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.

Sports Medicine Weekly on 670 The Score

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Aging Atletes and Their Joints.

Steve Kashul talks with Dr. Craig Della Valle from Midwest Orthopaedics at Rush about aging athletes and their joints. Are we getting joint replacements at a younger age and what factors in a more active lifestyle contribute to joint problems.

Dr. Della Valle is a native of New York and received his undergraduate and medical degrees from the University of Pennsylvania in Philadelphia.  He completed his residency at the Hospital for Joint Diseases in New York City.  During his residency he spent a full year devoted to clinical and basic science research in the field of adult reconstructive surgery.  Dr. Della Valle completed a fellowship in adult reconstructive surgery at Rush University Medical Center and Central DuPage Hospital.

He is presently the Aaron G. Rosenberg Endowed Professor of Orthopaedic Surgery and Chief of the Section of Adult Reconstruction at Rush University Medical Center in Chicago, Illinois.

Dr. Craig Della ValleDr. Della Valle is a busy clinician who specializes in primary and revision total joint arthroplasty.  A respected researcher, he has more than 180 peer reviewed publications on topics including unicompartmental, primary and revision total knee arthroplasty as well as total hip arthroplasty, hip resurfacing and revision total hip arthroplasty.

Dr Della Valle is a member of The Hip Society, The Knee Society and The International Hip Society. He currently President for the American Association of Hip and Knee Surgeons, Member at Large for the Knee Society and Secretary of the Hip Society.

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I Have “Rheumatoid Arthritis,” Announces Tennis Star Caroline Wozniacki

Tennis champion Caroline Wozniacki publicly announced her RA diagnosis last week.

Professional tennis star Caroline Wozniacki has always prided herself as being one of the most fit athletes on the WTA tour. “I think that’s something I definitely win quite a few matches on,” she has said. Earlier this year, Wozniacki regained her status as the No. 1 female player in the world when she won the Australian Open, her first Grand Slam victory. But after being besieged by injuries and debilitating fatigue, she suspected something was wrong beyond the typical sprains and pains that come with being an elite athlete.

Joint Pain, Stiffness, and Other Rheumatoid Arthritis Symptoms Started in Summer

“After Wimbledon, I really wasn’t feeling well,” Wozniacki said in a press conference on October 25. “I thought it was the flu. I thought it was fine; I’m going to get over it. I got to Washington, and my knees are hurting, my leg is hurting. Okay, I’ll just move on. I play in Montreal and something really doesn’t feel right. I can’t lift my arms over my head. I go to see the doctor, and they tell me everything is fine, and then I know that I’m not fine. I thought maybe I had mono. It turns out that I have an autoimmune disease, rheumatoid arthritis, which goes in and attacks your joints,” Wozniacki said.

Rheumatoid Arthritis Diagnosis Is Shocking News to Extremely Fit, Elite Athlete

“In the beginning, it was a shock,” Wozniacki said in reference to her rheumatoid arthritis diagnosis. “You feel like you’re the fittest athlete out there. That’s what I’m known for, and all of a sudden you have this to work with. Obviously, when the body has a lot of fluids in it and you swell up, you get tired, you get exhausted — all these things.”

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints. When a person has RA, her immune system confuses the linings of her joints as being something foreign to the body and begins attacking and damaging the joints. The result is a great deal of joint inflammation and pain, combined with a debilitating fatigue.

Pain Affects Joints on Both Sides With Rheumatoid Arthritis

RA most often affects the distal joints symmetrically — the hands, wrists, and knees. Nearly 1 percent of the U.S. population lives with rheumatoid arthritis. According to a report published in September 2017 in the journal Rheumatoid International, there were nearly 1.3 million adults living with RA in the United States in 2014. The Arthritis Foundation states that 70 percent of people with RA are women.

Dealing With Chronic Disease Is Different From Rehabbing a Sports Injury

Once Caroline Wozniacki was diagnosed with rheumatoid arthritis, she began to understand that unlike most athlete injuries that have a finish line for recovery, RA is a chronic disease that requires a lifetime of management. “It’s been a lot to take in,” she said. “After the U.S. Open, I had to figure out what was going on,” she said. “But at the end of the day, you find a plan. You figure out what to do. You do your research. And thankfully there are great things now that you can do about it. You just move on from it and work through it and figure out how to deal with it and live with it.”

Experts Cannot Predict This Tennis Player’s Future With RA

Wozniacki’s future path as an elite athlete may be hard to predict, because it is rare to see an adult female athlete diagnosed with RA.

“Typically, if an individual had juvenile rheumatoid arthritis as a child, even with excellent medical management, she would probably never rise to the level of an elite professional athlete,” says Brian J. Cole, MD, associate chairperson, department of Orthopedic Surgery and professor, Department of Orthopedic Surgery, Rush University Medical Center in Chicago. “The pool of elite female athletes also narrows substantially from high school to college to the professional level. So you are dealing with an elite athlete who has been diagnosed as an adult, which is extremely uncommon.”

