OA Update - Volume 1, Issue 4 (3.84 MB PDF File) - Orthopaedic ...

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OA Update - Volume 1, Issue 4 (3.84 MB PDF File) - Orthopaedic ...

FEATURES

In This Issue

6. Conditioning for the

Superior Pitcher

Debunking the distance running myth

The purpose of conditioning activities

for pitchers should be to build a superior

athlete. Stan Skolfield, ATC, CSCS, debunks

the myth that distance running results in

a better pitcher.

8. Finding Relief

for Your Arthritic Thumb

Diagnosing and treating thumb arthritis

Thumb arthritis develops when the cartilage

covering the bones wears out. Dr. Sacha D.

Matthews provides an overview of thumb

arthritis and its multiple treatment options.

10.Why a Second Opinion?

Don’t hesitate to ask for

another opinion

There are frequently multiple ways to

treat a given condition and second

opinions can be helpful and reassuring.

Patients should never be afraid to ask

for a second opinion.

12.Try a Tri

Trio of activities leads to

better fitness health

There is no better way to get in shape than

to try a triathlon. Dr. Eric Hoffman offers

tips for how to start triathlon training.

16. Experience in

Outpatient Shoulder

Surgery

Surgical advancements offer

more benefits to patients

Most shoulder procedures are now done on

an outpatient basis thanks to advancements

in arthroscopic techniques and safe

outpatient perioperative pain management.

20. Understanding Sports-

Related Concussions

Frequently asked questions

about concussions

The best way to prevent difficulties with

a concussion is to manage the injury properly

when it does occur. Dr. Lucien R. Ouellette

answers some of the most common questions

regarding sports-related concussions.

DEPARTMENTS

5. OA in Motion: What’s New? News and notes on people, places and happenings in the organization.

The OA Update is published by Oser-Bentley Custom Publishers, LLC, a division of Oser Communications Group, Inc., 1877 N. Kolb Road, Tucson, AZ 85715. Phone (972) 687-9035 or (520) 721-1300, fax (520) 721-6300, www.oser.com.

Oser-Bentley Custom Publishers, LLC specializes in creating and publishing custom magazines. Inquiries: Tina Bentley, tina@oser-bentley.com. Editorial comments: Karrie Welborn, karrie_w@oser.com. Please call or fax for a new

subscription, change of address, or single copy. This publication may not be reproduced in part or in whole without the express written permission of Oser-Bentley Custom Publishers, LLC. To advertise in an upcoming issue of this

publication, please contact us at (972) 687-9035 or (520) 721-1300 or visit us on the Web at www.oser-bentley.com. July 2009

The OA Update 3


Opening Remarks

The physicians and staff of OA Centers for Orthopaedics (OA) welcome you to the latest issue

of The OA Update. In publishing this magazine, OA hopes to create an opportunity for educating

patients and their families about various orthopaedic conditions, preventative strategies for avoiding

injury and treatment options should an orthopaedic problem arise. We believe that offering

information on new and evolving techniques and treatments enhances our patients’ ability to

participate in making educated treatment decisions.

In this issue, we’ve included information ranging from bone health to hip arthroscopy to

preparing for your first triathlon. We hope you find this issue informative and helpful, and welcome

any suggestions for future publications. We’ve already heard from some of you and are appreciative

of your comments and feedback!

Sincerely,

The Physicians at OA Centers for Orthopaedics

Satellite Locations:

Saco Office

15 Lund Road

Saco, ME 04072

(207) 282-4210

OA Centers for Orthopaedics

33 Sewall St.

Portland, Maine 04102

(207) 828-2100 • (207) 828-2190 fax

info@orthoassociates.com

John Wipfler Chief Executive Officer

OA is the premier orthopaedic practice in Maine.

Our 23 highly specialized physicians are experienced

in the latest techniques and innovations. OA

specialty centers include sports medicine; hand

surgery; joint reconstruction of the hip, knee and

shoulder; foot and ankle surgery; and complex fracture

treatment. OA—Experience in motion!

Windham Office

4A Commons Ave. Rte. 302

Windham, ME 04062

(207) 893-1738

Specialty Centers

Joint Replacement Center

Orthopaedic Trauma Center

Hand Center

Foot and Ankle Center

Sports Medicine Center

Spine Center

MRI Center

Orthopaedic Surgery Center

Physical Therapy Center

Performance Center

The information contained in this publication is not

intended to replace a physician’s professional

assessment. Please consult your physician on matters

related to your personal health.

4 The OA Update


OA in Motion

AAAHC Best Performer

OA again participated in a performance measurement

initiative evaluating best practices for knee

arthroscopy with menisectomy, with the purpose of

collecting data on key processes and outcomes for this

procedure. The information obtained is used for

clinical quality improvement efforts and to provide

organizations with alternatives in practice to provide

a better value in quality and cost to their patients.

