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History and Role of Team Doctors in Sports: From 19th Century to Present

Explore the history, training, and responsibilities of team doctors in sports, from their early presence on the sidelines to the formation of the NCAA and the significant reduction in injuries. Learn about the crucial role team doctors play in providing medical care for athletes and how they work together with athletic trainers in diagnosing and treating injuries.

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History and Role of Team Doctors in Sports: From 19th Century to Present

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  1. Team Doc 101 Lutul D. Farrow, MD Cleveland Clinic Sports Health Assistant Team Physician Baldwin-Wallace College

  2. History • 19th century • 1st Physicians on sidelines • Almost banned 1905 • Serious injuries • Deaths • Rule/equipment changes • Formation of NCAA • Greatly reduced injuries

  3. History • Hundreds of thousands athletes • Adolescent • High school • Collegiate • Professional • Thousands of team docs

  4. Definition • Licensed MD/DO responsible for treating and coordinating the medical care of athletic team members

  5. Principle Responsibility • Provide for the well-being of individual athletes

  6. How to Get There • Early desire • Athletic Background • 4 years college • 4 years medical school • Allopathic (MD) • Osteopathic (DO)

  7. How to Get There • Medical • Internal medicine • Pediatrics • Family medicine • Physical Medicine and Rehabilitation • Surgical • Orthopaedic Surgery • Sports medicine • Other subspecialties

  8. Case Presentation

  9. Case #1 • D.B. • 22 yo Varsity College FB player (DE) • Chief Complaint: Right ankle pain

  10. Case #1 • History • “Coming off of a block and rolled my right ankle” • Inversion injury • Felt a ‘pop’ in the ankle • Able to walk off the field • Not able to return to play

  11. Differential Diagnosis • Most likely diagnosis? • Ankle sprain • Ankle sprain • Ankle sprain • Fracture/dislocation • Muscle strain • Dislocated tendon • Torn tendon

  12. ATC’s Role • Alert coaching staff • Initial athlete evaluation • “ATC gestalt” • Triage • Patch and go • Versus • Communicate with Doc

  13. Team Doc’s Role • OBSERVATION! • Be a trained observer! • Gait • Swelling • Deformity • On-field performance • Compare to other side

  14. Team Doc’s Role • Communicate with ATC • Help coordinate care • Timely athlete evaluation • In gear • Versus • Gear off • Sideline vs Locker room • SAFELY get patient back into competition

  15. Anatomy

  16. Ankle Anatomy • Bones • Tibia • Fibula • Talus

  17. Ankle Anatomy • Ligaments • “ORTHO PROOF” • Named by bones

  18. Ankle Anatomy

  19. High Ankle Anatomy

  20. Ankle Sprain Anatomy • Type I • Stretched • Type II • Partially torn • Type III • Completely torn

  21. Ankle Exam

  22. Ankle Exam • Observation • Swelling • Bruising • Deformity • Palpation • Medial • Lateral • Proximal

  23. Ankle Exam • Special tests • Anterior drawer • Talar tilt

  24. Ankle Exam • Special Tests • Squeeze test • External rotation test

  25. Case #1 • Exam on sideline • Antalgic gait (visible limp) • +Swelling • No deformity • No ecchymosis (bruising) • Significant TTP (pain to touch) • No bony TTP • Stable • No “Syndesmosis pain” • “NV intact”

  26. Case #1 • On field • Ankle taped • Standard tape job + ‘spats’ • Unable to perform sport-specific drills • Placed in walking boot/crutches • Similar exam in injury clinic next day • Sent for xrays on Post-injury day (PID) #2

  27. Case #1 • Interval history • PID #7 • Weaned out of boot • Attempt to ramp up activity • No go • Back into boot • PID #7 – 21 • Continued ankle rehab • Step-wise improvement (objective/subjective)

  28. Case #1 • Returned to play 3 weeks after injury • Played in 2 Varsity Games • Still mildly hobbled by injury • Ankle not at 100% • No interval injury • MRI obtained at 5 ½ weeks post injury • Continued pain

  29. Not a sprain • MRI showed talus fracture • Nondisplaced • Also showed ligament tears

  30. Differential Diagnosis • Most likely diagnosis? • Ankle sprain • Ankle sprain • Ankle sprain • Fracture/dislocation • Muscle strain • Dislocated tendon • Torn tendon

  31. 10/29/2007

  32. 9/13/2007

  33. Capsular Distention – Original Films

  34. Case #1 • Treatment • Foot & Ankle Specialist consulted • Non-operative management • Cast x 3 weeks • Aircast boot x 3 weeks • Follow with serial imaging

  35. Case #1 • Healed fracture • 10 month xrays • 10 months later • No pain • Full motion • Spring practice

  36. Discussion • Talar neck fractures • Hi energy trauma • Usually require surgery • This is the first reported case in athletic competition

  37. Submitted for Publication

  38. Conclusions • Take home message • Keep the athlete first • Communication is key • Keep an open mind • Observe, observe, observe • When in doubt, get more information

  39. Questions?

  40. Detection of radiographically occult ankle fractures following acute trauma: positive predictive value of an ankle effusion. • Clark et al • Am J Roentgen 1995 • Prospective plain film evaluation • 1,153 ankles w/acute trauma • All with negative x-rays • 33 patients with capsular distention on x-ray • 11/33 with fracture on tomography Clark TW, Janzen DL, Ho K, Grunfeld A, Connell DG. Detection of radiographically occult ankle fractures following acute trauma: positive predictive value of an ankle effusion. Am J Roentgen. 1995;164(5):1185-1189

  41. Vascular supply • Inokuchi S, Ogawa K, Usami N: Classification of fractures of the talus: Clear differentiation between neck and body fractures. Foot Ankle Intl 17:748-750, 1996.

  42. Clark et al (cont) • Cumulative measurement of anterior/posterior fat pads • Predictive for fracture • Composite measure > 13mm • 82% sensitive • 91% specific • Retrospective analysis of our athlete • 16mm composite measure • Highly suggestive of occult fracture Clark TW, Janzen DL, Ho K, Grunfeld A, Connell DG. Detection of radiographically occult ankle fractures following acute trauma: positive predictive value of an ankle effusion. Am J Roentgen. 1995;164(5):1185-1189

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