OSS

After 40 years of service and the addition of expert surgeons, Orthopedic Specialists of Seattle has outgrown its NW Market Street Ballard location. It has now moved to a new Ballard location at 5350 Tallman Avenue NW, Suite 500. This office is located in the same building as the Swedish Hospital/Ballard emergency room.

The new Ballard location serves as an orthopedic clinic, while also offering same day emergency appointments. This clinic is using new, state-of-the-art X-ray equipment and offers a full scope of orthopedic services. Along with these services, this location gives access to all of its orthopedic surgeons.

All surgeons working at the Ballad location, Dr. Downer, Franklin, Ruhlman, Shapiro, Weil, Peterson, and Watt are experts in many orthopedic problems including sports injuries, total joint replacements, hand surgery and pediatric orthopedic care. To make an appointment with an orthopedic surgeon please call (206) 784-8833.

Did you know that you – and your 9-year-old son who just took a serious tumble and likely has a broken or sprained wrist – can receive top-quality pediatric orthopedic care, quick – right in our cozy Wallingford, Ballard and Mercer Island offices? Drs. Franklin, Peterson, Ruhlman, Watt and Weil all provide orthopedic care for pediatric patients, from infants to adolescents.

The most common pediatric conditions our physicians see are fractures (broken bones), ACL and meniscal tears in adolescents, as well as a wide range of sports- and activity-related injuries in active kids. OSS physicians also care for children with orthopedic deformities, such as webbed digits or congenital trigger thumb; often there are simple treatment options, and if surgery is required, we pride ourselves in a child-friendly experience from start to finish.

Many of our pediatric fracture patients require casting – and we offer exciting casting options, including waterproof Goretex® casts which can even allow for swimming while your child heals. For some of our younger patients, we take special attention to support your child through the experiences of X-rays and casting – including model casting on teddy bears, and plenty of “I graduated from X-ray school!” and “I met the doctor!” stickers.

And importantly – as any parent with an injured child certainly knows – time is of the essence. For many of our patients, visiting one of the OSS neighborhood clinics offered them the best of both worlds – the highest-quality care along with easy appointment access, especially for more routine – and urgent – orthopedic issues like fractures and severe sports injuries.

“For your child with a knee injury or a wrist fracture, we are regularly able to see them right away –always by a fully-trained attending provider – and get them on the road to healing much more quickly and always with the most state-of-the-art treatments,” says Dr. Scott Ruhlman, orthopedic surgeon at OSS.

He adds: “Children require a unique approach – as a physician, I really care for both the parent and the child as we navigate through the condition together, finding appropriate treatments and solutions to what they are experiencing – whether it’s a broken bone or a birth deformity – all in a way that reflects our genuine love of working with children to help them achieve their fullest potential,” says Dr. Scott Ruhlman. “And I always notice when our clinic has been full of children that day – because our entire staff is wearing a smile.”

Common shoulder injuries typically involve the muscles, ligaments and tendons – and rarely, fractured bones. Repetitive, stressful sport activities as tennis, pitching, or weightlifting can weaken the shoulder and injure the ligaments. Intensive training routines, involving excessive, repetitive overhead motion of the arm and shoulder, can over time cause shoulder instability and impingement, and a great deal of pain.

• Shoulder Instability is caused by injured shoulder ligaments allowing the shoulder joint to move out of its normal position. This condition can lead to dislocation of the shoulder joint.
• Shoulder Impingement is caused by the overuse or abrasion of shoulder muscles on the shoulder blade. This occurs when the arm is lifted away from the body, putting pressure on the rotator cuff soft tissues.

These problems of instability and impingement of the soft tissue or bony structures of the shoulder most often result in weakness in the arm, a limited ability for joint motion and temporary or continuous pain – eventually requiring medical treatment. Ignoring or underestimating the pain and weakness of a shoulder injury may lead to continued aggravation of the condition, potentially causing additional problems.

