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Treatment Options for Osteoporosis

If you or a loved one has osteoporosis, there are several treatment modalities available. Vitamin D3 supplementation is often the first line of treatment for patients with osteoporosis, low bone mass or those who have sustained an osteoporotic fracture. Vitamin D deficiency is frequently observed in a high percentage of patients with hip fractures. On the other hand, in patients older than 65 years of age, sufficient levels of vitamin D improves –

  • bone strength and mineralization
  • lower extremity muscle strength
  • gait speed
  • performance and balance
  • reduction in falls

About 1000 international units (IU) vitamin D3 daily is recommended.

Along with vitamin D3, Calcium citrate or calcium carbonate can also be prescribed. Total calcium intake recommendations are 1,000 mg to 1,200 mg per day in the form of diet and supplementation. However, higher dosages may be prescribed for certain populations. The safe upper limit is 2,000 mg total per day.

Other recommendations for patients suffering from osteoporosis are –

  • regular weight-bearing activity
  • muscle strengthening activities, such as walking and yoga
  • fall prevention strategies
  • reducing alcohol consumption, as it increases the likelihood of falls and has a negative effect on bone quality

Your orthopedic surgeon will consider your medical history, lifestyle, risk factors, diagnostic imaging tests and other details to design a comprehensive treatment plan for you.

If you are looking for the best knee replacement doctors, call the top orthopedic doctor in Gilbert, AZ, call OSPI Arizona at 480-899-4333. OSPI’s Board Certified orthopedic surgeons offer complete care and treatment for individuals in all stages of life, participating in all levels of activity.

Hamate Fractures

Fractures of the carpal bones are rare, with the exception of the scaphoid bone. Of all the carpal bones, the hamate accounts for only 2% of fractures, while the scaphoid fractures would be 70%. Hamate fractures are classified based on the Milch classification which takes into account the part of the bone fractured. Fractures of the hook of Hamate are commonly seen in golfers, baseball players, and racket sports players. It is also very common in patients with falls and crash injuries In comparison, body fractures of the hamate are more associated with the act of a clenched fist striking a wall.

Hamate fractures can be difficult to treat and the diagnosis is often missed. In fact, it can take anywhere up to 5 weeks, but the average is about 10 days. It typically causes hypothenar pain worsened by palpation or gripping. The hook of the hamate pull test is performed to assess for hook fractures, and it is deemed positive if the resisted flexion of the fourth and fifth digits displaces the fracture and causes pain. A fracture of the Hamate can damage the ulnar nerve given its close proximity, causing additional symptoms of paresthesia or weakness.

Treatment of hamate fractures is dependent on the degree of the displacement and fracture location

Plain film radiography is performed for the diagnosis of these injuries. There is an overlap of the hook of the hamate on the body, which makes the radiological diagnosis quite difficult. Computed tomographic (CT) scan can be performed to assist in such cases and for preoperative planning.

The treatment of hamate fractures is dependent on the degree of the displacement and fracture location. For minor, nondisplaced hamate hook fractures, short arm cast immobilization is usually sufficient, along with close clinical follow-up to ensure there is no non-union. Displaced hook fractures or those that are associated with nerve or tendon irritation require a more involved approach. Excision needs to be performed in these settings, and it does not adversely affect grip strength or wrist range of motion. Excision is actually preferred to open reduction internal fixation. Hamate body fractures, on the other hand, are treated with a short arm cast for 4 to 6 weeks, if nondisplaced. Displaced hamate body fractures actually require an open reduction and internal fixation with either compression screws or low-profile plates. In some cases, temporary fixation across the carpometacarpal joints may also be required to aid in stability. Sometimes, rigid fixation is considered for these fracture patterns but may not always lead to desirable patient outcomes.

Overall, hamate fractures are quite rare and can be difficult to diagnosis, given the lack of experience of the radiologist and the intricate nature of the injury, and can lead to significant morbidity if not recognized and treated appropriately. Choosing the right treatment is the next critical step as full recovery depends on it. It has special relevance in sports medicine and lasting sequelae can severely compromise a sports career, making it all the more necessary to properly diagnose and treat it.

Boxer’s Fracture

A boxer’s fracture is a break (fracture) in one of the metacarpal bones of the hand. As these forms form knuckles, it is easy to imagine how they could break while boxing or punching hard surfaces with a closed fist. The fifth metacarpal (pinky finger) is most commonly injured, followed by the fourth metacarpal (ring finger). Most fractures are in the neck, or top, of the metacarpal bone near the knuckle.

