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About Scott D. Ruhlman

Scott D. Ruhlman, MD Dr. Ruhlman offers the highest quality specialty care of hand, shoulder and elbow disorders. In addition to caring for such disorders in both the child and the adult, Dr. Ruhlman offer state-of-the-art fracture care, sports medicine and joint replacement surgery of both the upper and lower extremities.

Seattle Seahawks Injury Status

Football season is moving right along and our beloved Seattle Seahawks are 6-3 overall; ranking 10th in offense and 3rd in defense. There are several injuries on this season’s roster, including:

Seattle Seahawks Injuries

Coach Pete Carroll has cleared some of these players to return to the field but others are questionable for the rest of the NFL season. Of note, Zach Miller had undergone surgery and is on the injury reserve list and is not playing while Marcus Burley’s hamstring injury has sidelined him from playing for a questionable amount of time.

“With such devastating injuries to the squad up and down the line up, it reiterates the importance of preparation to prevent injury,” states Dr. Ruhlman.

The treatment protocol for football injuries varies and can range from basic RICE (rest, ice, compression, elevation) to surgery, with several options in between.

For all of these injuries, RICE can be improved with active cold and compression therapies to help speed up the healing process for injuries.

Cold compression therapy can also be used after surgery to help speed up the recovery process.

Football

OSS hopes that all these players recover from their injuries and wish the Seattle Seahawks a great rest-of-the-season.

If you believe you are suffering from a sports-related injury and need specialized orthopedic care, the orthopedic surgeons at OSS provide excellent treatment options for your injury.

Operative Treatment for Clavicle Fractures (Broken Collarbone)

Operative Treatment for Clavicle Fractures (Broken Collarbone)

Clavicle fractures are often caused by a direct blow to the shoulder. In sports, it usually occurs when an athlete is tackled in a football game, falls of a bicycle, or gets body-checked into the plexi-glass of an ice rink. It can also happen during a fall onto the shoulder or a car collision, a fall onto an outstretched arm, or in childbirth, when the baby is passing through the birth canal.

The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade.

Clavicle_OSS

Symptoms

Clavicle fractures can be very painful and may make it hard to move your arm.

Additional symptoms include:

  • Sagging shoulder (down and forward)
  • Inability to lift the arm because of pain
  • A grinding sensation if an attempt is made to raise the arm
  • A deformity or “bump” over the break
  • Bruising, swelling, and/or tenderness over the collarbone

Evaluation by an OSS physician

In order to pinpoint the location and severity of the break, your OSS physician will order an x-ray. X-rays of the entire shoulder will often be done to check for additional injuries. If other bones are broken, your doctor may order a computed tomography (CT or CAT) scan to see the fractures in better detail.

If your bones are out of place (displaced), your OSS physician may recommend surgery. Surgery can align the bones exactly and hold them in good position while they heal. This can improve shoulder strength when you have recovered, if displacement is significant. A recent large study showed improvement in function with operative repair when the fracture is significantly displaced.

The use of Plates and Screws

During this operation, the bone fragments are first repositioned into their normal alignment, and then held in place with special screws and/or by attaching metal plates to the outer surface of the bone. Newer locking plates are contoured to give significant strength while minimizing the prominence of the plate. Many patients notice immediate improvement in the disturbing bone movement right after surgery.

After surgery, you may notice a small patch of numb skin below the incision. This numbness will become less noticeable with time. Because there is not a lot of fat over the collarbone, you may be able to feel the plate through your skin. It is important to start full range of motion soon after surgery.

Plates and screws are sometimes removed after the bone has healed, but that is up to the patient’s discretion. This is a much smaller procedure with little down time, usually 4-6 months after the original surgery.

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(A) The clavicle is broken in more than one place and the fragments are severely out of alignment. (B)The fractured pieces are held in place by a combination of plates and screws.


Rehabilitation

Specific exercises will help restore movement and strengthen your shoulder. Your OSS physician may provide you with a home therapy plan or suggest that you work with a physical therapist.

Therapy programs typically start with gentle motion exercises. Your OSS physician will gradually add strengthening exercises to your program as your fracture heals.

