Pumpkin Carving Safety Tips

Every October, carved pumpkins peer out from porches and doorsteps in the United States and other parts of the world. Gourd-like orange fruits inscribed with ghoulish faces and illuminated by candles are a sure sign that Halloween and the holiday season is upon us. The practice of decorating “jack-o’-lanterns” – the name comes from an Irish folktale about a man named Stingy Jack – originated in Ireland, where large turnips and potatoes served as an early canvas.

Irish immigrants brought the tradition to America, home of the pumpkin, and it became an integral part of Halloween festivities. Click Here and find pumpkin carving safety tips for you and your loved ones!

Seahawks DE Michael Bennett taken off field on stretcher

On Sunday, September 29, seattlepi.com reported that Seahawks defensive end Michael Bennett, who has been a big story this season as Seattle’s sack leader, was taken off the field Sunday on a stretcher after he was injured on a play against the Texans in Houston. The article reported, “Late in the second quarter, Bennett was rushing Texans quarterback Matt Schaub when he was pushed from behind by a Houston defender into Schaub’s leg. Bennett’s head appeared to snap back, and his helmet flew off as he hit the ground. Bennett laid face-down on the turf for several minutes as trainers tended to him.”

According to the news article, “Bennett suffered a strained muscle in his back that was close to his vertebrae. The location of the injury was why medical personnel were extra-careful and carted Bennett off the field on a stretcher.” Head coach, Pete Carroll said that he was “fine” and a tweet was sent out the next day stating that Bennet was practicing and that he may be able to play in their upcoming game against Indianapolis.

Treatment of a lumbar muscle strain is important to understand. Once you know the cause of your symptoms, you can proceed with treatment. It is important that if you are not sure of the cause of low back pain, that you are evaluated by a physician. According to Dr. Charlie Peterson, “Back injuries can be painful, frustrating and even scary, but are also common. As such, the vast majority can be managed with a few simple techniques. However, if you have unusual symptoms or your pain persists, it’s time to seek advice from a specialist.”

If you are experiencing pain in your lower back or it has been injured as a result of physical activity, below is a list to help you treat your injury:

Step 1: Rest

The first step in the treatment of a lumbar muscle strain is to rest the back. This will allow the inflammation to subside and control the symptoms of muscle spasm. Bed rest should begin soon after injury, but should not continue beyond about 48 hours. While it is important to rest the injured muscles, it is just as important to not allow the muscle to become weak and stiff. Once the acute inflammation has subsided, some simple stretches and exercises should begin.

Step 2: Medications

Two groups of medications are especially helpful in treating the acute symptoms of a lumbar back strain. The first of these are anti-inflammatory medications. These medications help control the inflammation caused by the injury, and also help to reduce pain. There are many anti-inflammatory options, talk to your doctor about what medication is appropriate for you.

The second group of medications commonly prescribed for the treatment of lumbar strains is muscle relaxing medications. Again, there are several options that you may discuss with your doctor. These medications are often sedating, so they need to be used with care. For patients who have back spasm symptoms, these muscle relaxing mediations can be a very useful aspect of treatment.

Step 3: Physical Therapy/Exercises

Proper conditioning is important to both avoid this type of problem and recover from this injury. By stretching and strengthening the back muscles, you will help control the inflammation and better condition the lumbar back muscles. The exercises should not be painful. Without some simple exercises, the low back muscles can become “deconditioned,” or weak. When the low back muscles are “deconditioned”, it is very difficult to fully recover from low back injuries.

It is also important to understand that even if you are “in good shape,” you may have weak low back muscles. When you have a low back muscle injury, you should perform specific exercises that stretch and strengthen the muscles of the low back, hips and abdomen. These exercises are relatively simple, do not require special equipment, and can be performed at home.

Step 4: Further Evaluation

If your symptoms continue to persist despite treatment, it is appropriate to return to your doctor for further evaluation. Other causes of back pain should be considered, and perhaps x-rays or other studies (MRI, CT scan, bone scan, laboratory studies) may be needed to make an accurate diagnosis.

