blog Archives - Page 18 of 19 - Orthopedic Surgery San Diego

06/Aug/2014

It is safe to say that most people have at least some vague understanding of what constitutes a broken arm, but just case you don’t, mixed martial arts (MMA) and ultimate fighting championship (UFC) light heavyweight Ryan Jimmo has vowed to enlighten us on the matter. Midway through the second round of his most recent MMA bout, Jimmo began crying out to officials that his arm had been broken. He later told officials that he could literally feel his bone moving in his arm. As it turns out, Jimmo was right, his ulna (inner forearm bone) had a fairly clean break in it.

This is pre-surgery X-ray was posted on Ryan Jimmo’s twitter ryan-jimmo-broken-arm-xray

The arm consists of three main bones, the upper arm bone (humerus), outer forearm bone (radius), and inner forearm bone (ulna). A fracture to any of these bones would be considered a broken arm. There are many different types of fractures such as compound and simple fractures. A compound fracture is one in which the bone can actually shatters and results in multiple fragments. A simple fracture is one in which the bone is broken into two parts. Other classifications of fractures include greenstick, transverse, oblique, and spiral. Greenstick fractures are incomplete fractures in which the bone is not completely separated. Transverse fractures are fractures in which the break forms a straight line across the bone. Oblique fractures are fractures in which the break forms a diagonal break across the bone. Spiral fractures look similar to oblique fractures but are caused by a rotational force. In Jimmo’s case it appears that he is dealing with a transverse fracture. An arm fracture can be associated with symptoms such as pain, swelling, bruising. In addition there may be deformity and inability to rotate forearm. Its interesting because Jimmo’s fracture type is referred to as a ‘night stick’ injury. This is the fracture pattern seen when someone uses their forearm to defend against a police baton or nightstick! It is important for a trauma doctor to pay attention and not get lulled into complacency, because there are variation that look similar but can be disastrous if missed. A Monteggia fracture looks like a night stick type fracture but the elbow joint comes out of place.

Treatment for a broken forearm typically involves a sequence of realigning the bones followed by immobilization and therapy. When surgically realigning bones fixtures such as plates, wires, and screws are used to hold bones in proper position.This is the post-surgery X-ray posted on Ryan Jimmo’s twitter

As you can see, Jimmo opted for surgery and was suited with a fixture consisting of a plate and a set of screws. One of the screws is outside the plate…its okay- this is intentional. It is called a lag screw. After realignment, comes the immobilization stage’ this is minimal since the fracture is stabilized with the plate and screws. During the immobilization stage it is recommended that light, elbow, forearm and wrist range of motion exercises be completed in order to prevent stiffness. Once the splint is removed, physical therapy can be utilized to regain strength in the arm. All in all the entire healing and recovery process takes around three to six months. I level athlete will push to return closer to three months.

As for Ryan Jimmo, his successful surgery took place in the middle of June so it would be surprising if he weren’t back in the cage and ready to rumble before the end of the year.

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06/Aug/2014

While injuries can be devastating, there is something gratifying about getting injured while making a game saving play for your team. Unfortunately, for Toronto Blue Jay second baseman Macier Izturis there is no such saving grace. Isturiz was getting set to bat next when he tripped climbing up the dugout steps. He claimed that he felt two pops in his knee as he tripped. He was later diagnosed with a complete lateral collateral ligament (LCL) tear and has been placed on the long-term disabled list, likely unable to return this season.

The LCL is one of four major ligaments that help to align and stabilize the knee joint. The knee joint is the point at which thighbone (femur), shinbone (tibia), and kneecap (patella) meet. The LCL connects the thighbone and shinbone along the outer side of the knee. The function of the LCL is to provide to stability to the outer portion of the knee joint. The symptoms of an LCL tear include knee joint instability, pain or soreness on outside of knee, stiffness, and swelling. The intensity of these symptoms is dependent on the severity of the injury. Likewise, LCL injuries are diagnosed based off of severity. A grade 1 LCL sprain classification is used when only a few ligament fibers are damaged. A grade 2 LCL sprain is used when more ligament fibers are damaged but the ligament itself still remains intact. A grade 3 LCL sprain is used when the LCL is completely torn into two separate pieces making the outside of the knee joint very unstable.

