Dr Lederman, Dr Hosack and colleagues from the University of Arizona College of Medicine Phoenix discuss the potential for Vancomycin Powder to prevent infection in shoulder replacement.

Title: In vitro susceptibility of Propionibacterium acnes to simulated intrawound vancomycin concentrations

Luke Hosack MD MS, Derek Overstreet PhD, Evan S Lederman, MD

Background

There is convincing evidence supporting the prophylactic use of intrawound vancomycin powder in spinal fusion surgery and mounting evidence in the arthroplasty literature suggesting that it can reduce surgical site infections. As a result, a number of shoulder arthroplasty surgeons have adopted this practice, despite a paucity of evidence and the presence of a pathogen that is, for the most part, unique to this area of the body—Propionibacterium acnes. The purpose of this study was to evaluate the efficacy of vancomycin against planktonic P. acnes in vitro, using time-dependent concentrations one would expect in vivo after intra-articular application.

Full article available: https://doi.org/10.1016/j.jses.2017.08.001

The Journal of Shoulder and Elbow Surgery

Volume 1, Issue 3, October 2017, Pages 125-128
open access

 

Dr. Lederman was a recent invited lecturer at the American Academy of Orthopedic Surgeons Annual Meeting 2018

 

Complex Shoulder Arthroplasty: Primary and Revision, Anatomic and Reverse, Three-Dimensional Planning – When and How? A case-based, comprehensive review of shoulder arthroplasty.

Moderator: Asheesh Bedi, MD: Panelists: Evan Lederman, Anthony Romeo, Gilles Walch, JP Warner, Brad Parsons, john Tokish, David Dines, Josh Dines, Michael Freehill, Xinning Li

New Orleans, LA – AAOS 2018 – American Academy of Orthopedic Surgeons (AAOS) 2018 Annual meeting at the Ernest Morial Convention Center ,Tuesday March 6, 2018. With over 30,000 attendees, the conference is the preeminent meeting on musculoskeletal education to orthopaedic surgeons and allied health professionals in the world.

Congratulations to Dr. Evan Lederman for his recent publication!

Title: The Evolution of the Superior Capsular Reconstruction Technique

Alan M. Hirahara, MD, FRCSC; Evan S. Lederman, MD; Wyatt J. Andersen, ATC; and Kyle Yamashiro, PT, DPT, CSCS

Introduction

Irreparable, massive rotator cuff tears can result in unacceptable functional deficits in patients. When the supraspinatus tears and retracts medially, the superior capsule is also disrupted, and superior constraint is lost. With no superior restraint to the humerus, the humeral head migrates superiorly, causing a decrease in the acromial-humeral distance. [1-4]

Biomechanical analysis has shown that a defect in the superior capsule results in a minimum 200% greater glenohumeral superior translation and subacromial peak contact pressure compared with an intact capsule. [3] The malposition of the humeral head leads to functional abnormalities and pseudoparalysis.

Numerous proposed treatments for massive rotator cuff tears – including debridement and tenotomy, tendon transfers, and reverse total shoulder arthroplasty – have yielded mixed results and high complication rates. [5-12] In particular, reverse shoulder arthroplasty can result in humeral or glenoid fractures, persistent anterior or posterior instabilities, loosening of the glenoid or humeral cemented components, dislocations, and infection. [5-7]

The superior capsular reconstruction (SCR) was described by Hanada et al [13] in 1993 and by Mihata et al [1] in 2013 as an alternative procedure to increase function and decrease pain by restoring the restraint mechanisms in the shoulder. Using a graft to recreate the superior capsule, the humeral head is centered in the glenoid, allowing the larger muscles (ie, deltoid, latissimus dorsi, and pectoralis major) to function appropriately. Mihata et al [3,4] have found that the SCR reduces glenohumeral superior translation and subacromial contact force.

Full article link below.

ICJR.net  March 2018

Congratulations to Dr. Evan Lederman, Top Doc!

[vc_row][vc_column][vc_column_text]Congratulations to TOCA Physician and Orthopedic Surgeon Dr. Evan Lederman, who was named as a Top Orthopedic Surgeon 2017 in the Phoenix Magazine Top Doc’s 2018 publication.

