sbmander

@hjluks Maybe multiple things going on but that one coronal image looks like ITB friction syndrome.

60 yo runner. Also lifts 3x/week. Stable lateral meniscus tear and a small cartilage defect for 10 years. New pain.. worse. Mostly anterior, anterolateral. Pain with loading, jumping, etc... but on landing, not the jump. in other words... axial load hurts. New MRI: mostly anterior BME deep to PT insertion. Stress reaction from the tendon or load??

@northwoods1980 @DrDerekOchiai Subtle with a capital S. If you looked at 100 high level athletes, this fem-head neck junction would be one of the most “normal” you could find.

@DrDerekOchiai Wow. That one subtle.

#HipArthroscopy is a phenomenon tool to treat #HipFAI. When I do a cam FAI correction, the goal is to eliminate the impingement and make a normal hip shape, and not over-resect the femur. An optimal osteoplasty should just look like a normal hip.

@BarbellFi Comedy for a finance guy advertise this and not know it's illegal. LOL. You can do some version of this, but there is a set interest rate you have to charge your family. It's lower than what a bank would charge, but much higher than 0.

When my son is ready to buy a house We’ll loan him the full purchase price He’ll make monthly payments to us 30 year mortgage at 0% interest Thanks to the bank of Mom & Dad 💰

@RadiologyBiz @NeimanHPI @MDAndersonNews The issue is not workload, that’s high everywhere. It’s just easy to leave now, tele so ubiquitous. Jobs aren’t sticky anymore, if something is annoying you just go somewhere else.

Radiologists' odds of leaving an organization have nearly doubled in a short time span, a feat one expert calls "remarkable." @NeimanHPI @mdandersonnews ow.ly/TLEr50Ym0ne

@hjluks @mcuban Complete distal biceps tendon rupture from radial tuberosity with 8 cm retraction. Prominent anterior soft tissue swelling and small hematoma near lacertus fibrosis. I have my dictation ready.

The form is fine for that weight... but you need to question why you're doing heavy curls. As we age, we need to manage the risk of injury vs. longevity-related outcomes. This is a low longevity/healthspan-related exercise with a higher risk, given how challenging the weight was. IMO... I'd re-engineer the approach... FWIW ;-)

Guy giving me shit for my curls in my HIIT class yesterday. What do you think. pass or fail ?

@cdotharrison Chris Paul might be the worst possible contemporary player to use to prove this point. How about all the guys his age who have been retired/washed for many years??

To put into perspective how insane this LeBron run has been, he and Chris Paul were on the same McDonald’s All American team in 2003. Chris Paul retired today. LeBron had a triple double yesterday and is playing in the All Star Sunday.

@SportMDAnalysis @PepperLee1996 @BillSimmons Day after season our busiest MRI day of season by far. Plenty of don't ask/don't tell by players and staff before that. Cambpell was thought to be season ending injury mid season and ended up "only" grade 3 MCL (supposedly) but definitely a factor in his play IMO.

@PepperLee1996 @BillSimmons Also a fair point. One of my sports medicine mentors used to tell me about the flurry of MRI requests he'd receive from players who weren't previously known to be injured the first day after the NFL season ends. So I'd believe most of these reports, esp Campbell's

@BillSimmons Suspect Drake Maye's injury was an AC or capsular sprain from the play when Hufanga landed on him in Denver. Probably felt good pre-Super Bowl w/injection, but all of the hits he took put him at high risk for re-aggravation. Hard to imagine the shoulder not affecting him at all in that game, although it wouldn't explain the prior round struggles. Will Campbell most likely playing through an MCL or PCL tear, either of which likely tanked his performance. PFF graded him 66 pre-injury, only 57 post. #Patriots

@SportMDAnalysis @BillSimmons Campbell already announced as grade 3 MCL before his IR stint right? They heal enough to play in 6-8ish weeks but they still look bad on MRI at that time and I'm sure not back to usual level. Prior rounds for Maye good D/bad weather main reason for struggles. Plus was still OK

@francisdeng Shouldnt an ER doctor know a CT for “dissection” requires IV contrast? Or notice the report said “non contrast” if by some chance it got done incorrectly? Hard to believe any ER doctor would order non con chest CT in this situation.

A medical malpractice case about communication failures around imaging: 🧵 A young, very tall man with chest pain, nausea, and abdominal pain presented to the ED and was worked up by the emergency physician.

@dougbeall Have to say, I am as anti-insurance company as you can get.... However, sacroplasty is sort of a made up procedure that doesn't do anything (other than make the follow up imaging look weird and cause occasional complications) so I can't entirely blame them in this narrow case.

