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Category Archives: Common Problems and Guides

Common Swimming Injury – Swimmer’s Shoulder

SwimmershoulderSwimming is a sport in which there is a great diversity among participants. There are both recreational and competitive swimmers, ranging in age from preschool through college. Although the lack of impact in swimming makes it a perfect choice for avoiding lower-body injuries, the intense involvement of upper-body muscles makes overuse injuries a real possibility.

The most common swimming-related injury is swimmer’s shoulder, shoulder pain usually caused by rotator cuff tendonitis. Many cases of swimmer’s shoulder can be successfully treated through physical therapy. For competitive athletes, rotator cuff surgery may be recommended if shoulder pain continues after 6 months of guided rest and rehabilitation.

Signs and Symptoms of Swimmer’s Shoulder

• Shoulder pain while swimming freestyle
• A forward shoulder slouch while seated
• Underdeveloped posterior shoulder musculature
• A mild winging on the affected side’s left scapula
• Tenderness in the acromioclavicular joint and coracoid process in the impingement area
• Tenderness in the affected side’s bicep tendon and supraspinatus tendon
• A full range of motion in all planes
• Strength is slightly decreased in the supraspinatus and infraspinatus
• Full strength in the internal rotators, arm extensors, and flexors
• Moderate posterior and anterior laxity in both shoulders
• A bilateral sulcus sign
• Impingement and adduction-compression tests on the affected side were positive
• An apprehension test on the affected side was negative

Swimming Safety and Injury Prevention

According to Dr. Franklin, “Proper warm up, stretching, technique and conditioning are crucial in preventing tendonitis and overuse injuries in swimmers.”

• Learning proper technique goes a long way toward preventing injuries; if you’re just starting out, schedule some sessions with a swimming coach.
• Remember to warm up and stretch before every swim, giving particular attention to your shoulders.
• A strength-training program can help build up the muscles around the shoulder and upper back; ask a physical therapist or personal trainer if you need help creating a routine.

If you believe you are suffering from swimmer’s shoulder or swimming-related injury and need specialized orthopedic care, the orthopedic surgeons at OSS provide excellent treatment options for your injury. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Hand Rejuvenation – New Trend with Women and Plastic Surgery

June is the quintessential month for weddings.  The phrase “June Bride” is in our vernacular, conjuring up images of a beautiful bride, a handsome groom, family and a spectacular and exotic honeymoon.

 

Before the wedding takes place however, there is the all-important engagement photo shoot and for that, women throughout the country are acting on a new trend – plastic surgery for their hands, also known as hand rejuvenation or “handlifts” to show-off their beautiful diamond ring.

 

This new trend is rooted in today’s social media practice called the “selfie”.  Newly engaged women are excited to show off the ring on their finger and post it in social media outlets like Facebook and Instagram.  “Selfies” have made society more self conscious of their appearance including their hands.  “Handlifts” have gone up 40% since the rise of social media.

 

According to Dr. Weil, “Next to our faces the hands are the most recognizable and exposed parts of the body.  The hands are often forgotten when it comes to rejuvenation procedures. However, they are one of the first areas which are noticed by others, especially when there are years between the appearance of your face and hands. Just like our faces, our hands will show the signs of aging. In some cases our hands may even make us look older than we are. As we age our hands lose fat– along with collagen– which decreases the elasticity and leads to thinning of our skin. This can cause the skin to become loose and wrinkled and cause the veins and tendons of our hands to become more prominent. Today, however, Dermal Fillers (Juvederm, Restylane, Perlane, Radiesse, etc.) have become an excellent option for restoring the volume and smoothness that our youthful hands once had.”

 

Dr. Weil’s dermal filler of choice for hand rejuvenation is Juvederm Ultra XC. Juvederm Ultra XC works by restoring the volume of hyaluronic acid in your skin, helping to reduce wrinkles and smooth out folds. Hyaluronic Acid (HA) is a naturally occurring sugar found in the human body. Hyaluronic acid creates volume in the skin by delivering nutrients and by holding in water, making sure the skin stays hydrated. Its function is very similar to that of a sponge–it soaks up and absorbs water–which in this case creates volume in the skin of your hands. Dr Weil goes on to say, “Think of hyaluronic acid as the body’s internal moisturizer!”

