By Rebecca Storey, OTR/L
What do you think of when you think of Hand Therapy?
Most the time we think of “splints,” or in Medicare terms, “orthosis.” Custom orthoses can be fabricated using a thermoplastic material that is uniquely molded to the individual, depending on the body part or area being treated. Your doctor may order a custom orthosis for many different reasons, which may include:
Post-surgical positioning for proper healing
Arthritis and/or joint support
Correction for joint abnormalities (pediatric and adult)
Joint protection while engaging in sports
And various other conditions
With your therapist’s expertise and using the specialized materials, each orthosis is cut, then mold specifically to the individual and the area being treating. The benefit of this is the therapist can make adjustments or modifications in order to maintain skin integrity, minimize pressure points, allow for changes due to swelling, access to care for open and healing wounds, maintain proper movement patterns, increase ROM and many other benefits.
Hand Therapists have unique experience in this area due to their unique training, skilled hands and keen eye for details.
By Jeri Townsend, APRN-CNP
Medicine in all subspecialties is congested with more paperwork and management activities in an effort to meet the requirements placed by insurance companies and federal initiatives to ensure patients are receiving excellent preventive care. The electronic medical record consumes an extensive amount of the provider’s time and as a result, face-to-face time takes a hit. How can a physician maximize their time doing managerial paperwork and reviewing test results while still spending quality time speaking and treating the patient? Advanced practice providers fill a void to assist physicians with patient care.
Nurse Practitioners (NPs) are one of several advanced practice providers. Most advanced practice providers complete a bachelor’s degree and a master’s degree with some completing a doctorate as well. In orthopedics, NPs assist the surgeon with seeing patients, reviewing labs or imaging results, making orders, fulfilling billing and other managerial paperwork behind the scenes, and even assisting in surgery. The goal is to improve patient flow through the clinic and improve patient care overall.
As an NP, I have had the joy of working in many areas of orthopedics. I graduated from the University of Oklahoma as an Nurse Practitioner in 2001 after being a registered nurse in orthopedic surgery assisting in every type of case, from a routine carpal tunnel release to trauma. Prior to coming to Tulsa Bone and Joint, I worked at a different orthopedic group as a general orthopedic NP but also specialized in sports medicine and total joint surgeries along with hand and fracture care. I also ran the organization’s osteoporosis clinic. In 2017, I was able to join the greatest orthopedic group in the region here at TBJA when I joined the hand team with Dr. Childe and Dr. Mokhtee. I also help cover the Tulsa Bone and Joint Urgent Care when the need arises.
Advanced practice providers are not a substitute for your surgeon in orthopedics here at TBJ. Our physicians are directly involved in every patient’s care; however, NPs and physician assistants (PAs) are here to help improve overall patient care by assisting the physician in any way necessary. Interestingly enough, I have come full circle. The surgeons who taught me orthopedics at St. John Medical Center back in 1992 as a nurse are the same surgeons who started Tulsa Bone and Joint.
By Joseph Terry, PT, DPhty
In the world of orthopedics, osteoarthritis (OA) is one of the main conditions for which patients seek out our care. Arthritis, in its various forms, is prevalent in roughly 23% of our society and nearly 50% in those over the age of 65 (CDC). Many cases eventually require surgical intervention due to the severity of the condition and/or impact on the individual’s overall function; however, this is not always the case. There are also many cases in which conservative approaches may prove to be effective in restoring a patient’s function.
Before we discuss ways to care for and manage OA, let’s first look at what it is and what puts you at risk for developing it.
• What is OA?
Osteoarthritis is a degenerative condition of the joints that is characterized by loss of cartilage and the development of bony growths (spurs) as the body attempts to self-repair. These changes lead to pain, crepitus (grinding), decreased motion, swelling, and can eventually cause deformity in severe cases. All joints are susceptible to developing OA, but it is most commonly seen in the knees, hips, and shoulders.
• Risk Factors.
The number one risk factor in developing OA is age and the associated “wear and tear” our bodies go through over time. It is also more common in women and those who are overweight/obese. Other contributing factors are previous joint injury, working in manually intensive jobs, having a family history of OA, and previously participating in repetitive impact sports.
• Common Symptoms.
Commonly, those with OA complain of joint pain that increases with activity/throughout the day, frequent joint swelling and tenderness, and/or crepitus (grinding) in the joint. In more severe cases, individuals may even see joint deformity or enlargement.
Conservative management for OA is essentially any form of non-surgical treatment and can include any or all of the ones listed below. It is important to discuss these with your physician to determine if they are specifically appropriate for you and your condition.
