Thanksgiving is just around the corner and almost everyone is planning a big feast, strategizing for the family football rematch, watching the Macy’s Day parade and of course, NFL football on TV. With all these things going on in one day, there is no bigger star than the Thanksgiving turkey as it is paraded from the kitchen into the dining room where someone will be carving the revered bird. This holiday season, Orthopedic Specialists would like to caution all the carvers out there as they carve the main course and not their hands.
People sustain hand injuries during Thanksgiving and the entire holiday season. When friends and family are watching you as you carve the turkey, you may feel a little overwhelmed, so focus; don’t let your turkey day celebrations go fowl this year because of a hand injury.
Follow these easy tips and get your bird on the table in time so guests can start gobbling:
• Never cut towards yourself. One slip of the knife can cause a horrific injury. While carving a turkey or cutting a pumpkin your free hand should be placed opposite the side you are carving towards. Don’t place your hand underneath the blade to catch the slice of meat.
• Keep your cutting area well-lit and dry. Good lighting will help prevent an accidental cut of the finger and making sure your cutting surface is dry will prevent ingredients from slipping while chopping.
• Keep your knife handles dry. A wet handle can prove slippery and cause your hand to slip down onto the blade resulting in a nasty cut.
• Keep all cutting utensils sharp. A sharp knife will never need to be forced to cut, chop, carve or slice. A knife too dull to cut properly is still sharp enough to cause an injury.
• Use an electric knife to ease the carving of the turkey or ham.
• Use kitchen sheers to tackle the job of cutting bones and joints.
• Leave meat and pumpkin carving to the adults. Children have not yet developed the dexterity skills necessary to safely handle sharp utensils.
• Lastly, should you cut your finger or hand, bleeding from minor cuts will often stop on their own by applying direct pressure to the wound with a clean cloth.
Visit an emergency room or a hand surgeon if:
• Continuous pressure does not stop the bleeding after 15 minutes
• You notice persistent numbness or tingling in the fingertip
• You are unsure of your tetanus immunization status
• You are unable to thoroughly cleanse the wound by rinsing with a mild soap and plenty of clean water
Dr. Weil states, “I often see patients whose holiday season has been ruined by an accident in the kitchen. The most common kitchen injuries that I treat are lacerations. Lacerations sustained while carving pumpkins, turkeys, and other holiday fare can be quite serious. These injuries can include cut nerves, arteries and tendons. These types of injuries require immediate surgical management to restore function. Treatment can include microscope assisted nerve repairs, artery repairs, and tendon repairs. If you sustain a laceration where you lose sensation to your finger or hand or are unable to bend your finger please seek medical treatment immediately. “
These simple tips will help you enjoy that bird and the rest of your holiday season. If you would like more information on specialty care of the hand, call Orthopedic Specialists and make an appointment with one of our expert, orthopedic doctors at (206) 633-8100.Fall Clean-Up and Rake Safety
Fall is a beautiful time of the year when the leaves turn color and in the Pacific Northwest, it is sometimes also wet because of the rain. Preparation and taking a common-sense approach to raking the beautiful leaves is important and raking requires a number of different activities, including twisting, bending, lifting, and reaching, that use several different muscle groups. Improper use of lawn tools along with the potential for tool-related accidents further compounds the risk of injury to the bones and muscles.
–Do some form of light exercise (such as walking) for 10 minutes to warm up the muscles before raking or other yard clean-up
–Use a rake that’s comfortable for your height and strength. Wear gloves or use rakes with padded handles to prevent blisters. If you have a rake that is too short you will have to bend over which will cause strain on your back. It is the repetitive movement in raking, not the weight that can strain the muscle.
–Don’t wear hats or scarves that interfere with vision and beware of large rocks, low branches, trees stumps and uneven surfaces.
–Alternate your leg and arm positions often. When you pick up piles of leaves, bend at the knees, not the waist. Use your legs to shift your weight rather than twisting your back. Do not throw leaves over your shoulder or to the side while raking as this involves twisting movements that can overly strain the muscles in your back. As a reminder from Dr. Shapiro, “Take care of your shoulders and use more bags, filled ¾ full. Lifting and throwing heavy, wet bags is a common way to hurt your shoulders and neck.”
