Dr. TO 868

Dr. TO is back and ready to talk medicine with everyone. Todays topic's were about dislocating a finger, Knee dislocation, MRI discussion, Patients rehab/reecovery and we take callers on the show.

Episode Transcript

(00:00):
It's tip off time for Doctor tO. Sorrel and Inside Sports Medicine on
ninety seven to one The Freak.Doctor Sorriel, one of the nation's leading
orthopedic surgeons and former head team physicianfor the Dallas Mavericks, bringing his unique
sports insights and stories from inside thegame. With special guests from the world
of professional, college and high schoolsports and sports medicine, the Doctor breaks

(00:20):
it all down. Buckle up yourchin strap and tighten your laces for the
most informative ninety minutes in sports medicine. It's kickoff time for Inside Sports Medicine
with Doctor t O. Soryale onninety seven to one The Freak. Good

(01:07):
Saturday morning. Everyone, Good Saturdaymorning, and welcome to Inside Sports Medicine.
I'm your host, Doctor t O. Sorry, I live in the
studio on this kind of cold andwendy Saturday morning. This is your sports
medicine current events show where the topicsare ripped right off of the sports desk.

(01:30):
Over the next ninety minutes, you'regoing to be informed, entertained,
and hopefully learn something new. Youwill have an opportunity to call in or
text in your questions. We havea lot to get to today. Live
in the studio, sitting across fromme, doctor Ryan Blaylock. Morning Ryan,
Good morning, dar Soryl how areyou good? Good to my right

(01:55):
Hunter and Daniel, and across onthe other side of the glass, Garrett,
Good morning, Garrett, Good morning, guys, good morning, good
morning. We have a full fullhouse today. We have a lot to
get to. I'm going to giveout the number right off the bat,
just simply because this is one ofthose cold, kind of wintry days where

(02:16):
instead of you guys being out runningor doing things, you are indoors and
as a result, we got alot of phone calls and a lot of
texts. So the number is twoone four seven eight seven nineteen seventy one

(02:38):
for those of you in tarent County. And I smile when I say that,
because it doesn't make any difference thesedays. It's eight one seven seven
eight seven nineteen seventy one. Sotwo one four seven eight seven nineteen seventy
one. Also, we're going tocontinue our tradition, given the fact that

(02:59):
this is a text number, aswell of trying to find out how far
away the farthest listener might be.Lots of you listen on the iHeartRadio app,
and therefore you don't have to havethe air waves. So if you

(03:20):
are listening, like a few weeksago from Mexico, that'd be kind of
cool. We've had listeners from Chicago, o'l passo, etctera, et cetera.
So I'm very curious two one fourseven eight seven, nineteen seventy one.
On a text machine, you canjust text us. So during our

(03:43):
pre production meeting, we were talkingabout these kind of cool idea pants ski
pants that have a built in brace, I guess for lack of a better
word, so there are cables thatgo around the knee and hunter what'd you

(04:09):
say they were called? It's likea boa compression system. No, no,
no, the name of the pants, oh Stoko, Stoko, yeah,
stok. And I came across someone really early morning when I was
watching some remote channel on TV andI saw the ad and I thought that
was really kind of intriguing in thatthey're tights, which is great. Lots

(04:33):
and lots of athletes wear tights,and they have been proven to be medically
effective. Little sidebar here, soa muscle contracts a bit more efficiently if
it's squeezed. Now, whether that'sa tights or brace or even a rubber

(04:56):
band. Frankly, the studies showthat it does kind of to respond perhaps
a hundredths of a second faster andmore efficient. So we kind of know
that tights work. I don't thinkI don't think leggings are tights prevent any
injuries, but they are performance enhancing, so to speak. And so the

(05:21):
fact that they incorporated wires into thispair of tights, it's intriguing. And
during the pre production meeting we werereally kicking around whether it actually works or
not. I'm wondering if you canput so Ryan is a hand surgeon,

(05:46):
he's a board certified hand specialist.What if you put wires in a glove?
Is that going to keep you fromdislocating your finger? You know,
the hardest part with it is tohave something that provides enough stability but doesn't
but doesn't limit your range of motionso that you know the digit the risk

(06:10):
becomes ineffective. I mean, weget requests all the time for like,
I want to brace from my wrist, but I still want to want to
be able to move it, andit is limiting, isn't it. Unfortunately
there's just like they're they're just competingphilosophy, right, So I would tend
to think that putting wires into aglove is probably just going to limit your

(06:33):
function with questionable benefit. I reallyhave to sit down and think about it
and draw it out and tinker aroundwith it, but my gut is it
would probably be more annoying than useful. Yeah, So so I put a
lot of thought into this the othernight when I was when I came across
across it. So, when someonedislocates a finger and and I there's not

(07:00):
a there's not an NFL game ora college football game where someone doesn't dislocate
a finger, and sometimes it's it'scaught on camera and you see the finger
going all different directions, and thetrainer runs on in the field and you
see something happen and next thing youknow, the kids move in his hand
and it's back in place and everybodylives happily. Ever after, we do

(07:24):
a figure of eight tape around thatdislocated finger so that they can go back
in the game, and it typicallyis effective because it doesn't usually come out
a second time. And what Isaw on these pants is kind of a
figure of eight wire that goes aroundthe knee, So just think of the

(07:46):
knee as a big, giant indexfinger. Maybe it prevents the knee from
dislocating, but I don't know ifthat's enough to keep the ACL or MCL
from tearing. That is that alittle too graphic for Saturday morning? But
I'm thinking, you know what,perhaps, what do you think about a
figure of eight on a finger,Ryan, because we do this all the

(08:09):
time. Well, for you know, generally the most dislocated joint in the
finger is your what we call thepip joint or the proximal interferential joint,
and that that is not the knuckleon your hand, but the middle knuckle,
so to speak. And the majorityof those are what we consider a
dorsal dislocation. So if the fartherpart of your finger toward the tip goes

(08:33):
up rather than down, those areinherently stable once they're once you put it
back, yeah once like once youput it back, like reduce it.
They generally are inherently stable, Anda figure of eight taping of that to
prevent it from hyper extending again makesperfect sense because you know, these athletes
are going back to gripping linemen,you know, catching, so inflection,

