Category Archives: Blog

There’s a Cyst on my Wrist

Aaron Mull, Reconstructive Hand Surgeon, Plastic Surgeon

Your grandparents probably called them “Bible cysts” and “cured” them by whacking them with a large book, but ganglion cysts are the most common hand mass seen in orthopaedics accounting for 60-70% of patients. A ganglion cyst is usually asymptomatic but may just be an annoyance or considered unattractive to some patients. They often occur on the top or bottom of the hand or wrist and can grow larger over time. While ganglions are not harmful and safe to leave alone, many opt to have them either aspirated or removed surgically. Typically, the fluid inside a ganglion is thick, jelly-like and hard to aspirate and combined with the associated discomfort and high recurrence rate, it’s usually not worth it. Surgical removal has a better chance of fully removing the cyst but there is still a slightly lower, but still present, risk for the cyst to return. Finding a lump or growth can definitely cause some anxiety and concern for many patients, so it’s always best to have them checked to rule out anything more serious.

Tennis elbow; serious condition or just seriously annoying?

Daniel Emerson, Orthopaedic Surgeon

Tennis elbow, or lateral epicondylitis, is one of the most common causes for elbow symptoms in patients with elbow pain and affects 1-3% of adults annually. It’s most commonly seen in tennis players (hence the name) but can also be brought on by heavy or repetitive lifting or gripping. Pain from tennis elbow occurs primarily on the outside of the elbow but the pain can spread into the forearm and wrist and may increase with arm movement or simple activities such as bending the wrist back, shaking hands or turning a doorknob. In addition, the elbow may also be swollen and tender to the touch. Generally speaking, lateral epicondylitis is a self-limiting condition which means that in most, over time, it will go away. However, it is a nagging annoyance for many patients seen in our practice and can seem like it lasts forever to those suffering from the pain which can often intensify with even mundane daily activity. So how can patients improve their symptoms or make them tolerable until the issue resolves? Our physicians believe conservative treatment is best, and symptoms resolve in 95% of patients without surgical intervention. Treatment options available include oral NSAID’s (in moderation and with your PCP’s blessing of course), a simple wrist splint (to prevent the motions that aggravate), tennis elbow straps and Flexbar exercises (which involve eccentric exercises for the wrist extensors with a durable resistance device). Injections and surgery are a more aggressive approach and are controversial in the opinion of some physicians as current research indicates that injection treatments may actually prolong healing and increase pain (even if they provide initial relief of symptoms). While there are several surgical procedures performed for the condition, there isn’t a gold standard procedure practiced widely at this time and many patients are still left plagued by the same symptoms afterwards. Injections and surgery aren’t the “wrong” answer but simply put, there isn’t a quick and easy “fix” and the best treatment option available is patience!

While living with tennis elbow isn’t damaging or harmful per say, it’s definitely a pain in the…elbow. If you’re struggling with tennis elbow symptoms, feel free to make an appointment with our office for evaluation and treatment discussion with one of our orthopaedic specialists. 

Orthopaedic Care of Degenerative Disc Disease

Robert T. Vraney, M.D.

Many patients diagnosed with degenerative disc disease are left wondering exactly what this diagnosis means for them. Common questions that patients have include:

  • If I have degenerative disc disease as a young person, will it get worse with age?
  • Will the degenerative disease become a crippling condition?
  • Will the degenerative disease spread to other parts of the spine?
  • Will the pain from the degenerative disease cause permanent damage?

Part of the confusion probably comes from the term “degenerative.” This term implies that it will worsen with age. While the disc degeneration is likely to progressive over time, the associated pain usually does not get worse; and in fact, often times gets better over time.

Another source of confusion is probably created by the term “disease.” Degenerative disc disease is not actually a disease but is more accurately described as a degenerative condition that at times can produce pain from a damaged disc. It is quite variable in nature and severity. As we age, all people exhibit changes in their discs consistent with degeneration. It is a natural process; however, not all people will develop symptoms.

Finally, some of the confusion likely comes from the medical community, as medical professionals have yet to agree on what the terms describes. Often times the “disease” is nothing more than a radiographic description. Because few practitioners agree on what does and does not constitute a diagnosis of degenerative disc disease, very few medical textbooks even attempt to give an accurate description. Therefore, while many practitioners believe that degenerative disc disease is a common cause of low back pain in young adults, very few agree on the implications.

