When Should I See a Doctor About Hip Pain?Sore and creaky joints are parts of getting older, but could that aching hip be signs of something more serious? On today’s Health Minute, Dr. Mattheau Eysser describes the signs of hip…
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March 17, 2021 Interviewer: When should you have your hip pain checked out by a doctor? Dr. Matheau Eysser is an orthopedic surgeon. What's your advice? Dr. Eysser: Well, hip arthritis is a common condition that causes hip pain. Hip arthritis is characterized by wearing away of the cartilage of your hip joint. Symptoms of hip arthritis include pain in the hip joint that may include pain in the groin, outer thigh or buttocks, pain that is typically worse in the morning and lessened with activity, and some patients even have difficulty walking or walking with a limp. Sometimes the pain worsens with vigorous or extended activity and stiffness in the hip or limited range of motion. Hip arthritis symptoms tend to progress as the condition worsens. What is interesting about hip arthritis is that symptoms do not always progress steadily with time. If you are experiencing these type of hip symptoms, please see your doctor.
Signs of hip arthritis and when you should see a doctor about treating your joint pain. |
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Preparing for a Total Joint Arthroplasty - Joint Academy Nurse SegmentThis is the Nursing Session of the University of Utah Orthopaedic Center's Joint Academy. This session prepares patients for Total Joint Arthroplasty of the knee or hip. If you have any… |
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Treating Joint Pain from OsteoarthritisOsteoarthritis—the wearing out of joints, like a hip or knee—can be a debilitating and painful condition affecting certain people. Fortunately, there are things you can do to keep your…
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March 14, 2017
Bone Health Tom: You have osteoarthritis? What can you do about that before you require a total joint replacement? We're going to talk about that next on Scope Radio. Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. "The Specialists" with Dr. Tom Miller is on The Scope. Tom: I'm here with Dr. David Petron. He's a professor of sports medicine. He's a non-operative physician and he works in the Department of Orthopedics here at the university. David, what options does one have, prior to a joint replacement, in order to treat that pain and dysfunction? David: Well, ultimately, you want to try to stay away from a joint replacement obviously. And the thing that leads to that is osteoarthritis of the joint, most commonly weight-bearing joints like hip or knee. And a lot of people don't even know what osteoarthritis is, but it's generally the wearing out of articular cartilage, which is that smooth shiny cartilage at the end of bone. So it's more of a wear-and-tear process, and ultimately the joint narrows and you start to get bone spurs, and aching, and stiffness, and swelling. And then really what drives the patient to the doctor is pain. Tom: Does everyone anticipate that type of wear and tear over their lives, or are just some people prone to that? David: Some people are prone to it. So there is a genetic predisposition to it. But if you're overweight or you've had prior trauma, that also can predispose you to arthritis. But it's really insidious, so most people are surprised when I tell them they have arthritis because they didn't have an injury, and they said their knee just started hurting and swelling . . . Tom: Slowly comes on, over time, and it's nagging. And after a while, they just can't take it anymore. David: And finally they figure out, "Well, I can't run, anymore. I can't do the things I want to do, anymore, so I'm going to go see the doctor." Tom: So, by that time, I'm assuming they've maybe tried some home therapies. They've taken over-the-counter pain relievers like ibuprofen, or Naprosyn, or even aspirin, and, at some point, maybe those aren't really cutting it and they're not able to do the things that they used to do. What do you offer them? David: Well, there's really three things they can do that they can control themselves. One is to get the muscles around the joint as strong as possible. So if it's a knee, quadricep strengthening, and usually doing lower-impact activity. Tom: So that improves function. Does it help with pain? David: It does help with pain. So if they can increase strength, that helps the pain, really the muscles surrounding the joint are the shock absorber for the joint. So the stronger, the more balanced, the more strength you have, the less likely you are to have pain in that joint. Tom: So first tip is physical therapy. That's the way to start. And don't go with the old adage, don't use the joint. You know, don't slack off. Don't rest the joint. David: Well, exactly. That's when people get in a vicious cycle. It hurts, so they quit doing anything, so the joint stiffens. And because they're not doing anything, they gain weight, which makes the joint hurt more, and on and on it goes. So really there are three things they can control: one, keeping the strength up, two, avoiding high-impact exercise, and the third thing is keeping your weight right. Tom: Now, by high-impact exercise, I assume you're talking about running, jumping rope, skydiving? David: Right. Lower-impact things are okay, so usually walking, which can . . . you know, there's some impact with that, but that's usually not too bad. But biking can be a really good exercise for it, or even weight-lifting. So it's usually the high energy things. So, like, if you jump even off the height off the stair step, that could hurt the knee. But if you slowly low that up by, like, getting out of a chair, that doesn't hurt the knee, and you build strength with it. Tom: So how about running on a treadmill? So for people who like to run, and there are a lot of them, plenty of people don't bike and they love to run, I guess they could switch to swimming, but what about walking or running on a treadmill versus being outside? David: Absolutely, that can be