 

Hand1Youthful hands have a fullness of the skin and subcutaneous tissues. The skin is soft and without wrinkles except for the natural lines seen over the finger joints and knuckles. Veins may be visible, but not obvious.

 

 

 

 

Hand2 Loss of skin thickness and volume in the tissues underneath the skin make the veins easily noticeable and unattractive. Pigment changes and dark spots occur as a result of sun exposure. The thin skin becomes wrinkled and has far less elasticity.

 

 

 

 

Hand3 Hand rejuvenation with dermal fillers is an affordable, non-invasive way to treat volume loss and thinning of the skin that occurs with aging. Using dermal fillers to restore the volume and smooth away wrinkles of the hands is a procedure with little discomfort and no downtime.

 

If you would like more information about hand rejuvenation, call Orthopedic Specialists of Seattle (206) 633-8100 to schedule an appointment with Dr. Weil.

Summer Running

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As runners, think about the varied terrain and urban obstacles of jogging outdoors versus the treadmill’s regularity; now apply that same comparison to every gym exercise and the variables of their outdoor equivalents, from biking in the park to soccer on the grass.

 

Here are three important steps you should take to ensure that getting back into running leaves you free from injury this summer:

 

1)  Take a moment to set a goal. Setting a goal helps propel yourself towards a specific aim, a simple enough idea which cannot be overstated in its power to focus yourself on a reasonable achievement.
2)  Renew one of your new year’s resolutions or challenge yourself to meet or beat a pace that you haven’t quite kept up with over the past few years.
3)  More importantly, set up a log book to keep track of your times and achievements. Having a physical record of where you started with a means to your ends is paramount to meeting your goal.

Speaking of physical reminders, the change in season is the perfect opportunity to change your sneakers! Most dedicated running stores offer in-depth analyses of your feet and gait to make sure that you get the proper equipment. Think about marking your shoes with the date of purchase so you can keep tabs on when you got them so that you don’t keep using them after their time is up.

Dr. Mark Reed states, “With so many different running styles gaining popularity; selecting the shoe that fits your style is important. A properly fitted shoe will help protect against injury and may also enhance performance. “

You should also set up an appointment with your OSS physician to go over all the requisites, making sure to get the OK for the goals you’ve set for yourself before the start of new routines.

The simple act of updating your equipment and evaluating your physiology are powerful motivators for getting back in shape and keeping you injury-free.

If you believe you are suffering from a running-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provides excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Are you a Desk Jockey? How are your Joints?

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The orthopedic surgeons at OSS and the physical therapists at Seattle Orthopedic Center (SOC) see a fair amount of orthopedic injuries from all walks of life ranging from body-related complaints – some from accidents, some from surgery and some from extreme sports.  And yet, some of the most common injuries come from sitting at your desk all day.  Commonly dubbed a “Desk Jockey” means that most of your days is spent sitting at your desk, on the phone, pushing paper, and using your computer, laptop or tablet.

 

When compared to more physical occupations, a Desk Jockey wouldn’t seem like someone experiencing a joint injury but more like a paper cut or stapler accident.  All the work you do on your computer, there are several ways to incur both a neck and shoulder injury caused by repetitive motion.  All the mouse click you make in a day, improper monitor positioning, chair height and keyboard position may cause neck and shoulder pain that can become acute, causing a severe amount of fatigue.  Although most of these injuries may not become chronic in nature, for some, the shoulder pain and neck pain persists.

