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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Nursing Management of Fracture

By  aenriquez  published  November 14, 2018

Fracture stabilization is the use of a variety of processes to enhance the healing of bone fractures. There are several methods including surgical, non-surgical, minimally invasive (vertebroplasty, fusion, kyphoplasty). Fracture stabilization gives pain relief and prevents further damage to soft tissue and bone.

 

There are closed and open fractures. With open fracture surrounding tissues and bone are visible. Fractures may include one or more bones and can be a clean break or shattered into numerous pieces. Breaks are a traumatic injury to the bone, tissues, and individual.

 

There are five classifications of fractures. These include:

  • Greenstick – found in children, incomplete fracture where the bone is bent
  • Transverse
  • Oblique – pattern of curves and slopes
  • Comminuted – bone breaks into pieces
  • Impacted/Buckle Fracture – bone ends are driven into each other

Early stabilization leads to better outcomes, such as less complications, shorter hospitalization, and lower cost

In addition, a pathological fracture is due to bone weakness, stress, and hairline fracture.

 

The doctor will diagnose the type of fracture by physical exam, x-ray, and MRI.

With a stable fracture, minimal treatment is required. In a stable fracture, the bone just breaks in one place and is easier to fix.

 

An unstable fracture can result from a car accident, falls, and other high impact situations. They may be accompanied by other serious injuries as well. Surgery is always required to fix the fracture. Symptoms of an unstable fracture include:

 

  • excruciating pain
  • bone showing through the skin
  • swelling and numbness

 

Early stabilization leads to better outcomes, such as fewer complications, shorter hospitalization, and lower cost. However, it may be contraindicated if there are head injuries, internal injuries, and other risk factors.

 

There are a number of options including the following:

  • External fixation -Pins and rods are placed outside the extremity
  • Internal fixation – Fracture is aligned and plates and pins are placed to hold the pieces together
  • Ring fixator or Taylor Spatial Frame – used if there is a deformity to be corrected

 

An unstable fracture is a severe injury. It is normally treated with the bone reduction and the bone may still slip out of place. This makes it difficult for the bone to be realigned. The bone is shattered into fragments, and it may not be possible to put all the broken pieces back in place.

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Arthroscopic Surgery – Going Inside the Body

By  aenriquez  published  October 31, 2018

Arthroscopic surgery uses a tiny camera (arthroscope) to examine, diagnose and repair damaged tissues inside or around joint like the shoulder or knee. A small incision is made into the skin and the arthroscope is inserted into the area being examined. The number of incisions needed is determined by what needs to be done.

Benefits of arthroscopic surgery are smaller incisions and less damage. Some physicians prefer open surgery because the structures are visible to the naked eye. It depends on what needs to be done, the specific condition, and surgeon experience.

 

There are several shoulder conditions that are repaired with arthroscopy. They include:

  • Rotator Cuff tears
  • Shoulder instability – Labral tears
  • Shoulder bursitis
  • Bicep tendonitis
  • Frozen shoulder
  • AC joint arthritis
  • Bone spurs
  • Repair ligaments
  • Remove inflamed tissue or loose cartilage
  • recurrent shoulder dislocation

Less common repairs include nerve release, fracture repair, and cyst removal.

Following surgery, someone should drive you home. Drowsiness may be felt for two or three days following the surgery. Follow post-op guidelines once home.

Guidelines include:

  • wound care- keep the site clean and dry.
  • Pain control – apply ice during the first 24 hours to reduce swelling, take pain medications as prescribed, Do Not drink alcohol
  • return to activity per doctors instructions

Complications of arthroscopy are uncommon but, may include shoulder stiffness and prolonged rehabilitation

Complications of arthroscopy are uncommon but, may include shoulder stiffness and prolonged rehabilitation. There is one rare complication called chondrolysis (damages cartilage) and can lead to frozen shoulder. Other possible complications include:

  • Infection
  • head or neck injury
  • excessive bleeding
  • blood clots
  • damage to blood vessels or nerves.

 

Rehabilitation plays a huge role in regaining use of the of the joint and resuming daily activities. An exercise program should aim at regaining shoulder strength and movement.

With more complicated repair, physical therapy will be ordered so a physical therapist can supervise the exercise program.

Depending on the health condition treated, recovery times vary. A minor repair may only require a sling and a short period of physical therapy. It will take longer to recuperate from a more complicated surgery.  Full recovery could take several months of physical therapy. Healing is a slow process. Surgeons guidelines and a good rehabilitation plan are important for a successful outcome, as well as, personal participation in the healing process.

Due to the fact that shoulder surgery hurts less, patients tend to do more too soon. The area may feel fine but still needs adequate time to completely heal. Too much activity too soon can cause recurrence of the condition or other damage to repaired tissues.