(08:56):
a dorsal dislocation is stable, Soa figure a tape preventing that would help.
Now all bets are off if it'sthe other kind of dislocation, and
that's yeah, that's a discussion fora different day. So Hunter, you
played football, did you ever dislocatea finger? Probably during the course of
a game, but nothing that wouldever stop me from competing. You popped

(09:16):
it back yourself. We had trainersthat I could pop him back out for
US. I think one of thethings that I remember the most about college,
and you've probably seen it, wasan incredible moment. Jack Cone was
playing quarterback for US a Notre Dameat the time. He dislocates his finger
on a two minute I saw that. Yeah, yeah, yeah, runs
of the sideline or athletic trader MikeBean pops it back in, goes back

(09:37):
out next play, throws a gamewhen I touched out. Yeah, by
the way, I don't know howhe did that because those things hurt like
crazy. And in basketball, sofinger injuries are some of the most common
injuries I saw in the NBA,next to ankle springs. But yeah,
it happens a lot and I don't. I didn't want to really kind of
go towards the located finger aspect,but it didn't make me wonder, well,

(10:03):
if we think of a knee asa big, old giant finger,
will those wires actually hold it inplace? I don't know. I don't
know how much of those those pantscost three hundred I think they're on so
right now, three hundred and fiftyeight dollars, and you can get insurance
to cover it. Yeah, yourHSA. Look, it's a cool idea.

(10:26):
Does it actually work? I don'tknow, but it's a cool idea.
Yeah. See, this is thekind of thing that you hear and
you talk about on inside sports Medicinethat I'm not sure you get anywhere else.
It seems right for a study,It does seem right for a study,
but you know, sometimes a manufacturerdon't want to know the answer.
They don't want the real data,They don't want the real data out Look,

(10:50):
we've done, oh gosh, booksand books and books written about various
knee braces, books and books writtenon ose, and so far, there's
really nothing that will prevent an ACLinjury. There's not a brace that's going
to prevent an ACL injury, andthe reason is it's a rotational injury,

(11:11):
so you plant to change the directionyour knee pops. There's no brace that
is going to control rotation. Partof it is the actual physics of the
knee. You've got muscles, Sono matter how tight you've got the brace
around the quads and the hamstrings,they're still fluid, so they it will

(11:33):
rotate. I don't know, fifteentwenty degrees. Well, sometimes that's all
it takes to tear your acls fifteento twenty degrees. And the same thing
around the calf. So if youhave a bracelet goes around your knee and
you've got to strap up around thethigh and a strap down around the calf,
it just can't control the rotation enoughto make it work. All of

(11:54):
us see, and all of momsand dads see linemen wearing braces. Those
braces have been proven effective, butonly against one specific injury that is an
MCL, and the MCL, whichis the media collateral. It's on the
inside, the big toast part ofyour knee. I never played offensive line,

(12:20):
but there's a lot of collisions anda lot of bodies in a very
small space and most of these guysare big bodies, and if somebody falls
on the outside part of your legand sprains your MCL, a brace like
that prevents it. So linemen bracesthey have been proven to help prevent or

(12:43):
at least help prevent the severity ofan MCL injury. So if somebody falls
on the outside part of your kneeand you're wearing an alignment brace, yeah
you might get a first degree sprain, but you're not going to get a
third degree s brain. So thosework because that is not a rotation injury.
But one of the things that Ryanbrought up earlier, which I think

(13:05):
it's it's relevant here, ankle braces. Ankle sprain is the most common injury
we seen basketball large bodies under thebasket, you step on somebody else's ank
a foot, you come down froma rebound, and your ankle is going
to roll. We can prevent that. We can put you in a tape

(13:28):
job, we can cover the tapewith a brace. We can basically make
it a cast. Problem is,you can't really run up and down to
court and cut right and cut leftand do all that stuff. So if
you do want to brace, andyou want it to be an effective brace,
then it interferes with function uh twoone four seven eight seven, nineteen

(13:50):
seventy one. Little sidebar. Afew years ago, so we did an
episode on sports medicine secrets, andone of them is sometimes the athlete doesn't

(14:11):
want to play for whatever reason.That's a sports medicine secret that nobody ever
talks about. But one of theother sports medicine secrets is don't believe what
you hear or read about injuries publicly, because often those press releases come after

(14:37):
a long deliberation between the athlete andthe management and the trainer and the doctor,
and the press release comes out.This is especially unreliable in an individual
sport. Why do I bring thisup? Tiger Woods yesterday had to withdraw
from the Genesis Open because of flulike symptoms. We don't know if that's

(15:03):
true. I don't know if it'shis back because the day before they said
he had backspasms. I don't knowif it's his ankle. You know,
he's had numerous surgeries. Bottom lineis he withdrew. I don't know what
flu like symptoms are. They saidhe had a fever. But again,
so sports medicine secrets don't believe everythingyou read about why because often that is

(15:28):
embellished to I guess protect the innocent. I don't know, all right,
quick little break Inside Sports Medicine too, Sooreel, Ryan Hunter, Daniel Garrett,
the whole team is in Lots toget to two point four seven eight
seven nineteen seventy one. We'll takeyour questions and comments when you come back.

(15:50):
When you wake up in the morningand the light is mitchel here,
the first thing you do when youget off out of it is he a
beasty surrounding and try to beat themesses. Go get yourself some cheap sunglasses.
Welcome back, Welcome back to InsideSports Medicine too. Sorry, I'll

(16:17):
here. This segment brought to youby Jaguar Landover Land Landover Jaguar Land Rover
of Dallas, part of the SnellAutumn. I can't even talk today,
all right, start that over JaguarLand Rover of Dallas, part of the
Snell Automotive Family. Lots to getto today two one four seven eight seven

(16:42):
nineteen seventy one. Let's go toGenova from Dallas. Good morning, Genova,
How are you, Good morning dog? How are you? How's a
family? Very well, thank you. Good to hear from you what you
got. Okay, we gotta talkabout feet. I know you always talk
about knees and everything. I wouldlike to know about feet, and you

(17:03):
are you kind of segued into itusing your jargon about ankle springs. Oh
and linemen. You know I havetwo linemen and one is trying to go
to the next next level. Anklesprings in the foot YEP, it's is
it? Pretty much? You knowI would like to hear you talk about
that one day if you can giveme some insight on what ankle spring the

(17:27):
foot. Well, first of all, it's it's an important subject. It
is extremely common in football and basketballand pretty much any sport. And in
fact, I think ankle sprain isI want to say it's the most common
orthopedic injury, right, I mean, that would make sense. Dunt you

(17:47):
think it's definitely up there. Iknow, like low back pain is one
of the yeah other most common yeahso so. And it's funny when I
see a patient in the office andI'm examining whatever part. If I'm examining
their lower back, if I'm examiningtheir knee, if I'm examining their hip.

