So Colt McCoy is "being treated by doctors in locker room"

[surftheiop]

So in Rose Bowl Colt McCoy has some sort of shoulder injury (or atleast they have x-rayed his shoulder) and is getting treated in locker room to try to get him back out on field for second half.

I was curious what sort of treatment the sports docs are using on players once they make decision to try to "get him back on field" ?

Would they just be trying try stretch him out/massage and stuff or would they be giving him pain meds / injections, etc. ?

---

Members don't see this ad.

 

[Disciple]

You most definitely do not want to inject the affected joint or give them pain meds and send them back out.

 

[DigableCat]

Unfortunately, he's done.

It's all about protecting the shoulder for the NFL at this point.

 

[surftheiop]

Unfortunately, he's done.

It's all about protecting the shoulder for the NFL at this point.

figured that would be the case, certainly has made for a boring 2nd half so far

 

[pete27]

in his post game interview...he said he had no pain but his whole arm felt dead!

 

[lobelsteve]

C'mon guys.

Sports medicine 101:

MSO4, ice, compression, 60mg Toradol on entry to the locker room.

Wait 2 minutes.

Start Medrol drip with famprodine infusion over 10 minutes.

300 of Robaxin IM, 200mg Provigil PO, and subacromial marcaine coming out the door.

Play ball.

 

[Finally M3]

Or you can do a Chad Henne, get an AC joint injection pregame and somehow result in an axillary neuropathy and thus obliterating your team's chances for the rest of the season...

Not that I'm bitter.

 

[ampaphb]

C'mon guys.

Sports medicine 101:

MSO4, ice, compression, 60mg Toradol on entry to the locker room.

Wait 2 minutes.

Start Medrol drip with famprodine infusion over 10 minutes.

300 of Robaxin IM, 200mg Provigil PO, and subacromial marcaine coming out the door.

Play ball.

He had a shoulder separation - none of that would have resolved his instability

 

[RUOkie]

He had a shoulder separation - none of that would have resolved his instability

I thought it was a "pinched nerve"

 

[lobelsteve]

He had a shoulder separation - none of that would have resolved his instability

1. He would not have cared about the instability
2. A lot of coband and athletic tape.

We know college football players are not the most intelligent people- where did you play- AMPA? (inside joke)

 

[nleeds24]

C'mon guys.

Sports medicine 101:

MSO4, ice, compression, 60mg Toradol on entry to the locker room.

Wait 2 minutes.

Start Medrol drip with famprodine infusion over 10 minutes.

300 of Robaxin IM, 200mg Provigil PO, and subacromial marcaine coming out the door.

Play ball.

Not familiar with this drug. Do you mean Fampridine? According to yahoo search of the chemical name its a K-channel blocker which prolonges action potentials increasing neurotransmitter release at NMJ. Its used in MS, Lambert-Eaton and Myasthenia Gravis. Is there an article from where you learned this regimen or is this something you learned from a mentor?

 

[Disciple]

Looks like it was used in clinical trials, the thought being that it could preserve conduction in the face of demyelination, particularly MS.

I think the above post is supposed to be a joke (purple type).

 

[lobelsteve]

Dark orchid gentlemem. It's Sarcasm on the internet.

Though Fampridine may be available soon, it has been around for years in the SCI folks.

http://www.acorda.com/pipeline_fampridine_sci1.asp

It's 4-AP. Was supposed to heal SCI in the acute phase. Never panned out in initial studies, but may be useful for any nerve injury in the future (wink,wink).

Kind of like abc chondroitinase and rabbits. Was I the only one reading the crappy literature back in 2002?

 

[skiz knot]

So in Rose Bowl Colt McCoy has some sort of shoulder injury (or atleast they have x-rayed his shoulder) and is getting treated in locker room to try to get him back out on field for second half.

I was curious what sort of treatment the sports docs are using on players once they make decision to try to "get him back on field" ?

Would they just be trying try stretch him out/massage and stuff or would they be giving him pain meds / injections, etc. ?

Sounds and looks like what he had is a "stinger." It is basically a neuropraxia from stretch at the roots of the brachial plexus (or possibly distally). Proper sports medicine is to not let him return to play until symptoms completely resolve. Multiple "stingers" necessitates imaging studies of the c-spine to rule out any pathology there predisposing the player to these injuries.

 

[axm397]

Dark orchid gentlemem. It's Sarcasm on the internet.