• Nonsteroid Anti-inflammatory Medication (NSAIDs).
This is something you would discuss with your doctor.
This is something you could discuss with your doctor and/or a physical therapist.
• Nutrition and Supplements.
This is something you can discuss with your doctor and/or a registered dietitian/nutritionist.
Improving the flexibility and strength of the supporting muscles has proven to be extremely beneficial in treating OA and can often times delay or even prevent the need of having surgery. Increasing your activity level can also result in weight loss, which improves the symptoms associated with OA. If appropriate, being taken through a supervised exercise program by a licensed physical therapist may be the best way to treat your condition.
If you have been dealing with joint pain that increases with activity/throughout the day, frequent joint swelling and tenderness, and/or crepitus (grinding) in the joint, it might be worth having one of our orthopedic specialists perform an evaluation to determine the cause of your symptoms and what the appropriate course of treatment is.
By Jennifer Peterson, MD
While hip surgeries are common here at Tulsa Bone & Joint, we take a conservative approach to treatment. That means helping you stay out of the operating room if and
when possible. If you’re suffering from knee pain, here are 6 things you can do to treat the pain that do not require surgery:
- Try over the counter anti inflammatories like Aleve or Ibuprofen.
- Ask your doctor about trying prescription anti inflammatories like naproxen, meloxicam, or celebrex.
- Try physical therapy: Physical therapy can help you strengthen the muscles around the hip, and help treat any gait abnormalities that develop with arthritis.
- Steroid injections are a great way to treat the pain of hip arthritis, and these can often be done in the office under ultrasound.
- Head to the store and get yourself a stylish cane. Hold this in the hand opposite your bad hip. (Right hand for Left hip) This will help decrease the forces going through the bad hip and help
- Last but not least, the hardest of all…weight loss. 3-6x your body weight goes through your hips with every step. That means 10lbs of weight loss is at LEAST 30 lbs less weight that your hips feel with every step.
If you need guidance regarding your hip pain, I am accepting new patients and would be happy to help you find relief. Call 918-392-1400 to schedule an appointment.
By Dan Skierski, PT, DPT, Clinic Lead, Tulsa Bone & Joint Sand Springs
October is National Physical Therapy month, so I decided to address one of the top issues therapists face in the daily lives of our patients: the risk of falling. Many of our patients fit into one of two categories.
One, they are at high risk to fall and are unaware of the risk; or two, they have suffered one or more falls resulting in injury.
According to the CDC, 30% of adults over the age of 65 suffer a fall each year. Twenty percent of these falls result in serious injuries that require emergency care. Each year, 40% of hospital admissions by elderly people are a result of injuries from falling.
Unfortunately, less than half of the people who fall will tell their primary care provider if they have been seriously injured. Once someone falls, they are at high risk for falling again. Falls are the leading cause of death in the elderly, and nearly $50 billion in medical costs are spent annually treating resulting complications.
Here is a quick assessment to see if you are at risk for falling:
- Can you rise from a chair without using your hands?
- Can you stand on one leg without quickly losing balance?
- Can you stand with your feet in tandem (one foot in front of the other) without losing balance?
Who is at risk to fall? Anyone over the age of 65, small children or individuals with a history of low back or lower body injuries. This includes individuals who have had hip, knee and ankle replacements, low back surgeries or osteoarthritis of the low back, hip, knee or ankle. Another major cause is osteoporosis due to osteoporotic hip fractures.
How can you prevent future falls?
1. Home Modification. According to the CDC, the number one way to reduce costs associated with falls is home modification. This includes eliminating obvious trip hazards such as rugs and small items on the floor, clearing large walkways in your home and outdoor area, and enhancing lighting in dimly lit areas.
2. Physical Therapy. Seeking Physical Therapy can be very beneficial for assessment of the need for an assistive device, as well as gait and balance training. Therapists can also work on lower body strengthening and the prescription of a long-term exercise regimen to maintain functional strength. Physical therapists also screen for other risk factors and address each individual’s safety needs.
3. Consider Using Safety Devices. Other means that can be used for safety are: carrying a cell phone, purchasing a life alert button or wearing a smartwatch with a 911 function.
4. Get a Bone Density Scan. Bone density testing can be done as an early detection method to treat or prevent osteoporosis and falls associated with osteoporotic hip fractures. Tulsa Bone and Joint offers DEXA Bone Scans at our Healthy Bones Center.
Falling is NOT a normal part of the aging process, and there are many measures that can be taken for prevention.