A recent Bloomberg article should put the fear of God in anyone who wants to get a fusion operation for low back pain blamed on worn-out spinal discs.

When you start an article like this, you mean business! Pretty interesting read, so check it out!

read the article here

[blogs.forbes.com]

Austin, TX (September 16, 2010): A recent study in the British Medical Journal found that patients who had spinal surgery for sciatica only had short term benefits. After 6 months, patients who had surgery felt no different than patients getting physical therapy (http://www.texpts.com). The spine experts at Texas Physical Therapy Specialists (http://www.texpts.com) (TexPTS) deliver hands –on physical therapy to help patients with sciatica.

According to the Mayo Clinic, Sciatica is the pain that travels along the sciatic nerve that runs from the top of the back to the bottom of the leg. Sciatica usually ends quickly, but in some patients it stays. In the British Medical Journal study, patients had the option of early surgery or physical therapy. The patients who had surgery showed improvement for a short time following surgery. But, by 6 months, and up to 2 years following surgery, there was no difference between the groups having surgery and those that did not.

“The news in this study is that patients may be able to avoid surgery. If they can wait out the pain for 6 months, they can get the same results with physical therapy,” said Dr. Robert Wainner, a physical therapy professor at Texas State University , leading musculoskeletal researcher, and therapist/owner at Texas Physical Therapy Specialists. “Patients should know that surgery is not the only option to treat sciatica.”

The study states that since the early benefits of surgery are gone by 6 months, well-informed sciatica patients, and not physicians, should decide if they have surgery. The results of this study suggest that expensive treatments for low back pain may not be the best choice for patients. Options like physical therapy at TexPTS (http://www.texpts.com) may be the best choice for patients with low back pain.

‘…staff and therapy team were very knowledgeable and supportive of my problem and treatment’, stated a recent TexPTS patient in Austin. “I avoided surger which was my main focus.”

‘The best treatment for low back pain is to make sure it is addressed early and does not develop into leg pain, or become a long term condition,’ says Dr. Wainner. ‘Research has shown that early movement and treatments like exercise and physical therapy offer good benefits (http://www.texpts.com).’ These treatments include hands-on physical therapy to move the spine and exercises that ease low back pain. Dr. Wainner suggests that patients seek physical therapists first for treatment.

The spine experts (http://www.texpts.com) at Texas Physical Therapy Specialists can help reduce pain (http://www.texpts.com), reduce the use of medicines, and prevent painful and costly surgery. For more information visit our website at TexPTS.com.

About Texas Physical Therapy Specialists: 
Texas Physical Therapy Specialists (TexPTS) is a private physical therapy practice with locations throughout San Antonio, Austin, and Tyler. Known for teaching and training physical therapists all over the US, TexPTS physical therapists pride themselves in being spine experts (http://www.texpts.com). They deliver hands-on physical therapy based on the newest research to achieve the best results for patients with bad backs, achy joints, wounded hands, and work injuries. Along the way, the TexPTS family has fun and makes friends with their patients (and their pets, their kids, their in-laws, and neighbors….) Perhaps this is why they were voted the Best Private Physical Therapy Practice in the U.S. in 2009 by their peers in the American Physical Therapy Association. For more information visit our website at TexPTS.com or find us on Facebook.

Nobody wants unnecessary surgery. On the other hand, who doesn’t want to have more mobility and to be able to do the things they used to do? Elective orthopedic surgeries like knee arthroscopy and hip replacement tend to be very successful because they can greatly enhance quality of life for years or even decades.

But deciding on surgery can be complicated. People tend to bounce back quickly from knee arthroscopy, but bigger surgeries like spinal disc decompression and rotator cuff repair can be quite painful and require substantial healing and physical rehab periods.

Sixty-year-old Diane Wallace of Marengo recently faced this decision. After a complicated shoulder replacement, she was wary of pursuing knee surgery, even though pain had begun to prevent her from standing long enough to cook the delicious dinners she enjoyed. “I really love cooking and missed it, and the pain was keeping me awake at night and on the couch during the day,” she says. “I knew it was time to do something, but I didn’t know what.” Here are some of the points Wallace discussed with her surgeon as she decided whether surgery was right for her.

One: Try other remedies first.

Most orthopedic surgeons don’t want you to rush into surgery, either. Their first level of treatment for aching backs, hips, knees and shoulders often involves over-the-counter pain medications, supplements like glucosamine and chondroitin and possibly physical therapy to increase strength and function.

If none of these provide enough relief, the next step is to consider steroid injections into the affected joint. “ Steroidsare good for relieving pain and flare-ups, but they offer no lasting benefit,” says Dr. Charles Bush-Joseph, an orthopedic surgeon at Midwest Orthopedics at Rush. “They might provide enough anti-inflammatory relief to get your body into its natural healing process.”

Surgeons can also inject a gel-like substance into painfuljoints, particularly knees. These drugs are based on hyaluronic acid, a naturally occurring substance found in the joint fluid that soothes and lubricates healthy joints. “These viscosupplements help 50-70 percent of patients with osteoarthritis and the effects last up to 6-12 months,” says Bush-Joseph. “But they’re a bridge treatment and those patients will eventually need joint replacement.”

Two: Complicated diagnostics may not be necessary.

Nowadays, it’s common for patients to arrive at the surgeon’s office for their initial consult with MRI results already in hand, ordered by their primary doctor. But many orthopedists suggest relying on lower-tech diagnostic methods instead. “In nearly all cases, we can get an accurate diagnosis by taking an extensive physical history, doing a careful hands-on physical examination and relying on a $42 X-ray versus a $2,400 MRI,” says Dr. Wayne Goldstein, chairman of the Illinois Bone and Joint Institute. “It’s too easy to skip straight to technology instead.”