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Shoulder Dislocation Symptoms

By  david@ogrelogic.com  published  October 24, 2018

Shoulder dislocation is a painful injury. It is common among athletes and may result from a fall or other trauma to the joint. Because the shoulder is a highly mobile joint, it is also at risk for easy dislocation.

Shoulder dislocation can be 2 different types –

  • partial dislocation or subluxation – caused when the top of the humerus bone is partly out of the socket.
  • complete dislocation – when the top of humerus comes completely out of the socket.

The shoulder can dislocate downward, backward or forward.

Symptoms of Shoulder Dislocation

  • pain in and around the shoulder joint
  • swelling around the shoulder
  • shoulder joint stiffness
  • weakness and/or numbness in the shoulder
  • bruising in the shoulder region
  • shoulder instability

Any combination of the above symptoms can mean a dislocated shoulder. It is best to have your shoulder examined by an orthopedic surgeon.

Whether your shoulder dislocation has happened for the first time or it is a repeat injury, it is important to have it diagnose and treated right away. The surgeon will be able to restore the joint into the correct place and provide immediate relief. This process is known as a closed reduction. Afterwards, your doctor may refer you to a physical therapist in order to help the joint become stronger and prevent future re-injury.

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Everything About Kneecap Fracture

By  aenriquez  published  October 19, 2018

The patella is one of three bones that make up the kneecap. It is covered in cartilage on the underside and is important in maintaining the strength of straightening the knee joint. A fracture is a break in the bone. A fracture usually happens when there is a direct fall onto the kneecap.

A fracture like this can also damage the underlying soft tissue and the skin and result in an open fracture. A fracture can also occur when the quadriceps muscles contract but the knee is straight. When the muscle pulls forcefully the patella can fracture.

Sometimes the patella can fracture with a minor injury, but this is often a result of weak bones which can be caused by osteoporosis.

Names of fractures include:

  • eccentric
  • pathological
  • open fracture

 

Patella fractures can be severely painful and make it difficult to walk.

Signs of a patella fracture include:

  • severe pain
  • swelling and bruising on the front of the knee. After a few days, swelling and bruising may extend down the leg.
  • Inability to lift foot; straight leg lift is used in diagnosing this injury.
  • With palpation a break is felt; This may not be possible if there is considerable swelling.

Damage to the knee joint cartilage can result in a higher chance of arthritis in the joint

Treatment includes an exam in the emergency room and an x-ray to determine how bad the break is, as well as, determine the type of break. One critical factor is the ability to do a straight leg raise from a laying position.

This tests the quadriceps muscle and its attachment to the shin bone (tibia). A separation of the quadriceps tendon, patella and/or the patella tendon cause the inability to lift the leg. If the leg can be lifted then non-surgical treatment could be possible in order to set the fracture.

Knee swelling is common and is from the bleeding from the fractured ends of the bone. If there is a large amount of bleeding then an aspiration would be done to remove the blood resulting in pain relief. In addition, a knee immobilizer will decrease the discomfort from the injury.

Minimally displaced fractures or non-separated fractures can usually be treated without surgery. An immobilizer or a straight leg cast may be sufficient treatment.

Surgical intervention is necessary for displaced separated fractures. The process involves:

  • an incision over the front of the knee
  • the fractured ends are realigned
  • pins, screws or wires are used to hold it in place
  • in some cases, a piece can be removed ( a smaller fracture or fragments)

 

A common complication of patella fracture surgery is the metal implants can become painful especially when able to kneel. Often there is a second surgery to remove the hardware. This can be done a year after the first surgery.

An important aspect of surgery is to repair the cartilage to prevent the development of arthritis of the knee joint. Damage to the knee joint cartilage can result in a higher chance of arthritis in the joint.

 

Other possible complications may include:

  • infections
  • failure of the hardware to hold pieces in place
  • the fracture does not heal
  • kneecap pain
  • possibly knee arthritis

 

Rehab will be needed once the kneecap has healed sufficiently as the knee is kept straight initially to allow healing. Being able to move the knee will depend on the strength of the repair but gentle movement may begin within the first few weeks after surgery.

 

FXRX INC has experience in fixing fractures of all types. For consultation – contact the office at 480-449-FXRX (3979)

1215 W. Rio Salado Parkway
Suite 105
Tempe, AZ 85281

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A Variety of Treatment Options for Closed Fracture Healing

By  aenriquez  published  October 2, 2018

Let’s discuss what a closed fracture is and then look at the list of treatment options.  Be open to choosing the best healing protocol for you!

Closed fractures are classified as “simple fractures” that do not puncture the skin.  Although the skin is not penetrated, soft – tissue injury can be acute and alternate treatments will be offered.  In some cases, surgical procedures may be imminent.

