Lyme Disease and the Potential for Lyme Arthritis

Catching Lyme disease alone is already an unwanted and complicated concern. To make matters worse, if left untreated for too long Lyme disease can lead to the development of lyme arthritis.It is especially important for doctors to be vigilant when it comes to examining patients who show symptoms of joint pain after being affected by Lyme disease.

According to the Johns Hopkins Arthritis Center, approximately 60% of improperly treated Lyme disease patients will develop some manner of joint pain. Most commonly the knee is the main affected area. Both small and large joints having the potential for swelling. Typically the frequency and severity of swelling and pain will decrease over time. However, approximately 10% of ill-treated patients will develop chronic arthritis.

Cause of Lyme Arthritis

Lyme Arthritis

A tick bite can potentially lead to Lyme disease through transmission of the bacterium Borrelia burgdorferi. Being bitten by a tick does not guarantee Lyme disease, but if the tick is infected by the bacterium then the chances increase. If the bitten individual develops Lyme disease, they should immediately seek medical attention.

After the development of Lyme disease, there is potential for the bacterium to invade the joints. This leads to inflammation in the surrounding tissue and can eventually wear down the cartilage of the joints. It is not always obvious to the affected individual that they have Lyme disease, let alone Lyme arthritis. This makes it especially important for medical practitioners to be attentive to patients with joint problems in areas where ticks are common.

Prevention and Treatment

Lyme arthritis

The symptoms of Lyme arthritis often do not appear until the later stages of Lyme disease. Within the first few weeks of being bitten, patients feel flu-like symptoms, stiff neck, headaches, among other symptoms. But those who develop Lyme arthritis don’t usually notice joint pain for months or even a year after being bitten.To help avoid the potential for letting Lyme disease progress into Lyme arthritis look for the following symptoms if you’ve been bitten by a tick:

  • Rash near the insect bite
  • Aching, redness or swelling in one or more joints especially the knee
  • Fever
  • Lethargy
  • Headache

While these symptoms are helpful indicators, sometimes they never develop or go unnoticed by the affected individuals. One of the best ways to prevent Lyme arthritis is to be aware of the potential symptoms. Once you are familiar with the possible effects, then you will better be able to inform your doctor. Lyme arthritis most commonly develops because it goes untreated for too long. If you and your doctor catch the symptoms early on, then the chances decrease.

If you have been bitten by a tick recently, or think you might be developing Lyme disease it is essential that you contact your medical professional right away.Those who live in the Kentucky area, and want to know more about the treatment available for Lyme arthritis, should give Louisville Orthopaedic Specialists a call today at (502) 212-2663. To learn more about Lyme disease and its symptoms in women, read our previous blog post here.

What Clicking Knees Could Mean

Clicking Knees are Very CommonA common occurrence for a lot of people is the sound of their knee joints “clicking” when they sit down, stand up, or put a lot of weight on their knee. For the most part the issue of clicking knees is not any indication of injury or cause for concern. Most doctors advise that unless the clicking sound is accompanied by pain in the knee, then you shouldn’t worry. There are many harmless reasons for the clicking sound. However, if you are experiencing clicking in your knees that is accompanied by pain, or difficulty moving, then you should look into some potential causes with your primary care physician.

Below are a few of the common explanations for clicking knees:

Meniscus Tears

The meniscus is often referred to as the “shock absorber.” It is made up of two disks that keep the kneecap in place. If one of the disks is damaged, it can disrupt the balance of the knee. A Mensical tear can cause a clicking sound in the knee because the disk is rubbing against parts of the area it usually doesn’t come in contact with.

Cartilage Injury

Occasionally the cartilage covering the kneecap can become worn down. This may cause a piece of cartilage to dislocate and catch inside the joint. When this happen, people describe the feeling as a grinding sensation within their knee.

Extra Tissue

Sometimes you can build up additional unnecessary tissue around the knee joint. The build up will cause the tissue to be trapped between parts of the joint. This will cause a clicking whenever the knee joint is moving.  

