In Many Cases, Hip Replacement Also Eases Back Pain

In Many Cases, Hip Replacement Also Eases Back Pain

THURSDAY, July 9, 2020 (HealthDay News) — If you have a bad hip and lower back pain, a new study suggests that hip replacement surgery may solve both issues at once.

Researchers at the Hospital for Special Surgery in New York City focused on 500 patients who underwent hip replacement surgery and followed up with them one year after the operation.

Over 40% reported pain in their lower back prior to hip surgery. Of that group, 82% saw their back pain vanish after surgery.

It was “completely gone,” said study author Dr. Jonathan Vigdorchik, a hip and knee surgeon at the hospital.

He said that experts in his field have studied the connection between the hip and back for years.

A hip replacement is a surgical procedure to replace a worn-out or damaged hip joint with an artificial one. On average, it is a highly successful operation, with 95% of patients experiencing pain relief, according to the Hospital for Special Surgery.

“It’s an outstanding procedure,” said Dr. Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago. “There are very few things in medicine that are close to hip replacement in terms of how good of a medical procedure it is.” He wasn’t part of the study.

But Vigdorchik added that patients who have undergone some types of spinal surgery before a hip replacement face five times the rate of complications compared to the general population — for which the complication rate is less than 1%.

This knowledge prompted him to dive deeper into the hip-back interplay.

“We noticed that there are certain conditions where a hip condition can actually put undue stress on the back,” Vigdorchik explained.

He and his fellow researchers wanted to find out how effective a hip replacement can be in eliminating low back pain, and determine which patients are more likely to benefit.

The patients whose low back pain resolved after the surgery were those with “flexible spines,” according to Vigdorchik. When a person’s spine is flexible, a stiff or poorly functioning hip can drive the spine to move more than usual, causing pain.

Those with normal flexibility in their spine were also highly likely to have their pain resolved.

“Those are the patients whose back pain went away completely after their hip replacement, because their back pain was probably caused by their hip not functioning properly to begin with,” said Vigdorchik.

But the back pain in patients with stiff spines did not go away. Patients with stiff spines already have serious arthritis of the spine, and replacing the hip is unlikely to relieve their pain.

But how can you know if your back pain could be resolved with a hip replacement?

It’s not easy to figure that out on your own, according to Vigdorchik. “It really relies on a good physical exam, and then good X-rays,” he said.

Before a patient undergoes a hip replacement, surgeons will typically take an X-ray of the patient lying down.

In this study, researchers took X-rays of their patients standing up and sitting down, both before and after the surgery.

These X-rays allowed them to see how the hip and spine moved in relation to each other, and assessed the flexibility of their spine, as the patient switched from a standing position to a seated position.

Vigdorchik encouraged other surgeons to utilize these X-rays to identify patients whose ailing backs may be relieved by a hip replacement.

He also advised surgeons in the field to “look beyond just the hip.”

“Anytime they’re looking at the hip, they should also look at the back, and anytime they’re looking at the knee, they should also look at the hip,” Vigdorchik said.

The existence of an interplay between the hip and back is well known to experts, but Della Valle said that this study showed how consistent it is.

He said the study gives surgeons in the field “some tools to try to predict which patients you can tell, ‘Yeah, your back pain will get better,’ and others, well, maybe it won’t.”

The study was published online recently during a virtual meeting of the American Academy of Orthopaedic Surgeons.

More information

There’s more about low back pain at the U.S. National Institutes of Health.

SOURCES: Jonathan Vigdorchik, M.D., orthopedic surgeon, hip and knee replacement, Hospital for Special Surgery, New York City; Craig Della Valle, M.D., professor, orthopedic surgery, Rush University Medical Center, Chicago; AAOS 2020 Virtual Education Experience, March 26, 2020, online

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Which Surgery Works Best for Lower Back Pain?

Which Surgery Works Best for Lower Back Pain?

TUESDAY, June 16, 2020 (HealthDay News) — Patients with lower back problems often worry about how much time they’ll need to recover if they have surgery. A new study finds similar results for two common minimally invasive spine procedures.

