Why I Switched to the Anterior Approach for Total Hip Replacement (T.H.R.)

Posted on April 20, 2013 by Dr. Watt

I initially looked at switching to the anterior approach (going into the hip from the front rather than the side or back of the hip) because the PAs (physician assistants), nurses, and physical therapists in my hospital all told me that they felt that the patients who had anterior approaches were having significantly less pain and were able to rehabilitate faster.  I have a partner who was one of the first people in the Seattle area to do anterior approach THR and the hospital staff could watch the difference in how the patients recovered after their surgery.

Finally one day I asked our head PA how she would want her total hip done and she said definitely by the anterior approach.  At that point I knew I had to learn more about it and whether it was reasonable for a surgeon that has always done THR through a posterior approach to change to a dramatically different technique and still be confident that my patients would benefit.

I first observed the technique in the operating room and then studied the anatomy of the anterior approach.  The first obvious benefit is that the approach to the hip from the front is anatomically easy and does not involve cutting any major structures to get to the hip.  You simply spread the interval between two muscles and you are down onto the hip capsule.  When you go in from the back you have to divide the gluteus maximus (butt) muscle and split part of the ilio-tibial band on the side of the hip and then cut several small tendons off the back of the hip.

The thing that stops a lot of surgeons from doing this approach is that it is so different from what they are used to.  The other thing that stops them is the special technique that is necessary to place the stem into the femur (upper thigh bone).  When you approach the hip from the back, it is fairly easy to place the stem of the implant into the femur. From the anterior approach most surgeons use a special table called a fracture table that allows you to position the leg in a very specific way.  In my case, all of the operating room staff and my assistants were used to doing this approach and that made my job a lot easier.

Once I decided that I wanted to learn this technique, I went to a lab where you can practice on cadavers.  I was surprised at how easy the approach was and how well I could get good exposure of the socket and the femur to do the surgery.  Once I had the exposure, the actual placement of the implants was exactly what I had been doing from the posterior approach.

I have now been doing all of my hips using the anterior approach, and although the first few that I did made me a little anxious, after about 10 hips I knew that I would never go back.  For me to switch, I had to feel that it was an advantage to my patients and that I could do as good or better job implanting the components. I have definitely found both to be true.

I have found that my patients have less pain and are ready to leave the hospital sooner.  After an anterior hip there are no hip position precautions like there are after a posterior approach.  This means no pillows between the legs and you can bend over as far as you want.  My patients who have had one hip done through the posterior approach and one through the anterior approach tell me that not having to follow specific hip position precautions is one of the biggest positive differences that they noticed and they feel that it helped them recovery more quickly.

From my standpoint as a surgeon, I love the approach because I don’t have to cut any major structures to get to the hip, and also when it is done through the anterior approach it is easy to use fluoroscopy (real time x-ray) to check the position of the hip components while you are putting them in.  This allows the cup position to be optimal and allows the surgeon to check the leg length to be sure it is the same as the other leg.

I am very happy that I was pushed to learn this new approach to THR.  Total hip replacement surgery is one of the most rewarding surgeries that we do.  No matter how it is done, as long as it is done well, patients have wonderful results.  This is exactly why many surgeons don’t feel the need to change.  They are doing an operation with excellent results and they don’t want to take a chance on having problems while learning a new way of doing it.  Fortunately for me, I was able to see a good surgeon and support staff doing this procedure and it convinced me to change.

My last thoughts for anyone reading this who is contemplating having their hip replaced is to know that the most important thing for a successful hip replacement is having a good surgeon and a hospital that does hip replacement surgery routinely.  I do think the anterior approach has advantages over the posterior approach for both the patient and the surgeon and that’s why I switched.

Posted in Hip Conditions, Hip Surgery | Comments Off

Winter Sports Injury Prevention

Posted on February 7, 2013 by Dr. Watt

According to the United States Consumer Product Safety Commission, more than 440,000 people were treated in 2010 for winter sports-related injuries. These injuries were related to snow skiing, snowboarding, sledding, tobogganing, and ice skating.

What are some common winter sports injuries?

Injuries that are associated with winter sports include sprains, strains, fractures, and dislocations. Most of these injuries are easily prevented if sports participants adequately prepare by keeping in good physical condition, stopping when they are in pain or fatigued, or by staying alert. Knee injuries that occur include tears to the anterior cruciate ligament and the meniscus. Also, head injuries are common serious winter sports injuries.

What are some prevention measures?

There are several things you can do to prevent injury during your favorite winter activities.

