of the ulnar nerve in Guyon’s
canal at the wrist is known as Ulnar Nerve
Syndrome. This is also called “Handlebar
Palsy” in cyclists. Symptoms may include
parethesias in the small finger and ulnar
half of the ring finger and/or weakness of
the intrinsic muscles of the hand. Diagnosis
is based on history and clinical findings,
but NCS and EMG studies can support a
clinical suspicion. MRI may be helpful if
a mass lesion is suspected. Treatment consists of NSAIDs, splinting, and avoidance
of the aggravating activity. Surgical decompression may be needed in recalcitrant
cases and should be performed before any
atrophy of the intrinsics, as this may represent a permanent loss. RTP, is as tolerated.
Hypothenar Hammer Syndrome
Hypothenar Hammer Syndrome (HHS) is
an uncommon diagnosis that is most often
found in baseball catchers. The repetitive
impact loads experienced by catchers can
lead to ulnar artery thrombosis which causes
the athlete to present with hypothenar pain,
cramping, tenderness, and at times paresthesias. Diagnostic testing is performed
with clinical examination using the Allen’s
test, which will demonstrate lack of blood
flow from the ulnar artery presenting as a
loss of the superficial arch pulse. A Doppler
evaluation may also be helpful. Treatment
is surgical thrombectomy and vascular
reconstruction or ulnar artery ligation. RTP
after the surgical procedure is allowed
after the wound has fully healed. The
radial artery has not been shown to be
at risk, thus returning to baseball, even
the catching position is permissible.
Distal Radial Stress Syndrome
Repetitive stress on the immature distal
radius can lead to Distal Radial Stress
Syndrome. This overuse injury of the
distal radial physis will present with
complaints of distal radial pain and
tenderness to palpation over the physis.
This is most commonly seen in gymnasts
and is one of the few overuse injuries that
can lead to significant long-term problems.
Radiographic evaluation may reveal
widening of the distal radial physis. (See
Figure 10.) This
injury can lead to
premature closure of
this physis, which
can produce a positive ulnar variance
at the wrist. The key
to treatment is early
recognition in any
skeletally immature
Figure 10. X-ray
athlete, especially a
of early closure of
gymnast. The athdistal radial physis
letes who are at risk
must be removed from the sport for three
to six months. Early RTP is not indicated
because of the potential long-term problems with early growth arrest.
References
Carpal Fractures-Dislocations, Monograph Series. Trumble, T., Editor. American Academy of Orthopaedic Surgeons. 2002
“Hand and Wrist Injuries in the Athlete.” Chhabra, AB. AAOSM, AAOS Review Course for Subspecialty Certification in Orthopaedic
Sports Medicine. 2007.
Orthopaedic Knowledge Update 3, Sports Medicine. Garrick, JG, Editor. American Orthopaedic Society for Sports Medicine, American
Academy of Orthopaedic Surgeons. 2004.
Green’s Operative Hand Surgery, 5th edition. Green, DP; Hotchkiss, RN; Pederson, WC; Wolfe, SW (Editors). Churchill Livingstone.
New York. 2005
May/June 2008 SPORTS MEDICINE UPDATE
HOME
9
HOME
DON’T BE
A COPYCAT
Know the Copyright Laws
to Save Time and Money
Continued on page 11
10
SPORTS MEDICINE UPDATE May/June 2008
HOME
HOME
Q
UOTED
UOTABLES
Paula Cozzi Goedert
Barnes & Thornburg LLP
paula.goedert@btlaw.com
When a doctor writes an article, how much can be “borrowed” from another source without
permission? A paragraph? Three paragraphs? A table? Five tables? It is important to know
what constitutes a violation of copyright law, to avoid embarrassment and economic damages.
No One Ever Sues
Wrong. The boom of the Internet and
e-communications has made lawsuits
more common. Words and images can
now be transmitted worldwide with a few
key strokes. The ability to use or misuse
something that belongs to somebody else
has increased exponentially. The Internet
also makes it more likely that authors who
use the words of others will get caught, due
to wider dissemination and searchable databases. Figuring out who owns what and
what rights go along with ownership is crucial for anyone who creates or anyone who
uses words or images created by others.
It’s Constitutional
Protections for creators were built right into
the Constitution. Our Founding Fathers
granted authors and inventors the exclusive
rights to their writings and discoveries. The
theory is simple: without protection, there
would be no creation. If others could take
and profit from their creations, there would
be less incentive to create.
