Tag Archive: mesa

Customized Knee Replacement in Arizona

The knee is a complex, mobile joint. Knee joints are the largest joints of the body, and they differ in shape and size from other joints. A customized knee replacement uses specially designed implants that are made to fit the unique knee of the patient. Traditional knee replacement requires the surgeon to attempt to match prostheses to fit the knee.

How many knee replacements are performed each year?

In the United States, around 4.7 million people have a total knee replacement. Prevalence increases with age, with around 8% canstockphoto11809008have a history of total knee replacement. Women are more likely to have this operation than men (3 million: 1.7 million).

Why are customized knee implants important?

Once the Arizona knee surgeon selects the implant, the technique requires precision structuring so the implant fits snugly with your individual bone structure. An improper implant fit could result in residual issues that may cause problems after surgery.

Customized knee replacements are an innovative approach to correctly knee problems. The need for a precision implant fit has driven this new trend. Manufacturers now offer customized and personalized implants that are appropriate for gender and the individual knee. In a 2010 study, customized implants were found to reduce sizing problems during surgery, and also, found to replicate the curvature of the patient’s knee, giving a more natural feel to the replacement.

How are customized knee prostheses made?

Customized knee implants are created from CT and MRI scan data obtained from the patient. This assures the implant iFit-Designmatches the natural curves and shape of the knee. Knee implant manufacturers use specific technology to change the images of the knee into a 3D model, which is used to make an implant that matches the patient’s knee. Using scan data, the manufacturer can customize the implant using computer-assisted surgical instrumentation utilized by the surgeon during the procedure.

Why are women’s implants different than men’s?

Called gender-specific knee replacement, women are more petite and require special sized implants. A regular, traditional implant is designed for men, which means the implant for a woman could overhang on the bone at the sides. This could cause soft tissue interference or mid-flexion instability. For some patients, over-sized implants may cause pain and discomfort long after healing is complete. For this reason, new implants are used to accommodate the knee, which is smaller top-rightin women from side-to-side and from front-to-back. This reduces implant misfit and persistent knee pain.

Why do the differences between men and women make knee replacement difficult?

Researchers have found many differences between women’s knees and men’s. The gender-specific implants are based on research that shows:

  • Women’s knees have a thinner profile at the front.
  • Women’s knees have a distinct shape that accommodates the different angle between the knee and hip.
  • Women’s knees have a different contour.

Some researchers believe the differences in knee shape and size have less to do with gender and more to do with genetics. Certain ethnic influences tend to determine knee joint sizes.

Orthopedic and Sports Performance Institute offers customized knee replacements that have an amazing fit with exceptional outcomes. The total knee replacement surgeons in Arizona work with patients from all over the Valley including Gilbert, Mesa, Chandler, Queen Creek and Maricopa AZ.

Most insurance is accepted, call today to meet with the top knee specialists in AZ!

Resources

Bourne, et al; Patient Satisfaction after Total Knee Arthroplasty. Who is Satisfied and Who is Not? Clinical Orthopedics and Related Research; 2010, 468: 57-63.

Mahoney, et al; Overhang of the Femoral Component in Total Knee Arthroplasty: Risk Factors and Clinical Consequences. The Journal of Bone and Joint Surgery; 2010, 92: 1115-1121

 

Preparing for a Total Knee Replacement in Arizona

Preparing for a total knee replacement begins weeks to months before the actual surgery date. Good physical health is important for a successful operation. Getting the upper body strong will improve your ability to use crutches or a walker, and performing leg-strengthening exercises will improve ability to walk on your new knee. In addition, you should follow the Arizona knee replacement doctor’s orders explicitly before undergoing a total knee replacement.

Meeting with the Gilbert Orthopedic Surgeon

To prepare for the total knee replacement, you will meet with the AZ orthopedic knee surgeon. The doctor will ask you Knee pain 3questions about your past medical history, inquire about your current knee problems, and perform a physical examination. In conjunction with an internal medicine evaluation, you may have x-rays, laboratory tests, and an electrocardiogram (heart rhythm test). If you are a smoker, many doctors require that you refrain from smoking for 6 weeks before surgery.

The orthopedic surgeon will discuss your current medications and allergies. Certain agents that thin the blood must be held for several days before surgery. In case you require blood transfusions during surgery or right after, you may want to store your own blood at the hospital’s blood bank. In addition, you should see your dentist to evaluate for infected teeth or gums, which could cause problems with the new knee.

