Sports Injuries, Joint Replacements & Knee Problems
April 2021 Issue - Pink Prescriptions
Sports Injuries, Joint Replacements & Knee Problems
Living with pain is no fun. In fact, pain can take all the fun away, especially if you enjoy being active. It’s somewhat of a Catch-22, though. It seems the more active set are the ones who get sports injuries. Makes sense, afterall, doesn’t it take sports to get a sports injury? Not necessarily. Sometimes, just a simple walk to the mailbox, moving a planter in the garden, or a quick clean up of the garage can end in injury. The good news is pain does not have to be forever with many injuries, over use, or degeneration. There are new, modern and effective ways to stop the snap, crackle, pop in the knees, reduce the burn of bursitis and rejuvenate the rip of the rotator cuff. We asked our local orthopeadic experts to tell us all about sports injuries, joint replacements and knee problems. Here is what they had to say:
by Dr. Vandit Sardana
My knees are bad, what are some non-surgical options to relieve or cure pain?
There are various non-surgical options to alleviate arthritic knee pain. These start with physical therapy, not only under the direct supervision of a therapist, but also completing your prescribed exercises at home. This will allow you to strengthen specific muscle groups, which will reduce the stress on the knee joint.
Another thing to consider is oral non-steroidal anti-inflammatory drugs (NSAIDS), such as Advil, Aleve, etc. NSAIDS help to reduce the inflammation in the joint and alleviate pain, but one has to be very careful with these drugs, as long-term use can have a detrimental effect on the kidneys, gastrointestinal tract and cardiovascular system. To reduce the effects on the other body systems, I also recommend topical-NSAIDS, which have low absorption from the skin into the vascular system. Examples of these creams are Voltaren gel or compound creams.
Another modality for pain relief is cortisone or steroid injections, which help locally—in the jointˆto reduce inflammation. However, one must be careful with these, as no more than four injections are recommended per year.
There are other kinds of injections that can also help reduce pain. Hyaluronic acid, or gel injections, are a series of injections that help grease an arthritic knee and help provide nutrients to the cartilage to nourish it. Further, there is the new and upcoming trend for stem cell injections, such as platelet rich plasma (or PRP) injections which are gaining more evidence for arthritic knees in recent literature.
Lastly, if you carry a little bit of extra weight, it is wise to consider weight-loss programs: Every pound you lose, four go off the knee!
How can joint replacement change my life?
And what would you say to people who put it off?
In the last 50 years, joint replacement has gone through numerous advances. With the modern methods of anterior hip replacement, robotic total knee replacement, and anatomic partial knee replacement, an active lifestyle can be restored. This not only helps increase physical health, but also improves mental health, as patients are able to perform meaningful and enjoyable activities they were not able to do without feeling pain. Patients have been able to return to golfing, playing pickle ball and tennis, going for walks, enjoying the beach, participating in social events and playing with their children or grandkids.
Joint replacement also helps alleviate the need for anti-inflammatory pain medications, which can have detrimental side-effects on other body systems from long-term use.
Furthermore, many individuals lose weight after their joint replacements, as they can exercise more and enjoy their active lifestyle. It has also been evidenced that joint replacement helps improve one’s sex life.
Anyone who thinks he/she might need a joint replacement should get evaluated by an orthopaedic surgeon, who specializes in total joint replacement, to find out if they do, in fact, require joint replacement. Putting it off may weaken your muscles, change your gait patterns that will, in turn, affect other body parts, and eventually make the recovery processes longer and more arduous.
Vandit Sardana, M.D., FRCS, is a board-certified orthopaedic surgeon with Beaufort Memorial Orthopaedic Specialists in Okatie and Beaufort. A graduate of the University of Ottawa, he is fellowship trained in hip and knee replacement.
by Dr. John P. Batson
What is PRP and how is it used in sports medicine?
PRP stands for Platelet Rich Plasma and is growing in popularity as an option for injections in sports medicine and orthopeadics. For the PRP procedure, a patient's blood is drawn and placed in a centrifuge to separate out the platelet cells. Platelets are cells that have a number of healing and anti-inflammatory properties. We take the high concentrated platelets and inject them under ultrasound or x-ray guidance to the intended target. Common conditions treated with PRP include knee arthritis, hip arthritis, arthritis of the spine, partial rotator cuff tears, Achilles tendon problems and tennis/golfer's elbow. Currently there is more evidence for PRP than any other injection for knee arthritis. A recent study in the Orthopaedic Journal of Sports Medicine showed PRP improved hip arthritis symptoms and actually delayed the need for a hip replacement. Some studies indicate steroid injections for tendons, such as shoulder, elbow, and Achilles, for example, may be harmful to the tendon. PRP is a great alternative for these problems with little downside, especially in chronic cases. Patients with spine arthritis or degenerative disc disease may benefit from PRP injections, too. It is exciting to offer patients alternatives to surgery or repeated steroid shots and treat their pain with their own blood!
Lowcountry native, John P. Batson, MD, FACSM, graduated from USC School of Medicine and completed internship and residency in Greenville, SC. He then completed dual fellowships in both Sports Medicine and Spinal Pain Medicine and is the only physician in SC to hold these dual board certifications. His private practice, Lowcountry Spine & Sport, is dedicated to providing above and beyond care. 843-208-2420; spineandsportmd.com
by Dr. Jason Norcross
What are the top 5 most common sports injuries
in the over 40 age population?
Degenerative meniscus tears of the knee often occur when pivoting or twisting. This type injury can result in mechanical symptoms, such as a feeling of instability, catching, or giving way with sharp stabbing-like pain. It is typically diagnosed with a MRI, and if the tear is relatively small, it may be treated non-surgically, either with oral medications, or an intra-articular knee injection. For larger tears with persistent mechanical symptoms, an outpatient arthroscopic debridement of the meniscus can be curative with minimal recovery time.
