• A Study on Concussions: Symptoms and Severity

    Posted by Orthopaedic Specialists

    What are the symptoms of a concussion

    When it comes to concussions, oftentimes people are tricked into thinking that the symptoms and signs they experience are only temporary, since some of the more common ones aren’t necessarily considered severe. But this isn’t always true, and we’ll hear first-hand from Harriet Owen how brushing symptoms off, even after the smallest of head injuries, can be extremely detrimental in the scheme of recovery.

    Concussion Symptoms, Signs, and Grades

    This mild to severe system of recognition manifests in the existence of ‘grades’ that concussions can be classified by. While there is usually only one diagnosis of “yes, you have a concussion” or “no, you’re clear,” sometimes, a diagnosis can be furthered into 5 grades that build off of each other.

    1. Grade 0: A slight headache and perhaps some difficulty concentrating.
    2. Grade 1: A dazed or confused feeling for less than a minute.
    3. Grade 2: Cloudy, dazed, or confused senses that last longer than a minute, dizziness, amnesia, ringing in the ears, irritability
    4. Grade 3: Becoming unconscious for less than a minute
    5. Grade 4: Becoming unconscious for more than a minute

    These aren’t the only symptoms of a concussion, though, and when it comes to the full list of signs of a concussion, the CDC categorizes them into 2 groups: observed and reported.

    Observed symptoms are usually picked up externally, by outsiders who are watching the individual. This might include parents, teammates, coaches, friends, romantic partners, doctors, or trainers. It’s important to make note of head injuries so that if these signs do start appearing, then proper treatment can be sought and the injury isn’t left to become worse.

    Observed Signs of Concussion:

    • Can’t recall events prior to or after a hit or fall
    • Appears dazed or stunned
    • Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent
    • Moves clumsily
    • Answers questions slowly
    • Loses consciousness (even briefly)
    • Shows mood, behavior, or personality changes

    Reported symptoms are the opposite – they usually don’t have any outward evidence (although some of them might), and it’s the individual that recognizes the change or feeling and then let’s someone else know.

    Feeling dizzy and nauseous

    Reported Signs of Concussion:

    • Headache or “pressure” in head
    • Nausea or vomiting
    • Balance problems or dizziness, or double or blurry vision
    • Bothered by light or noise
    • Feeling sluggish, hazy, foggy, or groggy
    • Confusion, or concentration or memory problems
    • Just not “feeling right,” or “feeling down”

    No matter how mild the concussion is, a checkup with a medical professional should be sought out, because brain injuries can be very dangerous, if given the chance.

    Harriet Owen’s Growing Concussion Symptoms

    Harriet’s specific symptoms provide a great example of what can happen if concussions are not taken seriously by individuals and the doctors that provide them care – what could have been a short recovery time snowballed into a 15 month period of pain, confusion, and misdirection.

    Harriet describes the initial crash and subsequent signs as, “I knew almost immediately I’d hit my head, my helmet was scuffed and I had a bit of a headache, but I didn’t think it would have caused me a sustained concussion.”

    This is why concussions are such slippery conditions – if it’s just a headache, it really doesn’t seem like anything to have to go to the doctor for. But even Grade 4 concussions can start out with symptoms of a Grade 0 concussion. Within a few days, that one small, unassuming headache didn’t go away and continued to become worse, and that’s when Harriet realized that something was wrong.

    Her next problem? Her doctors didn’t. She was prescribed over the counter painkillers and more sleep, but no neurological or imaging tests were performed, even after persistent pain. Harriet began to experience more severe symptoms as time went on, with the reported worst being:

    • Fatigue

    Even the smallest tasks drained her, and that led to more time inside, in dark rooms, and unable to do the things she loved. This contributed to the worsening of other symptoms such as depression and physical activity difficulties.

    • Headaches

    What started as a small symptom quickly turned unbearable. This led to light sensitivity and contributed to a lack of concentration and memory from the constant pain.

    • Personality Changes

    Without the ability to cycle and complete daily tasks without pain and other side effects, the pain combined with the fact that her brain couldn’t regulate her emotions as well as it had been caused personality changes in the form of depression, mood swings, and reactive behavior.

    She says that, “…my change in personality really impacted everyone around me the most. I wasn’t myself; they didn’t know how I was going to react or be each day, and they didn’t know how to help me.”

    • Lack of Concentration and Memory

    Even as a professional cyclist, Harriet still has a full-time job as a data-analyst for Trek Bicycle Corporation, which involves a lot of screen time. The light from the screen triggered headaches and the work caused mental fatigue, even when she already felt that she couldn’t function at 100% due to her lack of concentration and memory, and that was demoralizing.

    • Difficulties Participating in Physical Activity

    Cycling is Harriet’s passion and her profession, so slowly becoming unable to ride at all became a dark spot in her life, and this big change in her life greatly affected her mental health.

    She says, “Cycling for me during this time, was mostly non-existent or very inconsistent. If I ever did ride, it would be no longer than an hour at a lower heart rate, and my body would play catch-up, and I’d pay for it a couple of days later. It wasn’t healthy for me to keep being in this vicious cycle, so there was a long period of time that I just couldn’t ride. It affected me mentally, as well as physically, I lost a lot of muscle mass!”

    When asked which symptoms impacted her daily life the most, Harriet quoted headaches, fatigue, and personality changes. But the shift from cycling every single day to barely being able to do an hour of low-heart rate exercises exacerbated her condition and the side effects that came along with it, and the initial habits she formed when she hadn’t gotten a concussion diagnosis ultimately hurt her recovery.

    Concussions Are All Around

    Sports players get a lot of concussions. Why?

    Especially in athletes, concussions are a likelihood of every head injury obtained. We’ve heard from a professional just how easy it is to brush off the burgeoning symptoms, and how that can play a part in the recovery process.

    Even if you don’t encounter concussive accidents much in your sport, it’s still a big risk! As a cyclist, Harriet didn’t believe that concussions were all that common in cycling, but once she deliberated further, she realized that a cyclist hits their head more often than not when they crash their bike, which is just a part of the sport.

    Helmets and other head safety gear provide some protection, but concussions occur internally. So, while your head might still be intact thanks to the helmet, your brain doesn’t have the same stability, and is very susceptible to injury and, subsequently, the side effects.

    No element of a concussion is enjoyable, but the worst part, according to Harriet, is that, “Life as you know it is taken away from you the moment you hit your head. People can’t see the injury, so it’s hard to anyone to understand what you’re going through. It is a real mental battle to get back.”

    What to Do If You Have a Concussion

    Don’t let a concussion trip you up or slow you down! Get help and a diagnosis as soon as you recognize any sign or symptom of even a mild concussion. If caught early, no matter the grade, treatment and recovery time will be far less intense and the toll on your body far less severe.

    In the third and final installment of this blog series, we’ll explore the extensive and innovative treatment that Harriet went through to get back to her best form, and what she might have done differently if she had known that she would end up with sustained concussion.

