Shoulder Pain

From time to time, local news outlets tackle the topic of shoulder pain, digging into the causes and treatments for this common condition. One recent video offered a nice overview of the different ailments that commonly strike the shoulder, and a look at some common orthopedic surgery procedures we have at our disposal.

As the article states, we have come a long way in our treatment and management of shoulder symptoms. Today some of the best shoulder surgeons can return patients to full function in a matter of months:

Now, with minimally invasive arthroscopy techniques, orthopedic surgeons are able to reattach the tendon to the bone, with the goal of restoring strength and function to the shoulder. . . . Fortunately, due to the advancements in shoulder replacement surgery, surgeons are able to relieve patients’ pain, remove bone spurs and restore their function.

To learn more about how you can treat and manage shoulder pain with shoulder surgery here in San Diego, please contact my offices today.

Hip pain is extraordinarily common among cyclists, runners, and dancers, and a variety of other types of athletes.  Although hip pain is difficult to endure, athletes that sustain an injury resulting in groin pain should be particularly cautious, as that may be a sign of bigger injuries to come.  Labral tears and femoral stress fractures seen amongst triathletes in San Diego is of particular concern.

Fred Jackson has been one of the most underrated players in the NFL for quite some time now. He is consistently productive despite being considered “too old” to be successful at the running back position. He is the oldest running back on any active roster and he was having another solid year for the Buffalo Bills. Unfortunately Jackson suffered an injury to the groin area and is expected to miss a month of football.

Groin injuries are actually one of the less common sports injuries as they only account for roughly 5% of all sports injuries. The groin area is very large and very anatomically complex, which can make diagnosing groin injuries a difficult task. To boot, it is pretty common to have two or more groin related injuries simultaneously. This can make the diagnostic process very frustrating for athletes. Luckily for Jackson, the Buffalo Bills’ orthopedic physicians were able to diagnose this rather quickly. Jackson has a torn adductor longus. The adductor longus is a muscle that connects to the femur and the superior pubic ramus. Jackson’s adductor longus was separated from the bone by about a centimeter causing the 33-year-old running back to be carted off the field.

The symptoms of a groin injury such as Jackson’s include severe stabbing pain, swelling, bruising, inability to move the leg across the body, loss of muscle strength, and muscle spasms. While this seems like a rather serious injury, rehabilitation can usually heal a torn adductor longus completely within 10 weeks. The likely course of action for Jackson is about a week or two of resting, ice, compression, and immobility. After that, he can begin doing stretching and strengthening exercises.

As I mentioned earlier, groin injuries are difficult to diagnose and I thought it would be appropriate to take a look at another common sports injury of the groin area: Torn hip labrum.

 Hip

The hip labrum is a ring of cartilage that sits between the ball and socket joint of the hip. This objective of the hip labrum is to securely hold the ball of the femur head into the socket of the pelvis. Unlike Jackson’s injury, the symptoms of a hip labrum tear can be acute and sometimes even unnoticeable. The symptoms that are reported are typically a locking, catching, clicking of the hip joint, as well as some pain, stiffness, and decreased range of motion. One particular case of this occurred last year to then Seattle Seahawks wide receiver Percy Harvin. Harvin actually ended up missing almost the entire season due to a slight tear of the hip labrum. Unlike the adductor longus tear Fred Jackson suffered, Harvin required surgery to repair his torn labrum. More and more orthopedic surgeons are opting for arthroscopic surgery to smooth off and repair a torn labrum. Once surgery is complete, patients often will need to stay on crutches for about one to two months until limp has completely subsided. At this point physical therapy is required to restore strength and mobility.

The onset of hip pain may be out of your control.  According to a recent study, babies with low birth weights and those born prematurely are at greater risk of developing hip pain, and eventually needing hip replacement surgery.

They are more likely to be diagnosed with conditions like hip arthritis, which can cause severe hip pain and decreased range of motion in the joint, Australian researchers found.

The study involved 3,604 patients, 116 of whom required knee replacement,  the New York Times reported in its “Well” blog. Seventy-five of the participants were osteoarthritis sufferers, older than 40, who underwent hip arthroplasty. The results were published in the online library “Arthritis Care & Research.”

The researchers took into account factors like age, gender, body-mass index, education level, hypertension, smoking and physical activity. They concluded that premature or preterm birth (defined as three weeks sooner than a normal 40-week pregnancy) doubled the odds of needing hip replacement as an adult. The risk for low birth-weight babies was 250% of the average patient. No link to knee replacement was determined.

“The reasons are unclear, but there is some evidence that prematurity and low birth weight can result in abnormal hip development or lower bone mineral density,” the Times reported. Nicholas Bakalar’s blog noted that the study marks the first time that premature birth has been associated with hip arthritis.

