Dr. Cindy Chang is a specialist in primary care sports medicine with almost 3 decades of experience. She has served as head team physician at UC Berkeley, chief medical officer for Team USA in 2008 & 2012 Olympics, and assisted in the WNBA COVID "Wubble." Chang takes an individualized approach to care, seeing athletes of all ages. She is Program Director of UCSF's Primary Care Sports Medicine Fellowship, board of trustees for the American College of Sports Medicine, chairs the Sports Medicine Advisory Committee for the California Interscholastic Federation & National Federation of State High School Associations, and past president of the American Medical Society for Sports Medicine. She earned her medical degree from Ohio State Univ. College of Medicine, followed by a residency in family medicine at UCLA Medical Center & a fellowship in sports medicine at Ohio State Univ. Medical Center.
It is possible to get a ganglion on the palmaris longus tendon, as 90% of ganglions arise from the wrist and hand. However, they are non-cancerous and usually not painful. They can become disfiguring if they become large and interfere with function. Transcript: "Is it possible to get a ganglion on your palmaris longus? The palmaris longus is a tendon on the inside of the wrist or the volar aspect of the wrist, palmar aspect. You can see it right there. And I have never seen it but, of course, it could be possible. Because over 90% of ganglion cysts in our body are located in the hand and wrist. And women are three times more likely to get ganglion cysts compared to men. Now, ganglion cysts I want to emphasize are non-cancerous. So you don't need to worry about those being cancer. And it's a benign fluid-filled cyst, and usually, it originates from joints or tendon sheaths from overuse, from tissue degeneration. And when you see them, they're usually not painful. But they can get disfiguring if they get large. And they can sometimes interfere with function. So while I have never seen a ganglion on the palmaris longus tendon, that doesn't mean that it wouldn't happen. And again, the chances are high that it could because, again, 90% of ganglions arise from the wrist and hand."
Female soccer players should consider wearing shin guards, a well-fitting sports bra and potentially protective headgear for concussions and neckwear. However, there is not enough evidence-based research to recommend that all female soccer players wear them at this time. Transcript: "What should female soccer players consider when selecting protective gear? Well, first and foremost, the first thing that comes to mind are shin guards, of course, for soccer players. But number two is just as important are sports bras. Sports bras are oftentimes not thought of. But certainly, these are very important for female soccer players to have a good well-fit sports bra, because it helps prevent the breast tissue from excessive motion, either side to side or up and down. And because the suspensory ligaments in the breast can get strained and cause pain and soreness during activity, it's important to have a well-fitting sports bra. And it's not one size fits all. And I would encourage every female athlete to make sure that they go to a good store that has a wide variety of sports bras for them to try on and someone there experienced in fit to help them feel comfortable in what's going to be a very, very important part of their sporting equipment. The last thing I'm going to mention, although there's not enough evidence-based research, are a lot of people ask about protective headgear to prevent concussions. And also, there is a neckwear that's out now, too. And I would say that we are still following the research. There's not a lot of good evidence for us to consider that every female soccer player or soccer players wear this at this time."
It is important to seek out care from either your primary care physician or a rheumatologist as they can do blood work and an evaluation to see if the joint pain and effusions are due to rheumatoid arthritis. If so, they can provide options on the best management plan to help prevent symptoms and progression of disease. Transcript: "My father suffers from debilitating rheumatoid arthritis that began at the age of 35. I am 45 and notice joint pain effusions from time to time. Is there any way to screen for RA and are there any prevention strategies? First of all, I'm sorry that your father has been suffering from this disease and hopefully he's under the care of a rheumatologist because there are really some new medications out there, biological medications that can help with symptoms as well as advancement of the disease. And that being said, you should seek out care as well from either your primary care physician or a rheumatologist because there is blood work and there is an evaluation that can be done to see whether or not your joint pain and effusions are indeed the result of rheumatoid arthritis. And if there is, then your physician can give you options on the best management plan to prevent your symptoms and help you lead a more active life and also to prevent progression of disease if it is indeed rheumatoid arthritis or maybe some other type of joint condition. Either way, they can also advise you once you have a diagnosis on any ways to help you further with your care. So good luck and please go seek out your physician."
