What is Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD)?

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By, Dr. Kevin Sigua

Complex Regional Pain Syndrome/ Reflex Sympathetic Dystrophy is an uncommon form of chronic pain that usually affects an arm or leg. CRPS/RSD typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury, if any.

The cause of CRPS isn’t clearly understood. Treatment for complex regional pain syndrome is most effective when detected and started early. In such cases, improvement and even remission are possible.

Symptoms may include continuous burning or throbbing pain, usually in your arm, leg, hand or foot, sensitivity to touch or cold swelling of the painful area. Other symptoms may include changes in the skin, including the skin’s temperature, color and texture. Changes in hair and nail growth, joint stiffness, muscle spasms and decreased ability to move the affected body part are also symptoms. Symptoms may change from person to person but not treated early these may become irreversible.

Diagnosis of CRPS/RSD is based on physical exam and history.  In addition tests like, MRI’s, bone scans, X-rays may help in diagnosis however there is no one single test that can give a definitive diagnosis.

Early detection is key to potentially successful treatment however treatment may include the use of oral medications like anti-inflammatories (Advil, Aleve), antidepressants (Cymbalta) and antivconvulsants (Gabapentin, Lyrica) and pain medications.  Sympathetic Nerve or Cervical Stellate Ganglion injections with local anesthetic can help diagnose and treat the disease.

To schedule an appointment with Dr. Sigua please call (317) 802-2872 or request an appointment online.

What can I do for my aching knee when I am not ready for surgery?

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By: Dr. Matthew Lavery, OrthoIndy Knee Specialist

In my practice I see quite a few middle-aged athletes with mild to moderate knee pain.  Many of these patients have very early signs of osteoarthritis, but are nowhere near ready for a knee replacement.

In reality, most of these athletes have a degenerative condition that has some likelihood of progressing over time.  Arthritis progresses at varying rates in different patients.  Despite this prognosis, there are a number of things patients can do to manage their knee pain non-operatively.

The first line of treatment should always involve the simplest, most cost-effective solutions.  Basic methods like rest, ice, compression, elevation and maintaining full range of motion should be included in any treatment plan.  In addition to these modalities oral anti-inflammatories, like ibuprofen or naproxen, can be used in patients experiencing acute flare-ups of pain who do not have a contraindication.

For more chronic aching patients can try glucosamine or fish oil.  Glucosamine is essentially like a vitamin for cartilage and has been studied in at least five separate placebo-controlled studies, which have shown some positive benefits to the supplement.  There is also newer information emerging to suggest that taking fish oil may lessen the production of inflammatory chemicals throughout the body, including in the joints.

Mild to moderate knee pain from early arthritis affects many middle-aged athletes.  Although the condition has potential to progress, the symptoms can often be lessened with appropriate treatment strategies, thereby allowing patients to maintain an active, healthy lifestyle.

To schedule an appointment with Dr. Lavery please call (317) 884-5170 or request an appointment online.

I Promise: OrthoIndy launches new campaign

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By: Kasey Prickel

The OrthoIndy Marketing department is excited to launch its new campaign, “I Promise.” According to the National Trauma Institute, trauma is the number one cause of death for Americans between 1 and 44 years old. “I Promise” helps bring attention to traumatic injuries and asks the community to make a promise to be safer.

OrthoIndy wants you to be safe, Indiana! As an orthopedic practice, our surgeons see a lot of traumatic injuries come through the emergency room. Accidents happen, but some accidents can be avoided. Make a promise to someone you care about. Promise to make a change. Promise to be safer and together we can help save lives.

In October 2014, the Marketing department set up a commercial shoot on Georgia Street during Food Truck Friday and asked people to step in front of the camera to make a promise to someone they cared about. Here’s what they had to say: 

Visit us at OrthoIndy.com/IPromise to submit your own promise to be safer.

Spring Cleaning: Your Fitness Routine

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By: Megan Skelly

It’s that time of year again: the weather is warming up, the sun is shining and everyone is ready to spend time outdoors. It’s time to switch up the same indoor exercises you have been doing all winter and get outside. Kick off spring by “spring cleaning” your workout routine. Here are six tips to get you started.

