Through the years, many of us have developed poor habits in regard to posture and body mechanics with resultant abnormal movement patterns. Others have developed abnormal movement patterns from injury, disease, or surgery. From these aberrant patterns, muscles tighten up and movement becomes painful. The muscle even becomes tender to the touch.
Running is a sport and a great way to exercise. However estimates are that up to 8,000 people per year had injuries caused by exercise and running requiring emergency room treatment in the United States. There are some precautions runners can take that can make their running experiences safe and healthy.
Visibility: When running on the street or sidewalk wear white or bright colored clothes. In the early AM, night, or dusk wear reflective clothing/gear. Consider wearing a headlamp and rear flashing light.
Many manual techniques are utilized by therapists to help their patients recover as quickly as possible. Active Release Technique® (or ART®) is a patented manual therapy technique that corrects soft tissue restrictions that lead to pain and decreased mobility.
ART® is a specific technique where the practitioner uses their hands to examine and treat any soft tissue dysfunction.
Many people suffer from chronic foot pain due to a condition called plantar fasciitis. Plantar fasciitis is a painful inflammation of the tissue running along the sole of the foot. Often with plantar fasciitis, people have severe pain when they first step out of bed in the morning, have limited tolerance to standing and walking, find it difficult to walk after sitting for extended periods, and are unable to participate in normal recreational activities. Initially, people with plantar fasciitis just hope it will go away.
High strength painkillers, known as opiates, represent the most widely prescribed class of medications in the United States.
The success of hip replacement has been well documented over the years; however, treatment of the young, active patient with hip pain has remained a difficult problem. We have come to understand that the majority of the time this pain is due to a discrete injury or overuse resulting in tears of the labrum (a ring of cartilage that surrounds the socket), damage to the cartilage, or irritation of the muscles surrounding the hip.
It is hard to miss the attention the media has given regarding concussions in the last 2 years. Just recently the NFL made a settlement for $765 million dollars due to a lawsuit with more than 4,500 former NFL players or their representatives. Millions have been pledged for research, education and prevention.
Not everyone understands just what a concussion is. Concussions can cause problems with thinking, remembering, physical and emotional symptoms or sleep disturbance.
In addition to the harmful effects on the heart and lungs, smoking also has a number of harmful effects on the musculoskeletal system. Below are a number of reasons why, as orthopedic surgeons, we encourage our patients to quit smoking.
Deleterious effects of smoking on the musculoskeletal system include:
Osteoporosis (and therefore increased risk for fractures)
Impaired circulation to the fingers and toes (which may result in painful, non-healing wounds)
Delayed/impaired fracture healing
Delayed/impaired wound healing
Increased likelihood of complications and patient dissatisfaction following surgical procedures
Increased risk of connective tissue diseases such as rheumatoid arthritis and lupus
A unicompartmental knee replacement (uni) resurfaces one of the knee's three articular compartments with prosthetic surfaces made of metal and plastic. A total knee replacement (TKR) resurfaces all three compartments with similar materials. Patients with osteoarthritis that is limited to just one part of the knee are candidates for this procedure. For these individuals (approximately 30 percent of patients), a uni offers quicker recovery, less pain after surgery and the potential for a "normal" knee in that no ligaments are sacrificed. All total knee replacements are cruciate deficient post-op thus limiting vigorous activities due to the resultant abnormal kinematics.
One of the biggest concerns with sports participation, especially in women, is a tear of the anterior cruciate ligament or ACL. Female athletes have 3-6 times increased risk of tearing the ACL compared to males. Most of these injuries are more common with “cutting sports” such as soccer or basketball. Women have a narrow notch to the femur that houses a smaller ACL. They also have a “knock-kneed” alignment of the legs due to a wider pelvis.
Most athletes have had the experience. You are reaching to catch a ball and somehow you mistime it just a little bit. Instead of the ball nestling nicely into your palm, it strikes the tip of your finger. The pain is instantaneous. You reach down, cradle your finger and go back to playing. After the game is over you notice your finger is swollen and painful but you can bend it and think to yourself “it will get better,” but after a few weeks the pain persists, the swelling doesn’t go away and you wonder if you should go to the doctor for something that seems so trivial.
Kyphoplasty is a surgical procedure used to relieve pain associated with compression fractures of vertebra. During the procedure a balloon is inserted into the collapsed space in the affected vertebra, and inflated. The balloon is removed and the newly expanded space in filled with a bone filler, and allowed to set. Dr. Goebel explains the procedure further in the video below.