For these reasons and others, I personally prefer to use the term “discogenic low back pain” or “disc incompetence.” The first term implies that it is the disc that is “generating” the patient’s pain. I often describe to patients that discs inability to handle forces and loads presented to it (“disc incompetence”) is the reason why a damaged disc can become a source of pain. I explain to patients that this damage can occur either through a natural degenerative process or can be accelerated through micro or macro trauma to the spine. Re-enforcing the issue of competence of the disc also illustrates to patients the potential for physical therapy to improve the symptoms. This is not by reversing an irreversible process, but rather by attempting to protect the disc via strengthening of the core extensor muscles.

I believe that providing good medical care and counseling are only part of my job here at Orthopaedic Associates. Patients have much to gain by becoming better educated about the conditions impacting their lives. This education is a vital part of the healing process and certainly one of the biggest services that we as physicians can provide.

For more information on Dr. Vraney, please visit his page. To schedule an appointment, click here.

Treating Joint Pain – What to do and when to see a Doctor

Jared Kiernicki, Physicians Assistant

If you’re experiencing pain in any joint—your knee, ankle, shoulder, hip, etc.—you need to know how to best treat it at home. It’s also important to know when it’s time to see a doctor.

Each day at Orthopaedic Associates, I help patients with joint pain. In most cases, it’s been going on for a while and the patient or caregiver has been trying to manage it for some time.

Below are tips for managing your symptoms at home. I also give guidance on when it’s time to see one of our experts.

Chronic joint pain vs. Acute joint pain

Chronic joint pain is something that’s been nagging for months to years. It has a predictable pattern, such as painful in the morning, after standing on your feet all day, etc.

Acute joint pain is from something sudden. For example, you’re playing a sport and you feel a “pop” or tearing feeling. Or acute injuries can result for a fall or other accident.

RICE treatment, medications at home

The methods below can be relevant and helpful for managing both types of pain at home, as nearly all joint pain benefits from the RICE method of treatment.

RICE is an acronym standing for Rest, Ice, Compression and Elevation. Each part helps in a different way.

  • Rest: Not only helps the injury heal, but prevents further irritation or injury from ongoing activity.
  • Ice: Ice stops the formation of new inflammation (swelling, pain, pressure), and helps with pain control. (More details on how to properly use ice below)
  • Compression: Helps minimize swelling and can also provide some stability.
  • Elevation: Elevating the irritated or injured body part above the level of the heart can help decrease swelling and pressure.

Also, some consider the “I” to “anti-inflammatory medications.” Anti-inflammatory medications not only reduce pain, but can help reduce the body’s inflammatory response to injury or irritation.

The most common OTC anti-inflammatory medication is ibuprofen, under brand names such as Advil and Motrin. Naproxen (brand name Aleve) is also an OTC anti-inflammatory medication.

Naproxen is typically taken twice per day, and ibuprofen is taken up to 4 times per day. Both work to reduce pain and address inflammation. Trying them for 7-10 days (in addition to other RICE methods) often works to reduce joint pain.

Also, acetaminophen (brand name Tylenol) helps treat pain, but doesn’t work to minimize inflammation. However, especially in combination with naproxen or ibuprofen, it can help with pain control.  It’s important to avoid any alcohol while taking acetaminophen.

If you find that you’re taking pain medication for a length of time, or you are at risk for stomach or kidney problems or other side effects, you should check with your primary care doctor.

When to see a doctor

Overall, if RICE and OTC medications don’t seem to help, it’s time to see a doctor.

It’s also time to see doctor when you experience the following:

  • Symptoms don’t improve, or even worsen with treatment. That means that the ankle or knee that was aching or sore is now throbbing and you can’t put weight on it.
  • Your pain has evolved to the point that it’s affecting your activities of daily living. Perhaps you now can’t go up or down stairs, or you can’t carry your child or bring in the groceries. If your life is impacted by joint pain that has become unmanageable on your own, it’s time to get help.
  • New symptoms, such as swelling that wasn’t there before, a “clicking” inside the joint, or a feeling that it’s locking up.
  • Signs of infection, such as heat and redness in the joint accompanied by a fever.

