Joint Effort PAs
We're two orthopedic surgery physician assistants discussing PA school, life as a PA, cases and topics related to orthopedics, and much more!
Joint Effort PAs
The Injuries Behind the Madness
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Bracket busters, buzzer beaters… and a lot of orthopedic injuries.
In this episode of Joint Effort PAs, we break down the most common injuries seen during basketball season and March Madness—from the classic ankle sprain to the biggest season ending injuries we've all seen.
We dive into how these happen, how they are managed, and thoughts from the ortho PA perspective.
Whether you’re watching the tournament, working the sidelines, or seeing these injuries in clinic, this episode gives you the orthopedic perspective behind the madness.
Tempo: 120.0
SPEAKER_00Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it. All right, guys, we are back. Back in action. Back in action. We have a guest with us today. Scout came to Yeah.
SPEAKER_02In honor of March Madness, we brought the most athletic dog that we have with us today. He won't stop moving. So.
SPEAKER_00Although is he as like jumping as athletic as your other dog? Or who's like the better jumper?
SPEAKER_02Um, he is the endurance athlete. Okay, he could just keep going and going, going. And then Annie, my my pit bull, has an insane amount of power. Like if we're talking about like triple jump, Annie. Yeah we're talking about like a 3200 scout. I love that. Yeah.
SPEAKER_00Amazing.
SPEAKER_02Yeah.
SPEAKER_00All right. Well, yes. For March Madness, the theme of the week. Um, we're gonna go over some common basketball injuries and some big injuries that have happened over the past uh several years in basketball.
SPEAKER_02So So do you think like just because you're an orthopedic PA, everybody assumes that you love all sports?
SPEAKER_00Yes. Yeah, I think that that's true. I mean, I have my favorites. Yeah. I don't I certainly don't love all of them. I have a really hard time watching baseball on TV personally.
SPEAKER_02Yeah. I mean, I think at this this time of year, Marsh Bandis is fun to watch because the volume is so high.
SPEAKER_00Yeah, and I mean you know, there's something in it for us with the brackets and everything.
SPEAKER_02Well, not for me anymore, but no, but as a like as a sports fan and a basketball fan, I like watching the game because it's quick. I mean, it's easy to like follow, whatever. But as a provider, I literally can't watch the injuries happen. Really? Yeah. Like if I see it, it's happening, it's like ad lib. I'm like, oh my god, when they were playing in slow-mo, I can't watch it. I can't do it.
SPEAKER_00Do you think that has to do with the fact that like you personally were an athlete? Yeah, yeah, and you have personally injured yourself. Yes. Yeah. I think it's interesting too. A lot of people who go into orthopedics um were athletes before. I would say most people.
SPEAKER_02I think there's just I think you think you're well, I'm speaking, I guess, personally, I think I can relate to athletes better because I've been there. Like I get their mentality. Whereas I would think if I had a provider that didn't know anything about sports and wasn't athletic looking, I'd be like, Yeah, what do they know? Like we had when I played um college soccer and we had a uh person, like a trainer or whatever. Yeah. And she was ridiculously overweight. And I was like, Come on, yeah.
SPEAKER_00Come on. Yeah. Like that's really hard to like, you know, like stress. You're gonna tell me what to do. Yeah.
SPEAKER_02If you're someone like we talked about the CrossFit people, like if I walk into a CrossFit gym and I see someone jacked, I'm like, this is the gym I need to go to. Yeah, yeah. Like I don't know. Yeah.
SPEAKER_00Yeah. Yeah. I actually I didn't play any. Well, I mean, like I played some sports when I was young, um, like little team sports or whatever. But once I got to high school, I joined the sports medicine club.
SPEAKER_02Yeah, but that's like, again, if you were my provider, I would be like, oh my God, their head was in the right place.
SPEAKER_00Yeah, I went to sports medicine camp one year. When I was a junior in high school, everybody like went on like cruises and was like, I don't know, partying or whatever. And I went to sports medicine camp at William and Mary. Um my God, it was so exciting. There was a cadaver lab and everything. Um, I was president of our sports medicine club and I started our National Honor Society for sports medicine. And I've never done anything different in my whole life now.