Surgery may be recommended for degenerative conditions of the lower spine, such as a herniated disc or spinal stenosis.

Researchers at Hospital for Special Surgery in New York City compared 117 patients who had minimally invasive lumbar decompression surgery and 51 who had minimally invasive lumbar spine fusion surgery. All the procedures were performed by the same orthopedic surgeon.

“Our study is the first of its kind to look at return to activities and discontinuation of narcotic pain medication after single-level lumbar decompression or single-level lumbar spine fusion performed with a minimally invasive technique,” said senior investigator Dr. Sheeraz Qureshi, a spine surgeon at the hospital.

It took the 117 decompression patients a median of three days before they no longer required narcotic pain medication, and seven days for the 51 spinal fusion patients.

Among patients who drove before their surgery, decompression patients took a median of 14 days to resume driving, and 18 days for the fusion patients.

There was no statistically significant difference between the two groups in how long they took to return to work, according to the study.

The findings are important because standard open spinal fusion surgery generally requires a much longer recovery and slower return to activities than standard lumbar decompression, Qureshi noted.

“In our study, all the patients in both groups were able to resume driving and return to work within three weeks of surgery,” he said in a hospital news release.

“When you compare this time frame to that of standard open spinal fusion surgery, it’s really striking. Patients having a standard spinal fusion could take six months or longer for a full recovery,” Qureshi said.

Degenerative conditions of the lower spine are common causes of pain and disability, and surgery may be considered when initial treatments such as medication and physical therapy don’t provide relief.

Lumbar decompression surgery involves removal of a small section of bone or part of a herniated (bulging) disc that is pressing on a nerve. Spinal fusion is a more extensive surgery in which surgeons join two or more vertebrae together, sometimes using screws and connecting rods.

The findings were presented online earlier this year at a virtual meeting of the American Academy of Orthopaedic Surgeons. Data and conclusions released at meetings are usually considered preliminary until peer-reviewed for publication in a medical journal.

More information

The American Academy of Family Physicians has more on low back pain.

SOURCE: Hospital for Special Surgery, news release, June 15, 2020

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What’s the Difference Between Carpal Tunnel Syndrome and Cubital Tunnel Syndrome?

What’s the Difference Between Carpal Tunnel Syndrome and Cubital Tunnel Syndrome?

Carpal tunnel syndrome and cubital tunnel syndrome share similar symptoms, but they are distinct conditions affecting different nerves in the elbow and wrist. 

If you’re experiencing pain and numbness in your fingers, you may assume you have carpal tunnel syndrome. But did you know another condition — called cubital tunnel syndrome — could also be the source of these symptoms?

Both carpal tunnel syndrome and cubital tunnel syndrome result from nerve compression; however, the damaged nerve for each is located in a different part of the body. In cubital tunnel syndrome, the ulnar nerve within the elbow becomes compressed due to injury or repeated bending of the elbow. The ulnar nerve sits inside the cubital tunnel, a passageway consisting of bone, muscle, and ligaments.

On the other hand, the compressed nerve causing carpal tunnel syndrome is the median nerve in the wrist. Repetitive motions of the hand and wrist (such as typing), fractures, and sprains are typically to blame. In addition, chronic conditions such as diabetes and arthritis are considered risk factors for carpal tunnel syndrome.

Despite some similarities — compressed nerves, hand pain, weakness when gripping objects — cubital tunnel syndrome and carpal tunnel syndrome are characterized by several differences. Knowing the symptoms for each can help you identify which condition you may have and determine the right treatment.

Carpal Tunnel vs. Cubital Tunnel

Both syndromes affect the hand and fingers, but the pain, tingling, and numbness of carpal tunnel syndrome is felt most acutely in the thumb, index finger, middle finger, and half of the ring finger. It’s also characterized by pain and burning in the hand and wrist that sometimes radiates up the forearm to the elbow.

Meanwhile, cubital tunnel syndrome is marked by numbness, pain, and tingling in the little and ring fingers as well as the inside of the hand. If you have cubital tunnel syndrome, you may notice these symptoms flare up at night when you bend your elbow for long periods as you sleep.

