Recovery After Shoulder Surgery #ASES #AAOS #Seattle #Health

The group of muscles and tendons that surround, stabilize and allow movement at the shoulder joint are the rotator cuff muscles. Because of this, any surgical procedure on the shoulder will likely have some involvement with your rotator cuff muscles.   No matter the reason for your shoulder surgery, here are some general tips to help maximize your recovery.

 Support your Rotator Cuff

It is important to insure that the muscles that have recently been operated on are supported and allowed to heal with minimal strain.  Wearing a sling or some sort of standing support will allow for this throughout the day and sleeping with a pillow to support the affected side at night will help.   

 Develop your Rotator Cuff

The rotator cuff muscles will take time to heal.  Initially you should avoid putting any strain at all on your shoulder.  After some time however, it’s important to stick to the physical therapists recommended exercises to slowly and gradually re-build the muscles. 

 Manage your Shoulder Pain

Of course pain will be more significant immediately after the operation as compared to a few weeks out.  To manage this, you can rely on prescription or over-the-counter medications as well as inflammation management practices like cold compresses.   In addition, wearing your sling should help reduce shoulder pain and reduce the likelihood of unnecessary strain or damage to the muscles and tendons during the recovery period.

 Gradually get back to normal

Consult with your physical therapist or physician as to when you can begin to resume normal activities with your post-operative shoulder. For example, from about 6 weeks you usually will be able to start using your shoulder for gentle tasks such as washing and dressing while at 12 weeks you will be thinking about using your arm for other moderate activities, such as swimming.

Successful Surgery in Space #NASA #Space

Today more than ever, the prospect of not only traveling, but colonizing, another planet seems less like fantasy and more like reality.  While many of the barriers that still exist are technological or logistical, like how to fuel such a voyage or communicate back to Earth, perhaps the most important barrier is how to treat health conditions that are bound to arise in space, especially if they require operative interventions.  While there are multiple environmental hazards in space, perhaps the most apparent is the gravity, or rather lack-there-of.

 An Example: The effect produced by microgravity exemplifies the potential for a single (albeit significant) environmental change to cause major multi-systemic consequences on the human body. On Earth, gravity pulls fluids to the lower extremities. In space, absence of gravity causes fluids to redistribute evenly throughout the body. The heart receives an increased volume of fluid returning to it, and compensates by increasing stroke volume. In microgravity conditions, increases in stroke volume are usually accompanied by increases in heart rate to boost total cardiac output. Via the parasympathetic effect, this will actually cause a drop in heart rate, which can be problematic in such an environment.

 In situations of internal bleeding when simple tourniquets or other topical treatment are inappropriate, more drastic surgery may be necessary. Relative to Earth, surgery in space may carry greater risks. For example, the intestines are essentially free floating within the abdomen, tethered only to the posterior abdominal wall. Consequent to microgravity, bowel may therefore freely float out of an abdominal incision, creating a risk of contamination or damage. In cases of bleeding in space, blood does not collect or pool in the same way it des on Earth, but instead forms miniature droplets on surfaces.

 If these droplets are disrupted, blood may float off the surface, potentially creating a biohazard. As surgery is a fine-motor task, vestibular may make performing even simple surgical tasks incredibly difficult and time-consuming. Inclusion of a surgical robot may address onboard surgical needs. Surgical robots have become widely used in certain surgical subspecialties. They use arm-like actuators that actually have a greater range of motion and are not susceptible to fatigue compared to the human hand. Commonly they are situated a short distance from the patient, with the operating surgeon controlling it in real time using controllers. The distance between the surgeon and robot can potentially be expanded, and robotic surgery has been conducted underwater and even across the Atlantic Ocean. Though this would effectively permit a surgeon on Earth to perform surgery in space, as distance between the surgeon and robot increases, the time taken for radio signals to travel in between operator and robot also increase.

 For example, Mars is several million miles from earth. Radio signals can take more than 20 minutes to travel from Earth to Mars. Obviously, if a patient were critically ill or actively bleeding, this time delay creates a greater risk to the patient and could lead to catastrophic results. Due to this, it seems like a medically trained crew member is essential personnel with the current state of technology. However recently, fully autonomous robotic surgery in an animal was demonstrated for the first time. If this technology is developed into a feasible solution for human surgery, an autonomous surgical robot could address the issue of needing an onboard surgeon and also allow independence from Earth-based surgical solutions.

