Avoid Sports Injuries: Tips From an Olympic Doctor
Medscape: Are there any other new treatments that you've learned about in your travels and think are useful? continued...
It takes about 60-70 seconds, all under local anesthesia. You don't even need a stitch because the incision is so small. The main indications for it now are patellar tendinitis, Achilles tendinitis, plantar fasciitis, tennis elbow, and golfer's elbow.
I have a great example of its use from the last Summer Olympics. A track-and-field athlete had had chronic patellar tendinitis for a year. Therapy had failed and he still had some muscle imbalances and hip weakness. I told him, "You know what? You need to do some hip strengthening." He came out to my clinic for a few weeks to work with my therapist and was maybe 60% better within about a year of therapy and conservative measures. At that point, he had an area of scarring embedded in his tendon that you could see on ultrasound and MRI. Because conservative measures were failing, this was an indication to surgically open up the tendon and clean out the scar -- open scar debridement of the tendon.
Fortunately I had learned about ultrasound-guided microtenotomy before this and had trained in it, so I performed it on this young man. He is currently, I think, 14 weeks out, and for the first time in 2 years he is absolutely pain-free and is doing great in his training. It is just miraculous.
Medscape: Is ultrasound-guided microtenotomy widely available now?
Beim: It was FDA-approved about a year and a half ago, and any surgeon can be trained to do it. However, you have to be a good ultrasonographer, which is, I think, the limiting step, because many orthopedists don't do ultrasound themselves. They might have their physician assistant or radiologist do it, but you really need to do it yourself to correctly perform this procedure. Once you are proficient at ultrasound, this procedure is quite simple. You just go in and take out the bad tissue and that's it. It just makes sense to use this approach rather than making a big incision and violating normal tissue to get to the diseased tissue.
This is another technique that I picked up through my travels and have taken into my practice. So, bottom line, being associated with these international Games has changed my practice for the better. It has been amazing.