Although it is a slow process, following your physical therapy plan is an important factor in returning to all the activities you enjoy.

Surgical Complications

People who use nicotine, have diabetes, or are elderly are at a higher risk for complications during and after surgery. They are also more likely to have problems with wound and bone healing. Be sure to talk with your OSS physician about the risks and benefits of surgery for your clavicle fracture.

There are risks associated with any surgery, including:

  • Infection
  • Bleeding
  • Pain
  • Blood clots in your leg
  • Damage to blood vessels or nerves
  • Nausea

The risks specific to surgery for collarbone fractures include:

  • Difficulty with bone healing
  • Injury to surrounding vessels/organs (rare)
  • Hardware irritation

Outcome

Whether your treatment involves surgery or non-surgical treatment, it can take several months for your collarbone to heal. It may take longer in diabetics or people who nicotine.

Most people return to regular activities within 3 months of their injury. Your OSS physician will tell you when your injury is stable enough to do so. Returning to regular activities or lifting with your arm before your doctor advises may cause your fracture fragments to move or your hardware to break. This may require you to start your treatment from the beginning.

Once your fracture has completely healed, you can safely return to sports and daily activities.

What to discuss with your OSS Surgeon

  1. When will I be able to start using my arm?
  2. When can I return to work?
  3. Do I have any specific risks for not doing well?
  4. If I have surgery, what are the risks and benefits and how long will I be in the hospital?
  5. If I do not have surgery what are the risks and benefits?
  6. Is my bone weak?
  7. Should I be taking calcium and Vitamin D?

If you would like more information about clavicle surgery, call Orthopedic Specialists of Seattle (206) 633-8100 to schedule an appointment with Dr. Ruhlman.

Avocados vs. UFC Fighter… and the Winner is?

avocado-cut-3aWho knew you would have to watch your back, or should we say hand, when making the family’s homemade guacamole? Avocados; they look innocent enough, but did you know that avocados are the cause of hundreds of hand injuries a year?

Take for example, UFC Tri Star Welterweight contender, Rory MacDonald.  He gave himself a deep cut in his left hand while cutting an avocado at home, prompting a trip to the emergency room and making him worry he’d have to drop out of his UFC 170 fight against Demian Maia.  Fortunately for MacDonald, he received stitches for his hand injury.

The danger is hidden inside the avocado. Avocados have a soft creamy skin, easily sliceable, but inside, the pit also needs to be removed carefully. Often times, this is done by stabbing the end of a knife onto the pit and twisting it off. If not done properly, the knife can glance off the pit and cut your hand. 

You can also injure yourself when slicing the inside of the avocado while it rests in the palm of your hand; the pressure may be too great and accidentally, you slice right through the peel and your palm along with it, hitting an artery, nerve or tendon in the process.

Slicing an artery, nerve or tendon can be serious. It is possible to have a partial injury to a tendon and still move the hand normally, but there is a risk that the tendon could rupture completely. According to Dr. Ruhlman, “Knife injuries from cutting an avocado are among the most common injuries I see, and unfortunately, often cause an injury that needs surgical repair.  Hopefully, awareness of this common injury might prevent a rate of such a devastating injury.”  By using the proper tools and technique, injury can easily be prevented.  If you do cut yourself it might mean surgery and possible months of therapy.

OSS has several providers specializing in hand injuries.  If you are suffering from a hand-related injury, contact OSS to schedule an appointment with one of our physicians at (206) 633-8100.

Avoiding Spring Gardening Injuries

Spring weather in the Pacific Northwest is beautiful and although we still have rain showers, it is the best time for gardening and getting in some spring cleaning.  If you are like some of us here at OSS, gardening is a popular hobby.  Over time however, it can take a toll on your body.  Creating a dream garden requires repetitive bending, kneeling, reaching, and twisting that may result in putting an extensive amount of strain on your muscles and joints.

gardening-safety

According to Dr. Scott Ruhlman, “Spring time is a great time to get outside and do yard work. In this case the old adage rings true, that an ounce of prevention is much more than a pound of cure. Use the proper tools and body positioning when gardening. I am not only a hand surgeon but an avid gardener too.”

