Saints Quarter Back will be playing today with 4 fractures in his back

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Agast

Agast

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  1. Attending Physician
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WTF. The way we treat athletes is horrendous.
 
Where are the fractures?

Edit-L1-4…..probably spinous or transverse process fractures….no biggie
 
Doctodd said:
Where are the fractures?

Edit-L1-4…..probably spinous or transverse process fractures….no biggie
Click to expand...
4 levels at the same time, though? I was thinking endplate fracture. Non-surgical sure but he should probably rest…based on his performance today…
 
I think Cam Newton had TP fxs from car accident and didn't miss much time
 
In other news, maybe its not a great idea for an orthopedic surgeon to do an ICNB in the training room before a game. Just think out loud here:

www.usatoday.com

Ex-Chargers quarterback Tyrod Taylor suing team doctor over punctured lung

Tyrod Taylor, now a backup with the Giants, is seeking damages for an injection that kept him from playing in 2020 and led to Justin Herbert taking over.
www.usatoday.com
 
SSdoc33 said:
In other news, maybe its not a great idea for an orthopedic surgeon to do an ICNB in the training room before a game. Just think out loud here:

www.usatoday.com

Ex-Chargers quarterback Tyrod Taylor suing team doctor over punctured lung

Tyrod Taylor, now a backup with the Giants, is seeking damages for an injection that kept him from playing in 2020 and led to Justin Herbert taking over.
www.usatoday.com
Click to expand...
Pneumothorax is a very well known complication so I guess he didn’t sign a consent? I know it’s fairly obvious to NFL fans but he was going to lose his job anyway. This lawsuit is pretty rich….. for lawyers. I hope he loses.
 
Doctodd said:
Pneumothorax is a very well known complication so I guess he didn’t sign a consent? I know it’s fairly obvious to NFL fans but he was going to lose his job anyway. This lawsuit is pretty rich….. for lawyers. I hope he loses.
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all about the documentation. if the doc says there is a risk of a PTX in consent, that should give him some protection. also, "dr. XYZ, how many ICNBs have you done?" " were you trained to do these?" "shouldnt these blocks have been done by a pain specialist?" "why wasnt flouroscopy used?" its unclear if this was done blind or under ultrasound. my guess is that it was actually blind b/c it was AT the stadium, but i could be wrong.

he would have eventually lost his job as a starter. but, he may have played a few games, and showcased himself for later in his career.

my guess is that this gets settled, and Taylor will get a good chunk of change
 
Coming from D1 team doc background:
There is tremendous pressure to get these athletes back on the field ... from trainers, coaches, admin/owners, AND the players. A lot of times players are the ones trying to hide symptoms or pushing treatment beyond what is safe and MDs have to be the bad guy to protect them. It can be hard to do that for some people, or your ego makes you think that nothing bad will happen to the player.

That being said any time we had a rib injury like this we would consent the player heavily, use US guidance, stay as sterile/clean as possible in a training room, and on my injections ere on the side of being too shallow. Anecdotally, many times we would just do trigger points if the player balked at the pneumo risks with heavy amounts of Bupivicaine and players would do just as well.
 
runfastnow said:
Coming from D1 team doc background:
There is tremendous pressure to get these athletes back on the field ... from trainers, coaches, admin/owners, AND the players. A lot of times players are the ones trying to hide symptoms or pushing treatment beyond what is safe and MDs have to be the bad guy to protect them. It can be hard to do that for some people, or your ego makes you think that nothing bad will happen to the player.

That being said any time we had a rib injury like this we would consent the player heavily, use US guidance, stay as sterile/clean as possible in a training room, and on my injections ere on the side of being too shallow. Anecdotally, many times we would just do trigger points if the player balked at the pneumo risks with heavy amounts of Bupivicaine and players would do just as well.
Click to expand...
Omoigui technique. Come down on the center of the rib, inject a larger volume to get spread superior/inferior over the intercostal spaces, let it soak down. Much lower risk of pneumothorax.
 
how can you not sound to bone and hit a rib on these muscular athletic players? Use a 1" needle to err on side of caution.
 
callmeanesthesia said:
Omoigui technique. Come down on the center of the rib, inject a larger volume to get spread superior/inferior over the intercostal spaces, let it soak down. Much lower risk of pneumothorax.
Click to expand...
I've seen this but how does it work anatomically? Nerve is between fascial layers
 
sounds like he was very qualified(Harvard, Steadman-Hawkins, etc).....could happen to anyone.