The TOCA Physicians and Orthopedic Surgeons have been ranked in Phoenix Magazine’s Top Docs consecutively since 2004!

Dr. Lederman is board certified in orthopedic surgery and subspecialty board certified in orthopedic sports medicine. Dr. Lederman has been practicing in Phoenix, Arizona since 1996. He has years of experience with specialty training in sports medicine, minimally invasive arthroscopic surgery of the shoulder and knee and complex reconstructive surgery. His practice encourages non-operative care when possible and considers surgery only when necessary. Dr. Lederman specializes in all disorders of the shoulder including advanced techniques for rotator cuff repair, shoulder instability repair, acromioclavicular joint repair and primary and revision shoulder replacement including reversed shoulder replacement and also specializes in knee arthroscopy and ACL reconstruction.

Dr. Lederman’s work has earned him acceptance as an associate member of the American Shoulder and Elbow Surgeons (ASES) and is only the second surgeon in Arizona to receive this prestigious honor. He has been awarded the distinction of Phoenix Magazine’s Top Doc and Phoenix SuperDoctors. He has been named one of the “20 of the Top North American Shoulder Surgeons: 2015″ by Orthopedics This Week.

To schedule an appointment with one of TOCA’s physicians call 602-277-6211 today!

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Join Team TOCA with Dr. Feng & the Arthritis Foundation for the Walk to Cure Arthritis!

Enjoy the beautiful Arizona weather by joining Team TOCA, Dr. Earl Feng (Orthopedic Surgeon, Arthritis & Total Joint Reconstruction) and the Arthritis Foundation in the Annual Walk for the Cure, Saturday May 5th, 2018 at the Phoenix Zoo! Dr. Feng is not only a TOCA Physician & Surgeon but also serves as a Board Member for the Arthritis Foundation!

At TOCA, each of us has an important role in helping the more than 1.2 million Arizonans living with arthritis including many our patients, our colleagues, and more than 6,000 children in Arizona alone. TOCA is proud to continue our support the 2018 Arizona Walk to Cure Arthritis on May 5th at the Phoenix Zoo. As a sponsor of the Walk to Cure Arthritis, our goal is to help more people with arthritis.

The Arthritis Foundation is the Champion of Yes for patients with arthritis who are being told “no” a lot. No, there isn’t a cure. No, you cannot play sports. No, you cannot pick-up your grandchild.

Here is how you can help!

• Through funding critical research for osteoarthritis to find better treatments and ultimately a cure.
• Giving kids living with arthritis the opportunity to attend Camp Cruz to meet other kids living with arthritis.
• Supporting programs like the Live Yes network for people in our community struggling with pain, connecting them with others with arthritis.
• Getting a patient get back on their feet so they can walk their dog.
• Helping a grandparent alleviate back pain so they can pick up their grandchild.
• Saying “YES” to a patient today!

The event features a three-mile and one-mile course, with arthritis information and activities for the entire family!

Let’s raise funds to find a cure for arthritis, then come together to support each other and walk! Every step counts, every dollar matters!  The Arthritis Foundation’s Walk to Cure Arthritis to help the more than 50 million Americans and 300,000 children with arthritis live better today and to keep the Arthritis Foundation’s promise of finding a cure for tomorrow. Be a Champion of Yes – join our team and raise funds to fight arthritis and find a cure, all while having A LOT OF FUN! If you aren’t able to join the team, we’d appreciate your donation to help reach our goal.

Click here to learn more about this event, join Team TOCA and/or Donate Today! Team TOCA

Event Location:
The Phoenix Zoo
455 N Galvin Pkwy
Phoenix , AZ 85008
Event Schedule:
Event Registration Starts 5/5/2017 6:30 am
Event Registration Ends 5/5/2017 8:00 am
Event Starts 5/5/2017 7:30 am
Event Ends 5/5/2017 10:00 am
Fees:
Walk to Cure Arthritis Registration: No Fees
Event Registration

To Learn more about Dr. Feng and TOCA visit: www.tocamd.com or call 602-277-6211

#Arthritisfoundation #WalktoCureArthritis #Results #Recovery #Relife#TOCAMD #TOCA #ArthritisPhxWalk #PhoenixZoo

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

Total Elbow Replacement: What you need to know

Total Elbow Replacement

The elbow is a necessary joint for normal functioning in daily life, yet it is susceptible to various degenerative conditions and traumatic lesions or posttraumatic sequelae.  Although a total elbow replacement is much less common than knee or hip replacement, it is just as successful in relieving joint pain and returning people to activities they enjoy.

