Your orthopedic doctor has assessed your injury and decided that a cast is the best treatment option…now what? Casts are used to protect and immobilize bones and joints in order to support injured limbs while they heal. Although casts can feel awkward at first, they play a big role in how fast your injury can heal. Here’s what to expect from your time spent in a cast.
If your injury is suspected to be a break or fracture, your doctor will usually order an x-ray to confirm the injury and determine the exact type and location of the injury. On some occasions, splints will be worn for a few days before the cast to reduce swelling, ensuring that your cast will provide the best fit. Splints are usually held in place by fabric fasteners, Velcro, or tape.
Getting your cast
When it’s time to get your cast put on, you’ll be taken to our cast room where an orthopedic technician will put on the cast for you. Your cast will be made in four parts:
Sock – a soft sock will be placed on your limb first to help with itching and keep your cast smooth and edge-free.
Cotton wrap – a cotton wrap will be placed over the sock to help with padding.
Casting material – a casting material containing fiberglass is applied next. Once the material has been properly wrapped, the technician will need to mold the cast to your limb to ensure it has the best functionality and heals your limb correctly. With this step, you also get to choose a fun color for your cast!
Caring for your cast
It’s extremely important to keep your cast in good shape so it can do its job and your bones can heal properly. The way you treat your cast can play a big role in how quickly you heal. By following the cast care tips below, you can make this phase a little more pleasant.
Keep your cast dry. All casts are made primarily of plaster or fiberglass. A wet cast will become soft, and may not hold your limb in place. It can also cause infections and/or rashes. Bathe as directed by your physician and keep your cast out of the water. Covering your cast with plastic can help. If your cast gets damp, pat it dry with a towel. A hairdryer on the cool setting can also do the trick!
Keep foreign objects out. Never slide anything inside the cast or put lotions/powders inside the cast. To relieve itching, try raising the cast or changing positions. Air from a blow dryer on the cool setting also works.
Don’t alter the cast. Keeping your cast in good shape will ensure your cast does the best job possible at healing your bones. Do not cut the cast or pull it apart. Allowing friends and family to sign or decorate is okay!
Elevate and wiggle. Elevate the cast above your heart whenever possible to reduce swelling and help your injury heal. Wiggle your fingers or toes as much as you can to help with circulation.
Cast caution signs
Be sure to call the clinic if you develop any of the following symptoms:
Pain or swelling, or inability to wiggle your fingers or toes.
Your fingers or toes change color or tingle.
The cast is too tight or loose, or has something stuck inside of it.
Your cast becomes wet, cracked, dented, or has soft spots.
You get a rash or chafing on the skin around the edge of your cast.
You get a bad odor or itching that will not go away.
What to expect after cast removal
Pain, swelling, and stiffness
After having a cast removed, it is normal to have some pain, stiffness, or limited range of motion. Being immobilized for weeks or months can cause your muscles and joints to weaken. Over-the-counter medications can be used for pain and swelling (ask your doctor which medication is right for you). Elevating the extremity, above the heart can also help to decrease swelling.
Dry skin
Your skin may also be flaky, discolored, or dry from being hidden under a cast. Start by gently washing with soap and water and moisturize with an alcohol-free lotion. It’s also important to avoid picking at the skin as it will cause further irritation. Dry skin can take a few days to a week to go back to normal.
When to resume activities
It’s important to speak with your doctor about when you can return to activities. It’s typically advised to refrain from running, jumping, or sports for a few days to a few weeks after removal. After that, you are usually able to return to activities as tolerated.
Carpal Tunnel Syndrome is a common condition that causes pain, numbness and tingling in the hand and wrist. This is caused when the tunnel becomes narrow or when the tissues surrounding the flexor tendons become inflamed and swell causing pressure on the median nerve.
Symptoms can include the following:
Tingling and numbness in fingers – primarily in the thumb, index, middle and ring fingers.
Pain or tingling that travels up the arm toward the shoulder.
Lack of strength in grip and finger coordination – this may make it difficult to participate in normal activities such as buttoning your shirt.
Dropping things due to weakness or numbness
Nighttime symptoms are very common and may awaken you from sleep.
What is carpal tunnel release surgery?
During a carpal tunnel release, your surgeon will either make one incision or several small incisions on the palm of your hand and cut the ligament that is putting pressure on your median nerve. The release of this ligament increases the size of the tunnel and decreases the pressure placed on the median nerve. This usually improves pain and function of the nerve.