SPEAKER_02So that's great though. Like I feel very good about that. Actually, my daughter is taking some sports medicine class and she she really likes it. Um, and they have in the area, you can do like a four-day boot camp where you go to like Duke ER and they'll take you through that. I'm like, can you sign up for that? That's so cool. Yeah, but she she's not thinking it's as cool as I think it is, which makes me think that I'm projecting on her, which I probably am. Yeah, I mean like a little bit. A little bit, but that I'm like, oh my god, you should do that.
SPEAKER_00Would be like the coolest thing to do. Yeah, but yeah, so orthopedics and sports obviously go hand in hand. Um, and march and basketball go hand in hand. So let's chat some like common basketball injuries first. So, like what what are the most common things we see? And um, it's a lot of lower extremity injuries, a lot of ankle injuries.
SPEAKER_02So, right now, actually, like last week, we fixed two 14, one was 14, one was 15, uh, tibial tuberosity avvulsion fractures, aka patellar tendon ruptures in the skeletal immature. Both were, well, one was a basketball injury, the other one was like a taekwondo situation, but it's the getting ready to jump and explode, and then your patellar tendon slash your tibial tuberosity just explodes as well.
SPEAKER_01Wow.
SPEAKER_02Yeah. And that's not the first time we've seen that. That unfortunately is like I jumped up for the layup or I jumped up for the rebound and um I came down and I like was on the ground.
SPEAKER_00So that's your skeletally immature immature. It's kind of like the uh the traumatic Osgood Schlauders. Yes, yeah. Um, versus Osgood Schlauders being like your chronic, uh easily, more easily managed. Yeah. So what are you doing for those? Do you use like a screw or so?
SPEAKER_02Actually, those two we did this past week. So those two, one had evolved his entire tibial tuberosity off. So put it put it back down, two screws done. The other guy had pulled some of the bone off, but it was more like an actual patellar tenin rupture. So believe it or not, like halfway up the patellar tenin, there was this little piece of bone big enough to put a screw down in through. So we ended up screwing that right into the um tibial tuberosity, and then just distal did the patellar ten repair. So it's like grid. It was really cool.
SPEAKER_00Yeah, yeah, yeah.
SPEAKER_02Um but those do pretty well rehab. Yeah, those they they will return. They will return to full sport probably in about four and a half to six months. Um more so the ORF faster than the patellar tendin repair just because bone versus soft tissue. Right.
SPEAKER_00Um, which people always think the opposite. They're like, oh, I didn't break it.
SPEAKER_02Yeah, no, yeah, yeah. Um, but those injuries, um, those those are always surgical. That's it's not like they they didn't have a chance to non-op that. Yeah. So that's never a great conversation for the kid that's in like, you know, in season, like this is over for you now. Yeah. Um, but we will see ACLs, like that's a big loss. Yeah, unfortunately for basketball players, and that's usually on the land. So if they're cutting and twisting, non-contact, jump and land, or you go to pivot, push off that leg, and it gives out on you, and it's all over from there.
unknownYeah.
SPEAKER_00A lot of ankle sprains. I don't treat those as often now, but I feel like that was like 80% of working in urgent care during basketball season. Football, like any season, like ankle sprains are just so freaking common. Yeah. Um, I was joking with our foot and ankle surgeon. I was like, we should have got you on there for or got you on here for this episode if you knew it had existed. But but you have to know it exists in the world. You have to know it exists in order to be involved.
SPEAKER_02But you can watch like March Madness Weekend and you can count the amount of ankle sprains. Like I was casually watching last night, and again, this guy came down from a rebound and just laying on the side of his foot. Yeah. Like you know that that's that's rough. Yeah. Um but upper upper extremity, like if you're playing a sport where you're catching something throwing at you, that's right. You do get things of it. Yeah.
