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Dr. Evan Lederman and colleagues review how bone reacts to shoulder replacements and propose a classification system for critical review of implant/bone interaction

Title: Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation

Patrick Denard MD, Patric Raiss MD, Reuben Gobezie MD, T. Bradley Edwards MD, Evan S. Lederman MD

Introduction

Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings.

Full article link below.

Journal of Shoulder and Elbow Surgery E-pub February 6, 2018

https://doi.org/10.1016/j.jse.2017.12.020

Dr. Josh Vella – 5th Annual World Congress in Orthopedics-2018

Dr. Josh C. Vella, TOCA Hand and Upper Extremity Surgeon, is honored to carry the distinction of becoming an international lecturer at the 5th Annual World Congress in Orthopedics-2018 in Milan, Italy.

He was one of a few distinguished international lecturers who discussed various new treatment options with the theme of this years conference “Breaking Barriers in Orthopedic Research”.

Photo: Dr. Josh C. Vella (center), Dr Michael Boland (right) of The Hand Institute, University of Auckland, New Zealand and Dr  Scott Fried (left) in collaboration with Thomas Jefferson University Hand Center in Philadelphia.

Dr. Padley has a long tradition of providing care for sports teams.

Dr. Padley returned to the Dominican Republic in April with the Cincinnati Reds for the annual opening of their Dominican complex. The trip included evaluations of 40+ Dominican athletes hoping to advance their way up the Cincinnati Reds baseball system. This marks the beginning of the baseball season for the Dominican teams. Most major league baseball teams have affiliates in the Dominican in search of that next great player! Dr. Padley is an orthopedic consultant and provider to the Cincinnati Reds for major league baseball spring training and throughout the year for their minor league and rookie league teams. In additional to this health care relationship, he is also a consultant to Japanese professional baseball for the Saitama Seibu Lions. With his expertise in hip disorders and injuries, Ballet Arizona benefits from his service as a consultant. He was a team physician for the WNBA’s Phoenix Mercury for four years including the 2014 championship season. Dr. Padley proudly serves as the team physician for Benedictine University in Mesa as well as Millennium and Verrado High Schools in Goodyear.

For more information on Dr. Padley, Click HERE

 

Congratulations to Dr. Evan Lederman for his recent publication!

Title: The Evolution of the Superior Capsular Reconstruction Technique

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

Introduction

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

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

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

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

Full article link below.

ICJR.net  March 2018

Halloween Safety Tips from your OrthoDocs

Halloween is known as a favorite holiday, full of spooky fun and lots of candy. However, it can also present many opportunities for injury, as we take to the streets in pursuit of trick-or-treating goodies. Let’s talk Halloween Safety!

Monsters and aliens are not the only scary things out on October 31st. Trips and falls (or even more serious accidents) can put a damper on Halloween festivities. But a little preparation and thought can go a long way in protecting you and your children from harm.Pedestrian injuries are the most common type of Halloween injury. There are four to five times more pedestrian fatalities on Halloween versus the average for the rest of the year.

Other common Halloween injuries are trips and falls from costumes that are too big or obstruct sight; burns from highly-flammable costumes; and cuts while carving pumpkins.

The following tips taken from the American Academy of Pediatrics and physicians at TOCA offers the following tips for Halloween safety:

Halloween Safety Tips from your OrthoDocs!

REMEMBER: The main thing to do is use your own common sense and rust your parental instincts. If it doesn’t feel safe or comfortable, then it probably isn’t; go with your gut, follow our advice, and keep things safe this Halloween.

Choosing a Costume

Everyone loves dressing up at Halloween, children most of all. And it’s so sweet seeing them go from door-to-door trick or treating locally – who doesn’t take a million pictures before they go out with their little buckets? But sadly it can be dangerous for some children, as there have been a number of well-documented accidents where children’s Halloween costumes were set alight by accident.

Don’t worry too much though- there are lots of things you can do to mitigate the risk. You need to make sure what you buy is as safe as it can be from candles, fires and sparks, and you need to brief them on what to look out for, as well as what to do if the worst happens. We’re sure everyone will stay safe this Halloween, but you can be super sure if you read our fullproof guide to Halloween costume safety!

1. Use flame-resistant materials

As it’s Halloween, your child is very likely to be near candles, lanterns, and other decorative flames. Polyester and nylon are both flame-resistant materials, for example. When picking out your child’s costume always look for the label “flame-resistant” and make sure there is a visible CE mark.