Diagnosing cubital tunnel syndrome or carpal tunnel syndrome begins with a physical examination. An orthopedist may also perform a nerve conduction study to assess nerve impulses in the wrist or elbow. Weak nerve activity in a certain area could indicate, for example, carpal tunnel syndrome.

Treating the Symptoms

Treatment options differ for each syndrome, although conservative therapies are recommended at first to reduce symptoms and restore function to the hand. Because cubital tunnel symptoms are more pronounced at night, you might be advised to wear a brace that straightens the elbow while you rest. Wrapping your arm in a towel to keep it straight can work as well.

If conservative treatments fail to relieve the nerve compression or muscle wasting is severe, surgery is another option. Two types of cubital tunnel surgery are currently performed: a medical epicondylectomy and an ulnar nerve transposition. In a medial epicondylectomy, the bony bump inside the elbow (the medial epicondyle) is removed. This allows the ulnar nerve to flex and straighten without pain. For an ulnar nerve transposition, the surgeon creates a new cubital tunnel and moves the ulnar nerve to the recreated tunnel.

Treating carpal tunnel syndrome non-surgically usually entails resting the hand, avoiding activities that aggravate symptoms, wearing a splint for several weeks, and applying ice to reduce swelling. Anti-inflammatories and steroids may also be prescribed. Once the pain subsides, you can practice exercises to stretch and strengthen the wrist and hand.

If these conservative treatments don’t alleviate carpal tunnel symptoms, surgery to relieve pressure on the median nerve by cutting the transverse carpal ligament may be necessary. This procedure is followed by physical therapy to strengthen the wrist.

What’s Causing Your Hand Pain?

If you’re experiencing hand and finger pain, you may be suffering from either cubital tunnel syndrome or carpal tunnel syndrome. The doctors at Comprehensive Orthopaedics can diagnose your condition and prescribe the proper treatment regimen. Whether through conservative therapy or surgery, our goal is to help our patients live pain-free. Contact us today for an appointment.

Vigorous Exercise Safe for Those at Risk of Knee Arthritis

Vigorous Exercise Safe for Those at Risk of Knee Arthritis

TUESDAY, May 12, 2020 (HealthDay News) — People at high risk for knee arthritis don’t need to avoid jogging and other types of vigorous exercise, a new study suggests.

Some folks hold back on physical activity because they fear it will increase their chances of developing knee arthritis, so researchers from Northwestern University’s Feinberg School of Medicine in Chicago took a closer look.

“Our study findings convey a reassuring message that adults at high risk for knee [arthritis] may safely engage in long-term strenuous physical activity at a moderate level to improve their general health and well-being,” said study author Alison Chang, associate professor of physical therapy and human movement sciences.

The study included nearly 1,200 people from several U.S. cities, ages 45-79, who were at high risk for knee arthritis but had no evidence of the condition.

Obesity, previous joint injury, surgery, aging and chronic knee symptoms increase the risk of developing arthritis of the knee.

Participants were followed for up to 10 years. Chang and her colleagues found that long-term participation in strenuous physical activities such as jogging, swimming, cycling, singles tennis, aerobic dance and skiing was not associated with risk of developing knee arthritis.

In fact, those who did vigorous exercise had a 30% lower risk of knee arthritis, but that’s not considered statistically significant, according to the authors.

Lots of sitting wasn’t associated with either an increased or reduced risk of arthritis.

“People suffering from knee injuries or who had arthroscopic surgical repair of ACL or meniscus are often warned that they are well on the path to develop knee [arthritis],” Chang said in a university news release.

“They may be concerned that participating in vigorous activities or exercises could cause pain and further tissue damage. To mitigate this perceived risk, some have cut down on or discontinued strenuous physical activities, although these activities are beneficial to physical and mental health,” she said.

The bottom line? “Health care providers may consider incorporating physical activity counseling as part of the standard care for high-risk individuals at an early stage when physical activity engagement is more attainable,” Chang said.

