NUsurface Meniscus Surgery: Are You a Candidate?

NUsurface Meniscus Surgery: Are You a Candidate?

Your Life Arizona talks with orthopedic surgeon Dr. Tom Carter and NUsurface Meniscus Implant recipient Robert Nowlan about a clinical trial for knee pain after meniscus surgery. For more information on the trial, please call (844) 680-8951.

Have you had surgery to repair a torn meniscus but are still living with knee pain? Have you been told that you’re too young for knee replacement surgery and thought you were out of options? If you answered yes to these questions, you may be a candidate for the NUsurface Meniscus Implant – a medial meniscus replacement to treat persistent knee pain caused by injured or deteriorating meniscus cartilage.

The implant, which is made of medical grade plastic and inserted in to the knee through a small incision, has been used in Europe since 2008 and Israel since 2011. A clinical trial called SUN (Safety Using NUsurface®) is taking place at TOCA (The Orthopedic Clinic Association) to determine the effectiveness of the NUsurface Meniscus Implant for individuals with knee pain. More information about this study can be found here.

While it’s not meant to take the place of a total knee replacement, the NUsurface Meniscus Implant can serve as an opportunity to treat knee pain and keep you active until knee replacement surgery, if needed, is a viable option. The unique materials and composite structure are designed to mimic the function of a natural meniscus and redistribute loads transmitted across the knee joint. To date, the implant has given nearly 100 patients a second chance at a pain-free, active life.

About the Procedure

The meniscus implant is inserted into the knee through a small incision, and patients are allowed to go home the same day or the day after the operation. After surgery, they undergo a six-week rehabilitation program and a physician will explain recommended activities during this period.

Who is Eligible?

If you’re interested in the NUsurface Meniscus Implant, ask yourself the following questions to determine if you might be eligible to participate in this clinical trial:

  • Have you had a previous medial partial meniscectomy that was performed at least six months ago?
  • Do you have persistent knee pain?
  • Has your physician recommended non-surgical therapies to deal with the pain?
  • Are you between the ages of 30 and 75?

Please note patients who are candidates for partial or total knee arthroplasty are not eligible.

How Can I Find Out if I Qualify?

Visit sun-trial.com, call (844) 680-8951 or contact the dedicated TOCA Team at 602-277-6211

Learn more about Dr. Carter Here

TOCA (The Orthopedic Clinic Association) performs the first meniscus replacement in Arizona read more Here

 

#MyOrthoDoc #TOCAMD #TOCA #YourLifeAtoZ #ActiveImplants #MeniscusReplacement

HUDDLE UP ABOUT SPORTS SAFETY

BACK TO SCHOOL, BACK TO SPORTS, TIME TO HUDDLE UP ABOUT SPORTS SAFETY

For many kids, back to school means back to sports. Youth sports are, and should always be, a valuable experience, filled with challenges, competition and fun. But too many kids are stuck on the sidelines because of an injury that is preventable. It is that time of year to huddle up about sports safety!

Every year, millions of teenagers participate in high school sports. An injury to a high school athlete can be a significant disappointment for the teen, the family, and the coaches. The pressure to play can lead to decisions that may lead to additional injury with long-term effects. High school sports injuries can cause problems that require surgery as an adult, and may lead to arthritis later in life.

When a sports injury occurs, it is important to quickly seek proper treatment. To ensure the best possible recovery, athletes, coaches, and parents must follow safe guidelines for returning to the game.

The Adolescent Athlete

Teenage athletes are injured at about the same rate as professional athletes, but injuries that affect high school athletes are often different from those that affect adult athletes. This is largely because high school athletes are often still growing.

Growth is generally uneven: Bones grow first, which pulls at tight muscles and tendons. This uneven growth pattern makes younger athletes more susceptible to muscle, tendon, and growth plate injuries.

Types of High School Sports Injuries

Injuries among young athletes fall into two basic categories: overuse injuries and acute injuries. Both types include injuries to the soft tissues (muscles and ligaments) and bones.

Acute Injuries

Acute injuries are caused by a sudden trauma. Examples of trauma include collisions with obstacles on the field or between players. Common acute injuries among young athletes include contusions (bruises), sprains (a partial or complete tear of a ligament), strains (a partial or complete tear of a muscle or tendon), and fractures.

A twisting force to the lower leg or foot is a common cause of ankle fractures, as well as ligament injuries (sprains).

Reproduced and modified with permission from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Overuse Injuries

Not all injuries are caused by a single, sudden twist, fall, or collision. Overuse injuries occur gradually over time, when an athletic activity is repeated so often, parts of the body do not have enough time to heal between playing.

Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates. For example, overhand pitching in baseball can be associated with injuries to the elbow. Swimming is often associated with injuries to the shoulder. Gymnastics and cheerleading are two common activities associated with injuries to the wrist and elbow.

Stress fractures are another common overuse injury in young athletes. Bone is in a constant state of turnover—a process called remodeling. New bone develops and replaces older bone. If an athlete’s activity is too great, the breakdown of older bone occurs rapidly, and the body cannot make new bone fast enough to replace it. As a result, the bone is weakened and stress fractures can occur—most often in the shinbone and bones of the feet.

Catastrophic Sports Injuries

Many sports, especially contact sports, have inherent dangers that put young athletes at special risk for severe injuries. Even with rigorous training and proper safety equipment, children are at risk for severe injuries to the head and neck with damage to the brain or spinal cord.

Catastrophic injuries have been reported in a wide range of sports, including ice hockey, wrestling, football, swimming, soccer, pole vaulting, cheerleading, and gymnastics. It is important for coaches, parents, and athletes to be aware of the guidelines and regulations developed for each sport to prevent head and neck injury.

Concussion

Concussions are mild traumatic brain injuries. They are caused by a blow to the head or body that results in the brain moving rapidly back and forth inside the skull.

Although some sports have higher instances of concussion—such as football, ice hockey, and soccer—concussions can happen in any sport or recreational activity.

In 2010, the American Academy of Pediatrics recommended that young athletes with concussions be evaluated and cleared by a doctor before returning to sports. The American Academy of Neurology issued a similar statement, and stressed that doctors who clear athletes for return to sports should be trained in managing and assessing sports concussions.

Growth Plate Injuries

Growth plates are areas of developing cartilage tissue near the ends of long bones. When a child becomes full-grown, the growth plates harden into solid bone.

Because growth plates are the last portion of bones to harden (ossify), they are vulnerable to fracture. Growth plates regulate and help determine the length and shape of adult bone, therefore, injuries to the growth plate can result in disturbances to bone growth and bone deformity.

Growth plate injuries occur most often in contact sports like football or basketball and in high impact sports like gymnastics.

 

Prompt Medical Attention

Whether an injury is acute or due to overuse, a high school athlete who develops a symptom that persists or that affects his or her athletic performance should be examined by a doctor. Untreated injuries could lead to permanent damage or disability.

Some athletes may downplay their symptoms in order to continue playing. Coaches and parents should be aware of the more common signs of injury, such as pain with activity, changes in form or technique, pain at night, and decreased interest in practice.

Doctor Examination

During the examination, the doctor will ask about how the injury occurred, the symptoms, and will discuss the athlete’s medical history. During the physician examination, the doctor will look for points of tenderness, as well as range of motion.

If necessary, the doctor may recommend imaging tests, such as x-rays or other tests, to evaluate the bones and soft tissues.

Treatment

Treatment will depend upon the severity of the injury, and may include a combination of physical therapy, strengthening exercises, and bracing. More serious injuries may require surgery.

 

Return to Play

A player’s injury must be completely healed before he or she returns to sports activity.

  • In case of a joint problem, the player must have no pain, no swelling, full range of motion, and normal strength.
  • In case of concussion, the player must have no symptoms at rest or with exercise, and should be cleared by the appropriate medical provider.