Mainly, closed fractures occur from sports injuries, car accidents, accidental falls and a severe hit to the injured area.

You are at greater risk for a closed fracture if you are elderly, have osteoporosis, smoke or consume excessive amounts of alcohol (which makes bones brittle), steroid use, or lengthily resting periods (which make bones stiff – causing increased risk of fractures).

Please note – not all closed fractures require an intervention.  Some can heal on their own, over time.

It is best to know which fracture treatments are available and which ones you prefer before making an informed decision.

When our doctor’s access treatment options, we look at these factors; age, what does our patient prefer and surgeon preferences (if need be).

Orthopedic doctors vary in their responses as to what form(s) will be best for your closed fracture.  Patients can appear to be in shock, so first, we ease their minds with simple reassurance and inspiration.  Next, we elevate the area (if possible) to reduce swelling and throbbing, along with keeping it still to prevent any additional damage.  We are extremely careful not to irritate existing injuries and will need to take X – Rays to ensure the extent of damage.  Doctors take into consideration the severity and recommend accordingly, avoiding surgery (if possible).

Some of the most common forms of treatment options are below:

Disable Movement:  some bone fractures do not require an intervention.  We classify them as “stable” and they can be monitored without immobilization.

Slings or “Walking Boots” might just do the trick in properly healing your simple fracture, where no further treatment is necessary.  When you force the fracture to stay stationary, for an extended period of time, you allow it enough of a grace period to heal.

Casts prevent further damage, hold bones in place and stabilize the alignment of the fracture.

Surgery is the last resort to fixing a closed fracture and would be utilized in extreme cases only unless pain is unbearable at the wound site.

At FXRX Orthopedics and Bracing, we offer medical fracture treatment for the following bones https://www.fxrxinc.com/fracturetreatment.html.

Our patients have many good things to say about our caring staff and state of the art facility.

“When I considered total knee replacement, like most people, I was anxious, but when I met Dr. D, he was very reassuring.  I did not feel rushed during our discussion or when scheduling surgery.  My surgery went very well.  I was up and walking soon.  I am walking my dogs again and feeling stronger in both legs.  I have respect for Dr. D not only as a surgeon but as a kind and caring person.”  Debbie R., Phoenix

Our staff is dedicated to providing the best care for you and your injury.

If you would like to schedule an appointment – you can do so here https://www.fxrxinc.com/fracturetreatment.html

 

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How to Deal with Emotional Issues During Orthopedic Treatment

By  aenriquez  published  September 29, 2018

Feeling a bit under the weather, during times of physical impairment?  Have you ever wondered if these midday blues will ever go away?  You might be asking yourself, what is the problem with me?  This is all normal during times of physical pain and treatment.

You just had surgery or are going to have a surgical procedure and you feel anxious.  You are nervous if the surgery will be successful or if you will ever feel the same again.  Will you be able to bend the same, walk normally, eliminate the pain and recover in a timely manner?  You have a right to ponder these unanswered questions.

Sometimes people don’t need advice or neurofeedback or a psychological evaluation.  What people need is family and friends to support them through difficulties and to listen while you vent.  It is very helpful to have people you care about understand your valid concerns.

When you face physical challenges and you must undergo a surgical procedure, it can bring about an onset of feeling anxious and potential depressive states.

What can I do about my emotional issues pre and post-surgery? 

It is extremely difficult to relax, but this one is a big solution to your bouts of anxiousness.  The old saying of mind over matter is powerful for the results that follow.  Lay down in a serene environment and visualize something happy.  When our thoughts are eased, our emotions remain calm as well.

It is also very beneficial to exercise self-care.  For example, take a hot bath (if you can), listen to soothing music, watch a Netflix series, read a book, meditate, pray, call a trusted friend, and write in a journal.

It is beyond frustrating when you are physically unable to walk, exercise or take a regular shower.  People internalize their aggravation and lack the coping skills to stabilize their moods and anxiety.

Part of the healing process prior to and after surgery is lovingly taking care of your mind, emotions and feelings, so you do not experience nerve-racking, uncontrollable episodes.  What we think about, we bring about.  We must learn to feed our mind positive words of affirmation and not negative ones, or we will become mentally exhausted.

The last resort would be to put a patient on a low dose of anti-depressant medication if they cannot learn to manage their emotions and become too stressed out.  Having a surgical procedure is very stressful as well and learning to deal with the pain it brings.  It is not easy to find the proper social support that is needed during fearful times. Worry takes over our once sound mind and produces negative side effects such as headaches, stomachaches, low sex drive, acne, decreased immune functioning and even suicidal thoughts.