–Wet leaves can be slippery. Wear shoes or boots with slip-resistant soles.
–Don’t overfill leaf bags, especially if the leaves are wet. To avoid back injury, you should be able to carry the bags comfortably.
–When raking, don’t throw leaves over your shoulder or to the side, because that kind of twisting motion places too much stress on the back.
–Don’t overdo it. Raking is an aerobic activity – you may need to take frequent breaks or slow your pace if you are an infrequent exerciser.
If you do experience a new strain or sprain, proper care can be easily remembered by using the acronym, RICE:
- Rest (minimize movement of the injured body part)
- Ice (apply a cold pack)
- Compression (light pressure wrap to the affected body part can help minimize leakage of blood and swelling)
- Elevation (raise the body part up so that the pressure from the blood and tissue swelling the affected area is reduced as the fluids drain from the area by gravity)
If you do experience an injury during your Fall clean-up, call Orthopedic Specialists of Seattle and make an appointment to see one of our expert doctors.Orthopedic Injuries of Celebrities
On Sundays while reading the sports page or perusing through the Internet, you come across articles regarding athletes who have been injured during a sporting event, but did ever stop to think about the entertainment industry? Well, if you think about it, there are quite a few injuries that occur while on stage, or even in their off time while they were horseback riding. We compiled a list of orthopedic injuries in both the sports and entertainment genres to note that sometimes, unexpected injuries can occur, even to famous sports and entertainment legends.
Pink – During her Funhouse Tour in 2009, the famous singer-songwriter separated her shoulder while on a trapeze.
Jennifer Grey – She had back surgery in 2012 to repair a ruptured disc in her back while performing on Dancing with the Stars season finale.
Liza Minnelli – Years of dancing caught up with her and had knee replacement surgery in 2010.
Bono – U2 singer Bono underwent emergency back surgery in May 2012. His injury – Severe compression of the sciatic nerve and a serious tear in the ligament and a herniated disc.
Dana Torres – Olympic Medal Swimmer had undergone a cutting-edge procedure on her knee to repair severe arthritis in 2010.
Phil Collins – He had surgery to repair a dislocated neck vertebrae in April 2009.
Soledad O’Brien – She injured herself on a horseback riding excursion and tore out her knee and had reconstructive surgery.
Big Boi – The Rapper hurt himself in a performance at the Summer Camp Fest in Chillicothe, IL. He jumped and landed badly and had torn a patella tendon.
Peyton Manning – During the 2011 NFL season, he had neck surgery.
Lance Armstrong – He had a cycling accident in 2009 with a clavicle fracture.
Tom Brady – In the 2008 NFL season had an ACL tear.
Joe Paterno – Former football coach of Penn state had a tibial plateau fracture.
Floyd Landis – The cyclist had surgery for his hip osteonecrosis.
Frankie Hejduk – MLS player had an ACL tear repaired.
Ronald Reagan – Former President of the United States had work done for his hip fracture.
Donovan McNabb – During the 2005 NFL season, he had work done to repair his sports hernia.
Drew Brees – In the 2005 NFL season he had a shoulder dislocation.
Gwyneth Paltrow – She had broken her knee and it was discovered that she had osteopenia, a pre-cursor to osteoporosis.
Kobe Bryant – Basketball player for the Los Angeles Lakers underwent surgery to repair a torn left Achilles tendon back in April 2013.
Misty May-Treanor – Olympian and volleyball superstar underwent surgery to repair a torn Achilles tendon back in October 2008 when she injured herself while rehearsing a dance routine for the television series Dancing With The Stars.
Dr. Reed notes, “Even celebrities have orthopedic ailments. From sprains, to fractures, to arthritis no one is immune. At Orthopedic Specialists of Seattle we treat all orthopedic conditions, from the everyman to the celebrity.”Save the Dates for OSS Physicians Speaker Series!
Save the Dates! OSS physicians will be speaking about several orthopedic health and information topics from October – December 2013 at Swedish Ballard. Below is a list of dates and times for you to choose from:
October 2, 2013
Dr. Peterson: Joint Replacement: The Right Choice for You? 6-8 p.m. at the Swedish Ballard Campus. Free hip- and knee-replacement seminar. If you have arthritic joint pain and are considering joint replacement, you’ll want to attend this important class. If you have arthritic joint pain and are considering joint replacement, you’ll want to attend this important class. Dr. Peterson will discuss hip- and knee-replacement surgery, as well as the latest in robotic-assisted surgery for those who have advanced arthritis in part of their knee. There will also be a question and answer session with Dr. Peterson.
