Monday, August 18, 2014

Joint Preservation Options at Floyd Memorial Hospital

Joint pain and swelling can have a significant impact on one's activities and quality of life.  Traditional options for managing a frequent cause of this, osteoarthritis, or degenerative joint disease, have ranged from medication to injections to surgery, frequently replacing the joint with an arthroplasty.  While very successful, many patients are hesitant to undertake this step and are looking for other options to treat their pain.  Today's post will discuss a range of joint preservation options, some nonoperative and others that involve surgery, but which thankfully can be done in a minimally invasive fashion while preserving one's native joint.

One of the most successful options for mild to moderate arthritis is low impact exercise and weight loss.  Even minimal weight loss can result in dramatically less stress on the joints of the hip and knee.  Low impact exercise like cycling, swimming, and walking can strenghten the muscles and supporting structures of our joints as well.  

Oral medications commonly used in treating this condition range from traditional NSAIDs, or non-steroidal anti-inflammatories, to acetaminophen.  These can be used in an over the counter fashion, or be prescribed by your physician to provide easier once daily dosing.  Other medications such as glucosamine and chondroitin sulfate have flourished in health food and supplement stores.   Evidence for their benefit is quite mixed in large studies but there do appear to be patients who obtain pain relief from these medications.  It can be useful to perform a trial of these medications to see if they really do work, as taking them provides no benefit toward commonly marketed goals of cartilage restoration and preservation.  

Another category of medications is what I call injectables.  Steroid injections have been a mainstay for decades. They can be quite effective for acute flairs of joint pain that can occur.  It is prudent to space out these injections as their overuse can lead to further joint and soft tissue breakdown.  A newer class of medication, viscosupplementation, involves injecting the joint with a gel.  This gel is hyaluronic acid, a natural protein found in human joint fluid.  Multiple brand names exist, and treatments can range from one to five injections.  These injections can provide some with longer term relief than cortisone and may have fewer side effects in the long term.  The newest injection utilized is PRP, or platelet rich plasma.  This involves processing blood drawn in similar fashion to a blood test one may have performed to monitor things like cholesterol levels.  It is then processed to form a concentrated fluid of platelets and growth factors.  This is then injected in to the joint.  Studies have shown this treatment to be at least as, and for some, more effective than viscosupplementation.   At Floyd Memorial Orthopdic Group we can perform this as an office procedure to help minimize the costs until insurance companies agree to reimburse for its use.

If these options are not working, minimally invasive surgical management can then be discussed as an option.  For the shoulder, some patients with arthritis can benefit from procedures to address bone spurs and painful soft tissue conditions such as biceps tendon tears.  In the hip, early surgery to address bone spurs can slow down the progression of arthritis that appears to stem from these spurs.  And in the knee, a new procedure called subchondroplasty can be done in conjuction with a standard knee arthroscopy can offer some patients relief of their knee pain in an outpatient setting.  These surgeries aren't for everyone though.  Many patients will still be best served by traditional joint replacement options so a consultation in our office is still the best way to find what will work for you!  

Friday, May 23, 2014

Summer Injury Prevention and Training

As we head into Memorial Day weekend, the summer season brings warmer weather and an explosion of outdoor sporting and recreational activities.  The trend for year round scholastic sports has also taken what was traditionally a time of rest and made it just another season for games and training.  With that in mind today we'll discuss some things to keep in mind whether the summer is a time for further competition, recovery, or just enjoying the outdoors

For the scholastic athlete, ideally summer would be a time away from competition, especially if you're a spring athlete who will resume sports like soccer and football in the fall.  Giving your body periods of rest is one of the best injury prevention techniques available.  Even if it's a month, time away from vigorous training can minimize the chance of suffering overuse injuries such as stress fractures and tendinitis.  Rest should not mean becoming a couch potato however.  Athletes should continue to maintain a healthy diet and get regular exercise, but cross training and participating in activities other than organized sports such as hiking, cycling, and swimming can allow recovery while maintaining conditioning and muscle mass.   If mandatory training is scheduled over the summer, be aware that warmer weather will increase your fluid requirements, so hydrate before training and throughout practice to minimize the chance of dehydration.  Don't wait until you're thirsty, otherwise it's sometimes too late. Lastly, training during cooler times of the day before ten and after four can be beneficial in reducing heat related illnesses.

For the outdoor enthusiast, summer affords a range of fresh opportunities from water sports to climbing and hiking and golf.  Each of these activities can provide hours of beneficial physical activity and enjoyment but also exposure to injury.  

Water sports especially require diligence to prevent what can unfortunately be catastrophic accidents.  Learning to swim and appropriate utilization of flotation devices are paramount for anyone participating in these events.  Utilizing resources such as community pools and the YMCA in the winter and spring months can get you a head start on acclimating to the water and increasing your endurance.  Recognize that river and lake currents can fatigue one quicker than the backyard pool so take appropriate precautions to avoid cramping and fatigue while on the water.  Swim with a friend always, as unfortunately drowning is the second leading killer of children ages 1-14.  Adequate supervision and lessons can minimize harm for this age group.  