 

OSS offers these tips while working at your desk to help alleviate neck and shoulder pain:

  • Simple Ergonomics – Set up your workstation so that your keyboard, mouse, monitor, and chair are in the optimal position for your body.
  • Move – Take breaks; stop working for a moment, get up and move.  Change positions into your day to help relieve the tension and reduce strain in your neck, back, shoulders, hips and knees.
  • Stretch - If you spend several hours a day typing, there are common finger and wrist muscles that get used over and over again. This repetitive motion can cause strain and lead to repetitive stress injuries.
  • Sleep - A good night’s rest is a great chance to give your back and neck some support and relief for as long as you’re lucky enough to remain horizontal. Sleep also plays an important restorative role in healing injuries and keeping the body healthy.

 

According to Nicole Marble, PT, “As physical and occupational therapists, we help patients achieve structural balance through education, therapeutic exercise, neuromuscular re-education, and manual therapies that mobilize soft tissues and joints. This will decrease pain and maximize function whether our patients sit for prolonged periods or participate in high level sports and activities. Here at SOC/OSS our physical therapists are able to offer personalized care with 45-minute one-on-one treatment sessions. We also work closely with the orthopedic surgeons to create and maintain a physical therapy program that is designed to get you back to what you love. “

 

If you are suffering from joint pain and injury, contact OSS to schedule an appointment with one of our physicians at (206) 633-8100.

 

Shoulder Dislocation and Treatment

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Here in the Pacific Northwest outdoor activities are a way of life.  From lumberjacks to the most experienced kayaker, healthy joints are important to perform various tasks and activities that involved upper body strength involving our shoulders.  The shoulder is the most mobile joint in the human body. To accomplish this, the shoulder requires a balance of stability and strength.

Shoulder dislocation is a fairly common injury sustained by people of all age ranges. It is generally a sudden onset type of injury, which is caused by trauma to the shoulder region. There are many causes of this type of injury, from athletics to falling from a ladder. Most dislocations occur as the arm is outstretched to the side or overhead in conjunction with a force pushing the arm backward.

Dislocated shoulder signs and symptoms may include:

  • A visibly deformed or out of place shoulder
  • Swelling or discoloration (bruising)
  • Intense pain
  • Inability to move the joint

Shoulder dislocation may also cause numbness, weakness or tingling near the injury such as in your neck or down your arm. The muscles in your shoulder may be in spasm from the disruption, often increasing the intensity of your pain.

When the shoulder dislocates, the ligaments in the front of the shoulder tear causing pain and at least some loss of function in the affected arm. Although the ligaments may heal, the result is a shoulder that has even more laxity and instability than prior to the injury. Many athletes and active individuals will experience multiple occurrences of dislocation after the first event due to the increasingly unstable shoulder. Successive dislocations, because of the increased amount of instability in the joint, often take significantly less force to occur. Whereas the first dislocation is usually the result of a traumatic force upon the shoulder, subsequent dislocations could result from ordinary, athletic or heavy use of the arm.

A common condition that may exist with shoulder dislocation is a SLAP tear, which is a tear to a structure in the shoulder known as the glenoid labrum. The labrum is a cartilage rim, similar to an O-ring, which covers the outside edge of the shoulder socket. This acts to deepen the socket and give the shoulder some extra stability. But under the extreme force of a shoulder dislocation, the labrum can be torn from the bone, creating a painful injury with reduced motion and strength of the arm.

Labral tears often produce a clicking or popping with shoulder motion, along with apprehension in the overhead ranges. Because these cartilaginous structures do not have a great blood supply, they often do not heal on their own and may require surgical intervention to re-attach the labrum to the bone.

According to Dr. Shapiro, “A consistent strengthening program is often the key to shoulder stability.”  There are many treatment options available for these types of shoulder injuries.   Some are non-surgical such as physical therapy, while more extensive injuries may require surgical repair. Joel Shapiro, MD, specializes in surgical and non-surgical treatment of shoulder injuries at Orthopedic Specialists of Seattle and uses the latest technologies and research studies to aid in the diagnostic process and treatment of your injury.