Maintain fitness. You should be in good physical condition to participate in winter sporting activities. If you are out of shape, start on a ski run that is not challenging.

Warm up. You need to warm up thoroughly before participating. Cold unstretched muscles, tendons, and ligaments are susceptible to injury. Warm up with running in place or doing jumping jacks for around 5 minutes.

Hydrate yourself. Mild dehydration can affect your endurance and physical ability. Be sure to drink plenty of water before and after winter sporting activities.

Ensure a safe environment. Be sure you stay on known marked trails and avoid avalanche areas. Pay close attention to rocks and ice patches. Ask about upcoming storms and severe drops in temperature.

Take a buddy. Do not participate in winter sports alone.

Know the safety rules. Be sure you understand and follow all rules of the ski resort or winter sports arena.

Layer up. Wear several layers of loose, light, water- and wind-resistant clothing for protection. This will allow you to accommodate your body’s changing temperature.

Wear proper footwear. Make sure your shoes keep your feet warm and dry, as well as provide adequate ankle support.

Seek shelter when necessary. Get out of the cold when you are experiencing signs of hypothermia or frostbite.

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Football Related Knee Injuries

Posted on January 17, 2013 by Dr. Watt

The knee is a complex joint that is vulnerable to a variety of injuries. The knee is made up of the femur (the thigh bone), the tibia (the shin bone), and the patella (the knee cap). The femur rotates on the upper end of the tibia and the patella fits on the end of the femur. There are also many large ligaments that connect the bones of the knee and help control knee motion. The meniscus is a wedge of cartilage that serves as a cushion between the femur and tibia and also absorbs shock. Many football athletes experience injuries to these knee structures.

Ligament Injuries

Football players frequently injure one or more of the knee ligaments. These ligaments include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL).

ACL Injury – When an athlete changes direction rapidly, lands wrong from a jump, or simply slows down when running, the ACL could tear. With this injury, knee swelling immediately occurs and walking is painful. The knee may have loss of range of motion and tenderness with an ACL injury. Treatment for this type of injury depends on the degree of tear to the ligament, whether or not there are other associated injuries, and how much physical demand the patient puts on their knee. Sometimes, the orthopedic specialist needs to operate to repair a complete tear of the ACL. Recovery is measured in months, rather than weeks for this type of injury.

MCL Injury – The MCL is generally injured from a direct blow to the outside portion of the knee. The ligament is torn or stretched when the foot is planted firmly on the ground and a sideways force hits the knee. An injured MCL causes pain, difficulty walking, and tenderness. Therapy involves the use of a knee immobilizer, rest, ice applications, compression with a support bandage, and frequent knee elevation. Surgery is only necessary for severe tears of the MCL.

PCL Injury – The PCL is injured when a football player receives a blow to the front aspect of the knee or makes a simple misstep on the turf. Most PCL tears and injuries will heal with conservative treatment. An injured PCL leads to pain with walking, instability, and swelling of the knee. Surgery may be necessary with complete tearing and extensive damage to the PCL.

LCL Injury – The LCL is the least likely ligament to be injured during football activities. When severe force is applied to the inside of the knee, a LCL injury could occur. Symptoms include pain, swelling, weakness, tenderness, and discomfort to the outside of the knee. Treatment involves the RICE method, anti-inflammatory medications, and immobilization. Surgery to reattach the ligament to the bone is sometimes required.

Cartilage Injuries

Torn Cartilage  -  Most of the time, the meniscus is the cartilage that is torn during a football game. This rubbery, tough structure serves as a shock absorber during athletic activities. The meniscus tears with cutting, decelerating, pivoting, twisting, or from being tackled. Most torn meniscus injuries cause gradual pain and swelling, worse with climbing steps or uphill. Not all meniscus tears require surgery, but frequently the damage can only be repaired through an operation.

Fractures

The patella can break if the football player falls directly onto it or receives a direct blow in that area. If the bone is fragmented, surgery will be required for repair. If the bone is in appropriate position, the orthopedic specialist may prescribe an immobilizer and rest for the injury. The head of the fibula on the outside area of the knee joint is easily fractured from direct blows or as part of an injury to the lower leg. If the bone is not out of alignment, immobilization and conventional therapy will treat the injury. Sometimes, however, the fibula fracture is complex and requires surgical repair. With jumping types of injuries, the tibia bone can be damaged. If the fracture occurs in the tibial plateau, surgery is often necessary.

