Archive for the ‘News’ Category

The Truth about Growing Pains

Posted on: January 29th, 2020

Dr. Jason Determann

Has your young one ever complained of general aches and pains… that have you stumped? The phenomenon we call “growing pains” is one of the most common causes of recurrent musculoskeletal discomfort in children. First described by a French physician in the early 1800s, we have spent nearly two centuries trying to get a better grasp on the exact cause and best treatment for such a common problem.

What Exactly are Growing Pains?

So what are growing pains?  The syndrome is described as intermittent pain, usually in the lower extremities, that occurs late in the day or early evening. The pain is typically gone in the morning and not worsened by physical activities. Discomfort with growing pains usually begins between the ages of 3 and 6, with the average age around 8 years old. Despite the coined term “growing pains,” there’s no direct connection to rapid growth.

The search for a cause hasn’t been completely successful.  Theories include:

  • generalized hyperlaxity (loose ligaments,)
  • psychological stress that leads to somatic symptoms
  • deficiency in blood flow
  • low vitamin D levels
boy having back examined

How Do I Know if Growing Pains are Something More?

The diagnosis is one of exclusion. Simply stated, “Everything checks out OK.” A few highlights:

Characteristic Typical Findings
Pain Location Bilateral
Lower Extremity (calves, thighs, shins)
Timing/Onset Late afternoon/evening
Resolution by morning
Intermittent
Not activity related
Severity Improves with massage, over the counter analgesics Does not increase in severity over time
Physical Exam Normal

The first thing we’ll do is look at a full medical history with a thorough physical exam to determine any other potentially serious causes of pain.  That might include fever, malaise, or decreased appetite. If your child can’t put their weight on a leg or has an altered gait (walk), we’re dealing with something beyond growing pains.  Any recent viral illnesses, rashes or travel are clues to alternative diagnosis as well.

If the physical exam is normal, we typically don’t need any further workup to make the diagnosis.  X-rays or bloodwork may be ordered to rule out a more serious condition. These can  include developmental abnormalities, infections, growth plates conditions, or even a remote injury or trauma.

What Relieves Growing Pains?

When the diagnosis of growing pains is made, often reassurance is the only treatment rendered. Some studies have found benefit to stretching the quadriceps, hamstring, and calves. Most children get relief with massage to the areas of pain, as well as the addition of heat. Over the counter medications such as acetaminophen or ibuprofen can alleviate some the pain and discomfort.

At the end of the day, the term “growing pains” describes a specific, benign pain syndrome in young children.   Even though we still don’t know much about the underlying causes, there’s no need for long-term concern.   If you have any doubts whatsoever – we’re here to help you sort it out.

“Though he may stumble, he will not fall. For the Lord upholds him with His hand.”  Psalm 37:24

Jason R. Determann, MD

Dr. Determann received his MD from Louisiana State University in Baton Rouge, followed by residency in Orthopaedic Surgery at the University of Alabama in Birmingham.  He is Board Certified and Fellowship Trained in Sports Medicine with a specialty in Shoulder & Elbow Surgery.

Sport Specialization: Is it Safe? Is it Necessary?

Posted on: December 29th, 2019

Albert Jay Savage IV, MD

(June 2020) Youth sports have surged across the country, and a weekend drive around Eastern Shore ballparks proves we’re part of that trend.  By all accounts, the physical, mental and emotional benefits of individual and team sports are well documented.  From a sports medicine perspective however, this boom in youth sports has raised some alarm:   increasing “sport specialization” at a young age means an increase in youth sports overuse injuries, too.

Doesn’t My Child Need to Focus on One Sport?

Sport specialization has been defined as “year-round intensive training in a single sport, at the expense of other sports.”  Some parents reading this may be skeptical , as conventional wisdom suggests young athletes determined to “up their game” as they age will fall behind if not working consistently on their skills.    However, a quick dive into current research reveals some surprises:  (1) most players in Division 1 athletics did not pursue early specialization, (2) baseball pitchers from colder climates that do not throw year-round tend to excel over those from warmer climates, and (3) early specialization may actually decrease the likelihood that an athlete will reach an elite level.

Furthermore, studies find overuse injuries consistently linked with the following risk factors: (1) a high level of sports specialization, (2) playing their sport for more than 8 months of the year, and (3) playing their sport for more hours per week than their age. 

child throwing baseball

Tips to Prevent Youth Sports Overuse Injuries

Most overuse injuries can be prevented with proper training and common sense.

  • Learn to listen to your body and listen to what kids are telling you.
  • Remember that “no pain, no gain” does not apply here. 
  • These young athletes are not just little adults.  They have growing bones and soft tissues and are susceptible to different types of injuries.
  • Follow the 10 percent rule. In general, you should not increase your training program or activity more than 10 percent per week. This allows your body adequate time for recovery and response.

