OA Update: Injury Prevention, Athletic Performance and Orthopedic Procedures

Knee Replacement Surgery and Its Alternatives

Baby boomers with osteoarthritis of the knee of the knee are increasingly asking for total knee replacement surgery. “But they should first try making changes to their lifestyles and try conservative alternatives,” Dr. Becker says. Other options that may extend the life of the natural knee include medications, steroid injections, physical therapy, and mechanical aids. In 1999, about 25 percent of all adults with osteoarthritis of the knee had some type of surgery. The procedure most frequently performed for patients is a total knee joint replacement. The procedure, known as arthroplasty, replaces the knee with an artificial joint. The replacement parts are made of cobalt- chrome or titanium metals and smooth, wear-resistant plastic. The results of total joint replacement are generally excellent. Patients experience significant pain relief and improved physical functioning. There are some risks to the surgery, however, and full rehabilitation may take three to six months. In addition, the prosthesis (artificial joint) may eventually loosen or wear out so that a second surgery is needed. However, at the 10-year mark, the success rate with most prostheses is about 90 percent. For some patients, knee replacement may not be the most appropriate first surgical treatment. Another surgical treatment option for the knee includes arthroscopy, a procedure that uses small incisions and miniature instruments. Typically, the surgeon inserts a tiny viewing scope (arthroscope) into the joint space and then fills the space with fluids so he or she can clearly see the joint components. Using small instruments, the surgeon can trim damaged cartilage and remove any loose particles or debris from the joint. In some cases, activity modification may be the only treatment a middle-aged patient needs. In all cases, however, even when surgery is needed, the patient is encouraged to modify activities first to preserve the replacement joint.
Part 4 of a 4-part series on the Aging Knee.

Osteoarthritis of the Knee

Osteoarthritis of the knee is painful condition occurs when the cartilage lining on the ends of bones gradually wears away. It can affect one or both knees. “Most patients with osteoarthritis of the knee are over age 55 and/or overweight” says Michael Becker, MD and a surgeon at the OA Joint Replacement Center. “They may also have a family history of osteoarthritis. Younger, highly active people may also develop osteoarthritis if their knees suffered a significant injury. Patients may experience pain when standing or climbing stairs. The knee may give way, lock in place, or become stiff and swollen.” According to the UK-based Arthritis Research Campaign (ARC), when a joint develops osteoarthritis, the cartilage gradually roughens and becomes thin. The surrounding bone reacts by growing thicker. The bone at the edge of the joint grows outward, forming bony spurs. The synovium, a membrane that releases fluid that lubricates the knee, swells slightly and may produce extra fluid, which then makes the joint swell. This extra fluid causes what some people call “water on the knee.” The synovium’s outer layer, called the capsule, and ligaments slowly thicken and contract, as if they are trying to push the joint back into shape. The muscles that move the joint gradually weaken and become thin. This can make the knee joint unstable so that it “gives way” when weight is put on it.

Part 3 of a 4-part series on the Aging Knee.

Knee Ligament Injuries

Athletic injury of the four major ligaments found in the knee, the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are most often injured in sports. The posterior cruciate ligament (PCL) is also frequently injured. Twisting or changing direction rapidly, slowing down when running, and landing from a jump often can tear the ACL. Athletes who ski or play basketball and those wearing cleated shoes are more at risk for ACL injuries and become candidates for ACL knee surgery .

Injuries to the MCL usually come from a blow on the outside of the knee. These types of hits are often encountered in contact sports such as football. The PCL can be injured when an athlete receives a jolt to the front of the knee or makes a simple misstep on the playing field. Athletes engaging in sports such as football or soccer are susceptible to PCL injuries. Torn cartilage is another common knee problem. When physicians refer to torn knee cartilage, they are usually referring to a torn meniscus. “The meniscus is a tough, rubbery cartilage that is attached to the knee’s capsule and ligaments,” says Peter Guay, DO. “It acts like a shock absorber.” In athletic activities, meniscus tears usually occur from twisting, cutting, pivoting, or decelerating movements, or from being tackled. Direct contact is often but not necessarily involved. Yoga postures can also lead to tears in the meniscus if one simultaneously flexes and rotates the knee to bring the foot to rest on top of the opposite thigh; yoga practitioners can reduce this risk by making the move in two steps: first bend, then rotate the knee, before bringing the foot to rest on the opposite thigh.