easier on it. And we actually have a running clinic at the Orthopedic Center, and we, a lot of times, evaluate runners and find that they can be putting too much stress on their quadriceps and not running enough out of their hamstring and their gluts. So they tend to over-stride, which makes them load up the quadricep, which puts more stress on the knee. So sometimes it's something as simple as learning how to run a little bit differently, a lot of time, shortening the stride, and having more of the energy through the gluts and through the hamstring. Tom: So let's say that they do these things and they're very diligent about the physical therapy, and they lose weight, but they still have pain. What else can be done? David: There's different injections that can be done. One of the things that can be done that's usually a short-term answer to the problem is a corticosteroid injection. But a lot of times, that can kind of reset the pain. So it can settle down inflammation and settle down the pain so that we can institute some of these other things that we're talking about. Tom: Now, there are other things besides corticosteroid injections that you have used in the past, I think. David: Right, there's something called viscosupplements which are more of a lubricant for the joints, so it's like . . . Tom: Those 50 weight [inaudible 00:04:41]. David: Yeah, that's it. It has a thickness to it, and that's either in a series of one to three injections, and it kind of resets the environment of the joint so that the arthritis doesn't progress as quickly. So there's some evidence to suggest that it may slow down some of the progression of arthritis, but it certainly can help with the symptoms. Tom: And how long can that effect last if it works? David: That tends to last . . . Tom: I guess the question might be: How many patients will respond to those viscous injections? David: I would say, in general, the less advanced the arthritis is, the more likely it is to respond. So if somebody gets down to bone-on-bone, a lot of times I don't even try it, and that's when you start looking at surgical options. But if there's still some joint space left, then those patients can respond well to these injections. Tom: That's the importance of getting in early and making correct diagnosis. David: Right. Tom: So with the corticosteroid injection, as well as the viscous injections, they last for a few months, and maybe longer in certain people. When can you repeat those, and how often can you repeat those injections if they work well? David: Oh, that's a great question. With corticosteroids, kind of a general rule is I wouldn't do it more than about three times a year. With viscosupplements, insurance companies will cover that about every six months. So most people with viscosupplements, it lasts a little bit longer. And typically with a viscosupplement, it's usually a series of three injections. And with the first injection, we put a corticosteroid in with the viscosupplement. So you get kind of a quick onset of the corticosteroid and the longer lasting on set with the viscosupplement itself. There's a couple other injections, too . . . Tom: Yeah, let's talk about those. David: . . . that can be done. One is called PRP, or platelet-rich plasma. And platelets have certain growth properties, healing properties, so we draw the patient's blood, spin it down, separate the platelets and inject that into the joint. And then I think a lot of people have probably heard about stem cells, and there's been a lot of publication about that. And I think if you think about it more as pain-relieving and maybe slowing down the progression of arthritis, rather than that it really heals or reconstitutes the joint, then stem cells can also be a good treatment for the joints. Tom: Let's talk about the stem cell therapy for just a little bit. Now, is that obtained from the patient's own blood? And then, how do you do that? David: There's different ways to obtain it. One is through bone marrow, so we do a bone marrow aspirate, usually out of the pelvis, which is a relatively pain-free procedure. Another way is derived from peripheral fat, so we can take fat cells and obtain the stem cells. And the third way, and this a little bit more controversial, but there's more and more amniotic stem cells that are out there. But there are some question about how many stem cells there really are, depending on how they're stored. A lot of times those are stored freeze-dried, and it's a little bit questionable on whether there's significant stem cells in that, or not. But there's no question that some of these amniotic stem cell treatments have helped patients, myself included, with arthritic pain. Tom: That's great. You've listed a whole list of procedures and treatments that can perhaps delay and improve patients' function and decrease pain prior to considering a total joint replacement. I think the first thing you said is, one, be healthy, lose weight, and then keep fit, use a physical therapist to strengthen the ligaments and tendons, muscles around the joint. And then moving on from there, to seek a diagnosis early on so that certain therapies can be applied before things get to be too advanced, and then, you know, eventually you just have to move into a joint replacement. Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of the University of Utah Health Sciences. |
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Surgery Can Relieve the Pain of Some Types of Hand ArthritisMost people with hand arthritis just live with it. However, there are two types of surgery that can effectively eliminate arthritis pain and improve your quality of life. Dr. Tom Miller talks to…
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May 16, 2019
