Ask the Doctor!

This regular segment of ‘Ask the Doctor’ addresses questions submitted by Sports Medicine Weekly followers. Dr. Charles Bush-Joseph is sitting in for Dr. Brian Cole from Midwest Orthopaedics at Rush and will be discussing the medical side of MLB teams signing free agents and obtaining players via trades along with:

  • Treatment protocol for tennis elbow.
  • When signs of muscle soreness should not be ignored.

Dr. Bush-Joseph is a graduate of the University of Michigan Medical School in 1983, he is currently a Professor at Rush University Medical Center and the Associate Director of the Rush Orthopaedic Sports Medicine Fellowship Program. Dr. Bush-Joseph is a respected educator of medical students, residents, fellows, and practicing orthopedic surgeons lecturing at numerous national educational meetings. He serves on the editorial board of several national orthopedic journals, including the prestigious American Journal of Sports Medicine.dr. charles bush-joseph

Long involved in the care of high school, collegiate, and recreational athletes, Dr. Bush-Joseph is a team physician for the Chicago White Sox Major League Baseball Club and Associate Team Physician for the Chicago Bulls. Through his experience with high-profile professional athletes, Dr. Bush-Joseph was elected to the Major League Baseball Medical Advisory Board and president of the Major League Baseball Team Physician Association for 2012.

This exclusive group of team physicians advises the Major League Baseball Commissioner on medical policy and emerging trends in training and the medical care of the elite athlete. Academically, Dr. Bush-Joseph is nationally renown with leadership roles in several national orthopedic societies and president of the American Orthopaedic Society for Sports Medicine. He has authored over 140 published manuscripts and book chapters.

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Ski Holidays and Head Injuries

Image result for skiing head injury

In this segment Dr. Brian Cole of Midwest Orthopedics at Rush, Steve Kashul & Dr. Jeremy Alland discuss Holiday ski trips and what parents (and adults!) should know about concussion.

Dr. Jeremy Alland graduated from Rush Medical College in Chicago, IL, where he was awarded the prestigious William H. Harrison, PhD Award for selfless leadership, aspiration and collaboration. He went on to complete a Family Medicine residency at UPMC St. Margaret Hospital in Pittsburgh, PA, where he served as Chief Resident and was peer-selected as the best resident teacher. After residency, he returned to Rush and his hometown of Chicago to complete a fellowship in sports medicine.

During his training, Dr. Alland served as a team physician for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club, DePaul University and multiple high school football, basketball and wrestling teams. Additionally, he has been a part of the finish line medical team at both the Chicago and Pittsburgh marathons. He is board certified by the American Board of Family Medicine and is a member of the American Medical Society of Sports Medicine, American College of Sports Medicine and American Academy of Family Physicians. Jeremy Alland

As a former collegiate baseball pitcher, Jeremy A. Alland, M.D. has a strong passion for sports and medicine. He finds pride in his ability to relate to his patients and strives to help his patients remain active. He specializes in the care of the entire athlete with special interests in the throwing athlete, the golfing athlete, sports performance, and ultrasound-guided procedures.

Dr. Alland is a team physician for the Chicago White Sox, Chicago Fire Soccer Club, Windy City Bulls (Chicago Bulls NBA D-League team), Chicago Dogs, Chicago Blaze and Mount Carmel High School. He previously served as a team physician for DePaul University. He is an active researcher and has authored numerous papers on topics in sports medicine. He also serves as a peer-reviewer for The Journal of Family Practice.

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Shoulder Instability Surgery- Reliable Results For Most Athletes

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Many young athletes with a shoulder dislocation from sports activity will choose to have shoulder stabilization surgery
  • Modern arthroscopic surgery techniques generally result in extremely stable shoulders for 90% of athletes and high satisfaction

I wrote last week about improvements in ACL surgery over the last 25 years and this week I’d like to explore improved results from another commonly performed sports medicine surgery- stabilization surgery for the dislocating shoulder. The results here mirror those of ACL surgery in many ways.

Many young athletes dislocate a shoulder from trauma, typically a dive with the arm outstretched overhead. This can happen in any sport involving that kind of motion, and any contact sport.

Most surgeries were performed through a large “open” incision 25 years ago, but nowadays can be performed arthroscopically in most cases. For uncomplicated stabilization of shoulders that have had a small number of dislocations from trauma, we should expect 90% of shoulders to remain stable and satisfaction rates upwards of 80% out to about 5 years with current methods, for recreational athletes.

Early Open Surgery Methods- Very Good At Stabilizing, Not So Good At Retaining Motion

Historically, the open surgery was for an unstable shoulder was reported in the early 1900s. A surgeon named “Bankart” first described the essential anatomy of the torn ligament and labrum stabilizing the shoulder in 1923, and for the most part we still generically refer to a shoulder stabilization as a “Bankart repair”.

Over the decades as additional knowledge was gained, modifications to the original procedures were developed. A key component surrounded understanding why surgeries on shoulders with many dislocations tended to do poorly compared to ones with only a few dislocations. While there are many factors, restoring bone loss that resulted from the dislocations was a major advancement.

As it turned out, open stabilization was extremely effective at providing excellent stabilization, with low re-dislocation rates.  But it came at a price. The rehabilitation was difficult and often resulted in permanent motion loss. Some techniques had unacceptably high rates of early arthrits. The end result was that many folks ended up with a stable shoulder but were unhappy about the result.

Arthroscopic Stabilization- Much Better At Retaining Motion With Excellent Stability

 “Arthroscopy” involves small incisions, with the surgeon visualizing and performing repairs through the small incisions. There are numerous advantages over open surgery.  Arthroscopy avoids some complications of open incisions, is generally faster, has minimal blood loss, is more comfortable after surgery, and generally leads to a faster return to sports with excllent joint motion.

And yet, in its earliest years, arthroscopic stabilization had a higher dislocation rate than open surgery. As it has been with ACL reconstruction surgery, arthroscopic shoulder stabilization has improved substantially over the years. Better surgical technique, improved surgical implants, and cutting-edge rehabilitation all play a role.

Measuring the ultimate outcome from arthroscopic shoulder stabilization surgery can involve many factors. Is there another dislocation after surgery? How is the range of motion? What’s the patient’s level of sport activity? How does the patient feel about their result?

If you’re a young athlete with an unstable shoulder, and you have a strong desire to resume a contact or collision sport you’ll likely want to consider shoulder stabilization surgery. Find an experienced shoulder surgeon and have a thorough discussion. You’ll have to work hard on your rehab and be patient but you should generally end up with an excellent result.

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How Snow Skiing can help keep You Young!

Snow Skiing as a Natural Anti-Aging Remedy

Dr. Charles Bush-Joseph from Midwest Orthopaedics at Rush and Steve Kashul talk with Peter Braun MS, LAT, ATC, ITAT from ATI Physical Therapy. This discussion focuses on how snow skiing can keep you young and what make skiing a unique type of exercise.

The effects of time on one’s body are unavoidable and often substantial. Many of us in the field of medicine are in an endless search to find the perfect sport, activity or exercise that will unlock our physical potential, well into our years. Scientific research has found that there are certain factors that contribute to longevity and sustainability.


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Bone density, lower extremity strength, balance and cardiovascular endurance all play critical roles in maintaining a physically active lifestyle. With this, physicians make an effort to integrate these factors into exercise plans for much of our elderly population. But what if there was a simpler answer? What if we could prescribe involvement in a recreational activity that naturally addresses all these areas? As we unravel the details, we challenge the question; “Is there such a thing as an anti-aging activity?”

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