A person holding her wrist in pain.

Coping with Hand Arthritis: Tips for Daily Activities and Pain Management

Is painful hand arthritis affecting your ability to perform daily tasks and engage in the activities you love? Hand arthritis can be debilitating and negatively impact overall quality of life. The good news is that there are treatments, both non-surgical and surgical, that can alleviate pain caused by hand arthritis. 

Hand arthritis is a disease that attacks the tissues surrounding your joints and most commonly affects the knuckle joints closest to the nails (distal interphalangeal joints) and the basal thumb joint (carpometacarpal arthritis). There are many types of hand arthritis, but osteoarthritis, rheumatoid arthritis, and psoriatic arthritis are the most common. Osteoarthritis causes the cartilage at the end of bones to degenerate is usually the result of wear and tear associated with aging. Rheumatoid arthritis is a chronic inflammatory autoimmune disease that can affect patients of any age. It causes the body’s immune system to attack its own tissue, eroding first the cartilage and then the bone. Psoriatic arthritis affects the skin and joints, causing swelling, stiffness, and pain.

Dr. Maximilian Meyer is a hand and upper extremity surgeon at Atlantic Orthopaedics who specializes in treatment of the fingers, hand, wrist, forearm, and elbow. His philosophy centers on listening to and working together with his patients to create individual care plans that help them return to an active lifestyle. Dr. Meyer stays up to date on the latest scientific evidence and advanced techniques, and is committed to providing compassionate orthopedic care. 

We asked Dr. Meyer to answer some frequently asked questions* about hand arthritis.

What are a few tips you would give your patients to cope with hand arthritis and pain management?

There are a variety of non-surgical treatment options available for hand arthritis, including bracing, topical and systemic anti-inflammatories, and injections. Additionally, working closely with a hand therapist can lead to significant improvements in pain and function. Surgery is typically reserved for patients whose symptoms have not responded to conservative treatments, and who feel that their hand arthritis limits their quality of life. When this happens, surgery can both relieve pain and improve hand function. My role as a surgeon is to help patients better understand the impact of arthritis on their hands, so that they can pick the treatment that is best for them. 

Are there any exercises that can help with hand arthritis pain management?

Arthritis in the hands typically presents with both pain and with stiffness. Both symptoms can often be improved with low-impact exercises that emphasize joint motion and tendon gliding. I commonly recommend the “6-pack” hand exercises for patients with stiffness, either from arthritis or after sustaining hand trauma. By systematically isolating and improving motion of the major joints in the hand with these exercises, patients often find that they are able to do more with less pain. The exercises are simple to do and illustrations that make it easier to visualize can be found online.

  1. Straight: straighten your fingers as much as possible.
  2. Tabletop: make a tabletop shape with your fingers by bending at the knuckles, keeping your wrist straight.
  3. Hook: bend and straighten your fingers, keeping your knuckles and wrist straight.
  4. Fist: make a fist, bending each joint as much as possible.
  5. Open and Close: straighten and open your fingers as if you are waving and then bring them back together.
  6. Thumb to Tip: make an “O” shape by touching your thumb to each fingertip, one at a time, opening your hand wide after each finger.

What are the signs it’s time to see an expert like yourself for hand arthritis pain?

It is never too early to see a hand surgeon for arthritis, as we can help guide non-operative treatments and relay patient-specific information to hand therapists prior to starting therapy.  

Patient Question: I have severe arthritis in my right hand. It affects everything I do from drying my hair, brushing my teeth, driving. How can I learn to deal with this excruciating pain?

Hand arthritis should not reach the point where it interferes with daily activities or with quality of life. If this occurs, surgical intervention in the form of joint-sparing procedures, joint replacement, or joint fusion can lead to significant improvements in hand function. I would encourage a visit to our office to explore treatment options.  

If you’re suffering from arthritis in your hands, there are many options available that can alleviate pain and help you get back to the activities you love. Schedule a consultation with Dr. Meyer to learn more. 

*Medical Disclosure: The information provided on this blog is for educational and informational purposes only. While we strive to provide accurate and up-to-date information, we do not dispense medical advice or treatments to individuals who have not been seen by a healthcare professional.

It’s crucial to understand that every individual’s medical situation is unique, and what may work for one person may not necessarily work for another. Additionally, individuals may have underlying health conditions, allergies, or other factors that require personalized attention and consultation with a qualified healthcare provider.

Therefore, we strongly advise individuals to consult with a licensed healthcare professional before initiating any new treatments, making changes to their current treatment regimen, or addressing any medical concerns. This includes seeking professional guidance for managing allergies, assessing potential medication interactions, and ensuring overall safety and efficacy of any suggested treatments.

We are not liable for any actions taken based on the information provided on this blog. The responsibility for healthcare decisions lies solely with the individual and their healthcare provider. If you have any questions or concerns regarding your health, please consult a qualified healthcare professional promptly.