Meeting with the Physical Therapist

Before you undergo surgery, you may see the physical therapist and start an exercise program. The therapist will work with you 2-3 times each week to perform strengthening and flexibility exercises. The work out helps prepare your muscles and soft tissue structures for surgery and recovery.

The physical therapist may either come to your home to assess your recovery environment or simply discuss it with you. If you have stairs, problems with hallways, and other issues, the therapist may recommend that you recover for the first couple of weeks in a skilled nursing facility. This will depend on your unique situation and health conditions.

canstockphoto10845760Preparing your Home and Assistance after Surgery

When you are preparing for surgery, you should begin thinking about recovery after surgery. You will go home from the hospital 2-5 days after the total knee replacement. Since you cannot drive, you should arrange to have a ride home. In addition, you will need someone to help you at home for a few days (getting meals, dressing, follow-up appointments, etc.)

Right Before Surgery

The morning of your surgery, you can brush your teeth and take necessary medications with a small sip of water. You are not to eat solid food within 8 hours before your surgery, and should not drink or eat after midnight. We recommend that you shower the morning of your surgery using an antibacterial soap.

When you arrive at the hospital, you will register at the surgical center. A nurse will have you change into a procedure gown. After discussing the procedure, you must sign a consent form. The nurse will attach monitoring devices to assess blood pressure, pulse, and oxygen level. In addition, an intravenous (IV) catheter is placed in your arm.

Orthopedic and Sports Performance Institute offers the top knee replacement surgeons in Arizona. Often times outpatient knee replacement is performed, and most insurance is accepted at the practice. Call us today to discuss your options with our Gilbert and Chandler knee specialists!

Life after a Total Knee Replacement

Pain and suffering from severe degenerative joint disease of the knee can compromise a person’s ability to maintain gainful employment, as well as perform usual activities of daily living. A total knee replacement (TKR) is a successful procedure for keeping people active and working. Returning patients to a higher level of functioning is the goal of knee arthroplasty, along with eliminating the chronic knee pain.

Returning to Work after Surgery

Around 98% of total knee replacement patients who were working before their surgery are able to return to work after surgery. Knee pain 3In addition, 90% of these patients are able to resume their previous position. A total knee replacement, also called total knee arthroplasty (TKA), is one of the most widely performed procedures in the world, and it is used to relieve pain and restore function in patients with advanced knee arthritis.

According to an independent survey center that interviewed more than 660 TKR patients 1-5 years after surgery, patients resume normal activities after the procedure. Their finding revealed that around 75% of patients were employed before surgery, and almost all of these people returned to work after the procedure. Men were more likely to have worked during the 3 months before surgery than women (83% vs. 70%), but of those patients, the rates of work return after surgery were similar.

A recent study out of Sweden evaluated joint replacement patients through self-reported assessments and physician evaluation. The researchers found that at 5- and 10-years post-surgery, most patients reported an active lifestyle. Surgery durably and substantially improves physical activity levels for men and women of all age categories.

Quality of Life Studies

canstockphoto11809008In a review of studies regarding quality of life among people who underwent total knee replacement surgery, and the various associated factors that impact recovery, researchers found several factors that were associated negatively with an active lifestyle. These factors were obesity, comorbidities, advanced age, persistence of pain, and lengthy wait for surgery.

Another study evaluated the self-reported outcomes after a total knee replacement to determine factors that influenced quality of life at 6 weeks, 3 months, 6 months, and one year post-surgery. Of the patients, 162 females and 40 males had a mean age of 69 years. At 6 weeks post-surgery, physical function was satisfactory. However, significant improvement was noted at 3 months postoperatively. Patients had decreased VAS pain scores, as well.

This quality of life study has proved that patients can return to previous level of functioning and enjoy an improved functional status. Researchers found that at one year post-operative, most patients reported that they had a significant improvement in quality of life. The researchers concluded that quality of life after TKR was noticeably different, with patients experiencing significant improvement for all parameters measured.

Longevity of the New Knee

It is difficult to predict how long the total knee implant/prosthesis will last, as lifespan depends on several factors. For a few patients, surgical complications occur which affects the longevity of the new knee. However, the majority of new knees last for 20 years, giving patients pain relief and improved function.