• Loose or torn ligaments, tendons, and shoulder muscles may lead to a constant state of instability and recurring dislocations.
• Continuous, severe impingement of the rotator cuff tendons, bursa and muscles can lead to tendinitis and bursitis, and even a rotator cuff tear – all causing pain and restricted movements.
• Bursitis is caused by swollen bursae – which are thin, jelly-like sacs that create a cushion between the bones and soft tissues. Bursae usually contain a small amount of lubricating fluid that helps reduce friction between the gliding muscles and the underlying bone. The shoulder bursa is located between the rotator cuff and the shoulder blade. Swelling of the shoulder bursa may be a result of excessive use of the shoulder, causing pain and restriction of movements. Shoulder bursitis often occurs together with rotator cuff tendinitis.
• Tendinitis causes swelling of the tendons – which are cords that connect muscle to bone. In the shoulder, there are four rotator cuff tendons and one bicep tendon. Most forms of tendinitis develop over time, due to long-term overuse wearing down the tendon. At first the tendon becomes swollen, causing pain and tenderness in the shoulder. As the tendonitis develops, the tendon may thicken or grow larger, and pain may radiate towards the upper arm. Acute tendinitis can develop from excessive overhead sport activities as ball pitching or throwing. Chronic tendinitis may develop due to degenerative diseases like arthritis.
• Tendon tears. Over time, the stress from repetitive shoulder movements may lead to the development of overuse tendon tears. Tendon tears are caused by a partial or complete split of the tendon into two parts – it’s painful and causes weakness in the upper arm. Tears can occur through an acute injury, degenerative changes due to age, or long-term overuse wearing out the tendons. Complete tendon tears – in which the tendon is pulled from the attachment to the bone – are among the most common rotator cuff and bicep tendon injuries.

The knee is a complex joint comprised of many components, highly vulnerable and easily injured. The large ligaments of the knee provide stability while the meniscus, which is a soft wedge of cartilage between the thighbone and shinbone, cushions the knee and absorbs shock from the movements of the knee.

RUNNER’S KNEE – WHAT IS IT & WHAT CAUSES IT?

Runner’s knee – or patellofemoral pain – is a condition caused by continual heavy stress on the knees, which is common in physically demanding activities such as running, jumping, skiing, cycling and playing soccer. It causes a dull, aching pain either under or around the front of the knee. The pain can be felt walking up or down stairs, kneeling, squatting or sitting for a long time with knees bent.

Runner’s knee refers to a number of conditions which may cause pain under or around the front of the knee. These include:

• Anterior knee pain syndrome: a result of irritation to the soft tissues, most often strained tendons, causing chronic pain in the front and center of the knee.
• Patellofemoral malalignment: when the kneecap is out of alignment, symptoms often intensified by intensive training or activities causing excessive stress on the cartilage of the kneecap.
• Chondromalacia patella: a condition which causes the softening and breakdown of the cartilage on the patella. Symptoms are irritation of the joint lining and pain in the underlying bone.

The knee has a complex and sensitive structure, and there are a number of contributing factors which may cause patellofemoral pain: malalignment of the kneecap, a partial or complete dislocation of the knee cap, a knee injury, excessive training and overuse putting stress on the knee, and inadequate stretching before and after running or participation in sports activities. Thigh muscle weakness, soft tissue tightness or muscle imbalance, and flat feet can also cause pain in the knees.

TREATMENT

If you suffer from knee pain following sports activities, it’s important to stop doing any physical activities that hurt the knee, and don’t start up again until you can do so without feeling pain.

For first aid treatment for the pain and swelling, remember:

R.I.C.E. — Rest, Ice, Compression, Elevation

• Rest and avoid putting pressure on the painful knee. Swimming is a safe, non-weight-bearing activity for this period of healing.
• Ice. Use cold packs or ice wrapped in a towel several times a day for short periods of time on the injured area to help relieve pain and swelling.
• Compression can be achieved using an elastic bandage or knee sleeve with a hole cut out for the kneecap. It should fit snugly without causing additional pain.
• Elevate the injured area by placing the knee on a pillow so it’s raised up higher than the level of the heart.

Additional methods of pain relief include taking nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen. After rest and pain medication, if you don’t feel any improvement in your knee, you should consult your doctor. As with all sport injuries, it’s important to consult a doctor for early diagnosis and treatment recommendations. The good news is that runner’s knee usually heals with early diagnosis and treatment including reconditioning.