Healthcare Advances Prompted by Space Exploration #NASA #SpaceX #BlueOrigin #Space

When considering the necessities for space exploration, it’s often forgotten that the health and medical requirements in such an environment are much different than what can be expected on firm ground.   With the majority of astronauts being physicists and engineers, it’s important to consider how to maintain health in a zero-gravity environment and what to do should something go wrong as there are no physicians or hospitals that can assist with such issues. 

 Past space exploration missions have proven that there is a unique subset of conditions that can develop in even the healthiest of astronauts after a relatively short period of time.  Without appropriate exercise, they lose bone and muscle mass, their hearts become deconditioned, and their blood vessels stiffen. A subset of astronauts develop a swelling of the optic nerve and possibly an increase in pressure on the brain. Even dormant viruses become activated, alongside changes to the immune system. There is a sense of urgency to solve these problems if we are to send humans to Mars and return them safely in the next decade or two.

 However, these kinds of issues being identified and studied have led to many medical and healthcare innovations on earth that serve a much greater population than just those who are slipping the bounds of our planet.  Discoveries in space robotics and new materials propelled the field of prosthetics, improving the quality of life for many. Millions of cancer patients depend on the digital imaging techniques developed by the space program to enhance MRI and computerized tomography (CT) scans so that we can detect tumors early, or better yet, that there are not any to find at all. Though many do not realize it, humans have been living and working in space continuously for the past two decades. The conditions of spaceflight have accelerated our ability to study progressive degenerative diseases as well. 

 With this being considered, it becomes more clear that these kinds of space missions have goals that go beyond just attempting to find what is out there.   These conditions allow for the rapid development of new technologies to ensure that not only astronauts, but all humans can receive the highest quality of care possible. 

 Space demands the best in healthcare innovations, focusing on prevention and early intervention using smart, creative solutions.  This is somewhat a shift in the existing paradigm of reactive treatment to conditions that arise in humans.  On a mission to Mars, blood tests must be done in a matter of minutes, by the patient, on a single drop of blood. A trained and adaptive computer algorithm will track health status based on a variety of physiological parameters and alert astronauts when important deviations from normal become evident.  These astronauts must rely on such computer resources because the sheer distance from Earth will prohibit the majority of communication.  Due to this, the astronauts must act as their own healthcare providers and rely on the assessment of these automated machines and computers to assist in the maintenance of their health.

 Space exploration has already produced hundreds of innovations that have saved the lives of countless humans. Simply put, to land women and men on Mars and return them healthy, we must reinvent healthcare. While this is an extremely daunting task, the positive consequences of this work will impact all of humanity.

The Secret To Staying Fit on Mars Journeys – Red Wine?

It appears that future astronauts charting a journey to the Red Planet will have to have an affinity for red wine, or at least something which is made with the skin of grapes

While most of the recent stories and research about Mars is based on what to do when humans arrive on the planet, there is still much to be considered about the journey there which can take the better part of one year.  One particular concern is the loss of muscle mass from the lack of use in the zero-gravity environment, but there is now research to suggest that red wine, or rather a compound found in red wine, can aid in the retention of muscle mass for astronauts traveling to the Red Planet.

 The research, which was published in Frontiers in Physiology, focuses on resveratrol, a compound that is found in the skin of some berries and is rich in red wine.  Based on this research, scientists now believe that the use of this compound in astronaut diets may allow for greater muscle mass retention and thus better physical outcomes from the journey.

 To better understand the muscle strain, you first have to understand the difference in gravitational pull between being on Earth, being in a space craft for an extended period of time, and being on Mars.  On earth, the gravitational pull is about 60% more than on Mars with open space being even more than that.  Due to this, the muscles will not be as strained and will atrophy as a result.   This is problematic for the overall health of the space traveler.

