Thursday, December 29, 2011

Dr. Barrack Transforms the Life of a Hero

U.S. Army helicopter pilot William Marcrander commanded an "ash and trash" Huey, a workhorse helicopter during the Vietnam War. In January 1968, he'd been in Vietnam five months.
A mortar round struck in the midst of several Huey helicopters prepared to head out on a mission. One helicopter inverted.

Tuesday, November 29, 2011

Have you been "treated like a pro" by one of our orthopedic surgeons? Share your story with us for a chance to win tickets to a Blues game, Blues merchandise, as well as a :30 second feature on the scoreboard! Enter to win at

Tuesday, September 20, 2011

Dr. Barrack Discusses Partial Knee Replacements

If you have knee arthritis and are experiencing pain in the knee that does not respond to medications or injections, you may think that a total knee replacement is your only option.

When arthritis involves only the inside half of the knee, which is common, there is an exciting new option called minimally invasive partial knee replacement.

Partial knee replacement involves a smaller muscle sparing incision keeping 75% of your healthy knee, allowing for more rapid recovery, less pain and more normal motion. 

For the right patient with knee arthritis, this approach offers a lot of advantages over traditional knee replacement.

Friday, September 16, 2011

Tuesday, July 12, 2011

I sprained my ankle last spring while I was running. The ankle doesn't really hurt anymore, but it keeps 'giving out." What should I do?

Foot and Ankle Surgeon, Jeremy McCormick, MD:

Ankle sprains are the most common foot and ankle injury in sports. Typically, sprains occur when inverts with an awkward step while running or jumping. As the foot rotates inward, the ligaments on the outside, or lateral aspect of the ankle, are stretched, causing swelling and pain. Most frequently, sprains will recover completely with rest, ice, compression, evaluation and early mobilization.

In less than 10% of cases, while ankle swelling and pain improves, the ankle continues to "give out" or feel unstable. Classically, this occurs when walking on uneven ground or when stepping off a curb. Repeated episodes of "giving out" is a condition called chronic ankle instability. Most frequently, this is a result of incomplete recovery from an acute ankle sprain that leaves the ankle with weakness and impaired postural control.

The initial treatment for chronic ankle instability is a program of structured rehabilitation with the help of a physical therapist. Exercises are aimed specially at strengthening the peroneal tendons which run on the outside aspect of the ankle. The regimen should also include use of a balance board or similar device to work on proprioception - awareness of the position of the foot and ankle in space. Improved proprioception helps the ankle react more quickly to stresses, preventing future sprains.

After 6-8 weeks of intensive therapy, if the ankle continues to feel unstable, one might be a candidate for surgery to reconstruct the injured ankle ligaments. At this point, an MRI is helpful to identify any underlying injury such as cartilage damage at the ankle or peroneal tendon tears. Complete recovery from surgery takes at least 3 months, but patients will typically be able to return to full activity without limitation, and, most importantly, without the sensation of their ankle "giving out."

Wednesday, July 6, 2011

Sport-Related Concussions

A concussion is an injury to the brain that commonly occurs in sports. There are an estimated three to four million sport-related concussions that occur in athletes each year. Concussions can occur from a direct blow to the head or a blow to somewhere else on the body that produces a jerking motion of the head. Most concussions do not result in being knocked out or losing consciousness. Mark Halstead, MD, discusses sport-related concussions.

Learn more about concussions.

Wednesday, June 22, 2011

My son started having elbow pain while pitching during a baseball game several weeks ago. It still hurts when he tries to pitch. What should he do?

Sports Medicine Specialist, Matthew Smith, MD:

Pain on the inside of the elbow can be a difficult problem for throwing athletes, especially baseball pitchers. Any pitcher who develops arm pain during a game or practice should stop throwing. If the pain does not go away within a week, or returns with pitching, he or she should seek medical attention.

Pain on the inside of the elbow can come from a number of different sources. Discomfort that develops during the late cocking or early acceleration phase of the throwing motion may be related to an injury to the ulnar collateral ligament (aka Tommy John Ligament). Pain on the inside and by the tip of the elbow that occurs at the end of the throwing motion is more likely due to bone spurs along the inside edge of the joint. Lastly, excessive soreness that is associated with numbness or tingling in the ring and small finger may be related to irritation of the ulnar nerve (the "funny bone" nerve).

The initial treatment for each of these problems is rest from throwing and physical therapy to improve upper extremity strength and endurance. If pain recurs after several months of rest and physical therapy, surgery may be necessary to treat one or all of the sources of pain. Surgery for isolated bone spurs on the edge of the joint can usually be done arthroscopically through small incisions. A longer incision on the inside of the elbow is used to treat ulnar nerve irritation or to reconstruct the Tommy John ligament. A Tommy John ligament reconstruction has an 85-90% success rate in getting throwers back to the same level of play. However it takes about one year of rehabilitation for pitchers to return to competition.

To protect the shoulder and elbow from injury in young baseball pitchers, a few simple guidelines have been developed by the USA Baseball Medical and Safety Advisory Committee. Pitch counts should be limited to 50 pitches per game/day in 9-10 year-olds and 75 pitches per game/day in 11-14 year-olds. Players should not play in multiple leagues or for more than one team in the same season and should avoid pitching in showcases. Players should take at least three months per year off from throwing and other overhead sports.