 

A good physical therapy program can help protect against instability.  While this cannot help everyone, a diligent therapy program is always the first step. After evaluating your shoulder, a customized therapy program will be created.

If you believe you are suffering from a shoulder injury, Orthopedic Specialists of Seattle is here to help.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment with Dr. Shapiro.

 

 

 

Avocados vs. UFC Fighter… and the Winner is?

avocado-cut-3aWho knew you would have to watch your back, or should we say hand, when making the family’s homemade guacamole? Avocados; they look innocent enough, but did you know that avocados are the cause of hundreds of hand injuries a year?

 

Take for example, UFC Tri Star Welterweight contender, Rory MacDonald.  He gave himself a deep cut in his left hand while cutting an avocado at home, prompting a trip to the emergency room and making him worry he’d have to drop out of his UFC 170 fight against Demian Maia.  Fortunately for MacDonald, he received stitches for his hand injury.

 

The danger is hidden inside the avocado. Avocados have a soft creamy skin, easily sliceable, but inside, the pit also needs to be removed carefully. Often times, this is done by stabbing the end of a knife onto the pit and twisting it off. If not done properly, the knife can glance off the pit and cut your hand.  You can also injure yourself when slicing the inside of the avocado while it rests in the palm of your hand; the pressure may be too great and accidentally, you slice right through the peel and your palm along with it, hitting an artery, nerve or tendon in the process.

 

Slicing an artery, nerve or tendon can be serious. It is possible to have a partial injury to a tendon and still move the hand normally, but there is a risk that the tendon could rupture completely. According to Dr. Ruhlman, “Knife injuries from cutting an avocado are among the most common injuries I see, and unfortunately, often cause an injury that needs surgical repair.  Hopefully, awareness of this common injury might prevent a rate of such a devastating injury.”  By using the proper tools and technique, injury can easily be prevented.  If you do cut yourself it might mean surgery and possible months of therapy.

 

OSS has several providers specializing in hand injuries.  If you are suffering from a hand-related injury, contact OSS to schedule an appointment with one of our physicians at (206) 633-8100.

 

 

The 21st Century Thumb – Texting Can Lead to Thumb Arthritis

534030-52122-30Let’s face it we’re all guilty of overusing the text feature of our cell phones!  The 21st century thumb has been introduced to ranges of motion that are now being overused.  Irregular motion of the thumb due to texting has presented new aches and pains that our bodies are not accustomed to performing.  Texting involves that our thumbs move at a higher frequency than normal and a higher frequency at which you may be texting with your thumbs causes an unnatural motion that may potentially lead to tendonitis or arthritis.

 

The texting thumb usually refers to the “trigger thumb” – The constriction of a flexor tendon in the thumb, which may result from repetitive gripping motions such as texting or holding a smartphone. Its symptoms include painful popping or snapping when the thumb bends and straightens; sometimes the thumb even becomes locked in a curled position.  Cortisone injections to treat the thumb eliminates the pain and restore mobility 80 to 85 percent of the time; in more severe cases, a brief surgical procedure may be required to release the pulley at the base of the thumb so that the tendon can move more easily.  If you have thumb pain or stiffness that seems to worsen with use of a smartphone, change the way you use your phone and hold your phone with the hand you use less frequently or type messages with your index finger to give your thumbs a rest.

 

Dr. Wayne Weil at OSS frequently diagnoses and treats trigger finger. In mild cases, splints to rest the finger, or over-the-counter pain medications and/or corticosteroid injections may be recommended. Injections are less likely to provide permanent relief when a person has experienced trigger finger for a long time, or if there is an associated medical problem such as diabetes. Surgical treatment may be recommended for more severe cases. If the finger is stuck in a bent position, or if the symptoms are severe, surgery may be the best course of treatment. Surgery’s goal is to widen the opening of the tunnel so that the tendon can slide through it more easily. It’s usually an outpatient surgery performed through a small incision. Dr. Weil frequently performs surgery for patients with trigger finger at OSS’ on-site surgery center.