    If you or someone you love has suffered a concussion or head injury in the Louisville, Kentucky area, board-certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    When to Phase Out Sports Gear for Safety Reasons

    Posted by Orthopaedic Specialists

    Sports gear should be replaced for safety

    When it comes to sports, especially athletes who are serious about their performance and further opportunities, equipment plays a big part in a lot of different aspects of the game. From how well they play, to how long, to if they can at all since there are a lot of requirements – sports gear can very quickly become a pricey addition to giving up evenings and weekends to get to practices or watch games. Unfortunately, some sports require more equipment than others and, for safety’s sake, need to be replaced more often.

    From structural integrity to an entire change in your form that puts more pressure on your bones and joints, phasing out gear is integral to those who participate in sports regularly. If you’re not sure if you or your child’s equipment needs to be replaced, we’ve done the research for you and have come up with a list of sports and their subsequent equipment that needs to be inspected, monitored, and renewed once their time in the safety parameter is up.

    Running Shoes

    When it comes to specialized sports gear, running is one that doesn’t require an entire bag of different items. However, the equipment it does require – running shoes – are a very important detail that contributes both to performance and safety.

    As shoes wear out, they will:

    • Lose tread, which can lead to slipping
    • Develop fabric holes in the top
    • Lose sole cushioning, which leads to more impact on your muscles and joints and more strain in your tendons and ligaments, and even stress fractures
    • Cause your gait to change with the deterioration of material

    To avoid this, it is recommended that you change your running shoes out every 300-500 miles or 4-6 months. Pay attention to your runs, though, and if you run more than that, it could be sooner!

    Signs that shoes (include cleats!) are getting worn down and need replacing:

    • You feel more sore or have aches and pains in your feet, ankles, knees, hips, or spine
    • You get new blisters/the shoes are uncomfortable
    • The shoe shows excessive wear or breakage on the interior or exterior
    • The shoe doesn’t feel like it protects you anymore

    Cleats

    So many sports require cleats to play; you’ll often find that cleats are not interchangeable between each individual playing field. Even so, some are similar in regard to how long you can wear them, and others are quite different. Sports gear that is categorized as non-running shoe footwear is just as important as running shoes, but with the highly differential nature between pure running and running during a game, need to be treated differently, as well.

    • Cycling:

    For these specialized cleats, it’s recommended that they’re replaced every 3,000-5,000 miles cycling or when you notice them either beginning to get stuck in the pedal or not catching on.

    • Soccer:

    Usually, every season does a number on soccer cleats. By the time a full, higher-intensity season is finished, they might be holding on by a few threads! For a lower-level season, such as a recreational or school league, cleats will usually last for a couple of seasons, but replace when they begin to lose shape or form holes, since every position will have a different playing style and intensity, which affects the life of the boot.

    • Football:

    Like soccer, football cleats will usually only last for one season. Depending on the surface that you’re playing on, though, you may be switching from one type of cleat to another, and each pair will last a little longer.

    • Baseball/Softball:

    In general, baseball and softball cleats will last around 6 months to a year, or approximately 1-2 years of weekly games, depending on how often they’re used. If they are used in a higher league, where practices and games multiple times a week occur, then it will be much shorter. Cleats should provide stability, grip, and acceleration; once they stop giving that, it’s time to invest in a new pair.

    • Honorable mention: Skates:

    With skates, since the actual fabric and material part never actually touch the ice, more often then not, it’s only the blade that needs to be replaced. It’s recommended that the blades be replaced once they are dulled down to lower than 3/8″ at the center of the ball of the foot area or the center of the heel area. In regard to the material part, you should be on the look out for loose rivets, holes, proper stiffness and support, and quality of the blade holder.

    Mouth Guards

    As a general rule, you should be replacing your mouth guard after every season or every 6 months. Not only does this provide cleanliness and sanitation, but mouth guards become less effective with use, thinning out and fraying and not being able to protect your teeth as well.

    However, especially with younger mouth guard-wearers, there are some circumstances that they should be replaced sooner. These are:

    1. If it gets damaged, thins, or deformed
    2. If your mouth is still growing or you are undergoing orthodontic treatment
    3. If your bite has changed (losing baby teeth or getting wisdom teeth removed will both change a bite)

    Helmets

    Depending on the sport, again, helmet replacement has a different time frame, especially in reference to the material it’s made with and how it’s used.

    • Bike helmets: Every 5-10 years depending on amount of use. More biking = sooner. Less biking = later.
    • Football helmets: The CDC recommends every helmet be replaced entirely every 10 years, but reconditioned and recertified every 2 years.
    • Batter/catcher helmets: After 10 years, batter helmets are not eligible for recertification and should therefore be replaced. However, some helmets are recommend not to recondition/recertify at all, and should be replaced every 3-5 years, depending on the quality of it.
    • Motor sports and equestrian helmets: Every 5 years is the standard, but if the material shows any signs of extreme wear and tear such as cracks, tears, breakage, or loose parts, its essential that it’s replaced sooner.

    Gloves

    There is a lot of nuance to softball and baseball gloves, which are the two sports that use them for safety reasons along with performance.

    The life and safety that a glove provides depends heavily on the use and care put into the glove. For higher leagues, the normal life of a glove is about 2 years, and then noticeable wear and tear begins to show, and the replacement happens. In order to protect the thinly covered bones in your hand from the intense and often fast-moving projectiles that you’re trying to catch, your glove needs to be up to the task of giving you the best performance and the best protection.

    It’s important to phase out gloves when:

    1. The padding feels thin and your hand feels unprotected
    2. The material feels dense and heavy when you use it
    3. There is a ripping, cracking, or other physical deficiencies
    4. The form is floppy, formless, and doesn’t hold shape anymore

    Bats and Rackets

    With these types of very necessary pieces of sports gear across the board, phasing them out can be a question of safety, especially when considering average breakage points and whether or not the gear breaking would put anyone at risk at any given time, but more often than not, this category of gear can be phased out when it loses its functionality.

    Baseball bats, with as much as they’re thrown around in proximity to other players and fans, are probably the riskiest of the items in this category, and their time in the hands of players usually lasts from 1-3 years. Especially with wooden bats, which break and shatter more often than composite and aluminum bats, there should be consistent and often inspection of bats to make sure that there are no physical deformities, rips, tears, or sharp edges present.

    Tennis, pickleball, squash, badminton, etc. rackets should be inspected for any fraying of the strings, as well as any exposed material underneath the grip of the racket that might cause you pain when it twists and shifts as you play. The materials begin to break down with the nature of the game – flexing and bending in a way that, overtime, will distort the racket and cause structural degradation. It’s suggested that, on average, around every 2 years, you might want to start looking for an upgrade.