Treatment options for an LCL injury can range from rest and physical therapy all the way to surgical reconstruction. For grade 1 LCL sprains the recovery period ranges three to six weeks and requires rest and progressive light strength and balance exercises. For grade 2 LCL sprains the recovery period ranges from six to eight weeks and requires more intense physical therapy than that of a grade 1 sprain. For grade 3 sprains, the optimal solution is surgery. The surgery for grade 3 sprains can include suturing or stitching the torn ends, or complete LCL reconstruction via a tendon graft such as the hamstring or quadriceps tendon. The post-surgery recovery time for grade 3 sprains is three to six months.

The LCL will generally return to close to its pre-injury form assuming that rehabilitation and/or surgical reconstruction. However, it is important to note than injuries involving the LCL tear often involve another one of the major ligaments in the knee joint. One such injury that comes to mind is current NFL running back Marcus Lattimore; who two years ago had a gruesome knee injury that ended with a torn ACL (anterior cruciate ligament), torn PCL (posterior cruciate ligament), and a torn LCL. Injuries that cause damage to multiple ligaments can be very damaging and make a return-to-form unlikely. Luckily for Macier Izturis he came away with damage to just his LCL He is expected to miss the rest of this season but he should be able to come back and continue his career in 2015.

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06/Aug/2014

Some people wonder what happened to the Tennessee Titans RB Chris Johnson (CJ2K)Did you know that CJ2K played a majority of the season on a torn meniscus last year? Yup, it’s true, since week 3 on the NFL season, CJ2K played on a meniscus tear. If his silver-plated teeth weren’t a dead give away, then playing on a symptomatic torn meniscus does Mr. Johnson is the real deal…he is as tough as they come.

To understand toughness that it would take to play on a torn meniscus, you must first understand the meniscus itself. The meniscus is essentially a wedge of cartilage in your knee. This tough and rubbery meniscus acts as a shock absorber between the femur and the tibia. In layman’s terms, the meniscus is a cushion between the thighbone and the leg bone. An intact meniscus is essential for proper cushioning and stability. When the meniscus is torn, there will be significant pain and swelling. It can cause a sharp searing pain that will bring you to your knees…literally. It can cause instability which can lead an athlete to fall. One of the worst feelings when dealing with a torn meniscus is the feeling you get when you place the brunt of your weight on that knee. It almost instantaneously does one of two things, locks up or gives out. Now imagine running for 1,000 yards and 6 touchdowns against an NFL defense on one of those bad boys. Gives you a new respect for CJ2K, doesn’t it?

There are two real ways to treat a torn meniscus and neither of them involves continuing to use your knee the way that Chris Johnson did. Non-surgical treatment involves the age-old acronym RICE. Rest, ice, compression, and elevation. This is pretty standard protocol for any inflammatory process. Measures like these can work for what is called a “degenerative tear”. Much of the scientific studies today talking about how arthroscopies aren’t helpful are targeting treatment of degenerative tears. However, acute meniscal tears that occurs in relatively younger athletes usually happens as a result of a twisting or pivoting maneuver. The tears usually require an arthroscopy for symptom relief. Knee arthroscopy is one of the most common orthopedic procedures involves the use of miniature cameras and surgical instruments to repair and/or clean away the tear. After a successful surgery comes a tremendous amount of rehabilitation. Rarely, meniscus tears are actually repairable. This is a special kind of tear that can actually be repaired. We can use platelet rich plasma (PRP) clots to augment the healing. The rehabilitation process for repairs takes longer but is well worth it. After a meniscus repair, the athlete will need a month on crutches followed by range of motion and strength exercises. The total rehabilitation time is approximately 3 to 4 months.

So what does this all mean for our 2009 fantasy football MVP, Chris Johnson? He had a successful meniscus repair surgery at the end of January and was completely rehabilitated by training camp. He gets a change of scenery as he heads to the run-happy New York Jets. To expect another 2,000-yard season would be foolish, but to think that he will bounce back to be the back we all thought he was, is not completely out the realm of possibilities

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04/Aug/2014

Shoulder pain. It can plague us all, even the great ones! There is very little debate over who the NFL’s greatest wide receiver of all time is. Jerry Rice is the best there ever was. But did you know that Jerry’s football DNA has been passed on to a son, Jerry Rice Jr.? That is correct. He is an incoming rookie wide receiver. With some experience at my old alma mater, UCLA. He was set to potentially follow in his father’s footsteps until an unfortunate injury. Jerry Rice Jr. suffered a significant shoulder injury when he landed awkwardly on it during practice. The diagnosis: a labrum tear.