 For the test, the team used two dozen male rats split into four groups. 12 of the rats experienced standard “loading,” which is what we all experience every day on Earth, while the other half were fitted with harnesses and rigged to a suspension system that subjected them to roughly 40%t loading, matching Mars’ gravitational pull

 The two groups were further split in half, with half of each group receiving resveratrol supplements in addition to their water, and the others receiving no additional supplements. Strength tests were administered throughout the test period, which lasted two weeks.

 As anticipated, the group which was subjected to the reduced loading without supplementation showed significant muscle atrophy. However, the 40% gravity rats that received the resveratrol supplement showed dramatically improved grip strength as well as less loss of muscle mass, while not affecting the rats’ overall body weight.

 The researchers believe this is due to how the compound affects the body’s sensitivity to insulin. “Resveratrol treatment promotes muscle growth in diabetic or unloaded animals, by increasing insulin sensitivity and glucose uptake in the muscle fibers,” Dr. Marie Morteux, lead author of the study, said in a statement. “This is relevant for astronauts, who are known to develop reduced insulin sensitivity during spaceflight.”

 Study Link - https://www.frontiersin.org/articles/10.3389/fphys.2019.00899/full

Eat Well for Good Joint Health #Seattle #Health #Fitness

Since bones are living tissues that are constantly working to regenerate and produce new tissue material, the food that we ingest and how remain physically active is vitally important to the maximized production of healthy bone and tissue.

Below are some foods that help boost healthy bone and tissue:

Soy-Based Foods: Foods like tofu and edamame are low in fat and high in protein and fiber. They have anti-inflammatory properties that may relieve joint pain and help with bone and tissue regeneration.

Extra Virgin Olive Oil:  Extra virgin olive oil has been associated with increased levels of bone formation and regeneration. In its pure form, olive oil has a lot of anti-inflammatory and antioxidant properties.

Fish: Fatty fish such as tuna, salmon, herring, and mackerel are rich in omega-3 fatty acids. About 3-4 ounces twice a week will benefit those with rheumatoid arthritis.

Dairy Products: Low-fat milk products such as cheese and yogurt are packed with calcium and vitamin D,  which increases bone strength.

Sweet Potatoes:  a rich source of potassium and magnesium which can aid in boosting bone health.

Grapefruit: This fruit is high in vitamin C, an important vitamin that helps prevent bone loss.

Broccoli: Besides containing a high amount of vitamins C and K, broccoli also contains the compound sulforaphane, which helps slow down the progression of osteoarthritis.

Eating a diet full of these foods will aid in maximizing your bone and tissue regeneration, allowing for you to experience better range of motion and likely better quality of life.

What can I expect when I go in for surgery? #Health #Seattle

Often times people will experience some anxiety when heading into a surgical procedure.  Whether it be because they are going to have to be put under anesthesia,  the thought of waking up with some pain, or the fear of the unknown it’s common to have feelings of apprehension.   Luckily,  knowing what to expect can help alleviate these feelings and lead to a more stress-free pre and post-operative experiences.     The first thing to remember is that everyone who you will come in contact from the moment you enter the facility is highly-trained and there to make your experience positive.    As far as time commitment,  typically you won’t spend a great deal of time waiting before going into the operating room.   During the operation, it can take anywhere from one to two hours to complete the operation however you will not remember this.    Post-operation, you may be required to stay in the hospital for some time in order to monitor your healing and how you come out of the anesthesia and then you will likely have to participate in some sort of post-operative physical therapy that can last from a few sessions to sessions that will span over a series of weeks.   While this may seem like a long process, it is a small price to pay for better quality of life in the long term and the advancements in medical sciences today have allowed for a quicker and more effective healing period than ever before. 

When should I seek a physician consults for my shoulder pain? #Health #Seattle

More than 50 million people in the U.S. have some type of arthritis, which can affect joints such as the shoulder.

What is shoulder arthritis?

Shoulder arthritis is inflammation of one or more shoulder joints. The acromioclavicular (AC) joint is located where the collarbone meets the top of the shoulder blade

What are the symptoms of shoulder arthritis?

Pain – This is the main symptom of shoulder arthritis. Your shoulder may hurt when you are not moving it at all, and the pain may get worse while you’re moving it and after you move it. The pain can also be concentrated in different areas of the shoulder, depending on the patient.