“There isn’t enough evidence now to change practice, but we know that congenital hip disease in children can proceed to osteoarthritis later,” the study’s senior author, Dr. Flavia M. Cicuttini of Monash University in Melbourne, told Bakalar. “It may be that eventually we will introduce simple interventions for all premature infants, like the double-diapering that is now recommended for much more serious congenital hip deformations.”

The conditions that are most often responsible for hip pain are:

1. Hip arthritis, which results from the deterioration of cartilage that covers the pelvic and femur bones that join to form the joint. This protective lining wears away, causing the inflammation that leads to osteoarthritis.

2. Hip bursitis, which occurs when bursa sacs that lubricate the hip joint and surrounding muscles become inflamed from injury or overuse.

3. Muscle strain, which can result from irritation or overuse of any of the three muscle groups that enable the hip to make its various movements.

4. Nerve irritation, such as sciatica, which features sharp pains in the back of the leg and outer thigh.

Other hip ailments include labral tears, ITB syndrome, femoral head avascular necrosis, hip impingement syndrome and snapping hip syndrome.

In most cases, hip pain and its causes are effectively treated with anti-inflammatory medication and physical therapy. When these methods are insufficient in relieving pain and restoring joint function, hip replacement may be warranted.

The surgery, also called hip arthroplasty, involves removing damaged bone and cartilage, then implanting prosthetic devices. While most hip-replacement patients are between the ages of 50 and 80, the procedure also helps juvenile arthritis victims and seniors with degenerative arthritis.

Indications that hip replacement could be needed include pain in the hip or groin that makes walking difficult, pain even while the hip is at rest, stiffness that limits range of motion, inability to easily climb stairs, and severely restricted walking distance without pain.

Study: Surgeons Show Little Bias in Recommending Knee Replacement

Knee arthritis and knee pain are extraordinarily common. Nowadays there are a tremendous number of treatment options to help alleviate the pain that might otherwise slow you down. There are many injection options: steroid (cortisone), PRP (platelet rich plasma), and HA (hyaluronic acid viscosupplementation). There are many oral medications. And even more kinds of braces. The final stop is a knee replacement. And even this option comes in different flavors (partial, total, and other nuances).

Most patients who undergo TKA (knee replacement) experience reduced knee pain and regain function. The procedure entails a surgeon removing damaged bone and cartilage from the thigh bone, shin bone and kneecap; and implanting an artificial joint made of metal, plastic or polymers. The prosthetics are available in a range of designs for patients with differing ages, weights, activity levels and general health.

The surgery is an effective method of repairing joint damage caused by osteoarthritis or rheumatoid arthritis. Many patients are able to relieve their symptoms by taking anti-inflammatory medications, receiving physical therapy and altering their activities. However, some continue to have trouble walking, climbing stairs and getting up from chairs. They experience knee pain even while inactive. TKA (knee arthroplasty) is frequently advised for such patients.

Although arthritis does seem to demonstrate some degree of genetic predisposition, research has failed to reveal significant differences in how often orthopedic surgeons recommend total knee arthroplasty (knee replacement) for patients of varying races and genders.

More than 100 surgeons conducted a study in 2012 while attending meetings of the New York State Society of Orthopaedic Surgeons, and the American Association of Hip and Knee Surgeons. They sought to challenge previous research that seemed to insinuate that orthopedists are sometimes biased in recommending TKA (total knee arthroplasty) for men over women, and whites over blacks.

The doctors wrote that they “developed four computerized scenarios for all combinations of race (white or black) and sex (male or female) for otherwise similar patients with end-stage knee osteoarthritis.” All the patients had experienced increasing knee pain, and a gradual loss of function in the joint, for at least two years. Anti-inflammatory drugs and corticosteroid intra-articular injections had failed to relieve their symptoms.

All the surgeons reviewed the medical history of a white man, and some were also asked to look at the cases of a white woman, a black woman and a black man. The doctors then decided which patients warranted TKA.

The result was “a 15 percent difference in the likelihood of recommending surgery for white versus nonwhite patients,” the research team concluded. Thirty-nine surgeons reviewed the white male and black female cases. Thirty-three (85 percent) of them said both patients needed the surgery. Six of the orthopedists recommended TKA for just one of the people, though “no effect of patient race and sex” reportedly was involved; ie, they recommended surgery for the black female and not for the white male or vice versa.

“Of the 37 surgeons who viewed the white male plus black male scenario, there were 33 (89 percent) concordant responses and four discordant responses, with no effect of patient race,” the researchers wrote. “Of the 37 surgeons who viewed the white male plus white female scenario, there were 30 (77 percent) concordant responses and seven discordant responses, with no effect of patient sex.”

