There are 3 severities of ankle sprains; Grade 1, Grade 2, and Grade 3.

• Grade 1 sprain:  Slight stretching and some damage to the fibers (fibrils) of the ligament.
• Grade 2 sprain:  Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.
• Grade 3 sprain:  Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs.

The R.I.C.E. principle, Rest – Ice – Compression – Elevation, should be followed immediately after the injury. Without evaluation by a medical professional these grades cannot be easily identified merely by the amount of swelling or pain, nor can the possibility of a fracture be ruled out.  A fractured ankle can have similar symptoms of even a Grade 1 or Grade 2 ankle sprain.  So be sure to get it checked out.

You should see a doctor following an ankle sprain if:

• You heard a “popping” or “clunking” sound at the time you sprained your ankle.
• You have moderate or severe pain or severe swelling or bruising around your ankle.
• You can’t walk or put weight on your affected foot, or your ankle feels unstable.
• You have no improvement in your ankle after 1 week.
• Your swelling and bruising last more than 2 weeks.

You should see a doctor immediately if after the injury:

• Your foot or leg bends at an abnormal angle.
• You feel severe pain.
• Your foot is cool or pale or changes color.
• You feel numbness or tingling in your foot or toes that lasts after the initial injury.
• You can’t move your ankle. 

Physical Therapy:

Even in Grade 1 ankle sprains, early and often brief stints of physical therapy and rehabilitation will vastly improve your recovery time and your outcome.  Physical Therapy will also quickly and appropriately restore the balance and stability at that ankle, reducing your chances of re-injury, because re-injury can lead to long term problems.  Quick and effective identification, treatment, and rehabilitation of an ankle sprain will get you back to where you need to be quickly, and will allow you to “Stay in the Game”.

Dr. Steve Ikard has specialized training in joint repair and replacement. In addition to his medical training at the University of Tennessee and his orthopaedic residency training at the Campbell Clinic, Dr. Ikard holds a fellowship in Total Joint Replacement Surgery from Tufts University in Boston, Massachusetts.

As your car ages, visits to the auto shop for repair and replacement services increase. The human body as it ages or when it is injured, may develop joint problems that call for the services of an orthopaedic surgeon. Dr. Ikard of University Orthopaedic Clinic answers some of your questions about joint repair and replacement surgery.

Q:     It seems like everyone knows someone who has had a joint replaced or repaired. I never use to hear about such things. Why the increase?

A:     People are living longer, more active lives. When a joint wears out, they don’t want to slow down! Now that the medical profession has the technology and knowledge to replace worn out parts, people are opting for surgery in order to enjoy more satisfying lives. Many of us are participating in sports and other physical activities. When a joint is damaged or becomes worn, rather than enduring the discomfort, we seek medical assistance so that we can return to the activities we enjoy.

Q:     The joint pain I am experiencing comes and goes. When it’s bad I take aspirin and live with it. How bad should it get before I come see you?

A:     Even if the joint pain you are experiencing comes and goes, it is wise to consult an orthopaedist. For example, the troubled joint may be cleaned or debrided arthroscopically during the early stages of an arthritic joint problem. This may prevent or at least significantly delay major joint repair.

Q:     My sister had arthroscopic surgery on her knee and was up and around the same day! What is this wonder called arthroscopic surgery?

A:     Arthroscopic surgery is a less invasive procedure that uses tiny incisions. Surgical instruments are inserted through one incision and small video monitoring equipment through the other. Arthroscopic surgery offers a number of advantages over conventional surgical techniques. In many cases, the patient can begin basic rehabilitation activities the same day of surgery. Inpatient hospital stays and clumsy casts are often avoided. Best of all, recovery time is greatly reduced.

Q:     What are joint replacements made of and exactly how long do they last?

A:     Originally, joint replacements were made of stainless steel. Unfortunately over a period of time, stainless steel can fatigue and break. Today’s replacements are composed of super alloys such as cobalt chromium and titanium as well as plastic. They last much longer than stainless steel. Exactly how long is a question waiting to be answered, but we expect these modern replacements to last 20-30 years.