October 9, 2013
Dr. Weil: Relief from Your Hand and Wrist Pain. 6-8 p.m. at the Swedish Ballard Campus. Learn about treatments for different types of fractures; ways to treat arthritis in the wrist, thumbs and fingers; and how to prevent and treat carpal tunnel syndrome and other overuse conditions.
November 13, 2013
Dr. Reed: Relief from Your Foot and Ankle Pain. 6-8 p.m. at the Swedish Ballard Campus. The foot and ankle are two of the most often under-treated structures of the body. Dr. Reed, who specializes in the care of the foot and ankle will discuss the anatomy and common injuries and disorders of the foot and ankle, and treatment options for the conditions. There will be a question-and-answer session with the surgeon included in the class.
December 4, 2013
Dr. Ruhlman: Relief from Your Hand and Wrist Pain. 6-8 p.m. at the Swedish Ballard Campus. Learn about treatments for different types of fractures; ways to treat arthritis in the wrist, thumbs and fingers; and how to prevent and treat carpal tunnel syndrome and other overuse conditions.
Who doesn’t want to run like a Kenyan? The speed, endurance, and efficiency of these elite distance runners is the stuff of legend, and those in the running community have tried to glean some insight as to what makes these African runners such a powerful force in marathon running. One of the obvious starting points is to analyze the biomechanics of the running stride and see if there are efficiencies inherent to the Kenyan athlete. Of course, this has been done with more than one researcher noting one glaring observation: Kenyan runners do not wear shoes. They grow up, play, and often train barefoot. Could this be the secret to running faster? Certainly, some people think that it is. The barefoot running trend has gained a steady following over the past few years. But as the barefoot running contingent has grown, so have its detractors. Let’s take a closer look.
First of all, most barefoot runners do not run in their bare feet. Even the fanatics realize that the roads and trails contain many hazards such as broken glass, nails and rocks that could cause potential injury or discomfort to the feet. Instead, they use minimalist running shoes, a type of sneaker designed to mimic the barefoot condition in terms of biomechanics. Typically, these shoes are lightweight and feature a thin sole without the large heel cushion found in traditional running shoes.
Biomechanically, the research has shown that barefoot running eliminates or minimizes the heel strike during running. The runner attempts to absorb the impact of body weight by landing with the foot flat or slightly on the ball of the foot. This allows the lower leg and foot to distribute the body weight over a larger surface area. The heel strike found in those wearing traditional running shoes, called shod runners, creates a condition where the full force of impact is driven through the heel, and ultimately the heel cushion of the shoe.
Proponents of barefoot running claim reduced injuries as a result of this change, although there is not much research available to support this claim. One claim that does seem to be supported in the medical literature however, is that of reduced energy consumption while running barefoot. Simply put, barefoot runners should not fatigue as quickly as shod runners. This would be a great advantage to distance runners and racers who want to attain peak performance or even achieve a personal best during local road races. The finding is interesting as stride frequency and mechanical work were higher in barefoot runners, indicators which would lead one to believe that the runner would consume more energy. However, the cushioning material in a running shoe absorbs a considerable amount of energy in the shod runner. Energy that would otherwise be used
to propel the runner forward is lost in the sneaker. Think of the traditional running shoe like a Cadillac. It gives a smooth ride, but not too efficient.
The obvious risks associated with barefoot running such as puncture wounds can be mitigated with the use of a minimalist running shoe. With this type of footwear, much of the biomechanical adaptations which proponents claim as advantageous are maintained, i.e. reduced heel strike and improved efficiency. However, there are other reasons why someone may not want to run barefoot. Without a traditional running shoe, the runner lands with a flat foot instead of the traditional heel strike seen in shod runners. This increases the pressure on the bones of the forefoot, which are quite a bit more fragile than the heel. Over time and with high mileage, a runner could develop a stress fracture, a small break in one of the forefoot bones. This would sideline a runner for several weeks at best, and could become more severe if ignored. Proponents claim that barefoot running is more natural and that we as humans evolved in a way that makes the barefoot method more efficient. But cavemen rarely put in thirty plus miles per week.
