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.

When Can Physical Therapy Help?

You may be wondering if or not you are a candidate for physical therapy (PT), or question whether physical therapy can help your ailment. This is an easy question for most physical therapists to answer: Yes, most people benefit from some form of physical therapy, whether their problem is simple (like an ankle sprain) or more severe (like a serious neurological disorder. At Orthopedic Specialists of Seattle, our physical therapists describe PT as conservative treatment that addresses the healing, management, and prevention of disabilities and injuries.

Physical therapy uses non-invasive and non-medical techniques and tools to help you improve total body function. Our physical therapist focuses on relief of pain, promotion of healing, restoration of function and movement, and adaption and facilitation associated with the injury involved. PT also focuses on body mechanics training, wellness, and fitness so you can improve your quality of life. Our physical therapist uses exercise, cold therapy, heat treatments, electricity, and therapeutic massage to achieve the goals of restoring maximum functioning to each individual patient. … read more

Biceps Tendon Ruptures

Have you felt a pop in your arm and been concerned that you may have torn your biceps?

You are not alone – this common injury affects thousands of Americans every day, with the typical tear occurring in males 30-50 years old, often with a distinct tearing feeling or even an audible “pop.”

These tears often cause significant bruising and loss of function and tend to do poorly without surgical reattachment of the torn tendon. Fortunately, there have been significant advances in the understanding of the tear and proper repair within the last couple of years that not only allows for a significantly stronger repair, but also allows for earlier recovery through minimally invasive treatments.

What is a biceps tear?

It is important to understand a bit of anatomy before delving into the specifics of the biceps tear rupture specifics. The biceps tendon has two attachments at the shoulder and one attachment at the elbow. The biceps tendon is not only important for elbow flexion, but also forearm supinaton –rotation of the forearm that allows us to open up a door or hold our hand out for change. Rupture of the biceps tendon at the shoulder or elbow will cause dysfunction in both functions.

Proximal Biceps Tendon Rupture

The typical injury to the upper end of the biceps is where the biceps tendon ruptures from its attachment at the shoulder joint, specifically at the superior labrum of the glenoid bone. Typical symptoms include shoulder pain, bruising, and often a bulging, shortened biceps muscle known as a “Popeye muscle.” Often patients who tear their biceps tendon describe preexisting pain at the front of the shoulder and pain with shoulder movement called biceps tendonitis. Biceps tendonitis can often be prophylactically treated to prevent or minimize biceps rupture, often through physical therapy, steroid injections or shoulder arthroscopy to debride or repair the tendon.

With Proximal Biceps tendon rupture, many active patients notice a slight loss of strength and a significant cosmetic change in their arm with the bulging muscle and many benefit from repair. I perform the proximal biceps tendon repair as an outpatient procedure and is often quite successful, typically allowing for full return to previous activity.

Distal Biceps Tendon Rupture

Injury to the distal biceps occurs when the biceps tendon is being flexed against a significant force. There is typically a “pop” or a tearing sensation followed by bruising and retraction of the biceps muscle. In a significant percentage of patients, this initial episode is followed by a reasonable return to activity over the next several weeks, delaying care. Active patients often notice pain, weakness and difficulty in twisting activities such as opening a door. Elbow flexion is somewhat preserved due to the presence of the brachialis muscle, which is quite strong and rarely injured.

Treatment for distal biceps tendon rupture includes prompt early diagnosis as the retracted muscle and tendon quickly scars into its retracted position. For the vast majority of patients, surgical reattachment is recommended and can be done as an outpatient procedure.

New Repair Treatment Technique

I perform a newer technique of Biceps Tendon repair, which includes performing the surgery through a very small incision, typically 2 centimeters at the elbow. The smaller incision is utilized due to a newer biceps button technique that provides not only stronger fixation and proper tension, but also earlier recovery due to the strength of the repair and the limited nature of the incision and dissection.

Chronic biceps tendon ruptures (typically over 3 months old) might require larger dissection, due to the retracted scarred nature of the tear. They can occasionally require the use of additional tendon graft, but still utilize newer more-reliable fixation techniques that allow for quicker rehabilitation.

All in all, advances in Biceps tendon tear repair allows for early return to activity and strength. The key to proper treatment includes early identification and diagnosis and is quite rewarding to help patients return to their pre-injury state of function.