The Institute for Quality Improvement, a

not-for-profit subsidiary of the Accreditation

Association for Ambulatory Health Care

(AAAHC), identified OA’s Surgery Center as a

“Best Performer” in the following categories:

• Lowest Pre-procedure

(No. 1 rank, top 3 percent)

• Lowest Procedure Time

(No. 1 rank, top 3 percent)

OA Sports Center Open House

OA Centers for Orthopaedics and MHG Ice

Centre have joined together to create a fully

integrated state-of-the-art facility, which includes

OA’s orthopaedic and sports medicine clinic, OA

Physical Therapy Center, the OA Performance

Center featuring the Parisi Speed School and a

biomechanical research center, as well as a yearround

indoor ice arena and home of the Portland

Junior Pirates. An open house celebration was held

in March, and the event was attended by 2,000

guests including Governor John Baldacci and Bill

Parisi, founder of Parisi Speed School.

Dr. Brown as “Godfather”

This past April, OA's Dr. Douglas Brown was

traveling with the fellowship program of the

American Orthopaedic Society for Sports Medicine

to Japan, South Korea, Taiwan, Thailand and

Singapore. The traveling fellowship program is an

annual scientific and cultural exchange among

orthopaedic sports medicine physicians in North

America, Europe, Latin America and the Pacific

Rim. Three fellows are selected to visit foreign sports

medicine centers for three weeks and are

accompanied by a “Godparent”—a well-known

senior orthopaedic sports medicine specialist

selected by the president of the national sports

medicine organization. The Godparent for this year’s

trip was our very own Dr. Brown. This is an honor

for Dr. Brown, and the OA Team is proud of him!

Dr. Charbonneau receives

2008 Caregiver of the Year award

In recognition of her extraordinary commitment

to the delivery of care to patients and their

families, Dr. Elissa Charbonneau was presented

with New England Rehabilitation Hospital

(NERH) of Portland’s Caregiver of the Year

award. Dr. Charbonneau shares her time between

NERH and OA Spine Center. Congratulations

to Dr. Charbonneau!

Relocation of Satellite Office Services

As part of our commitment to providing the best in

integrated orthopaedic care and treatment for our

patients, OA Centers for Orthopaedics has

relocated clinical services from our

Scarborough and Yarmouth locations

to the new Saco location at 15 Lund Road.

Along with the Saco location, OA’s

physicians will continue to provide services

at our other locations in Portland and

Windham. While appointments with all of

OA’s physicians are not available at every

location, our appointment specialists will

work with the individual to schedule with

the appropriate physician at the most

convenient location.

Joint Lecture Series

The physicians from the OA Joint Replacement

Center are offering educational lectures on

contemporary options in total joint surgery. These

sessions will highlight leading options for fast

recovery, durable results, high activity and less

pain after joint replacement surgery. For more

information, email jtilton@orthoassociates.com

or call (207) 710-5509.

Lecture Schedule (6:30 p.m.–7:30 p.m.)

• May 6: What is the Right Type of Hip

Replacement for You?

Brian McGrory, MD

• May 20: Your Total Knee Replacement Options

Steve Kelly, MD

• June 3: The 24-Hour Minimally Invasive Total

Hip Replacement

George Babikian, MD

• June 17: Minimally Invasive (MIS) Knees

Peter Guay, DO

• July 1: 5000 Total Knee Replacements

Michael Becker, MD

• July 15: Shoulder Replacement Surgery

Donald Endrizzi, MD

OA as a Community Partner

The 18 staff members who constitute the OA

Events Committee coordinate programs and

events to encourage socializing across the

organization and get employees involved in the

community. In the past year, OA physicians and

staff have generously supported the following local

organizations through this committee’s efforts:

• The Root Cellar (Portland) and People’s

Regional Opportunity Program (South Portland):

Thanksgiving dinner donations for three families

• Salvation Army adopt-a-family program

(Portland): Christmas family dinner and gift

donations for four families

• Animal Refuge League of Greater Portland: Inkind

donations to support the animals at the

shelter and group project work at the shelter

• American Red Cross: Blood Drive at OA

• United Way of Greater Portland: Annual

donation campaign

The OA Update 5


Conditioning for the

Superior Pitcher

By Stan Skolfield, ATC, CSCS

Warmer weather has returned, and that

means baseball season is underway. Boys and

girls will be running around throwing

baseballs and softballs as well as swinging the

bat. Coaches will also be busy preparing their

athletes for the demands of the season. Over

the years the training methods for developing

the superior ballplayer have changed, yet

many coaches are still doing things the “old

way” because that is the way they were taught

when they played competitive sports. I want

to share with you the biggest training myth

out in the game today in hopes that you will

not make the same mistake with your athlete.

The most common training myth that

baseball coaches and trainers fall into is: Pitchers

should run long or poles to get themselves in great

shape and recover from training.

