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March 13, 2013
Why Do Joints Swell?
Author: David D. Waddell, M.D.
One of the common presenting complaints in an orthopedic office is that of swelling in a joint. Pain may or may not be present, but is often present when a significant amount of swelling is present. The simple answer to the question of why a joint swells is the presence of excess joint fluid within the confines of the joint. This simplistic answer has many complex causes. If there has been significant trauma to the joint, then the swelling may actually be due to blood in the joint, called a hemarthrosis. This indicates that some structure has either been broken or torn as a result of the injury.
When the blood is removed from the joint by a procedure known as arthrocentesis it will be examined to see if any fat droplets are visible floating on the surface of the blood in the basin. The presence of fat droplets indicates that there has been a disruption of the bone structure of the joint. The fat droplets are from an area on the inside of the bone known as the intramedullary canal. This is the area where bone marrow is located as well as the fat. Even when an x-ray fails to demonstrate the bone injury, the presence of fat in the aspirated blood is a reliable indicator of such an injury.
Additional information may be obtained by ordering a test known as an MRI, magnetic resonant imaging. A severe bone contusion may be present with minor disruption of the articular surface of the joint. In other instances, a large fragment of bone known as an osteochondral fracture may be the cause of the bleeding. A tear of the anterior cruciate ligament may be the cause of blood in the knee joint. As you can see, there are several causes of blood in a joint, the exact etiology must be determined so that appropriate treatment
can be instituted.
Another cause of a swollen joint is arthritis. Osteoarthritis can cause a disregulation of the fluid in a joint. Normally a joint such as the knee joint will contain several milliliters (ml’s) of fluid. The inflammation of osteoarthritis can cause this amount to increase to 10-100 ml’s of fluid. A person may not notice amounts at the lower end of this spectrum, but the presence of 90-100 ml’s will cause a feeling of tightness, stiffness and discomfort. Removal of the fluid will offer almost immediate relief of the symptoms. If the person can tolerate corticosteroids, installation of 1-2 cc's of a steroid will often provided additional comfort. Steroids cannot be given on a regular basis but can be used several times a year. Use of injectable steroids in diabetic patients must be done with caution as they can cause an increase in their blood sugar. Consultation with their primary care physician may be done to determine if steroids can be utilized.
With the widespread use of home blood glucose monitoring, the effect of a patient’s blood glucose can easily be determined.
Joint fluid may be increased in a number of other conditions as well. A torn cartilage, a loose body and extreme overuse of a joint may cause the amount of joint fluid to increase. This condition of increased joint fluid is known as an effusion. Determination of the cause of the effusion again will be necessary to develop the correct treatment plan. A less common cause of joint swelling is that of infection. Bacteria can grow inside of the joint after a traumatic puncture leading to an infection. The fluid in this case will be thick and contain many white blood cells. The increase in the white blood cells of the joint fluid indicates the body’s effort to fight the infection. Metabolic conditions such as gout can also cause an increase in the amount of fluid in the joint. In the case of gout, the fluid will actually contain the uric acid crystals that cause the gouty condition. These crystals can be seen with a specialized microscope utilizing polarized light technology. The crystals cause irritation of the joint. The pain from gouty arthritis can be some of the most excruciating pain experienced with any joint condition. Aspiration of the fluid and injection of a steroid will give initial relief. However, other medications will be necessary to treat the condition. Special attention to diet may also be necessary.
These are just a few examples of why a joint swells. It can generally be said that swelling of a joint indicates a significant condition. Medical attention should be sought and the cause of the joint swelling should be determined. As with all health issues, specific health questions that you have should be discussed with your physician.
 February 1, 2013
Make Your Doctor Listen To You
AUTHOR: David D. Waddell, MD
Every aspect of our lives depends on good communication. In order for you to obtain the best quality health care, you must effectively communicate your symptoms and questions to your physician. Don’t be afraid to ask any question while talking with your physician. It is by this means, you can insure that you receive the proper evaluation and treatment. A major component in the evaluation of any health problem begins with a good history. Your physician began his or her medical career learning how to ask pertinent questions and assimilating those questions into a provisional diagnosis or plan to reach a diagnosis. You should pay particular attention to the different aspects of whatever it is that leads you to the doctor’s office. Note when you are having trouble. What makes your symptoms get worse? Are there certain things or activities that cause the discomfort to begin or get better? If so, note them either mentally or write them down so that you will be sure to tell your physician about them.