From a parent’s perspective I want my kids to enjoy playing sports –and to soak up the character traits and teamwork skills that healthy competition offers.  From my former athlete perspective, I know the value of hard work in reaching their greatest potential.    But all of us as parents can agree in the goal of safety first and foremost. Nothing is achieved when our children are sidelined with preventable injuries. 

The debate over single sport injuries is likely to grow along with the options and enthusiasm for youth sports overall.  I encourage parents and coaches to learn more – some great resources can be found at the American Orthopedic Society for Sports Medicine website, www.sportsmed.org.

Dr. Savage received his MD from the University of Alabama at Birmingham, followed by residency at the UAB Department of Orthopaedic Surgery. He is Board Certified and Fellowship Trained in Sports Medicine.

Enjoy Alabama’s Great Outdoors – Safely!

Posted on: November 29th, 2019

November marks fall and all its outdoor glory in full swing, with cooler weather at long last here in South Alabama and plenty of outdoor pursuits filling up weekend calendars.  Hunting is one of those fall pastimes that allow families and friends to get together and get outside to appreciate nature.  Whether dove, deer season, fishing or hiking is your plan; Alabama offers thousands of acres of public and private lands to enjoy.   From tree stands to firearms to ATV’s, there are several safety tips to keep in mind: 

If hunting with family or friends:

  1. Know your target and what is beyond it.
  2. Attend a hunting safety course.
  3. Make sure all guns are safe to operate.
  4. Don’t mix cartridges from different calibers.
  5. Wear ear and eye protection.
  6. Store guns so that they are inaccessible to unauthorized persons.
  7. Understand that some guns and activities require additional safety precautions.
  8. Do not use alcohol and be aware of drugs that might impair your ability to safely handle a firearm or weapon safely.

 *NRA Family

You might be surprised how many injuries we see in the orthopaedics field – especially in the early days of the season when hunters may be out of practice in the “ups and downs” of climbing a tree stand.   Twisted ankles, shoulder injuries or broken bones from a fall can happen in a flash.  Alabama Fish and Wildlife recommends before you hunt:

  1. Know your equipment which includes checking your stands, straps, and chains every season and replace them as needed.
  2. Select the right tree:  straight, the correct size for your stand, avoiding smooth barked trees, and check for insect nests.
  3. Wear a full body safety harness, know how to use it properly, and wear it at all times.
  4. Use a haul line to raise and lower your equipment.
  5. Make sure your weapon is unloaded while raising and lowering in your stand.
  6. Have emergency equipment available: knife, cell phone, and flashlight.

Off road recreational vehicles are often essential in exploring and accessing hunting grounds, and come with their own potential risks.  Protective head gear, eye wear, appropriate sizing and training are a must. Safety courses are a smart idea – and available through ATV dealers or the ATV Safety Institute.

We’re fortunate to live in a place with ample opportunity to get outdoors and up close to wildlife and nature.  All of us here at Bayside Orthopaedics care about your health whether on the field of play… or in the field… literally! Get out there – but do so safely.

Joey F. Carter, MD

Dr. Carter received his MD from the University of Mississippi School Of Medicine in Jackson, MS. He is

Board Certified in Orthopaedic Surgery and a Fellow of the American Academy of Orthopaedic Surgeons.

A Repetitive Problem – The One Sport Injury

Posted on: October 29th, 2019

Gregg Terral, MD

( August 2019) Summer break is over, kids are back in school and fall sports are in full swing from elementary to high school. With more and more young athletes under 12 focusing on just one sport and training year-round, we’ve seen a growing number of our younger patients with what’s called a “one sport injury” caused by repetitive movements.  The condition is called apophysitis.   

What Causes the One Sport Injury?

The apophysis is a growth plate that provides an attachment site for a muscle to attach to bone via a tendon. Apophysitis occurs due to repetitive or chronic traction at either the origin or insertion site. This is because the growth cartilage present in this younger age group is the weak link in the muscle-tendon unit and is prone to injury. Continuous stress can lead to injury with pain and swelling.

The knee is the most commonly seen site of apophysitis where the patellar tendon attaches to the upper tibia. Other common sites are the Achilles tendon at the heel, the lower part of the kneecap, the outer side of the foot), the inner elbow (Little League elbow), and shoulder (Little League shoulder). Runners, sprinters, and soccer players are especially prone to locations in the pelvis causing hip or groin pain.

child throwing baseball

Among athletes between the ages of 5 to 14, overuse injuries impact:

  • 27% of football players
  • 25% of baseball players
  • 22% of soccer players
  • 15% of basketball players
  • 12% of softball players *                                   
  • *American Academy of Orthopaedic Surgeons

How Can We Treat Overuse Injuries?