The common view of most baseball

coaches is that distance running helps pitchers

by building strength in their legs, enhancing

their endurance, developing mental toughness

and improving their overall physical fitness. I

completely disagree—when was the last time

you saw a marathoner throw at 95 mph?

Not only is this far from the best use

of training time, it is proven to be

counterproductive. It is one of the worst

things you can do to train an explosive

athlete. After all, pitching is an explosive

action and to be good at it requires a

tremendous amount of recruitment and

development of fast twitch muscle fiber.

Think about it. If you wanted to

optimally train an athlete for an activity that

involves one to nine sets (innings) of 15–20

6 The OA Update


full body explosions (pitches) lasting one

second and then 20 seconds of recovery, then

a 15-minute block of rest recovery between

sets, does running slowly for two to three miles

sound like the best method for creating a more

explosive athlete? Would you train a 100 or

200 meter sprinter by running long distance?

Of course not. Don’t do it with pitchers either!

The purpose of conditioning activities for

pitchers should be to build a superior athlete.

Help them become more durable, effective and

explosive. Running long distance is a giant

waste of training time, recruits the wrong

energy system (aerobic vs. anaerobic), recruits

the wrong muscle fiber type (slow twitch vs.

fast twitch) and adds an unnecessary and

repetitive stress to the hip, knee, ankle and

foot. Distance running conditions ballplayers

to trot instead of bounce.

For those of you who want to argue that

it builds mental toughness, I beg to differ.

Running at a very slow pace for a prolonged

period of time is a great way to build mental

toughness if you’re a very weak-minded

individual. If you want to better condition

your pitchers, have them do 10–15 by 40- or

60-yard sprints. You could also have them use

ladders, do agility drills, perform series of

body weight exercises with short rest intervals.

The possibilities are endless as long as the

activity is brief and intense. I promise you, if

you program the workout correctly then by

the 8th or 9th rep of 60-yard sprints the

athletes will be sufficiently challenged

mentally. Compared to that workout, running

10 poles would seem like a vacation!

Pitchers should develop a great base of total

body strength in the weight room. Develop

lower body strength with squats, lunges, single

leg squats and step ups. Promote great core

strength through stabilization exercises (planks,

side planks, bridges) and rather than crunching

movements. Finally, promoting upper body

strength with chin ups, rows and push up

variations is a great way to lay the foundation

needed to develop a more explosive athlete.

So I challenge you to change your

mindset when it comes to conditioning your

ballplayers. Some of the points I have made

may go against the grain of old school

baseball, but the game has changed and so has

the athleticism it takes to be a superior athlete.

I will take an athlete who has developed him

or herself to be much more explosive over an

athlete who has a high VO2 max any day!

Stan Skolfield is a Certified Athletic Trainer

(ATC) through the National Athletic Trainers

Association (NATA) as well as a Certified

Strength and Conditioning Specialist (CSCS)

through the National Strength and Conditioning

Association (NSCA). He has been involved with

the training, nutrition and rehabilitation of

athletes at multiple levels. He has worked for the

Boston Red Sox, providing injury prevention and

rehabilitation for in-season teams. Stan is the

Manager for the OA Performance Center.

The OA Update 7


Finding Relief

for Your Arthritic Thumb

By Sacha D. Matthews, MD

Thumb arthritis involves the joint at the base of

the thumb, the carpometacarpal (CMC) joint.

This joint is made of two bones—the trapezium

and the metacarpal. Thumb arthritis develops

when the cartilage covering the bones wears out.

As a result, the bones rub together causing pain,

swelling and stiffness. Anyone can develop

thumb arthritis, but it is seen more often in

women. It is more common as we age. Patients

experience an achy pain, which can wake them

up, and which is worse with pinching or gripping

such as opening jars. In advanced cases, patients

can develop weakness and a grinding sensation

with gripping. The thumb may appear deformed

with a “bump” at its base. The diagnosis of

thumb arthritis is made by a trained health care

professional. A history of pain in the base of the

thumb, worse with pinching, is suggestive of the

diagnosis. On physical exam, the CMC joint is

tender to touch and twisting causes a painful

grinding. X-rays can confirm the diagnosis.

Treatment begins with avoiding pinching

and gripping, heat in the morning to loosen the

joint, and ice at night to decrease swelling.

Mechanical jar openers and tools with larger

handles can be quite helpful. Splints that

support the thumb reduce pain. Cortisone

injections can lessen the pain for a time. If these

things fail, then surgery may be considered. The

type of surgery is determined by the treating

surgeon. Most commonly, surgery involves

fusion of the CMC joint, where the metacarpal

and trapezium are joined together, or a

Ligament Reconstruction Tendon Interposition

Arthroplasty (LRTIA), where the trapezium is

removed and a tendon is used to rebuild the

ligaments with the remaining tendon placed as

Arthritic Carpometacarpal Joint.

a spacer. These procedures are successful in

increasing motion and strength, while

eliminating pain. Don’t let thumb arthritis slow

you down—solutions are available.