Surgeons, researchers, and prosthesis manufacturers all continue to work to improve the long-term outcomes of total knee replacement. The life of an implant depends on the use and wear. In addition, uses of new high performance material had shown to decrease wear by as much as 60%.

Orthopedic and Sports Performance Institute offers top knee replacement surgeons in Arizona. The procedures are often able to be performed on an outpatient basis, with most insurance being accepted. Call the top orthopedic surgeons in Gilbert and Chandler today!

Resources

American Academy of Orthopedic Surgeons. (2013). 98 percent of total knee replacement patients return to life, work following surgery. ScienceDaily. Retrieved from: www.sciencedaily.com/releases/2013/03/130321082857.htm

Da Silva RR, Santos AA, de Sampaio CJJ, & Magos MA (2014). Quality of life after total knee arthroplasty: systematic review. Rev Bras Ortop, 49(5), 520-527.

Papakostidou I, Dailiana ZH, Papapolychroniou T, et al. (2012). Factors affecting the

quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord, 13, 116.

Physical Therapy After Total Hip Replacement

One of the most commonly performed orthopedic surgeries is a total hip replacement (THR). The surgical techniques and prosthesis used for a THR have improved over the years, allowing the patient to now achieve optimal recovery and less pain. Physical therapy is an important aspect in a successful, full recovery after hip replacement.

In the Hospital

Right after your total hip replacement, a physical therapist begins working with you to restore joint motion and strength. Initially, therapy begins in physical therapy1the hospital the day after surgery. A therapist shows you how to get in and out of bed, ways to get into the shower and car, and how to walk using a walker or crutches. In addition, the therapist has you perform simple exercises in bed to prevent blood clots, such as gluteal squeezes and tightening the thighs.

After a hip replacement, some patients received additional physical therapy in a rehabilitation facility before going home. This will depend on the age of the patient, what the home environment is like, and functioning when discharged from the hospital. The physical therapist works with the patient using exercise equipment for strengthening and mobility. Balance exercises are used to decrease risk of falling. In addition, the physical therapist uses heat to warm up tight muscles and ice to reduce soreness and swelling.

Avoiding Dislocation

After a total hip replacement, there are some considerations the physical therapist follows to help you decrease risk of dislocating the new hip. With the posterior approach hip replacement, you cannot bend the hip past 90 degrees, must avoid crossing your legs, and cannot rotate the hip inward. Maneuvers to assist with avoiding these activities include use of a raised toilet seat and shower chair, use of a pillow between the knees, and using an orthopedic device to put on shoes and socks.

Home Physical Therapy

Once you go home, the physical therapist will visit you 3-4 times each week to improve hip strength, mobility, and flexibility. Common therapy exercises include:

  • Buttock contractions – Tighten muscles and hold to a count of 5.
  • Abduction exercise – Slide leg out to the side as far as possible and then back.
  • Quadriceps set – Tighten thigh muscles and try to straighten knee. Hold for 5-10 seconds.
  • Straight leg raises – Tighten thigh muscles with knee straight. As muscles tighten, lift leg sever inches from bed and hold for 5-10 seconds.
  • Standing exercises – These include standing knee raises, hip abduction, and hip extensions.
  • Walking and full weight-bearing – These exercises are used to help you perform light everyday activities.

physical_therapy

Recovery at Home

Don’t be surprised if you feel fatigued right after surgery. This will improve over the next few weeks, however. You should arrange to have someone help you out for 1-2 weeks after your total hip replacement. The exercises given to you by your physical therapist are an essential part of recovery.

You should be able to stop using crutches or a walker, and resume normal leisure activities within 6 weeks of the surgery. However, it could take up to 12 weeks for pain to completely resolve. Your new hip is continuing to recover for up to 2 years after the operation, which involves scar tissue healing and restoration of muscles.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top surgeons specializing in joint replacement (hip and knee), along with sports medicine too. Most insurance is accepted with patients being seen from all over the Valley including Mesa, Chandler, Queen Creek and Scottsdale too! Call us today.

How does Surgical Approach to Hip Replacement affect Recovery?

Anterior hip replacement is an approach to surgery used to improved patient outcomes. Thousands of hip replacement surgeries are performed each year, but only 20% of surgeries in the United States are done using the anterior approach. The other 80% of surgeries are performed using the posterior or lateral approach.