The Achilles tendon is the largest tendon in the body, connecting the heel to the calf muscles. It is often subjected to great stress, from walking, running & jumping, making it prone to irritation. When Achilles tendinitis occurs a patient may experience pain along the tendon or heel, and swelling.
Most patients experience relief from non-surgical treatment, such as rest, exercise, physical therapy, and pain medication. In severe cases, surgery may be necessary to repair, or remove, the damaged section of tendon.
Disks are the rubbery pads that provide cushioning between vertebra. Also known as a "slipped" disk, a herniated disk occurs when part of the disk pushes past the edge of the vertebra, and puts pressure on the spinal nerves.
Depending on the location of the nerve pressure, herniated disks can cause pain, numbness, or weakness in the neck, back, arms, and/or legs. In the lower back, the most common symptom is sciatica — a sharp pain that extends from the lower back down the back of one leg.
Most cases of herniated disk can be...
ACL tears are one of the most common (and most well known) injuries of the knee, and are more common among athletes who participate in intense running and jumping sports. The cruciate ligaments are located in the knee joint connecting the femur (thigh bone) to the tibia (shin bone). Common causes for ACL injury include stopping running suddenly, incorrect landing, or direct impact (such as a football tackle).
Hand therapy is defined as the art and science of rehabilitation of upper limb dysfunction. This is defined as disorders of the hand, wrist, elbow and shoulder girdle. Hand therapists are expert in the application of physical medicine principles employing theory and techniques from both Physical and Occupational disciplines. Hand Therapy assists the patient in regaining function and enhancing the individual's ability to fully participate in the demands of daily life, employment and leisure activities.
Hand Therapy at Blue Ridge Bone & Joint is provided by Paul J Bonzani OTR/L CHT. Mr. Bonzani has been a certified...
The ASTYM System is an advanced form of soft tissue mobilization, which enables clinicians to effectively initiate remodeling and regeneration of dysfunctional tissue. ASTYM is an evidence based rehabilitation process designed to effectively treat chronic tendon disorders, scar tissue and fibrosis. These problems may have developed from trauma, surgery or overuse. The system is effective for new injuries as well as chronic nagging conditions.
Below is an archive of our educational magazine, featuring a Blue Ridge Bone & Joint staff directory and articles about a range of orthopedic topics. Click the links to view the PDFs.
2011 BRBJ Magazine
2009 BRBJ Magazine
Blue Ridge Bone & Joint is uniquely qualified to care for patients in the area of Orthopedic Sports Medicine and Primary Care Sports Medicine. Our three fellowship trained physicians — Jay Jansen, MD, Michael Shea, MD, Craig Burnworth, MD, and Robert Boykin, MD — specialize in the care of all athletes from elementary school to college athletes, weekend warriors toseniors. These doctors are currently the team physicians for several local universities and colleges, including UNCA, Mars Hill, Montreat College and Warren Wilson College. Multiplelocal high schools and youth and adult sports organizations are also covered year-round. Currently and throughout their...
Total shoulder joint replacement is an option for patients experiencing joint dysfunction. The decreased function and resulting pain is most often caused by arthritis. Osteoarthritis, rheumatoid arthritis, rotator cuff arthropathy, and trauma related arthritis are the four most common sources of shoulder joint destruction. When conservative methods of treatment (oral medications, injections and physical therapy) fail to provide adequate relief, shoulder replacement is considered.
The primary purpose of shoulder joint replacement is to relieve pain. Many patients will also experience an increase in range of motion. Shoulder replacement has an extremely successful track record with survival of implants over 90% at 17...
A knee has three compartments; one where the knee cap [patella] moves back and forth on the thigh bone [femur] and two weight bearing compartments where the femur moves upon the tibia separated by the two cruciate ligaments in the middle. Where these surfaces meet and move one on the other [articulate] the bone is covered with a thin [about 1/8th inch] layer of articular cartilage that is very smooth and slick. If this layer is disrupted for any reason and is no longer a low friction surface, the joint [arthro] becomes inflamed [itis] and the knee's owner has...
An evaluation of a neck or back condition entails a complete history and physical, as well as a review of any imaging studies. It is important to correlate a patient's symptoms with their objective findings and imaging abnormalities in order to arrive at an accurate diagnosis. Often times, there are findings on an imaging study that do not correlate with a patient's symptoms, and therefore are considered "incidental". These incidental findings often do not require any specific treatment. Delineating the exact etiology of a patient's symptoms is the most important initial step in the treatment process.
There have been a myriad of changes during the past 10 years in the management of patients with hip pain. Improvements in implants, refinements in surgical techniques, and advances in non-arthroplasty treatments have led to excellent outcomes and many satisfied patients.
