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.

OSS: Sponsor of The Heartbeat Serving Wounded Warriors – Golf Invitational

OSS Sponsored Wounded Warriors Golf Tournament

Hannah Lahrson- Administrator, Brian Haid PA-C, Scott Ruhlman MD, & Jonathan Franklin, MD at the Golf Invitational, September 14, 2012

Orthopedic Specialists was a proud sponsor of The Heartbeat Serving Wounded Warriors Golf Invitational last Friday, September 14th, 2012 at The Home Course located in Dupont, WA.

Often times when soldiers return home from battle they are plagued with a myriad of mental and physical limitations, changing their lives forever, creating unseen challenges for them, and for their families. OSS supports The Heartbeat Serving Wounded Warriors because of their dedication to those who put their lives on the line to protect our country, by providing them and their families with emergency assistance, therapeutic services, support groups, and morale-building programs.

Thank you for your help in celebrating the continued success of The Heartbeat and OSS on September 14th, 2012, the event was a relaxing quiet day of golf on one of the finest courses in the Northwest. The Home Course, home to numerous tours and tournaments, is located at 2300 Hoffman Hill Blvd in DuPont, WA.

We honor our much deserving soldiers at this time, and we encourage your continued support of The Heartbeat Serving Wounded Warriors. You can learn more about the organization at heartbeatforwarriors.org.

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Dupuytren’s Contracture and XIAFLEX® Treatment

Dupuytren’s contracture is a painless, thickening and tightening of the fibrous tissue that leads to curled fingers. This condition affects the fibrous tissue layer underneath the skin of the palm and fingers and is more common in men than in women.

The Cause

The cause of Dupuytren’s contracture is unknown but doctors know that it is not caused by an injury or heavy use of the hand. There are some factors that are associated with this condition, however. These include Northern European descent, heredity, alcohol consumption, and advancing age.

The Symptoms

The symptoms of Dupuytren’s contracture occur very gradually. Nodules form in the palm area and are often tender. These nodules may thicken and contract, leading to a tough band of tissue under the skin. One or more of the fingers bend forward toward the palm in a flexed position. The ring finger and little finger are the ones most commonly affected but any of the fingers can be involved. This flexed position makes it difficult to straighten the affected fingers and grasping objects becomes difficult.

The Treatment

One currently used treatment for Dupuytren’s contracture is an enzyme injection called XIAFLEX®. This is administered by Dr. Weil. Basically, the enzyme is able to break down the tough bands to allow for improved motion without surgery. This procedure is performed at the orthopedic office and results are fairly comparable to surgical treatment.

The doctor will inject the XIAFLEX® directly into the diseased tissue. Over the next 24 hours, the enzyme breaks down the contracted tissue. The following day Dr. Weil will perform a manipulation of the contracted finger in order to straighten the finger. This injection is approved by the FDA and early results are promising.

Before you receive XIAFLEX®, be sure to tell your doctor if you have an allergic reaction to a previous injection or anesthetic. Also, inform your orthopedic specialist if you have a bleeding problem or are on medications that increase bleeding. Common side effects to this enzyme include swelling at the injection site, hand swelling, bleeding, bruising, pain, or tenderness at the injection site or hand, lymph node swelling, and pain of the underarm area.

Needle aponeurotomy is another great procedure that Dr. Weil performs. After numbing the hand with a local anesthetic injection, Dr. Weil uses a hypodermic needle to divide the diseased tissue. Then a manipulation of the contracted finger is performed in order to straighten the finger. This procedure is performed in the office and generally takes about 30 minutes.

It’s a minimally invasive procedure and patients experience less pain and swelling when compared to surgery and early results are comparable to XIAFLEX® and to surgery.

Surgery for Dupuytren’s contracture remains the gold standard treatment and is usually reserved for the most severe cases. It involves making a series of zig zag incisions in the palm and fingers and the diseased tissues are excised from the palm. Surgery is usually performed under a regional block and as a day surgical procedure. Significant post operative hand therapy and splinting is also utilized for severe cases.

Soft Tissue Trauma Treatment

If you participate in physical fitness activities and sports, you are at risk for injuries to the soft tissues of your body. Damage to the tendons, ligaments, and muscles of the body can occur even during simple everyday activities. These types of injuries include sprains, strains, contusions, stress injuries, bursitis, and tendonitis. Soft tissue trauma is usually the result of a fall, a blow to the body, or a sudden twist. Many times injuries to the soft tissue of the body are obtained because of repeated overuse during athletic activities.

Soft Tissue Trauma Treatment & RICE … read more

Common Orthopedic Foot Problems

Achilles Tendinits

Achilles tendinitis is a commonly occurring foot condition that leads to pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body, and it connects the calf muscles to the heel bone. This tendon is used for jumping and running.

There are two types of Achilles tendinitis: noninsertional and insertional types. With noninsertional Achilles tendinitis, the fibers in the middle portion of the tendon have started to break down and the tiny tears swell and thicken the tendon. This more commonly affects young, active individuals.

With insertional Achilles tendinitis, the lower portion of the heel where the tendon attaches to the heel bone is affected. This particular type can occur for any type of patient, active or inactive.

What are the symptoms of Achilles tendinitis?

Like most foot problems, the symptoms vary from person to person. These include:

Pain along the tendon or the back of the heel that worsens with activity
Pain and stiffness which is worse in the morning
Severe pain the day after exercising
Thickening of the tendon
Swelling that is present all the time or worsens after activity
Bone spurring

What causes Achilles tendinitis?