Part 2 of a 4-part series on the Aging Knee.

Knee Ligament Injuries

Athletic injury of the four major ligaments found in the knee, the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are most often injured in sports. The posterior cruciate ligament (PCL) is also frequently injured. Twisting or changing direction rapidly, slowing down when running, and landing from a jump often can tear the ACL. Athletes who ski or play basketball and those wearing cleated shoes are more at risk for ACL injuries and become candidates for ACL knee surgery .

Injuries to the MCL usually come from a blow on the outside of the knee. These types of hits are often encountered in contact sports such as football. The PCL can be injured when an athlete receives a jolt to the front of the knee or makes a simple misstep on the playing field. Athletes engaging in sports such as football or soccer are susceptible to PCL injuries. Torn cartilage is another common knee problem. When physicians refer to torn knee cartilage, they are usually referring to a torn meniscus. “The meniscus is a tough, rubbery cartilage that is attached to the knee’s capsule and ligaments,” says Peter Guay, DO. “It acts like a shock absorber.” In athletic activities, meniscus tears usually occur from twisting, cutting, pivoting, or decelerating movements, or from being tackled. Direct contact is often but not necessarily involved. Yoga postures can also lead to tears in the meniscus if one simultaneously flexes and rotates the knee to bring the foot to rest on top of the opposite thigh; yoga practitioners can reduce this risk by making the move in two steps: first bend, then rotate the knee, before bringing the foot to rest on the opposite thigh.

Part 2 of a 4-part series on the Aging Knee.

The Aging Knee

According to the American Academy of Orthopaedic Surgeons (AAOS), the knee is the largest joint in the body and, unfortunately, one of the most easily injured. Knee problems were the single most common reason for visits to orthopaedic surgeons in 2001. In 1999, more than five million American adults reported having pain, swelling, and stiffness in the knee joint.

The knee joint comprises the lower end of the thighbone (the femur), which rotates on the upper end of the shinbone (the tibia) and the kneecap (the patella), which slides in a groove on the end of the femur. The knee also contains large ligaments, which help control motion by connecting bones and bracing the joint against abnormal types of motion. Meanwhile, the cartilage, with its smooth slippery surface, does away with friction between the bones during motion. Knee injuries and joint degeneration sometimes call for surgery, but many other treatments can be effective as well. In fact, orthopedic surgeons use a very common method, called R.I.C.E. (rest, ice, compression, and elevation), to treat mild knee injuries in athletes. It all depends upon the nature of the problem and its severity.

Part 1 of a 4 part series

OA Sponsors 6th Annual CELT Challenge Triathlon to Benefit the Cape Elizabeth Land Trust

The Cape Elizabeth Land Trust (CELT), a Maine non-profit organization committed to the conservation and stewardship of distinctive lands cherished by the Cape Elizabeth community, and OA Centers for Orthopaedics, the medical sponsor for the event, today announced details for the 6^th Annual Noyes Hall & Allen CELT Challenge Sprint Triathlon and Duathlon, Cape Elizabeth’s only triathlon. The event will take place on Sunday, September 26, 2010 at 9:00AM at Cape Elizabeth High School. Interested participants may register at http://www.capelandtrust.org/triathlon.

 

Noyes, Hall & Allen, a locally owned, independent Maine insurance agency with a long family history of serving the Greater Portland community, is the named sponsor for the event, which attracts more than 250 athletes from across Southern Maine and New England.

 

“Noyes Hall & Allen has supported the CELT Challenge since its inception in 2005,” said Chris Franklin, executive director of the Land Trust. “They have been a wonderful sponsor for this signature event, which has become a tradition among athletes in the area, both from Cape Elizabeth and throughout Southern Maine and New England.”