Elbow replacement surgery is a complicated procedure partly because the elbow has several moving parts that balance each other with great precision to control the movements of your forearm.

Your elbow can be damaged by problems ranging from rheumatoid arthritis to traumatic fractures. In some cases, the damage can be surgically repaired. But if the damage is extensive, your doctor might recommend elbow replacement surgery. Pain is the most common reason people choose to have elbow replacement surgery.

Over 3,000 people in the U.S. have elbow replacement surgery annually, according to the Agency for Healthcare Research and Quality.

Whether you have just started exploring treatment options or have  decided to have an elbow replacement surgery, this article will help you understand more about this valuable procedure.

Anatomy

The elbow is a hinge joint which is made up of three bones:

  • The humerus (upper arm bone)
  • The ulna (forearm bone on the pinky finger side)
  • The radius (forearm bone on the thumb side)

The surfaces of the bones where they meet to form the elbow joint are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.

 

Muscles, ligaments, and tendons hold the elbow joint together.

 

(The main structures of the elbow when viewed from the side.)

Types of elbow replacement

In some cases, you may need a replacement of just one portion of the joint. For example, if only the head of one of your forearm bones (radius) is damaged, it can be replaced with an artificial head.

If the entire joint needs to be replaced, the ends of the bones that come together in the elbow will be removed. Bones are hard tubes that contain a soft center. The long, slender ends of the artificial joint are inserted into the softer central part of the bones.

There are two main types of prosthetic devices available:

  • Linked. This type of prosthesis acts somewhat like a loose hinge because all the parts of the replacement joint are connected. This provides good joint stability, but the stresses of movement can sometimes result in the prosthesis working itself loose from where it’s inserted into the arm bones.
  • Unlinked. This type of device comes in two separate pieces that aren’t connected to each other. This design depends on the surrounding ligaments to help hold the joint together, which can make it more prone to dislocation.

Description

In total elbow replacement surgery, the damaged parts of the humerus and ulna are replaced with artificial components. The artificial elbow joint is made up of a metal and plastic hinge with two metal stems. The stems fit inside the hollow part of the bone called the canal.

(Total elbow replacement components.)

There are different types of elbow replacements, and components come in different sizes. There are also partial elbow replacements, which may be used in very specific situations. A discussion with your doctor will help to determine what type of elbow replacement is best for you.

 

Causes

Several conditions can cause elbow pain and disability, and lead patients and their doctors to consider elbow joint replacement surgery.

Rheumatoid Arthritis

This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.

Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

Osteoarthritis (Degenerative Joint Disease)

Osteoarthritis is an age-related, “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the elbow softens and wears away. The bones then rub against one another. Over time, the elbow joint becomes stiff and painful.

Rheumatoid arthritis and osteoarthritis cause cartilage damage that can result in severe pain and disability.

Post-traumatic Arthritis

This type of arthritis can follow a serious elbow injury. Fractures of the bones that make up the elbow, or tears of the surrounding tendons and ligaments may cause damage to the articular cartilage over time. This causes pain and limits elbow function.

Severe Fractures

A severe fracture of one or more bones that make up the elbow is another common reason people have elbow replacements. If the elbow is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this type of case, a surgeon may recommend an elbow replacement. Older patients with osteoporosis (fragile bone) are most at risk for severe elbow fractures.

In addition, some fractures do not heal well and may require an elbow replacement to address continuing problems.

Instability

Instability occurs when the ligaments that hold the elbow joint together are damaged and do not work well. The elbow is prone to dislocation. Chronic instability is most often caused by an injury.

 

Teamwork

TOCA’s treatment teams include specialists in orthopedic surgery and in physical medicine and rehabilitation. These experts work together with the goal of restoring strength and range of motion in your elbow.