The bottom line is that there has not been enough research performed to advocate one method or the other. More studies need to be conducted, and we need to be open-minded about the results. With the barefoot trend steadily gaining a following, the research is sure to follow. In the meantime, let’s go back to our elite Kenyan marathoners. In an environment where every conceivable advantage is sought and analyzed, these athletes all wear running shoes in competition. Maybe shod running is biomechanically advantageous, or maybe the cumulative effect of pavement on flesh for 26.2 miles eliminates the inherent advantage of running barefoot.
Dr. Mark Reed is an orthopedic surgeon specializing in foot and ankle surgery in the Seattle metro area. He can address all of your questions regarding barefoot running as well as any other foot and ankle conditions. Please feel free to contact Orthopedic Specialists of Seattle at (206) 784-8833 to schedule an appointment.5 Common Hockey Injuries
The regular NHL season is well underway and the Seattle Thunderbirds are respectively improving their stats with their recent win over the Vancouver Giants at ShoWare Center. In the regular season as well as the off season, players experience a variety of sports-related injuries as a result. Ice hockey is a contact sport where the players and the puck move at high speeds, so when players run into each other or objects, great force is used. This is why hockey is considered a collision sport. Injuries are fairly common, but efforts can be made to avoid them with training and proper equipment. Listed below are five common injuries that can occur while playing hockey.
AC Joint Injury
The acromioclavicular joint, or AC joint, is one of the joints in the shoulder responsible for motion and stability. The ligaments that hold the AC joint together can be torn through sudden impact to the shoulder, which can cause separation to occur in the AC joint. This sudden impact can happen in hockey when players skating at high speeds collide with one another or into a rigid surface. Swelling, bruising, pain, and motion range loss are all symptoms of AC joint separation. There may also be visible bumps on the shoulder if the bones separate.
Shoulder dislocation generally refers to a dislocation in the glenohumeral joint in the shoulder. This happens when the top of the humerus, or upper arm bone, is forced out of the glenoid, the socket in the shoulder joint it usually nestles in. If a player falls or receives a heavy blow or sudden impact on the shoulder, it can cause dislocation if the upper arm is forced to move in an abnormal way. Symptoms of shoulder dislocation include pain, weakness, and mobility issues. The arm may also appear to hang incorrectly off the shoulder.
Muscle strain occurs when a muscle is pushed past its limit. This can happen if a player’s muscle is suddenly presented with a heavy load or stretched beyond its normal ability. If a player’s muscles are tight but not warmed up or not conditioned well, tearing or straining is a risk. Symptoms of a muscle tear include pain at rest or when the muscle is used, and weakness or inability to use the muscle.
The meniscus is a C-shaped piece of cartilage in the knee. There are two menisci in each knee joint, and if they are torn they can affect stability in the knee. This tearing can happen if the cartilage is worn down or through the quick movements and stress put on the knees by ice skating. Symptoms vary depending on how and where the meniscus is torn, but symptoms can include pain, instability or feeling the knee “giving,” stiffness, swelling, and an impaired range of motion. Sliding, popping, or locking may occur if the tear is left untreated because loose fragments from the meniscus tear will drift into the joint.
The ulnar collateral ligament, or UCL, connects the bones at the base of the thumb, which prevents the thumb from moving too far from the hand. When an acute sprain or tear of the UCL occurs, it is called a UCL injury. When the injury is chronic and develops over time from repeated UCL stretching, it’s called gamekeeper’s thumb. UCL injuries are commonly caused by injury or trauma in which the thumb is bent away from the hand at the MCP joint. This can happen in sports hockey, or in any situation in which a fall is landed on an outstretched hand. This injury might also be sustained when a person is gripping something that is suddenly moving, like a hockey stick during a fall. Swelling, pain, and tenderness on the ulnar side of the thumb are all symptoms of UCL injury. You may also have difficulty pinching and gripping with the thumb, and you may have limitations in your range of movement. In severe cases, a bump under the skin, called a Stener lesion, may form due to the ends of the torn ligament being held apart by a nearby tendon.
