KSF Orthopaedic

Ethics in Sports Medicine

noemail@ksfortho.com — Tue, 01 May 2007 15:00:00 GMT

(ABSTRACT) Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

American Journal of Sports Medicine 2007, May;35(5):840-4. Epub 2007 Jan 11.

1-May-07 10:00 AM

Suture Anchors in Arthroscopic Rotator Cuff Repair

noemail@ksfortho.com — Fri, 30 Mar 2007 19:00:00 GMT

(ABSTRACT)

The use if suture anchors in shoulder surgery has facilitated the rapid advancement of arthroscopic rotator cuff repair techniques. Innumerable anchor types have been developed which allow stronger, rapid, more effective arthroscopic rotator cuff repairs. Abundant research has been performed to maximize the efficacy of suture anchors in arthroscopic rotator cuff repair. The article reviews the literature regarding implant designs, technical considerations, clinical results, and complications of suture anchors in the arthroscopic treatment of rotator cuff tears.

Operative Techniques in Sports Medicine: Vol. 12, Iss.4; October 2004 (210-214)

30-Mar-07 2:00 PM

Locked knee caused by meniscal subluxation: magnetic resonance imaging and arthroscopic verification.

noemail@ksfortho.com — Fri, 30 Mar 2007 17:00:00 GMT

(ABSTRACT)

Subluxation or dislocation of an intact lateral meniscus is a controversial and rarely reported cause of knee pain and locking. We report a case of knee locking caused by lateral meniscal subluxation in the absence of a meniscal tear or true discoid meniscus, with both magnetic resonance imaging (MRI) and arthroscopic verification. A 9.5-year-old child experienced multiple episodes of locking in full flexion of the knee. After 6 months of symptoms, arthroscopy was performed and showed no meniscal tear or a discoid meniscus. The patient's knee locking recurred after arthroscopy. MRI was performed when the patient presented acutely with the knee locked. MRI showed anterior dislocation of the posterior horn of the lateral meniscus with the knee in the locked position. The MRI was immediately repeated after the author reduced (manipulated) the locked knee into extension. On the repeat MRI, the lateral meniscus had returned to a normal position. On repeat arthroscopy, the posterior horn of the lateral meniscus was hypermobile and could be displaced into the notch and did not show a frank tear. The meniscus was repaired to the capsule with sutures. At the 2-year follow-up evaluation, the patient had no complaints and no clinical signs of locking.

Arthroscopy. 2003 Oct;19(8):885-8

30-Mar-07 12:00 PM

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture.

noemail@ksfortho.com — Fri, 30 Mar 2007 16:00:00 GMT

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture. (ABSTRACT)

This retrospective study evaluated the results of the Darrach procedure and the Sauve-Kapandji procedure for the treatment of distal radio-ulnar joint derangement following malunion of dorsally displaced, unstable, intraarticular fractures of the distal radius in patients under 50 years of age. Twelve of 18 possible patients in the Sauve-Kapandji group completed the disabilities of the arm, shoulder, and hand survey at a mean of 4 years postoperatively and nine of the 18 returned for a follow-up examination at a mean of 2 years. Twenty-one of 30 possible patients in the Darrach group completed the disabilities of the arm, shoulder, and hand survey at a mean of 6 years postoperatively and 13 of these 30 returned for follow-up examination at a mean of 4 years. The Darrach procedure and the Sauve-Kapandji procedure yielded comparable and unpredictable results with respect to both subjective and objective parameters.

Journal of Hand Surgery (Br). 2004 Dec;29(6):608-13

J Hand Surg [Br]. 2004 Dec;29(6):608-13

30-Mar-07 11:00 AM

Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction

noemail@ksfortho.com — Thu, 29 Mar 2007 13:00:00 GMT

Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction (Abstract)

Failed anterior cruciate ligament (ACL) reconstruction presents a difficult clinical challenge. Successful revision ACL reconstruction depends on identifying the causes of failure and correcting technical or diagnostic errors. Failed ACL reconstruction may be either traumatic or atraumatic. Atraumatic failures may be attributable to technical errors, diagnostic errors, or failure of graft incorporation. Published outcomes of revision ACL reconstruction have been worse than for primary ACL reconstruction. The preoperative evaluation, surgical techniques, and clinical outcomes of revision ACL reconstruction are reviewed.

American Journal of Sports Medicine:2006 Dec;34(12):2026-37.

