Treating Tennis Elbow

6 Jan 2017 General , , ,

Treating Elbow PainTennis elbow is another term for tendonitis that affects the elbow. Tendonitis is a repetitive stress injury, or an injury that results from overuse of tendons and muscles in a specific area. Tennis elbow is caused by overuse of arm, forearm, and hand muscles, which results in elbow pain. While it is a common injury for those who play tennis, athletes in other sports or employees who use vibrating equipment (e.g., a jackhammer) or their forearms during manual labor are also susceptible.

The medical term for tennis elbow is lateral epicondylitis, which stems from the part of the elbow that is affected: the lateral epicondyle, or the bony area on the outside of the elbow where the muscles and tendons of the forearm attach.

Most cases of tennis elbow respond to nonsurgical treatments, and resting the forearm from the activity causing the pain is the most important part of treatment. Rest allows the small tears in the tendon to heal. The length of time you need to rest depends on how severe your condition is. It might be necessary to rest for a few weeks to a few months. In addition to rest, treatments may include:

  • Ice: Apply ice to the outside of your elbow as soon as you notice pain. Use for 10 to 15 minutes at a time, several times a day.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter (OTC) medicines such as aspirin, ibuprofen, or naproxen can help relieve pain.
  • Corticosteroid medication: Your doctor may inject a corticosteroid at the outside of the elbow to relieve pain and enable you to participate in physical therapy.
  • Physical therapy: A physical therapist will prescribe specific exercises to stretch and strengthen muscles and tendons around the injured elbow. Your PT can also teach you new techniques to handle movements that aggravate your condition.
  • Counterforce brace: This is an elastic band that wraps around the forearm just below the injured elbow. It may relieve symptoms by spreading pressure throughout the arm instead of putting it all on the tendon.
  • Surgery: This is a last resort if other treatment isn’t helpful. Your doctor may recommend surgery if your elbow pain doesn’t improve after 6 to 12 months of rest and rehab, or if you have a large tear in the tendon.

If you have or think you may be experiencing tennis elbow and at-home treatment is not relieving your pain, make an appointment with one of our orthopedists at a Tucson Orthopaedic Institute office near you.

Tucson Orthopaedic Institute Expands Physical Therapy Access

5 Jan 2017 General, Media, Physical Therapy , ,

Tucson Orthopaedic Institute opens a third physical therapy location inside fitness gym, FIT at the River. Starting in January 2017, the new clinic will offer patients additional access to physical therapy treatment.

Open Monday – Friday

Monday, Wednesday (8am-5pm); Tuesday, Thursday (7:30am-3:30pm); Friday (7:30am-12:30pm)

2404 E. River Rd., Bldg. #1

Tucson, AZ 85718

At this location is physical therapist Golsa Lotfioff, PT, DPT. Lotfioff received her Doctorate of Physical Therapy in 2014 and now specializes in outpatient orthopedics, sport medicine rehabilitation, manual therapy, aquatic therapy, and pediatric rehabilitation.

Patients can now benefit from receiving physical therapy treatment in a convenient location for rehabilitation from injury or post-surgery recovery. The FIT at the River clinic provides the same quality of care and comprehensive physical therapy services as all Tucson Orthopaedic Institute physical therapy locations.

Tucson Orthopaedic Institute physical therapy locations also include the Northwest office, 6320 N. La Cholla Blvd, #200; and East office, 2424 N. Wyatt Drive, #130. For scheduling information, call (520) 784-6570 or visit www.tucsonortho.com.

New Office Hours Now Open in Continental Reserve

4 Jan 2017 Doctors, Troy Taduran , , ,

Tucson Orthopaedic Institute physician, Troy Taduran, DO expands office hours to provide convenient access to specialized orthopaedic care in the Marana community.

Open Mondays & Fridays

8:00 AM – 5:00 PM

8333 N. Silverbell Rd., Suite 141

Tucson, AZ 85743

Patients in Marana can now benefit from seeing an orthopaedic specialist for sports related injuries and acute musculoskeletal injuries – no appointment necessary. The Marana clinic provides same-day or walk-in appointments for prompt treatment of orthopaedic injuries. X-ray and casting services also serve patients with all the orthopaedic care needed in one visit.

Troy M. Taduran, DO is a fellowship trained Sports Medicine physician specializing in non-surgical Sports Medicine, Neuromuskuloskeletal Medicine, and Osteopathic Manipulative Medicine. Dr. Taduran moved to Tucson in 2014 and is the current team physician for Marana and Mountain View High School.

Dr. Taduran treats and manages sports-related concussions, and uses Osteopathic Manipulative Treatment (OMT) and Regenerative Injection Therapy (RIT) to supplement the healing of musculoskeletal injuries and pain. He says, “My goal is to understand the cause of pain and treat it at its origin using the body’s inherent ability to heal itself.”

Dr. Taduran also sees patients at three of Tucson Orthopaedic Institute’s locations, including St. Mary’s; Northwest, 6320 N. La Cholla Blvd, #200; and Oro Valley, 1521 E. Tangerine Rd., #101. For scheduling information, call (520) 382-8200 or visit www.tucsonortho.com.

Did You Know? 8 Interesting Facts about Physical Therapy

21 Dec 2016 General, Physical Therapy , , , ,

If you have a musculoskeletal injury or condition, physical therapists can help you recover by improving your mobility, reducing your pain, and restoring your function. While this is widely known, here are some interesting things you might not know about physical therapy (PT).

How did it all begin? The profession of physical therapy began during World War I in response to the need to treat injured soldiers. The benefits of PT have since been proven so great that it is now an integral part of strengthening and recovery. 8 Interesting Facts About Physical Therapy

Where do physical therapists work? Besides physician practices like Tucson Orthopaedic Institute, physical therapists can work in a number of other settings, including outpatient clinics, hospitals, inpatient rehabilitation facilities, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes.