Dr. Matthews is a hand surgeon in the OA Hand

Center, which provides comprehensive coverage for

the diagnosis, treatment and rehabilitation of all

types of hand and wrist problems. He is a fellow of

the American Academy of Orthopaedic Surgeons

and a member of the American Society for Surgery

of the Hand. He also has a Certificate of Added

Qualification in Hand Surgery.

Status-Post Carpometacarpal Suspension Arthoplasty.

8 The OA Update


The OA Update 9


Why a Second Opinion?

By Thomas F. Murray Jr., MD

In the practice of medicine, there are

frequently multiple ways to treat a given

condition. In many cases, there are different

recommendations and treatments that can be

offered for the same orthopaedic problem.

Practice styles can vary considerably, even

within a group practice, depending on where

and with whom the physicians trained. When

faced with the decision for proceeding with

surgery, many patients feel that another

opinion will be beneficial in verifying that a

diagnosis is correct and the treatment plan is

reasonable. In some cases, a patient may have

already initiated treatment with a provider, but

not be progressing as expected. Again, another

opinion may be reassuring or provide another

option not previously considered. A patient’s

physician may also request a second opinion

from another specialist to assist in providing

care to that patient. Finally, as is common in

work-related injuries, an insurance provider

may request a confirmatory second opinion to

be sure an employee’s care is reasonable.

The physicians at OA Centers for

Orthopaedics receive a number of requests

for second opinions. When requesting an

appointment for a second opinion, it is

important to provide the physician with a full

summary of prior evaluations, diagnostic tests

and treatments. While some patients may feel

that having access to this information may

negatively impact the new physician’s evaluation

and treatment recommendations, this is simply

not the case. This information is essential, not

only to provide the physician with a more

“complete” journal of the patient’s situation, but

also to minimize the need to duplicate studies

and incur unnecessary medical costs. In many

cases, the patient will be asked to gather

information and provide it to the physician he

or she is requesting to see prior to the

appointment. This will expedite the scheduling

process and make for a more comprehensive

evaluation process.

While another opinion can be helpful in

some situations, multiple opinions can be very

confusing and counterproductive to a patient’s

recovery. To help with making the decision

to pursue a second opinion, the patient may

benefit from having a discussion with his

or her primary care physician. The primary

care physician may provide insight to the

recommended treatment plan and guide you

in seeking another opinion, or address your

concerns enough to proceed without one.

Remember that physicians may in fact have

different opinions on the treatment of a

problem, and while it is appropriate to explore

those differences with the providers, don’t

expect to reconcile the differences. The goal of

another opinion should be to confirm care

recommendations or to learn more about other

options. In the end, you may need to make a

choice based on the information provided.

Finally, patients can sometimes be reticent

to ask for a second opinion. This should never

be the case. Physicians themselves request such

consultations and realize it is an important

part of medical practice. So if you are not sure

about your treatment course or results, don’t

hesitate to ask for another opinion.

Dr. Thomas Murray Jr. practices sports medicine

and arthroscopic surgery at OA Centers

for Orthopaedics.

Top 10 Reasons

for a Second Opinion

The diagnosis or treatment seems to be in question

Treatment fails to provide relief

Unusual or complicated procedure is recommended

Out-of-work time or expense seems unreasonable

Recovery seems prolonged, delayed or incomplete

Your physician has little or no experience with a

given procedure

A complication or mishap has occurred

A patient is told “nothing else can be done”

Physician-patient communication problems

Anytime you think it might help you

10 The OA Update


The OA Update 11


12 The OA Update


Try a Tri

By Eric D. Hoffman, MD

There is no better way to get in shape than to

try a triathlon. The combination of swimming,

biking and running leads to excellent upper

and lower body fitness health. Running helps

boost cardio health, speed and vitality. Biking

boosts endurance with low impact. And

swimming works the upper body, core and

helps to “stretch out.”

First-time triathletes usually target a sprint

distance race. This involves a short pool swim

or an open swim of approximately 1/3 mile,

biking 12–14 miles and ends with a 5K run.

Anyone can complete a sprint distance race, and

getting started is easy.

Start by signing up for an event. This will

give you goal-oriented exercise motivation.

Second, find an individual or group with which

to train. Having a “buddy” or group of friends

to work out with can make this a fun activity

that you look forward to. Third, begin work on

your fitness in a well-thought out manner given

your current fitness level.

Anyone in reasonable shape can get

ready in as little as six to eight weeks. It is

preferable to prepare over a longer period of

time, however, and most athletes end up

doing year-round exercise to maintain their

“tri” fitness. Some athletes prefer more

guidance and supervision as part of a

training program so that they can meet

their performance goals without injury.

