How Can Knee Arthroscopy Help?

By  admin6  published  April 23, 2018

Minimally invasive knee arthroscopic surgery has proven beneficial for patients with knee problems where surgery is recommended. Since arthroscopy requires smaller incisions, it doesn’t cause much damage to the surrounding soft tissues, reduces blood loss, decreases hospital stay and risk of complications. All these factors make recovery quicker and complete.

Clinical scenarios, in which arthroscopic surgery may be suitable, include –

  • known or suspected septic arthritis
  • Symptomatic meniscal tears that have been treated with non-operative treatment, without relief
  • Symptomatic loose bodies
  • Locked or locking knees
  • Meniscal tears that require repair
  • Inflammatory arthropathy requiring synovectomy
  • Synovial pathology requiring biopsy or resection
  • Unstable chondral pathology causing mechanical symptoms
  • As an adjunct to, and in combination with, other surgical procedures as appropriate for osteoarthritis: for example, high tibial osteotomy and patellofemoral realignment
  • As a diagnostic tool when the condition of the knee or the problem is unclear on MRI or MRI is not possible, and the symptoms are not of osteoarthritis

When osteoarthritis is present, the decision for arthroscopic surgery is made by the treating orthopedic surgeon –

  • after a thorough review and assessment of the arthroscopically treatable pathology, contribution of the osteoarthritis, and the patient’s symptoms
  • only after all conservative and minimally invasive treatment options have been utilized but failed to provide relief and restoration of function
  • after a thorough discussion with the patient about the advantages of the arthroscopic procedure as opposed to continuing non-invasive treatment
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3 Common Sports Injuries

By  admin6  published  March 30, 2018

Athletic activity is a great way to maintain fitness and is terrific for our overall health. However, any activity that causes stress on joints and soft tissues, can cause injuries. There are 3 common knee and shoulder injuries that athletes encounter.

Meniscus Injuries

The meniscus is a wedge-shaped cartilage in the knee joint. There are two menisci in each joint that act as “shock absorbers” between your thigh and shin bone. Meniscus tears are the most common knee injuries among those who play contact sports. When you hear your doctor talk about torn knee cartilage in the knee, s/he is usually referring to a torn meniscus.

ACL Injury

The Anterior Cruciate Ligament, or ACL, runs diagonally in the middle of your knee. The ACL prevents the tibia from sliding out and provides rotational stability in the knee. Skiers, soccer, basketball and football players are at high risk for ACL injuries due to the stress on the knees.

Rotator Cuff Injuries

The rotator cuff is a group of four muscles that cover the head of the upper arm or humerus. The rotator cuff helps you lift and rotate your arm. Injured or torn rotator cuff tendons can become inflamed and painful. You should get immediate medical evaluation if you are experiencing persistent shoulder pain and difficulty in reaching or overhead movements.

For any joint injury, it is recommended that you seek urgent medical attention to prevent the injury from worsening and to restore motion and function in the affected joint.

 

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Benefits of Orthopedic Bracing

By  aenriquez  published  March 22, 2018

Braces and splints are useful for chronic and acute conditions alike. They can also be used for prevention of injury. There is much scientific evidence that supports the use of braces and splints.

Unloader Knee Brace

The unloader (valgus) knee brace is often used for pain reduction in people with osteoarthritis of the medial compartment of the knee. These braces are designed to apply an outside (external) force to reduce the load on the medial (central) knee compartment, which reduces pain. Improved joint proprioception also helps to relieve pain. In a study involving 120 patients with knee osteoarthritis and varus deformity, researchers found that the unloader knee brace helped relieve pain and improve functional status. The benefits of this brace were found to be greater than a hinged brace.

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Common Shoulder Injuries and Conditions

By  aenriquez  published  March 21, 2018

Whether an injury occurs from paddling a canoe, throwing a ball, or lifting boxes, it does occur. We rely on our shoulders to do a number of activities, and with use of a shoulder, injury can occur. Normally, the shoulder has a wide range of motion, more than any other joint of the body. However, because it is this flexible, it is also not very stable and prone to injury.

