What happens during a shoulder manipulation?

July 29th — admin

Can you tell me how they do a shoulder manipulation? I know I’ll be asleep for the operation but what happens exactly?

Surgical manipulation of a joint refers to a procedure whereby the surgeon moves the joint slowly and gently through its full range of motion. The patient is anesthetized to allow for full relaxation of the muscles, which would hold and contract otherwise to avoid the pain of movement. Once you are asleep, the surgeon moves your arm carefully through each motion: flexion, extension, and rotations (internal and external). The arm will also be moved across the body. This movement is called horizontal adduction. Adhesions and fibrous scar tissue will be torn in the process. The surgeon feels and hears the snapping, popping, grating sound called crepitus that signals release of the adhesions. Once the adhesions are released, the shoulder will move more smoothly and fully. The manipulation procedure is complete when the affected shoulder has the same range-of-motion as the uninvolved side.

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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Accurate diagnosis of hip pain can be elusive

July 28th — admin

I saw my primary care physician for hip pain that just won’t go away. Despite a huge amount of time testing me every which way, there’s no known cause for the problem. Should I insist on X-rays or an MRI?

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of 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 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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What is an “incomplete” repair of the meniscus?

July 27th — admin

Three years after a meniscal repair I started having painful clicking in my knee again. The doctor says the repair was “incomplete.” What does that mean? I may have to have another operation to repair the problem.

Incomplete healing of a torn mensicus is usually found by having a second arthroscopy.

The surgeon makes one or more puncture holes in the skin and inserts a long, thin needle called a cannula into the joint.

Tiny tools can be passed through the cannula including a miniature TV camera to take a look inside the joint. What the surgeon sees as an incomplete healing of meniscal tears is a cleft or gap at the site of the tear. It may go down 10 to 50 percent of the thickness of the meniscus.

A gap of more than 50 percent is a nonhealed repair. A second operation is often needed in such cases.

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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Which surgery method is best for golfer with torn rotator cuff?

July 26th — admin

I’ve been getting ready to have shoulder surgery for a rotator cuff tear. I’m an avid (middle-aged) golfer. I’ve looked at arthroscopic surgery versus open surgery. I really want to get back on the golf course. Which one of these is better for golfers?

There’s still quite a bit of debate on this point. Studies don’t show a big difference in results between these two approaches. The arthroscopic procedure is minimally invasive. There is less soft tissue disruption and a smaller incision. But there is some concern that this method leaves some people with a repair that won’t remain stable or hold up.

Surgeons tend to use open repair techniques for over-head throwing athletes. The belief is that they need a mechanically stronger repair. But there are other surgeons who report that they are using all-arthroscopic surgeries for all patients including athletes. There are two other things to consider when making this decision. The first is return-to-sports and the level of activity you may achieve. It is possible to return to the game at your pre-injury level. But some patients who have the arthroscopic repair do so at a level below their former playing ability. And secondly, it is possible to retear the repair. Retear rates compare equally between open and arthroscopic techniques. In many reported cases, the patients with retears did not follow the rehab protocol and did more than was advised.

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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What is calcific bursitis of the hip?

July 25th — admin

Have you ever heard of calcific bursitis of the hip? That’s what I have. What can you tell me about it?

Calcific bursitis occurs as a result of tiny calcium deposits in the collagen tissue around the hip. The cause is chronic inflammation of the bursae. The bursa is a normal structure. It is a thin sac of tissue that contains fluid to lubricate areas and reduce friction between muscles, tendons, and bones. The patient reports pain and/or tenderness along the side of the hip. This is the area of the greater trochanter. The greater trochanter is a large bump of bone that juts outward from the top of the femur (thigh bone). Large and important muscles connect to the greater trochanter. Sometimes these muscles are referred to as the rotator cuff of the hip. Chronic tendinitis of the hip rotator cuff can also contribute to this problem. The calcium deposits are called calcification. They can occur as long as there is inflammation of the bursae (or tendons). The deposits don’t always go away after the inflammation has been taken care of, but the symptoms improve.

Treatment can help to prevent further calcification as well as relieve pain and stiffness. Antiinflammatory drugs, cortisone injections into the bursa, and physical therapy have been shown effective. In rare cases, the inflamed bursa is surgically removed.

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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Benefits of repairing meniscus with arthroscopy

July 22nd — admin

What’s the advantage of having a meniscus repaired by arthroscopy? Are there any problems with this kind of surgery?

There are several benefits to this type of surgery. First of all, only a few small puncture holes are needed to slip the surgical tools into the joint. No large scars are needed. The back of the knee doesn’t have to be opened to tie the sutures. Healing time is shorter.

There’s less risk of damaging nerves or blood vessels with arthroscopy. The risk of infection is also less. The disadvantages may be just coming to light.

