• THE PARTS OF A JOINT

    1. Articular Cartilage (Purple): The end of each bone is covered with articular cartilage. This is a tough material that cushions and protects the ends of the bones. When it degenerates, arthritis develops.

    2. Synovial Membrane or Synovial Sac (Light Blue): Around each joint is the synovial sac which protects the joint and also secretes the synovial fluid. Synovial fluid serves to protect the joint, lubricate the joint and provide nourishment to the articular cartilage.

    3. Bursa (Dark Blue): A bursa is a small sac that is not part of the joint but is near the joint. It contains a fluid that lubricates the movement of muscles as the muscle moves across muscle or as the muscle moves across bone. In some ways it is similar to the synovial sac.

    4. Muscle (Red): Muscles are elastic tissues that have the ability to change length. By becoming shorter and longer, muscles allow for motion at the joints.

    5. Tendon (Red): Tendons are fibrous cords that attach muscles to the bones. Unlike muscles which change length (contract), the tendons are unable to change length. However, as the muscle moves, the tendon to which it is attached also moves. You can feel the tendons on the back of your hand or in the back of your knee.

    6. Ligaments: (Green) Ligaments are much shorter fibrous cords that attach go from bone to bone. Typically, ligaments are located around the joints. They provide for the stability of a joint and hold the adjacent bones in the proper alignment.

    7. Meniscal Cartilage (Not shown): Meniscal cartilage is a type of specialized tissue. It is not found in every joint in the body. It is a C-shaped piece of cartilage which is located between the major weight bearing bones of the knee. It has several functions including stability, lubrication, nutrition, and shock absorption. To get some idea of what cartilage is like, feel the middle of your nose or ears. These are also made of cartilage. Meniscal cartilage tissue is similar to the "gristle" that is found in at the joint of a chicken leg and a chicken wing.

    For more information on ankle sprains: ANKLE SPRAINS

    For more information on meniscal injuries: TORN CARTILAGE (MENISCUS)

    For more information on degenerative arthritis treatment: HYALURONIC (HA) INJECTIONS FOR ARTHRITIS

    THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.

    THE CENTER FOR ORTHOPAEDICS & SPORTS MEDICINE

    1211 Johnson Ferry Rd
    Marietta, GA 30068
    770-565-0011
    http://www.arthroscopy.com

  • GENERAL INFORMATION

    Splints and casts support and protect injured bones and soft tissue, reducing pain, swelling, and muscle spasm. In some cases, splints and casts are applied following surgery.

    Casts are custom-made and applied by your doctor or an assistant. Casts are often made of plaster or fiberglass. Splints or half casts also can be custom-made, especially if an exact fit is necessary. Other times, a ready-made splint will be used. These off-the-shelf splints are made in a variety of shapes and sizes, and are much easier and faster to use. They have Velcro straps which make the splints easy to adjust, and easier to put on and take off. Unfortunately, splints offer less support and protection than a cast and may not a treatment option in all circumstances.

    Fiberglass or plaster materials form the hard supportive layer in splints and casts. Fiberglass is lighter in weight, longer wearing, and "breathes" better than plaster. Both materials come in strips or rolls which are dipped in water and applied over a layer of cotton or synthetic padding covering the injured area. Both fiberglass and plaster splints and casts use padding, usually cotton, as a protective layer next to the skin. When cotton padding, synthetic padding, or plaster is used in the making of a cast, the cast must be kept dry. If these materials become wet significant problems may develop. When a plaster cast gets wet, the cast becomes soft, loses strength, and may no longer adequately immobilize the injured area. As a result, broken bones may heal in the incorrect position if the cast is not replaced. When the cotton or synthetic padding gets wet, it is very difficult to dry. As a result, the wet skin under the wet padding may develop rashes, infections, or become macerated. All of these conditions, require further treatment. To keep these types of casts dry, it is necessary to wear plastic shower bags which are commercially available.

