Long-lasting pain and stiffness don’t have to be an everyday frustration, thanks to new advances in orthopedic medicine. Learn about the latest technques that are helping busy bodies get back to work faster.
Tot so long ago, people simply accepted the pain, stiffness and impaired movement of arthritis and injury. Fortunately, advances in orthopedics and orthopedic surgery are making it possible to regain movements once lost.
Medically speaking, orthopedics include the human skeleton and the muscles, ligaments and joints that enable it to move. Not only do orthopedic specialists treat congenital disorders and disease, but the injuries that keep people from working, playing and living pain-free.
For most aches and pains, surgery is neither the first, nor the best, option, says Dr. Brian Michalsen, a board-certified sports medicine and family practice physician at Rockford Health Physicians. No matter his patients’ ages, much of orthopedic medicine depends on whether pain is acute or chronic.
“Sprains, strains, muscle disorders – anything that affects the musculo-skeletal system – can be successfully treated without surgery in many cases,” Michalsen says. “We usually try various means to relieve the pain and heal the affected area. This can include prescribing oral or injected anti-inflammatory medicines, such as steroids, or beginning either a home exercise program or physical therapy.”
Treatment plans must take into consideration a patient’s existing condition, especially factors such as age, weight, and health concerns such as uncontrolled diabetes, high blood pressure, neuropathy, heart disease, arthritis and other chronic health problems.
“Some patients are skeptical about home exercise,” Michalsen says. “They’ll tell me they already exercise or that they don’t feel they need physical therapy. They might belong to a gym or have a self-designed program that promotes strength and endurance. What they need to realize is that physical therapy and home exercise plans focus on the pain and its underlying cause. It pinpoints the smaller muscles in the affected area and helps to alleviate pain, as opposed to a general exercise agenda.”
Short-term, non-surgical solutions can actually cure injuries and stop pain, but in more serious cases, these solutions merely postpone surgery. For example, knee replacements traditionally last for 10 to 15 years, but because surgery is so involved, physicians try to delay knee replacement as long as possible, says Michalsen. Instead, judicious use of short-course medications may prove more valuable, because they allow time for the condition to improve on its own. The end goal is restoring full motion and function without pain.
“Pain pretty much dictates the course of treatment,” Michalsen explains. “For example, we can inject fluids into a knee to relieve joint pain. After four weeks, the patient should be re-evaluated to see if follow-up injections are feasible, or if surgery would be a more successful option.”
When adolescents have joint pain, many times it’s because of extra-curricular activities. Football, basketball, soccer, dance, wrestling, cross country running and cheerleading, for example, put youths at risk for orthopedic injuries. Usually, it’s either trauma or overuse that causes pain, Michalsen says. When injury occurs, the goal is to get the young athlete back to physical activities as quickly and safely as possible.
In some cases, the cause of joint pain isn’t just overuse, but incorrect use. Michalsen says this is especially true with children who play the same sport year-round. For example, high school baseball pitchers can throw a fastball, but if they have poor throwing mechanics, they put unnecessary strain on the elbow and shoulder. This leads to pain and a decrease in their usual performance.
“Treatment includes not only proper strengthening and stretching, but also correction of the mechanics,” Michalsen says.
Younger children, on the other hand, usually have pain from injury, instead of overuse. When evaluating a patient, Michalsen is careful to look at the joint above and below the pain source, because pain is sometimes referred from other joints.
“This is especially true for younger children, who can have a difficult time expressing the exact location of pain,” Michalsen explains. “Treatment for many children, from the young child through teenagers, is a short period of joint immobilization and activity modification, followed by a gradual return to activities.”
Anti-inflammatories, taken at a shorter course and smaller dosage than adults, may help to alleviate joint pain. Injections are rarely, if ever, used to help children recover from their injuries, Michalsen says.
Still, the time may come when surgery is a patient’s best option. While any orthopedic surgery requires months of healing time and therapy, the initial recovery period has been substantially reduced, thanks to minimally invasive surgical techniques.
Dr. Thomas Hernandez, a board-certified orthopedic surgeon at KSB Hospital in Dixon, is also certified in sports-related problems. The orthopedic procedures he’s used since beginning practice in 2008 are far more advanced than treatment options available just 15 to 20 years earlier.
“It just keeps getting better and better,” Hernandez says. “Smaller incisions, better implants and quicker return to full function are all the results of improved equipment, technique and therapy.”
Most of his patients are between 40 and 70 years old, representing everyone from overly ambitious “weekend warriors” to overworked farmers. Yet KSB also partners with the Dixon school system, providing orthopedic support for high school athletes. No matter the age of the patient, it’s important to seek treatment for lingering pain and injuries.
“Orthopedic injuries can be very painful and debilitating, no matter how they occurred,” Hernandez says. “Treatment depends on the nature of the injury and the patient’s pain tolerance and activity limitations. When the patients feel pain to the point that their lifestyles are curtailed or they’re unable to work, we may try non-operative treatments such as injected steroids and therapy. When non-surgical treatments prove ineffective, this signals that we may need to intervene surgically.”