    Protective Gear/Pads

    In football, with as much contact as there is, it’s important for the safety gear outside of helmets to be properly cared for, reconditioned, and replaced. Shoulder pads should be cleaned and sanitized after every use, reconditioned every year, and replaced every 3-4 years. Sometimes, the retired pads can be reused and passed down to the junior varsity team for practice or a younger league that isn’t as intense as others are, but protective sports gear needs to be up to standard and able to prevent injuries in those situations for them to be ethical.

    Have You Had a Sports Injury Near Louisville, KY?

    If you or someone you love has suffered a sports injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    A Study on Concussions: Meet Harriet Owen, Professional Cyclist

    Posted by Orthopaedic Specialists

    Getting a concussion is a serious injury, especially if it goes undiagnosed or untreated. Head trauma, no matter how small, should always be tested for possible concussions, because as we'll read, they can have big consequences if left alone.

    You get rear-ended on your way home from work, a stray foul ball hits you when your attention is elsewhere at your child’s baseball game, you trip over a root on a hike and don’t have time to catch yourself before your head hits the ground – head injuries are more common than you might expect in everything you do. When doing recreational activities, though, especially contact ones, our risk of concussion skyrockets more than any other time, and most people might not think to take the proper precautions once the injury occurs.

    What is a concussion?There’s an age-old myth of ‘concussions don’t happen in non-contact activities’ that manages to fool many of us, but without proper gear, training, or awareness, you’re just as vulnerable to concussions in non-contact activities as you are in contact ones. And you can, of course, still get a concussion that isn’t sports-related – adults are especially prone to getting them as a result of a fall.

    Any head injury can result in a concussion, which is defined by the CDC as,

    “…a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

    Each year, there’s a suspected 1.7-3.8 million concussions that happen due to sports and recreational activity, but there’s a catch: only 5 in 10 concussions are reported or detected, which means there’s a hidden 50% of concussions that go untreated.

    If some concussions are so insignificant as to go undetected, then why worry about them? Surely a headache for a few days can’t be that bad, right?

    Wrong, actually.

    Meet Harriet Owen, a professional cyclist from the UK who took over a year to recover from a concussion – one she thought was simply a temporary headache that developed from crashing her bike like she had done so many times before.

    Harriet Owen and Her Story

    Can minor concussions be serious? This professional cyclist says yes - her's took 15 months to recover from.Having been cycling since she was 11 years old, Harriet Owen’s love for biking is a long, multi-generational one. Ever since she was a child growing up in Oxford, United Kingdom and watching her father compete in local races, Harriet looked at a bike and saw fun and excitement, but perhaps not her future as a professional cyclist, at the time.

    Her cycling teams stretch back to 2011, but her professional career didn’t start until 2015, and she was a year into it before coming over to the United States to race in criteriums in 2016. Her experience with concussions, though, began in March of 2021, as she was participating in her team’s first training camp in Belgium.

    On their first ride together, Owen and her team set out to practice some basic drills and rotating techniques. Whilst in the middle of the pack, the rider directly in front of Owen hit a bump in the road and subsequently knocked into the back wheel of the teammate in front of her, resulting in a crash that no one had time to react to.

    As she and another teammate were sent right over the top of the crash, she collided head-first into the ground, earning what she thought was a scuff on her helmet and a bit of a headache that would go away after a while – nothing that she even remotely thought would end up being a concussion that would take 15 months to recover from.

    From a minor injury to a nearly career-ending experience, Harriet quickly found that her concussion – left untreated or mistreated by the neurologists that she saw as the headaches persisted – was far more severe than she thought. Despite having to face a serious injury in a foreign country, Harriet found a support system that led her to the life-changing, innovative training and treatment that she received right here in Louisville with the help of Dr. Grossfeld, Dr. Mark Lynn of Lynn Family Vision, and their colleague Dr. Tad Seifert, a nationally-renowned neurologist.

    Coming back from 15 months of constant pain, memory and concentration issues, personality changes, mood swings, and constant fatigue was a battle that Harriet had to struggle through with previous doctors telling her to take over the counter pain medications. She was constantly overexerting her body and mind, and demoralizing adjustments in her everyday life led to periods of depression. Now, though, with the ability to look back at her experience, Owen has come out of it with a depth of knowledge regarding concussions, symptoms, signs, prevention methods, and a high respect for and understanding of the consequences that result from leaving head injuries untreated, as well as a story to tell other athletes to raise awareness.

    Make sure to tune into the next few blogs to learn more about Harriet’s story, her treatment, her roadblocks and hurdles on the way to recovery, and all about concussions, including their symptoms, their severity, and how they can affect facets of your life that you might not have considered.

    If you or someone you love has suffered a concussion or head injury in the Louisville, Kentucky area, board-certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Winter Paddle Boarding

    Posted by Orthopaedic Specialists

    Winter paddle boarding what to wear and how to do it

    Now that we’ve crept into the colder months, all those fun summer activities we listed seem to have run their course and passed their prime time. But that’s not true at all! In fact, the activities such as trail walking, running, and hiking and indoor fitness classes are just as applicable in the winter as they are in the summer. But what about winter paddle boarding?

    That doesn’t seem to make much sense upon hearing, at first. All water activities, actually, seem a little out of reach unless it’s lap swimming at an indoor pool. If you’re up for a challenge, though, incorporating or continuing certain summer water activities into your winter workouts is plenty feasible.

    Winter paddle boarding is a hobby that many don’t want to give up because of colder temperatures and frigid waters – and you don’t have to, either, if you’re willing to take the correct precautions.

    Considerations for a Safe Winter Paddle Boarding Experience

    1. Weather

    Just like summer paddle boarding, weather plays a very big part in your adventures. Precipitation isn’t anyone’s friend on the paddleboard, as it makes the board slick and difficult to remain upright on. Pairing this with frigid waters should you fall in, and you have much less favorable circumstances than you would if you fell in during the summer.

    To make sure you don’t get caught in a winter storm or a low-visibility environment, always check the weather before setting out on your winter paddle board journey. It’s good to remember that winter weather can be much more unpredictable than other seasons, and attempting to ride the front-end of any storm probably won’t work out in your favor.

    These conditions may also change the environment you think you know, as well as other features such as current strength and the stillness of the water. If you aren’t properly prepared, winter weather can play a much larger factor than you think, so always take it into account, especially when dressing for it.

    2. Clothing

    What should you wear when winter paddle boarding? Clothing is one thing that can make or break your winter paddle boarding excursions – we all know it’s cooler on the water, and you need to dress for that, even if you’re deciding to go paddle boarding during a mid-winter warm spell. Dress in layers, and try to avoid cotton, as it stays wet once it gets wet. If it’s your primary layer and it absorbs moisture, you might be a little colder than you anticipated.