 

Diagnostic and surgical innovation

TOCA’s physicians  have developed several diagnostic examinations and surgical techniques to help make elbow replacement a highly effective treatment option.

Table. Treatment Options for Elbow-Related Problems

Affected joint(s) Options Plain radiographs
Radial head Radial head replacement Figure 1
Ulna Total elbow arthroplasty Figure 2
Humeroradial Radial head replacement Figure 1
Unicompartmental replacement Figure 3
Humeroulnar Total elbow arthroplasty Figure 2
Humerus Hemiarthroplasty Figure 4
Radioulnar Radial head replacement Figure 1
Radial head resection

Preparing for Surgery

Medical Evaluation

If you decide to have elbow replacement surgery, your orthopaedic surgeon at TOCA may ask you to schedule a complete physical examination with your family physician several weeks before surgery. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process.

Many patients with chronic medical conditions, like heart disease, must also be evaluated by a specialist, such a cardiologist, before the surgery.

Medications

Be sure to talk to your orthopaedic surgeon and TOCA medical team about the medications you take. Some medications may need to be stopped before surgery. For example, the following over-the-counter medicines may cause excessive bleeding and should be stopped 2 weeks before surgery:

  • Non-steroidal anti-inflammatory medications, such as aspirin, ibuprofen, and naproxen sodium
  • Most arthritis medications

If you take blood thinners, either your primary care doctor or cardiologist will advise you about stopping these medications before surgery.

Home Planning

Making simple changes in your home before surgery can make your recovery period easier.

For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterwards on low shelves.

When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking, and laundry. If you will not have any support at home immediately after surgery, you may need a short stay in a rehabilitation facility until you become more independent.

 

Your Surgery

Before Your Operation

You will most likely be admitted to the hospital on the day of your surgery. After admission, you will be taken to the preoperative preparation area and will meet a doctor from the anesthesia department.

You, your anesthesiologist, and your surgeon will discuss the type of anesthesia to be used. In most total elbow replacement surgeries, a general anesthetic that puts you to sleep for the entire operation is used.

Surgical Procedure

To reach the elbow joint, your surgeon will make an incision (cut), usually at the back of the elbow. After making the incision, your surgeon will gently move muscles aside to get access to the bone. After removing scar tissue and spurs around the joint, your surgeon will prepare the humerus to fit the metallic piece that will replace that side of the joint. The same preparation is done for the ulna.

The replacement stems are placed into the humerus and ulna bones, and kept in place with a bone cement. The two stems are connected by a hinge pin. After the wound is closed, a padded dressing is then placed to protect the incision while it heals.

Some surgeons will place a temporary tube in the joint to drain the surgical fluid. This tube can be easily removed in your hospital room within the first few days after surgery.

 

Implants

The metal replacement parts are made of chrome-cobalt alloy or titanium and there is a liner made of polyethylene (plastic). The bone cement is made of polymethylmethacrylate (acrylic, a type of plastic).

Recovery

Your medical team will give you several doses of antibiotics to prevent infection. Most patients are able to eat solid food and get out of bed the day after surgery. You will most likely stay at the hospital 2 to 4 days after your surgery.

Pain Management

After surgery, you will feel some pain, but your surgeon and nurses will provide medication to make you feel as comfortable as possible. Talk with your surgeon if postoperative pain becomes a problem.

Rehabilitation

A careful, well-planned rehabilitation program is critical to the success of an elbow replacement. You will be taught some exercises for your hand and wrist to avoid stiffness and help to control swelling. You will do gentle elbow range-of-motion exercises as the incision heals. Your doctor may prescribe therapy or may teach you how to do the exercises yourself.

You will most likely not be allowed to put any weight on your arm or push against resistance with your hand until about 6 weeks after your surgery.

Long-Term Outcomes

The majority of patients have experienced an improved quality of life after total elbow replacement surgery. They experience less pain, improved motion and strength, and better function.

You should expect to do all basic activities of daily living, such as getting a plate out of a cabinet, cooking dinner, lifting a milk jug, styling your hair, basic hygiene, and dressing. Talk to your doctor about activities you may want to avoid, such as contact sports and activities with a major risk of falling (such as horseback riding or climbing ladders), as well as heavy lifting. These things increase the risk of the metal parts loosening or breaking, or the bone breaking.

