New treatment options for knee and shoulder

Recognizing that people will self-diagnose themselves, and often with the wrong information, we have an online symptom guide at SportsMedMontana.com that outlines acute and chronic knee pain symptoms, and when the patient needs to see a knee or shoulder specialist to prevent further damage to the joint. Patients and referral sources can download the educational PDFs off our Internet site.

Knee symptom charts online for patients

Copyright 2019 • PrizmDevelopment.com • Centers of Excellence for better healthcare

Superior Capsule Reconstruction (SCR) offers new hope for rotator cuff tearsIt’s estimated that 40% of rotator cuff tears are classified as “massive”. With these specific shoulder tears, if treatment isn’t done promptly, the injury can result in permanent atrophy of the muscles, resulting in an irreperable tear and lifelong problems including loss of strength, ongoing shouder pain and increased arthritis. Consequently, massive rotator cuff tears need to be treated quickly. The problem is that while shoulder replacement may be an option for the older patient, longevity of an artificial joint is an issue for younger patients. Some research cites that 15% of patients with shoulder replacement may need revision surgery after 10 years because of the artificial joint wearing out. Consequently, a patient in their 50s is likely to need revision surgery within their lifetime.

Thankfully, there is a new technique called Superior Capsule Reconstruction (SCR) that reconstructs the shoulder capsule so patients can recover the use of the shoulder. With a large rotator cuff tear, the humeral head over time will gradually drift up and out of the socket. The rotator cuff helps depress the humeral head. But without the downward force of the rotator cuff, the head leaves the socket. The goal of SCR is to reconstruct the joint with a graft of tissue from a cadaver to reconstruct the capsule and prevent the head from coming out of position. After the surgery, the shoulder joint is immobilized for about six weeks. Therapy for range of motion starts at about four weeks post surgery, with active motion at six weeks. We’re pleased to be one of few centers in the State of Montana to provide this new shoulder treatment option for rotator cuff tears.

Carl Schillhammer, MD Board Certified Orthopedic SurgeonFellowship-trained in Sports Medicine Dr. Carl Schillhammer received his B.A. in Biol-ogy from Dartmouth College. After graduat-ing from Dartmouth College, he attended the University of Washington School of Medicine in Seattle, then completed his orthopedic surgery residency training at the State Uni-versity of New York (SUNY). Dr. Schillhammer then completed an Orthopedic Sports Medi-cine Fellowship at Taos Orthopedic Institute in New Mexico where he treated complex ski injuries and other sports related issues. In his fellowship, Dr. Schillhammer spe-cialized in shoulder and knee procedures, including minimally invasive arthroscopic cases; rotator cuff repair; labrum repair; meniscus repair; cartilage restoration; ACL reconstruction; knee replacement; and shoulder replacement. By living in the New Mexico mountain community, Dr. Schillham-mer became proficient in treating trauma and joint in-jury related to skiing, hiking, biking and running. Dr. Schillhammer’s family was drawn to the Montana region both by its natural beauty and small town values. His family enjoys the local trails, ski slopes, rivers and lakes. His interests also include mountain-eering, mountain biking, rock climbing, canoeing, hunting, fly fishing, and baseball.

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Did the knee pain begin suddenly, with an injury, slip, fall, or collision?

Does the knee joint appear deformed, or out of position?

Go to an orthopedic surgeon immediately, you may have torn your anterior cruciate, or other ligaments in the knee.

Did you hear a “pop” and does your knee feel unstable or wobbly?

Does your knee hurt as you bend it?

D o e s i t h u r t w h e n walking or when you put weight on your knee?

Yo u m a y h a ve d a m a g e d a meniscus. If pain does not go away, this injury may require surgery.

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ON CHRONIC KNEE PROBLEMS THAT DEVELOP

OR WORSEN OVER TIME.

You may have damaged the articular cartilage on the bottom of the femur, top of the tibia, or inside the kneecap. There may be a small bone chip causing in� ammation.

