Scottsdale Sports Medicine

Dr. Carfagno will be discussing endurance medicine at the OrthoArizona Sports Medicine Conference at the Hyatt Regency Phoenix on Feb. 3. The conference is designed for physical & hand therapists, athletic trainers, strength & conditioning coaches, sports psychologists, orthopedic and primary care physicians, physician assistants and nurse practitioners! The doctor's session will be from 4-6:35pm. Check out the website for more information -- https://web.cvent.com/event/222533ba-79fc-4448-b268-d4b3262671e8/websitePage:a8ae4cf5-a479-4722-a6f2-55e3803cd975

I want to personally thank you each and every medical volunteer who came out on a cold and rainy day to help provide the medical coverage for the Rock And Roll Marathon, Half Marathon and 10K today. I hope everybody learned a little more about endurance medicine and are able to apply it in their every day medical work. I hope you all had a good time and are inspired to lead a more active, healthy life. You are all very appreciated and thank you! Also want to congratulate the three ladies on finishing their races, and were recipients of the Scottsdale Sports Medicine race day VIP pass. So proud of you and I hope you had an enjoyable time!

Hi SSMI Community -- Asking a favor for a teammate of mine -- Rachel, Medical Program Director for the Rock 'n' Roll Running Series! Her niece, Vivienne Berrett, has been nominated for Athlete of the Week in Stanwood, Washington. She is a 6'4 senior at Stanwood High School and has committed to play basketball for the University of Hawaii next year. If you can vote for her to be Athlete of the Week that would be awesome🤩 All you have to do is click on the link below, scroll down to athlete list, select Vivienne, and hit vote button. We thank you for the support! https://www.heraldnet.com/sports/vote-for-the-heralds-prep-athlete-of-the-week-for-jan-2-8/

Giveaway Alert! The Rock 'n' Roll Arizona Running Series is in a few days. Dr. Carfagno is heading up the sports medicine team on race day. The doctor has 3 VIP passes to giveaway and he's doing it again today! What you get is free entry to the marathon, half marathon or 10K, a parking pass and food. The first 3 people to get to the Scottsdale Sports Medicine Institute office (14220 N. Northsight Blvd., Suite 145, Scottsdale, 85260) between now and 5pm will win! We will share pictures on our social media of all the winners. Good Luck!

The Rock 'n' Roll Arizona Running Series is this Sunday! Dr. Carfagno is heading up the sports medicine team on race day. The doctor has 3 VIP passes to giveaway and he's doing it today! What you get is free registration to the marathon, half marathon or 10K, a parking pass and food. The first 3 people to get to the Scottsdale Sports Medicine Institute office between now and 5pm will win! We will share pictures on our social media of all the winners. Good Luck!

Looking for volunteers to help out at the Rock 'n' Roll Arizona race next Sunday, Jan. 15th! Dr. Carfagno is heading up the Sports Medicine Team.
Sign Up Here -- https://competitorgroupinc.volunteerlocal.com/volunteer/?id=68617. There are also a few spots open for course captains with healthcare experience -- Doctors, PAs, RNs, NPs, Paramedics and EMTs. Any questions, call the office at 480-664-4615.

Lexxa & Max Cardio Club will be out at the Arizona Super Bowl Host Committee 5K-9 Fun Run this Saturday, Jan. 7! Register here -- www.azsuperbowl.com/5k9/. Call the office to let us know you will be meeting Dr. Carfagno, Lexxa & Max!

Wishing everyone a Happy New Year! Cheers to 2023🥳

Dr. Carfagno is heading up the Sports Medicine Team for the Rock 'n' Roll Arizona Running Series on Jan. 15th! Volunteers are wanted with and without direct patient care. Check out the areas of need on this link -- https://competitorgroupinc.volunteerlocal.com/volunteer/?id=68617&utm_source=newsletter&utm_medium=email&utm_campaign=december_newsletter_give_the_gift_of_health_at_ssmi&utm_term=2022-12-21

Merry Christmas🎄 Enjoy the day spending time with family and friends:)

SSMI is feeling in the holiday spirit!! We're handing out 2 more VIP Passes to the Rock 'n' Roll Arizona Running Series Right Now:) The first 2 people to the office will be the winners🤩 The pass gets you a free registration to the marathon, half marathon, 10K or 5K, free parking and food. You need to be a current patient to participate.

Giveaway Alert! We're passing out another VIP Pass to the Rock 'n' Roll Arizona Running Series Today:) First person to the office will be the winner🥳 The pass gets you a free registration to the marathon, half marathon, 10K or 5K, free parking and food. You need to be a current patient to participate. We will share a picture of the winner on social media. Best of Luck!

