College basketball player dislocated shoulder, is surgery necessary?

May 31st — admin

Our college-aged son dislocated his shoulder playing basketball. We are trying to figure out if he needs surgery or not. The staff at the local clinic say he can wear a sling for eight weeks and come out alright in the end. Is this sound advice?

Studies show that immobilizing the arm after a primary (first) shoulder dislocation doesn’t change what happens in the long-run. Even applying the sling several weeks after the dislocation first occurred doesn’t seem to change what will happen a year or even more than a year later.

Over half of all shoulder dislocations stabilize and recover well. In fact, according to a study over a period of 25 years, many patients with a shoulder dislocation couldn’t even remember which arm was dislocated.

Some experts have advised immediate surgery for anyone with a shoulder dislocation who is an athlete, especially throwing athletes. Results of the long-term study just mentioned did not agree with this counsel. According to their data, athletic activity was not linked with recurrent shoulder dislocation.

A trial period of immobilization followed by a rehab program is considered a good first step following shoulder dislocation. Even if surgery is eventually needed, the strengthening program will prepare the shoulder for a better result after surgical reconstruction takes place.

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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Cancer survivor fears breaking hip

May 30th — admin

I am a 10-year breast cancer survivor. As I get older, I’m aware that my chances of falling and breaking a hip go up every year. Is there any direct link between having cancer and having a hip fracture?

There may be a link between cancer and hip fracture in the early years after having cancer. Metabolic changes after chemotherapy and radiation therapy increase the risk of fracture. But after five years, the risk of hip fracture in cancer patients actually drops below adults the same age who have never had cancer. The reasons for this aren’t clear yet. Some experts think that whatever made it possible for the person to be a cancer survivor is also working in their favor in the case of hip fracture. Some of the risk of bone fracture in cancer patients may be linked to the type of cancer, presence of bone metastases, and effect of treatment on the bones.

If you are concerned about your bone health and risk of fracture from osteoporosis, falls, or secondary to metabolic changes associated with cancer, see your physician for an evaluation. If you are osteoporotic, there are medications that can help prevent bone fracture.

Take a look at some of the other risk factors and modify anything you can. For example, patients who remain independent ambulators (walkers) without an assistive device of any kind do the best in the long run. Staying fit and active is the best medicine for many health problems including fracture prevention.

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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Do more people have cancer than have arthritis?

May 27th — admin

I see the news focused on cancer all the time. None of my friends have cancer but we all have arthritis. Do more people really have cancer than arthritis?

You and your friends are in the majority. Osteoarthritis (OA) is two and a half times more common than heart disease and six times more common than cancer. The incidence of both OA and cancer increase with age.

Since Americans are living longer with more active lifestyles, OA is expected to affect many more adults in the years ahead. An active lifestyle may be preventative for cancer. The odds are that cases of OA will continue to outnumber cancer in the near future.

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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Could intraoperative fracture during total shoulder replacement have been prevented?

May 26th — admin

We are really bummed as a family. We all encouraged Mom to have a shoulder replacement and then her upper arm broke during the surgery. Is this a fluke? Could it have been prevented?

There are many possible reasons why a bone fracture occurs intraoperatively. Sometimes it’s completely unavoidable. There are some known risk factors such as decreased bone mass (osteopenia or osteoporosis). Shoulder instability from a previous rotator cuff tear can make a difference.

Fractures of this type occur most often during a total shoulder replacement (versus a hemiarthroplasty where only one side of the shoulder joint is removed and replaced). Sometimes the surgeon has trouble getting to the shoulder socket. The angle and force needed may be too much for the brittle bones.

Older women seem to be at increased risk for humeral (upper arm) fractures. They are especially at risk if they also have rheumatoid arthritis or other health issues such as diabetes contributing to delayed or poor healing.

Surgeons must be aware of potential risk factors for fracture. Surgical approach and techniques must be chosen carefully with these risks in mind. Patient position during the operation is important. The elbow should never be used as a lever to get increased shoulder motion when under anesthesia.