If you believe you are suffering from a sports injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you. Please feel free to contact Orthopedic Specialists of Seattle at (206) 633-8100 to schedule an appointment.
OSS October Newsletter
OSS October Newsletter
Our October Newsletter is finally here! Click Here to take a look.MCL Tears and Repairs By Dr. Charlie Peterson, MD
MCL Tears and Repairs By Dr. Charlie Peterson, MD
The medial collateral ligament (MCL), located on the inside portion of the knee, is one of the more common sporting injuries to the lower extremity. It is usually an “acute” injury, meaning that it happens suddenly due to trauma. In sports, the athlete may take a sudden blow to the outside of the knee, creating excessive tensile force to the MCL, such as being tackled in football. This injury also occurs commonly in sports where the ankle is immobilized such as hockey and downhill skiing, where the ankle is stabilized in a skate or boot. This immobilization leaves the knee to absorb the full impact of a collision or fall and increases the risk of knee injury.
The skeletal anatomy of the knee consists of three bones. The thigh bone, medically termed the femur connects with the shin bone, called the tibia. In the front of the knee is the knee cap, or the patella. Holding these bones together are the four major knee ligaments. Two are located deep within the joint and are called cruciate ligaments. They prevent excessive forward and backward motion, as well as rotation. The remaining two are the collateral ligaments, and are located on the sides of the knee. Their job is to prevent lateral, or sideways, motion of the knee. The MCL is located on the inside of the knee joint and prevents the knee from collapsing inward. In addition to the bones and ligaments, the knee has two cartilage pads called the medial meniscus and lateral meniscus. These pads act as shock absorbers within the knee.
Types of MCL Injury
Tears to the MCL are usually a result of direct trauma, either from a blow to the outside of the knee, such as with a football tackle, or a fall that pushes the lower leg sideways. Partial tears will cause varying degrees of instability within the knee, and are often treated successfully with conservative interventions including bracing and physical therapy to strengthen the surrounding musculature. Complete tears may cause significant instability in the knee, especially if in combination with other ligament injuries such as the ACL.
If isolated, even high-grade MCL tears can still often be treated with bracing alone. However, such tears often occur in conjunction with other structures such as the medial meniscus or the anterior cruciate ligament (ACL). The medial meniscus has a direct connection to the MCL, making it particularly susceptible to injury during an acute MCL sprain. Should this be the case, surgical intervention may be required to restore full function due to the degree of instability caused by multiple injuries.
MCL tears are most often treated successfully without surgery. With significant tears there may be an initial degree if instability following injury. A hinged knee brace may be prescribed to limit control of this aberrant movement. As the ligament heals, your orthopedic surgeon may refer you to physical therapy to strengthen the leg musculature surrounding the knee, and also to restore normal movement patterns that may have been disrupted following injury and immobilization. Patients are able to perform most of their normal daily activities during this process, with the possible exception of high intensity athletics, and generally have very good outcomes following four to eight weeks of rehabilitation.
In cases where non-operative treatment has failed or in some multiple ligament injuries, the surgeon will recommend repair or reconstruction surgery. This means that the damaged MCL will be repaired with sutures if possible. If that is not possible, then a new ligament can be fashioned from a soft-tissue “graft,” a piece of tendon taken from either the patient or a cadaver. A small incision is made to gain access to the area, and the repair made, or the tendon graft is anchored in place with surgical screws.
Following surgery, there will be a period of immobilization, followed by physical therapy. The duration and intensity of the rehabilitation process is dependent on the type of MCL repair or reconstruction, and the other injuries present. In most cases, patients can return to full function including athletics at the conclusion of treatment.Rotator Cuff Tears and Repairs By Dr. Shapiro
Rotator Cuff Tears and Repairs By Dr. Shapiro
In the world of orthopedic surgery, there are few body parts as notorious as the rotator
cuff. It’s one of those medical terms that has become a household name, and usually comes
with a wince and a sympathetic nod when we hear it. Most people know of someone, a friend or family member, who has injured this particular part of the shoulder. We also see it in the sports news quite often. In fact, now that football season is in full swing, we may hear more about Seattle Seahawks defensive lineman Michael Bennett who was diagnosed with a rotator cuff tear earlier this year. He played through the injury last season and plans to do it again this year, although he will likely need surgery in the off-season.