What’s Protected
In layman’s language, everything created
by man that you can read, view, or hear
is protected under copyright law. A word
on a page, photographs, tables, drawings,
audio and visual works, and graphic designs
are all protected.
Importantly, ideas are not copyrightable.
Some ideas might be patentable, like a
business process, but not copyrightable.
When it comes to journal articles, copyright protects the words, tables, and photos,
that an author can summarize and paraphrase, but not copy the work of another,
unless the copying comes under the “fair
use” exception described below or the article is so old that the copyright has expired.
What Are the Rights in Copyright?
The owner of a copyright in a work has many
valuable rights. The owner has the right to
make and sell or distribute copies and to
prepare derivative works. These rights are
exclusive, unless they are sold or given away.
䡲 Right to Reproduce — The most basic
right associated with copyright ownership is the exclusive right to make copies
of the work. Anyone who has visited
a Kinko’s or a camera shop in the
last decade has had this fact forcibly
explained to them. The sign above the
do-it-yourself machines loudly proclaim:
IT IS ILLEGAL TO REPRODUCE
IMAGES UNLESS YOU ARE THE
RIGHTS HOLDER. It does not matter
if the photograph was purchased fair
and square from a professional photographer. The only person with the right
to reproduce that image is the photographer. Making copies without their
permission violates their copyright.
䡲 Derivative Work — The copyright
owner also has the exclusive right to
create derivative works: a new work
䡲
based on preexisting copyrighted material. Recasting or transforming a work
into a different format or medium is
creating a derivative work, even if some
of the words are changed. Many parents
of students have been asked, “How
much do I have to change so it’s okay
for me to copy this right into my essay?”
The answer is that no percentage of
changed words is safe. The ideas have to
be put into little Johnny’s own words.
Fair Use — The copyright field is filled
with myths and lore about uses that are
or are not permitted or protected. The
doctrine of “fair use” is the subject of
much misunderstanding, including the
myth that any use by or for a non-profit
organization is fair use. Fair use permits
the use of limited excerpts of copyrighted
materials without a license for criticism,
comment, parody, news reporting,
teaching, scholarship, or research.
Even if the use falls into one of these
categories, the courts will still analyze
whether the use was commercial,
whether only a limited excerpt was used,
and whether the use would impact the
market value of the work. You should
always attempt to obtain permission.
As a rule of thumb, however, if the use
falls into one of the categories above,
excerpts of a few sentences or paragraphs for longer works are usually
safe. Anything more and the publisher
will want to know why the author
May/June 2008 SPORTS MEDICINE UPDATE
Continued on page 12
HOME
11
HOME
pla·gia·rize
transitive verb: to steal and pass off (the ideas or
words of another) as one’s own : use (another’s
production) without crediting the source
intransitive verb : to commit literary theft : present
as new and original an idea or product derived
from an existing source
—Merriam-Webster Online
Copyright Laws — continued from page 11
failed to get — and pay for — permission. As to tables and images, it is best
to obtain permission as there may be
layers of rights, including the author
and creator of the table or image.
Even if the material falls in the “fair
use” exception, quotation marks and attribution are crucial for any quoted material.
They do not prevent a copyright violation,
but they prevent the humiliation of a claim
that the work was plagiarized. Many famous
authors have suffered this embarrassment,
and their publishers have been forced to
make public apologies. One such instance
will make it very difficult to get published
in the future.
Registration
Another myth about copyright is that only
works which are registered with a governmental authority are protected. Copyright
automatically applies to all covered works.
No registration is necessary. Authors and
artists who register their works are able to
claim special protections and obtain damages
more easily, but it is not legally required.
Neither is a copyright notice. Simply
because words or an image have no copyright notice attached to them does not
mean they can be used without permission.
Notice is not legally required.
What if it’s posted on the Internet? Isn’t
everything on the Internet in the public
domain? This common supposition is the
latest addition to the copyright myths. An
author or artist does not grant the right to
freely use a work by displaying it on the
Internet. The same need to obtain written
permission to use the work applies to works
displayed on the Internet, as applies in any
12
other medium. In fact, the U.S. Congress
has enacted special penalties applicable to
unauthorized uses of digital communications.
Copyright Expiration
The term of copyright in the United States
was recently changed to extend the time
period during which creators are protected.
Copyright now extends for the lifetime
of the creator plus 70 years. If the work is
made-for-hire (generally, when the creator
is paid to make the work for another), the
term is the shorter of 95 years from the
date of first publication or 120 years from
the date of creation. A visual work is first
published when it or a copy is first sold
or otherwise transferred. Once a copyright
expires, the work becomes part of the
public domain and the creator is not entitled to protections of the copyright law.
