Month: August 2016

What’s The Best Treatment for Tennis Elbow?

A recent New York Times article looked into the standard cortisone treatments for elbow pain and tennis elbow to explore just how effective they really are compared to placebos, and nothing at all.

As it happens, cortisone may cause more damage over the long term than it helps over the short term. This is because cortisone focuses on inflammation alone, which may not represent the root cause of the problem:

For decades, tennis elbow was thought to be caused by inflammation in the tissues around the joint. Newer science, however, including biopsies of the sore tissues, shows little inflammation, except in the very early stages of the injury. Instead, it is thought to involve degeneration of the tissues: If the joint is used repeatedly and strenuously, the body cannot repair any resulting minor damage before more damage occurs, and the tendons that hold the elbow together begin to fray and buckle.

If nothing else, studies such as this one remind us that we have much to learn about the issues and biology surrounding chronic pain.

If you are suffering from tennis elbow in San Diego and want to speak with an expert orthopedist who understands the limits of injections, you have come to the right place. Please reach out to us here today.

The Best Pediatric Orthopedic Treatment in San Diego

Pediatric orthopedic treatment could mean the difference between an active life for your child, and suffering with injuries throughout his or her childhood.

Pediatric orthopedists tend to treat many of the same issues as their “adult-oriented” counterparts, with a couple of key differences. The first is that the patients are still growing, a fact which demands a powerful sensitivity to the exigencies of hormonal shifts and nutritional needs, not to mention the mechanics of a child’s evolving bones and muscles. The second difference is that the patients in question aren’t adults, and therefore do not always make decisions regarding exertion and rest with the same perspective that an older person might.

This interview offers a nice look at what we do as pediatric orthopedists in San Diego:

If you’d like to speak with an expert in orthopedic care for patients of all ages, the San Diego Orthopedic Surgery Center is a great place to start.

A Case Study in Fibromyalgia

Fibromyalgia is a terrible affliction which can cause decentralized pain. Recently the Huffington Post published a first-person account of living with fibromyalgia, including some harrowing descriptions of what it was like to endure this disease before it had a name:

“I would get a lot of pain, and try not to do things that would make the pain worse. People would yell at me and say, ‘Oh, come on, you can do it.’ So I tried playing tennis, and sooner or later, I pulled something in my shoulder and my elbow.

The pain got worse and worse, and in 1978, I had my first operation on my elbow.

Then the other elbow went. Then the other shoulder. And then the groin.

After each surgery, I did nothing. No movement, no physical therapy. So during ‘recovery’, my condition just got worse.

It is a worthy article to read if you want to recognize yourself or a loved one in these accounts. And it is also a strong message in favor of seeking early diagnosis, and not being satisfied with useless diagnoses until you actually see results. As the author emphasizes:

One tip Marshall has for people diagnosed with Fibromyalgia is that they understand this is probably for the rest of their lives. And so, putting off getting to it isn’t going to buy you anything.

To learn more about how to combat wrist pain, shoulder pain, and elbow pain in San Diego, please contact the San Diego Orthopedic Surgeon site here today.

Nadal Beating Back Wrist Pain

Wrist pain is an occupational hazard in a number of athletic activities, but perhaps nowhere more so than in tennis. The wrist in tennis is pretty much the tip of the sword, responsible for the greatest acceleration at the end of every stroke – and for absorbing the blow of those smashing serves.

Rafael Nadal has long been as good at anyone at this kind of athletic power game, but lately it has begun to take a toll. When last we saw Nadal, he was withdrawing from a major due to wrist pain:

Nadal’s last event was the French Open, where wrist pain forced him to pull out the event prior to his third-round match against countryman Marcel Granollers.

Now he training, resting, and engaging in physical therapy in anticipation of a bid to win gold in Rio this summer. As with most cases of repetitive stress, Nadal’s pain is almost certainly being addressed with very careful regimenting of his exertions, and with stretches to help ensure the wrist heals in a pliable way. That same article noted:

Less than a day after the Beijing Olympics singles gold medalist confirmed he would compete in Rio in singles, doubles and mixed doubles, Nadal was back on court Wednesday morning for a practice session with Croatia’s Marin Cilic at the Olympic Tennis Center and was scheduled to train with Uruguay’s Pablo Cuevas in the afternoon.

I wish him luck. If you want the standard of care for wrist pain in San Diego, start here.