As a rule, most orthopaedic conditions can be corrected with conservative treatment, using drugs and therapy. Occasionally, a condition requires surgery. When it does, the physicians at University Orthopaedic Clinic are prepared with the most advanced procedures, including joint repair and replacement. Often joint problems can be helped by the use of arthroscopic surgery, a minimally invasive procedure performed on a same day basis. But there are times when the cartilage that cushions the bone becomes so worn that the joint must be replaced. Joint replacement surgery is performed in a hospital setting, and recovery requires a hospital stay. Advances in surgical techniques and technology make joint reconstruction very successful. Today, people are enjoying a very active lifestyle well beyond retirement years. So when joint pain strikes, they don’t want to slow down.

If you are experiencing joint pain, even if it comes and goes, University Orthopaedic Clinic recommends that you consult an orthopaedist. For more information about joint treatment, call 205-345-0192.

Dr. John Buckley has specialized training in surgery of the hand and upper extremity. He received his medical training at the University of Cincinnati and completed a residency at the Mayo Clinic. In 1974, he founded the University Orthopaedic Clinic with Dr. H. Chester Boston. He is particularly interested in microvascular surgery and surgery of the hand and completed a fellowship with the Mayo Graduate School of Medicine in those areas.

Q:     Please explain what Carpal Tunnel Syndrome is.

A:     Carpal Tunnel Syndrome or CTS is a condition that occurs when the median nerve is compressed as it passes through the carpal canal or tunnel. Located at the wrist, the carpal tunnel is a bone and ligament structure that contains tendons and the median nerve. CTS occurs when the contents of the carpal tunnel expand putting pressure on the median nerve. Several things can decrease space in the carpal tunnel: the synovium or covering of the tendons in the carpal tunnel may become thickened, a previous dislocation or wrist fracture may narrow the canal, and sometimes fluid retention causes swelling that can compress the nerve. Rarely a small cyst can occupy space in the canal compressing the nerve.

Q:     Is it true that symptoms are often first noticed a night?

A:     Yes. Many patients first experience CTS symptoms when they are awakened by pain, numbness or tingling. Exercising the hand may make the symptoms go away at first but if ignored, the pain may worsen, the grip may weaken and patients may begin dropping things. Untreated CTS can sometimes cause permanent damage if symptoms are more than occasionally present.

Q:     What is the difference in endoscopic carpal tunnel release and an open procedure?

A:     There are two techniques for releasing pressure on the median nerve at the wrist. One involves dividing the constraining ligament through an incision placed over the ligament. The other technique involves dividing the ligament from inside using an endoscope which is placed through a small incision on the palm and another at the wrist. There are, of course, many variations on these two basic approaches. During the first few weeks following the operation, the endoscopic technique may result in less discomfort. Several months post operatively there is little difference between the two techniques. The potential for complication is somewhat higher using the endoscopic technique.

Q:     Is surgical decompression the only treatment for CTS?

A:     No. An operation is needed when the patient has severe pain or is in danger of developing permanent nerve damage. Usually CTS is treated first by splinting the wrist and/or giving medication. These treatments are more successful when CTS is diagnosed early. Splints are designed to keep the wrist in a “neutral” position to relieve pressure. Medications such as anti-inflammatory drugs are used to reduce swelling and inflammation.

Q:     Is CTS a work-related condition? What kinds of tasks may contribute to CTS?

A:     Certain repetitive hand activities may be associated with an increased incidence of CTS, such as the movements common to garment workers, packing house workers, certain assembly workers, musicians and computer operators. The relationship between work place activities and carpal tunnel syndrome is not well defined since the majority of workers in any given occupation do not have trouble with carpal tunnel. Some studies have demonstrated that factors such as age, gender and body size may play a role in increasing an individual’s susceptibility to carpal tunnel. Other factors can contribute to the development of the condition and should not be overlooked. These include diabetes, thyroid disorders, inflammatory arthritis and pregnancy.

Q:     What can I do to lessen my chances of developing CTS?

A:     First, be sure to follow your company’s hand and wrist safety policies and procedures. Then avoid using your wrist in a flexed, extended or twisted position for long periods of time. Avoid repetitive movements taking brief breaks to rest your wrist. Alternate easy and hard tasks, switch hands or rotate work activities. Use power tools whenever possible, but avoid continuous exposure to vibration and slow down when making forceful, repetitive movements.