    Your clothing lineup should include all of the following:

    • Water Shoes
      • Insulative boots made of neoprene or other waterproof materials work best to keep your feet warm while still giving you a good grip on your board.
    • Gloves
      • Make sure your gloves are flexible enough to grip your oar
    • Hats and/or Ear Warmers
      • Most body heat is lost through the head, so you’ll want to make sure to cover it up! Beanies and other full-head covers are better suited than ear-warmers, but you might want to bring both in case your hat doesn’t cover your ears.
    • Sunglasses
      • Make sure you can see past any reflections on the water. Fishing sunglasses can even help you see what’s below the surface better, too!
    • Wetsuit or Drysuit
      • If you think you’ll come into contact with the water, rely on a wetsuit to keep you warm, but a drysuit is just fine if you don’t think you’ll fall in!
    • Body Warmer or Appropriate Covering

    3. Time and Place

    If you’ve only just started paddle boarding, or you’ve only ever paddled in one location, winter might not be the best season to branch out. Try to stick to locations you know with still water and not a lot of ice chunks or frozen-over, slushy zones. Sticking close to the shore is a good idea, as well, since those will be the warmer waters and with more places to stop should something go wrong.

    It also might be tempting to go when you’d normally work out before or after work, but with days getting shorter and darkness both lingering longer into the day and settling in earlier in the evening, you don’t want to be caught on the water in the dark. Anyone else on the water needs that light to be able to see you, and you need the light to see where you’re going. It’s always colder without the sun, so you’ll need to plan ahead for the sunrise or sunset that marks either the beginning or the end of your winter paddle boarding trip.

    4. Gear

    Besides clothing, your paddle boarding gear might stay relatively the same, depending on how light you pack and how experienced you are. In the winter, you should always have and use a SUP leash, so that in the case of an accident that ends up with you in the water, you have the quickest means to track down your board and exit the water without expending too much precious energy.

    Your phone should also be on-hand, in a waterproof case, and physically attached to either you or your board for easy access and safety. Especially if you’re paddling solo (which is something we’ll cover momentarily), you’ll want a way to contact a friend if something goes awry, you lose more energy than you expected before you get back to your entry site, or unexpected weather rolls in.

    5. Company

    Since open water activities hold more risk than controlled activities, you always need to have a point of contact. Phones are a great and necessary tool to have, but in the event that you lose the device, or it runs out of power, someone should either be with you or know where you are and what time they should expect the “I’m Okay!” call.

    Paddling is always more fun with a buddy, though, so it’s highly suggested that you find a friend to take on the winter waters with you! This goes for both winter and summer, however, and anthropocentric safety measure should never be overlooked.

    6. The “After”

    Having a warm-up bag ready for you when you get back to your mode of transportation is an easy way to combat the chill of winter. A warm change of clothes that include thick socks, a comfy sweater or sweatshirt, and some throw-on sweats can get your body temperature right back up – bonus points if they’re oversized for . Having a towel in case of any water accidents is also a necessity, and towels that you can attach to your body for an easy change outside of the car can be super helpful and much easier than trying to wriggle your way out of your suit in your seat.

    A lot of winter paddle boarders also pack a thermos full of something warm to eat and/or drink to refuel after your adventures on the water, and you should always have water around to hydrate! Even on cold days, you still sweat and need to drink water or some other rehydration beverage to replenish your body, so make sure you grab a drink before you leave!

    Are You Ready?

    Now that you have all this knowledge, you can include winter paddle boarding on your “to-do” list in these cold months! Make sure to warm up those arm muscles and stretch out those legs before you get moving, and don’t lock your knees! Are you ready to paddle? Check out the best locations to paddle board (remember to know your surroundings, though) in Louisville!

    If you or someone you love has suffered an injury in the Louisville, Kentucky-area, double-board certified physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    5 Ways You Can Prepare for Rotator Cuff Surgery

    Posted by Orthopaedic Specialists

    How to prepare for shoulder surgery rotator cuff

    If you’ve never had experience with surgery, your first time in the operating room might be daunting. That anxiety, combined with the fact that shoulder injuries are never fun, much less rotator cuff shoulder injuries that require surgery, might have you surprised to find out that you have a reason to be relieved.

    Now, we know you’re probably scratching your head and asking, “Relieved? How?” But, as tough as rotator cuff surgery can be, it does have one upside: you have the ability to prepare for it – sometimes even weeks to prepare – which is not an amenity some operations have.

    While each hospital might have variable guidelines and pre-operative guides, there are plenty of things you can do to prepare for the ‘after’ of rotator cuff surgery.

    How to Prepare for Rotator Cuff Surgery

    Rotator cuff surgery is one that requires roots of healing to become better. There is no band-aid method where the surgery is done and you become better without taking extra steps – it’s a high maintenance surgery. Full recovery can take up to a year, and you’ll be managing pain and juggling your everyday tasks one-handed for four to six weeks – it’s important to take your preparations seriously and do them thoroughly to mitigate discomfort and frustration during this time.

    Take a look at some of the top preparatory steps that doctors recommend for rotator cuff surgery.

    1. Establish Your Support System

    While rotator cuff surgery is usually considered an outpatient surgery – aka, you get to go home the same day – you’ll have been under general or regional anesthesia, which means you won’t be doing much for yourself afterwards until the medication wears off. You’ll need to have a companion with you – whether they are a trusted person in your life or hired help – following the surgery to drive you home, help you dress, shower, eat, and help with medications.

    Usually, people plan on having someone around for anywhere from a few days post-operation to a few weeks, especially if you have children or pets to take care of. If you take our second preparation tactic to heart, you might be able to regain most of your independence after a few days or so, but you should always have a contact to call should you need help, if only to mitigate re-injury. You should also make sure your place of employment is aware of the surgery, the recovery time, and the fact that your routine will need to be modified for an extended period of time.

    2. Practice Your Daily Tasks

    Now, this might sound like a silly preparation, but remember that four to six weeks of one-handed tasks can be a lot to handle if you’re not used to it – especially if you lose mobility of your dominant hand. Having someone on-hand is always recommended, but not always feasible. If you practice daily tasks beforehand, you’ll be ahead of the game.

    Suggested one-handed practice areas:

    • Morning routine (brushing teeth, applying makeup, taking medicine, dressing yourself, doing hair, etc.)
    • Cooking
    • Showering
    • Cleaning tasks (changing sheets, mopping spills, sweeping/vacuuming, etc.)
    • Caring for pets (it’s recommended you hire a caretaker to minimize risk of your pet accidentally re-injuring you)
    • Opening mail/packages

    Preparing your household to make this period of adjustment easier is a great way to ease the transition, and can be a part of practicing these modified tasks, since it’s a disturbance of normal routine.

    Suggested household preparations:

    • Lower anything on higher shelves that would require two hands to retrieve
    • Pre-cook and freeze meals/Meal-plan
    • Put shampoo/conditioner/body wash/hair products into containers that can be opened and scooped out instead of squeezed into your hand
    • Clean you house thoroughly before surgery so that you have time to recover before any tasks need to be addressed again
    • Shop for groceries that are easily handled/cooked with one hand

    3. Make a Plan With Your Physical Therapist

    Especially if you don’t already have a physical therapist, contacting and arranging a pre-operation appointment is a good way to be ready for what comes after the procedure. Get to know who will be leading you to recovery, and make a plan so that you know what comes next.

