Naples Orthopedic Surgeon - Dr. Robert J. Zehr

Three professionals = three diagnoses for shoulder pain. Who’s right?

admin — Fri, 12 Mar 2010 11:34:47 +0000

I saw two orthopedic surgeons and one physical therapist about a shoulder problem I’m having. All three gave me different explanations for the problem. None of them was the same problem. What’s going on here?

Shoulder pain is a common problem especially as we get older. The way the shoulder is examined isn’t the same from doctor to doctor or therapist to therapist. It’s not uncommon to get a different diagnosis from each specialist who sees a patient.

The shoulder joint itself is very complex. The way it works often causes more than one soft tissue structure to get pinched or pulled. This makes it hard to find out the actual cause of the problem.

Experience and training go a long way in making a correct diagnosis of shoulder pain. Besides musculoskeletal problems, shoulder pain can be caused by cancer, infection, or problems in other parts of the body. For example, a kidney infection or ruptured spleen can cause shoulder pain.

Researchers are trying to find a reliable way to test the shoulder. One model being studied is the selective tissue test (STT) first developed by an orthopedic surgeon (James Cyriax, MD). Many doctors and therapists use this skillfully and successfully to make a shoulder pain 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 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.

Do injections to lubricate the knee really work?

admin — Thu, 11 Mar 2010 20:47:18 +0000

I heard a report that knee injections to lubricate the joint are more and more popular. Do they work? And how?

Hyaluronic acid (HA) can be injected into the knee to restore the joint’s ability to move and glide easily. The knee already has some of its own HA. By injecting more, the HA already in the joint improves the flow of the synovial fluid. Injected HA also helps keep the naturally present HA from breaking down.

Overall, studies show that HA is both safe and effective. It seems to work better for younger patients (under 65 years) and for patients with only mild to moderate disease. Patients with severe osteoarthritis may not have any natural lubrication left in the joint. It seems without some HA, the injection doesn’t work as well.

How can having a total hip replacement improve my sleep?

admin — Wed, 10 Mar 2010 19:27:27 +0000

I’ve been dealing with an arthritic hip for years. Now it’s affecting my sleep. I heard that having a total hip replacement could help me sleep better. How does that work?

Arthritis sufferers are known to have poor sleep patterns caused by pain. Conditions such as osteoarthritis are a common source of hip pain in the older adult.

A recent study in New Zealand showed that sleep is improved after hip joint replacement. All patients had painful symptoms from arthritis that woke them up at night. Less hip pain after the operation meant better sleep. If the patients were awakened from sleep, it was for some other reason than from hip pain.

Steroid injections for pain relief – how long do they last?

admin — Tue, 09 Mar 2010 16:53:40 +0000

I had a steroid injection into my shoulder for a problem with bursitis. I got immediate relief that lasted about a week. Now my symptoms are starting to come back. How long do steroid injections usually work?

There aren’t too many studies just on the duration of pain relief with steroid injections into the joints. Results range from one week as in your case up to 13 weeks.

It’s clear that steroid injections work better than placebo injections with saline solution. And studies show that some steroids work better than others. Long-term pain relief may require a higher dose of the steroid.

In some cases steroid injections are used to control pain and reduce rehab time after arthroscopic surgery. In a patient with recurring bursitis there may be other factors such as posture and overuse to be addressed. The injection may help calm the joint enough to work on improving alignment and motion. Combining physical therapy with steroid injection may be one way to improve overall results.

What does “advanced” osteoarthritis mean?

admin — Mon, 08 Mar 2010 15:36:59 +0000

My doctor told me I have advanced osteoarthritis. What does this mean?

Osteoarthritis (OA) is staged according to how much damage has occurred in the joint and how much joint space is left. X-rays are used most often to stage OA. In advanced stages of OA, there is a complete loss of joint space.

The femur (thigh bone) and the tibia (lower leg bone) have no cushion between them. When you use the knee, the bones slide across each other without any protection or lubrication. We call this bone-on-bone.

Uneven wear in hip joint replacement result of third-body wear.

admin — Fri, 05 Mar 2010 15:54:41 +0000

I had a joint hip replacement for severe arthritis three years ago. The doctor tells me that third-body wear is likely the cause of some uneven wear in the joint. What does this mean?

