Take Charge of Your Bone Health!

“Know Your Bones” with Help From TOCA’s Integrated Bone Health Center

Whether you’re a growing child, active adult, or entering your senior years, good bones are important to your overall good health! After all, our bones support our bodies and protect the brain, heart, and other essential organs from injury. However, as we age, bones weaken and lose density, placing us at greater risk for osteoporosis and fractures. The key is to pay attention to bone health before a fracture occurs! That’s why The Orthopedic Clinic Association (TOCA) has an entire team of skilled specialists devoted to your bone health and care. And their mission is to help  patients keep bones strong and healthy at every age.

Helping Patients Identify Risks to Prevent Falls and Fractures

Led by Dr. Dean Cummings, MD, who is assisted by board-certified PA-C Ashlyn Sala, TOCA’s Bone Health Center team offers Integrated Bone Health Solutions™ and works closely with patients to help identify and prevent factors that may place them at risk for a fall or fracture. They created the “Know Your Bones,” program, which is an integrated, results-oriented approach to bone health. It is based around a four pillar system: Biological, Functional, Behavioral, and Environmental patient lifestyle factors.

After an initial patient assessment, the Bone Health Center team creates a multi-disciplinary integrated profile for each patient, with recommendations to help maximize their bone health. This includes input from the patient and their primary care provider in order to put an effective and customized prevention and/or treatment plan into action.

Our First Goal Is Education

According to Dr. Cummings, “Educating the patient is a critical component of our approach. Our first goal is to help the patient truly understand their bone health, and lifestyle issues impacting bone health, before we treat any underlying conditions or disorders. We believe that by building better awareness, we can empower our patients to help them prevent factors that can eventually lead to a debilitating condition like osteoporosis, or a fall or serious fracture.”

Keeping in mind that peak bone mass is achieved between the ages of 25-30, TOCA Bone Health Center specialists look for ways to help patients overcome the decline in bone formation that occurs as we age. Maintaining a proper diet and taking the recommended amount of calcium and vitamin D is critical. Weight bearing exercises, along with a healthy lifestyle, also lessen the impact of bone loss. TOCA’s Bone Health Center team seek input from patients in order to identify potential areas of concern in the home or workplace that could lead to a fall. In addition, medications to either lessen the amount of bone loss or increase bone formation can be started, if and when appropriate.

“We’re very much aware that no two patients are alike and different factors come into play that impact bone health during different stages of life,” adds Dr. Cummings. “Teenagers form bone faster than they lose bone. Women undergoing menopause lose bone more quickly. Whatever age or stage of life they’re in, we offer a range of preventative treatments customized to help each patient protect their bones so that they can live an active and healthy lifestyle.”

It’s never too early or too late to take charge of your bone health. Schedule an appointment with TOCA’s Bone Health Center specialists today! Contact us at 602.512-8452 or bonehealthcenter@tocamd.com.

Stress Fracture Symptoms and Treatment Tips from TOCA’s Orthopedic Experts

“You have a stress fracture” is a diagnosis shared all too often by orthopedic specialists, especially when treating athletes. Athletes are most at risk due to repetitive activity and overuse of their feet and legs. Overuse causes the lower extremities to continually absorb these forces and potentially causing tiny cracks in the bones.

If athletic activity is too frequent, it diminishes the body’s ability to repair and replace bone. And the likelihood of sustaining a stress fracture increases. That’s why runners, dancers, soccer players, and basketball players are particularly vulnerable to stress fractures.

And, according to The Orthopedic Clinic Association (TOCA) orthopedic and sports medicine care expert, Dr. Gerald Yacobucci, MD, “If they are already experiencing consistent pain, the more these athletes train and compete, the more they may be placing themselves at greater risk for injury – and time away – from the sport or activity they enjoy.”

Here’s what Dr. Yacobucci and the TOCA team want ALL athletes, parents, and coaches to know in order to recognize stress fracture symptoms, help prevent stress fractures from occurring, and remain injury-free.