Do not hesitate to contact us for further questions or for a prompt evaluation.

Read the original article on by our very own Dr. Scott Ruhlman. He performs the new surgical technique that allows for stronger repair and earlier recovery.

ACL Tears and Knee Arthroscopy

What is the ACL?

The most commonly injured ligament of the knee is the anterior cruciate ligament or ACL. The risk of injury is greater among those who participate in high-risk sports like football, basketball, soccer, and skiing. Around half of ACL injuries occur in combination with damage to the meniscus (cartilage pad), other ligaments, or other structures.

Most of the time, injury to the ACL occurs with pivoting, sidestepping, awkward landings or difficult cutting movements.

The knee is a hinged joint that is held together by four ligaments, one of them being the ACL. This structure runs diagonally in the middle portion of the knee to prevent the lower leg bone (the tibia) from sliding out in front of the thighbone (the femur). The ACL also serves to provide rotational stability of the knee.

What is Knee Arthroscopy?

One type of knee surgery is arthroscopy, a common surgical procedure in which a joint is viewed using a tiny camera. This camera looks into the knee through a small lens and projects an image on a TV monitor to allow the orthopedic specialist a clear view of what is inside the joint space.

An arthroscopic knee procedure allows the surgeon to diagnose and treat the knee injury at the same time. According to the American Orthopedic Society, more than 4 million knee arthroscopies are performed each year. This is a safe and effective way to treat the torn ACL.

Almost all arthroscopic knee surgical procedures are done on an outpatient basis. Knee arthroscopy is most commonly used for reconstruction of the torn ACL, trimming away pieces of torn cartilage, removing loose bone fragments or pieces of cartilage, and removing inflamed synovial tissue.

Arrival
Your surgery center or hospital facility will contact you with specific details about your appointment. You will be asked to arrive an hour or two before the procedure and not to eat or drink after midnight the night before.

Anesthesia
Once you are at the facility where the knee arthroscopic procedure will take place, a member of the anesthesia team will see you. Knee arthroscopy or ACL surgery is usually performed under regional, or general anesthesia. The anesthesia professional will help you decide which method is best for you.

Procedure
The orthopedic specialist will make three small incisions in your knee. A sterile solution will be used to irrigate the knee joint to wash away any cloudy fluid. This helps your surgeon see your knee clearly and in great detail. If surgical treatment is required, your orthopedic surgeon will insert tiny instruments through another incision. These instruments might be trimmers, scissors, and motorized shavers.

ACL tears are repaired by the use of substitute grafts, usually made of tendon. The graft tissues often involve autograft, meaning it comes from the patient. Tendons commonly used are the patellar tendon or the hamstring tendon. During the procedure, the orthopedic specialist will often drill small bone tunnels into the tibia and femur to place the ACL graft in the same position as the torn ACL. The graft is held under tension and is fixed in place using screws, washers, posts, or staples.

Recovery
Rehabilitation after ACL surgical reconstruction with arthroscopy is much faster than recovery from traditional open knee surgery. You will need to follow your orthopedic specialist’s instructions carefully. Be prepared for some swelling, so you will need to keep your knee elevated as much as possible the first couple of days after the procedure. Ice is usually recommended by the surgeon to take down swelling and help with the pain.

Dressing Care
Once the procedure is over, the doctor will cover your knee with a sterile dressing and you are to keep the incisions and this dressing clean and dry. Your orthopedic specialist will advise you on bathing and when to change the dressing.

Bearing Weight
After arthroscopic knee surgery to reconstruct the ACL, you will likely need crutches or some other assistive device for the first few days to prevent excessive swelling and bleeding into the knee. Your surgeon will tell you when it is safe to bear weight on your leg and foot.

Driving
Typically, you must wait 1 to 3 weeks before driving, depending on your doctor’s orders. The orthopedic specialist will base this decision on the knee that is involved, whether your car is an automatic or stick shift, the nature of your procedure, what type of medications you are taking, and how well you can control your knee.