That is not the last word on the creator’s
rights, however. The laws of different countries vary on the protection of intellectual
property rights. Some states have also enacted
special protections for creators of works.
Licensing
Given the maze of rules applying to intellectual property right usages, it is no surprise
that the licensing of rights is big business.
Anyone creating a work using words or
images of another will not want to risk
proceeding without having the necessary
rights granted in writing, or making sure
fair use applies, or all rights have expired.
The user need not obtain a copyright in
the words or images to use them, but will
need a license from the copyright holder.
A license is a grant of use, and typically
provides very specific language to limit
what the user may or may not do with
the words or image.
An important point about licenses is that
the copyright holder retains all rights not
specifically granted in the license. Except in
special cases where the unstated use was necessary for the licensee to obtain the value of
the stated license. Courts have been unsympathetic to licensees who have complained
“but I assumed...” or “we really meant...” If
a license is granted for a specific purpose,
no other use is implied. The wording of
the license agreement is crucial to ensure
that the user will get all needed rights.
For example, a doctor might obtain
written permission to use 10 paragraphs in
quotes and with attribution in a text book.
The doctor cannot use the same material
in an article without further permission.
Bad Ideas
Thinking no one will notice, assuming it’s
in the public domain, trusting someone
who told you the author or publisher does
not mind — these are all thoughts that flit
through the minds of authors from time
to time. They lead inevitably to problems.
Problems may not happen today or tomorrow, but probably will soon and it will be
painful. The certain knowledge that you
will be surrounded by lawyers for long
periods of time should be enough to banish
these thoughts and replace them with more
productive ones. Get solid advice from
professionals. Get the necessary permission
in writing. Review the wording carefully to
make sure everything needed is included in
the contract, clearly and unambiguously.
You’ll sleep better at night and you’ll be
protecting your association and yourself.
SPORTS MEDICINE UPDATE May/June 2008
HOME
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RESEARCH NEWS
AOSSM Hosting
Osteoarthritis
Post Joint Injury
Conference
AOSSM is holding a scientific conference
that will explore the strong association
between joint injury and the development of osteoarthritis (OA). The meeting
will be held at the Ritz-Carlton in New
Orleans on December 11–14, 2008.
Topics to be examined include the
incidence and impact of osteoarthritis
post joint injury, basic mechanisms
of trauma-induced cartilage damage,
translation of mechanistic information
into new strategies for prevention and
treatment, and new methods for assessing joint and cartilage injury and repair,
both biological and imaging. The specific objectives of the conference are to:
䡲 Determine the current and emerging
areas of research
䡲 Develop recommendations for
future directions in new areas
of cooperative research
Develop new collaborations and
strategies for the translation of
basic research into patient care
To obtain a preliminary agenda
for this meeting, please send a request
to Bart Mann, bart@aossm.org.
Attendance at this meeting will be
competitive and limited to those who
can document their ability to actively
contribute to the discussion. If you
are interested in being considered as
a participant, please send your CV and
a cover letter explaining your clinical
and research experience (e.g., record of
publication, presentations, or research
in OA and/or cartilage) that pertain
to the conference topics to Bart Mann.
Researchers who are under 42 years
old, women, minorities, and/or people
with disabilities are especially encouraged to apply.
䡲
AOSSM RESEARCH GRANT
PRE-REVIEWS IMPROVE
FUNDING CHANCES
In an effort to improve the quality and
competitiveness of submissions, the
AOSSM Research Committee will
pre-review and critique applications
for AOSSM research grants prior
to the final application deadline. This
pre-review is STRONGLY RECOMMENDED, but not required. It is
anticipated that by participating in the
pre-review process, the applicant’s
chances for funding will improve.
The pre-review will focus on:
䡲
Significance of proposed research
䡲
Scientific quality
䡲
Statistical methods
䡲
Realistic nature of goals
䡲
Long-term value of results
䡲
Pilot data
Please use the online submitter for
the pre-review.
You must complete an online
application by August 15 in order
to receive a pre-review. Visit the
research tab on www.sportsmed.org
for more information.
AOSSM Initiates Career Development Award Supplement
AOSSM will be initiating a $50,000, per year, supplement program to sports medicine
orthopaedic surgeons who receive a Career Development Award (K Award)
from NIH. The purpose of this program is to facilitate the research careers of
orthopaedic surgeons who have completed training in sports medicine and
who have accepted a faculty position at an academic institution. Although
the grant may be most attractive to researchers early in their careers, the award
is open to individuals regardless of time since training. You must first obtain
an NIH Career Development (K) Award and have an active award to be eligible.