It typically presents with a crack or pop sound at the time of injury. There will be pain around the fracture site, along with swelling, bruising, or discoloration. The knuckle may appear disfigured and flat if the break is severe.
Wrapping the hands or using boxing gloves to protect from injury when training is also important in order to prevent this type of injury

The diagnosis is based on clinical history and examination. The injured hand will be examined for deformity, tenderness, swelling, and discoloration. The local neurological exam is also performed to look for evidence for nerve damage. X-rays are obtained to diagnose the fracture.

 

The treatment begins with ice and elevation of the hand to lessen the swelling. Anti-inflammatory medication can also help with pain and swelling. Most such fractures will require immobilization in a cast or splint for 3-6 weeks. However, If there is a break in the skin at the time of the injury, then there is a high risk of infection and antibiotics should be prescribed. A careful surgical assessment is a need for open, complex, or displaced fractures. Physical therapy may be recommended to help regain full use of one’s hand. Surgery is also used for people who use their hands for minute motor skills, such as playing the piano or performing dentistry.

The best way to prevent a boxer’s fracture during boxing is to learn proper punching technique so that the initial contact is not with the fourth and fifth knuckles. Wrapping the hands or using boxing gloves to protect from injury when training is also important in order to prevent this type of injury.

Recovery time varies based on the severity of the fracture and the extent of ensuring treatment. If it was a simple fracture then the recovery may only last two to three weeks. But if surgery or physical therapy is required, then the recovery time may prolong up to four to six weeks or even longer.

It is important to keep to closely follow the doctor’s treatment plan, which includes keeping the splint on for the designated amount of time. It is equally important to follow the physical therapy regimen and perform all at-home exercises daily. Also, protect the injured hand while it heals. Recovery is faster if one eats a healthy diet rich in protein, calcium, and vitamin D. It is critically important to not use the injured hand until the doctor says it’s safe to do so. Stop smoking as it impairs tissue healing.

 

If the boxer’s fracture is diagnosed accurately and treated promptly, with the patient following the medical advice carefully, there are normally no long-term effects and full recovery is achieved in most cases.

Improve Bone Health to Prevent Orthopedic Injury

You don’t have to wait to reach a certain age to ensure optimal bone health. Most often, people tend to start worrying about bone health when issues, such as osteoporosis, have already set in. However, promoting bone health at an early age can drastically reduce the risk of orthopedic injuries.

Here are a few extremely effective tips to keep your bones healthy and strong.

Eat Calcium Rich Foods

Eat foods that promote bone health or foods rich in calcium. To increase the strength of your bones, include plenty of milk, yogurt, cheese, broccoli, kale and beans in calcium to your diet. Vitamin D is essential for calcium absorption. You can get your dose of Vitamin D through foods, Sun exposure or supplements.

Stay Active

It is vital to have an active lifestyle to promote bone health. Engage in weight-bearing exercises, such as walking, jogging and aerobics. Exercises, such as yoga and Pilates, are also important to make your core strong and reduce the likelihood of spine injuries.

Quit Smoking and Alcohol

Quit smoking and reduce your alcohol intake. Tobacco can weaken the bones and too much alcohol can prevent calcium absorption in the body.

Regular Health Checks

Talk to your doctor to determine the best ways of promoting bone health. Based on a variety of factors, such as your medical histyour doctor may suggest a combination of diet, exercise and other methods to ensure you have optimal bone health.

To learn more about shoulder and knee sports medicine treatments, call the top orthopedic surgeon in Gilbert, AZ, call OSPI Arizona at 480-899-4333. OSPI’s Board Certified orthopedic surgeons offer complete care and treatment for individuals in all stages of life, participating in all levels of activity.

The Sports Hernia

The sports hernia has been getting the buzz lately as many high-profile athletes have been diagnosed with it. But what is it?

A sports hernia is more accurately called athletic pubalgia. There is no real hernia but it is characterized by pain in the pubis seen in athletes. It is an increasingly common injury but the cause is not known. It may occur because of an imbalance of the strength of the muscles that attach to the pubis. In athletes involved in a rigorous workout happening all year round, it is possible that the lower extremity muscles may become preferentially strengthened compared to the abdomen, leading to an imbalance that can result in tearing of muscle fibers in the groin or abdomen.

The pain from a sports hernia typically begins slowly and increases gradually with continued activity. It is usually a one-sided groin or abdominal pain and is associated with sports that require frequent bending, twisting, and turning at speed. It can worsen with sudden twisting or turning.

Other nonsurgical treatments include treatments include dry-needling, therapeutic massage, and ultrasound therapy
The diagnosis is clinical, based on the findings mentioned above, but they can be seen with other conditions. X-rays and other imaging techniques are used to support the diagnosis.