SPEAKER_00So I was thinking about because when I initially like did a little outline, it was all lower extremity stuff, um, ankle sprains, Achilles ruptures, ACL. Um, but I'm like, well, where's the hand stuff? Like, where's my interest? Um, and we do see quite a few finger injuries. So hyperextension injuries, um, or the quote unquote jammed finger, my favorite term that people use, like, oh, I think they just jam their finger. I love that term. Yeah. Jamming your finger, mind you, can be like as simple as like a little mild volar plate sprain, yeah, all the way up to something that requires crazy surgery. Yeah. Um, so I mean, a jammed finger you have to you have to be careful with. So common ones, I think we see mallet finger injuries, right? From something hitting the tip of their finger, um, which do require extensive splinting. Um, and then yeah, PIP uh either sprains, like a volar plate sprain, all the way up to like fracture dislocation situations, which we dealt with. I think I was talking about that one last week where we had to do the hemi-hami. Yes.
SPEAKER_02And but the UCLs too. You'll see a lot of thumb UCLs.
SPEAKER_00Yeah, thumb UCLs, um, which we were looking at one of the UNC players uh injured. We I couldn't really find any details on what exactly it was, but it said it was a right thumb injury that initially was diagnosed as a sprain, but it was a misfracture. So I'm like kind of assuming it was a injury. Um, but I don't know, I couldn't really find details on it. But yeah, there there definitely are some finger injuries you have to be careful with because those are the ones I feel like even as an athletic trainer before I was in this specialty, I'm like, oh, like you popped your finger out of place. Like, let me just pop that back in, teep it, you're gonna get back out there and do your thing. Um, not that I wouldn't do that in the moment still, but like the later consequences I now know to be more dire.
SPEAKER_02I think though it's like, okay, let's say you're retreating a college athlete right now that is in your, you know, the first, second, third round of um playoffs. If they were to jam their finger, let's say x-rays were negative, you tape that bad boy. Oh, totally.
SPEAKER_00No, you keep you keep playing through it. I mean, this is all we were just chatting about this. This is all highly dependent on like the person's level and the stakes at hand. And I think um, you know, from like a sports medicine perspective versus looking at it purely from like a medical perspective, these are very different ways of approaching things.
SPEAKER_02But even the the UNC basketball player Caleb Will Wilson, you can't play with a chronically torn UCL. Sorry. I mean, I guess you could. Yeah. I mean, like and But like for basketball and catching hand, like throwing hand, like shooting hand.
SPEAKER_00I'm sure there's some, you know, if you have like gross instability, yeah, it's gonna be a problem. But I also saw a patient a couple weeks ago who was sent to us by our sports med doc and um had a complete UCL rupture, like MRI confirmed. Um, I evaluated him and I'm like, it's like really not loose compared to your other side, no pain, full range of motion. I'm like, yeah, we're not fixing, you know, we're not fixing this. Um so I think people can do well with them if it's not completely unstable.
SPEAKER_02Yeah, but I think that's also important, like some injuries for higher level athletes that may be surgical right then and there for the like mediocre population. Yeah, yeah. Maybe you kind of ride that a little bit further. Yeah. Um, and fun fact, Hannah used to be, currently is an athletic trainer.
SPEAKER_00Uh okay, yeah, yeah. We can't we can't advertise it anymore. But we can't get like uh shunned from the BOC. But no, I was an athletic trainer. Yeah. Um and I just let my certification lapse and I'm having feelings about it, so I may have to reinstate it coming up here soon. But I think it's just a different way of like approaching things because yeah, there's there is a importance factor associated with playing sports versus um the weekend warrior. And you know, we all we hate to hear that.
SPEAKER_02Yeah, but if you're if you are, you know, a provider, whether that's a PA or an athletic trainer, and you're treating somebody in season from a sports medicine standpoint, you're gonna let that person play if they can safely. And that's not worldwide in orthopedics. Like, I don't think a total joint surgeon would be able to have that conversation with a sports med medicine brain in mind, if that makes sense. Right. Yeah. Um, did you think when you were um, or do you think even at the collegiate level or when you were an athletic trainer, do you think if someone injured themselves they like hide it from you? Or they're like, No, no, it wasn't that bad. Like we can make out there.