Aetna denies sacroplasty for a very painful sacral insufficiency fracture. Did an appeal, peer to peer, and a 2nd appeal but they issued a final denial for this condition that has one year mortality rate of the 11.5% and a five-year mortality rate exceeding 25%. Unbelievable.

@BrianSuttererMD @jmthrivept Agree, maybe isolated Med mal avulsion. Doubt calcaneal avulsion. Could have popped a fib fx across syndesmosis on the next step I suppose, looked like a bit of an awkward inversion. Atypical situation all around whatever it is.

@jmthrivept I think medial mal avulsion from that eversion load

Bo Nix - I think the injury may have occurred on the plant just before he jumps. His right ankle is forced into eversion, lots of compression. Maybe a fracture of the talus, navicular or cuboid, like a crush injury? Payton said ankle, not foot (thought Jones Fx at first)..

@northwoods1980 Agreed. Can check hands for inflammatory OA but definitely doesn't mean they have AS

No, facet ankylosis does not equate to axial spondyloarthropathy. This older patient has not been missed over the years. Not sure why this fallacy keeps getting propagated on social media. Facets can fuse with DJD

@hjluks Leaking pop cyst/pes anserine bursitis type thing…. Assuming it’s you’re convinced on the other images it’s not a TUMAH

Where does this patient have discomfort? Interesting case.

@BrianSuttererMD @DrJN_SportsMed Even in super high level athletes have not seen much hamstring surgery for non-retracted moderate partial tears like this. Not sure would add much beyond rest/rehab. A consult is ok I suppose but seems like more trouble than it’s worth to me. Non trivial complication risk here.

Would typically agree - only different factor is the patient. In your average individual I would agree, not surgical. But a high level bodybuilder depending on upcoming schedule/comps? I may at least consider reviewing with a surgeon for an acute injury. Time loss from trial of PRP/rehab has to be considered imo

Consent✅ Body builder Doing Cossack squats in an attempt to improve mobility & build coronal plane control / strength In right side lunge, sudden sequence of left hip & groin painful disconcerting 'pops' Abandoned session (sensible!) Since - groin pain on sitting, pivoting - as well as any hinge or LSp flexion movements in the inferior gluteal region MRI - left hip labral tear & 50% undersurface tear of semibranosus origin at ischial tuberosity Unlucky guy

@BrianSuttererMD @DrJN_SportsMed Doesn’t look like surgical hamstring to me. Rest/rehab/hip diagnostic injection probably I think.

@DrJN_SportsMed Tricky combo - what’s your plan? PRP both and see what’s left after rehab, straight to surgical input with the hamstring given his activity level?

@BOSSportsGordo Crazy talk. Ragans is good when he pitches but not worth all that.

It’s a ridiculously steep price but I’d pay it for Ragans. Best whiff rate both overall and in the zone amongst starters with 50 innings. Weird 4.67 RRA to 2.67 expected ERA discrepancy. He’s an ace. If he’s available, I’d do anything.

@redsoxpayroll This is so silly. If they’re willing to give him 150M, it’s totally fine (and in fact better) to do 6/150. He may not be worthless in 4 years + it’s better to spread it out. If they’re worried about the last 2 years, put the excess $ from lower AAV in the bank as you go.

If Bregman is offered 5-6 years from a competitor over the next few weeks, wouldn't it make sense to just match the money and drop the years (similar to last winter?) Ex: *Arizona offers 6/$150M **We hit him with 4/$150M (or even better, 4/$160M with deferrals)

@BrianSuttererMD You’d think… tho I have a hard time getting radiology residents and fellows to say it correctly! The word repair means “fix” in a generic sense, and thats how these reporters are using it. Annoying for us I agree but I doubt they’ll ever be too precise.

@sbmander1 I know - but as people learn more it's an easy detail to get right. Someday we very well could have elite athletes getting repairs (I hope not from the data I've seen)

Really need the team to confirm/deny something in here. It's sloppy communication when the public understands the point. Repair or reconstruct? Reconstruction (use a graft to make a completely new ligament) is the gold standard and what I expect was done. Repair (ie the BEAR, using a scaffold to directly repair the torn ends) is a newer technique that is still in the early stages and not typically done on elite athletes. But it does lean towards earlier return to sport So was it actually a reconstruction, or did he have a repair and we might expect him back in the summer/early fall?

@BrianSuttererMD @ProFootballDoc Even in very strong guys the lung isn’t really that deep in some places either…

@ProFootballDoc It’s actually not that shocking at all. Talk to any high level athletic trainer and they’ll share stories about knowing times it happened to colleagues or hearing the stories secondhand

Shocked that "dry needling" could cause this #TJWatt has a lot of muscle to get thru first