By Rebecca Storey, OTR/L, CHT
As Occupational Therapy (OT) month comes to an end, we would like to take a minute to reflect on our highly skilled OT staff and what they bring to our orthopedic practice. Over the past year, our hand rehabilitation department has grown with the addition of one hand surgeon in June of 2021 and a new OT in November of 2021, making our entire staff consist of 3 hand surgeons, 5 Occupational Therapists (3 of them being Certified Hand Therapists (CHT)), and 1 Certified Occupational Therapy Assistant (part-time). Our therapy staff alone has over 20 years’ experience working in the OT/Hand therapy profession.
As we continue to navigate this crazy COVID-19 world, we continue to face many challenges that affect our growth as clinicians. Once the college courses are completed and the diploma has been earned, the learning does not stop for the therapist. We are required additional learning in order to maintain our licenses and specialized credentialing. As you can imagine, these past couple of years have made this very difficult to achieve with the restricted classroom/group gatherings and various travel restrictions. Most groups and organizations have tried to accommodate as best as they can by providing distance learning opportunities, but nothing compares to the in-person, hands-on learning experience, and meeting with other therapists and physicians from across the country who share in the same area of interests.
Here is just a small breakdown of what is required to maintain our license and credentialing as Occupational Therapists:
- Oklahoma Board of Medical Licensure and Supervision – requires OTs to renew their medical license every year and provide 20 hours of attended continuing education units every 2 years.
- National Board of Certified Occupational Therapist (NBCOT) – our national registration board requires renewal every 3 years and 36 hours of continuing education units.
- Hand Therapy Commission and Certification (HTCC) – requires renewal every 5 years with a minimum of 2,000 practice hours and 80 hours of continuing education units specifically focused on upper extremity.
This does not include additional training therapists do each year to stay up to date and provide the skilled therapy required to meet the standard of care provided by our clinicians here at Tulsa Bone & Joint.
We are happy to start getting back to the “new normal,” and the therapists are excited to return to hands-on learning. Over the past year, one of our OTs has been able to travel to Tucson, AZ and learn about Dry Needling. Tulsa Bone & Joint was able to host an in-person 1 CEU event for fellow hand therapists in the community. We were able to open our doors to OT students, allowing them the opportunity to learn from our highly skilled therapists. Just this last week, two of our therapists traveled to Indianapolis, Indiana for the Hand Care Conference, which was finally able to meet in person again after being cancelled in 2020.
When you are a hand patient here at Tulsa Bone and Joint, you are receiving the best possible care from our highly skilled therapists, who take the time to learn and provide the most up-to-date treatment approaches and skill interventions available.
If you have questions or would like to schedule an appointment to see one of our hand physicians or OT hand therapist, please call 918-392-1400 or click here.
The majority of orthopedic surgeries are considered “elective” because they are not being performed for life-threatening or limb-threatening problems. They are pre-planned and done on a non-emergent basis. These surgeries might be considered simple or low risk (like a knee arthroscopy or carpal tunnel surgery), or more major and higher risk (like joint replacement or spinal fusion). In general, you need to meet some health parameters in order to be considered a good candidate for elective surgery, especially if it is a major surgery. If you don’t meet those parameters, your surgeon might require you to postpone your surgery until you are “healthy enough” to proceed with surgery. This is not a punishment, but rather it is out of concern for you as a patient, as your surgeon wants you to have the best possible outcome from your procedure, with the lowest possible risk of complication. It is important to understand that there is no such thing as a “risk-free” surgery, no matter how minor the procedure is.
Some of the more common parameters considered when determining if a patient is healthy enough for a major surgery include, but are not limited to: blood pressure, lab values, body mass index, blood sugar/HgA1c, heart health, and lung function/smoking. If any of these parameters don’t meet criteria, surgery might need to be postponed until the problem is addressed. If the problem can’t be improved, then surgery might not be an option. Here is a list of some of the health problems, and a few of their respective associated risks, that need to be corrected before undergoing elective orthopedic surgery:
- Blood pressure greater than 180/110 mmHg (120/80 is normal): higher risk of heart attack or stroke during or soon after surgery.
- White blood cell count greater than 11,000/microliter (4,500-11,000 is normal): could indicate an infection somewhere, increasing risk for surgical infection.
- Hemoglobin less than 10 g/dL (normal for men is 13.2-16.6 and for women is 11.5-15): increased risk of needing blood transfusions, wound healing problems, and increased risk of death post operatively.
- Electrolytes such as potassium or sodium too high or too low (normal for potassium is 3.6-5.2 mmol/L and normal for sodium is 135-145 mEq/L): abnormal heart rhythms, muscle cramps, fatigue, or confusion.
- Albumin level less than 3.4 g/dL (3.4-5.4 is normal): significant risk for wound healing problems, prolonged hospitalization, and even death.
- Body Mass Index greater than 40 (18.5-24.9 is normal): significant increased risk of blood clots, infection, blood loss, and anesthetic complications, as well as increased risk of in-hospital death.