Achilles tendinitis is not the result of a specific injury; the problem results from repetitive stress on the tendon. Other factors that cause this syndrome include tight calf muscles and bone spurring.

How is Achilles tendinitis treated?

Nonsurgical treatment for Achilles tendinitis involves rest, ice therapy, NSAIDS, special exercises, physical therapy, and supportive shoes and orthotics. Surgical treatment may be necessary if conservative measures fail. Occasionally a gastrocnemius recession is performed, where the calf muscles are lengthened. Surgery typically involves debridement and repair of the affected tendon.

The aim of this procedure is to remove the damaged portion of the Achilles tendon. Occasionally a tendon transfer is required when a significant amount of damaged tendon is present. The unhealthy portion of the tendon is removed and reinforced with a graft to prevent the remaining tendon from rupturing with activity.

Adult Acquired Flatfoot Deformity (AAFD)

There are many different conditions that can lead to adult acquired flatfoot deformity. This syndrome results in a fallen arch with the foot pointed outward. For this condition, most people require orthotics and braces. For those who have no relief with these measures, surgery may be an option. Your orthopedic specialist will plan a treatment regimen for you based on what is causing your AAFD.

What are the symptoms of AAFD?

The symptoms of AAFD vary from patient to patient. They include:

Pain that is worse with activity
Pain along the course of the posterior tibial tendon which is on the inside of the foot and ankle
Pressure or discomfort on the outside of the ankle bone
Bony bumps on the top and inside of the foot that make wearing shoes difficult

What causes AAFD?

The most common cause of AAFD is damage to the posterior tibial tendon. This structure is one of the most important tendons of the leg. It extends from a muscle in the calf and travels down the inside of the lower leg to attach to the bones on the inside of the foot. This tendon functions to hold up the arch and support the foot with walking. Other things that can cause AAFD include arthritis, injury, and diabetes collapse (Charcot foot).

Who develops AAFD?

Women and people over age 40 are most likely to develop AAFD. Other risk factors are hypertension, obesity, and diabetes.

How is AAFD treated?

When orthotics and braces do not work, surgical treatment for AAFD may be necessary. The type of surgery will depend on the degree of dysfunction. With stage 1 dysfunction (pain along the posterior tibial tendon with no loss of arch), surgery involves debridement of the tendon and repair of longitudinal tears.

The operation for stage 2 dysfunction (pain along the posterior tibial tendon with associated fallen arch deformity) is more complex and involves realignment of the heel bone, a tendon transfer to support the arch, and often a spring ligament repair. When the deformity is due to arthritis, surgery to fuse the bones of the hindfoot (triple arthrodesis) is often required.

Plantar Fasciitis

If you are experiencing pain on the bottom of your heel, you may have plantar fasciitis. This condition occurs when the strong band of tissue that supports the foot arch becomes inflamed and irritated. The plantar fascia is a thin, long ligament that lies just beneath the skin on the bottom of the foot. This ligament connects to the heel in the front aspect of the foot to support the arch.

What are the symptoms of plantar fasciitis?

Common symptoms of plantar fasciitis include:

Pain after the first few steps when arising in the morning or after a long rest period
Pain on the bottom of the foot or heel area
More intense pain after (not during) activity or exercise

What causes plantar fasciitis?

The plantar fascia absorbs the high strains and stresses placed on the feet. Sometimes, however, there is too much pressure and damage or tears to the tissues of the foot occurs. When this happens, the body’s natural response to injury is inflammation resulting in heel pain and stiffness of the plantar fascia.

How is plantar fasciitis treated?

Nonsurgical treatment of plantar fasciitis involves rest, ice therapy, NSAIDS, exercise (calf stretch and plantar fascia stretch), cortisone injections, supportive shoes and orthotics, night splints, and physical therapy. Your orthopedic specialist will recommend what is best for you. If all these measures fail, occasionally shockwave therapy is an option. Surgery is rarely

Reverse Shoulder Replacement

Shoulder joint replacement is an excellent way to relieve pain in cases of severe arthritis of the shoulder, and sometimes for fractures or other conditions.

Nonsurgical treatments like medications and activity modification should always be tried before surgery. However, if these either fail to work, or stop working for you, you may be a candidate for shoulder joint replacement surgery.

“Traditional” shoulder replacement involves resurfacing the normal humerus “ball” with an alloy metal ball, and the cup on the shoulder blade with a plastic one (sometimes with a metal pin on the back, helping to hold the cup in place long-term):

shoulder1

About 53,000 people in the U.S. have shoulder replacement surgery each year, far fewer than the over-800,000 knee and hip replacements performed annually.

There are some patients with arthritis who cannot have successful traditional shoulder replacement surgery. These include patients with severe, irreparable rotator cuff tendon tears, some fractures, and tumors. For them, “Reverse Shoulder Replacement” might prove a good alternative.

Reverse shoulder replacement involves the opposite: replacing the ball with a cup, and the cup with a ball. This rather odd-sounding combination allows patients to control the motion of the shoulder by substituting the deltoid muscle for the deficient rotator cuff muscles:

shoulder2

One of OSS Shoulder Specialists has extensive training and experience in both traditional and reverse shoulder replacement, and has worked with the designers of the prosthesis he uses for implantation. He would be happy to see you in clinic and evaluate whether you would be a good candidate for this procedure.