Rotator Cuff Repair – Dr. Harmsen

From conservative treatment options to more advanced surgical techniques (rotator cuff repair)

*Credit Honor Health, featuring Dr. Harmsen

Shoulder pain that increases with motion, awakens one from sleep or is associated with weakness may be a sign of a torn rotator cuff. Whether the pain is caused by a sudden injury or develops gradually over time, treatment options for a rotator cuff tear are available at HonorHealth and can effectively reduce discomfort, improve range of motion and build shoulder strength.

Degenerative wear and tear

The rotator cuff is made up of four muscles that attach and create a cuff around the ball of the ball and socket joint of the shoulder. This cuff helps stabilize the ball and socket joint, allowing one to lift and rotate the arm.

A rotator cuff tear is a common cause of pain and disability, accounting for almost 2 million people in the United States who went to their doctor in 2013 because of a rotator cuff problem, according to the American Academy of Orthopaedic Surgeons.

“As we get older, we naturally experience some extent of rotator cuff wear and tear, which often occurs slowly, usually by age 60,” said Samuel Harmsen, M.D., an orthopedic surgeon and shoulder and elbow specialist at HonorHealth Greenbaum Surgical Specialty Hospital. “A rotator cuff tear is generally more prevalent in those who are active, but can also be attributed to family history, age, arthritis, or even smoking.”

Although not all individuals with rotator cuff tears develop symptoms, many experience shoulder pain, irritation, inflammation and weakness, which can be very debilitating.

“Patients often experience pain with activities such as throwing, lifting or lowering the arm, or even simple tasks such as putting the dishes away,” Harmsen said. “Night pain that awakens one from sleep is also very common.”

Treatment typically begins with a more conservative approach and may include a combination of physical therapy, activity modification, over-the-counter pain medication and steroid injections to alleviate pain and improve function.

“Our goal is to manage symptoms, increase function and stabilize the shoulder joint to improve quality of life,” Harmsen explained.

In about 80 percent of patients, nonsurgical treatment relieves pain and improves function in the shoulder, according to the American Academy of Orthopaedic Surgeons.

“When conservative management is no longer successful, surgery would be the next recommended step,” Harmsen added.

Acute injuries

A rotator cuff tear can also occur suddenly, while playing sports, lifting too much weight or after a bad fall. If the tear occurs with an injury, individuals may experience acute pain, a snapping sensation, and immediate weakness of the arm, according to the American Academy of Orthopaedic Surgeons.

“While an acute rotator cuff tear can happen to anyone, most injuries occur in younger and more active patients,” Harmsen explained. “Injuries are often associated with strenuous activities that cause a sudden pull or stress to the shoulder. Shoulder dislocations can also result in acute rotator cuff injuries in older patients.”

Surgical treatment

Experts say that if a rotator cuff tear is not treated, it could be more difficult to repair over time and symptoms may worsen. Depending on the timing of the injury, size and shape of the tear, a person’s age, their activity level and overall health, surgical intervention may be necessary.

The orthopedic surgeons at HonorHealth have access to the latest technology and can perform both traditional and minimally invasive surgical techniques to repair a torn rotator cuff.

“Arthroscopic surgery is a more advanced approach that utilizes a small camera which allows greater visualization of the shoulder joint to better understand the nature of the tear,” Harmsen explained. “Because of this less invasive technology, we are able to make smaller incisions that result in less postoperative pain.”

Other techniques, including superior capsular reconstruction and reverse shoulder arthroplasty, are sometimes used after multiple surgical attempts have been unsuccessful, if the rotator cuff cannot be repaired or when arthritis is present. These more advanced techniques are also available at HonorHealth.

Recovery

After surgery, patients often use a sling during a period of immobilization to keep their arm in a protected position, followed by physical therapy and home exercises to improve range of motion and regain strength.

“Most patients do very well with surgical intervention,” Harmsen said. “While some early stiffness is expected, the results often lead to resolution of pain and improved shoulder function.”

Experts say it takes approximately 12 weeks to heal before patients can return to activities of daily living.

“Improvements to overall shoulder health, pain and function can continue for up to a year after surgery,” Harmsen added.

Learn more about rotator cuff treatment options at HonorHealth.

 

To learn more about shoulder injury prevention tips click Here. To learn more about Dr. Harmsen click Here. To learn more about TOCA’s shoulder specialists click Here

 

#Recovery #Results #Relief #MyOrthoDoc #DrHarmsen #TOCA #TOCAMD #ShoulderPain

 

Celebrate National PA (Physician Assistant) Week October 6 – 12th!

Each year from October 6-12, we celebrate National PA Week, which recognizes the PA profession and its contributions to the nation’s health.

This week is also an opportunity to raise awareness and visibility of the profession. Before it was a weeklong event, National PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program. October 6th is also the birthday of the profession’s founder, Eugene A. Stead, Jr., MD. Now the profession is 50 years strong!

History of the PA Profession

The PA profession was created to improve and expand healthcare.

In the mid-1960s, physicians and educators recognized there was a shortage of primary care physicians.

To help remedy this, Eugene A. Stead Jr., MD, of the Duke University Medical Center, put together the first class of PAs in 1965. He selected four Navy Hospital Corpsmen who had received considerable medical training during their military service. Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II.

