The Case of the Wandering Kneecap

Kneecap dislocation occurs when the patella, or kneecap, slides to the outside of the joint, thus stretching and possibly tearing the ligaments that hold it in place. The patella is probably the most commonly dislocated bone in the body, with kneecap dislocation occurring most often in teenage athletes and adult women.

Kneecap dislocations fall into two categories. Those involving an accident, such as a blow to or a twisting of the knee, are called traumatic dislocations. Atraumatic dislocations occur when the person is “loose-jointed” or the kneecap is misaligned (tilted or shifted), thus making the joint less stable.

 

 

Symptoms of a dislocated kneecap include

  • bleeding under the patella
  • bruising around the patella
  • swelling of the kneecap
  • tenderness along the edge of the patella
  • pain and clicking when the patella pops out of its groove and then moves back into place
  • actual dislocation of the patella when it moves out of the groove and gets stuck out there

Surgery is required when significant damage, such as muscle rupture, bone fracture or detachment of the ligaments, occurs or when kneecap injuries become recurrent. When recurrent injuries or serious damage are not involved, however, the patient usually engages in protective rehabilitation for three to five weeks to prevent the kneecap from moving laterally and relieve pain.

The second phase of kneecap rehabilitation, which should take anywhere from two to four months, involves rebuilding and strengthening the quadriceps muscle to prevent dislocation from happening again. We will be glad to design an individual rehabilitation program that will address your particular needs and get this complex joint functioning smoothly and strongly once more.

 

Straightening the Curves of Scoliosis

Scoliosis is a condition in which the spine is curved toward either the right or left side. Thus, the upper back seems to be rounded, the lower back appears to curve inward (swayback), and one shoulder and/or hip looks higher than the other.

About 80% of scoliosis cases occur in people 10 to 18 years of age, and the condition is far more common in girls. While most cases among both genders are mild and require no treatment, girls are more likely to progress significantly without treatment.

For a diagnosis of scoliosis to be made, a curve must measure 11º or more; a curve less than that is labeled spinal asymmetry and is unlikely to get much worse, although a pediatrician or an orthopedic surgeon can monitor it with visual inspections and x-rays to be sure it does not move in that direction.

The following procedures are commonly used to treat scoliosis:

  • A brace is the most common treatment for children who have scoliosis spine curvatures of 25º to 40º and who have not finished growing. The brace will not correct the curvature, but it will keep it from worsening.
  • Surgery is an option for more severe cases, in which the curves are 40º to 50º or more.
  • Spinal fusion, which joins vertebrae permanently, is effective but is not used for children whose bones are not fully grown because growth will no longer be possible in the fused area. Thus, fusion is often performed for older adolescents.
  • Metal implants and bone grafts are utilized to straighten the curve, although a zero-degree curvature is not possible.

Scoliosis does not usually cause back pain, but in severe, uncorrected cases, it can compromise overall health because there is less room in the chest cavity for the heart and lungs to function properly.

While physical therapy alone cannot cure scoliosis, exercise helps maintain good muscle tone and a healthier heart and lungs, and it may reduce discomfort. We will be glad to work with your physician to design an exercise program to augment the benefits of a brace or surgery in the treatment of this condition.

Why You Need Crutches After Meniscus Surgery

If only surgical treatment worked so perfectly that the patient would hop off the operating table, cured, with no painful recovery required. For knee surgery, that is not the case.

Today, most surgical procedures on the crescent-shaped, fibrous knee joint cartilage called the meniscus are performed with tiny incisions, cameras and instruments. Thus, the recovery timeframe is much shorter than for the once more common open-knee surgeries.

The meniscus, the knee’s shock absorber, is composed of rings of spongy cartilage located between the thigh bone (femur) and shin bone (tibia). When the meniscus is torn by injury and surgery is recommended, postsurgical measures frequently include the use of crutches. How long you use them will depend on several factors, including whether the meniscus tear was actually repaired or if, more simply, a piece of it was just removed (partial meniscectomy).

With a partial meniscectomy, crutches may be needed until you can walk without limping (usually five to seven days). With a proper rehabilitation program, you can usually expect to resume sports within four to six weeks after the surgery.