Congrats to Argentina and France with which to be arguably, probably one of the best World Cup tournaments and definitely World Cup final… Entertainment and performance was spectacular… Lionel Messi rejoice… If you ever want to see content in someone’s facial muscles, soccer fan, or not watch the end of his celebration and see unbelievable…feliz navidad and merry Christmas and Happy Holidays to all!!

Congrats to Tracy Lenz! She is the winner of this week's Rock 'n' Roll Arizona VIP Pass at SSMI😊 Tracy will be doing the 10K on Jan. 15. We have 3 more VIP passes to give out. Make sure to check out our Facebook and Instagram handles as the next giveaway will be sometime next week!

We're giving away another VIP Pass to the Rock 'n' Roll Arizona Running Series Today! Get to the SSMI office first and you will be crowned the winner🏆 The pass gets you a free registration to the marathon, half marathon, 10K or 5K, free parking and food😉 You need to be a current patient to participate. We will share a picture on social media of the winner. Good Luck!

Did you know that Vitamin B12 has been used to enhance metabolism and increase overall energy? Interested in learning more or have questions? Feel free to consult with the SSMI staff and see if you're a candidate for a complimentary Vitamin B12 injection! Call the office to schedule an appointment.

Congrats to Madhuri! She was the first person to get to the SSMI office to claim the Rock 'n' Roll Arizona VIP Pass😊 Madhuri will be doing the marathon on Jan. 15. We have 4 more VIP passes to give out. Make sure to keep an eye on our Facebook and Instagram handles as the next giveaway will be sometime next week!

We're giving away 1 VIP Pass to the Rock 'n' Roll Arizona Running Series Today! Whoever gets to the SSMI office first will be the winner. It gets you a free registration to the marathon, half marathon, 10K or 5K, a parking pass and food🥳 You do have to be a current patient in order to participate. We will let everyone know who the winner is by taking their picture and sharing it on social media. Good Luck!

SSMI CASE
Carpal Tunnel Syndrome
31 year old female presents having pain as well as numbness and tingling in her right hand. She is a pianist and notes that she first started to feel these symptoms 1 month ago after a long bout of playing the piano. Her symptoms involve her 1st 2nd 3rd and half of her 4th digit but not her pinky. She describes the pain as a dull achy pain. She has also been experiencing weakness in her right hand. She has not tried anything to relieve her pain.
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Evaluation showed no decrease in grip strength or decrease in active or passive motion. Tapping upon the middle of this patient’s right wrist elicited pain. Patient had a positive Phalen and Phalens test.

An ultrasound confirmed the diagnosis of carpal tunnel syndrome. Carpal tunnel syndrome can be caused by anything that causes compression of the median nerve as it passes through the flexor retinaculum. Some of the most common causes include trauma to the wrist, overuse of the wrist, arthritis, or other inflammatory conditions. It is important to distinguish carpal tunnel syndrome vs other syndromes that present similarly such as cubital tunnel syndrome which is caused by compression of the ulnar nerve at the elbow. The most definitive way to diagnose carpal tunnel syndrome is by electromyography. Treatment varies from conservative management to surgical relief. Recent studies have shown a highly successful non-surgical treatment for carpal tunnel which is called ultrasound guided hydrodissection. This procedure involves injecting a solution of anesthetic, saline, or 5% dextrose in water in order to separate the nerve from its surrounding structures.

The patient was counseled treatment options and elected to first try conservative therapy. OMT was performed in office to try and eliminate any restrictions of the median nerve. She was also prescribed topical diclofenac and given a referral to physical therapy.
Resources:
​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414936#carpaltunnel

Have you been wanting to do one of the races in the Rock 'n' Roll Arizona Running Series, but haven't pulled the trigger? If you haven't registered yet - you're in luck because Dr. Carfagno is giving away 5 VIP Passes for current patients! Dr. Carfagno is in his 14th year as the local race Medical Director and Assistant National Director. That role brings some perks he wants to pass along to you! Whether you're running the Marathon, Half Marathon, 10K or 5K this pass will cover registration, as well as parking and food!

Each week starting December 5, SSMI will add a post on Facebook and Instagram letting you know a giveaway is happening. Whoever gets to the office first to claim the pass is a winner! We'll take your picture to share the good news on social media and will need you to tag us in your fun photos on race day. Stay Tuned!

SSMI CASE
Pes Anserine Bursitis

33 year old male presents to the clinic due to left sided knee pain. He states that his pain first started after he finished playing soccer 2 weeks ago. He states that he did not experience any trauma during the soccer game. When asked where the pain is located he points just below his left knee on the medial side. He describes the pain as a sudden sharp pain that is located only at that one spot. He has not noticed any numbness or tingling of his extremities. He has taken Tylenol to try and relieve his pain but found no relief.
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On Examination of the knee showed point tenderness at the location of the pes anserinus insertion. Muscle strength equal and appropriate in bilateral lower extremities. Negative Lachman test, negative varus and valgus tests, negative posterior drawer test, negative mcmurray’s test.

