|
|
Treatment Options The treatment options available to you, despite your specific injury range from doing nothing, to considering surgery, with a wide range of options in between. This page intends to provide an overview of common conservative treatment options, broken down below by body part. These represent common treatments, but do not represent the only options. Individual treatment recommendations will be made according to a comprehensive evaluation of individual conditions. Surgery will be discussed as an alternative when repair, reconstruction, or removal of the injured tissues is appropriate. Dr. Grotz having successfully completed 2 years of general surgery, 3 years of orthopedics at UCSF, and then a microsurgery fellowship takes pride in detailed work seeking to "fix what's broken". Shoulder ● Hand ● Knee ● Spine ● Physical Therapy ● Pain
Shoulder injuries are a common complaint. The two main areas of shoulder anguish are the subacromial space, relating to "bursitis" or impingement arthropathy, and the 'ball and socket' or glenohumeral joint. Evaluation and treatment parameters vary accordingly.
Hand
Treatment
Most treatment provided for hand injuries through this office is subacute
and reconstructive. Tendon and ligament repairs, joint replacements,
and microsurgical procedures which have included replantation and
toe-to-hand transplant surgeries have been employed.
Surgical options
through this office range from arthroscopic through open reconstructive
nerve and tendon options, to arthrodesis (fusion) to total joint replacement
arthroplasty.
Wrist arthroscopic, nerve surgery, tenosynovectomies and ganglion excisions
are also performed.
We often refer patients with hand injuries to a hand therapist, such as
Golden
Gate Hand Therapy or the
St. Francis Hand Therapy clinic for strength,
motion, and function acquisition.
Knee Treatment
Knee complains are very
common, and Dr. Grotz cares for many patients with a variety of knee
complaints. Considering that the average person takes 10,000 steps per day,
or 2-4 million steps per year, naturally this amount of stress placed on the
knee, even small problems can be exacerbated into painful conditions.
Knee treatment begins with a careful
evaluation through history and physical examination, and then
strengthening. The stronger one's leg gets, the less weight is actually
passed through the knee joints ( both patella-femoral, and femoral-tibial).
Activity modification, braces, straps, taping, physical therapy, and NSAIDs
may help as well .Various types of bracing and orthotics may be utilized, of
which there are several types, including cho-pat straps, kneed-it braces,
and unloading braces. Orthotics include several types of shoe inserts, as
well as custom-made shoes.
Another approach
to treatment, usually following arthroscopy, is an option which
includes the use of a viscosupplement, including
Hyalgan,
Orthovisc,
Supartz, and
Synvisc. These
types of injections deliver Sodium Hyaluron, a natural component within the
knee, directly into the knee joint via injection to cushion and lubricate
the knee. It requires a series of three to five weekly injections of a
clear gel lubricant placed into the intra-articular area. According to the
manufacturers and the FDA, pain relief can last for up to 6 months or
longer. Cortisone injections are typically not recommended, as the relief
therefrom is short-lived, and cortisone can be deleterious to the knee
cartilage structure.
Back Treatment
Although Dr. Grotz does
not perform back surgery, he does treat the back through conservative
means. In addition to the various modalities discussed above to treat
pain, treatment
options will be dependent upon the severity and pathology of your specific
injury symptoms. Physical Therapy or Aqua therapy may be recommended as a
means to strengthen specific muscle groups. TENS units, or any of the above
prescribed pain therapies couples with spine paravertebral muscle
strengthening are often encouraged.
In cases of more severe pain, with
radicular symptoms, epidural injections or Selective Nerve Root Blocks may
be recommended following diagnostic studies, such as MRI, CT and/or EMG. Epidural
treatment involves injecting a small amount of pain medicine to a precise
location in order to 'numb the nerve' in an effort to alleviate pain, and
often diagnostic information evolves.
When symptoms are severe and persistent,
despite epidural injection, surgical considerations may be developed. In
such cases, you will be referred to a trusted Spine specialist for surgical
consideration, such as Dr. Ken Light, Dr. Clement Jones, or
Dr. Sigurd Berven of UCSF who partners with Dr.Grotz
in varied invention technologies.