Stress Fracture Symptoms

What are some of the signs of stress fracture to watch out for? Rather than the sharp pain resulting from an acute fracture, stress fractures are typically accompanied by a dull pain that increases gradually. Often, the pain subsides during rest and intensifies during activity. Swelling around the site may be present as well as some tenderness and bruising. As mentioned above, stress fractures can be caused by overuse of lower extremities, common in athletes, but they can also arise from a sudden upsurge in physical activity. Osteoporosis can also increase the chance of a stress fracture.

It’s important to remember that, if dull pain persists, it’s time to seek help from an orthopedic specialist!

Treatment of Stress Fractures

Immediately after injury or stress fracture symptoms occur, patients are encouraged to follow the RICE (Rest, Ice, Compression, Elevation) method. Once you consult with you orthopedic specialist, he/she will examine the “pain point” and X-rays will likely be taken. If the stress fracture is not visible via X-ray, but your doctor still suspects that you have a stress fracture, he/she may recommend that you get an MRI.

Nonsurgical treatment options for stress fractures include keeping weight off of the area (perhaps wearing a boot or using crutches), and modified activity for a period of up to 8 weeks. In some, more severe, cases, surgery may be necessary to allow the stress fracture to heal properly. This typically entails using a pin, screw, or plate to “fasten” the bones together in order to promote healing. The key to recovery is to allow ample time for rest, healing, and rehabilitation. Taking time off ensures that you can eventually get back to the activities you enjoy safely and without placing yourself at risk for additional injury.

Stress Fracture Prevention

According to Dr. Yacobucci, “One of the most important pieces of advice I share with patients, especially athletes, is to monitor and be mindful of your activity and pain level. If you find that you’re consistently experiencing pain during training or workouts, then it’s time to listen to your body’s signals. Refrain from activity until you seek further treatment from an orthopedic expert.”

Additional stress fracture prevention tips from Dr. Yacobucci and TOCA experts include:

  • Wearing footwear with good support.
  • Strength training and cross-training to avoid overuse of certain muscle sets and strain on bones.
  • Good nutrition, including plenty of calcium and Vitamin D for optimal bone strength.
  • And good common sense. Listen to your body’s signals and seek help if pain persists after adequate rest.

To schedule a consult with Dr. Yacobucci, or one of TOCA’s knowledgeable and highly trained orthopedics specialists, please contact us at 602.277.6211.

Dr. Lederman and colleagues present a study comparing new techniques for rotator cuff repair!

Title: Triple-Loaded Suture Anchors Versus a Knotless Rip Stop Construct in a Single-Row Rotator Cuff Repair Model

Matthew Noyes, MD, Christopher Adams MD, Evan S. Lederman MD, Patrick Denard MD

Purpose

To compare the biomechanical properties of single-row repair with triple-loaded (TL) anchor repair versus a knotless rip stop (KRS) repair in a rotator cuff repair model.

Full article link below.

The Journal of Arthroscopy and Related Research: 2018 Feb 15. pii: S0749-8063(18)30029-X. doi: 10.1016/j.arthro.2017.12.024. [Epub ahead of print]

https://www.arthroscopyjournal.org/article/S0749-8063(18)30029-X/fulltext

Dr. Evan Lederman and colleagues review how bone reacts to shoulder replacements and propose a classification system for critical review of implant/bone interaction

Title: Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation

Patrick Denard MD, Patric Raiss MD, Reuben Gobezie MD, T. Bradley Edwards MD, Evan S. Lederman MD

Introduction

Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings.

Full article link below.

Journal of Shoulder and Elbow Surgery E-pub February 6, 2018

https://doi.org/10.1016/j.jse.2017.12.020

Dr. Lederman and colleagues discuss the outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Title: Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Reuben Gobezie MD, Patrick Denard MD, Yousef Shishani MD, Anthony Romeo MD, Evan S. Lederman MD

Background

The purpose of this study was to evaluate functional outcome and healing of a subscapularis peel with a stem-based repair after total shoulder arthroplasty (TSA). The hypothesis was that the repair would lead to subscapularis healing in the majority of cases.

Full article: https://doi.org/10.1016/j.jse.2017.02.013

Journal of Shoulder and Elbow Surgery

Volume 26, Issue 9, September 2017, Pages 1603-1608

Dr. Lederman, Dr. Lund and former fellows have described a new class of labral tears in the shoulder*

Title: The Glenoid Labral Articular Teardrop Lesion: A Chondrolabral Injury With Distinct Magnetic Resonance Imaging Findings

Evan S. Lederman MD, Stephen Flores MD, Christopher Stevens MD, Damien Richardson MD, Pamela Lund MD

*Identification of this lesion of MRI can help in diagnosis and treatment of labral tears.

