One of the most common injuries we see at Kerlan-Jobe is the ankle sprain. So what exactly is an ankle sprain, and how should it be treated?

A sprained ankle occurs following a sudden sideways or twisting movement of the foot. This can happen during athletic events, or simply during everyday activities. The ankle sprain is one of the most common sports injuries, but also an injury for which people typically do not seek medical attention.

Unfortunately, failing to seek treatment from a sports medicine specialist for an ankle sprain can result in laxity of the joints of the ankle complex, which can lead to:

·         impaired balance

·         reduced joint position sense

·         slower firing of muscles that stabilize the ankle

·         slowed nerve conduction velocity

·         impaired sensation on the skin

·         strength deficits

·         decreased ankle range of motion

There are three different grades of ankle sprain, with 1 being the least severe and 3 being the most severe. Patients with a grade 3 sprain are most likely to seek treatment, since damage can be both seen and felt, and ankle surgery is occasionally necessary.

“Sports medicine specialists are most concerned about addressing the grade 1 and grade 2 ankle sprains,” says Ben Butts, a Physical Therapist at Select Physical Therapy in Los Angeles. “With these sprains, patients tend to return to daily activities and sports while being unaware of the deficits in function that have occurred from spraining their ankle.”

A simple acronym to remember when treating an ankle sprain is RICE:

·         Rest

·         Ice

·         Compression

·         Elevation 

When the RICE treatment has reduced the pain and swelling in the ankle, your next course of action is to restore the ankle’s range of motion. “Reduced joint position sense, also known as proprioception, has been found to be the primary impairment after spraining an ankle, and it needs to be addressed once swelling has subsided,” says Butts. Recent research supports proprioceptive and balance training to reduce the associated impairments from ankle sprains:

·         Stretch the calf.

·         Start proprioception exercises, even if it is still painful to fully bear weight on the ankle.  You can begin proprioception training by lying on your back, extending your leg and tracing the alphabet with your toes, flexing the ankle to create the movement.

·         In a seated position using a rocker board, take your ankle through forward and back motions, side to side motions, or circles.

·         Once weightbearing on your ankle becomes tolerable, balance training can begin as part of the proprioception training. You can begin by standing one foot in front of the other, balancing with eyes open or closed on a flat floor, depending on your need of difficulty. Over time, you can progress to balancing on a single leg with your eyes open or closed. Varying the surfaces you stand on or using bands to add resistance will increase the difficulty of the exercise. 

After the sprained ankle is rehabilitated, you should expect that both your ankles have:

·         Equal balance and control

·         Equal strength

·         Equal flexibility and range of motion

If you were lacking any of these abilities prior to the injury, this is a great time to address these deficits.  If you wish to return to a higher activity level, such as soccer or basketball, you should train accordingly.  “Agility training, plyometric training and balance training are vital for a successful return to sport and prevention of future injury. Seeing a physical therapist is the best strategy to help manage this injury,” concludes Butts.

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Ben Butts, PT, DPT, OCS is a staff Physical Therapist at Select Physical Therapy in Los Angeles. He received a Bachelor of Science in Kinesiology from California State University – Long Beach and his Doctorate in Physical Therapy from University of Southern California.

He is passionate about functional exercise and treating sports related injuries and enjoys surfing, basketball and traveling in his spare time.

http://www.linkedin.com/in/benjaminbutts

http://www.selectphysicaltherapy.com/

The transfibular technique is one of the most popular procedures in the ankle fusion surgeries. This technique will offer the advantages of good exposure, ability to reduce the wound issues by improving thickness flaps, and also the availability of distal fibula for the graft of local bone. Either external or internal fixation will be used, and this has been shown to have high fusion rate with low complications. By using the proper fusion alignment, long term outcomes have shown more success rate.

Arthrodesis or ankle fusion fuses the joint bones completely, making one connected bone. Transfibular ankle arthrodesis with the internal fibular onlay grafting and fixation has resulted in the acceptable fusion rates. Transfibular ankle surgery is performed to repair the severely arthritic joint of the ankle. A foot and ankle surgeon removes the damaged bone and arthritic cartilage, and then ankle joint will be re-positioned to its proper position. The ankle will be stabilized and over time, the fibula, talus fuse and fibula fuse together so the joint of the ankle mo longer moves down and up but still it keeps the motion of side to side.

The orthopedic surgeon uses plates, pins and rods or screws to hold up the bones in the correct position while joints are fused. If the joint doesn’t unite or fuse, all these hardware will break.