(18:10):
One of the first things I'm gonnado is tell them take their shoes
and socks off and walk, justwalk back and forth. Just I want
to see how the mechanics of yourfeet and ankle work, because they do
impact everything further upstream and in thesports medicine world, a slight abnormal mechanic

(18:33):
mechanics of your feet, we'll reallyhave a significant effect. Pretty much all
of our athletes when I was withthe Mavericks, had some type of foot
abnormality, and they almost all gotsome type of foot orthotic. It does
not have to be a five hundreddollars custom made orthotic, but for those

(18:53):
guys it kind of was. Butfor us. For the general population,
if you've got flat feet, youknow, a ten dollars arch support might
correct a couple of angles, acouple of degrees. So we always emphasize
proper foot mechanics. Not everybody needsfive hundred dollars orthotics, No, that

(19:15):
is not true. But if you'regoing to be athletic and you're interested in
longevity, and especially if you've gotknee problem or hip problem, yeah,
we've got to look at the footand ankle. Back to the ankle brace
concept. We insisted that some typeof protective ankle bracing or taping take place

(19:41):
in basketball, not so much toprevent the injury. You know, if
you're if you're battling for rebound withYao Ming and you land on his foot,
which is about three feet long,your ankle is going to roll.
So the injury is going to happen, but it can keep it from being
a third GA sprain. It couldbe just a mild sprain. That is

(20:03):
if you have tape or if youhave an ankle a brace. So yeah,
look, we can devote an entireepisode on proper foot and ankle mechanics,
et cetera, et cetera. Butone of the things that's also unique,
especially about the athletes and foot injuries. If you're a runner, then

(20:23):
it doesn't matter what your mechanics looklike. Sometimes you get stress fractures,
Sometimes you get arthritis, whether it'sthe big toe or the ankles join itself,
and those are kind of overuse injuries. Those I don't know that.
I don't know that I can preventthose, but yeah, we can talk

(20:44):
about it. There are lots andlots of issues and if you have a
sore foot or if you have ifyou sprain your big toe, yeah you're
not going to run as fast,you can't cut as much. Dion Sanders
is the textbook example of a bigtoe was a big deal. We talked
about this a long time ago.And there's actually a SoundBite where I said,

(21:07):
a big toe is a big dealbecause it get you can't sprint,
you can't cut if if you've gota big toe spring and everybody kind of
laughs and downplays it. Oh it'syou know, it's just as toe.
No, it's kind of a bigdeal. So yeah, a good question.
Thanks. We can devote an entireepisode on that in one of these

(21:30):
days. We probably will get backto it. Thanks to oh go ahead,
no, thank you, all right, appreciate the call to one four
seven eight seven, nineteen seventy one. Now what, it didn't matter in
college if even for practice walked through, we were getting our ankles taped no
matter what, Like we're assets.So there wait even for walk throughs,

(21:56):
Like our walk through is more likerun throughs. Yeah. Yeah, played
football at Notre Dame and pretty highpowered program, and so that I guess
what you guys did there is prettymuch what everybody else in the country.
Did. I think it's probably prettysimilar. Yeah. Yeah. Were there
different protocols for different positions? Notreally so, I mean regardless of what

(22:21):
position you played. I mean,I don't think the kickers are punters necessarily
had to get their angles taped everytime, as they said, interfered with
their performance. But if you're anyposition you're playing, you're playing cornerback,
you're playing quarterback, You're getting yourangles taped no matter what. By the
way, kickers and punters, Ihave a question, did they practice alongside
you guys or were they on awhole other field. Absolutely not. I
mean if I could go back anddo things differently, I would be a

(22:44):
kicker. I mean, they maybeare involved with two periods ten to fifteen
minutes of practice and the rest ofthe time they're just goofing off like we
would have walk through some practices andthey'd be out there playing like stick baseball
with the ball of rolled up tape. Are they taught how to they do?
Do? They do participate in tacklingdrills? And over the course of
my four years though, they becamemore integrated into practice with the tackling drills

(23:08):
and involvement and team drills and thingslike that, but they live a pretty
sweet life. Well, I mean, sometimes the kicker is not necessarily the
smallest the biggest guy on the team, maybe relatively small. I'm not sure
that I would be tackling somebody comingat me full speed. You know.

(23:29):
Sometimes we actually would have them holdthe tackling dummies and they would be the
ones getting tackled. You couldn't payme to line up against Hunter, no
way, No like full head ofsteam coming at you. So yeah,
I did. I did. Iplayed football in high school and I was
not very good, and I'd weighone hundred and fifty six pounds and I
was an outside linebacker. And thehardest hit I took in I'm going to

(23:53):
say my whole life, was atight end that pulled and came around in
and he knocked me back at leastten yards. That was the hardest hit
I ever took. And he washe was a big guy and I was
a little guy. And I don'tknow if that I was not made for

(24:15):
football. Yeah. I played footballfor one year in high school thinking that
it was, you know, somethingI wanted to do besides go run track
and cross country, which aren't themost glamorous sports, silly snut where I
grew up, and I ended upwith an ac separation, and I just
realized that I was a much betterrunner than I was ever going to be
a football player. Daniel, doyou ever play football or just all basketball?

(24:37):
I played like a mighty mites thingin like middle school for a little
bit, and then transition to basketball. I got hit right in the chest
yep, knocked the wind out ofme and laid on the ground for about
five seconds, and rethrought my wholelife and went basketball. Is probably that's
what that tight end did to me. Yeah, he put his helmet right
in my sternum and I was wayback. Hey, what does Mike want

(24:57):
to talk about? Garrett? Isomething about infusion. I wasn't It was
hard to hear the first word ofit, but well you should we go
there. I think he's worth it, all right, Mike from Aubrey,
good morning. What's up? Goodmorning? Doc? This is your favorite
l patient. So I have ostiaporosisand you're talking about doing a reclass infusion.