Bursa Inflammation

Bursa inflammation is also called ‘housemaid’s knee’ or prepatellar bursitis and is the result of repetitive kneeling or crawling on the knees. The space between the kneecap and skin is called the bursa and it becomes irritated and fills with fluid. Bursa inflammation is a common type of knee injury of football players. Treatment includes using anti-inflammatory medications and rest. Occasionally the bursa needs to be drained for resolution of the problem.

Patellar Injuries

The patella can dislocate if it receives a direct blow. The blow can force this bone toward the outside area of the knee. Most dislocations of the patella easily return to normal alignment by simply straightening out the knee. However, some patella dislocations are serious and require surgery. Also, patella-femoral syndrome is inflammation to the underside of the patella. This condition causes localized pain, which is worse with running and walking down stairs. Treatment involves strengthening exercises, the use of ice therapy, and anti-inflammatory medications. Severe cases of this disorder require arthroscopic surgery to remove the damaged cartilage and realign parts of the quadriceps muscle.

Muscle and Tendon Strain

Most strains of the knee are treated with rest, ice therapy, elevation, and compression. Crutches help with walking, and the doctor may order an anti-inflammatory medication. These injuries are often the result of hyper-extension involving the hamstring muscles or hyperflexion causing the quadriceps to be injured. If the patellar or quadriceps tendon is ruptured, there is inability to extend the knee. Surgery is necessary to repair this type of injury.

Posted in Common Injuries, Knee Conditions, Sports Medicine | Comments Off

Treatment and Healing After a Joint Dislocation

Posted on December 12, 2012 by Dr. Watt

A dislocation is an injury to a joint in which the ends of the bones are forced out of their normal positions. Joints are the areas of the body where two or more bones come together. This particular kind of injury temporarily immobilizes and deforms the joint and results in severe, sudden pain.

Dislocations can happen to your shoulder, hip, knee, elbow, ankle, finger, thumb, or toe. If you suspect you have a dislocated joint, seek prompt medical attention. The orthopedic specialist will have to return the joint to its normal alignment.

What do I do if I think I have a dislocated joint?

It is difficult to distinguish a dislocated bone from a broken bone. If you suspect you have a dislocation or a broken bone, there are things you can do while you are waiting to see the doctor. While you are waiting for medical attention:

Don’t move the joint. Sling or splint the affected area in its current position. Do not try to force the joint back into place. This could damage the bones, muscles, ligaments, nerves, and blood vessels.

Ice the injured area. Apply ice to the injured joint to reduce swelling, control pain, decrease the buildup of fluid, and stop internal bleeding.

What causes a dislocation?

The most common cause among young people is sports injuries. Dislocations can occur during contact sporting activities, such as hockey or football. They can also occur with falls during sports, such as gymnastics, volleyball, downhill skiing, or snowboarding. Basketball and football players frequently dislocated the joints of the fingers or hands when striking the ball or during a fall. Also, any fall or hard blow to a joint can result in a dislocation, such as a motor vehicle accident.

What are the complications of a joint dislocation?

There are many serious complications with a dislocated joint. These include:

  • Nerve or blood vessel damage
  • Tearing of ligaments, tendons, and muscles
  • Development of arthritis
  • Susceptibility to re-injury

How is a dislocated joint treated?

Besides ordering X-rays and MRIs, the treatment of your dislocation may include:

Reduction – This is the process where the orthopedic specialist gently maneuvers the joint to put the bones back into proper position. You will be given an anesthetic or pain reliever prior to this procedure.

Immobilization – Once the doctor has your bones back in the right place, he will immobilize your joint with a sling or split for several weeks. This is done to allow the area to heal and protect it from further injury. How long you will wear the device will depend on the severity of your injury.

Pain Medication – After the doctor does the reduction, your pain will subside. However, if your pain continues, you may be prescribed a mild pain reliever or muscle relaxant.

Surgery – If there is damage to the nerves or blood vessels or if the doctor cannot move your dislocated bones back into position, surgery may be necessary. The orthopedic specialist often recommends surgery if you have recurring dislocations.

Rehabilitation – Once your sling or splint is removed, you will begin a rehabilitation program to help restore your joint’s strength and range of motion. Most dislocations take several months to heal.

What can I do to help heal my dislocated joint?

There are several things you can do to help encourage healing and ease discomfort. These include:

Use ice and heat. Applying ice to your injured joint helps reduce pain and inflammation. You can use a cold pack or a towel filled with ice cubes for 20 minutes at a time. Do this every couple of hours while you are awake. Also, hot packs or a heating pad helps relax sore, tight muscles. Limit heat applications to 15 minutes at a time and do these every couple of hours.

