Shoulder is overtightened during operation to prevent dislocation

December 31st — admin

I had an operation on my shoulder to tighten it up and keep it from dislocating. Unfortunately, it worked too well. Now I can hardly move it at all. Will this gradually get better?

Over tightening the shoulder causing loss of motion and decreased function are reported with traditional open surgical treatment of shoulder instability. Long-term reports of such cases suggest over tightening with loss of motion can lead to arthritis.

It’s unlcear what the best treatment is for this complication. Conservative care with a physical therapist to increase range of motion may be helpful. A second surgery may be needed to avoid developing osteoarthritis (OA) from over compression of the joint. The surgeon can release some of the soft tissues around the front of the shoulder.

If painful OA does occur, then a shoulder replacement may be needed. A partial replacement called a hemiarthroplasty may be all that’s needed. Your surgeon will help you decide what’s the next best step. Your age, general health, and shoulder condition will all be considered in making the best treatment decision for you.

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 weight gain affect my hip implants?

December 30th — admin

Eighteen years ago, I had both hips replaced with ceramic implants. They have held up very well for me. I’ve kept my weight down all these years. But now I’m starting to gain more weight. Will this hurt my hips?

Zirconia ceramic replaced the alumina implants used back in the late 1980s. The ceramic implants had excellent mechanical properties and performed well. They were especially favored because if a crack formed, the material expanded and sealed itself.

Researchers have found that over time, the surface layer of zirconia can change. Contact with water or body fluids increases the grains on the implant surface.

This change decreases the stability of the material making it more likely to wear unevenly. Surface roughness increases. At the same time, crack formation or fracture is more likely.

A recent study of failed and removed zirconia ceramic femoral heads was done. The surgeons found that time was the greatest factor in implant aging. The longer the implant was in place, the more likely the surface layer would undergo changes in stability and wear.

There was no evidence that the patient’s age or weight were factors. Activity level was not linked to wear pattern either. Although these factors do not appear to affect zirconia ceramic implants, many other health benefits occur from weight loss and activity. Experts agree that keeping your weight under control and staying active is a recipe for improved overall health.

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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Is amputee really walking faster?

December 29th — admin

It’s a funny thing but ever since my husband had his leg amputated, he walks faster. I have a hard time keeping up with him. Can you explain this to me?

Increased walking speed isn’t uncommon in leg amputees using a prosthesis. A prosthesis is an artificial limb or part of a limb. Changing the walking speed may be a way to compensate for the uneven gait pattern that develops when using a prosthetic device. By walking faster, the person shortens the stride length and equals out both sides.

When walking, the person with a prosthesis tends to shift the weight over to the normal or intact leg. The problem with this strategy is that over time, the nonamputated knee absorbs the force and is at increased risk for osteoarthritis.

Gait training and/or adjusting the prosthesis may help your husband even out the load on both legs and avoid future injury. A physical therapist can help you with this problem.

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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Too old for rotator cuff repair surgery?

December 28th — admin

I’m 73-years old and just diagnosed with a rotator cuff tear (left shoulder). I’m normally right-handed so it doesn’t seem like a big deal. The orthopedic surgeon who saw me assured me that I’m not too old to have surgery to repair this problem. What do you think?

The majority of studies show that age does not affect long-term outcomes for this type of surgery. Outstanding workers’ comp claims is a bigger predictor of poor outcome. Most older adults are not involved in this type of controversy.

Older adults are more likely to experience rotator cuff problems. In a review of 50 studies, only four per cent of the patients under the age of 40 had a rotator cuff tear. This was compared to 54 per cent in patients more than 60 years old.

Older adults report improved pain relief and function after rotator cuff tear repairs. Even with poorer tendon quality due to aging, results after surgical repair can be very good. Younger patients are more likely to report satisfactory results but that doesn’t mean older adults can’t have excellent outcomes.

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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What is a hip impingement?

December 27th — admin

What is a hip impingement? What causes it?

Hip impingement occurs when the head of the femur (thigh bone) butts up against the acetabulum (hip socket). In the process, the labrum gets pinched. The labrum is a thin layer of cartilage around the rim of the socket.

Anatomic changes in the femoral head and neck cause impingement. If the femoral head is flattened, it changes the relationship between the head and neck of the femur as it fits into the acetabulum.

Tears in the labrum or hip fractures that don’t heal can result in impingement. Childhood hip conditions such as Legg-Calvé-Perthes or slipped capital femoral epiphysis (SCFE) can lead to hip impingement.

Improved technology with MRIs have made it possible to study this problem more closely. As a result, we now know that many people who have no symptoms have femoroacetabular impingement.