If you are preparing to undergo carpal tunnel release surgery, you may be wondering what to expect in the coming weeks and in the months post-surgery. The outcomes of open surgery and endoscopic surgery are similar, and for patients who are eligible to utilize wide-awake local anesthesia rather than general anesthesia, recovery times and potential risks decrease. Wide-awake local anesthesia is surgery performed with only local anesthesia, allowing the patient to avoid grogginess, and even drive him or herself home after surgery, if necessary.
After your surgery, you may be encouraged to do the following:
Elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness.
Ice the surgical site for a given amount of time, a few times a day.
You may need to wear a splint or wrist brace for several weeks.
Follow your doctor’s specific instructions on when it’s okay to return to work and whether you will have any restrictions on your work activities.
If you experience increased pain and weakness for more than two months following surgery, you may be referred to a hand therapist to help improve your recovery.
Carpal tunnel surgery recovery time can look different depending on who you are and in what condition your median nerve is in before surgery. Age, health factors, and your ability to follow post-surgical care guidelines can all affect recovery times. “It’s important to massage the palm in the horseshoe area of the hand, to minimize scarring, decrease pain, and help desensitize the area,” says Dr. James Verheyden, orthopedic surgeon at The St. Charles Center for Orthopedic and Neurosurgery.
It is likely that surgery will improve your previous symptoms, but recovery can be gradual, and in some cases, can take up to one full year. Other factors that can contribute to longer recovery times are preexisting conditions, such as arthritis or tendonitis, which could also be contributing to pain and stiffness. “Most patients note dramatic and immediate improvements in their symptoms, but it frequently takes about three months after surgery before their grip strength returns. Patience may have difficulty opening doors and jars of food up to three months after surgery,” says Dr. Verheyden.
Carpal tunnel surgery recovery milestones
Carpal tunnel surgery aftercare and milestones you can expect to meet with carpal tunnel release vary depending on the factors stated above, but this is one example of how your recovery could progress.
Around one week after surgery:
Removal of bandages and stitches will take place. Physical therapy may be suggested to improve stiffness and restore range of motion.
Weeks 2-4:
You may gradually resume activity in the affected hand. Pain and soreness in the palm are expected to slowly decrease.
4 weeks post-op:
You will likely regain full mobility of the digits or will be working with a therapist to regain mobility.
6-8 weeks post-op:
You may still experience soreness in your palm and sensitivity to deep pressure or touch, but you should be able to participate fully in daily life and sporting activities.
One year post-op:
Grip and hand strength usually come back within 2-3 months after surgery, but it can take up to a year to fully recover. By one year, you should be receiving all the benefits of your surgery.
The good news is that this condition is very treatable. It is important to be evaluated by your orthopedic surgeon in the early stages to slow or even stop the progression of carpal tunnel syndrome. The sooner you start treatment, the better your chances of preventing long-term damage to your median nerve and recovering fully.
Rock climbing and bouldering are popular sports in Central Oregon. It’s no surprise since the birthplace of American sport climbing, Smith Rock State Park, is located just 30 miles north of Bend. In addition, there are many other outdoor and indoor options available for climbers of all abilities. While there is always a risk of falling or traumatic injury in this sport, avid climbers more frequently experience overuse injuries at some point in their climbing careers.
Should injuries
Rotator cuff injuries are common for climbers because of the amount of time they spend with their arms overhead pulling up their body weight. The rotator cuff provides stability for the shoulder. It is comprised of tendons in the shoulder that attach to the humerus, as well as the four major muscles that surround the shoulder joint. A weak rotator cuff and/or poor biomechanics can contribute to a tear or tendonitis. Common symptoms include pain, weakness when lifting or lowering the arm, limited range of motion, and hearing clicking or popping sounds.
Treatment for rotator cuff injuries
Conservative treatment can be effective in treating tendonitis and small tears. This includes rest, ice, anti-inflammatory medications, corticosteroid injections, or physical therapy. If symptoms don’t go away or there is a large rotator cuff tear, surgery may be necessary to repair the tendon.
Elbow injuries
Tennis elbow, or lateral epicondylitis, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Because climbers use motions that include repetitive gripping and lifting, this is another common overuse injury. Symptoms include tenderness on the outside of the elbow, pain or weakness when using the affected elbow, and pain with resistance.