Media stories about the early return to competition by professional athletes following injury create the impression that any athlete with proper treatment can return to play at the same ability level, or even better.

It is important for players, parents, and coaches to understand that depending on the type of injury and treatment required, the young athlete may not be able to return to the game at the same level of play—no matter how much effort is put into injury rehabilitation.

 

Prevention

Many high school sports injuries can be prevented through proper conditioning, training, and equipment.

High school athletes require sport specific training to prevent injury. Many injuries can be prevented with regular conditioning that begins prior to the formal sports season. Injuries often occur when athletes suddenly increase the duration, intensity, or frequency of their activity. Young athletes who are out of shape at the start of the season should gradually increase activity levels and slowly build back up to a higher fitness level.

Using proper technique for the position being played is also key to preventing injury. Proper equipment—from the right shoes to safety gear—is essential. In addition, injuries can be prevented when athletes understand and follow the rules of the game, and display good sportsmanship.

Because many young athletes are focusing on just one sport and are training year-round, doctors are seeing an increase in overuse injuries. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries. Specific tips to prevent overuse injuries include:

  • Limit the number of teams in which your child is playing in one season. Athletes who play on more than one team are especially at risk for overuse injuries.
  • Do not allow your child to play one sport year-round—taking regular breaks and playing other sports is essential to skill development and injury prevention.

As we begin the new school year, Safe Kids is teaming up with Johnson & Johnson to keep kids healthy and injury-free so they can reach their full potential. We conducted a survey of parents, coaches and young athletes to explore how the current culture of sports may be leading to unnecessary injuries, and how that culture needs to change.

Here are three ways to get started.

  • Put an end to dirty play. One in four young athletes reported it is normal to commit hard fouls and play rough to “send a message” during a game. This norm leads to a disturbing number of injuries: 33 percent of athletes report being hurt as the result of “dirty play” from an opponent. Sports teach valuable lessons and should be competitive and entertaining but we have to move away from a “winning at all costs” mentality that is actually detrimental to the health and development of our young athletes.
  • Let’s give coaches the training they need and want. One in four coaches say they don’t take any specific actions to prevent sports injuries. Less than half of coaches say they have received certification on how to prevent and recognize sports injuries. Shouldn’t there be more training for coaches to ensure that they are well versed in the proper techniques for top performance and injury prevention?
  • Teach young athletes to speak up when they are injured.About 42 percent of players reported they have hidden or downplayed an injury during a game so they could keep playing. We can remove the terms “taking one for the team”, “suck it up” and “playing through an injury” from the dialogue. At the end of the day, young players must feel it’s OK to tell coaches, parents and other players that they’ve been hurt and it’s time to sit it out.

Changing the culture in sports isn’t about limiting kids. It’s about creating an atmosphere where our young athletes can compete, have fun and reach their full potential. Let’s get the conversation going. Working together, we can keep our kids active, strong and safe so they can enjoy the sports they love for a lifetime.

 

If you are injured the Team of Orthopedic Physicians and Orthopedic Sports Medicine Physicians here at TOCA are here to help! To learn more or schedule an appointment call: 602-277-6211.

 

Learn more at safekids.org. and STOP Sports Injuries 

Additional TOCA articles to consider reading: Knee Injuries, Ankle Sprains and Shoulder Injury Prevention tips! 

#Recovery #Results #Relief #TOCA #TOCAMD #STOPSportsInjuries #Safekids #MyOrthoDoc #SportsInjury #SportsMedicine

Backpack Safety!

[vc_row][vc_column][vc_column_text]When you move your child’s backpack after he or she drops it at the door, does it feel like it contains 40 pounds of rocks? Maybe you’ve noticed your child struggling to put it on, bending forward while carrying it, or complaining of tingling or numbness. If you’ve been concerned about the effects that extra weight might have on your child’s still-growing body, your instincts are correct. Backpacks that are too heavy can cause a lot of problems for kids, like back and shoulder pain, and poor posture. Did you know that according to the Consumer Product Safety Commission, injuries from heavy backpacks result in more than 7,000 emergency room visits per year. Sprains, strains, and “overuse” injuries were among the top complaints.

When selecting a backpack, look for:

  • An ergonomic design
  • The correct size: never wider or longer than your child’s torso and never hanging more than 4 inches below the waist
  • Padded back and shoulder straps
  • Hip and chest belts to help transfer some of the weight to the hips and torso
  • Multiple compartments to better distribute the weight
  • Compression straps on the sides or bottom to stabilize the contents
  • Reflective material

Backpack Safety Tips:

  • Your backpack should weigh only 15% – 20% of your total weight
  • Use both shoulder straps to keep the weight of the backpack better distributed
  • Tighten the straps to keep the load closer to the back
  • Organize items and pack heavier things low and towards the center
  • Remove items if the backpack is too heavy and only carry items necessary for the day
  • Lift properly by bending at the knees when picking up a backpack

Remember: A roomy backpack may seem like a good idea, but the more space there is to fill, the more likely your child will fill it. Make sure your child uses both straps when carrying the backpack. Using one strap shifts the weight to one side and causes muscle pain and posture problems.

Help your child determine what is absolutely necessary to carry. If it’s not essential, leave it at home.[/vc_column_text][/vc_column][/vc_row]

 

If you or your child is experiencing neck or back pain the expert Physicians at TOCA and the dedicated staff are here to help! Call 602-277-6211 to schedule your appointment today!

 

#Recovery #Results #Relief #BackpackSaftey #MyOrthoDoc #BacktoSchool

Sciatica

If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have a protruding (herniated) disk in your spinal column that is pressing on the nerve roots in the lumbar spine. This condition is known as sciatica.

What is sciatica?

Sciatica (pronounced sigh-at-eh-kah)  is pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and can radiate down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. The pain of sciatica is sometimes referred to as sciatic nerve pain.

Symptoms

Sciatica may feel like a bad leg cramp, with pain that is sharp (“knife-like”), or electrical. The cramp can last for weeks before it goes away. You may have pain, especially when you move, sneeze, or cough. You may also have weakness, “pins and needles” numbness, or a burning or tingling sensation down your leg.

Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Symptoms are usually based on the location of the pinched nerve.

Causes

Sciatica rarely occurs before age 20, and becomes more commonplace in middle age. It is most likely to develop around age 30 and 50.

Perhaps because the term sciatica is often used loosely to describe leg pain, estimates of its prevalence vary widely. Some researchers have estimated it will affect up to 43% of the population at some point.

Often, a particular event or injury does not cause sciatica—rather it tends to develop over time.

The vast majority of people who experience sciatica get better within a few weeks or months and find pain relief with nonsurgical sciatica treatment. For others, however, the leg pain from a pinched nerve can be severe and debilitating.

Seeing a doctor for sciatica pain is advised, both for learning how to reduce the pain and to check for the possibility of a serious medical issue.

While sciatica is most commonly a result of a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can produce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Approximately 1 in every 50 people will experience a herniated disk at some point in their life. Of these, 10% to 25% have symptoms that last more than 6 weeks. In rare cases, a herniated disk may press on nerves that cause you to lose control of your bladder or bowel, referred to as cauda equina syndrome. If this happens, you may also have numbness or tingling in your groin or genital area. This is an emergency situation that requires surgery. Phone your doctor immediately. Aside from a pinched nerve from a disc, other causes of sciatica include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections in or around the lumbar spine, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

6 Most Common Causes of Sciatica

When discussing sciatica, it is important to understand the underlying medical cause, as effective treatment will focus on addressing the pain’s root cause as well as alleviating acute symptoms.

  • Lumbar herniated disc
    A herniated disc occurs when the soft inner material of the disc leaks out, or herniates, through the fibrous outer core and irritates or pinches the contiguous nerve root.

Other terms used to refer to a herniated disc are slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.

