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NC/GA line.

A great day in the mountains.  David is making good headway.  His spirits are high.  He had a bit of food poisoning but is back in business now.  He just crossed the North Carolina/ Georgia line.20160417_121118

Appendicitis

Appendicitis is one of the most common causes for a person living in America to need emergency abdominal surgery. Appendicitis is the inflammation of the appendix and although it is unknown why humans have an appendix, the appendix can create some serious problems.
            The patient will usually complain of abdominal pain in the umbilicus area. The severity of the abdominal pain may begin as minor pain, but will gradually become sharp and more painful. The pain will usually travel from the umbilicus area to McBurney’s point within the first 12-24 hours (PubMed, 2011). Other signs and symptoms that may also present themselves will be reduced appetite, pain that worsens when coughing, diarrhea, low-grade fever and/or constipation (Mayoclinic, 2011).
            The reason an individual may get appendicitis can include fecal obstruction, infection, lymph swelling, or it may even be caused by a carcinoid tumor (Prentice, 2011). Whatever the cause is the result will be an inflamed, swollen, and pus-filled appendix. As the blockage of the appendix continues to worsen the inflamed tissue will become infected with bacteria. The lack of blood supply to the appendix will result in the inflamed tissue to die, which will eventually rupture the appendix if treatment is not promptly delivered.
            If a person is presenting the signs and symptoms of appendicitis they should seek immediate medical attention. At the hospital an appendectomy will most likely be performed. The surgery will most likely be performed via laparoscopy and in some cases open abdominal surgery may be performed. Open abdominal surgery is usually performed if the appendix has already ruptured. Sometimes the diagnosis of appendicitis may actual be negative and not discovered until the surgery is performed. For this reason a CT scan will most likely be taken before the surgery just to increase the accuracy of the diagnosis
            After surgery the patient will most likely need to stay in the hospital for another day or two (Mayoclinic, 2011). The recovery period will take a few weeks and will take longer if open abdominal surgery was performed. In order to help the recovery period go faster some steps that can be taken include avoiding strenuous activity, get adequate rest, and support the stomach when coughing (Mayoclinic, 2011).
References:
MayoClinic.com. (2011, August 13). Appendicitis: Symptoms. Retrieved January 12, 2013, from http://www.mayoclinic.com/health/appendicitis/DS00274/DSECTION=symptoms
Prentice, W.E., Bobo, L.S. & Benson, A.A. (2011). Principles of Athletic Training. New York: McGraw Hill
PubMed Health. (2011, July 22). Appendicitis. National Center for Biotechnology Information. Retrieved January 12, 2013, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001302/

flexor digitorum profundus rupture

The occurrence for hand injuries is usually quite low for athletes, but it still accounts for 9% of all sports related injuries (Peterson, 2006). An acute injury found to happen frequently in contact sports is jersey finger. The medical community calls jersey finger an acute injury known as a flexor digitorum profundus rupture. A flexor digitorum profundus rupture can happen in any of the fingers, but it mainly occurs in the ring finger (Prentice, 2011).