SPEAKER_00I had this conversation on Friday night with our uh one of our concussion um doctors. Um, and he I was telling him, like, we're talking about thresholds of pulling people and stuff, because the the laws for that change pretty regularly. Um, and I always say my my threshold depended on the person and how well I knew the athlete because if they are top-notch, high level, if they're really good, I know they're gonna hide stuff right. Like they don't want to not play, right? Right. Right. So if they report, like if they're telling me even the slightest thing that like gets your radar off, I'm like concerned. I'm like, all right, this is this is probably serious. Versus, you know, little Johnny who like doesn't really get to play that much. And I think he actually doesn't want to play because he's not that good and he's not getting this like he his parents made him sign up for the football team, right? He's coming over to me and he's like, My head hurts. Like, yeah, I'll probably pull him because what does it matter anyway? Yeah, but like I'm not super, super concerned. Yeah.
SPEAKER_02But even um if you have someone who is very high level, I feel like if someone, like I think you were saying this before, if they're really hurt and they say something to you, like if you haven't communicated with them all season and they're the star player and they come over to you, like, hey, I hurt this, you know that they really hurt it.
SPEAKER_00It's like the farmer phenomenon in the ER. Yeah, like the the old farmer comes in, he's like, My chest kind of hurts, and everybody's like, You've had three heart attacks. This is your fourth, yeah. Yeah, so yeah, high level of concern for the high level because they they have so much at stake for it. Like that is they care a lot. So um, but yeah, speaking of that stuff, we have some like major injuries that we wanted to to kind of run through, some of the big ones that um that have cropped up over the years. So all this is the biggest one I always think of. Yeah. Kevin Ware. Yeah. Um, which was 2013. That was thir what 13 years ago. That was a long time ago. A long time ago, but it was a very different place in my life. Yeah.
SPEAKER_02But were you what place in your life were you here now? No, I I think I wait. No, I wasn't even here. I was living in Connecticut, two kids, about six years into my sports medicine, you know, career or whatever. Um, and I remember seeing this and thinking to myself, like, oh, that was that was aggressive that they fixed it that night. But now, you know, knowing all the things that I know, I was like, they had no other choice. Yep. Like that is something that is emergent. But I remember thinking at the time, like a healthy, what are they, 22, 22-year-olds, right? Yeah. Okay. Healthy athletes who come down and land awkwardly enough to suffer an open tip fib fracture. Like, there's some underlying things. Like, I think to myself, there was probably like a stress fracture that was happening. Totally.
SPEAKER_00Yeah. Like it was it was in the early stages.
SPEAKER_02It was not a healthy individual that just so happened to land and the tibby exploded.
SPEAKER_00Yeah. Yeah. There was had to be something brewing prior to that.
SPEAKER_02Yeah. And you you think about it, right? Like these athletes had started their season, what, November?
SPEAKER_00Yeah.
SPEAKER_02And then preseason was before that. And now they're playing, at least, you know, relating to current times, whoever played last night, which is Saturday, also played Tuesday, also played Thursday. You know what I mean? So much about it. This is at the time of the season where overuse injuries, yes, there's not a lot of rest happening. Um, so I think this one was a combination of there probably was something underlying happening, and the way that the player landed just uh resulted in disaster.
SPEAKER_00It was disastrous. That was during the elite eight rounds. We had already played several games, obviously. I was in um undergrad, I was in athletic training program at that time. So that was probably a big hit for us. We like went to class that morning. What would you do? Yeah, yeah, yeah.
SPEAKER_02Um, have you ever seen that one in your rotations to as an athletic trainer? An open tip fracture.
SPEAKER_00Um, no, I have not. The closest thing I ever saw that was like not quite as detrimental, but could have been. Um, I was working a baseball game for like a like a summer league, collegiate summer league, and um turf field metal spikes. Apparently that's a bad combination. I was naive to naive to that kind of stuff. I mean, I'm just like walking in and covering. This isn't my team or anything. And um he like landed weird on his knee. They called me out to eval him. He didn't get up. A little concerning for for baseball. Like if somebody goes down in the outfield, he like went up to catch a ball and came down and twisted weird. And so he's got on long pants and I'm like palpating through his pants. And I'm like, I like everything feels weird. Like, I'm not sure what I'm feeling, but this doesn't feel like a knee. Yeah. Because it was a complete tibio ephemeral dislocation. Yes. It was crazy. So I was like, why is your kneecap like over? I was like, I have no idea what I'm feeling. So I cut his pants down and I'm like, holy crap. Yeah. Um, fortunately, like he had no vascular injuries because of it. It was my personal nightmare because again, I walked in this situation covering like I knew a little bit about their emergency action plan. I knew that they like they had a gate where the EMS could come in through. So I call EMS or I have somebody else call EMS, um like checking his pulses and everything, and they're like, we can't find the key to let EMS in the gate. I'm like, get it the fuck together right now, guys.