Our biggest recommendation is to ASK for help and allow others to be there for you and let trained experts provide treatment, that will solve your issues.

FXRX employs the best medical staff to alleviate pain, but we are also here to assist in making sure you are mentally tranquil as well.  If you have questions, please email us or request an appointment https://www.fxrxinc.com/blog.html.

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All you need to know about Rotator Cuff Tears

By  david@ogrelogic.com  published  September 26, 2018

Rotator Cuff

The rotator cuff is a group of muscles and tendons around the shoulder joint. They keep the head of the humerus (upper arm bone) secure in the shoulder socket. A shoulder injury can affect the rotator cuff, causing a dull ache in the shoulder, which may worsen when sleep on the affected side.

Rotator Cuff Tears

A rotator cuff tear is a common injury, in sports such as baseball, or in jobs such as cleaning windows. It can occur due to age-related wear and tear or overuse and repetitive motions. Your rotator cuff may also get injured if you fall on your arm or lift something heavy.

A rotator cuff tears can be partial (when the tendon is frayed) or complete (the tendon is pulled off the bone).

Rotator Cuff Tear Symptoms

A rotator cuff tear may present as –

  • trouble raising your arm
  • pain with certain arm movements
  • pain when you lie on the affected side
  • weakness in the shoulder
  • inability to lift things
  • clicking or popping sounds with arm movement

Left untreated, a torn rotator cuff can lead to a frozen shoulder or arthritis which is harder to treat.

Treatment for Rotator Cuff Tears

The orthopedic doctor would initially recommend –

  • physical therapy to strengthen shoulder muscles stronger
  • anti-inflammatory drugs to help with pain and swelling

Surgery may be required in some cases, especially if you have a complete tear. Surgery can be done to stitch together the torn area or reattach the tendon to the bone.

There are three types of rotator cuff surgery:

  • Arthroscopic or minimally invasive surgery
  • Open surgery
  • Mini-Open surgery that uses both arthroscopic and open methods
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Who is at Risk for Injuries and what Treatment Options Should I Choose

By  aenriquez  published  September 20, 2018

Accidents happen all the time and people get injured for numerous reasons!  Athletes fall while running, sports stars twist ankles or bash their knees in, the elderly tumble while shuffling in the driveway, kids fall off their bikes and crack an elbow, weapon mishaps occur to anyone not being careful, car accidents demolish organs on impact and freakish wounds are unstoppable.

Injuries are known as physical trauma. Injuries occur when outside forces cause damage to the body, in unexpected, harmful ways.  Injuries can be life-threatening and be the foundation for much-added pain throughout your body.

Who is at risk for injuries and why?

Anyone that plays a sport has an increased risk for potential injuries to any part of their body.  We know that accidents can occur to anyone, anywhere.  Therefore, athletic gear is enforced.  Kids are forced to wear helmets, cups, body armor, elbow and knee pads, as well as chest protectors.

The elderly are specifically at risk of breaking bones, fractures weaken bone areas or sprained wrists due to not having the same agile mobility as they had in their younger years.  Also, osteoporosis is more likely to occur in older adults.  Osteoporosis is defined as a medical condition where your bones are brittle, they become weak due to your body not making new bones fast enough, and this makes people easily prone to fractures.

Everyone is at risk for bodily harm in an unforeseeable accident with a firearm or automobile catastrophe.  You can lower your risks by not drinking and driving, going the speed limit, wearing your seatbelt, not texting and driving, paying attention to the road and do not get distracted from other people in the car.

At FXRS Orthopedics & Bracing, we have a variety of treatment options, depending upon the severity of your injury and pain level.

We offer various knee therapy choices:

Knee Arthroscopy (Knee Scope)

Knee Replacement

Cartilage Regeneration is done through a knee scope – to avoid a knee replacement

Steroid Injections in joints ease and reduce pain

Regenerative Medicine with PRP (Platelet Rich Plasma) Therapy (regenerate damaged tissue)

Orthopedic Bracing (used for arthritis, Carpal Tunnel, and fracture stabilization)

Shoulder Therapy Choices:

Rotator Cuff Repair

Shoulder Arthroscopy – known as a shoulder scope

Partial and Total Shoulder Replacement

Arthroscopic Shoulder Labral Repair

Arthroscopic Shoulder Instability Repair

We also offer fracture treatment and bracing for of these types of injuries.

Our trained surgeons will devise a medical plan that is best for your personal situation.  You are not just a number in our practice.  Our doctors listen to your concerns and care about your road to recovery.

If you would like to schedule an appointment – sign up here https://www.fxrxinc.com/.

We will be with you every step of the way, no matter what solution your body needs.  We want you to live pain-free!  If you have questions or concerns – email us at https://www.fxrxinc.com/contact.html.

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