The first long-term studies are being reported. After about 10 years of using special devices that allow for an all-inside or all-arthroscopic repair, it’s clear that the repair is incomplete for many patients. A second operation may be needed to repair or remove the re-injured meniscus.

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 you have a torn rotator cuff and not know it?

July 21st — admin

Is it really possible to have a torn rotator cuff and not know it? My aunt tells me she was diagnosed with this type of injury. But they aren’t going to treat it because it doesn’t hurt. Does that seem reasonable to you?

Rotator cuff injuries can be difficult to diagnose. It is indeed true that many older adults with degenerative soft tissue changes have no symptoms. They are said to be asymptomatic. Studies show that it is possible to have a full-thickness tear of the rotator cuff without any symptoms. Finding a clinical test that can accurately diagnose a rotator cuff tear has been a challenge. There are four different tendons that form the rotator cuff. There’s a different clinical test for each one. But sometimes it’s impossible to separate out the supraspinatus from the infraspinatus (two of the commonly involved tendons). The surgeon may have to rely upon ultrasound or other more advanced imaging to make an accurate diagnosis. Many prefer arthroscopic exam because the repair can be done at the same time. Ultrasound does have the advantage of being able to compare one side to the other without invasive 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 hip arthritis be diagnosed without an x-ray?

July 20th — admin

My doctor thinks I might have hip arthritis. She would like me to have an X-ray. I’d like to avoid any more exposure to radiation. Can this condition be diagnosed without X-rays?

X-rays are still the number one tool physicians rely on to make an accurate diagnosis of osteoarthritis (OA). The radiograph shows changes that can’t be seen with a clinical exam. For example, narrowing of the joint space and bone spurs associated with OA are easily seen on X-rays.

Other changes common with OA that can be observed with X-rays include changes at the joint margins and subchondral bone. Subchondral bone refers to the first layer of bone underneath cartilage. Once the joint cartilage is destroyed by the OA process, the subchondral bone can be affected, too.

Without X-rays, there are some clinical tests that can be helpful in diagnosing hip OA. Hip range-of-motion (quantity and quality) is a key factor. A quick and easy screening test for the hip is to try assuming a squat position. If this position aggravates the symptoms (or you cannot do it because of hip pain), the hip is involved in some way.

The examiner looks for a specific pattern of motion typical with OA. Loss of hip internal rotation is a positive sign of OA. The examiner also relies on how the joint feels during testing motions. There should be a smooth, easy give through the full arc of motion. The examiner feels for a slight spring at the end of the motion. Any blocks or resistance to movement caused by pain or a bone-on-bone sensation may be an indication of degenerative joint disease.

X-rays may still be needed if all these tests are positive. But if they are negative, it may rule out OA and X-rays can be avoided. It’s likely that your physician found enough suspicious test results to suggest further testing with X-ray imaging. Don’t be afraid to ask your doctor about her findings so far and express your concerns about radiation exposure.

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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Hamstring vs. patellar tendon graft for ACL repair

July 19th — admin

Two years ago I had a hamstring graft to repair a torn ACL. There was a lot of controversy then over whether a hamstring or patellar tendon graft was better. I’m still wondering if I made the right choice. What’s the latest thinking on this issue?

If you are satisfied with the results then you have nothing to regret or wonder about.

Researchers agree the two methods have equally good results. There may be complicationsfrom time to time. These differ between the two types of repair.

The hamstring graft is a little nicer looking cosmetically. It gives a strong graft fixation early on. The hamstring may not be able to tolerate motion right away.

The patellar graft seems to help athletes get back into high-level action more often. There are still some problems with kneeling and quadriceps muscle weakness after a patellar tendon graft.

Overall patients report satisfaction with function and results after either type of graft repair.

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 determine if total shoulder replacement will relieve your pain

July 18th — admin

At what point do the doctors decide to replace a joint like the shoulder? Mine’s been hurting for what seems like forever, but my doctor says that he doesn’t think a shoulder replacement would help.

Joint replacements can be a wonderful life-changing surgery. By removing the painful joints and replacing them with mechanical ones, people can regain proper movement with little pain. However, joint replacements are not for everyone. The treating doctor has to assess if the injury or deterioration in your shoulder is something that would be fixed by a replacement – not all shoulder problems are. The doctors also have to look at risk when assessing if a patient is medically well enough to undergo surgery and if providing surgery may or may not cause complications. Finally, some doctors want patients to wait as long as they can before performing a replacement because the new joints have a certain life span and the doctors would prefer to avoid having to do a second surgery down the line, if at all possible.

If you are not happy with your care, perhaps you should seek a second opinion and you may ask the doctor as many questions as you feel are necessary.

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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