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About Orthopedic Specialists

Orthopedic Specialists of Seattle provides new and advanced procedures including endoscopic carpel tunnel release surgery for carpal tunnel syrome, complex joint restoration procedures, anterior approach hip replacement surgery, and more.

Orthopedic Specialists of Seattle Offer Minimally Invasive Anterior Hip Replacement

Our orthopedic surgeons Dr. Peterson and Dr. Downer, offer hip surgeries through a smaller, minimally invasive approach. The anterior approach to a total hip replacement allows for less trauma to the surrounding soft tissue and muscles. With smaller incisions, our doctors offer a less painful approach, and faster recovery.

Anterior hip surgery is not a new idea; in fact, many surgeons have used this approach since the 1980s. However, what is new about the anterior hip replacement procedure is the surgeons are using smaller incisions and more specialized instruments to make the surgery less traumatic.

Orthopedic Specialists of Seattle is proud to offer the anterior approach to hip replacement and other hip surgeries. Regardless of the type of incision, all hip replacements require your orthopedic specialist to remove and replace the hip joint. The hip joint is deep in your body, and consists of the top of the thigh bone, and the socket in the pelvis.

Is Anterior Hip Replacement Better than Traditional Surgery?

Our orthopedic specialists feel that the anterior hip replacement option is an improvement over other approaches for hip surgery because of the faster recovery The goal of surgery is to give you a joint that is pain-free, last long, allow you to recover in a shorter period of time, and to get you back to your activities of daily living.

Contact Orthopedic Specialists of Seattle to see if you are a candidate for a less invasive hip replacement surgery through the anterior approach.

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Distal Biceps Tendon Repair Surgery

Elbow and forearm tendon injury is common for overhead throwing athletes, such as baseball and softball players and those who play tennis. Acute tendon rupture can occur with repetitive, forceful overhead throwing. The biceps muscle is in the front portion of the upper arm, and it helps you rotate your forearm and bend your elbow. This structure is also necessary for shoulder stability.

The biceps tendons attach the biceps muscle to the bones of the shoulder and elbow. If you tear this tendon at the elbow, you lose strength in your arm and have significant weakness in supination (turning hand from palm down to palm up). Unless the biceps tendon is surgically repaired, there will be significant loss of arm function. The biceps tendon at the elbow region is the distal biceps tendon. The biceps tendon that attaches to the shoulder is the proximal biceps tendon.

Rupture of the proximal portion of the biceps tendon occurs often when there is a degenerative change within the tendon leading to structure failure. However, this tendon region could rupture during trivial activity. The primary cause of a distal biceps tendon tear is sudden injury.

Risk Factors

Those at risk for distal biceps tendon tears include men, age 30 or older. Smoking and the use of corticosteroids also increase the risk of these tears.

Symptoms

A distal biceps tendon tear causes the muscle to ball up near the shoulder, sometimes called the “popeye deformity”. Oftentimes, there is bruising at the elbow. If you tear this tendon, you may hear a “pop” at the elbow region. Pain is usually severe at first, but subsides after a couple of weeks. Other symptoms include weakness in twisting the forearm, swelling in the front of the elbow, and a gap in the front of the elbow.

Usually patients will have sudden pain associated with an audible snap in the area of their shoulder. The pain is usually not significant, and, as mentioned previously, some patients may experience pain relief after the rupture. After the ruptured tendon retracts, patients may notice a bulge in their arm at the biceps muscle. This is the retracted muscle bunched up in the arm, and is sometime referred to as a “Popeye Muscle,” because the muscle is more pronounced than normal.

Distal biceps tendon rupture is characterized by sudden pain over the front of the elbow after a forceful effort against a flexed elbow. Usually the patient will hear a snap and have pain where the tendon rupture occurs. Swelling and bruising around the elbow are also common symptoms of distal biceps tendon rupture.

Diagnosis

Medical History and Physical Examination

After discussing your symptoms, your doctor will review the events of the injury to determine how it occurred. During the physical examination, your doctor will feel the front of your elbow, looking for a gap in the tendon. He or she will test the supination strength of your forearm by asking you to rotate your forearm against resistance.

Your doctor will compare the supination strength to the strength of your opposite, uninjured forearm. In addition to the examination, your doctor may recommend imaging tests to help confirm a diagnosis.

Imaging Tests

X-rays. Although X-rays cannot show soft tissues like the biceps tendon, they can be useful in ruling out other problems that can cause elbow pain.
Magnetic resonance imaging (MRI). These scans create better images of soft tissues. They can show both partial and complete tears.

Treatment

Patients usually do not notice any loss of arm or shoulder function following a proximal biceps tendon rupture. A slight bulge in the arm, and some twitching of the retracted muscle are usually the most significant symptoms. Surgical repair of the proximal biceps tendon is usually only considered in the case of a younger patient who is more active.

