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Glenohumeral “Shoulder” Arthritis

Have you even woken up in the morning with stiffness in one of your joints? Do you find yourself noticing clicking, popping, or grinding when you move your joints? What about swelling especially after using the joint? You may be one of several million people in the United States who is affected by osteoarthritis. Osteoarthritis is a process that may affect any joint in the body including the shoulder. Arthritis is known as general “wear and tear” of the cartilage in the joint and generally affects people older than 50. The purpose of the cartilage is to provide a smooth surface so that the bones move with ease. As this cartilage wears away, the ragged surface of the cartilage and then the surface of each bone begins to rub together causing inflammation to occur which leads to pain. Once the process begins there is no cure, but fortunately there are several treatments to help alleviate the associated symptoms.

Today we’ll discuss arthritis of the shoulder, or glenohumeral joint. As demonstrated in the picture below, the shoulder is made of three bones: the scapula, clavicle and the humerus. Shoulder arthritis occurs in the glenoid of the scapula and the head of the humerus.

Shoulder Blog 1

Symptoms include pain, a grinding sensation with movement, and stiffness. The severity may range from a mild nuisance to debilitating. When discussing your symptoms with your healthcare provider, they may obtain an x-ray of your shoulder. Some of the findings of an arthritic shoulder are demonstrated in the picture below. The x-ray on the left demonstrates a normal healthy shoulder and the one on the right demonstrates an arthritic shoulder. As we compare the two x-rays, we notice that the arthritic shoulder has a loss of the joint space and bone spurs (aka osteophytes).

Shoulder Blog 2

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It is always important to discuss your symptoms with your healthcare provider before beginning any treatment regime. Nonoperative treatments may include suggestions such as over-the-counter non-steroidal anti-inflammatories (NSAIDs), such as Ibuprofen or Aleve, application of heat or ice, home exercises, and steroid injections. For those with advanced arthritis, your healthcare provider may refer you to an orthopedic surgeon for consideration of a total joint replacement.

The following is a link to more information about shoulder arthritis through the American Academy of Orthopaedic Surgeons: http://www.orthoinfo.org/topic.cfm?topic=A00222

-Christopher Pokabla, M.D.

-Lacy D. Johnson, P.A.

 

Concussions

In the past few years, we have seen the media bring the subject of concussions into the spotlight. One movie in particular, “Concussion” starring Will Smith highlighted the potential long-term effects of repetitive brain trauma in NFL players. The Center for Disease Control estimates that 1.6 to 3.8 million people in the United States will suffer a sports-related mild traumatic brain injury this year, which we can all agree is a significant number. This raises several questions with athletes, parents, coaches, and athletic trainers. How do we know if an athlete has sustained a concussion? How should they be treated? When can they return to their daily activities, school, and sports? How are they prevented?

Concussions have several different definitions ranging from “complete loss of consciousness” to “getting your bell rung”. In the 2016 Journal of the American Academy of Orthopaedic Surgeons article Concussions in Sports: What Orthopaedic Surgeons Need to Know? it was stated “The Concussion in Sport Group formally defined concussion as a complex pathophysiological process affecting the brain, induced by biomechanical forces.” What does this mean? Essentially, after the brain sustains an injury whether direct or indirect, the chemicals produced in the brain go into overdrive leading to symptoms such as confusion, headaches, irritability, nausea, vomiting, depression, or dizziness. Why don’t we just order a CT or MRI to determine if a concussion is present? A great question! The answer is that these tests are typically normal in a concussed patient and do not help us with diagnosis. This is why it is important for players, parents, coaches, and athletic trainers to know the symptoms. The severity of the symptoms can range from person to person. This in turn can make it difficult to determine if an athlete has sustained a concussion, but once the symptoms are recognized it is essential for them to be removed from the sport until cleared by a medical provider.  Your family physician, a sports medicine physician, or a neurologist are doctors that can treat patients with concussions. If a player returns to sports too soon or before being cleared by a doctor, it may prolong or even worsen their symptoms.