OA Performance Center in Saco offers

the Parisi speed and strength program that

can serve as an excellent base for triathlon

competition/participation. OA can provide

you with an excellent bike fit and gait

analysis to ensure that the “foundation” is

sound. For the more serious triathletes, there

is a human performance lab offering

physiologic testing, lactate threshold, VO2

max and more. In the future, OA will be

expanding their triathletes offerings to

include endurance programs and camps.

Peak Performance Multisport in Portland

offers the “Nor’Easters,” an inexpensive club

membership that allows participation in

organized group workouts, usually with a

guide or coach. Peak Performance also offers

individual coaching and equipment advice

about needs for your first race—wetsuit,

goggles, bicycle, apparel, helmet and shoes.

This doesn’t have to be expensive; most firsttimers

will use a bike they already have or

borrow one.

The event itself is a blast. It is a fun

atmosphere with a very unassuming crowd. The

loudest cheer often goes to the last one out of

the water. So go ahead and take the challenge!

Sign up for a “tri.” You won’t regret it. Maybe

you will catch the “tri-bug” and keep it as part

of your everyday life. Lastly, enjoy your fitness!

Dr. Hoffman practices orthopaedic sports medicine

with a special interest in arthroscopic treatment

of knee and shoulder injuries. He is the team

physician for Falmouth High School, consultant

for other local high schools and Sunday River Ski

Resort, as well as an instructor for the Maine Medical

Center Sports Medicine Fellowship Program.

He is active in many sports including triathlons

and is a 2007 Ironman Lake Placid finisher.

VISIT THESE WEBSITES FOR MORE INFORMATION ABOUT TRIATHLON TRAINING

www.orthoassociates.com

www.tri-maine.com

http://beginnertriathlete.com

www.mypeakmultisport.com

www.trifind.com/me.html

The OA Update 13


The Story Behind

Osteoporosis

By Carrie Bui with William Heinz, Heinz. MD

Osteoporosis is a silent disease until a fracture

occurs. The pathology of osteoporosis allows

bones to become weak and brittle, causing

them to fracture with very minor trauma.

An estimated 10 million Americans have

osteoporosis and another 34 million are at

risk, making osteoporosis the most common

bone disease, according to the National

Osteoporosis Foundation. Osteoporotic

fractures can heal completely or they may be

followed by chronic pain, disability and even

death. Hip fractures result in 10 to 20 percent

excess mortality within one year and are

associated with a 2.5 fold increased risk for

further fractures.

The disease is more commonly associated

with older women, but osteoporosis can

occur at any age and to both men and women.

Women are four times more likely than

men to develop osteoporosis, especially within

the first five to seven years after menopause,

when they lose significant bone mass. Risk

factors also include race and ethnicity

(Caucasians and Asians are more susceptible),

history of broken bones, inactive lifestyle and

diet (low calcium and vitamin D intakes).

It is recommended that all women age

65 and older and men age 70 and older be

screened for osteoporosis. Women with an

increased risk for osteoporosis should begin

screening at the time of menopause. To

diagnose osteoporosis or the potential risk for

it, the most common procedure is a dual

energy x-ray absorptiometry scan (DXA scan)

to measure the bone density of the spine and

hips. Alternative methods to measure bone

density are an ultrasound and a quantitative

computerized tomography (CT) scan. Bone

density tests measure how many grams of

calcium and other minerals are packed in a

segment of bone, and from that information

the relative risk of a fragility fracture (defined

as a fracture resulting from a fall from

standing height) can be estimated.

The National Osteoporosis Foundation

recommends five steps to healthy bones and

avoiding osteoporosis.

• A proper diet, making sure to include the

recommended daily amounts of calcium

and vitamin D. The recommended daily

intake of calcium for adult men and

women is between 1,200 and 1,500

milligrams and that of vitamin D is 1000

International Units (IU).

14 The OA Update


• Exercise, especially with a focus on weightbearing

and muscle strengthening exercises.

Examples of weight-bearing exercises

include jogging, hiking, gardening and

weight training. Strength training increases

muscle mass, leading to better coordination

and balance. Improved coordination and

balance can help prevent falls that can

result in fractures.

• Maintain a healthy lifestyle by avoiding

smoking and excessive alcohol consumption.

• Talk to a healthcare provider to discuss bone

health, prevention, risk and monitoring.

• Have a bone density test (DXA scan)

regularly. A bone density test can warn you

of low bone mass and track if bone density

is remaining stable or decreasing.

The effect of osteoporosis is fractures, most

often in the spine, hips or wrist. Often,

osteoporosis is not discovered until a fracture

occurs, but symptoms to note are back pain

and loss of height with accompanying

stooped posture. A comprehensive osteoporosis

treatment program would include maintaining

a proper diet, regular exercise and the

prevention of falls.

The pathology of

osteoporosis allows bones

to become weak and brittle,

causing them to fracture

with very minor trauma.