Treatment for tennis elbow
Most cases of tennis elbow can be resolved without surgery. Conservative treatment options include rest, ice, anti-inflammatory medications, bracing, or physical therapy. If symptoms do not improve over 6-12 months, your doctor may advise surgery to allow you to return to comfortable, normal activity.
Finger injuries
Rock climbers use an excessive amount of force on their fingers, especially when a climber’s foot slips and their hand grip tightens. An A2 pulley strain is the most common finger injury for climbers and most often occurs in the ring or middle finger. Each finger has tendons and ligaments that helps the finger bend, move, and grip. This network of tendons and ligaments runs under a sheath called a pulley that helps hold them near the bones of the fingers. There are five pulleys on the palm side of every finger. The A2 pulley is located in the first finger segment (proximal phalanx) closest to the palm. The most common symptom is hearing or feeling a pop in the finger while pulling down, followed by pain, bruising, swelling, and difficulty forming a fist. Injuries can range from a mild sprain or a complete tear. Rest, ice, splinting, and physical therapy are common treatment options. After the pulley heals, most people use tape on that finger to provide additional support when climbing.
Treatment for flexor tendon tear
The flexor tendons that run underneath the pulleys can also tear or stretch when climbing. When a flexor tendon tear occurs, pain is felt between the palm and the wrist, as well as tenderness, numbness, and an inability to bend one or more joints in the finger. Surgery is often necessary to repair complete tendon tears.
Collateral ligament strains usually occur with sideways loading, such as when you are throwing one hand out to a hold with the other. It most commonly occurs in the middle joint of the middle finger. The collateral ligaments surround each finger joint. Symptoms include pain, swelling, and tenderness at one or both sides of the finger joint. Treatment for this type of strain is usually nonsurgical and includes rest, ice, anti-inflammatories, and taping the finger for support.
Trigger finger is a common overuse injury that occurs when the flexor tendon becomes irritated and begins to thicken, eventually creating nodules that make it difficult for the joint to bend and straighten.
Treatment for trigger finger
If symptoms are mild, your doctor may suggest resting the finger or placing it in a custom splint. If there is pain and discomfort, taking a non-steroidal anti-inflammatory medication or injecting the area with corticosteroid can be effective. If pain does not subside after conservative treatment, surgery may be recommended.
Wrist injuries
The most common wrist injury in climbers occurs when there is damage to the triangular fibrocartilage complex (TFCC). This is a cartilage structure located on the pinky side of the wrist that sits between the end of the ulna (forearm bone) and the carpal bones of the wrist. It provides stability and support when the hand grasps or the arm rotates. When a climber feels the onset of wrist pain and continues to climb, the TFCC can degenerate and even tear. Symptoms include a dull, achy pain on the side of the wrist and sometimes a sharp pain is felt when bending the hand toward the pinky finger.
Treatment for triangular fibrocartilage complex (TFCC).
When diagnosed early, rest, anti-inflammatory medication, and using a splint can typically heal the injury. After the TFCC heals, taping the wrist while climbing can help provide additional stability and support, as well as prevent re-injury. In more severe cases, surgery is necessary to remove the damaged tissue and clean off the torn edges; this is also known as debriding. Recovery from this procedure includes wearing a cast for several weeks followed by physical therapy to regain range of motion and strength.
What causes climbing injuries?
Climbing injuries are caused by a variety of factors including but not limited to the following:
Overuse injuries:
Finger and hand injuries: Climbers frequently place a lot of stress on their fingers and hands, especially when gripping holds tightly. This can lead to conditions like pulley strains or tears, tendonitis, and overuse syndromes like climber’s elbow or wrist tendinitis.
Elbow injuries: Elbow injuries, particularly medial epicondylitis (also known as golfer’s elbow), can occur due to repetitive stress on the tendons that connect to the inner side of the elbow. This can be aggravated by frequent gripping and pulling motions.
Shoulder injuries: Climbing can place significant strain on the shoulders, particularly in moves that require overhead reaching or dynamic movements. Overuse or poor technique can lead to conditions like rotator cuff injuries or impingement syndrome.
Back and spine issues: Prolonged arching of the back or twisting movements can lead to strains, sprains, or even more severe spine-related injuries.