Technological and surgical advances have greatly reduced recovery time, especially in the short term. However, Hernandez points out that long-term recovery is still a lengthy process.
“People often think that an operation done through small arthroscopic incisions equates to a more minor surgery,” Hernandez says. “It’s not necessarily true. With today’s technology, many major operations can be done arthroscopically, but it still takes a great deal of work, therapy and time to fully recover.”
One example is reconstructive surgery for tears to the anterior cruciate ligament (ACL), an injury that can happen when a patient’s foot is firmly planted while the knee is forced out of alignment. Athletes playing soccer, football, baseball and basketball are vulnerable to ACL tears but surprisingly, skiers account for most ACL injuries, around 250,000 annually. According to the Mayo Clinic, these tears cannot be stitched back together. Instead, the torn ligament is replaced with a tendon from the patient or a donor.
Fixing Knees & Shoulders
When it comes to fixing ACL injuries, Dr. John Gluscic, board-certified orthopedic surgeon at FHN in Freeport, relies on arthroscopically assisted surgery to reduce pain, speed recovery and improve overall function.
“Most minimally invasive arthroscopic surgery requires just a 3/8-inch incision,” he says. “ACL surgery also requires a four- to five-inch incision for the graft. I bury all of the stitches under the skin. Patients are able to walk right away, but will need therapy.”
In the past, ACL reconstruction involved a nearly three-hour procedure, one week’s hospitalization and six weeks in a cast.
“Now, the patient goes into surgery at FHN Hospital at 11 a.m., is out of surgery at 12:30 p.m. and home by 3 p.m.,” Gluscic says.
The same improvements have also occurred in rotator cuff surgery for shoulders. Rather than the large puncture holes and drills of yesteryear, modern arthroscopically assisted procedures are quite streamlined.
“We make a small incision and insert a scope to help us debride the joint and remove any bone spurs,” Gluscic says. “Then, we open a 4- to 5-inch incision on top of the joint and we part, rather than cut, the deltoid muscle. We cut a trough in the bone and mobilize the tendon. We do not tie knots on top of the tendon, so there is bone-to-tendon healing, with no disruption of the blood flow to the joint and surrounding tissue. My patients start therapy 72 hours after surgery. The advantage to this method is that it promotes earlier blood flow and healing, and helps the patient return to full function quicker.”
Gluscic adds that within eight weeks, patients may be playing golf with no pain and with almost all range of motion restored.
“In most cases, not only is the pain gone, but with small tears, patients achieve 90 to 95 percent return of full function,” Gluscic says. “In patients who had larger tears repaired, 80 percent not only have their pain reduced but also regain their strength and function within 12 weeks. With the stitches buried, patients can shower within three days and use their elbows and wrists freely. We do caution that they refrain from reaching the arm out from the body for four to six weeks. Our patients can drive after being off their medications and be back to work in six weeks.”
Gluscic points to a low 5- to 10-percent rate of recurring injury.
“There is always a risk with any surgical procedure,” Glusic says. “But with today’s advances and combining techniques, we can help patients reach an earlier return to function and an active lifestyle.”
While orthopedic disease and injury can be prevented and treated, two factors are not controllable: time and genetics.
The need for knee surgery increases in relationship to age, says Dr. Tyler Gunderson, board-certified orthopedic surgeon at KSB. Injuries, disease, weight and other factors affect knee function at every age, but it worsens as time goes by. Recently, a new nonsurgical procedure, in which a viscous liquid is injected into the knee joint, is gaining attention.
“Injectable cushioning liquids can be used in a number of cases, with the right patient,” Gunderson says. “As an alternative, we can try it with pretty much any patient, but we find it is less successful with advanced arthritis patients.”
According to the American Academy of Orthopedic Surgeons, this procedure, called viscosupplementation, involves injecting a thick fluid called hyaluronic acid into the knee joint. This acid acts as a lubricant and a shock absorber, enabling the knee joint bones to move smoothly over each other and protecting against weight loads.
“Once this liquid flows into the open space, we schedule a follow-up in about eight weeks to see if the procedure is helping to reduce pain,” Gunderson adds. “The big question is how long its effects will last. Our patients are averaging between six months and one year, with 75 percent telling us they have felt pain relief. The injections can be repeated every six months or longer.”
He emphasizes that injections are only a short-term solution to unbearable pain. Eventually, patients may find the treatment helps less and less, until surgery becomes a more viable option.
“At some point, we may need to perform a partial or total joint replacement,” Gunderson adds. “Truth is, we find very few patients whose conditions indicate a partial replacement is the best choice.”
Total joint replacement is predicated on the patient’s weight, activity level, type of work and other factors. Partial replacements can last up to 10 years, depending on the individual, while full replacements can last between 15 and 20 years. Gunderson says he tells his patients 10 to 15 years is a good average.
“They will need regular follow-ups and to do the therapy required,” he adds. “So much depends on the patient and all those individual variables.”
Patients of all ages are finding relief from joint pain and injuries. Young athletes are getting back to their favorite sports, while older adults are retaining active lifestyles, and living longer than ever before.