The U.S. Department of Health and

Human Services suggests that the best way

to achieve the required vitamin D intake

is through sunlight. Ten to 15 minutes

of sunlight to the hands, arms and face at

least three times a week should offer enough

vitamin D. (Be careful not to overdo

the sunlight as it will increase your risk for

skin cancer!) This vitamin is necessary for

the absorption of calcium. Recommended

calcium-rich foods include all dairy

products, such as yogurt, cheese, milk

and ice cream. Also, calcium-fortified

Am I at increased risk of having osteoporosis?

Your chances of developing osteoporosis are greater if you are female and answer “yes”

to any of the following questions:

Are you…?

Do you have…?

Light skinned

Thin or small framed

Approaching or past menopause

Milk intolerant or have a low calcium intake

A cigarette smoker or drink alcohol in excess

Taking thyroid medication or steroid-based

drugs for asthma, arthritis or cancer

orange juice and broccoli are good

dietary sources of calcium.

To avoid fractures, consider fall prevention

strategies to reduce the risk of falling:

• Meet with your doctor to discuss whether

any medications or health conditions are

increasing your fall risk.

• Exercise to improve strength, balance,

coordination and flexibility.

• Wear sensible shoes to avoid falls. Tips for

sensible shoe buying include proper fitting,

non-skid soles and shoes with laces.

• Remove hazards within the home such as

cords, boxes or any kind of clutter blocking

walkways. Secure loose rugs, repair any loose

flooring immediately and use non-slip mats

in the bathroom and shower.

• Create plenty of light through lamps and

night lights to avoid falling or tripping

over items that can’t be seen in poorly lighted

or dark rooms.

The use of assistive devices can also help

prevent falls. Assistive devices include grab

bars mounted inside and just outside the

shower or bathtub, a plastic seat placed inside

the shower for sitting down, handrails on

both sides of a stairway and non-slip treads

for bare wood steps.

The key to understanding osteoporosis

is understanding the prevention of it.

Prevention of osteoporosis includes a proper

diet, with a focus on meeting calcium and

vitamin D requirements, exercise, with a

focus on weight-bearing exercises and careful

monitoring later in life.

A family history of osteoporosis

Chronic intestinal disorders

A sedentary lifestyle

Speak with your physician if you are concerned

about your bone health!

Dr. William Heinz works in the OA Sports

Medicine Center and specializes in the diagnosis

and non-surgical treatment of sports-related

musculoskeletal injuries. He has interest in bone

health and is a certified clinical densitometrist.

He performs diagnostic interpretations for all

bone densitometry scanning performed at OA

Centers for Orthopaedics.

The OA Update 15


Experience in

Outpatient Shoulder Surgery

OA Orthopaedic Surgery Center

By Donald Endrizzi, MD; Linda Ruterbories, MS, ANP; Craig Curry, MD and Thomas Murray, MD

Over the last two decades, shoulder surgery has transformed from a

largely inpatient-based practice to a predominantly outpatient series of

procedures. Although some procedures continue to be inpatient-based

such as arthroplasty or open reduction with internal fixation (ORIF),

most shoulder procedures are now routinely done on an outpatient basis.

Advancements in arthroscopic techniques, with less extensive surgical

dissection, have decreased the overall pain of many procedures to

manageable levels that allow safe outpatient management of

perioperative pain. Economic factors such as decreasing reimbursement

for overnight hospitalization and the availability of outpatient surgical

facilities contributed to this transition, along with patient demand.

Perioperative pain management remains a crucial part of outpatient

surgery and can seriously impact the patient’s perception of their surgical

experience. At OA, the team is committed to the highest standards of

outpatient surgery services that are personal, safe and cost effective. Our

specialized orthopedic surgeons and our highly trained staff of

experienced RNs, physician assistants and anesthesiologists (from the

Spectrum Medical Group) work together to provide the highest quality

surgical care available anywhere in the country. This includes working

together to develop effective pain management strategies, evaluate how

services are delivered and how patients respond.

Regional anaesthesia refers to blocking the nerve supply to part of

16 The OA Update


the body so the patient cannot feel pain in that area. Regional blocks

have become an important adjunct to pain management in the

shoulder. However, regional blocks are not without risks and costs.

Many centers use regional blocks in combination with general

anaesthesia, which can add significantly to the cost of the procedure.

The rate of complications varies greatly in the literature, with lower

rates reported as institutional experience increases. Local anaesthesia

means putting local anaesthetic around the affected area to make it

pain-free and is often referred to as “freezing” the area. Dr. Donald

Endrizzi, Dr.Thomas Murray and Linda Ruterbories, MS, ANP, of the

Orthopaedic Surgery Center at OA and Dr. Craig Curry from

Spectrum Medical Group collaborated in evaluating the effectiveness

and benefits of local anaesthesic infiltration (LAI) and general

anesthesia for outpatient shoulder surgery.