Following a repair, you will typically use crutches for at least three weeks to allow the repaired tissue to become attached and to avoid retearing the meniscus. Maximal weight training is not allowed for two to three months, and a return to running and agility sports is permitted after three to four months if strength and motion have returned and there is no pain in the joint. Of course, your pre- and postoperative condition and the progress of your overall recovery will influence that timeframe.

In addition to using crutches, you may also engage in physical therapy to

  • strengthen your leg muscles
  • strengthen and regain full motion in your knee
  • return to a normal activity level

We will be happy to work with you and your surgeon to customize a physical therapy plan that will meet your goal of returning to work, home responsibilities and sports as quickly, comfortably and safely as possible.

Stroke: Every Second Counts

Strokes, or cerebral vascular accidents, exist in varying degrees of severity, depending upon which part of the brain is affected, how much of the brain is affected and the level of exercise the person performs. Other factors that affect stroke severity include advanced age, high blood pressure, diabetes, smoking, minimal variety in the types of food consumed, high cholesterol and migraine headaches.

There are two main types of stroke: a hemorrhagic stroke, which occurs when a blood vessel bursts, and an ischemic stroke, the result of a clogged blood vessel. A transient ischemic attack is referred to as a “mini-stroke” because the blood flow to the brain is briefly interrupted.

Because the care a stroke victim receives in the first few hours can significantly affect recovery, rapid recognition and transport to medical evaluation and treatment is vital. By recognizing the following signs and symptoms of a stroke, you can help clinicians give you the most effective treatment possible, as soon as possible.

  • sudden numbness or weakness of the face, arm or leg
  • sudden confusion, trouble speaking or understanding what has been said
  • difficulty seeing out of one or both eyes
  • trouble walking
  • dizziness
  • loss of balance or coordination
  • severe headache without a known cause

During the stroke recovery period, we can work with your physician to assess your unique presentation–that is, how much recovery you can achieve–and design a rehabilitation program tailored to your particular physical requirements. We can devise a recovery program to help improve your physical skills and suggest various lifestyle changes you can make to reduce the future risk of stroke.

Move Your Hips After Hip Arthroscopy

Arthroscopy, a procedure using a small fiber-optic camera device, has revolutionized hip joint surgery. Often recommended for athletes or those with degenerative arthritis, it is used to remove damaged tissue or splintered-off cartilage floating around the hip joint or to reattach structures within the hip.

A surgeon uses a small incision to insert a tiny camera into the hip, so that the damage around the joint is visible and whatever is causing pain and dysfunction in the patient can be fixed. In the past, an invasive procedure (and much larger incision) would have been necessary to treat many hip problems, but arthroscopy can achieve the same results with easier recovery time and less chance of complications.

Hip arthroscopy is an outpatient procedure, meaning that you will be sent home within hours after the surgery. Your physician may recommend using crutches, resting and applying ice packs for a short time to relieve pain and inflammation. Within a few weeks, you will feel well enough to incorporate some gentle movement of the hip into your recuperative routine. It is important to start a rehabilitation program as soon as possible, because research suggests that early movement speeds healing while lack of movement can lead to lasting problems. The rehabilitation sequence will be dictated by the specific tissues affected by the surgery.

Working with us, you can take advantage of what some experts have dubbed the “window of opportunity” after hip arthroscopy, when physical therapy makes the muscles around the joint stronger and before your body re-creates the corrosive fluids that caused your hip problems in the first place. Because your surgeon has just removed inflamed tissues and extra fluid that have affected the hip joint, you may find yourself pain-free for the first time in years. This is a perfect time to increase flexibility and function in the hip and strengthen the surrounding muscles, especially in the case of degenerative arthritis, whose symptoms may reappear in time.

On average, the rehabilitation process takes around six weeks, but the length and intensity of your postoperative rehabilitation will depend upon exactly what was accomplished–and why–through your surgery. Regardless, we can assist you to achieve your best chance of a full recovery after this revolutionary and effective type of joint surgery.

Shake Hands with Dupuytren’s Contracture

What did Ronald Reagan, Margaret Thatcher and Samuel Beckett have in common? The answer is Dupuytren’s contracture, a progressive, slow-moving condition that affects the connective fibrous tissue in the hand. Thatcher was the odd person in this group, since the condition normally strikes men of Northern European descent over the age of 50 and is more common in people who smoke heavily or use alcohol.