Exacerbation of underlying osteoarthritis of the hip or knee is an extremely common occurrence in the over 40 athletic crowds. Sudden intense physical activity can create added stresses to an arthritic condition in the joint, which creates inflammation, pain, swelling and tightness. This arthritic flare typically can be managed with activity modification, oral medication, low-impact fitness techniques and occasionally some organized physical therapy. Intra-articular injections can provide rapid relief, if simple treatments do not work.
Trochanteric bursitis of the hip is typically a pain localized on the side of the hip associated with tenderness of the skin, pain arising from a chair and difficulty sleeping at night. Often this is related to underlying stiffness or degenerative changes in the lumbar spine. Treatment typically consists of moist heat, topical creams, stretching and occasionally some formalized physical therapy. Occasionally an injection may be required, but typically other modalities are utilized first.
Ligament sprains. During more vigorous sporting activities like pickleball or tennis, occasionally one can tear the ACL, which typically is accompanied by an audible pop and immediate onset of major swelling. This renders the knee unstable and will sometimes require ligament reconstruction depending on the x-ray health of the knee. Other common knee ligament sprains include the MCL, which stabilizes the inside of the knee. This usually occurs from a direct blow on the outside part of the knee while walking the dog or playing team sports. This injury can typically be managed without surgical intervention with a brief period of bracing and physical therapy.
Mechanical lower back pain is one of the most common things to occur in individuals over the age of 40 in response to sporting activities and physical activities around the house. Typically the pain is positional, related to lifting or twisting, making sporting activities, as well as sleep, difficult. The underlying disease process related to this mechanical lower back pain can be the result of a bulging disc, a degenerated disc, osteoarthritis of the facet joints, or a combination of all of the above that results in spinal stenosis. Occasionally, a bone spur or disc bulge can be significant enough to apply pressure to the nerve to result in sciatica down one of the legs. Treatment is usually nonsurgical with a period of activity modification, oral steroids, anti-inflammatory medications and a physical therapy regimen. If this fails, additional imaging with an MRI is typically the next step and referral for injection treatments into the spine.
Jason Norcross, MD, is a fellowship-trained, adult reconstruction surgeon, who specializes in hip and knee replacement surgery. He has become one of the nation’s top experts in the field of robotic-assisted surgery, and provides training to other orthopedic surgeons in learning this technology. Dr. Norcross recently joined Orthopedic Associates of the Lowcountry earlier this year and spent the first 14 years of his practice in Hickory, North Carolina, developing a 5-star rating and achieving one of the highest patient-satisfaction scores in the region. He has developed a reputation for being compassionate, humble, personable and completely dedicated to serving his patients.
by Dr. Philip Mulieri
So many of my friends have had rotator cuff surgery.
Is there anything I can do to prevent it?
The rotator cuff is a group of four muscles that surrounds the ball of the shoulder joint of the humeral head. The cuff is actually the tendons of the muscles which attach the muscle to the bone. The function of the rotator cuff is to help raise and rotate the arm around the shoulder and maintain the relationship of the ball-and-socket joint during motion.
The rotator cuff is commonly injured structure in the shoulder. Part of the reason is its location, which often causes pinching of the tendons with motion, which is called impingement, particularly with overhead motion. This causes degeneration and weakening of the tendon over time that occurs regardless of the patient’s activity level, as there are anatomic and genetic factors that play a role in injury and tearing. Certainly, activity plays a role both in increasing risk of injury and protecting the tendon from injuries. Injuries to the rotator cuff often occur slowly over time and do not have to be related to any specific activity or activity level, but can also occur with strenuous activity and trauma.
It is difficult to completely eliminate injuries to the rotator cuff, however, if someone wants to remain active, there are ways to help prevent injuring the rotator cuff during activity. One of the most important ways to prevent injury is to maintain good flexibility of the shoulder and to engage in focused strengthening of the rotator cuff muscles to help optimize the function.
Stretching and warming up before any activity, particularly anything that involves heavy lifting or overhead activities, will help reduce the risk of injury. Exercises focused on isolating the rotator cuff are also important and can be done with light weights or exercise bands. Whether exercising or lifting weights, using lighter weights with higher repetitions is safer and more effective in increasing tone and stamina of the muscles and decreasing stiffness and bulk, which will help prevent injury. This will help rotator cuff performance function more efficiently and for a longer duration, which will help prevent impingement and injury.
Another way to prevent injury to the rotator cuff is to avoid heavy lifting, particularly with the arm out to the side and overhead. Repetitive overhead motions can cause damage to the rotator cuff. Obviously, activities like tennis and pickleball require overhead activity, therefore, it is more important for the rotator cuff to be functioning at an optimal level during these activities.
Also, avoiding overhead lifting with exercise is important. There are numerous exercises that can be performed to strengthen the muscles around the shoulder and upper body without doing any overhead lifting. Also, keeping the arms closer to the body when performing lifting exercises reduces the stress on the rotator cuff muscles and reduces the chance of injury. Our shoulders are extremely important to help us maintain an active lifestyle. We should not give up activities because they may put us at risk for injuring the rotator cuff; rather, we should incorporate activities and modifications to help our shoulders function at their highest level.
Philip Mulieri, MD, Ph.D, is a fellowship-trained, board certified orthopedic surgeon specializing in elbow and shoulder surgery. Dr. Mulieri received his fellowship training in shoulder and elbow surgery and brings unique skills to provide comprehensive, treatment of all shoulder and elbow disorders-including minimally invasive, arthroscopic techniques, complex reconstruction, and shoulder replacement. He recently joined Orthopedic Associates of the Lowcountry and is practicing at Hilton Head Hospital