Bone Health Dr. Miller: Are there surgical solutions for your painful hand arthritis? We're going to talk about that next on Scope Radio. Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope. Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Doug Hutchinson. He's a Professor of Orthopedic Surgery here at the University of Utah. Doug, I have a lot of patients that come to see me with arthritis in their hands as they get older. They're asking me from time to time if there are any surgical solutions for their pain. Dr. Hutchinson: Everyone gets arthritis in the hand at some point in time as long as we last long enough. Most arthritis in the hand is something that people live with and I think that's appropriate. Surgery is not going to solve everything that comes down the road, but there's no question that some people have certain fingers that get arthritic changes that hurt them on a daily basis and really get in their way of doing certain things in the kitchen, doing certain things in the garden, doing certain sports activities, and those we probably in some situations can help a lot. Dr. Miller: How do we do that? Dr. Hutchinson: For example, in the fingers the most common place to get arthritis is near the tips in the last joint, called the distal interphalangeal joint, right underneath your nail. Some people get cysts that grow out of those that become a problem on the nail and they're painful. Those can be taken care of if we get rid of some of the arthritis there. Primarily, if the joint of the finger is stiff and painful and has arthritis on x-ray, which is common, one of the things we'll do the most commonly is fuse that joint. That just means putting a screw across the one bone into the other bone and making that joint effectively go away. You can't bend it at the end, but it stays straight the whole time. Dr. Miller: And that eliminates the pain? Dr. Hutchinson: That totally eliminates the pain, and the other joints still make you use your hand very well. Functionally, you're normal without that last joint working. Dr. Miller: Are there any particular joints in the hand that are more amenable to surgery than others? Dr. Hutchinson: Yeah, other than the DIP joint of the fingers, which is the last joint near the nail, the base of the thumb, which is all the way back closer to your wrist. Some people even think that they have wrist pain but in fact it's the base of the thumb that's hurting them. Typically a patient will really have a hard time with certain grips. They won't want to shake hands as much. They really hate the fact that they can't open a jar at home. They've got to give it to their wife or their husband to figure that out. It's generally a thumb pain problem that is really, in the world of humans the thumb is overwhelmed by what we do with our hands, and there are more forces put through our thumb joint than was originally intended. Dr. Miller: Do you perform a similar stabilizing surgery where you put a pin or screw in the joint? Dr. Hutchinson: Yeah. For a thumb arthritis, the most common solution is to remove a bone at the base of the thumb, which means the two ends of the bone that were grinding on each other causing pain, now one of them is gone. There's no longer a bone grinding on a bone. The word arthritis means "arth" which is joint, and "itis" which is inflammation. I tell my patients that if you don't have an "arth" you can't have arthritis. The getting rid of the "arth" is either a fusion, like we do in the distal joint of the finger, or a resection of the bone which means it can still move very well as opposed to a fusion. The pain is gone and we use a tendon to help stabilize the joint. Dr. Miller: Would you recommend conservative therapy prior to considering surgery for either a distal interphalangeal arthritis or base of the thumb arthritis? Dr. Hutchinson: Yes. We always recommend conservative care first, and most times that usually works for a lot of people for a good bit of time. A thumb arthritis, the mainstay for treatment is to get them a splint. The splint is something no one wants on their hand and no one wants on their thumb in particular, but it's worn at night when no one theoretically is using their thumb in the middle of the night. It allows the thumb to rest. That may make it better during the day when you take the splint off and use your thumb for normal activities. We always want them to avoid certain activities. You don't want to open a can with a hand crank if you have thumb arthritis. You want to go out and buy an automatic can opener. That's something our hand therapists insist on. They think that should be done; at age 20 we should all get automatic can openers. Dr. Miller: In your opinion, what would be the best conservative therapy? What do you advise patients to take? Dr. Hutchinson: We generally tell them to wear a splint during the night that's fairly rigid that holds their thumb. We give them a strap type of a splint that's easy to wear during the day that they can wear when they want. When they don't want to they can not wear it at all. It sometimes helps when they're gripping things and gives them a little bit more support and decreases their pain. If they get to the point where it's worse, we'll often inject them which helps them for two to three months at a time and really makes their pain go away, again, can delay the surgery if they want to have the surgery. Some people come back to me every six months and say, "Give me another injection. I don't want that surgery. I ain't got time for that. Let me just have three, five, six months of peace, please." Dr. Miller: What is the durability of the surgery? Is it long-lasting? Dr. Hutchinson: Yes. The surgery for base of the thumb arthritis is actually one of the best we have in our armamentarium. It works well in most any surgeon's hands. There are different procedures that can be done, all of which work about the same or as well as the others. I would caution a patient that it takes three months of being good and wearing a splint, and therefore it's a longer rehabilitation than they would like. Other than that being a negative, the rest of it is positive. They maintain their motion. They actually increase their grip strength a little bit. Their pain is effectively 100% resolved at that particular joint. Again, a person with a lot of arthritis in their hand is not going to get the rest of their arthritis to go away, but that one is usually the one that is causing the most problem. Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.