H. Chester Boston, Jr. MD, received his medical training at the University of Alabama. After completing an orthopaedic residency at the Mayo Clinic, Dr. Boston established the University Orthopaedic Clinic with Dr. John P. Buckley. Dr. Boston’s particular area of interest is the spine. In 1991, he was Senior Spine Fellow at the University of Maryland.

Q:     I’ve recently been experiencing some pain in my back. Should I consider visiting an orthopaedic surgeon for an examination?

A:     Be patient if the pain is tolerable. Fortunately, most back problems are better in a few weeks without treatment. If the pain is not bearable and persists, first seek help from your family doctor. A spinal surgeon usually becomes involved in the treatment of advanced or serious problems.

Q:     What are the typical causes of spinal problems?

A:     Many spinal problems are present at birth or result later from developmental growth deformity. For example, scoliosis, or curvature of the spine, is often not discovered or noticed until a child reaches adolescence. Other spinal problems can develop from trauma or accidents.

Q:     What are the most common causes of spinal injuries?

A:     Motor vehicle crashes account for almost half (45%) of all spinal injuries. Other major causes are falls – 21.7%; acts of violence – 16% (mostly gunshot wounds); and sport injuries – 13%.

Q:     When it comes to treatment of a spinal problem involving the back or neck, what is the difference between the work of a neurosurgeon and orthopaedic surgeon?

A:     Spinal surgeons, whether neurosurgeons or orthopaedic surgeons, perform many of the same procedures in the same fashion. Ordinarily it should not matter which spinal specialist is consulted. Occasionally the orthopaedist and neurosurgeon work together as a team and have traditionally consulted each other when desirable.

Q:     What specifically are the most common problems you treat?

A:     Traditionally we take a conservative approach to treating a problem. Only a small percentage of patients with spinal problems require surgery. Rest, physical therapy, medication, back supports, and education about body mechanics, are always fully explored prior to surgery. The most common surgical problems are:

• Ruptured lumbar or lower back discs: These ruptured discs are seen in people of all ages and walks of life. Frequently a recognizable event such as back strain will trigger the pain typically in the leg or buttock area.
• Ruptured cervical or neck discs: These ruptured discs are also seen in all people. They may typically cause arm numbness or pain. Neck pain is common.
• Elderly people may experience arthritic spinal stenosis or spondylolisthesis, resulting in partial closure of the spinal canal and causing back and leg pain commonly made worse by walking.
• Scoliosis (curvature of the spine). In many cases bracing can correct the problem.

Q:     What about laser surgery in the spine?

A:     For the past several years there has been interest on the part of some surgeons in developing a percutaneous procedure for the removal of herniated lumbar discs. A vacuum procedure has been tried and more recently the use of a laser has gained some popularity. The drawback of both these procedures is that they can only be used within the body of the disc itself. The portion of a herniated disc which actually is causing the problem has already been extruded from the body of the disc and rests within the spinal canal causing direct pressure to a nerve. Vacuum procedures and laser procedures cannot address this area without the threat of injuring or destroying the associated nerve. For this reason most spinal surgeons have either chosen not to use these procedures or have abandoned them since statistically the best results are still obtained from the traditional open lumbar discectomy.

Dr. William Standeffer has received his medical degree from the University of Alabama School of Medicine in Birmingham. After completing a residency in Orlando, Florida, Dr. Standeffer then received a Sports Medicine Fellowship at the Lipscomb Clinic in Nashville. Dr. Standeffer has worked as an assistant team physician with Tennessee State University, The Nashville Kats, the University of Alabama, and as team physician for Stillman College.

Whether it’s aerobics, jogging or team sports, adults of all ages are exercising more than ever. According to the Program Supervisor for PARA’s Athletic Department, more than 3,500 adults now participate in PARA team sports. Recently, PARA formed The Grumpy Old Men, a seniors-only softball team to compete in the State Tournament. As more adults enjoy the health benefits of an active lifestyle, more are experiencing sports-related injuries. Dr. Standeffer of University Orthopaedic Clinic believes many of those can be avoided. Here’s Dr. Standeffer to answer some of your questions about sports-related injuries.

Q:     Maintaining my health is important to me. What’s the best exercise for healthy joints and bones?

