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10/Sep/2014

Knee pain as a result of a meniscus tear is extraordinarily common in both the young teenage Carlsbad soccer player as well as the mature La Jolla tennis player.  The tear can occur from a twisting or pivoting mechanism.  This is commonly seen on the football field.

Quarterbacks, running backs, and wide receivers tend to get all the attention from fans and NFL analysts. One of the most underrated positions in all of sports could very well be NFL’s long-snapper. The position of long-snapper is important enough that most NFL teams use a roster spot specifically for a designated long-snapper. Unfortunately for the Steeler’s, long-snapper Greg Warren suffered a torn meniscus in practice two weeks ago. Warren has played every regular season game for the last four years for the Steelers but he is likely to have that consecutive game streak come to an end at the beginning of this season.Greg-warren-meniscus-tear

The meniscus is a wedge of cartilage that acts as a shock absorber and stabilizer between the thighbone (femur), shinbone (tibia), and kneecap (patella). A meniscus tear can result in reduced cushioning between the femur, tibia, and kneecap, as well as reduced stability. The result of a meniscus tear is an intense amount of knee pain, stiffness, swelling, decreased range of motion, and instability. Without treatment, there is a good chance that a piece of the meniscus can come loose. This often results in a slipping, locking or popping of the knee. Meniscus tear often occurs as a result of a twisting or pivoting motion in non-contact situations. They can also be caused by direct contact, as with a tackle to the knee. In the case of Greg Warren, the meniscus tear injury was sustained without direct contact.

meniscus-tear

Meniscus Tear Diagnosis:

The process of diagnosing a meniscus tear begins with a visit to a physician.  The doctor will most likely be the McMurray test, which involves bending, then straightening, and then rotating the knee. If there is a click then it is considered a positive McMurray test and if there is no click it is a negative McMurray test. A positive test would mean that there might be a meniscus tear.

After the McMurray test the doctor may order a battery of imaging tests to check for a meniscus tear and other associated knee injuries. An X-ray would be used to determine if there is a different cause of the symptoms. Rather, an MRI would reveal damage or tear to soft tissue such as a meniscus.meniscal-tear-injury

Meniscus Tear Treatment:

Treatment of a meniscus tear can involve either surgical or non-surgical treatment. Non-surgical treatment involves rest, ice, compression, elevation along with medication to relieve pain and swelling. Surgical treatment may be a meniscectomy or a meniscus repair. In a meniscectomy, the orthopedic surgeon trims away the damaged meniscal tissue. Meniscal repair involves the suturing torn meniscus pieces back together.

Rehabilitation is dependent on the severity of the injury and can require about two weeks for injuries that do not require surgery. Three to four weeks of rehabilitation is required for meniscectomy surgeries. Three to four months of rehabilitation is required for a meniscus repair. In the case of Greg Warren, he likely underwent a meniscectomy as he is scheduled to return to the field about a month after the injury. A little math shows that Greg Warren will be snapping again by week three of the 2014-2015 NFL season, which is great news for Greg Warren and the Steelers.meniscus-tear-view

If you have been told that you need an arthroscopy for a meniscus tear or would like a second opinion, call to schedule an appointment with our award winning sports medicine doctors at Orthopedic Surgery San Diego Clinic.

 

 


09/Sep/2014

Knee and Hip pain is 70% more common in patients with elevated BMI (body mass index).  In preparation to undergo a hip replacement or knee replacement for joint pain, it is imperative to shed any extra weight you may have.  Despite our active lifestyles in San Diego, sometimes it becomes necessary to utilize a diet. Here in America, it seems like most people are always on one type of weight loss diet or another. Comparing which diet helps you lose the most weight is a common topic of conversation these days. But, the answer remains unclear, as each diet has its benefits as well as disadvantages, based on the dieters’ needs. And, when it comes to overweight and obese adults, those needs tend to vary. Oftentimes, the need to eliminate pain is the biggest issue.