If you have had treatment for the problem before by another physician, be sure to bring copies of the old records or let your doctor know where they can be obtained. This may assist your physician in ordering the proper tests and avoid repeating tests that have already been done. If you have the results of previous studies, such as an MRI, be sure to bring them with you when you see the physician. Additionally, keep a list of all the medications that you are currently taking, not only for the problem in question, but also for any other medical problems that you may have. Certain medications will interact and either cause problems or be ineffective when taken with other medicines. If you have had previous surgery for a condition, it would be helpful to your physician to have a copy of the operative dictation. This provides information as to what has been done surgically; such information will be helpful in planning future surgery if it is necessary.
Making a list of your questions will insure that you do not forget to ask all of the pertinent ones. Having a relative or a close friend attend the visit with you may help to insure that all of your questions are addressed. Additionally, instructions that you are given, may be better understood or remembered if you have someone there to assist you. Studies have shown that patients remember only about half of the information verbally related to them by physicians. Often your physician will provide brochures that will describe what condition has been diagnosed. These are helpful in promoting your understanding of the problem. Some physicians use videos to promote patient education. These videos insure that all of the intended information is delivered to the patient every time. So if your physician asks you to watch a video, pay particular attention to it and take notes. It is perfectly proper to take notes during your discussions with your physician, so don’t be afraid to do so.
Learning as much as you can about a condition is always helpful. However, be aware that all you read or hear about a subject may not apply to you individually. Sometimes much is written in the newspaper or discussed on the television that really only applies to a small segment of the population. Your physician will be glad to explain how what you have seen or heard may apply to your condition. You may have heard that some new procedure is the ultimate in treatment of a condition that you have, only to learn that it really is applicable to one tenth of one percent of individuals with that condition. Still don’t be afraid to ask the questions. The only bad questions are the ones that you never ask.
With the rapid expansion of the Internet, other sources of information are now available to all of us. In preparing for a visit to the doctor, some people may want to check the Internet for information concerning their condition. Your physician will be glad to discuss those issues with you. Sometimes the answer will not be available immediately and may require your physician to discuss the matter with a colleague. In those cases, be patient. If you prepare for your doctor’s visit, you will no doubt get better care. So take a little time, write down your questions, make notes and above all make your doctor listen to you!
> More Articles by Dr. Waddell
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November 5, 2012
New Twist for Knee Injuries
Author: David D. Waddell, M.D
When we hear of knee injuries in the fall, most of us think of young men being injured while playing football. That has changed along with many other things in this new millennium. Most injuries are more related to the specific sport that one plays, but facts are emerging that point to some importance being associated with the gender of the athlete. Data collected over the last decade, suggests that the rate of injury in a specific sport may well be different for males and females. It is common knowledge, that sports such as soccer, football, basketball and volleyball have a high rate of knee injuries. Research has shown that in soccer, females are four times as likely to injure their anterior cruciate ligament as are males participating in that sport. For basketball the rate is twice as high for females.
The anterior cruciate ligament is a major stabilizing ligament of the knee joint. It prevents that lower leg bone (tibia) from sliding forward when the foot is planted firmly to the playing field. This ligament is often injured in sporting activities. Other parts of the knee may be injured as well, such as the cartilages (menisci) and capsular ligaments (medial collateral and lateral collateral ligaments). An acute injury to these structures usually will cause significant pain and prevent the athlete from participating in the sport for some time. Most ligament injuries occur in individuals from 15-30 years of age. This is true for both males and females.
There are several possible explanations for the differences noticed in the injury rates between males and females. Males tend to use their hamstring muscles more in their jumping activities and this muscle group is often more developed in them compared to females. Females, on the other hand, use the quadriceps (thigh) muscles more. Some researchers have suggested that the shape of the female knee may also play a role in the injury of the anterior cruciate ligament, however more research is necessary to prove the validity of this theory. There does not appear to be any hormonal basis for the difference, therefore no modification of female athletes’ sports schedule is warranted.