Once we have determined an athlete is concussed, how should they be treated? The answer always incorporates REST in the treatment plan! Both mental and physical rest may be necessary until patients are symptom free. We all know what physical rest is, but what is meant by mental rest? This includes limiting television, video games, and occasionally reading until symptoms resolve. Both players and parents of young athletes must be educated on the importance of being symptom free prior to return to play. While concussions may not be 100% avoidable, prevention is still an important factor. Making sure players have proper equipment and understand safe techniques for their sport can potentially aid in the prevention of concussions.

The following is a link to more information about concussions through the American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/topic.cfm?topic=A00574

-Christopher Pokabla, M.D.

-Lacy D. Johnson, P.A.

Dr. Harold Knight Retires

It is with mixed emotions that we announce the retirement of Dr. Harold Knight.  He has provided Memphis Orthopaedic Group with 34 years of service, sacrifice, and dedication.  Things around here won’t be the same!

Dr. Knight you will be sorely missed and impossible to replace!  However, we know you have plans to travel and OU games to attend.  Thank you for your 34 years with Memphis Orthopaedic Group!  We wish you nothing but the best!

 

Treatment Options for Rotator Cuff Tears

What are the treatment options for rotator cuff tears?  First and foremost, what is the rotator cuff?  It’s a group of four tendons all of which come from muscles that originate on the scapula or shoulder blade.  The tendons then attach to the “ball” of the shoulder joint forming about 1/2 of a shirt sleeve cuff from the front to the back of the “ball”.  The two middle tendons on the top of the ball are the one’s usually torn.  If you’re under forty years of age you probably don’t have a rotator cuff tear, i.e., the older you are the more likely the diagnosis. The under forty crowd most likely has rotator cuff tendinitis or, if injured, a shoulder separation, dislocation, or labral tear.   Middle-aged patients(forty to sixty years old roughly) tend to tear the rotator cuff after injuries whereas degenerative tears are more likely the older one gets. On the job rotator cuff tears are quite common.  

 Treatment options are conservative or nonsurgical, and surgical.  I treat most of my younger very active patients with surgery simply because they rarely respond to injections and physical therapy.  Surgery has a high success rate generally especially in healthy nonsmoking patients and many of these patients can resume normal activities and work several months after the repair. Rotator cuff surgery is easier and more likely to be successful if I can do the repair less than six months after symptoms begin.   Repeat surgery is required in less than 10% of patients. 

 Older patients have a much better chance of responding to injections, physical therapy, home exercises, activity modification, and “wait and see” treatment.  

 Hope this helps.  Thanks for your time.

Mark Harriman, M.D. 

Low Impact Exercise

As we age past 40, our bodies lose muscle mass and bone density. So it is certainly wise to exercise in order to maintain as much muscle mass and bone density as possible.

That being said it’s important to listen to your body. In our 20’s and 30’s, the mantra for exercise is “no pain, no gain.”

I would suggest that after 40 you should listen to your body. If a certain exercise hurts, you may want to modify, decrease reps or even discontinue it altogether.

Safe low impact exercises include biking, ellipticals, rowing machines, yoga, Pilates and pretty much anything in a pool.

So try to implement some of these into your regular routine!

-Kenneth Grinspun, M.D

Female Athlete Triad: Problems Caused by Extreme Exercise and Dieting

Female Athlete Triad: Problems Caused by Extreme Exercise and Dieting

Sports and exercise are healthy activities for girls and women of all ages. Occasionally, a female athlete who focuses on being thin or lightweight may eat too little or exercise too much. Doing this can cause long-term damage to health, or even death. It can also hurt athletic performance or make it necessary to limit or stop exercise.

Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these conditions are known as the “female athlete triad.”

The three conditions are:

  • Disordered eating
  • Abnormal eating habits (i.e., crash diets, binge eating) or excessive exercise keeps the body from getting enough nutrition.
  • Menstrual dysfunction

Females at Risk

Females in any sport can develop one or more parts of the triad. At greatest risk are those in sports that reward being thin for appearance (such as figure skating or gymnastics) or improved performance (such as distance running or rowing).

Others feel pressure to lose weight from athletic coaches or parents.