Conservative treatment begins with rest, which ranges from a few weeks to a few months. Anti-inflammatory medication such as NSAIDs can help with pain relief at this time. In some cases, oral steroids may be prescribed. Physical therapy is recommended following the initial rest period, which is focused on strengthening the abdominal muscles as well as stretching the lower abdominal muscles and leg muscles. Other nonsurgical treatments include treatments include dry-needling, therapeutic massage, and ultrasound therapy. Steroid injections, nerve blocks administered to the ilioinguinal and iliohypogastric nerves, or platelet-rich plasma (PRP) injection are other such options and have varying success rates.

 

If rest and conservative treatment fail, surgery is the definitive treatment. There are various surgical approaches targeted at reinforcing the abdominal muscles, and restoring balance of muscles across the pelvis as needed. Surgery typically requires 6- to 8-week period of intensive physical rehabilitation to rebuild muscle strength and endurance after surgery. Some surgical approaches may involve the placement of a synthetic mesh in the groin area to help stabilize the injury. While up to 80% of these procedures are reported to be successful, with the athlete returning to sport, some treatment-resistant cases of sports hernia require multiple surgeries.

Sports hernia is a new name for a known condition of athletic pubalgia, and it can be quite disabling, making it impossible for the athlete to play the sport. It is also quite likely to be misdiagnosed, so getting the right diagnosis is critical, which can sometimes mean getting second/third consults. Once diagnosed, the athletes have to work closely with their physicians to find a way to manage their injury, ensuring a successful and timely return to the sport.

Paget’s Disease of the Bone

Paget disease of the bone is a chronic condition that causes the bones to become dense, enlarged and deformed, leading to fragile bones that fracture. It is the most common bone disorder after osteoporosis in adults after the age of 50. The risk of Paget’s disease of bone increases with age and with family history.

Bone remodeling is defined as a process in which new bone tissue replaces old bone tissue. This process is affected by Paget’s disease, resulting in dense but brittle bones.  It most commonly affects the pelvis, skull, spine, and legs. Complications of Paget’s disease of bone can include broken bones, hearing loss and pinched nerves in your spine.

There are two types of Paget’s disease of bone: monostotic (when only one bone is affected), or polyostotic (when multiple bones are involved).
Paget’s is also associated with neurologic complications, such as deafness, facial nerve palsies, radiculopathies, and spinal cord compression
The exact cause of Paget disease of the bone is not known, but genetics are thought to play a role.

There is some evidence that viral infection may also have a role in its development. Proteins derived from the respiratory syncytial virus and measles virus are present in pagetic osteoclasts. Paget’s disease tends to aggregate in families. First-degree relatives of patients with Paget ’s have a 7- to 10-fold increased risk of developing the condition.

While about 70% of patients with PDB are asymptomatic, in the remaining cases, it presents with joint inflammation, bone deformity, pain, and predisposition to fractures.

 

Paget’s disease can cause skeletal deformities, such as bowing of long bones, enlarged skull, pelvic alterations, and osteoarthritis. It can lead to traumatic and pathologic fractures. Very rarely, it can lead to osteosarcomas, which have a poor prognosis (5-year survival rate of approximately 10%). Paget’s is also associated with neurologic complications, such as deafness, facial nerve palsies, radiculopathies, and spinal cord compression. If it affects the skull, that can lead to hydrocephalus, nerve entrapment, and cerebellar dysfunction, causing the symptoms of nausea, ataxia, incontinence, gait disturbance, or dementia. It is also associated with high cardiac output, hypercalcemia, and hyperparathyroidism, but these are all rare.

 

Tests that can be done to confirm/support the diagnosis include:

  • Serum alkaline phosphatase: these levels are raised in any condition of bone growth or an increased activity of bone cells.
  • Bone scan: This is a nuclear imaging test that shows blood flow to the bone and cell activity within the bone, which helps determine areas of abnormally high bone turnover. It detects up to 50% more lesions than seen on x-ray films.
  • X-ray films: It is the main mode of its diagnosis. It shows osteolytic, osteoblastic, or mixed lesions. Other characteristic features include transverse lucent areas, enlargement of bones, expanding lytic changes, thickened cortices, or osteoporosis with lytic involvement in the skull.
  • Bone biopsy: These may be done to confirm the diagnosis through tissue assessment, but they are mostly done if the malignant transformation of the bone is suspected, which is characterized by cortical destruction and the presence of a soft tissue mass outside of the bone.