What else do physical therapists do? Most people probably associate PT with orthopedic rehabilitation, but there are several other types of physical therapy, including neurologic rehabilitation (e.g., working with stroke patients and spinal cord injuries), acute care, post-operative care, cardiovascular and pulmonary rehab, lymphedema management, pelvic floor therapy, and burn/wound care.

Can physical therapists treat anything other than musculoskeletal disorders? Besides disorders of the bones, muscles, and joints, physical therapists can treat balance problems such as dizziness and vertigo (a dysfunction of the vestibular system in the inner ear), headaches, concussions, jaw pain (such as TMJ), lymphedema, urinary incontinence, COPD and other cardiopulmonary conditions, cerebral palsy, and multiple sclerosis and other neurological disorders.

What kind of credentials do physical therapists have? When physical therapy was first recognized as a profession, PTs only had to have a bachelor’s degree to practice. Today PTs have advanced degrees. Masters degrees became the required norm during the 1990s, while most of today’s PT graduates obtain a doctoral degree (DPT).

Do physical therapists do massage? Physical therapy is a hands-on therapeutic treatment. While PTs are trained in massage, it is not the type of massage you may have received from a massage therapist at a spa. Physical therapists use massage to reduce tightness and improve mobility of the muscle, soft tissue, or joint that is inflamed or in pain. It is typically referred to as manual therapy, manipulation, or mobilization. So massage is part of the therapy process to reduce pain and increase mobility.

How many physical therapists are there? In 2014, there were 210,900 PTs in the US. This number is expected to rise by 34% through 2024. (Source: Bureau of Labor Statistics)

Do I need a referral to receive physical therapy? It depends on where you live. Arizona and 21 other states allow unlimited direct access to PT. This means that you can see a physical therapist as often as you want for as long as you want without a referral from a doctor. However, you should check with your health insurance company first to make sure they will reimburse you for your physical therapy sessions.

For orthopedic physical therapy in Tucson, call Tucson Orthopaedic Institute today. We offer physical therapy in East Tucson [(520) 784-6570] and Northwest Tucson [(520) 382-8201]. Contact your preferred location to make an appointment.

Treating Musculoskeletal Headaches

2 Dec 2016 Headaches , ,

You know the feeling – the dull ache in your head, the tension in your shoulder, neck, and face muscles. Tension headaches, also known as musculoskeletal headaches for the accompanying muscle aches and pains, are the most common type of headache, affecting most of us at some point in our lives.

A tension headache causes mild to moderate head pain that may spread throughout your neck and shoulders. It may feel like a tight band is wrapped around your head. The muscles in your shoulders, neck, face, and head may feel sore and tender.

The most typical culprit of tension headaches is stress. Other triggers include anxiety, poor posture, lack of sleep, fatigue, eye strain, illness, hunger, or trauma, such as whiplash from an auto accident.

Besides the occasional headache, other types of tension headaches include episodic and chronic.  Episodic tension headaches are those that occur less than 15 days a month, while chronic tension headaches occur more than 15 days each month. This type may last for hours, coming and going over a long period of time.

Most tension headaches can be treated with over-the-counter pain relievers such as ibuprofen. For episodic or chronic tension headaches, you might want to try physical therapy. Physical therapists can employ hands-on techniques such as trigger point therapy or myofascial release to ease the muscular pains that contribute to tension headaches.

A trigger point is a small area in a muscle that is very sensitive to touch or pressure. It can be extremely painful. They most frequently occur in the neck, back, and shoulders. Targeting these trigger points with manual manipulation helps relax the muscle and relieve pain.

Myofascial release is a rehabilitation treatment that can relieve pain and relax muscles and tissue. Muscle tension causes both the muscles and fascia (the smooth tissue that covers muscles) to tighten. Myofascial release is a hands-on technique used by physical therapists to stretch tight and sore areas to relieve pain, restore tissue health, increase motion, and improve function.

If you have musculoskeletal tension headaches that just won’t go away, make an appointment with one of the skilled physical therapists at Tuscon Orthopaedic Institute. Call East Tucson at (520) 784-6570 or Northwest Tucson at (520) 382-8201.

The Importance of Imaging Studies in Diagnosing Orthopedic Conditions and Injuries

28 Nov 2016 General , , , , ,

The tools and techniques used to diagnose and treat orthopedic conditions are constantly evolving. Today’s orthopedic surgeons and sports medicine specialists have a bevy of imaging solutions at their disposal to help accurately diagnose disorders and injuries affecting the bones, muscles, ligaments, tendons, cartilage, and spine. Orthopedists also use these test results to create an effective treatment plan.

Two of the most common diagnostic imaging tools are X-rays (radiographs) and MRI (magnetic resonance imaging) . X-rays show bones and are always used to diagnose fractures and joint dislocations. Your orthopedist may also order an X-ray if he or she suspects that a bone or joint has been damaged from other conditions such as arthritis or osteonecrosis (bone cell death). 

Today most orthopedic practices use digital X-ray over traditional film X-rays. Digital X-rays use much less radiation and the images can be computer enhanced. Larger, clearer, color-enhanced images can result in a more accurate diagnosis.

MRI uses a magnetic field and a sophisticated computer system to give reliable and detailed images of soft tissues and bony structures. Your doctor may order an MRI to diagnose a torn muscle, ligament, tendon, or cartilage; herniated disc; hip or pelvic problems; osteoarthritis; and other conditions.

MRI can help provide information for a fast and accurate diagnosis and possibly reduce the need for exploratory surgery or other diagnostic procedures. There are different types of MRI scanners, including open MRI and closed MRI, whole-body scanners, and extremity-specific units (those that only scan arms, legs, hands, or feet).

Other imaging tests used in orthopedics include:

Arthrography: This special type of X-ray, which uses a fluoroscope and contrast iodine solution injected into the joint area, is often used to help diagnose the cause of unexplained joint pain.