Female athletes should consider these questions:

  • Are you dissatisfied with your body?
  • Do you strive to be thin?
  • Do you continuously focus on your weight?

Female Athlete Triad

Disordered Eating

Although they usually do not realize or admit that they are ill, people with disordered eating have serious and complex disturbances in eating behaviors. They are preoccupied with body shape and weight and have poor nutritional habits.

Females are five to 10 times more likely to have disordered eating compared with males, and the problem is especially common in females who are athletic. The illness takes many forms. Some people starve themselves (anorexia nervosa) or engage in cycles of overeating and purging (bulimia).

Others severely restrict the amount of food they eat, fast for prolonged periods of time or misuse diet pills, diuretics, or laxatives. People with disordered eating may also exercise excessively to keep their weight down.

Disordered eating can cause many problems, including dehydration, muscle fatigue and weakness, an erratic heartbeat, kidney damage, and other serious conditions. Not taking in enough calcium can lead to bone loss. It is especially bad to lose bone when you are a child or teenager because that is when your body should be building bone. Hormone imbalances can lead to more bone loss through menstrual dysfunction.

Menstrual Dysfunction

Missing three or more periods in a row is cause for concern. With normal menstruation, the body produces estrogen, a hormone that helps to keep bones strong. Without a menstrual cycle (amenorrhea), the level of estrogen may be lowered, causing a loss of bone density and strength (premature osteoporosis).

If this happens during youth, it may become a serious problem later in life when the natural process of bone mineral loss begins after menopause. Amenorrhea may also cause stress fractures. Normal menstruation is necessary for pregnancy.

Doctor Examination

Recognizing the female athlete triad is the first step toward treating it. See your doctor right away if you miss several menstrual periods, get a stress fracture in sports, or think you might have disordered eating.

Give the doctor your complete medical history, including:

  • What you do for physical activity and what you eat for nutrition.
  • How old you were when you began to menstruate and whether you usually have regular periods.
  • If you are sexually active, use birth control pills, or have ever been pregnant.
  • If you have ever had stress fractures or other injuries.
  • Any changes (up or down) in your weight.

Your doctor will give you complete physical examination and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In some cases, a bone density test will be recommended.

Treatment

Treatment for female athlete triad often requires help from a team of medical professionals including your doctor (pediatrician, gynecologist, family physician), your athletic trainer, a nutritionist, and a psychological counselor.

 

Last reviewed: October 2009

Co-developed with the American Orthopaedic Society for Sports Medicine

Shawn Matsunaga, ATC

Shawn-Matsunaga-e1434650533424

Shawn Matsunaga received his degree in Physical Education/Athletic Training from California State University Dominguez Hills in 1993. He began his career working for a prominent surgeon Dr. Karlan Michelson. In addition to working for Dr. Michelson, he also worked as an assistant athletic trainer for California State University Los Angeles from 1994-1999. He relocated to Bartlett, Tennessee and began working for the University of Tennessee at Memphis as a senior research assistant. Upon completion of the study, he became an athletic trainer for the Memphis City Schools. In 2006 he became a Certified Specialist in Health Ergonomics. That same year he started his own company called The Ideal Connection which deals with ergonomics/wellness consulting. He was able to help many different types of employees from Delta, Fedex and Accredo Pharmaceutical achieve their goals. Shawn enjoys spending time with his family, snowboarding and fishing.

Female Athletes at Increased Risk for ACL Injury

Female Athletes at Increased risk for ACL Injury

Over the past decade the speed, power and intensity displayed by female athletes has increased making them 2-10 times more likely to sustain a knee ligament injury such as an anterior cruciate ligament (ACL) injury. More aggressive styles of play has led to an increase in musculoskeletal injuries especially in female athletes who participate in jumping and pivoting sports such as soccer, basketball and volleyball.