There has been much written about the use of braces for knee injuries. After a knee has been injured, there are braces that are appropriately prescribed for sports participation. However, the use of braces has not been shown to prevent anterior cruciate injury. Prevention is more likely to be achieved with modification of training techniques and exercise programs. Women tend not to bend their knees as much during jumping activities. This fact increases the amount of force per pound of body weight onto the knee and leg. Modification of this jumping skill can help the female athlete land in a safer manner. This is a skill that must be taught early to young girls in sports. Teaching girls to strengthen their hamstring muscles will also provide more durable knees for them. Strength training for females should also be done on a year-round schedule.
Flexibility training is equally important for both males and females. The quadriceps and hamstring muscle groups should be stretched regularly. To stretch the quadriceps, while in a standing position, lift one leg off the floor and pull the foot back towards the buttocks. Hold the stretch for 5-10 seconds and repeat for about 3 minutes for each leg. Hamstring stretching is best done in a sitting position. The foot should be upright. The opposite leg should be crossed over the leg to be stretched. With the knee extended, lean forward grasping the foot if possible. Hold the stretch for 5-10 seconds per stretch. Each hamstring group should be stretched for about 3 minutes.
These simple training points and exercises have the ability to decrease the risk for injury to the knee in both males and females. As with any specific health question, feel free to discuss it with your physician.
September 4, 2012
Check us out in the September 2012 issue of SB Magazine
August 2012
Video: Dr. Stephen Cox talks backpack safety at KTBS 3
08/07/2012
From the AAOS:
At What Point is a Child’s Backpack Too Heavy?
Orthopaedic surgeons share safety tips as kids head back to school
Rosemont, IL
As kids return to school this August, don’t wait for them to complain about back pain. Instead pay attention to their posture and keep an attentive eye on all of the items that are loaded into their backpack each day.
Experts recommend that kids carry no more than 10 to 15 percent of their body weight, but that doesn’t always seem to be the case. According to the Consumer Product Safety Commission (CPSC) more than 13,700 kids, ages 5-18 years old, were treated in hospitals and doctors’ offices for injuries related to backpacks.
EXPERT ADVICE
“When used correctly, backpacks can be a good way to carry the necessities of the school day,” said orthopaedic surgeon and American Academy of Orthopaedic Surgeons (AAOS) spokesperson Melanie Kinchen, MD. “Backpack injuries are commonly caused by wearing overloaded backpacks, as well as lifting and carrying them incorrectly. Parents and teachers should guide kids to take preventative measures. Start by choosing a backpack that is appropriately sized for your child or have them use a rolling backpack as an alternative to carrying their heavy load on their shoulders.”
AAOS SAFETY TIPS
The Academy recommends the following safety tips to help eliminate pain and discomfort due to backpacks:
- Always use both shoulder straps to keep the weight of the backpack better distributed.
- Tighten the straps and use waist strap if the bag has one.M
- Remove or organize items if too heavy and place biggest items closest to the back.
- Lift properly and bend at the knees to pick up a backpack.
- Carry only those items that are required for the day; leave books at home or school, if possible.
- Keep walkways clear of backpacks to avoid tripping over them.
Parents also can help with backpack-related pain:
- Encourage your child or teenager to tell you about pain or discomfort that may be caused by a heavy backpack, like numbness or tingling in the arms or legs.
- Purchase a backpack appropriate for the size of your child and look for any changes in your child’s posture when he or she wears the backpack.
- Watch your child put on or take off the backpack to see if it is a struggle. Do not ignore red marks on the shoulders if your child or teenager expresses discomfort.
- Talk to the school about lightening the load. Keep the load under 10-15 percent of the child's bodyweight.
- Be sure the school allows students to stop at their lockers throughout the day.
Teachers can help by following these tips:
- When planning lessons, take into consideration ways to lighten a child’s backpack load.
- Allow enough time for kids to stop by their lockers to drop off books.
More tips:
Backpack safety
April 5, 2012
AUTHOR: David D. Waddell, MD
“RUNNER’S KNEE”
The fitness mania of the 1990’s continues in the 21st century. More people than ever are working out in aerobic activities. One of the most popular aerobic activities is running. This activity has especially captured the heart of the “baby boomer” generation. Early in the fitness craze, a number of foot conditions became evident. Fortunately these were addressed by the shoe manufacturers and physicians leading to good answers for the problems that presented. Indeed the foundation for a good running program is a very good running shoe. Read more ...
