Non-Opioids Often Underused After Back Surgery

Non-Opioids Often Underused After Back Surgery

Spine and joint surgery patients aren’t taking advantage of common pain relievers like Tylenol or Motrin during their recovery, researchers say.

Instead, many are given opioids, such as oxycodone (OxyContin) or hydrocodone (Vicodin). These highly addictive narcotics are potentially deadly when abused. The United States is currently grappling with an ongoing opioid epidemic.

The new study also found that post-surgical patients improperly store and dispose of their unused opioid painkillers.

“It’s clear we need to empower patients to ask their physicians about non-opioid pain management options, as well as call on prescribers to be more thoughtful of their prescribing practices,” said study first author Dr. Mark Bicket. He’s an assistant professor of anesthesiology and critical care medicine at Johns Hopkins University in Baltimore.

Greater use of non-opioid painkillers means fewer opioids would need to be prescribed, making it less likely that they’d be lost, sold, taken by error or discovered by a child, Bicket said in a university news release.

The researchers found that six months after surgery, more than one-third of patients still had unused opioids at home. And more than 90 percent admitted that they weren’t stored safely.

Three-quarters or more said they had not received instructions on how to store or dispose of the opioids, the study authors noted.

The study included 140 patients, average age 56, who were surveyed two days, two weeks, one month and six months after surgery about their use of non-opioid painkillers. These drugs include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin and Advil, and acetaminophen (Tylenol).

Two days after surgery, 82 percent of patients were not using NSAIDs. Forty-four percent reported not using acetaminophen. Only 5 percent used both NSAIDs and acetaminophen.

One month after surgery, only 6 percent of patients reported use of multiple non-opioid medications.

Also one month after their operation, nearly three-quarters of patients said they had unused opioids. Almost half of these said they had 20 or more unused pills, and 37 percent said they had more than 200 morphine milligram equivalents of opioids. Some experts say that, at this dosage, a patient who has never had narcotic painkillers would overdose.

The vast majority of the study patients reported unsafe storage of opioids a month after surgery and said they had not disposed of unused pills.

The study was published recently in the journal Anesthesia & Analgesia.

More information

The American Academy of Family Physicians has more on pain control after surgery.

SOURCE: Johns Hopkins University, news release, April 30, 2018

ACL Surgery Preparation and Recovery

ACL Surgery Preparation and Recovery

Professional athletes’ speedy recoveries from injuries have nothing to do with superhuman abilities. Instead, it’s all about proper preparation and planning.

It’s no surprise that professional athletes tend to be in much better shape than those of us who don’t play sports for a living — but what might seem more puzzling is that they also seem to recover more rapidly from injuries. Think of D’Angelo Russell, the Brooklyn Nets’ star point guard. After suffering a knee injury in November, he underwent arthroscopic knee surgery and fully recovered in just over two months, returning to the court by the middle of January.

Such a speedy recovery isn’t evidence of superior physical fitness, however, so much as a clear strategy in the wake of an injury. Professional athletes have access to some of the best orthopedic specialist available — and these doctors, trainers, and therapists help them follow strict guidelines throughout the process of rehabilitation, ensuring that they can return to action as soon as possible.

While you might not have a dedicated team of doctors at your disposal, there are many steps you can take to enjoy a similarly quick recovery. ACL tears — a rupture of the anterior cruciate ligament, one of several ligaments that stabilize the knee — are a common injury affecting star basketball players and casual gym-goers alike. Here’s what you can learn from the professional athletes’ approach to ACL rehabilitation.

1. KEEP YOUR BODY HEALTHY

In order to help your body best respond to arthroscopic surgery, you need to stay healthy and hydrated. For at least a week before your surgery, be sure to drink plenty of water and eat a nutritious, wholesome diet rich in antioxidants, both of which can boost your body’s ability to heal.

2. STRETCH AND EXERCISE BEFORE SURGERY

Staying healthy requires more than just eating right, of course. Your preparation for surgery should include regular stretches and massages, which can strength the tissues surrounding the ACL and increase their flexibility. These measures ensure that the knee joint remains relaxed and enjoys proper circulation, both of which foster optimal surgical conditions.

3. DON’T BE AFRAID TO ASK QUESTIONS

Nobody expects an injury, so when these unfortunate events happen, you might not know what to expect. Athletes have a whole team on hand — ranging from surgeons to physical therapists — to guide them through the process, and while you might not have the same resources readily available, you should do your best to stay informed. Your doctor and surgeon are there to help you, so be sure to voice your concerns and ask any questions you may have.

4. FORMULATE AND WRITE DOWN THE RULES

When it comes to recovery, you can’t break the rules. A rehabilitation plan isn’t something you can come up with on the fly, so be sure to consult with your doctor, therapist, and surgeon to formulate a concrete plan centered around defined protocols and regular benchmarks to help you stay motivated and focused.

