OrthoNorCal

Assistive Devices for Patients With Shoulder Arthritis Pain and Stiffness

by | Dec 1, 2017 | Patient Education Articles, Shoulder

If you are suffering from shoulder arthritis, you may find it harder to perform everyday activities like reaching for items in your cabinets, driving, and getting dressed. You will find that there are many assistive devices available that can help you perform your daily activities. You should also work with your doctor or occupational therapist to find specific gadgets that may help you work, play and live.

Reaching

Reachers are one of the most popular assistive devices for people with shoulder arthritis. Reachers allow you to pick up something without having to reach or bend for it. They come in a variety of sizes and styles so you may want to test one before purchasing.

Getting Dressed

Several companies sell clothes designed for people with shoulder arthritis. You can find clothes with larger armholes so that your shoulder doesn’t have to stretch too far. In addition, you can purchase buttoning aids and zipper pulls to help you get dressed.

Driving

To save your energy and joints, if possible, use a car that has electric windows, mirrors, seats and power steering. There are now devices that allow you to automatically start the car and unlock the doors. If you find it difficult to turn the wheel, there are gadgets you can attach to the steering wheel making it easier to grip.

You can buy most of these assistive devices in department stores, medical supply stores, through specialized mail-order catalogs, or through medical assistance web sites.

Diagnosis of Arthritis of the Shoulder

by | Dec 1, 2017 | Patient Education Articles, Shoulder

The diagnosis of osteoarthritis of the shoulder begins with a complete history of the problem, followed by a physical examination of the shoulder. Your doctor will ask you about old injuries of the shoulder. He will ask about any other medical conditions and surgical conditions. A physical examination will be performed to try and determine how much strength and motion you have in the shoulder. Your doctor may look at other joints for other signs of systemic arthritis. X-rays of the shoulder will be necessary to make the diagnosis of osteoarthritis. X-rays will show the degree of changes in the bones of the shoulder and give some idea as to how much wear and tear is present. If your doctor is concerned that you also have a rotator cuff tendon tear, he may also suggest either an arthrogram or a MRI scan of the shoulder.

An arthrogram is a test where a special dye is injected into the shoulder joint. X-rays are taken to see if the dye leaks out of the shoulder joint. If it does, then a tear of the rotator cuff tendon is present. The MRI scan can also be used to actually look at the rotator cuff tendons and determine whether or not they are torn. An MRI scan is a special radiological test where magnetic waves are used to create pictures that look like slices of the shoulder. The MRI scan shows more than the bones of the shoulder. It can show the tendons as well, and whether there has been a tear in those tendons. The MRI scan is painless, and requires no needles or dye to be injected.

Causes of Shoulder Arthritis

Causes of Shoulder Arthritis

by | Dec 1, 2017 | Patient Education Articles, Shoulder

The most common cause leading to a shoulder replacement is osteoarthritis, or wear and tear arthritis. Osteoarthritis can occur without any injury to the shoulder, but it is uncommon. This is in large part because the shoulder is not a weight-bearing joint. Wear and tear arthritis is more common in the hip and knee. More commonly, osteoarthritis occurs many years after an injury to the shoulder. A shoulder dislocation can result in instability of the shoulder that leads to chronic instability. Repeated dislocations over many years damage the joint leading to arthritis. Some fractures of the shoulder can also lead to arthritis. The problem with aseptic necrosis described above can also lead to osteoarthritis.

Arthritic Shoulder

The Anatomy of a Healthy Shoulder

The Anatomy of a Healthy Shoulder

by | Dec 1, 2017 | Patient Education Articles, Shoulder

The shoulder joint is considered one of the most complex joints in the body. It consists of three bones: the scapula (shoulder blade socket), clavicle (collar bone) and humerus (upper arm bone).

The shoulder joint is unique in that the ball of the upper arm bone is two times larger than the socket of the shoulder blade.This creates a very mobile joint, but it demands an extensive array of ligaments and muscles to keep the joint together.