Inadequate warm-up or stretching:
Muscle strains: Without proper warm-up and stretching, muscles may not be adequately prepared for the stress of climbing. This can lead to strains, particularly in the legs, back, and upper body.
Limited range of motion: Inadequate stretching can limit a climber’s range of motion, potentially leading to awkward movements and increased risk of injury.
Inadequate training or technique:
Muscle imbalances: Inadequate training can lead to muscle imbalances, where some muscles are stronger than others. This can lead to overuse injuries or improper movement patterns.
Improper weight distribution: Failing to distribute weight properly during climbs can lead to unnecessary strain on certain muscle groups, potentially causing injuries.
Foot placement and technique: Incorrect foot placement or not utilizing proper techniques for balance and stability can lead to slips, falls, or putting excessive strain on leg muscles.
To mitigate these risks, climbers should focus on building strength and flexibility in a balanced manner, engage in specific training to target climbing-related muscle groups, and practice proper climbing techniques. Additionally, incorporating warm-up routines and regular stretching can help prevent overuse injuries.
How to prevent climbing injuries?
Preventing common climbing injuries requires a combination of physical conditioning, proper technique, and careful attention to safety measures. Here are some key strategies to help minimize the risk of injuries while rock climbing:
Gradual progression and conditioning:
Start with climbs that match your current skill level and gradually progress to more challenging routes.
Incorporate strength training and flexibility exercises focused on the muscles used in climbing, including fingers, forearms, shoulders, core, and legs.
Proper warm-up and stretching:
Begin each climbing session with a thorough warm-up to increase blood flow and prepare muscles for the demands of climbing.
Incorporate dynamic stretches that target key muscle groups, including wrists, forearms, shoulders, and lower body.
Technique and form:
Seek instruction from experienced climbers or certified instructors to learn proper climbing techniques, including footwork, balance, and efficient movement.
Focus on precise hand and foot placements to reduce unnecessary strain on muscles and tendons.
Listen to your body:
Pay attention to any signs of fatigue, discomfort, or pain. Rest when needed and avoid pushing through excessive strain.
Recognize the difference between normal muscle fatigue and the early signs of overuse or acute injuries.
Use quality gear and check equipment:
Regularly inspect and maintain climbing equipment, including harnesses, ropes, carabiners, and belay devices, to ensure they are in good working condition.
Invest in high-quality climbing gear from reputable manufacturers to minimize the risk of equipment failure.
Rest and recovery:
Allow for adequate rest days between climbing sessions to give muscles and tendons time to recover and repair.
Incorporate active recovery techniques like stretching, foam rolling, and gentle exercises on rest days.
If you experience an injury while climbing, it’s crucial not to delay seeking care. Our team of upper extremity specialists is dedicated to evaluating and addressing climbing-related injuries.
With so many medical specialties, it’s important to understand what type of specialist to see when trying to get diagnosed for a medical condition. A neurosurgeon and a neurologist both specialize in the treatment of medical problems affecting the central nervous system. The central nervous system controls most of the functions of the body and mind, consisting of the brain and spinal cord.
Neurologist vs. Neurosurgeon
What is a neurologist?
A neurologist treats diseases and conditions of the brain and nervous system, but they do not perform surgery. They are trained to diagnose and treat a wide range of conditions, including but not limited to:
Neurological disorders: Such as epilepsy, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, and other forms of dementia.
Neuromuscular disorders: Such as muscular dystrophy, myasthenia gravis, and peripheral neuropathy.
Headaches and migraines: Including chronic and severe forms.
Stroke: Both ischemic (caused by a blood clot) and hemorrhagic (caused by bleeding).
Movement disorders: Such as tremors, dystonia, and restless leg syndrome.
Seizure disorders: Including epilepsy and other types of seizures.
Neurodevelopmental disorders: Such as autism and attention-deficit/hyperactivity disorder (ADHD).
Neurological injuries: Such as traumatic brain injury and spinal cord injury.
Neurologists may perform a variety of tests and procedures to help diagnose and manage these conditions, including neurological examinations, imaging studies (like MRI and CT scans), electroencephalograms (EEGs), electromyography (EMG), and nerve conduction studies.
It’s worth noting that neurologists often work closely with other healthcare professionals, including neurosurgeons, physical therapists, occupational therapists, and speech therapists, to provide comprehensive care for patients with neurological conditions.