CT Scan: A CT scan (computed tomography) combines X-rays with computer technology to produce a detailed, cross-sectional picture of the body part being scanned. Your doctor may order a CT scan to diagnose a bone or spinal tumor or a fracture that doesn’t appear on X-rays. CT scans can also detect trauma to the chest, abdomen, pelvis, or spinal cord. Sometimes your doctor may combine the scan with the use of a contrast dye to better visualize the area being scanned.

DEXA Bone Density Scan: DEXA, or dual-energy X-ray absorptiometry, is the most common test for measuring bone density (the amount of calcium and other bone minerals in a segment of bone) and diagnosing osteoporosis. It uses narrow X-ray beams to see how solid, or dense, the bone is and assess the risk of fracture.

Another entirely different type of bone scan may be used to identify areas where there is unusually active bone formation. It is frequently used to detect stress fractures or the presence of arthritis, infection, or cancer.

Musculoskeletal Ultrasound: Ultrasound imaging is invaluable in orthopedics. This noninvasive imaging technique is totally safe for all patients, including pregnant women, children, and those with pacemakers and metal implants. Ultrasound uses sound waves to produce pictures of muscles, tendons, ligaments, joints, and soft tissue throughout the body.

Musculoskeletal ultrasound is an excellent tool for diagnosing the cause of real-time tendon and ligament pain. As the ultrasound takes place, you can point to where you’re hurting and the orthopedist can evaluate that exact area as you’re moving and experiencing the pain. Many times, a patient’s pain seems to have no clear cause, but diagnostic ultrasound can detect tiny tears that an MRI might miss.

Ultrasound imaging is used to help diagnose numerous soft tissue injuries:

  • Sprains and strains
  • Tendon, ligament, or muscle tears
  • Tendonitis and bursitis
  • Benign and malignant soft tissue masses (lumps/bumps) and tumors
  • Inflammation and fluid collection
  • Ganglion cysts (foot, hand, wrist)
  • Hernias
  • Nerve entrapments such as carpal tunnel syndrome
  • Foreign bodies in soft tissues (such as splinters or glass)

At Tucson Orthopedic Institute, diagnostic imaging is an integral component of evaluating orthopedic injuries and conditions. Everyday our orthopedic surgeons, podiatrists, and sports medicine specialists depend on imaging studies to accurately diagnose all types of disorders and injuries in patients and plan appropriate treatment.

For the convenience of both our patients and doctors, we offer advanced imaging equipment on site. To schedule an office visit or imaging appointment, call (520) 784-6200.

5 Signs You May Have Hip Arthritis

22 Nov 2016 Doctors, General, Joint Health , , ,

Written by: Dr. Ali Dalal 

Degenerative joint disease is a very common cause of hip pain. Figuring out whether the true source of pain is the hip or the back can be a diagnostic challenge for both the doctor and the patient. Indeed, several patients have both back and hip problems. Here are 5 common signs that the pain you are experiencing is coming from your hip.

1. Do I need a different car?

It’s something we do every day and for some people, several times a day. For patients with hip arthritis, the simple act of swinging their leg to get in and out of a car can cause severe discomfort.

via GIPHY

 

2. “Honey, can you grab my flip-flops?”

Stooping forward to put on shoes and socks becomes extremely difficult and or painful due to loss of mobility. Frequently patients will report that their husband or wife assists them with this activity. In places with warmer climates, patients resort to wearing slip-on shoes.

via GIPHY

3. Get between the toes!

Frequently patients with hip arthritis experience pain when bending to wash their feet in the shower.

via GIPHY

4. Can’t stop counting sheep?

In advanced cases, patients have sleep disturbances because they cannot position their hip in a comfortable way to fall asleep. Oftentimes patients will only be able to sleep with a pillow underneath the thigh.

via GIPHY

5. It can’t be my hip; the pain is in the front.

Contrary to what many people think, the anatomic location of the hip is not the side of the upper thigh. The hip is located in the front in the crease of the groin. Groin pain and limited hip motion are the most reproducible signs of a hip problem.

via GIPHY

If any of these symptoms sound familiar, you may be suffering from hip arthritis. The diagnosis can be confirmed with a quick X-ray and treatment is usually non-operative in the early stages.  Come see Dr. Dalal at Tucson Orthopaedic Institute so you can stop living with pain and start living your life!

The Benefits of Physical Therapy after a Car Accident

18 Nov 2016 General, Physical Therapy , ,

If you’ve been in a car accident, the odds are high that you sustained some kind of injury. Depending on how serious the accident is, you might have only minor injuries such as cuts, bruises, or a sprain. More serious injuries might include broken bones, herniated discs, whiplash, brain injury, or damage to internal organs. What’s more, many people are in a state of shock after an accident, and may not notice certain muscle or joint pains right away.

Regardless of the severity of your auto accident injuries, the pain can interfere with your life and progress over time.

If you sustain any musculoskeletal-related injuries from an auto accident such as back or neck pain, arm or leg pain, pinched nerves, muscle pain, or fractures, you should see your primary care doctor or go directly to an orthopedist and request a referral for physical therapy.

Some of the benefits you’ll experience from therapy include:

Pain relief. Physical therapists can help relieve muscle, joint, ligament, tendon, and nerve pain using manual (hands-on) therapy techniques, modalities such as TENS, or therapeutic exercise.

Minimize use of pain medications. The pain relief you experience from physical therapy may help decrease your need to take pain medication or shorten the length of time you need it.

Accelerate your recovery. Physical therapy promotes healing by restoring function and mobility. Your physical therapist will work with you to improve your flexibility, strength, and range of motion.

Prevent chronic symptoms. Injury symptoms may worsen over time, even lingering for months or years after the car accident. Accident victims who do not receive physical therapy are more likely to experience chronic pain as well as degenerative disc disease later in life. That’s why it’s vitally important to begin physical therapy sooner, rather than later.