Advantages of the Anterior Hip Replacement

Supporters of the anterior hip replacement approach believe it offers the following canstockphoto10503438advantages:

  • Less damage to major muscles – The orthopedic surgeon avoids cutting and manipulating major muscles during the anterior hip replacement. The surgeon works between the front muscles rather than severing muscle fibers or detaching muscle from bone.

 

  • Less post-operative pain – Because anterior approach does not require manipulation and cutting of muscles, the patient has less post-surgical pain and requires less medication.

 

  • Faster recovery – After surgery, the patient can bend at the hip and bear weight sooner. Most anterior hip replacement patients use walker or crutches soon after surgery. In a recent study researchers found that anterior hip patients walked unaided 6 days earlier than those who had the posterior surgery.

 

  • Decreased risk for dislocation – With the anterior surgery, the hip is not at risk for dislocation because soft tissue structures are not moved.

 

  • Improved range of motion – Patients can bend over, sit with legs crossed, and perform other movements without risking hip dislocation.

 

  • Shorter hospital stay – A patient who undergoes anterior surgery will not stay in the hospital as long as with the traditional approach.

 

Advantages of the Posterior-Lateral Hip Replacement

In a recent study comparing posterior and anterior approaches to hip replacement, researchers found that both groups had improvements in pain and range of motion, with no observable differences in gait or dislocation. Advantages to the posterior approach can include:

 

  • Less technically demanding – The posterior approach to hip replacement is easier to canstockphoto24182699perform. Anterior approach requires considerable training, skill, and experience by the orthopedic surgeon.

 

  • Simpler and easier – Many Gilbert orthopedic surgeons believe the posterior approach is the simplest and easiest, therefore providing the greatest safety margin for patients.

 

  • Minimal risk of femoral fracture or implant problems – Due to ease of this surgery, there is less risk to the patient for femoral fracture or poor positioning of the prosthetic component.

 

  • No special surgical equipment required – This procedure does not require the use of high-tech, specialized surgical equipment.

 

Disadvantages of the Anterior Hip Replacement

There are a few limitations associated with anterior hip replacement. These include:

  • Not suitable for obese or large patients – Muscular, overweight, or obese people are not good candidates for the anterior procedure.

 

  • More technically demanding – The Arizona orthopedic surgeon must be very experienced in performing the anterior hip replacement. This surgery is known to be quite technically demanding.

 

  • Potential for nerve damage – The lateral cutaneous femoral nerve runs down the front of the pelvis and past the hip to supply the thigh. There is more potential for damage to this nerve with the anterior approach.

 

  • Delayed wound healing – Some studies show that wound healing is delayed using the anterior approach, with 1.4% of patients having a wound complication compared to 0.2% with the posterior approach.

 

Disadvantages of the Posterior-Lateral Hip Replacement

  • Higher post-operative dislocation rates – Some studies show higher rates of dislocation with the posterior approach. However, with improved technology, these rates have declined.
  • Longer recovery – The posterior approach to hip replacement is associated with longer hospital stays and recovery. However, with full participation in physical therapy and rehabilitation, the recovery time has shortened.

OSPI offers state of the art approaches for hip replacement which minimize hospital stay and complications, while improving outcomes. Most insurance is accepted by the Gilbert and Mesa orthopedic surgeons, call today!

Resources

Kennon RE, Keggi JM, et al. (2013). Total hip arthroplasty through a minimally invasive anterior surgical approach. Journal of Bone and Joint Surgery, 85-A:39-48.

Petis S, Howard JL, Lanting BL, & Vasarhelyi EM (2015). Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg, 58(2), 128-139.

Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, & Ong A (2014). Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons, 22:595-603.

Taunton MJ, Mason JB, Odum SM, & Springer BD (2014). Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. pii: S0883-5403(14)00340-4. doi: 10.1016/j.arth.2014.03.051.

 

Save

Recovery after Total Knee Replacement in Arizona

canstockphoto10845760

Each year, thousands of people undergo total knee replacement (TKR) surgery. This procedure is done to replace damaged portions of the knee, including cartilage and bone ends. The most important part of surgery is the recovery.

Hospital Recovery

  • Bandages/drains – The knee will have a bulky elastic bandage dressing on it. Depending on the situation, some patients have a small drain inserted at the surgical site to remove excess blood and fluid that accumulates. The bandage is removed 1-2 days after surgery, and the drain is usually removed within 3 days of surgery.

 

  • Incisions – The incisions must be kept clean and dry. Sutures or staples are removed in 7-14 days.

