Dr. Destin Hill

They would learn so mere moments later — and Giovanni’s life would be changed forever.

Though Giovanni is unsure — or chooses not to remember — whether his friend made contact with the cable incidentally or out of childlike curiosity, the friend did so. The cable had been made especially dangerous because it had been corroded by a recent storm. The friend was killed in seconds, and Giovanni tried to offer help. But the electrical current carried to Giovanni and was far too strong for the child.

Hours later, Giovanni woke up in a Port-au-Prince medical center, a facility that one of Giovanni’s current caretakers describes as “hardly a hospital.” He woke up with a visage that was charred and blackened, with the top of his skull blown away and his cranium exposed.

Giovanni didn’t expect to go to the places the horrific injury would send him next, which have taken him from his family for what has now amounted to years….

Read the full article here: Deseret News: Accident sends teenage boy miles from home to receive assistance from LDS network and hospital

Passing Hope in Haiti 2011 Video

When people ask me what kind of doctor I am or what kind of medicine I practice, I usually start by telling them I am a sports medicine doctor.  This is usually followed by plenty of questions or a funny look.  To the doctors at ASMC and many referring physicians and sports teams, sports medicine is the diagnosis and treatment of injuries or illnesses that arise from sports or other activities such as exercise or a physically demanding job.  Sports medicine starts with an accurate diagnosis within the shortest time possible.   Then a treatment plan and options are prescribed to allow a patient to return to function in a sport, activity, or work in the shortest and safest amount of time possible.  The following are common questions and answers regarding sports medicine in general and ASMC as a practice.

Do I have to be an athlete to be evaluated by an ASMC physician?

The answer to this is…..absolutely not!  Although we take care of many athletes from the club and high school level all the way to the professional athlete, many of our patients are not athletes at all.  If you have something that hurts, whether from an injury, fracture, overuse, activity at work, or just a nagging problem—we usually can help.  Our physicians have experience in many types of sports and activities, and can help you with an accurate diagnosis and treatment plan, getting you back in action.

What sets ASMC apart from other sports medicine groups or clinics?

Our Training:  Our physicians have trained at some of the most prestigious and recognized programs in the country, from Mayo Clinic to Taos Sports Medicine to the elite American Sports Medicine Institute in Alabama with Dr. William Clancy.  When you make an appointment at ASMC, you will be evaluated by a physician with experience and expertise in Sports Medicine, Orthopedic Surgery, and Family Medicine.  At this time we do not employ any physician assistants or nurse practitioners, so every visit you will be evaluated by a physician.

Experience:  All of our physicians are team physicians for multiple sports, from the high school to professional level.  Because of this, we have been trusted by many primary care providers, physical therapists, amateur and professional sports teams, and even elite training facilities such as Athletes Performance to evaluate and treat their patients and athletes.  Check out the most recent Phoenix Magazine Top Docs issues and you will see several of our physicians in the sports medicine and orthopedic surgery sections.

Total Sports Medicine:   Our physicians are trained in family medicine, sports medicine, and orthopedic surgery.  How would you like to have one place to call your medical home?  We provide family medical care such as preventive and sports medicine physicals, allergy and asthma care, and acute illnesses.  Our sports medicine care includes evaluation and diagnosis of sprains and strains, tears,  injuries, fractures, overuse problems, arthritis, and other common musculoskeletal issues such as back strains and sciatica.  If orthopedic surgery is necessary, we have fellowship trained surgeons who provide surgical care using the most advanced techniques in as joint arthroscopy if indicated.

What if I need x-rays or other special tests?

Both of our Scottsdale and Mesa office have x-ray capabilities, and we have recently added musculoskeletal ultrasound to our Mesa office and soon will add this to our Scottsdale office.  This allows us to take and read x-rays and ultrasounds at the time of your visit, providing expedited diagnosis and treatment options.  We also work closely with some of the best imaging facilities and radiologists in the Valley, so if advanced imaging such as MRI is necessary, we can arrange and expedite the ordering and interpretations of these specialized tests.

