November 17, 2016
Flat feet problems? Ankle, knee, or toe pain? Custom orthotics may help.
Custom orthotics are exactly that: one-of-a-kind shoe inserts or ankle braces molded just for you. They can relieve pain and discomfort in the foot and correct deformities. They can also provide stability and improve performance of the ankle and knee joints, especially during high injury-risk activities like sports. A custom orthotic is better quality than a standard off-the-shelf orthotic and usually lasts longer.
A board certified orthopedic doctor specializing in foot and ankle care is the best type of medical professional to diagnose and treat problems in that area. Why not just go straight to a physical therapist or podiatrist? Orthopedic doctors have earned a medical degree and trained extensively to evaluate the entire body from a medical perspective. That means, for example, they can properly diagnose a pain in the lower leg that turns out to stem from the hip, knee, or back. Other types of practitioners don't have the training to find the problem at its root like that.
While many of our patients have benefited from custom orthotics, many more have been helped with other solutions. A well-informed stretching or physical therapy regimen prescribed by an orthopedic doctor, ice, rest, anti-inflammation medications, or less commonly, surgery, may be just as effective or better in many cases. The only way to know is to see a doctor who can give the most comprehensive medical diagnosis.
October 26, 2016
"Ouch—I feel an electric shock down my arm!"
Nerves that are trapped or damaged send painful or tingling distress signals to the brain. Many different conditions in the shoulder or arm can cause these symptoms. However, a distinct electric shock feeling running through the shoulder down to the hand is called a burner or stinger. It can only be caused by a few things.
1. Most commonly, athletes in contact sports suffer from burners and stingers. Football players who get tackled to the ground onto their head and shoulder, or wrestlers who get "taken down" onto their head/shoulder/neck area are often affected.
2. Any kind of other accident or trauma that forcefully pushes the head and neck to the ground or a hard surface can also be the culprit: a bicycle or auto accident, for example.
These first two scenarios do the same thing to the nerves in the neck. By forcefully squishing the head down and sideways against something hard, the head stretches away from the arm and shoulder. The nerves connecting them get stretched too far and start sending pain signals. These signals can last for a few seconds, minutes, hours, or even days. If they last for days or become more frequent or worse, it's time to see an orthopedic doctor.
3. Anyone who hasn't had trauma but is still experiencing burners and stingers should also head to the doctor because spinal problems can also cause this type of pain. Neck pain, prolonged weakness, or stinging and burning in both arms may also be cause for concern.
A board certified orthopedic doctor specializing in sports medicine or the shoulder and arm area is the best medical option for properly diagnosing and treating pain from burners and stingers. He or she will start by asking questions and may order x-ray or MRI imaging to rule out other possibilities, depending on the situation. Physical therapy may be prescribed to help with strength and motion.
September 15, 2016
Why do joints hurt more with age? Mice may have an answer...
Osteoarthritis affects approximately 27 million Americans. It's the gradual degradation of cartilage, which is essential for cushioning our joints. Damaged, inflamed, and weak cartilage causes pain. But what causes the cartilage to wear out as we get older?
Researchers at the Mayo Clinic in Rochester, MN found that mice who had senescent cartilage cells injected into their knee joints displayed symptoms of osteoarthritis. Mice who received injections of non-senescent cartilage cells were free from the symptoms.*
Senescent cells are cells that have stopped dividing, or simply put, stopped doing a good job. As we age we get more of these low-performing cells and they build up in joint cartilage (and elsewhere in the body), causing the cartilage to underperform.
Now that the study has found a causal link between senescent cells and osteoarthritis, it's up to the field of medicine to figure out if targeting those cells will help people get better, and if so, how. While we watch and wait for the research to move in the right direction, there are great treatments for osteoarthritis available today. Anti-inflammatory medications, injections, physical therapy, lifestyle changes, orthotics, and in more advanced cases, surgery, can greatly improve symptoms.