  1. Find a buddy. You will be much more likely to stick to reaching your goals if you have someone to depend on. Come up with your goals together and then figure out a plan. Meeting up at least four times a week will help you stay on track.
  1. Clean out your pantry. Holding on to some leftover treats from Valentine’s Day or the comfort food from winter? Cleaning out your pantry will make it less tempting for you to cheat or stray from your fitness goals.
  1. Stretch! The best way to prevent an injury is to stretch before and after your workout. Even a quick five-minute stretch is better than not stretching at all.
  1. Stop by the farmer’s market. Stop eating your canned or frozen vegetables and indulge in some fresh fruits and veggies. Also be on the look out for dried fruits and nuts.
  1. Stay hydrated. With warmer weather you may experience more sweating so make sure to rehydrate with plenty of water. This is also the best way to avoid muscle cramping and fatigue.
  1. Sign up for a race. This will help you focus on goals and give you a purpose other than losing weight. A 5k is 3.1 miles, the perfect distance for beginners. Sign up with your fitness buddy and make sure to keep each other on track.

Check out our Pinterest page for healthy recipes and exercise ideas. How do you revamp your fitness routine? Comment below and share your tips!

What is sciatica?

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By: Dr. Ronald Miller

Many people have experienced back, buttock or leg pain and referred to this as sciatica, but what is this actually?

Sciatica is a commonly used term to describe the sensation of pain, numbness or tingling that radiates from the buttock down the back of the leg. The term originates from the usual source of the pain, the sciatic nerve. The sciatic nerve is a large nerve formed from multiple nerve roots that leave the lumbar spine and come together to form a larger nerve that travels down the leg. It is responsible for much of the sensation and muscle control of the posterior thigh and lower leg. Any irritation or compression of the sciatic nerve will cause the symptoms described above.

Sciatica typically involves only one leg, and may or may not be associated with back pain as well. The symptoms are often dependent on one’s position such as sitting (most usual) or standing and may present acutely after an injury or have a slow and gradual onset.

The most common cause of sciatica is compression of one of the lumbar nerves as it exits the spine, before it joins the sciatic nerve. This can be due to a herniated disc that presses on or irritates the nerve, or due to a lack of space for the nerve to exit, a condition referred to as spinal stenosis. Due to the fact that the spinal

nerve travels down the leg as part of the sciatic nerve, a person will often feel symptoms as far as the foot, depending on which spinal nerve is involved. Although the nerve is compressed in the lumbar spine, back pain may not accompany the sciatica.

Sciatica can also be caused by direct compression of the sciatic nerve as it courses through the buttock and posterior thigh. This can be due to scar tissue, tightness of one of the deep muscles of the hip that the nerve runs through or a mass or tumor. Other conditions can also mimic the symptoms of sciatica such as sacroiliac dysfunction or muscle strains of the hip and buttock.

Sciatic pain often improves on its own with rest, gentle stretching and the use of anti-inflammatories. Should it fail to improve, imaging studies such as an MRI are quite helpful in diagnosing the source of the problem. Treatment for lumbar disc herniations, the most common cause of sciatica, may involve physical therapy, focal injections to relieve pressure and inflammation of the nerve or possibly surgery.

Do you have any questions for Dr. Miller or OrthoIndy? Comment here and let us know!

How is an ankle sprain treated?

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By: Dr. Michael Shea

Ankle sprains are one of the most common orthopedic injuries. An ankle sprain is an injury/tearing of the ligaments about the ankle; usually the outside or lateral ankle.

Anyone can sprain their ankle. Typically this occurs when the foot rolls inward from the leg area. This is common in jumping/landing or cutting type sports, such as basketball or volleyball. Also activities such as running or even walking on uneven ground can cause one to sprain their ankle, such as a hole in the grass or misstepping on a curb.

There are three separate ligaments, which compromise the outer, or lateral ligaments, of the ankle. They are generally torn from the front of the back in order of severity. Ankle sprains are characterized by which ligaments are involved, and how significant the involvement.

Treatment consists of resting the injured ankle. Generally icing 10 to 15 minutes every one to two hours, as well as keeping the limb elevated above your heart level, and compressions such as an Ace wrap or a compression stocking, all to control the swelling and pain, as well as allow a quicker functional return. Occasionally a lace-up ankle brace or Velcro wrap brace may be of help to allow quicker return or increased activity level sooner.

Several days to a few weeks of conservative care is generally indicated unless there seems to be no improvement, at which point in time a physician should be seen. Seventy percent of lateral ankle injures are improved by six weeks, and 90 percent are improved by ten weeks.

Those that do not improve, a physician may recommend prolonged immobilization or possibly more formalized therapy or even decreased weight bearing depending on the severity of the ankle injury. Usually MRIs are not ordered until at least four to six weeks post injury in most ankle sprains.