Avoid or delay the need for surgery. Depending on your injury, physical therapy can help you heal to the point that surgery is not necessary. If you do end up needing surgery, physical therapy may make it possible for the orthopedic surgeon to use a less invasive approach. Plus, therapy both before and after surgery will speed your post-op recovery.

At Tucson Orthopaedic Institute, our physical therapists are skilled in treating a spectrum of car accident injuries, and they work closely with our doctors to help relieve your pain. Call today to schedule your physical therapy appointment in East Tucson: (520) 784-6570 or Northwest Tucson: (520) 382-8201.

Proper Techniques to Stretch the Benefits of Your Workout

11 Nov 2016 General , ,
Staying strong and active has become a very important part of the lives of many people, and for good reason. It keeps our bodies younger and healthier, and it can aid in warding off illnesses and injuries as we get older.

Flexibility is also an important factor, especially if you have joint pain or arthritis. Most doctors will tell you to keep your joints moving, but sometimes this is easier said than done.

There is one very important part of any workout that should not be missed, and that is to stretch before and after your workout. Stretching promotes flexibility, increases blood flow, and reduces the chance for injury.

Stretching after your workout can be more effective than stretching beforehand, because your muscles, tendons, and ligaments are warm and pliable. This is very important if you’re dealing with an injury or arthritis. Research done at the University of Texas has shown that athletes have more flexibility if they stretch after a workout, rather than before they exercise.

There are many benefits to making stretching a regular part of your workout routine. It can decease the “day after” soreness. It can improve range of motion and increase circulation. It can even calm your mind and possibly enable you to get a better night’s sleep.

Just as there are proper ways to perform a particular exercise, there are proper ways to stretch. Here are a few important stretching do’s and don’ts:

  • Do stretch the muscle group(s) you worked on after workout is done.
  • Do hold a stretch for 15 to 30 seconds.
  • Do use an exercise band or towel to aid in getting a better stretch.
  • Don’t use quick or rapid movements, only slow and easy stretches.
  • Don’t push the stretch to the point of pain.
  • Don’t hold your breath; take a deep breath before and blow out slowly as you stretch.
  • Don’t stretch first thing in the morning. Wait an hour or two.

Proper stretching should be an important part of your daily healthy routine. Even on days you don’t work out, stretching the whole body will be beneficial in many ways. It may be worthwhile to consider developing a yoga practice. Many fitness facilities offer classes, or you can do yoga in your own home.

But even with all our good efforts to stay strong, active, and flexible, sometimes injuries just happen. Aging can also play a big role in how your body moves and responds to exercise and other activities.

At the Tucson Orthopaedic Institute, Southern Arizona’s largest and most advanced orthopedic group, we are here and ready to be of service to you. Our world-class care and reputation for successful outcomes have made us the number one choice for orthopedic care in Tucson.

Our doctors specialize in general orthopedic injuries as well as arthritis, joint replacement, sports medicine, spine care, and pediatric orthopedics.

Take a look at our website to find a location close to you, and then give us a call to schedule an appointment, or request an appointment online.

Top 10 Work-Related Injuries You Can Prevent

17 Oct 2016 General , ,

A work-related injury is an unexpected challenge that can have a devastating effect on your family and finances.  Nobody plans on getting hurt on the job, but it can happen to anyone, in any industry.

Many workplace injuries involve overexertion, slipping, tripping, falling, or repetitive movements.  These injuries can often involve the bone and joints, so an orthopedic physician is often involved in workers’ compensation cases.  Fortunately, these injuries can be avoided with a little extra care and caution on the job.

Overexertion injuries are the #1 most common workplace injury that can be prevented.  Be careful about how you pull, push, lift, or carry equipment and supplies at work.  Lift with your legs, not your back.  Take breaks, especially if you are feeling sore.

Slipping, tripping, and falling at work is the #2 most common workplace injury that can be prevented.  Watch out for slippery floors and pavement, and look where you are going at all times.  Wearing appropriate footwear for your job is also very important.

Repetitive motion injuries are also on the list at #9.  While these injuries may be harder to prevent because they are specifically related to your tasks at work, you should always give your body a break.  Our bodies were not meant to do the same activity for 8 hours every day, so try taking a 10 or 15-minute break every hour to avoid tendonitis, bursitis, carpal tunnel syndrome, and other conditions related to repetitive motion or overuse.

See the complete list of preventable workplace injuries below. Have any of these happened to you?

  1. Overexertion
  2. Slipping/tripping/falling
  3. Falling from heights, such as falling off a ladder or roof
  4. Reaction injuries, like a jerky, sudden movement in response to slipping or tripping
  5. Falling or dropped objects
  6. Accidentally hitting your toe, foot, or head on an object or wall
  7. Vehicle crashes
  8. Machine entanglement
  9. Repetitive motion injury
  10. On-the-job violence

Employer/employee training is a good way to avoid some of these injuries, by conducting training on the use of personal safety equipment such as hard hats, or the placement of wet floor signs, and guardrails around slippery and hazardous areas, and how to properly use machinery. Make it your responsibility to know and follow your employer’s safety policies.

If your life has been affected by a work related injury, come see the local worker’s comp experts at Tucson Orthopaedic Institute of Southern Arizona.  We understand your challenges and are experienced in working with Arizona’s employers to minimize time off from work. We have three locations and 32 orthopedic physicians and therapists ready to get you back to work.

Visit our website and request your first appointment today.

Physician Spotlight: Dr. Mark Braunstein

10 Oct 2016 Doctors, Mark Braunstein , ,

A. Mark Braunstein, undefinedDr. Mark Braunstein is an orthopedist and surgeon with the Tucson Orthopaedic Institute in Tucson, Arizona, specializing in the hand and upper extremities.