Following the trials, the surgeons declared that “patient race and sex were not associated with a different likelihood of a surgical recommendation.”

They added: “Our findings support the notion that patient race and sex may be less influential on decision making when there are strong clinical data to support a decision. Physician bias may have a greater effect on decision making in situations where the indications for surgery are less clear.”

Often times studies done that make treatment recommendations that differ based on a patient’s gender or race have results that are shrouded in doubt secondary to associated socioeconomic differences and obesity differences that are inextricably tied with body mass index (obesity) and other confounders.

If you have been told you have knee arthritis or suffer from knee pain, contact our renowned sports medicine providers at Orthopedic Surgery San Diego.

Carpal tunnel syndrome is a painful condition characterized by wrist pain, numb fingers and tingling fingers. A procedure called open carpal tunnel release usually relieves the symptoms, and restores function in the wrist and hand, if conservative measures do not provide adequate relief.

The primary signs of carpal tunnel syndrome are numbness and tingling, which is a “pins and needles” sensation, in the fingers. The pain and lack of feeling often are more intense at night, which can make it difficult to sleep; this is called “night pain”. Patients also report burning or tingling of the thumb, index finger and middle fingers. Pain can radiate into the forearm and elbow. Hand weakness is another symptom.
Women are more susceptible than men, and there is a disproportionate number of cases involving the elderly. Experts believe “medical conditions (such as) diabetes, rheumatoid arthritis and thyroid gland imbalance can play a role,” according to the American Academy of Orthopaedic Surgeons. In most cases, multiple causes are responsible.

The syndrome is a progressive condition (ie, symptoms get more severe over time) unless a patient receives treatment. In some cases, when therapy begins early, the pain and loss of function can be reduced or eliminated. Some people find that altering their activities, perhaps even changing jobs, relieves their suffering.

Patients are often advised to wear a wrist brace or splint at night and during certain activities, to limit pressure on the median nerve. Among other nonsurgical treatments are anti-inflammatory, rehabilitation (physical therapy or acupuncture), and injections of corticosteroids.

When these methods are ineffective, surgical “open release” might be warranted. The procedure entails cutting the carpal ligament to give the nerve and tendons more space, so the nerve is not irritated. This is typically an outpatient operation, in which patients receive local anesthesia.

“Significant improvements” have been reported for “the general population, regardless of age, medical (conditions) or workers’ compensation status,” according to a paper drafted by the Department of Orthopaedic Surgery at the University of Minnesota in Minneapolis and the TRIA Orthopaedic Center in Bloomington, Minn.

The paper, “Outcomes Protocol for Carpal Tunnel Release: A Comparison of Outcomes in Patients With and Without Medical Comorbidities,” was published online in the Journal of Hand Surgery in September.

The researchers analyzed the outcomes of 950 open carpal tunnel procedures involving 826 patients (between the ages of 21 and 100 years of age) at an orthopedic surgery center. They compiled symptom and function assessments reported by the patients, who filled out questionnaires two, six and 12 weeks following surgery.

“Patients demonstrated a significant improvement in symptom severity scores at two weeks and functional severity scores at six weeks,” the report concluded. “Documented patient medical (conditions) did not affect improvement after surgery. Patients with diabetes improved more slowly, but were not significantly different at six weeks. Patients with workers’ compensation insurance were significantly worse at baseline, two weeks and six weeks, but were not significantly different at three months. The risk of negative postoperative endpoints was slightly higher in patients with a medical (condition), though not statistically different.”

The syndrome, a common condition, occurs when synovium tissues around the flexor tendons in the wrist become swollen. That puts excess pressure on the median nerve, which passes through the carpal tunnel. Synovium lubricates tendons that make it possible to flex the fingers.

Researchers have determined that heredity is the primary risk factor for the syndrome. People with small carpal tunnels, due to their genetics, are more vulnerable. Those who overuse their hands by taking part in repetitive-motion activities, and pregnant women experiencing hormonal changes, also are more likely to develop the condition.

The carpal tunnel is a narrow passageway in the wrist, with carpal bones on the sides and the bottom. The transverse carpal ligament is found on the top of the tunnel. The median nerve, which connects the hand and forearm, makes it possible to have feeling on the inner side of all the hand’s digits other than the little finger. The nerve is also essential for muscle function at the base of the thumb. Flexor tendons, also found within the tunnel, allow bending of the thumb and fingers. The carpal tunnel provides a protective space for the median nerve and flexor tendons.

Some patients experience recurrences of the syndrome, requiring further surgery.

If you have wrist pain or finger number and tingling, contact our orthopedic experts for evaluation today at Orthopedic Surgery San Diego.