Knee Surgery? Not For Everyone

Demographic data can be a double-edged sword in the world of medicine. In the wrong hands, it may be treated as evidence of an underlying health liability, or poor lifestyle choices. In the right hands, it can guide us toward more responsible medical decisions predicated on the idea that not every patient population is precisely the same.

Consider this recent study of total knee replacement (TKR) surgeries, which resulted in a startling set of findings, including:

In comparison to the white population, minorities had lower rates of TKR utilization.
Minorities were less likely to undergo TKR in high-volume hospitals.
The risk for in-hospital mortality, and the complication rate following TKR, were significantly higher for blacks, Native Americans and mixed-race individuals.

In other words, minorities underwent fewer knee replacement procedures, but experienced a higher rate of complications and mortality for them.

Does this mean that knee replacement is inappropriate or ill-advised for nonwhites? Not necessarily; this is an observational study, not a controlled or randomized study, which means it is entirely possible that other socioethnic factors may be pushing the figures in one direction or another, independent of the medical facts.

Still it is a worthy reminder that medicine must take into account the whole patient, and that surgery is not always the first or best answer for knee pain.

What Is Shoulder Bursitis?

The bursa in your body act almost like rollers or ball bearings: these fluid-filled sacs can shift and deform easily, thus reducing stress on bone surfaces which would otherwise create friction as they grind together.

The bursa in your shoulder do this on a daily basis, enabling the full range of motion you have come to expect. Lifting, throwing, and reaching all require an assist from your shoulder bursa; without them, even the most basic movements can become excruciatingly painful.

When those bursa become inflamed, it’s known as bursitis. (“-Itis” refers to any inflammation or irritation). This inflammation may arise as a result of disease, trauma, or injury. The key diagnostic feature is the pain it causes: shoulder bursitis can be debilitating, robbing us of the most elemental sort of mobility.

Most bursitis can be treated with rest, steroids, or with aspiration of the fluid itself. More extreme cases may require shoulder surgery, as performed by an orthopedic surgeon who specializes in shoulder and arm conditions such as this.

As a top San Diego orthopedic surgeon, I offer comprehensive treatment and recovery options for patients with shoulder bursitis, shoulder pain, and related conditions. Please reach out today to schedule your own appointment with the experts.

When Exercise for Kids Goes Too Far

Lost in Michelle Obama’s laudable effort to get kids off the couch and onto the field is the potential danger of going too far. There are some kids who do nothing but exercise all day, putting themselves at at risk of pushing their bodies past the limits of what young people are made to do.

When children train too hard for too long, the body adapts. Less energy goes into proper growth and development, and more goes into weathering the current condition, packing on bone mass and ceasing to grow taller and more flexible.

The result is a generation of kids who are far more prone to injury, and far less likely to develop as they otherwise would, leading to a rash of preventable health issues. The solution is to roll back the exercise and give their bodies time to recover:

“They are skeletally immature, trying to produce muscle and bone and get stronger, so adequate recovery is key – so [ensure] they get enough sleep for their age, that they are eating properly and getting all parts of the food chain. Also that they are hydrated adequately because dehydration can predispose to injury as well.”

Orthopedic injuries in kids are part of life: they play an outsized role in many youth sports whether we like it or not. But injuries which occur in slow motion through repetition and overuse are entirely preventable: all that is required is a sense of proportion and restraint.

To learn more, please contact the pediatric orthopedists at AOSM here today.

Good News for High School Pitchers

Sports injuries in children have been on the rise since the 70s, when youth and amateur play was not yet the high-stakes pipeline to professional athletics that it often is today.

Parents, coaches and athletic organizations have been slow to react, but lately there has been some encouraging movement as tales of preventable injury are spread through social media and the press.

Repetitive injuries are having a moment right now, as evidenced by recent measures to mandate more rest and recovery time for baseball pitches who have been suffering shoulder and elbow injuries with alarming frequency:

A group that oversees policy for high school sports — the National Federation of State High School Associations — has called on its state affiliates to adopt their own rules for how many pitches a student-athlete can throw in a single game and how much rest pitchers must have between appearances in games. In response, the New York State High School Athletic Association plans to have a proposal by October and new rules in place for next spring.

It’s an encouraging step, but it’s just the beginning. Ideally we will someday see rest and relaxation baked into the very notion of youth sports – not because it is mandated, but because it is simply what’s done.

Until that time, the American Orthopedic and Sports Medicine center is here to help with your pediatric orthopedic needs. Contact us today for an appointment