by Comp Ortho | Apr 12, 2022 | Knee, surgery
Knee replacement surgery is one of the most common procedures in the United States, with more than 790,000 performed each year.
Deciding the time for knee replacement needs to be determined by you and your doctor, but certain factors make it more likely, according to experts at Keck Medicine of the University of Southern California.
- Bad arthritis. “Osteoarthritis, rheumatoid arthritis and post-traumatic arthritis affect the knee through different mechanisms, however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion,” Dr. Nathanael Heckmann, orthopedic surgeon at Keck Medicine, said in a Keck news release. “When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.”
- When nonsurgical treatments such as medications, steroid injections and physical therapy are no longer effective. “As time passes, these arthritic conditions tend to progress in severity, rendering these types of treatments less and less effective,” Heckmann said.
- Your knee pain prevents you from doing normal activities or caring for yourself. “In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life,” said Dr. Jay Lieberman, chief of orthopedic surgery at Keck Medicine. “If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.”
- Severe knee pain. Especially if it happens even when resting and you can’t sleep.
- Swollen knees. Particularly if your knee is always swollen.
- Your knee has become deformed. If you have advanced arthritis, it can affect the way you walk, which can also lead to further problems elsewhere in your body.
- You’re of a certain age. While knee replacements are done in people of all ages, they’re most common in those older than 60. That’s because younger people’s more active lifestyles may place too much strain on the artificial knee and shorten how long it lasts, and second replacement surgeries may not be as successful.
If you’re thinking about knee replacement surgery, you need to know that you may have to avoid high-impact activities.
“Total knee replacement is quite successful in enabling patients to return to an active lifestyle — patients can perform all types of recreational activities, including hiking, bicycling, skiing, surfing, tennis and golf,” Lieberman said in the release. “In general, we do not limit activities but suggest that patients avoid impact activities on a consistent basis to reduce wear on the prosthesis.”
More information
There’s more on total knee replacement at the American Academy of Orthopaedic Surgeons.
SOURCE: Keck Medicine, University of Southern California, news release, January 2022
Copyright ©2022 HealthDay. All rights reserved.
by Comp Ortho | Jan 18, 2022 | Hand, pain, surgery, Wellness, Wrist
Carpal tunnel can be a painful and even debilitating orthopedic condition. But it’s one that can be prevented with some simple lifestyle changes.
Carpal tunnel syndrome, a progressive condition marked by pain, numbness and tingling in the hands and wrists, is an extremely common condition. While it is most often associated with typing on a computer, carpal tunnel syndrome can strike anyone who performs repetitive tasks with their hands, such as cashiers, knitters, and assembly line workers. Or it can occur after an injury to the wrist or hand. Some pre-existing conditions, like diabetes and rheumatoid arthritis, are also associated with a greater incidence of carpal tunnel syndrome. Additionally, women tend to suffer from the condition at higher rates than men because their carpal tunnels are smaller.
That’s relevant to the condition because, as the name suggests, carpal tunnel syndrome is directly related to the carpal tunnel. In carpal tunnel syndrome, your median nerve, which spans the length of your arm and ends in the wrist, becomes compressed due to any of the reasons described above. That median nerve passes through the carpal tunnel, a narrow pathway of bone and ligament at the base of your hand, which is the reason for the condition’s name. Because the nerve controls the movements of your fingers apart from the pinky, the first sign of carpal tunnel syndrome is typically a tingling or numb sensation in the fingers. Some people may also experience pain and a burning sensation radiating up their arm to their elbow in addition to a weak grip.
6 Tips to Prevent Carpal Tunnel Syndrome
Obviously it is best to avoid carpal tunnel syndrome if at all possible. The good news is that you don’t have to switch jobs or give up your hobbies to avoid carpal tunnel syndrome. You can take measures to ward off the condition before the pain starts. Check out these 6 tips for ways to stop carpal tunnel syndrome in its tracks:
Go for a Neutral Wrist Position. Avoid bending your wrists sharply up or down whenever possible, including when you’re at work or simply in your daily life. Such exaggerated positions stress the nerve. Lift the pressure off by keeping your wrist in a straight, neutral alignment.
