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Dr. Blazuk and colleagues study the Validity of Indirect Ultrasound Findings…

Title: Validy of Indirect Ultrasound Findings in Acute Anterior Cruciate Ligament Ruptures

Ken Mautner, MD, Walter I. Sussman, DO, Katie Nanos, MD, Joseph Blazuk, MD, Carmen Brigham, ATC, Emily Sarros, ATC

Objectives: Ultrasound (US) is increasingly being used as an extension of the physical examination on the sidelines, in training rooms, and in clinics. Anterior cruciate ligament (ACL) injury in sport is common, but the literature on US findings after acute ACL rupture is limited. Three indirect US findings of ACL rupture have been described, and this study assessed the validity of these indirect signs.

American Institute of Ultrasound in Medicine /  J Ultrasound Med 2018; 9999:1-8 / 0278-4297

 

Click here for full article!

 

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

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

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

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

Purpose

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

Methods

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

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

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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

 

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

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

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

Background

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

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

The Journal of Shoulder and Elbow Surgery

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

Dr. Lederman and Dr. Harmsen compare different techniques for shoulder replacement*

Title: Glenohumeral osteoarthritis in young patients: Stemless total shoulder arthroplasty trumps resurfacing arthroplasty—Opposes

Samuel Harmsen MD and Evan S Lederman MD

Abstract

When considering shoulder arthroplasty in a younger patient the surgeon can choose between stemmed, stemless or resurfacing implants for humeral reconstruction. Resurfacing arthroplasty can reproduce humeral anatomy independent of the humeral shaft, minimize bone resection and offer potential easier revision surgery. The resurfacing implant has been in use for over 30 years and has favorable long-term outcome.

Seminars in Arthroplasty

Volume 28, Issue 3, September 2017, Pages 121-123
*This is based on a lecture/Debate by Dr. Lederman with Dr. Sumant Krishnan at the 2017 Current Concepts in Shoulder Arthroplasty Conference in Las Vegas, NV.

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

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

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

Background

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

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

The Journal of Shoulder and Elbow Surgery

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

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.

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

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

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.

The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.

Proper treatment usually relieves the tingling and numbness and restores wrist and hand function. Many people get better if they rest their wrist and wear a splint. Some people need surgery.

Symptoms

Carpal tunnel syndrome symptoms usually start gradually. The first symptoms often include numbness or tingling in your thumb, index and middle fingers that comes and goes.

Carpal tunnel syndrome may also cause discomfort in your wrist and the palm of your hand. Common carpal tunnel syndrome symptoms include:

  • Tingling or numbness. You may experience tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. Sometimes there is a sensation like an electric shock in these fingers.

The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep.

Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.

  • You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.

When to see a doctor

See your doctor if you have persistent signs and symptoms suggestive of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.

Causes

Carpal tunnel syndrome is caused by pressure on the median nerve.

The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

There is no single cause in many cases. It may be that a combination of risk factors contributes to the development of the condition.

Risk factors

A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:

  • Anatomic factors.A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.

People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.

Diagnosis

Your doctor may ask you questions and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:

  • History of symptoms. Your doctor will review the pattern of your symptoms. For example, because the median nerve doesn’t provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome.

Carpal tunnel syndrome symptoms usually occur include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.

  • Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand.

Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.

  • X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
  • Electromyogram. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify muscle damage and also may rule out other conditions.
  • Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.
  • Gender. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
  • Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
  • Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.
  • Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.
  • Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome.
  • Workplace factors. It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.

However, the scientific evidence is conflicting and these factors haven’t been established as direct causes of carpal tunnel syndrome.

Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

Treatment

Treat carpal tunnel syndrome as early as possible after symptoms start.

Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help.

Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you’ve had only mild to moderate symptoms for less than 10 months.

Nonsurgical therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:

  • Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nighttime splinting may be a good option if you’re pregnant.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

There isn’t evidence, however, that these drugs improve carpal tunnel syndrome.

  • Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes your doctor uses an ultrasound to guide these injections.

Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.

Surgery

Carpal tunnel release

Surgery may be appropriate if your symptoms are severe or don’t respond to other treatments.

The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.

The surgery may be performed with two different techniques:

  • Endoscopic surgeryYour surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist.

Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

  • Open surgery. Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include:

  • Incomplete release of the ligament
  • Wound infections
  • Scar formation
  • Nerve or vascular injuries

During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.

Alternative Medicine

Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment.

  • Yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength.
  • Hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome.
  • Ultrasound therapyHigh-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.

If you are experiencing hand or wrist pain, the specialized Orthopedic Physicians at TOCA are here to help. To learn more call 602-277-6211 or visit our website at: www.tocamd.com

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