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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Should Iraq vet participate in VA amputee study?

December 24th — admin

My husband lost a leg while on active duty in Iraq this year. The VA wants him to be part of a study on amputees. They’ve given him a prosthetic device at no cost to us. Does this obligate us to be a part of the study? We’re just not up to it right now.

Most veteran amputees incurred from trauma while on active duty receive their care and prostheses paid for by the Veteran’s Administration (VA). The requirements are that your husband enroll in a VA clinic and attend regular follow-up care.

Taking part in formal studies is not required but certainly helpful for others. Information gathered from these studies helps the VA provide better care for war veterans wounded in the line of duty. If it’s an ongoing study you may be able to enter at a later date when it’s more convenient for your family.

Talk to the study coordinator and find out what are your options.

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. No Comments »

Can heat treatment cause loss of cartilage in shoulder?

December 23rd — admin

I had a chronically dislocating shoulder that never responded to nonsurgical treatment. Then I had radiofrequency heat to shrink the shoulder capsule. Now I’m losing the cartilage in the same joint. Could this be caused by the heat treatment?

The procedure you had with radiofrequency to heat and shrink the shoulder capsule is called thermal capsulorrhaphy. Although it has become a popular treatment option, long-term studies are lacking.

Case studies of individual problems have been reported silimar to yours. Loss of cartilage throughout the joint can occur. It’s thought that thermal energy is either more than expected or continues causing damage after it is stopped.

There’s some concern that the probes used to deliver the heat aren’t accurate. As a result, excessive heat is used causing cartilage cells to die. Other problems from this treatment have also been reported. Nerve damage and damage to the capsule can lead to recurrent shoulder instability.

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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Aggressive treatment leads to quicker recovery from total hip replacement

December 22nd — admin

My mother is going to have hip replacement surgery soon. Is there anything she can do to prepare for it to make for an easier recovery?

Research is starting to show that patients who receive patient education and who are treated aggressively (early physiotherapy, pain medication before the pain is severe, etc), tend to recover quicker and more efficiently than patients who don’t have this preparation.

Your mother should meet with her surgeon to discuss the surgery and see what information she can get, when her physiotherapy will start, and learn if she should be taking medications before the surgery.

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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Practice may be needed before putting ACL repair to the hop test

December 21st — admin

I am going to have my six-month check-up after an ACL repair. The therapist already told me I’ll be doing a single-legged hop test. This means I’ll hop as far forward as possible on my operated leg. This makes me very nervous. How do I know it won’t snap underneath me?

There are many ways to assess knee function after anterior cruciate ligament (ACL)repair. Range of motion, function, and strength are the main tests. The single-legged hop test is an accurate test of power. It’s a good test to compare one side to the other.

The test is done by having the patient hop as far as possible just on one leg. The patient’s arms are fee to use for balance while taking off and landing on that foot. Number of feet hopped is measured and compared to the other side.

At six months post-op you should have no problems completing this test. You should be concerned if your leg is giving out from underneath you during regular walking or other activities. If you’ve followed a standard rehab program you should have stressed the knee like this during your exercise program.

Talk to your therapist about your concerns. Perhaps you aren’t ready for this test and need some more time to progress your exercise program. You can certainly practice hopping under the therapist’s supervision. Most clinics have a pair of parallel bars you can use to hold on to during practice sessions until you feel the confidence you need to complete the test.

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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Training for Ironman competition results in snapping elbow

December 20th — admin

I’m training for an ironman competition. When I started increasing the weight training part of my program, I noticed my elbow started snapping when I do pushups. What could be causing this problem?

There is a condition like what you described called snapping triceps syndrome (STS). It is seen most often in men who lift weights or do pushups.

When the elbow is fully bent (flexed) or extended straight after being fully flexed, the medial tendon of the triceps muscle along the inside of the elbow dislocates. It moves out of the groove where it is normally located, and snaps over the bone along the inside of the elbow.

The condition is diagnosed based on the symptoms and confirmed with an MRI. Images of the elbow are taken when it is bent and while it straightens into extension. Realtime ultrasound can also be used to show the snapping structures.

What is actually causing the dislocation remains unknown. At first it was thought that the muscle firing pattern was abnormal. But studies have not been able to show a difference in muscle activation patterns between patients with STS and normal, healthy adults with no elbow symptoms.

Since the problem occcurs most often in weight lifters and men who perform pushups, there may be a connection between the size and bulk of the muscle and this snapping dislocation that occurs with elbow movement. Further studies are needed to prove or disprove this theory before we will know what to do about the problem.

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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