When is it time for Orthopedic Surgery?

By  david@ogrelogic.com  published  April 16, 2019

Every year orthopedic surgery allows millions of people suffering from debilitating injury or disease to return to their normal lifestyle.

Any type of surgery on the musculoskeletal system, performed to treat painful symptoms or restore mobility may be considered orthopedic surgery. Orthopedic surgery includes a wide range of procedures, from the repair or removal of torn ligaments and tendons to complex procedures, such as joint replacement surgery.

However, many people suffering from painful, degenerative joint diseases or painful injuries are unaware of the benefits of orthopedic surgery. Advancements in surgical techniques allows many patients to undergo outpatient surgery and return home the same day or the day after and recover much faster than ever before.

It may be time for orthopedic surgery, if you have tried conservative treatment options ,such as medications, steroid injections, physical therapy, lifestyle modifications and still experience the following signs –

  • Persistent or returning bone and joint pain
  • Pain worsens upon with activity
  • Limited mobility
  • Difficulty with activities of daily living
  • Pain interferes with sleep
  • Grinding sensation in the joints
  • Poor quality of life due to pain, restricted mobility and inability to carry out normal activities

Why should you live with pain when orthopedic surgery offers a safe and permanent solution to many bone and joint conditions? Waiting too long to seek treatment may worsen your condition. If you have been living with an orthopedic condition that seems stubborn, visit an orthopedic doctor or surgeon to have it diagnosed and to explore possible treatment options.

 

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Meniscus Tears and Repair

By  david@ogrelogic.com  published  March 28, 2019

Meniscus is a disc-shaped cushion that keeps the surfaces of bones at the knee joints from coming in contact with or rubbing against each other. The meniscus keeps the knee joint stable and helps in movement as well as maintaining balance.

When the meniscus is damaged, it can make even daily movements painful or even cause the knee joints to lock up.

Meniscus repairs have become more successful with the development of newer tools and advanced technology.

Each knee has two menisci and they can be torn due to some form of twisting or excessive knee bending. The meniscus may get torn due to –

  • Kneeling
  • lifting something heavy
  • squatting down
  • playing basketball
  • stepping off a curb
  • aging and having arthritic damage

Large tears can cause the knee to lock up. Meniscus damage can cause knee pain and swelling due to the irritation to the joint from the unstable meniscus tissue or the excess stress to the joint from the loss of the cushioning.

Most meniscus tears do not require surgery. There are a variety of treatment options that can be effective in reducing symptoms.

Your orthopedic surgeon would determine the need for and viability of a meniscus repair for you.

After surgery, physical therapy is needed to retsore range of motion, reduce swelling and regain muscle function. After 4-6 weeks, weight bearing is gradually initiated, and a normal gait is the next goal.

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All you need to know about a Knee Replacement

By  david@ogrelogic.com  published  February 20, 2019

The decision to undergo a knee replacement is tough. Several factors need to be taken into consideration. If your doctor recommends a knee replacement procedure but you are still sitting on the fence, here are important facts things that may help you make an informed decision.

Indicators for a knee replacement

Knee replacement surgery is typically advised when –

  • the pain makes it impossible for you to sleep or perform normal, everyday activities
  • you suffer from arthritis of the knee
  • your knee is significantly damaged (e.g., due to injury)
  • other treatments have proven ineffective

Knee replacement procedure

During the procedure, you’ll be given a local (in the joint), regional (from the waist down) or general (that will make you sleep through the surgery) anesthesia. A small incision is then made in the knee. The knee is pumped with saline and a small camera or arthroscope is inserted inside the joint to make it easier for the surgeon to look inside the joint and carry out the procedure. Your orthopedic surgeon then investigates the source of the knee pain. Depending on the underlying condition, the doctor clean up or repair the joint tissues. Artificial implants are used to replace the damaged parts of the joint. The procedure presents minimal risk and has proven beneficial to a majority of the patients.

Recovery after the knee replacement

The post-surgery period is critical in terms of getting back on your feet. You have to do rehabilitation exercises at home to ensure your knee can completely recover.

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Recovering from Rib Fractures

By  aenriquez  published  February 5, 2019

Chest injuries are quite common in sports and motor vehicle accidents, and many of them cause rib fractures. Broken or cracked ribs can be very painful, but in most cases can be easily managed, unless they have penetrated into the vital organs. In many cases, fractured ribs heal on their own in a month or two, although the condition is often associated with sharp pain, which exacerbates with movement. The healing process can be augmented with limiting activity and avoiding further injury.

