A recommendation for spine surgery usually occurs after a period of conservative treatment involving medications, physical therapy, and injections have failed to provide the patient with adequate relief of symptoms. Once surgery is decided upon, there is a process to determine if a patient is a candidate for minimal spine surgery. Not every patient meets the criteria for these techniques; however, some procedures that can be performed with a minimal approach include the removal of herniated disks, spinal fusions, and the treatment of deformities, fractures, and infection.

Traditional spine surgery usually requires a 5-6 inch incision with extensive dissection and retraction of muscle tissue. This is a common source of postoperative pain and can also lead to significant blood loss. Hospital stays following this type of surgery can last up to 5 days or longer with an overall recovery period of several months.

Minimally invasive spine surgery was developed to treat certain spine problems and delivers the advantage of smaller incisions, less bleeding, less injury to the muscles and other structures of the spine, and shorter hospital stays.  Some of these procedures can even be performed as same-day surgery with the patient going home after a short recovery period.

These procedures are performed through tubular style retractors and special tools that are designed to fit through these retractors. These retractors are placed in the body with the assistance of real-time X-ray. They are passed through the skin and soft tissues down to the spinal column and then held in place during the procedure. The retractor holds the muscles open to allow the surgeon to see the small area in the spine where the problem exists. Sometimes more than one retractor is required to perform the procedure. The surgeon then uses the appropriate instruments to remove bone or disk material through the retractor and is able to place any device, such as screws or rods, if a fusion of the spine is necessary. In order to assist in visualization, a surgeon may choose to use a microscope to magnify the view through the retractor during the surgery. After the surgery is completed, the retractor is removed, minimizing the damage to the muscles.

Back pain and spine problems are very common. Patients should always undergo appropriate nonsurgical treatment before considering surgery. However, if surgery is indicated, the option for minimally invasive spine surgery can make the recovery much easier. The technique is now available at the North Louisiana Orthopaedic & Sports Medicine Clinic.

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Functional recovery following hip fractures extends up to one year but only 40 percent of hip fracture patients can expect to walk with the same level of ease of functionality as before their injury occurred. Nonetheless, researchers have documented that three-fourths of hip fracture patients are able to perform basic activities of daily living within one year of their injury.

Hip fractures are classified according to their severity and by their location in the upper femur. Femoral neck fractures occur between the head of the thigh bone and the trochanters of this bone.  Intertrochanteric fractures occur between the greater and lesser trochanters, and subtrochanteric fractures occur below the lesser trochanter. Each of these fracture types may be displaced (meaning the blood supply to the head of the femur is injured), non-displaced (meaning the fracture is well-aligned), or minimally displaced.  

Displaced femoral neck fractures usually require a replacement prosthesis while both intertrochanteric and subtrochanteric fractures are usually stabilized with a rod & screws or a plate & screws.  Non-displaced femoral neck fractures can be managed non-operatively but must be X-rayed frequently as there is a significant risk for future displacement requiring a prosthetic. Operative intervention for patients having sustained an acute hip fracture is preferable within the first 24-48 hours after which an early rehabilitation course should begin. In cases such as these where surgical intervention is delayed, there is a greater likelihood of morbidity and mortality.

A high percentage of hip fractures are considered fragility fractures or injuries related to osteoporosis. Any individual over the age of 50 who sustains a fracture as a result of only modest trauma (i.e., fall from standing height) should be screened for osteoporosis. Calcium and vitamin D taken daily, encouraging weight-bearing exercise and/or weight training, smoking cessation, and avoiding excessive prolonged alcohol intake are preventative measures for osteoporosis. Medication such as bisphosphonates and calcitonin, along with newer medications just out or soon to be released has been shown to reverse osteoporosis and thus lessen the chance for future fractures. These pharmaceuticals should be strongly considered in individuals who have previously sustained a fragility fracture and are shown to have osteoporosis upon testing. 

If you are living with hip pain or suspect you have a condition such as osteoporosis that makes you susceptible to a hip fracture, consider scheduling an appointment with one of our orthopaedic surgeons who can properly diagnose and treat your condition. 

Info from this article gleaned from the aaos.org website.