How the MILD Procedure Helped an 86-Year-Old Woman Get Her Life Back 

In early 2023, 85-year-old Jackie Freehart reached to put something away in a kitchen cupboard and fell backwards, injuring her back. It was so painful that she needed her son’s help to get up from the kitchen floor. After two days of waiting for the pain to stop, she went to the hospital to get checked out. Jackie was seen by Atlantic Orthopaedics pain management specialist, Dr. Lehn, who told her that she had Spinal Stenosis, a condition that occurs when the channel inside the spine narrows, putting pressure on the spinal cord and nerves, and causing pain when standing or walking. Spinal Stenosis can be the result of an injury like Jackie’s, or just the normal wear and tear that comes with aging.  

Dr. Lehn listened closely to Jackie’s story and suggested she try conservative treatments for the pain first, rather than rushing into surgery. “I was so impressed with Dr. Lehn,” Jackie said. “He doesn’t rush but takes the time to explain things. He doesn’t give orders. He gave me a choice.”  She decided to try physical therapy, and then Cortisone shots, but found that neither one helped, at least not for long. “Getting in and out of bed was the worst thing,” Jackie said. “I just couldn’t get comfortable. The only position I could sleep in was lying on my side, but turning from one side to the other was painful and difficult.” 

At her next visit, Dr. Lehn told her about a procedure for Spinal Stenosis called MILD, short for minimally invasive lumbar decompression. MILD is a minimally invasive alternative to traditional spinal surgery where the surgeon inserts a spinal decompression device through a tiny incision in the back, using it to remove the tissue that’s pressing on the spinal nerves. The procedure takes less than an hour and is performed with local anesthesia so patients can go home the same day. Dr. Lehn gave Jackie a brochure about MILD to take home and asked her to think about it. In the meantime, she continued to get Cortisone shots in the hopes that it would provide relief. 

When she returned to Dr. Lehn a few months later for her Cortisone shot, he mentioned that he had done the MILD procedure on a 90-year-old patient the day before and she had walked out of the hospital on her own. “I had read the brochure and I Googled it,” Jackie said, “and we talked about it twice before I got serious about it. He didn’t try to coerce me into it.” About 7 months after her fall and still in pain, Jackie made up her mind to undergo the procedure.  

“Dr. Lehn explained everything, so I knew what to expect,” she said. “He was very reassuring and I was not a bit nervous when I went in.” Dr. Lehn performed the MILD procedure at NECOS in Portsmouth in August of 2023. Jackie woke up soon after and walked out with the help of a walker. She was still in some pain when she left the hospital and it continued for the next day. But two days after the surgery, Jackie reported, she was pain-free. “The recovery was almost miraculous!” she said. “Now I have no pain going to bed. I’m not fearful about it. I can sleep and I feel like myself again.” Jackie can get around now with just a cane. She recently attended a baby shower and is back to walking at the mall three days a week. “I can cook again, which is my passion,” she said. “I have company over now.”  

When asked if she would recommend the MILD procedure and Dr. Lehn to her friends, Jackie didn’t hesitate. “I can’t say enough wonderful things about Dr. Lehn. The whole staff was incredible, very helpful and kind,” she said. “This procedure is worth it for anyone having this pain, because quality of life is so important.” Jackie was so pleased with the care she received that she wanted to show her gratitude to everyone at Atlantic Orthopaedics. “I didn’t know what to do other than say thank you,” she said. “I told my son I wanted to do something more, and so we went out and got a great big basket of cookies and brought them for the staff.” Now, eight months after she had the procedure, Jackie remains pain-free. “I’m so glad I had it done,” she said. “I feel like I have my life back.” 

Relief From Hip Pain – How Arthroscopy Can Alleviate Pain and Restore Function

Hip pain can be debilitating, affecting everything from mobility to sleep to overall quality of life. The hip joint is where the thigh bone (femur) connects to the pelvis and is used constantly when one walks, bends, and supports his/her upper body. 

Who is a good candidate for Hip Arthroscopy?

Hip pain has varied causes; in young people the most common cause  is a labral tear–damage to the soft tissue lining the inside of the hip socket (acetabulum). A Labral tear can occur from repetitive wear over time, impingement from an underlying problem with the joint structure, or trauma from a sports injury or accident.  

For patients who suffer from a labral tear –and who have not found relief from conservative treatments like rest, over-the-counter pain relievers and physical therapy–hip arthroscopy may be the answer. It’s a minimally invasive procedure that can restore hip function and alleviate pain.

Patients with osteoarthritis, cysts, or ankylosis (fusion) of the hip joint are not good candidates for hip arthroscopy.  

What is involved in the Hip Arthroscopy procedure?

First, an orthopedic specialist will determine whether hip arthroscopy is appropriate based on a physical exam and x-ray or MRI imaging. Unlike open surgery, arthroscopy only requires a small incision through which a camera (arthroscope) is inserted. This gives the surgeon a clear, magnified view of the interior of the hip joint during the procedure. The surgeon will then repair or remove the damaged labrum, bone impingement, or loose bodies. Performed in  an outpatient setting , arthroscopic hip surgery usually leads to less post-operative pain and shorter recovery time than open hip surgery. 