How Obesity or Being Overweight Affects Knee and Hip Pain

One thing is clear, though, the heavier you are, the more weight your hips and knees have to carry around all day and night. So, if you’re obese, or very heavy for your body frame, your weight is probably the cause of much of your body pain. If you’ve been having Knee and Hip pain that simply will not go away, your weight is adding to your orthopedic problems. And, even if your orthopedic surgeon recommends knee replacement or hip replacement surgery, the pain still won’t go away for good without your help. You’ll still need to lose a substantial amount of weight in order to improve the outcome of the surgical procedures. If not, eventually, your weight will simply wear down your new hips and knees, causing them to be in pain again in the near future.

JAMA Study on Popular Weight Loss Diets

The Journal of the American Medical Association (JAMA) published an abstract paper in regards to popular diets. Its objective was to determine the outcomes of various popular weight loss diets. In this particular study, overweight adults with body mass indexes above 25 were randomly assigned to a specific popular weight loss diet. They all had to report their body mass indexes and weight at 3-month, 6-month and 12-month follow ups. The study which included 7,286 individual participants.

Results of the JAMA Popular Weight Loss Diets Study

Low Carb Diets Results

The highest weight loss amounts related to low-carbs diets:

  • 8.73 kg at 6-month follow up
  • 7.25 kg at 12-month follow up

Low Fat Diets Results

The highest weight loss amounts related to low-fat diets:

  • 7.99 kg at 6-month follow up
  • 7.27 kg at 12-month follow up

Results for Individual Diets

When it comes to the results for individual weight loss diets, the differences were minimal. Here are some examples:

  • At 6-month follow up, the Atkins Diet showed greater weight loss of 1.71 kg than the Zone Diet
  • Between the 6-month and 12-month follow up periods, the Atkins Diet combined with behavior support had a greater weight loss of 3.23 kg than the Zone Diet.

Weight Loss and Knee and Hip Pain

In other words, both low-carb and low-fat diets can help you achieve your goal of weight loss. The specific named diet doesn’t really seem to matter as long as you cut down on carbs and fat intake. So, what’s the bottom line for overweight and obese adults suffering from knee pain and/or hip pain? Your weight can be a major factor when it comes to sustaining relief from your hip and knee pain. When you combine maintaining a healthy weight with hip replacement or knee replacement surgeries, your long-term outcome is so much more successful.  Much lower risk of infection, blood clots, residual pain, and much longer lasting implant!! If you have been told that you would benefit from hip or knee replacement due to ongoing pain, call our award winning physicians at Orthopedic Surgery San Diego for an appointment.


09/Sep/2014

ACL tear can happen to proathletes or the teenage competitive soccer player scrimmaging in a Carlsbad park on a sunny  San Diego Sunday afternoon.Isaiah-Pead-acl-tear

Arguably the most volatile position in the NFL is the running back. Injuries, everyday wear and tear, and age can shorten the career of a running back. For Isaiah Pead, the end could be near. He was a top five running back in the 2012 NFL draft. He has been off and on injured, had some off-the-field issues, and has been overall underwhelming when he is available to play. Unfortunately for Pead, his career outlook just got even bleaker as he has suffered a season ending injury during a preseason kickoff return. Pead was running down field full speed when his feet got tangled and he went down. The result: an ACL Tear.  This knee ligament injury will stop you in your tracks.  Most athletes report hearing and feeling a pop and then they go down.acl-tear-san-diego

The ACL or anterior cruciate ligament connects the front of the shinbone (tibia) to the middle of the kneecap (patella). The main purpose of the ACL is to provide rotational stability and to prevent the shinbone from getting too far ahead of the thighbone (femur).

Sometimes ACL tear can occur as a result of direct contact with the knee, but more times than not, an ACL tear is a non-contact injury such as in the case of Isaiah Pead. The cause of this non-contact injury is often due to rapid direction changes, sudden stops and decelerations, as well as incorrect landing and pivoting. The symptoms of a ACL Tear include knee pain, knee swelling, knee discomfort, knee tenderness, and decreased range of motion in the knee.