Lighten Up. You probably don’t realize it, but you may be striking your keyboard too hard. Go for a lighter touch and relax your hand and wrist as you type.
Take a Break to Stretch. Stopping your task for 10 to 15 minutes gives your hand and wrist a chance to rest. But make good use of your break time by stretching your wrist! One good exercise to try is to make a fist then release your fingers and fan them out. Stretch them as far as possible. Repeat 5 to 10 times.
Switch Hands. If you always perform a task with one hand, switch to the other if you can. This gives each hand and wrist a break from a continual and stressful motion. Of course this isn’t always possible, but make a point of switching wherever you can.
Change Your Desk Setup. How your desk and chair are arranged may be causing extra strain on your wrists. Ideally, you want your desk, chair, and keyboard to be arranged so that your forearms line up with your work surface. The idea is to avoid bending your wrists as much as possible. Also try to keep your elbows tucked to your sides when working at a desk.
Stay Warm. Cold air stiffens up joints and muscles. Although you may be unable to control the office thermostat, you can slip on a pair of fingerless gloves to keep your hands warm and limber.
Treating Carpal Tunnel Syndrome
If you suspect you have carpal tunnel syndrome, it’s time to go to the orthopedist for a proper diagnosis and treatment. Your orthopedist will begin by performing a number of physical tests to assess any nerve damage. Once they’ve assessed the extent of the condition, treatment can begin.
Carpal tunnel syndrome treatments typically begin with recommendations of conservative therapies including:
- Avoiding repetitive motions for two weeks or more.
- Applying ice packs to reduce swelling.
- Taking non-steroidal anti-inflammatories medications.
- Wearing a brace for four to six weeks to keep the hand and wrist immobile.
- Working with a physical therapist on strengthening and stretching exercises after pain subsides.
In severe cases not helped by conservative treatments, your doctor may recommend carpal release surgery. In this procedure, the transverse carpal ligament is dissected to release pressure on the median nerve and enlarge the carpal tunnel.
Don’t Live with Wrist Pain
Healthy hands and wrists are critical when it comes to performing important functions in your everyday life. So don’t let pain stop you from doing your job or enjoying your hobbies! If you believe you may have carpal tunnel syndrome, it’s important to see a specialist right away to get to the bottom of the condition. The orthopedists at Comprehensive Orthopaedics can diagnose your condition and discuss treatment options with you to get you pain-free once again.
by Comp Ortho | Aug 18, 2021 | anatomy, Elbow, Exercise, pain, surgery, Wellness
Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities besides sports can also put you at risk. Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists and, in some cases, surgeons work together to provide the most effective care.
Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles, where several muscles of the forearm begin their course. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.
Muscles, ligaments, and tendons hold the elbow joint together.
Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).
Overuse
Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.
The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.
Activities
Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle or repetitive extension of the wrist and hand.
Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.
Age
Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.
Unknown
Lateral epicondylitis can occur without any recognized repetitive injury. This occurrence is called “idiopathic” or of an unknown cause.
The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.
Common signs and symptoms of tennis elbow include:
- Pain or burning on the outer part of your elbow
- Weak grip strength
- Sometimes, pain at night
The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however, both arms can be affected.
DISEASES & CONDITIONS
Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)
STAYING HEALTHY
Warm Up, Cool Down and Be Flexible
RECOVERY
Therapeutic Exercise Program for Epicondylitis (Tennis Elbow / Golfer’s Elbow)
Your doctor will consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.
Your doctor will talk to you about what activities cause symptoms and where on your arm the symptoms occur. Be sure to tell your doctor if you have ever injured your elbow. If you have a history of rheumatoid arthritis or nerve disease, tell your doctor.