If you’re having these symptoms, you should see your primary care doctor. However, you can also visit a Deaconess Urgent Care or the Orthopaedic Associates Walk-In Urgent Care.

Visiting a doctor or other provider for severe or worsening joint pain can lead to a variety of treatment options, depending on the cause and type of pain.

  • Medication options may be considered, including oral or injected steroids, or prescription strength anti-inflammatory or pain medications.
  • Physical therapy—for strengthening, stretching, etc.—is important to help overcome many types of joint pain, and to teach self-care methods for the future, including a personalized therapy/exercise program.
  • Advanced imaging may be required. Some injuries may need to be diagnosed with the help of MRI, CT, x-ray, etc.
  • Equipment or supportive devices. This could include a brace, sling, crutches, or a “boot.” There are lots of options depending on type of injury.
  • Further referrals to an orthopaedic specialist may be needed. Joint injuries sometimes need surgery, and chronic conditions, such as arthritis, may lead to joint replacement. To learn more about what to expect from joint replacement, my colleague Brooke Kline has written an excellent Q&A article.

Tips for using ice and heat

I want to give some tips on effective use of ice for the most benefit.

  • Ice the entire joint. For example, applying ice all the way around the knee is more beneficial than just putting an ice pack on the front.
  • Applying compression WITH the ice is more beneficial than just placing an ice pack. Wrapping an elastic or compression wrap around the ice pack can give double benefit.
  • Always have a layer of some type of fabric between ice and skin. A hand towel, sock, etc. is fine—you just don’t want to damage your skin with direct contact.
  • Use ice multiple times throughout the day, 20-30 minutes at a time. Let your joint re-warm back to normal temperature between times of icing.

Now let’s talk about using heat. Some people report that using a heating pad can help with joint pain before going shopping, golfing, or other types of activity. With chronic joint pain, sometimes applying heat can help “loosen up” the joint and surrounding muscles. A few minutes with a heating pad or similar heat can help reduce pain during activity. I would still recommend icing afterwards to help with inflammation and swelling.
Note: For acute joint pain, such as from an injury (an ankle sprain is a good example), heat can increase swelling and inflammation, so avoid heat for the first 48 hours after an injury.

I thought it was just a sprain! A closer look at scaphoid fractures.

Matthew L. Drake, MD, Orthopaedic Surgeon

Bumps and bruises can often feel like minor issues that don’t require medical attention, however sometimes that is not the case. A common issue I see in my practice is the scaphoid non-union. The scaphoid is a small peanut shaped bone in the wrist. Teenage boys and young men engaging in sports often break this bone after a hard fall at play. The initial symptoms are wrist pain and swelling, which does improve with time. However, if the scaphoid bone was broken and not treated, trouble is on the horizon.

Illustration and x-ray showing a break in the mid-portion, or “waist,” of the scaphoid. This is the most common location for a fracture. Photo courtesy of orthoinfo.aaos.org.

The scaphoid bone has a difficult time healing due to poor blood supply, it’s just the way we are built. If recognized right away, most scaphoid fractures will heal in a cast or with a minor procedure to place a screw inside the bone. Once the bone heals, the usual outcome is no long -term problems. If even a one -month delay occurs before treatment begins, the risk of the bone not healing or requiring a much more invasive surgery goes up significantly. If the scaphoid does not heal, long term problems of wrist arthritis are sure to develop.

These problems are usually preventable! If a wrist injury occurs, particularly in the young athletic male age group, medical evaluation is advised. If there is tenderness over the scaphoid bone, x-rays should be taken. Many times, the initial x-ray will not even show a fracture, therefore a cast should be applied and a follow up needs to occur in two weeks to determine best next steps.
One of the most fulfilling aspects of my practice is to help patients treat problems in a simple, practical fashion leading to good outcomes. However, the essential part for me is to have the opportunity to perform an expert evaluation. If the wrist is sore after a fall, be concerned, and get it checked out!

To schedule an appointment with Dr. Matthew Drake, MD, please use our online tool or call or text our office at 812-424-9291.

Halloween Safety Tips

Article from AAOS: https://orthoinfo.aaos.org/en/staying-healthy/halloween-safety-tips

Kids love Halloween. Pumpkins, spooky decorations, costumes, and trick-or-treating are fun for kids of all ages. Unfortunately, there is a downside to Halloween activities: Children often get hurt.