Rest the joint. You don’t want to repeat the activity that caused the injury in the first place. Also, avoid painful movements of the injured joint.

Take a pain reliever. Use your pain medication as prescribed. The orthopedic specialist will suggest an anti-inflammatory agent, such as naproxen (Aleve) or ibuprofen (Motrin). Follow the label directions and stop using the drug when the pain improves.

Maintain the range of motion in your joint. After a few days, do some gently range of motion exercises approved by your doctor or physical therapist. This helps to restore strength to the joint and maintain range of motion.

What can I do to prevent future dislocations?

To prevent further or future dislocations:

Take precautions to avoid falls. Make sure your vision is good by getting your eyes checked. If you take medications that make you dizzy, avoid standing up too fast. Also, keep your home well-lit and remove tripping hazards from walkways.

Wear protective gear. If you play contact sports, wear devices that protect your joints.

Follow doctor’s orders. While you are recovering, follow your doctor’s orders. To avoid recurrence, do the recommended stability and strengthening exercises.

Posted in Common Injuries, Sports Medicine | Comments Off

Care and Treatment of Clavicle (Collarbone) Injury

Posted on December 12, 2012 by Dr. Watt

Clavicle Fracture

The collarbone is also called the clavicle. A fracture to this bone is a common injury that occurs in people of all ages. Most breaks to the clavicle occur in the middle portion. The clavicle is located between the ribcage and the shoulder blade. This structure connects the arm to the trunk of the body and lies above several important blood vessels and nerves. These vital body components do not usually become injured with a clavicle fracture.

What causes clavicle fractures?

The collarbone gets broken when there is a direct blow to the shoulder. This can occur during a fall onto the shoulder or during a motor vehicle accident. A fall onto an outstretched arm can also lead to a fracture of the clavicle. Many infants are born with a fracture to the collarbone – an injury that occurs during a traumatic birth.

What are the symptoms of a clavicle fracture?

If you sustain a clavicle fracture, it will most likely be very painful and hard to move your arm. Other symptoms include:

  • Shoulder sagging downward and forward
  • A deformity or “bump” over the area of the break
  • Inability to lift the arm without pain
  • Bruising, swelling, or tenderness over the clavicle
  • A grinding sensation when the arm is raised up

How is a clavicle fracture treated?

With some breaks, the ends of the bone have not shifted out of place and line up correctly. These types of fractures do not require surgery, and the orthopedic specialist can treat them with conservative measures. These include the use of an arm support or sling (worn to keep the arm in proper position while the bone heals), mild pain medication, and physical therapy. Therapy is done to increase muscle strength in your shoulder and to prevent stiffness and weakness of the muscles.

The orthopedic specialist will recommend surgery if the bones are displaced (out of place) and do not line up correctly. During the procedure, the bone fragments are situated into their normal alignment and held that way with special screws and plates that are attached to the outer surface of the bone. These structures are not removed until after the bone has healed. Some surgeons use pins to hold the fracture in proper position once the bone ends are put back in alignment.

AC Separation

The acromioclavicular joint (also called the AC joint) is the area where the clavicle meets the highest point of the shoulder blade. An injury to this structure that is common is an AC separation, where a force causes the ligaments that attach to the underside of the clavicle to tear.

What causes an AC separation?

The most common reason for a person to suffer an AC separation is a fall directly onto the shoulder. The force causes the ligaments to be injured and the collarbone separates from the wingbone (shoulder blade). This type of injury will cause the wingbone to move downward with the weight of the arm, creating a bulge above the shoulder.

How is an AC separation treated?

If the shoulder is not seriously deformed, and the AC separation is mild, the orthopedic specialist will recommend nonsurgical treatment modalities. These include the use of a sling, cold packs, and pain medications. Most people will return to full activity once the injury has healed without permanent, significant deformity.

If the pain of AC separation persists with conservative treatment, or the tears to the ligaments are severe, the orthopedic specialist will recommend surgery. This is done to trim back the end of the clavicle so that it will not rub against the shoulder blade. This procedure can be done long after the injury has occurred, too.

Posted in Common Injuries, Shoulder Conditions, Shoulder Surgery, Sports Medicine | Comments Off

Common Sports Related Joint Dislocations

Posted on September 27, 2012 by Dr. Watt

Elbow Dislocations

The elbow becomes dislocated when the joint surfaces are separated. With a complete dislocation, the joint surfaces are separated completely. The joint surfaces are only partly separated with a partial dislocation, also called a subluxation. The elbow is a hinge joint as well as a ball-and-socket joint. Injuries and dislocations to this structure can affect the normal range of motion. Elbow dislocations are either simple or complex. With simple dislocations, there is no major bone injury. With complex dislocations bones and ligaments are injured.