Soft tissue release around the shoulder may be needed before moving the arm through its full range of motion. Special care must be taken when reaming out the humeral bone to place the stem of the implant inside. Hand reaming instead of power reaming is advised. The bone should be compressed, rather than removed, in patients who have low bone density.

These are just a few of the many considerations surgeons must include in the surgical process. When many risk factors present at the same time, then the risk of fracture goes up. Even being aware of all the risks doesn’t guarantee complications won’t occur. The surgeon can’t always predict who might develop intraoperative fractures.

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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Arthritis affecting hip range-of-motion, what can be done?

May 25th — admin

We are really concerned that Dad’s hip range-of-motion is getting worse instead of better. He has fairly severe hip arthritis. Each time a therapist measures him, it seems to slip a few degrees. What can we do to help him at least maintain his motion?

The first thing to be sure is that the testing is accurate. Testing joint motion can be very subjective depending on how it is done and who does it. If the same person measures joint motion each time, intrarater reliability of the test is important. Intrarater reliability refers to the ability of a single individual to complete the test the same each time.

If different people are testing your father’s hip joint motion, then interrater reliability is important. This refers to the test being done the same way from person to person. Interrater reliability is the term used to describe test-retest when performed by different individuals on the same patient. Patient pain levels can vary from day-to-day, too. A measurement on one day may not be the same as on the next if the pain goes up or down.

Assuming there is a true general trend of joint motion loss, the first step is to see his doctor. There may be an adjustment needed in medication that can help make a difference. Or there could be some other explanation for what’s going on. If no medical treatment is warranted, then referral to a physical therapist may be needed. The therapist is well acquainted with ways to help arthritis patients maintain and even regain range of motion. Not only that, but they will pay attention to strength, motor control, and joint proprioception (sense of joint position). Each of these components is important to function and preventing disability.

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 Arthritis, Hips. Tags: , , , , . No Comments »

Why didn’t new treatment for torn ACL work?

May 24th — admin

I tried a new treatment for a partially torn ACL in my left knee. The doctor used radiofrequency waves to heat it up and shrink it down. It didn’t work. My joint is still too loose. What went wrong?

There are many factors that could cause a failed treatment of this type. The exact shrinkage that takes place depends on how much heat is applied and for how long. Not enough heat may not shrink the collagen fibers. Too much heat can actually kill the tissue, a condition called heat necrosis.

The extent of the damage before treatment is important, too. For example larger tears are less likely to respond to this treatment and more likely to tear again. Smaller tears may respond better but studies show long-term results (five years later) aren’t successful. The collagen shrinkage doesn’t hold, and the ligament becomes lax again.

You may be better off having a surgical repair. There’s less chance for reinjury and degenerative changes in the joint. Talk to your surgeon about treatment options at this point in your recovery.

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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Hair stylist concerned about arthroscopic surgery for shoulder

May 23rd — admin

I need to have surgery on my shoulder because it clicks and hurts whenever I raise my arms over my head. Since I work as a hair dresser, I use this motion all day long. The surgeon I saw wants to put two puncture holes in my shoulder to repair this problem. Should I go through with it? Will the holes cause problems later?

It sounds like your surgeon is suggesting arthroscopic surgery. A long needle with a tiny TV camera on the end is inserted through the skin into the joint. The surgeon can see on a screen what is going on inside the joint.

The scope makes it possible to find and repair damage to the joint capsule, cartilage, and ligaments or tendons in the area. Studies show this type of surgery is very successful. There is no need for a large, open incision. Rehab and recovery is faster because major muscles haven’t been cut through.

The two or three puncture holes needed for placement of the scope usually present no problems. There is a small risk of infection at those sites. Usually, they just fill in with collagen fibers and scar tissue. They may only be visible on close inpsection.

The recovery process does take some time. Depending on what the surgeon has to do, you probably won’t be able to go back to work right away. Most patients are placed in a sling with a pillow under the arm.

You’ll probably see a physical therapist several weeks after the operation. The focus of rehab will be on restoring range of motion, strength, and function. Specific exercises may be prescribed to help you prepare to return to overhead work.