Limited range of motion – Patients may find that they are unable to retain full range of motion when experiencing symptoms of shoulder arthritis.

Sounds caused by movement – Your shoulder may develop a clicking, creaking, or snapping sound when you try to move it.

What are the causes of shoulder arthritis?

To address this questions, it’s important to note the different types of arthritis..

Osteoarthritis – This type of arthritis is also known as degenerative joint disease. It causes the cartilage that covers the top of bones to wear down over time and can frequently affect the shoulder joint and most often affects those over the age of 50.

Rheumatoid arthritis – Rheumatoid arthritis is an autoimmune chronic disease that causes your immune system to attack tissue such as cartilage and ligaments and also softens bone.  It usually affects the same joint on both sides of the body. It can affect people of any age and causes the lining of the joint to swell, which causes pain and stiffness.

Post-traumatic arthritis – This specific type of osteoarthritis is caused by an injury to the shoulder. Injuries such as a broken bone or torn ligament can lead to post-traumatic arthritis. It causes fluid to build up in the affected shoulder joint, as well as pain and swelling.

What are the treatment options for shoulder arthritis?

Depending on the type of arthritis you have and the severity of your symptoms, your doctor can treat your symptoms in several different ways. In many cases, shoulder pain can be effectively treated without surgery, but in some cases, it may be warranted.

The following are some of the most common treatments for shoulder arthritis:

Medication – Anti-inflammatory medication can help provide temporary relief from pain and help reduce inflammation. An injection of local anesthetic can also help provide relief. If you have rheumatoid arthritis, you may also receive corticosteroid injections to help reduce inflammation.

Lifestyle changes – You may be able to get some relief by resting your shoulder or applying heat or ice several times a day. Physical therapy that includes exercises designed to increase your range of motion may also help.

Surgery – If non-surgical options aren’t effective enough in controlling your pain and other symptoms, your doctor may recommend surgery if it could help in your particular case.

If you find that you are experiencing the symptoms described above and pain management techniques aren’t providing relief, it may be time to consult with your physician about other courses of action. 

What is “Golfer’s Elbow”? #Health #Seattle

Hitting the links on a beautiful day can be a relaxing and enjoyable experience.  However, many people experience what is called media epicondylitis or Golfer’s Elbow when playing a round.   Symptoms include tenderness and occasional sharp pains on the inside of the elbow, caused by inflammation or tiny tears in tendons near the elbow. The pain centers on the bony bump on the inside of the elbow and may radiate into the forearm.

Many professional players, including Tiger Woods, have battled golfer’s elbow severe enough to warrant withdrawal from major tournaments in the past.. Woods first experienced issues with his elbow at the U.S. Open in 2013 when he was hitting out of the rough, a stroke that is typically achieved with more force than others. That pain, along with tenderness, swelling and weakness on the inside of the elbow indicates a probable golfer’s elbow.

This condition is usually triggered by overuse of the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist. Repetitive flexing, gripping, or swinging (something that is of course very common in the game of golf) can cause inflammation or tiny tears in the tendons.  A similar condition, tennis elbow, is much more common and affects the lateral epicondyle, though the pain profiles of each of these are very similar.

When it comes to seeking treatment there is no benefit to early medical intervention. Playing through any discomfort is usually fine if the pain is tolerable and rest does not typically help elbow tendinitis.   Golfers should know, however, that it is not uncommon for low-grade symptoms to persist for many months before the condition resolves.

If you find that these symptoms are persisting for an extended period of time, it’s recommended that you visit your physician as there may be something that can be addressed medically happening. 

Juggling a Shoulder Procedure and Work

Some people love what they do for their career, some don’t, but the reality is that everyone works to earn a living wage.   In fact, the idea of a joint replacement can often be put off due to not wanting to miss work or worse, be let go due to not being able to perform essential duties.  However, this approach to management of joint-related pain can actually be worse that taking some time off for a procedure.  Generally speaking, your joints are hurting because there is something that isn’t functioning properly and the longer that you wait to have these issues addressed, the worse they can become.   The good news is that having a joint replacement might actually benefit your work output! In a recent study out of England, researchers studied 86 patients suffering from joint-related pain and found that nearly all of the patients working prior to surgery returned to employment following surgery.