  • Degenerative disc disease
    While some level of disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica.

Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the nerve root(s) in the area.

Bone spurs, which may develop with spinal degeneration, also may press against a nerve, resulting in sciatica.

  • Isthmic spondylolisthesis
    This condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the L5 vertebra slips forward over the S1 vertebra.

With a combination of disc space collapse, the fracture, and the vertebral body

  • Lumbar spinal stenosis
    This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults older than age 60.

The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.

Lumbar spinal stenosis commonly occurs along with spinal arthritis, and arthritis can also cause or contribute to sciatica symptoms.

  • Piriformis syndrome
    The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.

This is not a true lumbar radiculopathy, which is the clinical definition of sciatica. However, because the leg pain can feel the same as sciatica or radiculopathy, it is sometimes referred to as sciatica.

  • Sacroiliac joint dysfunction
    Irritation of the sacroiliac joint—located at the bottom of the spine—can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.

Again, this is not a true radiculopathy, but the leg pain can feel the same as sciatica caused by a nerve irritation.

What are risk factors for sciatica? What are sciatica symptoms?

Risk factors for sciatica include degenerative arthritis of the lumbar spine, lumbar disc disease, and slipped disc, and trauma or injury to the lumbar spine.

Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar painbuttock painhip pain, and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. The pain relief by changing positions can be partial or complete.

When Sciatica Is Serious

Certain sciatica symptoms, while rare, require immediate medical, and possibly surgical, intervention. These include, but are not limited to, progressive neurological symptoms (e.g. leg weakness) and/or bowel or bladder dysfunction (cauda equina syndrome). Infection or spinal tumors can also cause sciatica.

Because sciatica is caused by an underlying medical condition, treatment is focused on addressing the cause of symptoms rather than just the symptoms. Treatment is usually self-care and/or nonsurgical, but for severe or intractable pain and dysfunction it may be advisable to consider surgery.

How do health-care professionals diagnose sciatica?

Diagnosis begins with a complete patient history. Your doctor will ask you to explain how your pain started, where it travels, and exactly what it feels like.

A physical examination may help pinpoint the irritated nerve root. Your doctor may ask you to squat and rise, walk on your heels and toes, or perform a straight-leg raising test or other tests.

X-rays and other specialized imaging tools, such as a magnetic resonance imaging (MRI) scan, may confirm your doctor’s diagnosis of which nerve roots are affected.

Nonsurgical Treatment

The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks.

Nonsurgical treatment is aimed at helping you manage your pain without long-term use of medications. Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may also help. In addition, you may find it soothing to put gentle heat or cold on your painful muscles. It is important that you continue to move. Do not remain in bed, as too much rest may cause other parts of the body to feel discomfort.

Find positions that are comfortable, but be as active as possible. Motion helps to reduce inflammation. Most of the time, your condition will get better within a few weeks.

Sometimes, your doctor may inject your spinal area with a cortisone-like drug.

As soon as possible, start stretching exercises so you can resume your physical activities without sciatica pain. Your doctor may want you to take short walks and may prescribe physical therapy.

Surgical Treatment

You might need surgery if you still have disabling leg pain after 3 months or more of nonsurgical treatment. A part of your surgery, your herniated disk may be removed to stop it from pressing on your nerve.

 

The surgery (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg.

Rehabilitation

Your doctor may give you exercises to strengthen your back. It is important to walk and move while limiting too much bending or twisting. It is acceptable to perform routine activities around the house, such as cooking and cleaning.

Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it is always possible for your disk to rupture again.

Physical Therapy and Exercise for Sciatica

Physical therapy exercises incorporating a combination of strengthening, stretching, and aerobic conditioning are a central component of almost any sciatica treatment plan.

When patients engage in a regular program of gentle exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of pain.

Sciatica exercises usually focus on three key areas: strengthening, stretching, and aerobic conditioning.

  • Strengthening exercises
    Many exercises can help strengthen the spinal column and the supporting muscles, ligaments, and tendons. Most of these back exercises focus not only on the lower back, but also the abdominal (stomach) muscles and gluteus (buttock) and hip muscles.

Strong core muscles can provide pain relief because they support the spine, keeping it in alignment and facilitating movements that extend or twist the spine with less chance of injury or damage.

  • Stretching exercises
    Stretching is usually recommended to alleviate sciatic pain. Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible.

Hamstring stretching is almost always an important part of a sciatica exercise program. Most people do not stretch these muscles, which extend from the pelvis to the knee in the back of the thigh, in their daily activities.

Another stretch that is often helpful in easing sciatica is the Bird Dog move: After getting on their hands and knees, individuals extend one arm and the opposite leg. The arm and leg extensions are then alternated. A more advanced version of this exercise is the Plank Bird Dog move, in which the extensions are done once the person is in the plank position on their hands and toes.

  • Low-impact aerobic exercise
    Some form of low-impact cardiovascular exercise, such as walking, swimming, or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment.

Aerobic conditioning also has the unique benefit of releasing endorphins, the body’s natural pain killers, which helps reduce sciatic pain.

These types of exercise may be done separately or in combination. Examples of types of exercise that may include both strengthening and stretching include yogatai chi, and Pilates.

For anyone in chronic pain or with a relatively high level of sciatica pain, one option for gentle exercise is water therapy, which is a controlled, progressive exercise program done in a warm pool.

When sciatica pain is at its most severe, patients may find the pain hard to bear and may need to rest for a day or two. However, resting for more than one or two days is generally not advised, as prolonged rest or inactivity can increase pain and will lead to deconditioning. Regular movement is important to provide healing nutrients to the injured structures that are causing the pain.

If you are experiencing back or neck pain the experts at TOCA are here to help! Call our dedicated team to schedule your consultation today at: 602-277-6211!

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD #backpain

Foot & Ankle Conditioning Program

After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Following a well-structured conditioning program will also help you return to sports and other recreational activities.

This is a general conditioning program that provides a wide range of exercises. To ensure that the program is safe and effective for you, it should be performed under your doctor’s supervision. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals.

Strength: Strengthening the muscles that support your lower leg, foot, and ankle will help keep your ankle joint stable. Keeping these muscles strong can relieve foot and ankle pain and prevent further injury.

Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.

Target Muscles: The muscle groups of the lower leg are targeted in this conditioning program, as well as the tendons and ligaments that control movement in your feet. These include:

  • Gastrocnemius-soleus complex (calf)
  • Anterior tibialis (shin)
  • Posterior tibialis (center of calf)
  • Peroneus longus (outside of lower calf)
  • Peroneus brevis (outside of lower calf)
  • Soleus (calf)
  • Dorsiflexors (ankle)
  • Plantar flexors (ankle)
  • Invertors (ankle)
  • Evertors (ankle)

Length of program: This foot and ankle conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your feet and lower legs. Performing the exercises three to five days a week will maintain strength and range of motion in your foot and ankle.

 

Getting Started

Warm up: Before doing the following exercises, warm up with 5 to 10 minutes of low impact activity, like walking or riding a stationary bicycle.

Stretch: After the warm-up, do the stretching exercises shown on Page 1 before moving on to the strengthening exercises. When you have completed the strengthening exercises, repeat the stretching exercises to end the program.

Do not ignore pain: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising.

Ask questions: If you are not sure how to do an exercise, or how often to do it, contact your doctor or physical therapist

 

1. Heel Cord Stretch

Repetitions 2 sets of 10
Days per week 6 to 7

Main muscles worked: Gastrocnemius-soleus complex
You should feel this stretch in your calf and into your heel

Equipment needed: None

Step-by-step directions

  • Stand facing a wall with your unaffected leg forward with a slight bend at the knee. Your affected leg is straight and behind you, with the heel flat and the toes pointed in slightly.
  • Keep both heels flat on the floor and press your hips forward toward the wall.
  • Hold this stretch for 30 seconds and then relax for 30 seconds. Repeat.