Anatomy of the Shoulder

Tibial Osteotomy

Tibial Osteotomy

by | Dec 1, 2017 | Knee, Patient Education Articles

What is a Tibial Osteotomy?

During a tibial osteotomy, the surgeon removes a wedge shaped portion of the shin bone (tibia) to help compensate for a deformity in the knee joint. This deformity can cause the knee’s protective cartilage to wear on one side more than the other. This usually happens on the inside (medial side) of the knee.
articular worn

Removing a piece of the bone under the knee changes the alignment of the shin and knee and redistributes the weight of the body on the knee. Changing the alignment can transfer the stress to a less worn area of the knee, helping to relieve pain.

what are the Benefits?

Tibial osteotomies treat a varus, or bowlegged, deformity at the knee. This deformity may result from past trauma or surgery, congenital deformity and/or the progression of a degenerative disease, such as osteoarthritis. Candidates for tibial osteotomies are in pain and may eventually require a knee replacement.
Varus or bowlegged deformity

A tibial osteotomy could help delay a knee replacement for as many as 10 years. This makes the tibial osteotomy a viable option for younger patients who are not the best candidates for knee replacement since they will probably outlive the implant.

How is a Tibial Osteotomy Performed?

A tibial osteotomy usually involves cutting a wedge-shaped portion of bone from the tibia to correct the alignment of the knee. The surgeon will make a small incision on the front of the knee and/or another one on the side of the knee. The shinbone is exposed and a wedge shaped piece of the bone is removed just below the knee. The leg is moved in a way that allows the gap in the bone to be closed in a hinge-like manner. The edges of the cut bone are then stapled or held together with plates and screws. The osteotomy site should heal just like a fracture.
Tibial Osteotomy

Is There a Risk of Complications?

All surgeries have a risk of complications. Some of the major complications with tibial osteotomy include damage to the nerves or arteries of the leg, blood clots or even problems with the cut bones healing together. As with any surgery, patients should be aware of signs of infection, bleeding or abnormal swelling in the first few weeks after surgery. Patients should inform their doctor if any of these symptoms occur.

Additionally some surgeons believe that the because of changes made to the bone during tibial osteotomy, it may make a total knee replacement more difficult down the road.

How Long is the Recovery?

Because the tibial osteotomy involves cutting the bone and having it mend back together, a significant postoperative course of therapy needs to be followed. Hospitalization can last from three to six days. Once out of the hospital, the knee will need to be immobilized with a cast or brace for at least six weeks. Crutches should be used during that time. Knee swelling can last for three to six months. Typically patients could miss three to six months of work, but that depends on the doctor’s recommendations and each individual case.

The road back to full weight bearing will differ with each patient’s progress and situation. Normally, weight-bearing activities can begin at six weeks after surgery and gradually increase up to 10 weeks post surgery. After 12 – 14 weeks the patient will be able to resume some higher impact activities. A physical therapist usually helps the patient through the rehabilitation process.

Torn Meniscus Overview

Torn Meniscus Overview

by | Dec 1, 2017 | Knee, Patient Education Articles

Introduction

Injury to the meniscus of the knee is common and can occur in any age group. In younger people, the meniscus is fairly tough and rubbery, and a tear usually occurs as a result of a forceful twisting injury. As we age, the meniscus grows weaker, and tears can occur as a result of a fairly minor injury, even from the up and down motion of squatting.

Anatomy

What is the Meniscus and what does it do?
meniscus anatomy

As shown above, the meniscus, located on either side of the knee joint, acts like a gasket between the femur and the tibia to spread out the weight being transferred from the femur above to the tibia below. Articular cartilage covers the ends of the bones that make up the joint. The articular cartilage surface is a tough, slick material that allows the surfaces to slide against one another without damaging either surface. The ability of the meniscus to spread out the force on the joint surfaces as we walk is important because it protects the articular cartilage from excessive forces occurring in any one area on the joint surface. Without the meniscus, the concentration of force into a small area on the articular cartilage would damage the surface, leading to degeneration over time.
meniscus damage

The meniscus also helps with stability of the knee joint, since it converts the tibial surface into a shallow socket. A socket configuration is more stable than a flat surface, as shown below.
meniscus socket joint

Without the meniscus, the round femur would slide freely on top of the flat tibial surface.

