Category Archives: blog

Regenerative Medicine can relieve your Joint Pain

By  david@ogrelogic.com  published  May 22, 2019

Are you considering surgery for your chronic knee or other joint pain? Have you tried conservative treatments but not obtained enough relief? Maybe you should consider Regenerative Medicine. Innovative and advanced regenerative medicine treatments, such as PRP therapy, can enhance the body’s natural healing ability, providing remarkable solutions for all types of joint pain.

The body uses natural growth factors and stem cells to repair and regenerate tissues. These can be obtained from your own body in the form of PRP (Platelet Rich Plasma) or stem cells. Platelet-rich plasma is derived from blood taken from the person’s own body. Platelet rich plasma contains platelets and growth factors essential for healing.

How does PRP treatment help with joint pain?

Chronic joint pain is often the result of loss or wear and tear of the smooth, articular cartilage that helps the bones of a joint glide over each other during movement. Joint pain is mainly caused by osteoarthritis or inflammation of the joint due to rubbing of the bones against each other. Pain may result from injury to the soft tissues surrounding the joint such as ligaments, tendon, and bursae.

When fluoroscopy-guided injections of PRP are administered into a joint over a period of time, the cartilage regenerates, pain reduces and joint function improves.

Regenerative medicine treatments allow deep tissue healing and can be used to effectively treat joint pain and delay the need for surgery. Discuss with your orthopedic if regenerative medicine options are right for you.

 

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Pathologic Fractures

By  aenriquez  published  May 2, 2019

A pathologic fracture may be defined as a break in a bone caused by an underlying disease. An otherwise healthy bone typically fractures as a result of trauma. A diseased bone may do so either without trauma or due to minimal trauma. Diseases of the bone that predispose bones to fracture easily include osteoporosis, osteomyelitis, osteomalacia, Paget’s disease and malignancy (primary or secondary).

 

Pathologic fractures can affect any bone that is diseased, and the symptoms depend on the type and location of the bone involved. Many diseases affect the spinal vertebrae, which are prone to pathologic fractures, which can cause a range of symptoms from pain in back, legs, and arms to neurological impairment, such as numbness and/or weakness in the arms or legs.

Pathologic fractures can affect any bone that is diseased, and the symptoms depend on the type and location of the bone involved

Pathologic fractures are detected on imaging, which is initiated either by a suggestive history and physical exam or staging, restaging or surveillance workup for cancers.

 

  • X-ray – plain film radiographs provide an overall assessment of bone integrity and the presence and the extent of the fracture. It can also detect spinal dislocation or slippage, kyphosis, scoliosis, etc. In addition to these, it can detect specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion, etc. Dynamic or flexion/extension X-rays may help in detecting any abnormal or excessive movement or instability in the spine at the affected levels.
  • Computed tomography scan (CT scan) – shows more detailed images of the bones and the soft tissue, and is best suited for evaluating the extent of the fracture.
  • Magnetic resonance imaging (MRI) – is more suitable for evaluating soft tissue damage occurring as a result of the fracture. It is especially useful for the detection of neural damage. MR (or CT) angiography is considered when vascular compromise is suspected.
  • Nuclear bone scan – this scan can be helpful when surveilling for distant bone metastases, in addition to detecting bone infections, especially when MRI is not possible.

 

The goals of treatment are pain relief, reversal or stabilization of neurological deficits and stabilization. For less severe pathologic fractures, nonoperative/conservative management is considered. Severe pathologic fractures require surgical treatment, and the choice of procedure is based on the location of the bone and the extent of the injury. Spinal pathologic fractures can lead to collapsed vertebrae and vertebroplasty or kyphoplasty is required, during which a cement mixture is injected into the fractured bone to stabilize the fracture, treat pain, and prevent further spinal deformity from progressing. In cases where the collapsed vertebrae impinge on the nerve roots or the spinal cord itself, the surgeon may need to remove diseased bone to relieve pressure and possibly perform a spinal fusion to stabilize the spine until it heals. The underlying disease process needs to be adequately managed as well – whether it’s bisphosphonates for osteoporosis or suitable cancer treatment for metastatic disease.

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Sacral Fractures

By  aenriquez  published  April 25, 2019

The sacrum is formed by the fusion of 5 sacral vertebrae and articulates with 5th lumbar vertebra proximally and coccyx distally, and with ilia at sacroiliac joints bilaterally. It contains 4 foramina which transmit sacral nerves (L5-S5), which are responsible for the functions of anal sphincter tone / voluntary contracture, bulbocavernosus reflex and perianal sensation. As an osseous structure, sacrum transmits the load distributed by the first sacral segment through iliac wings to the acetabulum.

Sacral fractures are quite common, occurring in up to 45% of pelvic ring injuries related to high energy trauma (in young adults) or low energy falls (in elderly). They are often underdiagnosed and as a consequence, they are frequently mistreated and lead to serious complications such as neural damage (25% of all cases).

Transverse sacral fractures also have a high incidence of nerve dysfunction

The presence of a neurologic deficit is the most single most important factor in predicting the outcome. Untreated fractures with neurologic deficits lead to symptoms of lower extremity motor/sensory deficits and/or urinary/rectal/sexual dysfunction.

Sacral fractures are classified according to the Denis classification. Zone 1 fractures (50% of all) are lateral to the foramina and are least related to a nerve injury. Zone 2 fractures are through foramina, and based on whether they are stable or unstable, have an increased risk of nonunion, nerve damage and poor functional outcome. Fractures that are medial to foramina are associated with the highest rate of neurological deficit (60%), such as bowel, bladder, and sexual dysfunction. Transverse sacral fractures also have a high incidence of nerve dysfunction.  The u-type sacral fractures result from axial loading and represent spino-pelvic dissociation; these too have a high incidence of neurologic complications.

The clinical diagnosis begins with taking a proper history – motor vehicle accident or fall from height are the most common causes of these fractures, but repetitive stress, insufficiency fracture in osteoporotic adults are also important predisposing factors. The most prominent symptom is peripelvic pain. The physical exam should include testing for pelvic ring stability by internally and externally rotating iliac wings, palpating for subcutaneous fluid mass indicative of lumbosacral fascial degloving, as well as performing a vaginal exam in women to rule-out open injury. A focused neurologic, vascular and rectal exams are also important to assess the degree of tissue damage.

Radiographs are required to diagnose a sacral fracture, although only 30% show sacral fractures. CT is by far the diagnostic study of choice for proper assessment of the fracture, while MRI is considered when neural compromise is suspected.

Nonoperative management includes progressive weight bearing with orthosis if needed, and can only be considered in patients with <1 cm displacement and no neurologic deficit, and in cases of insufficiency fractures. Surgical fixation (without decompression) should be considered if there is a displaced fracture >1 cm with associated soft tissue compromise and persistent pain after non-operative management, and also if there is displacement of fracture after non-operative management. Surgical fixation with decompression is the treatment of choice whenever there is evidence for neurologic injury.

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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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