Another important activity that can really help is deep breathing. Fully expanding lungs using deep breathing exercises, coughing, and though incentive spirometry is very important and preventing atelectasis (or collapsed lung), which is a breeding ground for infection. A painful rib cage limits one’s ability to take full breaths, and coupled with bed rest, it can lead to atelectasis and pneumonia. Therefore, it is highly advisable to perform these activities to prevent atelectasis. Diminishing pain through over-the-counter painkillers (such as NSAIDs) can also help prevent atelectasis.

Signs of the typical complications of broken ribs - pneumonia, pleural effusion, or a punctured lung

For the first 4 to 6 weeks, the patient is advised not to lift more than 10 pounds or push/pull heavy objects. They should also avoid vacuuming, mowing, etc. Of course, that includes participating in contact sports. They are advised to do plenty of walking and perform low-impact exercise and resume normal daily activities.

 

It is critically important to look out for the warning signs, which include difficulty breathing, blue-tinged lips, fever of 102°F or higher, coughing up blood or thick mucus. If any of these are experienced, one should go to the emergency room right away, as these are heralding signs of the typical complications of broken ribs – pneumonia, pleural effusion, or a punctured lung.

 

For severe pain, opioids may have to be prescribed, but they are avoided as much as possible. This is because opioids have very high addiction potential and it may become hard to get off them. Moreover, they cause sedation and entail many precautions – including falls, handling machinery, driving, etc. They must not be taken with alcohol or other sedatives or other anti-anxiety or recreational drugs. Constipation is a very common side effect of opioids, and patients who are prescribed opioids are advised to stay well-hydrated and even take a laxative or a stool softener if needed. Ice helps decrease swelling and pain, and may even help prevent tissue damage. Use an ice pack or put crushed ice in a plastic bag.

 

In some cases, surgery may be needed if multiple ribs are badly fractured. It is definitely indicated if there is a condition called flail chest, in which the broken ribs will need to be held together with plates and screws. Also, if there is a serious injury to adjacent soft tissue, such as an organ, nerve, or blood vessel, it will require surgical treatment. And the recovery process is contingent on the extent of the injury and the type of surgical treatment.

 

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What is Osgood-Schlatter Disease?

By  david@ogrelogic.com  published  January 24, 2019

The Osgood-Schlatter disease is a common cause of knee pain among adolescents. The pain is experienced in the front of the knee, just below the kneecap. The condition involves inflammation of a growth plate of the shin bone or tibia.

The bones of growing adolescents have growth plates. These are areas of cartilage located near the ends of bones. When full growth is achieved, the growth plates turn into solid bone. Some growth plates also serve as attachment sites for tendons, the tissues that connect muscles to bones.

At the end of the tibia, there is a bony bump called the tibial tubercle, which covers the growth plate. The quadriceps (muscles in the front of the thigh) attach to the tibial tubercle.

When the child is active, the quadriceps muscles pull on the patellar tendon, which in turn, pulls on the tibial tubercle. In some children, this leads to inflammation of the growth plate. The tibial tubercle may become very noticeable as a bump.

Causes and Symptoms

Osgood-Schlatter disease typically occurs during growth spurts. Since physical activity causes additional stress on bones and muscles, children who engage in strenuous activity are at an increased risk for this condition.

Symptoms for Osgood-Schlatter disease include –

  • pain caused on jumping or running
  • knee pain and tenderness
  • swelling
  • tight thigh muscles

Osgood-Schlatter disease Treatment

In most cases the condition improves with –

  • rest
  • limiting activity
  • over-the-counter medication
  • stretching and strengthening exercises
  • symptoms typically go away when the individual completes the adolescent growth spurt, around 14 years in case of girls and 16 years for boys.
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Treating Common Knee Injuries with PRP Therapy

By  david@ogrelogic.com  published  December 27, 2018

Meniscus tears are the most common knee injuries. These injuries can affect either the medial or lateral meniscus. Tears may occur because of a sudden, twisting motion resulting in –

  • pain
  • swelling
  • ‘catching’ or ‘locking’ sensation

If the physical examination by the orthopedic surgeon shows a torn meniscus, an MRI can be advised for confirmation.

Initially, meniscus tears are treated conservatively with rest, ice and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen, naproxen. It may be complemented with physical therapy for muscle strength and improved range of motion. Arthroscopic surgery may be recommended for severe cases.

However, now a highly effective, non-surgical intervention is available – PRP therapy. PRP or Platelet Rich Plasma therapy uses concentrated platelets from your own blood. With the help of ultrasound guidance, the injection is administered into the tear, allowing the tear to heal naturally. The injection is given under local anesthesia in an outpatient setting.

Other common knee injuries are –

  • ACL or Anterior Cruciate Ligament tear

This tear occurs as the result of a sudden stopping, sudden change in direction or hyperextension. This could be accompanied with a ‘popping’ sensation followed by deep pain, swelling, and instability.