When traveling on airplanes, be prepared for extra security screening. There is a chance that your metal implant will set off the metal detector during the security check-in.

To make the check-in go more smoothly, tell the security officer beforehand that you have an elbow replacement and carry a medical identification card. Although this does not change the screening requirements, it will help the security officer confirm the nature of the alarm. Be prepared for the security officer to use a wand scanner, and perhaps examine your arm in a private area in order to see the scar. The new body scanners can identify joint replacements, making further individual screening unnecessary.

 

If you are experiencing pain from an elbow injury or chronic condition schedule an appointment with an Orthopedic Specialist at TOCA by calling 602-277-6211!

 

#Recovery #Results #Relief #MyOrthoDoc #ElbowSurgery #ElbowPain #TOCA #TOCAMD

Rotator Cuff Tear: What you need to know

Rotator Cuff Tear: What you need to know

Rotator Cuff Tear: The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens when you try to sleep on the involved side.

Rotator cuff injuries

Rotator cuff injuries can range in severity from simple inflammation to complete tears.

What Is a Rotator Cuff Tear?

A rotator cuff tear is a common injury, especially in sports like baseball or tennis, or in jobs like painting or cleaning windows. It usually happens over time from normal wear and tear, or if you repeat the same arm motion over and over. But it also can happen suddenly if you fall on your arm or lift something heavy.

Your rotator cuff is a group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms.

There are two kinds of rotator cuff tears. A partial tear is when the tendon that protects the top of your shoulder is frayed or damaged. The other is a complete tear. That’s one that goes all the way through the tendon or pulls the tendon off the bone.

Symptoms
You can’t always feel a torn rotator cuff. But in some cases, you might:

  • Have trouble raising your arm
  • Feel pain when you move your arm in certain ways or lie on it
  • Have weakness in your shoulder
  • Be unable to lift things like you normally do
  • Hear clicking or popping when you move your arm

See your doctor if you have any of these signs. If you don’t do anything about a torn rotator cuff, you can have more serious problems over time. You can end up with a frozen shoulder or arthritis that is harder to treat.

Diagnosis

To find out if you have a torn rotator cuff, your doctor will start with a history of the injury and a physical examination of the shoulder. During the exam, he’ll check your range of motion and muscle strength. He’ll also see what movements make your shoulder hurt.

In addition, your doctor may use one of the following:

  • MRI This uses radio waves and a powerful magnet to make detailed pictures of your shoulder.
  • X-rays to see if the top of your arm bone (humeral head) is pushing into your rotator cuff space.
  • Ultrasound to see the soft tissues (tendons and muscles and the bursas) in your shoulder.

Treatment

Your doctor is likely to start with a combination of physical therapy to make your shoulder muscles stronger, and medications like acetaminophen and anti-inflammatory drugs to help with pain and swelling. Surgery may be required in some cases.
You also may get exercises to do at home and suggestions that help you use your shoulder in safer, more comfortable ways in your day-to-day life.

If those don’t work, you may need surgery, especially if you have a complete tear. It’s likely your doctor will need to stitch together the torn area or reattach the tendon to the bone.

In some cases, he might need to take out small pieces of tendon or bone that are stuck in your shoulder joint or remove small areas of bone or tissue to give your tendon more room to move.

There are three types of rotator cuff surgery:

  • Arthroscopic: Your doctor will make a small cut in your shoulder then use an arthroscope — a tube with a small camera and tiny instruments — to fix the tear. This means your recovery time will likely be shorter than it would with another type of surgery.
  • Open: Your doctor uses larger instruments to go in to the muscles of your shoulder and fix the tear.
  • Mini-Open: This uses both arthroscopic and open methods. Your doctor starts with the arthroscope and finishes with larger instruments.

Recovery
After surgery, you’ll wear a sling for 4 to 6 weeks. Your doctor probably will tell you to do the following to speed along your recovery:

  • Take the sling off several times a day and move your elbow, wrist, and hand to get better blood flow in those areas.
  • If you have pain and swelling in your shoulder, use an ice pack for about 20 minutes at a time.
    Most important: Do not lift your arm at the shoulder until your doctor says it’s OK.
    How your recovery goes will depend a lot on the size of the tear and how long your rotator cuff was torn. The smaller and more recent the tear, the better your chances of being pain-free and having a full range of motion.