The study findings were published May 4 in the journal JAMA Network Open.

More information

The American Academy of Family Physicians has more on arthritis.

SOURCE: Northwestern University, news release, May 4, 2020

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Do I Have Arthritis?

Do I Have Arthritis?

How do you know if your joint symptoms mean you have arthritis? Only a health care professional can tell you for sure, but certain signs usually point to arthritis. There are four important warning signs that should prompt you to talk to a health care provider.

Warning Signs

1. Pain

Pain from arthritis can be constant or it may come and go. It may occur when at rest or while moving. Pain may be in one part of the body or in many different parts.

2. Swelling

Some types of arthritis cause the skin over the affected joint to become red and swollen, feeling warm to the touch. Swelling that lasts for three days or longer or occurs more than three times a month should prompt a visit to the doctor.

3. Stiffness

This is a classic arthritis symptom, especially when waking up in the morning or after sitting at a desk or riding in a car for a long time. Morning stiffness that lasts longer than an hour is good reason to suspect arthritis.

4. Difficulty moving a joint.

It shouldn’t be that hard or painful to get up from your favorite chair.

What To Do:

 

Your experience with these symptoms will help your doctor pin down the type and extent of arthritis. Before visiting the doctor, keep track of your symptoms for a few weeks, noting what is swollen and stiff, when, for how long and what helps ease the symptoms. Be sure to note other types of symptoms, even if they seem unrelated, such as fatigue or rash.   If you have a fever along with these symptoms you  may need to seek immediate medical care.

If the doctor suspects arthritis, they will perform physical tests to check the range of motion in your joints, asking you to move the joint back and forth. The doctor may also check passive range of motion by moving the joint for you. Any pain during a range of motion test is a possible symptom of arthritis. Your doctor will ask you about your medical history and may order lab tests as needed.

Most people start with their primary care physician, but it’s possible to be referred to doctors who specialize in treating arthritis and related conditions. Getting an accurate diagnosis is an important step to getting timely medical care for your condition.

What’s the Best Treatment for a Child’s Broken Bone?

What’s the Best Treatment for a Child’s Broken Bone?

TUESDAY, Jan. 28, 2020 (HealthDay News) — Fiberglass and plaster casts are widely used to treat broken bones in kids, but they have drawbacks compared with other methods such as braces and splints, experts say.

Doctors and patients should review the available options, considering not only treatment of the fracture, but also patient comfort and compliance as well as the burden on the family, according to a review article in the January issue of the Journal of the American Academy of Orthopaedic Surgeons.

Children “may be eager to get a cast, choosing a color that fits their personality,” said lead author Dr. Eric Shirley, a pediatric orthopedic surgeon at Naval Medical Center Portsmouth in Virginia.

“However, the thrill soon wears off when they learn that they will be unable to play, swim or engage in high-impact activities while wearing a cast. What’s more, complications like itching, blisters or dermatitis associated with cast management can lead to added frustration,” he said in a journal news release.

A cast can also be a challenge for children attending school, and families have to schedule follow-up visits for cast removal. For every 100 pediatric fracture clinic appointments, 54 school days and 25 workdays are missed.

And complications with casts can require emergency department visits that put time and cost burdens on both the family and the health care system.

“Pediatric patients are often seen in the emergency department with issues related to wet or damaged casts,” Shirley said. “These complications can nearly always be addressed during normal clinic hours; however, we find that families do not want to wait or feel anxious when caring for a cast.”

Using alternatives such as braces, soft casts or splints could help reduce patient anxiety, eliminate cast complications, and reduce follow-up visits, care costs and time missed from school and work, according to the review.

These alternatives are acceptable and effective for certain fractures to the forearm, shin, foot or ankle, but are not used not as often as they could be in children, the authors said.

Parents should talk with their orthopedic surgeon about the benefits and drawbacks of the different treatment options for children with broken bones, Shirley advised.

More information

The American Academy of Pediatrics has more on children and broken bones.

SOURCE: Journal of the American Academy of Orthopaedic Surgeons, news release, Jan. 9, 2020

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