Two types of surgery that can effectively eliminate arthritis pain and improve your quality of life. |
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Everything You Need to Know About Tendinitis and Its TreatmentIf you suffer from pain in a certain area during exercise, it could be tendinitis (also called tendonitis) or something worse. Sports medicine orthopedic specialist Dr. David Petron talks about some…
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February 12, 2019
Bone Health
Sports Medicine Interviewer: You found out you have tendonitis. Probably wondering what treatments are available, what do you need to know about them and what to expect afterwards. We're going to talk about that next, on The Scope. Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com. Interviewer: Dr. David Petron is an orthopedic sports medicine specialist at University of Utah Health Care and is also the chief medical officer for the Utah Jazz basketball team. So he knows what he's doing and today we're going to talk about tendonitis. What Is Tendonitis?Dr. Petron: Well first let me say what tendonitis is. There can be confusion about it. Tendon is muscle connected to bone. So at the end of the muscle, that's where the tendon is and then the tendon ultimately attaches to the bone. -Itis infers that it's an inflammation problem, when in fact most tendonitis is really what we call tendonosis because it ends up being a chronic problem. Usually in the first few weeks or maybe the first month we might call it tendonitis. After that it really is not an inflammatory problem, but it's more of a tissue break down problem and then we call it tendonosis. Interviewer: And that's something that's not going to go away without some sort of intervention. Is that correct? Dr. Petron: Frequently that's the case and generally the older the patient is, the longer it can take to go away. But even sometimes with prolonged rest, as soon as somebody goes back to doing their usual activity, the tendonosis problem comes back again. Treatment Options for TendonitisInterviewer: So something's going to have to happen, what are the options? Typically are there a lot? Dr. Petron: There a lot of options. The one thing that all these options have in common is they do something to disturb the tissue. So it gets in a chronic pattern where it won't heal itself and we need to do something to disturb that tendon to try to get the body to feel like it's an acute injury so that it can ultimately heal itself.
Some of the more advanced treatments I'll just talk about briefly.
And then one other thing that we do is called extracorporeal shock wave therapy, which is kind of like a de-tuned lithotripsy. Same kind of technology used to break up a kidney stone. But you do that on the skin surface, again to disturb the tissue, break up the degenerative tissue along the tendon to get that to heal. So there are a few of the more advanced treatments that are being used now for tendons to heal. Interviewer: My head's spinning. There's so many of them. Dr. Petron: There's a lot out there, and like most things when there's a lot of different ways to approach it, not one way is perfect. So the physician needs to evaluate the patient and see what might be best for their situation. Interviewer: Yeah that really sounds like you do need an expert. I mean you can do a little reading on the internet, but it sounds like an expert really needs to decide what is going to be best for your situation. Dr. Petron: Right, in the early phases though relative rest and gradual return to activity in a lot of patients do well. But once you've had this for three months or six months or longer, probably ought to see a physician. Interviewer: So getting in early is always the better option. Dr. Petron: Right, if you start to feel some breakdown say in an Achilles tendon or a rotator cuff in your shoulder, stop. Because once you get into that tendonosis phase, it can be very difficult to get better. How Long Until Treatments Work?Interviewer: What are some common questions people have about these treatments? Dr. Petron: One of the common things is when one of these treatments is done, is it going to instantly be better? And the answer to that is no. So some of that might be lowering the expectation. Because again, really the body still has to heal itself. So even with these treatments, it can usually be three months or so until they're healed. Interviewer: So in three months, back to 100%? I mean is that fair? Dr. Petron: Usually at least back to activity, their usual activity. Interviewer: And then how do you prevent— Dr. Petron: But there are some areas that really have a lousy blood supply, like the Achilles tendon. Once that's really inflamed, that can be even longer than that to return to play. Preventing New Injuries After TreatmentInterviewer: So I get the treatment, I'm back to activity. How do I prevent this from now happening again and being a vicious circle? Dr. Petron: Well the most important thing is start out slowly. All of these problems are not traumatic injuries, they're overuse injuries. So it's doing too much too quickly. So in general, the older the athlete, the slower you ought to ease into your particular sport. Interviewer: And then eventually your body is going to be able to handle anything you throw at it? Dr. Petron: The body adapts to the stresses put upon it. So just like a weight lifter gradually lifting more and more weight, muscles get bigger, tendons get stronger. That can happen to every part of your body. Bones get stronger, tendons get stronger, ligaments get stronger as you put stress on it. But the key is you need to do that in a controlled manner. Interviewer: Let's wrap this up with the final thought. What do you think the big takeaway is? Dr. Petron: Prevention is always key, so if you start to get feeling of tendon pain then back off on that activity. Relative rest, which means you can still stay active but don't overuse that tendon. If you do overuse it and you have the symptoms for say three months or longer, probably should seek the care of a physician. Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.
Teatments for tendinitis and tendonitis. |