 

  • Continuous passive motion (CPM) – A CPM machine is used to move the knee in physical therapy1regular motion. This helps the knee regain flexion.

 

  • Activities – Nurses will help you get out of bed and back in bed while in the hospital. You are encouraged to walk to the bathroom using a walker, crutches, or cane.

 

  • Deep breathing – After surgery, you must perform deep breathing exercises to rid your airway and lungs of mucus. This involves taking several deep breaths every hour.

 

  • Physical therapy – The physical therapist works with you to improve range of motion and strengthen muscles. The therapist assists with sitting at bedside, transferring in and out of bed safely, climbing stairs, walking with a cane or walker, and performing exercises without the CPM.

 

  • Pain management – The nurses will administer pain medicine to keep you comfortable.

 

Home Recovery

  • Preparation – Before going home, you need to arrange for a ride home, and have someone available to help you for a few days. It is a good idea to have plenty of gauze and tape ready, as well as pre-made meals, ice, and water. You will need to have a recliner or an ottoman so you can elevate your leg. In addition, you should remove all loose cords and rugs from walkways.

 

  • Physical therapy – The therapist continues to work with you after you go home. As the days progress, you will increase your frequency and distance of walking. Most patients are on a straight cane within 3-5 days of surgery.

 

  • Pain management – To control pain, take prescribed medications before pain gets too severe. In addition, avoid any alcoholic beverages while you are taking these medicines. We recommend taking pain medicine at least 45 minutes before physical therapy sessions, so the medicine will take effect.

 

Dos and Don’ts after Knee Replacement Surgery

 

  • Do position the knee comfortably as you perform daily activities.
  • Do use an ice pack if swelling occurs.
  • Do walk and perform range of motion exercises each day.
  • Do elevate the leg often to reduce swelling.
  • Don’t twist the knee.
  • Don’t jump or put any sudden stress on the knee.
  • Don’t put a pillow under the knee.

 

Fast-Track Recovery Protocol

 

During the last decade, many medical facilities have implemented fast-track protocols for total knee replacement. A fast-track protocol will reduce the length of hospital stay.

 

In a recent study involving fast-track recovery, researchers evaluated patients during the first 6 weeks after total knee replacement. They found that 28 of the 30 study participants were satisfied with a short hospital stay. It was determined that quality of life at 6 weeks discharge was the same for fast-track patients as those who stayed longer at the hospital.

OSPI in Gilbert AZ offers top knee replacement surgeons providing rapid recovery procedures. Most insurance is accepted, call today!

Resources

Van Egmond JC, Verburg H, & Mathissen, NMC (2015). The first 6 weeks of recovery after total knee arthroplasty with fast track. Acta Orthop, 86(6), 708-713.

Save

Overview of Partial Hip Replacement

Partial Hip Replacement in Gilbert AZ

 

With a partial hip replacement, also called a hemiarthroplasty, only the patients femoral head (top of thigh bone) is replaced. The prosthetic component will rotate in the natural hip socket. This procedure is used for patients who do not need replacement of the joint ModularEndoprosthesissocket (acetabulum).

How is the partial hip replacement different from total hip replacement?

The partial hip replacement surgery is less invasive than total hip replacement. With the partial procedure, only the ball of the femur must be replaced, and the joint socket is left alone. This surgery is used for patients who require replacement of the femoral head.

What are the reasons for a partial hip replacement?

Breaking or fracturing a hip can lead to breaks through the femur, which often displaces the femoral head. When the fracture occurs within the hip joint, it is called a femoral neck fracture. The upper portion of the femur is surrounded by muscle, and it has better blood supply than the neck. The partial hip replacement is used to repair damage that occurs after these injuries. A fracture of the femoral head or neck can lead to significant pain and loss of normal function.

Usually, patients who are good candidates for a partial hip replacement are those who have no significant underlying arthritis and people with healthy cartilage. A partial hip replacement is seldom used for patients with serious hip damage. Another use of a partial hip procedure is to repair damage in patients who already have a total hip replacement.

Can elderly people have this procedure?

uncemented-bipolarIntracapsular fractures of the femur account for the majority of fractures in older patients. The goal of surgery is to return the patient to his/her pre-fracture functional state. Partial hip replacement was studied in older people in a recent clinical study. Researchers found that all study participants returned to their pre-fracture level of activity after the procedure. In addition, they found that hemiarthropasty was a viable option for people age 70 years and older.

