Injuries Take A Toll On Us All

itatouWhat do you and Olympic gymnast Shannon Miller have in common? You and basketball star Michael Jordan? You…and tennis veteran Jimmy Connors?

Injuries. Getting hurt. Twisting it, pulling it, spraining it, breaking it. Now granted, our injuries don’t make the evening news. But whether we sprain an ankle on the pro tennis circuit or just jogging through the back yard, it hurts … and we want it fixed, pronto.

And that’s the other thing we have in common with today’s sports stars – the treatment we receive for injuries. Breakthroughs in orthopedic treatment of injuries to the joints, bones, muscles, ligaments, and tendons (many discovered by specialists in “sports medicine”) have altered treatment of nonathletic injuries as well.

“Everything that’s been learned in treating injuries at the elite athletic level is filtering down to the rest of us,” says Marjorie Albohm, associate director of Indiana University’s International Institute of Sports Science and Medicine. She notes that while athletes and nonathletes show different patterns leading up to an injury, they often wind up in the same place, needing the same sort of treatment.

“The athletic population most often tends toward acute injury, often involving the ligaments,” says Albohm. “In the nonathletic group, we see more ‘overuse’ injuries”. Repetitious activity using certain muscle groups or body areas can eventually flare up into an acute condition–one that requires the same treatment an athlete would receive.

Who treats injuries involving the bones, muscles, ligaments, and tendons? It’s all considered a part of the field of orthopedic medicine. And while orthopedic surgeons possibly are the most visible members of this specialty, an injury may call for the expertise of therapists, trainers, and “rehab” specialists in many different health care settings.

“Orthopedic medicine is a specialty that tends to change very slowly,” says Al Negelberg of the American Academy of Orthopedic Surgeons. If also, the past decade set an unusually dizzy pace for this “slow” corner of medicine. Let’s look at just some of the recent breakthroughs that could have an effect on the care of your next injury.

Honey, I Shrunk the Operation!

Bottom line… what’s the biggest overall benefit of recent advances in orthopedic treatment of injury? Dr. David Holden, an orthopedic surgeon whose emergency surgery kept gymnast Shannon Miller in the running for Olympic medals (see the story on page 11), says it’s being able to “get people moving very quickly” after an injury.

“We have a saying in orthopedics that motion is life,” Dr. Holden told us. “Muscle atrophy (deterioration) and scarring from some of the things we used to do were so bad that no matter how good the surgery was, the person didn’t get that flexibility back. Muscles atrophy in a matter of days, and you lose ground quickly.

“The difference today is that we are now able to do surgery to a point that lets people get into rehabilitation-and moving-very soon after the injury. And the biggest factor in that is how much arthroscopic surgery came along in the decade of the ’80s.”

Below, a look at “what’s new in orthopedics:

Arthroscopic Surgery

The idea sounds like a special-effects movie. Take one TV camera, shrinks it down to less than bite-size, add flexible strands of glass to produce intense fiber-optic light, and presto … you have a surgical kit that can operate in the tiniest of quarters and avoid making more than a Band-Aid-size incision.

Arthroscopic (the word comes from arthro “joint” and scope “view”) techniques got their start at the knees, where (relatively speaking) there’s plenty of room to operate. Older, “open” surgery techniques required at least a month on crutches and opened the body to infection. With an arthroscope and microsurgical instruments, a surgeon can repair torn cartilage and ligaments, remove bone chips, smooth out rough spots-and generally have the patient up and walking after only a weekends recuperation.

Today, fiber optics also makes it possible to use laser beams to cut and seal tissue. Tiny laparoscopes are used to view and repair back tissue leaking from a ruptured disk. And surgeons are using arthroscopic techniques to work on smaller and smaller joints: ankles, toes, a joint of the jaw that is less than one-tenth the size of the knee.

Arthroplasty

Joint replacement techniques have improved with the discovery of better materials to be used as full or partial replacement of the diseased or injured joint.

More than 150,000 total hip replacements are performed each year in the United States, according to Harvard Medical School’s Dr. Stuart Kozinn. In a complete replacement, the entire ball-and-socket joint is replaced by an artificial one, known as a prosthesis, that combines metal alloys and high-density plastics.

Traditionally, hip replacements used acrylic cement to hold the prosthesis in place. This worked well for older, less active patients. But one study of younger patients found that the cement loosened in 50 percent of cases after 10 years of use.

The solution? A cementless implant. A prosthesis is fitted into the femur (upper leg bone). Its porous or rough surface allows natural bone growth to attach itself to the implant in much the same way that a healing callus forms when a bone is fractured. Because the rate of new bone growth varies, recovery time for a cementless implant can be longer–but the patient can expect to lead a more active life after surgery.