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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How to diagnose hip bursitis

May 20th — admin

I have a very tender and painful point along the side of my hip. My doctor thinks I have hip bursitis but nothing showed up on the X-ray or MRI. Is there some other way to figure out what’s going on?

Hip bursitis can be difficult to diagnose accurately in some patients. Often there is really more than one problem going on. Osteoarthritis, bursitis, and tendon pathology can all occur at the same time with overlapping signs and symptoms. Some experts say that bursitis never occurs alone. They believe bursitis is just one of several problems that occur together. In fact, they suggest that bursitis is a sign that tendon and joint degeneration are occurring. And to make matters even more confusing, many people with bursitis don’t have any symptoms. So finding reliable test measures and symptoms to confirm a diagnosis of hip bursitis can be a challenge.

As you have discovered, sometimes bursitis shows up on an MRI, but not always. Pain with palpation over the greater trochanter may be the most reliable clinical sign of bursitis. The greater trochanter is a large bump that can be felt along the side of your hip. Large and important muscles connect to the greater trochanter. The bursa is designed to provide a buffer or cushion between the tendons of muscles and the attachment of the tendons to the bones. Overuse or misalignment of the gluteal muscles can cause irritation and inflammation of the bursa. The end-result may be painful and persistent bursitis.

Sometimes a trial and error process is required to figure out exactly what soft tissue structures are getting pinched or pushed. When tests aren’t clear as to the problem, then treatment may be started. The diagnosis is made after a specific treatment is successful.

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 wearing a knee brace prevent an ACL tear?

May 19th — admin

I think I might be prone to knee injuries. Would wearing a knee brace during volleyball practice help prevent an ACL tear?

Anterior Cruciate Ligament (ACL) injuries are a problem for many athletes in noncontact sports. Volleyball players are at increased risk because of the landing, turning, and pivoting required. Female athletes are up to eight times more likely to injure the ACL compared to male athletes.

Many studies have been done trying to find out the specific cause and ways to prevent ACL tears. Researchers have looked at weather conditions, playing surface, and footwear. They’ve examined hormonal differences between boys and girls. They’ve compared anatomy from head to toe as a possible reason for differences in the rates of ACL injuries between the sexes.

So far no single factor has been linked to ACL injuries. Bracing hasn’t been proven to prevent knee injuries either. Balance training and improving the joint’s sense of position seem to have the best record so far in preventing these types of knee injuries.

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 »

Pitching arm vulnerable to shoulder instability

May 18th — admin

I’ve been to three orthopedic surgeons now about a problem with my pitching arm. It hurts, clicks, and feels like it’s going to pop out of the socket. No one could figure it out. I finally had an arthroscopic exam that showed a posterior tear of the shoulder capsule. Why was this so hard to diagnose?

Posterior instability as a cause of shoulder pain and/or clicking is an uncommon, but not unheard of, condition. Anterior shoulder problems are much more common. In fact, many pitchers or throwing athletes suffer from an anterior instability. Posterior refers to the back of the shoulder. Anterior refers to the front of the shoulder.

In either case, repetitive microtrauma from the action of overhead throwing is the cause of the problem. During the follow-through phase of pitching, the shoulder is close to the body, flexed, and rotated inwardly. This repetitive motion may put stress along the back of the shoulder.

The shoulder capsule and labrum (rim of cartilage around the shoulder socket) can also get pinched causing pain. This is more likely to occur during the late cocking phase of throwing when the arm is drawn back and externally rotated.

The problem is made worse if the athlete has any natural laxity (looseness) or contracture (tightness) of the soft tissues in this area. Repeated stresses from throwing 100′s of pitches can lead to labral tears or a stretched capsule.

These types of injuries are not easy to diagnose. There can be different directions of instability at the same time causing confusion. Clinical signs and symptoms and results of testing aren’t always consistent for multidirectional injuries. Diagnosis is delayed when there is more than one lesion (and even a combination of problems).

The surgeon will have to sort out the site of damage and resulting structural and biomechanical problems. Even with history, physical exam, and imaging studies, arthroscopy may be the only way to make the final diagnosis.

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.

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