If a knee injury has occurred, an orthopedic physician will compare the structures of your injured and your non-injured knee and in most cases this is sufficient enough to diagnose ligament tears. However, the doctor will sometimes schedule an x-ray and an MRI in order to dismiss potential confounding problems, to validate the diagnosis, and to determine the degree of the injury.

Treatment for an ACL tear is dependent upon the severity of the injury. Grade I sprains involves overly stretched but still in tact. Grade I sprains typically require keeping the weight off the affected leg. Once the swelling has subsided, a physical therapy regimen will be prescribed. These exercises are meant to strengthen the leg muscles that support the ACL. Grade II sprains involves the ACL being stretched to the point that it has become loose. Grade II sprains are a little trickier to handle because they may or may not require surgery depending on lifestyle of the patient. The non-surgical approach is similar to that of grade I sprain but generally this is a longer process since these sprains are more severe. The surgical approach involves the rebuilding of the ligament via a tissue graft followed by rest and physical therapy. Grade III sprains occur when the ligament has been completely split into two pieces. In grade III sprains, surgery is required to rebuild the ligament. The recovery time for ACL surgery is often six to nine months. The prognosis for surgical recovery is positive and many athletes are able to return to their respective sport at near pre-injury form.ACL-Tear-Grades

As for Isaiah Pead, there is a very good chance he will make a full recovery, but considering his career thus far, it is doubtful he will ever become the player we once thought he could be. Then again, sometimes a player needs to hit rock bottom before they can really begin to understand what it takes to make it, maybe this, will be his wakeup call.

If you have been told you have an ACL tear or are suffering from knee pain, contact our top sports medicine specialists at Orthopedic Surgery San Diego to obtain a consult and be treated they way you deserve!

 

 


06/Sep/2014

Some folks with shoulder pain or knee pain walking around the streets of Carlsbad may be suffering from a very difficult pain syndrome called fibromyalgia. In fact shoulder pain can become so profound to a patient suffering from fibromyalgia that s/he may go on to develop a frozen shoulder (adhesive capsulitis).
Recent research has shown that treatment for fibromyalgia should be on an individualized basis, as opposed to a general, conventional basis. Experts tend to recommend treatment that includes non-pharmacologic approaches, which is often more effective than drugs. However, currently many orthopaedic surgeons and pain management specialists tend to rely on medications such as antidepressants, anticonvulsants, narcolepsy drugs, pain relievers, sleep aids, and the like. These medications alter brain chemistry to help reduce pain, improve sleep, and ease anxiety or depression, which often times seem to coincide with fibromyalgia. Some of the more common medications used include Cymbalta, Savella, Lyrica, Neurontin, Effexor, etc.
Fibromyalgia is a condition which causes muscular or musculoskeletal pain with localized tenderness at specific points on the body. These tender points include specific spots on the neck, shoulders, back, hips, arms and legs, hurt when pressure is applied to them.
fibromyalgia-tender-points

What is the musculoskeletal system?
The musculoskeletal system provides support, stability and movement to the body such as the connective tissue between joints, ligaments, muscles, tendons, nerves and bones. Inflammatory conditions such as fibromyalgia impair the normal function of this system, causing pain and negatively impacting on physical activities and joint mobility.
This is especially true of the shoulder joint which has a greater range of movement than any other joint in the body. Because of this very mobility, the inflammation of the connective tissue results in almost constant shoulder pain, seriously limiting movement.

Shoulder pain and shoulder injury.
A shoulder problem may be minor or serious, and besides the pain, could include swelling, numbness, a tingling sensation and weakness. This shoulder pain can make you more susceptible to shoulder injury, especially during sporting activities or work-related tasks. The severity of shoulder pain and the risk of shoulder injury can be reduced if fibromyalgia, being the root cause, is effectively treated.