            There will be inflammation and pain, along with the inability of the athlete to bend the tip of the finger. There will be pain and point tenderness on the distal phalanx (Prentice, 2011). The finger may also be numb and depending on the mechanism of injury there could also be a cut at the site of the injury.
            The mechanism of the injury is extension of the finger beyond what it normally should be and therefore the tendon will disconnect from the bone or the tendon may take along with it a little piece of the bone (Geier, 2012). The injury can cause a lot of pain and will render the injured finger to be fixed in extension, because the finger is no longer attached to the distal phalanx.
            Treatment will usually require surgery and will require the surgeon to reattach the tendon to its proper location. After surgery the injured hand will be placed in a splint for protection and to also help the tendon to heal. If surgery is not performed then the patient will still follow the splinting and exercise/physical therapy program warranted for the surgical treatment of a flexor digitorum profundus rupture. The type of injury that warrants nonsurgical treatment are usually partial tears and will be at the discretion of the physician.
            Depending on the severity of the injury the patient may require hand therapy to regain strength and functionality. Some rehabilitation techniques used during physical therapy will include hand strengthening exercises like wrist flexion and extension, finger flexion and extension, and incorporate stretches of the hand.
            After surgery the patient will take about 2 months to heal and then the splint will come off, which will then be followed by a month or more of physical therapy (American, 2011). The athlete may be able to continue with a cardiovascular training program which does not elicit pain or complications to the injured area. Some patients may always have stiffness in the finger or may even a have a build of scar tissue that will require another surgery.
References:
American Academy of Orthopaedic Surgeons (January, 2011). Flexor tendon injuries. Retrieved January 5, 2013, from http://orthoinfo.aaos.org/topic.cfm?topic=a00015
Cuccurullo S, (2004). Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Hand Disorders. Retrieved January 6, 2012, from http://www.ncbi.nlm.nih.gov/books/NBK27249/
Geier, D. (2012). Jersey finger sports injuries: Jersey finger injury treatment. Retrieved January 6, 2012, from http://www.drdavidgeier.com/injuries/jersey-finger/
Peterson, J., & Bancroft, L. (2006). Injuries of the Thumbs and Fingers of Athletes. Clinics in Sports Medicine, 25, 527-542. Retrieved January 5, 2011, from http://www.med.nyu.edu/pmr/residency/resources/Clinics%20of%20NA%20finger%20and%20thumb%20injuries.pdf
Prentice, W.E., Bobo, L.S. & Benson, A.A. (2011). Principles of Athletic Training. New York: McGraw Hill

Little league elbow

Little league elbow is a significant injury that can occur in athletes that participate in sports that require a throwing action. If recurrent microtrauma occurs at the elbow joint the probability of having little league elbow increases. Little league elbow, also known as medial epicondyle apophysitis, is a result of delayed or accelerated growth of the medial epicondyle, medial epicondylar fragmentation, and inflammation of the medial epicondyle of the elbow area (Benjamin, 2011).

The signs and symptoms associated with little league elbow are slow to present themselves.  The signs that can be observed in the athlete’s sport performance can be a decrease in throwing distance, pain in the medial elbow area, and a decrease throwing effectiveness (Benjamin, 2011). Symptoms that are often present in little league elbow may include swelling and tenderness in the elbow area. An athlete may also verbalize that the elbow feels like it is catching or that the elbow feels like it is locking (Prentice, 2011).
The action that causes little league elbow usually comes from repeated stress in the overhand throwing motion that involves the pronator teres muscle and the group of muscles that originate in the common flexor tendon on the wrist and hand. Chronic valgus overload can lead to microtrauma of the growth plate in the medial epicondyle area. This type of repetitive microtrauma is called medial epicondyle apophysitis and it mainly affects pitchers between the ages of 9 to 14 (Little League).
Athletes who suffer from little league elbow should ice the affected area and rest. The athlete may also take non-steroidal anti-inflammatory medication, as directed by their physician. The main form of treatment for little league elbow is non-operative and requires the patient to undergo 4-6 weeks of complete rest, as well initiating a strength and endurance program to maintain cardiovascular levels and to also focus on overall core strength (Karr, 2011). Understanding of proper form, technique, and the mechanics of the throwing action can lead to the prevention of elbow and shoulder joint problems. The rehabilitation exercise program will include proper technique along with strengthening of the forearm muscles. Along with strengthening the forearm muscles the triceps should also be strengthened and stretched (Prentice, 2011). The patient can return to play upon successful rehabilitation and a proper evaluation is concluded, along with the physicians permission to go back to play.
References:
Benjamin, H. (2011, April 19). Medscape. Retrieved January 1 20, 2012, from http://emedicine.medscape.com/article/97101-overview
Karr, S. (2011, April 4). Little leaguer’s elbow. Retrieved January 1, 2012, from http://www.sportsmd.com/SportsMD_Articles/id/293.aspx
Prentice, W.E., Bobo, L.S. & Benson, A.A. (2011). Principles of Athletic Training. New York: McGraw Hill

peroneal nerve contusion

A blow or injury to the peroneal nerve could result in a peroneal nerve contusion. The peroneal nerve branches off of the sciatic nerve and runs down the lower the lower leg to provide for the peroneal muscles. The peroneal nerve contusion is often a result of a blow during a sporting event.