The shoulder is made of two main bones: the shoulder blade (scapula) and the ball of the upper arm bone (humerus/humeral head). The humeral head is round, and it fits into the scapular socket. There are several muscles and ligaments that surround the shoulder, and they are called the rotator cuff. Tendons also connect the bones to the shoulder’s surrounding muscles. Injury to any or several of these shoulder structures can produce pain and disability.

Shoulder Instability and Separation

Shoulder instability affects mostly athletes and young people, but it can occur at any age. When ligaments and muscles are stretched beyond normal limits, the shoulder becomes unstable. This condition is often part of growth and development, and shoulders can stiffen and tighten with age. For athletes, shoulder instability is caused by repetitive motions, such as pitching or throwing. These motions put tremendous force on the shoulder, and the ligaments stretch out over time.

After years of having instability, or with persistent use, shoulder separation can occur. When the ligaments that hold the clavicle to the acromion bone of the scapula tear, it is considered separately. Sprains can also occur during a fall onto an outstretched hand/arm. A sprain causes severe pain and a misshapen shoulder, which also contributes to disability and decreased shoulder mobility.

Treatment for shoulder instability and sprain can involve medications, rest, and physical therapy. A sling is often used to limit movement while the shoulder heals. With severe instability and shoulder separation, surgery is often required to remedy the problem. Your treatment plan will be determined by the orthopedic specialist, who will collaborate with other professionals to develop the best course of therapy for you.

Shoulder Dislocation

When the ligaments that hold shoulder bones together tear, and they can no longer support the joint, the shoulder is dislocated. A shoulder dislocation can occur due to a fall onto the shoulder, a fall onto an outstretched hand, or from violent twisting. The main symptom of shoulder dislocation is a pain, and the discomfort becomes worse with movement.

To treat a shoulder dislocation, you should apply ice immediately and go see a doctor. Within 15 minutes of the injury, the joint becomes sore and painful. A dislocated shoulder often can be re-set using gentle traction, where the bones are put back in place. When the shoulder moves out of socket repeatedly, it is called recurrent instability, which requires surgery for correction.

Rotator Cuff Tear

A rotator cuff is a group of four muscles that support the shoulder. They allow a person to raise and rotate the arm. These muscles are attached to bones by tendons, which allow the muscle to strategically move the arm. When the tendons tear, the upper arm bone cannot move easily in the socket, which means you cannot move it away from the body in an upward motion. As people age, and they become less active, tendons start to lose strength and degenerate. Most rotator cuff injuries occur in older adults or middle-aged individuals.

The shoulder has a poor blood supply, which makes it harder for the tendons to repair and maintain themselves. Using the arms overhead puts pressure on the rotator cuff tendons, and repetitive movement and stress can lead to shoulder impingement. When the tissue or bone in the shoulder area becomes misaligned and rubs/chafes. The rotator cuff tendons are often injured or torn when someone lifts a heavy object with an extended arm.

Treatment of a rotator cuff tear depends on the severity of the injury. The doctor may recommend resting the extremity, using a sling to support the arm and medications. After the initial injury, swelling and inflammation are controlled with a nonsteroidal anti-inflammatory drug.

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Common Knee Injuries

By  aenriquez  published  March 2, 2018

Knee Injuries

Many people enjoy playing sports and participating in physical activity, whether playing for fun in the backyard or competitively on a sports tea. Sports participation is beneficial to your health, but there is always the risk of injury. The knee is very vulnerable to injury in sports and everyday life. Knee injuries can occur due to poor training practices, flawed techniques, improper equipment, or accidents.

The knee is a complex joint that serves as an integral component of healthy mobility, and when one experiences an injury, he or she often requires surgery and physical therapy. Our orthopedic specialists are skilled at diagnosing and treating these common knee injuries. We assess your knee, conduct testing and imaging to confirm the problem, and develop a comprehensive treatment plan.

Sprains and Strains

The most common types of knee injuries are sprains and strains. A sprain occurs when a ligament tears or stretches beyond normal points. A ligament is a band of connective tissue that attaches bone to bone, and sprains range from minor ligament tearing to severe severing. A strain is where a muscle or tendon stretch beyond normal, and this can also be minor or severe.