    Recently, Gortex cast padding has been developed. This padding is completely waterproof and allows a patient to completely immerse the cast in water without requiring the protection of a plastic bag. With this type of cast padding, coupled with the application of a fiberglass cast, patients may do activities such as showering and swimming without worrying about keeping the injured extremity dry. However, there are some clinical circumstances when this type of cast padding may not be applied.

    The splint or cast must fit the shape of the injured arm or leg correctly to provide the best possible support. Sometimes, it may be necessary to replace a cast as swelling decreases and the cast "gets too big." Often as a fracture heals, a splint may be applied again to allow easy removal for therapy.

    CAST CARE TIPS

    If your treatment is to be successful, you must follow your doctor's instructions carefully. The following information provides general guidelines only, and is not a substitute for your doctor's advice.


    DO's of CAST CARE

    1. Swelling due to your injury may cause pressure in your splint or cast for the first 48 to 72 hours. This may cause your injured arm or leg to feel snug or tight in the splint or cast. To reduce the swelling:

    • Elevate your injured arm or leg above your heart by propping it up on pillows or some other support. You will have to recline if the splint or cast is on your leg. Elevation allows clear fluid and blood to drain "downhill" to your heart.
    • Exercise the fingers or toes to decrease swelling and prevent stiffness and to increase circulation.
    • Apply ice to the splint or cast. Place the ice in a dry plastic bag or ice pack and loosely wrap it around the splint or cast at the level of the injury. Ice that is packed in a rigid container and touches the cast at only one point will not be effective.

    2. Keep your cast dry if it has a cotton or synthetic lining or if it is a plaster cast. Use a shower bag for bathing.

    3. If you have a Gortex cast, you may shower or swim, but rinse well with tap water afterwards.

    4. File down any rough spots with an emery board.

    5. To ease any discomfort from itching, you may blow cool air inside the cast with a hair dryer.

    6. Check circulation by pressing on the nail bed. The nail should turn pale when pressed, but normal color should return immediately when the pressure on the nail is removed. If this does not happen, contact your physician.

    7. Inspect the skin around the cast. If your skin becomes red or raw around the cast, contact your doctor.

    8. Inspect the cast regularly. If it becomes cracked or develops soft spots, contact your doctor.

    9. Keep dirt, sand, and powder away from the inside of your splint or cast

     

    DON'Ts of CAST CARE

    • Do not get your cast wet, unless you have a Gortex cast.
    • Do not insert any object objects such as coat hangers into the cast to relieve itching. Instead, use the cool setting on a hair dryer to blow air into the cast.
    • Do not apply powders or deodorants to itching skin. If itching persists, contact your doctor.
    • Do not pull out the cast padding. It is there to protect your skin.
    • Do not break or trim the cast edges.

    WARNING SIGNS FOLLOWING SPLINT/CAST APPLICATION

    After application of a splint or cast, it is very important to elevate your injured arm or leg for 24 to 72 hours. The injured area should be elevated well above the heart. Rest and elevation greatly reduce pain and speed the healing process by minimizing early swelling. If you experience any of the following warning signs, contact your doctor's office immediately for advice.

    • Increased pain and swelling which is not controlled with ice, elevation, and/or pain medication.
    • A feeling that the splint or cast is too tight.
    • Numbness and tingling in your hand or foot.
    • Burning and stinging.
    • Excessive swelling below the cast.
    • Loss of active movement of toes or fingers, which requires an urgent evaluation by your doctor.
    • A feeling of a blister developing in your cast.
    • A feeling that your calf is becoming swollen, tight and painful inside the cast.
    • You notice any unusual odor coming from inside the cast.
    • If the cast breaks or becomes too loose.
    • If the cast edges are causing skin problems.
    • If a fever develops.

    PROPER CAST REMOVAL

    Never remove the cast yourself. You may cut your skin or prevent proper healing of your injury. Your doctor will use a cast saw to remove your cast. The saw vibrates, but does not rotate. If the blade of the saw touches the padding inside the hard shell of the cast, the padding will vibrate with the blade.

    THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.

    THE CENTER FOR ORTHOPAEDICS & SPORTS MEDICINE

    1211 Johnson Ferry Rd
    Marietta, GA 30068
    770-565-0011
    http://www.arthroscopy.com

  • GOING DOWN THE STAIRS WITH CRUTCHES


    img00001

    1. Hold the railing with one hand and the crutches together in the other hand.
    2. Step up with the "good" or uninvolved leg.
    3. Bring the crutches up with the "bad" or injured leg.

    GOING DOWN THE STAIRS WITH CRUTCHES

    img00002

    1. Stand close to edge and put crutches down to step with the involved leg.
    2. Step down with the "good" leg.

    TO STAND UP WITH CRUTCHES

    img00003

    1. Hold both crutches in one hand by the hand grips.
    2. Put other hand on chair arm and stand.
    3. When you are standing, take one crutch and put it under the opposite arm.

    GUIDELINES FOR CRUTCH USE


    img00004

    1. Stand straight, shoulders, relaxed.
    2. Top of crutch should lie against the ribs, 2-3 finger widths from the armpit.
    3. Hand grips should be positioned so that there is a slight bend in the elbows.
    4. Crutch tips should also be about 6 inches from each foot and out to the side.
    5. Never hang or press down on the underarm pads. All weight should be on the hands.

    THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.

    THE CENTER FOR ORTHOPAEDICS & SPORTS MEDICINE

    1211 Johnson Ferry Rd
    Marietta, GA 30068
    770-565-0011
    http://www.arthroscopy.com

  • ORTHOPAEDIC SURGERY: THE SUBSPECIALITY

    Orthopaedics is a medical specialty concerned with the diagnosis, care and treatment of patients with musculoskeletal disorders. The physicians who specialize in treating injuries and diseases of the musculoskeletal system are called orthopaedic surgeons or orthopaedists.

    Although orthopaedists may perform surgery to restore function lost as a result of injury or disease of bones, joints, muscles, tendons, ligaments, nerves, or skin, they are involved in all aspects of health care pertaining to the musculoskeletal system. They employ medical, physical and rehabilitative methods as well as surgical methods. Typically, as much as 50 percent of the orthopaedist's practice is devoted to non-surgical or medical management of injuries or disease and 50 percent to surgical management.

    The orthopaedist also works closely with other health care professionals and often serves as a consultant to other physicians. Orthopaedists, in particular, play an important role in the organization and delivery of emergency care and work as a team player in the management of complex multi-system trauma.

    THE SCOPE OF ORTHOPAEDICS

    Orthopaedics is a specialty of immense breadth and variety. Orthopaedists treat a wide variety of diseases and conditions, including such common injuries as fractures, torn ligaments, dislocations, sprains, tendon injuries, pulled muscles, and ruptured discs. They also treat conditions such as low back pain, sciatica, scoliosis, knock knees or bow legs, bunions and hammer toes. More recently great advances have occurred in the surgical management of degenerative joint disease with the replacement of the diseased joint by a prosthetic device (total joint replacement). Similarly, the application of visualizing instruments to assist in the diagnosis and surgical treatment of internal joint diseases (arthroscopy) has opened new horizons of therapy.

    The Greek roots of orthopaedics are "ortho" (straight) and "pais" (child), and much of the early work in orthopaedics involved treating children who had spine or limb deformities. Orthopaedists continue to treat children with bone tumors and neuromuscular problems such as muscular dystrophy and cerebral palsy, as well as to correct birth abnormalities such as club foot, hip dislocation and abnormalities of fingers and toes and growth abnormalities such as unequal leg length. Orthopaedists also treat diseases prevalent in the elderly, such as osteoporosis, as well as arthritis and bursitis.

