Sport in a Virtual World

How Butterfly supported the continuance of pro-basketball through COVID-19 lockdown
A Case Study by
Original Research by
Robert Gambrell, MD

In early 2020, COVID-19 brought the world to its knees. While we slowly recoveredfrom and adjusted to the first wave of the pandemic, the NBA, WNBA and NBA GLeague resumed play in an attempt to return some sense of normalcy to the world.This required sequestering the players and support personnel into a specific locationwith limited access, frequent testing and quarantine for those individuals with provenor suspected Covid infection. As a G-League physician, Butterfly serveda key role in my work taking care of players within the bubble.

The bubble opened in January 2021, following the successful example of the NBAand WNBA the previous year. The entire G League season and championships werescheduled over a six-week period at Walt Disney World in Florida. The bubble posedmany challenges for our medical team trying to provide state-of-the-art medicalcoverage while maintaining full isolation. Each team brought its own athletic trainer(ATC), but my team served as front-line care, often coordinating with teams’ on-staffphysicians from their home market. Our medical team was responsible for the careof all the individuals within the virtual bubble, providing evaluation and treatmentin a clinic setting, as well as providing court-side game coverage throughout the 6weeks of play.

I was fortunate to have access to Butterfly¹, which I used both in the clinic and atcourtside. X-rays and MRI were not available within the bubble, and referrals toexternal medical facilities were complicated with the lockdown in place. In light ofthese difficulties, I used the Butterfly iQ+ frequently: it was always readily available, andscans were instantaneous. Rapid diagnosis and disposition with appropriate treatmentof the professional athletes under my care was of utmost importance,amplified by thecompressed schedule. The use of point-of-care ultrasound (POCUS) was extremelyadvantageous for rapid diagnosis, and for reassuring athletes about their safety to returnto play or the need for further treatment.

The vast majority of the injuries we saw were soft tissue muscle and tendonstrains, and ligament sprains. The use of POCUS was extremely well-suited for thispopulation. Although not traditionally used for the diagnosis of fractures, POCUS washelpful in diagnosing acute and stress fractures. One particular case of note occurredwhen a player landed hard on his knee during a game. He was able to leave the courtwithout assistance, but was complaining of severe anterior knee pain. He was able tofully extend and flex his knee and had a normal ligamentous exam but was extremelytender over his patella. Almost immediately, I was able to assess that he had a patellarfracture. The cortical disruption and separation was easily identified with ultrasound.Courtside POCUS ultimately protected this player from any further damage that couldhave occurred if he attempted to return to play. This was just one of many exampleswhere Butterfly proved to be a convenient and valued asset within sports medicine.

Image 1. Normal Side. Pediatric Lung setting, demonstrates clear pleural line with sliding and z lines (aka comet tails). No indication of B lines; normal appearing lung

Image 2. Abnormal side. Additional air bronchograms further identifying the consolidated lung region. With respiration consolidated lung is partially obscured by B lines. Consolidated lung with dynamic air bronchograms

Image 3. Abnormal Side. On left of image: few B lines indicating presence of fluid in lung, irregularly appearing pleural line with sub pleural consolidation (~ 2 cm in depth). Consolidated lung area looks like liver hence the term, lung hepatization. Echogenic dots are air bronchograms; these collections move with respiration therefore they are called dynamic air bronchograms. (Note: dynamic air bronchograms = pneumonia; static air bronchogram - no movement with respiration = atelectasis)

Robert Gambrell, MD

1. Dr. Gambrell was provided a Butterfly iQ+ in connection with this article. Rx only (USA). For trained healthcare professionals.