29-Mar-07 8:00 AM

Shoulder Impingement Syndrome

noemail@ksfortho.com — Thu, 29 Mar 2007 13:00:00 GMT

Shoulder Impingement Syndrome (Abstract)

Subacromial impingement syndrome is a common cause of shoulder pain. The purpose of this article is to review the clinical presentation, physical examination findings, and differential diagnosis of impingement syndrome. Using an evidence-based approach, we propose an algorithm for the management of subacromial impingement syndrome including indications for nonoperative management, advanced imaging, and operative management.

American Journal of Medicine:2005 May;118(5):452-5.

29-Mar-07 8:00 AM

Endoscopic versus Rear-Entry ACL Reconstruction: A systematic Review

noemail@ksfortho.com — Tue, 27 Mar 2007 15:00:00 GMT

George MS, Huston LJ, Spindler KP. "Endoscopic versus Rear-Entry ACL Reconstruction: A systematic Review." Clinical Orthopaedics and Related Research 2007 Feb;455:158-61

Vanderbilt University Medical Center, Nashville, TN 37232-8774, USA.

Anterior cruciate ligament reconstruction is commonly performed using the all-endoscopic (also known as all-inside or single-incision) method or the rear-entry (also known as outside-in or two-incision) method. We report a systematic review of four prospective, randomized clinical trials comparing these two operative techniques. Operative time was shorter in the all-endoscopic groups in two studies. A higher percentage of patients in the rear-entry group had a difference of 3 mm or less on the KT-2000 arthrometer, although the two surgical techniques were similar in the other studies. A higher rate of return to full activity was achieved in patients undergoing the rear-entry technique in one study. All four studies were similar in pain medication used, progression of rehabilitation, range of motion, quadriceps or hamstring strength, patellofemoral pain, one-leg hop test, Lysholm, Tegner, and International Knee Documentation Committee scores. Overall, these studies show similar outcomes comparing the all-endoscopic and rear-entry anterior cruciate ligament reconstruction techniques.

27-Mar-07 10:00 AM

Shoulder Labral Tears

noemail@ksfortho.com — Wed, 14 Mar 2007 15:00:00 GMT

SHOULDER LABRAL TEARS
   The shoulder joint is composed of a ball (humeral head) and a socket (glenoid). The glenoid has a greater radius of curvature than the humeral head, making the shoulder inherently unstable.
   A rim of fibrous tissue (labrum) surrounds the socket and acts as a bumper to help keep the shoulder joint stable. The labrum also serves as the attachment of the biceps tendon as well as several stabilizing ligaments of the shoulder. Injuries to the shoulder such as dislocations and falling on the outstretched arm can cause the labrum to tear off of the bone.

What are the symptoms?
Tears in the front of the socket are called Bankart tears and lead to recurrent instability of the shoulder. This leads to shoulder weakness and a feeling that the joint is slipping out of place.
    Tears at the top of the labrum near the biceps tendon attachment are called SLAP tears, which stands for Superior Labrum Anterior to Posterior. SLAP tears can cause pain with lifting and overhead reaching, as well as popping, catching, or clicking.
   X-rays can show bony injuries that may contribute to the shoulder pain and instability, although the labrum cannot be seen on xray. On physical exam, special tests are performed to determine the cause of the shoulder symptoms.MRI is used to visualize the soft tissues of the shoulder including the labrum and the rotator cuff.

How are they Treated?
   In some cases, physical therapy and anti-inflammatory medications may help relieve the symptoms. When a labral tear is present and conservative treatment has not improved the symptoms, surgery may be necessary. In the past, operative treatment of shoulder instability consisted of open surgery with large, painful incisions and slow recovery.
Recent advancements in shoulder arthroscopy have allowed Bankart and SLAP repairs to be performed via small, arthroscopic incisions, which speed recovery and minimize postoperative pain and stiffness. The labrum is re-attached with sutures that also repair the torn shoulder ligaments and tendons. Rehabilitation after surgery is aimed at strengthening the muscles around the shoulder to aid in the overall strength and stability of the shoulder.

14-Mar-07 10:00 AM

Patellofemoral Syndrome

noemail@ksfortho.com — Wed, 14 Mar 2007 15:00:00 GMT

PATELLOFEMORAL SYNDROME
   Patellofemoral syndrome (formerly known as chondromalacia patellae) is a dysfunction of the mechanics of the patella (knee cap). The patella normally rides in a groove in the femur known as the trochlea. The quadriceps muscle in the front of the thigh and the hamstring muscle in the back of the thigh control the motion of the patella. When the muscles become imbalanced, the patella does not ride normally in the trochlea, causing pain and sometimes a feeling of instability around the patella.