- Blood sugar greater than 200 mg/dL (90-110 is normal) or HgA1c greater than 8.0% (normal is below 5.7): significant increased risk for infection and wound healing problems.
- Heart disease: increased risk for stroke, heart attack, and death during or after surgery.
- Lung disease and/or being a smoker: risk for anesthesia complications, cardiovascular events (stroke, heart attack, etc.), delayed wound healing, wound infections, pneumonia, delayed bone healing, and death.
Your individual surgeon will have their own parameters that might slightly differ from those listed. This list is not complete, but reflects some of the more common health issues that need to be optimized prior to having elective orthopedic surgery. Anesthesiologists also have their own parameters that have to be met, though they are similar to those listed here. You don’t have to be perfectly healthy to have orthopedic surgery, but you do need to be “healthy enough.” Remember that your surgeon has your best interests at heart, and wants you to have a complication-free surgery and a full recovery. While they can’t eliminate all risks related to surgery, optimizing your health goes a long way to lowering your risk of complications.
By Lacy Clevenger, PTA
If you’re experiencing a nagging, achy pain on the outside of your hip or knee, you may be dealing with IT band syndrome. This is common with running and endurance sports or any activity that requires repetitive bending of the knee. The IT band is a thick connective tissue that starts at the top of the hip and attaches below the knee. Pain starts to occur when there is friction between the IT band and the bones of the hip or knee, though pain is more commonly experienced at the knee. Weak hips and lack of lower extremity flexibility can make you more prone to this.
Here are 5 stretches/exercises to treat IT band syndrome and help prevent recurrence:
- Foam rolling: Lie on the affected side with the foam roller just below the hip bone. Slowly roll until the foam roller is just above the knee joint, then roll back to the starting position. Repeat this 10-15 times. Discomfort is common with this, but will improve with time.
- Hip flexor stretch: Sit on the edge of a bed and hug one knee toward your chest. Lie back, then actively pull the opposite heel down towards the floor as well as back towards the bed. This should create a stretch along the front of your hip/thigh. Hold this for 30-60 seconds and repeat 3-5 times.
- Glute stretch: Lie on your back with knees bent and feet flat on the floor/bed. Cross one ankle onto the opposite knee then pull your knee towards your opposite shoulder. A stretch should be felt on the back and/or side of the hip. Hold this for 30-60 seconds and repeat 3-5 times.
- Clam shells: Lie on your side with both knees bent. Try to keep your shoulders, hips, and knees in a straight line so that your feet are resting behind you. Keep your heels together and lift the top knee, stopping just before you feel the hips start to roll backwards. Repeat slowly 20-30 times. An elastic band can be added around the legs, just above the knees to add resistance and increase difficulty. \
- Side leg lifts: Lie on one side and lift the opposite leg up towards the ceiling, keeping the knee straight. As you lift the leg, keep it slightly behind the hip which helps to engage the glutes. Do not let your hips roll backwards. Repeat 20-30 times or until muscle fatigue is felt.
Frequently, I see patients whose first question is, “Am I ready for replacement of my arthritic joint?”
This is not a question that is easy to answer, and the answer depends on many factors and variables:
- Joint Replacements have an excellent outcome, with greater than 90% of patients reporting that they are glad they proceeded with the surgery and are better than before surgery.
- Patients often ask if they are too old for surgery. Well, I believe that age is a relative factor. Some 50 year olds have multiple medical problems, while some 90 year olds have no medical issues and are not even taking any medications. So age must be evaluated by each individual.
- There are many treatments for arthritis of a joint:
- Activity modification
- Anti-inflammatory medications
- Anti-inflammatory injections
- Support aides, like canes or walkers
- Braces or shoe modifications
- Weight loss
- Physical strengthening
- The main reason for undergoing joint replacement is pain! However, limitation of activity or loss of function is another reason people think about undergoing surgery.
- The best answer to the question, “Am I ready for a joint replacement?” is, “You will know when it is time.”
If you want to discuss the options of surgical treatment for your arthritis, please make an appointment here or by calling 918-392-1400. By seeing you in person, myself or another member of our qualified joint replacement team can provide you an individualized assessment and discuss your concerns and expectations.
Whether it’s running, walking, soccer, or another outdoor winter activity, it’s important that you prepare your body for the cold temps you will experience when you exercise outside.
Here are a few tips from Tulsa Bone & Joint Physical Therapist Amanda Lynch, who is also an accomplished ultra marathon runner:
- Wear layers, especially on the top. The outermost layer should be wind and water-resistant.
- Wear a hat to help retain body heat and prevent exposed skin. Keep as much of your body covered as possible.
- Keep drinking to stay hydrated, even if you don’t feel thirsty like you would when it’s hot outside. You can still get dehydrated and cramp in the cold weather.
- Know the signs of hypothermia, particularly uncontrollable shivering, slurred speech, and confusion.
- Have warm, dry clothes immediately after your outdoor exercise to change into.
Stay safe during your winter exercising! If you should need a physical therapy consultation, please contact us at 918-392-1482.