Sometimes, a bone graft is required if this is loss of bone. The surgeon uses the graft that means a piece of the bone that is taken from the bones of the lower leg or from the pelvic wing to put in the place of the missing bone.

Typically this surgery is quite successful. Few cases have problems with the wound healing. These issues would be addressed by the bracing or an additional surgery.

The biggest and long term problem with the ankle fusion is the development of the arthritis at joints that are adjoining to those fused. This occurs from an increased stress that is applied on the joints.

A transfibular ankle fusion with rigid fibular onlay strut grafting and internal fixation can achieve high union rate in both high risk and low risk patient population. This procedure is an effective approach for most of the revision and primary situations with or without considerable deformity.

A shoulder separation is a very common injury, specifically in some sports. This is an injury to one part of our body’s mobile joints. Actually most of the shoulder separations are injuries to acromioclavicular joint. This is the connection between the clavicle and the scapula, often indicated with the visible bump on the area. These injuries also occur due to trauma or a fall, which may lead to the acromion to separate or move from the clavicle, or can also cause the ligaments to be torn or stretched.

A separated shoulder is a tear or stretch of one or more of ligaments that are supporting this joint.

Shoulder separation is a painful condition, which would make the simple things such as lifting a cup would be very painful. There are different degrees of separated shoulders that will help in defining the severity of injury.

Type 1 and type 2 separated shoulders are the most common types of shoulder separation injuries, and rarely these type of injuries require surgery like if there are any problems with the non surgical treatment.

Almost type 4, 5, and 6 shoulder separations require the surgery, but these types of injuries are very rare injuries. The hard decisions arise with the patients with type 3 separated shoulders. There is a controversy among physicians as to how to best manage the patient with the type 3 shoulder separation. At last, there is no final conclusion, but there are few things to consider while making the final decision.

Treatment:

When non surgical methods have failed to provide the relief from pain or in the situation of sever deformity, the shoulder separation surgery will be advised by the orthopedic surgeon. Whatever may be the treatment method, the shoulder requires rehabilitation to rebuild and restore motion, flexibility, and strength.

There are several types of surgical procedures that are available to treat a separated shoulder. All these surgeries are performed to stabilize the clavicle end in its right position. But there are some potential complications of the surgery, which would make this simple thought a difficult task.

Most of the surgical methods for treatment of a separated shoulder performed to reconstruct the coracoclavicular ligament, and hold the clavicle temporarily in proper position while reconstructed ligaments will heal. A usually performed method uses an adjacent coracoacromial ligament, and that moves it over to clavicle. Clavicle would held in the position with a metal screw or strong sutures while the ligament healing into the proper position. It is necessary to take enough rest immediately followed by the surgery.

Suffering from the pain in shoulder is a debilitating condition. This can limit the arm movement and also prevent you from doing your activities like reaching your back and raising your hand. Dealing with this pain is frustrating because most of the times this pain continues for a long period of time. Most commonly shoulder pain is associated with a pulled muscle or strenuous workout. But if the shoulder pain is chronic, it can be due to intolerance to the gluten. If you are unable to sleep properly on one side, and experiencing a sharp pain or a dull ache in your upper arm or shoulder, you may have the rotator cuff problem. The best way to eliminate this pain completely is to search for a proper treatment.

Joint of the shoulder is held in a place by tendons, ligaments and muscles. Shoulder is the most useful joint in our body, so it is prone to be affected by the problems like arthritis, rotator cuff and sprains.

Dealing with the shoulder pain:

Anti-inflammatory pain relievers:

Taking the medicines like aspirin and ibuprofen is one way of controlling the pain and to eliminate the swelling. These are nonprescription drugs, so you need to consider the side effects of those. Before taking these drugs on regular basis it is better to consult the doctor. Sometimes, you may need professional help in dealing with the shoulder pain.

Rest:

Too much of physical activity can increase the pain. Giving rest to your arms and shoulders is one way to control the inflammation and pain. Avoid repeated use of the shoulder for at least 2 days. In some situations a sling may be required to rest your arms and shoulders.

Exercise:

While too much of physical activity can increase you pain, in the same way inactivity may also cause pain in the shoulder. Staying inactive can promote the stiffness on the joints of the shoulder, so it is essential to keep active. Your physical therapist or doctor may advise exercise programs to improve strength and mobility of the shoulder bones.

Ice packs: Put cold compress or an ice pack on the affected area for at least 20 minutes and four times per day. You can use cold pack or ice bag that is wrapped in a clean cloth to prevent frostbite. Ice will be helpful in reducing pain and swelling.