Runner’s Knee

This condition is often caused by an injury or overuse of the tibia. Runner’s knee happens when the kneecap isn’t aligned with the femur. This displacement will often make the knee pop, or click whenever utilized.

Arthritis

The inflammation that occurs with arthritis will cause the knee to align differently than usual. Along with clicking knees, arthritis can also cause stiffness in the joint.

An ACL Tear or MCL Tear

Injuries unto themselves, an ACL or MCL tear will cause pain and stiffness in the knee joint. The injury will also affect the location of the kneecap within the leg, which may cause clicking knees.

If you are experiencing clicking knees that are accompanied by pain, or inhibiting you from movement, there are treatment options available. Call Orthopaedic Specialists at 502-212-2663 to schedule an appointment with Dr. Grossfeld today!

 

15 Habits of Healthy People

15 Habits of Healthy PeopleWhile eating nutritious foods and working out are great ways to improve your health, there is so much more to consider. Health and wellness requires a holistic approach that not only focuses on nutrition and fitness, but other areas as well. In order to achieve optimal health, it may be worth your while to take a look at the 15 habits of healthy people.

  1. Eat Well: Eating fruits and veggies is important, but don’t forget to add in other food groups. Healthy people are those that add in new food groups and make good choices in the kitchen and at restaurants.
  2. Exercise Often: Healthy people are constantly on the move and getting in their workout whenever possible. These people make time for exercise instead of simply fitting it in whenever convenient.
  3. Drink Lots of Water: Healthy people are constantly gulping down water throughout the day. Instead of drinking soda and coffee throughout the day, try getting your  recommended 8 glasses of water daily.
  4. Sleep: This may sound easy, but for some this is easier said than done. Healthy people are always well rested and stick to a solid sleep schedule. This will help you succeed throughout the day and stay focused.
  5. Smile: Healthy people tend to be happy people. Try smiling more and letting others see your radiant affection.
  6. Practice Good Hygiene: To be clean is another way to be happy. Always practice good hygiene and don’t forget to floss!
  7. Try New Things: Healthy people aren’t afraid to try new things from making a new recipe, to trying snowboarding for the first time. Be spontaneous and adventurous in your healthy lifestyle.
  8. Friends: Surround yourself with happy, positive people that care about you. These friends will help you stay focused on your healthy mission in life.
  9. Practice Portion Control: Healthy people allow themselves to have a treat now and then. The reason they are able to enjoy themselves is because they practice portion control and healthy serving sizes.
  10. Avoid Addictive Habits: Smoking and binge drinking keep individuals from living a healthy lifestyle. Those that lead a healthy, balanced lifestyle refrain from addictive behaviors like smoking and other harmful activities.
  11. Set Goals: Healthy people are constantly striving for improvement. This new year don’t forget to set goals and reward yourself for these accomplishments
  12. Schedule Routine Appointments: To maintain a healthy lifestyle, you should schedule regular appointments with your physician to monitor different areas of your health. You should also obtain preventative health screenings during your visits.  
  13. Balance: In order to be healthy, you have to address every aspect of your body and mind. Juggling, prioritizing and scheduling can get stressful at times. Limit your stress by learning how to balance your life.
  14. Quiet Time: Give yourself some time everyday to reflect, think and schedule all of your priorities and tasks. Take time for yourself each and everyday in order to reduce stress and maintain your balance.
  15. Be Flexible: It is important to realize that everyone is healthy in their own way. Don’t let the stress and structure of trying to maintain the perfect body or mind keep you from doing the things you love. Try and be flexible and understanding toward conflict and trials.

Healthy, happy people are those who are able to bring a positive, disciplined attitude into the many areas of daily living. A healthy lifestyle involves a good attitude, conscious effort, determination and work hard. Try adding some healthy habits to your routine and read more of our health and nutrition blogs here. Your body and mind will thank you!

Local Marathoner Shares Orthopaedic Specialists Experience

When many of us are still at home sound asleep, Andy Gunkler has already completed his first workout of the day.

Most days Gunkler wakes up at 4:45 a.m. and heads to the YMCA Norton Commons a short while later for spin classes, weight lifting and swimming. When not at the YMCA, you might see him around town taking long walks with his dogs, or riding his bicycle with the Louisville Bike Club.

