Total knee replacement can be carried out in two ways: the traditional approach that involves significant downtime and the newer minimally invasive approach, also known as the quadriceps-sparing method.

Conventional knee replacement generally involves an 8” incision and a stay of 3 to 5 days. It may require an additional stay in a rehabilitation center as well. The recovery period can last for as long as 1 to 3 months, in which you would be required to use a cane or walker.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV. 

What Is Involved In The Quadriceps-Sparing Method?

Quadriceps-sparing total knee replacement is a more recent and minimally invasive technique. It involves inserting the knee replacement implant by making a shorter incision that prevents trauma to the quadriceps muscles. The same proven implants are used in this technique. An incision of roughly 3 – 4” in length is used in this technique, allowing for a quicker recovery time. 

You should be able to walk within a few weeks of the surgery using a cane. Quadriceps are among the most important muscles of the legs. By avoiding trauma to this muscle-group, post-operative pain is diminished. There is a reduced need for therapy and rehab as compared to other traditional approaches. 

Primary Benefits of the Newer Technique

1. Rapid healing 

Patients that undergo this procedure are able to regain muscle control and strength in a fairly shorter period of time as compared to patients that underwent the traditional knee replacement procedure. The surgeon doesn’t divide the quadriceps muscles and tendons. The kneecap is not flipped out the way or everted as it is in a traditional replacement procedure. 

2. Shorter incision

Knee replacement is never performed for cosmetic benefits. But, you cannot negate the benefits of having a smaller incision. The incision length is almost halved in the case of quadriceps-sparing method.

3. Decreased pain during recovery

This is a benefit accruing from the smaller incision and the fact that the important quadriceps group is not touched. 

4. Involves same reliable replacement implants

There have been many advances made in the nearly 4-decade history of contemporary knee replacement techniques. Quadriceps-sparing method is an enhancement on the traditional surgery. It makes use of the same proven implant designs. Except, the surgeon will insert the implants through a smaller incision. 

Better Suitability Prospects than a Partial Knee Replacement

Some patients feel that getting a partial knee replacement may be a more reasonable choice. These are also known as unicompartmental (partial) knee replacements and have a proven track record. The technique has been in use for decades. It offers the same exemplary clinical results as that of total knee replacement. 

There are several less invasive techniques available for inserting smaller implants. With that said, only about 10% knee replacement patients ever qualify for these procedures. In contrast, a minimally-invasive quadriceps-sparing total knee replacement is considered appropriate for a wide range of knee arthritis patterns.

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for safe and proven orthopedic surgery procedures.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Cortisone injections play a major role in relieving inflammation and pain symptoms from the shoulder. Besides used for the shoulder, these injections can be used in the knee, hip, spine, elbow, ankle, and wrist. Furthermore, there are several side effects to these injections which limit the number you can receive in a year. 

During your initial consultation, your surgeon will explain the potential side effects of cortisone injections and the number of injections you can receive in the shoulder in a year. Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada and also in and around greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Side Effects of Cortisone Injections When Used in the Shoulder

Patients are at a higher risk of side effects if they receive a larger dose of cortisone. These are a few side-effects you should expect after getting the medication in the shoulder:

• Pain and discomfort
• Temporary facial flushing
• Temporary increase in blood sugar
• Temporary flare of pain and inflammation, also called a cortisone flare
• Joint infection
• Cartilage damage
• Death of nearby bone
• Tendon rupture or weakening
• Lightening or whitening of the skin at the injection site
• Osteoporosis 

Frequency of Cortisone Shots

You may request for a cortisone injection if your joint pain returns after a few months or week. Typically, patients are restricted from getting more than 3 cortisone shots in a year. With that said, you should speak with your doctor regarding your particular situation. They will be able to explain your options and the best treatment combinations that would work in your condition. 

Cortisone Shot Preparation

Cortisone injections can cause bruising and bleeding. It’s necessary that you don’t take any blood thinners for several days before the appointment. This includes dietary supplements which may have a blood thinning effect. You should speak with your doctor regarding the supplements or medications you should avoid. Pertaining to this, let the doctor know if you had a temperature of 100.4 F or above in the past 2 weeks. 

Getting a Cortisone Shot in the Shoulder

The doctor will position your shoulder in a way to make it easy and comfortable to get the shot. The injection site will be cleaned and sprayed with a topical anesthetic. The doctor may use fluoroscopy or another digital imaging technique for watching the needle’s progress and placing it in the right spot. 

You will be given the corticosteroid medication once the injection site is received. An anesthetic is usually mixed with the medication for providing immediate pain relief and to deal with any potential cortisone flare up. You will be sent home to recover once the injection has been given. 