    The journey is long, but with the right physical therapist, can be much more enjoyable than having to select one on short notice. Since it plays such a critical role in recovery, your research should be extensive so that you get the best care possible. Physical therapy is the cornerstone to getting back into the swing of things, and will be there at every phase of the recovery process, so establish a relationship with them beforehand! It’s always helpful to both patient and physician to be familiar with each other and lay out expectations before addressing active pain.

    4. Double Check Your Hospital’s Procedures

    Some hospitals have very specific guidelines of the do’s and don’t of pre-operation. Most require that you use a special soap to prevent infection for an allotted amount of time, such as the night before, the morning of, and some time afterwards. And some having different prohibitions, like chewing gum for a day before the procedure, wearing makeup and jewelry, eating or drinking after a specified time – there’s no telling what instructions might pop up, but some may be serious enough to postpone your surgery if not followed. This is especially important to time-restrictive instructions, so make sure you pay attention and are well aware of what needs to be done on your end!

    5. Make Sleep Accommodations

    One of the most common complaints of those who go through rotator cuff surgery is the inability to sleep. Pain makes sleep hard to come by, but it’s doubly-difficult when your normal sleeping position may not be feasible. It’s often suggested that you choose a comfortable recliner to claim as your bed for the weeks following surgery; propped up with your arm held close in a T-Rex position has been reported to have some success in establishing a consistent sleep routine. If you don’t have a recliner, collect a mass of pillows and heap them up on your bed to create a reclining surface there.

    This should be taken into account when practicing your daily tasks. You might benefit from conforming to this new sleep modification a couple of weeks before operation, so that you allow your body the proper time to rest and heal from your surgery when the time comes.

    Dr. Stacie Grossfeld, Your Louisville Orthopaedic Specialist

    In an effort to assist those who are coming out of post-operation, Dr. Grossfeld offers a series of helpful videos explaining a variety of different exercises that you can get help with by calling her number today.

    If you or someone you love has suffered a rotator cuff injury in the Louisville, Kentucky-area, board certified physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Pickled on the Court: Pickleball Injury Treatment

    Posted by Orthopaedic Specialists

    Pickleball Injuries and the importance of Physical Therapy before an injury

    Across the decades, different sports have come to be all the rage amongst particular age groups – perhaps you remember playing four-square and kickball in grade school, participating in the rage of football or basketball season in college, watched as the Spikeball national tournament earned a spot on one of ESPN’s networks.

    Sports have a funny way of appealing to different people at different stages of life, and one of which has become very popular with adults aged 55 and older is pickleball. We’ve mentioned pickleball a couple of times in our blogs, talking about the best places to play pickleball and the most common injuries that come from it. With 52% of pickleball players that participate 8 or more times a year falling in that 55+ range and 21% of those who play 8 or less times a year, it’s safe to say that this low-impact sport is a popular way to socialize and get moving, which is extremely important for people of any age.

    However, pickleball may not be as low-impact as previously thought – in fact, it may be this perception that’s contributing to the growth in pickleball injuries over the years.

    The Impact of Pickleball

    While pickleball may seem unassuming at first, no sport that requires regular, fast movement to play should be considered safe. Pickleball combines a lot of the movement of tennis or badminton in a smaller space, leading to quick stops and starts, sharp twists and lunges, and the greater temptation to overstretch the body to reach a ball. This, combined with the use of your shoulder and elbow joints, can lead to any injury you would expect in a ‘high-impact’ sport in comparison.

    Perhaps it’s no contact sport or long-distance run, but pickleball will work you up a sweat and leave you sore from working muscles you’re not used to when you start. Your joints, quads, calves, hamstrings, hips, and back will feel the workout – it’s one of the primary reasons pickleball is so popular. Using nearly all the muscle groups in a social sport, what better way to spend your evenings?

    Pickleball Injuries on the Court

    Unless proper protective and preventative measures are taken, your casual evening game of pickleball might just turn into quite a few evenings of bedrest or, in more serious cases, an evening in the hospital.

    Of the approximate 19,000 pickleball injuries every year (based off of a 2019 study) 90% of them affect players 50 and older, who are already at a higher risk of injury due to the natural degeneration of muscles, flexibility, cartilage, and bone density. This fact makes the emergency-room injuries identified in a 2021 study falling into a Slip/Trip/Fall/Dive category quite serious, yet extraordinarily common, since players over 60 accounted for 85% of those emergency room visits and equaled the number of ER visits for tennis of players in the same age group.

    The most common pickleball injuries include:

    • Slip/trip/fall/dive
    • Achilles strains/tears
    • Shoulder injuries
    • Rotator cuff injuries
    • Lower back injuries (especially disc-centric ones such as herniated or bulging discs)
    • Fractures
    • Epicondylitis (tennis elbow…or pickleball elbow)

    Should I Play Pickleball At All?

    Yes!

    The purpose of this blog isn’t to scare anybody off of playing the phenomenon known as pickleball – it’s just to inform you about the proper way to go about it so that you can keep on playing for years to come.

    If the perception of risk isn’t lower, than the correct preventative measures can be taken to avoid any injuries. Stretching – which includes warming up and cooling down – is more important than ever as we age, and going straight into a sport that utilizes muscles as pickleball does invites sprains, strains, and pulled muscles like no other. If there’s a particular part of your body that’s bothering you, then it’s always a good idea to address the pain before it grows.

    One way to do this is to participate in healthy aging physical therapy. A common misconception is that physical therapy is only there as a reactionary profession – meaning that it’s only beneficial after an injury. But that’s not true – it helps sustain five key elements that keep us up, running, and on the pickleball court, which are:

    • Flexibility
    • Strength
    • Endurance
    • Posture
    • Balance

    Physical therapy is both a preventative and a reactionary profession – it’s up to you, though, which it may be. Pickleball is a fun, engaging, social sport that is easily enjoyed by all, but it’s risks shouldn’t be taken lightly.

    If you’ve been injured, getting back to full strength might take a little longer the older you get, and physical therapy can help get you there. If you or someone you love has suffered a sports injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    The 3 Stages of Frozen Shoulder

    Posted by Orthopaedic Specialists

    What are the 3 stages of frozen shoulder or adhesive capsulitis?

    As a particularly important joint of the body, the shoulder seems to be prone to more than its share of a myriad of different aches, pains, injuries, and conditions. But, considering how much we use it in everyday life, these infirmaries are only made that much more noticeable when we can’t easily go about our day without pain or discomfort. Frozen shoulder, however, is a particularly nasty condition to develop out of all the shoulder maladies out there due to the amount of time it affects the body – talk about a disruption of daily life.

    What is Frozen Shoulder?