A:     All exercise is good. However weight-bearing exercise, such as walking and jogging is helpful because it strengthens bones and works the body’s largest muscles. Well conditioned muscles and strong well mineralized bones will help protect senior-aged patients from hip fractures. Any aerobic activity including swimming and biking is very good for the heart.

Q:     But I’ve heard that jogging causes problems with joints?

A:     There is no evidence that running causes arthritis in normal joints. If a runner has had a previous injury to the joint which has resulted in deformity or arthritis then a non weight-bearing exercise might be preferred, but if the joints are normal, moderate exercise may actually be beneficial to the joints.

Q:     I’m a senior and I still enjoy exercising. At what age should I slow down?

A:     Never! Regardless of your age, you will benefit from regular exercise. The human body is designed for physical work. If we don’t use our bodies as they were intended, we become susceptible to strains, joint problems, even fractures. So don’t slow down. I have cared for patients into their 80′s who have maintained active exercise programs of jogging and walking.

Q:     Is it important to stretch or warm up before exercising?

A:     Stretching is probably best performed after a short warm up period, when blood flow to muscles, tendons, and ligaments has started. Activities should be started slowly (warm-up) and then stretching may be done before, during or after. The older we are the less flexible we become because collagen, the main connective tissue of the body, becomes stiffer and loses its elasticity so we need to spend more time in stretching and warm up.

Q:     What’s the best way to avoid a sports-related injury?

A:     Many sports related injuries can be avoided with regular exercise. A number of people go all week without exercising, and then they play hard over the weekend, leaving them vulnerable to injury. It’s helpful to establish a regular exercise routine, daily would be good but may not be practical. Every other day or 3 times a week would be a good goal. Many fitness experts recommend 20-30 minutes per day of aerobic activity three times a week.

Q:     Can physical therapy be performed a home?

A:     Yes and no. Some people achieve satisfactory results for range of motion and strengthening by stretching and exercising at home. However, many people lack the motivation and discipline necessary and need the supervision, encouragement and structure of a well conceived program monitored by a physical therapist.

Minimizing blood loss is a major goal of any surgical procedure. Blood loss is more of a problem in some surgical procedures than in others.

In orthopaedic surgery, there are several ways to deal with this potential problem of excessive blood loss. Many orthopaedic surgical procedures deal with the extremities, and tourniquets are routinely used to prevent bleeding during the operation. Surgery of the elbow, hand, wrist, knee, foot and ankle are examples.

In some orthopaedic procedures, however, tourniquets cannot be used, and a certain amount of blood loss is inevitable. Hip surgery and spine surgery are typical cases. In order to deal with potential blood loss in these types of cases, other techniques are available.

First, specific medications can be given to patients several weeks before the operation to help increase or build up their blood count, so that they essentially have an extra amount of blood at the time of surgery. Therefore, when they lose blood during surgery, it is not so critical.

Secondly, during the operation, a blood cell saver suction device can be used to retrieve the patient’s lost blood in the wound, wash it and make it ready for the patient at the end of the case. This is a closed system within the body and does not represent stored blood. This type of blood salvage is acceptable to most patients and is used frequently.

Also during surgery, the anesthesiologist can safely keep the patient’s blood pressure lower than normal to help prevent excessive bleeding during the case.

Finally, medications are given after surgery to help the body more quickly replenish its own blood volume. Some or all of these techniques can be used in most orthopaedic cases to help minimize excessive blood loss and can be performed safely without the need for transfusions.

When doctors diagnosed Crystal Braxton’s Scoliosis during a routine screening at Eutaw High School, she remembers fearing the disease would squash her high school dreams.

“I just kept crying-I thought I was going to be wearing something horrible all day to school.” Crystal’s mom Mary Wilson shared her daughter’s fears.

“I think I was more frightened than she was” Wilson said. “All I could think was that she would be wearing this awful metal thing from her neck down all day”.

But University Orthopaedic Clinic orthopaedist Dr. Donald S. Scott eliminated Crystal’s and her mom’s worries with an alternative to the traditional chin-to-torso brace for Scoliosis, or curvature of the spine.

Rather than be trapped 23 hours a day in that confining contraption, Braxton wears the Charleston brace eight hours each night while she sleeps.