If you believe you are suffering from a back injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.

Shoulder Ligament Injuries

Things tend to wear out and break at the moving parts. It’s just one of those principles of engineering that we cannot shake. It is one of the reasons that we see so many people with shoulder injuries.

The shoulder is the most mobile joint in the body and we ask it to do a lot for us. Every day, we reach forward, overhead and behind the back, sometimes repetitively or with heavy loads.

Other times, the shoulder absorbs more force than it should as we use the arm to break a fall in sports. This activity can lead to either traumatic or repetitive use injury. Today, we will focus on those injuries specific to the ligaments of the shoulder complex.

Ligaments hold one bone to another bone and limit the amount of motion available in the joint. This prevents excess movement or motion in directions not intended for a particular joint.

The tighter the ligaments are, the less motion available. Because the shoulder is a highly mobile joint, the ligaments must be loose to allow motion in all directions. This creates some inherent instability in the joint, and an avenue to potential injury.

Anterior Ligament Sprain/Dislocation

This injury usually occurs when we raise the arm overhead or out to the side and apply a force, such as with retrieving a heavy object from an overhead shelf. If the load is too great, then the ligaments in the front of the shoulder become overloaded and can tear, causing a sprain. If the ligaments tear enough, then the bones can separate and cause a dislocated shoulder.

Dislocations should get immediate medical attention in the emergency room. Treatment involves applying traction to the joint, which allows the shoulder to return to its normal position and then a period of immobilization to allow the ligaments to heal.

Unfortunately, the ligaments do not heal quite as tightly as they once were. The shoulder becomes increasingly unstable, disposing it to another dislocation. Conservative treatment following a dislocation involves strengthening of the rotator cuff, a group of four muscles that provide additional stability to the shoulder.

As you move your arm through space, the rotator cuff sucks the head of the arm bone, medically termed the humerus, into the socket. After a dislocation, it is even more important to keep the rotator cuff working properly. You may be referred to a physical therapist, who can provide instruction in the proper exercises.

Should the shoulder continue to dislocate, surgical intervention may be required. This entails tightening the shoulder capsule by “pulling up the slack” in the loose ligaments and stitching them back in place. This surgery is highly successful at stopping future dislocations, but there is a period of immobilization and rehabilitation for several weeks following the surgery.

Shoulder Separation

This is a common traumatic injury caused by falling on an outstretched hand. With this injury, the force of landing on the hand is transmitted through the shoulder, causing a tear in the ligament that holds the collarbone in place. The result is a dislocation of the joint where the collarbone meets the shoulder blade, located at the bony area on top of the shoulder.

This joint is called your acromioclavicular, or AC joint, and because this is the pivot point where the shoulder blade rotates, an injury here can cause significant loss of function in the arm, especially in the overhead range of motion.

Minor sprains in the ligament may heal, but active individuals who have difficulty or pain with arm use may need to undergo surgical correction, as conservative treatment usually will not restore proper mechanics and movement patterns.

Surgery involves harvesting a tendon from elsewhere in the body and using is as a replacement for the broken ligament. This effectively anchors the collarbone back in its correct position.

Frozen Shoulder

Medically termed adhesive capsulitis, this condition may be a result of injury to the shoulder, but just as often occurs without any type of trauma. It is an inflammation of the shoulder joint capsule, which contains the shoulder ligaments.

As the capsule becomes inflamed and thickened, the shoulder becomes painful and loses significant mobility. Frozen shoulder may persist from several months to a year or longer and usually follows a predictable pattern of presentation that includes three stages.

  1. The acute stage is marked by sharp pain in the shoulder throughout the range of motion, but especially with reaching overhead and out to the side. Shoulder mobility becomes limited.
  2. During the frozen stage, acute pain starts to subside, but mobility of the shoulder continues to be limited.
  3. The final phase is the thawing phase, where the joint mobility of the shoulder begins to improve, and functional use returns.