The reason there is little functional loss following a proximal biceps tendon rupture is that there are actually two tendinous attachments of the biceps at the shoulder joint (that is why the muscle is named “bi-ceps,” meaning two heads). When the rupture occurs at the distal biceps tendon at the elbow, where there is only one attachment, surgical repair is much more commonly needed.

If pain persists following a proximal biceps tendon rupture, other causes of shoulder pain should be considered. These include impingement syndrome (rotator cuff bursitis), rotator cuff tears, or fractures around the shoulder.

Rupture of the distal biceps tendon at the elbow joint is much less common and accounts for less than 5% of biceps tendon ruptures. This injury is also usually found in middle-aged patients, although not always. There is usually some degree of tendinosus, or degenerative changes within the tendon, that predisposes the patient to rupture of the tendon.

The significance of a distal biceps tendon rupture is that without surgical repair, patients who experience complete rupture of the distal biceps tendon will notice loss of strength at the elbow. The strength will affect both the ability to bend the elbow against resistance, and the ability to turn the forearm to the palm-up position against resistance (for example, turning a doorknob or screwdriver).

Nonsurgical Treatment

Nonsurgical treatment may be considered for patients who are elderly and inactive, or who have medical problems that make them high-risk for modest surgery.

Patients must weigh the decision to proceed with nonsurgical treatment carefully, because restoring arm function with later surgery may not be possible.

The tendon should be repaired during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten.
While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.

Surgical Treatment

If you and your doctor decide upon elbow surgery,the surgery is performed as an outpatient procedure under either regional or general anesthesia. Your procedure will most likely take between one and two hours. Following surgery, your arm will be placed in a splint for several days to immobilize the elbow and allow the wound to heal. During this time gentle wrist, hand and shoulder exercises are performed.

Early range of motion is begun within three to seven days after surgery depending on the type and extent of the reconstruction. You will be able to remove the splint and use a range of motion brace in order to avoid elbow stiffness. It is particularly important to achieve elbow extension (that is to be able to straighten the elbow fully).

Procedure

Doctors use several procedures to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use two incisions, while others only one incision. There are pros and cons to each approach.
Sometimes the tendon is attached with stitches through holes drilled in the bone. Other times, small metal implants are used to attach the tendon to the bone.

Be sure to carefully discuss the options available with your doctor.
X-rays showing metal implants called suture anchors that have been used to secure the biceps tendon to the bone.

Rehabilitation

Right after surgery, your arm may be immobilized in a cast or splint.
Your doctor will soon begin having you move your arm, often with the protection of a brace. He or she may prescribe physical therapy to help you regain range of motion and strength.

Resistance exercises, such as lightly contracting the biceps or using elastic bands, may be gradually added to your rehabilitation plan.
Be sure to follow your doctor’s treatment plan. Since the biceps tendon takes 2 to 3 months to fully heal, it is important to protect the repair by restricting your activities.

Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be avoided for several months.

Although it is a slow process, your commitment to your rehabilitation plan is the most important factor in returning to all the activities you enjoy.

The physical therapy team at Hoag is orthopedic specialized, and they will work closely with your surgeon to establish a personalized rehabilitation plan for you. About six weeks after your surgery, elbow strengthening exercises may begin. For patients who remain dedicated to physical therapy the chances of complete recovery are very high, at above 90 percent.

Frozen Shoulder Causes and Treatment

Frozen shoulder, or adhesive capsulitis, is a disorder characterized by pain and stiffness in the shoulder joint. The symptoms generally begin gradually but worsen over time. As more time passes, the shoulder becomes very difficult to move. Around 2% of the general population is affected with this condition, and it typically occurs more often in women between the ages of 40 and 60.

The shoulder is a ball-and-socket joint that consists of the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). With frozen shoulder, the shoulder capsule thickens and gets tight due to stiff bands of tissue called adhesions.

To diagnose this condition, the orthopedic specialist will perform a complete physical examination and take an extensive medical history. Tests that will help the doctor rule out other shoulder disorders include X-rays, MRI, and ultrasound.

What are the stages of frozen shoulder?

Frozen shoulder develops in three stages: freezing, frozen, and thawing. The “freezing” stage occurs slowly and pain worsens gradually. With this stage, you lose range of motion of the shoulder joint, and it typically lasts from 6 weeks to 9 months. In the “frozen” stage, the painful symptoms actually improve – only the stiffness remains. This stage lasts around 4 to 6 months, and daily activities are troublesome during this time. The “thawing” stage is where shoulder motion slowly returns to normal. This stage lasts around 6 months to 2 years.

What are the symptoms of frozen shoulder?

During the “freezing” stage, the shoulder joint becomes quite painful. Any movement of the shoulder leads to discomfort during this time. Stiffness occurs in the “frozen” stage and there is decreased range of motion. These symptoms improve during the “thawing” stage.