Scott said this relatively new device, which he helped to develop, lessens Scoliosis’ psychological blow because teen-age patients like Braxton don’t have to face their peers or limit their activity with braces.

“I was worried that I couldn’t do gymnastics or anything, but Dr. Scott said that would actually help it (my back),” said the 12 year old gymnast, softball catcher, and aspiring basketball player. Diagnosed with Scoliosis in March, Braxton has already made dramatic improvements, Scott said. “If my kids had it, this is what I’d have them in,” Scott said.

Of the three types of Scoliosis, the adolescent idiopathic strain is the most common and strikes primarily teen-age girls ages 10-15, Scott said. While doctors cannot always pinpoint Scoliosis’ source, they can calm patient’s fears about the potentially debilitating disease.

Patients who have a 25- degree and higher curvature of the spine require bracing, while those with a 55- degree or greater curvature need surgery. To use the night-time bending brace, patients must have a 32-degree or greater curvature.

While some orthopaedists prefer the traditional bending braces, more are turning to this alternative for the freedom it offers. Scott and his colleagues first tested the brace on patients who failed other types of treatment. It was also used for patients who were almost skeletally mature but continued to show curve progression. In some early cases the Charleston bending brace was used for patients who refused other treatment options. In those cases a time-modified brace was seen as preferable to no treatment.

The team that created the night-time only brace demonstrated the device’s success in an orthopaedic journal. Their initial study of adolescent idiopathic Scoliosis, published in 1989, will be followed up with long-term results reported from the first study patients.

Initially, the widely used Milwaukee brace was required after surgery, then was tested on less severe cases of Scoliosis that did not require surgery. But the drawbacks, doctors discovered, were that young patients suffered psychological effects from this jacket-with-metal rings contraption and were tempted to slip out of the device at school.

In the early 1980′s, Scott and several colleagues developed the breakthrough Charleston brace. Like traditional braces such as the standard Milwaukee style, the Charleston device is worn until the patient reaches maturity, about 15 years old. But, unlike its predecessors, this brace is custom-fitted to the patient’s body. Because it relies on intense correction at night, the devise affords its wearers freedom during the day. In the past, Scoliosis patients wore the traditional device for 23 hours, taking it off just long enough to bathe.

Although she initially needed her parent’s help to strap the hard plastic and foam Charleston brace on, Braxton said she “slips in and out real quick now.” The morning soreness usually subsides after three hours, she said.

“I know that because I’ve been wearing it, it’s been helping and the problem’s been going down a lot,” Braxton said.

“This is the most wonderful thing we could have done,” Braxton’s mother said.

Reprinted with permission from The Tuscaloosa News

H. Chester Boston, Jr. MD, received his medical training at the University of Alabama. After completing an orthopaedic residency at the Mayo Clinic, Dr. Boston established the University Orthopaedic Clinic with Dr. John P. Buckley. Dr. Boston’s particular area of interest is the spine. In 1991, he was Senior Spine Fellow at the University of Maryland.

Low back pain is a major cause of disability for workers and one reason workers’ compensation costs stay on the rise. This pain is sometimes the result of a degenerating disc, the spongy cushion in between the vertebrae. UOC follows sound medical practice by first treating low back pain conservatively with rest, physical therapy, medication and bracing. When all non-operative treatment is exhausted, surgery may be necessary.

A new surgical procedure, called lumbar interbody fusion, is proving to be more effective than older procedures. This new method uses a unique hollow implant made of a titanium alloy. The implant stabilizes affected vertebrae, thereby reducing pain and improving function. In a recent study, pain reduction and improvement of daily function occurred in 90% of the patients. A two year follow-up of the same patients showed that almost 70% of those who were either working or disabled at the time of surgery were at work one year later and almost 80% were working two years later.

H. Chester Boston, Jr., M.D., UOC’s spine specialist, studied this new procedure in Vancouver where he completed a hands on course given by the North American Spine Association. Dr. Boston recommends that aggressive non-operative treatment be pursued first in cases of low back injury. But when that fails, the new lumbar interbody fusion procedure may be what’s necessary to relieve suffering and return an employee back to work.

If you would like more information about this new procedure, please email your questions, or call UOC at 205-345-0192.