How is fibromyalgia usually treated?
There is no single magic pill that will cure fibromyalgia. There are, however, medications that can help reduce pain and inflammation. Because of pain when moving about, many people tend to become inactive, which in effect just aggravates the condition, resulting in more pain. Now studies have shown that mild exercise, especially aerobic exercise, is of enormous benefit to fibromyalgia patients in helping them to stay functional.

fibromylagia_walking
What is aerobic exercise?
Aerobic exercise is any moderate exercise which maintains an increased heart rate for an extended length of time, oxygenating the blood which in turn feeds more oxygen to the muscles, improving their energy generating process and possibly reducing pain and inflammation.
How to manage your exercise program.
• Before starting a program, discuss it with your doctor.
• Don’t be over-intense, focus on moderate exercise.
• Be aware of your limitations.
• Opt for activities you enjoy doing.
• Start slowly and build up gradually.

Fibromyalgia is a chronic condition causing almost constant muscle and joint pain. The cause of the disorder is not known, and there is no cure. However it is treatable with anti-inflammatory and pain medication, and moderate aerobic exercise. A positive and proactive attitude to the illness will also help keep depression and anxiety at bay when you are feeling low.
If the condition is well-managed, it will give relief to muscle and joint pain including the important shoulder joint, and definitely reduce the risk of what could be a debilitating shoulder injury.


06/Sep/2014

player
NFL quarterback, NHL goalie, MLB starting pitcher, and NBA point guard are generally considered the most important positions in the major U.S. sports. A position that is arguably as important is the major league closer. The closer is responsible for whether a team wins close games. A majority of major league games are decided by only 2 runs or less. It is easy to see the importance of a quality closer. Unfortunately for the San Diego Padres, closer Joaquin Benoit has been sidelined off and on by ongoing shoulder pain. He has missed a number of games over the course of the season due to the shoulder pain. Benoit has described a pain fluctuates. That he will feel good for a couple of days but then the inflammation will return. The cause of this pain has not been diagnosed but there are some acute shoulder tears that may be attributing to Benoit’s discomfort.

A SLAP tear is a tear in the top part of the labrum. The labrum is a strong, fibrous tissue that stabilizes the shoulder joint. The labrum acts to deepen the shoulder socket and allows a stronger fit between the upper arm bone, the shoulder blade, and the collarbone. A SLAP tear occurs in both the top-front and top-back portion of the labrum and is often caused by repetitive shoulder motion such as constantly hurling MLB sized curve balls and sliders. When a SLAP tear is present, the patient may experience shoulder pain, decreased strength, decreased range of motion, and unusual and uncomfortable feelings that the shoulder is catching, locking, grinding, or popping out of it’s joint. For major league pitchers there will also likely be a decreased in their pitch velocity.
slap-tear
A partial thickness rotator cuff tear is an incomplete tear of the rotator cuff. The rotator cuff connects the upper arm to the shoulder blade and is essential for shoulder strength and lifting of the arm. A partial tear in the rotator cuff would include damage to the soft tissue of the rotator cuff but would not be severed and would not be disconnected from the upper arm or shoulder blade. When the rotator cuff is torn, a patient will likely experience shoulder pain, shoulder weakness, difficulty lifting and rotating arm, and a crackling sensation in the shoulder. For major league pitchers lifting and rotating the arm is an essential part of the pitching motion. A partial thickness rotator cuff tear can cause tremendous amount of pain and a decrease in pitcher productivity.
rotator-cuff-tear
For these acute injuries the suggested initial treatment is rest, anti-inflammatory medications, and physical therapy to restore the strength, flexibility, and range of motion. If non-surgical treatment is not sufficient and problems persist or worsen then the next step would be to review surgical options. At this point Joaquin Benoit is experiencing discomfort bad enough to miss some games, but team doctors do not believe that surgery is needed just yet. Time will tell whether he can overcome this nagging shoulder injury or if he will need to have the shoulder repaired via surgery. Call to schedule your appointment with our top notch sports medicine specialists at Orthopedic Surgery San Diego.
vote-players


