The Pat and Aaron Injury Report 10/6/22 with Dr. Remaley

Speaker 1: It is time for the Injury Report presented by Florida Orthopaedic Institute in partnership with Tampa General Hospital. Joining us on the hotline for the first time is Dr. Trey Remaley. Thank you, Dr. Remaley, for joining us today.

Dr. Remaley: Of course. This is awesome. It’s nice meeting you guys.

Speaker 1: Did you have to wrestle Dr. Sellman for this opportunity? I feel like he just wants to hold onto it for himself.

Dr. Remaley: He does, man. He really enjoys this. Luckily he stepped away so I could step in. I appreciate it.

Speaker 1: We’re happy to have you, Dr. Remaley, and I know how busy your schedule is, so we really do appreciate it. Let’s get started here with Tua Tagovailoa, we all know the whole world’s been talking about this scary head injury that he suffered the concussion. Really, he had a couple weeks ago, and then last week we saw it again and last week is when we saw what they call the fencing response where his fingers were contorted in front of his face. Dr. Remaley, what happened there?

Dr. Remaley: This is a pretty significant injury, he also had the injury the week before. I would appeal to concussion management, to my primary care sports medicine colleagues, Dr. Sellman and Dr. Moran, and everybody that we work with here. The fencing response is, the true name for it is an asymmetric tonic neck reflex. It happens when the soft tissue of the brain impacts the hard bone of the skull and you bruise the gray matter of the brain. What happens is it stunts and loses the control. The brain stem takes over. The fencing response is a normal reflex in brain development. Usually, it’s seen as a normal development in infants up to four months of age. When we see it in athletes like this, it’s a sign of a concussion and a brain injury that definitely needs to be treated and monitored.

Speaker 1: Doctor, the Dolphins came out this week and said Tua Tagovailoa won’t play on Sunday, to which I thought, yes, no kidding. I can’t believe it’s even an announcement. I expected it personally. Not that I know a lot about concussions, but just seeing that reaction, reading some of the things that I’ve read from experts since, to me, it seems like something that they should keep him out for quite a while. Is that your sense? Do you think this is something that we might see him in a week or two or because of that response and like you were just talking about, actual brain injury, a brain bruising, do you think they should keep him out for a month or even more?

Dr. Remaley: It’s hard to say with concussions because, unlike x-rays that I get, we can see fractures and we can determine a timeline. There’s really no imaging that gives us an idea of the severity of a concussion. They undergo pretty much, I would imagine, every day getting evaluated and watching the progression. There’s certain things with rehab and therapy and different things like that that they can do to help stimulate the recovery. Really with a concussion, there is no defined timetable for return. Players that get mild concussion can be out several weeks. It’s really hard to determine a time frame of return. It’s really watching his progress and things over the time. It could be two weeks, it could be longer than that. There seemed to be a pretty significant injury, but again, I didn’t evaluate him or anything like that.

Speaker 1: Dr. Remaley joining us right now on The Pat and Aaron Show, and we saw Jonathan Taylor go down, he’s going to miss this week with what we heard is a high ankle sprain. We know those high ankle sprains, that’s where the real problems come in. The dreaded high ankle sprain, he could be out even longer. Can we just talk about the difference between the high ankle sprain, the low ankle sprain, and any other injuries to the ankle?

Dr. Remaley: If we start with a low ankle sprain, it tends to be more of the ligaments below the bones of the ankle, the fibula, the tibia, and things like that. It’s pretty common amongst athletes to have a low ankle sprain. Usually, the return to play from that can be quick, a couple weeks, or things. A high ankle sprain involves ligaments that are higher up in the ankle, above the ankle, so to speak. These oftentimes are pretty more significant than a low ankle sprain. It involves a joint area called the syndesmosis. There’s four or five ligaments and structures in that area that are involved in the stability of that.

These high ankle sprains can take longer, upwards of six, eight weeks potentially for a return to play or even longer than that depending on how they’re recovering and things. With the pro athletes, and they’ve obviously got a lot of access to higher-end therapy and rehab, but I would speculate that he’d probably be out a couple weeks.

Speaker 1: Maybe I’m just reading this wrong, but is it the case where it takes longer for that high ankle sprain to heal, not because it’s maybe a more severe injury, but because it impacts more components around that ankle?

Dr. Remaley: Yes, it does. That’s an area that helps stabilize the ankle. You put stress and trauma through that area, it can take on a lot of issues. Stress and strain and the biomechanics get a little altered. It can take a lot longer for those to recover. It can be challenging to treat and very frustrating to return from.

Speaker 1: Cowboys wide receiver, Noah Brown, he injured his neck last week in the fourth quarter and he was seen favoring his arm. A lot of people thought it was just a stinger here. We see that a lot in football especially. What’s the difference between a stinger and a serious neck injury? How do between one or the other?