More good news on this front is that most shoulder procedures are now fairly routine, meaning that there isn’t much chance that there will be any notable complications as long as you stick with the surgeon-prescribed treatments after the operation!   If you have been suggested surgery as a treatment option and are considering the pros and cons of this route, it is a matter of weighing the long-term vs. short term rewards of doing this.  If you were to stick with pain management techniques like heating pads etc.. you may reduce your pain temporarily but you aren’t reducing the damage being done.  With a surgical procedure, the physician is aiming to repair what isn’t functioning properly, effectively stopping or reversing damage that has been done.   No need to sweat it!

Why does my shoulder hurt? #Health #Seattle

You can experience pain in your shoulder for a variety of reasons, many of which are issues that are minor and shouldn’t worry you.   Your shoulder joint is covered in a tissue that is tough and lubricates the joint articulation (where the bones in your shoulder meet) called cartilage.   When your cartilage is healthy and functioning properly, you are able to experience full range of motion with little to no pain.  However, as we age or when we experience an injury in the shoulder, the cartilage can wear thin or become damaged.  This damage can cause pain and stiffness which will limit your range of motion in the shoulder.    When you begin to experience pain or stiffness in your shoulder, try simple pain relief techniques like stretching, ice, and/or heat.   If pain persists, it may be time to review your options with a shoulder specialist.

Is spaceflight bad for your joints? #NASA #Space #AAOS

This was the question posed by scientist at Henry Ford Hospital. As many of you know, I am fascinated by the effect spaceflight has on the human body and in particular, the musculoskeletal system. The researchers found that after just 30 days in space, cartilage in rats began to degrade, imitating the process of osteoarthritis. They theorized that the unloading of the joints due to microgravity led to the cartilage breakdown. The biggest concern is that cartilage does not repair well, even on Earth, which is why many patients with osteoarthritis end up with hip, knee, and shoulder replacements. This could lead to long term issues for astronauts traveling to the Moon, Mars, or beyond. More research is needed, but this is a very interesting study and shows that we will need to continue to research the effects that spaceflight has on the human body.

Is this exercise bad for my shoulder? #Fitness #Health #Seattle

The deltoid

Shoulder injuries are very common with sports and exercise.    2 out of 3 people will experience a shoulder injury or problem at some point in their lives.  Deltoid exercises are very common with many who lift weights, however, the anterior deltoid normally gets most of the attention.  The deltoid actually consists of 3 main heads: the anterior, middle, and posterior.  Imbalance in the 3 heads of the deltoid can lead to injuries.  A study conducted by the University of Wisconsin LaCrosse evaluated proper deltoid exercises to see which were most effective.

To determine which exercises are most beneficial for activating shoulder muscles, researchers compiled a list of the 10 exercises most often performed by both recreational lifters and athletes and most commonly prescribed by trainers.

• Barbell upright row

• Battling ropes

• Bent-arm lateral raise, great for the medial deltoids

• Cable diagonal raises

• Dips

• Dumbbell front raise

• Dumbbell shoulder press, tops in training for the anterior deltoids

• Push-ups

• Seated rear lateral raise, excellent for the posterior deltoids

• 45-degree incline row, excellent for the medial and posterior deltoids

Following the testing these exercises on 16 athletes, researchers compiled and evaluated the data.  The conclusions were:

• For targeting the anterior deltoid, the dumbbell shoulder press elicited significantly higher muscle activation than any other exercise tested.

• For the medial deltoid, two exercises came out on top: the 45-degree incline row and the bent-arm lateral raise.

• For the posterior deltoid, researchers found that the seated rear lateral raise and the 45-degree incline row both provided the greatest muscle activation for the back of the shoulder. 

My Take

For the most high yield workout, you are best served starting with weakest rear deltoid with either the 45-degree incline row or the seated rear lateral raise followed by the dumbbell shoulder press to target the front of the shoulders.

Exercise is very important both physically and mentally, but always needs to be done the right way.  I hope that this info will add to your workouts.

