Dr. Jennifer Bauer is chief of spine surgery at Seattle Children’s. She is a committee member of leading international and national pediatric spine societies and study groups and an editor and reviewer for scientific journals.
Q: When should a child with scoliosis see a specialist?
Dr. Bauer: Kids with a thoracic or lumbar rib hump on an Adams forward bend who have a scoliometer reading of 3 to 5 degrees should be rechecked in six months by their PCP. For a scoliometer reading over 5 degrees, we recommend ordering a two-view standing PA/LAT spine radiograph. If it shows a Cobb angle over 20 degrees for any age child or over 10 degrees in a child under 10 years old, we recommend referral to Seattle Children’s. If they don’t meet those thresholds, we advise a follow-up X-ray in 6 months and referring to Orthopedics if any increase in curvature is seen.
We recently developed an algorithm for scoliosis that offers guidance on how to assess the pediatric spine and when to refer to orthopedics.
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Seattle Children’s has virtual appointments readily available at the Orthopedic and Sports Medicine Clinic with little to no wait (same as in-person appointments). Access is excellent at all our locations: Seattle, Bellevue, Everett, Federal Way, Olympia, Tri-Cities and Wenatchee. Telemedicine appointments are ideal for orthopedic and sports medicine visits that do not require a physical exam.
Types of Appointments Well-Suited to Telemedicine
- New patient visits: When a physical exam is not needed, providers can take a history and hear the patient’s story virtually. Families can get a good idea of whether there is harm in waiting or if treatment is recommended sooner.
- Review imaging and/or lab tests: Providers can share their screen with families and review images with them just as well as during an in-person visit, if not better.
- Concussion follow-up visits: Providers mainly offer education and counseling when a repeat exam is not needed.
- Some observations and pain tests: Providers can still “see” the injury or joint and assess for localization, swelling and motion. Providers can then give an opinion on next steps (i.e., whether to get imaging or to start with a specific treatment right away or if it is okay to delay interventions).
- Cast removal: A new at-home cast-off program is available for patients with a stable fracture that won’t require new X-rays after casting. When the cast is applied, it is bivalved and resecured with medical tape. The family removes the cast at home when it is time and self-applies a brace, without needing to come back in. Our provider walks the patient/family through the process remotely. We observe the parent’s exam, the body part and range of motion and give advice on activities, rehab and return to sports and exercise.
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Dr. Monique Burton and Dr. Celeste Quitiquit are both sports medicine pediatricians. Dr. Burton is medical director of sports medicine and Dr. Quitiquit is co-medical director of the athletic training program at Seattle Children’s.
What does the sports landscape look like for kids this fall?
Monique Burton
Celeste Quitiquit
Drs. Burton and Quitiquit: Youth sports definitely looks different this fall. Some sporting teams are in full effect, with fingers crossed. Other teams already cancelled their seasons in advance. Many sporting teams tread carefully, building safety and contingency plans, creating hybrid practice agendas and trying to stay current with COVID-related news. To say there are some modifications is definitely an understatement. For example, the Washington Interscholastic Activities Association (WIAA) has divided the upcoming school year into four sports seasons rather than the usual three, limiting play in fall and moving more play to spring. Almost all of November and December will be a no-play period during which WIAA will reassess plans for 2021 based on what’s happening with COVID-19. It’s very much a fluid, “stay tuned” type of situation. Read full post »
A Q&A With Dr. Michael Saper
Dr. Michael Saper
While some pediatric and adolescent patients with shoulder instability will improve with physical therapy, research has shown that patients with a traumatic first-time dislocation may benefit from early surgery.
We asked pediatric orthopedic surgeon and sports medicine specialist Dr. Michael Saper to describe how patients with a shoulder dislocation benefit from being treated at Seattle Children’s.
Should patients with a first-time traumatic shoulder dislocation have surgery?
Research has shown that in adolescent patients, having stabilizing surgery after a traumatic first-time dislocation is more cost-effective and leads to lower recurrence, higher function and less shoulder arthritis. Furthermore, repeated dislocations can make surgical stabilization more difficult, more invasive and less successful.
After a shoulder dislocation, patients and their families will benefit from a consultation with the Children’s surgical sports medicine team to discuss this option. However, surgical decision making is individualized to each patient, and not every patient is an appropriate candidate for arthroscopic surgery. Read full post »
The team of physicians and athletic trainers in Seattle Children’s Sports Medicine Program leads the way nationally with programs designed to prevent injuries among young athletes.
The Sports Medicine Program includes a team of providers with specialized expertise: two pediatric sports surgeons, a physiatrist and five pediatricians who all possess fellowship training in sports medicine, and three sports medicine-trained physician assistants.
These experienced providers work with more than 40 certified athletic trainers in the Athletic Trainers Program – the largest program of its kind in the country – who monitor the health and safety of young athletes at more than 300 school and community sporting events annually. All of the clinicians in our Sports Medicine Program understand the specific physical and psychosocial challenges of sports injuries, either because they were athletes themselves or have worked with elite international- and Olympic-level competitors. Read full post »
Seattle Children’s is one of the top treatment destinations in the country for children with cerebral palsy, a distinction made possible by the collaboration and expertise of surgeons and physicians.
Families of children with cerebral palsy seeking treatment at Seattle Children’s have access to a breadth of expertise unique to the Pacific Northwest.
The Cerebral Palsy Program includes a complete array of specialists. An orthopedic surgery team, which includes seven surgeons experienced in lower extremity, two surgeons experienced in upper extremity and four surgeons experienced in spine, performs single-event multilevel orthopedic surgery (SEMLS) along with a number of other procedures to address high tone and shortened muscles.
The program’s nationally and internationally recognized neurosurgeons have expertise in intrathecal baclofen pumps, selective dorsal rhizotomy (SDR) and hemispherectomy for children with intractable seizures. Read full post »
Research into tumor paint, glue embolization treatments and other fields of oncology care has allowed practitioners in the Bone Tumor and Sarcoma Clinic to provide unparalleled cancer care to children in the Pacific Northwest.
The Bone Tumor and Sarcoma Clinic is one of the first of its kind in the U.S. in which orthopedic surgeons and oncologists work side by side in the same program. The clinic’s expertise includes two surgeons with fellowship training in both pediatric orthopedics and musculoskeletal surgical oncology and a third with training in both pediatric and adult musculoskeletal oncology. Their interdisciplinary backgrounds and emphasis on collaborative care has resulted in one of the largest, most comprehensive bone and soft tissue programs in the country.
An emphasis on communication
At weekly bone tumor conferences, oncology, orthopedic and radiology teams review and discuss individual patient cases. An additional weekly clinic that includes a broader group of providers offers another opportunity for clinicians to maximize each child’s progress.
“Sarcoma requires team-based care,” says Dr. Suzanne Yandow, chief of Pediatric Orthopedics and Sports Medicine at Seattle Children’s and professor of orthopedic surgery at UW Medicine. “We have to have constant discussions about patients in group settings, and we have an entire team of oncologists, nurse practitioners with expertise in sarcoma care, social workers, and others who attend these weekly meetings.” Read full post »