01/Sep/2014

Our young athletes in Carlsbad and North County San Diego, especially soccer and football players, are particularly vulnerable to concussion.  This issue is particularly important to me; my daughter sustained a Grade 2 concussion as a result of a skiing injury.  I feel parental education regarding concussion awareness is tremendously important.  Middle school sports are more rigorous and ambitious than ever before. More physical demands, practice times, and pressures are placed on athletes and the path to perfection is often paved with injuries.concussion-football

One of the most popular sports, globally, is soccer. Children can begin playing as early as Kindergarten. While the sport is fun, good exercise, and a foundation for learning sportsmanship, it can also be damaging to young bodies.

Soccer injuries can range from something as mild as a small bruise to something as major as a concussion. Knee pain, calf pain, and ankle pain are commonly associated with soccer players. Some injuries, like a torn ACL (anterior cruciate ligament) or torn meniscus requires a visit to an orthopedic surgeon for knee pain treatment and possible knee surgery.  These types of injuries that occur in younger athletes may affect them their entire lives. Shin splints, which occur from overuse, stress and bone fractures, wrist sprains and fractures, and even painful shoulder dislocations can occur due to playing soccer.

One especially serious injury from playing soccer is a concussion. A concussion is a traumatic brain injury that occurs when a person is hit hard enough for the brain to shake inside the skull.  This can happen during a sport, a fall, or other types of hard hits. Many people assume a loss of consciousness is needed for a concussion, but this is not true. Symptoms of a concussion include confusion, dizziness, headaches, nausea, vomiting, changed sleep patterns, change of emotional state, and sensitivity to light. Any symptoms of a concussion should be discussed with a doctor as soon as possible.concussion-anatomy

Of all the sports for female middle school athletes, soccer causes the most concussions. High school female athletes have double the amount of concussions per year than male high school athletes.  A study was conducted from 2008 to 2012 that focused on 351 advanced female soccer players between the ages of 11 and 14. During this study, there were 59 concussion reported, which is about 17% of the players.

Because of the high amount of concussions, a class action lawsuit was filed against FIFA (Fédération Internationale de Football Association), along with U.S. Soccer Organization and the American Youth Soccer Organization. This lawsuit, as reported by The New York Times (8/28, Strauss), The Washington Post (8/27, Payne) and the Los Angeles Times (8/28, Baxter) among others, states that the groups have not acted responsibly in terms of monitoring concussions and head injuries.

The lawsuit was filed by parents and players and are asking for a change in the soccer rules. They ask that children under 17 be limited to the number of times to head a ball, and to allow substitutions for anyone being examined for a possible head injury, rather than limiting the number of substitutions in a game. While some are skeptical that new rules will make a difference, we can only wait and see.  As an orthopedic surgeon and sports medicine specialist, I back such legislation and policy change.

If you have questions or concerns about your child and their sports preparedness, feel free to reach out to our top notch Orthopedic Surgery San Diego sports medicine specialists.


31/Aug/2014

Many of the kids playing pop warner or teens playing high school football in the Carlsbad and North County area may have sustained shoulder injuries or neck pain, similar to Pro NFL players.  St. Louis Rams officials described Rodger Saffold’s recent shoulder problem as a “stinger,” a term familiar to people who play contact sports.

Saffold suffered the injury in his left shoulder during training camp, ESPN reported. It took nearly a month for symptoms to subside to the point that the offensive lineman was ready to return to action.  This is unusual.

Technically called a brachial plexus injury, a stinger afflicts about one in two college football players. Wrestlers, gymnasts, snow skiers and martial-arts enthusiasts also are vulnerable. A stinger can occur when a collision or fall causes the shoulder and head to snap in opposite directions. It also may result from the head being forced to the side, or from blunt-force trauma of the collarbone.