Describing himself as a “lifelong athlete,” Gunkler aims to take a minimum of 10,000 steps a day, and over the years he’s participated in nearly every sport you can imagine including: football, basketball, skiing, tennis, golf, racquetball, swimming, kayaking and cycling. And he’s run at least 10 marathons.

Sustaining an Injury

Andy Gunkler

Andy Gunkler and Alyce Weixler after completing the 2017 New York City Triathlon

After enjoying many injury-free years as an athlete, Gunkler experienced two major injuries in less than a year. The first, a painful lower back injury, was likely the result of long term wear and tear. Gunkler explains that he was in very serious pain, and after going to his regular doctor, he decided to consult with another regular from his early morning spin classes — Louisville orthopedic and sports medicine physician Dr. Stacie Grossfeld. Recognizing Gunkler’s symptoms, Dr. Grossfeld advised Gunkler on next steps and before long he was on the operating table undergoing surgery.

Fortunately, this determined 65-year-old bounced back with lightning speed, walking 5 miles just 48 hours after surgery. And then about 6 months later Gunkler took a serious fall while alpine skiing, crashing into a tree, and breaking some bones in his shoulder. “I don’t even remember falling,” he laughs, “and now I don’t have any pain, but it did impact the mobility in one of my arms.” Gunkler stretches both arms up to demonstrate and there is about a foot difference in his ability to extend the arm on his injured side.

Recovery at Lightning Speed

Despite the setbacks, Gunkler doesn’t seem to be slowing down. Most recently he and his wife
(and favorite training partner) Alyce Weixler completed the New York Olympic Triathlon which
included a 1500 meter swim, a 25 mile bike ride and a 10k run. Describing the experience,
Gunkler lights up talking about swimming in the Hudson. “In most races, the older people start
last, but in this one, they started first!” Gunkler explains enthusiastically, “The current really
helped improve my normal swim time in the Hudson,” he goes on to explain, “and the running
portion of the race was around Central Park which was wonderful!”

Gunkler moved to Louisville about 5 years ago from New Orleans where he completed two half-Ironmans and he has his own business working in franchise consulting. Growing up in Fort Wayne, Indiana, Gunkler has many happy memories of the time he spent playing basketball with his dad. In high school he participated in football, basketball, track and field, and tennis, and as a student at Wobash College in Crawfordsville Indiana, he played both football and hockey. “I came from an active family,” Gunkler explains, “My dad was one of the star basketball players for his high school team, and
my mom had a stint as a New York City model. She ate a healthy diet and walked up to 25 miles
a day, with 10 miles completed by 7 a.m.”

Staying Motivated

When asked about what keeps him motivated, Gunkler explains that he doesn’t need any
special books, training pros, music, or apps. He says that it’s just a mental thing … “You just kick
yourself in the butt and get going,” he states matter-of-factly… “A lot of us know what to do,
you just have to be disciplined enough to do it … And it helps if you have a little bit of attitude,”
Gunkler says smiling.

Reflecting on it more, Gunkler does emphasize the importance of having friends that are also
physically active. He talks fondly of his bicycle group that often shares a meal and good
conversations after their Tuesday night rides. He also enjoys getting involved in organizations
focused on making Louisville a better place to live. This includes serving on the Board of
Directors at the Norton Commons YMCA.

And he also likes supporting organizations that focus on helping out kids including the Brendon
P. Bachelor Foundation. This new organization recently launched Brendon’s Duffels of Hope, a
program designed to offer comfort to children who are in the foster system due in large part to
the drug epidemic in Kentucky.

People like Gunkler are a huge inspiration and an asset to our community. We’re very excited to
be able to consider him a part of the Orthopaedic Specialists family and we look forward to
seeing what challenges and goals he successfully accomplishes next.