What is a neurosurgeon?
One common myth is that neurosurgeons are just brain surgeons. However, according to the American Association of Neurological Surgeons (AANS), they typically spend a lot more time on spine conditions and procedures than brain conditions and procedures.
Common conditions neurosurgeons treat are back pain, neck pain, sciatica, herniated disks, degenerative diseases of the spine, cerebrovascular disorders, brain and spinal tumors, and stroke. In addition, since the nervous system extends from your brain to your spine and your nerves branch out into your entire body, they treat conditions that present symptoms in one part of your body that are actually related to a problem in the central nervous system. For example, carpal tunnel symptoms are sometimes related to a problem in your cervical spine (neck area).
Although they can perform very complex surgeries, neurosurgeons typically use non-operative treatment plans before performing surgery. If surgery is required, minimally invasive techniques are used whenever possible. Neurosurgeons are also on call for emergency room physicians when a patient has trauma involving the brain and spinal cord.
What do neurologists and neurosurgeons have in common?
Neurologists and neurosurgeons have several things in common including:
Specialization in Neurology: Both neurologists and neurosurgeons specialize in the field of neurology, which focuses on the diagnosis and treatment of disorders related to the nervous system.
Medical Doctors: Both neurologists and neurosurgeons are medical doctors who have completed medical school and obtained a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree.
Advanced Training: After completing medical school, both neurologists and neurosurgeons undergo additional, extensive training in their respective fields.
Diagnostic Skills: Both professions are skilled in conducting neurological examinations, interpreting imaging studies (like MRI and CT scans), and performing specialized tests to help diagnose neurological conditions.
Collaborative Approach: Neurologists and neurosurgeons often work closely together in the care of patients with complex neurological conditions. They collaborate to develop comprehensive treatment plans and determine whether surgical intervention is necessary.
Degree and training
Neurologists undergo four years of pre-medical education at a college or university, four years of medical school resulting in an MD or DO degree, one year of internship, and at least three years of specialty training in a neurology residence program. Some neurologists elect to take additional training in an area of interest such as stroke, movement disorders, or sleep medicine.
A neurosurgeon’s training is the longest training period of any medical specialty. In addition to four years of pre-medical education, four years of medical school, and a year of internship, their residency is five to seven years. After that, many pursue a fellowship to specialize in an area such as spine, pediatric neurosurgery, or peripheral nerve surgery.
Finding the right specialist
There is some overlap between these two types of specialists and the conditions they treat. Sometimes these doctors work collaboratively; a neurologist can refer their patients to a neurosurgeon when surgery is required (such as for a brain tumor) and then the patient returns to the neurologist for long-term management. If you have a condition or symptoms that you think require a brain and spine specialist, ask your primary care physician about which type of specialist to see. Our multidisciplinary team of physicians at The Center are equipped with the latest technologies and have the experience to treat any injury or condition that affects your musculoskeletal system.
Neurosurgeon at The Center, Dr. Ray Tien, explains the differences between a neurosurgeon and a neurologist in the video below.
Who should you visit first: A neurologist or a neurosurgeon?
The decision of whether to visit a neurologist or a neurosurgeon first depends on the specific nature of your symptoms and the suspected or diagnosed neurological condition. Here are some general guidelines:
Visit a neurologist first if:
You are experiencing neurological symptoms: If you’re dealing with symptoms like headaches, seizures, numbness, weakness, difficulty with coordination, or other neurological issues, it’s often best to start with a neurologist. They specialize in diagnosing and managing a wide range of neurological conditions and can determine if surgical intervention is necessary.
Your condition does not require immediate surgery: If your condition does not require urgent surgical intervention, a neurologist is typically the first point of contact. They will conduct a comprehensive evaluation, order appropriate tests, and initiate non-surgical treatments if needed.
You have been referred by a primary care physician: If your primary care doctor suspects a neurological issue, they will likely refer you to a neurologist for further evaluation and diagnosis.
You have a known or suspected neurological disorder: If you have already been diagnosed with a neurological condition (such as epilepsy, multiple sclerosis, or Parkinson’s disease), or if you suspect you may have one, a neurologist is usually the initial specialist to consult.
Visit a neurosurgeon first if:
Your condition requires urgent surgical intervention: If you have a neurological emergency, such as a severe head injury, a spinal cord injury, or a brain hemorrhage, it’s crucial to seek immediate attention from a neurosurgeon. They are trained to perform emergency surgeries and interventions.