What causes an elbow dislocation?

The most common reason an elbow is dislocated is when a person falls onto an outstretched hand. There is considerable force sent to the elbow when the hand hits the ground. Most often there is a turning motion in this force and this can rotate and put the elbow out of its socket. Elbow dislocations often occur during car accidents, when the passenger reaches forward in an attempt to cushion the impact.

What are the symptoms of an elbow dislocation?

With a complete elbow dislocation, there is considerable pain and obvious deformity. With a partial dislocation, the joint appears fairly normal. However, there usually is pain and bruising on the inside or outside area where ligaments have been torn or stretched. If the ligaments never heal, partial dislocations can recur.

How is an elbow dislocation treated?

Elbow dislocations require immediate treatment and are emergency injuries. The goal of treatment is to return the joint to its normal alignment and restore function of the arm. The orthopedic specialist can realign the elbow joint using a reduction maneuver. Once the joint is reduced, an immobilizer is required for two to three weeks. Physical therapy is often required to restore full range of motion. For complex dislocations, surgery is often required to restore bone alignment and repair ligaments. After the operation, the elbow will be protected with an external hinge device to prevent further dislocation.

Shoulder Dislocations

The shoulder is susceptible to dislocation because it can turn in many directions. A partial dislocation of the shoulder is also called a subluxation. This means the head of the upper arm bone is partially out of the socket. With a complete dislocation, the structure is all the way out of the socket.

What are the symptoms of a dislocated shoulder?

Most shoulder dislocations lead to swelling, bruising, numbness, and weakness. Many times, a dislocation results in torn ligaments or tendons or damaged nerves. It is possible for the shoulder to dislocate downward, forward, or backward.

What is the treatment for a dislocated shoulder?

Many times the shoulder can be reduced. This is where the surgeon places the ball of the upper arm bone back into the socket. After the reduction, the orthopedic specialist will immobilize the shoulder in a sling or device for a few weeks. Ice is recommended 3 to 4 times a day to reduce pain and swelling. Also, the doctor will prescribe rehabilitation exercises for you to help restore the shoulder’s range of motion and strengthen the muscles. If recurrent dislocations occur, surgery is sometimes necessary.

Hip Dislocations

The hip becomes dislocated when the head of the thighbone slips out of the socket in the hip bone. For around 90% of people, the thighbone is pushed out of position in a backwards direction. This is known as posterior dislocation.  Rarely, the thighbone slips out of socket in a forward direction. This is called an anterior dislocation.

What causes hip dislocations?

The hip joint is formed of a ball-and-socket construction. The ball is the head of the thighbone (femur) and it fits into a cup-shaped socket in the pelvis. This joint has a great deal of stability and moves freely. The most common reason for a dislocated hip is motor vehicle accidents. Falls can also result in dislocated hips.

How is a dislocated hip treated?

With a dislocated hip, the orthopedic specialist must administer an anesthetic or sedative and then position the bones back into proper position. This is called a reduction and surgery is often required. The surgeon will make an incision over the hip region in order to reduce the hip. It takes up to three months for a hip to heal once it has been dislocated. Many times it is necessary for the patient to be in traction for a short period of time. Special controlled exercises are prescribed to help the hip regain strength and function.

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Partial Knee Replacement

Posted on August 3, 2012 by Dr. Watt

The purpose of knee replacement surgery is to restore function, increase mobility, and decrease pain. Many times a total knee replacement is the best option for patients who have severe knee arthritis. However, patients with osteoarthritis that is limited to one particular area of the knee may be candidates for a partial knee replacement (also called a unicompartmental knee replacement).

What are the advantages of a partial knee replacement?

There are many research studies available that support how a modern partial knee replacement performs superbly for a vast majority of patients. There are many advantages to having a partial replacement versus a total replacement of the knee. These include a quicker recovery time, less blood loss during the procedure, and less pain after surgery. Many report that a partial knee replacement feels more “natural” than a total replacement and the range of motion is often reported as “better”.

Who is a candidate for a partial knee replacement?

The orthopedic specialist may recommend this procedure if you have severe osteoarthritis of the knee and have tried and failed with nonsurgical treatment measures. A partial knee replacement is only considered if your knee problems affect your quality of life and interfere with your daily routine. Also, your arthritis should be limited to one compartment of the knee, not the entire knee as seen with inflammatory arthritis. Those patients with significant knee stiffness or ligament damage are not ideal candidates.