A well-trained and experienced board certified orthopedic doctor and surgeon is the best health professional to properly diagnose and treat osteoarthritis. He or she can set up a custom treatment plan that works for your lifestyle and goals. It will be based on your health history, a thorough examination, and you and your doctor's opinions about how best to proceed. It's most common to start with conservative treatments and if you don't respond well to those, move toward injections or surgery. Everyone is different, but our doctors are committed to improving your symptoms as much as possible. Many patients end up pain free and others improved and able to do more activities they love.
August 15, 2016
"My knee pain moves around. Will my doctor think I'm crazy?"
Knee pain that moves around all over the place is just your body telling you to adjust your movements a little here, a little there. Hopefully you'll find a place of comfort within a short amount of time. Knee pain that's getting worse all over can be wear and tear from osteoarthritis, or a symptom of repetitive overuse. Knee pain that moves around the FRONT of the knee but can't be exactly pinpointed may be Patellofemoral Pain Syndrome (PFPS). It can be more bothersome than other types of "moving" knee pain because it affects such a large area.
PFPS affects the kneecap (patella), which covers a large portion of the front of the knee. Since the kneecap moves around, so does the pain. Jumping, running, climbing stairs, kneeling, sitting for too long, and many other activities can cause pain and stiffness. There are all sorts of structures that make the kneecap work correctly: two large tendons above and below it, and cartilage, tissue, and a fat pad underneath it. When any of these fail to provide the right motion or cushion, pain starts to develop. Overtraining is one of the most common causes.
Because PFPS can also be caused by misalignment somewhere else in the legs, it's important to see a knowledgable and experienced doctor. During your initial examination, he or she will look at your body alignment and ask about other musculoskeletal problems to see if the underlying problem starts in another joint.
Once diagnosed, treatment for PFPS is often straightforward. An orthopedic doctor specializing in joint problems and/or sports medicine can diagnose knee pain correctly and set up a treatment program customized to your exact situation. If you are an athlete, you may be able to cut back and change your training for a while instead of having to give it up altogether. The doctor can work with a licensed physical therapist to make sure you are strengthening the knee area safely and effectively and not causing further injury. Anti-inflammatory medication, ice, injections, and other conservative treatments may also be helpful if you and your doctor decide they're right for you. Surgery is rare and usually only for those who don't respond to conservative therapies.
PFPS is an active area of orthopedic research. Seeing a doctor who stays up to date on current studies will help you get the smartest treatment.
July 15, 2016
"My hip makes a snapping sound when I move it, and I can feel it pop. Is this a serious problem?"
The large muscles and tendons in the hip sometimes become so tight that they pop and make snapping sounds when they move over the bony surfaces of the hip joint. As long as it doesn't hurt, it's not considered a serious problem and probably doesn't need medical attention. It can, however cause painful swelling of the hip bursae, which are the little fluid-filled sacs that add cushion in the hip. Their job is to be the pain-free buffer zone between bones and the muscles and tendons that rub over them. When they're unable to do this, they become painful and swollen, causing a condition called bursitis.
Snapping hip can be felt in the back or front of the joint. There is a large tendon in the front of the hip that moves back and forth over the top of the thighbone from front to side. There is a smaller tendon in front of the hip that can catch on the bony structures as well. The hamstring muscle can catch on the "sit" bones in the back of the hip. Snapping in any of these three places would be felt and/or heard.
A more serious cause of snapping hip may be damaged cartilage. Torn cartilage catching on the inner structures of the hip joint can become extremely painful to the point of no longer being able to walk. Pain that interferes with daily living should be addressed by a doctor. Earlier treatment may put off surgery or help avoid it altogether, although every patient is different.
Athletes of any age who participate in repetitive hip-bending activities may be prone to snapping hip, but adolescent athletes are especially prone because muscles can be tight during growth years. Dancers are also particularly prone to the condition. An orthopedic doctor specializing in the hip area or sports medicine has a lot of experience helping patients with this condition. To properly diagnose it, he or she will want to know what activities bring the pain on, will take a health history, and will probably x-ray the area to rule out bone problems.