Individual treatment recommendations depend on the reasons for the knee pain. You may require reconditioning to recover your full range of motion, strength, endurance power, speed, dexterity and coordination. Rehabilitation typically includes an exercise program to regain the flexibility and strength of your thigh muscles, and exercises for stretching.

There are various other treatments including taping the kneecap or using a knee support brace or shoe insert – these may also help relieve knee pain and help in gradually returning to running or other sporting activities.

Proliance Surgeons – and Orthopedic Specialists of Seattle, which is a division of Proliance Surgeons – are now a Preferred Provider in all Premera physician networks. This agreement officially went into effect August 1, 2011, and reflects Proliance Surgeons and Premera Blue Cross reaching a shared view for the delivery of high quality healthcare.

For more information or to link to Proliance Surgeons care center listings, visit the Proliance Surgeons website at www.proliancesurgeons.com.

By Scott Ruhlman, M.D.

Do you experience thumb pain after repetitive activities such as knitting, gardening, or lifting your new child? You may be experiencing a common (and treatable!) tendonitis of the thumb called De Quervain’s Tenosynovitis, which can occur in activities such as

• Knitting
• Gardening
• Playing a musical instrument
• Lifting a child improperly (lift with your shoulders and fixed wrists, not by flexing your wrists)
• Typing
• Carpentry
• Walking pets on a leash
• Sports

What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is an inflammation of the synovial tissue surrounding the thumb tendons at the thumb side of the wrist – where the tendons have to pass through a tight pulley.  As this tissue becomes inflamed, it becomes more difficult and painful for the tendons to pass smoothly through the pulley. Eventually, all thumb movement becomes painful.

How is De Quervain’s Tenosynovitis diagnosed?

The most sensitive test is Finklestein’s test, which will cause pain at back of the thumb for a patient who makes a fist with the thumb inside the fingers, with the thumb side up, and tips the wrist forward and down, as shown below.

To properly diagnose this condition, it is important to visit your hand surgeon, as other conditions such as arthritis, nerve injury, or even fracture can mimic De Quervain’s Tenosynovitis.

How is De Quervain’s Tenosynovitis Treated?

The first step is to identify the cause. Often activity modifications – such as properly lifting a baby or using the proper position for a wrist during knitting – can help alleviate symptoms. Additional options include full-time bracing of the thumb and wrist, anti-inflammatory medications or a steroid injection –all of which can dramatically decrease the inflammation.

Finally, surgical release of the affected tendons can relieve the symptoms of De Quervain’s Tenosynovitis, but is typically reserved for the most serious cases. The vast majority of cases we see at Orthopedic Specialists of Seattle do not require surgery.

If you would like to schedule an appointment with OSS hand surgeons Scott Ruhlman, MD or Wayne Weil, MD for further discussion, please call (206) 633-8100.

Patients in Seattle’s north end now have an additional clinic option to see Scott Ruhlman, orthopedic surgeon and hand specialist with Orthopedic Specialists of Seattle – in the UW Medicine/Northwest Outpatient Medical Center building. Dr. Ruhlman shares a first floor office space with the Bone and Joint Center, and provides general orthopedic care as well as specialty care for hand conditions, including carpal tunnel syndrome, tendonitis, arthritis and fracture care, among many others.

The Northwest Outpatient Medical Center building is located at 10330 Meridian Avenue North. Dr. Ruhlman’s office is located in Suite 190. To schedule or for more information, please contact OSS at (206) 633-8100.

On Tuesday, Swedish Hospital organized a live knee surgery available via web stream, accompanied by a live chat on Twitter where viewer questions were answered in real time! It was a rare opportunity for people to get an inside look at a new surgical technology: a robotic-assisted technology that makes minimally invasive partial knee replacements possible.

Our surgeons at Orthopedic Specialists of Seattle also perform this surgery at Swedish Hospital using this state-of-the-art equipment.

In addition, OSS surgeons perform the Oxford partial knee replacement as an outpatient in our surgery center in Wallingford. The Oxford partial knee replacement repairs only one side of the knee (the medial side), and is much smaller than a total knee implant.  It removes 75 percent less bone and cartilage, is less painful and enables a more rapid recovery than a total knee replacement.

If you’re interested in learning more, OSS Surgeon Dr. Charlie Peterson recently wrote this article about partial knee replacements.