Bush-Joseph estimates that an X-ray provides enough information to cinch the diagnosis in more than 95 percent of his patients. “Patients often demand that the primary care physician order an MRI but virtually every patient who has arthritis that is visible on X-ray will also have a visible but symptom-free abnormality on MRI,” he says. “Orthopedic surgeons generally prefer to use an MRI to show us exactly where to operate in specific circumstances, not as a routine diagnostic tool.”

Three: Don’t have surgery unless you’re prepared to do rehab faithfully.

If you’re just having your knee ?scoped and are otherwise active, you may not need physical therapy after surgery. But if you’re having joint replacement or rotator cuff repair, physical therapy will most likely be a crucial part of your healing process.

And it probably won’t feel good, either, but that’s part of normal healing. “Being in good physical condition with strong muscles is very important for the normal function of any joint and physical therapy is a way to make that happen,” says Dr. Michael O’Rourke, an orthopedic surgeon at Illinois Bone and Joint Institute, which has 17 offices throughout the region. “After surgery, therapy can help with balance and normalize the walking pattern. When patients walk abnormally for a period of time before surgery, that starts to seem normal, so people often need help getting used to a proper gait again.”

Four: Minimally invasive is not always better.

The term “minimally invasive” has become something of a buzzword in the media to describe surgeries done with smaller incisions and possibly different technologies and surgical techniques. Patients may experience less pain and blood loss and may heal more quickly with a lower infection rate. Or they may not.

The issue of whether minimally invasive surgery is better for you depends on your unique circumstances and the skill and preferences of your surgeon.

O’Rourke requests that patients consider carefully. “People tend to focus exclusively on how quickly they can recover from surgery, which is certainly very important. But surgeons also think about long-term successes,” he says. “My goal is to perform surgery in the least intrusive way while reconstructing a joint to allow it to last for decades.”

Goldstein is more blunt: “We’re inserting an appliance of finite size into your body and we need adequate room to insert it. If either the appliance or the incision is smaller than it should be, that can be the difference between lifelong comfort and having to go through replacement again in just 7-10 years when it should last for 25-30 years.”

As for Wallace, her surgery turned out even better than she expected. The first surgeon she consulted advised knee replacement, but the second convinced her that joint replacement could wait a few more years as long as she had arthroscopy now. “Now that I’ve had the surgery, I can cook again, go up and down stairs and sleep through the night–It’s been wonderful,” she says. “I know I’ll need knee replacement eventually, but I’m not afraid of it anymore.”

[source]

Ever seen a Total Knee Replacement surgery? Many PT students have a chance to witness one while on their clinical rotations, but for those who don’t, here is a great video of the surgery. Warning-this is a little bit graphic. Enjoy.

A surgery is not always the best remedy in case of a knee ligament injury, reveals a novel study aimed at comparing the benefits of surgery and physical therapy in case of a knee injury.

An intense physical therapy proves as effective as a surgical operation for most of the people with a knee ligament breakage, which commonly affects athletes.

Trying rehabilitation can evade almost half of the operations done in order to repair a tear in the anterior cruciate ligament (ACL), which lies beneath the kneecap and attaches the thigh bone to the shin bone.

Treatment of “an acute ACL injury should start with structured rehabilitation rather than early ACL reconstruction,” Richard Frobell of Lund University in Sweden, whose study appears in the New England Journal of Medicine, said.

Around 200,000 ACL reconstructions worth billions of dollars are performed every year in the United States.

121 people studied

121 people aged between 18 to 35 years were studied by the researchers. None of the participants had ever been professional athletes.

After a period of 2 years, participants in the surgery group performed no better than those who received only physical therapy. Thus, without any compromise in the end results, surgery was evaded in 61 percent patients of the study group.

The participants were randomly given either a surgical treatment or rehabilitation.

However, 23 out of the 59 participants in the rehabilitation group also ended up with a surgery by the end of the study period.

Surgery group no better

After a period of two years, participants in the surgery group performed no better than those who received only physical therapy. Thus, without any compromise in the end results, surgery was evaded in 61 percent patients of the study group.

“It confirms what we have always intuitively thought and known, and that is that not all patients need their ACLs reconstructed and that the decision to perform an ACL reconstruction really needs to be individually tailored,” Levy said in a statement.

However, doctors need to be cautious as longer-term evaluations have shown that delayed ACL reconstruction in some people poses a risk of damaging other parts of the knee, and it was really hard to predict which patients will need surgery

“There’s solid evidence that people who have ACL tears and do not have reconstruction, if they go on to have frequent giving-way or instability episodes, they are at an increased risk of doing damage,” Levy said.

source [themoneytimes]

Acromioplasty is a common procedure performed often in conjunction with a rotator cuff repair. Repetitive impingement under the sub acromial space leads to damage on the rotator cuff tendons.

Patients who are indicated for this type of procedure are those who cannot be treated with therapeutic means and the only alternative to remedy the situation is surgery.

Although this surgery is often routine, many complications can arise such as: traction spurs on the bone, coracoacromial ligament damage, decreased lever arm at the deltoid, adhesions of the rotator cuff tendons and damage to the subacromial bursa.

All these complications can be remedied easily, however they will add to the amount of time it takes the patient to heal.

Typically this surgery is known as a decompression of the subacromial space. The acromion is often reshaped to allow for a decreased chance of future impingment. Read the full story