The rotator cuff is a group of four small muscles and tendons that surround the head of the shoulder. Their job is not so much to move the arm through space, but to provide dynamic stability to the shoulder. This means that as the larger muscles of the chest and shoulder create arm movement, the smaller rotator cuff muscles pull the upper arm into the shoulder socket. This design allows the ligaments of the shoulder to be relatively loose so that we can enjoy a vast degree of mobility, being able to reach in a near three hundred and sixty degree range of motion.
Tearing of the rotator cuff can happen in two ways. An acute tear happens suddenly, such as when you fall on an outstretched hand, or lifting a heavy object. There is generally the sudden onset of pain and a corresponding loss of function of the arm, to varying degrees.Tears can also happen slowly over time. As we age, the tendons of the rotator cuff become weaker and gradually fray. This is particularly so with the supraspinatous tendon, located on the top of the shoulder blade. This muscle and tendon tends to get pinched between the shoulder blade and the arm bone, especially if theother rotator cuff muscles are weak. The supraspinatous also has poor blood supply, sotears often do not heal on their own, making surgical repair necessary to restore function.
Symptoms of a rotator cuff tear include pain with movement of the shoulder and tenderness to touch. Inability to lift even household objects out to the side or overhead is also typical. Sometimes a person will not be able to actively lift the arm overhead due to abnormal movement within the joint itself. Another indicator is a prior history of shoulder tendonitis or bursitis as this would point to excessive stress on the rotator cuff over time.
Treatment can be conservative for some tears, including physical therapy to improve shoulder mobility and progressively strengthen the cuff muscles. However, the majority of tears will likely require surgery if function of the shoulder is to be restored. Rotator cuff surgery has come a long ways in recent years, with many surgeries being arthroscopic. This is a minimally invasive technique where the surgeon inserts a camera and surgical tools through small incisions in the shoulder. The instruments are only about a centimeter in diameter and can burrow through layers of muscle on top of the rotator cuff, whereas in past years these muscles had to be cut, making for longer recovery times. During the
surgery, the torn rotator cuff tendon will be sutured together. The surgeon will also clean away any bone spurs that may have contributed to a degenerative tear.
If the tear is complex or involves additional procedures such as tendon transfers due to excessive degeneration of the rotator cuff tendon, then the surgeon may need to open the shoulder with a slightly longer incision. It involves more cutting of shoulder musculature and may slightly lengthen recovery time; however, from time to time it is necessary.
Fortunately, most repairs will not require this technique.Recovery is generally a four to six month process, involving four phases:
1. Phase 1 (protection): Lasting from day one to four weeks, this stage of healing involves protecting the surgery. You will be required to wear a sling during most parts of the day. Gentle mobility exercises may be prescribed.
2. Phase 2 (passive motion): Lasting until the sixth week, you will be prescribed physical therapy and begin moving the shoulder with assistance within a prescribed range of motion.
3. Phase 3 (active motion): From weeks six through twelve, the focus will be on moving the arm and shoulder on your own, increasing the active range of motion.
4. Phase 4 (strengthening): You should have improved mobility at this time, allowing you to focus on building full strength and function of the arm.
Undergoing a rotator cuff repair can be a lengthy process. The amount of time that you will be required to be away from work will vary depending on the physical demands of your job. This will all be discussed in depth during pre-operative visits so that you may plan accordingly. However, if surgery is recommended, you should not delay for long, as the torn tissue becomes weak and shortened over time, making a successful repair more difficult.If you are experiencing persistent shoulder pain, please feel free to contact my office to arrange a consultation.Pumpkin Carving Safety Tips
Pumpkin Carving Safety Tips
Every October, carved pumpkins peer out from porches and doorsteps in the United States and other parts of the world. Gourd-like orange fruits inscribed with ghoulish faces and illuminated by candles are a sure sign that Halloween and the holiday season is upon us. The practice of decorating “jack-o’-lanterns” – the name comes from an Irish folktale about a man named Stingy Jack – originated in Ireland, where large turnips and potatoes served as an early canvas. Irish immigrants brought the tradition to America, home of the pumpkin, and it became an integral part of Halloween festivities. Click Here and find pumpkin carving safety tips for you and your loved ones!