(25:23):
I was just wanting your lagging whatkind of infusion? So it's it's
obviously it's an IV medication. Isthat what you're talking about. Yes,
sir, it's an im medication.It's called re reclass class Yeah yeah,
yeah, yeah, yeah yeah yeah. So I can speak a little bit
to bone health in that. SoI'm double checking here to make sure that

(25:49):
what category of medication reclass is andit falls in the class of medications called
bisphosphonates. There's a lot of themout there, and they basically prevent bone
resorption. So the theory is isyour bones to bone. Well, first
off, bones aren't dead. They'rea living tissue. They have they have

(26:11):
veins, they have arteries, theyhave blood supply, and your body turns
them over in order to you know, prevent to t uh to heal small
cracks that develop in them. Andthe theory is, if you have osteoporosis
and you prevent the resorption of bonewith abysposcinate reclassed is one of the many

(26:32):
types out there. If you decreasethe resorption and you're still adding new bone,
you get more dense bone. Andthere is to my understanding, at
least last time I checked good datathat it can prevent certain fragility fractures.
Now, the one thing you doworry about with this foscinates is long term
treatment can lead to not weaker bones, but more of you think of a

(26:56):
brittle or chalky type bone. Andthere is a known association with certain fractures
in the lower extremity with long termtreatment of this, particularly a subtro enteric
femur fracture can happen when people whoare on these medicines for a long time.
There are also a large variety ofother treatments for osteoporosis, some of
which actually build new bone rather thanprevent resorption. One of the ones that's

(27:22):
on the market is FORTEO And I'mimpressed, you know all this. I
like bone health. I'm terribly Iyou know what you said, what you
said earlier was really important and wekind of we gloss over that in this
an orthopedic world. So bone isliving tissue and there are osteocytes, and

(27:42):
it's often almost on a daily basis. You lay down new bone and you
take away old bone, and youlay down new bone and you take away
old bone. And that turnover ishealthy. It's good, it's good for
us. Absolutely. Often in thesports medicine world, especially with African Americans,

(28:03):
we see vitamin D deficiency, sothey have a hard time, you
know, laying down new bone.And when you see stress fractures, one
of the first things that we lookfor is what your calcium metabolism looking like
and what your vitamin D looking like. So, Mike, yes, if
you have osteoporosis and you're at riskfor you know, a hip fracture or

(28:26):
or a stress fracture of some sort, yeah, I think somebody is thinking
the correct way by trying to getyou on these infusions, right sologist,
there you go. The only problemis is that the side effecture can be
horreduous. Yeah. Yeah, Welllook, we talked about this on episode

(28:48):
one. Right now we're in episodeeight hundred and sixty eight. The risk
reward equation, the risk reward equationif if you're risking a insufficiency fracture of
your hip that might cause you tohave a hip fracture and require surgery versus
the side effects of the infusion.Yeah, it's always always a difficult debate,

(29:15):
but yeah, you're into chronologists.He's way more knowledgeable about this than
we are. Also, talk toyour inter chronologist about other types of bisphosphonates
that maybe have a different dosing,So if you have to take it more
frequently, if you decide to getoff of it, it's out of your
body quicker. A lot of theinfusion type bisphosphonates are dosed I think sometimes

(29:37):
even yearly is how long they canstay. So if there are other ones,
just like like say their cousin thatcome out of your body quicker,
so if you decide to get offof it, you can come off of
it quicker, and they should providesimilar benefits. So that's a good question
for your inter chronologist and any indocrinologistwho's willing to do bone health. I
think is great because it's unfortunately notthe easiest thing to find out there.

(30:00):
Yeah, yeah, thanks Mike,Good luck with it, Good care.
Keep listening, by the way,you can hear the podcast, which,
by the way, if you missany part of the show, or if
you missed the show altogether because youdidn't get up early enough on a Saturday,
a podcast is usually up how longafter the last Saturday. It was

(30:23):
up three hours after the show.I know that I was quick kissed,
I was quick last week. Thatwas wonderful. Lot I had to actually
patience to let me let me knowthat. Oh, yeah, it doesn't
take me long. Once the show'sover, I'll give it time for the
backlogs and stuff to update and getenough time away from when the show was

(30:44):
and then it takes me about twentyminutes or so to pull it. Clip
it. Where do people go tofind it? You can go to is
it iHeart It's iHeartRadio app, iHeartRadioapp. Anywhere where you get podcasts.
I believe you can go just toyour regular podcast apps on your phone.

(31:04):
I'm about to double check, ohreal quick, just to make it.
Yeah. So if you miss anypart of that of the show, or
you thought it was interesting and youwant your friends to hear it, Yeah,
the podcast usually is up by theend of the day on Saturday.
And if you are somewhere that isnot within the Dallas Fort Worth area and

(31:27):
you want to listen to the showlive, iHeartRadio app and do ninety seven
to one and you can listen tous wherever you're at. By the way,
nobody has texted yet two one,four, seven, eight seven,
nineteen seventy one. We did geta good morning doctors. I saw that.
No, no, I mean noone has texted yet. How far
away they're listening from. I'm veryyou might want to refresh that. Okay,

(31:49):
all right, we're going to talkabout MRIs when we get back.
And whoever invented magnetic resonance imaging.I'm pretty sure they won a Nobel Prize.
I'm pretty sure. I don't knowthat for a fact, but whoever

(32:10):
invented it? Wow? And updateon the podcast. You can listen to
Inside Sports Medicine any on any podcastplatform. If you have an Apple phone,
Apple product, all you have todo is go to the Apple with
the podcast app. It's on thereInside Sports Medicine. So, Garrett,
I'm sorry, you good. Mybrain went to a whole different direction.