We treat all types of apophysitis with a period of rest, ice, activity modification, and potentially physical therapy depending on the condition severity. Depending on the location, a variety of straps, braces, and orthotics can aid in providing comfort, protection and stabilization of the involved site. Healing time varies from a few days to weeks or months depending on a patient’s willingness to rest and avoid contributing activities.

What Parents and Coaches Can Do

  • Have a pre-season wellness check to determine any health concerns that could lead to injury
  • Warm-up and cool-down before and after athletic activities
  • Use correct sport specific equipment
  • Train in proper techniques like throwing or running
  • Hydrate!  Drinking plenty of water maintains health and minimizes cramps
  • Play different positions or sports throughout the year to minimize overuse injury risk
  • Don’t  play with pain – allow time to rest and heal

Keeping those growing bones, joints and muscles healthy ensure the ultimate goal: a healthy lifetime love of sports, too.

Dr. Terral received his MD from Louisiana State University Medical Center in New Orleans, followed by residency in the Department of Orthopaedic Surgery at the University of Mississippi Medical Center in Jackson, MS.  He is Board Certified and Fellowship Trained in numerous specialties including trauma-related musculoskeletal injuries and joint reconstruction.

Dr. Gregg Terral Performs 100th Mako Joint Replacement Surgery

Posted on: October 24th, 2019
Gregg Terral, MD (right) performed the first Mako-assisted joint replacement in Baldwin County. South Baldwin Regional Medical Center recently added a second Mako robot.

(Foley)  Sixteen months after performing the first Mako robot-guided joint replacement surgery in Baldwin County, Dr. Gregg Terral marked his 100th surgery this month.  The 3D virtual model of a patient’s unique joint offers a revolutionary capability for customized joint replacement making lengthy, painful recovery a long-gone experience.

South Baldwin Regional Medical Center partnered with Bayside Orthopaedic Sports Medicine and Rehab Center in launching the robot-arm assisted joint procedure in May, 2018.  A significant leading-edge investment for SBRMC, Mako is a $1 million system designed for total hip and total or partial knee replacement.

Terral is a board-certified and fellowship-trained orthopaedic surgeon specially trained in the robotic arm. Dr. Jay Savage and Dr. Jason Determann of Bayside Orthopaedic have teamed with Terral to perform 256 of South Baldwin’s 359 surgeries to date.

“It’s been very rewarding to see my patients return to the lives they’ve enjoyed before arthritis so quickly, and with much less pain with the Mako process,” said Terral. “Every knee is different. Until we had the precision of a robot arm and customized model, we would typically make the cut and work with what we had.  The unexpected would often made procedures tougher, with more tugging and pulling. The precision now reduces the potential for complications, and we’re in and out quickly – that’s always better for the patient.”

The robotic arm uses CT-based 3D modeling of bone anatomy to identify the implant size, orientation and alignment based on the individual patient’s unique anatomy. The technology is able to help administer microscopic, precise cuts and measurements during surgery and even change the plan mid-procedure, if needed.  The robotic arm can position the cutting tool to the exact degree of cut needed, an impossible task with human hands.  “We’re in control of the tool at all times, and can stop at any time. It only does what we tell it to do and so far it’s been perfect.”                                               

For more than 40 years, Bayside Orthopaedic Sports Medicine & Rehab Center has provided Baldwin County’s most comprehensive leading-edge orthopaedic care.  Our fellowship-trained and board-certified doctors have extensive specialization in joint replacement, fracture care, sports medicine and physical therapy.  Founded in Fairhope in 1977, the practice today includes on-site rehabilitative care, a Bone Health Clinic, and additional offices in Foley, Gulf Shores and Brewton.     We’re committed to the wellness of body, mind & spirit in restoring patients to active, healthy lives.

WKRG’s The Doctor is In

Posted on: October 24th, 2019

WKRG’s The Doctor is In – featuring Dr. Jason Determann discussing shoulder pain and its causes September 13th.

THE DOCTOR IS IN: Dr. Jason Determann with Bayside Orthopaedic Sports Medicine and Rehab is talking about shoulder pain and sports injuries. Ask him your questions now!

Posted by WKRG on Friday, September 13, 2019

Watch Joshua Wing with the Bayside Orthopaedic Bone Health Clinic – June 7th on The Doctor is In .

Summertime: Fun, Freedom and… Fractures?

Posted on: June 29th, 2019

Dr. Jay Savage

It’s no secret that summer on the Eastern Shore is loaded with opportunities to get out, get active and enjoy this beautiful area that we are blessed to call home.  But, sometimes summertime fun for our children can be interrupted by an injury, and if it happens in your house it can be helpful to know that you are not alone.  The struggle is real, and for younger children an injury often means a broken bone or fracture that will require treatment and possibly even the dreaded summertime cast.