Although frozen shoulder can afflict a wide range of people, there are certain risk factors that may dispose someone to getting this condition including diabetes, cardiac disease, and hypo or hyperthyroid issues. Treatment is usually non surgical, as the condition usually gets better with time.

During the acute and frozen phases, anti-inflammatory medications may be prescribed, as well as a steroid injection directly into the joint capsule, which significantly limits the degree of inflammation.

Physical therapy may be ordered in order to learn some gentle mobility exercises, followed by more aggressive stretching and mobilization of the shoulder as the condition progresses into the thawing phase.

Treatment of Cavus Foot Deformity

Cavus Foot Deformity

Now that it’s summer, we spend more time at the beach or swimming pool enjoying the warm weather. As an orthopedic surgeon that specializes in conditions of the foot and ankle, I tend to notice wet footprints across the pool deck or in the sand and cannot help but analyze the health of the individual’s feet. One of the conditions that I notice is the high arched foot, medically termed pes cavus. This is noticeable by a footprint that is pronounced in the heel and forefoot, with very minimal or even absent impression in the middle part of the foot.

Causes of Cavus Foot Deformity

Pes Cavus is caused by muscle imbalances in the lower leg and foot that draws the front of the foot, or sometimes draws the heel downward, making the arch higher than normal. It usually begins during childhood and may be associated with neurological conditions such as muscular dystrophy or spina bifida, but not always. In many cases the muscles of the feet become tighter or weaker for unknown reasons. As with many medical conditions, genetics play a role in who will become afflicted with high arches.

Symptoms of Cavus Foot Deformity

High arches can cause a number of symptoms, ranging from mild to severe. Pain in the forefoot is a common occurrence due to increased weight bearing in this area. Excessive callus buildup at the ball of the foot behind the great toe as well as just behind the fifth toe is common, as these become high-pressure areas during standing and walking. Tightness in the calf muscles is often present, and the individual may also suffer from recurring ankle sprains due to the inwardly rolled ankles associated with the deformity.

Diagnosis of Cavus Foot Deformity

Identifying pes cavus is a straightforward process. The high arched foot is noticeable to anyone, but an orthopedic surgeon should evaluate the individual in order to identify some of the nuances of the condition. Diagnosing which muscles are tight or weak and assessing their potential to be stretched or strengthened is important for initiating an effective treatment plan.

Also, the cavus foot causes increased body weight to be distributed through areas of the foot that are not designed for this purpose. Evaluation by the surgeon will aid in a proper prescription of orthotics, if deemed necessary.

Treatment of Cavus Foot Deformity

Conservative intervention is generally the rule when starting to treat high arches. Often times if the feet have become painful, orthotic inserts are prescribed. As opposed to pes planus (flat feet), which is often a flexible disorder of the foot that we try to correct with orthotics (i.e., push back into the correct position), pes cavus is usually a rigid deformity,meaning that the shape of the foot cannot be changed.

In this case, the goal of orthotics is to accommodate the shape of the foot and to redistribute body weight over a larger area. Because of the rigidity, the cavus foot is not able to flex and absorb impact as the individual walks. For this reason, orthotics are usually constructed of softer materials to act as a shock absorber.

Physical therapy may also be prescribed to stretch and strengthen the muscles of the lower leg. Tight calf muscles and weak muscles along the outside of the lower leg (peroneal muscles) are often present in pes cavus. While therapy cannot change the shape of the foot, it may be able to help with pain control and function. Because the foot is usually rolled inward along with the high arch, the individual is susceptible to chronic ankle sprains and some reactive muscle strengthening may be beneficial, along with ankle bracing.

If conservative treatment fails to achieve the desired result, then surgical correction maybe necessary. There are many types or surgeries that the physician can perform based on individual need:

  • Tendon lengthening: This procedure involves making precision cuts in the tight tendons of the lower leg to allow better alignment of the foot. Following surgery,there is a period of immobilization for several weeks to allow the tendons to heal.
  • Osteotomy (bone cut/realignment): If the condition has been present since childhood and the bony structure of the foot has grown abnormally, then small sections of bone may need to be removed in order to restore proper position of the foot. The first metatarsal, located in the midfoot behind the great toe, is often treated with an osteotomy. The metatarsal often is positioned at a downward angle that is greater than normal, which in turn rolls the ankle toward the outside of the foot as the person bears weight.