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In 2010, Xiaflex® was approved as a non-surgical alternative for Dupuytren’s disease. Xiaflex® is a collagenase, an enzyme that breaks down collagen. It is a minimally invasive, non-surgical treatment that can be dramatically effective with just one injection for appropriate candidates. The procedure involves an injection of Xiaflex® into the thickened tissue of the hand. The patient goes home and the medication begins to dissolve the excess collagen overnight. The patient returns to the office the next day. A local anesthetic is then injected into the area and the affected finger is manipulated into a straight position. The patient then meets with our Certified Hand Therapist to have a splint made, which is worn at night for 4 weeks. This alternative treatment gives patients a more conservative, non-surgical choice. It can be extremely effective and avoids the risks commonly associated with surgery. If you have any questions about Dupuytren’s disease or this treatment, please call our office to schedule an appointment.

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• Carpal Tunnel Syndrome
• Injuries and fractures of the hand and arm
• Tendonitis of the elbow (often referred to as tennis or golfer’s elbow)
• Wrist or hand pain
• Trigger finger
• Dupuytren’s contracture
• Arthritis
• Nerve and tendon injuries

It is important to know that not all problems need surgery. Many non-surgical treatments may be offered as well. Examples of non-surgical options may include medication, physical therapy, or injections. If you have a problem with the hand, elbow, or shoulder call the North Louisiana Orthopaedic & Sports Medicine Clinic today to schedule your appointment.

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The rotator cuff tendons play a key role in the normal healthy function of the shoulder. The rotator cuff is formed by the tendons of 4 muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff connects the ball part of the shoulder (the humerus) to the shoulder blade and socket (the scapula).

The rotator cuff tendons have areas of very low blood supply, and these areas make the tendons especially vulnerable to degeneration from aging. These degenerative changes help explain why the rotator cuff is more commonly injured later in life.

Unfortunately, with degeneration rotator cuff injuries can occur even with everyday activities. However, repetitive activities (especially overhead) tend to lead to the most problems with the rotator cuff.

Many tears to the rotator cuff occur with excessive force, such as trying to catch a heavy object or lifting a heavy object with the arm extended. In addition a fall directly on the shoulder can lead to tears of the rotator cuff.

Rotator cuff tears typically cause pain and weakness in the shoulder. In some cases tears may be partial and cause pain but still allow good motion and strength.

Most complete tears will result in weakness and pain, and very large tears can sometimes limit the ability to raise the arm away from your side.

Rotator cuff injury is best diagnosed with a history, physical exam, plan X-ray and in most cases an MRI. MRI is extremely useful in determining if a tear is present, as well as where the tear is located and the size of the tear.

A complete rotator cuff tear will not heal. Complete tears usually require surgery if your goal is to return your shoulder to optimal function. Partial tears may not require surgery. Non-operative treatment options include rest, anti-inflammatory medicine, steroid injections, and physical therapy. However, if pain and dysfunction persist, then surgery may be needed.  

If surgery is needed to repair the rotator cuff, excellent results can usually be obtained through an arthroscopic repair. This is an outpatient procedure that only requires small stab incisions. The arthroscope allows excellent visualization of the rotator cuff and a thorough evaluation of the entire shoulder joint. The repair is done by placing small anchors in the bone (humerus). Stitches from the anchor are passed through the rotator cuff tendon and securely tied, repairing the tendon back to the bone.

If you are living with shoulder pain or suspect you have a rotator cuff tear, consider scheduling an appointment with one of our orthopaedic surgeons who can properly diagnose and treat your condition.

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The knee joint is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and lower leg bones (tibia and fibula) are connected by ligaments, tendons, and muscles. The surfaces of the bones inside the knee joint are covered by articular cartilage which absorbs shock and provides a smooth gliding surface for joint movement.

While the knee joint’s main function is to act as a hinge in order to bend and straighten the body, the knee can also twist and rotate. Thus, injuries to the knee and overuse of the knee may hurt both the bone and also the ligaments, tendons and cartilages that help support the knee.