This is often recommended along with the medication to avoid the shoulder pain. In this therapy a wide variety of treatments are available starting from the massage to heat therapy that are offered by the experienced physiotherapist.

Of course it is better to consult an orthopedic surgeon for medical help, because they are experts in dealing such types of pains.

If you have developed the arthritis in your ankle, that may cause pain. This means your joint surfaces are no longer smooth. Your bones become rough and also lining of the cartilage will depleted. This may develop stiffness and pain in your ankle. Usually good cartilage forms the joints, which allows for painless motion between the bones. Diseased or damaged cartilage can allow motion but this can be quite disabling and painful.

Ankle fusion surgery would be performed when the motion of ankle joint become degenerative or painful due to the worn out of cartilage. Sometimes, ankle fusion would be called as arthrodesis. The most common cause of arthrodesis is an ankle fracture.

Ankle Fusion surgery Procedure:

Different types of surgeries are now developed to perform the ankle fusion. The basic method in each surgery remains the same. The common way of ankle fusion surgery is performed by making small incision through the skin to open the joint. After opening the joint, surfaces of the articular cartilage of the joint must be taken off. Once the cartilage is removed on both the sides of the joint, your body would try to heal two surfaces of joint together as if it were broken or fractured.

Once the incisions are made, the bones should be held in the right place while they mend. This can be performed by using the metal plates and large metal screws. Usually the screws are under the skin and they are removed unless they start to rub and induce the pain.

In few situations, especially if fusion is being performed because of a failed initial fusion or an infection, an external fixator will be used to hold up the bones together during the healing process. This external fixator has metal pins, which are inserted into the bones through the skin. The metal pins will be connected to the bolts and metal rods outside the skin, which hold the bones in certain position during the period of ankle fuses. Once the bones have healed, the fixator will be removed, usually the time period will be 12 to 15 weeks.

Some orthopedic surgeons will perform the ankle fusion surgery with the help of arthroscope. This is a miniature TV camera, which is inserted into the ankle joint through a small cut. Arthroscope is used to watch other instruments that are inserted into the ankle joint to remove the surface of the cartilage. The surface of the cartilage would be removed by using a small rotary cutting tool. After preparing the surfaces, screws are placed through small cuts in the skin to grasp the bones together while they are fusing. This method is same as the open procedure but only difference is the incisions are very smaller.

Biceps tendinitis is the inflammation to the tendinitis around the head of biceps muscle. This can be caused due to the degeneration of tendon from the normal aging process or overhead motion that athletes require.

Biceps tendinitis would develop gradually from the effects of tear and wear, or it may also happen suddenly from the direct injury. Tendon may also be inflamed in response to some other problems in shoulder, like impingement, instability, or rotator cuff tears.

Treatment:

Non surgical:

Mostly doctors recommend for the non surgical treatment for biceps tendonitis. Usually the treatment starts by giving rest to the affected shoulder. The activity or sports that led to the inflammation is alleviated. Resting the affected shoulder can provide relief from pain and also calms the inflammation.

Anti-inflammatory drugs can be prescribed to reduce the pain and also to help the patients return to their daily activity. These medicines include usual over the counter drugs like ibuprofen.

Doctors may have the patients work with an occupational or physical therapist. These therapists apply the treatment to alleviate the inflammation and pain. Also, the present situations causing biceps tendonitis can even be approached.  Treating the actual cause will normally cure the biceps tendinitis. Therapists also evaluate the way you need to do work or sports activities to alleviate the problems of overuse.

In very rare conditions, an injection of cortisone can be used to control the pain. This is a very effective steroid. Cortisone is recommended in very cases, because it may weaken the biceps tendon, and also cause the tendon to rupture.

Surgery:

Patients who are improved their condition with non surgical treatments are not require surgery. Surgery would be recommended if the condition doesn’t improve or when there are some other problems are presented.

Acromioplasty:

This is the most common surgery for biceps tendonitis. Especially this is recommended when there is an underlying problem in the shoulder. This method involves removing front part of acromion. Bony ledge will be formed where scapula meets the upper part of the shoulder joint. More space will be created between the humeral head and acromion, if the small part of the acromion is removed. This space will take the pressure from the soft tissues in between, which also include biceps tendon.

Biceps Tenodesis:

This is a process of reattaching the upper end of biceps tendon to the new location. Tenodesis can be required if the biceps tendon becomes very severe or if the shoulder reconstruction for some other problems required.