From 1998 through 2007 the data on 3,115 patients undergoing

outpatient shoulder surgery was collected prospectively. This included

both arthroscopic and open surgical procedures performed by two

experienced shoulder surgeons. The surgical procedures included 757

rotator cuff repairs, 404 instability repairs, 996 acromioplasties, 165

acromioclavicular joint excisions, 290 SLAP repairs or debridements and

503 other shoulder surgeries. Patients were contacted on post-op day one

and assessed by nursing as to any post-operative difficulties or complaints.

It has been the impression of the investigators that general

anaesthesia with local anaesthetic infiltration is a safe and effective

method for shoulder surgery. The advantages of this technique include

its low complication rate and acceptance by patients, with a high degree

of patient satisfaction after surgery. No significant complications related

to local anaesthetic infiltration were noted. There were no seizures or

cardiac disturbances related to the anaesthetic infiltration, in contrast

with some rare but significant complications reported with regional

blocks. The cost of local anaesthetic infiltration is low. Regional block

analgesia is often combined with conscious sedation or general

anaesthesia which can significantly raise the cost of the procedure.

Other alternatives to a regional block exist. Unfortunately there are

some patients and procedures in which local anaesthetic infiltration might

not be appropriate, such as longer, more extensive surgeries associated with

higher levels of pain with more tissue disruption.

There is a role for regional block in the post-operative

management of pain; however, its use as a routine part of shoulder

surgery can be questioned. The Orthopaedic Surgery Center team at

OA believes that selected surgical cases can be managed just as

effectively with a short-acting general anaesthetic agent and local

anaesthetic infiltration, lowering risk to the patient and costs to the

payer, without sacrificing post-operative pain relief.

Dr. Endrizzi specializes in shoulder surgery and is the Medical Director

at OA Orthopaedic Surgery Center (OSC). Dr. Murray specializes in

sports medicine and arthroscopic surgery at OA Centers for Orthopaedics.

Ms. Ruterbories is a nurse practitioner and serves as Director of OSC.

Dr. Curry is an anesthesiologist from Spectrum Medical Group and has a

special interest in regional anesthesia and pain management.

The OA Update 17


Medical Advances

Provide New Option for Hip Pain

Explaining Hip Arthroscopy

By Benjamin H. Huffard, MD

Each year more than 7 million people visit their

doctor with concerns related to hip pain. For

many, the pain is so severe that simple things

like climbing stairs or bending to tie their shoes

are difficult. Some may even have back or groin

pain and not realize this pain is actually the

result of a hip condition.

Many patients find pain relief through antiinflammatory

medications, physical therapy or

the right kind of exercise. But for others, only

surgical intervention will help.

Thanks to recent medical advances,

patients with ongoing hip pain who don’t

require a hip replacement may now be treated

with minimally invasive surgery. The procedure,

called hip arthroscopy, allows surgeons to

diagnose and repair most injuries through tiny

incisions in the hip instead of larger incisions

like those needed for replacements. This less

invasive approach usually means less pain and a

quicker recovery for the patient.

While a hip replacement may be needed if

there is severe hip trauma or damage from

arthritis in the joint, hip arthroscopy is most

often used to treat a specific and less severe

condition that may be causing pain. This makes

it beneficial for younger, more active people.

Historically, active individuals in the 30–

50 age range with chronic hip pain were more or

less told to live through their pain until they

reached an age when a hip replacement was

feasible. Physicians used this approach because

Hip arthroscopy uses specialized instruments inserted

through small incisions to remove or repair damaged tissue.

18 The OA Update


a practical treatment option simply wasn’t

available. In some cases, doctors couldn’t even

determine the cause of a patient’s pain because

the injury wasn’t detectable on an x-ray.

As diagnostic techniques and instruments

for the hip have improved, more and more

doctors are now using hip arthroscopy to

diagnose and treat injuries such as labral tears,

the most common problem in the hip joint.

The labrum is the ring of cartilage that

surrounds the rim of the hip socket, also

known as the acetabulum, and acts as a

cushion. Labral tears can occur as the result of

an accident, through overuse or sometimes

through basic wear and tear.

In addition to labral tears, two other

injuries commonly treated with arthroscopic

procedures are hip impingement, a condition in

which a lack of room between the head of the

femur, or the ball, and the acetabulum, or

socket, causes painful friction when the hip is

flexed and the removal of loose bodies in the

joint—small pieces of soft tissue or bone that

are usually the result of trauma such as a fall,

accident or sports injury.

Similar to knee and shoulder arthroscopy,

which have been performed for many years,

hip arthroscopy includes the use of a narrow

scope and specialized instruments. The scope

is attached to a camera and is inserted into the

joint through a small incision, allowing the

surgeon to see the injury and the area

surrounding it. The hand instruments are

inserted through another incision and are used

to remove or repair the damaged tissue.

Because the whole procedure is performed

through keyhole-size incisions, the patient can

usually return home that same day. In many

cases, hip arthroscopy allows for a quick

return to activity, with the least amount of

pain possible, while also diminishing the risk

of arthritis and possibly even delaying the

need for a hip replacement.

