FIVE MOST COMMON BONE FRACTURES

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The adult body has 206 bones so it’s no surprise we are susceptible to mishaps.  It’s likely you’ve already experienced a fracture at some point in your life and know how this can be painful. Are you able to name the five most common fractures? Read on …

A COLLARBONE fracture is most common in small children and teens and typically a result of a sports injury. For many, a sling may be utilized to immobilize the arm while the bone is healing.

It’s not unusual to take a tumble over a curb or misplaced rug. The first reaction is to put our hands in front to protect us from the fall. Unfortunately, the WRIST experiences the brunt of the body’s weight and may result in a fracture. Wrist injuries are common in active children as well as seniors with balance issues.

A quarter of our bones are in our feet and ANKLES. There are many causes for an ankle break including stumbling, a twist or roll of the foot, or a trauma.  Particularly vulnerable are dancers, women wearing high heels, and sports enthusiasts of soccer, basketball, and running. Treatment may be as simple as a cast or boot, while surgery may be necessary if ligaments need reattachment.

Elderly folks are predominantly vulnerable to HIP injuries largely due to balance complications. Some hip fractures may heal with rest however surgery will help the fracture heal faster provided the patient is healthy. Severe fractures may even require a hip replacement.

A FOREARM injury can happen from an auto accident, a fall from significant height, or a trauma from a hard hitting object. The injury may even be severe enough to fracture the bone into small pieces.

In all of these cases, whether the treatment is conservative or surgical, physical therapy is important to rebuild strength and achieve an optimal result. Neglect of treatment may further exacerbate the bone if another injury occurs. Pain is not normal so consult your physician if you experience continued discomfort and swelling.

Sarasota Orthopedic Associates offers same day or next day appointments when needed at any of our three locations in Sarasota, Lakewood Ranch, and Venice.  Our physicians are Board Certified and you may view their profiles on the website at www.SOA.md   you may also make an appointment directly through the home page of our website or by calling 941-951-2663.

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WHY IS BACK PAIN SO COMMON

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Up to 80% of Americans will experience low back pain at some point in their life. Why is it so common and is there anything that can be done about it?

It has to do with the shape of the spine, specifically the part of the spine in the lower back called the lumbar spine. The spine is made of vertebrae bones stacked on top of each other separated by spongy cartilage-like discs acting like shock absorbers.   The spine supports all the upper body weight which puts a lot of load on the lumbar spine and results in mechanical stress and strain. The lumbar spine is curved at the bottom. This is normal anatomy, however, it predisposes the lowest segments of the lumbar spine to extra wear and tear. The cumulative wear and tear can cause longer lasting and constant low back pain that may become chronic (lasting at least 3 months). The most common reasons for low back pain include:

  • Degenerative disc disease is when the lumbar discs wear down over time from cumulative wear and tear and no longer do their job of providing a cushion between the vertebra bone.
  • Herniated disc is sometimes called a “slipped disc”. In this case part of the disc bulges out from its normal location. This may result in not only back pain but also pain that radiates down the leg if the bulge pushes on a nearby nerve, commonly referred to as “sciatica.”
  • Spinal stenosis is when the spinal canal has become narrowed over time resulting in less room for the nerves. Often this is due to a combination of arthritis of the spine as well bulging discs. Over time it leads to pain in the lower back as well as in the legs, especially with walking and standing for long periods of time.
  • Vertebral compression fracture – In this case the cause is fractured vertebrae bone due to osteoporosis (brittle bones due to low bone density).
  • Facet joint pain – Here the pain is due to arthritic pain stemming from the spinal joints called facet joints. These attach vertebra bones to one another. The pain here is typically in the lower back and mostly with prolonged standing and walking.