Physical therapy, special stretches, anti-inflammatory medication, injections, activity modification, rest, and ice are all common nonsurgical treatments to alleviate pain associated with snapping hip issues. Surgery may be necessary if these treatments fail or if cartilage needs to be repaired.
June 23, 2016
Type with Straight Wrists. Jackhammer Less.
(And Cyclists, Change Hand Position Frequently.)
The ulnar nerve is a common culprit for numbness and tingling in the hand. If it's constricted in the wrist area, the pinky side of the hand can become numb and tingly. The thumb and forefinger can lose pinching strength when the muscle between them becomes atrophied as well. These symptoms develop gradually and can be a result of repetitive tasks irritating the nerve (such as typing with bent wrists, jackhammering, and similar actitivites), putting too much prolonged pressure on a bent wrist (such as long bicycle rides), or most often, a small ganglion cyst that develops in the wrist area and puts pressure on the nerve.
This condition is called Ulnar Tunnel Syndrome of the Wrist. It should be properly diagnosed and treated by an orthopedic doctor specializing in hand, wrist, and arm problems. Because the ulnar nerve runs from the neck to the fingers, the doctor will likely examine the elbow as well. Other symptoms he or she may look for during the examination include dry skin between the fingers and tingling in the hand when certain spots are tapped. MRI imaging can show a cyst. X-ray imaging can reveal a bone fragment. Either of these can be blamed for the symptoms. And even if you don't know exactly what's wrong, symptoms that are getting worse are usually worth a trip to the doctor.
Treatment for Ulnar Tunnel Syndrome depends on the cause. Since most cases are caused by a cyst, which must be removed surgically, seeing an experienced, well-trained hand surgeon is recommended. If the condition is brought on by activities, the doctor will likely advise changing them to reduce or eliminate pressure on the nerve. Anti-inflammatory medications, ice, and a period of rest are also common treatments.
May 26, 2016
"My hands are clumsy and my arm feels weak!"
A narrowed, irritated, or compressed spinal canal in the neck area can cause a variety of problems in the upper extremities. One or both arms, shoulders, or hands may feel weak or not seem to function properly. It can be harder to button a shirt or hold onto things, especially smaller objects. Pain from the neck to the arms and hands may be present, as well as numbness. Even the legs and feet can be affected, causing unsteadiness and the need to hold onto something while walking. It may feel like the brain doesn't quite know exactly where the arms and legs are located in the space around the body. More extreme cases can result in decreased bowel and bladder control.
Depending on your exact symptoms and examination results determined by your orthopedic spine doctor, a diagnosis of cervical (neck) spinal stenosis, cervical spinal myelopathy, or cervical spinal radiculopathy are most likely. These conditions tend to come on gradually because narrowing or irritation in the spinal canal is most common with age-related factors. This includes arthritis, bone spurs, and years of poor posture or other activities that stress the spine. The conditions can also be brought on or exacerbated by trauma such as crashes or serious falls.
Treatment for problems caused by spinal canal narrowing, irritation, and compression is not usually surgical. Medication, physical therapy, injections, posture coaching, activity modification, and ice can relieve symptoms. More pronounced symptoms will need more intervention and for longer, so see your doctor sooner if possible. An orthopedic spine specialist will be able to properly diagnose and treat neck and back problems with great expertise. He or she will approach your concerns with a caring attitude and have the knowledge to create a treatment plan with options for your lifestyle and needs.
March 14, 2016
Did "Popeye" need an orthopedic doctor?
The 1960's cartoon sailor was famous for "popping" his biceps up after consuming a can of spinach. To an orthopedic doctor, however, he looked like the next patient about to walk in the door. Anyone whose biceps tendon has just torn, or popped and curled up is probably in a lot of pain. That damsel in distress will have to wait...sorry, Olive Oil!