Tip Do not arch your back.

2. Heel Cord Stretch with Bent Knee

Repetitions 2 sets of 10
Days per week 6 to 7

Main muscles worked: Soleus
You should feel this stretch in your calf, the sides of your ankle, and into your heel

Equipment needed: None

Step-by-step directions

  • Stand facing a wall with your unaffected leg forward with a slight bend at the knee. Your affected leg is behind you, with the knee bent and the toes pointed in slightly.
  • Keep both heels flat on the floor and press your hips forward toward the wall.
  • Hold the stretch for 30 seconds and then relax for 30 seconds. Repeat.

Tip Keep your hips centered over both feet.

 

3. Golf Ball Roll

Repetitions 1
Days per week Daily

Main muscles worked: Plantar fascia ligament
You should feel this exercise along the bottom of your foot

Equipment needed: Golf ball

Step-by-step directions

  • Sit on a stable chair with both feet planted on the floor.
  • Roll a golf ball under the arch of your affected foot for 2 minutes.

Tip Sit up tall and keep your foot toward your chair.

 

4. Towel Stretch

Repetitions 2 sets of 10
Days per week 6 to 7

Main muscles worked: Gastrocnemius-soleus complex
You should feel this stretch in your calf and into your heel

Equipment needed: Hand towel

Step-by-step directions

  • Sit on the floor with both legs out in front of you.
  • Loop a towel around the ball of your affected foot and grasp the ends of the towel in your hands.
  • Keep your affected leg straight and pull the towel toward you.
  • Hold for 30 seconds and then relax for 30 seconds. Repeat 3 times.

Tip Sit up tall and keep your legs straight.

 

 

5. Calf Raises

Repetitions 2 sets of 10
Days per week6 to 7

Main muscles worked: Gastrocnemius-soleus complex
You should feel this exercise in your calf

Equipment needed: Chair for support

Step-by-step directions

  • Stand with your weight evenly distributed over both feet. Hold onto the back of a chair or a wall for balance.
  • Lift your unaffected foot off of the floor so that all of your weight is placed on your affected foot.
  • Raise the heel of your affected foot as high as you can, then lower.
  • Repeat 10 times.

Tip Do not bend the knee of your working leg.

 

5. Ankle Range of Motion

Repetitions 2 sets
Days per week Daily

Main muscles worked: Dorsiflexors, plantar flexors, invertors, evertors
You should feel this exercise at the top of your foot and throughout your ankle

Equipment needed: None

Step-by-step directions

  • Sit down so that your feet do not touch the floor.
  • Use your foot to write each letter of the alphabet in the air. Lead with your big toe.

Tip Keep the movements small, using just your foot and ankle.

 

 

6. Marble Pickup

Repetitions 20
Days per week Daily

Main muscles worked: Plantar flexors
You should feel this exercise at the top of your foot and toes

Equipment needed: 20 marbles

Step-by-step directions

  • Sit with both feet flat and place 20 marbles on the floor in front of you.
  • Use your toes to pick up one marble at a time and place into a bowl.
  • Repeat until you have picked up all the marbles.

Tip Do not place the marbles too far out in front or to the side.

 

 

7. Towel Curls

Repetitions 5
Days per week Daily

Main muscles worked: Plantar flexors
You should feel this exercise at the top of your foot and your toes

Equipment needed: Hand towel

Step-by-step directions

  • Sit with both feet flat and place a small towel on the floor in front of you.
  • Grab the center of the towel with your toes and curl the towel toward you.
  • Relax and repeat.

Tip You can make this exercise more challenging by placing a weight on the edge of the towel.

 

 

8. Ankle Dorsiflexion/Plantar Flexion

Repetitions 3 sets of 10
Days per week 3

Main muscles worked: Anterior tibialis, gastrocnemius-soleus complex
You should feel this exercise at your calf, shin, the back of your heel, and the top of your foot

Equipment needed: Use an elastic stretch band of comfortable resistance

Step-by-step directions

  • Sit on the floor with your legs straight out in front of you.
  • For dorsiflexion, anchor the elastic band on a chair or table leg, then wrap it around your foot.
  • Pull your toes toward you and slowly return to the start position. Repeat 10 times.
  • For plantar flexion, wrap the elastic band around your foot and hold the ends in your hand.
  • Gently point your toes and slowly return to the start position. Repeat 10 times.

Tip Keep your leg straight and heel on the floor for support.

 

If you are experiencing foot and/or ankle pain the experts at TOCA are here to help! View our website for more information or call our dedicated team to schedule an appointment today at: 602-277-6211!

 

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD#orthopedics #footpain #anklepain #injuryrecovery

 

Knee Re-Alignment (OSTEOTOMY) What you need to know!

Osteotomy literally means “cutting of the bone.” In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint.

Knee osteotomy is commonly used to realign your knee structure if you have arthritic damage on only one side of your knee. The goal is to shift your body weight off the damaged area to the other side of your knee, where the cartilage is still healthy. When surgeons remove a wedge of your shinbone from underneath the healthy side of your knee, the shinbone and thighbone can bend away from the damaged cartilage.

Imagine the hinges on a door. When the door is shut, the hinges are flush against the wall. As the door swings open, one side of the door remains pressed against the wall as space opens up on the other side. Removing just a small wedge of bone can “swing” your knee open, pressing the healthy tissue together as space opens up between the thighbone and shinbone on the damaged side so that the arthritic surfaces do not rub against each other.

Knee osteotomy is most commonly performed on people who may be considered too young for a total knee replacement. Total knee replacements wear out much more quickly in people younger than 55 than in people older than 70. Because prosthetic knees may wear out over time, an osteotomy procedure can enable younger, active osteoarthritis patients to continue using the healthy portion of their knee. The procedure can delay the need for a total knee replacement for up to ten years.

 

Why it’s done

Slick cartilage allows the ends of the bones in a healthy knee to move smoothly against each other. Osteoarthritis damages and wears away the cartilage — creating a rough surface.

When the cartilage wears away unevenly, it narrows the space between the femur and tibia, resulting in a bow inward or outward depending on which side of the knee is affected. Removing or adding a wedge of bone in your upper shinbone or lower thighbone can help straighten this bowing, shift your weight to the undamaged part of your knee joint and prolong the life span of the knee joint.

Osteoarthritis can develop when the bones of your knee and leg do not line up properly. This can put extra stress on on either the inner (medial) or outer (lateral) side of your knee. Over time, this extra pressure can wear away the smooth cartilage that protects the bones, causing pain and stiffness in your knee.

(Left) A normal knee joint with healthy cartilage. (Right) Osteoarthritis that has damaged just one side of the knee joint.

Advantages and Disadvantages

Knee osteotomy has three goals:

  • To transfer weight from the arthritic part of the knee to a healthier area
  • To correct poor knee alignment
  • To prolong the life span of the knee joint

By preserving your own knee anatomy, a successful osteotomy may delay the need for a joint replacement for several years. Another advantage is that there are no restrictions on physical activities after an osteotomy – you will be able to comfortably participate in your favorite activities, even high impact exercise.

Osteotomy does have disadvantages. For example, pain relief is not as predictable after osteotomy compared with a partial or total knee replacement. Because you cannot put your weight on your leg after osteotomy, it takes longer to recover from an osteotomy procedure than a partial knee replacement.

In some cases, having had an osteotomy can make later knee replacement surgery more challenging.

The recovery is typically more difficult than a partial knee replacement because of pain and not being able to put weight on the leg.

Because results from total knee replacement and partial knee replacement have been so successful, knee osteotomy has become less common. Nevertheless, it remains an option for many patients.

Procedure

Most osteotomies for knee arthritis are done on the tibia (shinbone) to correct a bowlegged alignment that is putting too much stress on the inside of the knee.