Shoulder ailments come in all shapes and sizes. From the teenage gymnast to the elderly gardener, limitations from shoulder pain are quite disabling. Confirming the correct diagnosis and integrating proper treatment pathways will again allow the patient to position their arm in space and return to the activities they love. Common shoulder problems can be identified by taking a comprehensive history, performing a detailed shoulder exam, and complimenting these with diagnostic tests as necessary.
Subacromial impingement syndrome occurs in the middle aged population. Structurally, this occurs when the rotator cuff and humerus impinge on anterior acromial osteophytes and the...
Trigger fingers are a common cause of discomfort in the palm, often associated with a distinct locking of the affected digit. The digits most commonly involved are the ring finger and the thumb, though any digit can be affected. Patients with Carpal Tunnel Syndrome have a higher propensity to develop trigger finger, and again the cause is usually unknown. Symptoms can sometimes resolve spontaneously, and rest and NSAID’s can provide relief. Steroid injections can be curative in about 50% of cases.
Osteoarthritis can affect any synovial joint. Most commonly affected in the hand are the DIP joints, followed by the thumb CMC joint and the PIP joints. The wrist joint can be affected as well, usually as a consequence of prior trauma (fracture or ligament rupture). Hand surgeons have a range of treatments available to help. Treatment is generally symptomatic initially (heat, gentle range of motion, NSAID’s, splints, activity modification.) Steroid injections can provide transient relief.
Ganglions are the most common “lumps” in the hand and wrist. They are fluid-filled synovial cysts generally emanating from a joint or tendon sheath.
Dupuytren’s contracture is the result of a pathological thickening of the superficial palmar fascia of the hand leading to an inability to straighten the finger, usually at the MP joint but sometimes at the PIP or even DIP joints. Although it is usually painless, it can interfere with function. The cause is unknown but there appears to be a genetic component (it is more prevalent in those of northern European heritage) and a loose association with alcoholism and epilepsy.
DeQuervain’s tendonitis is a common condition affecting the tendons of the first dorsal compartment on the radial side of the wrist. It is classically described in new mothers but can affect adult men and women of any age.
Cubital Tunnel syndrome (ulnar nerve entrapment in the elbow) is the second-most common compressive neuropathy of the upper extremity. Symptoms usually consist of a sensation that the small and ring fingers are asleep and are sometimes associated with discomfort in the elbow.
Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy of the upper extremity. The cause is usually unknown but it can be associated with certain medical conditions (diabetes, thyroid disease) or previous trauma (wrist fractures or ligament injuries). Genetics is increasingly believed to play a role as well. Contrary to popular belief, there is no evidence that “repetitive motion” causes CTS — a myth that is particularly difficult to dispel, especially since patients often are more aware of their symptoms when they perform those activities.
“I have heard that you can get carpal tunnel syndrome from typing, but my symptoms have occurred since beginning to play the guitar. Is there any relationship here?”
The hand is composed of a sophisticated system of bones, ligaments, tendons, muscles, and nerves designed to perform complex tasks. Diagnosis and treatment of this system allows a return to normal activities. Our team of professionals have the special skills necessary to successfully treat your hand problems.
Additional sources of information on the hand can be found at:
Post Operative Instructions
Meniscal repair is usually performed in conjunction with anterior cruciate ligament reconstruction, but occasionally is performed as an isolated procedure. Specific to meniscal repair is the need to use postoperative bracing. Weight bearing is allowed only in extension (with the leg fully straight).
Post Operative Instructions
Anterior Cruciate Ligament Reconstruction is usually done with a graft from one of two sources: from a donor (allograft) or from your own tissue (autograft).
Post Operative Instructions
Arthroscopy of the knee is done as an outpatient procedure. Some of the most common knee arthroscopy procedures I perform are listed below. You were given a set of instructions after your surgery explaining the basics of what is coming now that your surgery is complete. Hopefully this site will answer any further questions you may have regarding your surgery and post operative course. This section is broken down to the following procedures:
General Post-Operative Instructions
Following total knee arthroplasty, you will be involved with several care providers. Our office will coordinate physical therapy and home health to make sure that your surgery has been a success and you obtain maximum benefit from this procedure. I routinely use a rotating platform knee (knees that bend and rotate).
Total hip arthroplasty post-operative patients have several unique and specific restrictions. These instructions and precautions are initially introduced during the preoperative class and continue for as long as you live. Specific precautions for total hip patients include restrictions on position of the hip after surgery. The hip should not be flexed, adducted, and internally rotated at the same time or a dislocation may occur.
This set of positions of the hip is best illustrated in the seated position with the hip flexed or bent at the waist. Adduction is when the leg crosses the...