Prevention is probably the most important type of treatment for low back pain and is not emphasized nearly enough in our society. Good posture, proper ergonomics and biomechanics, and daily exercise, especially core strengthening, is crucial in the prevention of back injury and unnecessary extra wear and tear. Once a back problem develops the treatments can vary, are usually diagnosis specific, and can be very effective. Most important, surgery is rarely needed and should be reserved for when conservative modalities are not effective or, when there is neurologic emergency such as weakness, numbness, incontinence, tumors, or infections.

If you are suffering from back pain it is important to see a skilled physician who offers you conservative treatment options. Ashot Kotcharian, MD is a Physical Medicine & Rehabilitation physician with a specialty in Interventional Pain Management. He is accepting new patients at Sarasota Orthopedic Associates where we offer same or next day appointments in any of our three locations.

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THE MONSTER OF ALL HEADACHES

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Did you know there are 11 types of headaches, each with varying causes and symptoms, and all are painful in fluctuating degrees? Fortunately, most headaches are common and short lived, however one type of headache may prove to be life altering.

Migraine headaches typically occur on one side and may be accompanied by throbbing, nausea, and/or sensitivity to light and sound. Some may experience an aura of lights or flashing just prior to the migraine and while there are different triggers to set off a migraine, there is more and more evidence of genetics playing a role.

Common migraines may last one to several days and may be alleviated by OTC (over the counter) medication like Ibuprofen, rest, or ice. Chronic Migraines, however, are more serious and more difficult to treat.  These headaches last 15 or more days a month for a period of three or more months. In the past, prescription medications were commonly used as were alternative approaches like meditation and acupuncture.

Some fast facts about migraines:

  • They affect over 4 million people daily in the United States
  • 85% of all sufferers are women
  • 70% have a family history of migraines
  • 91% are unable to work or function normally during their episodes

While medications are helpful for the onset of a migraine attack, it is important to avoid overuse of these medications. Currently the only FDA approved intervention for Chronic Migraine is Botox or Onabotulinumtoxin A and has been in use for over ten years. It is also effective in relieving spasticity (muscle contraction) and cervical dystonia (painful spastic twisting of the head). The treatment is performed in office and takes about 30 minutes or less. A tiny dose of the Botox is injected into specific nerve endings to block pain signals to the brain. The most common side effect is a temporary sore neck which may be alleviated with icing.

Ashot Kotcharian, MD is a Board Certified Interventional Pain Management physician at Sarasota Orthopedic Associates. He joined the orthopedic group after serving as Assistant Professor of PM&R at Johns Hopkins University School of Medicine. SOA has three locations and offers appointments on a same day/next day basis when needed. For more information go to www.SOA.md or call 941.951.BONE.

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HELP FOR THE LADIES: HOW TO MANAGE YOUR ORTHOPEDIC PAIN

Does gender affect orthopedic injuries and conditions? The simple answer is:  you bet it does.  Consider the differences and where women are at higher risk and experience conditions exclusive or largely related to gender. More important, let’s look at how women can prevent risk.

Feet and Ankles

With 26 bones and 33 ligaments, so much can go wrong on both men and women. While genetics is a factor, women are two times more likely to experience foot injuries than men. So, what’s the variance? Those shoes! Stiletto heels … flip flops … pointy toes … any of these can cause a number of painful conditions like hammertoes, plantar fasciitis, bunions, poor posture, back pain and ankle strain. What to do? Be sure to stretch your calf muscles daily, opt for wedges when you want height, look for shoes with support, and alternate heel heights daily.  Check out Vionic.com for some stylish, yet practical choices.

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Knees

Women have a higher risk for ACL tears than men. There are several theories as to why, however a common belief is that the space in a woman’s knee is narrower, leaving it at greater risk than men. Strengthening exercises like seated leg raises, side-lying leg raises, and calf raises may help. Always check with your physician prior to starting any exercise routine.

Headaches

Women are more prone to experience headaches, particularly tension headaches and chronic migraines. Of headache sufferers in the U.S., 70% have a family history of headaches and for chronic migraines, 85% are women. Among the reasons, aside from genetics, are diet, allergies, stress, sound, hormonal changes, and posture. There are multiple treatments for headaches including Botox injections of the head and neck to relax muscles. An Interventional Pain Management Physician can determine if you are a candidate.