Shin Splint

A shin splint is pain along the tibia (shin bone). This pain is typically at the anterior (front) region of the lower leg, but it can also occur in the knee region. Shin splints often affect runners who run on hard surfaces. Contributing factors for shin splints are poor running shoes, lack of support, failing to warm up/stretch, and having flat feet.

Fractures

The knee bones include the femur, tibia, and patella. Small cracks in any of these bones can occur from repeated stress. A stress fracture occurs from repeated impact, such as jumping or running. A patella fracture can occur from a fall onto the kneecap region. A tibia plateau fracture occurs when sudden excessive pressure collapses the top region of the tibia bone.

Dislocations

A dislocation occurs when one bone of a joint comes out of alignment. Also known as luxation, excessive stretching, falling, and twisting injuries can lead to a dislocation. Dislocated bones may be able to be realigned by a doctor, but some of these injuries require surgery. The condition involves bones of the knee being dislodged partially or completely.

Anterior Cruciate Ligament Injury

The anterior cruciate ligament (ACL) is an important knee structure. Injuries of the ACL are not just problems for athletes. A partial or complete ACL tear can occur from a quick change of direction, or from a compressive pressure of landing improperly when jumping. Damage to the ACL can cause an unstable knee.

Posterior Cruciate Ligament Injury

Posterior cruciate ligament (PCL) injury occurs when the knee is in the bent position. This type of injury results usually in only a partial tear and injury of the PCL can occur from falls or car accidents. The PCL does not have good blood flow, so tears of this type have difficulty healing.

Meniscus Tears

The meniscus is a wedge-shaped cartilage that serves as a cushion between the femur and tibia bones of the knee joint. Twisting or squatting can result in a meniscus tear, which also occurs from normal degeneration as people age.

Patellofemoral Syndrome

When the underside of the patella becomes irritated and inflamed, patellofemoral syndrome occurs. This is related to the kneecap rubbing against the femoral condyle with extension and flexion (bending) of the knee. The inflammation can result in serious pain.

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4 Signs your Shoulder Pain requires Urgent Medical Attention

By  admin6  published  February 21, 2018

Shoulder pain can happen for so many different reasons, it is important to know the difference between something that would go away by itself or something serious that requires medical attention.

Let us understand when your shoulder pain requires an urgent trip to the doctor.

1. If your shoulder seems popped or out of place, especially after an injury or accident, this requires immediate medical attention. Out of place shoulder could indicate ligament tears that would threaten shoulder stability.

2. A popping or clicking sensation may be a sign of a labral tear, which may require surgery to fix.

3. If you are not able to lift your arm pain free, it is time to see a doctor. It could indicate a rotator cuff injury which often requires surgery.

4. If your shoulder pain is not due to a trauma but due to overuse or aging, it is important to note any changes in the severity of pain and range of motion. Increasingly worsening pain could be an indication of arthritis. Getting timely medical help for early diagnosis and treatment of arthritis can delay its progression.

If you simply not sure, seek professional medical advice anyway. Seemingly harmless discomfort and pain may worsen and turn chronic, if left untreated. So, it is best to see an experienced orthopedic surgeon right away.

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When Is Shoulder Arthroscopy A Better Option Than Open Surgery?

By  aenriquez  published  January 29, 2018

Subacromial decompression is a surgery that treats shoulder impingement syndrome and can be done through an open incision or arthroscopically.

Surgeries such as open decompression or arthroscopy have almost the same results in a reduction in pain ranging in almost 77-90 percent of the patients. The methods to be used are dictated largely by the surgeon’s preferences and the condition of the patient.

Arthroscopic Surgery for wellness

Arthroscopic surgery

A minimal two to three small cuts are made surrounding the shoulder during the surgery. An arthroscope, which is a small viewing device is inserted in the cut. The surgeon can look inside through the camera and check the biceps and joints along with the rotator cuff tendons to any issues that can otherwise be overlooked or go unnoticed in an MRI or an open procedure.

Arthroscopic surgery is generally recommended for people who are young and have a mild impingement in the shoulder. It is done to promote regaining of daily activities. Moderate shoulder impingement refers to pain which hinders daily life activities. It often occurs in individuals around the age of 25 to 40 years old.