What should I expect before the surgery?

Your orthopedic specialist, working closely with your family doctor, will determine which type of procedure you need. He may test your range of motion, the ligament quality, and assess your activity status. Patients who have pain located entirely on either the inside portion or outside portion of the knee are good candidates for a partial knee replacement. Those who have pain throughout the entire knee or in the front aspect are usually better qualified for a total knee replacement. You may have additional imaging tests on your knee to determine which surgery suits you best.

Before your operation, a member of the anesthesia team will evaluate you. Anesthesia will either be spinal (you are awake but numb from the waist down) or general (you are completely asleep). The choice will depend on your surgeon’s preference and your health needs.

What happens during the surgery?

A partial knee replacement generally lasts 1 or 2 hours. The orthopedic specialist makes an incision at the front of your knee in order to explore the three compartments of the joint space. He uses a special saw to remove the damaged cartilage and knee components and caps the ends of the femur (thighbone) and tibia (lower leg bone) with metal coverings. These metal pieces are connected to the bone with a special type of cement. To create a smooth gliding surface, the doctor places a plastic insert between these two metal components.

What happens after surgery?

After your procedure, you will be taken to a recovery room and closely monitored. Expect to have an IV for around 24 hours to receive medicines for pain control and antibiotics. Once you are awake, you will notice a bandage on your knee and a small drain that collects fluid from the joint space. Some patients may be candidates to have this procedure on an outpatient basis, but most will need to be admitted to the hospital.  You can expect to go home 1 to 3 days following a partial knee replacement.

Posted in Knee Conditions, Knee Surgery | Comments Off

Common Shoulder Injuries Related to Sports

Posted on May 24, 2012 by Dr. Watt

Clavicle Fracture (Broken Collarbone)

A broken collarbone (clavicle) is a very common fracture that occurs in people of all ages but occurs more commonly with sports related injuries. The clavicle is located between the ribcage and the shoulder blade and it connects the arm to the body. The collarbone lies above many vital structures, such as nerves and blood vessels.

What causes a clavicle fracture?

Clavicle fractures are most often caused by a direct blow to the shoulder area. These types of injuries occur during a fall on an outstretched arm, a contact hit (when a football player collides with an opponent), or any other type of direct impact to the shoulder that can occur during sporting activities.

What are the symptoms of a broken collarbone?

These types of fractures can be very painful and make it difficult to move your arm. Other symptoms include a sagging shoulder, inability to lift the arm due to pain, a grinding sensation with arm movement, a deformity or “bump” along the collarbone area, bruising, swelling, and tenderness over the broken area.

How is a clavicle fracture treated without surgery?

Broken collarbones do not always require surgery. If the bone ends are not shifted out of place and line up correctly, you may be treated with an arm sling and rest. Basically, the orthopedic specialist will have you wear this to keep your arm in proper position while the collarbone heals. Once your bone begins to heal, your doctor may order physical therapy for you to help you strengthen the muscle of your shoulder. The therapist will teach you exercises, too, to help prevent weakness and stiffness.

What is involved with surgical treatment?

If your bones are displaced (out of alignment) your orthopedic specialist may recommend surgery to align the bones. This is done to hold them in position while they heal.

During the procedure, the bone fragments are repositioned into normal alignment and held in place with special screws and metal plates that attach to the outer surface of the bone. After your surgery, you may notice a small patch of numb skin below the incision but with time this is less noticeable. You will also be able to feel the plate through your skin. These plates and screws are not removed until long after the bone heals.

Dislocation of the Shoulder

Many athletes who play tennis, baseball, or football tend to experience a dislocated shoulder. The shoulder joint is the body’s most mobile joint, turning in many directions. This advantage puts this joint at risk for dislocation. A complete dislocation means that the humerus (upper arm bone) is all the way out of the socket.

What causes dislocation of the shoulder?

Your shoulder can become dislocated by throwing, hitting, and overuse. Many people who play softball or baseball injure their shoulder this way.

What are the symptoms of a dislocated shoulder?

Symptoms include numbness, weakness, bruising, and swelling of the shoulder area. Some dislocations are severe enough to tear tendons and ligaments and to damage nerves. The shoulder joint can be dislocated forward, backward, or downward. The muscles of the shoulder area may have spasms from the disruption, as well, leading to pain and stiffness.

How is a dislocated shoulder treated?

Your orthopedic specialist will have to place the ball of the humerus back into the joint socket. This procedure is called a closed reduction and no surgery is necessary. Once the shoulder is back in place, the pain stops immediately.