 

According to Dr. Weil, “The modern day thumb is required to perform an incredible amount of repetitive activities with use of computers, cell phones and gaming systems.  This can lead to significant tendonitis and inflammation of the thumb flexor and extensor tendons.  If not adequately treated conditions such as trigger finger and de Quervain’s tendonitis can compromise the ability to perform activities of daily living.  I often see patients with these conditions and if caught early can treat them with hand therapy, activity modifications, cortisone injections and sometimes surgery.”

 

Thumb arthritis – Arthritis of the carpometacarpal joint, where the thumb connects to the wrist is also sometimes called “texting thumb” where forceful pinching motions occur when gripping your phone or texting with your thumbs may lead to more severe symptoms.  This condition requires rest and treatment to alleviate the pain and restore mobility.  Treatments may include splints and cortisone injections.  Patients with persistent symptoms may need a procedure called carpometacarpal arthroplasty, in which a surgeon removes part or all of the arthritic trapezium bone to relieve pain and improve function.

 

If you believe you are suffering from a hand-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

 

 

 

 

 

Avoiding Spring Gardening Injuries

Spring weather in the Pacific Northwest is beautiful and although we still have rain showers, it is the best time for gardening and getting in some spring cleaning.  If you are like some of us here at OSS, gardening is a popular hobby.  Over time however, it can take a toll on your body.  Creating a dream garden requires repetitive bending, kneeling, reaching, and twisting that may result in putting an extensive amount of strain on your muscles and joints.

gardening-safety

According to Dr. Scott Ruhlman, “Spring time is a great time to get outside and do yard work. In this case the old adage rings true, that an ounce of prevention is much more than a pound of cure. Use the proper tools and body positioning when gardening. I am not only a hand surgeon but an avid gardener too.”

Raking, digging and planting may present injuries and OSS would like to share some helpful tips to keep you pain-free while you garden:

 

  • Sunscreen – Fair-weather skin tends to burn faster and in the Pacific Northwest when we see the sun peek out from the clouds, we rush to catch some of those sunshine rays.  Use sunscreen with SPF and wear a wide brimmed hat.
  • Light Stretching and Walk – Before you take on your dream garden, do some light stretching so that your muscles can warm up and take a short walk to get your blood flowing.
  • Spread out your workload – If your  garden took a toll over the winter months, pace yourself and spread out the work; this gives you the opportunity to see your garden progress and prevents you from injury by doing all the work at once.
  • Kneeling vs. bending – Place less strain on your back by avoiding bending; kneel instead.  Wear kneepads and use a cushioned mat to comfort your knees while working on the ground.
  • Keep Moving – Long periods of time in one position will put stress on your muscles and joints; so keep moving so that you avoid overworking specific areas of your body
  • Lift cautiously – Lift with your legs and not your back when carrying heavy loads and remember to hold objects close to your body when lifting.

 

If you believe you are suffering from a gardening-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment or consultation with Dr. Ruhlman.

 

Knee Injuries on the Job

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Driving down Interstate 5 through the Pacific Northwest, you see a lot of logging trucks pass you by.  Loggers and truck drivers do a lot of heavy lifting and/or climbing, but so do other professions, like nurses, construction workers, doctors or even chefs who walk long distances while lifting items they may need on the job.  You may not think of these jobs as a place where a knee injury might occur, but in fact, occasionally injure a person.

 

A knee injury might not be apparent at first, but over time, may become swollen and painful.  The knee injury now becomes an impediment, and you are unable to lift things because your stance is unstable.  Think about the last time you wobbled a little because your knee gave out and developed a nagging pain soon after.  Did you do anything to alleviate the pain you felt in your knee?

 

Common Knee Injuries

Meniscus Injuries: Meniscus tears can cause intense pain and instability in the knee depending on the severity of the tear. Clients with tears to the meniscus describe a sensation of their knee “giving out” or “coming out from under them” while walking or climbing stairs.