Shoulders

This topic is common with women. Carrying a large shoulder bag can throw your body out Botof alignment causing multiple conditions. “Heavy Purse Syndrome” can create shoulder and neck pain from muscle overuse. It can also throw your entire body out of position and affect your gait. A change in posture may lead to falls.  There are a few things you can do to avoid discomfort: Use a wide strap for your bag and frequently alternate sides for carrying. Remove items you don’t need … do you really need to carry your partner’s keys or all those pens and candy? Make sure your bag weighs no more than 10 pounds.

shoulder bag

Back and Neck

Back and neck pain may be related to any number of reasons including a too-heavy purse, poorly fitting shoes, or weak muscles. Even frequent texting lowers your neck and can put extra pressure on your neck and spine … it’s good to follow mom’s wise words, “Sit up straight”! When lifting heavy objects be sure to lift properly by maintaining a wide base of support at your feet, squatting from the knees and hips (NOT at the waist), and maintaining a straight back. Pregnant women are more susceptible to low back pain due to swelling tissues along with changes in the musculoskeletal system. If a woman has back pain prior to pregnancy, she is two times more likely to experience it during the pregnancy.

Osteopenia / Osteoporosis

Lastly, the aging process may sometimes be unkind. Osteoporosis is a common condition affecting over 10 million Americans. Of those, 80% are women. It is predicted that one in two women over the age of 50 with osteoporosis will eventually break a bone. What to do?  Exercise and diet play a significant role in keeping bones healthy.

What’s a girl to do? The good news is that YOU are in control. Keep these helpful hints in mind:

  • Strengthen your muscles with exercise
  • Watch your diet and maintain an optimum weight
  • Practice good posture
  • Empty out that purse
  • Wear smart shoes with support
  • Lift properly
  • Use a cross body purse instead of a shoulder bag
  • See your physician if discomfort persists

One small change can make a huge difference. Be well!

Sarasota Orthopedic Associates has three locations and offers same day / next day appointments when needed. Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

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A PHYSIATRIST: Taking a Look at the Big Picture

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Physical Medicine and Rehabilitation (PM&R) physicians known as physiatrists (fizz-EYE-ah-trist) are medical doctors who have graduated from medical school and have completed 4 years of residency training. The specialty is a very small one beginning with WWII when many military personnel returned home with various disabilities from the war.  Over time the specialty has grown and now board certified physiatrists care for those with amputations, stroke, spinal cord injury, and traumatic brain injury, including concussions.

In addition to these conditions, physiatrists may also have sub-specialty certification in the management of sports medicine injuries.   While they complement orthopedic surgeons in their care, they do not perform surgery, preferring to treat the injured athlete utilizing the most effective research-based non-surgical care.  In addition physiatrists do not limit their care to only one area of the musculoskeletal system but instead focus on the interaction of how one link in the kinetic chain may affect the rest of the problem (i.e., “the shin bone’s connected to the knee bone” philosophy).  For instance an overhead athlete such as a tennis player with recurrent shoulder pain may have inflexibility to their hamstrings or weakness of the hip muscles as the underlying issue.  Similarly, a runner with knee pain may have difficulty with absorbing shock due to ankle and calf mobility issues.

While an athlete’s history and examination will often determine the cause of an athletes’ condition, a physiatrist will often utilize musculoskeletal ultrasound (US) to examine the injured area.  Musculoskeletal US, much like that used to examine a pregnant woman, is able to use sound waves to determine if any ligaments, muscles, or tendons have been sprained or torn.  Unlike MRI, claustrophobia is not a problem using US and the patient can actively move the injured tissue to give a dynamic picture to the physiatrist.  This allows the physiatrist a glimpse as to what is happening at the tissue level. In this way they are better able to give an athlete a more accurate diagnosis as well as guide appropriate therapy.