SPEAKER_02Yeah. Well, it's crazy though, because like, you know, you're there and the plan is call EMS, but like, how many times does that really happen?
SPEAKER_00They call EMS. Right.
SPEAKER_02I mean, enough times where they don't know where the key is, right?
SPEAKER_00Um, but yeah, I've never seen anything to that extent. I mean, the the basic principles of it, I mean, obviously they like covered it up really fast, you know, whatever. They're gonna they're gonna have to irrigate the shit out of that anyway in the OR. He ended up getting an uh IM nail um that night.
SPEAKER_02So yeah, but open fractures. I mean, I played with a girl in college who went in for like a um, she went in for a tackle with a goalie and she broke her tibia, but that was a closed fracture. I mean, it's like you know, Lindsay Vaughn versus open. When you have an open Tibfib fracture, the bone is through the skin, like that immediately is a contaminated surgical site. So if we were to see that, you know, well, one, we probably wouldn't that wouldn't walk into our clinic, but um, neurovascular structures, you have to make sure they're okay. You need to get that reduced ASAP. Like that's not something you can go home and like maybe come in the next day. Like, not gonna happen. Um, so that player, straight to the hospital, straight to surgery, you know. So irrigate the crap out of that, rod that, not walking on it for what, four weeks.
SPEAKER_01I'm sure. Yeah.
SPEAKER_02Yeah. And then that, you know, the atrophy that happens in the lower leg and learning to walk again and then getting all the muscle strength, like that's a six to nine month recovery. Yeah. Yeah.
SPEAKER_00Even even for somebody that elite who's like arguably you're doing things as quickly as possible, they're getting rehab every single day as opposed to once or twice a week. Yeah. Um, for our, you know, weekend warrior outpatient setting person.
SPEAKER_02But it's so super crazy though. Like that happens in the middle of the game, and then you know, athletic trainer, coaches, medical staff, EMS, yeah, uh patient goes off the court. Okay, let's return to play. Like what? Yeah, yeah. That's crazy. Wild. Yeah. So that that happens, and then you just kind of get the old, you know, the old broom out on the floor, and then you finish the game. Yeah.
SPEAKER_00So let's move on. And now everybody like, you know, from a from a other player's perspective, like mentally that messes with you. You're like one distraught because like that just happened to your teammate or whatever, and like the the cost of um, like how that's gonna be that, yeah. Um, and then like also the fear of like, am I about to shatter the shit out of my leg when I jump up?
SPEAKER_02But also, like, this is like so relevant for even like the life you and I live. Like, you're the best player until you get hurt, and then guess what? The sub just comes on and the game goes on. You are you can't handle that.
SPEAKER_00No, I hate that. I can't think about that.
SPEAKER_02Your unfortunate circumstance opened the door for somebody else.
SPEAKER_00For somebody else, I know, but like, can we can we talk about the fact that maybe they're not completely replaceable? Maybe like maybe they were better. They were better, they were better.
SPEAKER_02That's why they started and that's why they played.
SPEAKER_00Oh, and then like he wondered are they gonna get back to will they ever be their old self again?
SPEAKER_02So open tip fib fractures, and again, uh, you know, Lindsay Vaughn, not open, but closed tip fib, like that requires a tremendous amount of survey surgical fixation. It's traumatizing, but it doesn't affect a joint. Yeah, like it's not the ankle and it's not the knee. Theoretically, as long as that heals okay, they should be able to get the same.
SPEAKER_00Yeah, but like the phenomenon mentally of it, like I was like, psychological warfare, yeah. The box jumps. I can't do a box jump anymore.
SPEAKER_02But yeah, I don't know that that player would want to, like if there's you know a 50-50 ball and you're going for it. Like maybe you don't. Yeah, you don't. Yeah, that's crazy. Yeah.