5. STAY STOCKED UP ON SUPPLIES

Proper recovery requires keeping plenty of tools on hand, such as ice packs and non-steroidal anti-inflammatories. You may struggle to get out of the house while you recover from the procedure, so ensure that you have an ample supply of everything you might need before you undergo surgery.

6. MAINTAIN A POSITIVE MOOD

As a minimally invasive procedure, arthroscopic surgery is designed to shorten recovery timelines, but you’ll still need to spend some time resting immediately after surgery. Since you won’t be able to participate in many of your daily activities, try to have some projects at the ready to keep you happy and occupied. Maintaining a positive mood will help boost your morale, and ultimately assist in recovery.

If you’re considering arthroscopic surgery for an ACL tear, CompOrtho is ready to help. Our team of specialists has decades of combined experience in treating knee injuries, providing every patient with the care and attention they need from the initial diagnosis to the final follow-up. Call us today to schedule a consultation!

Spring is approaching, which comes sports & the rise of ACL injuries

Spring is approaching, which comes sports & the rise of ACL injuries

“The traumatic injuries are something that you can’t avoid in the nature of sports,” said Michael Hughes, Clinic Coordinator and lead Physical Therapist at Agape Physical Therapy of Gates. “A lot of kids will come from the winter and start their spring season, and they don’t have a good strengthening regimen when starting their specific sport. It can lead to some injuries if they don’t have the proper muscle training.”

Orthopedic surgeons at Strong Memorial Hospital are seeing similar trends. According to a hospital spokesperson, orthopedic sports medicine surgeon Mike Maloney, M.D., confirms that he’s seeing the same rate of increase in his practice. We’re told Maloney specializes in treating elite student athletes and says the following factors are causing the alarming increase in this injury:

• The increasing level of intensity in scholastic sports

• More kids specializing in one sport and doing year-round training in that sport

• Lack of emphasis on proper nutrition

• Lack of focus on preventive care – teaching kids how to get conditioned to be strong, and how to move to help prevent injury.

Jeff Bobzin can’t preach it enough to the youth soccer players he coaches in Gates.

“We encourage kids to drink a lot of water, eat right and exercise,” Bobzin said.

Boys between ages 10-14 make up more than half of the reported injuries in the study. Therapists at Agape say its important for parents and kids to map out a training plan to prevent serious body injuries.

Shoulder Instability:  More common than you would think

Shoulder Instability: More common than you would think

Professional athletes aren’t the only people who suffer from unstable shoulders. We’ll walk you through the most common causes of — and treatments for — this condition.

Because professional athletes have undergone intense training to mold their bodies into peak physical shape, it’s easy to assume that they’re immune to the common injuries that affect the rest of us. Recent news, however, has shown that no one is completely protected from injury. For example, Tom Brady and Aaron Rodgers — two of the best quarterbacks in the NFL — have both shown that they are suffering from significant shoulder injuries, with Rodgers missing the remainder of the season due to a broken collarbone.

In fact, shoulder damage is one of the most common injuries for NFL players and laymen alike. Since the shoulder is the most mobile joint in the body, it’s especially prone to problems. For most of us, however, shoulder injuries are caused by gradual wear and tear rather than sudden trauma. While these injuries don’t ultimately result in chronic instability, they can hasten the degeneration of the cartilage in the shoulder, which then can leave the shoulder unstable. Fortunately, these problems can be effectively treated with the help of a qualified orthopedic specialist such as Dr. Main and Dr. Gershtenson, and a rigorous rehabilitation program.

What Is Shoulder Instability?

Shoulder instability is a chronic condition that leads to frequent dislocations of the shoulder. It occurs when the end of the humerus (the ball of the shoulder joint) separates from the glenoid (the socket of the shoulder joint). These dislocations can be either partial or full.

Shoulder instability has a variety of causes. In many cases, it’s simply a product of previous shoulder dislocations, since a traumatic dislocation often causes tears in the stabilizing cartilage and ligaments. A shoulder is more likely to be dislocated again if it’s already been dislocated. Unusually loose ligaments in the shoulder can also heighten the risk, especially if they’ve been loosened by repetitive motion and strain, as often occurs in football players, swimmers, and tennis players.

Symptoms and Diagnosis

There are several symptoms of a chronically unstable shoulder. One of the most common is frequent subluxation, or repeated partial dislocations. Often caused by overhead motions, these subluxations create a brief feeling of pain and a slipping sensation in the shoulder. In more severe cases, full dislocation may occur, resulting in intense pain and visible abnormalities like bumps in the shoulder. Shoulder instability can also result in a “dead arm”, or a feeling as though a nerve has been pinched.