Purpose

Evaluation and description of a pathognomonic lesion identified on magnetic resonance imaging (MRI) of a chondrolabral injury of the glenohumeral joint.

Methods

Patients were prospectively identified at the time of MRI by a characteristic teardrop appearance of a pedicled displaced chondrolabral flap in the axillary recess on coronal imaging and retrospectively reviewed.

Full article: https://doi.org/10.1016/j.arthro.2017.08.236

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 34, Issue 2, February 2018, Pages 407-411

 

Dr. Lederman and colleagues discuss the outcome and safety of a short stem shoulder replacement

Title: Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty

Anthony A. Romeo MD, Robert J Thorness MD, Shelby A Sumner MPH, Reuben Gobezie MD, Evan S Lederman MD, Patrick J Denard MD

Background

Short-stem press-fit humeral components have recently been developed in an effort to preserve bone in total shoulder arthroplasty (TSA), but few studies have reported outcomes of these devices. The purpose of this study was to evaluate the short-term clinical outcomes of an anatomic short-stem humeral component in TSA. We hypothesized that the implant would lead to significant functional improvement with low rates of radiographic loosening.

Full Article: https://doi.org/10.1016/j.jse.2017.05.026

The Journal of Shoulder and Elbow Surgery

Volume 27, Issue 1, January 2018, Pages 70-74

Dr. Lederman and Dr. Harmsen discuss the challenges and techniques for revision shoulder replacement.*

Title: Humeral cemented revision: Techniques for safe extraction

Samuel Harmsen MD, Evan S. Lederman MD

Abstract

Removing a well-fixed humeral component in revision shoulder arthroplasty can present a difficult challenge. Intraoperative complications including iatrogenic fracture, humeral perforation, segmental bone loss, nerve and soft tissue injury can occur. These complications can occur with both cemented and press-fitted stems and can lead to increased morbidity and decreased functional outcomes. Complete removal of the cement mantle and cement restrictor, when necessary, can present even further challenges. Several extraction techniques have been described that can help minimize complications and enable safe, complete component extraction.

Seminars in Arthroplasty

Volume 28, Issue 3, September 2017, Pages 175-179
*This is based on a lecture by Dr. Lederman at the 2017 Current Concepts in Shoulder Arthroplasty Conference in Las Vegas, NV.

Dr. Lederman and colleagues review how bone reacts to shoulder replacements and document the potential benefit and safety of short stem shoulder implants

Title: Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty

Patrick J. Denard MD, Matthew P Noyes MD, J B Walker MD, Youself Shishani MD, Reuben Gobezie MD, Anthony A Romeo MD, Evan S. Lederman MD

Background

The purpose of this study was to compare the radiographic changes of the humerus in the short term after total shoulder arthroplasty with two different short-stem humeral components. The hypothesis was that there would be no difference in radiographic changes or functional outcome based on component type.

Full article available: https://doi.org/10.1016/j.jse.2017.08.010

The Journal of Shoulder and Elbow Surgery

Volume 27, Issue 2, February 2018, Pages 217-223

 

Dr. Lederman and colleagues review how bone can react differently to shoulder replacements and document the potential benefit and safety of short stem shoulder implants

Title: Proximal Stress is Decreased with a Short Stem Compared to a Traditional Length Stem In Total Shoulder Arthroplasty

Patrick J. Denard MD, Matthew P Noyes MD, J B Walker, MD, Yousef Shishani, MD, Reuben Gobezie MD, Anthony A Romeo, MD, Evan S. Lederman, MD

Background

This study compared the outcome and radiographic humeral adaptations after placement of a traditional-length (TL) or short-stem (SS) humeral component during total shoulder arthroplasty (TSA). The hypothesis was there would be no difference in outcome or radiographic adaptations.

Full article: https://doi.org/10.1016/j.jse.2017.06.042

The Journal of Shoulder and Elbow Surgery

Volume 27, Issue 1, January 2018, Pages 53-58