Welcome to Prisma Health On Call, a new Q+A series that connects you, our readers, to the pros at Prisma Health.
This month, Sports Medicine Orthopedic physicians are here to answer all your questions about sports injuries, nagging orthopedic issues, daily exercise best practices, and more.
You asked, and the pros answered. (Big thanks to Guillaume D. Dumont, MD, Sports Medicine Surgeon at Prisma Health Orthopedics - Midlands + Tyler J. Schmitz, DO, Family/Sports Medicine Physician at Blue Ridge Orthopedics - Anderson.)
Q:What shoes and prep are the best for running in my neighborhood (pavement/sidewalks)?
A: There is no one shoe that is perfect for everyone. Generally, a shoe with a well-cushioned sole and proper arch support will serve you best. Some shoe retailers have tools to help better understand the pressure distribution of your foot and they can customize inserts for you. But off-the-shelf shoes generally work well for most recreational runners.
Appropriate preparation usually includes a period of stretching prior to your run. A “cool down” walk at the end of your run is often helpful as well. If you are a beginner, gradually increase your running distance and pace so as to not injure yourself or become discouraged.
Q: My hand hurts occasionally. How do I know if I have injured it or whether it is arthritis? Do you go to an Orthopedist for something like this?
A: A history, physical examination and X-ray would be the first steps for evaluating the cause. Diagnostic ultrasound can also be helpful. Common things that may cause hand and wrist pain include osteoarthritis, tendon and ligament conditions, nerve entrapments and fractures. These can all be initially evaluated by your primary care provider or an orthopedic provider. If it is more complicated, an orthopedic provider may be needed.
Q: I am a 78-year-old female with a very active lifestyle, but my right thumb prevents me from doing many of my activities that make my life enjoyable — is there such a thing as thumb replacement?
A: Thumb pain can certainly interfere with daily activities, and this can be very frustrating, especially with an active lifestyle. As for the management of thumb pain, it depends on the underlying cause. Arthritis at the base of the thumb is common, but there are multiple other causes of thumb pain.
The first step would be to see an orthopedic provider for evaluation. If the problem is determined to be arthritis of the thumb, conservative options, including bracing and injections, can be tried. If these options fail to adequately manage your symptoms, then surgical options could then be explored. One popular technique involves using one of the tendons in your wrist to serve as a joint replacement.
Q: Is acupuncture helpful in relieving the routine aches and pains that come with advanced age?
A: Acupuncture has gained popularity as an integrative and complementary therapy for pain. It is generally considered safe and low risk for serious side effects. Studies have shown modest benefits of traditional and nontraditional acupuncture in acute and chronic low back pain, knee osteoarthritis, myofascial pain and fibromyalgia. However, similar benefits have also been seen in sham acupuncture, suggesting there may be a notable placebo response to acupuncture treatment.
More studies are needed, but if acupuncture works for you and you can afford it, it seems to be a relatively safe treatment. I would suggest first being evaluated for the cause of the pain as pathological pain does not necessarily need to be routinely associated with advanced age.
Q: Are there any new treatments for tennis elbow?
A: Tennis elbow is a tendon condition of the elbow that has historically been challenging to treat. Because of this, there are multiple treatment options available, but there is not one universal cure. Like other tendinopathies, first line treatment includes modification of activities, ice, topical and oral analgesics, bracing and an eccentric stretching and strengthening program. In select patients, topical nitrates can be an option. Although once a mainstay, corticosteroid injection has not been shown to be effective for long-term relief. Other injections that can be considered are prolotherapy (combination of saline and dextrose) and platelet rich plasma injections, with the latter being an out-of-pocket expense.
A noninvasive option, although also an out-of-pocket expense with limited availability, is extracorporeal shockwave therapy. Lastly, a newer nonsurgical intervention is ultrasound guided percutaneous tenotomy. This can be performed by needle fenestration of the tendon at some orthopedic clinics or by a special procedure called the Tenex procedure that is not as widely available.
Q: I spend 12 hours a day on my feet between work + exercising but now have a bunion forming. Is there anything I can do to slow its progression?
A: Although a bunion may look like a bump or growth on the side of the foot, the prominence is caused by a twisting and inward bending of the great toe. A common cause or aggravating factor for bunions is narrow shoes. Though they might not make a fashion statement, shoes with a wider toe box will allow more room for your great toe.
There is also a hereditary component to bunions, so, unfortunately, you won’t likely be able to completely avoid them. Some simple measures available at most pharmacies include toe spacers that can help hold the great toe in a more neutral position. When these measures aren’t enough, surgical correction can help realign the toe.
Q: I had spine surgery in Dec (L-3, L-4 & L-5) Laminectomy and a total knee (right) 4 years ago. What exercise can I do in order to strengthen the Core Muscles (which I believe will help both issues)? My back still aches, but it feels like it is muscle related, and my knee needs to be strengthened.
A: There are many core muscles that work synergistically to aid in spine and pelvic stability, affecting both your spine and lower extremities. A few that are easily overlooked and commonly become weak include the transversus abdominis and hip abductors. Some exercises that can help strengthen these include posterior pelvic tilts, bridges, clam shells and lateral and monster walks with resistance bands. I strongly recommend a consult with a physical therapist to better evaluate your specific weaknesses and design a tailored strengthening and stretching program that can safely be performed at home.
Q: What advice do you have for current medical students who want to obtain an orthopedic surgery residency spot? Anything specific I should do during med school to stand out to ortho residency programs?
A: Many residency positions are difficult to obtain, with orthopedic residency positions ranking amongst the most competitive. Many of the best orthopedic surgery residency applicants have demonstrated excellence in a variety of disciplines including academic achievements in medical school but also extending to involvement in extra-curricular activities such as athletics, the arts, and work with charitable organizations that are meaningful to them.
One recommendation I have for applicants is to become involved in things they are truly passionate about. Almost every applicant has a multitude of accomplishments listed on their resumé, but during the interview process, it is easy to identify those who have truly engaged with organizations and activities they believe in. As an applicant to a competitive medical specialty, being involved in clinical research that helps advance our understanding of how we treat diseases and injuries also helps show a genuine interest in the field. Finally, finding a mentor in orthopedic surgery while in medical school can often be a great resource to help you navigate the application process and preparation for it.
Q: I had COVID earlier this year, and ever since, my joints have been crackling. Should I be worried?
A: Joints can often make sounds — cracks, pops and such — however, we often ignore these unless they are associated with pain, discomfort or dysfunction. Occasional painless sounds from joints are most often not considered problematic and don’t require in depth evaluation. If the sounds are accompanied by pain, it may be worth having a physician examine the affected joints and possibly obtain imaging to further assess the issue.
We aren’t aware of a specific association between these types of joint issues and a recent diagnosis of COVID-19. Though the possibility of an association is there, the timing could also be coincidental. As an added comment related to COVID, we would emphasize the importance of vaccination to reduce the spread of COVID-19 and reduce the risk of severe symptoms, hospitalization and death in the event that one does contract the virus.*