Where is the pain?
   Patellofemoral pain is typically most pronounced in the front of the knee or behind the patella, although pain in the back of the knee and in the muscles around the knee is also frequently seen. The pain tends to be worse with running, going up and down stairs, and when the knee muscles are tight.

How is it treated?
   Physical therapy is aimed at rebalancing the muscles that control the patella by stretching the quadriceps and hamstring muscles and strengthening the specific muscles around the knee that centralize the patella. Braces and anti-inflammatory medications may also be beneficial. If conservative treatment is unsuccessful, surgery is rarely necessary to realign the patella.

14-Mar-07 10:00 AM

Basal Joint Arthritis

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Basal Joint Arthritis
   Arthritis is a disease that causes inflammation and stiffness in the joints.It often affects the joint at the base of the thumb. This joint is called the carpometacarpal joint.
   CMCJ arthritis occurs as a result of wear and tear on the joint. It is more likely to occur at a younger age if you have fractured or injured your thumb. Repeated gripping, twisting, or turning objects with your hand may make symptoms worse.
   If you have CMCJ arthritis, you may notice pain in the lower part of the thumb associated with swelling and stiffness. You may frequently drop things due to the pain.
   Your doctor can diagnose CMCJ arthritis by examining your hand and by taking x-rays.

If arthritis is diagnosed early, it may respond to conservative treatment which includes:
• A thumb spica splint that you wear all the time (except when bathing) for 6 weeks. This splint prevents movement of your thumb and helps reduce the inflammation.

• Oral anti-inflammatory medication.

• A small injection of cortisone into the thumb joint to help reduce the inflammation.

    If this treatment does not relieve the pain and stiffness, or if arthritis has destroyed the joint, your doctor may recommend surgery. The diseased joint is removed and rebuilt with a piece of tendon (graft) taken from your wrist.
   The approximate recovery time for this surgery is 3 months, but that does not mean that you can’t use your hand at all for that time. It means that you will be limited in motion and strength during the healing process.
   Arthritis does not have to prevent you from doing the things that you enjoy most. Successful treatment is available.

14-Mar-07 9:00 AM

Meniscus Tears

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Meniscus Tears
   The meniscus is a specialized C-shaped cartilage in the knee. The medial (inner) meniscus and the lateral (outer) meniscus act as a cushion in the knee to prevent the joint cartilage surfaces from grinding against each other. Meniscus tears in young patients are usually caused by a traumatic twisting injury to the knee and may be seen in combination with other ligament and cartilage injuries to the knee. In older patients, the meniscus can tear over time without any specific injury.

How are they diagnosed?
   Signs of meniscus tears include pain on the inner or outer part of the knee, swelling, tenderness, popping, locking, and buckling of the knee. Xrays do not show the meniscus, but they can show fractures, arthritis, or other causes of knee pain. MRI can show tears in the meniscus as well as injuries to the ligaments and tendons around the knee.

How are they treated?
   Arthroscopic surgery is usually recommended for painful meniscus tears. Most tears involve the central part of the meniscus and are treated with removal of the torn portion (partial meniscectomy). Some tears in young patients involve the outer rim of the meniscus and can be repaired with sutures (meniscal repair). Full recovery can usually be expected in 4-6 weeks.

14-Mar-07 9:00 AM

DeQuervain’s Tenosynovitis

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

DeQuervain’s tenosynovitis
   Many different problems, from a simple sprain to severe arthritis, can cause pain or swelling
of the wrist. One of the more common causes of wrist pain and swelling is DeQuervain’s tenosynovitis.
   DeQuervain’s tenosynovitis is inflammation of tissue on the thumb side of the wrist. Tendons (cord-like fibers that attach muscle to bone) and synovium (a slick membrane that covers tendons and allows them to move easily) become irritated, causing pain. The pain is felt on the thumb side of the wrist and swelling is often present.
   Your doctor can tell, from examining the wrist and hand, whether the tendons are inflamed
   Causes of DeQuervain’s include repetitive motion of the wrist, overuse, direct trauma, and inflammatory diseases such as rheumatoid arthritis. DeQuervain’s often occurs in new mothers, as they overuse their wrists lifting little ones.