            Signs and symptoms of a peroneal nerve contusion can include tingling or numbness in the lower leg and sometimes the top of the foot. If the contusion or injury is austere then the foot may not be able to be lifted, due to rendering the nerve’s ability to serve the peroneal muscles. The lower anterior leg and the dorsum of the foot may become sensitive, weakened, and a slapping gait may become apparent (Bahr, 2004).
            The cause of injury is due to sports that have a high occurrence of stretch or contusions to the peroneal nerve area. Sports that have higher rates of peroneal nerve contusions include football, rugby, and soccer. A peroneal nerve contusion may be a result of a fibula fracture, knee dislocation, repeated pressure on the outer knee, and injury during surgery (Dugdale, 2011).
            The treatment and outcome of the individual’s injury will depend upon the severity of the peroneal nerve contusion. For some cases corticosteroids may be injected to reduce the inflammation and pressure on the nerve, surgery could be an option, and physical therapy may also be a form of treatment to enhance muscular strength (Dugdale, 2011). Ice and heat may also be recommended, but if sensation is loss in the skin then the patient should be extra careful about the use of ice and heat. Again, depending upon the severity of the injury, the patient may have atrophy in the leg and a physical therapy program will most likely be implemented. If the peroneal nerve injury is substantial in the knee-level then a graft repair will often be the prognosis of the nerve repair (Cho, 2011).
            Recovery time can be lengthy, due to the delicacy of the healing process of a nerve. The treatment may be to let the nerve grow back on its own and this could take several months or the injury may be severe enough to permanently disable the individual.
References:
Bahr, R., & Maehlum, S. (2004). Clinical guide to sports injuries. Campaign, IL: Human Kinetics.
Cho, D., Saetia, K., Kline, D., & Kim, D. (2011, November). Peroneal nerve injury associated with sports-related knee injury. Retrieved December 27, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/22044100

Dugdale, D. (2011, September 26). Common peroneal nerve dysfunction. Retrieved December 27, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/000791.htm

Medial tibial stress syndrome (MTSS)

Medial tibial stress syndrome (MTSS) is an overuse injury or repetitive stress injury that affects the shin area. Athletes often subject their tibia and the surrounding connective tissue with too much force and their physical acidity levels also raise the risk of MTSS. This type of injury is more often seen in athletes that participate in sports that are require sudden starts and stops, such as basketball, soccer, and tennis (Mayo Clinic, 2010). Many athletes refer to MTSS as “shin splints”, but there exist a variety of injuries that can be sustained in the lower leg area and therefore a professional healthcare provider will need to accurately diagnose the athlete.
            Signs and symptoms that are associated with MTSS are tenderness, soreness, and pain around the tibia area. There may be swelling in the lower leg area, as well. The prevalence of these signs and symptoms vary for each individual, but are usually more likely to be seen and/or felt during the exercise and may stop when the activity is discontinued. There may be complications in the diagnosis of MTSS, so the healthcare provider we need to do an in-depth history and physical exam to eliminate other causes that could be misconstrued as MTSS. Other measures that may be taken to ensure the correct diagnosis is provided include imaging, vascular and nerve conduction studies, and compartment pressure measurements (Galbraith, 2009).
            The cause for MTSS is the excessive force, the overloading, of the tibia bone and the connective tissues of the muscle of the tibia area (Mayo Clinic, 2010). The athlete engaging in a running program or exercise program that has implemented running too hard, too fast or for too long may cause the injury. Specific athletic activities that can cause and overload on the tibia area include running on a decline, running on an uneven surface, participating in sports with constant stops and starts, and running inadequate footwear (Mayo Clinic, 2010). The injury is often a combination of both training errors and biomechanical abnormalities.
            Although MTSS is usually not that severe injury, it can be somewhat debilitating and may even progress into more complicated injury if not treated properly. Rehabilitation includes ice, rest, and analgesic in the first 48-72 hours (Galbraith, 2009). The healthcare professional may also suggest discontinuing the activity that is suspected of being the culprit of the injury. Usually, decreasing by the weekly running distance, frequency, and intensity by 50% will likely improve the symptoms, so completely stopping activity may not be warranted (Galbraith, 2009). The healthcare professional may suggest or recommend someone more knowledgeable that can prescribe a specific training program for stretching and strengthening the lower extremities. Other recommendations may include modifying the athlete’s previous training routine, implementing the use of orthotics, wearing the appropriate footwear, and the use of manual therapy to correct biomechanical abnormalities (Galbraith, 2009).
            The key to treatment for MTSS is the prevention of the injury. Athletes are more susceptible to incurring the same injury if the errors in their previous training program are not corrected and the alignment of the abnormalities are not corrected by a competent healthcare professional. An athlete that partakes in an extracorporeal shockwave therapy (ESWT) compared to a graded running program will recover significantly faster, respectively 59.7±25.8 and 91.6±43.0 days (Moen, 2011). The length of recovery is dependent upon the severity of the injury, the adherence to the prescribed rehabilitation program set forth by the healthcare provider, and the individual person’s biomechanical abnormalities.
References:
Galbraith, R., & Lavallee, M. (2009, October 7). Medial tibial stress syndrome: conservative treatment options. National Center for Biotechnology Information. Retrieved December 18, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848339/
Moen, M., Rayer, S., Schipper, M., Weir, A., Tol, J., & Backx, F. (2011, February 3). Shockwave treatment for medial tibial stress syndrome in athletes. British Journal of Sports Medicine. Retrieved December 18, 2012, from http://bjsm.bmj.com/content/early/2011/03/09/bjsm.2010.081992
Mayo Clinic (2010, December 21). Shin splints. Retrieved December 18, 2012, from http://www.mayoclinic.com/health/shin-splints/DS00271

