Category Archives: Injuries

Causes and Treatments of Common Shoulder Injuries

shoulder painThe shoulder is a complex joint that facilitates the movement of the arm . Without this crucial joint, the most basic movements of the arm and hand would be impossible.

Think about the mobility that the shoulder affords the arm and hand. Although it is crucial for our daily activities, this movement often comes with a price as we age. Over time the shoulder joint can wear down causing increasing pain.

Due to the complexity of the joint, there are many categories that shoulder injuries fall under:

  1. Fractures
  2. Instability
  3. Arthritis
  4. Soft tissue inflammation and tears

Fractures

Shoulder fractures usually consist of a complete or partial break of the collarbone (clavicle), upper arm bone (humerus), and the shoulder blade (scapula). This type of injury can range from minor to severe depending on how the injury was suffered. Shoulder fractures are accompanied by severe pain, swelling, bruising, and decreased mobility.

The most common causes of these fractures are car accidents, contact sports injuries, and falls. While the treatment of the injury depends on the severity and patient type, the most common treatment is a sling, worn for 8 weeks. However, surgery may be required in more severe cases. In all cases extensive Physical Therapy is needed after healing to regain strength and mobility.

Instability

The shoulder is the most mobile joint in the body, putting it at high risk for instability. This phenomenon occurs when the upper arm bone comes out of the shoulder socket. Once this happens the shoulder may “catch” or become completely dislocated. Instability in younger patients can be a huge problem that creates recurrent issues if the problem is not addressed properly. As the ligaments around the shoulder have been torn during the dislocation, instability can persist if the ligaments do not heal. Recurrent dislocations can occur, causing pain and ultimately arthritis.

Shoulder instability usually happens as a result of a specific sports injury or trauma. There is very little possibly that it will occur without a specific injury. Treatment usually involves the wearing of a sling and extensive physical therapy. However, if the muscles are not strengthened, and dislocation continues, surgical stabilization may be necessary. New minimally invasive arthroscopic shoulder surgery can fix the problem quickly with a shorter recovery period.

Arthritis

The most common type of shoulder arthritis is osteoarthritis. This type of arthritis comes from extreme wear and tear and/or age. At the onset of shoulder arthritis, people try to minimize the pain by using the shoulder less. Although this decreases the pain, immobility for too long leads to tightening of the joint resulting in even more pain.

Osteoarthritis is extremely common, and is often the result of genetics or family history. Sports or work injuries and/or chronic wear and tear are also common causes. Previous shoulder injuries, like rotator cuff tears, and multiple dislocations can cause painful shoulder arthritis as well.

So, how do you relieve this pain? Most effective pain management comes from lifestyle changes, range-of-motion exercises, physical therapy, and rest. Your doctor may also prescribe some pain reduction medications like ibuprofen. Only in the most extreme cases will you be advised to have joint replacement. If you do require joint replacement, make sure to talk to your doctor about minimally invasive shoulder replacement.

Tendon inflammation and tears

Tendon injuries and tears of the shoulder are extremely common. Overuse can easily cause tendonitis or bursitis; both of which inhibit shoulder mobility and cause extreme pain.

Although there are many tendons in the shoulder, the most commonly injured are the rotator cuff tendons and or the biceps tendon. Rotator cuff strains or partial tears may progress to get worse due to aging blood supply and or impingement. Impingement is usually due to bone spurs pinching the tendon during motion.

The best way to prevent an inflamed shoulder Tendon from tearing is rest. Avoiding activity will allow the tendons to heal, reducing the risk of a tear. Anti-inflammatory medications or injections may be prescribed along with rest and physical therapy. However, if these measures do not work, the Tendons can tear. Once this happens, Therapy is less successful and surgery may be advised.

Nobody wants to suffer from shoulder pain. So, if you find yourself suffering from any one of these shoulder injuries come see Dr. Stickney. He will provide you with the best treatment, tailored specifically to your injury and condition. Don’t wait, come see Dr. Stickney and get back to your normal routine faster.