January 24, 2012
Two Local Orthopedic Surgeons replace 29 Joints in Nicaragua
David Googe, M.D. and Steven Atchison, M.D. Returned from a week long mission trip with First Baptist Church of Minden, LA. The group left January, 9 2011 and spent a week of meeting the spiritual and physical needs of the people of Nicaragua. The medical team conducted 29 free orthopedic surgeries on patients who do not have the resources for major medical care at Hospital Regional Santiago in Jinotepe. The non-medical team members will minister to children by holding Bible schools in the area.
View 3 minute video of Doctors Atchison & Googe talking about their experience on the trip.
View 30 minute KTBS 3 interview of Doctors Atchison & Googe talking about their experience on the trip.
January 23, 2012
PAIN - IT REALLY HURTS
AUTHOR: David D. Waddell, MD
Pain is a protective mechanism allowing your body to realize that something is occurring that is not beneficial to your body. That recognition tells you to avoid whatever is causing pain. When we touch a hot stove, instantaneously we know to withdraw our hand. Unfortunately sometimes the cause of pain is internal and we cannot avoid it. That pain usually takes us to a physician to determine its cause and what can be done about it. Fortunately in most instances, the cause of the pain can be recognized and treatment restores the body to normal function. In some instances, the cause of the pain may be a chronic condition that cannot be eliminated with medical treatment. In very serious injuries, residual scar tissue and deformity may be the cause of ongoing pain. The recognition of chronic pain is a step towards managing the problem. Unrecognized chronic pain perpetuates the problem. An entire specialty has developed for the treatment of chronic pain. The physicians that specialize in this area are called Pain Management Specialists. Quite often, the physician who specializes in chronic pain management is an anesthesiologist. He or she is first trained as an anesthesiologist for the management of patients in surgery and their post-operative pain. Further training allows them to differentiate various causes and types of pain that can occur. Read more ...
December 19, 2011
View Photos from the annual Chirstmas Party!
View Photos from 'Shop with a Doc'
December 12, 2011
From the Shreveport Times Sunday, December 11, 2011
LightHouse students 'Shop with a Doc'
Caleb Barnes walked down the aisles of Batman, Toy Story and Tonka trucks at Target on Saturday morning in awe, pushing every button, carefully testing each piece of shiny plastic before choosing a motorized Hot Wheels drag racer.
His personal shopper, Angela Moore, followed closely, pushing the buggy that was quickly filling with toys and clothes and calculating how much money was left in Barnes' toy budget.
"I just let him look at his own thing," Moore said. "We went to clothes first, but he wanted to go to toys. He and my son are the same age, so this is right up my alley. I'm just glad to be a part of it."
Barnes, 6, was one of 50 children from Volunteers of America's LightHouse after-school program who participated in the Shop with a Doc Christmas shopping spree at Target on Youree Drive.
Specialists Hospital of Shreveport makes an annual Christmas donation to charity, and this year, hospital marketing specialist Amanda McCarter wanted to help a group that doesn't get a lot of publicity and do more than just make a donation.
"You can see the good you're doing rather than writing a big check," McCarter said.
Each child was given a $350 gift card and had his or her own personal shopper from Volunteers of America, and doctors from Specialists assisted.
Of that $350, children were allowed $125 to spend on toys and $125 to spend on practical items, such as clothes and shoes. Out of the remaining, $30 was allotted for taxes and $70 was spent on a gift for someone in their family.
"Target has been great with all the staff," McCarter said of the extra employees on duty to assist with price checks, stocking and item location.
Target also gave a 10 percent discount, allowing Specialists to donate $2,000 to the First Baptist Church School scholarship program. Volunteers of America's LightHouse program serves children in kindergarten through 12th grade and their families from some of Shreveport-Bossier City's poorest neighborhoods.
Academics are the first priority for the students, who also take part in character building, community service and enrichment activities.
From KTBS 3 News:
"Shop With A Doc" Gives Lighthouse Kids Special Treat
POSTED: 5:34 pm CST December 10, 2011
SHREVEPORT, La. -- About 50 kids from the Lighthouse after-school program in Shreveport got an early Christmas today.
Each child was given $350 to spend at the Youree Dr. Target for the "Shop with a Doc" event.
The Specialists Hospital of Shreveport donated the money, and the kids stormed the aisles to stock up on toys, clothes and other necessities.
The doctors say seeing the children's excitement is what it's all about.