SPEAKER_00Um, I mean, that I would say that that's arguably like the biggest, most like traumatic one that was aired. And then um, I was looking at other ones. So Kevin Durant um in 2019, Achilles rupture. Uh, I don't really like have too much recollection of that. Uh uh, maybe it just like wasn't big. No, I feel like the ones that you're in my life.
SPEAKER_02No, but when those happen, they don't look as traumatic.
SPEAKER_00Yeah, and Achilles ruptures to me, I'm like, mm, we see them a lot. Yeah, but again, it's season ending.
SPEAKER_02It is Achilles ruptures, let's talk about that for a minute. So if you rupture your Achilles tenon, and again, let's not talk about elite athletes. If you fix them, they have a 25% failure rate. That's really high. That's crazy. If you don't fix them, they have a 25% rate of rerupture. Like, think about that for a second. I play uh I play soccer with this guy. He is a big dude, he's like 6'4, and he ruptured his Achilles tendon again playing soccer. And he didn't fix it. And it well, one, it got diagnosed super late. We won't talk about that. But um, he's back out there playing. And I see this guy cutting and moving, and I'm like, how? Yeah. How did you? And again, this is not six to nine months later. This is like a full year and a half later. Um, but if an elite athlete, again, explosive, quick turning, healthy Achilles tendons don't rupture. Yeah. Right. So you've got chronic Achilles tendinitis, maybe you've got tight calves, maybe your warm-up and recovery is not great. And then you explode trained directions once and pop. If you've ever seen one or heard one, it sounds like a gunshot. And you're like, what like what where did that come from? My um my roommate in college, she played soccer too, ruptured her Achilles tendon after taking cipro. Which is big risk factor, yeah, which is one of those um risk factors. But in a otherwise healthy 20-something year old female, like that doesn't happen. Yeah. Achilles tendon rupture is much more common in males than females. But um, I won't say one, it's not a surgical emergency. Yeah. Two, it usually is surgical for an elite athlete. Um, but again, the recovery, at least what we do, we serial cast them in uh planner flexion, like where it is appropriate, have them come back in a week and put them more into neutral, more into neutral until they can walk on that. Yeah, you can boot those, um, you can cast those, but those are lengthy recoveries. Yeah. Those are lengthy and the atrophy that happens in the calf is ridiculous.
SPEAKER_01Yeah.
SPEAKER_02Ridiculous. So again, usually season ending when it is an Achilles tendon injury.
SPEAKER_00So from a like um usable information. There's a word I'm looking for. I'm ready for it. I think most of what we talk about is usable information. Uh application basically. Here we go. For application of this, like what would we say? Let's talk about like what you do in managing these things from an orthoclinic perspective. Like it walks into your urgent care or whatnot. Because um, you know, uh unfortunately for most of us, or I don't know why I said unfortunately, but we're not dealing with these high-level athletes. Yeah, this is a different population, generally speaking, we're dealing with now. You're gonna have your higher-level athletes, relatively speaking. You know, we take care of a lot of the um local high school teams and some of um the college teams around the area, and you may have some some of the weekend warriors who feel as though they're pickleball or the yeah, the elite. Um, so management of these things. Achilles, you know, typically they present, they walk in, or they felt a massive they don't walk in, they limp in.
SPEAKER_02Normally they limp in or they're in a wheelchair. They feel a pop. It's like after they exploded, they they or they hear it, they look around to see what that sound was. Then they realize they can't push off. So when you see these acutely, they have a defect in the Achilles tendon. It's usually myotendinous junction, hopefully more distal than proximal. But Thompson Sass, lay them on their stomach, squeeze their calf. Um, if there's no motion in their um their foot, then that's not connected.
SPEAKER_01Yep.
SPEAKER_02I will tell them I will tell our urgent care the best tool that you have, again, should be your physical exam, but again, provider dependent. Yeah. Um, ultrasound it. Yeah. Yeah. Just have them lay on their stomach and the foot just flops into um plantar flexion and ultrasound it, and you can literally see the gap. Um, those that are like, was it, wasn't it? Was it calf? Is it the helios? Like, where exactly is that? Stat MRI, that's usually the the diagnostic test um of choice, especially if you don't have ultrasound available. But um, you're looking at where it tore. Is it, you know, off of the actual calcaneous? Is it more mid-substance? Is it myotendinous? Is it their calf? Like, is it so high up that it's their calf? And then, you know, depending on where they are in life and what their you know, age, level of sport, level of physical activity, you either fix it or you don't. But shout out to Arthurx, they've got this really cool pars jig, which is this oh yeah, yeah, yeah. Easy like so cool, yeah, um way to fix these, and they do really, really well.