  • PCL or Posterior Cruciate Ligament tear

The PCL can become inured due to a force to the anterior shin bone when the knee is flexed.

Both ACL and PCL tear can be treated with PRP therapy, stimulating the body’s natural healing mechanism.

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Wrist Splint for Fracture

By  aenriquez  published  December 18, 2018

The wrist is subject to fractures due to falling with outstretched or flexed hand. This can happen in a car, bike, skiing accident or with certain other sports activities. There are two bones in the forearm including the radius and ulna. The radius is on the thumb side. A fracture of the radius near the wrist is called a distal radius fracture.

 

Splinting is one choice for immobilizing the fracture and is commonly used for wrist fractures, reduced joint dislocations, sprains, soft tissue injury, and post-laceration repairs. Splints are mainly to immobilize and protect the injured wrist, aid in healing and decrease pain. Splints are primarily used for extremity injuries. Good anatomical fracture alignment is important.

 

There are a variety of splints used to treat fractures of the wrist and forearm. The splint used depends on the location of the fracture. These splints include:

  • Volar short arm splint
  • Dorsal short arm splint
  • Single sugar-tong
  • Long arm posterior
  • Double sugar-tong
  • Long arm

For immediate treatment, a splint may be applied to reduce pain and provide some comfort

There are two types of distal radius fractures called a Colles or Smith fracture. Determining the break depends on the angle at which the break occurs.

  • Colles fracture: results from a direct impact on the palm of the hand; a bump in the wrist results from the distal radius shifting toward the back of the hand.
  • Smith fracture is less common and can result from impact to the back of the wrist; a bump in the palm side of the wrist results when the distal radius shifts toward the back of the hand.

 

Wrist fracture symptoms include:

  • immediate pain when area is touched
  • bruising and swelling
  • deformity

 

Treatment for a distal radius fracture is dependent on several factors. For immediate treatment, a splint may be applied to reduce pain and provide some comfort. If the fracture is displaced it is put back into correct alignment under local anesthetic before application of the splint.  Additional factors influencing treatment are:

  • whether bones have shifted (displaced)
  • if there are multiple fractures presentation
  • involvement of the joint
  • ulnar fracture with injury to median nerve
  • whether it is the dominant hand
  • occupation and activity level

 

Once the fracture is in good position, a splint or cast is applied. The splint (or cast) will remain in place for approximately 6 weeks. A removable splint will be worn after that to allow physical therapy to regain proper wrist function and strength. X-rays may be taken at 3 weeks and 6 weeks to assess healing of fractures that were reduced or unstable.

 

It is still important to be aware of potential complications that require additional monitoring. Complications from immobilization include:

  • joint stiffness
  • muscle atrophy
  • complex regional pain syndrome

 

The fractured extremity should be immediately evaluated if:

  • pain worsens or does not improve after medications
  • cast or splint becomes damaged, breaks, or gets wet
  • hands/fingers feel numb or cold
  • hands/fingers turn blue or white
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Femur Fracture Complications

By  aenriquez  published  December 14, 2018

The femur is the biggest and generally the strongest bone in the human body. Fractures take a long time to heal. Normal activities of daily living are impacted as it is the main bone used for walking and standing.  Depending on the type of fracture and potential complications the impact will last a lifetime.

There are several types of fractures. Each has its own characteristics. Each fracture is dependent on the force that breaks the femur.

Elderly people are subject to femoral breaks from falling due to weak bones

These types of fractures include:

  • stable fracture – pieces of bone line up
  • displaced fracture – bone is out of alignment
  • closed fracture – the skin remains intact
  • open fracture – bone punctures the skin

 

Fractures are classified by:

  • location – distal, medial, proximal
  • pattern – bone breaks in different directions (crosswise, lengthwise, in the middle)
  • skin and muscle damage

 

The most common femoral shaft fractures include:

  • transverse – straight horizontal break across the shaft
  • oblique – angled line across the shaft
  • spiral – spirals the bone shaft caused by a twisting force
  • open – bone or fragments stick through the skin; also known as a compound fracture; there is damage to tissues, tendons, and ligaments. High risk of complications.
  • comminuted – bone breaks into three or more pieces

 

Common symptoms noted with a femoral break include:

  • immediate severe pain
  • cannot bear weight
  • injured leg appears to be shorter and/or looks crooked

 

A femoral fracture is normally found in severe accidents such as an automobile accident. Elderly people are subject to femoral breaks from falling due to weak bones. Hip fractures are also common with the elderly.