The labrum is a fibrous cartilage that is located in the shoulder joint. The shoulder joint is one of the most common examples of a ball and socket joint. This joint is where the shoulder blade cavity (glenoid cavity) and upper arm bone (humerus) meet and form the respective ball and socket. The labrum acts as a joint stabilizer that both deepens the socket and sucks the humerus into the socket.

If the labrum tears, the shoulder can become unstable. Labrum tear causes decreased range of motion, decreased strength, and pain. In addition, severe labrum tears tend to cause abnormal shoulder joint interactions such as grinding, locking, popping, and catching. While these interactions sound like a set of trendy new dance moves, they can be painful and quite discomforting.

There are a number of different types of labrum tear; the main types are SLAP tears and bankart tears, but these also has a set of sub-categorizations based on the severity of the tear. A SLAP (Superior Labrum Anterior and Posterior) tear involves the top of the shoulder and essentially involves the disconnection of the labrum from its ball and socket attachment points. A SLAP tear is usually diagnosed in terms of severities from type 1 to type 4. Type 1 is a partial tear where the edges of the labrum fray but do not become completely detached. Type 2 is the most common and does involve a complete detachment of the upper labrum from the socket. Type 3 is where the tear from the socket causes the labrum to actually folds over itself between the ball and socket. Type 4 is where the tear actually extends to the bicep tendon. The bankart tear involves the front of the shoulder. The reverse bankart tear involves the back of the shoulder.

Treatment can involve anything from rest followed by rehabilitation to arthroscopic surgery. In the case of type 1 SLAP labrum tears the typical treatment would just be rest, anti-inflammatory medications, and rehabilitation if needed. Most large tears will require surgery, which will involves trimming, repair or reattachment. After successful surgery, recovery time involves using a sling for approximately a month followed by anywhere from a month to three months of rehabilitation to regain complete strength and range of motion.

In the case of Jerry Rice Jr., his torn labrum did require surgery and it is considered season ending. But if he has half of the heart that his father had, you can bet that Jerry Rice Jr. will have a bright future in the NFL.

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01/Aug/2014

Like Santa, bones know when you’ve been sleeping, and they know when you’re awake. They know when you’ve behaved or misbehaved. They know when you’ve been exercising–so go out and walk! In all seriousness, bones are aware of what is happening in your body (not Skynet aware, but more like The Sixth Sense aware). What’s truly amazing is that the bones adjust accordingly, based on your exercise routine. When you exercise, your bones help retain minerals and will be there like a good friend supporting you through your activities into maturity. If you do not exercise, your bones stop caring about minerals and will hang out on the couch with you eating potato chips. Your bones do as you do, not as you say.

What Exercises Help the Bones?

Impact activities are the most successful at strengthening the bones. Sports like soccer, track, volleyball and other sports that require a significant amount of running and jumping will give the best results. Weight-lifting is also useful when used in conjunction with other impact activities. All of the fun stuff you used to do around the neighborhood as a kid: tag, football, racing, jump rope, and toilet papering the neighbor’s house at night (after all, one must jump to get the proper paper placement in the tree) are great for strengthening the bones.

“I’m Too Old to Play Those Games!”

No, you’re not. It is never too late to get your body up and moving. It may sound counterproductive, but even if you have problems such as osteoporosis or weak bones, it is better for your body to stay mobile rather than stay at rest. Luckily, the older you are, the less impact you need to do to strengthen your bones. In fact, a brisk walk a few times a week can be all you need to start getting stronger. You can become stronger still by throwing in a hip shake and a side step while you’re walking. This type of movement can also help prevent falls in the elderly.

Shake It Up

If walking briskly while thrusting out the glutei seems daunting, there are other ways to help strengthen bones. While not for everyone, there are vibrating platforms one can use to build bone. According to Dr. Keith DeOrio, your entire skeletal structure is affected by vibration platforms and “Your muscle spindles fire secondary to the mechanical stimulation produced by the vibrating plate, and this rapid firing of the muscle spindle causes a neuromuscular response that leads to physiological changes in your brain as well as your entire body.”