Dr. Braunstein attended medical school in New Brunswick, New Jersey at Robert Wood Johnson Medical School, also completing his internship and residency at Robert Wood Johnson. He is board certified and fellowship trained in hand and upper extremity, completing his fellowship at Stony Brook Medical Center in New York before joining Tucson Orthopaedic Institute.

Dr. Braunstein’s specialty includes the entire arm, from shoulder to the fingertips. He is trained in the latest surgical techniques, such as arthroscopic and microsurgical procedures for the hand, wrist, elbow, and shoulder.  He works closely with each patient, helping them to understand the cause of their pain, and the best treatment going forward.

He has experience with rotator cuff tears and complete shoulder replacements, as well as more general orthopedic conditions such as bursitis, tendonitis, arthritis, and fracture care.

“The worst pain is from carpel tunnel syndrome…”, Dr. Braunstein recently stated at a lecture given at Green Valley Recreation’s East Center in 2015. Other common conditions of the upper extremities are “golfer’s elbow” (lateral epicondylitis) and De Quervain’s tenosynovitis, which is painful inflammation of the thumb tendons. Dr. Braunstein also treats patients with rheumatoid arthritis.

We are proud and privileged to have Dr. Braunstein working with us here at Tucson Orthopaedic. His expertise with the hand, wrist, elbow and shoulder is invaluable.  He provides both surgical and non-surgical treatments, and is committed to involving his patients in every part of their treatment to bring them back to a healthy, full and pain-free life.

If you are experiencing pain in your wrist or hand, or have had a recent injury to your elbow or shoulder, don’t hesitate to make an appointment with Dr. Braunstein today. He sees patients in our East office located at 5301 E. Grant Road, Tucson, AZ 85712.

Request an appointment online or call (520) 784-6200 to schedule a visit with Dr. Mark Braunstein.

What is Runner’s Knee?

3 Oct 2016 Uncategorized , , , ,

Many people these days live a very active lifestyle, running marathons, triathlons, and playing sports. This is a wonderful thing, but also increases the potential for injuries.  For runners, one of the areas of the body that takes a beating are the knees. Consequently, knee pain and knee injuries are one of the most common complaints that orthopedic surgeons deal with. If you add age and arthritis to the mix, you end up with the perfect recipe for knee pain.  One of the most common complaints is pain around the patella, or kneecap, which causes pain when climbing stairs, but not while running or walking. This condition is called runner’s knee.

Runner’s knee is caused by the softening or deterioration of the cartilage under the kneecap. This can lead to a misalignment of the knee cap as you bend your knee. The deeper you bend your knee, there is more movement and friction that can cause pain. When you walk or run, you’re not bending your knee very much. However, when you climb the stairs, squat, or stand up, the knee is bent to almost a 90-degree angle.

Although this condition can cause a lot of pain and discomfort, the fix is usually simple. Rest from physically demanding activities, taking anti-inflammatory medication, and strength-building exercises are the first course of action to improve symptoms of runner’s knee. But if the condition is due to a severe injury or arthritis, surgery may ultimately be necessary.

When you are experiencing knee pain, the doctors at Tucson Orthopaedic Institute are thoroughly trained and experienced in all knee issues and conditions. A sports medicine physician can be a good place to start.  Dr. Troy M. Taduran is a sports medicine, fellowship-trained orthopedist who sees patients at three offices. He specializes in a non-surgical approach for sports injuries.

The body is an amazing thing, and pain is how the body communicates when something is wrong. When something hurts and can’t be relieved with a few days of rest and ice, we should listen.  Don’t put off finding out what could be a problem that needs an orthopedics’ touch, or you might be doing more damage to the condition.

We have four conveniently located offices to meet your needs. Call today or go online to request an appointment.

 

Dr. Troy M. Taduran

Growing Pains – Are They Real?

26 Sep 2016 Brian Nielsen, Doctors , ,

When it’s nice outside, kids like to run, jump, ride bikes – the normal, every day summer activities. Many also play sports such as soccer, baseball, and football.  So when your child says their legs hurt it may not be a surprise, but as parents, when should we become concerned?  Is it just “growing pains”?

Well, guess what? Growing pains is actually a real condition. Growing pains are achy, throbbing muscles in the legs that affect some 25-40% of children between the ages of 3 to 5 and 8 to 12, but researchers do not know exactly what causes growing pains.

Your child might be experiencing growing pains if muscles in their thighs, calves, or behind the knee hurt in the late afternoon or evening. The pain might even get bad enough to wake them up.  If your child has had a full day of activity, there is a greater chance of having muscle pains or growing pains at night. Growing pains are typically felt in both legs and subside by morning.

How can we treat growing pains? 

The achiness and pain should go away with ibuprofen and gentle massage or heat. You may need to call a doctor if the pain does not subside, or if the muscles seem overly tender. If your child refuses to let you touch the area, this could be a concern.  Other signs to watch for are redness, or heat, or swelling especially in the joints, as growing pains do not affect the joints.

If you are concerned about the pain and symptoms your child is experiencing, please don’t hesitate to call the offices of Tucson Orthopaedic Institute for an appointment at (520) 327-KIDS (5437).

We have two board-certified and fellowship-trained pediatric orthopedic surgeons – Dr. Luis Piedrahita, MDand Dr. Brian Nielson, MD – on staff ready to serve your family’s needs.  They see patients at two locations – East or Northwest Tucson.

For more information on what we can do for you check out our pediatric orthopedic section on our website.

Dr. Brian Nielson, MD

Two Issues Reverse Shoulder Therapy May Help Eliminate

19 Sep 2016 Andrew Mahoney, Christopher Stevens, Doctors, Joel Goode, Kevin Bowers, Steven Shapiro , , , ,

The shoulder joint is the most movable and complex joint in the body, therefore the opportunity for complex problems is greater. A few of the more common shoulder conditions are arthritis and rotator cuff injuries.  When both of these conditions are present, it can present a complex problem for the orthopedic surgeon. A relatively new FDA-approved procedure may be the answer:  reverse total shoulder replacement.