Dr. Huffard spent a year as a sports medicine

fellow at the Steadman Hawkins Clinic in Vail,

Colo., training with Dr. Marc Philippon on minimally

invasive and arthroscopic treatment of soft

tissue injuries around the hip. Dr. Huffard

specializes in arthroscopic surgery of the shoulder,

knee and hip.

The OA Update 19


Understanding

Sports-Related Concussions

By Lucien R. Ouellette, MD

No athlete should return to sport or other atrisk

participation when symptoms of a

concussion are present and recovery is

ongoing. The best way to prevent difficulties

with a concussion is to manage the injury

properly when it does occur. Here are some

commonly asked questions and answers

regarding concussion injuries:

What is a concussion?

A concussion is any temporary change in how

the brain works caused by injury to the head

that may or may not involve a loss of

consciousness. This can be a direct blow to

the head or a hit to the body causing shaking

of the head. Another term for concussion is

mild traumatic brain injury (MTBI). A

sports-related concussion is specific to an

injury while playing sports and will

temporarily limit involvement with sports.

Is sports-related concussion common?

Yes, sports-related concussion is common

especially in collision sports like ice hockey,

boxing and football, but a sports-related

concussion can occur in any sport. Estimates

are that 5 percent of injuries in high school

sports are concussions, with a higher rate in

certain sports (60 percent in football).

Unfortunately, many more concussions go

unrecognized and untreated.

How do I know if I have a concussion?

Symptoms of a concussion can be very subtle

(irritability, ringing in the ears, nausea,

difficulty concentrating, difficulty sleeping,

personality changes, sensitivity to lights or

sounds or just not feeling right). Symptoms

can also be more obvious (headache, confusion,

loss of memory, clumsiness, change in vision,

appearing dazed). ANY change to normal

brain function is a concussion no matter how

minor the symptom may be or how long the

symptoms last. Even a “ding” or getting your

“bell rung” is a concussion.

What do I do if I have a concussion?

Tell your athletic trainer or team physician. The

only treatment for sports-related concussion is

rest. This will involve stopping all sport

participation until all symptoms have resolved

and to return with a slow increase in activity

without symptoms recurring. Sometimes rest

needs to include limiting school or work

activity. If the symptoms are prolonged (more

than seven days), your doctor may be able to

help the symptoms with some medications;

typically, no medications are needed.

Will my brain return to normal?

With a single concussion and appropriate rest,

typically you will regain all your normal brain

function within 7–10 days. Sometimes a

neuropsychological test (ImPACT) will be used

to help determine when normal brain function

has returned. We cannot determine how severe

a concussion is until all the symptoms have

gone away, and we have no way to predict when

they will resolve. We do not know how many

concussions one person can have in a lifetime

before permanent brain injury occurs. This

number is different for each person. We only

know if the damage is permanent when the

symptoms don’t go away.

Can I prevent a concussion?

The only way to prevent a concussion is to avoid

injury to your head. No equipment (helmet,

mouthguard) has been proven to decrease the

rate or severity of concussion, but they do

prevent other injuries (cuts, tooth damage, eye

injury, etc) and should be worn.

Dr. Ouellette serves as team physician for Bowdoin

College and Old Orchard Beach High School. He assists

with coverage for the Portland Pirates (AHL) and

the U.S. National Soccer Teams. He utilizes the Im-

Pact test on his athletes to ensure a safe return to sports.

20 The OA Update


The OA Update 21


Advertising

Directory

OA Centers for Orthopaedics thanks the

following advertisers for making this

publication possible.

Berry, Dunn, McNeil & Parker ..................................page 9

ConMed Linvatec ................................................. page 21

DJO Incorporated .....................................................page 9

Ethos Marketing and Design ...............................page 23

Genzyme Corporation .................................. page 11 & 12

Hebert Construction, LLC ....................................... page 7

Ledgewood Construction ..................................... page 22

Maine Heart Surgical Associates ......................... page 17

Maine Medical Center ...........................................page 19

Marzilli’s Embroidery Plus

6 Marzilli Way

Windham, ME 04062

(207) 893-2948 • (207) 893-0558 Fax

marzillinc@adelphia.net

Mercy Hospital ....................................................... page 2

New England Medical Transcription, Inc. ............ page 21

New England Rehabilitation

Hospital of Portland ............................................ page 22

Outdoor Service Company, Inc.

219 Roosevelt Trl.

Windham, ME 04062

(207) 892-7700

PDT Architects.......................................................page 21

Pratt-Abbott Inc. ................................................. page 21

RBC Wealth Management. ................................... page 17

Spectrum Medical Group ................................. back cover

Surgical Systems. Inc. ........................................... page 9

22 The OA Update


The OA Update 23


OA Centers for Orthopaedics

33 Sewall St.

Portland, Maine 04102

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