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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

HUDDLE UP ABOUT SPORTS SAFETY

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

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

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

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

The Adolescent Athlete

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

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

Types of High School Sports Injuries

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

Acute Injuries

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

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

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

Overuse Injuries

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

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

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

Catastrophic Sports Injuries

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

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

Concussion

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

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

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

Growth Plate Injuries

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

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

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

 

Prompt Medical Attention

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

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

Doctor Examination

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

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

Treatment

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

 

Return to Play

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

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

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

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

 

Prevention

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

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

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

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

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

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

Here are three ways to get started.

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

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

 

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

 

Learn more at safekids.org. and STOP Sports Injuries 

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

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

Backpack Safety!

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

When selecting a backpack, look for:

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

Backpack Safety Tips:

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

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

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

 

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

 

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

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

 

http://orthoinfo.aaos.org

Sciatica

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

What is sciatica?

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

Symptoms

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

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

Causes

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

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

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

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

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

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

6 Most Common Causes of Sciatica

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

When Sciatica Is Serious

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

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

How do health-care professionals diagnose sciatica?

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

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

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

Nonsurgical Treatment

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

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

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

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

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

Surgical Treatment

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

 

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

Rehabilitation

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

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

Physical Therapy and Exercise for Sciatica

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Foot & Ankle Conditioning Program

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

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

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

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

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

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

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

 

Getting Started

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

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

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

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

 

1. Heel Cord Stretch

Repetitions 2 sets of 10
Days per week 6 to 7

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

Equipment needed: None

Step-by-step directions

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

Tip Do not arch your back.

2. Heel Cord Stretch with Bent Knee

Repetitions 2 sets of 10
Days per week 6 to 7

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

Equipment needed: None

Step-by-step directions

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

Tip Keep your hips centered over both feet.

 

3. Golf Ball Roll

Repetitions 1
Days per week Daily

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

Equipment needed: Golf ball

Step-by-step directions

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

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

 

4. Towel Stretch

Repetitions 2 sets of 10
Days per week 6 to 7

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

Equipment needed: Hand towel

Step-by-step directions

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

Tip Sit up tall and keep your legs straight.

 

 

5. Calf Raises

Repetitions 2 sets of 10
Days per week6 to 7

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

Equipment needed: Chair for support

Step-by-step directions

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

Tip Do not bend the knee of your working leg.

 

5. Ankle Range of Motion

Repetitions 2 sets
Days per week Daily

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

Equipment needed: None

Step-by-step directions

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

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

 

 

6. Marble Pickup

Repetitions 20
Days per week Daily

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

Equipment needed: 20 marbles

Step-by-step directions

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

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

 

 

7. Towel Curls

Repetitions 5
Days per week Daily

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

Equipment needed: Hand towel

Step-by-step directions

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

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

 

 

8. Ankle Dorsiflexion/Plantar Flexion

Repetitions 3 sets of 10
Days per week 3

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

Equipment needed: Use an elastic stretch band of comfortable resistance

Step-by-step directions

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

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

 

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

 

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

 

What is Spinal Stenosis & How do I treat it?

What Is Spinal Stenosis?

Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or “vertebrae”) and shock-absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects the brain to the body. The cord rests in the canal formed by your vertebrae.

For most people, the stenosis results from changes because of arthritis. The spinal canal may narrow. The open spaces between the vertebrae may start to get smaller. The tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso.

There’s no cure, but there are a variety of nonsurgical treatments and exercises to keep the pain at bay. Most people with spinal stenosis live normal lives.

 

Healthy Spine

The spinal canal has a rounded triangular shape that holds the nerve roots without pinching. Nerve roots leave the spinal canal through openings called nerve root canals which are also free of obstruction.

Affected Spine

New bone growth within the spinal canal causes compression of nerve roots, which leads to the pain of spinal stenosis.

 

Causes

The leading reason for spinal stenosis is arthritis, a condition caused by the breakdown of cartilage — the cushiony material between your bones — and the growth of bone tissue.

