My 78-year old aunt dislocated her shoulder. Will putting off surgery make things worse?

February 28th — admin

My 78-year old aunt dislocated her shoulder last week. She’s wearing a sling and wondering how to decide if she should have surgery. How can we know what’s best for her? Is putting surgery off likely to make things worse in the end?

The need for immediate surgery after a first shoulder dislocation is not predictable. Many patients opt to wear a sling for a week or so. Then they start to gradually work on getting their motion and strength back. Sometimes people don’t even bother with the sling.

 Each patient must make his or her own decision about whether or not to have surgery. Is it their dominant arm? That’s important because in older adults, a shoulder dislocation can set them back in terms of function. Was the doctor able to put the shoulder back in place easily? If so, that would suggest minimal additional trauma to the soft tissues around the joint.

Was an X-ray, CT scan, or MRI done to show any damage done to the area? A torn rotator cuff or fractured bone might swing the decision more toward surgical intervention sooner than later.

A study to show the natural history of a first-time shoulder dislocation in people of all ages and occupations has been done. Natural history refers to what happens (final outcome) if the person is followed over a period of years. They reported that not all people needed surgery.

Those who had a rotator cuff repair did not dislocate again. Many patients who didn’t have surgery recovered fully. After five years, their shoulder was as stable as those who did have the repair operation.

The results of studies like these help us all realize that everyone is different. It’s not always possible to predict the best course of action. Sometimes, after looking everything over, it’s clear what to do. In other cases, doctors encourage their patients to take the conservative route. They advise patients to try rehab first, because they can always have the surgery later if that seems best.

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 a 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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The doctor gave my mother a shot into her hip, to find out if it was her hip or back causing her pain. How does that work?

February 25th — admin

My mother had a shot into her hip – the doctor said it was to find out if it was really her hip causing her hip pain or if it was her back. Could you explain how this works?

Many people who have hip or groin pain could have arthritis in the hip or in the lumbar spine, the lower part of the back. X-rays, while helpful in many cases, often can’t help in this situation. However, in order to treat your mother’s pain properly, the doctor needs to know where the pain is originating.  

A procedure called a fluoroscopically guided intra-articular injection is one way to determine this. By injecting a medication directly into the joint, the doctor can find out if this helps decrease the pain. If the pain does decrease, then the problem is with the hip. If it doesn’t decrease, there is a good chance that it is the spine.

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 a 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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After knee joints replacement surgery, my father keeps falling. Is this normal?

February 24th — admin

My father had both knee joints replaced in the last year. He walks much better now and can even climb stairs. But I notice he still falls a lot. Is this normal? What can be done about it?

Total knee replacement (TKR) often gives patients good pain relief. With less pain they can walk better and farther. Function improves and they can start doing things they haven’t done in years (like stair climbing or even dancing).

But studies show there are other problems that aren’t solved with a joint replacement. In fact, the surgery may make things worse. For example, loss of quadriceps muscle strength (the large muscle along the front of the knee) makes balance more difficult.

Patients who have both knees replaced are more likely to trip and fall. This is especially true if and when they have to get around objects or obstacles. A program of balance training and exercises to improve joint position sense may be to good place to start.

But first, make sure there isn’t a medical reason for your father’s loss of balance. Have him see his doctor for a check-up. If there are no medical problems, then give rehab a try.

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 a 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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My daughter has thoracic outlet syndrome. Is there any way to cure this problem?

February 23rd — admin

My 33-year old daughter just emailed me that she has thoracic outlet syndrome. She may have to give up her wallpaper business. Is there any way to cure this problem?

Thoracic outlet syndrome (TOS) involves the neurovascular bundle of the neck and arms. Specifically, there is the brachial plexus (group of nerves) and the blood vessels. Symptoms occur when there is pressure on either of these structures as they pass from the neck down the arms.

Symptoms include neck, arm, and hand pain. Many people are awakened at night with hand numbness and tingling. In the morning, their hands are stiff and swollen. The symptoms are often brought on or made worse by working with the arms overhead.

This occurs for several reasons. The upward rotation and outward motion of the shoulder blade causes the pectoralis minor muscle to clamp down on the subclavian artery and brachial plexus just under the collarbone where the collarbone and shoulder joint meet.

Sometimes there are congenital fibrous bands that also put pressure on the neurovascular bundle. Congenital means it’s something you were born with. And in some people, there is an extra rib that can also apply pressure to these structures.

There is successful treatment possible for many patients. A physical therapist can help change the person’s posture enough to take pressure off these areas. The therapist can help manually stretch the muscles and any fibrous bands that might be involved. And the patient can be taught specific stretching exercises to lengthen the muscles as they cross over critical structures.

In rare cases, surgery can be done to remove the extra rib or release the fibrous bands compressing the neurovascular bundle. 

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 a 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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My father has pain in his hip,but his doctor says it’s because of arthritis in his back. How can that be?