 

Common complications from femur fractures are related to the following:

  • the bone must be set properly – there’s a chance injured leg may become shorter and can cause chronic hip and knee pain; poor alignment can be painful
  • peripheral injury – muscles, ligaments, and tissues can be damaged
  • surgical – infection or blood clots, common surgical risks
  • Compartment syndrome

 

 

On a special note: Compartment syndrome is caused when increased pressure inside a closed space, that compromises circulation and function of surrounding tissues. Temporary or permanent damage to muscles and nerves may result in temporary or permanent damage.

Compartment syndrome may be:

  • Acute – most often caused by trauma, generally more minor. Prompt diagnosis and urgent treatment are required.
  • Chronic – usually caused by exercise. Symptoms begin with recurrent pain and disability. These symptoms may subside when the cause (usually running) is stopped and returns when activity is resumed.

The bones have many blood vessels that help promote healing. With time, the body will regenerate and further promote healing. Practice caution to prevent a re-fracture.

A diet that contains bone-boosting foods like calcium and vitamin D helps with healing, as well as, using protective gear that can help prevent future fracture.

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Reverse Shoulder Replacement Surgery

By  aenriquez  published  November 21, 2018

Reverse shoulder replacement surgery differs from standard replacement because the ball and joint of the shoulder switch places. In essence, the socket rotates on the outer side of the ball. This is a complicated surgery warranted by certain conditions. It provides significant pain relief and helps improve range of motion of the joint, although after surgery there is some limitation.

The main reason for this complex procedure is arthritis but, there are other reasons as well:

  • the rotator cuff tendons are gone or torn.
  • Shoulder remains painful after a routine shoulder replacement
  • Fracture in the proximal humerus (nearest the joint)
  • bone is shattered or splits into pieces
  • tumor in the humerus shaft or the ball of the humerus

In the event of torn or missing rotator cuff tendons, a person is unable to lift the arm enough to be functional. There may or may not be pain but the main reason for replacement is to regain functionality and motion.

There may or may not be pain but the main reason for replacement is to regain functionality and motion

There are instances when the procedure is not advised. Individuals should avoid this procedure if:

  • The socket bone of the shoulder blade (scapula) is too deteriorated that implants cannot be attached with screws or a bone graft is needed before placement can be done
  • ongoing infection in the shoulder
  • previous infection – increases post-operative risk of infection
  • rotator cuff cannot be repaired
  • complex fracture of the shoulder
  • other treatments did not work (meds, rest, etc)

Surgical risks include bleeding, nerve damage, and possible infection. There may be surgical complications such as:

  • humerus or arm portion (the socket) can become dislodged from the ball (the shoulder blade part) and the prosthesis is “dislocated.”
  • infection
  • the arm portion of the prosthesis can make contact with the bone of shoulder blade in certain positions
  • tingling, numbness and weakness with nerve damage
  • Injury to blood vessels
  • scaring
  • conditions, such as blood clots in the legs (deep venous thrombosis)
  • pulmonary embolus
  • heart attacks and strokes
  • drug or anesthetic reactions

After surgery, several doses of antibiotics are given to reduce the risk of infection. Pain medication will help relieve pain. Most patients can eat a solid diet and get out of bed the day after surgery. Discharge to go home is on the second or third day after surgery.

The arm will be in a sling on discharge from the hospital. The surgeon may provide instruction for gentle range of motion exercises to build mobility and endurance. Physical Therapy may also be ordered.

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What does your Knee Pain indicate?

By  david@ogrelogic.com  published  November 16, 2018

The Knee Joint

The knee is the largest bone joint in the body that allows you to run, walk, stand, sit, bend your legs, pivot, swivel and more. The knee joint consists of bones, cartilage, muscles, ligaments, and tendons, all working together. Three bones – the tibia (shinbone), the femur (thighbone) and the patella (kneecap) come together at the knee joint.

Knee Pain

Knee injuries are complicated because they can be the result of damage or injury to any of the several parts that make up the knee. It is also important to understand that the knee functions between two very mobile joints – the hip and the foot. Injury to the hip or foot can also affect the mobility of the knee.

With age, the strain on our knees increases and pain and discomfort become common complaints. However, the pain may also result from injury or an underlying condition, apart from aging. An experienced orthopedic doctor or surgeon can make an accurate diagnosis of the cause of knee pain and treat it.

Depending on its location, different problems can be responsible for knee pain.

  • Front of the knee – related to kneecap injury or damage
  • Inside or medial side of knee – related to medial meniscus tears, MCL injuries, and arthritis
  • Outside or lateral side of knee – often caused by lateral meniscus tears, LCL injuries, IT band tendonitis, and arthritis
  • Back of knee – due to the collection of fluid, also referred to as a Baker’s Cyst
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