When patients with hip joint replacements are compared, there are very different results in wear patterns of the new joint. This is true even when the same replacement parts are used from patient to patient.

In fact, one study looked at patients with both hips replaced using the same implant. The researchers compared one side to the other and found that the wear pattern was different from side to side. One of the reasons for this is third-body wear.

This is the presence of tiny particles in the joint. These pieces may be bits of bone or fragments of glue or cement used to hold the new joint in place. Even metal debris from the coating around the joint implant can cause the joint liner to be scratched and roughed up. Joint wear and tear is increased when the surfaces are roughened.

Still have pain 3 weeks after shoulder surgery?

admin — Fri, 05 Mar 2010 00:04:00 +0000

I had some shoulder surgery three weeks ago. I am doing my exercises faithfully, but there’s still quite a bit of pain. Is this normal?

Pain is a normal sign at certain points in the recovery process. This is most common during the early phase after an operation. Drugs to control pain and inflammation are used from one to three weeks after surgery.

At the same time, physical therapy to stretch and move the tissue is begun. The therapist will include exercises to retrain the muscles, restore normal posture, and begin motion. The program is progressed from three to six weeks postop.

Throughout this time, it’s best to complete the exercises without pain. Pain is a sign that something is wrong. Either the exercise is being done too soon or improperly. It’s better to do a little often than doing a lot occasionally.

Keep at it with the help of your therapist. Quality is more important than quantity. Good muscle control comes first before the ability to do many repetitions. Stop when the muscle gets tired. You’ll know you’ve reached this point when the muscle starts to shake or you can’t go through the same motion as during the first few repetitions.

Are stem cells used to grow cartilage?

admin — Wed, 03 Mar 2010 20:21:04 +0000

I’ve heard there’s a way to regrow torn cartilage in the knee. Are they using stem cells to do this?

Not yet. Researchers at Johns Hopkins have tried using stem cells to grow into tissue that’s like cartilage. They are testing a method injecting fluid filled with stem cells into the joint. The liquid hardens into a stable gel when placed under a special light. Stem cells inside the gel start to multiply and form new cartilage. So far only animals have been used in these studies.

In the meantime, doctors have found two other ways to get cartilage to repair itself. The first is called microfracture. Surgeons use a blunt awl (a tool for making small holes) to poke a few tiny holes in the bone under the cartilage. This causes new tissue, mainly scar tissue, to grow and fill in the holes.

The second is autologous chondrocyte implantation. Normal, healthy cartilage cells are taken out of the knee. They are sent to a special lab where more cells are grown from the original cells. The new batch of cells are put into the joint surface where the damage is located.

What position is best for sleeping after a total hip replacement?

admin — Wed, 03 Mar 2010 15:00:38 +0000

What position is best for sleeping after a hip replacement?

It depends how long ago you had the operation. During the first weeks-to-months, patients are restricted to lying on the back. Many doctors request they use a special abduction pillow between the legs with another pillow under to knees to keep the hips slightly bent.

When the doctor gives you the go ahead you can sleep on the “good” side. This means the hip replacement is up facing the ceiling. You’ll still need a firm pillow that goes between the legs from the hips down to the ankles.

Lying on your stomach is not advised. If your doctor approves this position, you may need a pillow under the hips to keep them in a slightly flexed or bent position. It’s usually many months (if ever) that stomach sleeping is comfortable or safe.

Sleeping on the operated side is also delayed by many months if it is resumed at all. Most patients find this position too uncomfortable to rest well at night.

Will laser heat treatment work for arthritis in the shoulder?

admin — Tue, 02 Mar 2010 14:33:33 +0000

I heard there’s a new laser heat treatment for loose shoulders. Will this work for arthritis?

Using heat in the form of laser or radiofrequency has gained in popularity over the last 10 years. Uses for laser therapy in the shoulder are still limited. Research only supports its use for shoulder instability.

When the fibrous tissue surrounding a joint (the capsule) is torn or stretched, it’s causes joint laxity. This is another way to say “loose joint.” Joint laxity causes a joint to be unstable. In the case of the shoulder, this can lead to dislocation.

Currently, thermal devices are used to treat shoulder instability caused by damage to the capsule. Arthritis is a condition that primarily affects the bone and joint surfaces. Laser hasn’t been approved for use with arthritis at this time. More studies using laser are being done and may include arthritis in the future.