Surgical Expertise + State of the Art Technology

Dr. Tyler Welch is a board certified orthopedic surgeon who has performed approximately 300 hip arthroscopy procedures – In addition to his extensive experience, Dr. Welch utilizes state-of-the-art technology, including “HipMap” software that generates a detailed 3D image of the hip structure in advance of the procedure. Used as a planning tool, this advanced imaging enables him to precisely target the surgery and minimize disruption to surrounding tissue. 

Another innovative device employed by Dr. Welch is the Guardian, a cutting-edge operating table designed to hold the patient comfortably and securely in place, while providing the surgeon greater range of motion and visibility during the procedure. Traditionally, achieving proper positioning for hip surgery required the use of a post between the patient’s legs, a technique  that can cause groin pain . The Guardian table has eliminated post-operative groin pain. 

Below, we asked Dr. Welch a few questions about hip arthroscopy.

Where do you perform this procedure?
I perform hip arthroscopy at NECOS and at York Hospital.

Are you still the only practice in the Seacoast that uses the Guardian Table for this procedure?
That’s right, I’m still the only surgeon on the Seacoast that uses the Guardian Table.

Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
What is nice about hip arthroscopy is that it is a relatively straightforward recovery.  Crutches are only required for about one week, and most patients make significant gains within 4-6 weeks. It is not too painful, and I have found that most patients only require pain medication for the first 24-48 hours.

Also, surgery is reliable for the right patient.  As long as the patient has hip impingement without any sign of arthritis, surgery typically alleviates pain and eliminates most symptoms.

If you suffer from hip pain, don’t ignore it. Atlantic Orthopaedics and Sports Medicine offers treatments–both surgical and non-surgical–that can alleviate hip pain and restore your quality of life. If you think that hip arthroscopy may be right for you, schedule a consultation with Dr. Welch to learn more.

A Solution for a Common Orthopedic Injury – Distal Radius Fracture Repair  for Wrist Fractures

Along with cold weather, snow, and ice, winter in the Northeast means an increase in distal radius (wrist) fractures, most of which occur from landing on an outstretched hand after  a slip and fall. These fractures result in pain, limited range of motion, and decreased wrist function. For patients with a fracture that is significantly displaced, surgical intervention may be recommended.

Our orthopedic surgeon, Dr. Meyer, specializes in treating upper extremity injuries (fingers, hand, wrist, and elbow), and understands the tremendous impact that wrist fractures can have on patients’ lives. In patients who are candidates for surgery, he has seen excellent outcomes from Distal Radius Fracture ORIF (open reduction and internal fixation, which means fixing the bone in its native position with a plate and screws). 

Below, we asked Dr. Meyer some questions about the procedure.

Q: In your own words, how does this procedure benefit your patients?

A: Distal radius fractures are the most common fracture of the upper extremity (shoulder, elbow, wrist, and hand). The radius bone is part of the forearm, and the distal (end-portion) of the radius supports the bones of the wrist. Certain distal radius fractures are stable and will heal well with a period of immobilization in a cast. Other distal radius fractures are unstable and often benefit from surgery to align the fracture pieces in a more anatomic position. 

When surgery is performed, a combination of a plate and small screws are used to hold the bones in the optimal position. Surgery for displaced distal radius fractures have been shown to lead to excellent outcomes, including near-complete return of motion and grip strength and very low rates of persistent pain and disability. The majority of patients sustaining these injuries are able to return to their jobs and hobbies without limitation.

Q: Who is a good candidate for this procedure? 

A: Anyone who sustains a broken wrist should be evaluated with a physical exam and a set of x-rays. A wide range of both patient-related factors (age, medical history, functional demands from jobs/hobbies, smoking status, etc.) and injury-related factors (mechanism of injury, fracture alignment/displacement, etc) are used to help guide the decision between treating a wrist fracture with a cast (no surgery) versus performing surgical fixation.

Q: Where do you perform this procedure? 

A: I perform surgical fixation of distal radius fractures at the New England Center for Orthopedic Surgery (NECOS), Portsmouth Regional Hospital, and York Hospital.

Q: Tell us about a recent success story.  

A: A 65 year old woman presented to my office after slipping on black ice and injuring her wrist. She had a displaced distal radius fracture that significantly limited her wrist motion. She is an elementary school teacher, and her two biggest goals were to optimize her long-term wrist function and to return to activity quickly. We discussed the treatment options, and she chose surgery in order to accelerate her rehabilitation, minimize her time in a cast, and give herself the best chance for healing her wrist injury in an anatomic position. 