Your condition has been specifically identified as surgical: If you have a known neurological condition that is likely to require surgery, or if you have received a recommendation for surgical treatment from a neurologist or another healthcare provider, it may be appropriate to see a neurosurgeon directly.
You have a complex neurological issue that may require surgery: In some cases, particularly for complex or difficult-to-treat neurological conditions, it may be beneficial to consult with a neurosurgeon early in the diagnostic process to explore potential surgical options.
Ultimately, in many cases, the decision of whether to see a neurologist or a neurosurgeon first will be guided by a referral from a primary care physician or another specialist. It’s important to communicate with your healthcare provider about your symptoms and concerns so they can help guide you to the most appropriate specialist for your specific situation.
How neurologists and neurosurgeons work jointly through patient care
Neurologists and neurosurgeons sometimes work together to provide comprehensive care for patients with neurological conditions. This collaborative approach ensures that patients receive the best possible care, combining the expertise of both specialties. Here’s how neurologists and neurosurgeons work jointly through patient care:
Consultation and referral: When a patient presents with a neurological issue, they may initially see a neurologist. The neurologist will conduct a thorough evaluation, which may include a neurological examination, review of medical history, and ordering of diagnostic tests. If surgical intervention is deemed necessary, the neurologist may refer the patient to a neurosurgeon.
Case discussions and treatment planning: Neurologists and neurosurgeons often engage in discussions about complex cases. They review the patient’s medical history, examination findings, and diagnostic test results to collaboratively determine the best course of action. This may involve deciding whether surgery is the most appropriate treatment or if non-surgical interventions should be pursued.
Preoperative assessment: Before surgery, the neurologist plays a crucial role in preparing the patient for the procedure. They may conduct preoperative assessments to ensure that the patient is medically optimized and able to undergo surgery safely. This may involve managing any underlying medical conditions and adjusting medications as needed.
Intraoperative collaboration: During surgery, neurologists and neurosurgeons work closely together in the operating room. The neurosurgeon performs the surgical procedure, while the neurologist may be present to provide expertise on neurological anatomy and function. This collaborative effort ensures that the surgery is conducted safely and effectively.
Postoperative care and follow-up: After surgery, the neurosurgeon takes the lead in managing the patient’s immediate postoperative care, including monitoring for any complications and overseeing the recovery process. The neurologist remains involved, providing input on neurological status and helping to manage any ongoing neurological issues.
Long-term management: In cases where a patient requires ongoing care for a neurological condition, the neurologist and neurosurgeon continue to work together. They collaborate on long-term treatment plans, which may include medication management, rehabilitation, and periodic follow-up visits to monitor progress.
Multidisciplinary team collaboration: In complex cases, neurologists and neurosurgeons often work with other healthcare professionals, such as radiologists, anesthesiologists, physical therapists, and occupational therapists, to ensure comprehensive care for the patient.
Open communication: Effective communication between neurologists and neurosurgeons is essential for successful patient care. They regularly share updates on the patient’s condition, treatment progress, and any changes in the care plan.
By combining their specialized knowledge and skills, neurologists and neurosurgeons provide a holistic approach to patient care, addressing both non-surgical and surgical aspects of neurological conditions. This collaborative effort ultimately leads to the best possible outcomes for patients.
The surgeons and staff at the St. Charles Center for Orthopedics & Neurosurgery have created this educational video series to help you prepare for knee or hip replacement surgery. Our ultimate goal is to support your recovery and get you back to the activities you enjoy pain free. We highly recommend that your coach or caregiver watch all of the videos to support your recovery.
Please watch the eight-video series below in its entirety. Take notes in your Guide to Total Joint Replacement, so you can ask questions at your next appointment. When you are finished, click the “Complete” button to confirm you watched the entire series.
Total joint replacement can help relieve pain in your joints and enable you to live a more active life or complete activities of daily living. Generally, it is done after conservative treatment options, such as medications, injections, and physical therapy have not helped.
If joint replacement surgery is the best solution for you, the St. Charles Center’s orthopedic surgeons and support staff are ready to help you prepare for surgery and plan for a successful recovery. We offer the latest technology, including robotic-assisted surgery and outpatient total joint replacement.