Knee Osteoarthritis: 3 Types of Recommended Exercise

knee osteoarthritisKnee Osteoarthritis is a common type of arthritis that often occurs in older people, but can affect younger people, as well. Osteoarthritis of the knee is a degenerative disease that occurs when the flexible, sponge-like tissue between joints wears down. When this tissue wears down, joints no longer have padding between them and bone rubs on bone causing extreme pain. Osteoarthritis can occur in hands, the lower back area, wrists, hips, the neck, and in the knees. Quite a lot of people think that the only resolution to Knee Osteoarthritis is to take it easy on using the knees, but that is actually not true. Exercise in small, monitored doses is commonly recommended by doctors as the first approach to treating Knee Osteoarthritis.

Dr. Stacie Grossfeld of Orthopaedic Specialists in Louisville, KY recommends three types of exercise to help patients with knee osteoarthritis. The three exercises that she recommends include: flexibility exercises, resistance exercises, and cardiovascular exercises. Follow along to learn more about each type of recommended exercise.

Flexibility Exercises for Knee Osteoarthritis

Flexibility exercises include stretching of the neck, upper body, lower body, and back, upper arm raises, and yoga. These types of exercise are very good for easing stiff joints and if the exercises focus on the knees then they will help relieve tension and pain caused by Knee Osteoarthritis. Dr. Stacie Grossfeld recommends that patients suffering from Knee Osteoarthritis complete their stretching exercises in the morning. When stretching is performed soon after waking up, your body is loosened up for the rest of the day and can make moving through it much easier. If joint stiffness is extremely bad in the morning, Dr. Grossfeld recommends performing flexibility exercises in warm bath water.

Resistance Exercises for Knee Osteoarthritis

Resistance exercises are important because not only do they help to ease arthritis pain, but they also help to build muscle back around the arthritic joints. Building muscle back helps to absorb shock in the knees and protects the joints from further injury. There are two types of resistance exercise: isometric and isotonic. Isometric exercises are typically the easier resistance exercise for patients with Knee Osteoarthritis because the joint angle and muscle length stay the same. Isometric exercises include: plans, push ups, wall sits, quads, and squat holds. In contrast, isotonic exercises maintain equal muscle tone while the muscle length shortens and lengthens during exercise. Isotonic exercise are mainly used to strengthen muscles and Dr. Grossfeld recommends sticking to isometric for improving joint flexibility.

Cardiovascular Exercises for Knee Osteoarthritis

Cardiovascular exercises use large groups of muscle while simultaneously raising your heart rate. Dr. Grossfeld highly recommends that patients with Knee Osteoarthritis looking to partake in cardio fitness try water aerobics or cycling – either indoor or outdoor. Both of these forms of cardiovascular exercise are highly effective, but low impact on joints. This ensures that patients will get the exercise they need to rebuild joint health and not hurt themselves further. Dr. Grossfeld also recommends visiting the website of The National Arthritis Foundation and using it as a resource for exercise DVDs.

If exercise doesn’t seem to be helping, Dr. Grossfeld recommends a referral to a local physical therapist. Physical therapy can be helpful, especially for patients who like personalized instructions and the ability to focus on maintaining technique through fewer exercises. If you feel like you are suffering from Knee Osteoarthritis with older age or as a younger person, contact Orthopaedic Specialists today and make an appointment with Dr. Stacie Grossfeld.

Top 10 Things You Should Know About Shoulder Dislocation Injuries

Shoulder dislocation injuries can be painful and debilitating if one does not seek proper medical attention following the injury. For most, this injury occurs due to a traumatic event or during a sports game. In sports like football, hockey and basketball, shoulder dislocations are more prevalent due to the level of contact involved. While this injury is usually very simple to treat, it does require some healing time and possibly physical therapy or even surgery. If you dislocate your shoulder, immediately seek medical attention in order to readjust your arm and begin the healing process. Shoulder Dislocation Injuries

Due to the fact that shoulder dislocations injuries are common in sports, Dr. Grossfeld has created a list of the top 10 facts patients should understand about shoulder dislocation injuries.