We fixed her wrist with a plate and screws. The surgery took a little over an hour and she was back to work the same week. Within two weeks, she was out of her splint and working on gentle wrist range of motion exercises. She is an avid pianist, and found that playing piano helped to improve her wrist and finger motion in the early post-operative period. Six weeks after surgery, we started gentle strengthening. By the 2.5 month-mark, she was cleared for full strengthening and return to all activities. Now, she is back to all school-related activities and does not feel limited at all by her wrist. 

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them? 

A: These fractures occur most commonly after a slip and fall onto an outstretched hand. Here in the Seacoast, we see a large upstick in the number of patients sustaining distal radius fractures during the wintertime. Whether it is slipping on ice or falling while skiing or skating, these injuries can unfortunately happen at any time. The best way to treat a wrist fracture is to not have one! So, my best advice is to make sure to tread carefully when walking, skating, and skiing. Furthermore, many patients in their 60’s and 70’s have osteoporosis (thin bones that are more prone to fracture). With several months of cold and cloudy weather in the Seacoast, many of us also have low calcium and Vitamin D levels. I would encourage patients to discuss their bone density and calcium and Vitamin D levels with their primary care physicians in order to make sure their bone health is optimized to start off the new year.

If you’ve suffered a wrist fracture, it’s important to consult with an orthopedic specialist as soon as possible. Dr. Meyer’s treatment philosophy centers on listening to patients and working together to find solutions, both surgical and non-surgical, that help them resume a pain-free active lifestyle. Contact us to schedule an appointment with Dr. Meyer today.

Relief From Lower Back Pain With SI Fusion

Living with chronic lower back pain can have a profound impact on not just your physical well-being, but your overall quality of life. Many people suffer from back pain due to dysfunction in the sacroiliac (SI) joint, which connects the bottom of the spine (sacrum) to the pelvis (ilium). These two joints, one on each side act as a shock absorber for the spine and play a crucial role in stability and weight bearing ability, transferring pressure from the lower back to the legs. The SI joint can be damaged by traumatic injury, a degenerative condition, or tissue loosening from things such as connective tissue disorders and pregnancy. Patients with SI dysfunction will feel pain in the low back, especially when walking, standing up from a seated position, or lifting. Other symptoms can include numbness or tingling in the lower extremities; pain in the pelvis, hip, or groin; pain radiating down the legs; or buckling in the legs.

Diagnosing SI Dysfunction 

Because low back pain can be a symptom of other conditions like sciatica, diagnosis is usually done with a physical exam, followed by an injection that will temporarily block the pain if it’s originating in the sacroiliac joint. In some cases, the pain can be managed with anti-inflammatory medications, physical therapy, or steroid injections, but for patients who haven’t responded to those treatments there is a minimally invasive procedure called SI Fusion that may offer sustained relief. 

What is the SI Fusion Procedure?

SI Fusion, short for sacroiliac joint fusion, is a minimally invasive procedure in which the surgeon inserts an implant into the SI joint space. Guided by real-time imaging, a small incision is made and the implant is fixed in place, fusing the sacrum to the ilium in order to limit movement. This fusion, by restricting excessive motion in the SI joint, restores stability and alleviates pain. 

What Does the Recovery From SI Fusion Involve?

Because the procedure is minimally invasive, the risk of complications is low and recovery times are quicker than with traditional open surgery. Patients can expect to be mobile immediately after the procedure, and most experience rapid pain relief. Post-operative physical therapy may be recommended to restore function in the joint and aid recovery.

Below, a Q&A about SI Fusion with pain management specialist Dr. Lehn:

How does this procedure benefit your patients?

15-30% of low back pain comes from the SI joint. The SI joint can be a difficult pain to treat as many times PT, medications, and injections only provide temporary relief.

Who is a good candidate for an SI fusion?

If a patient has 90% relief of pain from a SI injection and the pain keeps returning despite exercise, medications, and repeated injections, then they can be considered for SI fusion.

Where do you perform this procedure?

The procedure is performed in the operating room but is done with minimal sedation, and the patient can walk out of the recovery room and go home the same day as the procedure.

Do you have a recent patient success story to share? 

One patient had her left side done in June and felt so good she came back in September to have the other side done! She is very happy and back to her very active lifestyle.

Anything else you’d like current or future patients to know about this procedure and how it could benefit them? 

This is a very minimally invasive procedure with minimal downtime. The pain from the procedure is minimal. Unfortunately, intense activity is limited for 6 weeks but patients are up and walking the same day. Fusions sound really big and dangerous, but it is essentially a stabilization procedure. SI joints are often painful due to excessive movement. The SI stabilization procedure takes away the additional movement and helps return the patient to a normal functioning joint.For patients grappling with chronic lower back pain caused by SI dysfunction, the SI Fusion procedure can provide long-term pain relief and renewed quality of life. If you suffer from pain that hasn’t responded to non-surgical treatments, schedule a consultation with Dr. Lehn to explore whether SI Fusion is right for you. Take your first steps toward a pain-free future!