During the examination, your doctor will use a variety of tests to pinpoint the diagnosis. For example, your doctor may ask you to try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, it tells your doctor that those muscles may not be healthy.
Tests
Your doctor may recommend additional tests to rule out other causes of your problem.
- X-rays. These tests provide clear images of dense structures, such as bone. They may be taken to rule out arthritis of the elbow.
- Magnetic resonance imaging (MRI) scan. MRI provides images of the body’s soft tissues, including muscles and tendons. An MRI scan may be ordered to determine the extent of damage in the tendon or to rule out other injuries. If your doctor thinks your symptoms might be related to a neck problem, he or she may order an MRI scan of the neck to see if you have a herniated disk or arthritic changes in your neck. Both of these conditions can produce arm pain.
- Electromyography (EMG). Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.
Nonsurgical Treatment
Approximately 80% to 95% of patients have success with nonsurgical treatment.
Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop or decrease participation in sports, heavy work activities, and other activities that cause painful symptoms for several weeks.
Medications. Acetaminophen or anti-inflammatory medications (such as ibuprofen) may be taken to help reduce pain and swelling
Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulation techniques to improve muscle healing.
Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.
Steroid injections. Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject the painful area around your lateral epicondyle with a steroid to relieve your symptoms.
Platelet-rich plasma. Platelet-rich plasma (PRP) is a biological treatment designed to improve the biologic environment of the tissue. This involves obtaining a small sample of blood from the arm and centrifuging it (spinning it) to obtain platelets from the solution. Platelets are known for their high concentration of growth factors, which can be injected into the affected area. While some studies about the effectiveness of PRP have been inconclusive, others have shown promising results.
Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promotes the body’s natural healing processes. Shock wave therapy is considered experimental by many doctors, but some sources show it can be effective.
Equipment check. If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.
Surgical Treatment
If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery.
Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.
The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs. Talk with your doctor about the options. Discuss the results your doctor has had, and any risks associated with each procedure.
Open surgery. The most common approach to tennis elbow repair is open surgery. This involves making an incision over the elbow.
Open surgery is usually performed as an outpatient surgery. It rarely requires an overnight stay at the hospital.
Arthroscopic surgery. Tennis elbow can also be repaired using miniature instruments and small incisions. Like open surgery, this is a same-day or outpatient procedure.
Surgical risks. As with any surgery, there are risks with tennis elbow surgery. The most common things to consider include:
- Infection
- Nerve and blood vessel damage
- Possible prolonged rehabilitation
- Loss of strength
- Loss of flexibility
- The need for further surgery
Rehabilitation. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed.
After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery.
Your doctor will tell you when you can return to athletic activity. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80% to 90% of patients. However, it is not uncommon to see a loss of strength.
by Comp Ortho | Jun 28, 2021 | Knee, pain, surgery, Wellness
ACL tears are common in physical activities that involve quick stops, changes in direction, or direct contact with the knee. Knowing the symptoms of ACL tears can help you recognize an injury and prevent it from getting worse. Explore our guide to learn how to tell if an ACL is torn and the procedures a knee specialist can perform to help you get back on your feet faster.
Signs & Symptoms of ACL Injuries
Individuals who suffer an ACL tear often note an audible “pop” or snapping sound as the injury happens. The onset of symptoms is immediate and usually accompanied by:
- Decreased range of motion in the knee
- Rapid swelling
- Severe pain, soreness, and tenderness along the joint
- Instability and discomfort while walking
ACL injuries usually occur during sports and fitness activities that can put stress on the knee. This includes movements like:
- Pivoting with your foot firmly planted
- Suddenly slowing down and changing direction
- Stopping suddenly
- Landing awkwardly from a jump
- Receiving a direct blow to the knee
There are three levels of ACL injuries, which are classified by the amount of damage to the ligament (partial or complete tear). A grade 1 sprain, for example, is when the ACL is stretched but not ruptured. While a grade 3 sprain means the ACL is torn into two pieces, rendering the joint completely unstable.