The first PA class graduated from the Duke University PA program on Oct. 6, 1967.

The PA concept was lauded early on and gained federal acceptance and backing as early as the 1970s as a creative solution to physician shortages. The medical community helped support the new profession and spurred the setting of accreditation standards, establishment of a national certification process and standardized examination, and development of continuing medical education requirements.

What is a PA? (American Academy of PAs)

What is a PA?

A physician assistant (or PA) is a nationally certified and state-licensed medical professional. There are currently more than 100,000 clinically practicing PA’s in the United States! PA’s practice medicine on health care teams with physicians and other providers. They also prescribe medication in all 50 states.

 

What does a PA do? Well, at the most basic level, a PA is a medical practitioner who works under the supervision of a physician.

Physician assistants (PAs) work closely with doctors and handle duties that range from taking medical histories to setting simple fractures. They are allowed to prescribe medications in some states. Many PAs specialize in a particular area of medicine, such as pediatrics. A master’s degree is required, and all states require that PAs be licensed. Licensing requires passing a multiple-choice exam and completing continuing education courses to keep knowledge current.

Beyond the basic definition, however, the PA profession represents an essential part of the health care infrastructure in a number of important ways.

Physician assistants examine, diagnose and treat patients under the supervision of licensed physician. PAs can prepare casts or splints, suture small wounds and interpret medical tests. According to the American Academy of Physician Assistants (AAPA), these medically-trained professionals can also prescribe medications (www.aapa.org).

Some PAs specialize in a particular area of medicine, such as emergency care or geriatrics, and can assist doctors in advanced medical techniques and procedures. Physician assistants are often the first line of medical care in rural and underserved areas. In some cases, a physician assistant will refer the patient to a medical doctor or make arrangements for transferring the patient to a hospital or clinic.

During this week, TOCA is excited to honor our amazing PAs and to say a big thank you. We appreciate your dedication to patient care, and we recognize the impact that you make in the lives of those patients every day.

To read more about the dedicated Physician Assistant staff at TOCA Click Here

To learn more about TOCA or to schedule an appointment call 602-277-6211

 

#Recovery #Results #Relief #TOCA #TOCAMD #PA #PAWeek #ThankAPA #Patientcare #PhysicianAssistant #PADay #MyOrthoDoc

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

New Biologic Therapies for Osteoarthritis of the Knee

[vc_row][vc_column][vc_column_text]Our knowledge of the healing process in the human body is rapidly expanding. We have learned a great deal from studying the body’s response to injury at the chemical and cellular level. Much of this knowledge of tissue repair is now being used to develop new and exciting treatments for degenerative conditions such as arthritis…and, as always, the knee joint is getting most of the attention at the outset.

  • Hyaluronic Acid
  • Platelet Rich Plasma
  • Amniotic Tissue Preparations
  • Stem Cells

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A stem cell is a cell that has the ability to differentiate into different cell types. Bone marrow derived stem cells are mesenchymal stem cells that can differentiate into soft tissues including muscle, tendon and cartilage that are most relevant to orthopedic issues. Stem cells sit at the center of a growing field of medicine called regenerative medicine. Regenerative medicine aims to use the body’s own natural healing systems to repair damage, decrease pain and improve function.
Stem cell therapy is a minimally invasive, same-day, non-surgical procedure that is done in an office-based setting. TOCA is among a select group of orthopedic practices that have physicians fellowship-trained in regenerative procedures. Stem cells are harvested or withdrawn with the use of ultrasound guidance through a large needle from the back of the hip. Going to a surgical center or operating room is not necessary. IV sedation is not necessary. This treatment offers a promising alternative for those patients considering having an artificial joint implanted. Patients who have continued pain despite having exhausted more traditional non-surgical treatments such as physical therapy, anti-inflammatory medications and cortisone injections may benefit as well. Stem cell treatments are experimental and are not the current standard of care. However, similar to how interventional cardiology has substantially decreased the number of open heart bypass procedures, interventional orthopedics is a growing field that hopes to use less invasive treatments such as stem cells to stave off or decrease the number of joint replacements and, at the very least, improve pain and function.

During the procedure, stem cells taken from the back of the hip and are concentrated using a centrifuge machine. Together with a patient’s own platelet-rich plasma (PRP), these cells are injected under ultrasound guidance into areas of damage. Though the procedure is experimental, there is evidence that these procedures are safe and effective for a majority of patients. (link: https://www.ncbi.nlm.nih.gov/pubmed/24113698). We assess stem cell therapy’s effectiveness using pain relief and functional improvement as the criteria.

To read more about Stem Cell Therapy Click here. To Download TOCA’s PRP/Stem Cell Therapy Packet information and view patient education videos Click Here.

What Should I do If I Think I’m a Candidate?
Dr. Joseph Blazuk and Dr. Richard Emerson are dedicated to quality comprehensive patient care and to answer all of your PRP and Stem Cell Therapy and procedure questions.

To schedule a consultation call the TOCA Team at 602-277-6211 today!

Please bring whatever radiology films or studies (X-rays, MRIs) you have available.