The biceps are the strong upper arm muscles on the inside of the arm. They can tear or detach at the elbow or shoulder after a trauma such as falling on an outstretched arm, throwing something with great force, or lifting something too heavy. Overuse can also cause a tear or rupture of the biceps, especially if the patient uses the arm and shoulder for a lot of overhead motions. This means that the older a person is, the higher the risk for this type of injury.
The symptoms of a biceps tear or rupture are usually obvious to a good orthopedic doctor:
• loss of strength in the biceps
• pain/difficulty turning the palm up and down
• a "pop" sound at the time of injury
• sharp pain at the time of injury
• pain, bruising, and swelling after
• cramping of the biceps when strained
Treatment depends on a patient's lifestyle needs. Sometimes less active, older patients don't need to regain full strength in the arm. If this is the case, the biceps may be left alone. In time, the muscles will atrophy (shrink) from lack of use, and the arm will still work but remain weaker than it was before. After the initial injury, the pain is managed until it goes away, and no further intervention is likely needed. Patients who need to regain strength should see an orthopedic doctor right away, as the muscles can be difficult to treat or reattach if left damaged too long.
February 22, 2016
"Should I live with the pain or have surgery?"
Any one of our doctors will tell you that in almost every instance, their patient tells THEM when it's time for surgery, not the other way around. While serious trauma like fractures or other extreme injuries often require surgery immediately, most orthopedic conditions happen gradually or just aren't bad enough to have to rush to the doctor.
All of the TOSMG doctors are very skilled surgeons, yet approximately 10% or less of their non-trauma patients actually end up having surgery. There are many, many options for treating orthopedic pain. These options can either prevent surgery altogether (this happens a lot!) or put it off for months or years. This responsible, well-informed type of medicine creates important time and space for patients to decide what's best for themselves and their families.
One of the things our doctors are known for is listening. Another is investigating the whole health story of every patient and finding the best treatment program for each. Activities, lifestyle, and diet profoundly affect the body's musculoskeletal system. A course correction from an excellent doctor can make all the difference toward living a healthier life.
Here are some of the most common non-surgical treatment options you and your doctor can use to help you:
• Activity Modification
• In-Office Physical Therapy and Home Therapy Instructions
• Anti-inflammatory Medications
• Steroid Medications or Injections
• Joint Lubrication Injections
• Platelet-Rich Plasma Therapy
• Braces and Orthotics
• Environment Modification
January 22, 2016
Who's at risk for a hip fracture?
A hip fracture is actually a break at the top of the thigh bone, just below the hip socket. These types of injuries are painful and very serious. Someone with a broken hip cannot walk. Most hip fractures happen when someone with low bone density falls or was injured in an auto accident.
Women with small builds over the age of 65 are by far the most at risk for hip fractures. Genetics, family history, and hormones also play a part. However, even if you or a loved one have some or all of these risk factors stacked against you, there are several effective ways to reduce the chances of getting a hip fracture. Here are some of the best ones:
• Diet: Eat a healthy diet with enough calcium and Vitamin D. If your diet alone doesn't provide enough, your doctor may recommend calcium supplements. Make sure to take the correct amounts—too little won't help your bones enough; too much can cause other health problems.
• Exercise: Even moderate exercise, such as stair climbing, jogging, hiking, swimming, and many others, slows bone loss and increases muscle strength around the hip area, which stabilizes and protects the bones. Weight bearing exercises are especially helpful because the bones respond by building themselves stronger, increasing bone density.
• Balance/Stability: Having good balance reduces the likelihood of falling. There are many balance training exercises that can improve the body's stability. Some medications can cause dizziness or fatigue, so be aware of any side effects that could increase the chance of falling.
• Other Hip Problems: Be aware of any other problems in the hip or back that could contribute to poor posture or add stress to the hip bones. A board certified orthopedic doctor can help diagnose and treat those conditions, and in turn reduce the risk of a future hip fracture.