Be patient. Recovery is a gradual process. It can take up to a year for you to have full use of your shoulder again.

If you are experiencing a shoulder, sports medicine/orthopedic pain or a sports injury, the team of Physicians here at TOCA are here to help! To view more information about the shoulder/ upper extremity and all of our shoulder physicians click here. If you have questions or to request an appointment call 602-277-6211.

For more articles about shoulders you may be interested in: Shoulder Injury Prevention Tips,  Shoulder surgery, Shoulder Pain: When to Worry,

#InjuryPrevention #Injury #Knee #ACL #shoulderpain #Pain #SportsMedicine #SportsInjury #Results #Recovery #Relief #TOCA #TOCAMD #shoulderinjury #rotatorcuffsurgery #MyOrthoDoc

Shoulder Surgery

Shoulder Surgery

The shoulders are among the most important joints in the human body. Unfortunately, as we age our shoulders can wear out plus they may be subject to debilitating conditions such as arthritis, disease, or other injuries.

Your shoulder is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This flexibility also makes your shoulder susceptible to instability and injury.

Depending on the nature of the problem, nonsurgical methods of treatment often are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the problem will be more difficult to treat later. Early, correct diagnosis and treatment of shoulder problems can make a significant difference in the long run.

How the Normal Shoulder Works

(Anatomy of the shoulder joint)

The shoulder is a ball-and-socket joint. It is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle).

The ball at the top end of the arm bone fits into the small socket (glenoid) of the shoulder blade to form the shoulder joint (glenohumeral joint).

The socket of the glenoid is surrounded by a soft-tissue rim (labrum).

A smooth, durable surface (articular cartilage) on the head of the arm bone, and a thin inner lining (synovium) of the joint allows the smooth motion of the shoulder joint.

The upper part of the shoulder blade (acromion) projects over the shoulder joint. One end of the collarbone is joined with the shoulder blade by the acromioclavicular (AC) joint. The other end of the collarbone is joined with the breastbone (sternum) by the sternoclavicular joint.

The joint capsule is a thin sheet of fibers that surrounds the shoulder joint. The capsule allows a wide range of motion, yet provides stability.

The rotator cuff is a group of muscles and tendons that attach your upper arm to your shoulder blade. The rotator cuff covers the shoulder joint and joint capsule.

The muscles attached to the rotator cuff enable you to lift your arm, reach overhead, and take part in activities such as throwing or swimming.

A sac-like membrane (bursa) between the rotator cuff and the shoulder blade cushions and helps lubricate the motion between these two structures.

 

Shoulder Problems and Treatments

Bursitis or Tendinitis

Bursitis or tendinitis can occur with overuse from repetitive activities, such as swimming, painting, or weight lifting. These activities cause rubbing or squeezing (impingement) of the rotator cuff under the acromion and in the acromioclavicular joint. Initially, these problems are treated by modifying the activity which causes the symptoms of pain and with a rehabilitation program for the shoulder.

Impingement and Partial Rotator Cuff Tears

Partial thickness rotator cuff tears can be associated with chronic inflammation and the development of spurs on the underside of the acromion or the acromioclavicular joint.

The conservative nonsurgical treatment is modification of activity, light exercise, and, occasionally, a cortisone injection. Nonsurgical treatment is successful in a majority of cases. If it is not successful, surgery often is needed to remove the spurs on the underside of the acromion and to repair the rotator cuff.

 

Full-Thickness Rotator Cuff Tears

Full-thickness rotator cuff tears are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting, or falls. Nonsurgical treatment with modification of activity is successful in a majority of cases.

If pain continues, surgery may be needed to repair full- thickness rotator cuff tears. Arthroscopic techniques allow shaving of spurs, evaluation of the rotator cuff, and repair of some tears.

Both techniques require extensive rehabilitation to restore the function of the shoulder.

 

Instability of the Shoulder

Instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of sudden injury or from overuse of the shoulder ligaments.