(32:30):
How does it get from here inthe studio to all of those sites?
So there's a website we have.It's called SIA. It's a pulls all
data and all radio transmissions and stuffback from the past hours, hour and
a half, from a couple ofdays, maybe a month, and we

(32:54):
pull it. If we're gonna uploadit to live radio, we have to
pull a certain wave like a nonPPM standard, Or if we're just streaming
in and posting in a podcast,we pull it as a streaming service and
then it goes everywhere, and thenit goes everywhere. We pull it,
we clip it, wo uploaded,put it a little description what the topic

(33:15):
was for the day, Like today'stopics were knee issues, MRIs, and
we're taking some callers because we haven'thad callers in a while, so we've
been busy. We have been.It's been a busy morning. Yeah,
So we're gonna talk about MRI whenwe get back. Magnetic resonance imaging.
So someone discovered that all of ourbody cells, bone cells, cartilage,

(33:45):
cells, whatever, whatever, havea spark, have a not a spark,
a charge, a charge, apositive and negative charge, and you
go to a magnet. If youput the body in a magnet, all

(34:06):
those cells align with the magnetic field. Who would have even thought of that
part? Okay, who would havejust thought of that aspect of it.
And then if you vibrate those cells, it takes different time intervals for them

(34:27):
to realign again with the magnetic field. So if you've ever been in an
MRI scanner, it's loud. AnMRI scanner is basically someone taking a hammer
and hitting it on the side ofa trash can, and so you vibrate
the cells and some computer something somethingI'm not sure how this works, figures

(34:50):
out how long it takes for thecell to realign with the magnetic field,
and you get a digital picture ofall of these cells. It's it's ingenious.
I I can't even imagine who wouldhave even thought of that. But
you can get a three dimensional pictureof a knee, a three dimensional picture

(35:12):
of a brain, a three dimensionalpicture of any body part without having to
cut it open. We're gonna talkmore about m RIS. Coming back.
Someone is listening from Germany. CoolInside Sports Medicine coming right back. Welcome

(35:45):
back, Welcome back to Inside SportsMedicine too. Story I'll hear live in
the studio doctor Ryan Blaylock, worldfamous hand surgeon, Hunter Daniel, world
famous interns, Garrett world famous everything. So we were talking about MRIs and

(36:14):
I did my best to try toexplain how it worked, and I'm not
really sure I know how it worked. Ryan was telling me about Nebula.
So there's a there's a channel thatdoes incredible videos explaining, you know,
for people who aren't in the fieldon how things work. The channel is
called Real Engineering. They are ona streaming service called Nebula. You can

(36:37):
also find their content, which Ithink is for Loarly at least a few
days later on YouTube. But theyhave a it sounds kind of geeky.
It is, Okay, I'm acomplete nerd, all right, but it's
called the Insane if you google it, the Insane Imaging of MRI machines,
and it's an awesome video that itdoes the best to explain to somebody who
isn't a electrical engineer how this works. And it really is nothing short of

(36:59):
matt It is unbelievable. So themagnetic field the vibration, and then I
lose it when it comes to thecomputer. So to my understanding is the
magnetic field is static, meaning itdoesn't change, correct, and so the
magnetic field aligns all of the hydrogenatoms in your body or within the field

(37:23):
of the magnet, because the magnetdoesn't encompass your whole body. So when
so then you now have and hydrogenatoms basically act like little magnets. So
you have all these magnets they're nowaimed the same way. Then the MRI
generates a radio frequency pulse in aspecific plane that vibrates those hydrogen atoms,

(37:44):
which are small magnets. As theythen realign with the magnetic field that the
MRI magnet is generating, they releasea small amount of energy in the form
to my understanding of a radio wavethat is then detected by the machine,
and then a complex computer algorithm cantranslate that into one plane of a picture.

(38:06):
It does that in multiple angles,multiple planes, and then combines that
data for the three dimensional image.Do you think somebody, one person figured
this out. I know, Idon't think one person figured this out.
I mean, this is a combinationof multiple technologies that came to fruition in
the seventies and eighties, and Iam not personally aware. Please correct us

(38:28):
via the call line if I'm wrong. I'm not aware of one specific person
who got credit for I mean,truly like revolutionary technology. It's well so
again. We did a part ofthe history of Inside Sports Medicine eight hundred
and sixty eight episodes. We hadan episode on the five technologies that revolutionized

(38:54):
sports medicine and MRI was number two. What was number one? Arthroscope?
Arthroscopic being able to stick a camerain the knee and look that that revolutionized
sports medicine. But MRI was numbertwo. It's I look back at the
early days of sports medicine. Idon't know. Gail Sayers, football player

(39:22):
legend towards ACL, ended his careerprematurely. Joe Namath the same kind of
thing. He tore both acls endedhis career prematurely. We only had X
rays, that's it. So youget an X ray, you may say,
yuh, he didn't break it,But we had no idea what was

(39:42):
going on with We didn't even knowACL existed back in the Joe Namath days.
What no, I shouldn't say thatwe knew it existed, We didn't
know what it did. You know, there was there was talk in the
fifties that the ACL was like anappendix. Oh yeah, go in there
and take it out. What yeah? Anyway, so MRI comes along and

(40:04):
you get this incredible picture of theinside of the body without having to cut
anything open. It completely revolutionized medicine. So MRI machines come in multiple different
flavors. The stronger the magnetic field, the clearer the picture. And the

(40:27):
way magnets are and Ryan, youprobably know way more about this than I
do. The way magnets are judged. The magnetic field is a unit called
a Tesla. So a one oneTesla MRI is good. One point five
Tesla MRI is better because of themagnetic field is quite as strong, twice

(40:52):
as strong. And now they havethree Tesla MRI scanners. The stronger the
magnetic field, the clearer the picture. A three Tesla MRI scanner is three
million dollars plus. They're ridiculously expensive. There's only a handful in the dallasport
Worth area the for most MRIs.A one or a one point five Tesla

(41:16):
machine gives you great pictures. Athree Tesla probably gives you a detailed picture
of the brain. I think thatthat's when they're where they're most useful.
But it's a really expensive technology.Now, the other component of the MRI

(41:40):
result is the protocol. So whathappens when when you go in to have
an MRI of your knee let's justuse your nee because that's what I know
the most about, or wrist.Ryan, You get multiple sequences we call
them sequence. That's why you're ina scanner for thirty minutes. You get

(42:01):
multiple sequences. And what the sequencesdo is they basically slice up your joint
in various different planes, over andover and over again, and the computer
can kind of put all of thesedifferent images together and almost give you a
three dimensional picture of the body part. The protocol is how close are these