"Certainly this is something they haven't been able to do before and they're excited and they're an anxious about getting stuff for their brothers and sisters who live in others states, many of them. So they're having a blast," said Dr. Steven Atchison, Orthopedic Surgeon with the Specialists Hospital.
The Lighthouse program serves children from kindergarten through 12th grade and emphasizes academics, character building and community service.
December 7, 2011
Doctors sponsor shopping spree for LightHouse kids
Christmas wishes will come true Saturday, when about 50 children from the LightHouse after-school program storm the aisles of Target thanks to a generous donation from Specialists Hospital of Shreveport.
In the first "Shop with a Doc" Christmas shopping spree to be held Dec. 10, each child will receive $100 to spend on toys and another $100 for basic needs such as clothing and school supplies. The doctors involved come from Orthopedic Specialists of Louisiana, Spine Institute of Louisiana, and Pain Care Consultants.
"The doctors are really excited to see the kids, instead of just writing a check," said Amanda McCarter, marketing specialist for the Hospital.
The children will meet at 9 a.m. Saturday at the Shreveport Target, 7110 Youree Drive, where doctors and volunteers will be there to serve as personal shoppers for each child. Target agreed to set aside one lane for them to make their purchases.
Volunteers of America's LightHouse after-school program serves children ages kindergarten through 12th grade and their families from some of Shreveport-Bossier's poorest neighborhoods. Academics are the first priority for the students, who also take part in character building, community service and enrichment activities.
November 16, 2011
Dr. David Googe speaks to KTBS 3's Health Reporter Chrissi Coile about preventing sports injuries. Bossier High School's head coach Jeremiah Williams and player Devonte Hall join them to talk about how they are getting ready for this years season. Hall also show's off his 2011 State Championship Ring.
Check out the video!
See more photos of the Bossier Bearkats receiving their rings
October 27, 2011
Just What is a Total Knee?
Most of us know someone who has undergone a total knee replacement. Despite this fact, there is still much confusion about just what is involved in a total knee replacement. Many people mistakenly feel that everything around and including the knee is replaced in this operation. In this column, I will try to clarify some of the misunderstanding about this very common operation. Almost 300,000 Americans will undergo this operation this year, and that number is growing each year. The actual operation is more appropriately called a total knee arthroplasty. The term total knee replacement is frequently substituted for the more formal nomenclature. The diseased joint surfaces are replaced with prosthetic components.
Read more about total knees from David D. Waddell, M.D
October 7, 2011
Let's Talk About Total Knee Replacement
Author: David D. Waddell, M.D.
In recent months, there has been a lot of talk on the radio and television about minimally invasive surgery in orthopedics. The quintessential minimally invasive orthopedic surgery is arthroscopic surgery. Almost fifty years ago, orthopedic surgeons in Japan pioneered this surgical field, changing the manner in which problems of a number of joints are handled. The impressive fact about arthroscopic surgery is the length of time from its inception until it has become the standard of care.
This same issue is now being debated among orthopedic surgeons as they face new technology in the joint replacement field. This entire field of minimally invasive joint replacement is really in its infancy. Much has been said about techniques for the hip and knee, but the fact of the matter is that there are many considerations that must be proven before it can be said that minimally invasive total joint replacement is better than the "gold standard" joint replacement techniques that have been proven for many years.
Currently the minimally invasive techniques have focused on basically doing a standard total joint through a smaller incision. The instruments utilized for this surgery have been downsized, but the artificial joints themselves are still the same ones that have been in use for many years. Critical aspects of the surgery must be done exactly as they have been for decades. The prosthesis must be adequately secured to the bones of the joint once the diseased portions have been removed. The alignment must be proper and any abnormal joint angles must be eliminated. The proper completion of these steps is necessary in order for good function to be achieved.
Another critical issue is the determination of whether or not a patient is even a candidate for the minimal incision technique. One of the biggest contraindications for this technique is an obese patient. Unfortunately, many of us are overweight in this country. If you are more than a few pounds over the normal range of weight for your height, it is likely that you are NOT a candidate for minimally invasive surgery. Additionally, if the joint has significant restriction in the amount of motion, then these techniques are probably not indicated.
