Have you ever noticed how a tomato plucked from a garden tastes so much better than store bought? It’s near impossible to purchase that amount of flavor. Anybody that has ever planted a vegetable garden is sure to agree. Enjoying a salad or sandwich made with fresh vegetables from your own backyard is one of summer’s many benefits.

Flower gardening is also enjoyable for many people, and often those who like to be outside in the warm weather will spend considerable time planting, weeding, and harvesting the fruits of their labor. For those with chronic hand pain due to arthritis, this once pleasurable activity could now become a chore due to the aggressive hand movements that are involved, and the anticipated discomfort that it may cause. Luckily, there are some ergonomically designed tools on the market that will help those with hand pain continue with their hobby, and also some self-treatment strategies to minimize pain. So take heart, you can still get out there and enjoy one of your favorite activities with a little planning and strategy.

Pace yourself

You may be used to planting an entire garden or pruning an entire yard full of bushes in a day, but working with arthritis means that you should often work slower to minimize the cumulative stress on your hands. Whether you have osteoarthritis or rheumatoid arthritis, this is a good idea. Plan your activity so that you spread the work out over a few days. This will help keep the arthritis from flaring and causing increased pain.

Use arthritis friendly gardening tools

Gripping is one of the major movements in gardening work. Repetitive clamping of pruning tools can put excessive pressure on the joints of the fingers and thumb. Some tool manufacturers such as Fiskars® have designed garden tools specifically for those with limited hand and arm strength. Many of these tools have been commended by the Arthritis Foundation due to their ease of use.  These tools include spring opened scissors and pruners which maximize leverage with the use of gears and longer handles.

Keep tools sharpened

Having a dull blade on your tools means that you will have to exert more pressure in order to cut branches and stems. Have your pruning tools sharpened annually to maximize their effectiveness. Many local hardware stores offer a sharpening service, and pricing is usually very reasonable compared with the cost of new tools.

Wrap tool handles in foam

Wrapping the handle of a trowel or hand rake in foam tubing increases the handle’s diameter and reduces the muscle pressure needed to keep the tool steady within your hand. Some tools made specifically for the arthritis sufferer already have a wider handle, but otherwise this is a great technique to alleviate hand stress. You can use water pipe insulation found at the same hardware store where you get your tools sharpened.

Wear gloves

Gardening gloves do more than just keep dirt from getting under your fingernails. They also absorb perspiration. This is important because as your hands get sweaty, they also get slippery. That means you must grip your tools harder to keep them from sliding in your hand. Wearing gloves mitigates this and results in less force needed to handle your tools.

Use a lightweight coiled hose

Managing a standard garden hose can be aggravating for anyone. The kinks that develop and cut off the water supply often lead the gardener to vigorously shaking the hose to untangle it. Of course, this adds to the cumulative strain on the arthritic hand and wrist. Today’s pre-coiled garden hoses are made of a lighter weight material than standard hoses, and they resist tangling. When you are finished, the hose automatically recoils, making clean up easier.

Stay ahead of the pain

Taking ibuprofen or naproxen based medications 30 minutes prior to gardening can reduce the inflammation associated with heavy use of the hands. If you know that working in the yard will produce some soreness, then you may wish to employ this strategy prior to starting.
So get out there and enjoy the nice weather. You don’t have to give up your gardening hobby because of arthritis. Try these tips, but if pain persists you should feel free to contact my office so we can discuss effective treatment options if further detail.

What is arthroscopic surgery?

Arthroscopic surgery is a technique that orthopedic surgeons use to diagnose and repair structural damage within a joint.  The surgeon makes 3 or 4 small incisions around the joint, about ½ inch each. Here, a fiberoptic camera is used to see within the joint and miniature surgical tools are used to perform the repair.

Arthroscopic surgery of the shoulder is an outpatient surgery, which means that you will not have to be admitted to the hospital. You will return home shortly after the surgery is over.

Arthroscopy of the shoulder joint has been a major advancement in surgical technique. This procedure allows less cutting of intact tissue to perform repairs, allowing for faster recovery times than with open surgery.

What types of shoulder surgeries can be performed using arthroscopic technique?