Rheumatoid Arthritis Symptoms May Impact Small Joints in Hands, Knee Joints

Despite the rarity of seeing the world’s former No. 1 tennis player being diagnosed with RA, Dr. Cole says Wozniacki, who is not his patient, may benefit from the significant advances in how the disease is being treated.

“Typically, rheumatoid arthritis can affect everything — organs, fatigue, and so forth,” Cole said. “But it most commonly will present with joint pain, particularly in the hands, which is a big issue for tennis players. A lot of it depends upon what symptoms she shows. If it affects the small joints in her hands and her knuckles, obviously that could be a really big issue with her recovery and her performance grip strength. If the disease develops in another common area, her knee, that’s also a challenge.”

Rheumatoid Arthritis Is a Treatable Disease, Especially When Treatment Starts Early

The good news, says Cole, is the modern rheumatoid arthritis treatments that have been developed have become so phenomenal in managing the symptoms that people can live a fairly normal life in many instances.

“When I was a resident,” says the co-host of the Chicago radio program Sports Medicine Weekly, “RA was a disease that they didn’t manage well with medicine, and we were operating on rheumatoid patients all the time. Now it’s extremely rare that those patients ever come to surgery, because the medical management is so good. It really stays out of the purview of the orthopedic surgeon and in the purview of rheumatologists and medical management.”

The fact that Wozniacki was able to continue competing at a high level with her recent diagnosis is a testament to her will and perseverance as an athlete. With the WTA season drawing to a close, she feels the off-season will help her adapt more to life on the professional tennis tour with RA.

Positivity Persists as Pro Athlete Learns to Cope With Rheumatoid Arthritis

“I’m very proud of how I’ve been so positive through it all and just try not to let that hinder me,” Wozniacki said. “I didn’t want to talk about it obviously during the year, because I didn’t want to give anybody the edge of thinking that I’m not feeling well. But I’ve been feeling well. You learn how to cope after matches. You wake up, and some days you can’t get out of bed. You just have to know that that’s how it is. Other days you live and you’re fine, and you don’t even feel like you have it. I’m happy that I’m done with the season, so that I can control it a little bit more and figure out a plan how to control it even better in the future.”

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Dealing with Anterior Cruciate Ligament Injury

By Jess Walter

Anterior cruciate ligament (ACL) injuries are common in sports such as football, basketball, netball, and alpine skiing. They have a big impact on athletic performance, because approximately 79% of people go on to develop knee osteoarthritis after an ACL tear. A study by T Nessler et al called ACL Injury Prevention: What Does Research Tell Us? stresses the importance of ACL injury prevention as a way to avoid the long-term effects of this injury. It all begins in youth – programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries.

What Does An ACL Injury Involve?

The anterior cruciate ligaments (ACL) is found inside the knee joint. It provides the knee with rotational stability and stops the tibia from sliding out in front of the femur. An ACL injury occurs when this ligament is torn, most during sports that involve sudden stops, changes in direction, or jumps. Its symptoms include a popping sensations in the knee, severe pain and inability to continue practicing sport, swelling, a reduced range of motion, and the knee giving weight when bearing weight or playing one’s normal sport.

How Can ACL Injuries Be Prevented?

As mentioned above, the earlier neuromuscular and strength training take place, the better. Prevention programs show a high success rate (52% in female athletes and 85% in male athletes) when preventive programs are adopted. There are six important components of a prevention program: early age; correct sports movements; consistency of sessions; frequency (sessions should last 20 to 30 minutes and commence pre-season), feedback; and exercise variety. There are three main components of an ACL prevention program: plyometrics (focusing on good technique in movement); neuromuscular training (which work on balance and stability); and strength training combined with resistance training.

What Treatments Exist for ACL Injuries?

Treatment for ACL usually involves several weeks of rehabilitation involving exercises provided by a physiotherapist. Injury is sometimes recommended for athletes who will need to perform jumping, pivoting and cutting movements regularly, or for those who have more than one ligament or cartilage injured. During surgery the damaged ligament is removed and replaced with a tendon graft taken from a donor or from another part of the knee. New tissue then grows over this graft. The process of recovery is long and can take between eight and 12 months of rehabilitation.

If you are a professional athlete, ACL prevention is key, simply because treatment is long and the reinjury rate is high. Studies have shown that around 2.3% to 13% of those operated can have a similar injury after surgery. The knee joint is a complex network of tendons, bones, and ligaments so if you are in pain, it is vital to determine the exact cause of the problem so treatment can commence. From an early age, athletes should undertake exercises focusing on strength, balance, and stability, to enjoy their sport in an injury- and pain-free manner.

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