During this procedure, a wedge of bone is removed from the outside of the tibia, under the healthy side of the knee. When the surgeon closes the wedge, it straightens the leg. This brings the bones on the healthy side of the knee closer together and creates more space between the bones on the damaged, arthritic side. As a result, the knee can carry weight more evenly, easing pressure on the painful side.

In a tibial osteotomy, a wedge of bone is removed to straighten out the leg.

Tibial osteotomy was first performed in Europe in the late 1950s and brought to the United States in the 1960s. This procedure is sometimes called a “high tibial osteotomy.”

Osteotomies of the thighbone (femur) are done using the same technique. They are usually done to correct a knock-kneed alignment.

 

Candidates for Knee Osteotomy

Knee osteotomy is most effective for thin, active patients who are 40 to 60 years old. Good candidates have pain on only one side of the knee, and no pain under the kneecap. Knee pain should be brought on mostly by activity, as well as standing for a long period of time.

Candidates should be able to fully straighten the knee and bend it at least 90 degrees.

Patients with rheumatoid arthritis are not good candidates for osteotomy. Your orthopaedic surgeon will help you determine whether a knee osteotomy is suited for you.

Read More About Eligibility for Knee Osteotomy

Your Surgery

Before Surgery

At most medical centers, you will go to “patient admissions” to check in for your outpatient arthroscopic surgery.

After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry.

You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room.

Here are some important steps to remember for the day of your surgery:

  • You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.
  • Wear a loose pair of shorts or sweatpants that will fit comfortably over your knee bandage when you leave the hospital.

Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

 

Surgical Procedure

A knee osteotomy operation typically lasts between 1 and 2 hours.

Your surgeon will make an incision at the front of your knee, starting below your kneecap. He or she will plan out the correct size of the wedge using guide wires. With an oscillating saw, your surgeon will cut along the guide wires, and then remove the wedge of bone. He or she will “close” or bring together the bones in order to fill the space created by removing the wedge. Your surgeon will insert a plate and screws to hold the bones in place until the osteotomy heals.

This is the most commonly used osteotomy procedure, and is called a closing wedge osteotomy.

After the wedge of bone is removed, the tibia may be held in place with a plate and screws.

In some cases, rather than “closing” the bones, the wedge of bone is “opened” and a bone graft is added to fill the space and help the osteotomy heal. This procedure is called an opening wedge osteotomy.

After the surgery, you will be taken to the recovery room where you will be closely monitored as you recover from the anesthesia. You will then be taken to your hospital room.

After Surgery

Recovery Room

Following a knee osteotomy, you usually stay in the recovery room for at least two hours while the anesthetic wears off.

This procedure typically causes significant pain. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days.

Your knee will be bandaged and may have ice on it. You may have significant pain early on and you should take the pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present, so ask the nurse for medication when you feel pain coming on.

You should try to move your feet and ankles while you are in the recovery room to improve circulation.

Your temperature, blood pressure, and heart rate will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. Most patients remain in the hospital for two to four days following an osteotomy.

After knee osteotomy, you usually are taken to a hospital room where nurses, anesthesiologists, and physicians can regularly monitor your recovery. Most patients spend two to four days recovering in the hospital.

As soon as possible after surgery is completed, you will begin doing continuous passive motion exercises while in bed. Your leg will be flexed and extended to keep the knee joint from becoming stiff.

This may be done using a continuous passive motion (CPM) machine. The CPM is attached to your bed and then your leg is placed in it. When turned on, it takes your leg through a continuous range of motion.

There will likely be pain, and you can expect to be given pain medication as needed. Ice also helps control pain and swelling.

For two or three days after surgery, you may experience night sweats and a fever of up to 101. Your physician may suggest acetaminophen, coughing, and deep breathing to get over this. This is common and should not alarm you. The incision usually starts to close within six days and the bandage can be removed. Physicians commonly fit you with a knee brace that may allow a limited range of movement and helps push your knee into the correct position. For a high tibial osteotomy, the knee brace pushes your knee inward, making you slightly more knock-kneed. Please note that some surgeons will cast your knee for 4 to 6 weeks to ensure that the osteotemy heals.

You may be able to put some weight on your knee, but physicians usually prescribe crutches for at least six weeks. You will be given a prescription for pain medication and usually schedule a follow-up visit sometime around six weeks after surgery.

You will most likely need to use crutches for several weeks.

About 6 weeks after the operation, you will see your surgeon for a follow-up visit. X-rays will be taken so that your surgeon can check how well the osteotomy has healed. After the follow-up, your surgeon will tell you when it is safe to put weight on your leg, and when you can start rehabilitation.

During rehabilitation, a physical therapist will give you exercises to help maintain your range of motion and restore your strength.

You may be able to resume your full activities after 3 to 6 months.

Read More About: Knee Osteotomy Recovery

Rehabilitation

Most patients can begin physical therapy around six to eight weeks after surgery. Unlike other surgical treatments for arthritis, osteotomy relies on bone healing before more vigorous, weight bearing exercises in the gym can begin. In the best scenario, people respond to strengthening exercises and stop wearing the brace after the first three to six months of therapy.

Light exercise is one of the most effective ways to relieve arthritis pain by stimulating circulation and strengthening the muscles, ligaments, and tendons around your knee. Strong muscles take pressure off the bones so there is less grinding in the knee joint during activities. In conjunction with a healthy diet, exercise can also help you lose weight, which takes stress off your arthritic knee.

Stretching

In the first few weeks of rehabilitation, your physical therapist usually helps you stretch the muscles in the hamstrings, quadriceps, and calves while flexing and extending your knee to restore a full, pain-free range of motion.

Aerobic Exercise

When pain has decreased, physicians generally recommend at least 30 minutes a day of low-impact exercise a day for patients with arthritis. You should try to cut back on activities that put a pounding on your knees, like running and strenuous weight lifting.

Cross-training exercise programs are commonly prescribed when you have arthritis. Depending on your preferences, your workouts may vary each day between cycling, cross-country skiing machines, elliptical training machines, swimming, and other low-impact cardiovascular exercises. Walking is usually better for arthritic knees than running, and many patients prefer swimming in a warm pool, which takes your body weight off your knees and makes movement easier.

Strengthening

Strength training usually focuses on moving light weights through a complete, controlled range of motion. You should generally avoid trying to lift as much as possible with your quadriceps and hamstrings. Your physical therapist typically teaches you to move slowly through the entire movement, like bending and straightening your knee, with enough resistance to work your muscles without stressing the bones in your knee.

Once your physical therapist has taught you a proper exercise program, it is important to find time each day to perform the prescribed exercises.

Recovery at Home

You will likely feel pain or discomfort for the first week at home after an osteotomy, and you will be given a combination of pain medications as needed. A prescription-strength painkiller is usually prescribed and should be taken as directed on the bottle.

Swelling in your leg usually decreases over a span of three to six months after surgery. There may be some minor bleeding for a few days, but by the time you are released from the hospital, most bleeding should have stopped. If you notice an increase in swelling or bleeding, you should call your physician.

Physicians generally recommend that you avoid putting stress on your knee until the bones have healed. Putting weight on your knee too early may damage the bone surface and prolong healing time.