A brief review of shoulder anatomy

The shoulder joint is made up of three main bones; the collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus). The shoulder joint is a ball-and-socket-type joint. The “socket” is a shallow dish-shaped area of the scapula. The top of the humerus bone is round like a ball, and fits into the socket.  The bones are held in place by the rotator cuff, which is made of four major muscles, tendons, and ligaments. The ligaments from the rotator cuff attach directly to the head of the humerus bone and hold the arm in place.

The shoulder joint is the most movable and complex joint in the body, therefore the opportunity for complex problems is greater. A few of the more common shoulder conditions are arthritis and rotator cuff injuries.  When both of these conditions are present, it can present a complex problem for the orthopedic surgeon. A relatively new FDA-approved procedure may be the answer:  reverse total shoulder replacement.

A brief review of shoulder anatomy

The shoulder joint is made up of three main bones; the collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus). The shoulder joint is a ball-and-socket-type joint. The “socket” is a shallow dish-shaped area of the scapula. The top of the humerus bone is round like a ball, and fits into the socket.  The bones are held in place by the rotator cuff, which is made of four major muscles, tendons, and ligaments. The ligaments from the rotator cuff attach directly to the head of the humerus bone and hold the arm in place.

Rotator Cuff Tear and Arthritis

The shoulder can be injured easily at work, around the house, or during sports or exercise activities. When the cause of shoulder pain is related to your rotator cuff, the simple act of throwing a ball to your grandchild may cause enough pain to drop you to your knees.  In many cases minor rotator cuff injuries can be rehabilitated without surgery, but major damage must be surgically repaired.  In some cases, it may not be possible to fully restore the strength and stability of a damaged rotator cuff.

When your pain is caused by degeneration of soft tissues and the effects of arthritis inside the joint, you can thank the natural aging process. While Mild to moderate arthritis can be managed conservatively with medication, physical therapy, and therapeutic injections; severe arthritis can only be resolved by replacing the joint.

Traditional Vs Reverse Shoulder Replacement

In a traditional shoulder replacement, the ball of the humerus is replaced by a half ball, and the socket is replaced by a “cup”.  This mimics the same anatomy as the original bones, minus the arthritis.  If necessary, the rotator cuff is repaired and reattached to the new joint.  A traditional shoulder replacement is best for patients when the rotator cuff is intact or is repairable.

In a reverse shoulder replacement, the cup is placed on the top of the humerus – replacing the ball – and the ball is placed in the cup – replacing the socket.  See figure below. Reversing the ball and cup placement puts the deltoid muscle in place as the major muscle for the new joint instead of the rotator cuff. A reverse shoulder replacement is also recommended for people with severe arthritis and rotator cuff damage, or prior failed traditional shoulder replacement.  The reverse shoulder replacement procedure was approved by the FDA in 2004.

Am I a Candidate?

Through a comprehensive evaluation by your doctor which can include X-rays, and MRI, the doctors will determine which type of shoulder replacement is best suited for your case.  The extent of damage in your shoulder joint will determine the type of surgery you need.  People with unrepairable damage to their rotator cuff along with severe arthritis are the best candidates for reverse shoulder replacement.

It all starts with a visit to Tucson Orthopaedic Institute, Southern Arizona’s largest and most advanced multi-specialty orthopedic group.  Here, we are able to diagnose your symptoms to determine the best course of action for you. We can perform either a traditional or reverse shoulder surgery, and arrange your physical therapy so you can get back to doing all you like to do.

Several of our orthopedic surgeons are trained and experienced in both traditional and reverse shoulder replacement: Dr. Kevin Bowers and Dr. Christopher Stevens in the Oro Valley office, Dr. Joel Goode and Dr. Andrew Mahoney in the East office, and Dr. Steven Shapiro in the Northwest office.  Call one of our conveniently located offices today to schedule an appointment at Tucson orthopaedic Institute.

Focus on Continuous Improvement

16 Sep 2016 General, Media , , ,
Source: BizTucson published September 2016

Written by: Mary Minor Davis

Photo Credit: Amy Haskell

After three years of living on the road as a national healthcare consultant, Paula Register is ready to plant her roots on firmer ground in Tucson. The new CEO at Tucson Orthopaedic Institute recently got a dog. She’s planted flowers. She cooks at home more.

The North Carolina native first came to Tucson in 2010, working two years at Carondelet Health Network before her consulting job took her back on the road. Now engaged to local cardiac anesthesiologist Michael Hecht, she said she’s ready to settle down.

“Settle” isn’t a word that would normally describe Register. Look at her resume and it is easy to see why she was included in Becker’s 2011 list of Most Influential Women to Know in Healthcare. She’s held senior leadership and executive positions for most of her career. A licensed CPA, she has worked as a senior accountant and CFO for two North Carolina school districts and participated in several mergers throughout her career. In healthcare her roles include CFO and CEO for multi-specialty physician groups and CEO for a Management Services Organization, doubling its size during her tenure. She came to TOI in April of 2015.

“The opportunity at Tucson Orthopaedic came at a perfect time,” Register said. “For most of my career in healthcare I worked with supervising multi-specialty areas. This was an opportunity to focus my time and talent on one area.”

For the previous three years, Register’s consulting career took her to Oahu frequently. “I had the greatest experience working in Hawaii,” she said. “The spirit of the people, the kindness they demonstrate – it’s a good lesson for those of us who work in healthcare. I really learned the true meaning of ‘Aloha.’ ”

She’s incorporated her experience in Hawaii into the TOI philosophy – adopting “kina’ole” – the Hawaiian word for flawlessness.

“It means doing the right thing, in the right way, at the right time, in the right place, to the right person, for the right reason, with the right feeling the first time,” she said. “It embodies the whole patient experience – making them feel welcome, making them feel comfortable, being respectful of their time and hearing everything they have to say. It’s all important.”