Top 10 Facts About Shoulder Dislocation Injuries

  1. Most commonly occurs from a traumatic event.
  2. In patients under age 18 years and younger, males are more likely to undergo a shoulder dislocation compared to females.
  3. The highest rate of recurrent dislocation among younger athletes occurs in the 14 to 16 year old group.
  4. Athletes that are age between 10-13 years of age have a low risk of recurrent dislocation after initial shoulder dislocations.
  5. In general, patients younger than 20 years of age are at highest risk of sustaining a primarily anterior shoulder dislocation as well as to develop recurrent glenohumeral joint instability, i.e., recurrent dislocations.
  6. Patients that involve in contact sports are at highest risk for repeat discoloration after their initial dislocation.
  7. The most common dislocation is where the shoulder comes out the front, also known as an anterior dislocation. The most common dislocation among linebackers while playing American football is a posterior dislocation where the shoulder is dislocated out the back.
  8. Posterior dislocations are also associated with electrocution and seizures.
  9. For healthy patients, shoulder dislocations heal within 12 weeks of the injury.
  10. In summary, males, aged 20 years or less, in a contact sport are most likely to sustain a shoulder dislocation and sustain recurrent dislocations if returning back to the contact sport.

If you think your shoulder is dislocated you should seek emergency medical treatment immediately. Dr. Grossfeld is available to help assess the injury, determine treatment options and help you get back out on the field, court or life!

Concussions in the NFL: A Study in Review

Concussions occur frequently in the NFLThe frequency in which concussions occur in the National Football League (NFL) is an issue of concern. In the March issue of the American Journal of Sports Medicine, authors Michael Clark, Breton Asken, et al. explore the relationship between concussions and the mechanisms by which they occur. The authors state that although there is a significant amount of information regarding the prevalence of concussions in the NFL, there isn’t as much about the manner of those occurrences.

Below we compiled pertinent statistics mentioned in the AJSM article. Also other relevant found data, and the findings that Clark, Asken, et al. provide in their compelling conclusion.

  • From 1945 to 1999, there were 497 reported deaths directly resulting from football participation.
  • Between 1965 and 1974, the highest number of football related fatalities occurred; 36 out of the 167 brain injuries happened in 1968 alone. These fatalities led to a rule prohibiting dangerous tackling techniques. A safety standard for football helmets was also implemented by the National Operating Committee on Standards of Athletic Equipment.
  • Concussions are a concern in every contact sport.  However, football accounts for the highest proportion of these sports related injuries.
  • A concussion is reported almost every other game in the NFL.  Also a substantial portion of football concussions have historically been under-diagnosed and under-reported.
  • In 2007, and again in 2009, the NFL implemented a revised concussion management policy. Since 2009, several rule revisions have been introduced to address goals of player protection:
    • In 2010, 2011, and 2012, language regarding defenseless receivers was broadened. Helmet to helmet contact was strictly prohibited and violent players were subject to fines.
    • In 2011, the kickoff line was moved up by 5 yards to reduce the number kick returns. The running start was reduced by 5 yards in hopes of decreasing the force of collision.
    • In 2013, crown of the head impacts were also made illegal.
    • Starting in 2009, any player with the common symptoms of a concussion was to be withheld from play until fully asymptomatic and cleared by both his team physician and an independent neurologist consultant.
  • Starting in 2011, independent certified athletic trainers began to watch from the press box for possible injuries during the game.
  • In 2013, an NFL PA mandated that a neurotraumatologist consultant should be on the sideline of every game to evaluate players with suspected concussion. They required that the neurotramatologist be unaffiliated with the NFL to avoid any collusion.
  • More concussions happen in the second half of play. Fatigue most likely causes the players to neglect proper technique. The risk of concussion increases by about 24% in in the second half of a game.
  • Just up to 2013, nearly 5,000 former NFL players brought lawsuits against the NFL for concussion-related injuries.
  • One of the most common issues is chronic traumatic encephalopathy (CTE). CTE is a degenerative disease caused by repetitive blows to the head. Frequently CTE is found in professional football players as well as boxers, wrestlers, rugby players, and other participants in contact sports.
  • As of 2016, 90 out of 94 former NFL players that underwent an autopsy were diagnosed with CTE.

