What causes popping and cracking sounds in knee?

September 30th — admin

I notice I’m having more and more pain when I go up and down stairs (especially down). My left knee pops and cracks with every step. What could be causing this to happen?

You may be having symptoms of a problem called patellofemoral pain syndrome (PFPS). PFPS can occur when the kneecap rubs against the femur (thigh bone) as it moves up and down with knee motion.

Sometimes the patella, or kneecap, gets out of the groove it normally glides in. Abnormal positioning of the patella leads to inflammation and pain. This problem can get started by muscle imbalance, inflexibility, changes in the bones, improper walking pattern, overuse, or trauma.

There are many ways to treat PFPS. Consult with a physical therapist or orthopedic surgeon for a proper diagnosis. The best treatment plan depends on the exact cause of the symptoms.

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.

Posted in Knees. Tags: , , . No Comments »

How long after total hip replacement surgery before trucker can drive again?

September 29th — admin

I am an over-the-road trucker. I need a total hip replacement but can’t be off work too long. How long does it take most people to get back behind the wheel?

Return to work, sports, driving, or other activities varies based on several factors. Your age and general health and fitness can make a difference. Your recovery can be delayed if you are an older adult or if you have other health problems such as diabetes or heart disease.

The type of surgery you have can also make a difference. The newer minimally invasive surgery (MIS) uses smaller incisions with less blood loss. Usually, there is a shorter hospital stay and a faster recovery.

Several studies have been done to track return to function. The average patient used a cane for two weeks. The average time to go up and down stairs without assistance was three weeks. Walking half a mile took place six weeks later.

Patients can actually go without a walker or cane whenever they feel comfortable doing so. Driving may be more dependent on the use of pain medications. You should not drive while still taking narcotic-based drugs used for pain after surgery.

Driving probably isn’t the only issue for you. Most OTR truckers are driving (sitting) for long hours. Getting in and out of the cab can be a challenge at first. The job often requires heavy lifting or handling heavy materials. Your decision to return to work will be based on all the variables mentioned.

Talk to your surgeon about your particular situation. Find out what type of surgery will be done and what you might be able to expect in a best-case/worst case scenario. Plan on something in between as your likely timeframe.

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.

Posted in Hips. No Comments »

Should teenage athlete have surgery or rehab for dislocated shoulder?

September 28th — admin

Our 16-year old daughter dislocated her shoulder playing soccer. We’ve been told she should have surgery by one surgeon and by another to try rehab first. What’s the current thinking on this?

Surgery to stabilize the shoulder after dislocation used to be saved for patients who had recurrent dislocations. It wasn’t routinely done after the first dislocation. Surgery has its complications and rehab worked for many people. This same guideline is still used by many surgeons. The change has come in patient selection.

Patients who are at high risk for another dislocation on the same side may be advised to have stabilization surgery after the first dislocation. Studies show that early repair makes a big difference in quality of life. This is especially true for younger patients (less than 30 years old).

Recurrence rates are as high as 75 percent in active individuals who try four weeks of immobilization followed by a rehab program. This compares to 11 percent in patients who are surgically repaired.

Recurrence rates have dropped and results have improved as surgical techniques have changed over the years. Now surgeons recognize the need to repair any damage to the soft tissues around the shoulder after dislocation.

For a young, active, athlete like your daughter the data suggests that early repair and rehab will put her back on the playing field sooner and with fewer problems compared to a wait-and-see rehab approach. You may want to get a third opinion to make sure there aren’t good reasons to choose one treatment approach over the other.

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.

Posted in Shoulders. Tags: . No Comments »

Get a new kneecap or keep the old during total knee replacement?

September 27th — admin

I’m going to have my left knee replaced because of severe arthritis. The doctor has told me I can keep my own kneecap or get a new one. Which is better?

Studies show a general trend toward better results with kneecap (patellar) replacement during total knee replacement (TKR). Replacing the patella is called resurfacing. Patients with their own patellas (nonresurfaced) are more likely to have knee pain afterwards. The pain is worse when going up and down stairs.

Anyone with good cartilage can keep the patella. Young, active adults who are not obese are good candidates for nonresurfacing. Difficulty tracking the patella up and down over the knee joint is one reason to replace it. Inflammatory changes, abnormal shape, or bone spurs are all good reasons to replace (resurface) the patella.

Ask your surgeon to give you his or her best opinion based on the condition of your kneecap now and the type of implant you’ll be getting.

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.

Posted in Knees. Tags: , , , , . No Comments »

Are women at greater risk for postoperative delirium?

September 24th — admin

Both my parents and my mother-in-law have had total hip or total knee replacements. The women were very confused and disoriented after surgery. Is this more common for women than men? If so, does anyone know why this happens?

Confusion or disorientation after surgery of any kind may be a neurologic problem called postoperative delirium. Agitation and disorganized thoughts are part of this problem. Women are not necessarily at greater risk for delirium. The most significant risk factor is older age. Since women outlive men two to one, older adults are more often women than men.

Other factors that put patients at risk include poor mental health or decreased physical fitness. The use of alcohol or other drugs is a greater problem among older adults than often realized. Withdrawal from alcohol and other drugs can also bring on periods of confusion and/or delirium.

Certain medications such as narcotic pain relievers and antidepressants may be another risk factor. Dehydration, lack of oxygen, and immobility are common risk factors for delirium among older adults.

Doctors are being encouraged to prevent postoperative neurologic symptoms like confusion and delirium. Assessing patients’ physical condition and mental status before surgery is an important part of reducing these problems.

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.

Posted in Hips, Knees. Tags: , , . No Comments »

Will airport security detection devices harm my implant?