A usual way to perform this surgery is through keyhole technique. This will describe the shape of the small hole that is made by the physician in the humerus. The end part of the tendon is accelerated into the top of keyhole and that is pulled down to the anchor in its place.

Contacting an orthopedic surgeon will give you effective advice on what type of treatment you need to undergo.

Orthopaedic surgery is mainly performed with the conditions involving the muscles and bones. Orthopaedic surgeon performs both surgical and non surgical treatments such as sports injuries, infections and congenital disorders. Orthopaedic surgeon treats anything from joint replacement to amputation. There are different types of orthopaedic surgeons and also different specializations available in orthopaedic surgery and each surgeon has different speciality. Orthopaedic surgery plays a major role in sports medicine development. Musculoskeletal system plays major role in sports medicine for athletes. To perform a muscle operation, some doctors are trained specially we called them as an orthopaedic surgeon in sports medicine.

Roles of the orthopaedic surgeon:

·         An orthopedic surgeon mostly deals with knee joints in sports medicine because in many physical activities knees are involved and almost in each sport, knees are being used.

·         Orthopedic surgeon gives a treatment for an injury and after the treatment to injury or an operation and the surgeon has to carefully observe the healing process.

·         Surgeon regularly checks-up the patients and recommended medications to improve the performance of an athlete and reduce the injury risk.

·         Surgeon provides an advice on fitness relating to the performance of an athlete.

·         The doctor gives advice regarding the effect of medications and dietary supplements on athletes’ long and short term health.

·         After an injury, orthopedic surgeon understands the desire of athletes to return back to participate in sports as soon as possible.

·         They will teach athletes about prevention of the injuries and about proper nutrition and also they will teach about the ways to use muscles in a proper and safe manner.

·         Developing the personal plan for every person helps the athlete with the weight management, nutrition and exercises that are specific for the injury, which all can play a major role in maintaining healthy joints.

·         They also taught to patients about the functionality of the knee and how to use the group of muscles to help support an injured knee.

·         During the first visit with the surgeon, patients would receive a total assessment of their bone and muscle system. There is a scope to discuss the daily routine and lifestyle habits for improving the personal plan.

·         If you are overweighed, orthopaedic surgeon would recommend you a proper nutrition plan.

·         The injury would be treated and if the surgery is not necessary, the patient would be placed on the program. Patients who need surgery would be explained the entire procedure in a detail manner and also put on the program, which includes nutrition and exercise to ensure that they would recover quickly after having the surgery.

·         Sports medicine also plays an important role in pain relief and recovery efforts for the sports related problems. 

If you are suffering from knee pain, then your physician might recommend you the physical therapy that would be helpful in reducing the pain, restoring the strength, and regaining the function.

Much of these can be achieved with physical therapy, as well as exercises. Most of the pains that are related to structure are associated with the improper body posture, like excess seating and bending postures, which affect your knees.

A physiotherapist should check the patient’s overall condition and the pain associated with the knee. Physical therapist would apply some hands on the work to show you an exact form. There is an ongoing discussion about your knee condition and its progress, your goals and the scheduling period. It is very essential to make sure that you have a good plan for to be a part in physical therapy.

Apart from the facts, typically physical therapy for knee means attending the sessions for 2 to 3 times per week over the duration of course that is 3 to 6 weeks that would depend on the severity of the condition.

There are several ways to treat structural aches such as medications and in few cases surgery may be needed. However, one of the most effective ways to deal with this type of pains is the physical therapy. This would entail both active and passive processes. In addition to the exercises, the physical therapist can also use other methods to help in reducing your pain, such as applying ice, ultrasound, etc.

Passive physical therapy:

This is opposed to the active therapy. The processes that are performed on the body by the physiotherapy without involving the exercising include:

·         Massage:

Massaging the deep tissues is ideal for knee pain. Through this, sufficient pressure is applied on the tissues to give relief from muscular tension and pain. Especially massage is ideal for simple conditions such as pain associated with the poor posture. If the knee pain is very severe, performing massage is not ideal and it may lead to further discomfort.

·         Electric muscle therapy:

This will help in reducing the muscular pain and body aches by alleviating the muscular tension. This method also triggers your body to produce increased amount of endorphins, which are used by your body to provide relief from pain naturally. This is mainly used for knee pain.

·         Heat therapy:

This would work very effectively in relaxing muscles and also allows the better blood circulation, which provides more nutrients and oxygen to the inflamed areas. This therapy will reduce the pain, but it can’t resolve the actual cause of the pain.