Such violent movements and impacts compress and excessively stretch nerves in the neck and shoulder, causing an electric stinging sensation that may extend to the arm and hand. Some patients describe the pain and discomfort as “burning” or “tingling.” Others feel weak or numb in the shoulder or arm. Neck pain can be an indication of another type of injury or disorder.

Many experience the symptoms for only a few seconds or minutes. Others need treatment for several days or weeks. Sometimes, there is a nerve injury that continues to cause shoulder pain and weakness. People who have had one stinger are more likely to suffer more of them. Each time it happens, the joint gets weaker and nerves sustain additional damage.

Nerves function like electrical cables in the spinal canal, allowing the brain to send messages to the muscles. Nerves that branch from the spine, where it meets the neck, form the brachial plexus (a bundle of nerves). All the nerves that permit a person to feel and move the arm travel through the cord.

Most patients get stingers on one side of the body, though full contact with another person or an unmovable object can injure both shoulders. In some cases, people have stingers on both sides because of spinal-cord damage.

Treatments for the pain and burning include resting the shoulder and arm, alternating applications of ice and heat, and taking anti-inflammatory drugs. When the discomfort continues longer than several weeks, medical tests are needed to diagnose the problem. There might be nerve damage that cannot heal on its own.

Doctors study patients’ medical histories, and conduct physical exams, to diagnose stingers. They determine the extent to which the brachial plexus has been stretched, and evaluate nerve function and reflexes. More tests are ordered if a patient appears to have a cervical spine injury. Diagnostic methods include x-rays, MRIs and EMGs.  It is important the player seek medical attention so that a doctor can unmask any latent anatomic risks that puts a player at risk.

Some patients wear cervical collars to take pressure off the nerves until they can recover. Doctors often give cortisone to reduce the swelling. They advise patients to refrain from strenuous activity until the pain is gone, full range of neck motion returns, and testing has confirmed there is no nerve damage. Strengthening neck muscles and improving posture can help prevent recurrences.

Surgery becomes necessary when a herniated disk or bone spur compresses and injures a nerve. Without the procedure, a patient is likely to continue experiencing severe pain and weakness.  Let our Orthopedic Surgery San Diego award winning orthopedic sports medicine specialists evaluate you to help you maximize your recovery.


31/Aug/2014

Many of our Carlsbad and North County San Diego competitive soccer players sustain ACL tear every year.  Even though, sports medicine specialists take measures to prevent such devastating knee injuries, a twisting injury to the knee suffered by the Arizona Cardinals’ Darnell Dockett is just the latest ACL tear to sideline a professional athlete.acl-tear

ESPN reported that Dockett, a defensive tackle, damaged the knee when his foot caught in the turf during training camp in Tempe, Ariz. Following an examination, doctors scheduled Dockett for surgery. Just a few days earlier, Rams quarterback Sam Bradford sustained an ACL tear  as a result of a hard hit by a defensive lineman. Both players are out for the season.  The risk of sustaining such knee injuries and other ligament tears are somewhat preventable with proper core strengthening.  acl-tear-knee-injury

ACL is short for anterior cruciate ligament, connective tissue that extends from beneath the femur (thigh bone) to the top of the tibia (the large bone in the lower leg). The smallest of the four main ligaments in the knee, it stabilizes the knee for rotational movements. The ACL enables a person to make fast “cuts” while running. It is rarely stressed during activities like jogging that do not involve sudden stops, twists or turns.

ACL tear and sprains were once referred to as “trick knees.” They occur frequently in football, basketball, soccer and tennis because of the pressure and repetitive stress that athletes put on their knees. Most of the 250,000 to 300,000 ACL tear injuries reported in the United States each year involve people who play sports. The odds of an athlete spraining or tearing an ACL reportedly is about 1,000 to 1.