Other types of knee pain or discomfort that develop over a short period of time may mean that you have tendinitis or a ligament strain. In fact, sprains are sometimes mistaken for a broken bone. The signs of a sprain include joint pain which increases with movement; tenderness to the touch; and rapid swelling. These may be followed by a black and blue discoloration. Sprains in the knee involve partial tears to the ACL, PCL, MCL, and LCL. Rapid acceleration or deceleration causes strains. A strain is characterized by a sharp pain or “stitch.” The area becomes sore and sti� within a few hours or moments of straining. Pain accompanies further movement but often improves within days.

You may have a fracture or dislocated patella.

Stop what you are doing immediately and go to a hospital emergency room or an orthopedic surgeon specializing in knee problems.

If possible, splint the leg to limit the movement of the knee until you reach the doctor. Do not put any weight on the knee. Use a wheelchair, a cane, or crutch to prevent putting any weight on the leg, which might cause further damage to the joint.

Stop what you are doing. Continuing activity despite the feeling that the knee is unstable can cause additional damage to other ligaments, meniscus, and cartilage. Try ice on the knee to control swelling. Take anti-in� ammatories like Advil or Nuprin until your doctor’s appointment. About a third of ligament tears get better with exercises, a third may need a brace, and a third may need surgery.

Try anti-in� ammatories, as directed on the bottle, for two days to reduce the chronic in� ammation.

Restrict activity which causes pain. Call a specialist for a more in-depth diagnosis and treatment.

Try anti-in� ammatories, as directed on the bottle, for two days to reduce the chronic in� ammation.

Call a knee specialist. A serious meniscus tear can require surgery.

Try anti-in� ammatories to reduce the chronic in� ammation. Also, use ice to reduce swelling.

The good news is that many knee injuries are simply strains from overuse. The three knee tendons at risk for pain are the patellar tendon, the quadriceps tendon, and the popliteus. Dancers, cyclists, and runners frequently experience bouts of tendinitis, when heavy usage stretches out their tendons. This can include patellar tendinitis or patellofemeral pain syndrome. Neither requires surgery. When you return to activity, keep in mind that in sports like tennis, strains are often caused by poor footwork. Consider a tennis lesson with a pro who can improve your preparation and anticipation so there is less need for lunging and uncoordinated stops and starts.

Remember, those who choose to self-diagnose themselves, assume responsibility for their actions. Always consult with a specialist to assess the cause of your symptoms.

Symptom chart for acute knee pain

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Use R•I•C•E for sore knees

R: RestI: IceC: CompressionE: Elevation

We specialize in::KNEE:• knee cartilage preservation • arthroscopic rotator cuff reconstruction• ACL reconstruction• revision ACL reconstruction• superior capsule reconstructionSHOULDER:• shoulder instability• revision shoulder surgery arthroscopy• shoulder replacement (standard)• shoulder replacement (reverse)

Dr. Carl SchillhammerBoard Certified, Fellowship-trained Orthopedic Surgeon305 W. Pennsylvania. Anaconda, MT 59711Appointments and referrals: 406-563-8571SportsMedMontana.com

UNDERSTANDING JOINT PAIN SYMPTOMS &WHEN YOU NEED TO SEE THE DOCTOR

Those who self diagnose and self treat themselves do so at their own risk. We accept no responsibility for any problems that may result from the use or misuse of educational information intended to be helpful guidance.

Copyright © 2018 Prizm Development Inc. • All Rights Reserved

NUMB FINGERS: Numbness in the tips of the fingers can relate to Carpal Tunnel Syndrome. Watchful waiting with the use of a brace can be tried for a couple months. Numbness, if ignored over several months, can become permanent and lifelong, along with weakness in grip. Treatment can include a 30-minute surgery to relieve the tightness in the wrist.