Osteoarthritis can lead to disc changes, a thickening of the ligaments of the spine, and bone spurs. This can put pressure on your spinal cord and spinal nerves.

Other causes include:

  • Herniated discs. If the cushions are cracked, material can seep out and press on your spinal cord or nerves.
  • Injuries. An accident may fracture or inflame part of your spine.
  • Tumors. If cancerous growths touch the spinal cord, you may get stenosis.
  • Paget’s disease. With this condition, your bones grow abnormally large and brittle. The result is a narrowing of the spinal canal and nerve problems.
  • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Thickened Ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.

Some people are born with spinal stenosis or diseases that lead to it. For them, the condition usually starts to cause problems between the ages of 30 and 50.

Symptoms

Spinal stenosis usually affects your neck or lower back. Not everyone has symptoms, but if you do, they tend to be the same: stiffness, numbness, and back pain.

When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis:

  • In the neck (cervical spine).Cervical stenosis can cause numbness, weakness or tingling in a leg, foot, arm or hand. Tingling in the hand is the most common symptom, and many people also report problems with walking and balance. Nerves to the bladder or bowel may be affected, leading to incontinence.
  • In the lower back (lumbar spine).Compressed nerves in your lumbar spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.

 

More specific symptoms include:

  • Sciatica. These shooting pains down your leg start as an ache in the lower back or buttocks.
  • Foot drop. Painful leg weakness may cause you to “slap” your foot on the ground.
  • A hard time standing or walking. When you’re upright, it tends to compress the vertebrae, causing pain.
  • Loss of bladder or bowel control. In extreme cases, it weakens the nerves to the bladder or bowel.

If you’re having symptoms, you might want to talk them over with your doctor. If you’re having a loss of bladder or bowel control, call your doctor at once.

Diagnosis and Tests

When you visit your doctor, she’s likely to ask you questions about your medical history. After that, she might order at least one of the following tests to figure out whether you have the condition:

  • X-rays. These can show how the shape of your vertebrae has changed.
  • Magnetic resonance imaging (MRI). By using radio waves, an MRI creates a 3-D image of your spine. It can show tumors, growths, and even damage to discs and ligaments.
  • Computerized tomography (CT scan). A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones.

Treatment

Your doctor may start off with nonsurgical treatments. These might include:

Medication: Common pain remedies such as aspirinacetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen can offer short-term relief. All are available in low doses without a prescription. Other medications, including muscle relaxants and anti-seizure medications, treat aspects of spinal stenosis, such as muscle spasms and damaged nerves.

Corticosteroid injections: Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make inflammation go down. However, because of side effects, they are used sparingly.

Anesthetics: Used with precision, an injection of a “nerve block” can stop pain for a time.

Exercise: You can improve your flexibility, strength, and balance with regular activity. Your doctor may recommend a physical therapist to help you.

Assistive devices: You might get braces, a corset, or a walker to help you move about.

Surgery

Some people have severe cases. They struggle to walk or have issues with their bladder and bowel. Doctors may recommend surgery for these people. Procedures such as laminectomy and laminoplasty create space between the bones so inflammation can go down.

Surgery carries its own risks. You should have a talk with your doctor about how much it can help, recovery time, and more before taking that step.

Many patients also try nontraditional therapies, including chiropractic and acupuncture. Again, be sure your doctor knows if you’re trying a nontraditional approach.

What You Can Do at Home

Some things you can do to help ease symptoms of spinal stenosis include:

  • Exercise. Think about moderation — not 100 push-ups. Just take a 30-minute walk every other day. Talk over any new exercise plan with your doctor.
  • Apply heat and cold. Heat loosens up your muscles. Cold helps heal inflammation. Use one or the other on your neck or lower back. Hot showers are also good.
  • Practice good posture. Stand up straight, sit on a supportive chair, and sleep on a firm mattress. And when you lift heavy objects, bend from your knees, not your back.
  • Lose weight. When you are heavier, there will be more pressure on your back.

 

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

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

The Orthopedic Clinic Association

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(TFC/TFCC) Triangular Fibrocartilage Complex Tear

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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