The studies on the vibration platforms are few for now, but there have been no downsides to using it. People 65 and older seem to benefit from just 12 minutes a day a few times a week. It is even suggested that doing squats while standing on the platform can increase speed and agility. While helpful, be mindful that it isn’t such a significant amount you will be begged to participate in the summer Olympics, but chances are your bones and body will feel better and stronger.

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10/Jun/2014

Frozen shoulder, otherwise known as adhesive capsulitis, is a painful and paralyzing shoulder condition. Although it can take weeks or even months to fully develop, most people find the initial symptoms concerning enough to seek help.

The simple truth is that this is a terrible ailment that can take upwards of a year to resolve. Patients with diabetes and/or hypothyroidism, especially women, are particularly vulnerable to this problem. It may start as a result of a simple slip and fall or other seemingly insignificant shoulder injury. The pain is extraordinarily high and profoundly limits life style. Often times the patients find that they cannot sleep through the night, they have pain reaching behind them for hygiene or dressing, and they have pain reaching overhead.

But what kind of help is considered the most effective course of treatment? I have written before about the vast benefits of shoulder exercises for orthopedic pain, and about the growing consensus that pain relief can be covered at home nearly as well as it can at the hospital or clinic. Now researchers have found good evidence that simple exercise can be a “drug” all its own. In this study exercise was used as a treatment measure in various settings. After dividing patients with frozen shoulder into three groups – some patients were placed in an exercise class; a second group were to perform individual physical therapy; a third group were to perform individual home exercises. Researchers found the most dramatic improvement among the group exercisers:

They discovered improvement in the exercise class group from a mean Constant Score of 39.8 at baseline to 71.4 at 6 weeks and 88.1 at 1 year, as well as a significant improvement in shoulder symptoms in the Oxford and Constant scores compared to the individual physiotherapy or home exercises alone groups.

This is a good sign that getting out of the house and remaining active can help to “thaw” a frozen shoulder, and may also prevent further recurrence of the problem. If you’d like to learn more about the latest advances in shoulder pain management, please contact my San Diego orthopedic shoulder surgery offices today.

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21/Apr/2014

Large-scale cohort studies have a tough time proving that one thing causes another, but they can raise interesting questions about strong correlations. This week, for instance, saw a published study which found that people who drink more milk may have less pain and slower progression of osteoarthritis, an affliction which strikes roughly a third of adults in the U.S.:

[The researchers] found that increasing milk consumption was associated with slower progression of the disease in women. In men, only those who consumed the most milk — seven or more glasses a week — saw the effect. More than 90 percent of the people in the study drank fat-free or low-fat milk, and the study did not find the effect with cheese and other dairy products.

It is possible, of course, that people who drink more milk are just healthier in every way, and that the milk is merely a signpost of that lifestyle than the cause of arthritis prevention. But we can safely assume that the milk isn’t causing any joint distress – and that upping your intake of liquid dairy may, in fact, represent a doorway to safer living. That being said, it is extremely important for growing children, lactating women, and postmenopausal women to ensure adequate calcium intake. That threshold may more easily be met with calcium supplements. Most of the better quality supplements will also have the necessary Vitamin D dosage as well. For further details reach out to your primary care physician or me to answer your questions.

We’ve spent lots of time in previous posts to discuss how to manage arthritis. We have now also touched on measures to try to prevent it. So try it if you like and see if that glass a day keeps the knee pain at bay. As an expert in orthopedic surgery, I have certainly seen enough chronic joint pain to know that every preventive measure is worth a shot.

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21/Apr/2014

The debate has been raging for some time: is walking or running better than an elliptical machine? And what does “better” mean, anyway?

As it happens, some talented physicians, technicians and orthopedic specialists have looked at the respective motions and benefits of both forms of exercise, and a few clear answers have emerged.