    The osteotomy procedure seeks to normalize that angle and place the foot in a neutral position that is perpendicular to the ground. Many times, this osteotomy is performed in conjunction with soft tissue surgery such as tendon lengthening. Also, the calcaneus (heel bone) tends to be oriented toward the midline in pes cavus, as opposed to away from the midline in the normal foot, and sometimes an osteotomy is required to correct this.

  • Arthrodesis: Also known as a joint fusion, this procedure permanently locks the affected joint into a fixed position. It is a last resort option, but sometimes necessary when the cavus foot deformity is severe or when arthritis is present.

The FAQ’s on Thumb Arthritis

Try this experiment. On your dominant arm, take a piece of masking tape and strap your thumb to the side of your hand. Then leave it in place for a few hours as you try to go about your normal activities. You will soon find out just how integral this appendage is to getting through the day. Answering your cell phone, grabbing the coffee creamer from the refrigerator, turning the key to unlock the front door, are all activities that depend on proper functioning of your thumb.

Recreational activities such as golf or tennis – forget it. Now, if you have arthritis in the thumb joints, then this experiment does not end after only a few hours. It keeps going until treated medically by a qualified hand surgeon.

Degenerative arthritis of the thumb is one of the most common types of hand arthritis. It usually strikes at the base of the thumb where it meets the wrist. This joint, known as the carpometacarpal (CMC) joint, is a highly mobile joint that allows motion in all directions. It is also the joint that allows for a strong pinching motion.

However, because of its wide range of mobility, the bones that comprise the CMC joint must give up some stability, similar to the shoulder joint. Because of this, the ligaments around the joint are forced to bear most of the burden of stabilizing the thumb during hand use, and if they are unable to do it effectively then the aberrant motion in the joint over time can contribute to arthritis.

Diagnosis

The bones of the body at the joint surfaces are covered with cartilage, a slippery coating that allows smooth motion at the joints. Arthritis is an inflammation and eventual wearing away of the cartilage, creating rougher surfaces and painful motion. In my practice, arthritis of the thumb is a common occurrence with a straightforward diagnosis. Palpation of the joint as the patient moves the thumb will often reveal the typical grinding sensation as if the joint surfaces were lined with sandpaper. There also may be an audible grinding sound known as crepitus. I may also order an X-ray to confirm the extent of the arthritis and determine the most effective treatment options. Other tests such as the CT scan or MRI are most often unnecessary.

Treatment

In the earlier stages of the disease process, this type of arthritis is usually treated with anti-inflammatory medication. This is often successful for months to years, allowing the individual to fully use the hand at home and work. Thumb splinting may also be advantageous as it allows the thumb to rest in a neutral position where mechanical stress is at its least, which in turn may settle the inflammation.

However, arthritis is a generally a progressive condition and because the thumb is used so frequently and strenuously, the disease often progresses despite these measures. As more conservative treatments fail to provide adequate relief, I will attempt to reduce the joint inflammation with one or more cortisone injections to the affected joint.

In the later stages of arthritis, as more and more hand function is lost, surgical reconstruction is often the best course of action. Part of the diseased joint is removed and reconstructed using a tendon graft from another part of your body. Following surgery, you will have to wear a splint for several weeks to allow the surgical repair to strengthen. If your occupation depends upon heavy use of your hands, then you may need to be out of work during this time if you are not able to find restricted duty work.

It is important to factor this into your overall planning prior to surgery. After removal of the splint, occupational or physical therapy with a therapist who specializes in rehabilitation of the hand will be prescribed. This will help you regain strength and motion and allow you to fully utilize the thumb and hand.

If you believe you are suffering from degenerative arthritis of the thumb and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.