Dr. Shapiro performs many types of shoulder arthroscopy. Among those are:

• Rotator cuff repair
• Subacromial decompression (removal of bone spurs)
• Glenoid labrum repairs (SLAP tears)
• Repair of shoulder instability (dislocation)
• Biceps tendon repair
• Bursitis
• Debridement due to arthritis
• Frozen shoulder release

How long will my surgery take?

Most surgeries will take 45 minutes to 1 hour. You will then be required to stay in the recovery room for about another hour. You will then be discharged home. Please be sure to make arrangements for a ride home, as you will not be able to drive the day of surgery.

How long is the rehabilitation process after shoulder arthroscopy?
This depends on the type of procedure you had performed. It is important to understand that physical therapy is an important piece of recovery. You must be committed to the post-operative rehab if you wish to achieve the best outcome.

General rehab guidelines for specific surgical procedures are as follows:

Rotator Cuff Repair, SLAP Repair, & Shoulder Dislocation Repair: Physical therapy is grouped into several phases, beginning with gentle mobility and progressing to strengthening through the full range of motion. The process generally takes 4-6 weeks. Dr. Shapiro will provide both you and your physical therapist with specific instructions following your surgery.

Bone Spur Removal: Because the shoulder is left structurally intact, the rehab process flows quicker, about 6-8 weeks.

How much pain will I have following my shoulder surgery?
This varies greatly from patient to patient. You will be prescribed pain medication following surgery, along with instructions for icing the shoulder, which will help control excessive swelling. During physical therapy sessions, you will be asked to move the shoulder joint in order to restore full arm motion.

This may cause an increase in your pain level, and for this reason it is recommended that you take your pain medication 45 minutes prior to the start of therapy sessions. In time, you will need to take less pain medication.

Will I have to wear a sling following surgery?
This depends on the type of surgery that you had performed. For rotator cuff repairs, SLAP repairs, and dislocation repairs, you will be required to wear the sling for 2 weeks after surgery. For subacromial decompression surgery, a sling may be worn for comfort measures following surgery, and discontinued as pain decreases.

Can I take a shower following surgery?
Showering is permitted 72 hours following surgery.

When do I follow up with Dr. Shapiro following my arthroscopic surgery?
Dr. Shapiro or his physician assistant will follow up with you 1 week following your surgery. The goal of this visit is to make sure that your pain is under control, and the incision is free of infection and healing well.

Physical therapy is also prescribed at this time. This visit is designed to give the patient an opportunity to ask any new questions that may have arisen following your surgery.

When can I return to work?
Of course, this is highly dependent upon your occupation. You will be unable to actively use your arm following rotator cuff repair, SLAP repair, or dislocation repair. This is important in order to allow for proper healing and to not disrupt the surgical area.

If you have a sedentary job or are able to secure restricted duty where use of the arm is not required, then you should anticipate being out of work for 5-7 days. If you are required to use your involved arm, then time away from work is greater. You should discuss your situation with Dr. Shapiro prior to surgery so that you can make appropriate arrangements with your employer.

The Summer Season is Here

Summers in the great Pacific Northwest brings out the adventurous side in all of us.

Sports activities like kayaking and kiteboarding on the Puget Sound as well as hiking, cycling, running, sky diving, and mountain biking all things we like to take advantage of while the weather cooperates with us. Physical activity is a great way to keep the mind and body healthy and fit.

Preventing sports injuries so you can enjoy the summer takes some preparation, including assessing your current fitness level and any risk factors or pre-existing conditions. Ways to prevent summer sports injuries include:

• Annual physical exam – The healthier you are, the better you are at participating in a sports activity.

• Proper equipment and sports activity training – Check your equipment and get some simulated practice time in so that you get a feel for the sports activity as well as building up your aerobic endurance on the off season.

• Hydrating properly before and after a sports activity.

• Proper understanding of your playing field – “Lay of the land” for all sports activities can be tricky if you have never been to an area before and are attempting your first adventure sports activity like kiteboarding.

If it’s paddling down Columbia Gorge, kiteboarding on the Puget Sound or mountain biking on Tiger Mountain, remember, good preparation before attempting an adventure or high risk sport will help in preventing future injuries.