While you can perform some tests on your own, self-examinations can further aggravate the shoulder — so it’s best to let a professional diagnose your condition. In addition to consulting your medical history, a doctor may move your shoulder into specific positions to test the stability of the joint. If these movements cause pain or further displace the shoulder, it’s likely unstable, and X-rays and an MRI might be needed to determine the extent of the injury.

Treatment

Non-traumatic shoulder instability can often be treated nonsurgically, through rest, anti-inflammatory medication, and physical therapy. If the instability is the result of trauma and it creates a Bankart lesion (a tear in the cartilage), then arthroscopic surgery is usually necessary to stabilize the joint and prevent recurrent dislocations, which can otherwise lead to degeneration and premature arthritis.

Physical therapy largely consists of various stretching and strengthening exercises that rebuild the joints, ligaments, and muscles and restore their range of motion, stabilizing the shoulder in the process. These exercises are often targeted to strengthen the rotator cuff and the scapular muscle, and can be aided by resistance bands. In addition, your physical therapist will teach you how to properly use your shoulder, reducing the chance of painful subluxation and dislocation while you heal.

If you’re concerned about your shoulder, our team of best-in-class orthopedic physicians at CompOrtho are here to help. With our extensive experience, we have the knowledge and ability needed to help you at every stage of treatment, from diagnosis through rehabilitation. If you’re searching for a reliable and compassionate provider, contact us today to schedule an initial consultation.

Boxer’s Fracture

Boxer’s Fracture

What is a boxer’s fracture?

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers.

The metacarpal bones are the intermediate bones of the hand found inside the flat of the hand. They connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The fifth metacarpal is the metacarpal of the fifth (pinky) finger. The neck of the metacarpal bone is where the main shaft of the bone starts to widen outwards towards the knuckle.

Boxers are not the only people who can get a boxer’s fracture, but usually the injury results from direct injury to a clenched fist. The force fractures the neck of the metacarpal bone below the pinky.

Your doctor will need to distinguish boxer’s fractures from other metacarpal fractures, which break the shaft of the metacarpal, or fractures of the base of the small finger. These injuries may need different treatments.

Metacarpal bones, in general, are some of the most commonly fractured bones in the hands. A large percentage of these qualify as “boxer’s fractures.”

What causes a boxer’s fracture?

Usually, a boxer’s fracture happens when you punch a wall or another solid object at a high speed. You also might get a boxer’s fracture if you fall hard on your closed fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture here.

What are the symptoms of a boxer’s fracture?

Symptoms of a boxer’s fracture can include:

  • Painful bruising and swelling of the back and front of the hand
  • Tenderness of the back of the hand in the region of the fractured fifth metacarpal
  • Bent, “claw-like” pinky finger that appears out of alignment
  • Limited range of motion of the hand and of the fourth and fifth fingers

Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity depending on the complexity of your fracture. You might have only mild pain, or the pain might be more severe.

How is a boxer’s fracture diagnosed?

Your doctor will ask you about your symptoms, how you injured the hand, and your past medical problems. Your doctor will also examine your hand carefully, checking for tenderness, strength, misalignment, range of motion, breaks in the skin, and other features.

An X-ray of the hand can clearly confirm a boxer’s fracture.

How is a boxer’s fracture treated?

Your treatment depends on how severe the fracture is. Initial treatment might include:

  • Washing any cuts that are present in the skin
  • Getting a tetanus shot if you have a cut and haven’t had a shot for several years
  • Resting your hand for a few days
  • Keeping your hand above the level of your heart for a few days
  • Icing your injury several times a day
  • Taking pain medicine (prescription or over-the-counter)
  • Wearing a splint for several weeks

Before your doctor puts your hand into a splint, he or she may need to put your bones back into alignment. Usually, you’ll receive a local anesthetic to keep you from feeling any pain, and your doctor will physically manipulate the bones back into place. In some cases, your doctor might have to open up your hand surgically to get the bones back into alignment.

You also may need to work with a physical therapist for a while as your fracture heals. You’ll learn exercises to strengthen the muscles of your hand and keep them from getting stiff.

If you have an unusually severe boxer’s fracture, you may need immediate and more complicated surgery. For example, if your bone has broken through the skin, or if it has broken in several places, you will probably need surgery. You might also need surgery if you have a job or significant hobby that requires a lot of fine-motor movement of the hand, like playing the piano.

Even if you don’t need surgery right away, you might need it at some point. If your hand doesn’t heal as well as expected, surgery might be an option.

What are the complications of a boxer’s fracture?

An untreated boxer’s fracture can lead to a decrease in your ability to grip, limited range of motion of the finger, and an abnormal looking finger. With proper treatment, these complications are usually minor, if present at all.

What can I do to prevent a boxer’s fracture?