    Frozen shoulder – or adhesive capsulitis, as it’s sometimes called – affects approximately 2% of the general population, which, at first, doesn’t seem all that common, but that’s 158 million people documented. It’s most common in women aged 40-70, and is often associated with pre-existing medical conditions, such as:

    • Diabetes
    • Hypothyroidism
    • Hyperthyroidism
    • Parkinson’s Disease
    • Cardiac Disease
    • Previous Injury
    • Prior Extended Periods of Shoulder Immobilization

    This condition is trademarked by stiffness and loss of mobility in the shoulder, even by external means, such as someone else attempting to gauge mobility. This loss of motion is caused by the thickening and tightening (contracture) of the connective tissue called the shoulder joint capsule, and unfortunately does not have a definitive cure or comprehensive treatment that makes the condition go away immediately.

    In fact, the best frozen shoulder treatment option available outside of short-term prescription pain medication is physical therapy, which can be either home sessions or professionally guided ones. Orthopaedic Specialists has a program for you, so contact us today at 502-212-2663 and let us help you in your management of this long-term condition or to prevent it after a shoulder injury.

    The 3 Stages of Frozen Shoulder

    One of the most unique facets about frozen shoulder, however, is that it comes in stages, and these stages each last for a time period that varies greatly between cases. Most cases present an increasing time period by order of stage, so that stage one is shorter than stage two, which is shorter than stage three.

    Stage 1: The Freezing Stage

    In this stage, the shoulder joint capsule is beginning to thicken and stiffen, causing increasing levels of pain and a decreasing range of motion. The time frame for this stage has been documented lasting anywhere from 6 weeks to 9 months, with most cases falling between the earlier 6-9 weeks period.

    Stage 2: The Frozen Stage

    In the stage after freezing, the frozen stage plateaus the thickening and stiffening of the capsule, leaving the shoulder with very little motion, but less pain. This loss of motion, however, makes daily activities extremely difficult, and physical therapy is of great importance at this stage to make sure you can manage your condition and minimize the effect it has on your life. This stage lasts approximately 4-9 months, with most cases thankfully clocking in again at the earlier periods, between 4-6 months.

    Stage 3: The Thawing Stage

    In the final stage of frozen shoulder, there comes the ‘thaw.’ This is where there is a return to previous strength and motion – either to a complete degree or one close to it. Physical therapy is perhaps most important in this stage, when motion is returning where muscle was lost, and the joint is both susceptible to injury and healing. This stage has been documented over a range of 5 months to 3 years, but most cases are contained to a 6 month-2 year scope.

    Frozen shoulder, or adhesive capsulitis, can be a very scary thing to deal with, especially following an injury if you thought you were in the clear. Physical therapy can help shorten the time frame your stages last and get you returned to your prior status with healthy, resilient shoulders. Call us here at Orthopaedic Specialists today!

    If you or someone you love has suffered a shoulder injury or has experience frozen shoulder in the Louisville, Kentucky-area, board certified physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Temporomandibular Joint Dysfunction

    Posted by Orthopaedic Specialists

    Jaw pain, TMD, and TMJ - what is it?

    Jaw pain. We’ve all been there at some point in our life – our jaw locks up as we take a bit of our dinner, you bite down wrong and feel a shooting pain in your face, there’s a pesky click every time you shift your jaw – whatever it may be, it’s actually quite common to develop what’s know as TMD, or temporomandibular dysfunction.

    What is TMD? Or TMJ?

    You may have heard it both ways, when it comes to the abbreviation, but the two refer to separate terms. TMJ refers to the actual temporomandibular joint, which connects your jawbone to your skull, while TMD stands for temporomandibular dysfunction, but is used to describe any malfunction of the TMJ. The two terms are used rather interchangeably when it concerns jaw pain, even if the medical terminology classifies them as distinctly unique entities.

    When it comes to TMJs, humans have two of them: one for each of the joints on either side of the face that connects the two points of contact between the jawbone and skull. These joints may not be as commonly associated with joint-centric injuries or diseases as other joints in the body are, but it can be just as susceptible to arthritis, injury, genetically-inherited disease, and overuse. However, just like other joints in the body, jaw pain and TMD can be managed, even if it can’t be cured.

    How Do I Know if I Have TMD?

    11-12 million adults have pain in the TMJ region, and as it turns out, women are 2x as as likely to develop TMD than men, particularly women between 35-44 years old.

    So, how do you know if you have fleeting jaw pain or TMD?

    Well, firstly, there are three classes of TMDs that you can reference to see if your pain fits into a TMD category:

    • Disorders of the joints, including disc disorders (degenerative joint disease)
    • Disorders of the muscles in the jaw (myofascial pain)
    • Headaches associated with a TMD

    If your jaw pain fits into any of these three classes, you may want to get it checked out by a dental or orthopaedic specialist.

    Other symptoms of TMD are:

    • Pain or tenderness of the jaw, especially around the TMJs
    • Earaches or an aching pain in and around your ear
    • Difficulty or pain while chewing
    • Aching facial pain
    • Locking of the TMJs
    • Decreased jaw mobility
    • Headaches and migraines
    • Neck or shoulder pain
    • Clicking, popping, or grating sounds at the TMJs
    • Facial fatigue
    • Tinnitus
    • Change in position of the teeth or jaw
    • Toothaches

    Diagnosing TMD is not usually an invasive procedure. Dental or Orthopaedic specialists will take you through a series of movements and exercised to gauge the mobility of your jaw and the severity of the TMD – if your dentist is trained to recognize TMD, they may even do it during a regularly scheduled dental checkup. If necessary, additional diagnosis methods such as X-Rays, CBCT Scans, or MRI Scans may be conducted to assess further damage, especially if the TMD is the result of an injury.

    What Causes TMD?

    Speaking of, what does cause TMD? As mentioned before, the temporomandibular joints are susceptible to genetically-inherited diseases and other conditions, such as arthritis, but sometimes, there is no cause that can be pinpointed as the origin of dysfunction. This goes case-by-case, however, and there has been evidence supported by research that potential explanations could include:

    • Bruxism (teeth grinding/clenching)
    • Dislocation of the disc between the ball and socket joint
    • Arthritis in the TMJ
    • Stress/Behavioral Reasons
    • Acute trauma

    A recent study by the National Institute of Dental and Craniofacial Research identified clinical, psychological, sensory, genetic, and nervous system factors that may put a person at higher risk of developing chronic TMD.

    How is TMD Treated?

    If TMD is like other forms are arthritis, that means that the condition isn’t curable. It is, however, manageable. Most TMDs go away on their own, and there have been less studies conducted on treatments which means less forms of treatment available to the public, but if the pain persists and interferes with daily life, after consulting with a professional, general treatments may include:

    • Heat and Cold therapy
    • Change in diet to soft foods for mandibular rest
    • NSAIDS and other over the counter pain meds
    • Nightguards/mouthpieces
    • Physical Therapy
    • Conscious change in jaw habits, like:
      • Jaw clenching
      • Gum chewing
      • Avoiding jaw movement for yawns
      • Keeping pressure off the jaw
      • Practicing good posture

    Less conventional, but still non-invasive action may also be suggested. Acupuncture, meditation and relaxation techniques, and transcutaneous electric nerve stimulation (TENS) have often been accepted as treatments for TMD, usually used in conjunction with other methods.

