Mastectomy could be cause of shoulder pain

January 28th — admin

I’m a 48-year old woman and I had a mastectomy for breast cancer three months ago. Now that I’m back to swimming, I notice I’m having trouble with my stroke. My husband says when I reach forward to stroke, the shoulder blade pops out noticeably. Could this be caused by the mastectomy?

You may be describing an injury to the long thoracic nerve that controls the serratus anterior (SA) muscle. When there is weakness in the SA the shoulder blade or scapula can’t rotate and slide like it should when the arm is lifted up. The result is called scapular winging.

Mastectomy is one possible cause for this problem. During the surgery for the mastectomy, the nerve can get stretched from the position of the arm. There are many other possible reasons such as a viral illness, working with the arms overhead, or lifting a heavy weight.

The best way to know for sure what’s going on is to have some testing done. Electromyography or EMG studies can find out for sure which muscles are involved. Nerve conduction velocity (NCV) tests can be done to see if the nerve is damaged. Talk to your doctor about these symptoms and see what he or she suggests.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Tibial plateau fracture may lead to total knee replacement

January 26th — admin

What is a tibial plateau fracture and what’s the final outcome with proper treatment?

The tibia is the lower leg bone between the ankle and the knee. The tibial plateau is at the top of the tibia. It’s the surface where the upper leg bone rests on the tibia. In other words, the tibial plateau is the bottom surface of the knee joint.

A fracture in this area can be treated with or without surgery. This depends on how severe it is and whether or not there is another injury with it. A torn ligament or a second fracture may also require surgery.

Over the years, studies have shown that tibial plateau fractures result in arthritis. A total knee replacement (TKR) may be needed. The final outcome isn’t as good for patients receiving a TKR without a previous fracture. The operation can be very complex.

Results are good when the doctor is aware of these problems and plans carefully.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Diagnostic injection used to treat shoulder pain

January 25th — admin

I had a sudden onset of shoulder pain that sent me to the doctor’s office in a hurry. I couldn’t remember any kind of injury or recent illness. The bill I received describes the treatment as a “diagnostic injection.” What does that mean exactly?

You may have had a steroid injection into the shoulder or one of the nearby joints. This is an anti-inflammatory drug given locally right to the potential source of the problem. It’s called diagnostic because the doctor is using it to figure out what’s wrong. This step can cure the problem for some patients and avoid expensive imaging studies such as MRIs.

If you got good pain relief from the injection, then it’s likely there was some swelling or inflammation in the joint pressing on soft tissues or a nerve causing the pain. If the pain relief was only temporary (an hour, several hours, a day up to a week), then more tests may be needed.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Short reader needs total hip replacement that fits

January 22nd — admin

I am a small woman (5 feet 1 inch) with small bones. My doctor has advised me to have a total hip replacement for severe arthritis. Do they make new hip joints to fit people like me?

The implants are made in a wide range of shapes and sizes. The stem of the implant is placed inside the center of the thighbone. This is called the femoral canal. The size of the femoral canal varies in patients as well.

The doctor will choose the right implant for you. This is decided at the time of surgery when the doctor can see the size of your bones and the size and shape of your femoral canal.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Will I be able to climb stairs after my total knee replacement?

January 21st — admin

I had a total knee replacement five months ago. I can walk just fine, but I still can’t climb the two stairs in front of my house. Will I ever be able to do this?

Stair climbing is a difficult skill for many people who have had total knee replacement. This is true even one year after surgery. After surgery, the support from leg muscles is only one-third of the strength and force needed to climb stairs.

Bring your concern to your doctor’s attention. A physical therapist can help you begin an exercise program specifically designed to assist you with stairs. If you saw a physical therapist during your recovery from surgery, do not hesitate to contact the therapist and request additional services.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Arthroscopic procedure to relieve frozen shoulder pain described here

January 20th — admin

I’m going to have an arthroscopic release of a frozen shoulder next week. Can you tell me what is done during this operation?

The basic steps to this operation are the same from patient to patient. There may be some small differences based on what the doctor finds during the procedure.

First you will be anesthetized or put to sleep (some patients have a nerve block and remain awake but feel no pain). The doctor will gently mobilize the shoulder joint. This means while lying on your back, your arm will be lifted and rotated inwardly. This shows the doctor how the back (posterior) half of the joint capsule is moving (or not moving if it’s stuck or bound down).

Then the arm is gently moved out to the side away from the body. This motion is called abduction. Next the arm is rotated outward. This is done first with the elbow bent and then with the elbow straight with the arm down at the side. This gives the doctor information about the front (anterior) half of the joint capsule.