While many jobs, sports and recreational activity, getting older or having a disease such as osteoporosis or osteoarthritis increase the chances of having knee problems, injury is the most common cause of knee problems. Sudden or acute injuries may be caused by a direct blow to the knee from abnormal twisting, bending or falling. Pain, bruising and swelling may be severe and develop within minutes of the injury. The nerves, blood vessels, bursa (fluid sacs) which allow tendons to rub over the bone may be pinched or damaged during the knee injury. The knee or lower leg may feel numb, weak, cold, tingle or look bruised or blue. Swelling can occur sometimes very quickly after knee injuries.

Acute injuries to the knee may include:

1. Sprain, strain or other injuries to the ligaments or tendons.
2. Tear in the rubbery cushion to the knee joint (the meniscus), ligament tear such as an anterior cruciate ligament (ACL) or medial collateral ligament (MCL).
3. Breaks or fractures of the kneecap, lower portion of the femur or upper part of the tibia or fibula.
4. Severe force to bend the knee or when the knee forcefully hits an object.
5. Kneecap dislocation. This type of dislocation occurs most frequently in 13-17-year-old girls.

Overuse injuries occur with repetitive activities or prolonged pressure on the knee. Activities such as stair climbing, bicycle riding, jogging or jumping stress the joints and tendons that support the knee and can lead to irritation and inflammation. In children, injuries to the growth plate and overuse injuries to the growth plate (Os-Good Schlatter’s) are fairly common. Other common causes of children’s knee pain include infections, tendinitis and adult-type injuries as well.

Most knee injuries and knee pain can be diagnosed in the office with a thorough history and physical exam. X-rays and occasionally an MRI scan can help confirm the diagnosis. Once the correct diagnosis of the knee pain is made, the treatment plan (medicine, physical therapy, surgery, etc.) can then be discussed with the patient. The orthopaedic surgeons at Orthopaedic & Spine Clinic of Louisiana are uniquely trained to diagnose and treat correctly knee pain or knee injuries. Please come and see one of our board-certified orthopaedic surgeons about your knee pain.

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Hip arthroscopy, or hip scope, can be utilized to treat a number of conditions in the injured hip. From mild arthritis to labral tears and bursitis of the hip, it is now possible to correct problems with an outpatient procedure and obtain very good results for the patient. To determine if a patient is a candidate for hip arthroscopy, an evaluation in the office is typically followed by an MRI to identify the pathology. Not all problems require and conservative treatment should, in most cases, be attempted to correct the issue. Usually, this involves the utilization of physical therapy, avoidance of certain activities which could aggravate the condition, and medications such as NSAIDs (non-steroidal anti-inflammatories). Occasionally, an injection in the joint or into the bursal region can be attempted to alleviate the problem. If all conservative treatment fails, then your surgeon may suggest surgery.

A hip scope is performed through small incisions where a tiny camera is placed into the hip joint or other spaces to treat the pathology. It is almost always an outpatient procedure. Depending on what surgery is performed, the patient may be required to use crutches for a period of time to allow repaired structures to heal. In most cases, physical therapy is necessary to walk without a limp.

One of the more common procedures performed is the removal of greater trochanteric bursitis. This is a condition that can be very painful and can develop from trauma, such as a fall into the side of the hip, or simply without any clause. It leads to pain on the side of the hip which makes it difficult to lie on the injured side and is aggravated by walking or jogging. Again, conservative treatment is attempted first, but if necessary surgical removal is a very sucessful treatment. The camera is placed into the space where the bursa is located and the inflamed bursal tissue is then removed with a special instrument. Crutches are utilized until the pain resolves and then the patient can resume normal activities to his/her tolerance.

To discuss your hip pain and to be evaluated for possible hip arthroscopy, contact your surgeon at the North Louisiana Orthopadic & Sports Medicine Clinic

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In doing so, we provide patients with convenient access to specialized state-of-the-art medical services throughout our region. We believe that providing high-quality care is not only about the medical advice and treatment that we dispense, but more importantly about the relationships that we have with our patients. That is why we are going the extra mile and are proud to have opened our Orthopaedic After Hours Clinic in August 2015.

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The practice of medicine is one of constant learning. We are excited about the many advances in orthopaedic surgery. Our ability to treat the injuries and joint issues of our patients has improved significantly with these new technologies.

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