What’s in the works?

Researchers are experimenting with ways to stimulate bone growth through use of electromagnetic fields and other methods. And the future also holds the possibility of human-donor hip transplants.

Diagnostic Tests and Scans

More high-tech stuff: Though not widely used yet, CT scans and computer programs can now map the precise shape of a needed implant and design a custom job (one size fits YOU) to replace an injured joint.

But some experts think the greatest breakthrough in diagnostic testing has been the use of MRI-magnetic resonance imaging.

“That’s a big advance,” says Albohm. “MRI can do soft-tissue evaluation, and that adds a key piece of information to what the physician knows. It was first very important in things like evaluating muscle strains among athletes, but the technology is now filtering down to the rest of us. In many cases, MRI can mean avoiding surgery altogether, because the physician doesn’t have to do anything invasive just to find out what’s going on in there.” For patients with soft-tissue injuries to tendons, ligaments, and muscles, MRI is fast becoming a first step to knowing whether surgery is really necessary.

What Else? Biofeedback…and More

A patient injured in a fall uses a computer-designed orthotic device placed inside the shoe to change the angle of an injured ankle and foot and promote faster healing.

A race walker carries a portable monitor that calculates whether certain pressure points on the foot are receiving too much or too little force.

A computer analysis suggests ways to improve technique … and reduce the chances of leg fatigue and injury.

These are just two current uses of the science of biomechanics — a way of analyzing the human body as a living machine reacting to forces outside and inside the body.

Only recently, sophisticated biofeedback devices were sort of thing you’d find only at places training world-class athletes- for instance, the US Olympic facility in Colorado Springs. Among the biofeedback programs in use: high-speed speed filming and video imaging, force platform studies, scanners that can “read” movement from light-emitting diodes (LEDs) attached to an athlete’s body, computer-designed “stick figure” replications of an athlete’s motions, and so on.

Today, however, many home exercise machines (stair climbers, etc.) are equipped with some similar measuring devices that will monitor pulse rate, oxygen consumption, and other factors. Look for more and more feedback equipment in use among casual athletes or nonathletes-to help prevent and heal many types of orthopedic injuries.

What’s the last word in orthopedic treatment? Just ask. Whether you’ve been injured at home, in an accident, or participating in athletic activity, chances are the there’s more than one way to treat your injury. Ask questions about what can be done- and be sure your injury is helped along by recent advances in orthopedics.

Normally, it might not have felt like such an emergency. A local high school freshman walks into the emergency room after a fall that dislocates her elbow. We can fix that.

But this high school freshman was a world-class gymnast on the road to Barcelona. The fall that injured Shannon Miller’s happened just five weeks before the U.S. national championships, and only a few months before the Summer Olympics. She didn’t have any time to waste.

“Shannon had what we call a fracture dislocation,” Dr. David Holden told us. “She was doing a relatively easy maneuver and just landed a little awkwardly on her arm. She slipped along the mat, and the force dislocated the elbow. In the process, a good-size bone chip was broken off, too. Normally when you dislocate your elbow, you tear the ligaments- but in her case, the bone was weaker than the ligaments, and the bone chip that tore away was where the ligaments attach to the elbow.”

Dr. Holden immediately repositioned the elbow in the emergency room to reduce Shannon’s pain. But that was only part of the problem.

“Now we had a loose, unstable elbow, and some choices to make. I talked to her parents and coaches about it. We could treat the injury conservatively- as it would have been [treated] 10 years ago, or today by someone who doesn’t deal with sports injuries. That is, we could immobilize the arm in a cast for five or six weeks.

“I felt that would be a disaster for her-no way she’d be back in time to complete at the nationals or in Barcelona.” (Russian coaches said a gymnast on their team with a similar injury took more than a year to recover before she could complete again.) “And too,” he adds, “the stiffness after a fracture dislocation can be severe. A gymnast can’t afford to lose the extension of her arm-and I knew if we put it in a cast, she’d never straighten that elbow out again.”

Shannon’s parents and coaches agreed that surgery was really the only choice. Dr. Holden operated that night.

“We were lucky in that the ligaments weren’t torn. I used a small fragment screw to place the bone chip back onto the bone. That immediately stabilized the elbow, and we were basically able to get her into therapy right away and never had immobilize the arm at all. She had an excellent trainer, and her coach was extremely good at bringing her along without pushing to hard.”

The combination of high-tech surgery, therapy, and Shannon’s determination paid off. Barely more than a month following her surgery, she placed first on balance beam in the U.S. championships. And in the summer, she blasted past more highly touted U.S. gymnasts to take the Olympic silver medal in the all-around competition at Barcelona.

 

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