It's biking season all year long in Seattle but with the warmer and drier weather upon us, more and more bikes are on the road. Both cyclists and motorists have the responsibility to maximize safety. Bike rider are much more exposed than drivers so even when a rider does something boneheaded, remember - your broken headlight is much easier to fix than their broken bones. Take the high road, be patient, and give bicyclists the space they need to ride safely.
Some of the most common cycling injuries that orthopaedic surgeons treat include broken collar bones, shoulder and elbow injuries, and broken wrists.
Tips for Preventing Injuries
To minimize your risk of injury while riding a bicycle:
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.
I finished reading Atul Gawande's book Better and loved his five suggestions for how a physician "might make a worthy difference" professionally. Here they are with some editing:
"1. Ask an unscripted question. . . sometimes you discover the unexpected. . .
2. Don't complain. . . resist it. It's boring, it doesn't solve anything, and it will get you down. You don't have to be sunny about everything. Just be prepared with something else to discuss: an idea you read about, an interesting problem you came across - even the weather if that's all you've got. See if you can keep the conversation going. . .
3. Count something. . . Regardless of what one ultimately does in medicine - or outside medicine, for that matter - one should be a scientist in this world. In the simplest terms, this means one should count something. . . The only requirement is that what you count should be interesting to you. . .
4. Write something. . . I do not mean this to be an intimidating suggestion. It makes no difference whether you write paragraph for a blog, a paper for a professional journal, or a poem for a reading group. Just write. What you write need not achieve perfection. It need only add some small observation about your world.
5. Change . . . make yourself an early adopter. Look for the opportunity to change. I am not saying you should embrace every new trend that comes along. But be willing to recognize the inadequacies in what you do and to seek out solutions. As successful as medicine is, it remains replete with uncertainties and failure. This is what makes it human, at times painful, and also so worthwhile."
These are excellent goals to strive to accomplish on a daily basis in practice. My favorite is the unscripted question; I've discovered so many interesting, surprising, and lovely things about my patients that have come to light after an offhand question completely unrelated to their current orthopaedic complaint. Interacting with my patients like this is one of the best parts of my job.
Some content courtesy of AAOS/OrthoInfo
Summer is here, and with it are many outdoor activities, adventures, and possibly some heavy lifting. I recently had a patient who was on a camping trip and attempted to move a heavy picnic bench; he bent at the elbows, pulled against the bench, and . . . POP! Something seemed to explode in his elbow; that something was his biceps tendon.
His arm looked like the photo to the left. He had swelling and bruising in his elbow and forearm, and a bulge in the upper part of his arm caused by the recoiled biceps muscle. He was weak with certain motions of the elbow and forearm.
The main cause of a distal (at the elbow, as opposed to the shoulder) biceps tendon rupture is sudden injury. It occurs when the elbow is forced straight against resistance. A "pop" is often felt at the time of injury. Bruising, swelling, and pain are common initial symptoms, as is weakness in bending the elbow and twisting (supinating) the forearm Diagnosis is made with a clinical exam of your elbow by your doctor, with MRI sometimes necessary for confirmation of the diagnosis. Pain in the forearm and elbow may be very severe initially, but usually subsides after a week or two. It is important to seek the consultation of an orthopaedic surgeon early as these injuries need to be repaired within the first two or three weeks after injury, if surgical repair is deemed necessary.
The biceps muscle helps you bend (flex) your elbow and rotate (supinate) your forearm. The biceps attaches at the elbow to the radius bone at a location termed the radial tuberosity. A ruptured distal biceps tendon will cause your arm to be 40% weaker in supination (rotating the forearm from palm down to palm up) strength and 30% weaker in flexion strength.
Once torn, the biceps tendon at the elbow will not heal back to the bone on its own.
Generally, a distal biceps rupture in a healthy, active person is treated surgically with repair. Nonsurgical treatment, however, may be the best option for patients who are elderly and inactive, or who have medical problems that make them high-risk for relatively minor surgery.
Patients must weigh the decision to proceed with nonsurgical treatment carefully, because restoring arm function with later surgery may not be possible.
The torn tendon should be repaired during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten. While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.
I typically use a single-incision technique to reattach the ruptured distal biceps tendon to the radius with a metal button made specifically for the procedure. The xray to the left shows a repair I recently performed; the metal button provides excellent fixation of the tendon to the bone. Some doctors prefer to use two incisions and suture anchors or screws; there are pros and cons to each approach and repair technique. The most important considerations are a strong repair of the tendon to the bone and protection of the nearby nerves and blood vessels.
Almost all patients have full range of motion of their elbow at their final follow-up visit with their surgeon. As with all surgery, ther risk of complications exist. For distal biceps repair, complications are generally rare (6-9% incidence) and temporary. These include temporary numbness of the forearm and growth of new/extra bone at the site of tendon attachment. Be sure to talk to your doctor about the surgical risks. After time and rehabilitation, it is reasonable to expect full return of function and strength.
To help keep kids in the game for life, STOP Sports Injuries targets the sports that have the highest rates of overuse and trauma injuries. I have just accepted a position as a member of the STOP Sports Injuries Outreach and Education Committee for a four year term effective August 1, 2014. We will be meeting Friday, July 11th at the annual meeting and I am excited to post new developments here; stay tuned!
Dr. Lynn Kovacevich and I will again be at Super Jock 'n Jill Running Store in Greenlake for Medical Night Tuesday, July 15th from 6:30 to 7:30 pm. Bring your questions and your injuries! Hope to see you there!!
Big thanks to Super Jock 'n Jill in Greenlake for hosting my Minor & James colleague, Dr. Lynn Kovacevich, and me for their Medical Nights at the store last night. We saw many athletes and runners and discussed injury prevention, training and medical issues.
This is the second time we've done a Medial Night; I'll keep you posted when we schedule the next one. Hope to see you there!
Kudos to SonoSite for hosting an outstanding webinar this weekend on musculoskeletal ultrasound, Diagnostic Shoulder Ultrasound, Part 2, featuring Dr. Antonio Bouffard. Dr. Bouffard is a senior staff radiologist in the division of musculoskeletal imaging at Henry Ford Hospital and is a consultant to NASA, the US Olympic Committee, and has also begun work with the PGA.
Dr. Bouffard's talk focused on the posterior structures of the shoulder including the infraspinatus, the posterior labrum, the teres minor, the spinoglenoid notch and the suprascapular nerve.
I also had a chance to review Part 1 with Dr. Ben DuBois, focusing on the anterior and lateral shoulder structures and pathology. This included the long head of the biceps tendon, the subacromial bursa, the supraspinatus tendon, as well as the subscapularis tendon and bursa.
Both presentations were incredibly informative and the knowlege gained will certainly enhance my in-clinic diagnostic and ultrasound-guided injection skills.
I recently attended a comprehensive course to learn how to utilize ultrasound to diagnose injuries and pathology in my patients. Additionally, I learned how to use ultrasound to guide injections and aspirations (removal of fluid) into difficult-to-access joints such as the hip. It was a tremendous experience and I am excited to leverage this technology to help my patients. Ultrasound is safe (no radiation), dynamic (it shows how things move and work), and real time (no delay in having the study performed, no need to wait to schedule an MRI -- we will do it in clinic during the office visit!). Studies show that ultrasound can be as accurate, if not more so, in the diagnosis of certain conditions such as rotator cuff tears and that ultrasound guidance significantly improves the accuracy of and significantly diminishes the pain associated with in-office orthopaedic procedures.
Sara Jurek, MD