Joint Pain at Night: 6 Possible Causes

Written by admin on November 24, 2012 – 11:05 pm -

Have you ever suffered night pain? Have you ever wondered why? Check out Joint Pain at Night: 6 Possible Causes for more information.


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Deep Vein Thrombosis (DVT)

Written by admin on November 10, 2012 – 9:43 pm -

When hearing of a blood clot, one typically considers a person who recently had major surgery, for example, a knee replacement, or a traveler after a long plane ride. While these assumptions may be accurate, many are surprised to learn that athletes can develop blood clots as well. Serena Williams (Tennis) and Phil Dalhausser (beach volleyball) are two examples.

Blood clots are also referred to as a DVT or Deep Vein Thrombosis. They are most common in the legs, causing extreme calf pain, swelling and tightness, but also can occur in the upper extremity where they cause similar symptoms. DVT results from: diminished flow of blood through the veins, injury to the veins and hypercoagulability (“thickening” of the blood). Typically after surgery, patients are less able to move the lower extremities and joints due to pain and swelling. Since the flow of blood in the veins is dependent upon movement and contraction of muscles, this lack of mobility results in a decrease in blood circulation and increased viscosity (or thickness) of the blood. Both factors predispose to developing a clot. Upper extremity DVT is much less common, comprising only 10% of all cases of DVT. The typical cause of an upper extremity DVT in an athlete is repetitive micro-trauma of the subclavian or axillary veins (as is typical of a high level overhead athlete: tennis, volleyball, or baseball).

Signs and symptoms of an upper extremity DVT are similar to those seen in the lower extremity: pain, swelling and tightness of the affected arm/shoulder region.

DVT is a serious medical condition and can progress into an even more serious complication–pulmonary embolism. PE occurs when the blood clot or portion thereof, dislodges itself and travels into the lungs, causing shortness of breath, chest pain, dizziness and rapid pulse. PE can be fatal, and immediate medical attention must be sought if these symptoms occur.

Months before the London Olympics, Phil Dalhausser experienced significant swelling in his left arm. He was admitted to the hospital, diagnosed with DVT and treated with blood thinners (anti-coagulants and thrombolytic agents) to dissolve the clot. It was determined that the DVT was precipitated by scar tissue in his subclavian vein which resulted from being pinched between his first rib, collar bone and the surrounding muscles each time he struck the ball or reached for a block. Since his DVT, Dalhausser has successfully competed in the London Olympics representing the United States in men’s beach volleyball.

Serena Williams’ case, while much different was more typical. After sustaining a laceration in her foot, she first developed a hematoma in the wound. They are a local collection of blood but not related to DVT, nor can they ever become DVT or lead to PE. Hematomas result from blunt force trauma or within a healing wound. She subsequently developed a DVT in the same leg. Presumably this was the result of the immobilization required to allow the injury to heal. The pulmonary embolism occurred months after she cut her foot, and required immediate hospitalization. She recovered fully and won the 2012 US Open and gold medals in the London Olympics.

Resources:

Associated Press. (2011, March 02). Serena Williams hospitalized after suffering blood clot in lungs. Retrieved from http://www.foxnews.com/sports/2011/03/02/serena-williams-hospitalized-suffering-blood-clot-lungs/

Joffe, H. (2012). Upper-extremity deep vein thrombosis. Retrieved from http://circ.ahajournals.org/content/106/14/1874.full

Vein Specialists of the South. (2012). Olympic beach volleyball star develops blood clot in subclavian vein. Retrieved from http://varicoseveintreatmentga.com/wpi/deep-vein-thromobosis/olympic-beach-volleyball-star-develops-blood-clot-in-subclavian-vein/

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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Orthokine Therapy: Modern Day Fountain of Youth?

Written by admin on October 1, 2012 – 9:52 am -

Orthokine therapy is a new sports medicine treatment recently receiving widespread interest and acclaim. It was developed primarily for the treatment of osteoarthritis (OA) by German doctors, Dr. Peter Wheling and Julio Reinecke, PhD., of Dusseldorf, Germany. Little is known about this experimental technique, and there is scant data to support its efficacy, but anecdotal reports have been, high-profile and promising. Much like the mythical fountain of youth, the technique, its clinical mechanism, and its results are shrouded in mystery. Similar to Platelet Rich Plasma Therapy (PRP therapy), whose mechanism and effect has been discussed at great length, and is now widely-recognized in the public consciousness as the standard musculoskeletal rejuvenation therapy, Orthokine therapy is also an autologous treatment provided as an injection of the patient’s own blood. There are no foreign materials or substances used, so risk of adverse side effects is minimal, and the injections are well-tolerated.