What causes frozen shoulder?

Experts do not fully understand the causes of frozen shoulder. There is no distinct connection to arm dominance or occupation. With this condition, the capsule that encases the shoulder joint becomes thickened and tightens, restricting movement. There are some factors that can put you at risk for developing this condition. These include:

  • Age and Sex: People over the age of 40 are more likely to experience frozen shoulder, and it is more common among women.
  • Diabetes: Frozen shoulder has been found to occur more commonly in the diabetic patient, affecting around 15% of the diabetic population.
  • Other Diseases: There are some additional medical problems associated with frozen shoulder like hyperthyroidism, hypothyroidism, tuberculosis, cardiac disease, and Parkinsons disease.
  • Immobilization: When the shoulder is immobilized for an extended period of time, frozen shoulder can develop. Possible conditions requiring immobilization include a broken arm, a rotator cuff injury, a stroke, or recovery from surgery.

How is frozen shoulder treated?

Frozen shoulder typically resolves with time, although it can take as long as three years. The focus of treatment is to control pain and to restore strength and motion of the shoulder joint. Nonsurgical measures include non-steroidal anti-inflammatory medications (NSAIDS), steroid injections, and physical therapy. The orthopedic specialist can also inject sterile water into the joint capsule to stretch the tissue and enhance movement. This is called “joint distension.”

If these conservative measures do not improve the symptoms, the orthopedic specialist may find it necessary to operate on the shoulder. The surgeon can perform manipulation under anesthesia or shoulder arthroscopy. During the manipulation procedure, the doctor will force your shoulder to move under an anesthetic so it will not be painful to you, making the capsule and scar tissue stretch.

This is done to release the tightening and increase the range of motion. With shoulder arthroscopy, the doctor cuts through tight portions of the joint capsule to increase motion of the shoulder. This can be done with tiny instruments and a small camera.

Common Sports Shoulder Injuries

Most injuries to the shoulder occur during athletic activities that involve repetitive, excessive overhead motion. These include pitching, weightlifting, tennis, and swimming.  Some sports related shoulder injuries include shoulder instability, shoulder impingement, shoulder separation, shoulder dislocation, rotator cuff tears, acromioclavicular joint sprains, and SLAP lesions.

Shoulder Instability

When the shoulder joint is forced out of normal position, the condition is known as instability. Shoulder instability can result in a dislocation, which is quite painful. Most people who suffer with shoulder instability have pain when raising the arm and the shoulder feels as if it is slipping out of place. If this instability becomes a chronic, recurring problem, the surgeon may find it necessary to perform an arthroscopy. This procedure allows for the orthopedic specialist to look inside the shoulder with a tiny camera to assess the extent of the injury and perform surgery on the area to repair the soft tissues.

Shoulder Impingement

Impingement of the shoulder is caused by excessive rubbing of the tendons against the upper portion of the shoulder blade (the acromion). When there is repeated use of the arm overhead, shoulder impingement is likely. Injections and physiotherapy can improve this syndrome, but surgery is often necessary to remove bony spurs that trap the rotator cuff tendons and worsen the condition.

Shoulder Separation

With a separated shoulder, the acromioclavicular (AC) joint is injured. The AC joint is located where the collarbone (clavicle) meets the upper area of the shoulder blade (acromion). Most of these injuries are the result of a fall where the ligaments attaching to the underside of the clavicle become torn. A separated shoulder causes pain and deformity of the shoulder region. A mild separation involves AC ligament sprain and will appear normal on X-rays. With a more serious injury, the AC ligament could tear, putting the collarbone out of alignment.  Most minor shoulder separations can be treated conservatively with the use of slings, cold packs, and medications for pain.

For more severe injuries, the orthopedic specialist may need to surgically trim back part of the end of the collarbone to prevent rubbing against the acromion. Also, the torn ligaments may need to be addressed by attaching them back to the underside of the collarbone to restore stability of the AC joint therefore allowing motion, flexibility, and strength to return.

Shoulder Dislocation

The shoulder joint is the most mobile joint of the body, making it potentially unstable and at risk for dislocation. Repeated dislocations result in instability and stretching of the shoulder joint, which can lead to poor sports performance and long periods out of the game. In order to reduce a shoulder dislocation, the surgeon will position the ball of the upper arm bone back into the joint socket by means of a closed reduction. For severely dislocated shoulders, however, surgery is often necessary to repair the torn or stretched tissues around the shoulder that normally support the joint.

Rotator Cuff Tears

The rotator cuff is a group of tendons and muscles that allow for movement and stability of the shoulder. The rotator cuff allows an individual to lift the arm and reach overhead. When this structure is injured, pain and weakness occurs. If tearing is significant, the surgeon may need to perform a rotator cuff repair through small incisions (arthroscopy) or by an open method.