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

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Patients, who have been suffering from chronic arthritis throughout their lives, have a new treatment option worth investigating. The new treatment is one Dr. Peterson is proud to be offering to his patients. Patients, that could not find relief before, may find relief with Gel-One. Zimmer Corporation, the company that developed Gel-One, created a brand new single use injection that is unlike the older ones on the market. This product has no false injections into the knee.

Out with the Old – Hyaluronic Acid Injection Therapy

The current treatment method, when used in patients who have had their arthritis for over a decade, has only around a 50 percent chance of actually relieving the pain of arthritis of the knee for an extended period of time. Those who find success with it have relief that lasts approximately 6 months, on average.

A second aspect of the current method of treatment is that even if the hyaluronic acid injection is successful in providing relief, some methods of therapy require a patient undergo multiple injections weekly, typically three to five per week depending on the severity of the arthritic pain.

In with the New – Gel -One

The Gel-One product by the Zimmer Corporation is not the first single-use injection treatment to be offered on the market. The previously used injection often provided an amount to be injected that was not sufficient to properly reduce pain and inflammation in the knee, producing what is affectionately called a pseudosepsis (fake infection). The Zimmer Corporation has worked hard to counter this first injection option by working to produce one that is much more effective while being processed in a way that still allows for delivery in a single use injection system.

Gel-One however has been clinically tested in a controlled study group to confirm that it does not produce a pseudosepsis effect.  The study consisted of 379 randomized patients, which 248 of them receiving the Gel-One formula. The patients were compared to the control at the thirteenth week beyond the baseline and demonstrated a greater amount of pain relief, averaging out at approximately 40% reduced amount of pain.

Also in this study there were no unexpected side effects observed, lending to the confidence our clinic has in this product as a new therapy option for those with chronic arthritic pain.

Gel-One and Our Clinic

Dr. Peterson offers Gel-One to his patients, and early results seem promising. He is continuing to use other forms of hyaluronic acid for those patients who have done well with them, and prefer not to switch.

If you would like to discuss your arthritis treatment options and find out if Gel-One is  right for you, make an appointment with Dr. Peterson at Orthopedic Specialists of Seattle. OSS is a comprehensive orthopedic practice.

Over the last decade, direct anterior approach (also called anterior supine incision or ASI) total hip replacement has been gaining popularity in the United States.  The reasons for this surge in popularity can be traced to three factors.

More traditional posterior or anterolateral surgical approaches to total hip replacement have to cut muscles attached to the hip joint in order to expose the joint.  In ASI total hip replacement, no muscles are cut, which results in less initial postoperative pain and faster early recovery with a shorter hospital stay for many patients.  Most patients have a one-night stay after surgery, and are off crutches by about 2 weeks after surgery.

The ASI approach allows for the use of x-ray imaging during surgery to precisely position the components, and to ensure very accurate measurement of leg lengths.  Since component position is critical to optimal long-term function of the implant, and leg-length inequality is one of the most common reasons for repeat surgery after older methods of hip replacement, this use of precise x-ray control is very advantageous.

Dislocation of the prosthesis is one of the more frustrating and challenging complications of total hip replacement.  With other techniques, the reported rate of dislocation over the lifetime of the prosthesis is 3-5% (Medicare data).  To try and minimize this, many surgeons performing those older techniques will tell their patients never to bend more than a right angle at the waist, and not to scissor their legs.

Because no muscles are cut during the ASI approach, the dislocation rate is markedly less.  After more than 2000 total hips performed by surgeons at Orthopedic Specialists of Seattle, the dislocation rate is less than 0.1% (less than 1 in 1000).  We therefore put no restriction on patient motion after surgery.  Dr. Peterson’s only restriction for his patients is no running for exercise.

An excellent YouTube animation video of how the ASI approach is performed is available below. While this video was made in Omaha by Dr. Ajoy Jana, the technique used by Dr. Peterson is very similar in all regards.

The surgeons at OSS perform more ASI hip replacements than any other practice in the Northwest.  Dr. Peterson has been performing total hip replacements for over 20 years, and switched to the ASI approach for most cases several years ago after seeing the significant benefits for his patients.  He would be happy to discuss this remarkable new technique with you during your office visit.