 

Most ACL injuries occur by non-contact mechanisms:

 

  •  One-step/stop deceleration
  • Cutting movements
  •  Sudden change in direction
  •  Landing from a jump with inadequate knee and hip flexion
  •  Lapse of concentration (resulting from unanticipated change in the direction of play)

There is no easy explanation as to why female athletes are more prone to non-contact ACL injuries. Research shows that female athletes run and cut sharply in a more erect posture than men, and they bend their knees less when landing from a jump. There is also debate on the opinion that another explanation could be the anatomical and hormonal differences between men and women. Another cause is a wider pelvis. Women have a “Q” angle, which makes the thigh bone angle downward more sharply then in men. This alignment makes women’s knees bend more inward when they land which could predispose women to ACL injuries.

Recent studies tells us that the rate of ACL injuries among women can be reduced by following a proper neuromuscular training and conditioning program called Prevent Injury and Enhance Performance (PEP) (http://www.aclprevent.com/pepexercises.pdf) before practices and games. The PEP program consists of a series of 19 warm-up, stretching, strengthening, plyometric, and sports specific agility exercises that can be done in 30 minutes without any specialized equipment.

In general, experts say that there are four ways to reduce the risk of ACL injuries:

 

  •   Proper leg muscles strength training and core training
  •   Proper neuromuscular (balance and speed) training
  •   Proper coaching on jumping and landing and avoiding any straight knee landing
  •   Proper footwear that gives optimal traction to allow peak performance in sports with cutting and stopping

Reference: American Academy of Orthopaedic Surgeons

 

Bob Dunaway, ATC

Bob-Dunaway-e1434650579861

 

Bob graduated with a B.S. Degree from Memphis State University in 1988. He became a Certified Athletic Trainer January 1990, and has worked in sports medicine outreach with area high schools and college level athletics since graduation. He served as the Athletic Trainer for world basketball league Memphis Rockers for two seasons & has been with Memphis Orthopaedic Group since 2011. Bob covers St. Mary’s Episcopal School and Southwest Tennessee Community College. He is a Certified Instructor Trainer for the American Heart Association Certified Ergonomic Specialist.

Prevent Pain Throughout Your Body By Taking Care Of Your Feet

Did you know your can prevent or reduce acute and chronic pain throughout the entire body merely by taking care of your feet? Your feet are the gateway to what is known as the kinetic chain. The kinetic chain is what the National Academy of Sports Medicine defines as the relationship or connection between your nerves, muscles and bones. In other words, how you walk/run (correctly or incorrectly) determines how your muscles, bones, and nerves respond to that stress.  Since your body is linked together, your feet can be the cause of pain in your knees, hips, back, and even your neck. Approximately 24% of adults have foot ailments, and the prevalence increases with age.

The first step and most obvious way to help is your footwear. Proper footwear should: smooth out gait inefficiencies, be flexible and durable, provide shock absorption, protect and adapt to uneven terrain, control motion, and prevent injury.  When selecting footwear you should consider all of these factors, especially with store bought shoes. Footwear can be customized to the specifications and needs of the individual, often times through a foot specialist or Podiatrist. In addition to footwear, an individual should also consider getting fitted for a custom orthotic. Orthotics are shoe inserts which support and align the foot and lower extremities, and are usually formed by making a plaster mold of the foot. Non-custom orthotics can also be found in foot/shoe stores but are generally not as effective as custom made orthotics. Ideally, orthotics should improve balance, re-align anatomical structures, control bio-mechanical function, accommodate foot deformities, and re-distribute external and internal forces.

Foot pain, particularly as it relates to shoes, footwear and arthritis-related disorders may be an important modifiable factor. Emerging research suggests that there may be a significant role for foot orthotics and footwear in the treatment of rheumatoid arthritis and osteoarthritis of the hip, knee and foot. Bio-mechanical evidence indicates that foot orthotics and specialized footwear may change muscle activation (muscles we use when we walk) and gait patterns (how we walk) to reduce the stress placed on our joints.

 

Mac JuVette

Mac Juvette, Athletic Trainer

Union University Graduate – B.S in Athletic Training

Mac has been with Memphis Orthopaedic since 2013 where he currently serves as an ATC to LeMoyne-Owen College and local high schools in Tipton County including Munford High School. He has a passion for serving the youth and local community with a dedication to providing care and assistance to the injured and the healthy.