Expectations Following a Cortisone Injection

Some patients notice a reduction in pain after a few hours while for others it may take up to 7 days. Severity of pain determines how soon the injections work. Chronic shoulder pain may require several weeks for continued relief. Patients that received an anesthetic with the cortisone shot may experience numbness for at least 24 hours. 

Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler receive patients from Las Vegas, Nevada and also from greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery procedures. 

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Cortisone medication can help ease swelling and pain from arthritis, illness, or injury when injected into the body. Cortisone shots or corticosteroid shots don’t start working immediately. Some patients wonder when those chemicals begin to have an impact and which factors impact their efficacy. This is particularly true in the case of athletes that have a game or any type of contest on the horizon. Choosing the best time to have a corticosteroid shot can prove to be the difference between success and failure.

Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada and also in and around greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV. 

Outlook Following Cortisone Shots

In general, cortisone shots take about 4 – 5 days to start working. In relation to this, it’s prudent to give the shot at least a week to ease pain. In most patients, corticosteroid shots take about 7 days to start showing benefits. The effect may last for up to 2 months. In some cases, the effect may last for more than 2 months. 

Cortisone reduces inflammation in damaged joints. Your doctor may recommend other treatments to address the cause of joint pain. This can be treatment for an autoimmune disorder, obesity, ligament damage, or another condition. 

Mechanism of Cortisone Shots

Cortisone shots are in-office medication. They may be injected directly in the joint involved. In some cases, the injection contains local anesthetic to start easing pain. Where shoulders are concerned, the cortisone injection can be injected in the:

• Joints
• Bursa
• Tendons

Longevity of Results

The effect of a corticosteroid shot may last between 6 weeks to 6 months. You will begin feeling great as the injection reduces inflammation. Furthermore, the injection doesn’t cure the disease. You should combine the shot with lifestyle changes, such as gaining muscle strength, losing weight and other similar methods. 

In some patients, the cortisone injection may not work. Failure can be due to the following reasons:

• Diagnosis was incorrect
• Cortisone shot was injected in the wrong area
• Needle placement was incorrect
• Failure of proper rehabilitation

Side Effects of a Cortisone Shot

Cortisone shots, in general, are safe when used for the right reasons. Correlating with this, there are always side effects to every medical treatment. Potential side effects, include:

• Infection (1 in every 100,000)
• Allergic reaction (rare)
• Skin discoloration and thinning (can be reduced by using ultrasound)
• Bleeding into joints
• Temporary increase in blood sugar levels of diabetics, which lasts for up to 2 weeks
• Increased pain in the first few days due to cortisone flare

These are all short-term side effects and can be prevented by getting the cortisone shot from a reliable treatment provider. In rare cases, there are certain long-term side effects as well. Recent studies have shown that incorrectly or repeated cortisone injections may damage the cartilage. Cortisone injections may cause weakness in the tendons for a few weeks. 

You can reduce the risk of these long-term side effects by using cortisone shots sparingly and always for the right reasons. Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler receive patients from Las Vegas, Nevada and also from greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery procedures.  

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Shoulder Treatment

Shoulder impingement takes place when the acromion impinges on or rubs against the rotator cuff beneath it. Acromion is the top outer edge of the shoulders. Impingement can cause irritation and pain. Shoulder impingement syndrome is believed to be the cause of up to 65% of complaints related to pain in the shoulder.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Development of Shoulder Impingement Syndrome

The rotator cuff swells like a sprained ankle when it is irritated or injured. However, swelling causes other events to take place because the rotator cuff is surrounded by the shoulder bone. Swelling also reduces the amount of space present around the rotator cuff. This leads to the acromion rubbing against the rotator cuff.

And, like a vicious cycle, the amount of space around the rotator cuff is reduced because of swelling, which causes the acromion rubbing action. The rubbing leads to further swelling in the rotator cuff tendons. This narrows the space under the acromion further.

Bone spurs on the acromion bone in some cases can also contribute to impingement. This causes the space where the rotator cuff is present to become even more narrowed.

Shoulder Impingement Causes

Shoulder impingement syndrome is generally seen in athletes involved in sports and similar activities. This is particularly true for individuals involved in overhead rotational motion, such as volleyball, baseball, swimming, and tennis among other things, such as painting and window washing. Shoulder impingement can also occur because of an injury, such as falling on an outstretched arm or on the shoulder.

Treatment of Shoulder Impingement Syndrome

The goal of this treatment is to reduce pain and restore shoulder function. Ice, rest, steroid injections, anti-inflammatory medications, and physical therapy are a few popular treatment options for impingement syndrome.