Wearing masks and costumes, as well as walking in unfamiliar areas in the dark, can lead to trips and falls. Bumps, bruises, and even sprains or fractures can quickly dampen children’s spirits. In addition, pumpkin-carving can result in serious cuts on the hand, as well as injuries to bones and tendons.

Of course, there are many precautions you can take to help make your Halloween injury-free, such as the safety tips provided below.

Costumes

  • Costumes should fit properly. Costumes that are too long may cause kids to trip and fall, so trim or hem them as necessary.
  • Bright-colored costumes make it easier for children to be seen at dusk or in the dark. Add reflective tape to costumes and treat bags to provide additional visibility.
  • Wear sturdy, comfortable, slip-resistant shoes to avoid falls.
  • Masks can obstruct a child’s vision and should be avoided, along with hats that fall down over a child’s eyes. Child-friendly makeup is a good option.
  • Look for flame-resistant costumes and accessories.

Pumpkin Carving

  • Young children should not carve pumpkins. They can get creative with paint, markers or other non-carving decoration kits.
  • Use a pumpkin carving kit or knives specifically designed for carving. These are less likely to get stuck in the thick pumpkin skin. Some Halloween carving devices, designed especially for older children, may be safe for use with parental supervision.
  • Always carve pumpkins in a clean, dry and well-lit area, and make sure there is no moisture on the carving tools or your hands.
  • If you are cut, apply pressure with a clean cloth and elevate the injured area above the heart. If bleeding does not stop within 10-15 minutes or if the cut is deep, you may need to contact your doctor. Make sure cuts are cleaned and covered with clean bandages.
  • Avoid candles in Halloween pumpkins and other decorations. Instead, use non-flammable light sources, like glow sticks or artificial pumpkin lights.

Trick-or-Treating

  • Children younger than age 12 should be accompanied by an adult. Parents of older children should plan a safe trick-or-treating route together, and set specific times for children to check-in and return home.
  • Older children trick-or-treating without parents should be reminded to always stay together.
  • Walk on sidewalks and never cut across yards or driveways.
  • Cross streets at designated crosswalks and obey all traffic signals.
  • Both children and parents should carry flashlights to see and be seen.
  • Approach houses that are well lit. Remind children to never enter a home to obtain a treat.
  • Be aware of neighborhood dogs when trick-or-treating. Remember that these pets can pose a threat when you approach their home.
  • Carry a cell phone while trick-or-treating in case of an emergency.
  • Be sure to throw away any unwrapped or spoiled treats.

Anterior Hip Replacements

Dennis J. Beck, MD, Orthopaedic Surgeon

Hip replacements are a highly effective and efficient way to treat arthritis of the hip, either from wear and tear or from the effects of trauma. Hip replacement has been around for several decades and has proven to be a quality way to alleviate pain and suffering and increase mobility and function. Thanks to advancements in surgical techniques and special equipment available at our partner hospitals, patients can now consider Anterior Hip replacement and discuss the possible benefits with their surgeon.

Traditionally, hip replacements are performed through an incision that is 10-15cm in length on the side or back of the hip joint. Anterior hip replacements involve a smaller incision near the front of the hip joint. The surgery itself may take a bit longer than a traditional hip replacement; however, due to the less invasive approach, patients typically have less surgical discomfort following this technique.

Patients who undergo anterior hip replacement have the same risks as traditional hip replacement of infection and other wound complications. However, patients with anterior hip replacement can typically leave the hospital in 1-3 days and mobilize sooner. By doing a hip replacement through an anterior approach, the backside of the hip is left intact. Most activities of daily living, such as sitting, driving a car and crossing your legs are not affected by the risks of destabilizing the backside of the hip joint.

The anterior hip replacement may involve some transient periods of numbness in the anterior thigh and may involve some restoration of strength of the front of the hip joint. However, it has been shown that anterior hip replacements do provide an earlier return of function, mobilization of the patient and shorter length of time in the hospital, with less pain.

We are striving to lead the way to introduce new technology and techniques for our patients at Orthopaedic Associates. Thanks to the cooperation of Methodist Hospital and continuing education in the techniques of anterior hip replacement, we hope to be able to provide state-of-the-art joint replacement care for all patients in the region.

