Shoulder pain and weakness explained by Jeffery S. Cantrell, M.D. - Living well Magazine

Coming back from injury to win a national championship title and represent Team USA - By Nicholas D. Evans

 

In the summer of 2006, I broke my right ankle playing soccer with my kids in one of the parks in Highland Village. I had accidentally stepped on top of the ball at full running pace when the ball hit a patch of uncut grass and had slowed up unexpectedly. I twisted my ankle inwards as my foot rolled off the ball and, since standing up was not an option, had to be stretchered off the field and taken to the hospital for x-rays. 

My family and I had been existing patients of Orthopedic Associates in the past, so we choose Doctor Cantrell to perform my surgery. Since both my tibia and fibula were completely broken, I ended up with a plate and about nine screws in my ankle to hold everything together. Since I was home-office based, in addition to my work commitments, I spent a lot of the summer at home watching the World Cup on television as my injury healed.

The ankle needed considerable physical therapy to get back as much strength and range of motion as possible, but after a few months I was able to start walking and even running again. At the time, the running was a very slow jog around the athletic track at Briarhill Middle School. After about a year, I had progressed to much more strenuous workouts at the local gym, including the rowing machine, and with the consultation of Dr. Cantrell, we decided to remove the plate and screws to provide a bit more flexibility. 

I went about my usual routine for a couple of years, and then in late 2009 I decided to pick back up competitive sports in the form of triathlon. I had swum a lot for my local school and for the city where I grew up and had also been an avid cyclist. I had also competed in sailing, windsurfing and rowing in my younger days and had always enjoyed competition. After my first local triathlon, a Sprint distance event of a few laps in the pool, a 12 mile bike, and a 5K run I was hooked! I promptly entered a further three or four races that fall including the LifeTime Fitness Toyota U.S. Open. What was amazing was that the ankle held up perfectly and was perhaps even stronger than my other one. All the physical therapy had strengthened my legs, so that the only limitation was my fitness level.

 

 

As I continued to train and race in local events, and with the guidance of one of the top coaches out of California, I was able to elevate my fitness level to the point where I qualified for Team USA at the USA Triathlon national championships in Iowa in 2010 and then represented the U.S. at the ITU Sprint Distance World Championships the same year in Budapest, Hungary. More recently, in 2011 I won the National Championship title in the Sprint Distance triathlon in the Clydesdale (over 200 lbs), 40+ division. Today, I am truly enjoying the opportunity to race in these events and am thankful for the fine work of the doctors and medical staff that enabled me to get back to everyday life and in some ways even do more than I had in the past.

 

Tommy John Surgery - Manuj Singhal M.D.

Tommy John surgery, more commonly known as ulnar collateral ligament reconstruction (UCL), is a common surgical graft procedure to the elbow that was first performed in 1974 by Dr. Frank Jobe and named after its first patient, former major league baseball pitcher, Tommy John.

Common among college and professional athletes, especially baseball player, throwing a baseball or a javelin enforce repetitive and violent motions to the elbow which could lead to inflammation, microscopic tissue trauma, and possibly tear to the ulnar collateral ligament (UCL). Only rarely do UCL injuries interfere with non-throwing activities.

Symptoms associated with a UCL injury include:

·         Pain on the inside of the elbow

·         A sense of looseness or instability in the elbow

·         Irritation of the "funny bone" (ulnar nerve): This is felt as tingling or numbness in the small  finger and ring finger.

·         Decreased ability to throw a baseball or other object

UCL injury is diagnosed using patients' medical history and physical examination including X-Ray and MRI. Rest, ice, and physical therapy are generally recommended prior to the surgery.

Tommy John procedure is a surgical operation in which a ligament in the elbow is replaced with a tendon from elsewhere in the body. Complete recovery is estimated at 85 to 90 percent.  For baseball players, rehabilitation takes about 12 to 15 months for baseball pitchers and 6 months for position players.

Manuj C. Singhal, M.D. of Orthopedic Associates is one of the few doctors who perform the Tommy John Surgery in the DFW area. Doctor Singhal had surgical fellowships in sports medicine at the American Sports Medicine Institute in Birmingham, Alabama with doctor James R. Andrews who is known and recognized on an international level for his skills in Orthopaedic surgery and his scientific and clinic research contributions in knee.

 

Please refer to the table below to help prevent UCL injuries:

Pitch count limits and rest before pitching again for all levels.

League Age	Pitch count limit	Rest Requirements	Rest Requirements	Rest Requirements	Rest Requirements
10 and under	75 pitches a day	61+ pitches- 3 day rest	41-60 pitches- 2 day rest	21-40 pitches- 1 day rest	1-20 pitches- 0 days of rest
11-12	85 pitches a day	61+ pitches- 3 day rest	41-60 pitches- 2 day rest	21-40 pitches- 1 day rest	1-20 pitches- 0 days of rest
13-16	95 pitches a day	61+ pitches- 3 day rest	41-60 pitches- 2 day rest	21-40 pitches- 1 day rest	1-20 pitches- 0 days of rest
17-18	105 pitches a day	76+ pitches- 3 day rest	51-75 pitches- 2 day rest	26-50 pitches- 1 day rest	1-25 pitches- 0 days of rest

(Source: http://www.massgeneral.org/ortho/services/sports/pdfs/little-league-pitch-count.pdf) (www.webmd.com)