How do I prepare for surgery?

Before hip surgery, you need to arrange someone to drive you home from the hospital, and have someone ready to stay with you for a few days. You will need to prepare your home for discharge. Some things to do include:

  • Remove all loose cords and rugs from walking areas.
  • Secure safety handrails in bath/shower and along stairways.
  • Have pre-made meals and drinks available.
  • Have a firm recliner chair or chair with ottoman.
  • Purchase a raised toilet seat.

What can I expect during recovery?

After a partial hip replacement, a nurse monitors you in the recovery room for 45-75 minutes. Once you are stable and awake, you will be moved to a room or discharged home. Discharge depends on your unique situation, your health status, and the surgeon’s preference. You may need to stay in the hospital for 1-2 nights. You will begin passive range of motion exercises with the help of a physical therapist, and nurses administer pain medications to ease postoperative pain.

Once you are home, you must keep the incisions clean and dry, and avoid soaking in a tub or pool until wounds are healed. Expect to use a walker or crutches for a few days. Physical therapy is used to improve hip strength, flexibility, and range of motion. The Mesa orthopedic surgeon encourages frequent movement to prevent blood clots and improve recovery.

The top orthopedic surgeons in Arizona are at OSPI, serving Mesa, Gilbert, Chandler, Tempe, Queen Creek and surrounding areas. Call today!

Resources

Marya SKS, Thurkral R, & Singh C (2008). Prosthetic replacement in femoral neck fracture in the elderly: Results and review of the literature. Ind J Orthop, 42(1), 61-67.

Basics of Compartment Syndrome from a Top Gilbert Orthopedic Surgeon

Compartment syndrome is an uncommon, painful condition caused by pressure within the muscles. With this dangerous condition, the pressure decreases blood flow to the muscles and nerves. If not treated, compartment syndrome could result in limb amputation.

Compartment syndrome can be acute or chronic. With acute compartment syndrome, the condition is related to severe injury, which is a medical emergency. Without proper treatment, acute compartment syndrome can lead to permanent muscle and/or nerve damage. Chronic compartment syndrome is often caused by athletic exertion, which is not a medical emergency.

How common is compartment syndrome?canstockphoto7004441

According to a recent study, the incidence of compartment syndrome of the foot is 6% in patients with acute foot injuries. The incidence of lower leg compartment syndrome is around 1%.

What are compartments?

Compartments are groups of muscles, blood vessels, and/or nerves in the arms and legs. These tissues are covered by a tough membrane (fascia). The fascia keeps tissues in place and doesn’t expand or stretch easily. The area between the ankle and knee has four major muscle compartments

What causes acute compartment syndrome?

When bleeding and/or swelling occur within a compartment, this syndrome develops. The fascia does not stretch well, which increases pressure on the nerves, muscles, and capillaries in the compartment. Blood flow to the nerves and muscle is disrupted, causing damaged and tissue death. Common causes of compartment syndrome include injury, such as a broken bone or car accident, as well as an infection.

What causes chronic compartment syndrome?

Chronic compartment syndrome is caused by exercise, which leads to muscle pain and swelling. Those at most risk are athletes who participate in activities using repetitive motions, such as biking, swimming, and running.

What are the symptoms of compartment syndrome?

The classic sign of compartment syndrome is pain, which is related to the muscle being stretched. The pain is more intense than the actual injury. Many people also report burning and tingling sensations in the skin, which are called paresthesias. The muscle feels full or tight, and numbness often occurs later on. During exercise, the patient may notice pain or cramping, which will subside when activity ceases.

How is compartment syndrome diagnosed?

Acute compartment syndrome is a medical emergency, so you should go immediately to the hospital. The Gilbert orthopedic doctor will take a history, conduct a physical examination, and perform an ultrasound. Surgery is often required to decrease pressure on the muscles and nerves. With chronic compartment syndrome, the doctor will measure pressures in the body before and after exercise.

How is surgery performed?

For acute compartment syndrome, the orthopedic doctor in Arizona makes a small incision over the skin and fascia of the affected compartment. This procedure is called a fasciotomy. With severe swelling, the incision must be left open, and it is not closed until swelling subsides. A skin graft is often used to close the incision.

What is involved in non-surgical treatment?