Voted Best Podiatrist 2023

Since 1987, our team of board-certified orthopedic physicians have delivered the highest level of care to the Seacoast community. Serving athletes and residents alike, we operate as the area’s premier orthopedic and sports medicine practice. It’s what we love to do, and because of that we were recently voted “Best Podiatrist” by the Seacoast NH community in the 2023 Best of the Seacoast awards and we couldn’t be more proud of our foot and ankle team for this accomplishment.

If you’re suffering from foot or ankle pain, don’t ignore it. Come see our foot and ankle specialists in Portsmouth, NH, or York, ME, led by Dr. Eilts. Our teams will evaluate the extent and severity of your foot or ankle pain and recommend the treatment that’s best for you. Contact us with questions or schedule an appointment online to have your hip pain evaluated and treated. Our offices can be reached at 603-431-1121 (Portsmouth, NH) and 207-363-3490 (York, ME).

Will Injections Help or Do I Need Surgery? The Straight Facts About Cortisone Shots

Cortisone is a potent anti-inflammatory medication that can be used to treat a wide range of orthopedic conditions, but Cortisone shots are not a one-size-fits-all solution. For some patients, injections can be highly effective, but in other cases it may be time to consider surgery. 

According to orthopedic surgeon Dr. Noerdlinger, there are three common misconceptions people have about cortisone shots:

1. Cortisone is Just Temporary

Although the effects can be temporary, there are cases where Cortisone can offer long lasting pain relief for years.  

2. Cortisone Only Masks the Pain 

Novocain, such as lidocaine, will mask pain, but Cortisone decreases the inflammation which is causing the pain. The analogy is taking a steroid to decrease the inflammation from a sore throat. The steroid effect of the Cortisone decreases the inflammation and allows the joint to move more freely, enabling the patient to rehabilitate the joint more effectively.

3. Cortisone Damages Tissue 

Used judiciously, cortisone will not damage tissue. Just like taking a bottle of Tylenol will destroy the liver, large amounts of cortisone–in a short time period, in the same body part–can weaken the collagen fibers. But, like Tylenol, where it is ok to finish off the bottle over the course of a year, intermittent Cortisone injections are permissible.

While Cortisone shots can be incredibly beneficial for some, there are situations where surgical intervention may be necessary:

1. Loss of Function

If your orthopedic condition has progressed to the point where it severely limits your ability to participate in daily activities and compromises your quality of life, it may be time to consider surgery.  

2. Structural Damage

In patients with significant structural damage to a joint, such as advanced osteoarthritis with bone-on-bone contact, joint replacement surgery may be the best solution to restore function and relieve pain.

3. Repeated Injections are Ineffective

If you find yourself needing frequent Cortisone injections for the same issue, it indicates that the underlying problem can’t be managed with injections alone. If Cortisone offers only temporary relief, it might be time to have a discussion with your orthopedic specialist about surgical options.

Cortisone is a valuable tool in orthopedic care, providing pain relief and delaying the need for surgery in some patients. But it’s important to recognize the limitations of injections and to know when it’s time to consider the next step–surgical intervention like joint replacement. One scenario in which cortisone injections are not recommended is in the setting of fixable rotator cuff tears in patients considering surgery. Studies show that re-rupture rates and infection rates are higher in patients undergoing rotator cuff repairs who receive cortisone injections before surgery.

Your orthopedic specialist is your best resource in determining the most appropriate treatment plan for your specific condition, symptoms, and goals. Whether it’s cortisone injections or joint replacement surgery, the ultimate aim is to help you regain function, eliminate pain, and enjoy a high quality of life.

Knee Pain From a Dislocated Kneecap? 

Patella Instability Surgery Can Provide Relief!

What Is Patellar Instability?

When the kneecap shifts out of its normal alignment, you may feel pain, trouble walking, a buckling or locking sensation, or a feeling of the knee “giving way.” Patella instability can impact daily life and make it difficult to stay active. 

How Does the Patella Instability Procedure Work?

In this procedure, the surgeon carefully realigns the patella within the femoral groove to ensure proper tracking during knee movement. The specific surgical technique can vary based on factors like the patient’s age, and the severity of the injury. In the Medial Patellofemoral Ligament (MPFL) Reconstruction procedure that Dr. Welch describes below, the patient’s ligament was reconstructed to stabilize the patella on the inside of the knee. In cases of severe instability, the surgeon may also reposition the tibial tubercle–the bony bump below the patella–to improve patellar tracking.

What Can I Expect Post-Surgery?

Patients can expect to go home the same day as the procedure. Recovery time varies and patients will need to use crutches and wear a knee brace for a period of time, typically 4-6 weeks. Physical therapy is also an important part of the recovery process.

We sat down for a Q&A with our Orthopedic Surgeon and Sports Medicine Specialist Dr. Welch. 

In your own words, how does this procedure benefit your patients? 