Muscle strain

A muscle strain is a musculoskeletal injury that can be sustained by any muscle in the body and is often the result of improper form and excessive load placed upon the muscle. A muscle strain is an injury that involves the tearing or stretching of a muscle or tendon (Mayo Clinic, 2011).

            Signs and symptoms for a muscle strain include swelling, pain at site, limited ability to move the affected muscle, and muscle spasms may also occur (Mayo Clinic, 2011). A muscle sprain may cause some individuals to bruise, have redness, and may even cause an open cut. Symptoms and signs for muscle strain vary between three different grades of severity. A Grade I muscle strain is the less severe and progresses in severity to a Grade II and finally to a Grade III. The symptoms may include feeling pain when performing movements and there may be slight muscle tenderness. An injured person with a Grade I muscle strain may show signs of mild point tenderness. An injured patient with a Grade II or III would show signs of weakness, swelling, muscle spasm, moderate to severe point tenderness, present an indentation or lump where the muscle or tendon is torn, and may be unable to perform their normal techniques with normal motion (Flegel, 2008).
            A muscle strain causes can fall into two different categories: acute or chronic. An acute cause for a muscle strain is when the individual is injured in an abrupt manner. When a muscle strain is acute in nature the muscle or tendon is torn, overstretched, or pulled beyond its limit. Acute muscle strains are often a result of slipping/falling unexpectedly, lifting a heavy object, utilizing poor and improper form, or running (Mayo Clinic, 2011). A chronic muscle strain results from prolonged and repeated movements that cause injury to the muscle and/or tendon. Chronic muscle strains often occur from repetitive movements, usually at work or sport, that cause damage.  Other causes of a strain can include weak and inflexible muscles in and/or around the injured area.
            If a patient sustains a muscle strain the patient should maintain the strained muscle in the stretched position and implement rest, ice, compression, and elevation (Shiel, 2012).  The injured individual should also take a nonsteroidal anti-inflammatory drug and may need to see a physician if the severity of the injury is too great. Depending on the severity of the injury crutches or a brace may be recommended. A physician will also tell the patient if certain activities should be avoided, how much time off work is necessary, and may suggest a flexibility and strength program (Shiel, 2012).
            Recovery time is dependent upon the severity and location of the muscle strain. Recovery time can also be minimized if the patient adheres to the rehabilitation program set forth by the physician and also by avoiding activities that cause undue pain. The recovery time for a Grade I, II, and III injury would be dependent upon the injured patient regaining full strength, range of motion, and flexibility in the injured area. In the case of a Grade I strain the patient could be classified as safe to return to normal activity once these three criteria are satisfied. The main difference for the Grade II and III is that the patient has to see a physician and be medically cleared.
References:
Flegel, M. (2008). Sports First Aid: A coach’s guide to the care and prevention of athletic injuries, 4th ed. Human Kinetics Inc.
Mayo Clinic. (2011, October 25). Sprains and Strains. Retrieved December 11, 2012, from http://www.mayoclinic.com/health/sprains-and-strains/DS00343
Shiel, W. (2012, January 13). Muscle Strain. Retrieved December 11, 2012, from http://www.emedicinehealth.com/muscle_strain/page5_em.htm