Activities in wooded areas such as hiking and climbing require their own preparation and precautions to ensure safety.  Checking safety equipment that has been stored all winter is the first step.  For remote destinations having adequate provisions for first aid, nutrition, water, and communications is mandatory.  Just as competitive athletics requires training, so do recreational activities such as these.  Being in appropriate shape and fitness and setting realistic goals for the level of difficulty one is ready for can go along way towards preventing injury.  Similar to watersports, don't travel alone.  Lastly many illnesses can be transmitted from insects such as ticks and mosquitoes so utilize appropriate clothing and sprays to minimize these pests.

With these and other guidelines, summer can be a great time for the weekend warrior to enjoy new activities and the scholastic athlete to optimize their recovery and conditioning.  If you are injured, we at Floyd Memorial Orthopedic Group are here to get you back and healthy.  Stay safe and enjoy the warm weather!

Friday, April 25, 2014

Free joint pain seminar for anyone with hip, knee or shoulder pain. More information at Floyd Memorial Events

Monday, January 27, 2014

Free shoulder pain seminar

Join me for a free shoulder pain seminar discussing a range of topics affecting the shoulder such as rotator cuff tears, shoulder instability, bursitis, and arthritis. Topics will also include minimally invasive surgery, joint replacement, and rehabilitation. The seminar will be held tomorrow at 6 pm at Floyd Memorial Hospital. For details

Monday, December 2, 2013

Updated ACL prevention

I've previously written on this space about ACL prevention. I wanted to update any readers that a new web site, sort of the next generation of the PEP program, has been unveiled. The FIFA 11+ program combines all the research of the PEP program and other ACL prevention strategies into a compact program meant to prevent a wide range of injuries, not just ACL tears. Check out more details and some great information at

FIFA 11+

Tuesday, November 26, 2013

Shoulder replacement, is it right for me?

Shoulder pain can be a debilitating condition. A range of issues can be the cause of this pain, from tendon and ligament tears that are more common in younger patients, to arthritis which more commonly affects middle-aged and older patients. Options for treating shoulder arthritis have increased dramatically in the last decade due to new technologies and research that has helped surgeons better understand the best approach to treating the various causes of shoulder pain in the older patient. Today I’d like to focus on that research, which predominantly involves shoulder arthroplasty, or replacement.

As in other joints in the body, the shoulder joint relies on smooth articular cartilage that lines the bones which form the joint. This smooth surface allows the shoulder to glide through a remarkable range of motion. If however the cartilage starts to thin out, those surfaces are no longer smooth. The human body will often react by forming bone spurs, or osteophytes, in an attempt to limit motion at this no longer smooth surface. This can result in further pain and loss of motion in the shoulder. At the same time, the muscles that stabilize the shoulder, the rotator cuff, can also be tearing. This can lead to further problems such as weakness in the shoulder, damage to the biceps tendon, and a special type of arthritis called rotator cuff arthropathy.

When this occurs, you will often notice pain, especially at night, in the shoulder. Motion will be lost, especially in attempting to reach overhead or behind your back. The shoulder may like it is grinding as well. If these symptoms are occurring the next step is to be seen in the office and evaluated by your surgeon. This will involve a physical exam and likely x-rays of the shoulder. In most cases of shoulder arthritis this is often enough testing to provide an accurate diagnosis and treatment plan. Sometimes an MRI or CT scan can be helpful for a more detailed assessment of the soft tissue and bony structure of the shoulder. Depending on the amount of cartilage loss and other damage to the shoulder, multiple treatment options exist. This can range from oral medications, ice, and physical therapy, to cortisone injections, to surgery.

The most predictable option to relieve arthritis of the shoulder joint is total joint replacement, or arthroplasty. This involves surgery to implant a combination and metal and plastic components that restore a smooth surface to the joint, improving motion and relieving pain. Standard arthroplasty is the most common option, with the newer reverse arthroplasty that I have displayed below an option for situations where there is a deficient rotator cuff. The surgery involves being placed under general anesthesia and several days stay in the hospital. After the replacement you can expect to wear a sling for 4-6 weeks and participate in physical therapy to focus on regaining motion and strength in the shoulder. Full recovery can take 3-4 months. Shoulder replacement surgery is highly successful. Risks of the surgery can involve infection, nerve injury, fracture, prosthesis related problems, and stiffness. Talk to your surgeon to discuss your specific condition and see if this surgery is an option for you.

Tuesday, August 20, 2013

Expanding Team Coverage

I wanted to write today and thank the new schools that have offered to have me as part of their already excellent medical teams. I'll be working with a stellar group of doctors and trainers to provide orthopedic and sports medicine coverage at Jeffersonville, Clarksville, Providence, Charlestown, and North Harrison High Schools for the upcoming scholastic season. This is in addition to continuing my work with Indiana University Southeast, the University of Louisville, and Waggener High School. Providing care for scholastic athletes is one of the highlights of my career and I look forward to a successful and healthy season for all the competitors. Thanks to everyone at these institutions for having me as part of the team.