When To Seek Treatment
If you are experiencing symptoms of an ACL tear, you should schedule an appointment with a knee specialist. They will conduct a physical exam in order to determine the extent of the injury. An X-ray may also be performed to assess if there is damage to the surrounding bone, but MRI will ultimately be the deciding factor in treatment.
Rehabilitation can be the first step in the recovery process with the goal of regaining full range of motion. You may spend several weeks working with a physical therapist who will develop a custom exercise program centered around your unique needs and symptoms.
However, ACL reconstruction surgery is often recommended if the ligament is injured or the injury is causing your knee to buckle during everyday activities. During the procedure, a surgeon will remove the damaged ligament and replace it with a new segment of tendon which recreates the ACL. This replacement tissue — called a graft — can be taken from your own patellar, hamstring, quadricep, or cadaver tendons.
The surgery is typically done using a minimally invasive, arthroscopic approach. Special surgical tools and a video camera are inserted through small incisions in the knee joint. The graft is then secured to the tibia (shin bone) and femur (thighbone) using sutures (special surgical thread) or screws depending on the type of graft. This acts as a bridge for the new ligament to grow on and reconnect the bones.
Recovery time varies based on the severity of the injury. Your doctor will recommend physical therapy in order to regain full range of motion, strength, and stability in the affected knee in the weeks and months that follow. Regular follow-up visits with your knee specialist and physical therapists are necessary to assess progress and readiness to return to your favorite activities.
Understanding the common symptoms of ACL tears can help reduce the risk of injury while playing your favorite sports. If you find yourself with pain or injury, CompOrtho offers top-level care to help you get on the road to recovery quicker. To learn more about injury prevention or make an appointment, contact us today!
by Comp Ortho | Jun 14, 2021 | surgery, Wellness, Wrist
Triangular fibrocartilage complex tears are painful and can affect a person’s ability to use their hand or wrist. But what is a TFCC tear exactly? And how is this injury treated? Understanding what this injury is and how to identify its symptoms can help you resume a pain-free life faster. Explore our guide to TFCC tears and learn how a wrist specialist can help you regain mobility in your wrist.
What Is a TFCC Tear?
The triangular fibrocartilage complex (TFCC) connects the hand and forearm bones to form the wrist. Your TFCC is made up of several ligaments, tendons, and cartilage. It helps your wrist move and stabilizes the forearm when gripping something with your hand or rotating your forearm. A TFCC tear is any injury or damage to this area. There are two types of TFCC tears:
- Type 1: These tears result from a physical injury. This often occurs when a person overextends their wrist or falls on their hand with it extended.
- Type 2: These tears occur gradually and can result from damage due to aging or an underlying health condition, gout or rheumatoid arthritis.
TFCC tears commonly cause pain in the wrist. The pain may be constant or only appear when you apply pressure to your wrist or move it. Other symptoms of a TFCC tear can include:
- Weakness or stiffness in the wrist
- A limited range of motion in the hand or wrist
- Wrist swelling
- Loss of grip strength
- A clicking or popping sound when you move your wrist
Athletes who regularly put pressure on their wrists — like tennis players or gymnasts — have a higher risk of developing a TFCC tear. You are also at a higher risk of a TFCC tear if you have previously injured your wrist.
TFCC Tear Treatment
If you suspect a TFCC tear, the first thing you should do is temporarily stop doing any activities that cause wrist pain to allow the injury to heal. You might need to wear a cast or splint to prevent your wrist from moving. Your wrist specialist will also likely recommend physical therapy. This involves doing gentle exercises to rebuild strength in your TFCC. If non-surgical treatments don’t provide any relief, you may need surgery to repair the tear.
Surgery to treat a TFCC tear involves a minimally invasive procedure called a wrist arthroscopy. During the surgery, your doctor will make several small incisions on the wrist’s outer edge to repair the damaged portion of the TFCC. Sometimes, they may also shorten the ulna — a long bone in the forearm — to alleviate your symptoms. You must wear a cast for a few weeks after the procedure to allow the area to heal.