For many years, the length of the incision in total joint replacement has been decreasing in size. Recently, I had the opportunity to see one of my patients in whom I placed a total joint 25 years ago. Two years ago, I replaced their other arthritic knee. The knee that was operated on 25 years ago had an incision that was 10 inches long. The most recently operated knee had an incision that was just over 4 inches. Experience, advancements of surgical techniques and instrumentation allowed me to do the same incision through a much smaller incision. Indeed, that was minimally invasive surgery. The advantage of this approach is quite obvious. A smaller incision is less traumatic to the soft tissues around the joint. Less post-operative pain allows for more rapid mobilization and an earlier discharge from the hospital. Rehabilitation is made easier with less swelling and pain associated with the smaller incision.
Even with the advances that have been made with joint replacement to date, there will be more impressive ones in the future. The entire design of artificial joints will change over the next decade. The materials that are used now will become obsolete. It is likely that polymers and materials that will be inserted through even smaller incisions will replace them. Until that day arrives, don't be confused. The total joints that are being implanted today are actually the ones that have been around for a long time. Yes there have been improvements in materials and instruments, but they are quite similar to the ones utilized in the 1980's. Don't be too disappointed, because those joints actually worked very well. The example cited earlier testifies to that fact because of the 25 years of service that artificial knee has given to the patient. Yes the incision was longer, but the knee has worked very well. It did so because it was implanted securely and in the proper alignment.
If you have any specific questions regarding your health, be sure to discuss them with your physician. He or she will be glad to answer them for you. You can also shoot us an email at info@msil.md
MAKOplasty seminar
Date: October 21, 2011Time: 11:30 am - 2:00 pm
Location: Clarion Hotel Shreveport
1419 East 70th Street
Shreveport, LA 71105
Contact: Nichole FulgiumPhone: 1-866-759-9679Email: nfulgium@msil.md
Healthline 3 Orthopedic Specialists of Louisiana
Want to hear more from our doctors? Check out the Healthline 3 interviews on KTBS.com
Back to School Safety: Avoid Pain from Heavy Backpacks
Orthopaedic surgeons offer tips to steer clear of injuries from backpacks
See the video and story at KTBS.com
A student’s backpack might contain homework, books, laptops, iPods, lunches and even gym clothes. As their backpacks become stuffed to the brim, the pack can become much too heavy or might be worn improperly, causing unnecessary back strain and pain to a child’s back. The American Academy of Orthopaedic Surgeons (AAOS) suggests that backpacks be worn correctly and should not carry too much weight, that can cause pain or discomfort.
STATISTICS
According to the U.S. Consumer Product Safety Commission, in 2010, nearly 28,000 people were treated in hospitals, doctors’ offices, and emergency rooms for backpack-related injuries like strains, sprains, dislocations and fractures.
AAOS SAFETY TIPS
The AAOS recommends the following safety tips to help eliminate pain and discomfort due to backpacks:
- Always use both shoulder straps to keep the weight of the backpack better distributed;
- Tighten the straps and use waist strap if the bag has one;
- Remove or organize items if too heavy and place biggest items closest to the back;
- Lift properly and bend at the knees to pick up a backpack;
- Carry only those items that are required for the day.
Parents also can help with backpack-related pain:
- Encourage your child or teenager to tell you about pain or discomfort that may be caused by a heavy backpack, like numbness or tingling in the arms or legs.
- Purchase a backpack appropriate for the size of your child and look for any changes in your child’s posture when they wear the backpack.
- Watch your child put on or take off the backpack to see if it is a struggle for them. Do not ignore red marks on the shoulders if your child or teenager expresses discomfort.
- Talk to the school about lightening the load. Keep the load at 10-15 percent or less of the child's bodyweight.
- Be sure the school allows students to stop at their lockers throughout the day.
EXPERT ADVICE
“Pain from backpacks is a common occurrence for students when they over pack their bags or don’t distribute the weight evenly in the pack,” said orthopaedic surgeon Laurel C. Blakemore, MD, AAOS spokesperson and chief of orthopedic surgery at Children’s National Medical Center in Washington, D.C. “There are a number of options to help alleviate backpack-related pain, like making sure the backpack doesn’t weigh more than 10-15 percent of the child’s body weight and wearing a backpack that fits well over both shoulders and at the waist.”
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Links we like:
American Academy of Orthopaedic Surgeons - http://www.aaos.org
American Society for Surgery of the Hand - http://www.assh.org
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