To treat Achilles tendonitis, stop the activity if it is causing pain or discomfort and replace your shoes with ones with a heel lift or small heel to reduce tension on the Achilles. Additionally, icing the affected area for no more than 15 minutes may be beneficial, depending on the level of swelling. Transcript: "How do you treat Achilles tendonitis? I recommend that all of you listen to the post from Dr. Brian Krabak. He did an excellent job talking about the pathophysiology of Achilles tendinopathy. Tendonitis is an acute inflammation of the tendon. So I'd like to give you just a few practical tips. One is that if you feel it's stinging or pulling or sore in the midst of an activity, I would recommend you stop right away. By stopping right away, you'll prevent further damage, and you'll be able to return back to your activity sooner. And so if you have a mile to finish, if you have a half left of a soccer game to play, definitely stop. Walk back to your car. Walk back to your house. Whatever, but do not continue playing. There's been discussion about whether or not ice is good for it or not. We know that inflammation can cause healing factors to come to the tissue. So that is totally dependent on you. If there's a lot of acute swelling there in the tendon, which I don't assume there will be, you don't necessarily have to ice it. If you're someone that really feels like it's always benefited your tissues to do so, then go ahead and ice it but for no longer than 15 minutes. I will also recommend that my patients go into a heel lift in their shoes or wear shoes with a small heel because that will take the tension off the Achilles for the first several days, so it doesn't hurt when you walk."
Before ACL surgery, it is important to ensure that the injured knee has full range of motion, good strength and stability, no limping, and decreased swelling or effusion. It is also important to focus on strengthening the core muscles, such as the gluteus medius, surrounding low back and hip muscles, in order to help with balance and strength when beginning rehabilitation exercises post-surgery. Transcript: "Are there ways someone should prepare their body before ACL surgery? Absolutely. We call this prehab. And so, prior to ACL surgery, it's very, very important to ensure that the injured knee has full range of motion. You have good strength, as well as stability or balance on that knee, that you can walk without a limp and that the swelling or effusion in the knee has substantially decreased since the injury. And that's why most surgeons won't operate on the knee until several weeks after the ACL injury to make sure that the knee joint has quieted down and that the blood products in the knee have been resolved by the body because this will decrease the risk of stiffness after the surgery. The other thing to do besides that focusing just on the knee is also focusing on the remainder of the body, making sure that the rest of the muscles, for example, the core muscles, gluteus, medius, and the surrounding low back and hip muscles are strong because from those core muscles in your hip and your abdomen will come and generate the balance and the strength for when you're ready to return back after ACL reconstruction to begin to walk and do some of the other rehabilitation exercises."
I found my passion for sports medicine in high school when our coach taught us how to tape and stabilize injuries, and my passion for beach volleyball began in middle school when I started playing at a nearby rec center. Despite having six knee surgeries and osteoarthritis in my knee, I am still able to play beach volleyball. Transcript: "When did you find your passion to do what you're doing? So I am a primary care sports medicine physician. And my passion actually started in high school. We did not have an athletic trainer, and therefore our coach was the one who would help assess injuries to the best of her ability and then also taught us as players how to tape and how to, for example, tape an ankle or stabilize a thumb sprain so that we could try to return back to our sport and that's where I learned how to look at injuries and see how to stabilize them and support them in order to return back to sport to the best of our abilities. The second part is my passion of beach volleyball. I found that passion in volleyball when I was in middle school. And thank goodness a local rec center had open down the road, and I started playing when I was in middle school. And then continue to play through high school. But that passion has developed into me continuing to play at my age beach volleyball, and after six knee surgeries and a diagnosis of osteoarthritis of my knee, the beach is really the most forgiving surface that I can find for my knee, and I'm able to continue to play doubles pretty actively where I am now."