Acromioclavicular Joint Sprain

The AC joint is important for athletes who throw and put their arms overhead. It is often sprained from repeated falls and can dislocate easily. When this joint is sprained, there will be pain and loss of normal movement of the shoulder. The orthopedic specialist can provide injections and physiotherapy to improve an AC sprain. Occasionally, with more significant AC sprains, an operation may be necessary to help alleviate persistent, long-term pain.

SLAP Lesions

Tears of the Superior Labral Antero-Posterior (SLAP) region of the shoulder occur with overhead throwing, tackling sports, and heavy lifting. Because the biceps anchors the shoulder, it is easily pulled off the bone by force. The symptoms of this type of injury include pain within the shoulder with lifting and sports. Many complain of a clicking sensation that extends down the upper arm. If the SLAP tears are not serious, the orthopedic specialist will prescribe non-steroidal anti-inflammatory medications and physical therapy. Some tears, however, will require surgical repair via arthroscopy or open techniques. This way, the surgeon can determine the extent of your injury and repair it at the same time.

Common Sports Related Joint Dislocations

Elbow Dislocations

The elbow becomes dislocated when the joint surfaces are separated. With a complete dislocation, the joint surfaces are separated completely. The joint surfaces are only partly separated with a partial dislocation, also called a subluxation. The elbow is a hinge joint as well as a ball-and-socket joint.

Injuries and dislocations to this structure can affect the normal range of motion. Elbow dislocations are either simple or complex. With simple dislocations, there is no major bone injury. With complex dislocations bones and ligaments are injured.

What causes an elbow dislocation?

The most common reason an elbow is dislocated is when a person falls onto an outstretched hand. There is considerable force sent to the elbow when the hand hits the ground. Most often there is a turning motion in this force and this can rotate and put the elbow out of its socket. Elbow dislocations often occur during car accidents, when the passenger reaches forward in an attempt to cushion the impact.

What are the symptoms of an elbow dislocation?

With a complete elbow dislocation, there is considerable pain and obvious deformity. With a partial dislocation, the joint appears fairly normal. However, there usually is pain and bruising on the inside or outside area where ligaments have been torn or stretched. If the ligaments never heal, partial dislocations can recur.

How is an elbow dislocation treated?

Elbow dislocations require immediate treatment and are emergency injuries. The goal of treatment is to return the joint to its normal alignment and restore function of the arm. The orthopedic specialist can realign the elbow joint using a reduction maneuver. Once the joint is reduced, an immobilizer is required for two to three weeks.

Physical therapy is often required to restore full range of motion. For complex dislocations, surgery is often required to restore bone alignment and repair ligaments. After the operation, the elbow will be protected with an external hinge device to prevent further dislocation.

Shoulder Dislocations

The shoulder is susceptible to dislocation because it can turn in many directions. A partial dislocation of the shoulder is also called a subluxation. This means the head of the upper arm bone is partially out of the socket. With a complete dislocation, the structure is all the way out of the socket.

What are the symptoms of a dislocated shoulder?

Most shoulder dislocations lead to swelling, bruising, numbness, and weakness. Many times, a dislocation results in torn ligaments or tendons or damaged nerves. It is possible for the shoulder to dislocate downward, forward, or backward.

What is the treatment for a dislocated shoulder?

Many times the shoulder can be reduced. This is where the surgeon places the ball of the upper arm bone back into the socket. After the reduction, the orthopedic specialist will immobilize the shoulder in a sling or device for a few weeks. Ice is recommended 3 to 4 times a day to reduce pain and swelling. Also, the doctor will prescribe rehabilitation exercises for you to help restore the shoulder’s range of motion and strengthen the muscles. If recurrent dislocations occur, surgery is sometimes necessary.

Hip Dislocations

The hip becomes dislocated when the head of the thighbone slips out of the socket in the hip bone. For around 90% of people, the thighbone is pushed out of position in a backwards direction. This is known as posterior dislocation. Rarely, the thighbone slips out of socket in a forward direction. This is called an anterior dislocation.

What causes hip dislocations?

The hip joint is formed of a ball-and-socket construction. The ball is the head of the thighbone (femur) and it fits into a cup-shaped socket in the pelvis. This joint has a great deal of stability and moves freely. The most common reason for a dislocated hip is motor vehicle accidents. Falls can also result in dislocated hips.

How is a dislocated hip treated?

With a dislocated hip, the orthopedic specialist must administer an anesthetic or sedative and then position the bones back into proper position. This is called a reduction and surgery is often required. The surgeon will make an incision over the hip region in order to reduce the hip.

It takes up to three months for a hip to heal once it has been dislocated. Many times it is necessary for the patient to be in traction for a short period of time. Special controlled exercises are prescribed to help the hip regain strength and function.