(42:27):
slices together, So you can getslices that are thin, kind of like
melba toast, if you know whatthat means. Or you can get slices
that are thick like texas toast,if you know what that means. The
better the protocol, the more imagesyou get. So when we do a

(42:49):
knee, we get two hundred andseventy eight images of your knee in various
different planes and expensive protocol. AndI saw one. I saw an athlete
who came to see me from China, and he had an MRI in China
was thirty two pictures. Now youmiss quite. You miss a lot with

(43:10):
just thirty two pictures rather than twohundred and seventy eight. So the protocol
matters, the magnet strength matters,the protocol matters, and the final piece
of the puzzle, the radiologists readingthe MRI matters. There are radiologists that

(43:30):
that's all they do. They readMRIs all day long. And there's a
subset of those radiologists that just readmuscular skeletal MRIs, knees, shoulders,
wrists, spines. So the educationallevel of the radiologists and the training level,

(43:52):
all that factors in the accuracy ofthe result. So I started by
saying, not all MRI are thesame. You can get an MRI for
three hundred dollars. Well, thatmay be on a weak magnet, it
may be on an old magnet.It may be a crappy protocol where they're

(44:15):
slicing your wrist up in one inchintervals, which means that they lose everything
in between. Or it could bea radiologist that reads chest X rays all
day and he's moonlighting to read awrist MRI. So not all MRI's results
are the same. Have you experiencedthat? Absolutely? The other component I

(44:40):
will say, you said almost threelegs to a stool. I think the
fourth one is the patient. Thepatient is a huge contributor to the quality
of the MRI because you have tostay still. Oh yeah, yeah,
there is. There's just no there'sno way around it with the technology.
If you move at all during thesequence, it it's just vibration. They

(45:04):
just you can't get a picture.It messes up them, It messes up
the math that generates the picture.This is why MRIs are so difficult to
obtain in young children because they don'tunderstand they have to stay still. So
frequently do get a young child MRI, you're also putting them under general anesthesia,
which we try to avoid in generalis at all possible. So that's

(45:25):
that's a good point. I'm gladyou brought that another component to the what
you get to get a good MRIpicture. If you're in a scanner in
your fidgety you just wasted whatever moneyyou're spending. And the final thing I
will say is we I get alot of questions like, oh, doc
out, I want the best imagingright now, let's get an MRI.
And MRIs are incredibly useful. ButI kind of liken it to like one

(45:51):
of my senses. You know,it's good to hear something. It's good
to hear a band hear music,but it's you get a more full picture
if you're watching them live at aconcert. That's kind of how we think
about our different imaging modalities. Becausewe need the X ray, which is
one sense, we need the MRI, which is the other sense, and
we put it together into the fullclinical picture. So to answer the question

(46:14):
to a lot of patients, says, why do I need an X ray
if I'm getting an MRI, It'sit's to give him more it's to have
all of your senses available, morecomplete. Yeah, you've got more complete
diagnosis. X rays are very accurateto look at the bones. MRIs are
not very good at looking at thebones, but they are excellent looking at
the soft tissues. So you getan X ray, you get an MRI.
You put the two together. Youget a much clearer picture of what's

(46:36):
going on than if you do eitherone of them by themselves, and you
actually raise a really good point.I know we have to go on break,
but often I will get a callfrom an agent, Hey would you
mind looking at this MRI for me? I don't like doing that because MRI
is just one piece of the puzzle. I want to hear this story.

(46:58):
Why am I looking at the MRI. Why did he have the MRI?
What was the injury? I wantto feel I want to examine. So
often when somebody says, hey,would you look at an MRI for me?
That's just incomplete. It's just incomplete. But yeah, you put the
whole picture together. I like thecensus idea. That's a really good analogy.
I may use that later. Youwant the history, you want the

(47:22):
physical, you want the various imaging, you want all of the exam You
want all of that stuff to gotogether in order to come up with a
diagnosis. MRI has revolutionized sports medicine, but it's part of a much bigger
picture. All right, quick,a little break coming back. Somebody on
the text tells us that I don'tknow. I'll read it and I'll report

(47:43):
to you after the break. I'mcrazy about it. So apparently, so
apparently there is someone who's credited forinventing the MRI. Daniel think you have

(48:12):
to read it because it's too faraway from me to read, sure,
it says Raymondmadian, the inventor ofthe first MRI scanner, celebrates his eighty
fifth birthday on March sixteenth. Hewas a physician, and he performed the
first full body scan of the humanbody in nineteen seventy seven. Wow,
March sixteenth, that's what I tookaway from that little That's the day I

(48:34):
matched for medical school, and that'sthe day I matched for my residency,
March sixteenth. And so yeah,so Wow, how does one person think
of that? Yeah, and sowe were talking about a lot of factors
that go into the quality of anMRI and it does matter. And Ryan

(48:59):
was telling me that. So Iwas sitting here bragging about a three tesla
scanner because it's got such a strongmagnetic field, and apparently six teslas exist.
So I did a little googling inthe you know, in a break.
Apparently there is actually seven tesla atut Southwestern. Really yeah, apparently

(49:20):
it's used for research. I'm youknow, if there's a somebody who's involved
with that here in Dallas, we'dlove to hear from them. But uh,
yeah, it looks like they havea seven tesla research scanner. I
don't know they are used for routinediagnosis, No, probably not. So
a strong magnetic field with a reallytight protocol where there may be a millimeter
apart. Imagine the pictures that wouldgive. I mean, I don't know

(49:46):
what the resolution would be. It'dbe like using a telescope to like zoos.
Which brings us to a subject thatI'm always very uncomfortable talking about the
business of medicine. I hate,I hate going there, but I have
to. So I told you earlierthat not almris are the same, and

(50:13):
they actually made I think this stillmake them. A point two tesla,
very very weak magnet. A pointtwo tesla MRI scanner that you can have
in your office, and it wasprimarily used for hand I don't know if
you're old enough to know this,because it was what twenty years ago.
I've seen a hand only MRI.Yeah, you just sit in front of

(50:36):
it. I haven't used one though, right one. Well, it's a
point two tesla. It's not avery strong magnetic field. It's not a
very big computer. And back inthe day they been the big scheme of
things that weren't very expensive. SoI told you that a three tesla is
three million dollars. A point twotesla is maybe sixty thousand dollars. Comes

(51:00):
to business of medicine, insurance companiesreimburse the same whether it's on a point
two TESLA scanner, whether it's readby a chest X ray radiologist or a
fellowship trained muscular skeletal MRI radiologist.It reimburses the same whether it's on a

(51:23):
three million dollar three T scanner orone that's in the closet of somebody's house.
And that somehow seems a bit unfair. Again, I don't want to
debate it, but moms and dadsneed to know not all MRIs are the
same, but yet reimbursement is thesame. This doesn't seem to make sense.