To apply for the supplement, please send a copy of your letter of award from
NIH along with your NIH Biosketch and the Career Development Plan
from your NIH application, to Bart Mann at bart@aossm.org. Deadline
for submission is August 1.
May/June 2008 SPORTS MEDICINE UPDATE
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RESEARCH NEWS
AOSSM Announces
2008 GRANT WINNERS
2008 Young Investigators Grant
The Young Investigator Grant (YIG) is
specifically designed to support young
researchers who have not received prior
funding. This year, two YIGs were awarded.
Grantee: Michael
Shindle, MD
Dr. Shindle’s grant will support research on the role of
inflammation on rotator cuff injury and
repair. The first aim of the study is to determine if an increase in tear size (partial versus
full thickness) will promote pro-inflammatory cytokines, angiogenesis factors, and
tissue remodeling genes in the tendon,
synovium, and bursal tissues. The second
aim of the study is to determine if there
is a correlation between pro-inflammatory
cytokines and clinical outcomes based on
post-operative physical examinations, outcome questionnaires, and ultrasonography.
Identifying the molecular marker(s) that
differ between partial and full thickness
tears and correlate those results with clinical
results may lead to the development of
pharmacological methods that can alter
the natural history of disease progression
and/or improve the outcomes following
rotator cuff repair.
Dr. Shindle graduated from the Johns
Hopkins University School of Medicine in
2004 and is currently a PGY-4 resident at
the Hospital for Special Surgery in New York
City. Dr. Shindle will continue his training
at the Hospital for Special Surgery, as a
sports medicine fellow beginning in 2009.
Dr. Verma will study the
effect of gamma irradiation
on soft tissue graft healing and in vivo
biomechanical properties. The research will
investigate if soft tissue allograft healing
to bone will be delayed compared to that
of autograft tissue. To test this hypothesis,
Dr. Verma’s team will use an established
rabbit model of ACL reconstruction in
which a semitendinous allograft or autograft is transplanted into bone tunnels in
the femur and tibia. The second hypothesis
to be tested includes analyzing whether
the use of low-dose (1.2 MRad) gamma
irradiation will negatively affect the quality
of allograft healing after ACL reconstruction. The findings of this study may help
clinicians decide what type of allograft to
use in their patients.
Dr. Verma completed his orthopaedic
residency in 2004 at the Rush University
Medical Center in Chicago, Illinois. He
then completed a fellowship in Sports
Medicine and Shoulder at the Hospital
for Special Surgery in New York City.
Currently, he is an assistant professor in
the Department of Orthopedics, Sports
Medicine Section at Rush University
Medical Center in Chicago.
randomized to use a nitroglycerin patch or
a placebo patch. All subjects will undergo
an eccentric strengthening exercise program.
Progress will be measured clinically via
physical exam and patient reported symptoms, as well as via standardized questionnaires, including the International Knee
Documentation Committee Score, the
Tegner Activity Score, and the Victorian
Institute of Sport Assessment (VISA scale).
The VISA specifically measures the severity
of patellar tendonitis. All outcome measures
will be collected at six and 12 weeks.
Dr. West obtained a B.A. in biology at
the Johns Hopkins University and an M.D.
from George Washington University, and
then completed her residency training at
George Washington University and her
sports medicine and shoulder fellowship
at the University of Pittsburgh. She is
currently an assistant professor at the
University of Pittsburgh. Dr. West is the
head team physician for the University of
Pittsburgh men’s basketball team, Carnegie
Mellon University, and an assistant team
physician for the Pittsburgh Steelers.
Grantee: Nikhil
Verma, MD
2008 Kirkley Grant
The Kirkley Grant provides start-up
supplemental funding for an outcome
research project or pilot study.
Grantee: Robin West, MD
The purpose of Dr. West’s
study is to evaluate the effects
of topical nitroglycerin in
alleviating the symptoms of patellar
tendonitis. Topical nitroglycerin has been
shown to relieve symptoms in Achilles
tendonitis, supraspinatus tendonitis,
and lateral epicondylitis. Subjects will be
14
SPORTS MEDICINE UPDATE May/June 2008
HOME
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SOCIETY NEWS
Self-Assessment and
Board Review — Version 4
Released this Summer
Specialty Day Highlights
New Techniques and Research
n March 8, 2008, more than 1,300 orthopaedists and related health
care professionals attended Specialty Day in San Francisco, California.
