0:00

We don't have any submitted questions,

0:02

but I'm gonna quickly, we'll,

0:04

we'll take maybe just a few minutes

0:06

because I do have, uh, questions.

0:08

Uh, that maybe, uh, Minnie, if you're there,

0:11

I have a question for you.

0:13

Um, I don't know if Minnie is there. We'll see. Yeah.

0:17

Hi Minnie. Uh, you mentioned tennis leg.

0:20

I just wanna go back to that

0:21

because I know we had one of our Chilean scholars, you know,

0:26

write an article about that and you showed a case

0:28

and you said, I don't know what you said.

0:31

You don't worry about the plant terrace

0:32

or something in that area,

0:34

but, you know, there's always been a debate whether tennis

0:37

leg is a plant lesion or a gastroc lesion.

0:41

What are your thoughts about that?

0:43

I think, uh, the original descriptions talked about the

0:46

plantars, but I think the only significant injury is the

0:50

medial gastrocnemius.

0:52

I, the plantars does get injured with it,

0:55

but our surgeons don't reconstruct it.

0:58

They don't care about the isolated ones.

1:00

Um, so I focus in way more on the medial gastroc.

1:05

Um, that, that's my my impression.

1:08

I think that the isolated plantar tears in my experience are

1:13

quite unusual that we see medial gastroc injury in

1:16

almost all those patients.

1:18

I dunno, I'd like to hear from

1:19

Rodrigo because he has a big sports.

1:21

Yes, yes. The same for, for me, I, uh, we see a lot

1:26

of medial gastro name is lesion and like the planter tendon.

1:30

And the planter muscle is, uh, it is something that we

1:35

rarely see.

1:37

And when you see, we do some archive nowadays.

1:44

Okay. Let me ask another question I'll directed at Evelyn,

1:48

but maybe, uh, others want to comment on it.

1:51

Minnie mentioned, uh, in one of the earlier lectures, all

1:54

of the work that Spinner has done, uh,

1:57

when he talks about intradural ganglion cyst,

2:00

and he's been impressed that a lot of those, uh, relate

2:04

to articular branches supplying a variety of joints,

2:08

particularly, uh, the proximal tibial fibular joint.

2:12

Um, as you know, we've discussed this in fact, with one case

2:15

of a hip pathology a number of years ago

2:18

where it looked like there was spread from the articular

2:21

branch, a, a ganglia cyst that spread over to the sciatic.

2:25

I just wonder, Evelyn, in our practice,

2:27

are we seeing examples

2:29

of intradural ganglion cyst arising from articular branches,

2:34

uh, of various joints?

2:36

Mi many brought up one perhaps in the knee,

2:40

I don't think I've ever seen other than at the knee, um,

2:45

a gang antra neural ganglion cyst.

2:48

So I don't know about your experience,

2:51

but the common peral nerve is the most common one.

2:53

The tibial nerve is quite rare

2:55

and we go shown also a nice case,

2:58

But I Don't dunno, many wants to comment on that.

3:01

Yeah. Minnie, what do you think?

3:02

I think it is a unifying concept,

3:04

and I think that the paralabral cysts at the hip can track

3:09

certainly posteriorly along the iliac branches

3:12

or along the perforating branches back

3:15

towards the sciatic nerve.

3:16

I know we've seen a couple of cases of those,

3:18

and those are well reported, uh, in the literature.

3:23

I personally think that the cyst

3:26

that we see in the shoulder are probably coming along a

3:29

nerve, and I'm surprised Spinner hasn't written about that

3:32

because I think that's one of the most common para articular

3:35

ganglia that we identify.

3:37

And to me it makes no sense why they always go

3:39

to the same place unless they're tracking along a nerve.

3:42

So I think it's a fabulous unifying concept for cysts

3:47

and how they leave joints and where they go.

3:50

Yeah, I think it's interesting.

3:51

You remember the case of the hip that was, uh,

3:54

That was, that was clearly a per articular.

3:58

I don't wanna go into detail about that.

4:00

Uh, I have a question for Rodrigo or any of the others,

4:03

and that is, when you look at these muscle injuries,

4:07

are you asked to give a idea of the time return to play?

4:11

Is that something that you put in your report?

4:14

Yeah, I, I, I don't put in my report,

4:17

but we have a close relationship with, uh,

4:20

with the orthopedic surgeons of the teams.

4:24

And most of the time we talk on the phone.

4:29

So we discuss about that,

4:32

but it's not like, it's not me

4:34

that gives like the return to play.

4:37

The orthopedic surgeons, like they know this, uh,

4:41

they know this classifications

4:44

and so they work with the physical therapy

4:48

and they work together to,

4:51

and one thing that I usually do is if I'm doubt, I tend

4:56

to be a little bit conservative.

4:59

It's like, uh, uh, I, I try to

5:03

to increase a little bit more the, the classification, uh,

5:07

if I'm doubt because it's like if you let them,

5:11

they will put their, the athletes the other day to,

5:15

to go to a new game.

5:17

So it's something that I, I prefer

5:21

to be a little bit more, uh, conservative

5:23

and let them to, to, to decide.

5:28

But they don't ask. But I usually, I am, I recall by the,

5:32

on, on the phone about that.

5:33

Do many or Evelyn, do we put anything on on that?

5:37

Do we try to predict that

5:39

We make a personal phone call on every

5:41

professional athlete?

5:43

We don't put it in the report because the trainers

5:45

and the athletes access those reports and get freaked out.

5:49

There's a lot of financial implications about

5:52

whether they should go back.

5:53

It's very touchy.

5:55

So all of that is done verbally

5:57

and you know, it's only to the extent

5:59

of it's not gonna take long

6:01

or this is gonna take a while to heal.

6:03

He may be out for the season.

6:06

Honestly, I get that question more by all of our faculty

6:10

that are injured because they call me about their injury

6:13

and say, should I play?

6:15

And I tell 'em all, no, can't play anymore.

6:19

Um, so the faculty call, they call about their spouses.

6:23

Everything else with the professional

6:25

athletes is never in writing. Only

6:28

One, one final, uh, question

6:29

or for you, uh, many showed, uh, doms of the brachialis, uh,

6:34

muscle, and I've seen a few cases of that.

6:37

Um, and it, it was interesting to me

6:39

that in those cases it was isolated to the brachialis

6:42

and the biceps was not involved.

6:45

Uh, I'm a little, you know, con worried about that

6:48

or wonder about that

6:49

because they both lead to, uh, flexion of the elbow.

6:53

But the position of, no, but there's

6:55

An, there's an exercise called reverse curls

6:58

and the reverse curls isolates the brachi.

7:01

So according to my weight lifting,

7:06

uh, I

7:07

Thought it was your own experience.

7:08

My experience is more towards fatty degeneration

7:13

of my muscles, but, um, those reverse curls, right?

7:18

Apparently not pro, I don't, I dunno exactly how you do it,

7:21

but, but the biceps is relatively not active during that.

7:25

And that's the injury that in injures the brachialis.

7:28

And I think people that are starting to exercise, a lot

7:32

of them, they're not,

7:34

they have never conditioned their brachial

7:36

and they just overdo it.

7:37

But it's very common site.