ACL Tear Types:

A Grade 1 ACL tear features a ligament that has been stretched too far. It does not usually prevent normal use of the knee. A Grade 2 sprain results from the ligament being stretched to the point that it is loose. This condition also is called a partial tear. The most serious ACL tear injury, a Grade 3 sprain, is a complete tear, in which the ligament is severed and the knee becomes unstable.acl-tear-grades

The ways that Dockett and Bradford hurt their knees were typical. ACL tears result from changing direction too quickly or stopping suddenly, landing wrong on the knee after jumping, and the blunt-force trauma of a blow to the joint or a collision. When an ACL tear occurs, the person might hear a popping sound in the knee. The joint gives out and quickly becomes inflamed. This causes a great deal of pain, as well as loss of mobility and range of motion.

While a mild sprain sometimes heals without surgery, an ACL tear must be repaired for a patient to regain full use of the knee. It is not possible to merely stitch back together the two pieces of a severed ligament. Orthopedic surgeons reconstruct ACLs by grafting tissue from the patellar tendon (with attaches the kneecap to the shine bone), the hamstring tendons (in the back of the thigh) or the quadriceps tendon (which runs from the kneecap to the thigh). Tissues from cadavers also are used.

The arthroscopic procedure requires only small incisions in the skin. Surgeons insert miniature instruments, which they manipulate to graft the tissues. Patients experience less pain, and recover more quickly, than they would if more invasive surgery were needed. Sometimes, ACL injuries happen in conjunction with damage to other ligaments or cartilage. That can necessitate more extensive surgical procedures.  You don’t have to live with the knee pain and instability.  Contact our Orthopedic Surgery San Diego Sports Medicine specialists to help you regain your mobility and be the best athlete you can be.

 


31/Aug/2014

Separated Shoulder Injury Sidelines Another Athlete……

Whether a soccer player in Carlsbad, mountain biker in San Diego,  or an ice hockey player on the ice, shoulder injury such as a separation are a dime-a-dozen but need to be taken seriously.  Pittsburgh Steelers’ rookie Martavis Bryant is the latest professional football player to suffer an AC joint sprain, commonly known as a shoulder separation.sports-shoulder-injury

The wide receiver could miss much of the season, depending upon the extent of the damage in his shoulder, ESPN reported.The source of the shoulder pain resulting from such a shoulder injury is the acromioclavicular (AC) joint, between the shoulder blade (scapula) and collarbone (clavicle) on the top of the shoulder. The scapula and clavicle form the joint socket, which holds the rounded end of the arm bone (humerus). A shoulder separation happens at the point where the shoulder blade (acromion) attaches to the clavicle.

Falling on a shoulder while the arm is extended is often responsible for an AC joint separation. This shoulder injury can happen while playing sports, or when riding a horse or bicycle.  Extraordinarily common with mountain bikers going over the handle bars.  A collision or direct blow to the shoulder also may cause this shoulder injury.

shoulder-injury

The impact of falling or getting hit damages ligaments that stabilize the joint. When the ligaments under the clavicle tear, a separation of the collarbone and wingbone occurs. The wingbone shifts into a lower position, producing a bulge above the shoulder.

The severity of AC sprains varies. In some cases, people feel only slight shoulder pain, along with some swelling and bruising. More serious shoulder injuries involve additional pain and physical deformity. The more a joint is distorted, the longer it takes for the patient to recover.

Shoulder separations are classified in six categories, based on the degree of damage. A Type 1 separation, in which the bones are not forced out of alignment, is only an injury to the capsule that surrounds the AC joint. Patients feel pain, but typically recover quickly.