CTE caused by concussionsIn an attempt to combat the frequency of concussions, the NFL implemented concussion management policies, and changed rules to place greater emphasis on penalizing players for aggressive behavior. However, there is still an urgent need to further strengthen policies and introduce concussion prevention and management programs.

The AJSM authors conclude their article with: “In-game concussions in the NFL occurred through a diverse variety of mechanisms, surprisingly tended to be well-anticipated, and, also surprisingly, occurred with <10 yards of closing distance. The impacts causing concussion were broadly distributed over the helmet.” While there is more and more research regarding concussions in the NFL, there is obviously still much more to be done. Safety in sports is extremely important, and those who participate in contact sports should be extra vigilant. Learn more about safety and concussions in an earlier Orthopaedic specialists blog here.

For more information about concussions or other sports injuries, Dr. Stacie Grossfeld and Orthopaedic Specialists are here to help. For an appointment with a board certified orthopedic surgeon and sports medicine doctor in Louisville, Kentucky, call 502-212-2663 today!

Four Layers of The Hip & How They Factor Into Athletic Injuries

A recent article from the April edition of American Academy of Orthopaedic Surgeons focused on how hip injuries can lead to long-term negative effects within the athletic community. To thoroughly explain how these injuries occur, the authors Dean Lynch, Aseesh Bedi, and Christopher Larson discuss the hip joint according to four separate layers.

The Osseous Layer

Hip Joint Injuries in Athletes

The first layer involves the femur bone, the pelvis and the hip socket. Hip injuries to this layer often include:

  • Static overload

  • Impingement

  • Dynamic instability

Another less common hip injury is femoroacetabular impingement, or FAI. FAI is a condition that limits range of motion in the hip because of improper bone formation during childhood. The decrease in movement within the hip causes abnormal stress to the sacroiliac joint, pubic symphysis, and lumbar spine. Cam impingement is one variety of FAI where the femoral head is not round and therefore cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum. Also, if an anterior cam effect is present it can limit internal rotation. So it may cause levering of the femoral head which could also create posterior hip subluxation or dislocation and resultant labral tearing and cartilage damage.

The Capsuloligamentous Layer

This layer includes:

  • Labrum

  • Joint capsule

  • Ligamentum/capular complex

  • Ligamentous teres

Asymmetric wear of the chondral surfaces of the femoral head and/or the acetabulum may result from stress of the Osseous layer. The authors noted in their study that the structure of layer one produces an injury pattern for the second layer. For example, if an athlete has FAI and hip pain then a labral tear is highly likely.

The Myotendinous Layer

Layer three includes all the muscles around the pelvis, lumbosacral and pelvic floor regions. Dynamic impingement from a cam deformity in layer one causes increased strain on the SI joints, pubic symphysis and ischium. Secondary strain is placed on muscles attached around the hip joint. Due to the increased strain of the muscles and tendons it can cause tendinitis of enthesopathies.

The Neurokinetic Layer

Layer four includes the nerves within the hip area:

  • Thoracolumbosacral plexus

  • Lumbo pelvic tissues

  • Ilio inguinal

  • Iliohypogastric

  • Genitofemoral

The Neurokinetic layer is responsible for the posture and the ability to sense stimuli of the pelvis over the femur.

Athletic Hip Injuries

Common hip injuries for athletes include:

Adductor Strains

Specific muscles contribute to adductor strains. These muscles include: the adductor longus, adductor magnus, adductor brevis, gracilis, obturator externus and pectineus. The adductor longus is the most common muscle to sustain injury. On average, a soccer player with a strained adductor longus will lose 2 weeks of play time, and will have a 18 percent recurrence rate. It is important to take time to heal because player who return to practice too quickly will likely worsen their injury.

Four layers of hip injuries

Osteitis pubis

This condition occurs from overuse and stress of the pubis symphysis. It can cause lower abdominal pain secondary to stress and abnormal motion of the joint. The rectus abdomens elevates the pubic bone and the adductor tensions depress the pubic bone. An imbalance can cause a stress injury to the pubic bone. Chronic pubic symphysis can cause chronic sclerosis and widening of the symphysis. The best imaging for diagnosis of the condition is a MRI.