This philosophy is what drives Register, who takes her responsibility to run a $50 million business very seriously.

“My job is to provide a good, strong business structure and clinical infrastructure to support the clinical practices, which allow (the physicians) to do what they do best. I call it the triple lane – we’re here to provide better patient experience, better patient outcomes, at a more efficient cost. It’s what we all want.”

To achieve this, Register established a culture focused on continuous improvement. “We want to make sure we get better every day.”

To this end, Register said she asks a lot of questions – especially “why?” – with respect to processes, procedures and programs that serve as patient touch points. “Why do we do it this way?” And the next questions are “How should we be doing it? Can we do it differently and achieve a better outcome?”

“We’re always going to make mistakes – it’s human nature,” she said. “But it’s how we react to that mistake that I think is important. Patients need to know that when things go wrong, we analyze what happened and what we are going to do differently so that it doesn’t happen again.”

Register said she doesn’t look to adopt change for the mere sake of change, but recognizes that there are some things that don’t need to be handled the way they were in the past because of changes in technology, information systems and other patient interactions.

One of the most noticeable examples of this is the renovated lobby space at the Grant Road location, shared in the central tower with Tucson Medical Center. Previously, check-in for TOI was behind the TMC reception area in a small office. “There were lines out the door,” she said. “When you’re in pain, the last thing you want to see is a waiting line.”

TOI re-engineered the waiting area, moving from the TMC reception area to a more open area at the west end of the tower. In addition, multiple check-in stations were added. “It opened up our availability to patients,” she said. “It’s a much better environment for our staff and our patients.”

Locating services nearer to patients is also part of Register’s strategy. There are currently four TOI clinics in greater Tucson. In the next 18 months, the TOI located on the Oro Valley Hospital campus will complete an expansion, and TOI’s newest satellite office will open next year as part of the new TMC Rincon Health Campus on the southside.

“I have this philosophy that I heard early in my career – people don’t care how much you know, until they know how much you care,” she said. “I think if people know we care, that’s what’s important. I try to show people how much I care – the team, our culture, our patients – and I hope our business owners know how much I care about how I run their business.”

Tucson Orthopaedic surgeon helps new hip replacement procedure

23 Aug 2016 Doctors, Media , , ,

Source: KVOA 4 Your Health published on August 22, 2016

Written by John Overall

TUCSON – The first hip replacement surgery was performed in 1960. Now, more than 300,000 total hip replacements are performed each year in the United States.

Dr. Russell Cohen from the Tucson Orthopaedic Institute joined a team of other surgeons to develop a new surgical technique that allows their patients to get back on their feet sooner.

59-year-old Mindy Sparks suffers from severe arthritis in her hips. About six months ago the pain became unbearable, “I would walk across a parking lot and almost feel like crying it hurt so badly,” Sparks said.

Dr. Cohen showed News 4 Tucson Mindy’s X-Rays, “You can see here that her hip joint is completely gone. There’s no separation between the ball and the socket. So these two hips are about as bad as a hip needs to be before we recommend it be replaced,” Dr. Cohen said.

Dr. Cohen has been performing minimally invasive hip and knee replacements since 2003. About three years ago Dr. Cohen joined six other surgeons and came up with a procedure they call The Direct Superior Approach to the hip.

Most surgeons make an incision along the femur bone, cutting into the Iliotibial Band which causes pain and requires more recovery time.

“The Direct Superior Approach stays at the very upper end of that incision so we come down to the top of the femur bone but we don’t go into the I-T band,” said Dr. Cohen.

Since the I-T band isn’t compromised and fewer muscles are disrupted, patients like Mindy experience less pain, less bleeding and fewer restrictions when they’re released from the hospital.

“Traditional hip patients are told don’t cross your legs, don’t bend past 90 degrees, watch out for dislocation, all these things. Well, I don’t do that anymore, I haven’t for quite some time,” Dr. Cohen said.

Sparks says she bounced right back after surgery, “It was easy, it was easy in the hospital. I felt better in the hospital instantly. They had me up and walking that day.”

Mindy started physical therapy the day after having her left hip replaced.  Three weeks later she’s walking much easier and looking forward to having her right hip replaced in a few weeks.

Dr. Cohen and his team are now traveling around the world teaching the Direct Superior Approach to other surgeons.

To learn more, visit the Tucson Orthopaedic Institute 4 Your Health page.

Bisphosphonate Femur Fractures: An Ounce of Prevention is Worth a Pound of Cure

19 Jul 2016 Doctors, Joint Health , , , , ,
Written by: Ali Dalal, MD

view post on original source – LinkedIn

7/17/2016- Bisphosphonates (BPs) are a revolutionary class of medicines that can preserve bone health and prevent fractures caused by osteoporosis. They go by the trade names of Boniva™, Fosamax™, and Reclast™ among others. They have been shown to decrease spine fractures by 40-70% and hip fractures by 20-50%. They are truly life changing treatments when one considers that 1 in 3 women and 1 in 5 men will experience an osteoporotic fracture after the age of 50.

Like all medicines, BPs have side effects. One especially fearsome side effect of BP treatment is atypical femur fracture (AFF). AFFs are fractures caused by BPs. They are characterized by aching pain in the thigh or groin with weight bearing. They are easily visible on x-rays in their early stages and are much easier to treat before they become complete fractures. To be clear, AFFs are very rare and bisphosphonates most definitely prevent more fractures than they cause. However, the prolonged course of healing and the unpredictable nature of AFFs have caused great concern among patients and the media. A link between the number of years BPs are taken and the risk of AFF has been established. A task force of leading bone doctors and scientists has provided guidelines in 2016 on how to prevent AFFs based on individual patient risk factors. The guidelines are as follows:

Post-menopausal women treated with oral (pill form) bisphosphonates for 5 continuous years or intravenous (IV) bisphosphonates for 3 continuous years should be re-evaluated. If they have not had an osteoporotic fracture during treatment with the medicine (hip, spine, wrist, shoulder fracture), do not have osteoporosis on a DEXA scan (bone mineral density test) and are not considered to be a “high fracture risk” based on age and other factors, they should consider a temporary stoppage of medicine or a “drug holiday” for 2-3 years.  After this time period they should be re-evaluated. The drug holiday allows some of the potential harmful effects of BPs to decrease.