(51:51):
Are we ready to move on fromMRI scanners? And I think we
could devote a whole episode to justlike, oh, MRIs, but our
listeners are probably like, okay,yeah, well they're not all the same,
all right, So now let's talkabout something that's a bit more practical.
And I do want to finish upwith this because it is a positive
note. In a sports medicine world, I can't do what I do effectively

(52:17):
unless the patient does the rehab effectively. And so this was something on my
list of things to talk about todayand put a star next to it.
Most surgeons we can do a topnotch job of putting your ankle back together
again, or putting your knee backtogether again, or putting your wrist back
together again. But if you're notactively participating in the rehab, if you're

(52:43):
not actively participating in the recovery inthe physical therapy, you may have a
less than good result. It isvery important for the patient to be on
board with the importance of rehab andrecovery. When I studied, my first

(53:04):
mentor in the sports medicine world wasa former physical therapist. So he was
a former physical therapist. He wentback to medical school, became an orthopedic
surgeon, and in his clinic hehad physical therapy. And fast forward forty
five years Texas sports Medicine. Inour clinic, we have in house rehab.

(53:28):
It is not it is not meantor intended to be a profit center.
It is meant to ensure a goodresult. So if we do an
ACL reconstruction and the patient comes intwo or three times a week for the
first three weeks and then once aweek for the next three weeks, whatever,

(53:51):
whatever, whatever, that is reallyto help ensure that they are on
schedule and they're coming along. Everyonce in a while, I'll see a
second opinion where a patient has hadknee surgery, risk surgery, whatever,
whatever, and never had rehab.Did you did you do your your physical

(54:13):
therapy? But I didn't. Iwasn't given any physical therapy. Well,
so what what were you given?Well? I was given a little piece
of paper that had some exercises todo. That's that's not enough. In
the in the olden days of sportsmedicine, after we did acl surgery,
we used to put them in acast for six weeks. Oh my gosh,

(54:35):
after they we cut that cast offand they started moving, well,
they didn't. Bottom line is theydidn't. And it took almost a year
of therapy just to get the kneemoving again after six weeks of being immobilized.
So now what we do is westart the rehab almost immediately. So

(54:55):
most of my patients wake up inrecovery room with a CPM machine, a
continuous passive motion machine. That's partof rehab. That's part of recovery.
But I really have to emphasize howimportant rehab and therapy is to the end
result. Same in your world.I cannot agree more. I tell a

(55:22):
lot of my patients that the easiestfive percent of you getting better is what
I did in the operating room.The other ninety five percent is what you're
gonna do with therapy. And Iwould like to ask, now, I
say fifty to fifty, I'm goingto take a little more credit than five
percent. Well, fifty, therehab is important. I'd love to give
a shout out to Certified Hand TherapistHDS. They are an integral part to

(55:46):
any hand surgeon's practice. For example, if you have a flexor tendon injury,
so the tendons are the ropes thatpull your fingers down and you have
it in an area which we wouldcall zone two, which is right between
like the first two knuckles, soto speak of your hand more or less
one of the hardest injuries to rehabI think at all of orthopedics or plastic

(56:09):
surgery, depending on how you weretrained, even general surgery. For hand
surgery, rehabbing a zone to flexertendon injury is I mean, it's really
difficult. Why Why is it?Because they scar down scar It's an incredibly
tight area. The tendons run througha tunnel that is composed of a ligament

(56:31):
is sheath and then the bone.And for a lot of time and even
still it was considered no man's land. So you'll some of the CPT calls,
you'll be like flexor tend to repairno man's land is like actually the
description given and they scar any bulkinessto the repair. If you are not
technically on point, I mean evena quarter of a millimeter can affect tendon

(56:54):
gliding, so it's technically demanding torepair it. That repair has to be
perfect, and then you have tohave therapy that almost starts, like you
know, within a couple of days, a therapist who knows what they're doing,
a patient who is compliant, andit is they're just they they're very
difficult to Everything has to go justright, everything, and it it's just

(57:19):
really hard. I mean, I'veseen some of the best hand surgeons I've
ever seen, and even they strugglewith that injury. I think it's right
for somebody's gonnaigure out a better wayto do it. And I'm always like
banging around ideas in my head,but uh, it's it's just a really
hard thing. But without back totherapy, without a certified hand therapist and
a patient who's bought in, it'sgoing to go poorly. Yeah. And

(57:42):
and so fortunately or unfortunately to theguys sitting in the room with us today,
both had any surgeries, both hadto go through rehab. And I
always tell everybody it's not easy goingthrough the rehab, going through the therapy
is not easy, but you gottado it. What was it like that

(58:06):
that very far? Because I hadmy a CL's done on both my knees.
So I know, what was itlike that first circle on the stationary
bike. I mean it's rough yourknee most of time, get a little
bit of swelling after surgery, butjust the return of motion definitely, it's
like basically like you're learning how toride a bike again for the first time.