Tuesday, June 14, 2011

What is hip preservation surgery and when is it needed?

Joint Preservation, Replacement and Resurfacing Surgeon, Ryan Nunley, MD:

Pain in the groin region, especially with prolonged sitting or driving in a car, may be the earliest sign of a progressive hip problem resulting from a labral tear or hip impingement. If left untreated, this could lead to hip arthritis at a young age. Recent advances in the understanding of groin pain now allow us to accurately evaluate and treat patients before they develop hip arthritis. We now have minimally invasive surgical procedures to slow down and possibly prevent the development of arthritis. While not all groin pain needs evaluation, people with recurrent groin pain may benefit from an evaluation by a dedicated hip specialist.

Friday, June 3, 2011

I have bunions, but my feet don't hurt. My sister says that I should have them fixed before they become worse. Is this true?

Foot and Ankle Surgeon, Sandra Klein, MD:
Many people have bunions, but not all bunions are painful. A bunion is more than a "bump" on the side of your foot. It is actually a deformity of the great toe that frequently runs in families. If bunions run in your family, you may be predisposed to developing a bunion over time. Bunions range from mild to severe and are most common in populations of people who wear shoes.

In fact, shoe wear plays a significant role in the development of a bunion deformity. Bunions can worsen over time and become painful if your shoes are not an adequate width for your foot. High-heeled shoes also influence the development of a bunion by increasing pressure on the forefoot. As bunions become worse, they can become painful or the lesser toes can become painful.

Many bunions do not become painful or change over time. With appropriate shoes, bunions can remain stable and may not limit your activity level. The primary indication for surgical treatment of a bunion is pain. If you are having pain that limits your activities, you may consider surgical correction of your bunion. If yu are not having pain, there is no reason to correct a bunion today due to concerns that it may become worse in the future.

Surgical treatment for bunions usually involves an osteotomy, or a cut in a bone to realign the great toe. Sometimes multiple osteotomies are necessary to correct the deformity. The surgical treatment depends on the specific deformity causing the bunion and may vary from person to person. If hammertoe deformities of the lesser toes develop, these are often corrected at the same time. If you have foot pain related to a bunion, an orthopedic foot and ankle surgeon can provide you with a surgical evaluation.

Tuesday, May 31, 2011

Orthopedic Spine Center in Chesterfield offers non-operative treatment for back pain

The Washington University Orthopedic Spine Center in Chesterfield was featured on the cover of the May 27th Ladue News.

The Washington University Orthopedic Spine Center, conveniently located at the Outpatient Orthopedic Center in Chesterfield, provides comprehensive, specialized care to patients with acute back pain and neck pain. Appointments are given within 48 hours of your inital phone call (314-514-3500), because we understand that acute back pain cannot wait a week. Non-surgical treatment modalities are offered, including medications, physical therapy, massage therapy, occupational therapy, acupuncture, bracing and injections. At the Orthopedic Spine Center, surgery is a last resort.

Psychiatry, Podiatry, but what the heck is PHYSIATRY?

Many people have never heard of a Physiatrist. However, patients who need comprehensive evaluations and conservative treatment of orthopedic conditions will benefit from an appointment with a Washington University Orthopedics physician specializing in non-operative care, also known as a physiatrist.

Dr. Heidi Prather explains more about this unique specialty within our orthopedic department. Click here.

My 50-year-old father has numbness in his left small finger. My friends believe he has carpal tunnel syndrome. Is that accurate?

Hand Surgeon, Ryan Calfee, MD:
There are actually several common nerve compression syndromes in the upper extremity. Family and friends of individuals with numbness and tingling in the hand, often suggest carpal tunnel syndrome. However, your father's symptoms are more likely related to compression of the ulnar nerve.

Carpal tunnel syndrome, the most common upper extremity nerve compression syndrome, is produced when the median nerve is compressed at the wrist. Patients with carpal tunnel syndrome may note that the thumb, index, and middle fingers feel "asleep." They may drop small items, and awaken at night feeling the need to shake out the hand to regain feeling.

In contrast, the ulnar nerve provides the sensation to half of the ring finger and the small finger. It also controls many of the small muscles within the hand. The ulnar nerve can be compressed at the elbow (most common) and at the wrist. The ulnar nerve courses around the back of the elbow where, when struck, it is responsible for the common complaint that, "I hit my funny bone." Ulnar nerve compression at the elbow is termed cubital tunnel syndrome. Numbness and tingling in the small and ring fingers is characteristic of ulnar nerve compresion. Individuals may also note atrophy of the hand muscles and difficulty bringing the small finger together against the other digits.

The diagnosis of cubital tunnel syndrome is based upon patient history, physical examination, and electrodiagnostic studies, which test the nerves ability to transmit sensory and motor signals.

Once diagnosed, treatment is dictated by the severity of compression. Mild nerve irritation can be effectively managed with bracing designed to avoid full bending of the elbow and activity modification. As the nerve becomes more involved, surgery can be performed to release the tissues that are compressing the nerve or even to move the nerve to a more protected location in the front of the elbow. Current medical literature indicates that such surgery is largely successful although severe cases may realize only a halting of disease progression as opposed to a complete reversal of symptoms.