Funny - dark orchid is my wedding color... hmmmm what does that say about me?

 

[truthseeker]

You most definitely do not want to inject the affected joint or give them pain meds and send them back out.

What if he has a grade I Throwing shoulder AC sprain? Stucturally sound but to painful to participate? I think some orthopods might inject that for a crucial game. Right or wrong, I think it happens.

As an athletic trainer the question I ask myself is "are they at a greater risk for harming themselves by returning now?" if the answer is yes then they ice it and sit out that game. If it is a matter of pain management, you let them try to tough it out.

 

[RUOkie]

What if he has a grade I Throwing shoulder AC sprain? Stucturally sound but to painful to participate? I think some orthopods might inject that for a crucial game. Right or wrong, I think it happens.

As an athletic trainer the question I ask myself is "are they at a greater risk for harming themselves by returning now?" if the answer is yes then they ice it and sit out that game. If it is a matter of pain management, you let them try to tough it out.

I got out of the team physician (football) business after I did a EMG on a linebacker with a "stinger". He had a bad Lateral Cord Plexopathy with widespread denervation. I advised the head team doc to keep him off the field until his strength returned to normal. He played in the team Bowl game 2 weeks later. The guy wanted to play since it was his last game as a senior.

 

[atstudent]

Sounds and looks like what he had is a "stinger." It is basically a neuropraxia from stretch at the roots of the brachial plexus (or possibly distally). Proper sports medicine is to not let him return to play until symptoms completely resolve. Multiple "stingers" necessitates imaging studies of the c-spine to rule out any pathology there predisposing the player to these injuries.

This was my thought too when I saw how he came off the field.

 

[PMR 4 MSK]

I got out of the team physician (football) business after I did a EMG on a linebacker with a "stinger". He had a bad Lateral Cord Plexopathy with widespread denervation. I advised the head team doc to keep him off the field until his strength returned to normal. He played in the team Bowl game 2 weeks later. The guy wanted to play since it was his last game as a senior.

See, I have no problem with that. You made a diagnosis, advised the patient, and he took your advice under consideration but made a decision to the contrary. He's a big boy and can do that. Meat heads will play with body parts hanging off if you let them.

I am much more strict with peds athletes, but again, When I say they can't lpay, then the patient, their parents and the coach have them play, NMFP anymore. Come back and see me after you've made it worse. I have no problem letting them know they are dumb***es.

I always document that I advised the athlete not to play and the possible outcome of returning to play too soon.

More fun is dealing with professional athletes. They're usually seen either under work comp or for free. Either way, the athletic trainer is on your butt constantly.

 

[rysa4]

This was my thought too when I saw how he came off the field.

It may well have been a "stinger." His deficit was in the median nerve distribution and when he tried to hold a foot ball it basically fell out anytime he would practice a motion to bring the ball up with his arm in trying to get set for a throwing attempt. Interestingly, his sensory deficit was very prominent relative to his motor deficit. Looking at the hit, a root avulsion isn't at all likely and I agree that a brachial plexus injury is high on the list.

His EMG in a few weeks might be interesting and hopefully after 300 lbs accelerated into his shoulder his humeral head is still intact, glenoid labrum and all.

 

[skiz knot]

Looking at the hit, a root avulsion isn't at all likely and I agree that a brachial plexus injury is high on the list.

Neuropraxia is not equal to "root avulsion."

 

[rysa4]

Neuropraxia is not equal to "root avulsion."

Of course not. Jasper Daube, one of the guys who trained me, would certainly agree. ( You aren't reading my line correctly )

There is an interesting case entitled "
Multiple Root Avulsions From the Brachial Plexus. Case Illustration"

Check it out. It might help you a bit, based your quotes around root avulsion. Lemme know if I can help ya out on this!

 

[latinman]

I did have a chance of seeing once a root avulsion case. Now the textbook teaches you that the SNAP amplitudes are always preserved. I am not sure whether this is always is the case in real life. I guess the point I am trying to make is that even when you think it might be a plexopathy involving PNS, it doesn't hurt to get cervical or lumbar imaging to make sure no roots got yanked in the process. I know how SNAPs and paraspinals are suppose to make that distinction (ie., radic vs. plexopathy), but even then I don't think this is 100%bullet proof, and everything else should be brought into the picture including clinical hx, mechanism of trauma when making a diagnosis and determining your management.