Backpack Safety for Back to School

backpackIt’s back to school season it’s time to clean out those backpacks to make room for the new school year! 

Sure, you may have some items that should have been thrown out from the previous school year, but now, you need to make room for those new books and supplies to get you through the next school year.

Did you know that according to the Consumer Product Safety Commission, injuries from heavy backpacks result in more than 7,000 emergency room visits per year? Sprains, strains, and “overuse” injuries were among the top complaints.

Safety Tips

OSS would like to offer some basic safety tips for you:

  • Your backpack should weigh only 15% – 20% of your total weight
  • Backpack straps should be wide and padded
  • Make sure the backpack has two shoulder straps
  • The backpack should have a padded back
  • Adjust the bottom of a full backpack and make sure it is not more than four inches below your waistline.
  • Consider using a rolling backpack, an air backpack or a light-weight backpack
  • Periodically check the contents and weight of your backpack; you may be amazed at the amount of unneeded items you are carrying

Prevent injury when using a backpack, do the following:

  • Use both shoulder straps to keep the weight of the backpack better distributed
  • Tighten the straps to keep the load closer to the back
  • Organize items and pack heavier things low and towards the center
  • Remove items if the backpack is too heavy and only carry items necessary for the day
  • Lift properly by bending at the knees when picking up a backpack

Here’s a great tip from Dr. Shapiro, “Take the time to lift your kids backpack. What could they leave behind to lighten their heavy load?”

If you believe you are suffering from a backpack-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you.  Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Operative Treatment for Clavicle Fractures (Broken Collarbone)

Operative Treatment for Clavicle Fractures (Broken Collarbone)

Clavicle fractures are often caused by a direct blow to the shoulder. In sports, it usually occurs when an athlete is tackled in a football game, falls of a bicycle, or gets body-checked into the plexi-glass of an ice rink. It can also happen during a fall onto the shoulder or a car collision, a fall onto an outstretched arm, or in childbirth, when the baby is passing through the birth canal.

The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade.



Clavicle fractures can be very painful and may make it hard to move your arm.

Additional symptoms include:

  • Sagging shoulder (down and forward)
  • Inability to lift the arm because of pain
  • A grinding sensation if an attempt is made to raise the arm
  • A deformity or “bump” over the break
  • Bruising, swelling, and/or tenderness over the collarbone

Evaluation by an OSS physician

In order to pinpoint the location and severity of the break, your OSS physician will order an x-ray. X-rays of the entire shoulder will often be done to check for additional injuries. If other bones are broken, your doctor may order a computed tomography (CT or CAT) scan to see the fractures in better detail.

If your bones are out of place (displaced), your OSS physician may recommend surgery. Surgery can align the bones exactly and hold them in good position while they heal. This can improve shoulder strength when you have recovered, if displacement is significant. A recent large study showed improvement in function with operative repair when the fracture is significantly displaced.

The use of Plates and Screws

During this operation, the bone fragments are first repositioned into their normal alignment, and then held in place with special screws and/or by attaching metal plates to the outer surface of the bone. Newer locking plates are contoured to give significant strength while minimizing the prominence of the plate. Many patients notice immediate improvement in the disturbing bone movement right after surgery.

After surgery, you may notice a small patch of numb skin below the incision. This numbness will become less noticeable with time. Because there is not a lot of fat over the collarbone, you may be able to feel the plate through your skin. It is important to start full range of motion soon after surgery.

Plates and screws are sometimes removed after the bone has healed, but that is up to the patient’s discretion. This is a much smaller procedure with little down time, usually 4-6 months after the original surgery.


(A) The clavicle is broken in more than one place and the fragments are severely out of alignment. (B)The fractured pieces are held in place by a combination of plates and screws.


Specific exercises will help restore movement and strengthen your shoulder. Your OSS physician may provide you with a home therapy plan or suggest that you work with a physical therapist.

Therapy programs typically start with gentle motion exercises. Your OSS physician will gradually add strengthening exercises to your program as your fracture heals.

Although it is a slow process, following your physical therapy plan is an important factor in returning to all the activities you enjoy.

Surgical Complications

People who use nicotine, have diabetes, or are elderly are at a higher risk for complications during and after surgery. They are also more likely to have problems with wound and bone healing. Be sure to talk with your OSS physician about the risks and benefits of surgery for your clavicle fracture.

There are risks associated with any surgery, including:

  • Infection
  • Bleeding
  • Pain
  • Blood clots in your leg
  • Damage to blood vessels or nerves
  • Nausea

The risks specific to surgery for collarbone fractures include:

  • Difficulty with bone healing
  • Injury to surrounding vessels/organs (rare)
  • Hardware irritation


Whether your treatment involves surgery or non-surgical treatment, it can take several months for your collarbone to heal. It may take longer in diabetics or people who nicotine.

Most people return to regular activities within 3 months of their injury. Your OSS physician will tell you when your injury is stable enough to do so. Returning to regular activities or lifting with your arm before your doctor advises may cause your fracture fragments to move or your hardware to break. This may require you to start your treatment from the beginning.

Once your fracture has completely healed, you can safely return to sports and daily activities.

What to discuss with your OSS Surgeon

  1. When will I be able to start using my arm?
  2. When can I return to work?
  3. Do I have any specific risks for not doing well?
  4. If I have surgery, what are the risks and benefits and how long will I be in the hospital?
  5. If I do not have surgery what are the risks and benefits?
  6. Is my bone weak?
  7. Should I be taking calcium and Vitamin D?