How soon can I be seen by one of the doctors at ASMC?

The short answer to this is….sooner than you would think.  At ASMC, we know how important it is to get you back in the game or back to activity and to help you alleviate any pain or discomfort you may have.  We understand that most injuries or illnesses can’t wait, and we strive to provide expedited appointment times to help you with any acute injury or illness.  We have recently expanded our practice to five physicians, and will continue to grow to allow patients to be evaluated in a timely manner.  Our goal is for you to see one of our physicians within two days for an acute injury or illness, and within one week for an ongoing problem or follow up appointment.  Even though our surgeon’s schedules may be booked out for weeks at a time, we have made the commitment to expedite your care if necessary.  If an urgent surgical diagnosis has been confirmed, we will make every effort to work that patient in.  If a patient has not been worked up, one of our sports medicine doctors can begin the evaluation and management plan and expedite the consultation with one of our surgeons if necessary.

How does a SLAP tear occur?:  There are numerous mechanisms and some of the more common ones (with examples) are:

Traction injury–lifting a heavy object with sudden pull, waterskiing or attempting  to stop a fall or slide

Fall on outstretched arm–a baseball outfielder diving for a ball

Repetitive overhead–baseball pitch or tennis serve

Degenerative–non injury related and often times not very symptomatic

How do I know if I have a SLAP tear?:  There is a significant degree of overlap of symptoms with other shoulder issues, but patients frequently complain of painful clicking, popping, catching, or pain with throwing or with overhead motions or reaching behind.  Pain is often described as deep and may be associated with weakness or loss of range of motion.

How is a tear diagnosed?:  There usually are clues from the history and mechanism of injury and there are numerous clinical tests to aid in the diagnosis including the O’Brien sign and crank test, although there is no definitive test.  X rays will not show labral damage because the labrum is soft tissue, but xrays are important to make sure that symptoms are not from other pathology such as a fracture, bone spur, arthritis or a loose body.  MRI is commonly performed to confirm the diagnosis and injecting a contrast dye (arthrogram) into the shoulder just before the MRI can allow this to be much easier seen.  There are times when the SLAP tear is diagnosed during arthroscopic surgery.

What else could be wrong?:  There could be associated problems or something unrelated to a SLAP tear.  Examples include rotator cuff tears, biceps tears, tendonitis/bursitis, arthritis of the shoulder joint or shoulder blade/collarbone joint (AC), instability, a calcium deposit, compressed nerve, or ganglion cyst.

How are SLAP tears treated?:  Often an initial trial of rest, physical therapy and anti-inflammatories are prescribed which may calm inflammation or treat associated problems.  Sometimes this has been tried even before the diagnosis of SLAP tear has been made.  Rehab cannot fix a torn labrum, but can make the surrounding muscles stronger and attempt to better dynamically stabilize the shoulder and improve symptoms.  If there is persistent pain or disability, surgery is generally recommended.

What does the surgery involve?:  SLAP tears can be repaired using an arthroscope to view and work in the shoulder joint through multiple small incisions (less than one centimeter).  A thorough evaluation of the shoulder can be made and the problem identified and repaired.  Small, typically 3 mm in diameter anchors, whether plastic or metal are drilled into the bony socket and attached sutures are passed through the torn labral tissue to secure it back to the bone.  Rarely a simple debridement (trimming) instead of a formal repair may be indicated in some patients, and if an associated biceps tear is present, a small additional procedure may be done.  This may include a simple cutting of this long head of the biceps (tenotomy) or cutting and then suturing the biceps back to tissue or bone (tenodesis).  Details of this are beyond the scope of this article, but sometimes the SLAP tear may not be the primary cause of pain and not every SLAP tear requires surgery.

What is the rehab?:  Please understand that rehab may be customized to match the needs of a particular patient or specifics of the surgery, but on average a sling is worn for between 3-6 wks, with very simple exercises shown to help avoid stiffness, but not too aggressive at first to allow for healing.  Physical therapy is quite beneficial and home exercises complement the formal PT.  Return to full activities or sports generally is 4-6 months or occasionally longer.