With packed rooms throughout the day, attendees came early and
stayed late to keep their seats. The annual John C. Kennedy Lecture
was delivered by Russell Warren, MD, director of the soft tissue research
laboratory at the Hospital for Special Surgery (HSS) in New York City.
His stimulating presentation on shoulder instability reviewed a variety
of diagnostic considerations, treatment options, and clinical results from
the HSS registry and maintained the lectureship’s esteemed history.
AOSSM teamed in the afternoon with the Arthroscopy Association of North
America (AANA) for a joint session of symposia, including “The Failed ACL in the
Scholastic Athlete,” moderated by Jack M. Bert, MD, and Scott A. Rodeo; “Lateral
Epicondylitis in the Elite Tennis Player,” moderated by Larry D. Field, MD, and
Laurence D. Higgins, MD; and “Glenohumeral Instability in the Contact Athlete,”
moderated by Robert Arciero, MD, and Richard Angelo, MD.
Thank you to Program Chair, Brian J. Cole, MD, MBA, members of the AOSSM
Program Committee, AANA Program Chair, Nicholas A. Sgaglione, MD, and all
abstract reviewers for their work in making the Society’s Specialty Day a success. If you
weren’t able to attend this year’s Specialty Day or simply wish to review what you did
see and hear, visit the Online Meetings section at www.sportsmed.org where selected
speakers’ audio and PowerPoint presentations will be available mid-May.
O
AOSSM’s new self-assessment and
board review tool will be released
this summer and help members:
䡲 Prepare for the sub-specialty
exam in sports medicine given
by the American Board of
Orthopaedic Surgery
䡲 Test knowledge in seven critical
areas of sports medicine
䡲 Identify strengths and
weaknesses in clinical and
practice management issues
䡲 Review diagnostic, surgical, and
other therapeutic measures and
techniques used in sports medicine
Product features include:
䡲 125 NEW questions, images,
and answers
䡲 Citations and references that
can be used as a study guide
䡲 Reports that compare your
results to peers
䡲 Ability to complete questions at
your own pace
䡲 Earn a maximum of 12 AMA PRA
Category 1 Credits™
For more information and to reserve
your copy visit www.sportsmed.org.
Did you miss participating
in a live AOSSM meeting?
You can now register to view
past live AOSSM meetings online.
The online programs contain slide
presentations and speakers’ voices
of select sessions captured at each
live meeting. Currently we have the
following online meetings:
䡲 2008 Specialty Day
(available mid-May)
䡲 Advanced Team Physician Course
䡲 AOSSM Sports Medicine and
Baseball: A Comprehensive
Approach
To register for an online meeting,
visit the online meeting page at
www.sportsmed.org (use the
Online Meetings quick link).
May/June 2008 SPORTS MEDICINE UPDATE
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15
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SOCIETY NEWS
DID YOU KNOW...
SOCIETY GETS
New “Uniform”
A sports team’s colors remain true with time, but its logo
periodically is modified to stay current. In AOSSM’s case,
our logo has been virtually untouched since 1973, and in
our present graphic rich environment, a cleaner look is
needed. Frequently, the details in AOSSM’s logo cannot be
distinguished because of size and placement. So earlier this
spring the AOSSM Board approved modifying the logo as
illustrated below. The leadership’s overall objective was to
“freshen” the logo in a way that would help carry our past
into the next 35 years. We welcome your thoughts on
AOSSM’s new “uniform.” Please send your comments
to Director of Communications, Lisa Weisenberger at
lisa@aossm.org.
16
Who designed the original logo?
After an organizational meeting
in Eugene, Oregon, in the fall of
1972, Don O’Donoghue had his
staff/illustrator develop a logo
based on conversations from
the initial meeting.
What does the oval shape
represent?
The oval was intended to represent
a football — the Society’s primary
sport of focus at that point.
What does the red symbolize?
At the suggestion of Les Bodnar,
team physician for Notre Dame, the
red highlight was included as a
tribute to O’Donoghue’s affiliation
with the University of Oklahoma,
where he was the first orthopaedic
resident and the Chair of the
Department of Orthopaedics.
Does it matter which way the
athlete runs?
Yes. Though the athlete runs to the
left in the previous logo, in today’s
graphic rich environment it is
technically incorrect, as he/she
is running away from the words
on the page.