Treatment includes:
• Rest (taking a break from activities that cause pain).
• Oral anti-inflammatory medications (to decrease inflammation).
• A thumb spica splint (to rest the thumb and wrist and to decrease inflammation).
• A small injection of cortisone in the wrist (to decrease inflammation).
   If other treatments do not relieve the pain, then surgery may be recommended. The ligament tunnel that surrounds the tendons is released so the tendons can move easily.
This helps to reduce the inflammation and pain. Sometimes, hand therapy is needed after surgery to regain strength and motion and to help decrease swelling and pain.
   Many patients’ pain and swelling resolve with non-operative treatment. If surgery is required, the recovery period is short with minimal limitation in using your hand.

14-Mar-07 9:00 AM

Rotator Cuff Injuries

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Rotator Cuff Injuries
   The rotator cuff is the group of four tendons (supraspinatus, infraspinatus, teres minor, and subscapularis) that helps rotate the shoulder and aid in overhead reaching. It also acts to depress the top of the humerus, opening the space between the humerus and the bone above it, known as the acromion.

What is the difference between rotator cuff tendonitis and a rotator cuff tear?
   Rotator cuff tendonitis (also known as “bursitis” or “impingement”) is an inflammation of the rotator cuff tendon. As a result of the weakness and inflammation in the rotator cuff, the humerus rides up against the acromion above it, leading to painful scar tissue, bursitis, and bone spurs.
   A rotator cuff tear is a condition in which a part of the rotator cuff, usually the supraspinatus, is torn from its attachment to the humerus. Rotator cuff tears can be partial thickness, where some fibers have torn and some are still intact, or full thickness, where a portion of the rotator cuff has completely torn off of the bone.

What causes rotator cuff problems?
   Rotator cuff injuries may be caused by a specific incident such as a fall on the arm, or may come on gradually with no inciting event. Symptoms include weakness, pain with overhead motion, pain at night, and popping in the shoulder.

How is it diagnosed?
   History and physical exam is important in differentiating rotator cuff problems from other shoulder problems. The rotator cuff cannot be seen on xray. MRI is useful to visualize the rotator cuff and other structures in the shoulder.

What are the treatment options?
   Conservative treatments such as physical therapy, anti-inflammatory medications, and injections may relieve the symptoms. When nonoperative treatments do not help, surgery may be necessary. Innovative, new surgical techniques allow rotator cuff surgery to be performed arthroscopically, avoiding the large, painful incisions of open surgery. Arthroscopic rotator cuff repair is outpatient surgery performed through very small incisions. Bone spurs and bursitis above the rotator cuff are arthroscopically removed. If the rotator cuff is torn, the tendon is repaired back to the bone using arthroscopically placed sutures. Postoperative rehabilitation focuses on regaining shoulder motion and strength. A sling is usually worn for 4-6 weeks postoperatively. Full recovery can be expected after 3-4 months.

14-Mar-07 9:00 AM

ACL Tears

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Anterior Cruciate Ligament (ACL) Tears
The anterior cruciate ligament (ACL) is the main ligament that controls the rotation of the knee. The ACL is important in providing stability during cutting and pivoting motions of the knee.

What are the other main ligaments of the knee?
   The other main ligaments of the knee are the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). These ligaments provide stability to the knee in all directions of motion.

How is the ACL torn?
   ACL tears occur when the knee is twisted inwardly such as in a sports injury or a twisting fall. The knee usually becomes immediately swollen and painful. When the ACL tears, other structures inside the knee such as the meniscus and other ligaments can tear as well. The ACL does not repair itself after it is torn.

What are the symptoms?
   Immediate pain and swelling usually occurs. The knee becomes unstable because the torn ACL no longer controls the rotation of the knee. A feeling of the knee shifting or buckling is common.

How is it diagnosed?
   On physical exam, special tests are performed to determine if the ACL and the other key structures in the knee are intact. The ACL cannot be seen on xray. MRI is used to visualize the ACL as well as the meniscus and other ligaments in the knee.

How is it treated?
   ACL tears in young, active patients are generally treated with surgical reconstruction. In patients with a more sedentary lifestyle, conservative treatment may be recommended initially. If knee instability continues despite nonoperative treatment, then surgery may be necessary.
   ACL reconstruction involves replacing the torn ACL with a tendon graft usually taken from another part of the knee. The tendon graft is passed through bone tunnels in the femur and tibia and secured with a screw on each end. Postoperative recovery is focused on regaining the strength and motion of the knee. Generally, patients are allowed to run after two months, and return to cutting and pivoting activities after four months.