Hernia

A hernia is a “protrusion of abdominal viscera through a portion o the abdominal wall” (Prentice, Bobo & Benson, 2011). Hernias of the abdominal wall are listed in one of two categories, congenital and acquired. Those that are congenital are developed before birth and those that are considered acquired are developed after birth.

Hernias are described as having a mouth, neck and body. They are most common in the groin area. The most common types of hernias are inguinal and femoral. Inguinal hernias are seen mostly in males where the femoral hernias are more commonly seen in females.
Some of the signs of a hernia are pain and discomfort in the groin area. A patient may also complain of a superficial protrusion that is made worse by coughing. They may also feel a pulling sensation.
Surgery is the best option to treat a hernia that is producing significant discomfort and pain.  There are other options such as light workout and mechanical devices but they have not been proven successful.
·         The surgery is normally an outpatient procedure and patients can go back to light activity two weeks after surgery and may return to strenuous activity 4 weeks post-surgery. There are also some risks to having the surgery such as the normal risks of general anesthesia,scar tissue and infections. There are also bigger risks such as  pain or damage to the cord that carries sperm from the testicles to the penis. This could affect your ability to father children, fluid (seromas) or blood (hematomas) in the scrotum, the inguinal canal, or the abdominal muscles (Poinier, & Mercer, 2011).
Hernia surgery is not guaranteed to cure the problem 100% of the time. There is a possibility from 1-10% that a hernia will come back after surgery treatment (Poinier, & Mercer, 2011).
References
Poinier, A., & Mercer, C. (2011, April 26). Laparoscopic inguinal hernia repair. Retrieved from http://www.webmd.com/digestive-disorders/laparoscopic-inguinal-hernia-repair
Prentice, W.E., Bobo, L.S. & Benson, A.A. (2011). Principles of Athletic Training. New York: McGraw Hill

Sacroiliac sprain

Patients often complain of a dull ache in their bones. The pain may be radiating.  Our book states that “palpable pain and tenderness directly over the joint” (Prentice, Bobo & Benson, 2011).   They may complain of an increase in pain when walking especially at an incline or decline (Prentice, Bobo & Benson, 2011).  They may also complain of pain when moving from a sitting to standing position. Pain intensifies when the patient is laying on their “bad” side or bending forward. Most patients also experience muscle spasms.

   Pain relief is seen in sitting. Patients most likely to experience sacroiliac sprain may be pregnant, have a difference in leg length, suffer from degenerative arthritis, have asymmetrical anterior superior iliac spine or an asymmetrical posterior superior iliac spine. They may suffer from a rotation of the pelvis or pelvic inclination and lumbar lordosis. 4- Rehabilitation: The first step in rehabilitation for a sacroiliac sprain is bed rest (Sacroiliac Sprain Syndrome, n.d.). Inflammation is combatted with non-steroidal anti-inflammatories. Because muscle spasms are often apparent muscle relaxants may be used. On some occasions steroid shots are used when medication does not relieve the inflammation.  Some patients may need to use a brace. Physical therapy is often used to help strength and mobility. Manipulation of the sacroiliac joint can really be helpful (Sacroiliac Sprain Syndrome, n.d.). Recovery time is from 4-6 weeks (Sacroiliac Sprain Syndrome, n.d).
Reference
Prentice, W.E., Bobo, L.S. & Benson, A.A. (2011). Principles of Athletic Training. New York: McGraw Hill
Sacroiliac Sprain Syndrome. (n.d.). HealthCentral.com – Trusted, Reliable and Up To Date Health Information. Retrieved January 8, 2013, from http://www.healthcentral.com/encyclopedia/408/464.html