First things first: the calorie question seems to be a wash. That is to say that it takes roughly the same energy to propel your body forward no matter how you’re moving. My advice is “Just move!” and do what you like (by that, I mean exercise the way you enjoy to exercise). Some feel better on a treadmill. Some feel better in a spin class. Some feel better running on the open road. At the end of the day, the more you move the more calories you burn. So, obviously you must walk longer or farther to make up for the slower pace, when compared to jogging.

But the larger questions surrounding musculoskeletal health get a bit trickier. Yes, ellipticals offer a more robust workout for your thighs and buttocks, while running offers a better workout for your calves. But for orthopedic surgeons such as myself, the real question is about joint pain. And here, the winner is clear:

According to a study published this month in The British Journal of Sports Medicine, walking causes 112 percent of someone’s body weight to strike the ground with every step, while only 73 percent does in elliptical training. This slighter jarring is an advantage for people with sore joints, but less so for those who hope that exercise will improve bone health.

In summary, while elliptical training is less ‘traumatic’ to joints, it does less to prevent osteoporosis (bone thinning).

And there it is. Sore joints such as knees and ankles are more likely to worsen by running on concrete, whereas joints are less likely to become inflamed on the comparatively smooth trajectory of an elliptical machine. But I would recommend you do what you like, because that is what is gonna get you out to do it again. And that is the best form of exercise.

Do you want to learn more about how you can prevent joint pain and head off the need for knee surgery? Please contact my San Diego orthopedic surgery offices to set up an appointment today.

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21/Apr/2014

The plaster cast is a mainstay of modern orthopedic medicine. It is the star of countless movies and memories in which an injured child returns to school and collects signatures from dozens of fawning friends. There is nothing like a cast.

Yet now the vaunted cast may be threatened. 3D printing promises to disrupt just about everything about the way objects are created, especially in medicine. Recently a graduate student created a prototype for a lightweight, printable cast made of polymer that includes low-intensity pulsed ultrasound (LIPUS) within its casing. The benefits are clear – far less weight, far more customization in form and appearance, and a greatly increased chance of faster healing thanks to the proven benefits of LIPUS. Most importantly, depending on the 3D printed cast material, it may be safe to use in the water.

Think of this as just one of many new technologies that are changing the field of orthopedic surgery, giving patients across the country better access to more comfortable aftercare and healing. To learn more about some of the most advanced technologies in sports medicine, please contact my San Diego orthopedic surgery center today.

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21/Apr/2014

It is a question that has bedeviled physicians, nutritionists and trainers for generations: Why do some people hit the gym every day without fail, while others can barely find the motivation to hit the restroom in the morning?

Now scientists may have found a clue. A new study in the Journal of Physiology suggests genetic loading may influence the level of activity in which most of us engage on a daily basis. A rat study suggested that identical twins have a tendency to exercise a similar amount no matter what environment with which they are faced. Researchers then bred rats that were inclined to be highly active, and a separate group inclined to be more sedentary. Once again, the rats did as their genes predicted:

Even so, Dr. Booth said, his group’s data would seem to suggest “that humans may have genes for motivation to exercise and other genes for motivation to sit on the couch,” and over generations, one set of these genes could begin to predominate within a family. But predispositions are never dictatorial.

The silver lining in this particular study, however, is that rats who spent more time sedentary soon began to mimic their active counterparts; studies indicated that their brains actually began to look more like their motivated cousins across the lab. It seems possible that you, too, can raise your energy level just by, well, raising your energy level. Just say to yourself “I will do it!” Get out there and move!

We have plenty of hard data that tells us exercise can prevent knee pain and back pain, and prevent costly orthopedic knee surgeries. This study should be a strong reminder that exercise is a choice we can all make when necessary.

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CLASSIC LIST

Jimmo broken arm

Batting next… oh nevermind: LCL tear-symptoms & treatment

Meniscus repair surgery revitalizes a career… maybe?

Son of the greatest and his labrum tear

Exercise to Strengthen Bones

Exercises for frozen shoulder

The link between milk and arthritis pain

Walking vs. elliptical exercise for joint pain

Print One of These and Call Me in the Morning

Don’t Feel Like Exercising? Blame Your Genes

How Acupuncture Can Help With Fibromyalgia Pain

ACL Reconstruction Surgery in San Diego

Fibromyalgia and Chiropractic

Physical Therapy and Fibromyalgia

Fibromyalgia – More than Just Aches and Pains

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