The two basic forms of shoulder instability are subluxations and dislocations. A subluxation is a partial or incomplete dislocation. If the shoulder is partially out of the shoulder socket, it eventually may dislocate. Even a minor injury may push the arm bone out of its socket. A dislocation is when the head of the arm bone slips out of the shoulder socket. Some patients have chronic instability. Shoulder dislocations may occur repeatedly.

Patients with repeat dislocation usually require surgery. Open surgical repair may require a short stay in the hospital. Arthroscopic surgical repair is often done on an outpatient basis. Following either procedure, extensive rehabilitation, often including physical therapy, is necessary for healing.

 

Fractured Collarbone and Acromioclavicular Joint Separation

A fractured collarbone and acromioclavicular separation are common injuries of children and others who fall on the side of their shoulder when playing. Most of these injuries are treated nonsurgically with slings or splints. Severe displaced fractures or acromioclavicular joint separation may require surgical repair.

 

 

 

Fractured Head of the Humerus (Arm Bone), or Proximal Humerus Fracture

A fractured head of the humerus is a common result of falls on an outstretched arm, particularly by older people with osteoporosis. If fragmented or displaced, it may require open surgical repair and possibly replacement with an artificial joint (prosthesis).

 

 

 

 

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis and rheumatoid arthritis can destroy the shoulder joint and surrounding tissue. They can also cause degeneration and tearing of the capsule or the rotator cuff. Osteoarthritis occurs when the articular surface of the joint wears thin. Rheumatoid arthritis is associated with chronic inflammation of the synovium lining which can produce chemicals that eventually destroy the inner lining of the joint, including the articular surface.

 

 

 

Shoulder replacement

Shoulder replacement is recommended for patients with painful shoulders and limited motion. The treatment options are either replacement of the head of the bone or replacement of the entire socket. Your orthopaedic surgeon will discuss with you the best option.

 

 

Orthopaedic Evaluation

The orthopaedic evaluation of your shoulder consists of three components:

  • A medical history to gather information about current complaints; duration of symptoms, pain and limitations; injuries; and past treatment with medications or surgery.
  • A physical examination to assess swelling, tenderness, range of motion, strength or weakness, instability, and/or deformity of the shoulder.
  • Diagnostic tests, such as X-rays taken with the shoulder in various positions. Magnetic resonance imaging (MRI) may be helpful in assessing soft tissues in the shoulder. Computed tomography (CT) scan may be used to evaluate the bony parts of the shoulder.

Your orthopaedic surgeon will review the results of your evaluation with you and discuss the best treatment. You and your doctor may agree that surgery is the best treatment option. He or she will explain the potential risks and complications that may occur. Your doctor may discuss donating your own blood to be used if needed during surgery.

Some surgical procedures require hospitalization for a number of days. Your doctor may discuss planning for the period after surgery. You may need to either stay in an extended care facility or have someone help you when you return home.

Preparing for Surgery

  • No food or drink after midnight before surgery.
  • Discuss with your doctor what to do about medications taken in the morning.
  • An hour before surgery, you will be assessed in the preoperative area by a nurse anesthetist or anesthesiologist.

Types of Surgical Procedures

You may be given the option to have an arthroscopic procedure or an open surgical procedure.

Arthroscopy

Arthroscopy allows the orthopaedic surgeon to insert a pencil-thin device with a small lens and lighting system into tiny incisions to look inside the joint. The images inside the joint are relayed to a TV monitor, allowing the doctor to make a diagnosis. Other surgical instruments can be inserted to make repairs, based on what is with the arthroscope. Arthroscopy often can be done on an outpatient basis. According to the American Orthopaedic Society for Sports Medicine, more than 1.4 million shoulder arthroscopies are performed worldwide each year.

Open Surgery

Open surgery may be necessary and, in some cases, may be associated with better results than arthroscopy. Open surgery often can be done through small incisions of just a few inches.

Recovery and rehabilitation is related to the type of surgery performed inside the shoulder, rather than whether there was an arthroscopic or open surgical procedure.