Acute compartment syndrome requires surgery, as there are no non-surgical options. For chronic compartment syndrome, the doctor may recommend physical therapy, orthotics (shoe inserts), and nonsteroidal anti-inflammatory drugs (NSAIDs). The symptoms subside with resting, so you may need to avoid activity for a while.

Orthopedic and Sports Performance Institute offers top orthopedic surgeons in Gilbert serving the entire valley. These orthopedic doctors provide top notch care for all bone and joint conditions including compartment syndrome. Call today!

What is Turf Toe and How is it Treated?

A turf toe is a sprain of the big toe’s main joint. This injury occurs when the big toe is forcibly bent upward, which is referred to as hyperextension. This can occur when pushing off into a sprint from the turf and having the toe get stuck flat on the ground.

Who gets turf toe?

Sprains of the big toe are prevalent among football players who play on artificial turf. Artificial turf is a harder surface than grass, and there is no “give” when force is placed upon it.canstockphoto12027384

Which toe structures are affected with turf toe?

The big toe has two joints. The largest joint of the toe is called the metatarsophalangeal joint (MTP). The MTP is where the first long bone of the foot (metatarsal) meets the bone of the toe (phalanx). With turf toe, the MTP joint is injured. The joint has many structures that form the plantar complex. These include:

  • Plantar plate – Thick fibrous tissue lying beneath the MTP joint. This prevents the big toe from bending too much.
  • Flexor hallucis brevis – Attaching to the toe bone, this is the tendon that runs under the first metatarsal bone. This structure provides stability and strength of the big toe.
  • Collateral ligaments – These are located on each side of the toe, and they connect to the metatarsal bone to the phalanx bone. These structures prevent the toe from going too far to either side.
  • Sesamoid bones – These two small bones are surrounded by the flexor hallucis tendon, and they help the toe move easily, provide stability to the MTP joint, and assist with weight-bearing on the forefoot.

How common is turf toe?

In a study of NCAA football players, the incidence of turf toe injuries was 0.062 per 1,000 athlete exposures. Football players were 14 times more likely to sustain a turf toe injury during games than during practice. Less than 2% of these injuries require surgical intervention.

How is turf toe diagnosed?

Turf toe is diagnosed based on symptoms, physical examination, and x-rays. To help the doctor devise a canstockphoto7107950treatment plan, the injury is graded from 1 to 3.

  • Grade 1 – The plantar complex is stretched causing slight swelling and tenderness.
  • Grade 2 – There is partial tearing of the plantar complex causing tenderness, swelling, and bruising.
  • Grade 3 – There is complete tearing of the plantar complex causing severe tenderness, swelling, and bruising.

During the exam, the doctor checks for range of motion, as well as swelling and bruising. The doctor will order x-rays to visualize the bones, and magnetic resonance imaging (MRI) scans for viewing soft tissues and cartilage.

What causes turf toe?

Turf toe occurs when the forefoot is fixed on the grown with the heel raised, and a force pushes the big toe into a hyperextended state. This injury can also occur during a forceful tackle.

How is grade 1 turf toe treated?

The RICE protocol is first-line treatment for grade 1 turf toe injuries. This includes:

  • Rest – Taking a break from sporting activities, avoiding walking, and not bearing weight on the affected toe.
  • Ice – Use of ice packs for 20-minute intervals several times each day.
  • Compression – Wearing an elastic compression bandage.
  • Elevation – Elevating the affected toe to decrease swelling.

In addition, taping the big toe to other toes (buddy taping) will restrict motion and improve healing. Nonsteroidal integrity-fracture-walkeranti-inflammatory drugs (NSAIDs) are used to reduce swelling and relieve pain. The athlete should use orthotics when returning to activity, such as a phraphite shoe insert with a stiff forefoot component.

How are grade 2 turf toe injuries treated?

For grade 2 injuries, the MTP joint is kept immobilized, and a walking boot is used for 7-14 days. For most athletes, a full 2 weeks of rest is recommended before returning to activity.

How is grade 3 turf toe treated?

For severe MTP joint injuries, the toe is immobilized for 3-4 weeks. The athlete uses a walking boot or cast that keeps the big toe in a downward position. Physical therapy is used to stretch and strengthen the big toe and to prevent joint stiffness.

Is surgery required for turf toe?