    Some orthopaedists confine their practice to specific areas of the musculoskeletal system, such as the spine, hip, foot, or hand, knee, sports medicine, or arthroscopy. However, 41 percent of orthopaedic surgeons designate themselves as "general orthopaedic surgeons", 36 percent consider themselves as "general orthopaedic surgeons with specialty interest", while 23 percent consider themselves as "specialists within orthopaedic surgery". Many generalists may have a special interest in a specific area, but still treat most injuries or diseases of the musculoskeletal system.

    THE CAREER PATH

    Those considering a career in orthopaedics should have a high scholastic aptitude, mechanical ability, a high degree of manual dexterity and excellent three-dimensional visualization skills. In addition, orthopaedists generally are action-oriented individuals. Furthermore, many have an interest in athletics and are team physicians at the high school, college or professional level.

    To become an orthopaedic surgeon requires completion of four years of college, four years of medical school and five years of accredited graduate medical education after medical school. The majority of approved orthopaedic residency programs now provide for four years of training in orthopaedic surgery and an additional year of training in a broadbased accredited residency program such as general surgery, internal medicine, or pediatrics; however, a small number of programs require two years of general surgery prior to three clinical orthopaedic years. Salaries of orthopaedic residents are similar to other graduate medical education opportunities. To be certified as an orthopaedic specialist by the American Board of Orthopaedic Surgery, a candidate must complete the orthopaedic residency, practice orthopaedic surgery for two years and pass written and oral examinations offered by the Board.

    Each year, the orthopaedic surgeon spends many hours studying and attending continuing medical education courses to maintain current orthopaedics knowledge and skills.

    Orthopaedics is an extremely competitive field. There are approximately 650 residency positions available annually in the 170 accredited programs. Candidates for orthopaedic residencies generally graduate at the top of their medical school class. Most have completed a full orthopaedic rotation in medical school. Historically, few women have chosen to enter surgical careers; however, there has been an increase in the number of women entering orthopaedic residency programs in recent years.

    Research experience is encouraged in many programs and clinical rotations may occur in one or more affiliated hospitals for basic or special educational needs; e.g., pediatric orthopaedics or rehabilitation. There are many areas of special interest upon which orthopaedists choose to focus their practice, and many physicians spend an additional six to 12 months of training in a particular field of interest. Fellowships of six months to one year are available in hand surgery, pediatric orthopaedics, reconstructive surgery, spine, foot and ankle, shoulder, and sports medicine to mention a few.

    Practice Patterns

    Orthopaedists typically practice in one of three settings. Solo practitioners work for themselves, although they may share office space and clerical help with other orthopaedists or other physicians. A large number practice in orthopaedic groups. In most cases, two to six orthopaedists work together, sharing costs for the office, seeing each other's patients, and providing continual "coverage" in hospital rounds, as well as other means of working together. In many groups, there may be a number of generalists and a number of other orthopaedists who do most of their work in a particular area such as the hand or spine. The third typical practice setting is in multi-specialty groups, where a number of orthopaedists work together with other specialists, such as internists, family practitioners and cardiologists. Generally, the larger the multi-specialty group, the larger the number of specialties are represented.

    An increasing number of orthopaedists choose to practice in managed health care and alternative health care delivery systems such as health maintenance organizations (HMOs), independent practice associations (IPAs), and preferred provider organizations (PPOs). Such health care options provide physician services for a fixed or an agreed upon rate rather than the traditional fee-for services arrangement.

    Many orthopaedists are also involved in education-either as full-time members of a medical school faculty, treating patients, supervising resident education and conducting research, or as part-time teachers of medical students and residents in the private practice setting. Other career choices selected by members of the American Academy of Orthopaedic Surgeons include military orthopaedists and those who work in administrative capacities for government or health care providers.

    For additional information: http://www.aaos.org (American Academy of Orthopaedic Surgeons).

    THE CENTER FOR ORTHOPAEDICS & SPORTS MEDICINE

    1211 Johnson Ferry Rd
    Marietta, GA 30068
    770-565-0011
    http://www.arthroscopy.com