14-Mar-07 9:00 AM

Tennis or Golfer's Elbow

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Lateral Epicondylitis (Tennis Elbow)
   Epicondulititis is an irritation or inflammation of the tendons around the elbow joint. Lateral Epicondylitis (tennis elbow) is a painful condition on and around the bony prominence (epicondyle) on the outside (lateral side) of the elbow. Pain may radiate down your arm. Gripping or extending your wrist may intensify the pain.

Medial Epicondylitis (golfer’s elbow) describes a similar condition. The pain focus is the knobby bump on the inside of the elbow closest to the body (the medial side).
   Both tennis elbow and golfer’s elbow typically result from repetitive arm movement. Over-using the muscles in your arm can lead to tiny tears (micro tears) in the tendons that attach the muscles in your forearms to the epicondyles.
   If you continue to do the activity without allowing the tears to heal, the tendons can become inflamed and very painful.
   This condition can be caused by excessive use of your arm such as long sessions practicing your golf swing or tennis stroke and in many other activities including painting, raking, pitching, rowing, hammering and using a screwdriver.

Treatment may involve:
   • Rest, which allows the micro- tears to heal. If the symptoms are sports-related, you might
examine your technique and equipment. You may need to take breaks during work or play; avoid activities or movements which cause pain; and limit heavy lifting, pushing, or pulling.

   • Ice Pack, applied to painful area for approximately 20 minutes 3 times a day, to decrease inflammation and pain. (Do not place ice directly on the skin)

   • Anti-inflammatory medication, an oral medication to help relieve inflammation and pain.

• Steroid injection, a locally acting injection to help decrease inflammation and pain.

• Counterforce brace (elbow cuff) worn during the day hours to help support the inflamed tendon.

• Cock-up wrist splint (wrist brace) worn during the night hours to help rest the tendon.

   • Physical Therapy (3 times a week for approximately 6 weeks) initially to decrease pain and inflammation, maintain muscle strength, and finally to increase strength and endurance.

   • Surgery – if all else fails.

14-Mar-07 9:00 AM

Ganglion Cysts

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Ganglion Cysts
   Have you noticed any lumps or bumps on your hand or wrist? You may have a ganglion cyst. A ganglion cyst is a firm, fluid-filled mass that may appear on the back of the wrist, palm side of the wrist, or at the base of the fingers. These cysts usually come from a nearby joint or around a tendon. Although ganglion cysts are common, they do not spread, do not become cancerous but can often change in size and sometimes disappear by themselves.
   A ganglion cyst may be painful, especially when using your wrist and hand. Most often, there is no specific cause, however, ganglion cysts may occur after an injury to the wrist.
   Your doctor can usually diagnose a cyst by examining your hand. He may order an x-ray to rule out other problems such as arthritis.
   Some ganglion cysts will shrink and become painless without treatment. If the cyst becomes unsightly or painful, your doctor may recommend:

•Extracting fluid from the cyst with a needle followed by an injection of cortisone to relieve
the irritation.
•A pressure dressing worn at all times, except when bathing, for 2 weeks.
•A wrist splint worn at all times, except when bathing, for 4 weeks.

   If other treatments do not relieve your symptoms or if the cyst returns after conservative treatment, your doctor may recommend outpatient surgical removal.

14-Mar-07 9:00 AM

Carpal Tunnel Syndrome

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Carpal Tunne Syndrome
Carpal tunnel syndrome (CTS) is a common problem that affects the hand, wrist and fingers. This condition occurs when there is increased pressure on the median nerve at the wrist.
   The median nerve travels from the forearm into the hand through a “tunnel” in your wrist – the carpal tunnel. Wrist bones form the bottom and sides of the tunnel and a ligament covers the top. This tunnel also contains nine tendons. Increased pressure within the carpal tunnel squeezes the median nerve. Eventually the pressure affects the functioning of the nerve which may result in numbness, tingling and pain.
   Your doctor may confirm the diagnosis of CTS by the following: a physical examination, an x-ray and an EMG (electromyography)or NCS (nerve conduction study) will be ordered to determine the severity of the CTS.
   Causes include anything that causes swelling of the tendons or decreases the space in the carpal tunnel, such as, repetitive use of the hand and wrist or regular use of vibrating instruments. Some other causes could be, fractures (broken bones in the hand or wrist) arthritis, thyroid disease, diabetes and pregnancy.
   Symptoms of CTS may include: numbness and tingling in the hand (often at night or after use), aching or pain that may radiate up the forearm towards the shoulder, a feeling that you have “poor circulation” making you shake your hands to try and restore the circulation,
and clumsiness or weakness in handling objects.