In the final step, the doctor uses a special tool (arthroscope) to look inside the joint for any areas of scar tissue, inflammation, or tears in the capsule. The scar tissue will be released and any rough spots shaved smooth. The doctor may cut and remove the joint capsule from the front and the back. Any other damage will be repaired and space made for all structures to move freely.

Most patients are seen in physical therapy right away. Rehab often continues after discharge from the hospital. A home program is essential.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Can hip pain be caused by a back problem and vice versa?

January 19th — admin

Can back pain be caused by a hip problem? My doctor thinks my low back pain is really coming from the hip on that side.

Pain from one area of the body can be referred to another part of the body. Back pain can be caused by the hip. The opposite is true, too: hip pain can be caused by a problem in the spine.

Sometimes the pain is close by but at other times it can travel far away from the source. A standard rule of thumb for any part of the body is to check for problems at least one level above and below the site of pain.

There are special tests that can be done to find out where pain is really coming from. For example rotating the hip inward can help screen for problems coming from the hip. Likewise, bending the hip and knee and putting pressure through the hip can help identify back versus hip pain. Your doctor has probably used these tests to come to this diagnosis.

The final proof will be in treating the hip. Expect to see your back pain go away by improving hip motion and function.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Why women athletes suffer more ACL injuries than men

January 18th — admin

I’ve been following college basketball. I notice the women seem to have twice as many ACL injuries as the men. Why is this? Do men have some training secrets that women don’t know?

It is a well-known fact that women athletes suffer more ACL injuries than men in the same sport. The reason for this remains unknown. Although many possibilities have been suggested, no one factor or combination of factors has been identified.

One group of researchers decided to measure the effect of muscle contraction on the knees. They looked at how stiff the knee becomes when the muscles contract in men and women. Knee stiffness protects the ACL. By tightening up the knee, the bones can’t slide enough to tear the ligaments inside.

Surprisingly, the researchers found that men are able to tighten the knee joint to three times its normal stiffness. Women can only double the stiffness. This difference does not appear to be caused by muscle strength, body weight, or height. It may be that men use the muscles around the knee differently than women.

The study also showed that men use the hamstring muscles on the back of the thigh more than the quadriceps muscles in front to get this much knee stiffness. It may be that women can train the hamstrings to react faster and with more force to help protect the knee from injury. Further studies are needed in this area.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Full disclosure important when facing total hip replacement surgery

January 14th — admin

I’m filling out a form for my doctor before having a total hip replacement. It asks me to list all drugs (prescription and over-the-counter). Do I need to report vitamins and herbal supplements too? There’s no place on the form for that, but it seems important.

You’re right. Vitamins and herbal supplements can have dangerous interactions with prescribed drugs. They must be reported. Sometimes these products are called nutraceuticals. Nutraceuticals refers to any food, supplement, or dietary substance that improves health or offers medical benefit.

This can include herbs like ginkgo biloba, ginseng, Echinacea, and St. John’s wort. Antioxidants such as lycopene, Vitamins E, A, and C, and supplements like calcium are also included.

Anyone planning surgery of any kind should go over their complete list of drugs and nutraceuticals with the doctor. This is important because some over-the-counter products can cause bleeding or decrease the effect of the prescribed drug.

For example you may have heard that grapefruit juice shouldn’t be taken with cholesterol lowering drugs, calcium channel blockers for high blood pressure, and some migraine medications. The juice keeps the body from using and getting rid of these drugs from the body.

Vitamin K should not be taken by anyone who is also taking Coumadin (warfarin) to prevent blood clots. Warfarin works by stopping vitamin K factors needed to make blood clots. Too much vitamin K can keep the warfarin from doing its job.

These are just a few examples of drug-herb interactions. Your doctor will be able to see if you’re taking anything that could be a problem.

Considering a total hip replacement? Choose an experienced surgeon. Dr. Zehr is one of the few surgeons in Southwest Florida using the minimally invasive anterior approach. In fact, it is estomated that fewer than 5% of the orthopedic surgeons in the United States employ this approach.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Going up eaasier on knees, coming down causes more knee pain

January 13th — admin

I notice climbing up hills is much easier on the knees than coming down. Why is that?

Runners and hikers have all noticed that stiffness is worse the day after going downhill compared to going up. Going downhill puts much more strain on the muscle fibers and connective tissue compared with moving over a flat route. Downhill running can be damaging because of the greater eccentric muscle contractions that occur. Let me explain.

When your foot hits the ground, the muscles in the thigh contract to support you. But the nature of the downhill action is such that although the muscle is contracting, it’s forced to lengthen at the same time. Contracting while lengthening a muscle at the same time is called an eccentric contraction. It can cause trauma and damage to muscle fibers.

Trauma to the muscles and connective tissue around the muscles causes tiny tears of the tissue fibers. Stiffness occurs as a result of muscle damage and breakdown of nearby connective tissue.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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