Mastering Posterior Instability: From the "Lightbulb Sign" to Reverse Hill-Sachs Repair

Stop Stretching the IT Band: Evidence-Based Loading Protocols for GTPS with Dr. Ferdinand Chan, MD - Ep. 21

What do you do when a patient presents with chronic lateral hip pain that wakes them up at night? In this episode, we sit down with orthopedic surgery and sports medicine specialist Dr. Ferdinand Chan from Montefiore Medical Center to dissect Greater Trochanteric Pain Syndrome (GTPS). Dr. Chan shares insights regarding non-operative loading strategies versus advanced endoscopic surgical solutions. We debunk old myths surrounding "trochanteric bursitis" and "tight IT bands," shifting the focus to underlying gluteus medius and minimus tendinopathies. Dr. Chan maps out his exact clinical examination—including how to utilize the Jump Test, Trendelenburg sign, and the "C Sign" to differentiate intra-articular hip pathology from lumbar radiculopathy. We also dive deep into the mechanics of endoscopic IT band diamond-shaped lengthening, microtenotomy bone-drilling for chronic healing, and structural precautions for post-op physical therapy. Key Takeaways & Timestamps: * 00:00 – Welcome Dr. Ferdinand Chan (Lenox Hill/NISMAT fellowship alum). * 02:15 – What is GTPS? Transitioning from "Bursitis" to Tendinopathy. * 04:30 – Demographics: The role of estrogen and hormonal components in middle-aged women. * 07:15 – The Clinical Exam: Master the Jump Test, Trendelenburg Sign, and FADER/FABER differentiation. * 11:00 – Lumbar L3 Radiculopathy vs. GTPS: Clearing the diagnostic confusion. * 13:45 – Imaging Algorithms: When to rely on clinical presentation over X-ray or MRI. * 16:30 – Diagnostic Ultrasound: Is it a game-changer for point-of-care physical therapists? * 18:50 – Cortisone vs. PRP: Financial realities, insurance hurdles, and tissue healing properties. * 22:15 – Non-Operative Loading: Isometrics, University of Delaware soreness rules, and load management. * 25:30 – Surgical Deep Dive: Endoscopic vs. Open Z-plasty, diamond-cut pliability, and bursal debridement. * 29:00 – Microtenotomy & Biologics: Spurring healing with K-wires and bovine collagen patches. * 33:15 – Post-Op Rehab Precautions: Lightweight recovery vs. 6-week non-weight-bearing protocols. Resources Mentioned: * Read Dr. Chan’s study in Arthroscopy, Sports Medicine, and Rehabilitation. * Connect with Dr. Chan at Montefiore Medical Center (Bronx) or Hudson Yards (Manhattan). * Earn evidence-based CEUs for your license renewal. Visit our website to access our full course library. Disclaimer: This podcast is for educational and clinical tracking purposes only and does not constitute direct medical advice.

Management of Lumbar Spondylolysis in Adolescent Athletes | Ep 20 w/ Dr. David Matusz

Is that adolescent athlete's back pain a simple muscle strain, or is it a stress fracture waiting to worsen? In our 20th episode of the Sports Medicine Research Rundown, host Tim Tyler and co-host Rob Shapiro are joined by Dr. David Matusz to dive deep into the management of lumbar spondylolysis and spondylolisthesis in young athletes. We break down the critical differences between these conditions, the gold standards for imaging, and why the "single leg hyperextension test" might actually be setting your patients back. Plus, we critically review Jeffrey Troy’s recent article analyzing over 200 cases of symptomatic spondylolysis to determine the most effective, evidence-based treatment algorithms. Episode Highlights: * 00:00 - Welcome to Ep 20 & Introduction of Dr. David Matusz * 01:50 - Defining Spondylolysis vs. Spondylolisthesis * 06:20 - Red flags and the gold standard for imaging (MRI vs. CT vs. X-Ray) * 11:15 - Why L5 is the most common site for pars injuries * 16:30 - Review of the Jeffrey Troy article: Management of Lumbar Spondylolysis in Athletes * 24:40 - Non-operative physical therapy protocols & criteria-based progression * 34:10 - Reintroducing lumbar extension safely for return to sport Guest: Dr. David Matusz, Chief of Orthopedic Spine at Lenox Hill and surgeon at Spinal Associates of New York City.