Athletic pubalgia/core muscle injury

Athletic pubalgia/core muscle injury is commonly referred to as a sports hernia. There is no actual hernia associated with the condition, rather it’s more of a weakening or tearing of the abdominal wall. The pain radiates into the groin and proximal adductors during sporting activities. Pain will be reproduced with a resisted setup, palliation over the pubis and the abdominal obliques and or rectus abdominus. Most imaging studies will be normal. On occasion an MRI can pick up a thinning of the abdominal wall or a tear called a cleft sign. Management is done through activity modification, NSAIDS and physical therapy. Sometimes injections will help diagnosis and treat the condition. Sports hernias rarely resolve without surgical intervention. Surgical procedures fall under three classes. These classes include: open repair with or without mesh, scope repair, pelvic floor repair with or without adductor release/repair and neurectomy.

Dr. Stacie Grossfeld is a double board-certified orthopedic surgeon in Louisville, KY with a specialty in sports medicine. If you are suffering from hip pain that is not going away or you have injured your hip and need medical attention from an experienced orthopedic doctor, contact Dr. Grossfeld today by calling 502-212-2663.

Shoulder Dislocation Research Discovers Age as Biggest Threat

Shoulder Dislocation Research News

Competitive sports and accidents may result in shoulder dislocation injuries for some individuals. This type of injury is treated through rehabilitation, immobility, and sometimes surgery. Shoulder dislocations can be debilitating, uncomfortable and painful. Dr. Grossfeld has some of the latest research on shoulder dislocations to help you better understand this injury and further complications.

The researchers evaluated 100 patients who had undergone shoulder dislocations and subsequently underwent a Bankart reconstruction. A Bankart reconstruction is used to repair the capsule and labrum that gets torn in a shoulder dislocation. The researchers were interested in the amount of recurrent dislocations that occurred after surgery. They also wanted to know the percentage of patients that then developed osteoarthritis and the severity of the osteoarthritis.

It is a well-known fact that once you have had a shoulder dislocation, your shoulder is at risk for two future problems: 1) Recurrent dislocation and, 2) The development of osteoarthritis within the shoulder joint. The trauma sustained at the time of the dislocation can damage the cartilage that involved the shoulder joint which can result in early onset osteoarthritis involving the shoulder.

There is scientific documentation that after shoulder dislocations, arthritis can occur. A study completed in Munich, Germany, specifically looked at how many shoulder dislocation patients developed osteoarthritis post-injury.

This research was published in the American Journal of Sports Medicine in May, 2015 by Dr. Plath. The researchers included 100 patients that were available for evaluation. They found that 31 percent of the patients show no evidence of osteoarthritis in the shoulder joint at 10 years of follow up. Twenty-one percent of the patients sustained a recurrent dislocation even after undergoing a shoulder stabilization procedure, and 31 percent of the shoulder showed no evidence of glenohumeral joint arthritis.

The researchers divided up the patients that had osteoarthritis after the shoulder dislocation and after undergoing surgery. They found that 41 percent of the patients had mild osteoarthritis, 16 percent had moderate osteoarthritis, and 12 percent had severe osteoarthritic changes.

In Conclusion

In conclusion, the researchers stated that on average, 13 years after arthroscopic Bankart repair, osteoarthritic changes were a common finding. They noted that the age of the patient seemed more relevant for long term dislocation arthropathy than the treatment. They felt that avoiding preoperative dislocations is more important for the prevention of osteoarthritis than short term treatment.

Older age and initial dislocation and surgery appear to be a particular shoulder osteoarthritis development. In fact, age at the time of surgery is the most consistent risk factor in the literature to date. The findings related to the normal aging process found that older patients have a higher incidence of arthritis than younger patients; however, primarily shoulder arthritis is a rare condition, and given the strong correlation of osteoarthritis and age within the study, it is evident that an older joint is more susceptible to damage at the time of the shoulder dislocation.

We also know that if you are over age 60 and you have a shoulder dislocation, 80 percent of the time there is a full thickness rotator cuff tear that occurs secondary to the injury.