Avoid fistfights and punching solid objects to prevent many cases of boxer’s fracture. If you box, make sure you use the correct technique and the proper equipment.

How to manage a boxer’s fracture

Your doctor may give you some instructions about how to manage your boxer’s fracture, such as:

  • Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and protein
  • Stopping smoking, to help your fracture heal more quickly
  • Keeping your splint from getting wet

Your hand will be very easy to reinjure for 4 to 6 weeks after your splint is gone. You may need to use a hand brace if you return to contact sports during this time. Talk with your doctor about what makes sense for you.

When should I call my healthcare provider?

Call your doctor if:

  • You have numbness or tingling in your fingers
  • You fingers look blue
  • You have severe pain or worsening swelling
  • Your splint gets damaged and you need a new one

Key Points

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It usually happens when you punch an object at a high speed.

  • Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range of motion of the pinky finger, and misalignment of the finger.
  • Your doctor can diagnose your boxer’s fracture with a medical history, physical exam, and X-ray.
  • You might need treatment with simple rest, ice, pain medicine, and splinting.
  • You might need surgery for your injury if it is severe.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Don’t Delay Hip Fracture Surgery. Here’s Why

Don’t Delay Hip Fracture Surgery. Here’s Why

Seniors with a fractured hip need surgery as soon as possible or they could suffer life-threatening complications, a new Canadian study concludes.

Having surgery within 24 hours decreases the risk of hip fracture-related death. It also lowers odds of problems such as pneumonia, heart attack and blocked arteries, the researchers found.

“We found that there appears to be a safe window, within the first 24 hours,” said lead researcher Daniel Pincus, a doctoral student with the University of Toronto.

“After 24 hours, risk began to clearly increase,” Pincus said.

U.S. and Canadian guidelines recommend hip fracture surgery within 48 hours of injury, but it’s likely that many people don’t receive care that quickly, he noted.

In the United Kingdom, guidelines call for surgery within 36 hours, but hospitals often fail to get patients promptly into the operating room, Pincus added. Rates range from 15 percent to 95 percent among U.K. hospitals, according to the report.

Oftentimes, there’s no operating room or surgeon available, or other patients are awaiting surgery, Pincus explained.

“There’s a triage system and these patients historically were not prioritized,” he said. “Sometimes there’s medical reason for the delay, but that’s very rare. We’re starting to realize there’s almost no reason why a patient should be delayed.”

Delay also likely occurs because doctors approach these elderly patients with a good deal of caution, said Dr. Harry Sax. He is executive vice chair of surgery for Cedars-Sinai Medical Center in Los Angeles.

“The perception is that if you’re old and you’ve broken your hip, that you’re going to have a lot of other [health problems],” said Sax, co-author of an editorial accompanying the new study. “Therefore, I need to spend several days running tests on you to try to make sure I can get you through the hip fracture surgery. ”

To see how this delay affects the health of patients, Pincus and his colleagues evaluated data on over 42,000 people treated for hip fracture at 72 hospitals in Ontario between April 2009 and March 2014. The patients’ average age was 80.

The investigators compared patients based on whether they had surgery before or after 24 hours.

Overall, about 12 percent of hip fracture patients died within the month following their surgery.

However, patients who got surgery within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery, the findings showed.

Those patients also had lower complication rates. They were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.

“The problem is the longer you sit in bed, the more likely you are to get pneumonia and blood clots. The unfixed bone is continuing to flick off little bits of fat, which can go to the lungs,” Sax said. “The delay doesn’t necessarily make things better. It could make things worse.”

People with an elderly relative facing hip fracture surgery should ask the health care team to get their loved one into surgery as soon as possible, with as little additional testing as possible, Pincus and Sax said.

“A prompt evaluation to make sure there’s nothing quickly correctable should be done, but otherwise the patient should move to the operating room as quickly as possible,” Sax said.

Families should ask doctors about every test, scan or screen that delays the surgery, Sax said.

“The question needs to be, what is the information that you’re going to gain and how would that change your management of this patient,” Sax said. “There are very few things you find with all this expensive testing that you can do anything about.”

The patient would be best off in a hospital that has a specific program to manage elderly people with hip fractures, Sax added. These programs have a team of surgeons, geriatricians, anesthesiologists and other professionals well-versed in the procedure.

“If you can find a hospital that does that, the chances are your outcomes are going to be better,” Sax said.

The study was published Nov. 28 in the Journal of the American Medical Association.

More information

For more on hip fractures, visit the American Academy of Orthopaedic Surgeons.

SOURCES: Daniel Pincus, doctoral student, University of Toronto, Ontario, Canada; Harry Sax, M.D., executive vice chair, surgery, Cedars-Sinai Medical Center, Los Angeles; Nov. 28, 2017, Journal of the American Medical Association