Stress fractures are common in the feet and legs.

Stress Fracture Types & Treatments

Stress fractures are common injuries experienced by people of all ages and activity levels.  Learn more about the different types of stress fractures and the treatment options available at Arkansas Surgical Hospital.

Low-Risk Stress Fractures

Low-risk stress fractures can usually heal without requiring surgery.  They are not likely to develop complications.  Common locations of low-risk stress fractures include your fibula, which is next to your shin bone, and your calcaneus, or heel bone.

Conservative treatment involving RICE (rest, ice, compression, and elevation), NSAIDs (non-steroidal anti-inflammatory drugs), and limited weightbearing is the standard first line of treatment.  This treatment can last anywhere from around six weeks to a full year and is typically enough to heal your stress fracture when there are no complications.  However, low-risk stress fractures can sometimes progress to high-risk stress fractures if conservative measures do not help.

High-Risk Stress Fractures

Stress fractures are categorized as high-risk if there is a high chance of displacement, delayed union, non-union, or completion (a complete break) of the fracture.  These stress fractures often occur in areas with low blood supply, which is necessary for bone development.  Examples of these areas include certain bones in your feet, such as the metatarsals (the long, tubular bones in the middle of your foot) and the navicular (a concave bone towards the inner side of your foot).

Other high-risk stress fracture locations include “tension-side” bones, which means they bear weight as your body goes through various movements.  Stress fractures in these areas are more likely to become displaced or progress to a complete fracture.  One of these locations is the outer side of your femur, or thigh bone.

Finally, bones in areas without much muscle or other soft tissue coverage—such as your tibia, or shin bone—are also prone to high-risk stress fractures.  If your stress fracture is in one of these areas, your orthopedic surgeon may recommend surgery.  While some high-risk stress fractures heal on their own, surgical intervention is often needed to ensure complete healing.

If your stress fracture does not heal with rest, you may need surgery.  There are several different surgical techniques for stress fracture treatment, including screws, wires, rods, and plates designed to help your bone progress to full union.

Displaced Stress Fractures

Displacement is the term used to describe bone edges that have moved out of alignment, which makes it harder for your stress fracture to heal.

Displacement has several risks.  For example, displaced stress fractures in your femur can lead to avascular necrosis—the death of bone tissue caused by lack of blood supply—in the ball of your joint, which can cause arthritis or even collapse of the bone.

If your stress fracture is displaced, your treatment will need to be more aggressive.  Your bone will need to be immobilized, usually using a cast or splint, and you will need to rest it completely (i.e., no weight-bearing or unnecessary activity) for several weeks.  If that does not help, internal fixation using screws or rods is the next step to ensure healing of your stress fracture.

Delayed Union and Non-Union of Stress Fractures

There are several factors that can slow down or even prevent the healing of your stress fracture, including diabetes, hormone imbalance, and unhealthy habits.

In order to ensure complete healing of your stress fracture, you will need to follow your orthopedic surgeon’s instructions on what to do—and what not to do—before, during, and after your treatment.  Examples include:

  • Stop smoking.  Nicotine delays healing and tobacco weakens your bones.
  • Improve your diet.  Insufficient calcium and vitamin D can make it more difficult for your stress fracture to heal.
  • Do not return to activity before your orthopedic surgeon approves it.  This could delay healing and may even result in a complete fracture.

Diagnosed with a Stress Fracture?

If you are suffering from a stress fracture, contact Arkansas Surgical Hospital at (877) 918-7020 for help setting up an appointment with one of our specialists.

What to Know Before Replacing Your Hip

Considering a Hip Replacement? Here’s What You Need to Know

If you’re living with hip pain and have tried non-surgical treatments—like painkillers, physical therapy, and injections—without relief, it may be time to consider hip replacement surgery.  But before you make that decision, there are many important factors to consider.

Is Hip Replacement Surgery Right for You?

A total hip replacement procedure isn’t the answer for everyoneBefore deciding to undergo hip replacement surgery, you should consider several factors, including your age, the severity of your symptoms, your diagnosis, and your ability to complete the recovery process.