People suffering from Dupuytren’s contracture usually become aware of the condition when the skin on the palm of their hands starts to thicken; they may notice lumps, puckering or dimpling of the skin before any pain or discomfort develops. As the condition progresses and more tissue is affected, forming tight “bands” that can force fingers (typically the fourth and fifth fingers) to curl, patients may find that shaking hands or grasping objects becomes more difficult.

Although Dupuytren’s contracture is typically painless, treatment may help relieve discomfort and preserve the hand’s range of motion. Treatment depends on the severity of the condition and the rate of progression. Surgery can remove fibrous tissue in extreme cases, but the hand will require extensive physical therapy as part of the healing process. Common nonsurgical interventions include

  • corticosteroid (anti-inflammatory) injections to soften or flatten the thickened tissue on the palm of the hand
  • a procedure whereby needles puncture and break up the thick cords of tissue that cause fingers to contract
  • njections of an enzyme called collagenase to soften the thick cords of tissue, allowing the physician to gently manipulate the hand and stretch the fingers back into normal position

For mild cases or to support other treatments, physical therapy is a safe, effective way to alleviate symptoms of Dupuytren’s contracture. We can design a program that utilizes massage, stretching and tissue mobilization to treat the condition. We will also show you ways to use therapeutic tools, splinting or alternative movements to more easily handle such everyday tasks as writing, placing your hands in your pockets, putting on gloves or shaking hands, despite the deformities caused by Dupuytren’s contracture.

Keep Your Blood Pressure in Check

To lower the risk of high blood pressure, or hypertension, public health officials have urged Americans to reduce their salt intake. In addition to modifying your diet, however, a sensible exercise program is essential to control hypertension.

Significant evidence reveals that moderate exercise for as little as 30 minutes a day may lower blood pressure more effectively than intense exercise. The best exercises to lower blood pressure are endurance activities, such as jogging, walking, running and cycling. Adding resistance training to the overall exercise regimen can help reduce high blood pressure in adults even more. However, the American Heart Association does not recommend resistance training for people with uncontrolled high blood pressure.

It is also important to use common sense when beginning an exercise program by taking the following precautions:

  • Have a thorough physical examination, and obtain your physician’s approval before beginning an exercise program.
  • Start exercising slowly, and gradually build up frequency and duration.
  • Use circuit training for resistance rather than free weights if you already have hypertension.
  • Take precautions to avoid dehydration, and be aware of the heat when you exercise.

Remember that nutrition and physical fitness go hand in hand. The recommended daily intake of sodium for healthy adults should not exceed 2500 milligrams, the amount contained in a teaspoon of salt. Because the majority of salt in our diet comes from prepared and prepackaged foods, one way to reduce salt intake on your own is to pay close attention to the amount of sodium listed on product labels and purchase products accordingly. When cooking at home, use seasonings other than salt to enhance food flavor and palatability.

To make the most of your efforts to lower your blood pressure, you will need to visit your family physician regularly. We can work with you and your physician to customize an exercise plan to help you achieve your long-term health goals.

Nothing Funny About a Humerus Fracture

Say you have fractured your humerus, the bone in the upper arm that attaches the limb to the shoulder, but your physician does not think that surgical intervention is the best course of action. This decision may depend upon the part of the humerus involved. You might have a distal fracture, occurring near the elbow joint and most common in young children; a proximal fracture, occurring near the shoulder joint; or a midshaft fracture, involving the middle portion of the bone but not affecting the shoulder or elbow joint.

Proximal and distal fractures are more likely to be treated with surgery. However, humerus fractures can be challenging to fix surgically, and because the humerus bone is not very dense, surgeons often use plates, screws or other fixation devices to stabilize the bone while it heals. Furthermore, this procedure is rather invasive and carries a unique set of risks and potential complications.

The good news is that around 85% of proximal humerus fractures and most midshaft fractures can be treated nonsurgically. The usual protocol involves wearing a sling or brace for approximately six weeks and beginning a rehabilitation regimen with us to regain full range of motion in your injured arm, without overly stressing your shoulder.

