Parents often hear the word fracture for the first time and think it is less severe than a broken bone. Fractures, however, are broken bones. The severity of a break depends on the force that caused the fracture, where the fracture is located, and if the break is complex or simple.
If a bone breaks and fragments of it stick out through the skin, this is called an open fracture. These are particularly serious because the skin is broken and the child is at risk for infection. … read more
Anterior hip replacement is a surgery that has been performed for twenty years. Currently, Dr. Watt is one of only a few orthopedic surgeon performing this technique in the Seattle area. This technique allows the orthopedic specialist to provide you with the same procedure as the standard hip replacement, but with less disruption to the surrounding soft tissues and muscle tissues.
The surgery is performed through a smaller incision and there is less tissue dissection and this allows you to get back on your feet sooner and allows unrestricted motion of the hip immediately after surgery. This guide informs you of what to expect during the hip evaluation, what to be aware of before the surgery, and what you should know about after the procedure.
An orthopedic specialist is a surgeon who specializes in problems that affect the bones and joints. When you go in for a hip evaluation, the doctor will ask you many different questions about your general health, your symptoms, and your expectations. This way he can determine if an anterior hip replacement is right for you.
The evaluation will include careful examination and review of your X-Rays and other preoperative tests. This is done to allow the surgeon to better understand your physical limitations and the exact progression of your hip problem. The orthopedic specialist will take a medical history and perform a detailed physical examination.
This will include range of motion tests of your hips and knees and evaluation of your muscle strength. The doctor will take X-Rays of your hip to evaluate the joint and plan for a new hip if needed.
Before you undergo an anterior hip replacement, you will have to see your family doctor for a thorough medical evaluation. It is essential that you bring all your medications and supplements to the visit so the doctor can make a note of them and tell you which ones you must stop taking before the surgery.
If you are taking aspirin or anticoagulants, be sure you tell your doctor so he can advise you whether or not to continue these as directed. With this procedure it is usually not necessary to donate your own blood ahead of time.
With the anterior approach, the surgeon will be replacing the top of the thighbone and socket through a small incision. Basically, the surgeon will get to the hip by means of a muscle-splitting approach. Rather than removing the muscle, he goes between the muscle tissues.
Because the incision is minimally invasive, you will be back on your feet sooner. The anterior approach to hip replacement has a lower rate of dislocation, too.
Once the surgery is over, you will be monitored in the post-anesthesia recovery room. You will stay there until your blood pressure, pulse, and breathing has stabilized and your pain is under control. You will be asked to move both legs as soon as you wake up and the nurse will help you find a comfortable position to lay in.
To protect you against development of blood clots, you may be asked to do ankle pumping exercises every hour and you will have sleeves on your legs to help prevent blood clots by pumping the blood for you. You will begin to take in regular food and fluids soon after your operation.
There will be a dressing on your surgical site that will be changed and checked frequently. The nurse will have you cough and deep breathe frequently and use an incentive spirometer after your surgery to expand your lungs. Remember, it is normal to have minimal discomfort after the procedure so ask your nurse for pain medication, as you need it.
Because the anterior approach to hip replacement is a tissue sparing operation, you will be able to freely bend the hip and bear full weight immediately after surgery. This is done so you can enjoy a much faster recovery than with traditional hip replacement. Isometric exercises begin while you are still in the bed.
These are muscle-tightening exercises done without moving the joint. You will be assisted in doing these a number of times each day during your waking hours.
A physical therapist will work with you to help you move your joints so they remain strong during your recovery. The therapist will document your progress and keep your surgeon well informed of your condition. It is important for you to follow both the therapist’s instructions and the orthopedic specialist’s advice to enjoy a healthy, full recovery.
In patients that are in good shape and good general health before the surgery a discharge from the hospital can be achieved in 2-3 days and frequently patients go home on the afternoon after surgery. Patients are only discharged when they are ready and both the surgeon and therapists feel it is safe.
The wrist is a complex joint with two intricate rows of bones at the base of the hand. There are a total of eight small wrist (carpal) bones and five longer metacarpal bones, which support the fingers and thumb bones (phalanges). The ulna and the radius are the two long bones that form the forearm and these attach to the first row of the carpals. Each bone end is covered with cartilage, an elastic tissue that creates a cushioned smooth surface that allow the bones to glide smoothly against each other.
Arthritis comes in many forms, but the three main forms that affect the hand and wrist are osteoarthritis (OA) and rheumatoid arthritis (RA), and post-traumatic arthritis. Arthritis simply means joint inflammation, and usually causes pain, stiffness, and swelling of a particular joint, depending on the cause. Osteoarthritis is a progressive form of arthritis that destroys the smooth articular cartilage covering the ends of the bones and is generally known as “wear and tear” arthritis.
The cartilage wears away in this form of arthritis resulting in the well-known “bone on bone” pain of osteoarthritis. Rheumatoid arthritis is a chronic autoimmune disorder that affects multiple joints throughout the body. With RA, the arthritis is not limited to a particular joint of the hand or wrist, also involving inflammation of the tendons and ligaments, meaning these structures soften and erode which can lead to tearing of the tendons that are necessary to straighten the fingers. This results in a deformed joint with gnarled fingers and bent wrists.