Patella instability is a condition in which the patella (kneecap) dislocates from the femur (thigh bone). Most patients are young, often teenagers. Fortunately we can fix this condition surgically. This procedure benefits patients because it generally restores one’s confidence and his/her ability to play sports.

Who is a good candidate for the Patella Instability Procedure?

A good candidate for patella instability surgery is anyone who has had at least one patella dislocation or multiple subluxations (partial dislocations).

Where do you perform this procedure? 

I perform this procedure at New England Center for Orthopedic Surgery (NECOS) in Portsmouth and at York Hospital in York, Maine. 

Do you have a recent patient success story you can share?

Recently, a 15 year old male high school student came to see me with his family. The patient had sustained two dislocations prior to his visit with me. These dislocation events are painful and stressful, and the young man was apprehensive about playing sports ever again unless we fixed his knee. He underwent a procedure–a medial patella femoral ligament (MPFL) reconstruction–to stabilize his patella. Surgery was straightforward and he recovered nicely. He required crutches for 10 days and a brace for four weeks. After six weeks, he had normal motion and no swelling in his knee. I cleared him to return to sports three months after surgery.

Anything else you’d like current or future patients to know about this procedure and how it would benefit them?

There are a few important things to consider regarding patella instability surgery. The procedure is very reliable – dozens of studies have demonstrated success rates in the 90-95% range, and my experience has been similar. The vast majority of these patients are happy because they regain “trust” in their respective knees, and recovery is straightforward. Further, patients usually return to the same level of activity that they had prior to the dislocation(s). 

If you have knee pain from dislocation, visit our website to learn more about Arthroscopic Knee Surgery or schedule a consultation with Dr. Welch.

Is Pain in Your Thumb Holding You Back?

CMC Arthroplasty As A Solution For Thumb Pain

If you’re experiencing pain and stiffness at the base of your thumb, you might be dealing with CMC (carpometacarpal) arthritis. But don’t worry – you’re not alone. There are effective treatment options available for this common thumb condition that can provide much-needed pain relief and restore motion.

What are the symptoms of CMC arthritis?

Common symptoms include pain at the base of the thumb, especially during pinch and grip activities. The joint also may become swollen and tender to the touch. Typically, CMC arthritis decreases mobility in the thumb, and weakness may develop that makes it difficult to grasp objects.

What causes CMC arthritis?

CMC arthritis is a degenerative condition, often attributed to the aging process. Other contributing factors can include:

  • Repetitive use: activities that require repetitive thumb movements can accelerate joint wear and tear.
  • Trauma: a previous thumb injury can increase the risk of developing CMC arthritis.
  • Genetics: genetic history may predispose some people to joint degeneration.
  • Inflammatory conditions: certain immune or inflammatory conditions can contribute to CMC arthritis.

Atlantic Orthopaedics’ hand surgeon Dr. Meyer answers some common questions about CMC Arthroplasty, a life-changing procedure for patients suffering from advanced thumb arthritis.

In your own words, how does this procedure benefit your patients?
Arthritis at the base of the thumb (CMC arthritis) is a common source of pain and disability for adults, affecting one in three women and one in eight men over the course of their lifetime. A variety of treatment options exist, starting with conservative management (bracing, therapy, anti-inflammatories, corticosteroid injections) and progressing to surgery. For advanced thumb CMC arthritis that does not respond to the above treatments, CMC arthroplasty can provide lasting pain relief and improvement in thumb strength and motion.

There are a variety of surgical techniques for CMC arthroplasty. Most involve the removal of the painful, arthritic bone at the base of the thumb (trapezium) and use of a nearby tendon to stabilize the thumb in its native position. Recent innovations in the field of hand surgery have allowed for the use of a non-absorbable suture instead of a patient’s own tendon to maintain the thumb’s resting position. This procedure, termed a suture-button suspensionplasty, avoids complications from harvesting nearby tendons and allows for accelerated rehabilitation and recovery after surgery. While most other techniques require between four to six weeks of immobilization in a cast, I allow my patients to start gentle motion after their first post-operative visit (approximately 10 days after surgery) when using this technique.  

Who is a good candidate for this procedure?
Thumb CMC arthritis can affect anyone, but it becomes more prevalent with older age. This procedure is typically indicated for middle-age and elderly adults who have painful arthritis at the base of their thumb that limits their daily activities.

Where do you perform this procedure ?
I perform thumb CMC arthroplasty procedures at NECOS, Portsmouth Regional Hospital, and York Hospital. 

Do you have a recent patient success story you can share?
A 65-year-old retired professional pianist presented to the office with painful thumb CMC arthritis that failed to improve with bracing and steroid injections. Alleviating pain and preserving thumb motion were her biggest priorities. Due to her activity level, we elected to perform a CMC arthroplasty using the suture-button suspensionplasty technique.