Pes anserinus bursitis. The pes anserine tendon is made up of three muscles: the sartorius, gracilis and semitendinosis. Pes anserinus bursitis can be caused by many things such as overuse and imbalance of the leg muscles. Often treatment will start with conservative management and physical therapy. Other treatment modalities include ultrasound guided PRP or cortisone injections at the location of the pes anserinus bursae. It can be confirmed with imaging such as MRI or MSKUS help to confirm this diagnosis as well as rule out other causes such as a medial meniscus tear, MCL tear or a tibial stress fracture.

After discussing treatment options with this patient, he decided to first try conservative therapy with the intention of starting PRP or cortisone injections if his symptoms persist. MSKUS and MRI performed which confirmed. He was advised on the benefits of using voltaren gel and he was given a referral for physical therapy.

Resources:
https://www.ajronline.org/doi/10.2214/AJR.19.21315
https://pubmed.ncbi.nlm.nih.gov/33574009/

SSMI CASE
Ischiofemoral Impingement

29 year old male presents with right sided hip pain. It started two months ago after colliding with a teammate during a soccer match. He describes his pain as a dull ache that periodically becomes sharp. He states his pain is located on the lateral side of his right hip and often moves to his groin area. He has also noticed that sometimes his hip makes a clicking noise. He noticed that his pain is worse after long bouts of sitting down in a chair.
Objective:​Muscle strength is normal and symmetric in bilateral lower extremities. Sensation to light touch is intact in bilateral lower extremities. When flexing and then extending his right hip an audible pop is heard. Provocative testing for impingement testing was positive test on right side.

Assessment:​ This patient underwent an MRI which showed a right sided labral tear as well as a right sided ischiofemoral impingement. Ischiofemoral impingement is caused by pathological contact between the femoral head-neck junction and the acetabular rim during a functional range of hip movement. It is often found in conjunction with a labral tear. The majority of patients with ischiofemoral impingement are asymptomatic but when symptomatic it most commonly presents as pain in the hip/groin area and is worsened after prolonged sitting with the knees flexed at a 90-degree angle. Symptomatic ischiofemoral impingement is most often noted in athletes after trauma to the hip and is a significant risk for osteoarthritis. Orthopedic evaluation should be considered once a diagnosis of ischiofemoral impingement is made. Exercise-based rehabilitation with a physical therapist is recommended for initial treatment. If physical therapy alone is not enough to relieve a patient’s symptoms an arthroscopic surgery may be performed.

Plan:​All treatment options were discussed with the patient, and he was referred to an orthopedic surgeon for further evaluation. He was given a referral PT. https://pubmed.ncbi.nlm.nih.gov/23168183/
https://www.uptodate.com

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SSMI CASE HEART PALPITATIONS

21-year-old college swimmer presents to the clinic for heart palpitations which he has once per week. He has swim training 4 hours per day total with his swim team. He also performs weight training exercises. ROS WNL. Lungs are clear. Auscultation of the heart reveals a regular rhythm with bradycardia, and a normal S1 and S2 sound. EKG showed signs of left ventricular hypertrophy with one premature ventricular contraction (PVC) noted, sinus arrhythmia, and a concave ST segment elevation of 1 mm in several leads. Left ventricular hypertrophy in athletes is a common phenomenon resulting from heart remodeling with hypertrophy due to increased workload of the left ventricle during high intensity training. Additional findings in this patient's EKG including sinus arrhythmia and a ST elevation in several leads is also benign as these findings are identified in over 90% of young athletes. This is an 21 year old male negative for symptoms other than palpitations which were identified as a benign PVC on the EKG. Findings on physical exam were also normal, with bradycardia also frequently identified in high intensity athletes.

Differences do exist between pathological heart enlargement and physiological, as well as overlapping shared characteristics. Interestingly, studies show differences in heart remodeling between endurance athletes and weight trainers. In weight trainers, an increase in wall thickness will be seen, whereas in endurance training such as tennis, the left ventricular heart dimensions (LVDD) will increase. According to a study with 947 athletes versus controls, swimming manages to achieve both phenomena with an average increase in LVDD of 4.9 cm, and an average increase in wall thickness of 1.71 cm The patient was educated on these points and was reassured. It was advised that the patient drink plenty of fluids during his workouts and to keep his weight training to a minimum to avoid over-exhaustion as he already swims daily
Lovic D Et al. Left ventricular hypertrophy in athletes and hypertensive patients. J Clin Hypertens 2017 Apr;19(4)