When is it not recommended?

It is generally not recommended for people who experience the following:

  • Existing shoulder problem
  • Have a large tear in the rotator cuff which is medically proven as unrepairable. Patients who have such significant injuries can only be treated with open surgeries.
  • Individuals with a flat acromion or tissue inflammation like tendonitis in the rotator cuff, which is not due to shoulder impingement but rather the cause.

Open Surgery

This procedure involves a large incision of about 4-6 cm. It is necessary for patients who have a large rotator cuff tear. In many cases, surgeons recommend open surgeries compared to other options as it allows them access to a large area of injury. On the other hand, however, a large incision increases the chance of infection. Patients who undergo open surgery may have to spend 1-2 nights in the hospital for recovery.

Open Surgery vs Arthroscopic

Open surgeries are for external rotation while arthroscopic procedures are linked with less motion. Open surgery can be performed faster, while arthroscopic procedures require a detail-oriented set of skills.

Many surgeons are comfortable with open surgeries for the latter can be a difficult procedure.  Recovery time varies for both, and in general, takes 3-6 months to fully recover. People may be able to use the affected arm by two weeks of the surgery.

It is reported that people who go through arthroscopic surgery recover faster, and experience less pain during the recovery period. The recovery process involves stretching and exercise that prevents swelling and stiffness. In both cases, a therapist would likely be involved to assist the patient with exercises that promote healing and recovery.

Risks

There are potential risks of both types of surgeries, including:

  • Chronic shoulder pain and stiffness
  • Damage to the nerves or blood vessels
  • Infection  (less risk in arthroscopic compared to open surgery)

 

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Platelet Rich Plasma Therapy Can Delay Knee Replacement Surgery

By  admin6  published  January 25, 2018

Osteoarthritis is a degenerative condition that gradually wears away the protective joint cartilage. It is the most common form of arthritis and has no cure till date. However, several conservative and interventional pain management methods can help to reduce pain and delay progression.

Treatment options include physical therapy, prescription pain medications, steroid injections, or joint replacement surgery. But regenerative medicine has given us a new treatment called platelet-rich plasma (PRP) therapy which may help to delay the need for surgery in moderate arthritis cases.

PRP therapy uses the patient’s own blood for its healing properties. The patient blood sample is drawn and filtered. Platelets are then concentrated. Platelets produce a high concentration of essential growth factors which initiate a natural healing response. The extraction and injection, both, are relatively painless. The growth factors can repair the degenerative cartilage, reduce inflammation and relieve pain.

Patients need to undergo treatments for about 4 to 6 weeks. The basic aim of PRP is to assist repair and build up damaged and worn out tissues.

Since the platelets are extracted from the patient’s own blood, there are virtually no risks of infection and rejection.

If you are experiencing knee pain due to osteoarthritis and don’t want it to prevent you from living a healthy, active life, ask your orthopedic doctor about PRP therapy.

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Can You 3D Print Knee Cartilage?

By  aenriquez  published  January 8, 2018

Young or old, you’ve probably felt a nagging pain in your knee at some point.  In fact, some studies suggest that knee pain has increased up to 65% in the over the past few decades. But for some that pain becomes constant and unbearable. That can be for a number of reasons including:

Printing 3D Cartilage for Knee Surgeries

  • Osteoarthritis (often referred to as degenerative or “wear and tear” arthritis
  • Damage to the meniscus or cartilage (this can also be caused by osteoarthritis)
  • Gout
  • Tendonitis
  • Bursitis
  • Torn ligament or tendon

 

For many of these conditions, there are clear treatment plans that pave a way to recovery. However, cartilage damage (the regions of cartilage in the knee are known as menisci) has previously been tricky to treat. But now revolutionary technologies and surgeries could provide hope to those suffering in silence.

 

What do the menisci do?