Treatment includes:
• Wearing a wrist splint to keep the wrist from bending may treat mild cases.

• Non-steroidal anti-inflammatory medications may be prescribed to decrease
swelling and pain.

• A small cortisone injection into the carpal tunnel may be given to decrease inflammation.

    If these simple measures fail to control your symptoms, a carpal tunnel release may be required to reduce the pressure on the median nerve and prevent irreversible damage.
   The surgery is an outpatient procedure. The procedure itself takes approximately 15
minutes, although you will be at the hospital for a total of approximately 3 hours.

14-Mar-07 9:00 AM

Total Shoulder Replacement

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

TOTAL SHOULDER REPLACEMENT
What is shoulder arthritis?
   The shoulder joint is a ball and socket joint. The joint surfaces are normally covered by a smooth cartilage layer. Arthritis is a degeneration of the joint cartilage. Over time, the cartilage becomes thin, sometimes to the point that bone rubs on bone inside the joint. This process eventually leads to bone spurs and painful scar tissue in and around the shoulder joint.

What are the symptoms and treatments of shoulder arthritis?
   The pain associated with shoulder arthritis may be gradual in onset, or may be worsened by an injury to the shoulder. Symptoms of shoulder arthritis include stiffness, pain with motion,popping, and pain at night. The severity of the arthritis can usually be determined on xray and physical exam. MRI and CT scan can be useful to evaluate the arthritis as well as other potential causes of shoulder pain.
   Initial treatment of shoulder arthritis includes anti-inflammatory medications, physical therapy, and injections. When nonoperative treatments do not relieve the pain, surgery may be necessary.

What is total shoulder replacement?
   Shoulder replacement is similar to joint replacement in other joints such as the knee and hip. The arthritic joint surface of the humerus is replaced with a metal ball connected to a metal stem that fits inside the humerus. The arthritic socket is replaced by a plastic socket that is secured by bone cement. Recovery typically includes an overnight stay in the hospital and several weeks of physical therapy. Excellent motion and shoulder function is usually seen after full recovery.

14-Mar-07 9:00 AM

Trigger Finger

noemail@ksfortho.com — Wed, 14 Mar 2007 13:00:00 GMT

Stenosing Tenosynovitis (Trigger Finger)
   If you wake up in the morning and your thumb or finger is “locked” in a flexed position, you may have a trigger finger. Trigger finger or (Stenosing Tenosynovitis) is inflammation around the tendons to your fingers or thumb.
   Tendons (cordlike fibers that attach muscle to bone and allow you to bend your fingers) are held in place on the bones by a series of ligaments called pulleys. These pulleys form a series of arches through which the tendons run along the bone. To keep tendons moving smoothly through these pulleys, the tendons are wrapped in a slick membrane called tenosynovium.
   Irritation to the tendon or the tenosynovium may cause a nodule to form, which makes it difficult for the tendon to slide through the pulley. When the tendon catches and then suddenly releases, you feel a “triggering” sensation.
   The cause of a trigger finger is not always clear. Anything that irritates the tendons in the finger, such as repeated use of tools, rheumatoid arthritis, gout, or diabetes can lead to the development of trigger finger. When you have a trigger finger, you will feel discomfort or pain where the finger or thumb joins the palm. You may have swelling or thickening at the base of the finger or thumb. A clicking sensation is often felt when the finger is bent. The finger may lock in a bent or straight position.
   Your doctor can tell from examining your finger or thumb whether a tendon is inflamed and triggering is occurring.

    The treatment for a trigger finger is aimed at decreasing the inflammation around the tendon and tendon sheath.
This includes:
• Resting the finger or thumb. Sometimes a splint is used
• Taking oral anti-inflammatory medication.
• A small injection of cortisone into the area of inflammation.

     If other treatments do not relieve your symptoms then a trigger finger release may be performed to open the pulleyand allow thetendon to glide smoothly again.
    This is an outpatient surgery. Normal use of the hand can be resumed once comfort permits. Occasionally, hand therapy is indicated after surgery to help you regain your motion and strength.

14-Mar-07 8:00 AM

Listen to Dr. Michael S. George's Appearence on ESPN Radio

noemail@ksfortho.com — Mon, 26 Feb 2007 17:00:00 GMT

26-Feb-07 11:00 AM