September 24th — admin

After my hip replacement, the surgeon gave me a special card to get me through airport security. This doesn’t seem to make any difference. I still have to go through the detection unit. Will this damage or harm my implant?

Only people with heart pacemakers are exempt from the security detection units (walk-through or handheld wand). They are, however, still required to be searched via a pat-down exam.

Carrying a surgeon’s certificate, card, or letter no longer gives you special privileges. Since 9-11, increased airport security requires that all passengers participate in routine airport screening. You may still want to carry this documentation for your own peace of mind.

No harm can be done to your implant from any airport metal detectors. These devices operate on the basis of a pulse induction eddy current generation and electromagnetic field distortion.

There’s a coiled wired in the detector. It generates short bursts of current forming a magnetic field used to detect metal. No change occurs to the metal object that is detected. Some types of implants are more likely to set off the alarm. That’s because the type of metal or the amount of metal makes it easier to magnetize and set off the alarm.

Talk to your surgeon if you still have any doubts or concerns. He or she can tell you what kind of implant materials you have and how likely they are to set off security alarms.

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.

Posted in Hips. No Comments »

Bristow procedure linked to higher rate of arthritis

September 23rd — admin

Thirty years ago I had a special operation called the Bristow for a shoulder dislocation. It seems to have held up pretty good but now I’m getting some arthritis. Is that from the surgery or the dislocation?

Cases of joint arthritis after a traumatic injury are very common. This is true for any joint, not just the shoulder. The type of operation you had is also linked with a higher rate of arthritis afterwards.

The Bristow procedure named after W. Rowley Bristow, MD was used most often back in the 1970s when shoulder repairs were done with an open incision. Today, arthroscopic surgery has replaced open procedures in many cases.

The Bristow procedure transferred the tip of the coracoid process to the front of the shoulder socket. The coracoid process is part of the scapula (shoulder blade) that juts forward toward the front of the shoulder.

The idea was to use this piece of bone to reinforce the shoulder socket. It kept the head of the humerus (upper arm) from popping out of the socket. Usually a piece of muscle was also attached like a sling to help as well.

The Bristow procedure is still used in Europe but has been replaced by other methods now in the U.S. There were concerns about restricted motion and arthritis leading to the development of other methods of surgical repair. The coracoid transfer is still used for some patients. Long-term results have been excellent bringing this method back to the attention of orthopedic surgeons for a second look.

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.

Posted in Shoulders. Tags: , , , , , , . No Comments »

Still limping after an ACL repair?

September 22nd — admin

I had an ACL repair nine months ago. I don’t have any pain but I still seem to walk with a slight limp. I can’t figure this out. What could be causing it?

It takes many patients up to a year or more to return to a normal walking pattern after ACL repair. Researchers aren’t sure why there’s such a slow return. It could be patients change the way they walk early on to avoid pain. Then the pattern is hard to break.

There may be slight changes in how the knee functions as a result of the surgery. Most ACL repairs are done with donor tendon from either the patellar tendon or the hamstring tendon. Problems with the donor site can make a difference.

A recent study from Australia found slight changes in knee motion based on the type of ACL graft used. With the hamstring tendon graft the knee had less knee extension when walking. Patients with patellar tendon grafts had less knee flexion.

Check with your doctor and physical therapist for their assessments. Watching you walk, measuring your motion, and checking the internal movements of the joint may help them pinpoint the problem and a solution.

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.

Posted in Knees. Tags: , , , . 1 Comment »

What is dead arm syndrome?

September 20th — admin

What is the “dead arm syndrome”? I heard on ESPN that my favorite baseball pitcher is benched for the season with this problem.

Dead arm syndrome starts with repetitive motion and forces on the posterior capsule of the shoulder. The posterior capsule is a band of fibrous tissue that interconnects with tendons of the rotator cuff of the shoulder. Four muscles and their tendons make up the rotator cuff. They cover the outside of the shoulder to hold, protect, and move the joint.

Overuse can lead to a build up of tissue around the posterior capsule called hypertrophy. The next step is tightness of the posterior capsule called posterior capsular contracture. This type of problem reduces the amount the shoulder can rotate inwardly — a motion needed by pitchers to throw the ball forward before releasing it.

Over time, with enough force, the player may develop a tear in the labrum. The labrum is a rim of cartilage around the shoulder socket to help hold the head of the humerus (upper arm) in the joint. This condition is called a superior labrum anterior posterior lesion. The final outcome in all these steps is the dead arm phenomenon.

The shoulder is unstable and dislocation may come next. Dead arm syndrome won’t go away on its own with rest — it must be treated. If there’s a SLAP lesion, then surgery is needed to repair the problem. If the injury is caught before a SLAP tear, then physical therapy with stretching and exercise can restore it and return the player to the field.

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.

Posted in Shoulders. Tags: , , , . No Comments »

Method of repairing ACL may affect gymnast’s future

September 17th — admin

My 14-year old daughter is a gymnast with a bad knee. She needs an ACL repair before she can continue competing. We know there are two different ways to fix the ACL. Is one method better than the other for a gymnast?

ACL repairs are done using a tendon graft from either the patellar (knee) tendon or the hamstring tendon. Which choice is better is a topic of ongoing debate and the subject of many studies.

We do know the patellar tendon graft makes it difficult for the patient to kneel on that side. This could make a difference depending on your daughter’s event(s). Patients who hop and land on one leg have a little more trouble when the patellar tendon graft is used. This may be something to consider for many gymnastic events.

Make sure the surgeon is aware of your daughter’s plans to return to gymnastics. The type of surgery and rehab program may be based on her long-term goals to compete.

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.

Posted in Knees. Tags: , , , . No Comments »
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