Your Age

In general, hip prosthetics last around 15 to 20 years.  Just as our natural hips can become worn down over time, so can your artificial hip: your implant can be weakened by friction during decades of everyday use.  This weakening is often accelerated by obesity or being too active.

Orthopedic surgeons typically recommend waiting until you are older to receive a hip replacement.  The younger you are when you receive your hip implant, the more likely it will be that you will have to get it repaired or replaced one day.

The Severity of Your Symptoms

If the problems caused by your hip pain symptoms are still bearable—meaning, if they don’t hinder your daily life—it may not necessarily be time for a hip replacementYou should only consider replacing your hip if all other non-surgical treatments have failed.  While hip replacement surgery is proven to be safe and effective, all surgeries carry a risk of complications and infections.  For this reason, hip replacement surgery should be considered a last resort.

Your Diagnosis

An orthopedic surgeon will need to determine the underlying cause of your hip pain to see if a total hip replacement is the right answer for you.

Arthritis

Osteoarthritis and rheumatoid arthritis are some of the most common causes of hip pain and disability.  Post-traumatic arthritis, which can develop as a result of an injury, fracture, or dislocation, can also create the need for a hip replacement.

Although hip replacement surgery is commonly utilized as a treatment for arthritis in the hip, it’s important to note that loosening of the implant is common in patients with inflammatory arthritis.  Your orthopedic surgeon will need to perform imaging tests on the area to see if a hip replacement is right for you.

Osteonecrosis

Osteonecrosis of the hip occurs when the head of your femur, or thigh bone, doesn’t receive enough of the blood supply that keeps it healthy and functioning.  This loss can lead to damage, arthritis, and even collapse of the femoral head.

Fractures, dislocations, thrombosis, vasculitis, Crohn’s disease, and alcoholism can all lead to the development of osteonecrosis.  Hip replacements relieve the pain caused by osteonecrosis because the femoral head and the damaged cartilage are replaced with artificial materials.

Other Medical Conditions

Your overall health will need to be assessed to determine whether or not you are a viable candidate for total hip replacement surgery.  Your bone health and bone density, for example, can affect whether an artificial hip will be more likely to become loose or shift out of place.  Your doctor will need to do a physical examination and go over your medical history.

Poor candidates for hip replacement surgery include those who smoke, those who have already undergone a hip replacement, those with high-risk health issues, and those who cannot commit to the rehabilitation process after the surgery.  Talk to your doctor about managing any chronic conditions—such as heart disease, diabetes, obesity, or sleep apnea—throughout the stages of your joint replacement.

Recovery Requirements

Recovery from hip replacement surgery is an extensive process.  For this reason, there are things you need to take care of well before the scheduled date of your procedure.  Being prepared ahead of time will help the recovery process go much more smoothly.

Physical Therapy

Physical therapy is necessary for success after any joint replacement procedure.  Completing your prescribed physical therapy requirements helps you heal more quickly and with fewer complications.

Physical therapy often starts shortly after your surgery while you are still in the hospital.  Your regimen will be customized to your needs as determined by a physical therapist and your surgeon.  When you are discharged, you will be prescribed specific exercises to help your new hip.

If you are unsure if you will be able to complete a physical therapy regimen after you undergo surgery, a hip replacement may not be right for you at this time.  Factors that could impact your ability to successfully perform physical therapy activities include:

  • Your health.  Your doctor will evaluate you before your joint replacement surgery to determine if you are healthy enough to participate in physical therapy.  If the physical activities you can do are limited, you may need a specialized regimen.
  • Your resources.  Not every patient has a rehabilitation center they can access near their home.  Your discharge planning team will help you find the best option for you, whether that means sending a physical therapist to your home or helping you find an inpatient facility that will better suit your needs.
  • Your time.  If you are unable to take time off of work or from other duties to commit to a physical therapy program, your body will not be able to effectively heal and strengthen.  Schedule your hip replacement during a time when you won’t be too busy to commit to your recovery.
Preparing Your Home

Before your surgery, you will be given a list of changes to make to your home in order to make it easier for you to move around and function with your new hip as you recover.  Examples include:

  • Staying on the ground floor.  Climbing stairs should be kept to a minimum, so you will need to make sure that all your essentials are on the ground floor with you.  Do you have places to sleep, eat, and use the bathroom that don’t require you to climb stairs?  If not, consider staying in a rehabilitation center or at a friend or family member’s house.
  • Rearranging furniture.  You will need a walker or cane to move around for a while after your surgery, so be sure to clear plenty of space in your living areas.
  • Removing rugs.  Rugs can slip or bunch up, impeding your mobility and increasing your risk of falling.
  • Installing shower handles.  These should be sturdy enough to prevent you from slipping and falling in the shower.  A bench or chair for your shower may also be helpful.
  • Preparing meals.  Your ability to cook will be limited, so preparing and freezing meals ahead of time is important to ensure you will have convenient access to food.
  • Getting firm pillows.  If your pillows and chair cushions are soft, buy or borrow firm ones.  These are needed to allow you to sit with proper support.  They can also be used to prop up your leg while you sleep.
Other Arrangements

For a successful recovery from total hip replacement surgery, you will need plenty of time off of work.  You will also need to arrange for help from family and friends for a few weeks once you are home, so be sure to coordinate schedules as required.  If you don’t have nearby friends or family that can help, your discharge team can help you with caregiver arrangements.

You should stop smoking before your surgery as it leads to unnecessary risks and affects your healing.  To reduce your risk of infection, schedule major dental procedures before your surgery.  No other surgical procedures should be performed within the first 90 days after your surgery.

Lifestyle Changes

While your new hip will allow you to resume many of the activities you enjoyed before you developed chronic hip pain, it is important to note that you should keep high-impact movements like running and jumping to a minimum as they can accelerate the wear and tear of your implant.  Walking, biking, and swimming are great low-impact exercises for hip replacement patients.  Other activities you can safely and comfortably take part in with your new hip include golfing, driving, and dancing.

When traveling, keep in mind that the materials used in your artificial hip may set off metal detectors.  Alert security officers at airports, museums, and other public places about your artificial hip before you are scanned.

Finally, you may need to limit, adjust, or change the way you currently bend at the hip when reaching and sitting.  Your surgical team will advise you on the specific restrictions and benefits of your new hip.

Living with Hip Pain

If you’re living with hip pain and think it’s time for a hip replacement, contact Arkansas Surgical Hospital today at (877) 918-7200 for help making an appointment with one of our specialists.

 

Source: InjuryMap

Common Causes of Shoulder Pain

If you are suffering from shoulder pain caused by osteoarthritis or injury, it is possible to restore your mobility and quality of life.  Learn more about shoulder pain and some of the shoulder treatment options available at Arkansas Surgical Hospital.

A version of this article featuring Dr. Brent Lawrence appeared in the August 2019 issue of the Arkansas Senior Resource DirectoryThe above image is sourced from InjuryMap.

The Parts of Your Shoulder

Your shoulder joint has three bones: the scapula (shoulder blade), the clavicle (collarbone), and the humerus (upper arm bone).  Your shoulder also contains muscles, tendons, ligaments, and cartilage that provide strength, stability, and flexibility.  Damage to these parts of your shoulder can lead to persistent pain and stiffness.

Common Causes of Shoulder Pain

Most shoulder problems fall into four major categories: tendon inflammation (including rotator cuff tears), instability, arthritis, or fractures.

Tendon Inflammation & Rotator Cuff Tears

Tendon inflammation commonly occurs due to bursitis, tendinitis, or shoulder impingement.

  • Bursitis: The bursa, a small fluid-filled sac located above the shoulder joint, acts as a cushion between the bones and the overlying soft tissue.  This helps reduce friction as you move your shoulder.  Sometimes, injury or excessive use of your shoulder can lead to swelling of the bursae between the rotator cuff and the acromion (part of the shoulder blade).  This results in a condition known as bursitis.
  • Tendinitis: Bursitis commonly occurs in association with tendinitis.  Tendinitis is a result of inflammation in the rotator cuff tendons and may be acute or chronic in nature.
    • Acute injuries of the shoulder can be caused by excessive throwing or other repetitive overhead activities.
    • Chronic injuries of the shoulder occur over time and are degenerative in nature.
  • Impingement: Shoulder impingement occurs when you lift your arm over your head or away from your body and the acromion impinges on the bursa and the rotator cuff tendons beneath.