About Dennis J. Beck, MD
Dr. Beck specializes in general orthopaedics and total joint replacement and is one of three surgeons in the area that can perform anterior hip replacements.  As part of a recent partnership between Methodist Hospital and Orthopaedic Associates, Dr. Beck provides services to patients of Henderson and surrounding communities at Methodist Hospital in addition to the services he provides at Deaconess Hospital and Gibson General Hospital.  To schedule an appointment with Dr. Beck, call 812-424-9291 or request an appointment online.

Conservative Treatments for Joint Pain

Rhiannon Anderson, PA

Experiencing joint pain? Surgery is not your only option. There are many conservative (non-surgical) options that can provide significant relief from joint pain. At Orthopaedic Associates (OA), we work with our patients to help them get relief from joint pain in a way that minimizes disruption to daily life.

Treat joint pain at home
Most people can successfully treat minor joint pain at home with the RICE method and/or anti-inflammatory medication.

RICE, which stands for rest, ice/anti-inflammatory medication, compression and elevation, can go a long way in addressing joint pain.

These treatments can help alleviate swelling, pain and inflammation, and help you get on with your daily life with more comfort.

My colleague, Jared Kiernicki, has published an article that discusses RICE in-depth.

Anti-inflammatory medications
The proper use of anti-inflammatory medications can help reduce pain very effectively. Some medicines are over the counter, such as ibuprofen, naproxen, etc. while others are by prescription (these may be stronger and require more supervision).

Arthritis, which is the most common cause of joint pain in middle-aged and older adults, is not adequately treated with opioid-type medications. Those medications don’t address the cause of the pain. Opioids may dull the pain a little but aren’t really helping the situation improve. In fact, using opioids for joint pain relief may result in needing higher and higher doses for the same effect.

Learn more about opioids, and some alternative options for pain control, offered by the experts at Deaconess Comprehensive Pain Center and Progressive Health.

Treat joint pain with physical therapy
Physical therapy (PT) can make a world of difference for patients with joint pain. What can therapy do?

  • Physical therapy can improve range of motion in a joint. Some patients complain that the joint feels stiff, or “locked up,” etc. and PT can help with that.
  • PT can strengthen muscles around joints, helping to reduce the strain on those joints, improve stability and more.
  • Balance can also improve from PT, reducing the risk of falls, and improving overall stability and strength.
  • Therapists can also use ultrasound, electrical stimulation and other treatments to significantly reduce pain.
  • Another important note about PT: while it can often prevent surgery, sometimes therapy can only delay the need for surgery. However, by the time you are ready for joint replacement surgery, the PT you’ve done has helped you become stronger. Patients who have followed PT instructions very carefully have better, quicker outcomes from surgery, including a less difficult rehabilitation.

Physical therapy treatment of the knee

Treat joint pain with injections
Joint injections can also significantly reduce pain and inflammation. There are two types of injections that OA doctors use for patients: steroid injections and hyaluronic injections.

Steroid injections reduce inflammation caused by arthritis, which reduces pain and swelling. These injections may be given as often as every 3 months, but many patients do well with only 1-2 shots per year or less.
These injections can be a long-term treatment; however, some patients find that over time, the injections are less effective, and replacement surgery may need to take place.

Steroid injections may be a good choice for patients who are taking blood thinners (anticoagulants) but not an ideal choice for a patient with diabetes.

Hyaluronic acid injections supplement the hyaluronic acid that naturally occurs in joints. The acid acts as a “joint lubricant” making the joint move more smoothly. As people age and develop arthritis, the body may need a “booster” of this lubricating substance.

These shots can be given for long spans of time, and many patients respond well for many years.

In Summary
If you’re experiencing joint pain, don’t assume that you will definitely need surgery.  There may be several other options that your orthopedic specialist can recommend.

To schedule an appointment with me or my colleagues at Orthopaedic Associates, request an appointment online or call 812-424-9291.

Weekend Warrior to Total Knee

Dr. Gary Moore 

Sports Medicine, Total Joint Replacement, General Orthopaedics

You inherit the durability of the articular cartilage – the smooth gliding surface that coats the end of all bones that form a joint.  We do not fully understand this lack of durability, but we see a family history of multiple family members that have arthritis in their knees without unusual overuse or injury.