REMEMBER: It’s safer to choose costumes made up of one layer of heavier materials as opposed to flimsy, layered, frilly ones. Thinner materials made up of lots of layers tend to burn much faster because more oxygen can get to the fire.

2. Pick a costume that’s made out of ONE material

Costumes that are made of one single type of material will often catch fire more slowly than those that are made out of lots of different materials.

If a costume is made of a variety of different fabrics, they can all react to a flame in a different way and, in some cases, can fuel the fire even faster.

3. Wear clothes UNDER the costume

Not only because it can go from warm to chilly here in Arizona when you’re trick or treating but also because it’s safer. Speaking about costumes, Kevin O’Neill from the Fire and Rescue Service said: “These are toys. Toys have a lower fire safety requirement. They have a lower fire safety standard. Just be aware of that and take measures.

One of those measures is to ensure children are wearing clothes under the costume.

They should be wearing woollen tights for example or a woollen jumper or jeans. That way it gives some protection that if they were to catch fire you’ve still got a barrier between the garment and your skin.”

4. Ditch the capes

Capes are very common on Halloween costumes, but – as proven by Madonna – they can pose a tripping hazard even to adults. More worryingly, however, is the fact that they pose a strangulation risk.

And on that note…

Avoid costumes and costume jewellery that is tight around the throat. Avoid anything, especially cords and sashes, that tie around the neck.

5. Read the label on face paints

If you are buying face paints then they should be FDA approved. Always look for a CE mark and always check the packaging displays clear ingredients in English.

And remember that the words ‘non-toxic’ doesn’t always mean it will be safe for your skin. Do an allergy test on a small patch of skin before using on you or your childs face.

No matter how tired you are following a night of fun, make sure you remove any costume makeup before bedroom to prevent possible skin irritation.

6. Keep an eye on accessories and props

Swords, knives, and other costume accessories should be short, soft, and flexible. If you think if you, a friend or your child would be hurt if their was a fall on the accessory, be it a wand or a sword, then do not wear it.

Again, look for a visible CE mark when purchasing.

7. Be careful with masks

You want to make sure that a mask fits well (so that it’s comfortable and doesn’t slip), that the eye holes are big enough to see out of, and that you can breathe comfortably while wearing it.

8. Remember to stay visible

Choose bright and light coloured costumes and clothing wherever possible. If you or your kids are heading out trick-or-treating or an outdoor party, carry a glow stick, and buy reflective tape and attach it to your/ your childs costume. This will ensure that motorists can see your child – and that you can keep an eye on them!

9. Don’t forget the shoes!

Related imageWear well-fitting, sturdy shoes. You don’t need to wear “red-carpet starlet” high heels; leave them at home and pop on sturdy footwear that you won’t trip in.

And, on the note, remember that many shoes that come with costumes are NOT meant for outdoor use; make sure your child is wearing shoes that fit properly and have proper grip to them, so that they don’t slip and fall. Also so they can comfortably survive the night walking around in their shoes.

10. And of course, make sure it fits

Do not purchase costumes that are flimsy, billowing, too big, or that drag on the ground; not only will this be a tripping hazard, but it could also get caught up in Halloween candles.

A Few Additional Halloween Safety Precautions:

While Out Trick or Treating

  • Be safe, be seen. To easily see and be seen, children should also carry flashlights.
  • Young children should always be accompanied by an adult or an older, responsible child.
  • All children should WALK, not run, from house to house and use the sidewalk, if available, rather than walk in the street.
  • Cross streets at the corner, use crosswalks (where they exist), and do not cross between parked cars.
  • Parents should plan out the trick-or-treating route – best to stay on well lit roads with sidewalks.
  • Children should be cautioned against running out from between parked cars or across lawns and yards where ornaments, furniture, or clotheslines present dangers.
  • For greater visibility during dusk and darkness, decorate or trim costumes with reflective tape that will glow in the beam of a car’s headlights. Bags or sacks should also be light colored or decorated with reflective tape. Reflective tape is usually available in hardware, bicycle, and sporting goods stores.
  • Bring a flashlight and cell phone with you.

Choose Safe Houses

  • Children should go only to homes where the residents are known and have outside lights on as a sign of welcome.
  • Children should not enter homes or apartments unless they are accompanied by an adult.
  • People expecting trick-or-treaters should remove anything that could be an obstacle from lawns, steps and porches.