Once you and your orthopedic surgeon have decided to undergo surgery to reconstruct the anterior cruciate ligament (ACL) in your knee, you will need to choose which replacement graft to use. The torn ligament will not repair itself, nor can it be sewn together successfully. It must be replaced with a new tissue that will develop into a ligament over time. Choosing which graft is appropriate is not always an easy decision. There are pros and cons to each alternative. Your choices include your own tissue (autograft) or cadaveric tissue (allograft).
Autographs
The patellar tendon and hamstring autografts are the most common choices for ACL reconstruction. The patellar tendon runs from the knee cap (patella) to the lower leg bone (tibia). Surgeons have the most experience with this autograft and it is the most widely used. A vertical incision is made from the bottom of the patella to the top of the tibia. The middle third of the tendon is then cut, as well as the bony portions from the patella and tibia. The final autograft is made from the partial tendon and bones on either end. The bone on both sides allows for quicker healing of the graft.
Benefits
Orthopedic surgeons have the most experience with this procedure
Strongest graft concerning initial fixation
Quicker return to full athletic participation, typically 5-6 months
Risks
Increased chance of pain or discomfort while kneeling
More painful due to harvesting the tendon and bone portions
There is an extra incision where the graft is harvested
Increased risk for patellar fracture
Increased risk for patellar tendonitis
Although called the hamstring autograft, the tendons associated with this graft are not technically part of the hamstring. The semitendinosis tendon and the gracilis tendon are removed from a small incision just below and near the inside of the knee. This autograft has no bony portions and uses two tendons.
Benefits
Least amount of post-operative pain
Easier rehabilitation in regards to quadriceps activation
Quicker return to activities of daily living
No extra incision is required. The same incision is used to place the fixation hardware.
Risks
The fixation is not as strong initially. Caution is advised with rehabilitation.
Some hamstring weakness may be noted
Return to full athletic participation is slower, 6-7 months
There is no hamstring activation for at least four weeks to allow the harvest site to heal
Increased risk for hamstring strain/tenderness
Allografts
Allografts provide another option for ACL reconstruction. The tissue is harvested from a cadaver, so there are no complications from taking the tissue from your own body. The most common choices are Achilles tendond, quadriceps, anterior tibialis tendon, and patellar tendon. The decision on which allograft option to use is based on what is available and surgeon preference. Overall, the grafts are just as strong if you follow the specific rehabilitation protocol. Although donors are screened for communicable diseases, there is a risk of disease transmission associated with using graft tissue from a cadaver. There is a potential for viral transmission such as hepatitis or HIV.
Benefits
No pain or complications from harvesting the tissue
Fastest return to activities of daily living
Smaller incision on the medial tibia
Risks
Potential risk of viral transmission (chance of HIV transmission is 1 in 1.8 million)
Return to full athletic activities is generally 6-7 months
Higher re-tear rate in younger competitive athletes
Choosing which graft to use for ACL reconstruction is highly individualized for each patient. Discuss your lifestyle and the risks and benefits with your orthopedic surgeon to determine the best course of action to reach your goals.
Plantar fasciitis is the most common cause of foot pain, radiating from the bottom of the heel throughout the foot. The plantar fascia is the strong band of tissue in the arch of your foot, which runs from your heel to toe and absorbs strains and stress placed on the foot each time it is in use. Plantar fasciitis occurs when that supporting tissue becomes irritated and inflamed. Signs of plantar fasciitis include heel pain, pain with first initial steps after rest, and pain with extended exercise.
About 90% of plantar fasciitis cases heal successfully with conservative treatment options, but the longer it goes unaddressed, the longer it will take to heal and more complications can arise.
Symptoms of plantar fasciitis
The symptoms of plantar fasciitis typically develop gradually over time and may include sharp or stabbing pain in the heel, especially with the first steps in the morning or after prolonged periods of sitting or standing. The pain may also worsen after physical activity. The bottom of the foot may feel tender or inflamed, and the arch of the foot may feel tight or stiff.
In some cases, swelling may be present in the heel or arch. The pain and discomfort associated with plantar fasciitis can interfere with daily activities and make it difficult to exercise or walk for extended periods of time. It is important to seek medical attention if symptoms persist or worsen over time. Early treatment can help reduce pain and prevent further damage to the plantar fascia.