    More advanced treatment methods include prescription muscle relaxers, anti-anxiety medication, prescription pain relievers, and antidepressants, as they each focus on the inflammation of the muscles surrounding the joint and behavioral aspects that may be leading to jaw pain.

    Doctors recommend staying away from any permanent changes to the jaw joint, teeth, or bite without going through all potential avenues of conventional, non-invasive treatment first, but if the TMD is due to an underlying issue that can be fixed, sometimes corrective dental treatments can be utilized to treat jaw pain.

    What About Surgery?

    As stated before, most of the times, pain will go away on its own. Surgery is very rare in TMD cases, so unless its a severe case, no surgery is required or suggested – in fact, it’s discouraged. If you’ve surpassed all conventional treatments and the pain is still unmanageable or there are additional issues arising, such as advanced joint deterioration, lingering injury trauma, tumor formation, or bone issues, you may be prescribed for surgical treatments, which may include:

    • Arthrocentesis
    • Arthroscopy
    • Open-Joint Surgery

    Need help managing your joint pain? If you or someone you love suffers from TMD in the Louisville, Kentucky-area, physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Why Does My Gout Flare Up At Night?

    Posted by Orthopaedic Specialists

    Gout, Attacks at Night, and how to treat it

    While all forms of arthritis seem unbearable at times, a particularly painful, rather common and, most of the time, unexpected strain is gout. Perhaps you’ve heard the term, but don’t know how to characterize the form of arthritis – but now, suddenly, the joint of your big toe has become affected and you’re looking for any kind of relief available. What is gout? Why does it attack at night? And what can I do to help it?

    If you’re experiencing sudden, severe gout flare ups, don’t hesitate to get a specialist’s opinion. While you wait for your appointment, here’s a short guide to gout and night-time flare-ups.

    What Is Gout?

    Gout is a specific form of arthritis that usually manifests in the joint of the big toe. While it can affect any joint, over 50% of gout cases occur in the big toe, with the ankle, lesser toe joints, and knees also common sites of inflammation.

    It’s characterized by common arthritis symptoms, but in sudden and severe attacks, usually at night. A study published in Arthritis Rheumatology found gout attacks were 2.4 times more likely to happen during the night and early morning than the day. Associated symptoms include:

    • Acute pain
    • Swelling
    • Redness
    • Heat

    This affliction is caused by Hyperuricemia, which means that there is too much uric acid in the body. Uric acid is your body’s naturally-produced method of breaking down purines found in foods and the body. But when there is an overproduction of uric acid, it crystalizes and builds up in joints, fluids, and tissues within the body.

    There are certain factors that can contribute to this overproduction, including:

    • Gender – Males are more prone to Hyperuricemia
    • Weight – Increased weight causes an increased production of uric acid, which can lead to Hyperuricemia and gout
    • Diet – Alcohol (particularly beer), high-fructose foods and drink, red meat, organ meat, anchovies, sardines, mussels, scallops, trout and tuna are all high-purine foods
    • Health Conditions – Hyperuricemia has been linked to increase with the presence of congestive heart failure, high blood pressure (hypertension), insulin resistance, diabetes, sleep apnea, metabolic syndrome, and kidney problems
    • Certain Medications – Diuretics have been linked to a higher risk of Hyperuricemia

    Gout flare-ups can last from days to weeks, and are often followed by long periods of remission that can last up to years without symptoms before another flare-up occurs.

    One of the worst features of gout is its propensity to manifest at night, when you’re at your most vulnerable and pain seems so much more intense. Along with a disturbed sleep schedule that can bleed into other parts of your life, it’s not fun to deal with.

    So why does gout flare-up at night, when you least expect it to?

    Potential Reasons for Gout Flare-Ups at Night

    Dropping Body Temperature

    The natural drop in body temperature when you’re resting can contribute to uric acid crystallization in the joints. And, since the body’s extremities usually drop to an even lower temperature than the rest of the body due to blood flow and the body’s protective measures for its organs, toes and fingers are prime locations for uric acid crystals to accumulate.

    Change in Breathing

    What the change in your breathing actually does is acidifies your blood. With less expulsion of carbon dioxide, the excess escapes to your blood, increasing the amount there in a condition called respiratory acidosis, which encourages the formation of uric acid crystals.

    Dropping Cortisol Levels

    As you sleep, your body slows its natural production of cortisol, which plays a critical role in the fight against inflammation, which is why corticosteroid shots are used to help treat arthritic conditions, including gout.

    Dehydration

    As you sleep and stop the consumption of fluids that you supply the body with during the day, your system draws on the water it retains, as well as both sweats it out and expels it out by breathing, which depletes its stores that are maintained throughout the day. As water content decreases by absorption and expulsion, uric acid concentration in the blood and joints increase, which leads to Hyperuricemia, and consequently, gout flare-ups.

    Sleep Apnea

    Sleep apnea, which is a disorder characterized by a decreased intake of oxygen when asleep, contributes even further to the change in breathing, but in a different way. Instead of carbon dioxide as the main culprit, with sleep apnea, decreased oxygen results in higher levels of the naturally-produced purines that cause Hyperuricemia and gout. It’s been reported that there is a 50% risk increase of gout with the presence of sleep apnea.

    How to Help Gout Flare-Ups

    Luckily, all is not hopeless when it comes to treatment and prevention of gout. Since attacks are sudden and relatively short-lived, there are plenty of ways to prevent or mitigate the effects. If you suffer from frequent or in-frequent gout flare-ups, make sure to consult a doctor for professional guidance and treatment options, but in the meantime, there are a couple of things you can do to help gout stay out of your joints.

    Keep a Healthy Lifestyle

    While some of the primary risks and factors that contribute to the formation and development of gout relating to personal health, keeping a healthy lifestyle is critical in all factors of life, not only in managing gout. Big factors that you can actively monitor, however, can be:

    • Maintenance of proper hydration to combat dehydration and to flush uric acid out of your body
    • Paying attention to your diet to avoid high-purine foods (alcohol (particularly beer), high-fructose foods and drink, red meat, organ meat, anchovies, sardines, mussels, scallops, trout and tuna)
    • Weight control
    • Regular exercise to improve sleep

    These are all lifestyle factors that will benefit other facets of your health, and should be considered even if you haven’t experienced a gout attack recently.

    Seek Treatment

    Professional treatment should always be an option, especially if the pain is frequent, lasting, or debilitating when it occurs. Common medical treatments for gout include:

    • Prescription pain medications
    • Corticosteroid shots
    • Colchicine

    Since gout is a form of arthritis, it isn’t curable – but it is treatable, and the symptoms can be highly managed to reduce pain, duration, and other side effects.