Shoulder Impingement (Rotator Cuff Tendinitis)

The rotator cuff is made up of tendons and muscles that allow for a great range of motion of your arm. This is a frequent source of pain for athletes and an area that is at risk for injury during sporting activities. Shoulder impingement is often referred to as rotator cuff tendinitis and is one of the most common causes of shoulder pain.

What causes rotator cuff tendinitis?

When you raise your arm to shoulder height, the space between the bone and rotator cuff narrows. The bone can rub against (or impinge on the tendon and the bursa, causing irritation and pain when the arm is used repeatedly. Young athletes who use their arms for overhead action are particularly vulnerable. This includes those who play tennis, softball and baseball, and swimmers.

What are the symptoms of shoulder impingement?

When the rotator cuff is irritated this can lead to local swelling and tenderness in the front aspect of the shoulder. You may also have pain and stiffness when you lift your arm. There is also a sensation of tenderness when the arm is lowered from an elevated position. Other symptoms include sudden pain when reaching or lifting, pain radiating from the front of the shoulder to the side of the arm, minor pain at rest, and pain when throwing or using the arm.

How is rotator cuff tendinitis treated without surgery?

Your orthopedic specialist wants to reduce your pain and restore function of your shoulder. He will consider your activity level, your age, and your general state of health. Many times shoulder impingement can be treated with medications and rest. It is not uncommon for athletes to be ordered physical therapy to help restore normal motion of the shoulder. Your therapist will teach you specific stretching and strengthening exercises to relieve your shoulder pain and help you get back to normal activities.

What is involved with surgical treatment?

The goal of surgery is to create more space for the rotator cuff and this involves removing a portion of the inflamed bursa. Your orthopedic specialist will perform an anterior acromioplasty, where part of the bone is removed to allow for movement of the rotator cuff. Many times, the surgeon opts to perform this procedure by way of arthroscope.

The arthroscopic technique allows for use of small thin surgical instruments to be inserted around puncture wounds around the shoulder. The doctor can see inside the shoulder through a small camera inserted into the joint that displays images onto a computer TV monitor.

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Arthroscopic Shoulder Surgery

Posted on May 8, 2012 by Dr. Watt

Arthroscopy is a procedure that our orthopedic specialists use to inspect, diagnose, and repair problems inside a joint. During arthroscopic shoulder surgery, the surgeon will insert a tiny camera, called an arthroscope, into your shoulder joint area. This small video camera projects images onto a TV screen so the surgeon can guide miniature surgical instruments to repair damage inside the joint.

This common procedure has been performed thousands of times since the 1970s and it has made the diagnosis, treatment, and recovery of shoulder surgery easier and faster. What’s more, this results in less pain for you, the patient, and shortens the length of time it takes for you to recover.

When is Shoulder Arthroscopy Recommended?

If your condition is not responding to nonsurgical treatment, your orthopedic specialist may recommend arthroscopic shoulder surgery. Some causes of shoulder discomfort include inflammation that leads to pain, stiffness, and swelling; injury; overuse; and age-related wear-and-tear. Some of the most common shoulder arthroscopic procedures include:

  • Repair of ligaments
  • Rotator cuff repair
  • Removal or repair of the labrum
  • Bone spur removal
  • Removal of inflamed tissue or loose cartilage
  • Repair for recurrent shoulder dislocation

What Happens during the Arthroscopic Surgical Procedure?

Your orthopedic specialist will perform this procedure in an operating room or day-surgery room. Once you are there, he will position you so it is easy for him to adjust the arthroscope to have a good look inside the shoulder joint. The most common positions are the beach chair position (you semi-seated in a reclining position) and the lateral decubitus position (you lying on your side). The surgeon and his team remove all hair from the site and then spread an antiseptic solution on your skin to clean it. The shoulder will be draped with sterile pads and your arm will be in a holding device to keep it still and in place.

To inflate and clean out the joint area, the surgeon will inject fluid into your shoulder. This makes it easier for him to see the structures. He will them make a small buttonhole incision to insert the arthroscope. Once your orthopedic specialist clearly identifies the problem, he will use small instruments to repair it. These specialized instruments are for tasks such as cutting, grasping, shaving, suturing, and tying. The surgeon will close these incisions when he is finished using stitches or small Band-Aid like structures called Steri-Strips. Then the surgical site will be covered with a soft, large bandage.

What Should I Expect after Shoulder Arthroscopy?