Purchase Three Bulk Issues
of In Motion Get One Free
New AOSSM Resource
AOSSM’s patient education newsletter,
In Motion: Active Living for All Ages, highlights relevant information for multiple age
groups, from exercise and rehabilitation tips
to nutrition and psychology. This important
educational and marketing tool is published
quarterly and can be purchased in bulk for a
nominal fee, for distribution in waiting rooms
and other public areas. As an added incentive to purchase copies in bulk, AOSSM is
offering a “buy three, get one free” offer.
Purchase 50 or more copies of any three
issues and you’ll receive the fourth set
of issues FREE! You can also personalize
the newsletter with your clinic’s logo or
practice name. For more information, visit
www.sportsmed.org and click on the
Patient Education tab or call the Society
office at 1-877-321-3500.
The newest resource from
AOSSM, The Athletic Health
Handbook: A Key Resource
for the Team Physician, Athletic
Trainer and Physical Therapist,
provides quick references on
relevant topics you frequently
face in your everyday practice
or sporting event. This unique
3-ring handbook provides the
team physician, athletic trainer,
and physical therapist with more
than 60, up-to-date Team Physician’s Corner articles and consensus statements from Sports Medicine Update, all in one location. Members pay
only $10 for their initial copy to cover shipping and handling. Additional
copies are $48 each, plus shipping and handling. This publication is
made possible by a generous grant from Genzyme Biosurgery. To order
visit www.sportsmed.org or call 1-877-321-3501.
SPORTS MEDICINE UPDATE May/June 2008
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NAMES IN THE NEWS
Bergfeld Receives
Budd Award
The Honors Committee of
the Academy of Medicine
of Cleveland and Northern
Ohio (AMCNO) awarded AOSSM member, John Bergfeld, MD, the John H. Budd
MD Distinguished Membership Award
for 2008. The award is given to a member
of AMCNO who has brought special
distinction and honor to the medical
profession, to the community, and to
the physician association, as a result of
his or her outstanding accomplishments
in biomedical research, clinical practice,
or professional leadership. This award
was given in recognition of Dr. Bergfeld’s
longstanding work in orthopaedic medicine, as well as his dedication to the
health care community in Cleveland.
Lowrey Inducted
into Rome-Floyd
2007 Sports Hall of Fame
Dr. Darrell Lowrey was recently
inducted into the RomeFloyd, Georgia Sports Hall of Fame.
The award recognizes Dr. Lowrey’s
longstanding work in the local sports
community from team physician for
Armuchee High School, Darlington
School, Shorter College, Berry College,
and event physician for the National
NAI College Soccer Championships and
Medical Director for the Georgia Games.
Dr. Lowrey was also instrumental in
beginning a sports medicine program for
all local high school and college athletic
departments and as a result there are now
trainers for each school in the service area.
Shafer Receives OREF
Tipton Award
AOSSM member, Michael
Shafer, MD, recently received
the third Annual Tipton
Award from Orthopaedic Research and
Education Foundation. The award honors
commitment to mentorship, bridgebuilding, and collaboration. The award
was given to Dr. Schafer as part of the
American Academy of Orthopaedic
Surgeons annual meeting March 5–9
in San Francisco. In acknowledgement of
Dr. Tipton’s dedication to education and
his own lifelong commitment to forming
orthopaedic surgeons, Dr. Schafer will
establish the William W. Tipton Jr., M.D.
Orthopaedic Surgery Student Fund at
Northwestern’s Feinberg School of
Medicine. The fund will provide five
$1,000 stipends to encourage interested
medical students to explore a commitment
to orthopaedics through observing surgery
and conducting a research project.
Zumwalt Recently
Promoted
Dr. Mimi Zumwalt was
recently promoted
to Associate
Professor at Texas
Tech Medical
Center. She also
just completed
co-authoring a book The Active Female:
Health Issues Throughout the Lifespan.
Why isn’t your name listed here? We love to list members’
accomplishments, achievements, and awards! Don’t be shy:
Send your “Names in the News” items to AOSSM Director
of Communications, Lisa Weisenberger at lisa@aossm.org,
fax, 847/292-4905, or by calling the Society office. Please
send a photo with your submission, if possible. This is your
space to let your colleagues know what you’ve been up to!
Fus Make One Million Dollar
AOSSM/OREF Research Commitment
Incoming AOSSM President,
Freddie H. Fu, MD, and his wife,
Hilda Pang Fu, have recently made
a $1 million gift commitment to the
OREF by way of a life insurance
policy that will fund a new research
award. The award will be made in
cooperation with AOSSM and will
be known as the OREF/AOSSM/
Dr. Freddie H. and Mrs. Hilda
Pang Fu Research Award.