Here is what you can expect and how you can cope after an osteotomy:

  • Icing your knee for 20 or 30 minutes a few times a day during the first week after an osteotomy will help reduce pain. Ice therapy may need to intermittently continue for a few months if pain bothers you.
  • As much as possible, you should keep your knee elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your ankle.
  • Immobilize your knee in the prescribed, hinged knee brace for about six weeks. You may remove the brace for brief periods to perform passive motion exercises with the aid of a physical therapist or a CPM machine. Range of motion exercises are important for healing. Regaining full extension is just as important as bending your knee.
  • Your leg may appear slightly bent after the surgery as it heals into its new alignment.
  • Most patients have to keep the incision dry for seven to ten days. Your physician can recommend a surgical supply store that sells plastic shower bags. Wait until you can stand comfortably for 10 or 15 minutes at a time before you take a shower.
  • Crutches or a cane may be needed for between six and ten weeks, depending on the pain. It is difficult to describe the amount of pain any given patient will experience.
  • Six weeks after surgery, your physician usually gives you a check-up. X-rays can determine how your bones are healing and whether you are ready to begin rehabilitation.

You may have to take between six weeks and six months off from work, depending on how much you rely on your knee to perform your job.

Prevention

After rehabilitation, preventing osteoarthritis is a process of slowing the progression and spread of the disease. Because patients remain at risk for continued pain in their knees after treatment, it is important they are proactive about managing their conditions.

A fall or torque to the leg during the first two months after surgery may jeopardize the healing of your bones. You should exercise extreme caution during all activities, including walking, until your physician determines that your bones have healed.

Maintaining aerobic cardiovascular fitness has been an effective method for preventing the progression of osteoarthritis. Light, daily exercise is much better for an arthritic knee than occasional, heavy exercise.

When you have arthritis in your knees, it is especially important to avoid suffering any serious knee injuries, like torn ligaments or fractured bones, because arthritis can complicate knee injury treatment. You should avoid high-impact or repetitive stress sports, like football and distance running, that commonly cause severe knee injuries. Depending on the severity of your arthritis, your physician may also recommend limiting your participation in sports that involve sprinting, twisting, or jumping.

Because osteoarthritis has multiple causes and may be related to genetic factors, no simple prevention tactic will help everyone avoid increased arthritic pain. To prevent the spread of arthritis, physicians generally recommend that you take the following precautions:

  • Avoid anything that makes pain last for over an hour or two.
  • Perform controlled range of motion activities that do not overload the joint.
  • Avoid heavy impact on the knees during everyday and athletic activities.
  • Gently strengthen the muscles in your thigh and lower leg to help protect the bones and cartilage in your knee.

Non-contact activities are a great way to keeping joints and bones healthy and maintain fitness over time. Exercise also helps promote weight loss, which can take stress off your knees.

Osteotomy can relieve pain and delay the progression of arthritis in the knee. It can allow a younger patient to lead a more active lifestyle for many years. Even though many patients will ultimately require a total knee replacement, an osteotomy can be an effective way to buy time until a replacement is required.

If you are experiencing knee pain call one of our experts at TOCA at 602-277-6211!

#Recovery #Results #Relief #kneepain #painfree #DrYaco #TOCA #TOCAMD #DrPadley #DrLederman #DrCarter #MyOrthoDoc

TOCA Performs First Meniscus Replacements in Arizona with NUsurface® Meniscus Implant

The Orthopedic Clinic Association

 

Media Contacts: Merryman Communications for Active Implants
Joni Ramirez joni@merrymancommunications.com
323.532.0746

Lisa Paulson for TOCA (The Orthopedic Clinic Association)
602.512.8525
lpaulson@tocamd.com

TOCA (The Orthopedic Clinic Association) Performs First Meniscus Replacements in Arizona with NUsurface® Meniscus Implant

Phoenix Suns Physician Treats Local Resident with Persistent Knee Pain in SUN Clinical Trial

PHOENIX, Arizona – July 6, 2017 – TOCA (The Orthopedic Clinic Association), a one-stop resource for orthopedics in Arizona, and Active Implants, a company that develops orthopedic implant solutions, today announced that the first meniscus replacement procedures in Arizona were successfully performed by Dr. Tom Carter. TOCA is the only center in the state – and one of just 10 sites nationwide – enrolling patients with persistent knee pain caused by injured or deteriorating meniscus cartilage in the SUN trial, which is designed to assess the safety and effectiveness of the NUsurface® Meniscus Implant (pronounced “new surface”) in restoring function similar to that of a natural, healthy meniscus.

One of the first patients to receive the implant in Arizona was Robert Nowlan, a 55-year-old Anthem resident, who first tore his meniscus 17 years ago while hiking in the Grand Canyon. Although he underwent three surgeries and injection therapy to treat the injury, he experienced constant pain that limited his daily activity. Nowlan’s knee was consistently throbbing with pain whether he was walking, working or even sitting. The pain became so intense, he had to give up hobbies he loved like running, hiking and karate.

The meniscus is a tissue pad between the thigh and shin bones. Once damaged, the meniscus has a very limited ability to heal. Over 1 million partial meniscectomies to remove or repair a torn meniscus are performed in the U.S. every year, about the same as the total number of hip and knee replacement surgeries combined. However, many patients still experience persistent knee pain following meniscus surgery.

“There aren’t many options for patients who experience persistent knee pain following meniscus surgery,” said Dr. Tom Carter, orthopedic surgeon at TOCA. “We hope the NUsurface implant decreases or alleviates pain in these patients, helps them delay knee replacement surgery, and improves their level of activities.”

Nowlan received the NUsurface Meniscus Implant in October 2016 through a small incision in his knee and completed a six-week rehabilitation program. Eight months into his recovery, he is most looking forward to biking and hiking the Grand Canyon again with his family – but this time pain-free.

“My knee pain over the last 17 years had reduced my quality of life, as I was too young for knee replacement and had resigned myself to just living and working with constant pain,” Nowlan said. “A couple weeks after receiving the NUsurface Meniscus Implant, the knee pain I was used to living with was gone. It felt like I drank from the fountain of youth – I can finally walk around and do all the activities I’ve been missing out on.”

The NUsurface Meniscus Implant has been used in Europe under CE Mark since 2008 and Israel since 2011.

About the Clinical Trial
The SUN study (Safety Using NUsurface®) will enroll approximately 120 patients as part of regulatory process to gain approval from FDA to sell the device in the U.S. All patients who meet study requirements and agree to enter the trial are offered the NUsurface Meniscus Implant as treatment. Treatment with NUsurface in the SUN trial is eligible for coverage by Medicare and some private insurance companies. To be eligible for the study, participants must be between the ages of 30 and 75 and have pain after medial meniscus surgery that was performed at least six months ago. To learn more about the SUN study, please visit http://sun-trial.com or call (844) 680-8951.

About the NUsurface® Meniscus Implant
The NUsurface® Meniscus Implant is an investigational treatment for patients with persistent knee pain following medial meniscus surgery. It is made from medical grade plastic and, as a result of its unique materials, composite structure and design, does not require fixation to bone or soft tissues. The NUsurface Meniscus Implant mimics the function of the natural meniscus and redistributes loads transmitted across the knee joint. Clinical trials are underway in the U.S., Europe and Israel to verify the safety and effectiveness of the NUsurface Meniscus Implant.

About TOCA (The Orthopedic Clinic Association)
TOCA (The Orthopedic Clinic Association) has served the Valley with orthopedic care since it was founded in 1949. TOCA is a one-stop resource for orthopedics in Arizona, led by nationally recognized, established orthopedic physicians who are passionate about quality care. TOCA brings expertise in orthopedics and sports medicine, numerous sub-specialties, physical therapy and hand therapy. Each TOCA Physician brings their own passion and integrity to a common purpose, honoring TOCA’s mission statement: “Serving our Patients through Innovative and Comprehensive Orthopedic Care.” Our physicians and staff are dedicated to providing for each person’s needs and ensuring the highest level of care for a wide range of musculoskeletal conditions. For more information, visit https://tocamd.com/.

About Active Implants
Active Implants, LLC develops orthopedic implant solutions that complement the natural biomechanics of the musculoskeletal system, allowing patients to maintain or return to an active lifestyle. Active Implants is privately held with headquarters in Memphis, Tennessee. European offices are in Driebergen, The Netherlands, with R&D facilities in Netanya, Israel. For more information, visit www.activeimplants.com.