(58:27):
That first circle, you don't youdon't start going forward, You start
going backward because that's generally a littleeasier. But I you sort to sort
of like you're breaking off all therust that you gained while you're idle after
surgery. And by the way,we get you on the bike like within
four or five days, and andyou'd be shocked, shocked, how how

(58:47):
much scarn, how much discomfort thereis in four or five days, and
so that I'll never forget that.So, yeah, you're right, going
back Going backwards on the bike iseasier. So you raise the seat way
way way up high so that yourknees barely bending, and you kind of
rock back and forth on the pedals, rock back and forth on the pedals,

(59:08):
and then that first little surprise whenyou go full circle, that first
little surprise takes your breath away andand after that you kind of loosens up
a little bit and then you startgoing forward. But there's nothing that feels
better than after you get off thatbike the first or second time. But

(59:30):
it's not easy. What was itlike for you, Daniel? Difficult?
I think it's as much as itis physical. I think it's also the
mental battle as well. Yeah,which I mean you can talk about from
your own experience, but yeah,it's it's tough. It hurts. I
always tell my patience. And that'sa really good point what you brought up

(59:52):
about the mental aspect. When whenyou're recovering from knee surgery, ankle surgery,
any extremity surgery, you're scared thingsare going to come apart. You
know, you're thinking, oh gosh, if I go full circle, then
the stitch is going to fall out, or if I had an ACL surgery,

(01:00:13):
I don't want to tear my ACL. Well, the surgery is done
in such a way that it actuallyhelps you when you move it, so
if the stitches actually get closer togetherwhen you start moving your knee, so
it's not going to come apart.It's actually the exact opposite of that.

(01:00:35):
It goes together better, and thesame thing for the ACL or ankle or
wrister or the flexor tendons or whateverit. Everything is put together in a
way that it is better when thingsstart moving. So I try to kind
of instill in their mind the confidencethat, look, if you fall off

(01:00:57):
the stationary bike, yeah, thingswill come apart, but if you're just
follow the instructions and go forward andgo backwards, and it will be better
for you. And that is mental, That is absolutely mental. But we
all have to overcome that. Everysingle patient has to overcome that. I
can't imagine going through a knee surgeryor knee replacement and whatever and not having

(01:01:21):
therapy. I just can't imagine.You know, when I'm confident that I'm
ready for a patient to start pushingit for whatever issue, and you know,
I'll tell them then. One ofmy favorite things to tell them is
like, it may hurt you,but you're not going to hurt it.
It's time to go. So there'sanother line I'm going to steal from you.
I like that. I think anotherpoint to reiterate is and I know

(01:01:43):
we see a lot of patients comein for post off or knee injuries,
especially after acls, they'll come inand say, my knee feels unstable or
my knee gives out. I mean, I think it's just another point to
reiterate, Well, the ACL doesstabilize the knee. You don't necessarily realize
after you have the surgery how importantgetting your quad back and your hamstrings back
and getting your caps back involved,how important that is in terms of stabilizing

(01:02:05):
your need. So that's a greatpoint. Often a patient will say money
feels weak or unstable. Well,what they're really telling you is there's no
muscle control. And early in therecovery absolutely yeah, sure you've lost a
lot of muscle mass in the firstfew days after a procedure, But the

(01:02:27):
way to fix that is to getyour muscle tone back. And there's a
there's an interesting dichotomy here in thatyou kind of have to it. It
hurts to get your muscle tone back, so you're making things uncomfortable, but
they're beneficial. I mean, it'slike the number one thing we tell patients

(01:02:49):
for low back pain. If somebodycomes in and says they have low back
pain, you've got to improve yourcore strength. Like planks are your friend,
and planking for more than me forabout more than thirty seconds. It's
not actually easy. So like doingcore strengthening is just like a perfect analogy
for strengthening your quad strengthening the otheryou know, muscles in your leg,

(01:03:10):
Like if you have good muscle tone, it works in conjunction with the bony
anatomy to give you better stability.So the number one thing for low back
pain is proved course strengthening. Sothe importance of this segment was if you're
having an orthopedic type of procedure,do the therapy, do the rehab.

(01:03:34):
Uh, it is so important.And again I sometimes I scratch my head
when I see second opinions where they'venot been offered that you gotta ask.
Yeah, yeah, i'd ask nexttime you go back to see your doctor
and say, hey, listen,am I going to start therapy at some
point because it's involved in pretty muchevery procedure that I know of. You

(01:03:57):
can't you can't do an elbow withouttherapy. Tell patients they're like, well,
how long is gonna take me toget back? And you're discussing it
with them, I'm like, ifyou want, and I liken it to
this other analogy. I love analogies. It's like, if you want six
packs abs, you're gonna have todo some sit ups. If you want
a good result, you're gonna haveto do some therapy. And it's not
just with the therapist. It's atyour own it's at home, it's following

(01:04:21):
their home exercise program. The therapistsare your cheerleaders and your you know,
the people who are gonna keep youhonest. But you you got to put
in the work if you want theresult. Well before we before we end
this segment, you don't need supervisionevery single time you rehab. You don't

(01:04:43):
you need supervision in the beginning,so someone tells you how to do it,
and someone shows you how to doit, and someone tells you how
much weight to use. But thenafter that you don't. You don't need
supervision to write a station ery backfor thirty minutes. You know, if
you go to if you're going tothe if that's all your doing, then
you're leaving stuff on the table,you know. So yeah, I'm gonna

(01:05:05):
leave you with this. Often oneof the number one questions I get is
what is the difference between the proathlete and the recreational athlete in terms of
recovery. Well, that's their job. So where you and I will get
rehab two or three times a week, they get rehab two or three times

(01:05:26):
a day. And so yeah,the more frequently the better. If it's
me or you and we're getting rehabtwo or three times a week, we're
gonna have to supplement. We're gonnahave to find time after work to go
get on the stationary bike. Allright, Uh all right, Uh,

(01:05:47):
well, I guess we're out oftime. I guess Episode eight hundred and
sixty eight is done. Thank youguys for listening, Thank you guys for
calling, Thank you guys for Iwant to also thank our sponsors, Backendorf
Jewelers since nineteen forty eight, Centerfor disc Replacement up in Plano. And

(01:06:10):
I always forget, and I probablyshouldn't because I get in trouble when I
get back to the office, TexasSports Medicine and the Performance Center. Look,
that's our home practice. That's whereRyan and I work. That's where
doctor Levy and doctor Manning and doctorBergmeier and Ballard. That's our home office.
But we also have a performance centerwhere we can do some of the

(01:06:32):
high tech recovery stages that I alwaysforget to bring it up and again because
often we're talking about the basics,but then with the performance Center, we're
taking it up a couple of notches. Anyway, on behalf of all of
us here on Inside Sports Medicine inninety seven won the freak until next week.
I tell your friends and Sid spentsis and synon sipplements.