The award will support research
directed by a female orthopaedic
surgeon researcher on a topic
related to sports medicine, or
directed by an orthopaedic surgeon
researcher of either gender on
a topic of special interest to
female athletes.
The award will be added to
a developing portfolio of OREF
research awards from several of its
orthopaedic partners. The selection
of the award recipient will be made
through the OREF peer review
process with participation from
representatives of AOSSM’s
Research Committee. For more
information on OREF’s research
grant program, visit www.oref.org.
May/June 2008 SPORTS MEDICINE UPDATE
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SHAMU, MICKEY, AND AOSSM
SUMMON YOU TO
ORLANDO
This is the final article in a three-part series on AOSSM’s 2008
Annual Meeting in Orlando, Florida, July 10–13. In this issue of
SMU, we’ll preview the key social and educational functions that
are the hallmark of our annual meetings. Online registration is now
open for courses and events. To register and view the preliminary
program, visit www.sportsmed.org (use the Annual Meeting quick
link). Advance registration closes June 9, so register today!
Continued on page 19
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SPORTS MEDICINE UPDATE May/June 2008
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The Society is rolling out the red carpet for our members during our
Annual Meeting. This year’s educational activities encourage interactive
learning and skill development, with more than 24 instructional courses
and 22 scientific posters, while the social activities are sure to bring the
magic of one’s imagination to life.
Wednesday, July 9
8:00 a.m.–5 p.m.
Pre-Conference Program
AOSSM Research Workshop—
Setting-Up Your Practice to
Participate in Clinical Trials:
Opportunities and Challenges
Associated with Multi-Center
Clinical Studies
This complimentary pre-conference workshop is devoted
to the topic of setting up your
practice to participate in clinical trials. The agenda includes:
䡲 Identifying basic and
cutting-edge research
principles and methods
䡲 Applying strategies to set
up practices to participate
in clinical research trials
䡲 Describing the challenges
and opportunities of multicenter research projects
A cocktail reception will follow
the meeting. Advance registration is necessary. The full agenda
and a list of faculty can be
viewed at www.sportsmed.org.
Thursday, July 10
1:00–4:00 p.m.
Family Olympics
Please join us for the AOSSM
Family Olympics at the
JW Marriott Orlando Grande
Lakes. Olympic-like games
for adults and children along
with light refreshments will be
part of this fun-filled annual
event. Registration is open to
immediate family members
only and is on a first-come,
first-served basis. There is
no fee to participate thanks
to event supporter Breg, Inc.
6:30–8:00 p.m.
Welcome Reception
Renew old acquaintances and
meet some new ones on the
Porte-cochere at the JW
Marriott Orlando Grande
Lakes. Enjoy some tropical
music along with activities
especially designed for the
children in attendance. A full
complement of beverages and
appetizers will be provided.
This event, supported by Breg,
Inc., is free and open to all
attendees and their families.
Friday, July 11
1:30 p.m.
Golf Tournament
Set within the pristine headwaters of the Florida Everglades
and surrounded by magnificent
pines, palmettos, and live oaks,
the Ritz-Carlton Golf Club
will be the site for this year’s
tournament. The Ritz-Carlton
Caddie Concierge accompanies
each group to offer tips for
playing the course, locating
golf balls, providing accurate
yardages, repairing ball marks,
and cleaning golf clubs. Supported by DJO Incorporated,
the tournament is open to men
and women, members and
nonmembers. Pre-registration
is required. The fee for this
event is $120, which is donated
to AOSSM research and education. Last year the tournament
raised more than $10,000.
Please indicate your participation, handicap, and any pairing
requirements when registering.
1:30–4:30 p.m.
Fly Fishing Tour at
Grande Lakes Outfitters
This three-hour excursion, supported by DJO Incorporated,
offers the fly angler hands-on
casting instruction and a walking tour of the Fly Fishing for
Trophy Largemouth Bass area
of the resort. Anglers should
come prepared with comfortable
walking clothing and footwear.
All ORVIS equipment is provided on your journey, and
the adventure departs from
the ORVIS Fly Fishing corner
at the Ritz-Carlton Golf Club.
The registration fee for this
exciting activity is $150, which
will be donated to AOSSM
education and research.
Pre-registration is required.
Saturday, July 12
9:15 a.m.–2:15 p.m.