If you would like more information about clavicle surgery, call Orthopedic Specialists of Seattle (206) 633-8100 to schedule an appointment with Dr. Ruhlman.

Common Swimming Injury – Swimmer’s Shoulder

Swimmers shoulderSwimming is a sport in which there is a great diversity among participants. There are both recreational and competitive swimmers, ranging in age from preschool through college.

Although the lack of impact in swimming makes it a perfect choice for avoiding lower-body injuries, the intense involvement of upper-body muscles makes overuse injuries a real possibility.

The most common swimming-related injury is swimmer’s shoulder, shoulder pain usually caused by rotator cuff tendonitis. Many cases of swimmer’s shoulder can be successfully treated through physical therapy.

For competitive athletes, rotator cuff surgery may be recommended if shoulder pain continues after 6 months of guided rest and rehabilitation.

Signs and Symptoms of Swimmer’s Shoulder

  • Shoulder pain while swimming freestyle
  • A forward shoulder slouch while seated
  • Underdeveloped posterior shoulder musculature
  • A mild winging on the affected side’s left scapula
  • Tenderness in the acromioclavicular joint and coracoid process in the impingement area
  • Tenderness in the affected side’s bicep tendon and supraspinatus tendon
  • A full range of motion in all planes
  • Strength is slightly decreased in the supraspinatus and infraspinatus
  • Full strength in the internal rotators, arm extensors, and flexors
  • Moderate posterior and anterior laxity in both shoulders
  • A bilateral sulcus sign
  • Impingement and adduction-compression tests on the affected side were positive
  • An apprehension test on the affected side was negative

Swimming Safety and Injury Prevention

According to Dr. Franklin, “Proper warm up, stretching, technique and conditioning are crucial in preventing tendonitis and overuse injuries in swimmers.”

  • Learning proper technique goes a long way toward preventing injuries; if you’re just starting out, schedule some sessions with a swimming coach.
  • Remember to warm up and stretch before every swim, giving particular attention to your shoulders.
  • A strength-training program can help build up the muscles around the shoulder and upper back; ask a physical therapist or personal trainer if you need help creating a routine.

If you believe you are suffering from swimmer’s shoulder or swimming-related injury and need specialized orthopedic care, the orthopedic surgeons at OSS provide excellent treatment options for your injury. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Training for a Triathlon

The 2014 Seattle Seafair Triathlon and Kids Seafair Triathlon will take place on July 20, 2014. OSS is the Presenting Sponsor for these events and the orthopedic surgeons would like to congratulate the athletes who are coming out to be part of this event.

Training for a triathlon is tough but that’s part of the challenge. Consider this: Four out of five amateur triathletes are injured while training, and three of those four are injured badly enough to affect their daily activities.

The complexity of the sport and broad range of knowledge needed to train and compete safely are contributing factors. The triathlete must learn about appropriate equipment specifications, proper body mechanics, injury prevention and overall training programs that prepare the body for the stresses of triathlon.

Cross-training for three different events also increases the risk of certain overuse injuries, and an untreated injury in one part of the body can lead to problems elsewhere. For example, a knee injury from running can cause extra stress on the back, leading to lower back pain when cycling; and the cumulative effects of swimming and cycling can fatigue calf muscles, making legs more susceptible to injury during a run.

The good news is, most nontraumatic injuries are related to training errors that can be corrected – and professionals with specialized knowledge in triathlon training and injury prevention can help.

Prevention: Training Smart

The best way to avoid a traumatic injury is a training program that balances strength, flexibility and endurance through appropriate weight-lifting, stretching and cross-training. But training techniques are not one-size-fits-all. Every individual has a unique combination of anatomy, strength, endurance, and flexibility – so what works well for one athlete is not always the best advice for another.

Understanding the complex interactions between musculoskeletal groups related to swimming, cycling, and running is essential in triathlon training. An OSS surgeon can evaluate your physical conditioning, analyze your training techniques and correct errors that can lead to future injuries, and provide a training program optimized for you as an individual.

The best training program can’t prevent all injuries. When injuries do occur, there are three things you need to know: (1) how to evaluate the severity of an injury, (2) how to self-treat an overuse injury, and (3) when to seek professional help.

Dr. Weil has this to say about the upcoming triathlon and words of wisdom when it comes to training for a triathlon, “I’d like to congratulate all the triathletes participating in the 2014 Seafair Triathlon! I’d also like to send a special congratulations to the first time triathletes participating in this year’s event. As you all know training for and participating in the sport of triathlon involves a huge commitment on the part of athletes and their families. Unfortunately, sometimes things don’t go as planned and injury can derail even the most experienced triathletes. I have experienced this issue first hand from all perspectives, as a treating physician, as a 2013 Ironman Canada Finisher, and currently as an injured athlete in rehabilitation trying to get back to the sport. When the unforeseen occurs, it is always best to seek medical evaluation. Often times if issues are addressed early on, they can be treated without significant time loss from training and without surgery. It is my goal as a treating physician to understand athletes needs and to work together with athletes to help them return to sport as soon as possible.”

If you believe you are suffering from a sport-related injury and need specialized orthopedic care, the orthopedic surgeons at OSS provide excellent treatment options for your injury. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.