Dr. Remaley: You really assume the worst when they’re coming off the field and you want to get an evaluation and really talk to the athlete and they’ll tell you more of what happened in what position. A stinger or a burner sometimes it’s called, is a injury of the brachial plexus, which is a group of nerves that leave the cervical spine and go to the arm. In a stinger, those get stretched or compressed from their hips or tackles or whatever and causes a sudden feeling of lightning bolts or electricity running through the arm and almost a dead arm.

The good thing about stingers usually is, they can resolve pretty quickly and we’ll do serial evaluations or repeat evaluations on the sideline and, 5, 10 minutes, if the athlete can prove that they’ve got full range of motion of their shoulder and their strength is about 90% of what the other side is, generally they’ll be able to return to play. Neck injuries tend to provide more significant nerve injuries to the arm, whether you’ve got weakness or loss of motion. Those types of things tend to linger longer than what we see with a quicker recovery on a stinger.

Speaker 1: Julio Jones returned on Sunday night for the Buccaneers, but was very limited due to his knee injury that kept him out before Sunday. Todd Bowles basically said after the game that he just never loosened back up after halftime. At this stage of Julio’s career, at his age, is this something that’s just going to be an issue for him moving forward, or is it the thing where shutting him down for a few weeks could mean having him at the best we could possibly have him towards the end of the season?

Dr. Remaley: The frustrating thing with these is the answer would probably be yes to both of those. He’s had a great career and he’s done amazing things and I’m sure, if we were to look at x-rays of his knees or things like that or be able to examine him, we would probably see some interesting arthritis or things like that. Again, I haven’t looked at his x-rays or anything like that, but these types of things can linger and most of it is symptomatic control. You may be able to tolerate game day if you modify your participation through the week or modify your workouts and different things like that to really work on symptom control. That’s more of the issue and what level they can tolerate things. If they’ve got a lot of pain and can’t do it, it puts them at risk for injury because they just can’t protect themselves. Most of it is just symptomatic management.

Speaker 1: Speaking with Dr. Trey Remaley of the Florida Orthopaedic Institute. Doctor, I know you specialize in hips, knees, and shoulders, and you do a lot of hip and knee replacement, I’m curious when you’re going into surgery, we talk all the time about pre-game meals for athletes, and last year we asked a lot of the doctors what music they like to listen to during surgery, but we’re switching it up this year to the old pre-game meal. Are there things that you like to eat before you perform a surgery, or more importantly, are there things that maybe you stay away from because you know you won’t be able to go to the bathroom for a few hours potentially?

Dr. Remaley: [laughs] Yes, that’s a good point. Those cases can get long. I do my workouts in the morning. I go to the gym and do a 5:00 AM workout and try to get that done for the day. Then usually, I’ll have a protein shake or something after that. I usually don’t eat a lot of heavy stuff in the morning, just because it can tire you down and just helps me keep my head clear and stuff. I definitely want to try to stay away from eating a lot of sugar before surgery. You can get the sugar crash a couple hours later and then not have the energy and stuff. Early morning I try to just stick with a protein shake or a light omelet. Some of the hospitals around here make some pretty good omelets. Try to get one of those and then make it through until I can get to a decent lunch.

Speaker 1: What’s the go-to omelet topping or filling I guess?

Speaker 2: Mushroom.

Dr. Remaley: I’m not much of a veggie guy. I’m sure my wife won’t be happy about that. I like the sausage, the bacon. I do put some tomatoes and maybe some peppers in there. I like an egg white omelet. It’s a little bit lighter and less calories though. It’s good.

Speaker 1: We really appreciate you joining us today, Dr. Trey Remaley. This is The Injury Report presented by Tampa General Hospital in partnership with Florida Orthopaedic Institute. They provide you access to one of the top orthopedic programs in the nation. They are the best if you’re dealing with any injuries. We had Dr. Remaley on right now, we’ve had doctors on before. They will be able to treat you. Just schedule that appointment today at floridaortho.com. Dr. Remaley, great stuff. We look forward to having you on again.

Dr. Remaley: Great, guys. I really appreciate it. It was awesome meeting you guys.

Speaker 2: Thanks, doc.

Speaker 1: You as well. Thank you. We forgot the doc. The doc, that’s what we call them. The doc.

Speaker 2: Yes, the doctor. Thanks, doctor.

Speaker 1: Great stuff.

Speaker 2: [laughs] He’s like, “What?”

Speaker 1: We love having the doctors on. We really do-

Speaker 2: The doctors.

Speaker 1: -every year the doctors, because they do. They help people out. We’ve had listeners reach out to us before and let us know that they’ve seen them in the past or they’ve seen them since we’ve talked to them. They’re the best.