Image result for jack-o-lanternSmart Jack-o’-lanterns

  • Use a flashlight, battery tea light or flameless candle to light your jack-o’’-lantern.

When carving pumpkins:

    • Carve pumpkins on stable, flat surfaces with good lighting.
    • Have children draw a face on the outside of the pumpkin, then let an adult do the cutting.
    • Place lighted pumpkins away from curtains and other flammable objects, and do not leave lit pumpkins unattended

 

RESOURCES:

American Academy of Pediatrics
http://www.aap.org

 

#TOCA #TOCAMD #Halloween #HalloweenSafety #KidSafe #MyOrthoDoc #HalloweenFun #Trickortreat #Halloweencostume #Holidays #Celebrate #HappyHalloween

The Orthopedic Clinic Association names John Kinna Chief Executive Officer

The Orthopedic Clinic Association

FOR IMMEDIATE RELEASE

October 6, 2017
Media Contact: Lisa Paulson, Director of Marketing
lpaulson@tocamd.com; Office: 602.512.8525; Cell: 602.501.7583

The Orthopedic Clinic Association names John Kinna Chief Executive Officer

TOCA – The Orthopedic Clinic Association, a leading Orthopedic Clinic in Arizona, led by nationally recognized Orthopedic Physicians, has appointed John Kinna as Chief Executive Officer, effective October 2, 2017.

“John Kinna has a distinguished record of accomplishment and dedication to the critically important role of Orthopedics. “As we plan for the future, Kinna’s commitment to combining the highest levels of quality with outstanding patient experience will help achieve TOCA’s inspiring vision for the future,” said Joseph Haber, M.D., President of The Orthopedic Clinic Association. “John will build on the many strengths of the past and we are confident he will ably lead the association into the future.”

“TOCA is a trusted and admired, one stop resource for Orthopedics in Arizona. It is a tremendous opportunity for me to join an organization as distinguished as they are. I’m eager to work with TOCA’s skilled and respected physicians’ and staff, and together provide the best possible patient experience and outcomes.

Kinna has worked in healthcare for the past 29 years in leadership and management roles in both not for profit and for profit systems in Montana, Washington and now Arizona, including private practices, and large integrated groups as well as two large Catholic healthcare systems running employed Physician Divisions. He has served as the CEO at Barrow Brain and Spine and most recently at OrthoArizona.

About TOCA – The Orthopedic Clinic Association

TOCA (The Orthopedic Clinic Association) is the best one stop resource for orthopedics in Arizona, led by nationally recognized orthopedic physicians. We are passionate about consistent quality, the most advanced treatment options and personalized patient care for superior lifetime outcomes.

TOCA has built a reputation for excellence in Arizona for more than 65 years as the first and foremost orthopedic group. Our Nationally and Internationally recognized orthopedic physicians and surgeons utilize the most advanced proven technologies for the best recovery possible to return you to your active lifestyle.

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To learn more about TOCA’s physicians read more Here. For more information on TOCA’s history read more Here. To contact TOCA find more information by clicking Here

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD #JohnKinna #NewCEO

TOCA on Facebook  TOCA on LinkedIN TOCA on Pinterest  TOCA on Twitter

NUsurface Meniscus Surgery: Are You a Candidate?

NUsurface Meniscus Surgery: Are You a Candidate?

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

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

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

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

About the Procedure

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

Who is Eligible?

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

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

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

How Can I Find Out if I Qualify?

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

Learn more about Dr. Carter Here

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

 

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

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

 

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Ankle Sprain

Ankle Sprain

Ankle sprains are very common injuries. There’s a good chance that while playing as a child or stepping on an uneven surface as an adult you sprained your ankle–some 25,000 people do it every day.​​​

Sometimes, it is an awkward moment when you lose your balance, but the pain quickly fades away and you go on your way. But the sprain could be more severe; your ankle might swell and it might hurt too much to stand on it. If it’s a severe sprain, you might have felt a “pop” when the injury happened.

Even though ankle sprains  are common, they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

A sprained ankle means one or more ligaments on the outer side of your ankle were stretched or torn. If a sprain is not treated properly, you could have long-term problems. Typically the ankle is rolled either inward (inversion sprain) or outward (eversion sprain). Inversion sprains cause pain along the outer side of the ankle and are the most common type. Pain along the inner side of the ankle may represent a more serious injury to the tendons or to the ligaments that support the arch and should always be evaluated by a doctor.