Any of the excellent doctors at ASMC would be glad to answer further questions and provide top notch care for your shoulder or other orthopedic concerns.  Call for an appointment at 480 558-3744.

A shoulder dislocation occurs when the ball of the shoulder pops out of the socket of the shoulder.  This usually occurs when falling with your arm outstretched in front or behind you, with aggressive overhead activities, or with your arm out away from your side.  A shoulder dislocation usually has to be “reduced” , that means put the ball (humerus) back into the socket (glenoid), by someone else – a team trainer or ER doctor for example.  In order to dislocate or pop the ball out of the socket the ligaments of the front of the shoulder are torn as well as the cartilage bumper along the edge of the socket (see Dr. Freedbergs article on SLAP lesions).  This combination of labral tear and ligament tear is called a “Bankart Lesion”.  Often the ball of the shoulder gets “dented” by the edge of the socket similar to if you push your thumb and indent a ping-pong ball.  This dent in the ball is a “Hill-Sachs lesion” – a sign on xray that the shoulder has been dislocated before.

A separated shoulder is more of a clavicle/collarbone injury.  With a shoulder separation the end of the collarbone pops upward away from its attachment to the top of the shoulder blade at the AC joint and there is a noticeable prominence at the end of the collarbone compared to the other side. This usually occurs if you fall and land on the point of the shoulder with your arm at  your side or crash into a wall or an opponent sideways, again usually with your arm at your side.   A shoulder separation does NOT get reduced by the trainer or at the ER.  Separated shoulders are usually graded 1, 2, or 3 depending on how high the end of the clavicle/collarbone sticks up.

Treatment of the two injuries is different also.  Most shoulder separations leave the patient with a visible prominence of the collarbone tip at the top of the shoulder but most often there is no pain, no weakness and the patient/athlete regains full function of the shoulder.  Therefore we usually treat this injuries, even/especially in professional contact athletes (football, hockey, snowboarding) non-operatively with a sling early on for pain and swelling and then physical therapy and strengthening.  Most shoulders are strong and pain free by 3 months.  Some college and professional athletes with return to competition within 2-3 weeks of suffering a grade 3 AC separation.  The results of surgical treatment for fixing or re-aligning a separated shoulder are generally as good in the delayed setting as the results of early fixation so there usually is no downside to an initial period of non-operative management of these injuries.

Shoulder dislocations are more often a surgical problem.  Dislocations can be recurrent (happen again and again) and for certain job  requirements such as law officers, firefighters and active duty military for example, could have disastrous complications if the shoulder were to dislocate again in the line of work.  Surgical repair of a dislocating shoulder can be performed arthroscopically, with some exceptions such as a piece of bone broken off the socket or unusual ligament tear.  However, both arthroscopic and open shoulder stabilization surgery requires a minimum of 6 weeks use of a sling and several months of activity restrictions post-operatively.  Most contact athletes are not cleared for return to sport until 5 months post op.

All 5 physicians at ASMC have extensive experience managing shoulder dislocations, separations and subluxations in both the competitive athlete and the weekend warrior, as well as the unfortunate patient who has a slip or fall at home or in a non-athletic situation.  Call 480 558-3744 to have your injured shoulder evaluated by one of the physicians at ASMC.

Acute tendon and ligament strains can often be effectively treated with conservative measures such as icing, anti-inflammatory medications, rest, and physical therapy. If these treatments do not provide the necessary recovery, treatment can progress to surgery. A treatment gulf can exist between conservative and surgical treatments when injuries simply don’t heal, but do not necessarily require surgery. Platelet Rich Plasma (PRP) treatment provides an alternative to continuing conservative methods and surgical care.

Injured tissue suffers diminished blood flow, which can diminish the body’s ability to heal through the natural process of inflammation, tissue regeneration, and tissue remodeling. PRP shortens the healing curve by hastening this natural process to regeneration and remodeling. PRP improves the imbalance between supply and demand of growth factors that occurs following muscle and tendon injuries and injuries to joint spaces, cartilage and ligaments.

PRP works by harvesting the body’s healing powers. Our blood contains platelets, which function to help repair injuries in the body. They activate and provide a patch-like matrix to an injury. They also release growth factors that stimulate healing through cell division and release cytokines that attract additional cells, including stem cells, for healing and remodeling.

Whole blood is drawn and then spun down to collect the platelets in concentrated plasma, increasing platelets to >4 times baseline levels. This is then injected into the injured tissue, using ultrasound imaging to guide the needle to the precise area of treatment.

PRP treatment can be an effective alternative for people with tendon injuries and tendonitis, ligament sprains, muscle strains, and cartilage problems. Unfortunately, PRP is not yet covered by some insurance companies and is provided on a cash pay basis. The cost can typically be less than the deductible for surgery and PRP carries far fewer risks as a less invasive, office-based procedure.

Orthopedic surgeons are frequently looking to enhance their practice through physician extenders.  The advantage?  Physician extenders can often spend more time with a patient and can enhance your experience during your office visit.  Whether it is taking a medical history, evaluating injuries, patient education for injury prevention, crutch or brace fitting, developing rehabilitation programs, casting or assisting with diagnostic ultra sound, an athletic trainer is fully equipped for the task.

Nearly 70% of certified athletic trainers (ATC) have a master’s degree or higher.  Any athletic trainer with the ATC credential has received at least a college education and training in comprehensive preventative services and care in six domains of clinical practice: prevention, clinical evaluation, immediate care, treatments, rehabilitation and reconditioning, organization and administration and professional responsibility.  Upon graduation, candidates are eligible to sit for the NATA (National Athletic Trainers Association) Board of Certification exam.  Athletic trainers who pass the exam are awarded the ATC credential.  In states like Arizona, an athletic training license is required in addition to certification to practice.

The relationship between orthopedists and athletic trainers has historically been seen on the sidelines managing and treating athletic injuries.  In the office, an athletic trainer can utilize triage skills and the ability to evaluate musculoskeletal injuries to maximize efficiency for the clinical staff.  The transition into the clinical setting helps ensure that all patients – not just athletes – can benefit from a unique team approach in health care.

Here at Arizona Sports Medicine Center we recognize the benefits of an ATC as a physician extender and are amongst the first in the valley to employ an athletic trainer. Chelsea Lohman, MAT, ATC/L, CSCS works with Dr. Amit Sahasrabudhe in both our Mesa and Scottsdale offices. Currently she focuses on patient education, rehabilitation and is helping with diagnostic ultrasound and ultrasound-guided injections. Utilizing an ATC is one of the many ways we are working to develop and expand our services at ASMC.

Ultrasound imaging involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use radiation (as in x-rays).  Because ultrasound images are captured in real-time, they can show the structure and movement of the body’s internal organs, as well as blood flowing through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions by providing images that show normal and abnormal muscles, tendons, ligaments, joints and soft tissue structures throughout the body.

What are some common uses of the procedure?

Ultrasound images are typically used to help diagnose:

• Shoulder: rotator cuff injuries, tendonitis, bursitis, impingement
• Elbow: medial epicondylitis (golfer’s elbow), lateral epicondylitis (tennis elbow)
• Knee: meniscal tears, ligament strains, Baker’s cyst
• Hip: bursitis, tendonitis
• Ankle sprains
• Carpal tunnel syndrome
• Stress fractures

How does the procedure work?

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid, or both).

How is the procedure performed?

For most ultrasound exams of the musculoskeletal system, the patient is seated on an examination table or a swivel chair. For some ultrasound exams, the patient is positioned lying face-up on an examination table.

A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The ultrasound technologist or physician then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.