Platelet-Rich Plasma Treatment for Orthopedics

Platelet-Rich Plasma TreatmentInvasive surgery and long recovery times for orthopedic surgery are becoming a thing of the past. After years of extensive surgeries and painful recovery times, surgeons are now looking towards new nonsurgical management of orthopedic issues. The current nonsurgical treatment that everybody is talking about is platelet-rich plasma, or PRP.

PRP is an autologous derivative of blood, which singles out high concentrations of platelets and is loaded with many growth factors and cytokines. While it is clear from the buzz that PRP can be useful for orthopedics, there is some debate as to the best use of PRP in the orthopedic world.

PRP has been used to treat osteoarthritis, to repair fractures, and in ACL reconstruction. By first examining what PRP is made of, we can then examine how effective it is in treating these orthopedic issues.

PRP: What it is

First let’s look at what PRP is made of.

The most significant growth factors and cytokines in PRP are: platelet-derived growth factor (PDGF), transforming growth factor beta (TGF- B), fibroblast growth factor (FGF), insulin-like growth factor 1 (IGF-1), connective tissue growth factor (CTGF), epidermal growth factor (EGF), and vascular endothelial growth factor (VEGF). If you are not a doctor these things may sound like gibberish to you. So, to put things more simply, these growth factors and cytokines are essential for hemostasis, construction of new connective tissue, revascularization, cellular recruitment, and inflammation reduction after an injury.

Other components of PRP include fibrin, fibronectin, vitronectin, and thrombospondin; all of which are extremely important to the healing process. In addition, the optimal platelet concentration used in the PRP formula is between 3 and 5 times that of normal blood. Any more than that can have the opposite effect and slow the healing process.

PRP: Why and how it’s used

Now that we know the basic components of a PRP treatment we can focus on the purpose of this new technology as it relates to orthopedics.

According to the AAOS “the proposed function of PRP is to promote tissue healing by increasing extracellular matrix deposition, reducing pro-apoptotic signals, and minimizing joint inflammation”. The draw towards this kind of orthopedic injury treatment is obvious; it is easy to get your hands on, safe, adaptable, and can be used by athletes.

Although there are obvious benefits to this treatment, like less recovery time and no surgery, as with any new treatment there is a lack of long-term clinical justification. The PRP treatment is so new that there is a lack of uniform preparation, delivery, and dosing of the treatment. Because there are different ways that PRP can be prepared the final concentration of platelets can vary greatly. This means that the regenerative potential of the treatment also will be widely varied. Furthermore, there is no clinical consensus on the best way to prepare and deliver the treatment, which has caused much discussion on the true benefits of the treatment.

Osteoarthritis and PRP

Over 27 million people in the United States are affected by osteoarthritis. The condition accounts for over 50% of all non-steroidal, anti inflammatory drug prescriptions, and in 2011 was the second most expensive orthopedic condition seen in hospitals, totaling a staggering $15 billion dollars! Thus, it should come as no surprise that people began to look for other ways to treat such a widespread disease.

After many studies, examined intra-articular PRP injections, as a treatment of osteoarthritis, there were varied outcomes. One study demonstrated that short-term clinical trials could not conclude that intra-articular PRP injections were a good alternative for combating osteoarthritis. However, another demonstrated that these PRP injections could benefit adult and younger patients with mild-to-moderate knee osteoarthritis. In conjunction, this study also stated that more long-term research was needed to determine the benefits of PRP. Thus, the benefits of PRP for osteoarthritis are slightly inconclusive.

Fracture repair and PRP

As with any other new treatment, PRP injections were first tested in the lab before brought to clinical trial. In these preclinical trials PRP did show some osteogenic (bone regeneration) properties in some in vitro studies. However, a clinical study conducted with 76 patients there was no bone healing found when using PRP lumbar fusion. Furthermore, the presence of thrombin in the PRP formula was shown to actually decrease bone formation.

It can be concluded then that: the efficacy for bone formation due to PRP is inconclusive and needs more research.

ACL reconstruction and PRP

The very nature of an ACL tear dictates that the injury will have poor vascularity, and due to its intra-articular location it will be subject to synovial fluid proteases. In simpler terms, this means the environment for injury healing is extremely hostile.