Sarasota Orthopedic Associates believe in treating the whole person so you can get back on your feet, back to work, back in the game, and back to life.  We have three convenient locations and are able to accommodate same/next day appointments.

Paul Lento, MD is a Fellowship Trained / Triple Board Certified PM&R physician with a subspecialty in sports medicine. He specializes in the non-surgical treatment of various musculoskeletal conditions to determine if the problem is mechanical, inflammatory, or degenerative.

Top Doc       blue shirt cropped

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TUESDAY TRIVIA ORTHOPEDIC POP QUIZ – How Much Do You Know?

SKELETON THINKING

Let’s have some fun today and see if you can answer these questions.  Answers below…no peeking!

  1. Does cracking your knuckles increase your risk of arthritis?
  2. Should you put ice or heat on an injury?
  3. What’s the #1 condition experienced by seniors?
  4. How many years of education does it take to become a fellowship trained orthopedic surgeon?
  5. What’s the reason for most visits to the emergency room?

answers

  1. While the sound of cracking knuckles can be particularly annoying to some people, truth is, contrary to popular myth, that it does not increase your chances of developing arthritis. It does, however, increase chances of minimizing your grip strength over time. The popping sound you hear is merely nitrogen releasing from the liquid in your joints. That liquid helps to lubricate your joints and keep them moving. If you experience pain with the popping, see an orthopedic hand specialist.
  2. Trick question! The answer is both. Using ice at the beginning of an injury will assist in reducing swelling. After swelling subsides, heat will help to increase blood flow to the injury and may reduce discomfort. When pain is not alleviated, consult your physician.
  3. The most common complaint among the elderly is arthritis and over 50% of seniors experience discomfort from this chronic condition. Unfortunately, arthritis is part of the aging process, however, there are many simple remedies such as NSAIDS and exercise to alleviate the associated discomfort. There are more options for more aggressive pain. As with any condition causing pain, a visit to your physician is warranted.
  4. It typically takes 14 years of education to become a fellowship trained orthopedic surgeon. The requirements are 4 years of an undergraduate degree, 4 in medicine, 5 in a residency program, and 1 in fellowship. That’s a lot of education and it ensures you’re in good hands!
  5. Most emergency room visits are from falls and injuries. Sports injuries are common among youth sports participants, weekend warriors, professional athletes, and even “DYI” homeowners. Falls are particularly common among the elderly population and may occur from balance disorders, slip & falls, medication, obesity, walkway hazards, or poor footwear.

How did you do with your answers? Any surprises?

If you have a chronic pain or injury, you’ll be pleased to know Sarasota Orthopedic Associates offer same day/next day appointments at all three of our locations when needed. Check out our website at www.SOA.md or call us at 941-951-2663.

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THE SUPER SEVEN

superfoods

Our previous blog post talked about foods and drinks to NOT put into your body. Now let’s talk about the 7 foods that are nutritious AND taste good to help preserve your musculoskeletal system.