With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful. In a severe ankle sprain, the ankle is unstable and may feel “wobbly.”

More about Your Injury

There are 3 grades of ankle sprains:

  • Grade I sprains: Your ligaments are stretched. It is a mild injury that can improve with some light stretching.
  • Grade II sprains: Your ligaments are partially torn. You may need to wear a splint or a cast.
  • Grade III sprains: Your ligaments are fully torn. You may need surgery for this severe injury.

The last 2 kinds of sprains are often associated with tearing of small blood vessels. This allows blood to leak into tissues and cause black and blue color in the area. The blood may not appear for several days. Most of the time it is absorbed from the tissues within 2 weeks.

If your sprain is more severe:

  • You may feel strong pain and have a lot of swelling.
  • You may not be able to walk, or walking may be painful.

Some ankle sprains may become chronic (long-lasting). If this happens to you, your ankle may continue to be:

  • Painful and swollen
  • Weak or giving way easily

What to Expect

Your health care provider may order an x-ray to look for a bone fracture, or an MRI scan to look for an injury to the ligament.

To help your ankle heal, your provider may treat you with a brace, a cast, or a splint, and may give you crutches to walk on. You may be asked to place only part or none of your weight on the bad ankle. You will also need to do physical therapy or exercises to help you recover from the injury.

Self-care

You can decrease swelling by:

  • Resting and not putting weight on your foot

Ice it to keep down the swelling. Don’t put ice directly on the skin (use a thin piece of cloth such as a pillow case between the ice bag and the skin) Apply ice every hour while you are awake, 20 minutes at a time and covered by a towel or bag, for the first 24 hours after the injury. After the first 24 hours, apply ice 20 minutes 3 to 4 times per day.

  • Compression can help control swelling as well as immobilize and support your injury.
  • Elevating your foot on a pillow at or above the level of your heart
  • Pain medicines, such as ibuprofen or naproxen, may help to ease pain and swelling. You can buy these medicines without a prescription. DO NOT use these drugs for the first 24 hours after your injury. They may increase the risk of bleeding. DO NOT take more than the amount recommended on the bottle or more than your provider advises you to take. Carefully read the warnings on the label before taking any medicine.

Getting Active

The pain and swelling of an ankle sprain most often gets better within 48 hours. After that, you can begin to put weight back on your injured foot.

  • Put only as much weight on your foot as is comfortable at first. Slowly work your way up to your full weight.
  • If your ankle begins to hurt, stop and rest.

 

Rehabilitating your Sprained Ankle

Every ligament injury needs rehabilitation. Otherwise, your sprained ankle might not heal completely and you might re-injure it. All ankle sprains, from mild to severe, require three phases of recovery:

  • Phase I includes resting, protecting and reducing swelling of your injured ankle.
  • Phase II includes restoring your ankle’s flexibility, range of motion and strength.
  • Phase III includes gradually returning to straight-ahead activity and doing maintenance exercises, followed later by more cutting sports such as tennis, basketball or football.

Once you can stand on your ankle again, your doctor will prescribe exercise routines to strengthen your muscles and ligaments and increase your flexibility, balance and coordination. Later, you may walk, jog and run figure eights with your ankle taped or in a supportive ankle brace.

It’s important to complete the rehabilitation program because it makes it less likely that you’ll hurt the same ankle again. If you don’t complete rehabilitation, you could suffer chronic pain, instability and arthritis in your ankle. If your ankle still hurts, it could mean that the sprained ligament has not healed right, or that some other injury also happened.

To prevent future sprained ankles, pay attention to your body’s warning signs to slow down when you feel pain or fatigue, and stay in shape with good muscle balance, flexibility and strength in your soft tissues.

Talk to your provider before returning to more intense sports or work activities.

When to Call the Doctor

You should call your provider if you notice any of the following:

  • You cannot walk, or walking is very painful.
  • The pain does not get better after ice, rest, and pain medicine.
  • Your ankle does not feel any better after 5 to 7 days.
  • Your ankle continues to feel weak or gives away easily.
  • Your ankle is increasingly discolored (red or black and blue), or it becomes numb or tingly.

 

If you have an Foot or Ankle Injury, the dedicated team of Orthopedic Physicians and Physical Therapists are here to help. For questions or to schedule an appointment call 602-277-6211!

 

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