Treatment is targeted at suppressing osteoclastic activity.  The most commonly used agents are the bisphosphonates (such as Etidronate) that inhibit bone resorption. Intravenous options are also available, such as pamidronate. Salmon and human calcitonin are also FDA-approved and are given subcutaneously.

Occupational Repetitive Strain Injury

Repetitive strain injuries (RSI) are a group of disorders that most commonly develop in workers whose work involves excessive and repetitive motions of the neck and upper extremity. There are quite a few occupations that comprise such activities. It is also quite common in people involved in sports activities.

 

It all starts with taking a careful history, performing a proper physical examination and specific diagnostic maneuvers to detect these musculoskeletal injuries.

 

RSI may be present in a range of ways – cervical syndrome, tension neck syndrome, thoracic outlet syndrome, and frozen shoulder syndrome. Injuries involving the elbow, wrist and hand joints include epicondylitis, carpal tunnel syndrome and ulnar nerve entrapment.

RSI may also occur as a result of sports and recreational activities

RSI is especially common in all kinds of workplaces. The disorders of the forearm flexor tendons are most common among workers at assembly lines and trainees, whereas the cervical rotation and side-flexion are most affected in office workers. RSI may also occur as a result of sports and recreational activities. These injuries result from repetitive and forceful motions, awkward postures, and other sports/work-related conditions and ergonomic hazards.

 

Occupationally induced RSIs are costly, creating a strong incentive for physicians to become familiar with the symptoms, signs, and risk factors so that they can be diagnosed early and properly treated.

 

Hand/forearm-related RSI are common in office settings – such as carpal tunnel syndrome, cubital tunnel syndrome, Guyon canal syndrome, lateral epicondylitis, and tendonitis of the wrist or hand. The diagnosis is clinical but MRI and ultrasonography can be used for the diagnosis, but the role of such imaging in the diagnosis of upper limb disorders remains unclear. Once diagnosed, exercise can be beneficial for non-specific upper limb disorders. Other options, such as the immobilizing hand braces and open carpal tunnel surgery release are beneficial for carpal tunnel syndrome. Nonsurgical management, such as topical and oral non-steroidal anti-inflammatory drugs, and corticosteroid injections are helpful for lateral epicondylitis. Exercise is probably beneficial for neck pain, as are corticosteroid injections and exercise for shoulder pain.

 

In general, mainstay of treatment is mainly conservative and consists of rest, application of ice or heat and anti-inflammatory drugs. It typically takes a few or months to completely resolve.

 

It is very important to make necessary modifications in the workplace in order to prevent many of these injuries. Assessing the exposure of workers to known risk factors is essential The ergonomics of the workplace should properly be studied and accounted for in order to prevent workplace-related RSI. Training staff and performing necessary workplace changes would allow the staff to more effectively use their workplace through increased office ergonomics knowledge and skills. Once such training and interventions are in place, it leads to an increase in workers’ office ergonomics knowledge and awareness, and that results in a significant decrease in work-related musculoskeletal disorders.

 

RSI that is sports-related, can also be prevented by getting professional training to ensure the technique is right and the chance of injury is minimized.

Can PRP injections reduce my knee pain?

PRP or Platelet Rich Plasma injections are a hot topic among patients who are looking for ways to delay a knee replacement. If you are wondering how PRP can reduce your pain and help you return to an active lifestyle, read on.

Platelet Rich Plasma

Your blood contains a fluid component, or plasma and red cells, white cells and platelets. PRP refers to the plasma derived from your blood along with platelets. This plasma is prepared such that it carries more platelets in volume than your whole blood. The concentration of platelets in PRP can be 2-10 times that in the patient’s blood and more growth factors.

During an injury, platelets help the blood to clot and bring hundreds of proteins including anti-inflammatory and growth factors. All these factors initiate a healing response at the site of injury.

PRP Injections

When used as a knee injection, PRP can stimulate natural healing in the injured or inflamed knee environment.

A PRP injections is prepared by drawing blood from the patient and spinning it in a centrifuge to separate the platelets from other blood cells. The concentrated platelets and the plasma are prepared for injection.

Benefits of PRP Knee Injections

PRP injections have proven highly beneficial in treating knee injuries.

  • Reduction in knee pain without surgery
  • improved joint function

Side effects of PRP injections are very limited since the injection components come from the patient’s own blood.