  1. Salmon is often referred to as a “super food”, packing a punch of protein, minerals, and vitamins like B12. Most important: salmon is rich in omega-3 fatty acids.
  2. Greek yogurt is thicker than regular yogurt because the liquid is drained giving it a creamy texture. It contains probiotic cultures and is lower in lactose than regular yogurt. Greek yogurt is an excellent source of calcium, zinc, and B12. Stir some blueberries or strawberries into a cup of plain Greek yogurt and you have a great kick start to your day.
  3. Sweet potatoes are another “super food” and extremely versatile. Plain or fancy with stuffing or toppings, they are high in fiber and potassium. They are also known to maintain a healthy blood pressure. A sweet potato contains more nutrients and less calories than a white potato.
  4. While dairy products are essential to a child’s growth, it can be a source of discomfort for some adults. Dairy products are rich in calcium and vitamin D, along with other nutrients, to help keep bones and teeth strong. For those on a diet, you may opt for a fat free version and there are lactose free brands for those with a low tolerance. Both still have the calcium that is provided in regular milk.
  5. When your mom told you to eat your veggies, she was on to something. Leafy greens should be your “go-to” vegetable whenever possible. Greens like broccoli, kale, cabbage, spinach, romaine lettuce, and arugula contain essential vitamins like A (for the immune system), C (for tissue repair), and K (for blood coagulation). Nuts may also lower your blood sugar. The best nuts for your health are almonds, pistachios, walnuts, and cashews, however, go easy since a large handful may contain as many as 200 calories.
  6. Another great source of fiber and vitamin B can be found in beans. They may also help lower cholesterol and blood sugar. The best beans with benefits are chickpeas, lentils, peas, kidney and black beans.
  7. Figs, dried or fresh, are rich in fiber and give you a feeling of fullness. They are also high in calcium to help promote bone health.

So there you have it. Add these “Super 7” to your regular diet and you’re on your way to a healthy eating habit. When you do have pain or injury to your musculoskeletal system, Sarasota Orthopedic Associates can be your “go-to” place for help. We have 3 convenient locations and offer same or next day appointments when needed.

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FIVE BAD TO THE BONE FOOD/DRINK HABITS

We often talk about how important exercise is to keep your joints lubricated.  At Sarasota Orthopedic Associates our favorite mottos are “move it or lose it” and “motion is lotion”. But what about our bones and musculoskeletal system? What we feed our bodies affects our overall health including our bones. Let’s take a look at some  foods that may be harmful when used in excess.

sugar

    1. Sugar. Yep, sugar is bad for you. You’ve heard it hundreds of times and unfortunately, that sweet stuff that tastes so good can do serious harm. First, there are calories, and heaps of them. There are good sugars in fruits and veggies, however, adding sugar in any form (including the healthy-sounding agave) is a problem. That problem worsens if you have diabetes. Sugar may also affect your heart and dental health. If you have arthritis, sugar may exacerbate symptoms. Some studies show sugar may cause addiction and cravings compared to cocaine addiction.
    2. Next is salt. Sodium is a necessary nutrient for the body in maintaining muscles, nerves, and balancing body fluids. When used in excess salt becomes a time bomb. High salt intake has been associated with increased risk of stroke, heart disease, hypertension, swelling of feet, and overall bloating.
    3. Our next culprit is soda. The average consumption per person in America is 38 gallons per year. Yes, you read that correctly. The good news is the statistic is down 6 gallons/year from a decade ago so we are starting to be more health conscious. Soda, or “pop”, contains high fructose, a form of sugar, and increases your sweet cravings. Soda also contains phosphoric acid which weakens bones and teeth. Even diet soda is harmful as it contains acids, food coloring and for some sodas, caramel coloring, a carcinogen. A diet soda may still trick the brain and induce cravings similar to one containing real sugar.
    4. Caffeine is a tough habit to break. Ninety percent of Americans consume it in some form at a rate of 300 mgs a day. That would be about three 8 oz. cups of coffee. Caffeine contains addictive qualities resulting in it being named by some as America’s favorite “drug”. It’s even more popular in European countries.
    5.  Last on the list, and you may have already guessed this one, is alcohol. While drinking small amounts of red wine have been linked with healthy benefits, there is an enormous downside to overindulgence, abuse, and addiction. Side effects may put you at risk for some cancers like liver and mouth. It may also cause poor judgement, hostility, depression, obesity, and lowered brain function.

That’s the bad news but don’t despair. On our next blog we’ll deliver the good news on how to keep your bones and muscles healthy with nourishing, tasty foods … stay tuned!

Sarasota Orthopedic Associates offers same/next day appointments at three locations. Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

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UP CLOSE AND PERSONAL

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Our newest physician, Dr Adam Mandel, is an Orthopedic Foot and Ankle Surgeon at Sarasota Orthopedic Associates. He took some time to sit with us and answer a few questions to get to know him on a more personal level. Take a look at our conversation:

What inspired you to become a physician?