SPEAKER_00Yeah, I've seen that once. Yes.
SPEAKER_02We did that, we did that a couple times, but that was a really cool thing. Um, and then I would oh hold on. DVT prophylaxis. Oh my god, my god. If these these are so swollen that and then they're non-weight bearing, right? Yeah, or at least they're weight bearing in a boost. Huge risk of a DVT. So guess what? You can't operate on people that have blood clots or at least not advise. Some people do, but um, but yeah, DVT prophylaxis. Yeah. What do you do, aspirin, or do you do something more aggressive? No, like aspirin 325. Yeah, especially if they're, you know, usually they're athletes and they're non-weight bearing. Even if you tell them they can, they're just not.
SPEAKER_00Boot versus splint. Um I would provider dependent for like when the person uses post-op protocol wise.
SPEAKER_02If I know it's torn, I'll boot them maybe with a couple heel wedges in there. Yeah. Yeah. But yeah.
SPEAKER_00Um, ankle sprain is probably the most common thing that we see walk in. Highly dependent on how people treat these. And I think there's like this is one of those things that there's not like one set right or wrong answer. There is, depending on the doc that you're working with that you talk to, they have a right and a wrong answer, but like that's variable among people and like what their threshold is for these, yeah, immobilization-wise and rehab-wise.
SPEAKER_02But you know what's crazy about ankle sprains is I feel like you can have someone who has a traumatic, like inversion, fail to pop, immediate swelling, can't walk. And you can have someone who does the same thing, plays the rest of the game, they wake up the next morning and it's massive. And you can look at the x-ray, it's the same, nothing's broken. It's usually the ATFL laterally. Um, if it involves any type of deltoid, usually those take longer to heal, longer to get back. But these present, like with a little bit of swelling, sometimes massive swelling and bruising.
SPEAKER_00Yeah, they'll literally come in. I've had people come into urgent care walking on it, massive, purple, yeah, you know, negative x-rays. Yeah. And they're moving it fine. They're like, yeah, it hurts a little bit. I'm like, oh, wow, impressive. And then I've had girls come in like on the wheelchair, can't wait bear, very minimal to, if any, swelling, like totally different presentation.
SPEAKER_02So um, but the ankle sprains that happen when you're running and you kind of just like hit the ground funny and just what happened to you today? Like an hour ago, those ones where you invert real quick and then it just like boomerangs back. Yeah, those ones I feel like I don't know, I feel like when someone says in the five minutes after it happened, like, could you walk and could you do things? That will help me predict how to treat them. Right. Versus those that like, I can't walk. And I'm like, you know that's gonna be a long recovery. Yeah. But the number one question that patients will ask when they come in with an ankle sprain, like, when can I get back? It literally depends. Like sometimes it's a week, sometimes it's eight weeks. And they they all rehab and um and recover so differently. Yeah.
SPEAKER_00The rehab is super important for it too, because I mean these chronic ankle sprains, like these chronic repetitive ankle sprains and chronic laxity, leading you more um predisposed to getting them. Um, so definitely appropriate rehab balance training is super important. Um, but yeah, I'm doing the same, like usually if they can't wait bear, right? They're getting some, they're getting crutches or they're getting some sort of um more extensive immobilization versus the person who can might get a brace or an ace wrap in a much earlier rehab. Yeah.
SPEAKER_02But I like to treat these, especially if it's an athlete, like encourage them to walk on that. But again, you're dealing with a population that will feel comfortable with that or not. And you know that some they just need permission to, and then they're good to go. Yeah. Whereas some you're like, no, you can walk on it. Like, no, I'm not gonna do that. Yeah, that's gonna take a long time to get back. Yeah, and then like three weeks later they come in for a follow-up and they're like incredible. I'll tell you what I do like the old ASO brace.
SPEAKER_00Yep.