Risks of untreated plantar fasciitis
Plantar ruptures: Plantar ruptures can happen if plantar fasciitis is not addressed and you continue to place heavy impacts on the plantar fascia. These activities include running, sports, or even standing for long periods of time.
You likely have ruptured your plantar fascia if you hear a loud popping noise followed by intense pain, bruising, and swelling in the foot. If you believe you have ruptured your plantar fascia, seek medical help immediately. You may be required to wear a boot or use crutches for a period of time.
Plantar tears: When plantar fasciitis is left untreated, the plantar fascia can become inflamed and cause small micro tears. Many don’t notice these small tears as they arise until the pain becomes gradually worse. If left untreated, these tears can grow in size and numbers, causing further complications.
Heel Spurs: Heel spurs are a common response to plantar fasciitis left untreated. In order to protect the arch of your foot from damage, your body generates calcium. Over time, these calcium deposits create sharp protrusions that push against the fatty part of the heel causing pain with each step. Heel spurs can often be avoided if treated early.
Plantar Fibromatosis: Plantar Fibromatosis is a condition where benign nodules grow slowly along the plantar fascia. These often are undetected in the early stages until they suddenly begin to grow more rapidly. Over time as the nodules continue to grow, walking may become painful and uncomfortable.
If you’re suffering from plantar fasciitis pain visit one of our foot and ankle specialists for treatment.
Treatments for plantar fasciitis
The treatment for plantar fasciitis is aimed at reducing heel pain, inflammation, and improving the flexibility of the plantar fascia. The treatment options for plantar fasciitis may include rest, ice, compression, and elevation (RICE) therapy to reduce swelling and pain. Over-the-counter pain medications such as acetaminophen or ibuprofen may also provide relief.
Stretching exercises and physical therapy helps to improve flexibility and strength in the plantar fascia and surrounding muscles. Orthotic shoe inserts or heel cups may be recommended to provide additional support and cushioning for the foot. Surgery is typically a last resort and is only considered in severe cases that do not respond to other treatments. It is important to seek medical attention from a foot and ankle specialist early to receive a proper diagnosis and develop an appropriate treatment plan that addresses the patient’s specific needs.
In this quick video, foot and ankle specialist, Dr. Anthony Hinz, explains his treatment for plantar fasciitis
Body
What is a neurosurgeon?
Neurosurgeons or neurological surgeons specialize in the treatment of medical problems affecting the brain, spine, neck, back and central nervous system. These conditions can include stroke, brain injuries, spinal cord injuries, aneurysms and diseases of the brain and spine. With the region’s only pediatric neurosurgeon, the St. Charles Center for Orthopedics & Neurosurgery is also committed to caring for all types of pediatric brain and nervous system conditions.
St. Charles' board-certified neurosurgeons practice a conservative approach, using a wide variety of non-operative treatment options. When surgery is necessary it is performed in the least invasive way to shorten recovery times and reduce pain. Using state-of-the-art diagnostic tools, they develop and implement care plans that are as individualized as the patients being treated. Our neurosurgeons are committed to getting patients better and back to doing what they love.
Body
Orthopedic Surgery
Orthopedic surgery is a medical specialty that deals with the treatment of injuries, diseases, and disorders of the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles. The St. Charles Center is dedicated to providing the highest quality of care to its patients and is staffed by experienced and highly skilled orthopedic surgeons who are committed to achieving the best possible outcome for each patient.
The St. Charles Center for Orthopedics & Neurosurgery is the premiere location in Central and Eastern Oregon for orthopedic injuries and conditions. With offices in Bend, Redmond, Prineville, La Pine, Madras, Sisters, Burns and John Day, the St. Charles Center offers a full range of orthopedic services, including both surgical and non-surgical options. From diagnosing and treating common conditions such as osteoarthritis, sports injuries, and fractures, to performing complex joint replacements and hand surgeries, the Center’s team of experts are equipped to handle all types of orthopedic needs.
In addition to a five-year residency after medical school, each of our orthopedic surgeons are board certified and completed additional fellowship training in their respective areas of subspecialty such as foot and ankle, hand and upper extremity, shoulder, knee, minimally invasive joint replacements, arthroscopic surgery, pediatric orthopedics, and sports medicine. In addition, many of our surgeons have completed additional board certifications or participate in ongoing research and clinical trials.
At the St. Charles Center, our orthopedic surgeons are committed to getting patients better and back to doing what they love.