There are many treatments for wrist joint arthritis, depending on the location and severity of the condition. Wrist bracing, activity modifications and over the counter pain medication such as ibuprofen and Tylenol are the first line of treatment. With wrist arthritis, there is often diagnostic and treatment value to an intra-articular steroid injection as many patients find months to years of relief with such treatments.
When symptoms persist despite these treatments, surgical management can be quite successful. The procedures for wrist arthritis include arthritis bone excision called a proximal row carpectomy, which requires no hardware. Other patients benefit from partial wrist fusions depending on the location and cause of the arthritis. Still other patients eventually need a wrist fusion that limits the painful wrist flexion and extension that typically accompanies advanced wrist arthritis.
A newer type of treatment that I offer in select situations is a wrist replacement, known as wrist arthroplasty. The typical candidate for a wrist joint replacement is someone who has severe arthritis but doesn’t rely on the wrist for heavy daily use. I primarily perform this procedure to relieve pain and to maintain function of the hand and wrist.
Wrist replacement surgery will help recover and retain wrist movements and also will improve the ability to perform activities of daily living. During this procedure, the worn-out ends of the bones are removed and replaced with an artificial joint, which allows for smooth painless motion. This will help reduce or eliminate pain and improve grip strength. It is important to note that if the bones are fused together, the wrist will not be able to bend.
This procedure is done usually on an outpatient basis, but some patients require on overnight stay. An incision is made on the back of the wrist and the damaged ends of the arm bones are removed. Sometimes the first row of carpal bones must be removed also. Then, the prosthesis is inserted into the center joint region and held in place with a combination of screws and press fit that allows for bony in-growth.
After the surgery, a cast will be worn for several weeks. Once this is removed, a protective splint may be necessary for up to two months. I will prescribe pain relief medications and an exercise program to restore movement gradually by increasing power and endurance. Wrist arthroplasty often improves motion to around fifty to sixty percent of normal motion.
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.
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.
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.
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.
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.
Carpal tunnel syndrome is a condition that causes weakness, pain, and numbness in the hand and wrist. My patients often describe worsening of symptoms when driving a car, reading the newspaper, or holding a telephone. These symptoms are also worse at night and often wake people up at night. This syndrome occurs because of increased pressure on the median nerve in the wrist. The pain of carpal tunnel syndrome occurs more often around the palm side of the wrist and hand and may radiate to the forearm, shoulder, and neck. The median nerve gives sensation to the fingers so many patients describe a tingling or numbness there. Many complain of dropping objects they pick up or difficulty buttoning buttons.
The carpal bones of the hand form a “C” shaped ring that is covered by a ligament. There are eight of these bones that vary in size and shape to make up the wrist area. This ligament and bony structures form the carpal tunnel through which the median nerve and nine tendons pass. These tendons flex the fingers and thumb. Any condition that affects the size of this tunnel can lead to carpal tunnel syndrome.
There are several factors that lead to carpal tunnel syndrome. Most commonly, it is thought that the syndrome is genetic, while repetitive, strenuous use of the hands often worsens the symptoms. Other conditions that can cause or worsen carpal tunnel syndrome include fractures, masses, severe bruising. Conditions that are associated with carpal tunnel syndrome include hypothyroidism, infections, arthritis, pregnancy, and diabetes.
The first line of treatment is non-operative. Wrist braces, activity modification and anti-inflammatories are usually the first step and can be helpful in many early cases. Surgery is often considered when you do not gain relief from these treatments. Worsening symptoms indicate a nerve at risk of permanent damage.
The decision is based mostly on the severity of your symptoms and your desire to return to normal functioning. In the most severe cases, surgery is done much sooner because the other treatment options are not likely to help. Also, long-standing cases often require surgery when the disease has resulted in constant numbness and wasting of the thumb and finger muscles.
Carpal tunnel release surgery is one of the most common operations performed on the upper extremity and is among the safest and successful surgeries I perform. During the surgery, I will make a small cut in the palm of your hand. This will allow me to see the transverse carpal ligament of the carpal tunnel and divide this structure to increase the size of the tunnel and decrease the pressure placed on the median nerve.
Once this is done, I close the skin and the ligament will start to heal and grow across the divided area. This new growth actually heals the ligament and more space is available for the nerve and flexor tendons. Once this is done, the skin is sutured and a sterile bandage is applied. The sutures will need to be removed in seven to ten days.
The endoscopic method for carpal tunnel release allows me to visualize the ligament with a small camera and the procedure results in a more speedy recovery. Other benefits of this procedure are less postoperative pain, earlier return to work, and earlier return of grip strength.
Immediately following your carpal tunnel release surgery, you will be instructed to frequently elevate your hand above your heart and move your fingers as well. This is done to prevent stiffness and reduce swelling. There is some pain, swelling and stiffness to be expected after the surgical repair. The dressing is removed in 3-5 days and normal use of the hand is allowed once you are comfortable. Minor soreness of the palm region is common but reliably improves over time.