SPEAKER_02Love that brace. It's like a little lace up figure of eight situation.
SPEAKER_00I like there. There's a what's the name of that one? Um, one of our docs here used to use it more for his his soccer athletes. It's more like got a neoprene sleeve and it's got the same concept as the ASO without the laces. Because I hated it. Bulky. Yeah, the laces were bulky. Yeah. And like I would have to sit there like I was lacing a Converse, like staring at the patient, like you're a shoe salesman. You're like, okay, let me start at the bottom. Yeah, like put your little foot right here upon my thigh and I'm lacing it up.
SPEAKER_02Like all Bundy. Like, here we go. Yeah. Um, but no, they're they're bulky though, too. Like to get into a basketball shoe, fine. To get into a soccer cleat is a little tough. Um taping better. What about taping? Yeah. Yeah.
SPEAKER_00Um, fan of taping. Oh my gosh, we could do a whole episode on athletic trainers' uh preferences on um or thoughts on spatting or taping over the the shoes. Um, but yeah, no, I think for certain athletes, like taping is much more functional. It's not quite as rigid depending on the techniques that you use and the supplies that you use. Um but yeah. So what's crazy?
SPEAKER_02How fast can you tape an ankle?
SPEAKER_00Now? Yeah. No, no, in your prime. In my prime, I don't know. We we did a uh time situation. I remember like my fourth year, my fourth year of athletic training was all like just you know, messing around, like fun times. So we definitely all timed ourselves for ankle taping. Um, and we did it blindfolded one day. I I vividly remember my program director, he was like, I can tape an ankle in X amount of time blindfolded. And literally, like we blindfolded him. Did he do it? Yeah, he did it. Right, yeah, yeah, he did a great job. It was hilarious. Um, but yeah, I'm sure in my prime quickly and well today, I don't know. That's like I'm gonna have to practice or I'm gonna have to see if I still have yeah, try it out. And then based on that, I will make my decision if I recertify myself or not. There you go.
SPEAKER_02Well, return so return to play after ankle sprains, highly variable. I think I encourage early weight bearing, early mobility, yeah, early physical therapy, you know, rebalance um training strength, um, get back to impact as soon as you have all the foundational things. Now, patients will ask for MRIs, especially because when you take the x-ray and they expect it's broken because it looks so terrible and it's not, let's say you get an MRI scan, ATFL, grade two, or three sprain, AK, partially torn or fully torn. Guess what?
SPEAKER_00You can still it doesn't matter. It doesn't matter. You still non-op all of these initially at least.
SPEAKER_02So when uh, and again in your urgent hair brain, when would you suggest a patient would maybe need to see the foot and ankle surgeon for surgery?
SPEAKER_00For surgery? Yeah, for like a I will never say the words to somebody with a grade one, two, or three lateral ankle sprain that they need surgery 100%. However, I will um recommend uh that they follow up with them at some point and then we'll figure it out based on that.
SPEAKER_02So but your repetitive ankle sprains where they're walking on an uneven surface, and uh you can't even like you know, they they sprain their ankle just looking at a an uneven sidewalk. Yeah. Those that have recurrent instability, they sprain their ankle 500 times. Now it's atraumatic. Um, they probably have EDS, right? Like those patients you can talk to about doing like a brostrum procedure for stabilization, but um But I tell them like the majority of these are all non-op.
SPEAKER_00They're not until they're not, um, which is very rare. Yeah. Um, I mean, the only time that I'm setting someone up and teeing up for surgery is if they have like a you know, whoever be fracture, syndismosis injury, something like that, then then we're then we're doing that. Um, but yeah. Well, this was good. I think uh I think we've hit on some very important basketball topics. And um, I hope everybody enjoys watching the remainder of the tournament.
SPEAKER_02And hopefully no significant injuries because I can't watch them.
SPEAKER_00Yeah, if not, we'll have to talk about it next time. So I hope not and knock on wood. All right, till next time.
SPEAKER_02Bye. Episode three. Thanks for tuning in to Joint Effort PAs. If you enjoyed this episode, be sure to subscribe, leave a review, and share it with a fellow PA or med-minded friend. You can also follow us on Instagram at Joint EffortPAs for updates and extra content. See you next time.