Rotator Cuff Tears

Many Americans suffer rotator cuff tears and they are a common cause of pain and disability. When you tear your rotator cuff, you weaken your entire shoulder making daily activities more difficult. Just raising your hand up to comb your hair could cause serious pain. Read on to find out what makes up the rotator cuff, who is at risk for this type of injury, what are the symptoms of a tear, and how a rotator cuff is treated. … read more

Hand Masses-Lumps and Bumps on the Hand and Wrist

I see many patients with different types of lumps and bumps of the hand and wrist. The vast majority of hand and wrist tumors are benign (non-cancerous), but they should all be evaluated by an orthopedic hand specialist. Any abnormal mass or growth is considered to be a “tumor”. These can occur on the skin, like a mole or a wart, or can be underneath the skin in the soft tissue, the fat layer, the muscle, or even the bone. There are many different types of tissues in the hand and wrist, so many types of tumors can occur.

What are the most common hand and wrist masses?

Ganglion cysts – These are the most common type of mass that represents around 50% of all hand and wrist growths. A ganglion cyst occurs when the tough lining of the small joint forms a pouch where joint fluid collects resulting in a “ballooning-out” of the lining of the tendon sheath or joint. This fluid is very thick, with a molasses-like consistency and when it fills the cyst, it makes it feel very firm. These cysts can also form as pouches off a knuckle joint or tendon sheath and are often referred to as mucous cysts. The treatment options I offer for these include aspiration, where the mass is punctured and the fluid is removed with a needle, or removal by means of surgery.

Giant Cell Tumor of the Tendon Sheath – Giant cell tumors are not true tumors as much as they are firm masses, and they are the second most common types of hand and wrist masses. These masses develop from joint lining known as synovium or from a tendon sheath. Giant cell tumors grow slowly and are quite painful. I can usually easily remove these lesions, but they often come back. Though these growths sound bad but they are slow growing and benign.

Epidermal Inclusion Cysts – I see these masses after an injury to the hand or finger and they often show up years later. An inclusion cyst develops just underneath the skin and is often quite firm. When an injury such as a deep cut occurs, the surface cells are pushed into the deep layers of the palm or finger resulting in the formation of a cyst in the area of injury. Skin cells produce a protective, way substance called keratin and when skin cells get trapped under the surface, they will continue to grow and make this keratin, which forms the cyst.

Carpal Boss – This common type of mass isn’t a tumor, but rather is an overgrowth of bone on the back of the hand. Carpal bosses are similar to bone spurs and often are often misdiagnosed as ganglion cysts. This type of mass is firmer and not movable, however. Occasionally the bump of a carpal boss is problematic, I might recommend removal of the symptomatic bone spur.

Enchodroma – When the cartilage grows inside the bone, an enchodroma occurs. These masses are non-cancerous but can present a problem when the bone becomes weakened and can lead to a fracture from weak bone. Usually I can fix the fracture while bone grafting the lesion to treat the lesion. Again, these are usually benign.

Lipomas, Neuromas, and Fibromas – These masses are all usually benign growths. Lipomas are fatty tumors, neuromas are nerve tumors, and fibromas are tumors of the fibrous connective tissue material of the hand and wrist. They can occur on the hand and wrist regions and are usually benign but often symptomatic. Many patients request removal of these lesions which not only treats the lesion, but provides a firm diagnosis.

Should I worry about cancer?

Though uncommon, the most common kinds of cancer that affects the hand and wrist include squamous cell carcinoma, basal cell carcinoma, and melanoma. While cancer seldom originates in the hand and wrist region, there are rare cases of bone and cartilage tumors that could result. When cancer originates in the hand, it is called sarcoma and is due to abnormal growth of the bone, cartilage, or soft tissues. While sarcomas are rare, it is always best to come to my office for an evaluation if you have a concerning mass of the hand or wrist.

What will an orthopedic specialist do for a lump or bump of the hand or wrist?

First of all, I will perform a careful history and physical examination to help determine the type of hand or wrist tumor you have. Often, x-Rays may be necessary to evaluate the bones, joints, and soft tissues. Further diagnostic studies, such as CT, MRI, or Bone Scan, might narrow down the diagnosis. Treatment will depend on the type of mass you have. Generally, definitive treatment with the lowest recurrence rate involves the surgical removal of the mass. This will allow me to send the tissue off to a pathologist to analyze it and determine what exact type of growth you have.

In general, I recommend evaluation of all hand masses to establish a firm diagnosis and a reasonable treatment plan. Most tumors are benign, but can often be symptomatic. Usually excision of the lesion is curative and can help provide a reassuring diagnosis.