Raking, digging and planting may present injuries and OSS would like to share some helpful tips to keep you pain-free while you garden:

  • Sunscreen – Fair-weather skin tends to burn faster and in the Pacific Northwest when we see the sun peek out from the clouds, we rush to catch some of those sunshine rays.  Use sunscreen with SPF and wear a wide brimmed hat.
  • Light Stretching and Walk – Before you take on your dream garden, do some light stretching so that your muscles can warm up and take a short walk to get your blood flowing.
  • Spread out your Workload – If your  garden took a toll over the winter months, pace yourself and spread out the work; this gives you the opportunity to see your garden progress and prevents you from injury by doing all the work at once.
  • Kneeling vs. Bending – Place less strain on your back by avoiding bending; kneel instead.  Wear kneepads and use a cushioned mat to comfort your knees while working on the ground.
  • Keep Moving – Long periods of time in one position will put stress on your muscles and joints; so keep moving so that you avoid overworking specific areas of your body
  • Lift Cautiously – Lift with your legs and not your back when carrying heavy loads and remember to hold objects close to your body when lifting.

If you believe you are suffering from a gardening-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment or consultation with Dr. Ruhlman.

Google Glass Technology: 21st Century Solutions for Medical Professionals and Their Patients

Have you heard of Google Glass?  It’s a new form of technology that has the potential to facilitate better and more efficient patient care.

Carl Spitzer, M.D. and Craig Rosenberg, Ph.D. are the founders of the startup company Healium, based in Seattle, WA. They developed software for Google Glass with an eye on how wearable computing can help physicians.

This latest technology development has particular significance for Spitzer, according to the King5 article, is not only a practicing emergency physician at Marin General Hospital, but is also its chief medical informatics officer. It’s his job to research the latest technologies and see if there are applications for his profession.  According to King5’s article, Dr. Spitzer said, “I saw this as an opportunity to kind of create a solution that would serve my needs and the needs of the doctors that I’m serving, and also help patients.” The article goes on to say that Healium’s application provides patient intake information in the Glass heads-up display, and real-time communications with other doctors or facilities. Doctors and paramedics wearing Healium-powered Glass can record videos and send/receive them for consultation.  Rosenberg, with a deep background in user experience and systems design in a variety of industries, is Healium’s chief technology officer. He and Spitzer view the hands-free nature of Glass as a potential advantage for ER physicians as well as first responders.

Dr. Ruhlman from OSS had this to say about this new technology, “It would be very helpful to go back to the imaging (x-rays, etc.) very quickly with Google Glass, or even more powerfully, to be able to have access with other surgeons – to have an interoperative consultation with somebody 3,000 miles away – to say, hey, I’m looking at this, you see it, what do you think?”

King5 explains that Healium’s application provides patient intake information in the Glass heads-up display, and real-time communications with other doctors or facilities. Doctors and paramedics wearing Healium-powered Glass can record videos and send/receive them for consultation.  Those qualities highlight what Spitzer sees as the benefits of Glass for physicians – “the fact that it’s wearable, the fact that it’s on all the time and I can consult with it in the middle of a trauma resuscitation, or in the middle of interviewing a patient,” he said. “I can be seeing a patient in one room and get called by the nurse about a patient in another room, and be able to reference their lab results, their x-rays.”  He goes on to say, “It’s one thing to hear that report,” Spitzer said, “It’s another thing to see the accident scene and to see the extrication (patient removal from accident wreckage) and that actually kind of helps to set the level of expectation for the types of injuries to expect, so it’s another way that it can positively impact patient care.”

Spitzer also believes it will be easier – not to mention less expensive and time-consuming – for physicians to simply record their patient interviews via Glass and then transfer that information into electronic health records. He’s also aware of questions regarding patient privacy/confidentiality, so transparency and giving patients the ability to opt out are important.

Read the full article here and check out Dr. Ruhlman’s thoughts in the video from King5 regarding this new, emerging technology:  http://www.king5.com/news/technology/Seattle-medical-startup-focuses-on-Google-Glass-for-emergency-rooms-242260021.html