In theory, proteins commonly found in patient’s blood –such as Interleukin – 1- Receptor – Antagonist (IL -1Ra) – possess inherent anti-inflammatory and analgesic properties that serve to protect and to preserve the cartilage in an arthritic joint against degradation by osteoarthritis.

During the Orthokine procedure, blood is obtained from the patient using a syringe containing beads that will enhance and/or release the production of these cartilage-protective proteins. The blood is stored at body temperature for up to 9hours, during which time, the concentration of the joint preserving proteins, have increased up to 100 times greater than normal. After the incubation period, the sample is centrifuged to isolate the enriched serum of proteins from the other elements of blood. It is then divided into numerous vials that may be used immediately or frozen for future treatments. The serum is then injected into the affected joint to decrease pain, increase range of motion, and decelerate the progression of degenerative joint disease, and (hopefully) improve the joints longevity. The practitioners report almost immediate improvement and symptom resolution for 2-4 years.

Orthokine therapy is being used throughout Europe but is not yet FDA approved for use in the United States. Professional athletes such as Kobe Bryant and Alex Rodriguez are among those who have traveled to Europe to receive the Orthokine therapy with the hopes of alleviating pain, enhancing their performance and extending their athletic careers.

It is unclear whether Othokine is the long-sought OA treatment (minimally invasive, long-lasting, relatively inexpensive to provide), the next innovation, or just the latest “snake oil” cure-all. It is certain, however, that despite the lack of clinical data, many more modern day Conquistadors will travel to Europe to imbibe this latter day fountain of youth, following the examples of the superstar “Ponce de Leon” that preceded them.–at least until it is “discovered” again somewhere else.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, ATC/LAT is a post graduate fellow at GOSM… For more information, visit us at www.atcfellowship.com

References
Wehling, P. D. P. (2012). Molecular orthopaedics. Retrieved from http://www.wehling-hartmann.de/en/wir-ueber-uns/
Wheling, P. D. P. (2007). Osteoarthritis: The individual osteoarthritis therapy. Retrieved from http://alfa-arthro.com/dokumenti/BookletOA_Pat_05062007.pdf


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Take Five To Stretch

Written by admin on April 6, 2012 – 7:29 am -

This post can also be found on the Association Executives of North Carolina’s Success By Association blog.

The core of my practice is sports medicine. But it isn’t just athletes that get injured. As we rely more heavily on technology and the average person uses a desktop computer, a smartphone, and an Ipad in a given day, chronic overuse injuries are only going to increase. Ailments like epicondylitis (tennis elbow), carpal tunnel, and tendinitis are generally caused by repetitive use of the forearm, wrist, and hand muscles. These problems are degenerative in nature and can be extremely uncomfortable and activity limiting. Ergonomics, the study of efficiency in the workplace, can offer many solutions and adjustments for reducing the severity and frequency of these problems. Here I’d like to offer my own advice- Take 5 to stretch.
5 minutes in the mid-morning and 5 minutes in the afternoon to do these 3 simple stretches will go a long way to keeping your arms limber and pain free, hopefully for years.

1. Epicondylitis Stretch- Epicondyle is the medical term for the bony area of your elbow where your wrist and forearm muscles attach. You have a medial epicondyle for the muscles that flex your wrist and enable you to pronate (turn your palm toward the floor). You also have a lateral epicondyle for the muscles that extend your wrist and allow you to supinate (turn your palm up). In order to stretch these muscles, you should reach your arm out in front of you with your elbow straight and use your opposite arm to bend the wrist into flexion. Hold 20 seconds. Then, keeping your elbow straight, pull your wrist into extension. Hold 20 seconds. Repeat each way one more time.

2. Wrist Rotation- Keeping your wrist poised while typing all day can cause stiffness, pain, and contribute to carpal tunnel. To give your wrist a break, make a loose fist and rotate your wrists in circles for about 20 seconds. Go on to stretch your hands (exercise 3) then repeat for 20 more seconds.

3. Hand/Finger Stretch- Give your hands a break from typing, emailing, texting, tweeting, blogging, and data entering. For this stretch, you want to spread your hands and fingers out as wide as you can and then make a tight fist. Open your hand and widen your fingers then pull it back into a fist. Repeat about 10 times.

Three exercises. Five minutes. Make it part of your daily routine until it becomes a habit- just like brushing your teeth. I would be happy to see you in the office for any problem any time, but if I can help keep you healthy, that’s even better.


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