Her surgery and post-operative course both progressed very smoothly. She was seen at her first post-operative visit and transitioned to a removable brace that allowed for gentle motion. At six weeks, she began gentle strengthening under the guidance of our occupational therapy team. At three months, she was cleared to return to full activity. She is back to playing piano and feels that her motion is even better than before surgery because she is no longer limited by pain. We were thrilled to help her get back to one of her favorite activities and to enable her to keep teaching other aspiring pianists.   Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
Thumb CMC arthroplasty yields excellent results, but it is not the only treatment recommendation for patients with thumb CMC arthritis. There are a variety of non-surgical and surgical treatments that can help with pain at the base of the thumb prior to considering a CMC arthroplasty. Every patient evaluation begins with a thorough clinical history, physical examination, and radiographs (x-rays) of the hand. From there, I work with each patient to understand their goals before we collectively decide on an appropriate treatment plan moving forward.

CMC arthritis can be a debilitating condition, but there is help available. For many patients, CMC Arthroplasty has proven to be an effective way to alleviate pain and restore quality of life. If you’re suffering from pain and limited function in your thumb, schedule a consultation with Dr. Meyer to discuss whether CMC Arthroplasty may be right for you.

Platelet-Rich Plasma (PRP) Injections Help the Body Heal Itself

What Are Platelet-Rich Plasma (PRP) Injections?

PRP injections are a treatment that separates the platelets in a patient’s own blood and uses them to promote healing. A small sample of blood is collected and placed in a centrifuge, a machine that spins at high speeds to separate the platelet-rich plasma from the other components, like red and white blood cells. Guided by ultrasound imaging to ensure accuracy and precision, the concentrated PRP is then injected directed into the affected area. The entire procedure takes about an hour. 

Post-injection care may mean avoiding certain movements or activities for a period of time to optimize the healing process and minimize potential side effects. It’s normal for the injection site to become inflamed and may be quite painful for one to three days following treatment. The swelling and soreness are part of the healing process, and patients should avoid taking anti-inflammatory medication like Aspirin or ibuprofen, which can make the injection less effective.

What conditions do PRP injections  treat?

PRP injections are frequently used to treat musculoskeletal injuries and orthopedic conditions like tendonitis, ligament sprains, bursitis, and partial rotator cuff tears, and tennis elbow. The injections can also be used to reduce joint pain, stiffness, and inflammation caused by arthritis.

How long will it take for me to see improvement?

Because the bioactive substances in the platelet-rich plasma need time to stimulate tissue repair and cellular regeneration, it can take a few weeks to start noticing the effects of PRP injections. Patients with musculoskeletal injuries like tendonitis or ligament sprains may experience improved functionality and pain relief quicker than patients with more severe or chronic conditions. Factors like age, overall health, and adherence to post-injection instructions all influence the speed of the healing process. It’s crucial to follow your doctor’s recommendations to maximize treatment benefits.

We recently sat down for a Q&A with our Sports Medicine provider and PRP expert, Dr. Andrew McMahon.

Q: In your own words, how does this procedure benefit your patients? 
A: Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient’s own healing system to improve musculoskeletal problems.

Q: Who is a good candidate for a PRP Injection?
A:

  • Patients with overall good health
  • Patients with mild to moderate arthritis, partial tears, or chronic wear and tear injuries
  • Patients with decreased function due to pain, stiffness, or lack of mobility
  • Failure with more conservative treatment methods

It’s important to note that while PRP injections are generally considered safe, they may not be suitable for everyone. The treatment can’t be used if the tendon is torn completely and though PRP injections can address symptoms of arthritis, they can’t reverse pre-existing damage. The treatment’s efficacy and appropriateness depend on the specific condition being treated and individual patient factors. It’s important to consult with a specialist to evaluate whether PRP injections are appropriate for your specific needs.

Q: Where do you perform this procedure? 
In our Portsmouth, NH office only, some of the surgeons use it intraoperatively.

Q: Do you have a recent patient success story you can share?
A: Recently, I have had a lot of success with PRP treating knee arthritis. Peter S. is a 68-year old gentleman who is very active in tennis/pickleball and is an avid skier. His moderate arthritis has given him a lot of stiffness and some pain which resulted in him cutting back on these activities at times, affecting his happiness and mental health. He had a consult for treatment options and we ultimately opted to inject PRP into both knees. Within 4 weeks, he had regained a significant amount of his function and he was able to play more tennis, and he successfully took a week long ski trip to Colorado. 

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: In the appropriate patient, PRP can offer a nice treatment option for patients with musculoskeletal problems who have failed conservative treatment options like PT, bracing, and cortisone injections. PRP can help heal soft tissue injuries (a torn tendon, for example), potentially avoiding surgical repair. PRP also provides patients with arthritis a treatment option that decreases pain and increases mobility and function. It typically lasts 2-3 times longer than cortisone injections and does not contribute to deterioration of the joint like a cortisone injection can.

Think PRP Injections may be right for you? Schedule a consultation with our specialist Dr. McMahon to learn more.

Pain Relief for Rotator Cuff Tears–Introducing the Stryker InSpace Balloon

What is a Rotator Cuff Tear?