CAUTION Investigational device. Limited by United States law to investigational use.

Protect you and your Children from Injury this Fourth of July Holiday!

Protect you and your Children from Injury this Fourth of July Holiday: Celebrating our Independence with a Boom has been a tradition for many families for years over the July 4th Holiday season. Unfortunately every year thousands of children and adults are needlessly injured by not following basic fireworks safety tips. With the proper respect fireworks deserve, everyone can safely enjoy the show.

Children are most frequently injured by fireworks. Most are under the age of 15. You may think firecrackers or other types of explosive or rocket variety fireworks are most responsible for their injuries. In fact, the biggest risk of injury comes from sparklers. Sparklers account for roughly 16% of all firework related injuries. If you consider children alone, sparklers account for about 1/3 of all injuries and over half of the injuries to children under 5.

In order to prevent children from being injured by sparklers, it is important to consider following some very simple safety tips.

1. Never let children handle, light or play with sparklers without adult supervision.
2. Don’t let your child handle or light more than one sparkler at a time.
3. Don’t pass of a lit sparkler to someone else, have them hold the unlit sparkler while you light it.
4. Don’t hold your child in your arms while you or the child is using sparklers.
5. Keep your distance: its recommended children stay at least 6 feet apart from one another while handling sparklers.
6. Instruct your child to hold the sparkler away from their body keeping them at arm’s length.
7. Avoid waving the sparklers wildly through the air as children frequently lose hold of the sparkler causing injury to themselves or others around them.
8. Wear proper clothing and footwear. Many injuries occur when an burnt out sparkler is dropped on the ground causing foot burns or puncture wounds from stepping on them.
9. Once the sparkler flame goes out, the metal rod should be dropped directly into a bucket of water. The extinguished sparkler and metal rod remain hot for a long time.
10. Keep your fireworks out of the reach of children. Lock them up. Kids are creative and can easily find a source of fire to ignite fireworks, i.e. a lit candle.

Above all, use common sense, pay attention to children, and if alcohol is involved in an adult party with children, designate someone to remain sober and responsible while any and all fireworks are in use. Hopefully these simple tips can help you and your family avoid an unwanted trip to the emergency department, or worse yet, a permanent and disfiguring injury.

The Hand Surgeons at TOCA, as well as the rest of the Physicians and Staff with you and your family health and happiness as we celebrate with pride, our Independence Day.

To learn more or to schedule an appointment call our dedicated TOCA Team at: 602-277-6211!

#Recovery #Results #Relief #4thofJuly #IndependanceDay #FireworkSaftey #InjuryPrevention #4thofJulyInjuryPrevention #TOCA #TOCAMD

(TFC/TFCC) Triangular Fibrocartilage Complex Tear

WHAT IS A TFCC TEAR?
The triangular fibrocartilage complex (TFCC) is a cartilage structure located on the small finger side of the wrist that, cushions and supports the small carpal bones in the wrist. The TFCC keeps the forearm bones (radius and ulna) stable when the hand grasps or the forearm rotates. An injury or tear to the TFCC can cause chronic wrist pain.

There are two types of TFCC tears:
1. Type 1 tears are called traumatic tears. Falling on an outstretched hand and excessive arm rotation are the most common causes.
2. Type 2 TFCC tears are degenerative or chronic. They can occur over time and with age. The degenerative process wears the cartilage down over time. Some inflammatory disorders, such as rheumatoid arthritis or gout, may also contribute to Type 2 TFCC tears.

WHAT ARE THE SYMPTOMS OF A TFCC TEAR?
• Common symptoms of a TFCC tear include:
• Pain, at the base of small finger side of the wrist
• Pain worsens as the wrist is bent from side to side
• Swelling in the wrist
• Painful clicking in the wrist
• Loss of grip strength

WHO IS LIKELY TO GET A TFCC TEAR?
Anyone can get a TCFF tear. It occurs most often in those who fall on an outstretched hand. Athletes are at risk, especially those who use a racquet, bat or club and those who put a lot of pressure on the wrist such as gymnasts. Degenerative tears are more common in people over 50. Medical attention should be sought as soon as possible after an injury to the wrist.
The hand and wrist specialists at TOCA we provide the most advanced treatment options for TFCC tears. Individualized treatment options are developed for each patient to ensure optimal outcomes.

WHAT CA– USES A TFCC TEAR?
TFCC tears are often sustained when a person falls and lands on the hand, bending the wrist backwards. They can also be present in patients with wrist fractures. Degenerative TFCC tears are more common in people over 50. A longer ulna (arm bone on the small finger side of arm) can also contribute to this condition because it puts more pressure on the TFCC.

HOW IS A TFCC TEAR DIAGNOSED?
TFCC tears are diagnosed through careful examination of the wrist. This involves some manipulation to see the extent and location of pain and immobility. An X-ray may be performed to check for fractures and other abnormalities. The most reliable imaging test is an MRI, which allows doctors to inspect the tissue and cartilage to see the extent of the injury. It is important for a patient to see a board certified physician specializing in treating wrist conditions soon after a traumatic injury.

WHAT ARE THE TREATMENTS FOR TFCC TEAR?
Treatment of a TFCC tear depends on stage of severity.
Non-surgical Treatment Options

• Rest
• Ice
• Splint or cast
• Anti-inflammatory medication, such as ibuprofen
• Cortisone injection
• Ultrasound therapy
• Surgical Treatment Options

Surgical Treatment
If no-operative management fails and the TFC tear is still painful, the next step is often a diagnostic arthroscopy. If there’s just a flap of injured tissue causing the problems, but the DRUJ is stable, the flap can be removed arthroscopically. If the TFC is torn, but the DRUJ is stable, the TFC tear can be repaired arthroscopically. If the TFC is torn and the DRUJ is unstable (loose), an open repair is usually the best treatment. The results from these surgeries are usually very good. If a TFC repair is performed, an above-elbow cast will be used for 4 weeks, and then therapy is started.

Often times, the TFC injury is either caused or exacerbated by the ulna being longer than the radius. In these cases, the ulna may have to be shortened to prevent the TFC from re-tearing. The ulnar shortening can be performed at the same time as the TFC repair. Sometimes, if the relative ulnar length is not too bad, a TFC repair is done without ulnar shortening. In these cases, if pain persists the ulnar shortening is then performed as a 2nd surgery.

Ulnar shortenings are traditionally done through a long incision: A small length of bone (usually 2-4 mm) is removed from the middle of the ulna and a plate is put on to stabilize the ulna while it heals. A short-arm cast is worn for 6 weeks and heavy activities are avoided until the bone is healed, which can take 3-4 months. However, a newer technique of ulnar shortening can be performed through a smaller incision, with a quicker healing time. In these cases, after 2 weeks only a removable splint is used. The newer type of ulnar shortening usually heals in 6 weeks. Most, but not all, patients will have this newer option available to them.

In summary, TFC tears are very common. Fortunately, there is effective treatment for them. All of the surgeries discussed here are performed as outpatient procedures (you go home the same day), and newer techniques are available that allow patients to return to activities quicker, with fewer problems.

At TOCA (The Orthopedic Clinic Association) we have some of Arizona’s most experienced physicians who treat triangular fibrocartilage complex injuries, in addition to other hand and wrist injuries, degenerative diseases and many other orthopedic needs.

To schedule an appointment contact our dedicated TOCA Team at 602-277-6211! You can also learn more about our Orthopedic Hand & Wrists Specialists here on our TOCA website.

 

#Recovery #Results #Relief #Handpain #painfree #TFC #handsurgery

Protecting Yourself from Dehydration in the Hot Summer Months

The heat is on “high” in Arizona! Staying hydrated in the Arizona climate is definitely a challenge but most importantly a necessity.