"Dr. Gazzaniga specializes in sports medicine, including sports related injuries of the shoulder, elbow, knee, and hip. In addition, he performs procedures such as hip arthroscopy and osteoarticular transplantation for cartilage defects of the knee. After growing up in Orange County, Dr. Gazzaniga left to play football at Dartmouth College and remained to attend medical school. He then went on to complete his residency at Harvard University. Dr. Gazzaniga has completed the following separate fellowships: Trauma Fellowship and a Sports Medicine Fellowship at the Steadman-Hawkins Clinic in Vail, Colorado.

Dr. Gazzaniga had been in practice in the state of New York before relocating back to Orange County. While in New York, he served as one of the team doctors for the New York Jets as well as the head Orthopedic Surgeon for the New York Islanders and Hofstra University. He also worked as the attending Orthopedic Surgeon at the US Open in Flushing, New York. Currently, Dr. Gazzaniga is the Head Team Physician for the Los Angeles Chargers & the Hoag Orthopedic Institute Division Chief of Sports. In his leisure time, he enjoys spending time with his wife and children."
 
im not following this timeline......Taylor lost his job to Herbert in 2020.....the lawsuit says they are suing for the difference in salary between a backup and a starter. But this ESPN article says he signed to be the starter with Houston after 2020.

www.espn.com

Taylor sues Chargers doc over '20 punctured lung

A Chargers team doctor is being sued for medical malpractice by former quarterback Tyrod Taylor, who is seeking at least $5 million after suffering a punctured lung while being treated for a rib injury in 2020.
www.espn.com www.espn.com

"After the 2020 season, Taylor joined the Texans on a one-year deal worth up to $12.5 million and began the season as Houston's starting quarterback,...."
 
Last edited:
Doctodd said:
sounds like he was very qualified(Harvard, Steadman-Hawkins, etc).....could happen to anyone.

"Dr. Gazzaniga specializes in sports medicine, including sports related injuries of the shoulder, elbow, knee, and hip. In addition, he performs procedures such as hip arthroscopy and osteoarticular transplantation for cartilage defects of the knee. After growing up in Orange County, Dr. Gazzaniga left to play football at Dartmouth College and remained to attend medical school. He then went on to complete his residency at Harvard University. Dr. Gazzaniga has completed the following separate fellowships: Trauma Fellowship and a Sports Medicine Fellowship at the Steadman-Hawkins Clinic in Vail, Colorado.

Dr. Gazzaniga had been in practice in the state of New York before relocating back to Orange County. While in New York, he served as one of the team doctors for the New York Jets as well as the head Orthopedic Surgeon for the New York Islanders and Hofstra University. He also worked as the attending Orthopedic Surgeon at the US Open in Flushing, New York. Currently, Dr. Gazzaniga is the Head Team Physician for the Los Angeles Chargers & the Hoag Orthopedic Institute Division Chief of Sports. In his leisure time, he enjoys spending time with his wife and children."
Click to expand...

ortho sports guys learn how to scope a knee and fix a RTC tear. they dont get training in ICNBs. yes, it could happed to anyone, but if the training or techniques were substandard, then that makes a difference
 
thats why there is malpractice insurance. this doesnt bode well for his future as a team physician, but that job is a fool's errand.
 
RoloTomassi said:
I've seen this but how does it work anatomically? Nerve is between fascial layers
Click to expand...
It’s close enough to the nerve that it reaches and blocks it before it’s carried away. it can penetrate the cell wall - it can penetrate fascial layers too.
 
callmeanesthesia said:
It’s close enough to the nerve that it reaches and blocks it before it’s carried away. it can penetrate the cell wall - it can penetrate fascial layers too.
Click to expand...
Hope it pans out as an equivalent or superior technique but I'm skeptical. Lumbar sympathetic block for example--if you aren't deep enough and you see psoas/fascial pattern, it doesn't work. Same with a lot of regional blocks. "In the area" just doesn't seem to diffuse that well.
 
