Having two sons in club soccer turned me into “soccerdoc”.  I considered getting a vanity plate for the car….

A graphic depiction of soccer follows:

It was a very competitive game against tough rivals.  C. was in the goal trying to grab the ball high as their forward came in.  I watched him slide in, “cleats up.”  That is, he was illegally attacking the goalie with his sharp metal soccer cleats.  He struck Conrad right over the knee.  The ref blew his whistle, the attacking kid was ejected from the game.  But C?  He was beyond enraged, and came charging out verbally attacking the kid who had cleated him.  I saw the flap of skin over the patellar tendon hanging loose, and made note of the glistening white tendon showing.  Conrad was cut down to the tendon, but was so full of rage he seemed to feel nothing.  I took him to the ER where my colleague calmly and expertly cleaned the wound and sewed him up, advising Conrad to stay out of play for a couple of weeks.  We left the ER patched up.  I already knew Conrad would NOT take the doc’s advice.  So we went to the local soccer store.  My clinic had neoprene sleeves for knee injuries.  A quarter of an inch of neoprene would allow him to play without endangering his stitches.  We sold them without a profit for about $100.  I found one a bit less expensive at the soccer store:  $12!!  Beware, folks!  There’s a bit of a markup buying consumer goods from anyone labeled “medical”!  Naturally, C missed no practices and played until the stitches were out and the wound healed.  Teenaged boys!!

Tom joined a new team.  The coach asked me to look at the first aid kit.  The shaving-kit-sized pack had bandages, scissors, bandaids, and in the bottom a slew of little round brown pills.  “What are these?”  “Ibuprofen” “What are they doing in here?”  “The kids use them to kill the pain of injuries before play or practice.”  Well, not any more they don’t!  That is an excellent way to make injuries even worse.  One of our players was trying to do both HS track and club soccer, and stress-fractured his tibia, taking himself out of both activities through overuse.  No more ibuprofen before play or games!!  But kids are not allowed to wear hard splints or metal or casts on the field.  And how to keep a bandaid on a sweaty teen?  Coban.  I am now saving all the “wraps” I get after donating platelets.  The adhesive is reusable and sticks to itself.  Brilliant.  A kid gets cut:  wash and dry, antibiotic ointment, gauze or bandaid, and a stretchy flexible wrap to protect it from the next injury, and so no blood escapes for the ref to see and take the kid out of play

K was in the goal.  He blocked a shot brilliantly, one hand, then starting waving at the coach to come out.  Goalies just don’t do that, unless they are injured!! K came out and came over to show me his finger, which was what we call grossly deformed.  The middle joint was dislocated backward, and shortened over the first bone.  It looked from the side like a stairstep.  Ugly, scary to Kerry!  I motioned him to step forward, grabbed the finger and applied manual traction, pulling the joint back out to its normal length, then gently popped it back into the joint the way I had learned to do in training, and it slipped back in, and worked fine.  The injury was so fresh it was not yet even swollen.  “So, K, this needs to be splinted now at a 45-degree angle.  You’re out of the game.  Within the next 24 hours, it needs to be X-rayed to make sure you didn’t chip the bone inside the joint, which could mean casting or even surgery, understand?”  “Yes, doc.”  “Ok.  And one more thing, K.”  “What?”  “I’ve always wanted to fix one of those!”  His eyes bugged out of his head.  “I’m glad you didn’t tell me that BEFORE you fixed it!”

The two boys both came hard at the ball simultaneously with full force.  Down he went.  He motioned for help, as he couldn’t stand up.  I ran out to see.  He had a knee injury.  So I went through a typical knee exam:  stress the joint to the inside, it’s painful, to the outside, not.  Push on the menisci, the medial one is tender.  The kneecap, the tendons are fine.  The injury is medial, so likely meniscus or tendon, but the field tests give the answer.  So far so good.  I had him carried off the field by his teammates and came up to his mother.  “He tore his medial meniscus.”  He’ll want to see a knee specialist.  His mother found a doc she thought was the best in town.  It took a few days to get in.  The doc examined him, and ordered an MRI.  The MRI was normal.  So the boy went to rehab for a few weeks and returned to play.  He was only on the field for a minute or two when his knee went out and he couldn’t walk normally.  Back to the surgeon.  Now the surgeon was really puzzled, and scheduled an arthroscopy.  Mom got a video and shared it with me.  “This is OK, this is OK, OK, OMG!  There’s a big tear in the medical meniscus!  How did the MRI miss that!  Sounds self-serving, right?  MY exam was BETTER than his, and better than an MRI.  Well, it’s not me:  It’s the timing.  A field exam at the time of injury BEFORE it’s swollen is FAR more accurate than any doctor exam once the joint is all swollen, and imaging studies are not the gold standard, arthroscopy is.  Images can show things that don’t matter and are trivial, and miss important things.  So, this story has no bragging rights.  But I do like to be right!

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