The knee will most likely swell in order to protect itself, which can be intensely painful and can limit movement. Although physical therapy, anti-inflammatory medication and cortisone injections can help reduce symptoms, an orthopedic doctor will often recommend arthroscopic surgery to repair the tear.

 

Ligament Injuries: Injuries to the cruciate ligaments – such as the anterior cruciate ligament (ACL), medial collateral ligament (MCL) and posterior cruciate ligament (PCL) – are sometimes referred to as sprains, but they can be much more complicated than simple muscle strains. These injuries can require months of treatment to recover, and some cruciate ligament injuries — e.g., anterior cruciate ligament (ACL) tears – may require reconstructive surgery.

 

Chondromalacia: Chondromalacia is a disorder caused by softening of the articular cartilage of the kneecap. It can be caused by traumatic injury or overuse or repetitive motion on the job. Signs and symptoms of chondromalacia include dull, achy pain in the front of the knee, increased pain when walking up or down stairs, pain in the knee when kneeling or squatting, knee pain after sitting for long periods of time, a grating or grinding sensation when you extend your knee and knee stiffness. To diagnose the problem, an OSS physician may require you to attempt simple knee exercises or recommend X-rays or other imaging tests such as an MRI or CT scan. Treatment options include rest, pain relievers or physical therapy. In rare cases, arthroscopic or realignment surgery may be options.

 

According to Dr. Watt, “Knee problems and injuries may be job-related or not.  Sometimes it is obvious and sometimes not obvious and this may be part of the initial evaluation.  I have extensive experience on all types of knee problems and injuries and would love to help anyone with a knee problem to try and regain a healthy knee.”

 

Dr. Watt is a board-certified orthopedic surgeon here at OSS who works with patients dealing with a wide range of orthopedic issues. Dr. Watt carefully weighs conservative and aggressive methods of treatment to devise a plan tailored to the specific needs of the individual. This personalized approach creates excellent outcomes, with patients working as close partners in the treatment process.

 

If you are suffering from a knee-related injury, contact OSS to schedule an appointment with Dr. Watt at (206) 633-8100.

 

 

Are you suffering from Hip Impingement?

Patients may have hip impingement for years before diagnosis because it’s rarely painful in its early stages. Early diagnosis is important; however, hip impingement if left untreated, can cause cartilage damage and osteoarthritis.

Once hip impingement becomes more advanced, symptoms include:

  • General stiffness in the groin or front of the thigh.
  • Running, jumping or sitting after flexing will also cause pain the groin region

What is hip impingement? Hip impingement (femoro acetabular acetabular impingement) is a more recently recognized cause of hip pain in the active adult.

Hip impingement is caused by a lack of room or clearance between the neck of the femur and the rim of the socket (acetabulum). In a normal hip, there is a gliding motion of the round femoral head within the socket, but with an impinged hip, the gliding motion is disturbed.  Dr. Downer states, “Mechanical problems do not always require surgical treatment; when symptoms affect function and lifestyle then surgery is justified.”

Dr. Downer, provides specialized care in hip restoration and replacement, and has a special interest in hip impingement conditions.  Treatment options may include:

  • First approach – Trying to control the pain with anti-inflammatory medications – If pain persists, surgical treatment may be necessary.
  • Surgical treatment of hip impingement involves removing or correcting the cause of the reduced clearance between the neck of the femur and the rim of the socket (acetabulum). This may require arthroscopic surgery of the hip to remove diseased portions of the acetabulem (labrum) as well as femoral neck.
  • In severe cases, it may be necessary to correct the deformity and reshape the femoral neck and/or rim of the socket through a larger incision. In cases of malposition of the socket, a redirecting procedure, called a periacetabular osteotomy (PAO) may be required.

 

Don’t let a hip impingement slow down your healthy, active lifestyle.  Find out treatment options so that you can continue doing the things you love.  Call Orthopedic Specialists of Seattle and schedule a consultation with Dr. Downer at (206) 633-8100.