Thus, many studies have been done using MRI to determine if PRP augmentation can aid in the healing process. Data from the Multicenter Orthopaedic Outcomes Network (MOON) determined that the use of PRP in ACL allograft reconstruction made no difference in patient-reported outcomes after a 2-year follow up. The results were the same with those who did receive PRP treatment and those who did not. However, there was some success shown in a study that applied PRP directly to the patellar and tibial bone plug harvest sites after ACL surgery. Studies showed that direct PRP application to the patellar and tibial sites led to better knee function and decreased patellar tendon gap following ACL reconstruction.

Conclusion

As an alternative to the more expensive orthopedic treatments, PRP or platelet-rich plasma has shown some promise. It has been mildly effective in treating osteoarthritis and ACL reconstruction healing, but showed less promise in fracture repair. However, in all cases it can be concluded that PRP as a widespread treatment needs more testing and desperately requires uniformity in development and delivery.

How PRP Affects Soft-Tissue Injuries

intra-articular injectionThe discussion about platelet-rich plasma, or PRP, treatment is becoming a more popular topic by the minute. PRP treatment is being proposed as an alternative to normal orthopedic treatments that tend to be costly for the wallet and for your time. In a previous blog we looked at PRP treatments’ ability to handle orthopedic difficulties like ACL reconstruction, fractures, and osteoarthritis. This time, let’s shift our focus to: how PRP affects soft-tissue injuries.

For the purpose of this analysis we will look at how PRP affects meniscal repair, rotator cuff repair, and tendon healing.

Meniscal Repair

The evidence for how PRP affects meniscal repair is short, concise, and inconclusive. There is only one good study, which we can reference, that gives us any conclusive data about how PRP affects meniscus repair. This particular study examined animal models in which scaffolds were used for PRP injection. After 12 weeks it was concluded that PRP augmentation showed no significant difference from the control group in meniscal regeneration/repair. Thus, more studies are needed, perhaps in human subjects, to determine if PRP can aid meniscal repair.

Rotator Cuff Repair

Rotator cuff tears are one of the most common injuries that orthopedic surgeons face. For this reason there has been much research focused on the biologics of these types of injuries. These studies are most concerned with the tear location, time to fixation, need for surgery, optimal surgery technique, etc. To see if PRP treatments can aid in the healing process of rotator cuff repair 5 randomized controlled trials (RCT) and 3 nonrandomized trials were completed.

In one of the tests, it was found that patients who received PRP augmentation saw higher retear rates of the rotator cuff. Furthermore, those same patients saw no significant difference in the healing process. Thus, according to this study it seems that PRP augmentation may have detrimental effects to the rotator cuff repair process.

In other similar studies it was also found that PRP use had no significant advantages after rotator cuff repair in relation to pain, motion, strength, or retear rate. However, there was a study in Italy that showed that PRP injections used in conjunction with a thrombin component did have some positive results.

Overall though it has been concluded that there is no clear benefit of PRP use in arthroscopic rotator cuff repair, if it is used alone. In fact, in two cases it proved to be detrimental to the effectiveness of the surgery. More studies are needed to determine the usefulness of PRP injections in rotator cuff repair.

Tendon Healing

Although there has been little positive evidence suggesting use of PRP found in meniscal or rotator cuff repair, there have positive outcomes in relation to tennis elbow and Achilles tendinopathy.

Normal treatment of tennis elbow is a combination of bracing, physical therapy, and steroid injections. In three different studies the steroid injections were substituted for PRP injections. In all three studies the group that received the PRP injection noticed significantly less pain and faster healing time. Thus, it can be concluded that PRP injections can help the healing of tennis elbow.

Achilles tendinosis is another soft-tissue injury that has been treated using PRP injections. Normally this condition is treated nonsurgically with rest, pain medications, physical therapy, bracing, orthotics, and ultrasound. PRP use here aims to improve and speed the healing process. In two studies no significant healing improvement was found when PRPs were used compared to saline injections. One study did show that the use of PRP did slightly improve functional outcomes of Achilles tendinosis, there is not enough statistical evidence to suggest that PRPs are effective in aiding the healing of Achilles tendoinosis. Thus, more research is needed.