The number of dislocations before Bankart repair correlated with the grade of the dislocation osteoarthritis. This implies that regardless of surgery, the extent of the trauma likely decides the fate of the long-term joint injury/degeneration.

If you have suffered a shoulder dislocation in the past and are suffering from osteoarthritis, we can help. Call Dr. Stacie Grossfeld at 502-212-2663 today or visit Orthopaedic Specialists in Louisville, KY to seek medical care.

Are There Benefits in Undergoing ACL Reconstruction After 60?

ACL reconstructionACL stands for Anterior Cruciate Ligament and this part of the human body runs between the femur and the tibia. It is one of a pair of cruciate ligaments in the human knee. The other is the Posterior Cruciate Ligament which is located deeper within the knee joint. When an ACL is injured, or torn, it is due to the ligament being overstretched. Most often, ACL injuries occur as a result of a sudden stop or twisting movement. The most common form of repair for a torn ACL is a complete ACL reconstruction. More often than not, the reconstruction is done by autograft and arthroscopically. Despite the repair tissue coming from the same body in which the injury has occurred and the invasiveness of the surgery being minimal, recovery time is set at anywhere between one to two years before a patient can return to normal sports activity.

When Dr. Stacie Grossfeld was training, the idea of performing an ACL reconstruction on a patient over the age of 60 was unheard of. In the past, ACL reconstructions were only offered to patients who were much younger. This was in part due to the extensive recovery time. Over the years, Dr. Grossfeld has found that patients in their 60s who have remained active and show no signs of knee arthritis do benefit from ACL reconstruction. This is especially true in regards to patients that live very active lifestyles. The benefits of undergoing ACL reconstruction are evident when observing patients who are over the age of 60 and have undergone the surgery.

In March of 2017, an article was published in the American Journal of Sports Medicine by authors Dr. Toanen, et al. This group of researchers conducted a study and observed patients who had ACL injuries. All patients were over the age of 60 and athletic with no signs of knee arthritis. These patients underwent ACL reconstruction and their recovery was observed by the group of researchers responsible for the article. What they found was that these patients benefited greatly from the reconstructive surgery. Not only were they able to return to their normal level of activities including: twisting, turning, jumping, and running; they also had no increased incidence of arthritis two years post reconstruction.

Based on these finding, the ground of researchers led by Dr. Toanen concluded that regardless of your age, ACL reconstruction is the best choice for repairing a torn ACL. Age is a factor that should in no way be considered when discussing options for reparation of a torn ACL. Other medical research papers and articles have been published in the past that reinforce Dr. Toanen’s team’s findings.

In December of 2014 a study was done on the long-term outcomes after ACL reconstruction in patients 60 years and older. This team of doctors, led by Dr. Champ L Baker, found that all 13 patients within their study who underwent ACL reconstruction regained their full range of motion and made complete returns to their sports or exercise of choice. This led to the conclusion that “patients aged 60 years or older have good to excellent outcomes with ACL reconstruction and should not be excluded from ACL reconstruction opportunities based on age alone.”

So, Are There Benefits in Undergoing ACL Reconstruction After 60?

In conclusion, yes, there are benefits that come with undergoing ACL reconstruction after the age of 60. Benefits include complete return of mobility, the ability to return to daily sports activity, and the lack of increase in incidence of arthritis. Furthermore, age should not be considered when deciding if a patient is eligible for an ACL reconstruction. If a patient is active, healthy, shows no signs of arthritis in the afflicted knee, and is willing to undergo ACL reconstruction, they should be considered a candidate for the surgery.

If you are 60 years old or over and an active adult who has suffered from a tear in an ACL, contact Dr. Stacie Grossfeld at Orthopaedic Specialists, PLLC in Louisville, KY. Dr. Grossfeld has been routinely performing ACL reconstruction surgeries for over 10 years. She is constantly staying up-to-date on the latest research findings surrounding ACL reconstruction. If you still have questions about ACL reconstruction for patients over the age of 60, call 502-212-2663 and make an appointment today.