Candidates for PRP injections

You could be a candidate for PRP knee injection if you have –

  • knee pain, due to osteoarthritis, that affects your daily activity
  • some joint space remains
  • pain is mainly due to the inflamed soft tissues rather than bone pain
  • conservative treatments, such as physical therapy, bracing and anti-inflammatory medications, have failed

To learn more about best knee replacement and treatments, consult the top orthopedic doctors in Gilbert, AZ, call OSPI Arizona at 480-899-4333. OSPI’s Board Certified orthopedic surgeons offer complete care and treatment for individuals in all stages of life, participating in all levels of activity.

Anxiety and Bone Health

Anxiety has already been known to be harmful to our body in many ways, such increased cardiovascular risks. It’s now becoming apparent that anxiety and persistent stress are linked to an increased risk of bone fractures in postmenopausal women as per a recently published study in the journal of The North American Menopause Society (NAMS).

Postmenopausal women are already prone to developing osteoporosis, for which they are prescribed vitamin D. Their risk of developing fractures is a major concern and this risk grows as they age. Stress and anxiety now add to this concern by adding another common predisposing factor.

Studies have shown that women with anxiety disorders were almost twice as likely to develop osteoporosis than were those without anxiety. High anxiety levels have been shown to be associated with low bone mineral density, which is a key indicator of fracture risk. The most common sites of osteoporotic fractures in these women are the lumbar spine and femoral neck.
In addition to these risk factors, cigarette smoking, sedentary lifestyle and prolonged use of steroids are major risk factors of osteoporosis-related increased fracture risk.

Anxiety may cause more oxidative stress, which may be related to osteoporosis in postmenopausal women
There are several ways anxiety may affect bone health. It is postulated that there may be some degree of systemic inflammation in people with high anxiety levels, which leads to bone loss. Anxiety and stress cause high cortisol levels in the blood, which has a known effect on bone demineralization and brittleness. Anxiety may cause more oxidative stress, which may be related to osteoporosis in postmenopausal women. To make matters worse, you may be more prone to falls if you have an anxiety disorder. Furthermore, some antidepressants may also cause a decrease in bone mineral density as well.

 

Based on this, it is becoming increasingly evident that mental issues, specifically anxiety and stress should be addressed in all patients – this is even more important in women postmenopausal age as stress and anxiety in this population can lead to significantly high fracture risk. Approximately 7% of the world suffers from an anxiety disorder, and it is as common in women. There is a link between anxiety and low vitamin D levels, which might explain the connection between anxiety disorder and bone fractures.

 

Women’s peak bone mass is said to be at age 35. Ever woman seeing a doctor should be screened for anxiety disorders and high-stress levels during their clinic visits. They should be taking 1200 mg of calcium a day in order to minimize the risk of developing osteoporosis. It is also important to have sufficient magnesium and vitamin D — from either sun exposure or supplements. Furthermore, having a healthy lifestyle with activities such as walking, lifting weights, ensure good bone health.

In addition, these women should also avoid smoking, excessive drinking, taking excessive thyroid replacement medications, and/or medications such as steroids or proton pump inhibitors. If anxiety issues are indeed found on screening, they should be addressed and professionally handled – with various techniques including mindfulness, cognitive therapy, self-calming strategies, yoga, etc.

 

Urgent Orthopedic Injuries

While some orthopedic injuries can heal on their own, others require urgent treatment. Such injuries and problems include:

  • Cuts and lacerations
  • Fractures
  • Ligament tears
  • Painful, swollen joints
  • Pediatric injuries
  • Sports injuries
  • Sprains, strains, and discolorations

Orthopedic Injuries that should be urgently treated by an orthopedic doctor or surgeon –

Any injury or condition that can prove serious or life-threatening should be treated at a hospital ER, such as –

  • arm or leg is severely fractured and/or out of alignment
  • bone is fractured and exposed through the skin
  • significant blood loss has occurred
  • other injuries from falls or accidents are present
  • severely injured children

Children who require urgent orthopedic care include:

  • children with a fractured bone, are experiencing pain and/or are irritable, despite treatment and medication. Any pain, swelling, redness, tenderness at a site or injury that has been treated may also require urgent medical attention.
  • children who have no obvious symptoms of an injury but is crying, restless, feverish, and unable to walk. This could indicate a serious hip joint infection.
  • children with large, deep cuts or wounds
  • children with positional deformities of the limbs

To learn more about orthopedic injuries and treatments, call the top orthopedic surgeon in Gilbert, AZ, call OSPI Arizona at 480-899-4333. OSPI’s Board Certified orthopedic surgeons offer complete care and treatment for individuals in all stages of life, participating in all levels of activity. This includes orthopedic, physical therapy, chiropractic, medical weight loss, hormone replacement, performance training, pain management, podiatry, regenerative medicine, stem cell therapy and family practice.

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