Distinctly Montana Magazine

d i s t i n c t ly m o n ta n a • w i n t e r 2 0 1 5 54 ing and treating many injuries we would have ignored or treated with conservative, non-operative treatment in the past. Regarding rotator cuff injuries, which are very common, any sports physician should be able to treat the small to medium tear, but when the tears become large or irreparable, then a true shoulder specialist should be consulted. These patients are often referred to me through other orthopedic surgeons for graft place- ment, muscle transfers, or even replacement, which are all newer experimental options. I also think the patient needs to make sure the sports surgeon is truly a sports surgeon. You can figure this out by looking at their Web site and discussing it with the physician. aMrInE: Good sports medicine doctors have a strong ability to understand the desires of their patients. This comes from their interest in sports, their training, and simply asking what your goals are. A physician that doesn't understand what you do, will have a difficult time understanding your goals. whEn Should onE ChooSE an orthoPEdIC doCtor InStEad of a faMIly doCtor for SPort-rElatEd trauMa? lEgrand: As an orthopedic surgeon, I will freely admit to a strong bias here. Although there are phenomenal family practitioners who do an excellent physical exam, the incredibly varied scope of their practice makes it difficult to master all elements. For most sports trauma, an orthopedic surgeon with a sports medicine focus will typically be able to provide the correct diagnosis and treatment options in less time and with less expensive (MRIs) studies. There is sometime a concern that a surgeon will al- ways be looking for surgery as a treatment option at the expense of less invasive options. The truth is surgeons invest heavily in their patients and want them to do well. When faced with equal results with and without surgery, a good orthopedic surgeon will recommend conservative care the vast majority of the time. From a practice or business model, unindicated surgeries will decrease a surgeon's reputation and have a long term negative financial impact. KlEPPS: At Ortho Montana, we actually train the residents and provide the only sports medicine fellowship in the state. So, I think in most cases, patients should start with their family practice doctor who will refer them if they are not responding to conservative treatment. However, if the patient has a clear injury that requires surgery such as some fractures, ACL injuries, or muscles tears such as the quadriceps or Achilles, it is more efficient to just go straight to the orthopedic surgeon. Often times, patient can make this determination in the training room, on the field, in the ER or Urgent care setting. We have recently developed an Orthopedic Urgent Care center to assist with this which is much more convenient and less expensive than the ER to evaluate these type of injuries. aMrInE: A strong family physician often has a good foun- dation of basic sport-related trauma. This knowledge often is advantageous to guiding you quickly to the cor- rect consultants and therapies. Thus, if you have a good relationship with your doctor and have good access, this is a great starting point. However, if you don't have a relationship or are unable to be seen, calling your sports medicine clinic may offer you guidance. In Montana, what SPort-rElatEd InJurIES do you trEat MoSt oftEn? KlEPPS: In the shoulder, I will see injuries such as dislo- cations that can lead to recurrent instability as well as labral tears which can lead to pain in overhead athletes such as volleyball, tennis, or baseball players. I also see patients with shoulder (AC joint) separations and even fractures. Rotator cuff tears tend to be more common in older patients but can occur in athletes as well. Elbow injuries include ligament injuries such as the Tommy John injury in baseball players, cartilage injuries known as OCD lesions, biceps and triceps tears, ulnar nerve compression, and fractures. I also see general injuries in the knees such as ACL tears, meniscus injuries and patella dislocations. lEgrand: Approximately 80 percent of my practice is knee injuries and 20 percent is shoulder. The most common knee injuries I treat are ACL tears, meniscal tears (both of which often require surgery) and MCL injuries (most of which do well without surgery). By far the most com- mon shoulder injuries I take care of are instability (dislo- cations) and rotator cuff tears. Starting at in January, we will have a second sports medicine specialist who will be doing complex and simple hip arthroscopy. aMrInE: Montana is a small enough state that many of my athletes know me socially and know my interests in endurance sports. Thus, the majority of my patients are also endurance athletes with their primary interests being in running or cycling. This is also helped by Mis- soula and Montana becoming known as a hot bed for ultra runners, mountain bikers and outdoor enthusiasts. Thus, I see frequent overuse injuries of the hip, knee, and ankle along with illnesses that prevent them from continuing to do what they love. how IS thE MEdICal aPProaCh dIffErEnt for youth, 18 and undEr? arE thEy a largE Part of your PraCtICE? KlEPPS: Younger athletes raise a few issues. Many of these athletes especially in Montana are multi-sport athletes. So, one injury may take them out of several seasons of sports. Fortunately, the younger someone is quicker to heal, so we try to use this as an advantage to help them get back to sports. A second issue is they have open growth plates, which need to be closely followed for Montana is known as a hot bed for ultra runners,

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