 

The Noyes, Hall & Allen CELT Challenge features a triathlon (swim-bike-run) and a duathlon (run-bike-run). The triathlon consists of a 425-yard pool swim, a 14-mile bike ride and 3-mile cross-country trail run, while the duathlon replaces the swim with an additional 1.5-mile trail run, followed by the bike and the run. Teams of two or three people may also sign up and compete in either the triathlon or the duathlon.

 

“We are pleased to help make this day of fun, family-friendly competition possible,” said Tom Noyes, president of Noyes, Hall and Allen. “The CELT Challenge continues to grow in popularity each year, and we are looking forward to another terrific turnout. We are also pleased to help the Land Trust bring attention to its important mission of ‘Saving Cape’s Great Places.’” Saving Cape’s Great Places is a multi-year planning and fundraising initiative designed to identify, preserve and protect lands cherished by the Cape Elizabeth community.

 

In addition to the Noyes, Hall and Allen Insurance, the CELT Challenge has received strong sponsorship support for the event. CELT is pleased to announce the following sponsors for this years’ event:

 

OA Centers for Orthopaedics

Returning as our Medical Sponsor, OA Centers for Orthopaedics is the premier orthopedic practice in Maine and one of the country’s leading innovators in orthopedics. The orthopaedic specialists at OA include 23 physicians and surgeons are highly specialized in areas such as sports medicine; hand surgery; joint reconstruction of the hip, knee and shoulder; medical and surgical treatment of the spine; foot and ankle surgery; and complex fracture treatment.

OA—Experience in Motion!

 

CycleMania

We are pleased to have Cycle Mania of Portland return as our Equipment Sponsor for the Noyes, Hall & Allen CELT Challenge this year. Cycle Mania will provide onsite mechanical services for triathlon participants the day of the race. In addition to a top notch service department, Cycle Mania sells and supports bikes and frames from Trek, Cannondale, Specialized and Seven Cycles, as well components, accessories, car racks, rentals, nutritional products and racing wheels by Zipp, Bontrager and Mavic.

Cycle Mania – Since 1981. For more information, visit http://www.orthoassociates.com.

 

Tri-Maine
Tri-Maine serves as the race organizer for the Noyes Hall & Allen CELT Challenge. Tri-Maine Productions is an experientially based, entrepreneurial company based out of Portland, ME. It was formed in response to the growing demand for high-quality multisport events in Maine. Tri-Maine Productions owns and/or manages a number of race properties, ranging in scope from local road races to highly complex triathlons with hundreds of competitors. Annually, Tri-Maine events attract over 3,000 athletes, 500 volunteers, and 5,000 spectators. Additionally, the company designs and maintains www.tri-maine.com, which features information about all the Tri-Maine races. For more information, visit http://www.tri-maine.com.

 

Noyes, Hall & Allen

Based in South Portland, ME, Noyes, Hall & Allen is a locally owned independent insurance agency with a long family history of serving the Greater Portland community. Noyes, Hall & Allen was founded in 2006 as a result of the merger of two of the area’s oldest and largest independent agencies, Blake, Hall & Allen and Noyes and Chapman. Noyes, Hall & Allen provides personal, commercial and healthcare professional liability insurance, partnering with four of the leading national medical malpractice providers. For more information, visit www.noyeshallallen.com.

 

REGISTRATION:

Both seasoned and aspiring athletes who are interested in participating in the triathlon or duathlon may register at capelandtrust.org/triathlon/. The triathlon is limited to the first 156 registrants, while the duathlon is open to all interested participants.

Trigger Finger – Inflamed Tenosynovium

Anatomy of a Finger

Bending your fingers actually starts within your forearm. The muscles responsible for the movement are located in the forearm—one muscle for the thumb and two muscles for each finger. The muscle-tendon junctions, where the muscles blend into the tendons, are in the part of the forearm just before the wrist. The tendons then pass through the carpal tunnel and out into the hand. At the base of the fingers and thumb the tendons enter a sheath that guides them to their insertion, or attachments. Without the sheath, the tendons would bowstring away from the bones and the fingers would not be able to make a fist. A tissue called tenosynovium, which provides lubrication and nutrition, surrounds the tendons. When the tendons become stuck or snap, the result is referred to as trigger finger.