Do non-surgical factors affect recovery after a rotator cuff repair? #AAOS #Health #Seattle

A recent paper - A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors set out to answer this question. 

Many shoulder surgeons like myself have noticed that patients can have a wide range of outcomes after the same rotator cuff repair surgery.  This paper gives further evidence that many psychosocial factors can affect the result of surgery and need to be addressed to maximize a patient's outcome.  Patients with preoperative narcotic use, higher preoperative pain scores, and lower scores on the WORC (rotator cuff questionnaire) index and emotion sections.

I am immensely interested in studying how we can use different technologies and treatments to best address the psychosocial factors that we all have our shoulder and elbow patients.  Check out more about my research in this field here.

If you have a rotator cuff tear and are considering rotator cuff surgery, please ask your shoulder surgeon if there is anything that you can do before surgery to improve your outcome.

Frequently asked questions: Why does my shoulder hurt? #Health #Seattle

Dr,. Andrew Pastor

Q: I have been suffering from worsening shoulder pain and stiffness for several months. I finally had to stop exercising or playing sports because of the pain. The pain is waking me up at night and it's difficult to raise my arm above my head. I don’t recall injuring my shoulder. What could the problem be?

A: This is a question that I am asked on a daily basis. There are many possible causes of your shoulder pain.

The shoulder is a very complex joint that is vulnerable to overuse injuries and arthritis. It is actually the most mobile joint in the body.

The most common causes of shoulder pain are tendinitis/bursitis, arthritis, and rotator cuff tears.

The shoulder is actually comprised of two joints. The acromioclavicular (AC) joint is between the tip of the scapula (shoulder blade) and the clavicle (collarbone). The glenohumeral joint is between the humerus (upper arm bone) and the scapula.

The shoulder joint has a much more shallow socket called the glenoid (on the shoulder blade) than the deep hip socket.. Surrounding the glenoid is an O-ring made of cartilage, called the labrum. The labrum deepens the socket and adds stability. The four rotator cuff muscles and tendons stabilize the shoulder joint in the socket as well as rotate the shoulder. There is a fluid-filled spongy tissue known bursa sac that lubricates and cushions this joint space above the rotator cuff. The biceps muscle attaches to the shoulder in two places and helps control motion at the shoulder and elbow. The strongest muscle in the shoulder is the deltoid which help rotate, flex and lift your arm.

The shoulder joint

Injuries or inflammation of any of these structures can cause shoulder pain, stiffness and diminished range of motion.

In your case, in the absence of an acute injury, overuse of your shoulder (especially repetitive overhead activities at your job or with exercise) and aging may result in inflammation of the rotator cuff (tendinits), bursa (bursitis), and gradual deterioration and eventually tearing of the rotator cuff.

Inflammation in any of these areas almost always cause night pain, especially if you sleep on the affected side. Chronically inflamed shoulders may develop scarring in the shoulder over time that eventually completely immobilize the shoulder joint, which is known as adhesive capsulitis or frozen shoulder.

Osteoarthritis, which is the wearing down of cartilage in the shoulder joint, is another common cause of shoulder pain, especially if you had an old injury that damaged your cartilage. Osteoarthritis may also cause night pain, weakness and limited range of motion.

A torn labrum may cause pain, locking or clicking, or the feeling that your shoulder will dislocate.

There are other diseases that can cause shoulder pain like a herniated cervical disc, but your history doesn’t really support this.

Depending on your history and physical examination, your doctor may want to do X-rays, an MRI, or an ultrasound for more specific diagnostic information.

Treatment options include applying ice or heat, non-narcotic pain medication, TENS (transcutaneous electronic nerve stimulator), physical therapy (including a home exercise program to continue stretching and strengthening and prevent recurrence).

I recommend activity modification by refraining from any aggravating repetitive activities, but you must maintain the range of motion in order to prevent stiffness. Gentle range of motion activities can almost never make your condition worse. .Ask your physical therapist or doctor how much you can use it and don’t immobilize the joint or wear a sling unless specifically told to do so. I hope this helps!