Surgery is required for:

  • Severe tearing of the plantar complex
  • Vertical instability of the MTP joint
  • Loose bone chips of the joint
  • Fracture of the sesamoid bone
  • Damage to the joint cartilage
  • New or worsening bunion

OSPI offers the top sports medicine orthopedic treatment in Arizona. The Gilbert orthopedic surgeons are experts in both the nonoperative and operative treatment of injuries such as turf toe. Most insurance is accepted, call today!

Resources

George E, Harris AH, Dragoo JL, & Hunt KJ (2014). Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int, 35(2):108-15. doi: 10.1177/1071100713514038.

An Overview of Stress Fractures and Treatment

A stress fracture is a small crack in a bone. This common injury occurs in high impact sports, such as basketball and long distance running. Stress fractures are painful, but they usually heal with rest.

How common are stress fractures?

Stress fractures comprise about 10% of all athletic injuries. The incidence of stress fractures is around 10-20% of the general population.

Which bones are more likely to incur a stress fracture?

The most common injured bones include the metatarsals (foot), as well as the lower leg bones (tibia and fibula). Stress fractureMore than 50% of stress fractures occur in the lower leg bones, with 25% of these injuries occurring in the metatarsal bones of the feet.

What increases the risk for stress fractures?

Certain factors increase the incidence of stress fracture, either directly or indirectly. Risk factors include:

  • Muscle weakness
  • Muscle inflexibility
  • Inappropriate footwear
  • Training changes (shoes, terrain, intensity, and activity)
  • Excessive muscle strength
  • Poor running technique
  • Lower extremity alignment anomalies
  • Previous history of injury

What sports activities are likely to lead to stress fractures?

There is a higher incidence of stress fractures in sports that require repetitive movements. These include:

  • Cricket (bowling the ball)
  • Rowing
  • Aerobics
  • Running
  • Basketball

What bones are affected by stress fractures?

  • Tibia (lower leg) stress fractures – These are associated with running, jumping, walking, and dancing, and are stress fracture3more common in females.
  • Metatarsal (foot) – These are linked to dancing, running, marching, and walking.
  • Femur (thigh) stress fractures – These are seen mostly in female athletes who engage in running and walking.

What causes a stress fracture?

Stress fractures are more likely to develop in persons who have just begun a new activity, or those who have increased the intensity of their workout routines. Stress fractures occur when the muscles are not conditions, causing them to tire easily so they do not support and cushion the bones. In addition, stress fractures are more common in women than men.

What are the symptoms of a stress fracture?

A stress fracture causes a dull, intense pain at the affected site. The pain is worsened with walking, standing, or exercising. Swelling is likely to occur, and some patients have mild bruising.

How is a stress fracture diagnosed?

To diagnose stress fracture, the doctor will conduct a thorough physical examination of the painful area. X-rays may not detect a stress fracture, so the doctor may order another imaging scan, such as a nuclear bone scan or magnetic resonance imaging (MRI) scan.

What is the treatment for stress fractures?

Initial treatment involves the RICE protocol. This involves rest, ice, compression, and elevation. The extremity is rested for a few days, and ice packs are applied to reduce pain and swelling. A compression bandage will reduce the likelihood of re-injury, and elevation helps take down swelling. For pain, nonsteroidal anti-inflammatory drugs integrity-fracture-walkerare used, such as naproxen or ibuprofen.

In addition, a walking boot may help prevent excess pressure on the fracture, provide pain relief and accelerate healing. There is some evidence for electrical impulse treatment of stress fractures as well.

Surgery for a stress fracture may become necessary if conservative treatment fails. In addition, athletes who desire to get back into sports activities faster may desire surgery for a speedier recovery. One example may be a 5th metatarsal fracture that is keeping a person out of competition.

Can stress fractures be prevented?

Prevention is important for any athlete wishing to avoid stress fractures. This involves:

  • Modifying training – To reduce the incidence of stress fractures, training regimens should be individualized.
  • Stretching – During warm-up, the athlete should perform leg muscle stretching.
  • Use of orthotics – This includes shock-absorbing shoe inserts, which reduce the occurrence of leg stress fractures.
  • Supplements – Taking calcium with vitamin D is helpful for preventing stress fractures.

Resources

American College of Sports Medicine (2015). Stress Fractures. Retrieved from: https://www.acsm.org/docs/current-comments/stressfractures.pdf

Patel DS, Roth M, & Kapil N (2011). Stress Fractures: Diagnosis, Treatment, and Prevention. Am Fam Physician, 1;83(1):39-46.

JOIN OUR E-MAIL LIST!