Gentle “pendulum” exercises can begin as early as five to ten days after the injury. We will then slowly increase the intensity and range of exercises to restore the flexibility and function of your shoulder and elbow joints. To minimize weakness and muscle loss in your arm, a gentle, progressive approach to lifting will be employed, but your participation in this activity will be restricted.

Then, once it is safe to begin strength training, we can help you do this in the safest and most effective way possible. Resistance-based movements will strengthen the shoulder and major arm muscle groups and promote blood circulation around the injury, which is critical to the healing process. After a while, you may engage in more difficult exercises such as chin-ups, thus incorporating increased loading to further strengthen your muscles. Speak with us about a specific set of exercises personalized for your situation.

Shed Those Extra Holiday Pounds

The holidays are here once again, with all their edible temptations, and you would like to get into better shape after they have passed. This time you are determined to find an approach that will prevent frustration, keep you motivated and help you achieve your fitness goal.

The first thing you need to determine is your real physical shape. The best way to do this is to schedule a physical examination with your physician for important feedback about your physical condition. Some people will merely have to tweak their conditioning while others will have to work harder.

After completing the physical assessment, it is time to design a physical fitness program. Remember, each facet of fitness is critical, including strength, cardiovascular health, flexibility and balance. When designing a comprehensive fitness program, the following points are important to remember: 

  • Each physical fitness program should include a strength-training regimen to burn calories, improve your balance and body control, and enable your body to burn calories even after you have completed your workout. Importantly, as muscle increases, a rise in general metabolism follows, and you burn more calories at rest.
  • Cardiovascular exercise, such as aerobics, running, jogging, walking, hiking or dancing, is essential to any weight-loss program.
  • Interval training is also important because exercising intensely for brief periods is more effective than maintaining a steady pace throughout. Because such training adds variety to the program, you are more likely to stick with it.
  • Core exercises that work the midsection, oblique muscles and lower back keep your body optimally aligned for whatever activity you are doing (swimming, biking or running), which in turn reduces fatigue.
  • Stretching to increase flexibility and body control will enable your muscles and limbs to reach their limits.

 A successful fitness regimen includes a solid plan and the determination to stick with it. We can provide you with an enjoyable exercise program that will enable–and encourage–you to reach your fitness goal.

Heel-ing Your Achilles Tendon

Although the fibrous Achilles tendon is the strongest band of connective tissue in the body, it is prone to damage, which can necessitate surgery. In one scenario, most of the tendon has degenerated, and the paratenon (the tissue covering the tendon) has become inflamed (paratendonitis), causing pain. Or a person–often a middle-aged weekend athlete playing a sport requiring quick movements like basketball or tennis–experiences a sudden, very painful tear in the tendon. When there is a complete tear, the physician will determine whether surgery or nonoperative management is optimal.

Achilles tendon conditions that require surgery are potentially very painful before and after surgery. In fact, getting a patient to the point of being pain free is one reason that rehabilitation may last so long–sometimes, up to one year.

Because the surgical incision is made in an area of the body that is literally thin-skinned and has a less-than-ideal blood supply, the larger the incision, the greater the chance of poor healing and infection, which can impede the progress of rehabilitation. Thus, patients may wear a brace for up to two months to protect not only the repaired tendon but the incision as well.

Limited rehabilitation therapy–range-of-motion and conditioning exercises, for instance–can be performed while you wear a brace. A removable brace/splint can minimize the likelihood of blood clots, muscle atrophy and joint stiffness associated with a cast, and with it, more rehabilitative physical therapy can begin earlier, perhaps within a few days after surgery. A little later, strengthening exercises may be performed in a pool, allowing the tendon to start to regain its function in the safety of water’s buoyancy. Exercises carried out on land will involve both legs to “share the load.”

Of course, recovery and rehabilitation rates differ for each patient. Generally, a person with a surgically repaired Achilles tendon should be able to walk and swim six weeks postsurgery, while running and other sports drills may be possible within four to six months. Although some pain may linger for a while, at the six-month mark many athletes are ready to initiate a gradual return to sport activities.

We can work with your physician to design an exercise program individualized to your rate of recovery. This way, you can regain strength and range of motion that will permit you to resume your sports activities pain free.

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