    Non-Steroidal Anti-Inflammatory Drugs

    IMPORTANT: DO NOT take Aspirin, however, as Aspirin has ben known to increase uric acid in your blood and make gout attacks worse.

    Over the counter medications are still an option for those who don’t want or don’t have the option of prescription treatments. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox DS, Naprosyn), and Celecoxib (Celebrex). Pairing NSAIDs with a cold compress or ice pack can also alleviate symptoms.

    If you or someone you love suffers from gout or arthritis in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    An Overview of Meniscus Tears

    Posted by Orthopaedic Specialists

    Different types of meniscus tears and if they need surgery

    The meniscus is one of the many cartilage-fueled shock absorption cushions that your body has to keep your bones and joints protected. Acting as the main protective measure in one of the major joints of the body, the two menisci of the knee are located between the top of the shinbone and the bottom of the thigh-bone, termed the lateral meniscus and the medial meniscus. Tears in the meniscus happen to be one of the most common causes of knee pain, with symptoms of a tear manifesting as:

    • Pain
    • Popping sounds
    • Stiffness and swelling
    • Locking, catching, or giving away of knee
    • Lack of usual range-of-motion in knee

    Meniscus tears happen every day to everyone, with causes ranging from heavy use and high levels of activity to joint disorders and arthritis to the simple wear-down of cartilage that allows everyday tasks to put you at risk. So how are they avoided, then? And how are they treated?

    Well, like all injuries that affect particular demographics more – in this case, athletes and the elderly – there are certain exercises and preventative measures to aid in strengthening the muscles around the meniscus. To learn more about preventative measures, call 502-212-2663 and get a consultation on your knee pain, or check out Dr. Grossfield’s videos on knee injuries in the Videos section.

    As for treatment, not all meniscus tears are the same – there are actually six common types that are treated, and each tear relies on a number of different factors to determine which avenue of treatment should be taken, including age, the body’s response to non-surgical treatment, and any damage that extends beyond the meniscal tear.

    The most important takeaway is that not all tears require surgery, and our job at Orthopaedic Specialists PLLC is to diminish your need for invasive surgery – most often arthroscopic knee surgery – or to help you recuperate from it.

    So what are the six most common meniscus tears?

    Categorizations

    Before we delve into the list, it’s important to mention that meniscal tear diagnoses are usually very detailed, and can have an effect on the type of treatment received. Your particular tear may be described in terms of:

    • Category

    Every tear is categorized as either an acute tear or an degenerative tear.

      • Acute tears occur in weight-bearing situations, which is why this is usually the category athletes and injuries due to unnatural positions fall into.
      • Degenerative tears, on the other hand, is a category that usually holds more statistics for the elderly and are usually less severe than acute tears. These types of tears develop from a weakened meniscus, which happens naturally as the body ages, much like degenerative disc disease in the back.
    • Location

    The location of the tear is critical in the ability to treat the injury non-surgically, and, alternatively, if surgical repair is even a viable option for treatment. There are four primary locations used to describe tears: anterior horn, posterior horn, central, and peripheral.

      • Anterior horn tears are located in the front of the meniscus and are usually caused due to sudden twists or trauma, with pain occurring during knee extension.
      • Posterior horn tears are located in the back of the meniscus and are one of the most common locations for tears, with pain occurring along the joint line and back of your knee – such as when you squat down.
      • Central tears are located on the inner side of the meniscus. This part of the meniscus does not have a blood supply and is therefore not responsive to repair. Most pain from central tears happen when twisting or rotating your knee.
      • Peripheral tears are located on the outside of the meniscus. If a meniscus can be surgically repaired, peripheral tears are the most likely to respond to surgical treatment.
    • Completeness

    Depending on the extent of the injury, meniscus tears have a sub-classification of either complete or incomplete.

      • A complete tear travels all the way through the meniscus, meaning that a piece of the tissue is entirely separated from the rest of the meniscus.
      • An incomplete tear stops before total separation, meaning that the tissue is still partly attached to the body of the meniscus.
    • Stability

    Additionally, a second sub-classification that tears are sorted into are stable and unstable tears, which can also be a crucial factor in concluding if surgery is necessary.

      • A stable tear is a best-case scenario meniscus tear because it does not move and may potentially heal on its own, depending on the location in terms of vascular or avascular zones.
      • An unstable tear is the opposite – it is the worst-case scenario meniscus tear, since it does allow the meniscus to move abnormally, which will likely develop to be a problem if not surgically corrected.
      • Pattern

      The six types of meniscus tears are actually in reference to the type of tear pattern, so now, we’ll get deeper into the types of tears that you may be diagnosed with.

        Radial Tear

        Coming in as the most common kind of tear, this centrally-located injury lies within an avascular zone of the meniscus – and where there is no blood flow, there can be no natural repair, and this type of tear must be resolved with surgery that trims the damaged portion of the meniscus so that no further tearing occurs.

        Intrasubstance/Incomplete Tear

        Intrasubstance or incomplete tears – known by both names – are stable tears and usually mild injuries that don’t require surgery. They are, however, usually signs of early degeneration in the meniscus, which should be monitored and treated with preventative PT to prevent more serious meniscus injuries later in life.

        Horizontal Tear

        As a surgically-responsive form of meniscal tears, horizontal tears “go with the grain,” so to say, meaning that the tear follows the curved fibers of the meniscus. So, rather than removal, there is an opportunity for repair via stitching the tear together, although the success of this is highly dependent on the location of the tear. As with all central and avascular-located injuries, if the tear does not have access to blood flow, the body will not be able to heal.

        Flap Tear

        In the case of the unusual tear pattern flap tears in the meniscus present, this type of tear has the potential to cause a ‘catching’ sensation in the knee, as a part of the tissue has been torn and peeled back from the rest of the meniscus, causing it to get stuck in the joint. This type of tear is usually mended surgically, where the flap is trimmed away so that it no longer catches. In most cases, this tear will not need much tissue trimmed away to fix the problem.

        Complex Tear

        Complex tears are exactly what they say they are – complex in nature pertaining to both the tear pattern and surgical reparations. Since complex tears are identified by a combination of tear patterns, both radial and horizontal tear patterns often occur and make any potential surgical option complicated. If surgery is at all considered, often times, the surgeon will treat each portion of the tear differently – removing some parts while attempting to completely repair others, which is why this tear is very dependent on location.

        Bucket-Handle Tear

        Bucket-handle tears usually require surgery due to the nature of blockage that occurs. Similar to a horizontal tear, these tears occur along the grain of the meniscus, but are deeper and involve a larger part of the meniscus. Because of this, the torn part can separate from the rest of the tissue and cause the knee to become stuck and immovable, which is why surgery becomes more urgent in order to restore movement.

        For more insight into what your meniscus tear looks like, visit VeryWellHealth for images.

        If you or someone you love has suffered a knee injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.