Show Express at SeaWorld™
Come see Shamu and all her
friends during this three-hour,
special behind-the-scenes
guided tour. You’ll have
preferential seating at two
shows, plus receive guided
tours of two animal attractions
and multiple other venues. A
knowledgeable staff member
from the SeaWorld Education
Department will also be
available to answer questions.
In addition, you’ll have an
hour on your own to explore
the park and $5 in Shamu
fun money to be used at any
of the shops and restaurants
in the park. Transportation is
provided from the JW Marriott
Orlando Grande Lakes. The
fee is $125 for adults and $105
for children 3–9 years of age.
Children 3 and under free.
6:00–10:00 p.m.
An Evening in Margaritaville
Channel your inner Jimmy
Buffet for an evening replicating
the sights and sounds of Key
West. You and your AOSSM
colleagues will be joined by
Volcano Joe and his Hot
Lava Band for an interactive
evening of dancing, beach
party games, and parrot head
hat creations for both adults
and children. Enjoy some
“Cheeseburgers in Paradise,”
margaritas, and other beach
concoctions throughout the
event. If you plan to attend,
please indicate the number
of adults and children on the
registration form. This event
is supported by Bledsoe and
Smith & Nephew Endoscopy.
Other Activities
9:00 a.m.–2:00 p.m.
Thursday, Friday, and Saturday
Climbing Wall
A 24-foot rock climbing wall
is available during the meeting
for all meeting attendees and
their families to enjoy. The
wall is supported by Ossur
Americas.
July 10–11
Health and Fitness Testing
AOSSM is sponsoring a
health and physical evaluation
for interested parties. Testing
includes body composition,
flexibility, cardiovascular
endurance, power, muscular
endurance, and agility. These
field tests will provide a participant with an overall picture
of physical fitness. Please refer
to the form in the preliminary
program for registration and
further details. The cost for
the assessment is $50.
May/June 2008 SPORTS MEDICINE UPDATE
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UPCOMING
MEETINGS
AND COURSES
AOSSM 2008 Annual Meeting
July 10–13, 2008
Orlando, Florida
Annual AOSSM & AAOS
Review Course for Subspecialty
Certification in Orthopaedic
Sports Medicine
August 1–3, 2008
Chicago Marriott Downtown
Magnificent Mile
Chicago, Illinois
The Puck Stops Here:
Comprehensive Management
of Hockey Injuries
August 22–24, 2008
The Westin Michigan Avenue
Chicago, Illinois
Advanced Team Physician Course
December 11–14, 2008
Hilton Austin
Austin, Texas
(Administered by American College of
Sports Medicine) Visit www.acsm.org
for more information and registration.
AOSSM & AAOS Review Course for
Subspecialty Certification in Sports Medicine
Give yourself the gift of experiencing a great orthopaedic
sports medicine review and join us in Chicago, August 1–3,
2008, at the Chicago Marriott Downtown Magnificent
Mile. The Annual AOSSM & AAOS Review Course for
Subspecialty Certification in Orthopaedic Sports Medicine
has been designed for orthopaedic surgeons preparing for
the ABOS Subspecialty Certificate in Orthopaedic Sports
Medicine and individuals wanting an in-depth course on
orthopaedic sports medicine. Come to Chicago and learn
from some of today’s leading subspecialty experts, as they
address key testable material in 18 subspecialty areas,
including three shoulder and three knee subsections.
The preliminary program can be downloaded at
www.sportsmed.org.
The Puck Stops Here
Schedule a quality time-out and come to Chicago this
summer for The Puck Stops Here: Comprehensive
Management of Hockey Injuries. Being held August
22–24, 2008 at The Westin Chicago, the course
offers physicians and allied health professionals an
excellent opportunity to address medical issues
and orthopaedic injuries specifically related to
hockey, including injury prevention strategies
and the psychological impact of athletic injuries.
Co-chaired by AOSSM members Drs. Scott D.
Gillogly and Benjamin S. Shaffer, this 2.5-day
course focuses on treating the hockey athlete
at diverse levels of play and offers plenty of
practical advice to wield on and off the ice.
Preliminary programs and registration now
available online at www.sportsmed.org.
For more information on upcoming meetings and courses, or to view preliminary programs, please
visit our Web site at www.sportsmed.org (click on Education), or call 847/292-4900 or
877/321-3500 (toll free).
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SPORTS MEDICINE UPDATE March/April 2008
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AOSSM THANKS BREG FOR THEIR
GENEROUS SUPPORT OF SPORTS
MEDICINE UPDATE.
Sports Medicine Update
AOSSM
6300 North River Road
Suite 500
Rosemont, IL 60018
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