Monday, December 3, 2012

Fall Prevention - The Best Fracture Treatment is Prevention of the Fracture

The vast majority of fractures in our elderly population are due to falls.  The data is remarkable.  One out of three people over age 65 have a significant fall each year.  One of two women over age 50 will sustain an osteoporosis (weak bone) related fracture each year – many of those due to a fall.
We often say that orthopaedic injuries and fractures don’t happen in a vacuum.  We mean that there is much behind the source of the fracture and the fracture is simply the end result.  Simply focusing on the fracture and it’s repair and healing process isn’t enough.

So, let’s talk about how we prevent falls and fractures, specifically in our older population. 
The first step is to move!  The more we safely move and exercise the more we improve and maintain our muscle tone, balance, and bone strength.  If we don’t move an ugly cycle of deconditioning develops that leads us toward the path of a fall and fracture.  Simply walking with friends or family 10 – 20 minutes a day is a good start.  Other options are working with a fitness instructor at your local gym or starting water aerobics.

The second and third steps have to do with standard check-ups with your health care providers.  Making sure that your regular doctor has an opportunity to review your medications will help limit side effects such as sedation, low blood pressure, or low blood sugar that might lead to a fall.  In addition, an eye exam will ensure that a change in your vision isn’t the culprit that causes you to miss the edge of the rug or a step that throws you off balance.

Lastly, removing things, like the rug mentioned above, that increase your risk of a fall, will greatly reduce your chance of falling and breaking a bone.  Go through your living area and remove trip hazards like rugs, boxes on the floor, etc.  Other simple adjustments like moving medicines and other important items to lower areas that don’t require a stool to reach them may save a trip to the emergency room.

St. Peters Bone and Joint looks forward to meeting you and helping you through your orthopaedic problems.  However, if we don’t see you because you saved yourself from a fall, we’ll gladly wish you the best as you keep moving toward your daily goals.

Please click here to see the fall prevention brochure from the Centers for Disease Control and Prevention that further highlights the four ways to prevent falls discussed above.

Written by Dane Glueck, MD

Tuesday, November 27, 2012

Anti-Inflammatory Medications (Non-Steroidal Anti-Inflammatory Drugs – NSAIDs) How Do They Work and What are Their Risks and Benefits?

A significant number of our patients come through our doors because of pain and decreased function related to inflammation.  Diagnoses due to inflammation include:  tendonitis, bursitis, and arthritis.  In some cases the symptoms are relatively short-lived.  However, often, simple treatments like rest and modification of activities aren’t enough to resolve the symptoms.  In those cases, anti-inflammatory medications can treat the underlying inflammation and resolve the symptoms.  In addition, other treatments may be added such as bracing and physical therapy.

So, how do they work?  First, it’s important to recognize that they’re not just a pain reliever.  They help reduce inflammation that is the source of the pain.  NSAIDs prevent joint and tissue inflammation by stopping an enzyme called cyclooxygenase (COX).   More specifically, the COX-2 enzyme stimulates the inflammatory response. The  COX-1 enzyme is more helpful to us, protecting the stomach’s lining and maintaining kidney function.  Standard NSAIDs block both COX-1 and COX-2 while COX-2 inhibitors focus specifically on the source of inflammation.  The potential benefits of COX-2 inhibitors includes a decreased risk of stomach / GI bleeding.  

Typically, either a standard or COX-2 inhibitor is taken in pill form.  Examples of common standard anti-inflammatories include medicines like ibuprofen (Motrin®), Naproxen (Aleve®), and Meloxicam (Mobic®).  The currently available COX-2 inhibitor is Celecoxib (Celebrex®).  However, another option that’s more recently available is applying an anti-inflammatory topically, as a rub, to the affected arthritic joint.  An example of this is Voltaren® gel.

Like most medicines, there are risks associated with NSAIDs.  Therefore, it’s best to take the lowest dose possible for the shortest time needed.  However, many patients respond better to taking the medication regularly for a time period, as opposed to more haphazardly.  A potential balance may be achieved by initially taking the NSAID on a more scheduled basis initially (for example, the first two weeks), and then transitioning to stopping the NSAID or taking it on an  “as needed” basis.  

Risks of NSAIDs include an increased risk of bleeding or getting an ulcer.  This can be limited by decreasing the amount and length of time that you take the medicine, or by taking a selective COX-2 inhibitor.  In addition, taking the NSAID with an anti-ulcer medication such as Naproxen/Esomeprazole (Vimovo®) can lower the risks of developing an ulcer.

Other risks include (but are not limited to) heart disease, kidney disease, and interactions with other medications.  For patients with heart and kidney disease, NSAIDs should be avoided or limited.   Patients already taking a blood thinner (such as Warfarin (Coumadin®, Plavix®, or similar medications) should also avoid or significantly limit NSAIDs.  Patients older than 65 are typically at greater risk of side effects and medication interactions than younger patients.

The Basic Bullet Points on NSAIDs

Benefit of NSAIDs
·        Treats the cause of pain (inflammation) for many typical orthopedic problems such as arthritis, bursitis, and tendonitis.  