Andrew Pastor

Can an “old” treatment find new life for rotator cuff repair treatment? #AAOS #Health #Seattle

A study that was presented at the American Academy of Orthopedic Surgeons has demonstrated that transcutaneous electrical nerve stimulation may reduce the pain scores and opioid use after rotator cuff repairs.  In this study, 37 patients were randomized to use either an active or a sham TENS unit during the first week after a rotator cuff repair.  
Electrical stimulation for pain control was first used in ancient Rome.  The first modern, patient wearable TENS unit was patented in the United States in 1974.  It was initially used for chronic pain patients but its use has expanded to other areas.

TENS unit

Following  arthroscopic rotator cuff repair, the use of a TENS unit during the first postoperative week was associated with significantly lower pain scores and opioid pain medication use when compared to patients who received the sham TENS unit.

I have used the this treatment  as part of my shoulder pain protocol after rotator cuff repair surgery with good results.  I continue to research ways to decrease postoperative pain and improve the overall outcomes of my patients after shoulder surgery.  The study is encouraging and may provide an inexpensive and safe way of improving pain control after surgery.
 

New tech may improve overall health #Seattle #Health #Fitness

A volunteer demonstrates Inspiratory Muscle Strength Training at the University of Colorado Boulder.

Credit: CU Boulder

As many of the know, I focus most my research time on shoulder and elbow conditions, space medicine, and reducing musculoskeletal pain, however, occasionally I will come across an article about general health that I find fascinating.  I read an article today about a 5 minute breathing treatment that was shown in a recent study to lower blood pressure, improve vascular health, boosts fitness and sharpen memory.  The treatment is called Inspiratory Muscle Strength Training.  Here is a link to the article if you would like more information.  This is a technology that I will research more as it may be a good treatment to recommend to my patients, especially those with high blood pressure or interested in increasing there fitness. 

What is elbow bursitis? #Seattle #health

Today, I’ll talk about a common condition that I see in clinic - elbow or olecranon bursitis.  Elbow bursitis, or olecranon bursitis, is inflammation of the fluid filled sac (bursa) at the tip of the elbow due to trauma, infection, or inflammation.   Some have referred to this condition as “Popeye elbow” because of the swelling and the bump that develops at the tip of the elbow.  The normal olecranon bursa provides protection and decreases friction to the elbow joint and contains only a small amount of fluid. 

Bursitis of the elbow can occur for a variety of reasons including:

• Trauma to the tip of the elbow causing swelling and fluid build up

• Repetitive stress to the elbow.

• Infection

• Gout

• Rheumatoid arthritis 

Treatment of the bursitis depends on the cause.

In general, most cases of elbow bursitis can be treated with time, prevention of repetitive stress to the elbow, and compressive ACE wraps.  There are certain conditions, however, that have specific treatment as seen below.

Infection

Bursa aspiration

Most infections can be treated with either oral or IV antibiotics.  Your doctor may also recommend aspirating (see Figure), or removing the fluid with a needle.  This can provide useful information, including the type of bacteria, but can also provide some pain relief.  Very rarely, I have to perform an arthroscopy to clean out the infected bursa.

Trauma

Most bursitis related to trauma resolves on its own once the injury has been treated.

Repetitive stress

This is the most common cause of bursitis that I see.  The key to preventing olecranon bursitis due to repetitive stress is to stop the repetitive trauma.  This can be as simple as not resting your elbow on hard surfaces, but may include placing pads on your table or desk, or in extreme cases - wearing an elbow pad for a period of time.

Gout and rheumatoid arthritis

Treatment of the underlying disease, normally improves the symptoms of the bursitis.  On occasion, the bursa will become chronically scarred or will have abnormal material due to gout that may have to be surgically removed.

Conclusion

Elbow bursitis is very common and is generally easy to treat.  It can be frustrating, however, due to the high rate of recurrence.  Please reach out to me or your primary care provider if you think that you have elbow bursitis and would like treatment. 

Thank you,

Andrew Pastor

Frequently asked questions

Hello all. With moving practice to The Everett Clinic, I have had a busy winter. I am back now in full force and will be starting a new series answering Frequently Asked Questions that I hear often from patients. Also, please message me below if any of you have specific questions that you would like answered. I am excited to get started. More to follow and have a great weekend.

Andrew