Orthotics are often recommended for
patients with foot and/or ankle injuries. Various types of shoe inserts are
available for use, and/or custom-made orthotic shoes may be recommended.
Viscosupplements, though only FDA
cleared for use in the knee, may be a consideration in specific cases of
ankle injury. Current literature indicates that this is a safe and
effective treatment modality for those with certain ankle injuries.
Surgical options through this
office range from arthroscopic through open reconstructive to ankle joint
replacement arthroplasty.
Physical therapy is a useful treatment
for most injuries. Various specialty types of therapy also exist and may be
used instead of or in addition to traditional therapy. Physical therapy
should proceed two or three times a week until a plateau in recovery is
accessed. Such a plateau can usually be achieved in two and one-half months
or thirty or fewer visits. This information is based on the patient’s
findings, in my experience with recommending the process of rehabilitation,
to gain maximum strength, motion, and endurance in similar cases.
Aqua therapy is a useful alternative or
adjunct to traditional therapy. The buoyancy provided by the aquatic
setting decreases the stresses upon the lower extremities and lower back.
Thus, Aqua therapy may be recommended for patients with lumbar, knee, and/or
ankle injuries.
In its basic level, the
Feldenkrais Method improves posture, coordination, flexibility and
suppleness. Moreover, Feldenkrais alleviates pain by minimizing
physiological and psychological stress associated with restricted
functions. Patterns of inefficiency, compromised self-expression, and
forgotten ways of feeling can all be improved.
The positive integration
of the mind and body through the Feldenkrais Method enables people to live
more comfortable and rewarding lives. With improved efficiency comes greater
enjoyment and pleasure in daily living. Ordinary problems associated with
the work place or caused by aging are remedied. Persons with orthopedic or
neurological problems experience wonderful therapeutic benefits. Meanwhile
athletes, actors, dancers and musicians substantially improve their
performance skills through the Feldenkrais Method.
Dr. Grotz has also
advocated martial arts as a rehabilitation option. Consistent with his
training as a blackbelt in taekwondo, with teaching experience pertaining to
martial arts and aging, he believes that strength, balance, motion, and
spiritual enrichment can accrue from studying taekwondo. Having owned a
physical therapy center years ago, to which 270 physicians and surgeons
referred patients, with Joe Montana as the spokesman, Dr. Grotz believes
that taking responsibility for ones own strengthening and healing are
important to achieve the best results.
Pain
Orthopedic injuries are
typically accompanied by some level of pain. Through this office, a variety
of treatment modalities are often invoked in order to help alleviate pain
while the underlying injury is addressed.
Conservative treatments for pain include
time for healing, prayer, activity modication, adjunct care options
including acupuncture, chiropractic, physical therapy, occupational therapy,
and the use of medications, of which there are three types: topical, oral,
or injected. Topical medicines may involve homeopathic balms, topical
pharmacological preparations, or lidoderm
patches. Oral medicines often used to treat orthopedic injuries include
non-steroidal anti-inflammatories (NSAID's), which can both control pain
and enable healing, and medicines that "cover up" noxious symptoms of injury
or illness while healing takes place. An ideal anti-inflammatory is one that
will reduce pain maximally, without adverse side effect, providing permanent
pain relief. Additional medicines prescribed through this office include
muscle relaxants, analgesics (pain relievers), and others-such as soporifics
(sleep inducing medicines) when patients are awakened from sleep with pain.
When pain is severe, we may provide injections inside the office, including
Toradol to suppress pain and inflammation, Norflex for muscle spasm, and
Steroid/Lidocaine shots for trigger points.
Acupuncture is recommended for certain
cases as a non-pharmacological means of pain control, and is an option that
patients may choose to pursue. Certain patients have responded very well,
and others have not. In those who do find acupuncture useful, they are able
to avoid the complications that sometimes develop with oral or injected pain
medications.
When high-levels of pain are expected to
be chronic, we will often refer patients for either
pharmacologic/anesthesiologist narcotic medication pain management, and/or
to a psychological behavioral counselor for the treatment of related
reactive depression and behavioral pain management. |
|
      
| ||
|
|