I always was inspired to help people and strive to achieve health. Physicians help to not only cure disease but also to prevent it.  I enjoy educating people as well as continually educating myself.  Being a physician in an ever-changing world allows that.

Why orthopedics?

I was always mechanically inclined. In medicine there are procedural jobs such as orthopedics.  Being an athlete and mechanically inclined just matched me perfectly with orthopedics.

What do you love most about your job?

I enjoy the variety of cases that I do within my subspecialty. This includes trauma, sports cases, cartilage repair, tendon repairs, reconstructions, joint replacements.  I also enjoy constantly meeting new people and learning of their lives and help to ease and cure their pain or problems.  It gives me great personal satisfaction to be very gifted at what I do.

 What is your biggest challenge?

Electronic medical records, constant changing in laws, regulations, and compliance issues always challenge me. Being a physician isn’t always as glorious as it seems to be played out on television.

If I weren’t an orthopedic physician what would you be?

I’d be a bartender on a beach.

Your proudest moment?

Becoming a father to two amazing children.

Where is the most interesting place you’ve travelled? Why?

Most interesting was to Italy. The people, culture, different way of life.  It was all amazing to me.  I kept thinking of nature versus nurture and what a different life I would have if I was born there instead of the United States.

Any hobbies? Activities?

Working out, running, paddle boarding, boating, wood-working.

What’s your next adventure?

Traveling. Definitely traveling.

Your guilty pleasure food?

I’m not a sweets kind of guy or dessert, but I love sushi.

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Dr Adam Mandel is a Fellowship Trained and Board Certified Foot and Ankle Physician. He sees patients in our Lakewood Ranch and Sarasota offices. We are able to offer same day / next day appointments at any of our three locations and appointments may be may online at www.SOA.md or by calling 941-951-2663.

 

When Should My Child See an Orthopedist?

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It can be hard to know whether a child needs orthopedic treatment or is just experiencing growth development. Symptoms can be signs of underlying causes. While many orthopedic problems that arise in childhood are temporary, it can be hard to know when your child may need additional care. Parents who notice persistent musculoskeletal problems may need to consider seeking pediatric orthopedic treatment. There are two primary orthopedic problems found in young children. These typically form when a child is first learning to walk and can lead to irregular walking habits.

Intoeing is identified as running or walking with the toes turned slightly inward as opposed to straight forward. The layman’s term for this condition is “pigeon-toed.” Intoeing typically corrects itself around the age of 8 in the majority of children, however, if it continues the child may need the assistance of a brace or other orthopedic treatment. Intoeing can be a symptom of metatarsus adductus (when a child’s foot is bent inward near the middle of the foot), tibial torsion (the inward twisting of shin bones), or femoral anteversion (an inward twisting of the thigh bone). Treatments include casts, braces, or surgery to reset bones.

Bowleggedness, or genu varum, is more commonly found in toddlers under the age of 2 and those suffering from childhood obesity. If a child has bowleggedness, there will be a noticeable gap between their legs when they place their feet together. As the child continues to grow, bowed legs typically straighten themselves out. However, if one leg is more bowed than the other or if the bowing is more severe than usual, the child may need orthopedic treatment. Furthermore, bowleggedness can be an indication of something more serious such as Blount’s disease or rickets. This is often identified via x-ray after the child is three years old. If left untreated, bowing may worsen or become permanent. Treatments include bracing, medication, or surgery depending on the underlying cause.

If parents notice these symptoms and they seem more severe than usual, it’s important to ask a pediatrician if seeing a specialist is necessary. At Sarasota Orthopedic Associates, we treat patients from pediatrics to adults. We have three convenient locations and are able to offer same day / next day appointments when needed. Our mission is to get patients back on their feet, back to work, back in the game, and back to life.