Conclusions of PRP use for soft-tissue injuries

Even though PRP treatment is still a new and up-and-coming treatment in the orthopedic world, and it may hold much promise. In relation to meniscal and rotator cuff repair it is extremely evident that much more research is needed. Different combinations of PRP need to be tested for efficacy if there is any hope of this treatment becoming successful for soft-tissue injuries. On the other hand there has been some success in treating tennis elbow and Achilles tendinosis.

Although the measure of success has been small in these areas, it leaves hope that PRP treatment for orthopedic injuries could one day be the norm. Thus, doctors and scientists must push on in their research for the best PRP treatment, backed with proven evidence of success.

7 Signs You Should Stop Exercising Immediately

Ashley Langford​ is in tune with his body. The 40-year-old Web developer and ​photographer near Dallas, Texas, traded his party-hard lifestyle for intense exercise such as P90X and CrossFit in 2010. So when his heart rate “took off” from 140 to 180 beats per minute while on the rowing machine last year, he knew something was seriously wrong. But would you know the signs it’s time to ​stop exercising immediately and head straight to the hospital? 

Treatments that reduce knee buckling may help prevent falls in older adults

Symptoms of knee instability in older adults may indicate an increased risk of falling and of experiencing the various physical and psychological effects that can result from falling, according to a study published in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR). The findings indicate that determining effective treatments for knee instability should be an important priority as clinicians care for aging patients.

Knee buckling, often described as a knee “giving way,” is a symptom of knee instability that frequently affects older individuals, in particular those with knee pain and knee osteoarthritis (OA), and may be caused by muscle weakness and balance difficulties. If knee instability leads to frequent falls and fall-related injuries, exercises and other interventions that stabilize the knee may help maintain older individuals’ health and quality of life.

3 Secrets to Improving your Orthopedic Health

Walkers_350x233Thousands of people every day are starting out on a path towards a healthier lifestyle. This means that people are now more conscious about what they eat, and many people are trying out new types of exercise they would never have dreamed of before. While the goal here is to stay healthy and active, many people often forget that adding daily exercise to their lifestyle can take a toll on their body and orthopedic health.

As people become more active, the number of bone and joint injuries and chronic conditions continues to increase. This increase calls for a need to take care of our orthopedic health. Read about these few secrets that will help you improve your orthopedic health and ultimately avoid injury.

Nutrition

For proper bone health your body requires lots of calcium and vitamin D. The vitamin D allows your body to efficiently absorb the calcium, which in turn builds your bones. Because your body cannot create calcium on its own, it is important to eat foods that contain this important nutrient.

So, what kinds of foods should you eat? Dark leafy greens like spinach, turnip greens, broccoli, and kale are all extremely high in calcium. There are also many cereals that are packed full of the vital nutrient. Yogurt and other dairy products are also a great source of calcium for your body.

It is a good idea to add at least one high calcium food to your meal plan everyday. Although we usually don’t think about it, our bone health is extremely important as we get older. These foods can help your bones stay healthy so that you avoid injury further down the line.

Exercise

Leading an active lifestyle is an extremely important component to maintaining your orthopedic healthy. However, avoiding high-impact types of exercise is crucial. High-impact activities create extreme wear and tear on your bones that is counteractive to orthopedic health. Activities like fast paced walking, using hand-held weights, and stretching bands are great alternatives.

It is also important to remember to stretch before and after a workout. Increasing your flexibility will help you maintain a wide range of mobility, which will in turn help you avoid injury.

Good Posture

Most people would not expect that posture has an effect on bone health. However, having good posture can greatly reduce unnecessary pressure on your joints, alleviate ligament stress, and prevent back pain. Correct posture also keeps bones and joints in the proper alignment so that your muscles can function properly.

Sleeping posture is also incredibly important. Make sure that you sleep lying on your back or on your side with your knees slightly bent. These positions will keep the natural curvature of your spine in the correct position, and thus alleviate joint stress.

These three 3 secrets are only the first stepping-stones on your journey towards total and complete orthopedic health. Always make sure to eat smart, live healthy, and stay active. Following these simple rules will start you out on the track to success.