If you have further questions or have any orthopedic concerns, Orthopedic Specialists of Seattle physicians are available to answer your questions. Please contact our offices at (206) 633-8100.

If you suffer from chronic lateral epicondylitis (“tennis elbow”) or plantar fasciitis (pain in the bottom of the heel), a new treatment is available to you onsite at the OSS Wallingford location: extracorporeal shock wave therapy (ESWT).

What is ESWT? How does it work?

ESWT works by sending low-energy shock waves, similar to those used to treat kidney stones, to the area with the most pain – causing an interruption of the pain pathways by affecting nerves at the cellular level, and healing the degenerative process that caused the initial pain by creating new blood vessel growth.

Shock waves are generated by a device called the Sonocur Basic, which can provide treatment whether the patient is in a sitting or lying position. The shock wave head holds a kind of loudspeaker that drives acoustic pulses via a lens and a water channel, through a coupling gel on the treatment area to allow the waves to enter, to the affected area. Each treatment delivers 2,100 pulses, and the complete therapy usually requires three sessions, with a week in between each session.

What are the benefits of this treatment?

Because this treatment is performed in your physician’s office, with no need for imaging studies or anesthesia, it is less expensive than treatments in a hospital or surgery center. ESWT offers patients a non-invasive option to more traumatic traditional surgical treatments, with excellent clinical results.

Who is a good candidate for this treatment?

Patients who have had pain for at least six months and who have tried other conventional therapy methods without success are good candidates to consider treatment with ESWT.

Are there any side effects of this treatment?

ESWT may cause redness and bruising of the treated area, which typically clears within a few hours to a few days of the treatment. Some pain during and immediately after the treatment is commonly reported, as it is necessary to focus the waves directly onto the area of most pain in order for the waves to heal that area. A few patients have reported numbness and/or tingling sensations that radiate from the affected area, however these sensations have resolved without additional treatment in each case.

If you suffer from lateral epicondylitis or plantar fasciitis, make sure to discuss this treatment option with your orthopedic surgeon. You can download a Sonocur Basic brochure here, and please call our offices with any questions or to schedule a visit with one of our physicians at (206) 633-8100.

Last month, many watched Green Bay Packers star Charles Woodson sustain an injury that forced him onto the sidelines of the biggest football game of the year – Super Bowl XLV. During a fairly routine defensive play in the second quarter, Woodson, a cornerback for the Packers, dove onto the ground, landed on his right shoulder, and fractured his collarbone.

While we certainly do not have inside information on Woodson’s particular injury, OSS surgeons routinely provide treatment for collarbone fractures, one of the most commonly injured bones in the human body – and can provide the following perspective on the typical course of such injuries.

What is a Clavicle Fracture?

The clavicle, or collarbone, is the most commonly fractured bone in the body. The vast majority of clavicle fractures are completely fractured or broken, rather than partially fractured (when a bone does not completely break apart).

The clavicle bone connects the spine to the shoulder and arm – and when that connection breaks, the clavicle can appear to have sprung up, sometimes even poking out the skin. However, this appearance is due to the whole upper arm sinking down relative to the spine once the clavicle’s connection is broken.

What is the Treatment?

Most clavicle fractures are treated with a sling for comfort for a few weeks, followed by progressive use of the arm as the bone begins to knit together and symptoms subside. During those first few weeks, as the bone moves and the shoulder has no bony support, pain can be significant.

Surgery is usually reserved for severe fractures, including those that penetrate the skin. However, there is a recent trend to surgically treat significantly displaced fractures in active patients in an attempt to regain the fullest function. Specifics of the fracture as well as the surgical risks must be weighed, but there is evidence that certain fractures heal better with operative fixation.

Regardless of the specific course of treatment, clavicle fractures generally require X-rays for three months until full healing occurs.

What is the Prognosis?

In general, patients experience excellent results in healing from collarbone fractures. In Woodson’s case – without seeing his films, of course – we can assume he will certainly be given serious consideration for surgery if there is significant displacement to restore him to fullest function. Even if non-operative care is chosen, he will likely have full use and strength of his arm by next season’s training camp.

If you have further questions about clavicle injuries or have any orthopedic concerns, Orthopedic Specialists of Seattle physicians are available to answer your questions. Contact our offices at (206) 633-8100.