The meniscus can be torn in several ways. The entire inner rim of the medial meniscus can be torn in what is called a buckethandle tear.
buckethandle tear

The meniscus can also have a flap torn from the inner rim,
torn meniscus over rim

or the tear can be a degenerative type tear where a portion of the meniscus is frayed and torn in multiple directions.
multiple meniscus tears

Causes

How does the meniscus cause problems in the knee?

While meniscus injuries can occur in any age group, the causes are somewhat different for each group. Tears in the meniscus in patients under the age of thirty usually occur as a result of a fairly forceful twisting injury, usually involving a sports activity.

In older people, the meniscus grows weaker. The meniscus tissue degenerates and is much easier to tear.

Meniscal tears can occur as we age as a result of a fairly minor injury. Degenerative tears of the meniscus are commonly seen as a part of the overall condition of osteoarthritis of the knee in the senior population. In many cases, no injury to the knee can be contributed to the meniscal tear. Instead, the tear is the result of cumulative wear.
osteoarthritis

Symptoms

The most common symptom caused by a torn meniscus is pain. The pain may be felt along the joint line where the meniscus is located or may be more vague and involve the whole knee. If the torn portion of the meniscus is large enough, locking may occur.

Locking simply refers to the inability to completely straighten the knee. This occurs when the fragment of torn meniscus gets caught in the hinge mechanism of the knee and will not allow the leg to straighten completely. (Imagine sticking a pencil between the hinges in a door and trying to close it.)
Degeneration of articular surface

The constant rubbing of the torn meniscus on the articular cartilage may cause wear and tear on the surface, leading to degeneration of the joint.

The knee may swell with use and become stiff and tight. This is usually because of fluid accumulating inside the knee joint, which is sometimes called water on the knee. This is not unique to meniscus tears, but occurs whenever the knee becomes inflamed.

Diagnosis

Diagnosis begins with a history and physical. The examination will try to determine where the pain is located, whether or not locking has occurred, and if you have any clicks or pops as the knee is moved. X-rays will not show the torn meniscus; however, they are useful to determine if other conditions are present.

The MRI (Magnetic Resonance Imaging) scan is very effective at showing the meniscus. The MRI machine uses magnetic waves rather than x-rays to show “slices” of the soft tissues of the body. This test does not require any needles or special dye and is painless. If there is uncertainty in the diagnosis following the history and physical examination, or if other injuries in addition to the meniscal tear are suspected, the MRI scan may be suggested.
MRI of torn meniscus

If the history and physical examination strongly suggest that a torn meniscus is present, then arthroscopy may be suggested to confirm the diagnosis and treat the problem at the same time. Arthroscopy is an operation where a small fiberoptic TV camera is placed into the knee joint. The arthroscope allows your doctor to look into the knee joint and see the condition of the articular cartilage, the ligaments and the menisci.
meniscus arthroscopy

Treatment

Initial treatment for a torn meniscus is typically focused on reducing the pain and swelling in the knee. The physician may recommend using crutches for several days to rest the knee and ice to reduce the pain and swelling. If the knee is locked and cannot be straightened, surgery may be recommended as soon as reasonably possible to remove the torn portion. Once a meniscus is torn, it will most likely not heal on its own.
meniscus treatment

If the symptoms continue, surgery will be required to either remove the torn portion of the meniscus or to repair the tear. Most meniscus surgery is done using the arthroscope. Small incisions are made in the knee to allow the insertion of a small TV camera into the joint. Through another small incision, special instruments are used to remove the torn portion of meniscus, while the arthroscope is used to see what is happening.

In some cases, the meniscus tear can be repaired. In this situation, sutures are placed into the torn meniscus until the tear is repaired.

Repair of the meniscus is not possible in all cases. Young people with relatively recent meniscal tears are the most likely candidates for repair. Degenerative type tears that occur as we age are not usually repairable.