The rotator cuff is a group of four tendons that surround and stabilize the shoulder joint, connecting the muscles of the upper arm to the shoulder blade. When a rotator cuff tear occurs–from acute trauma, repetitive stress, or degeneration over time–the tendon becomes separated from its attachment point on the bone. Rotator cuff tears are painful and cause weakness in the joint and limited shoulder mobility. Common symptoms of a tear include difficulty lifting your arm, a popping or crackling sensation in the shoulder, and pain both at rest and with movement.

Unfortunately, rotator cuff tears don’t heal on their own. If an untreated tear results in arthritis in the joint, patients often require shoulder replacement surgery, but for patients who still have shoulder function and haven’t developed arthritis, there is a less invasive treatment option called the Stryker InSpace Balloon.

What is the Stryker InSpace Balloon?

The Stryker InSpace Balloon is a medical device used to treat rotator cuff tears. It’s made of biocompatible material–a substance that can be implanted in the body and tolerated without damaging existing tissue. The balloon creates more space within the subacromial area–the space between the bone at the top of the shoulder and the ball of the shoulder–reducing compression and friction caused by the torn rotator cuff.

What’s involved in the procedure?

The Stryker InSpace Balloon is placed arthroscopically, using a small incision and the guidance of a camera to precisely place the deflated balloon in the subacromial space. The balloon is then inflated with a sterile saline solution, causing it to push the acromion away from the rotator cuff tendons. This reduces impingement on the injured tissues to restore function and alleviate pain.

The procedure is minimally invasive and performed on an outpatient basis. Recovery time varies, depending on the individual patient and the extent of the injury, and rehabilitation may include physical therapy to help restore strength and mobility in the shoulder.

How do I know if the Stryker InSpace Balloon can help me?  

If you’re experiencing shoulder pain, or have been diagnosed with a rotator cuff tear, it’s important to consult with a shoulder specialist as soon as possible. The specialist will evaluate your injury and medical history, and may recommend the Stryker InSpace Balloon procedure as a treatment option.

Below is our Q&A with Dr. Noerdlinger, an orthopedic surgeon specializing in the shoulder. Dr. Noerdlinger is a partner at Atlantic Orthopaedics with extensive experience performing the Stryker InSpace Balloon procedure.

Q: In your own words, how does this procedure benefit your patients? 
A: This is a pain relieving procedure.

Q: Who is a good candidate for the Stryker InSpace Balloon procedure?
A: The procedure is indicated for patients with irreparable rotator cuff tears, with good shoulder function and minimal to no arthritis.

Q: Where do you perform this procedure? 
A: I perform the procedure at NECOS (New England Center for Orthopaedic Surgery) in Portsmouth, and York Hospital in Maine.

Q: Do you have a recent patient success story you can share?
A: I performed the Stryker InSpace Balloon procedure on a 67 year old man with years of pain and an unfixable rotator cuff tear. He described his shoulder as getting worse despite physical therapy and injections. He had pain with an active range of motion, and stated his shoulder was 30% normal. Four months after his February surgery, he described his pain as a 2 out of 10 on a daily basis and rated his shoulder as 60% normal.

I also treated a 73 year old female patient who came to me with pain from an irreparable rotator cuff tear. She described her shoulder as 40% normal before the procedure and 70% normal 3 months after her March 1st surgery.

Another patient, a 60 year old man with bilateral irreparable rotator cuff tears, had the balloon placed in his right shoulder on March 1st, and his shoulder improved from 20% normal to 65% normal in 6 weeks. He then underwent left shoulder balloon placement May 10th.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: The rotator cuff is the one structure that, when torn, causes the most pain and dysfunction in the shoulder. Rotator cuff tears do not heal, get bigger over time, become unfixable, and cause arthritis. Rotator cuff repair surgery is very successful and can restore normal, pain-free function.

If the rotator cuff is irreparable, the painful shoulder is often treated with a reverse shoulder replacement. For patients with unfixable, painful rotator cuff tears with little to no arthritis and good function, an InSpace balloon is a good option. 

If you’re suffering from shoulder pain from a rotator cuff tear that hasn’t responded to treatments like injections or physical therapy, schedule an appointment to find out if the Stryker InSpace Balloon procedure is right for you.

FREE Sports Physicals – July 31st, 2024

Updated July 2024 – Atlantic Orthopaedics & Sports Medicine will be offering free sports physicals to all student athletes for the 2024-2025 sports season on Wednesday, July 31st from 5pm to 6pm at our Portsmouth, NH facility.

Young athletes planning to participate in a sports activity during their school year are encouraged to stop by for a complete examination. Physicals will be free of charge and a RSVP is required. Please call (603) 431-1121 to schedule an exam.

The Atlantic Orthopaedics & Sports Medicine Portsmouth, NH address is 1900 Lafayette Road Suite A. Please complete this form prior to your exam.

Atlantic Orthopaedics & Sports Medicine