In most instances, you will be able to return home on the day of your surgery. You will need someone to drive you home, especially if general anesthesia was used. For some patients, the orthopedic specialist requires an overnight hospital stay. Here are some of the things you will need to know following your arthroscopic procedure:
Shoulder Immobility: The amount you are allowed to move your shoulder will all depend on what was done during surgery. Your doctor will give you instructions related to this and be sure you follow them closely. Your shoulder will be held in a sling, a swath, or a brace following the procedure.

Incision Care: The small incisions should be kept clean and dry. Dressings are usually light and kept on for a few days. Sometimes, the dressing will drain during the first 24 hours but it usually stops. Call your orthopedic specialist if the dressing is saturated with blood and the bleeding does not stop.

Ice: Most of our orthopedic specialists recommend that ice be used to the shoulder to control your pain and the swelling. Excessive swelling is not common and should be reported to your doctor. Use the ice for at least 20 minutes around three or four times each day. Do not place the ice directly on the skin but rather use a towel or soft cloth place between your skin and the ice bag.

Medications: There will be some medications prescribed for pain, usually in pill form. Your orthopedic specialist will control your pain as he sees necessary.

Posted in Shoulder Conditions, Shoulder Surgery | Leave a comment

Common Knee Injuries Related to Sports

Posted on April 29, 2012 by Dr. Watt

The knee is a complex structure with many components that make it vulnerable to a variety of sports injuries. Most people suffer a minor knee problem at one time or another. Knee injuries often occur during sporting activities, too. In 2009, knee injuries were the most common reason for visiting an orthopedic specialist.

Knee Anatomy and Function

The knee joint is the largest joint of the body and the one that is most easily injured. Two cushioning discs call menisci separate the upper and lower bones of the knee. The upper leg bone (the femur) and the bones of the lower legs are connected by ligaments, tendons, and muscles. The surface of the bones is covered by cartilage, a substance that absorbs shock and provides a smooth, gliding surface. Knee injuries are the result of damage to one or more of these structures. Of the four major ligaments found in the knee, the three that are injured the most are the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the posterior cruciate ligament (PCL).

ACL Injury

The ACL is injured when athletes are changing direction rapidly, slowing down when running, or landing from a jump. Individuals who play basketball, football, and soccer and those who ski are particularly at high risk for ACL injuries. If this structure is damaged, you could require surgery to regain full function of your knee. This will all depend on the severity of your injury and your activity level.

Most of the time ACL tears are too severe to be stitched back together. The orthopedic surgeon will have to surgically repair this structure by reconstructing the ligament. Most of the time the doctor will use a tissue graft to repair the ligament. This graft acts as scaffolding for new ligament to grow on. Most of the time grafts are taken from the patellar tendon or the hamstring tendons.

MCL Injury

A direct blow to the outer aspect of the knee commonly causes injuries to the MCL. Those athletes who play football and soccer are at the highest risk. When the knee is forced sideways, the MCL can tear and result in knee pain. Swelling will occur with a MCL injury as well and the knee will become unstable and give way.

When the MCL is torn severely and cannot heal correctly, surgery is necessary. This will involve grafting a piece of tendon to allow the portions of the torn ligament to connect to. Most of the time, however, these injuries can be treated without surgical intervention.

PCL Injury

The PCL is most commonly injured when an athlete receives a blow to the front of the knee. This structure can also be torn or injured if the individual makes a simple misstep on the playing field. Those who participate in football and soccer are at the greatest risk for a PCL injury. This ligament is located in the back of the knee and connects the femur to the shinbone (the tibia).

When an athlete suffers a PCL tear or injury, the orthopedic specialist will most likely recommend surgery. This is done to rebuild the ligament by replacing the torn structure with a tissue graft. During the procedure the doctor will rebuild the PCL. A tendon or other structure is used to replace the torn ligament.

Meniscus Injury

The menisci tear in different ways. The orthopedic specialist depending on how they look, where they occur, and how complex they are classes the tears. Common tears include the parrot-beak, flap, bucket handle, longitudinal, and mixed/complex. Sports-related tears of the meniscus often happen along with other knee injury. Sudden tears can occur when the athlete squats or twists the knee. Direct contact or a sharp blow can also cause meniscus injury.

When a meniscus tear is serious and the symptoms persist with nonsurgical treatment, your doctor may recommend an arthroscopic procedure of the knee. This is one of the most commonly performed surgical procedures where the orthopedic specialist inserts a miniature camera into the knee joint to trim and repair the tear to the meniscus. While he is doing this surgery, other torn structures can be repaired and treated as well.

Posted in Knee Conditions, Knee Surgery, Sports Medicine | Leave a comment