Possible Complications After Surgery

There are always some risks with any surgery, even arthroscopic procedures. These include possible infection, and damage to surrounding nerves and blood vessels. However, modern surgical techniques and close monitoring have significantly minimized the occurrence of these problems.

After surgery, some pain, tenderness, and stiffness are normal. You should be alert for certain signs and symptoms that may suggest the development of complications.

  • Fever after the second day following surgery
  • Increasing pain or swelling
  • Redness, warmth, or tenderness which may suggest a wound infection
  • Unusual bleeding (some surgical wound drainage is normal and, in fact, desirable
  • Numbness or tingling of the arm or hand

Prevention of Future Problems

It is important that you continue a shoulder exercise program with daily stretching and strengthening. In general, patients who faithfully comply with the therapies and exercises prescribed by their orthopaedic surgeon and physical therapist will have the best medical outcome after surgery.

Your orthopaedic surgeon is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles, and nerves.

Using your shoulder after surgery

You had surgery on your shoulder to repair a muscle, tendon, or cartilage tear. The surgeon may have removed damaged tissue. You will need to know how to take care of your shoulder as it heals, and how to make it stronger.

What to Expect at Home

You will need to wear a sling when you leave the hospital. You may also need to wear a shoulder immobilizer. This keeps your shoulder from moving. How long you need to wear the sling or immobilizer depends on the type of surgery you had.

Follow your surgeon’s instructions for how to take care of your shoulder at home. Use the information below as a reminder.

Self-care

Wear the sling or immobilizer at all times, unless the surgeon says you do not have to.

  • It is ok to straighten your arm below your elbow and move your wrist and hand. But try to move your arm as little as possible.
  • Your arm should bend at a 90° angle (a right angle) at your elbow. The sling should support your wrist and hand so that they do not extend past the sling.
  • Move your fingers, hand, and wrist around 3 to 4 times during the day while they are in the sling. Each time, do this 10 to 15 times.
  • When the surgeon tells you to, begin taking your arm out of the sling and let it hang loosely by your side. Do this for longer periods each day.

If you wear a shoulder immobilizer, you can loosen it only at the wrist strap and straighten your arm at your elbow. Be careful not to move your shoulder when you do this. DO NOT take off the immobilizer all the way unless the surgeon tells you it is OK.

If you had rotator cuff surgery or other ligament or labral surgery, you need to be careful with your shoulder. Ask the surgeon what arm movements are safe to do.

  • DO NOT move your arm away from your body or over your head.
  • When you sleep, raise your upper body up on pillows. DO NOT lie flat. You can also try sleeping on a reclining chair.

You may also be told not to use your or hand on the side that had surgery. For example, DO NOT:

  • Lift anything with this arm or hand.
  • Lean on the arm or put any weight on it.
  • Bring objects toward your stomach by pulling in with this arm and hand.
  • Move or twist your elbow behind your body to reach for anything.

Your surgeon will refer you to a physical therapist to learn exercises for your shoulder. To learn more about TOCA’s Physical Therapy Team Click HERE

  • You will probably start with passive exercises. These are exercises the therapist will do with your arm. They help get the full movement back in your shoulder.
  • After that you will do exercises the therapist teaches you. These will help increase the strength in your shoulder and the muscles around your shoulder.

Consider making some changes around your home so it is easier for you to take care of yourself. Store everyday items you use in places you can reach easily. Keep things with you that you use a lot (such as your phone).

When to Call the Doctor

Call your surgeon or nurse if you have any of the following:

  • Bleeding that soaks through your dressing and does not stop when you place pressure over the area
  • Pain that does not go away when you take your pain medicine
  • Swelling in your arm
  • Your hand or fingers are darker in color or feel cool to the touch
  • Numbness or tingling in your fingers or hand
  • Redness, pain, swelling, or a yellowish discharge from any of the wounds
  • Fever of 101°F (38.3°C), or higher
  • Shortness of breath and chest pain

 

For questions about your shoulder pain or to schedule an appointment call the dedicated TOCA Team at: 602-451-4051!

For more articles and information about your shoulder consider reading more on our shoulder page and/or additional articles such as: Shoulder Pain: When to Worry and Shoulder Injury Prevention Tips

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD #shoulderpain #painfree #shouldersurgery

 

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