Types of NSAIDs
·         Common Nonselective NSAIDs
o   Ibuprofen (Motrin®, Advil®)
o   Naproxen (Aleve®)
o   Meloxicam (Mobic®)
o   Nabumetone (Relafen®)
·         Selective NSAID (COX-2)
o   Celecoxib (Celebrex®)
·         NSAID combined with anti-ulcer medication
o   Naproxen / Esomeprazole (Vimovo®)
·        Topical NSAID
o   Voltaren® Gel

Risks of NSAIDs 
  •  Bleeding
  •  Ulcers
  •  Heart Disease / Stroke
  •   Kidney Disease
  •   Interaction with other medications
Ways to Avoid Risks of NSAIDs
  • Take lower dose if possible
  • Limit length of time taking the NSAID
  • Don’t take a prescription NSAID and an “over the counter” NSAID together
  • Avoid if you have a history of common risks associated with NSAIDs
  • Limit NSAIDs if over age 65
Other Resources

Dane Glueck, MD
November 2012

Wednesday, November 7, 2012

SPBJ and St. Louis Area Foodbank

SPBJ will be participating from now through Christmas with the St. Louis Area Foodbank to help others less fortunate. This organization relies on the generosity of folks like us to make a difference in the lives of those in need of food assistance. You can help by donating food and other health and beauty items to keep the Foodbank shelves stocked.

We feel that our support is crucial in allowing the St. Louis Area Foodbank to feed the over 57,000 individuals who rely on them for food assistance each week and your efforts will be greatly appreciated. 

The St. Louis Area Foodbank began its service to the community in 1975.  Today, we continue to be an organization that relies on the generosity of others to make a difference in the lives of those in need of food assistance.  Since that time, we've grown to become the bi-state region’s largest non-profit 501(c)(3) food distribution center dedicated to feeding those in need. Through our network of more than 500 partner agencies, we distributed more than 25 million pounds of food in FY2012. For more information, visit

To find the best items to Donate click here.


Tuesday, November 6, 2012

Frozen Shoulder

Frozen shoulder happens when inflammation develops inside the shoulder joint.  Frozen shoulder is also called “adhesive capsulitis”.  The inflammation from frozen shoulder causes pain at first, but over time causes thickening of the ligaments inside the shoulder.  This thickening of the ligaments is similar to the formation of a scar.  As this occurs, the shoulder becomes progressively more stiff.  This process occurs slowly over many months.  Most people start to notice that they can’t put their hand behind their back, to put on a bra or put a wallet in the back pocket.  Pain at night is very common, and throwing or reaching above the head become difficult or impossible.
We don’t know why frozen shoulder happens, but it is more common in patients with diabetes or thyroid problems.  Sometimes it starts as the result of a minor injury.  Most often, though, it begins for no reason at all.

It is not always possible to tell the difference between pain from frozen shoulder or pain from arthritis, bursitis, or tendonitis.  Only your physician can make a definitive diagnosis.

The good news is that frozen shoulder is not a permanent problem.  It will always get better on its own, but slowly, over many months.  It can take up to one or two years for the pain to completely go away and the shoulder motion to return to normal.  Most people don’t want to wait a year for the symptoms to clear up.  So what can be done?

In my practice, I usually start with cortisone shots.  Since the problem is related to inflammation, and cortisone is a powerful anti-inflammatory, cortisone shots help most people get past the worst of the pain and stiffness.  These injections are done with the help of an ultrasound machine, which guides the injection into the correct spot.  Most people will have significant relief of pain with cortisone injections.  Some people, though, may continue to experience stiffness even if the pain improves.

Patients with persistent stiffness sometimes benefit from a simple surgical procedure called a “manipulation and release”.  This procedure is done under general anesthesia.  First, the shoulder is gently stretched to break up the scar tisuue.  Then, through small “arthroscopic” incisions about one-half inch long, the inside of the shoulder is cleaned up and the tight scar tissue is removed.  Most patients recover fully from this surgery within 6 weeks, although it may take longer.  The results are generally very good.

To summarize, frozen shoulder is a problem of inflammation in the shoulder.  It results in pain and stiffness, and is treated with cortisone injections.  If cortisone shots don’t work, then a simple arthroscopic surgical procedure may help.

-Dr. Anthony Frisella

Saturday, October 20, 2012

Exercise Helps Decrease Arthritis Pain!

Did you know that arthritis is the leading cause of disability in the United States? 22% of adults have arthritis. For many of my patients a diagnosis conjures up fears of needles, medication side effects, and ultimately--surgery. Most look at me with disbelief when I tell them that exercise--even weightbearing exercise--may actually help alleviate their pain.

Numerous medical studies have shown that physical activity is an important but underused intervention for adults with arthritis that decreases pain, delays the onset of disability, improves physical functioning, mood and independence, and enhances quality of life, aerobic capacity, and muscle strength.
Here are some recommendations for all adults:

  • 2 hours and 30 minutes of moderate intensity, or 1 hour and 15 minutes a week of vigorous intensity aerobic physical activity.
  •  Additional health benefits are provided by increasing to 5 hours a week of moderate intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous intensity physical activity, or a combination of both.
  • Muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.

Brisk walking is a good example of moderate intensity exercise and more intense jogging is considered vigorous. Biking and swimming are also good options.

It is often difficult for folks to find time in their busy schedules to exercise, but the great thing is that these periods of exercise can be broken up into small chunks. Even a ten minute bout of exercise is worth it. Strive to do enough of these a week to add up to the recommendations above. Those knees won't ache as much if you do!

For more ideas on exercise activities:

-Written by:
Brandon D. Larkin, MD
St. Peters Bone & Joint