 

Cause

Most orthopaedic specialists agree that cause of trigger finger, in the vast majority of cases, is idiopathic, or unknown, likely because there are many different factors that can result in a trigger finger. Ultimately, the condition results from an imbalance between the normal “wear and tear” that we subject our bodies to daily, and the body’s ability to heal that damage. It is more commonly seen in patients with diabetes, gout and rheumatoid arthritis.

 

Symptoms As the tenosynovium becomes inflamed, it causes pain at the base of the finger and pressure in the flexor tendon sheath. This results in a crunching sensation with movement of the finger and may result in swelling. As the tenosynovium becomes more inflamed, the patient may experience clicking and eventually, painful locking of the finger—either straight or bent, as a nodule develops in the tendon and the mouth of the tendon sheath thickens.

 

Treatment Initial treatment for trigger finger involves moist heat in the morning and icing at night with anti-inflammatory medications. Avoiding known provocative activities such as weeding, knitting, and other things requiring pinching, along with utilizing night splinting, will help some patients. If this fails, then occupational therapy may be tried. Injections of cortisone are another option. If these efforts fail, then surgery where the mouth of the tendon sheath is opened, taking the pressure off the tendon, may be necessary. Additional resources: visit www.youtube.com. Search key words “ASSH Trigger Finger.”

 

Dr. Sacha Matthews is a hand surgeon in the OA Centers for Orthopaedics Hand Center, which provides comprehensive coverage for the diagnosis, treatment and rehabilitation of all types of hand and wrist problems. He is a fellow of the American Academy of Orthopaedic Surgeons and a member of the American Society for Surgery of the Hand. He also has a Certificate of Added Qualification in Hand Surgery.

Avoiding Neck and Shoulder Pain on the Bike

By Scott Marr, M.D.
Many cyclists complain of neck and shoulder pain while on the bike. While common, these injuries can be easily avoided.

Cyclists need to make sure that the neck, shoulders and arms are conditioned to withstand long intervals in the same position. Bike riders are encouraged to avoid locking elbows, extending the neck by riding for long periods of time in the handle bar drops or aero bars (tough for a triathlete, I know), and changing positions frequently to avoid gradual, but painful injuries.

If you are experiencing discomfort in your shoulders, back, neck or anywhere else, it’s probably a good idea to have someone look at you and your bike and make sure the two of you are a good fit. Neck and shoulder pain is often caused by an extended reach, so it's a good idea to have your position on the bike evaluated and optimized.

Whether you’re riding a brand new bike or you have just made some minor adjustments to your ride over the winter, it’s important that the frame, seat position and pedals all match your individual body mechanics. Because of the repetitive nature of the sport, it’s easy for minor discomfort to escalate into something more serious.

While any good bike shop will help you find a bike that fits your riding style, budget and body size, there are also specialists in Southern Maine that make additional adjustments (for a price) that can help you maximize your cycling efficiency and overall comfort. The more miles you plan to put on your bike this season, the more these specialized services may make sense to you. At OAPT, Tim Davoren at OAPT offers a comprehensive bike fit assessment from a physical therapist's point of view.

By taking precise, often laser guided measurements and calculating ideal bike-to-body ratios, these experts can almost guarantee that you’ll get more out of your riding experience.

Dr. Marr practices Sports Medicine and Medical Orthopaedics at the OA Sports Medicine Center. As a sports medicine specialist, he has served as a team physician for St. Joseph’s College, Windham High School and the Portland Pirates (AHL) hockey team.  Dr. Marr has a special interest in elite endurance athletics including performance physiology and injury prevention.

Beach to Beacon 10K Road Race - Avoiding Injury