Complications of ankle sprains include instability, which would lead to chronic recurrent giving out of the ankle. This could be improved with bracing and physical therapy or one may need to have surgery.

After recovery from an ankle sprain, one will need to prepare for the next season. Usually six weeks prior to the start of the sport’s season one should start an aggressive strengthening program, as well as a balance/proprioceptive exercise program to try and avoid recurrent injuries.

Do you have any questions for Dr. Shea or OrthoIndy? Comment here and let us know!

Bite Into a Healthy Lifestyle

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By: Melissa Foor, Clinical Nutrition Manager and Registered Dietitian Nutritionist at OrthoIndy Hospital

You know that New Year’s resolution you made? The one you may or may not have worked on the past few months? Well, what better time to get back to those healthy habits you pledged than National Nutrition Month?

This March, the theme for National Nutrition Month is ‘Bite into a Healthy Lifestyle.’ When I picture this theme, I see myself biting into a crisp red apple. However, it doesn’t have to be an apple; it can be any fruit or vegetable. The picture I am trying to paint in your mind is that in order to bite into a healthier lifestyle, you should eat more fruits and vegetables.

Why? Primarily, because research has shown that consuming fruits and vegetables can help lead to a decreased risk of disease; especially diabetes, obesity and cardiovascular disease. Secondly, fruits and vegetables are low in calories and often filled with fiber and water. They’re a great choice to help fill you up when you’re trying to maintain a healthy weight.

The first step you can take to eat more fruits and vegetables is to up your current intake by one serving. The following is a good rule of thumb for judging portion sizes: a medium sized whole fruit, one half cup for cut vegetables and fruit, one cup for leafy vegetables and one fourth cup of dried fruit for one serving. Examples include: one cup of raw spinach, half a cup of blueberries or a quarter cup of raisins.

Branch out and try new fruits and vegetables with different preparations. There are so many resources and recipes online that will help you find flavor combinations and cooking methods that you can enjoy. Some of the websites I frequent and favorite recipes include:

  1. http://www.bettycrocker.com/recipes/health-and-diet

Frosty Marbled Yogurt Dessert & Pork Chops in Country Onion Gravy

  1. http://www.mayoclinic.org/healthy-lifestyle/recipes

Cauliflower Mashed “Potatoes” & Spinach Frittata

  1. http://www.eatingwell.com/recipes_menus

Grilled Eggplant & Tomato Stacks & Spinach Ravioli with Zucchini Ribbons

You can also apply ‘Bite into a Healthy Lifestyle’ to any food you may want to eat. There are no bad foods, just bad portion sizes. You hear the phrase ‘all in moderation’ fairly frequently, but it really is what dietitians advise when it comes to the foods you eat.

The key to eating foods that may be more calorie-filled, without as many nutrients, is to try to find that balance. Rather than eating the whole sleeve of cookies, try to savor each bite of a normal portion size of one or two. Fill up on foods with a lot of nutrients such as fruits, vegetables and whole grains so you won’t be as tempted to eat more than one serving of those cookies in one sitting.

Additionally, consider ‘bites’ of exercise, aiming for two or three 10-minute ‘portions’ to get your heart rate up. This can include walking briskly outside, a quick 10-minute jog, body weight exercises, high-intensity interval training (HIIT), 10 minutes of Zumba or really anything that gets you moving. Research has shown that physical activity can lower disease risks, improve mood and help maintain a healthy weight. Nobody ever ends his or her exercise saying, “I wish I didn’t work-out.”

There is no magical pill, drink, machine or food that is the key to having great health. What can help is to include nutrient-rich foods and physical activity. Enjoy each bite you take, by taking your time while eating. Make your meals an experience that you enjoy. Focus on making your lifestyle healthier, not just trying to follow a short-term diet.

How do you stay healthy? Share your tips below!

IMG_5123Melissa Foor is the current Clinical Nutrition Manager and Registered Dietitian Nutritionist at OrthoIndy. Melissa is responsible for the nutrition management of all inpatients at OrthoIndy Hospital as well as assisting in management of the Food Services department. She graduated with her master of science in dietetics from Eastern Illinois University in 2014 while completing her internship at St. Anthony’s Memorial Hospital in Effingham, IL. Melissa attended Michigan State University from 2008-2012 graduating with a bachelor of science in dietetics. She has been with OrthoIndy since December 2014.