A person with a Type II separation also has an injured AC joint capsule, as well as a partially torn coracoclavicularone ligament (which supports the clavicle). The injury is often characterized by a small bump. A Type III sprain is similar to a Type II separation, but more extensive. The bump on the top of the shoulder is pronounced.shoulder-injury-types

A less common diagnosis, Type IV shoulder separation, features a clavicle that has been forced behind the AC joint. In a Type V separation, the end of the clavicle punctures the muscle above the joint, causing a large bump. A Type VI separation is rare. It involves the clavicle being pushed down, below the corocoid (a section of the scapula).

shoulder-injury-joint

Treatments for AC joint separations include rest, ice and medication. Patients often wear slings, and refrain from intense physical activity, until the pain subsides and normal joint mobility returns. Most people, even those who suffer deformities, regain shoulder function. Some continue to experience pain, because the AC joint has been misshapen in a way that causes bones to rub together. Cartilage damage and arthritis also can cause persistent pain.

Shoulder-Anatomy

If a patient’s condition does not improve, surgery is an option. A common procedure entails trimming the end of the collarbone to prevent it from irritating the shoulder blade.  Dedicated shoulder surgeons like the award winning doctors at Orthopedic Surgery San Diego can perform even more cutting edge procedures that reconstruct the damaged shoulder ligaments.  To correct deformities, orthopedic surgeons reconstruct the ligaments that support the bottom of the collarbone.  Call Orthopedic Surgery San Diego for an appointment to discuss your injury.


30/Aug/2014

This has nothing to do with orthopedic surgery.  However, as a father, I feel that this is relevant to most of my patients.  So here goes!

Already banned in baby products, the industrial compound BPA also might be a threat to women’s reproductive health.

The New York Times reported that “the accumulating research (is causing) rising concern among scientists that childhood exposure to BPA may contribute to female infertility, and that adult exposure may result in a shorter reproductive life span.”

The degree of the danger is unknown, as numerous efforts to study BPA effects have produced mixed results. Lifestyle, heredity and exposure to other chemicals also might be responsible for the symptoms observed in research subjects. However, most medical authorities believe there is enough evidence to link the compound with ovarian damage.

University of Illinois bioscientist Jodi Flaws injected BPA into young, female mice for a month. She observed that the mice developed fewer, and smaller, follicles in their ovaries. They had insufficient levels of estradiol, a sex hormone necessary for reproductive development. Flaws concluded that BPA inhibits the ability of enzymes to produce the hormone.

Her research was confirmed in another study, which found that the production of eggs in BPA-treated mice ended when the animals were young. The same results have been detected in sheep, monkeys and people.

Patricia Hunt, a genetics professor at Washington State University, gave BPA to rhesus monkeys while the animals were pregnant. She reported that the compound altered the follicles in the same way it had affected rodents in earlier studies. According to Hunt, there is no reason to expect a different outcome in humans.

Flaws called BPA an “ovarian toxicant,” an opinion shared by researchers whose findings appeared in the journal Environmental Health Perspectives.

Harvard University researchers studied women at in-vitro fertilization clinics, to find out how BPA affected them. The compound was detected in the urine of 80 percent of the young mothers. Women with the highest levels of BPA had the lowest number of follicles, resulting in the production of fewer fertile eggs. In many cases, the subjects’ follicular fluid also tested positive for BPA.

The Times reported that the researchers also analyzed 357 oocytes (ovarian cells) from more than 120 women at the clinics. BPA appeared to inhibit the cells’ growth and damage chromosomes.

“Together with prior animal studies, the data support the negative influences of BPA on oocyte maturation,” the scientists wrote.

BPA is an ingredient of numerous products, including plastics, can and pipe linings, and thermal paper coatings. Identified by scientists in the late 1800s, the compound became popular with manufacturers in the mid-20th century. The Times noted that few people questioned the safety of BPA before the late 1990s, when a study indicated that the chemical adversely affected hormones.

Based on the mounting evidence of health risks, the U.S. Food and Drug Administration banned the use of BPA in baby bottles and products intended for infants. However, the compound is still found in a number of consumer products. Studies suggest that BPA contaminates the bodies of most people in the United States.

Authorities advise women to avoid BPA, as researchers continue efforts to prove the compound’s toxicity.


© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow