Listen to the episode at podcasts.apple.com.

“The baseball throwing motion is probably unnatural and stressful motion you can do to the elbow. Especially that ulnar collateral ligament," said Dr. Carr.

“There are sports that don't require as strong as a UCL. Unfortunately, baseball is one of them where you have to have robust, strong UCL, or the body can't hold up to the stresses of throwing 90 plus miles an hour,” explained Dr. Carr. 

When it comes to Tommy John Surgery, “What we are trying to do is restore a strong ligament to the inside of the elbow. Typically, with the classic Tommy John Surgery, we take a tendon from elsewhere. So if there is an extra tendon in the wrist or we take a hamstring tendon and create a new ligament for the elbow,” said Dr. Carr. 

“Teaching pitchers how to pitch and not necessarily just go for velocity is important. Really strengthening the shoulder and elbow is important. A lot of pitchers try to use weighted baseballs to increase velocity. That has been shown to increase the risk of injury, so focusing more on mechanics using your lower extremities, trying to make sure your elbow is supported throughout your mechanics is important. Keeping a strong shoulder and elbow to support the ligaments is important. Those things have been shod to help reduce the risk of injuries, but we still haven't found that magic key, but hopefully in the next few years, we will have more information there,” explained Dr. Carr. 

Listen to the podcast at podcasts.apple.com. 

“ACL injuries are very common. They happen more frequently in female athletes, but also very frequently in male athletes. Mostly athletes that do a lot of cutting and pivoting. So, soccer, lacrosse, field hockey, basketball, football. These athletes are the most at risk for these injuries. They happen the most in our younger athletes from age about 15-20. But they happen in our older professional athletes and weekend warriors as well,” explained Dr. Carr. 

Dr. Carr explained that HSS has partnered with the Aspen Institute and a number of sports organizations to form the National ACL Injury Coalition that seeks to reduce the injury to young athletes. 

“There is really good data showing that high risk athletes can drastically reduce their risk of injuring their ACL by doing certain training programs that focus on neuromuscular control. At HSS we are really passionate about injury prevention, especially in our young athletes, so we partnered with a couple different organizations to try to get a more national program that can bring these programs to high school athletes to train the coaches, athletes and parents on what they can do to reduce risk of these career altering injuries,” said Dr. Carr. 

Listen to the podcast at podcasts.apple.com. 

Dr. Carr cited that soft tissue injuries are the most common during the football preseason, such as hamstring strains, calf muscle strains or oblique muscle strains. “The injuries can be related to a lot of factors: hydration, conditioning and overall strength and endurance as the players continue to build that back up,” he noted.

To avoid soft tissue injuries in the football offseason, Dr. Carr recommended appropriate conditioning prior to training camp. “Most players will take extended time off to recover at the end of the football season…and it’s important to take an extended time leading into training camp to build up muscle strength, endurance and flexibility and get acclimated to the heat. All those things need to occur for a football player to report at their maximum fitness and minimize risk of injury regardless of level – middle school, high school, college and professional.”

Dr. Carr discussed the evolution of baseball and how he has adjusted management approaches for professional players. “We have to manage workload to prevent injury, but when it does occur we do everything we can to get them as back as fast and as safely as we can without risk of re-injury,” he said.

Dr. Carr explained how HSS Florida is serving the West Palm community. “We are a comprehensive place for caring for the community, professional athletes and athletes of all levels. If you find yourself sidelined by an injury we want to get you back in the game and want to do it better than anyone else,” he concluded.

The segment aired on September 2, 2021.

Dr. Carr explained he takes a personalized approach to care by listening to patients to better understand their goals and help them get back in the game. He treats athletes of all ages - from middle school, to high school, college, professional and weekend warriors.

The initial physical exam is important to Dr. Carr as well as imaging, such as radiographs, x-rays or MRIs. He noted, “My biggest goal is the right diagnosis, because if you have the right diagnosis then you can have the right treatment plan.”

Dr. Carr said he starts with non-operative measures whenever possible for his patients, and often surgery is the last resort. He explores several first-line options, such as physical therapy, injections, braces, rest or anti-inflammatory medication.

Dr. Carr also addressed the increase of Tommy John elbow injuries in recent years the potential causes.

As someone who regularly treats baseball players, Dr. Carr attributed the rise to an increase in higher pitching velocity and disregarding pitch count rules, as this correlation is especially apparent in youth players. Further, he advised while younger players are resilient they should ease into pitching. “It’s really important to not pick up a ball and throw as hard as you can. Take time, at least a month or two, to get your arm and body ready for max effort pitching.”

The segment aired on May 27, 2021.

Dr. Carr noted most throwing injuries are the result of overuse, suggesting athletes should only play on one team at a time. Players should also take a minimum of 3-4 months off from throwing every year to allow their bodies to heal.

According to Dr. Carr, shoulder or elbow pain is never normal, and players should not try to “throw through” the pain. Some soreness the following day can happen, however pain while throwing is not typical. If pain persists despite adequate time off, Dr. Carr advised to seek further evaluation.

Additionally, players should avoid unsafe training and throwing programs. Dr. Carr explained many programs designed to increase velocity use extreme methods that place dangerous stress on the arm. Safe pitching mechanics should never be compromised for velocity.

Furthermore, athletes should avoid specializing in one position at a young age. Dr. Carr cited playing a variety of positions builds different skills and can prevent overuse injuries from excessive pitching.

This article appeared in the print edition on March 14, 2021.

Dr. Carr explains that participating in youth sports is an essential part of childhood for many families as there are many positive benefits for children including increased self-esteem, improved physical fitness and character building.

He shares some tips to minimize the risk of injury including encouraging cross-training, playing on one team at a time, utilizing age-appropriate techniques and getting help early when you do get injured.

This appeared in the print edition on January 3, 2021.

The Athletic spoke to James B. Carr II, MD, sports medicine surgeon at HSS Florida, who did not treat Kelly, but commented on the recovery for this type of injury. What might give Kelly a better chance to return to sport is the type of TOS he had. Most pitchers develop neurogenic TOS, which is when the nerves are compressed in the area between the shoulder, the clavicle and the top rib. Kelly had vascular TOS, which involves the compression of the blood vessels. Vascular TOS is the more serious condition, but it offers a less complicated recovery. Dr. Carr noted it’s rare, but some pitchers with neurogenic TOS experience neuropraxia, which is the damaging or deadening of the nerves during surgery. Some operations to alleviate neurogenic TOS involve cleaning up scar tissue around the nerves. Kelly’s procedure involved the removal of his rib and the detachment and reattachment of one of his scalene muscles. This doesn’t mean his recovery will be stress free, but it gives him a better shot. “Some players just don’t tolerate having their neck muscles and core muscles violated from the surgery,” explained Dr. Carr. “It’s a little bit less of a risk of having a complication just because you’re not having to do a lot of nerve work,” he said.

The success rate for thoracic outlet surgery is far lower than that for Tommy John surgery. Pitchers who never recapture their form offer the reminder "that we have probably a little more work to do to understand it better and make sure we understand the whole rehab process," said Dr. Carr. There have been improvements with diagnosis and the key is that team medical staffs now know to keep TOS on the mind when examining a player. Dr. Carr cited there are a few tests he can do just in his office that will alert him to any thoracic outlet issues. “In the past, the disease was seeing us, but we weren’t necessarily seeing it,” he said. “Now, we know what to look for.”  

Read the full article at Theathletic.com.

“Give yourself a lead time to get your endurance and conditioning back to the level you were, with careful monitoring and an intentional ramp up to your previous level of activity,” says James B. Carr II, MD, sports medicine surgeon at HSS Florida.

He also recommends a dynamic warmup and cooldown which is just as important as the actual training itself.

Read the full article at PalmBeachPost.com.

HSS is eager to bring its medical services to the growing, aging and affluent Florida community. Last year, 3,000 Florida residents traveled for care to HSS in New York. "We want to deliver care closer to where people live and work,” said Mr. Shapiro. HSS also hopes to be a destination center for all sports medicine needs in the Southeast U.S., including professional athletes as well as teenage athletes, cited Justin Oppenheimer, senior vice president and chief strategy officer at HSS.

David W. Altchek, MD, sports medicine surgeon at HSS, will serve as the Medical Director of HSS Florida. Joining him is HSS orthopedic trauma surgeon, Nicholas Sama, MD, as associate medical director for inpatient services; sports medicine surgeon Ryan W. Simovitch, MD, as associate medical director for ambulatory services; hand an upper extremity surgeon, Michelle G. Carlson, MD; sports medicine surgeon, James B. Carr II, MD; physiatrist Kathleen L. Davenport, MD; and hip and knee surgeon, John L. Wang, MD.

Read the article at Palmbeachpost.com. This article also appeared in the February 2 print edition. 

Additional coverage:

• Healio.com
• Beckersasc.com
• Beckersasc.com
• Beckersasc.com
• Beckersasc.com 

In their review, Dr. Carr and Dr. Rodeo evaluate the basic science and clinical evidence for the most commonly used biologic agents for treating common shoulder pathologies (i.e., rotator cuff tears, osteoarthritis, and tendinopathy), to help physicians better understand the terminology for the most commonly used biologic agents; review the current literature on the use of various biologic agents in the treatment of the most common shoulder pathologies; and highlight emerging therapies and potential future applications of biologic agents in the management of these shoulder pathologies.

While the outlook may be positive, Dr. Carr and Dr. Rodeo advised that further laboratory and clinical research is needed, to define optimal formulations, dosing schedules, and approaches for various tissues and injuries. As the safety and efficacy of these approaches are further defined, changes in the regulatory environment at the FDA level may also aid progress.

“Orthopedic surgeons must be well informed when discussing biologic agents with patients," added Dr. Rodeo. "It is paramount that orthopedic surgeons provide leadership in this area and work toward developing practice guidelines and policies for the use of biologic agents. A rigorous approach to the use of 'regenerative medicine' therapies and the maintenance of high clinical and research standards are required to move the field forward."

Read the full article at News-medical.net.