Recovery usually takes a few weeks for TFCC tears that don’t require surgery. However, it may take anywhere from a few weeks to several months before you regain full use of your wrist if you do need surgery. Doing physical therapy and avoiding activities that strain your wrist can help speed up your recovery time.
by Comp Ortho | Apr 28, 2021 | Ankle, pain, surgery, Wellness
Do you have an ankle sprain or an ankle fracture? Learn how to spot the signs for each condition.
Considering how much weight our ankles carry and the mobility this hard-working joint provides, it’s not surprising that ankle sprains and fractures are quite common. Sports injuries, car accidents, and bad falls can wrench the ankle joint out of alignment and result in either a fracture or a sprain. But how do you know which one it is?
Severe pain, swelling, and impaired mobility all indicate significant ankle trauma. An orthopedic specialist can determine with an X-Ray or other imaging tests whether your ankle is sprained or broken. But before you book your appointment, here are some clues as to which injury you may have suffered.
Ankle Sprain Vs. Fracture
Both injuries cause similar symptoms — pain, swelling, and an inability to put weight on the joint. At the same time, there are some key differences. It’s important to know these differences and get a quick diagnosis so you can receive the proper treatment.
Ankle Fracture. Your ankle consists of three main bones: the tibia (shinbone), fibula (lower leg), and the ankle bone (talus). All three join together at the ankle to give the joint its wide range of motion. Ankle fractures occur most often due to a car accident or a severe fall that breaks or chips one or all three bones. A swollen, painful ankle is a sign of an ankle fracture, particularly if the area over the ankle bone is tender to the touch. If you’ve fractured your ankle, you may also experience numbness in your toes and notice your ankle appears misshapen. An ankle fracture is usually accompanied by a cracking sound.
Ankle Sprain. Holding the ankle bones together is a network of flexible but strong ligaments. When those ligaments are stretched or twisted beyond their normal range of motion, they can become strained, partially torn, or completely torn. Soreness, tenderness, bruising, swelling, stiffness, and pain when trying to put weight on the ankle are signs of an ankle sprain. Depending on the severity of the sprain, you may hear a popping sound, although in most cases there is no discernable sound. If you feel pain when you touch the soft part of the ankle, it’s most likely a sprain.
How to Treat Ankle Fractures and Sprains
An immediate diagnosis of either a sprain or fracture prevents the injury from worsening and doing more damage to the ligaments or bones. Do not delay treatment if you think you’ve broken your ankle, or your ankle sprain doesn’t improve in a day or two.
Treatment for an ankle sprain begins with the PRICE method: Protecting the ankle from further harm, Rest, Ice, Compression, and Elevation. You may need to wear to a brace to support the ankle and use crutches to take weight off the joint as you heal. Over-the-counter pain medications can alleviate the discomfort. Mild sprains clear up in about two weeks, but it may take longer for more significant sprains to heal. Surgery is not recommended unless there is a severe ligament tear. Physical therapy can also help restore flexibility and range of motion to the joint.
How an ankle fracture is treated depends on whether the bone is stable — meaning it’s broken but not out of alignment — or knocked out of place. A stable fracture can heal in about six weeks immobilized in a cast. If the bones are shattered into small bits and/or out of place, surgery may be necessary to attach the bones together with plates, screws, rods, or wires in a procedure known as reduction. Similar to ankle sprains, treatments for fractures include PRICE, taping around the ankle or a boot to stabilize the joint, crutches while walking to reduce pressure on the ankle, and physical therapy to strengthen and increase flexibility in the joint.
Treat Your Ankle at Comprehensive Orthopaedics
Ankle injuries can be especially debilitating. Fortunately, the physicians at Comprehensive Orthopaedics have years of experience in diagnosing and treating orthopedic injuries like ankle sprains and fractures. We use the latest equipment and techniques to quickly heal your ankle. Contact us today to set up an appointment.
