Month: August 2015

Making Sense of Shoulder Surgery

One of the principal complaints that brings patients to my door is shoulder pain, especially chronic pain brought on by repetitive movements or athletic trauma. Although many symptoms can be relieved with rest, medication and exercise, there are some issues that remain so stubbornly painful that shoulder surgery is the only option.

Shoulder surgery can take many forms, depending on the source and cause of the injury. But the basics remain more or less the same for most procedures, as outlined in this simple description:

During conventional shoulder surgery, a large open incision is made in order to reattach the tendon to the bone where it pulled apart. Sometimes open surgery is performed through small incisions that makeup only a few inches. Dissolvable sutures that will not have to be taken out at a later time are frequently used to fasten the tendons. At the completion of the open surgery, the incisions are closed followed by the application of a dressing.

As an orthopedic surgeon in San Diego, I see a lot of injuries due to sports, exercise and even military service. Our approach is holistically oriented, which means we take each patient’s full lifestyle into consideration as we design a surgical plan that makes sense for you.

If you’ve been experiencing shoulder pain and want to speak with an expert orthopedic surgeon today, please contact my offices.

New Insights on Knee Pain

Knee pain is often a persistent nuisance, but for some people, it’s devastating. Because our knees drive nearly every motion we make while standing, chronic pain in this joint can have lasting and systemic effects on everything we do.

For many years, the conventional wisdom held that knee pain should be treated at the source – namely, the knee. But a new study recently found that knee pain can be relieved by focusing “upstream” as well, on the hip, thereby strengthening the entire leg as a system:

British and Australian scientists analyzed 14 previous studies of people with patellofemoral pain, the official name for the ache in the front of the knee that strikes many runners. Participants whose programs included moves to build strength, endurance, and activation in the muscles around the hip had less knee pain and improved joint function when compared with those whose therapy focused on the quadriceps muscles alone.

It is an interesting finding that underscores the simple fact that our bodies are full of interdependent pieces, and that no orthopedic issue ever arises in a vacuum. My San Diego orthopedic practice offers effective therapy, treatment and surgery for chronic knee pain, and takes care to treat entire patients young and old.

Want to learn more? Contact the orthopedic surgeons today.

When Elbow Surgery Becomes Elbow Replacement

Some of you may have just read my prior post on knee pain and its discontents. This one focuses on its upper body analog, the elbow, and the many ways that pain, inflammation and injury can impede the body’s natural ability to bend and use this major joint.

Elbow surgery can be as minor as a tendon repair or as major as a full replacement. Understanding when and why each procedure is indicated is the role of your orthopedic specialist, who will take you through a range of diagnostic exercises to determine the best course of treatment.

If the joint requires replacing, the procedure can be lengthy and the recovery difficult, but there is an upside: you should regain some measure of freedom and mobility once again.

Some people can start to use their new elbow as soon as 12 weeks after surgery. Complete recovery can take up to a year. There will be limits to how much weight you can lift. Lifting too heavy of a load can break the replacement elbow or loosen the parts. Talk to your doctor or nurse about your limitations.

If you have lived with impaired movement or chronic elbow pain for too long and want to speak with a team of orthopedic surgeons in San Diego, please call or write my practice here today.

San Diego Shoulder Pain 101

Shoulder pain can take many forms, from radiating waves to uncomfortable tingles to utter agony. It is perhaps unsurprising, then, that the causes of shoulder pain can vary widely too, and may include such varied sources as rotator cuff injuries, glenohumeral disorders, and referred neck pain.

I have provided a brief overview of elbow pain on this website, but as an orthopedic specialist here in San Diego, I’m always looking for new ways to explain the details of shoulder pain to my patients nationwide.

This page includes a great diagram and plenty of granular descriptions of shoulder pain, including the various anatomical and orthopedic issues that can give rise to discomfort. This passage may prove especially useful – a checklist for diagnosis:

  • Is the pain arising from the shoulder, neck or elsewhere?
  • Are there any ‘red flag’ symptoms/signs? (See box ‘Red flag symptoms/signs’, below.)
  • Is the pain localised to the acromioclavicular joint: the ‘pointing sign’?
  • If yes, there is acromioclavicular joint disease.
  • Is there global pain and restriction of all active and passive movements? If yes, this suggests glenohumeral joint disorder (either ‘frozen shoulder’ or arthritis).
  • Does the patient show a broad area of pain: the ‘grasping sign’ suggestive of subacromial pain?

To receive a full examination, workup and treatment plan, contact the orthopedic surgeons at AOSM.net today.

Understanding Elbow Surgery

As a San Diego orthopedic surgeon who treats kids alongside adults, I spend a lot of time talking to athletes about how to extend their active careers.

Baseball is an evergreen topic when it comes to sports medicine, especially the various burdens that pitchers place on their shoulders and elbows. Many of these conversations focus on the pros and cons of a common elbow surgery procedure known as Tommy John surgery. At one end of the spectrum I see rising pitchers who wonder when they might require a Tommy John procedure, while at the other I field questions from seasoned pitchers who have had the procedure and wonder what to expect as they ease out of their competitive years.

The answers to such questions typically depend on each patient’s individual history, genetics and lifestyle, but they all start with an understanding of the process. This article covers the basics of Tommy John surgery in simple language, including this key passage about a wrist tendon known as the palmaris:

Once the tendon is harvested, the doctor will have the tendon cleaned and cut to size while he goes back into the elbow. Holes are drilled through the bones of the upper and lower arm, angled to allow the tendon to loop through and be placed in as near an identical position as the damaged ligament. In some cases the doctor will leave the damaged tendon in place, but most dissect it away.

The donor tendon is then looped through two or three times and locked into place. The doctor will then check that the ulnar nerve (“funny bone”), which runs through the same area, is not entrapped. Some doctors will move (transpose) the nerve as a matter of course, while others leave it in place. Nerve entrapment is one of the most common complications of the surgery. Tommy John himself suffered from the issue.

Recovery is often rapid, and research shows that this kind of elbow surgery is surprisingly durable and resilient. It’s not a magic bullet, however, and pitchers should be disabused of the notion that it will result in superhuman improvement. Like anything else, the mechanics of Tommy John surgery don’t hold up forever, and revision or followup appointments may be required.

Bottom line: if you’re experiencing elbow pain already, it’s wise to speak with an orthopedic surgeon about your options for surgery, recovery, and aftercare. To learn more, contact the San Diego elbow surgery experts here today.

The Link Between Student Athletics and Orthopedic Surgery

Competitive athletes tend to suffer more injuries than their sedentary peers. As someone who specializes in orthopedic surgery for athletes in San Diego, I have witnessed firsthand just how often an active lifestyle can land patients in my office.

But until recently, no one had bothered to examine how often college athletes require orthopedic surgery, and whether there is any correlation with earlier injuries.

One study attempted to do just that, using multiple regression analysis to try and tease out the relationship between prior and future injuries within a population of NCAA athletes. Their conclusion?

Results from the multiple Cox regression model showed lower extremity surgery before college and type of sport were independent predictors for shoulder and knee surgery.

The strongest indicators for orthopedic surgery were participation in gymnastics, basketball and volleyball, whereas volleyball, gymnastics and baseball/softball were strongest indicators for shoulder surgery. The strongest indicators of knee surgery were basketball, football and volleyball, according to the researchers.

The takeaway is that we should be doing more to protect high school athletes as their bodies develop, and ought to consider systematizing a more rigorous approach to healing and rehab from injuries in young people.

If you’re any athlete in search of expert orthopedic care, please contact the San Diego sports medicine specialists at my practice today.