Rotator cuff tears may develop from acute injury or degenerative changes in the shoulder due to advancing age, long-term overuse, wear and tear, or sudden injury.

Shoulder Instability

Shoulder instability occurs when the ball or head of the proximal humerus is forced out of the shoulder socket.  This may be partial (subluxation) or complete (dislocation) and may be caused by acute trauma or degenerative processes.  Some people are even born with general laxity in their shoulders and other joints.  Damage to the ligaments, tendons, and muscles around the shoulder may lead to recurring dislocations and even arthritis.

Arthritis

Arthritis is a common term used to refer to inflammation in a joint.  There are many types of arthritis, but the most common type of arthritis in the shoulder is osteoarthritis (also known as “wear and tear” arthritis).  Other types of arthritis may be related to rotator cuff tears, inflammation, or history of trauma.

Osteoarthritis develops slowly over time and results from cartilage being worn down to bone, causing increased friction and inflammation in the shoulder.  Symptoms of osteoarthritis of the shoulder include stiffness, swelling, pain, limited motion, and weakness.

Fractures

Fractures occur when bones around the shoulder are broken.  In older patients, this usually results from a fall.  In younger patients, it is usually the result of high-energy trauma such as a motor vehicle accident or a sports injury.  Fractures result in severe pain, swelling, and bruising around the shoulder.

Diagnosing Shoulder Pain

Consult an orthopedic surgeon for diagnosis of your shoulder problems.  An orthopedic surgeon will evaluate your medical history and your daily activities.  He or she will also physically examine you, which may include x-rays, ultrasounds, or an MRI.

Your surgeon will also ask you to describe your shoulder pain.  If the pain travels down your arm to your elbow or fingertips, for example, it may indicate that a disease is responsible for your discomfort.  Diseases that can cause shoulder pain include disorders of the spine, liver disease, heart disease, and diabetes.

Shoulder Surgery

The large majority of patients with shoulder pain will respond to simple, non-surgical treatment methods.  However, depending on your injury or condition, you may require shoulder surgery.

Examples of non-surgical treatments for shoulder pain include NSAIDs (non-steroidal anti-inflammatory drugs), physical therapy, and steroid injections.  Once non-surgical options have failed and your activities remain painful or limited, your orthopedic surgeon may recommend shoulder surgery.

Surgery may be performed with a shoulder scope for conditions such as impingement, rotator cuff tears, or instability.  In the case of arthritis, you may require shoulder replacement.  Shoulder replacement surgery has excellent success rates, and new surgical techniques have made it even more effective at eliminating your shoulder pain, improving your mobility, and restoring your quality of life.

Recovery from Shoulder Surgery

Full recovery from shoulder surgery is a long process.  Your specific recovery protocol will vary depending on your orthopedic surgeon, but here is a general outline of what to expect:

  • While you are recovering in the hospital from your shoulder surgery, you will be given IV antibiotics to prevent infection and medications to relieve your pain.
  • For the first two weeks you are home, you will need to be assisted 24 hours a day by a family member, friend, or other caregiver.
  • Physical therapy will usually start around week four and will focus on improving your shoulder’s range of motion.  Then, once your tissues have had time to heal, you will advance to strengthening exercises.
  • You will be confined to a sling for about the first six weeks after surgery.
  • Your mobility should continue to improve over the first three to six months after surgery.

Living with Shoulder Pain

There are many treatment options for shoulder pain.  To learn more about different solutions, contact Arkansas Surgical Hospital at (877) 918-7020 for help making an appointment with one of our specialists.

Dr. Brent Lawrence's Arthritis Treatment Options

Dr. Lawrence’s Treatment Options for Arthritis of the Hip & Knee

Dr. Brent Lawrence, Arkansas Surgical Hospital’s newest surgeon, offers his expertise on treating arthritis of the hip and knee.  Dr. Lawrence is now accepting patients at the Arkansas Surgical Hospital Orthopedic Clinic in Conway.

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