Naples Orthopedic Surgeon - Dr. Robert J. Zehr

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.

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.

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.

I had total hip replacement surgery, how long will I limp?

admin — Fri, 26 Feb 2010 12:50:07 +0000

I’m very self-conscious that I still limp after a total hip replacement I had five months ago. Will this ever go away?

Muscle weakness is the usual cause of a limp while walking. Three to six months after a total hip replacement, the muscles around the hip are still only at 50 percent of normal. Limping is not unusual up until six months after the replacement.

Limping may even go on up to one year later. This is because joint strength and function are still only at 80 percent of normal. It’s important to keep doing your rehab exercises. By five months you should be able to move past the basic program and continue to improve your strength.

Try to get back to your favorite physical activities. Any nonimpact sports you enjoy will help keep you on track for full recovery. If you aren’t seeing some gradual improvement over time, ask your doctor if there are any special or unusual reasons why you are still limping. Perhaps you’re a good candidate for an updated rehab program.

Blue hands are not just in Avatar!

admin — Thu, 25 Feb 2010 15:56:35 +0000

Sometimes, I wake up in the middle of the night and my arm is cold and stiff. My hand is blue and it looks like I’ve lost the blood supply to my hand. What causes this?

The condition you’re describing is called positional cyanosis. Cyanosis means a bluish discoloration. It’s caused by a lack of oxygen to the tissues. This can occur if you sleep in one position too long or if you lay on the arm without moving for more than two hours.

Another possible cause of this problem is a condition called thoracic outlet syndrome (TOS). In the adult body, there’s a bundle of nerves and blood vessels that travel from the neck down the arm. These pass under the collarbone. If anything presses on the vessels, the blood supply can get cut off.

TOS can occur as a result of postural changes, bone spurs in the neck or shoulder, or problems with the muscles. A physical therapist can help you find the cause of the problem and solve it. If you don’t get relief from your symptoms in three months, see your doctor.

Is it possible to have bursitis of the knee?

admin — Wed, 24 Feb 2010 19:12:15 +0000

Is it possible to have bursitis of the knee? I’ve had shoulder bursitis. Now my knee is acting up much the same way.

The bursa is a fluid-filled sac placed between two structures to help cushion friction during movement. Usually it’s located between a tendon and the bone. The bursa cushions the tendon as it moves over the bone. Sometimes there’s a bursa between two ligaments.

In bursitis the bursa gets inflamed. The patient has pain mostly on movement. The most common cause is repeated motion. Arthritis, infection, and injury can also cause bursitis. Bursitis occurs more often with aging as the bursa becomes thinner and dried out.

Problems with bursitis occur in the feet, hips, knees, shoulder, and elbows. There are several bursae around the knee joint. Kneeling is a common cause of one type of knee bursitis. This is sometimes called housemaid’s knee. Another type of bursitis occurs most often in people who install carpet, but anyone can get bursitis of the knee.