So the “weekend warrior” who has played sports their entire life or participates in sports in their spare time increases their chances of causing wear and tear injuries, especially if this is compounded by genetics, obesity, malalignment and past injuries.  The high school athlete that has a major portion of their meniscus excised at age 18 will commonly start seeing some arthritis forming 20-25 years later.

Obesity
The United States has record high levels of obesity.  Obesity increases the stress to the knee joint by a factor of 4-5 times.  50 extra pounds can increase the knee joint forces up to 250 pounds per square inch.

Malalignment
Bow legs (varus) or knock knees (valgus) wear the joints out faster.  The normal joint is 50 valgus so it shares the load 50% inside and 50% outside.  If the knee is abnormally aligned, this can shift to 60:40 or 70:30 so the abnormal joint receives excessive stress.

Articular Cartilage Damage
The smooth gliding surface of the knee joint can be damaged by multiple small injuries that accumulate through life and sports or significantly damaged by major injuries or fractures.  If a fracture (or broken bone) involved the knee joint it can accelerate the arthritics.  We call this post traumatic arthritis.  Major ligament injuries like ACL tears can also damage articular cartilage.

Meniscus Tears
The meniscus is a C-shaped cartilage spacer that acts as a shock absorber for the knee.  You have 2 – one on the medial side (inside) and lateral side (outside) of the knee.  When someone has a “cartilage tear” this structure is torn.  If it has to be removed by arthroscopic surgery (which is a very common surgery that we perform), the shock absorbing function can be diminished leading to increased wear on the joint.

Other
I will not ever get into inflammatory arthritis (rheumatoid, Lupus, gout psoriatic) or Avascular necrosis – people that have this are not going to be participating in “weekend warrior” activities to a very high degree.

What do you do if you start to develop arthritis?

Knee Pain, Total Knee, Arthritis

Decrease Activity
Planting, pivoting sports like basketball, soccer and long distance running may have to be limited.  Golfers may have to ride golf carts instead of walking.  Runners may have to shift to activities that are less stressful (Walking, elliptical machines, bicycle, swimming, weight lifting) that avoid stress to the knee joint.  If it hurts, don’t do it.

NSAID’s
Non-Steroidal Anti-inflammatory medications can be used – Aspirin, Ibuprofen, Aleve and the 20 prescription NSAID’s that are available.  They can decrease the inflammation and pain and allow more activity.  NSAID’s have side effects so they have to be used carefully with following by your primary care physician.  Some potential side effects are stomach irritation (even ulcers), kidney damage, blood thinning and cardiac effects.

Braces
Supporting braces can help take the stress off of the knee.  This can be as simple as an elastic sleeve or as complex as a valgus loading brace that distributes the joint forces to the “good” side and unloads the arthritic side – these are expensive and somewhat cumbersome to wear but they can be helpful.

Injections
Cortisone – the world’s most powerful anti-inflammatory – can be used sparingly to limit pain and inflammation.  There are limits to the frequency and extent of their use.  Hyaluronic acid (Synvisc, Hyalgan) injections can also be used to improved pain and decrease inflammation.

Arthroscopy
Outpatient resection of meniscus tears and smoothing of articular cartilage can be performed through 3 “stab” incisions.  This dramatically helps pain from meniscus tears but does not predictably help the articular cartilage damage.

Total Joint
If the articular cartilage is damaged to the degree that bone is exposed at the joint surface, this is the beginning of severe arthritis.  When all non-surgical treatments have been exhausted and the pain and disability start to greatly limit activities, then artificial joint replacement using metal and high tech plastic can be considered.  Basically, the worn surfaces of the joint are removed and replaced with stainless steel surfaces and cross linked polyethylene plastic spacers.  Modern total knees are durable and long lasting but they do not allow running and jumping.  Once you have a total knee, sports are limited to walking and low stress activities.

Millions of people can enjoy sports their entire life without major damage to their knees.  There are also many athletes and “weekend warriors” who participate in competitive and recreational sports that damage their articular cartilage over time and develop arthritis that needs to be treated.  Total joints should be considered as a last resort to these athletes but there are still many low impact activities and sports that can be enjoyed by ageless and active people.

Orthopaedic Doctors in Evansville, IN