With Valley temperatures in triple digits, it’s important to stay hydrated. How much water do you need to drink during the summer in Phoenix?
According to the Mayo Clinic, men should drink about 13 cups (3 liters) of total beverages per day in a moderate climate and women should drink about 9 cups (2.2 liters) per day. That’s roughly in line with the old adage to drink eight 8-ounce glasses of water or fluid per day, at least if you’re a woman. Eight 8-ounce glasses per day is about 1.9 liters. Men would need to drink more to meet their needs. Keep in mind, though, that the 13 cups for men and 9 cups for women applies to moderate climates. Phoenix is in a desert climate, so your body needs significantly more water to keep hydrated.

2-1-1 Arizona, the state’s community information service, suggests drinking 5 to 7 ounces of fluids every 15 to 20 minutes to replenish the fluids necessary to stay hydrated. That translates to roughly 240 ounces or 30 cups per day if you drank 5 ounces every 20 minutes for the 16 hours (the typical person is awake).

The typical bottler of water holds nearly 17 ounces or 2 cups of water, so to drink 30 cups, you need to drink roughly 15 bottles of water per day in Phoenix. If you’re heading outside for any length of time or exercising, you’ll need to up your fluids even more!Image result for summer hydration

The good news is that you don’t need to rely solely on the water and fluids you drink. You can get some of your water intake from the foods you eat. Fruits and vegetables are particularly good for getting additional water since some, like cucumbers, melons, tomatoes, celery, and lettuce, are at least 90 percent water.

Since it’s hard to track how much water you’re getting from your food, it’s important to know the signs of dehydration. Mild dehydration can leave you feeling lethargic; signs of more severe dehydration include nausea, headaches, and dizziness. If you start experiencing those symptoms, get water as soon as possible.

Dehydration can come on quickly, especially if you are outside. If you plan on playing sports or hiking during the summer, the recommends starting to hydrate a few days before you go out.

Beverages: some hydrate, others dehydrate

Some beverages are better than others at preventing dehydration. Water is all you need if you are planning to be active in a low or moderate intensity activity, such as walking, for only an hour or less. If you plan to be exercising longer than that, or if you anticipate being out in the sun for more than a few hours, you may want to hydrate with some kind of sports drink. These replace not only fluid, but also chemicals like sodium and potassium, which are lost through perspiration. Too much or too little sodium and potassium in the body can cause trouble. Muscle cramping may be due to a deficiency of electrolytes, such as sodium and potassium.

Alcoholic and caffeinated beverages, such as coffee, teas, and colas, are not recommended for optimal hydration. These fluids tend to pull water from the body and promote dehydration. Fruit juice and fruit drinks may have too many carbohydrates, too little sodium, and may upset the stomach. If you’re going to drink fruit juices while exercising, you may try diluting them with 50% fruit juice and 50% water first.Image result for summer hydration

Adequate hydration will keep your summer activities safer and much more enjoyable. If you need to increase your fluid intake, keep an extra pitcher of water with fresh lemons, limes, or cucumber in the refrigerator.

Hydration tips

As summer temperatures hit, here are a number of important tips.

  • Drink enough water to prevent thirst.
  • Monitor fluid loss by checking the color of your urine. It should be pale yellow and not dark yellow or cloudy.
  • For short-duration (less than 60 minutes), low-to-moderate-intensity activity, water is a good choice to drink before, during and after exercise.
  • Any time you exercise in extreme heat or for more than one hour, supplement water with a sports drink that contains electrolytes and 6 percent to 8 percent carbohydrates. This prevents “hyponatremia” (low blood sodium), which dilutes your blood and could also lead to serious impairment and death.
  • Begin exercise well-hydrated. Drink plenty of fluids the day before and within the hour before, during and after your exercise session.
  • Avoid alcohol the day before or the day of a long exercise bout, and avoid exercising with a hangover.
  • Consider all fluids, including tea, coffee, juices, milk and soups (though excluding alcohol, which is extremely dehydrating). The amount of caffeine in tea and coffee does not discount the fluid in them, even if they have a slight diuretic effect, according to the most recent report by the National Research Council’s Food and Nutrition Board.
  • Eat at least five cups of fruits and vegetables per day for optimum health, as they all contain various levels of water and the all-important nutrient potassium.
  • During exercise, for those who experience high sodium losses, eat salty foods in a pre-exercise meal or add an appropriate amount of salt to sports drinks consumed during exercise. Orange juice is high in potassium. Dilute juices, such as V-8 or orange juice, 50/50 with water so that the drinks are 6 percent carbohydrate solutions (the same as sports drinks), which will empty from your stomach quicker than 100 percent juice (juices are naturally 12 percent solutions), allowing the electrolytes and water to quickly reach your heart and organs.
  • Following strenuous exercise, you need more protein to build muscle, carbohydrates to refuel muscle, electrolytes to replenish what’s lost in sweat, and fluids to help re-hydrate the body. Low-fat chocolate milk is a perfect, natural replacement that fills those requirements.
  • You can also replace fluid and sodium losses with watery foods that contain salt and potassium, such as soup and vegetable juices.
  • For long hikes, when you’ll need food, dried fruit and nut mixtures contain high amounts of potassium, sodium, protein, carbs and calories — though continue to drink plenty of water.
  • To determine your individualized need for fluid replacement: During heavy exercise, weigh yourself immediately before and after exercise. If you see an immediate loss of weight, you’ve lost valuable water. Drink 3 cups of fluid for every pound lost; use this figure to determine the amount of water (or sports drink) you’ll need to drink before and during your next exercise session to prevent weight/water loss in the future.

Signs and Symptoms of Dehydration

If you want to avoid health problems from dehydration it’s vital to listen to your body and drink water throughout the day. Water is the best way to prevent and beat dehydration, especially during the warm summer months when we are all prone to perspire even more so than usual.

Symptoms of Dehydration

  • Dry mouth
  • Sleepiness
  • Thirst
  • Decreases urination
  • Muscle weakness
  • Fatigue
  • Headache
  • Dizziness

Symptoms of Severe Dehydration

  • Extreme thirst
  • Irritability
  • Confusion
  • Extremely dry mouth and mucus membranes
  • Sunken eyes
  • Lack of sweating
  • Lack of tears
  • Very little or no urination
  • Skin that won’t ‘bounce back’
  • Low blood pressure
  • Rapid heartbeat
  • Fever
  • Delirium

People at Risk for Dehydration and Hypernatremia

  • Children and infants
  • Elderly
  • Chronically ill
  • Endurance athletes
  • High altitude dwellers

Simple Steps to Avoid Dehydration

The best way to avoid dehydration, particularly during hot summer months, is to be sure you and your loved ones are drinking plenty of pure water on a daily basis, at least eight to ten, eight ounce glasses full. If you are exerting yourself or out in the heat, drink even more water.

Avoiding dehydration is as simple as drinking enough pure water on a daily basis but so many just don’t do this. When you realize the high price your body will pay from a serious case of dehydration or hypernatremia, you’ll be asking for more water to drink everyday.

Top Hydrating Foods

  1. Coconut Water
  2. CeleryImage result for hydrating foods
  3. Watermelon
  4. Cucumber
  5. Kiwi
  6. Bell Peppers
  7. Citrus Fruit
  8. Carrots
  9. Cultured Dairy (amasai/kefir/yogurt)
  10. Pineapple
  11. Tomatoes
  12. Strawberries
  13. Star fruit
  14. Cantaloupe

 

If you suspect that someone is dehydrated, seek immediate medical attention.

The Maricopa Association of Governments coordinates the Heat Relief Network, a listing of places where people, especially vulnerable individuals such as those experiencing homelessness, can receive water and, in some cases, a place to cool off. Get more information www.azmag.gov/heatrelief.

 

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