It’s not a coincidence that the season for extended daylight and outdoor activity is also the season for broken bones. Increased physical activity leads to increased likelihood of bone fractures. According to the American Academy of Pediatrics, nearly 3.5 million sports-related injuries occur each year in the United States to children younger than age 15, with fractures among the most common.

Broken bones in children are often very different than similar adult injuries.  Our kids’ bones are growing and they have open areas in the bone call physes or “growth plates” that are more susceptible to injury.  Children are also susceptible to “greenstick” fractures where the bone may bend and break on one side but not break completely through the bone.  This is similar to the way that a green limb from a tree or bush may splinter on one side when it is bent, but not completely break in two.

These specific characteristics of children’s bones make them more likely to have a fracture rather that a sprain on strain even during the course of normal activity or seemingly minor falls, bumps or bruises.  Common signs of a fracture include swelling, redness, tenderness to touch, “fever” in the area of injury and a child avoiding motion of the injured area. 

If your child has these symptoms after an injury, evaluation by an Orthopedic specialist with a physical exam and x-ray are usually all that is needed for a prompt diagnosis.  Treatment usually consists of a cast or brace for several weeks, but the good news is that kids heal much faster that we do as adults!  That means they should out of that cast and back to enjoying their summertime fun in less time that you might expect!

New robotic arm assists South Baldwin surgeons

Posted on: May 14th, 2018

Bayside Orthopaedic featured in Gulf Coast Media’s “Focus on Health” – May 9, 2019

Direct Anterior Approach Total Hip Arthroplasty

Posted on: June 22nd, 2016

Hip replacement or Total Hip Arthroplasty (THA) is one of the most commonly performed Orthopaedic procedures with an estimated 350,000 patients in the United States having hip replacement surgery each year. There has been a great increase in the number of hip replacements performed over the past 10-15 years in large part due to improved surgical techniques, improved anesthetic techniques, postoperative management and improved rehabilitation protocols after surgery. It is estimated that the number of patients needing hip replacement surgery will continue to increase in the foreseeable future.

Hip replacement surgery is also one of the most successful procedures in Orthopaedic surgery, often allowing patients with previously debilitating hip pain to return to their previous level of activity with little to no pain after a full recovery.
Hip replacement surgery can be performed by several different surgical techniques.

posterior-approachThe most common technique used by most Orthopaedic surgeons is the Posterior Approach which has been used for thousands of hip replacements with excellent results. This approach generally involves a 4-6 inch incision of the side or back of the hip; requires splitting of the iliotibial band and the gluteus maximus; detachment of the piriformis and short external rotators and the posterior hip capsule. The hip is then dislocated at which point we can now access the hip socket and the upper part of the hip and perform the replacement. During this time we replace the ball of the hip with either a metal or ceramic ball which has a stem that goes into the upper part of the thigh bone. We then place a new metal socket, with a liner made of polyethylene, into the pelvis. The detached posterior structures are subsequently repaired to restore the soft tissues around the hip. Immediate weightbearing is allowed. Patients observe hip precautions to prevent posterior dislocation in the area of these repaired structures. These precautions are generally strictly observed for 2-3 months postoperatively.

hana-tableIn contrast, Direct Anterior Approach hip replacement is performed through a 4-6 inch incision on the anterior (front) or anterolateral thigh. The procedure is aided by the use of a special Orthopaedic operating table called the Hana®Table, which allows improved access to the hip from the anterior approach and the ability to manipulate the leg to allow for access to the femoral canal.

The approach uses an anatomic plane between 2 muscles; the Sartorius and the tensor fascia lata. The hip capsule is opened and only the piriformis tendon is generally released to aid in insertion of the implants. The hip implants are then inserted in the same manner used for a posterior approach. The hip capsule is closed. Immediate weight bearing is allowed. No hip precautions are necessary.

There are several potential advantages to an anterior approach for hip replacement. One advantage appears to be a quicker return to walking and daily activity in the early post-op period. However by 6-12 months after surgery, the results with regards to level of function are not different from a posterior approach. Other potential advantages include lower rates of postoperative dislocation, improved implant position due to the use of intra-operative fluoroscopy and a potentially shorter hospital stay (although this is comparable between the two approaches and depends on many factors).

Some disadvantages specific to the anterior approach include risk of injury to the lateral femoral cutaneous nerve (a sensory nerve in the thigh); increased operative time; the inability to perform the procedure in some overweight or obese patients or with some types of hip deformity. Also, this is not generally a technique that is used for any type of revision hip replacement.

Our Practice has Surgeons who perform hip replacements through each of these (and other!) approaches. We encourage you to discuss this with us at your appointment so that we can make the best decision for your individual case!