As you can tell, the guidelines are not simple. As a doctor I had to read it a few times before it sank in.  Stopping or continuing the medicine requires significant judgment on the part of the doctor prescribing it. These medicines should not be stopped without a consultation with the prescribing doctor. As a patient, the important thing to take away is that if you have been on these medicines for years and are experiencing the symptoms of AFFs, don’t ignore them. AFFs are much easier to treat in the early stages. Secondly, if you have been taking these medicines for years but haven’t seen the prescribing doctor in a while, it might be time to find out where you stand in terms of your risk. With AFFs, an ounce of prevention is worth a pound of the cure.

  1. Adler et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research. Volume 31, Issue 1, pages 16–35, January 2016

Plantar Fasciitis Sufferers Can Wear Sandals

18 Jul 2016 General , ,

It is summertime. Time for the beach, the pool and backyard BBQs. Time for flip flops!  If you suffer from a condition called plantar fasciitis, you may feel limited on your choice of footwear because you’d rather avoid heel pain than wear a flimsy flip-flop.  Are there any options for supportive sandals or flip flops that won’t trigger the pain?

Plantar fasciitis is a condition of the foot that is usually brought on by over activity such as running or playing a sport. It is also caused by wearing ill-fitting, unsupportive shoes.  Everyone can suffer from plantar fasciitis but age and diabetes can predispose you to the condition.

The plantar fascia ligament does the job of a shock absorber that contracts and stretches with every step we take. This ligament can develop small micro tears which results in sharp stabbing pain in the heel or along the bottom of the foot. Treatment can range from resting, cold and heat therapy, to surgery in severe cases. Preventative measures include stretching exercises and wearing good supportive footwear, which can include sandals and flip-flops if you know what to look for.

Finding an adequate supportive sandal is not too hard to do. The internet is a great source with many retailers offering styles of sandals specially designed for plantar fasciitis. Prices range from $20 to over $100.

There are a few important features you should look for in any shoe.

  • A deep heel cup can help control pronation
  • Arch support designed to stretch the tendon
  • Cushioned foot bed for stability and shock absorption

The American Podiatric Medical Association (APMA) gives a seal of acceptance or approval to products that meet certain standards and criteria.

For more information on plantar fasciitis and heel pain, or if you would like more advice on types of shoes, the foot and ankle specialists here at Tucson Orthopaedic Institute are ready to help.  Dr. Eric Anctil and Dr. Scott Evans will see you in the East Tucson, and Dr. Geoffrey Landis will see you in Northwest Tucson or Oro Valley.

Contact Tucson Orthopaedic Institute to make an appointment at a location close to you.

Image source: https://www.sportspodiatry.co.uk/images/plantarfascia.jpg

Muscle-sparing surgery for hip replacement

1 Jul 2016 Joint Health , ,

Joint replacement surgery is one of the oldest procedures in history. Since 1891, orthopedic surgeons have been replacing faulty hips due to fracture, arthritis, and structural abnormalities. Thanks to 125 years of innovation, modern-day hip replacements are arguably the most advanced orthopedic surgery performed today.

The way the artificial hip is designed and the material it is made of has been the focus of many researchers and companies. The goal is to provide an artifical joint that functions and feels like a natural joint as much as possible.

Orthopedic surgeons are continually looking for ways to make surgery less invasive, less painful, and less risky. Minimally invasive procedures are the way of the future. For hip replacements, the anterior approach is gaining popularity as a less-invasive alternative to your grandmother’s hip replacement.

The anterior approach to hip replacement is a muscle-sparing technique that offers the following benefits:

  • Less pain and bleeding
  • Faster recovery
  • Better results
  • Most people are candidates

Instead of making an incision on the side or back of your hip, the surgeon accesses the hip joint from the front (anterior) side. From this side, there are no muscles that need to be cut in order to remove and replace the joint. This makes it easier to resume activity after hip surgery, because the supportive muscles remain intact. It’s also less painful than traditional hip replacement. Additionally, using the anterior approach allows for better placement of the new joint, which leads to improved outcomes for patients.

To learn more about the technique, check out this YouTube video.

Many people do not realize that the anterior hip replacement is not new. It was first done nearly 70 years ago in France, although the modern-day version was implemented in the 1960s. The reason it has not been widely performed is likely due to the complexity of the procedure. Advanced training is needed to master this technique, but there are clear benefits for the patient that make it worth the extra work.

To learn more about this muscle-sparing procedure for hip replacement, please contact Tucson Orthopaedic Institute for an appointment.

Image Source: Johns Hopkins Mediicne

Get Prepared for the Game! Sports Physical Clinic

24 Jun 2016 General, Media , , , ,

Tucson Orthopaedic Institute is providing pre-activity physicals for all student athletes.

A team of sports medicine specialists and medical professional will provide a thorough exam and assess each athletes’ ability to participate in sports for the upcoming season.

Saturday, July 9, 2016

8:00am – 12:00pm

Tucson Orthopaedic Institute – Northwest office

6320 N. La Cholla Blvd, #200

Cost is $20 per athlete* (discounted rate is available for families with multiple athletes)

Exam includes:

– Vitals check
– Vision test
– Medical & Musculoskeletal exam
– AIA approved forms completed (athletes must bring form)

*Self-pay only. Cannot be combined with insurance.

See flyer for additional details

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