Do You Really Need Surgery for Atraumatic Rotator Cuff Tears with Dr. Michael Knudsen

Is surgery always the answer for a full-thickness rotator cuff tear? In Ep. 19, Dr. Michael Knudsen breaks down the 10-year MOON study outcomes. Join host Tim Tyler and Donis Gil as they sit down with Dr. Knudsen, an orthopedic surgeon at Columbia University, to discuss the evidence-based management of atraumatic rotator cuff tears. We explore why patient expectations matter more than tear size, the crucial difference between traumatic and degenerative tears, and advanced clinical examination techniques. Chapter Highlights: * 00:00 - Introduction to Dr. Michael Knudsen & the MOON Group study * 06:00 - Traumatic vs. Atraumatic Rotator Cuff Tears * 09:00 - Special Tests: Bear Hug, Lag Signs, and Belly Press * 18:00 - Epidemiology: 26 million tears, but only 2% get surgery * 20:00 - 10-Year MOON Study Outcomes: Expectations vs. Tear Size * 46:00 - PT Pearls: Scapular kinematics and neuromuscular control Guest Bio: Dr. Michael Knudsen is an Assistant Professor of Orthopedic Surgery at Columbia University and an attending at New York Presbyterian Hospital. He is a member of the American Shoulder and Elbow Society (ASES). Resources: * MOON Shoulder Group PT Guidelines: https://moonshoulder.com [https://moonshoulder.com/] * (Visit our website for full transcripts and CEU information). Disclaimer:This podcast is for educational purposes and not medical advice. Consult a professional for personal health decisions.

Shin Splints or Stress Fracture? Navigating the Bone Stress Continuum

Are you still calling them "stress fractures"? In this episode, we sit down with Dr. Christian Muller to discuss why the industry is moving toward the term Bone Stress Injury (BSI) to describe a spectrum of pathology. We explore the epidemiology of these injuries—affecting up to 20% of the sports population—and the critical "intrinsic" factors often missed, from Relative Energy Deficiency in Sport (REDs) to metabolic deficiencies like Vitamin D and Ferritin. What You’ll Learn: * The High-Risk Zones: Why injuries to the femoral neck, navicular, and anterior tibial cortex require aggressive management. * Diagnostic Gold Standards: When to stick with X-rays and when the MRI or new VIBE sequences are non-negotiable. * The "Quarterback" Approach: How to build a multidisciplinary team involving dietitians, endocrinologists, and physical therapists for optimal recovery. * Footwear & Biomechanics: The truth about minimalist shoes, orthotics, and why "low step rates" might be increasing your injury risk. Featured Guest: Dr. Christian Muller is a Primary Care Sports Medicine Physician at Northwell Health. He completed his fellowship at the University of Alabama, Birmingham, where he covered a diverse range of collegiate sports.

Mastering Posterior Instability: From the "Lightbulb Sign" to Reverse Hill-Sachs Repair

Is it a frozen shoulder, or is it a missed posterior dislocation? In this episode of the Sports Medicine Research Rundown, Tim Tyler and Rob Shapiro sit down with Dr. Alex Volpi (Orthopedic Surgeon, Optum Pro Health) to demystify one of the most challenging diagnoses in the shoulder complex: Posterior Shoulder Instability. While posterior instability makes up only ~5-10% of instability cases, it is frequently misdiagnosed as rotator cuff pathology or adhesive capsulitis. Dr. Volpi breaks down the critical "signal vs. noise" diagnostic cues, including the mechanism of injury (seizures vs. offensive linemen), the "Lightbulb Sign" on X-ray, and the utility of the Jerk and Kim tests. We also go deep into the surgical evolution—debating the Modified McLaughlin procedure versus the modern humeral head allograft—and outline the specific rehab protocols necessary to protect the posterior labrum post-op. Key Takeaways: * The Diagnostic Trap: Why posterior dislocations are often missed and misdiagnosed as frozen shoulder. * Clinical Pearls: How to perform and interpret the Jerk Test and Kim Test for subtle instability. * Surgical Strategy: Understanding the Reverse Hill-Sachs lesion and why Dr. Volpi prefers Allograft reconstruction over the McLaughlin procedure. * Rehab Restrictions: Why the standard "sling position" might be dangerous for posterior repairs and when to introduce active external rotation. Topics & Timestamps: * (00:00) Intro & Guest Welcome * (08:50) Anterior vs. Posterior Instability Incidence * (12:40) Mechanisms of Injury: Seizures vs. Microtrauma in Athletes * (17:45) How to Reduce a Posterior Dislocation (and when NOT to) * (21:00) Special Tests: The Jerk Test & Kim Test * (36:30) Imaging Secrets: The "Lightbulb Sign" * (38:30) Surgical Debate: Modified McLaughlin vs. Humeral Head Allograft * (47:30) Post-Op Rehab: Sling positioning and Range of Motion Guest Bio:Dr. Alex Volpi is an Orthopedic Surgeon at Optum Pro Health in New York/Long Island, specializing in sports medicine and shoulder/elbow surgery. A graduate of Wake Forest and Drexel University, he completed his residency at the prestigious Lenox Hill Hospital and fellowship at the Kerlan-Jobe Orthopaedic Clinic. Resources: * Paper Discussed: Posterior Shoulder Instability: Spectrum of Presentation and Treatment of Outcomes in Three Cases (Birmingham, England). * Connect with Dr. Volpi: Optum Pro Health (Lake Success, NY) Disclaimer:Content is for educational purposes and not medical advice. Consult a professional for personal health decisions.