RoloTomassi said:
Hope it pans out as an equivalent or superior technique but I'm skeptical. Lumbar sympathetic block for example--if you aren't deep enough and you see psoas/fascial pattern, it doesn't work. Same with a lot of regional blocks. "In the area" just doesn't seem to diffuse that well.
Click to expand...

its old school at this point, and the only way to do ICNB
 
ICNB with US is a very simple procedure.

Use the XRAY to count the ribs. Mark the skin with a marker so you know you're on the correct rib.

This isn't a hard shot.
 
it is if you arent trained for it.

also: omoigui paper explains their rationale.

According to one anatomic study of intercostal nerve block technique, iothalamatemeglumine 60% (Conray) was injected bilaterallyinto the intercostal grooves of the ninth or tenth ribs in 30 surgicalpatients. Roentgenograms showed extensive spread of the contrast centrally and peripherallyfrom the site of injection within 30 seconds, with almost completeabsorption within 10 minutes 30 seconds [1]. These findings help to explain how the injected anesthetic is spread during an intercostal nerve block regardless of the site of injection. In another study of twenty patients undergoing thoracotomy, twelve patients received intercostal nerve injection with 10 ml of 0.5% bupivacaine with methylene blue, and eight patients received 5 mlof 0.5% bupivacaine with methylene blue. The area of spread of the methylene blue was measured after the pleural cavity was incised. The 10 ml group had a mean area of spread of 51.1 cm2 as opposed to 17.6 cm2 for the 5 ml group. In the 10 ml group, eight patients had bupivacaine-methylene blue spread to two intercostal spaces, three patients to three intercostal spaces, and one patient to four intercostal spaces. In the 5 ml-group, seven patients had bupivacaine methylene blue spread confined to one intercostal space and one patient to two intercostal spaces [2]. This demonstrates that there is extensive spread of local anesthetic after intercostal nerve block injection.
Click to expand...
long and short, an injection with a volume of 10 ml spreads extensively throughout - injection 1 rib spread to at least 2 ribs, possibly 4 ribs.
In our diffusion technique of Intercostal Nerve Block, we inject local anesthetic solution directly over the ribs. The anesthetic solution diffuses within the subcutaneous tissue, muscles, intercostal membranes and intercostal space. The anesthetic solution then blocks peripheral nociceptors and peripheral nerve endings including both medial and lateral branches of the Anterior Cutaneous Branches, which are the terminal endings of each intercostal nerve. The anesthetic solution may also be transported by retrograde axoplasmic flow from the peripheral branches into the intercostal nerve. The anesthetic solution also interrupts nociceptive afferent impulses from peripheral nerve endings at the site of injury and inhibits the release of neuropeptides by the proximal nerves and the propagation of the inflammatory response from the site of injury [6]. Our diffusion technique utilizes the spread and diffusion characteristics of the injected local anesthetic fluid solution.
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for all inpatients with rib fractures, after i infuse the rib, i might add a little extra local at the bottom edge of the rib but i never go as far as i used to (which was about a mm.) the results for rib fracture have been very good, but no, i do not have a placebo controlled randomized study to back it up...


now i dont do this technique for intercostal neuralgia.
 
Did some schlub just drop another lung?

www.espn.com

Steelers' Watt at hospital having lung evaluated

Steelers star pass rusher T.J. Watt is in a local hospital for further lung evaluation after "experiencing discomfort" at the practice facility Wednesday, and his status for Monday's game against the Miami Dolphins is "in question."
www.espn.com www.espn.com
 
SSdoc33 said:
Did some schlub just drop another lung?

www.espn.com

Steelers' Watt at hospital having lung evaluated

Steelers star pass rusher T.J. Watt is in a local hospital for further lung evaluation after "experiencing discomfort" at the practice facility Wednesday, and his status for Monday's game against the Miami Dolphins is "in question."
www.espn.com www.espn.com
Click to expand...
Maybe it’s just a peanut to the right bronchus. Someone handed him a snickers bar because he was hungry?
 
I feel like you’d have to be incredibly aggressive with your dry needling to cause a pneumo in someone with back muscles as thick as his….
 
you'd have to go in > 1.5 inches and really dig around. anybody know if this was a PT? anybody know the gauge and needle length typically used?
 
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