·         Active physical therapy:

This therapy involves exercises, which relaxes the body muscles and also improves the blood circulation. If the case is severe and if that is unable to treat with these exercises, other treatment methods may be used.

Radiculopathy is a scientific term that is given to the condition of the damaged spine discs or nerves with damaged roots. The damage may occur anywhere on the spine. If the damage occurred on the neck, it is called as the “cervical radiculopathy”. If the damaged site is your lower back, this condition is known as “lumber radiculopathy”. An extra or unwanted pressure that is exerted on the spine may damage the nerve roots thus causing the pain. Generally herniated disc causes pressure. But there may be other reasons like tumors and bone spurs or vasculitis that could be the cause for unwanted pressure.

Injury of or irritation to the nerve root typically can cause numbness, weakness, or pain in the parts of the body that have nerves from root.

Symptoms of radiculopathy can be easily detectable. One of the major symptoms of this is pain. The pain may tends to show up in either legs or arms. The person may have symptoms like shoulder or neck pan, sharp pain in head, weakness, numbness, or tingling down in legs or in the lower back. There are some other symptoms too. The person may feel like stiffness in muscles, weak reflexes and bounded motion of limbs.

You can also be at the risk of radiculopathy if you drive for long time or if you stay as sedentary for much time. Sitting in one position for long time can compress your spine discs and causing herniation, and also prolonged pregnancy and cough are considered as the risk factors of developing the radiculopathy.

 If you any have doubt that you might have the symptoms of this disease, the best way is to get diagnosed by the professional. Each nerve, which begins from the spine, has its own specific function to a particular area. Diagnosis of this is to be performed in a way to detect the root cause of the issue. There are several reasons for the back pain, but not necessarily all are radiculopathy.

During the diagnosis process, doctor may ask you some questions that are related to your symptoms and they may also conduct tests such as MRI and neurological tests to ensure the issue. Without a proper confirmation, they would not proceed to do any treatment.

Treatment:

To treat radiculopathy, mostly physical therapy and prescribed medication would be used. You must alleviate activities, which increase the immobilization or pain. Traction during the physical therapy would be helpful in reducing the pain. In many cases injections also give better result.

However, very few cases are treating with the surgeries, although this should be the final option. Before having surgery you need to discuss all the possible ways with your doctor. Before deciding on any kind of treatment, consult an experienced orthopedic surgeon for better results.

Minimally invasive techniques are the standard procedures for spinal surgery. The aim of minimally invasive surgery is to do the same operation with less pain, potential complications, and side effects and with the better or same outcomes. The benefits of this procedure include less pain, less loss of blood, lower risk of infection after having the surgery, less damage to the tissue and collateral musculature, and earlier return to the daily routine.

Minimally invasive techniques include:

For cervical spine:

·         Foraminotomy and disectomy: This type of surgery is used to treat herniated disc, but it also works effectively in relieving pain of arm that is caused by the pressure of nerve from the arthritic bone spurs. This surgery can widen the opening in the back where the roots of nerves leave the spinal canal.

·         Fusion: Fusion is one type of minimally invasive technique that is used to treat fractures and trauma of spine. Especially this surgery is designed to eliminate the motion at the painful vertebral part that would decrease the pain caused from the joint.

·         Foraminotomy fusion: This is a medical procedure that provides relief from pressures of compressed nerves. A foraminotomy fusion would be performed either as minimally invasive or conservative.

·         Decompression Resection: Spinal decompression surgery is the combination of several procedures that would be intended to provide relief from symptoms that are caused by compression, or pressure, on the nerve roots or spinal cord.

For thoracic Spine:

 Minimally invasive techniques are also used to treat thoracic spine.

·         Costotransversectomy: This is used to treat the herniated disc. This technique allows surgeon to access ventral thoracic spine for many kinds of spinal disorders that include degeneration, tumor, infection and trauma.

·         Thoracoscopic surgery: This is used for tumors. This is a robotic surgery performed on the VATS platform. This procedure involves four steps. The robot would be used to cut the rib and to divide the muscles of scalene.

For Lumbar spine:

·         Disectomy:  This surgery is performed to remove the herniated disc from a spinal canal. Herniated disc causes pressure on the nerves.  The surgical procedure can remove the spinal disc fragment. In this surgery, the surgeon made a small incision to look at the herniated disc and to remove that disc. This will provide relief from the pressure on the nerves.

·         Laminectomy: This is a spine surgery to remove a part of the vertebral bone that is called as lamina. This is a minimally invasive technique, in this surgery some small incisions are made to push the back muscles aside instead of cutting them, and the portion of lamina would leave intact.