During the examination, the technologist or physician is often able to point out problem areas in real-time (big difference compared to MRI). This ultrasound examination is usually completed within 15-30 minutes but may occasionally take longer.

What will I experience during and after the procedure?

Most ultrasound examinations are painless, fast and easy.If scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer. The technologist or physician may ask you to move the extremity being examined or may move it for you to evaluate not only anatomy but also function of a joint, muscle, ligament or tendon. Once the imaging is complete, the gel will be wiped off your skin.
After an ultrasound exam, you should be able to resume your normal activities immediately.

What are the benefits vs. risks?

Benefits

• Performed quickly in-office
• Non-invasive
• Comfortable
• Exam is performed in real-time with dynamic motion
• Can be easily compared to the non-injured side
• Instant results
• Differentiates between new and old injuries
• Cheaper than an MRI
• Can be used for guided injections directly into a problem spot

Risks

• For standard diagnostic ultrasound there are no known harmful effects on humans

What are the limitations of Ultrasound Imaging of the Musculoskeletal System?

Ultrasound has difficulty penetrating bone and therefore can only see the outer surface of bony structures and not what lies within. For visualizing internal structure of bones or certain joints, other imaging modalities such as MRI,CT, and plain xrays are typically used.

Dr. Peterson speaks Haitian Creole and served as a missionary for his church for two years prior to becoming a doctor. He has been back on several occasions over the years for medical missions. When the earthquake struck, there was no hesitation in his commitment to return to Haiti in their greatest hour of need. He was in Deer Valley, Utah, covering the World Cup competition for the U.S. Ski Team, when the earthquake hit. He and several friends, also former missionaries who spoke the language and who became physicians, immediately began working to find a way to Haiti.

5 days after the earthquake they were able to leave for Haiti, the day after the ski competition ended. Dr. Peterson and his companions left directly from Utah, arriving in the Dominical Republic, then on to Haiti in helicopters. They decided to focus on Leogane, a city of approximately 100,000 that was near the epicenter. Leogane was devastated, 90% of the building collapsing and 25%-30% of the population having died in the earthquake.

Dr. Peterson and his team immediately began treating patients upon landing in the church building where he had attended as a missionary for nearly a year 21 years ago. The team then established a field hospital with an eclectic group of providers comprised of Navis, a private Bavarian disaster response team, a Cuban team with Haitian medical students, and a group of Mennonite missionaries. Dr. Peterson’s group of physicians included several search and rescue professionals from St. George, Utah.

The injuries were devastating, many open wounds and fractures having progressed to severe infections. Their stamina and skills stretched to their limits, Dr. Peterson and his team provided care and needed operations for hundreds of patients.

The experience was one of the greatest in Dr. Peterson’s life. To be able to provide life-saving care in a situation of devastating urgency left him not with a feeling of accomplishment or personal aggrandizement; rather, he feels profoundly grateful for the experience and for the ability to help the people he loves so much in Haiti. He made many new friends and renewed old friendships.

Dr. Peterson and his team returned in June with new objectives. In addition to providing medical care in clinics, they placed water filters in schools and isolated, rural locations, interviewed hospital administrators and doctors, organizing the information for use by other groups interested in providing medical care in Haiti. They also put a 13 year-old boy on a flight on route for high-level surgical care at Shriners Hospital in Boston, the culmination of several months of work. He has completed two of a projected five operations and is doing well. The group was financially aided in accomplishing their goals by Mesa United Way and WesTech Engineering of Salt Lake City, Utah.

Dr. Peterson and his friends touched the lives of many. Their lives were equally touched by the remarkably resilient and loving people of Haiti. A symbolic culmination of care and emotion, Dr. Peterson was reunited with 10 year-old Djenny, their first patient. She had a fracture-dislocation of the left ankle from the earthquake. He and Dr. Steve Hanson, of St. George, reduced the injury and immobilized her leg. In June, he was able to see her again, healed and pain-free. They danced together. That dance was worth all of the training, cost, and work that preceded it.