 

The menisci sit on the bones of your knee and act as cushions. They absorb shocks and make sure the bones of your knee don’t bump and rub against each other. However, unlike most tissues they don’t have a blood supply and as such can’t get the nutrients they need to repair themselves. Damage often occurs in young people with sports injuries. You may hear doctors talk of the “unhappy triad” where athletes tear their ACL, MCL and damage their medial meniscus. This is what happened to Judy Hobson who talked to the DailyMail about her road to recovery

 

“I had to give up sport altogether. I could barely walk a couple of hundred yards and was starting to limp. I was miserable because it was such a huge part of my life. I even thought about having my leg amputated and being fitted with an artificial limb”

 

A 3D printing breakthrough

 

New hope could be on the horizon as researchers at the University of Alberta are working on 3D printing knee cartilage needed for transplant surgery. They have been able to print a 3D leaf made of natural proteins. One of the engineers, Stella Matthews, said

 

“It is the first step towards tissue engineering,”

 

Next, they will try to print cartilage shaped for the individual that surgeons can transplant into the patient’s knee.

 

What can be done at the moment?

 

Whilst these results are highly exciting, they aren’t available for the patient right now. However, patients can still have a meniscus replacement surgery. This is what Judy Hobson had done. Again talking to the Daily Mail she said

 

“After nine months, I could walk more than a mile pain-free – now it’s five or six miles and I’ve also started to play a little volleyball again. I’m so grateful to the person who donated the meniscus.”

 

Specialist clinics across the United States offer the procedure. Ricky Valadez, who had the procedure and talked to Fox32 about it said

 

“The best thing, in the long run, is I’m going to be able to have the opportunity to do whatever I want and not be held back,”.

 

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What Makes an Orthopedic Surgeon “The Best”?

By  aenriquez  published  January 2, 2018

Orthopedic surgery is one of the most competitive medical specialties. These surgeons work to fix musculoskeletal issues, for instance like a torn ACL in an athlete or perform a hip replacement in an elderly patient with osteoarthritis.  If you have a sports injury or are in need of an orthopedic surgeon, you will probably find yourself googling “best orthopedic surgeons”. But how do you actually know somebody is the best at what they do? Coming from a non-medical background it is incredibly difficult to work out whether somebody is truly the best. But new research gives us a sneak peek into the inner workings of those that are at the top of the orthopedics game.

Tempe shoulder surgeon

A recent study by doctors in Canada looked at what makes a highly successful orthopedic surgeon. It was published in the Journal of Bone and Joint Surgery, so is probably inaccessible to the average patient looking up the best orthopedic surgeons.  The authors looked to those at the top of the profession, those with academic departmental chairs, journal editors, past or current presidents of major orthopedic associations. They defined these are the best as they had risen to the very top of the profession, and presumably, the best surgeons will have similar characteristics as these doctors (but may be much younger and not have reached such heights yet). This information should be accessible to the general public, so below is a list of characteristic identified by the Doctors that you should look out for.

 

  • Research Research Research: The authors found that 30% had over 100 publications of book chapters, clinical research etc. Being involved in pushing the practice forward, in a sense being an innovator, was significantly associated with success. Look out for doctors who are heavily involved in research.
  • They want to be the best at surgery, not the richest: This might be slightly harder to spot, but these individuals were identified as having a desire to develop themselves as surgeons much more than they were interested in financial gain.
  • Are they happy?: Happiness was identified as the third characteristic. Those that enjoyed the work they did were likely to be successful.
  • Healthy Lifestyle: Again, this might be slightly difficult to identify in prospective surgeons, but a healthy lifestyle seemed to correlate with being a successful surgeon. Presumably, those that know how to look after themselves also know how to look after you.

 

Other things to look out for

 

However, the study does note that it did not take into account patient experience and statistics on surgeries. Therefore they did not account for some things in the survey. Other things to look out for in the best doctors could be:

 

  • Patient satisfaction: It’s not everything, but it can be a real indicator of a fantastic doctor. Many sites provide reviews to look through of physicians in your area. Also look out for Docs who have been awarded Patients Choice Awards. Those with multiple awards have shown year on year satisfaction in their patients.
  • Years of experience: Again, it’s not everything and some less experienced surgeons can be fantastic, but it’s definitely something to take into consideration.

 

In conclusion, meet prospective surgeons and look at their careers holistically to make a decision.

 

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