ANKLE PAIN at the back of the leg above the ankle can be related to a sprained or ruptured Achilles tendon, which can be accompanied by a pop while performing an activity, followed by intense pain and impaired ability to walk. A torn Achilles tendon may require surgery.ANKLE SWELLING following activity or awkward landing on the ankle can relate to a sprained ankle. If the swelling and pain does not self resolve over several days, an orthopedic surgeon should evaluate the ankle. Other persistent ankle joint pain can be caused by arthritis. PAIN IN THE HEEL is often plantar fascitis and may require an orthopedic surgeon evaluation & treatment.PAIN IN THE BIG TOE JOINT can caused by a bunion (bone spur) that causes a deformed and painful toe joint. Surgery may be required to remove the bunion.

HIP PAIN not linked to dislocation due to trauma, fall or car accident, is often linked to bursitis (inflammation of the joint) or degeneration of the hip joint due to arthritis which damages the surface of the top of the thigh bone and the socket within the pelvis. • Self care for hip joint pain can include: anti-inflammatories; rest; ice or heat; and physical therapy.• Visit an orthopedic surgeon for a thorough evaluation for the cause of your hip joint pain and treatment options. You should see a doctor when you have a hip joint that appears deformed, if you are unable to move your leg or hip, or bear weight on the leg.• Long term treatment for an arthritic hip joint is hip joint replacement through artificial hip replacement or mini hip replacement. Hip replacement is often delayed where possible to minimize the likelihood of the patient outliving the artificial joint which would require a complex revision surgery and a second artificial joint surgery.

FROZEN SHOULDER can develop from overuse or inflammation.BURSITIS can make it difficult to raise the arm with twinges of pain. TENDONITIS is inflammation of the tendon which connects muscle to bone.Self care for all three can include anti-inflammatories and R-I-C-E: Rest, Ice, Compression & Elevation. Rest your shoulder for a day or so, using ice for 10 minutes at a time. Compress the shoulder snugly with an elastic band (not tightly) and lie down with the shoulder elevated. An orthopedic surgeon can provide a steroid injection to improve motion and relieve pain.

TORN ACL: A torn anterior cruciate ligament can involve an audible “pop” followed by a feeling of nausea and instability. A complete ACL tear will require surgery where a new ligament is harvested from the hamstring or patellor tendon. BURSITIS can cause inflammation of the “bursae” in the joint resulting in pain upon movement.SHIN SPLINTS involve pain on the lower leg following exercise or stress. DISLOCATION occurs with an injury or fall moving the knee “out of joint.”TORN MENISCUS can be caused by an injury during activity.ARTHRITIC KNEE can be common with age and can worsen when the person is overweight or obese. Long term treatment may include knee replacement.Self care for many knee pain ailments can include anti-inflammatories and ice. An orthopedic surgeon can provide a knee injection to relieve pain, or drain the knee of excess accumulated fluid in the knee. A person should see an orthopedic surgeon for a complete evaluation to determine the cause of knee pain.

KNEE: HIP:

ANKLE:

FOOT:

SHOULDER:

TRAUMA, FALL, FRACTURE:HAND:

NUMBNESS/WEAKNESS IN LEG OR FOOT:Numbness or weakness in the leg or foot can be an emergency symptom related to a herniated disc in the back. Left untreated, the symptom can become permanent. You should see a spine specialist within 3 days.

NUMBNESS/WEAKNESS IN ARM / HAND:Numbness or weakness in the arm or hand can be an emergency symptom related to a herniated disc in the neck. Left untreated, the symptom can become permanent. You should see a spine specialist within 3 days.

TRAUMA:Any time there is trauma (fall, impact, car accident) along with pain, a bone or joint could have fractured. X-rays will be needed to check for broken bones. See an orthopedic specialist or an Emergency Room.

On the campus of Community Hospital of Anaconda305 W. Pennsylvania, Anaconda, MT 59711Appointments & referrals: Phone: 406-563-8571Web: SportsMedMontana.com