February 22nd — admin

My father has been having a lot of pain in his left hip but his doctor says that this is being caused by arthritis in his back. How is it that the pain is in the hip?

Pain often migrates, or radiates, from one part of the body to another. A good example is when someone has a heart attack – often their pain is in the left arm or up into the jaw. In the case of your father, many people who have arthritis in the lumbar spine, the lower back, feel the pain radiate down into the hip or groin area.

The important part of getting proper treatment is for a physician to find out where exactly the pain is coming from, the hip itself or the spine. Only then can the pain be treated properly. 

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 a 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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My mother-in-law…she has a pump on her leg after knee replacement. What does it do?

February 21st — admin

My mother-in-law just had a total knee replacement. I notice she has a plastic wrap around her leg with cold water inside. There’s a pump that seems to go on and off every minute or so. What’s this supposed to do?

You may be describing a device used to apply compression with cold to control swelling, pain, and bleeding into the joint. The pump exchanges warm water for cold.

Intermittent pressure (cycling on and off) helps mimic the muscle action to keep the blood circulating and to keep fluid from pooling or collecting.

The cuff is easy to put on right in the operating room. No time is lost controlling pain and swelling. The device is designed to allow some motion while wearing the cuff. It’s easy to put on and take off for full motion.

Many patients wear the Cryocuff for the first 48 hours after surgery for best results.

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 a 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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I’ll be getting my shoulder replaced. What should I expect?

February 18th — admin

I have to have my shoulder replaced. What can I expect?

Of course, the best thing to do is to discuss this with your own doctor, but there are some general things that you can expect.

 Your shoulder is made of a socket and ball, as well as muscles, tendons, and ligaments that hold it all together. The ball part in the replacement is generally made of metal. This is attached to your humerus either with a straight fit or with bone cement. This ball fits into the socket, which is called the glenoid component.

After the surgery, you will likely have to use a sling to keep the weight of your arm from pulling on the shoulder. A physiotherapist will show you how to strengthen your arm and shoulder and your doctor will tell you when you can stop using your sling. It is very important that you follow the instructions closely to increase the chance of a successful 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 a 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 arthroscopy procedures be done for hips?

February 17th — admin

I’ve heard of arthroscopy done for shoulders and knees, but never for hips. Why is that?

Arthroscopies are usually done for the knees and shoulders because of the way the joints are formed – they are easier to access with the small instruments used. However, the procedure is done on other joints, such as the hips, as surgeons learn the best ways to do them and for what reasons.

A small study done recently found that patients with certain types of hip problems did benefit from arthroscopies in helping determine their diagnosis and treatment.

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 a 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 patellar tendonitis go away, or is surgery required?

February 16th — admin

I’ve just been diagnosed with patellar tendonitis. Will this condition go away over time? Is surgery required?

Patellar tendonitis is an inflammation of the tendon just below the kneecap. Most patients report pain and swelling with this problem. It’s often caused by overuse of the tendon from jumping or other repeated activities like walking or running.

Sometimes people have this kind of tendonitis as a result of alignment problems from the hips down to the feet. This could be from wide hips, knock-knees, fallen arches, or other abnormal posture.

If the problem is coming from the foot or ankle, a shoe insert to correct the alignment might help. If the problem is caused by a muscle imbalance, then a specific exercise program may be advised. In the case of overuse, rest and ice are used most successfully. Surgery is only considered when all forms of conservative care have been tried without success.

Studies show that patellar tendonitis can last from weeks to months to years. This is especially true for athletes who practice and train hours each day. Treatment will be guided by your physician, and will depend on the cause of your tendonitis and your particular circumstances. 

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 a 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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I’ve been told I have a massive rotator cuff tear. What does that mean for me?

February 15th — admin

The results of my MRI came back with the report that I have a massive rotator cuff tear. What does that mean and what happens next?

Your surgeon will probably review the report with you and give you more specific and accurate details. A massive tear of the rotator cuff tendons around the shoulder usually means there are at least two tendons torn. And the tears are significant in size (length and/or width).

 There are many ways to treat a rotator cuff tear (RCT). The surgeon may form a preliminary decision based on your clinical exam and the results of MRIs. Once inside the shoulder, then the location, shape, and size of the tear guide what type of surgery is needed.

Small tears can be treated with debridement. The surgeon removes any frayed edges or free floating pieces that may have torn off completely. The edges are smoothed down in hopes that they will reattach or re-adhere to an area close by. This type of procedure is called debridement.

For larger tears, a partial or complete repair is done. The joint capsule and some of the ligaments around the joint may be cut or released. This allows the surgeon to rebalance the shoulder where it belongs. Mobility is improved and tested in the operating room. Then the surgeon uses sutures to hold it in place until everything heals again.

It’s likely you’ll be seeing a physical therapist for instructions and a rehab program. The exercises and timing of the program are determined by the type of tear and repair you have done. You can expect a three month period of rehab. This will be followed by some life-long activities and exercises needed to keep a healthy shoulder.

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 a 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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