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Osteoarthritis—the wearing out of joints,…
Date Recorded
March 14, 2017 Health Topics (The Scope Radio)
Bone Health Transcription
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.
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If you suffer from pain in a certain area during…
Date Recorded
February 12, 2019 Health Topics (The Scope Radio)
Bone Health
Sports Medicine Transcription
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 Tendonitis
Interviewer: 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.
Rest and ice
Early on the treatments are conservative, later on they can become more interventional. Some of the early treatments of course are just rest and ice, and relative rest. So say it's a swimming problem and a shoulder problem, you might be able to stay in aerobic shape by running or riding a bike, working on some shoulder exercises while you ease your way back into the pool. So that can be some of the most simple treatment, just relative rest and then gradual return to activity.
Anti-inflammatories
Frequently people take anti-inflammatories and they're helpful for the pain, but they're not really helpful for healing. In fact there are some studies that show that they may actually slow down healing. Cortisone is something that people frequently may run into at their doctor's office. And I think that's okay when you're in the -itis phase, so the inflammatory phase. But later on we actually know that cortisone can slow down healing and cortisone in a tendon can actually weaken the tendon, so we've got to be careful about that.
Some of the more advanced treatments I'll just talk about briefly.
Focused aspiration of scar tissue (FAST)
There's something called FAST or focused aspiration of scar tissue. This is a newer treatment where you use a percutaneous needle that vibrates about 2000 times a second and then it has irrigation that goes in and fluid that sucks out the necrotic tissue. So it's a way of removing the scar tissue just kind of through a poke hole through the skin's surface.
Platelet rich plasma (PRP)
Some of you may have heard of PRP or platelet rich plasma. That's where we draw your own blood off, spin it down, remove the platelets, which have some healing properties, and then re-inject that back into the tendon. Again to disturb the tissue and try to give it a jump start to ultimately heal itself. Even some use of stem cells now using in a similar way as PRP.
Astym
Sometimes physical therapists will do something called Astym where they're using—I call it a butter knife—but it's basically some tools that they're rubbing, kind of like a deep tissue massage. Again to try to disturb that tendon to try to get it to turn over and heal itself.
Extracorporeal shock wave therapy
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.
Choosing a Treatment Option
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 Treatment
Interviewer: 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.
updated: February 12, 2019
originally published: April 8, 2015 MetaDescription
Teatments for tendinitis and tendonitis.
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