• Physical therapy is an important treatment option for shoulder impingement syndrome. You would only require 1 – 2 in-office visits in most cases to learn how to perform physical therapy at home. You will learn to improve your shoulder’s range of motion by performing stretching exercises. You can begin strengthening exercises as well as the pain reduces.
• Ice applied on the shoulder for 20 minutes twice daily can help. A bag of frozen corn and peas also works.
• Naproxen or ibuprofen can be used for relieving pain. Stronger prescription strength medication may be required for severe pain.

Surgery

Surgery is considered when all other options have been tried without any relief. Arthroscopic shoulder decompression or subacromial decompression surgery can create more space in the shoulder for the rotator cuff by removing parts of the acromion. The procedure is performed using arthroscopic technique, which involves small incisions in the shoulder.

Other issues, such as inflammation of the bicep tendon, arthritis, and partial rotator cuff tear can also be repaired at the time of the surgery. Open surgery is another option to consider for severe tears.

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for safe and proven orthopedic surgery procedures.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Tendon Tears

The shoulder tendons and muscles are placed under a significant deal of strain on a daily basis. Painting, cleaning, lifting boxes, gardening, and majority of recreational activities, such as swimming, tennis, and golf can case shoulder tendon tear or strain.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Symptoms and Signs

Overuse and injury are common causes of shoulder tendon tear. Symptoms and signs of shoulder tendon tear include:

• Deep and dull pain in the shoulder
• Pain in the night, especially when sleeping on the troubled side
• Inability to bear weight on the troubled side
• Feeling or hearing a popping or snap when moving the shoulder
• Shoulder weakness caused by pain or exertion
• Shoulder stiffness
• Inability to keep the arm at an elevated position

Types of Shoulder Tendon Tear

Tendon tear of the shoulder can either be complete or partial:

• Partial tears occur when the tendon is not severed completely
• Complete tears occur when there is a split in the tendon

Treatment for Shoulder Tendon Tears

Tendon tears can be microscopic in size to complete ruptures causing the tendon to come away completely from the bone. Further, initial injuries can cause secondary tears.

Treating mild to moderate tears

You should speak with an orthopedic expert if you suspect a rotator cuff tear. The following treatment may be recommended for mild to moderate injuries:

• Steroid injections
• Anti-inflammatory medications
• Physical therapy

In certain cases, a combination of patients, conservative treatments, and rest is enough. Mild tears can take 6 – 8 weeks to heal while a more serious one may need 12 weeks to heal.

Severe tears

You may need surgery in severe cases of tendon tears. This is particularly in the case of people working in construction or athletes. Partial or complete tears of the rotator cuff tendon may require an arthroscopic surgery. Open surgery involving a larger incision may be needed in the case of difficult tears. It is vital to immobilize the shoulder following the surgery. Rehabilitation exercises should be started gradually for regaining shoulder strength.

Risk of Shoulder Tendon Injury

Shoulder injuries can take place in anyone, whether from repetitive overuse, falling on an outstretched arm, or direct impact. However, there are certain factors that may increase the risk of shoulder tendon injury:

• Age: older people are at a higher risk of degenerative weakening soft tissue because of wear and tear. Degenerative disorders generally begin at the age of 40.
• Jobs: Repetitive exertion of the shoulder can cause tiny tears in the soft tissue. This damage can worsen over time. Painters, construction workers, and athletes are at a greater risk of injury.
• Smoking: Flow of blood and oxygen is reduced to the body’s soft tissues because of smoking. This increases the susceptibility to injury and slows down the healing process as well. Smoking can make it difficult to prevent future injuries.

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for safe and proven orthopedic surgery procedures.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Shoulder Instability

Shoulder instability happens when the shoulder joint’s lining, labrum, or ligaments become torn, stretched, or detached. This allows the humeral head or the ball of the shoulder joint to move partially or completely out of the socket. Individuals with this type of instability feel pain when the shoulder is not in its place.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Shoulder Instability Types

1. Shoulder Subluxation and Dislocation

The humeral head can be dislocated or subluxed with significant trauma to a normal joint. Shoulder subluxation takes place when the humerus quickly slides in and out (partially) of place. Shoulder dislocation takes place when the humerus comes out of the glenoid. It may need to be pushed back in place with medical assistance or may fall back in with time on its own.

2. Labral Tear

Shoulder instability happens when the labrum is peeled or torn off the glenoid. It can happen following a shoulder dislocation or shoulder trauma because of repetitive motion.

3. Genetic Condition

Some people are born with loose shoulder ligaments because of spacious or loose capsule. Instability, for these people, can happen without any trauma or after a relatively minor injury. Some people may also have a genetic condition that loosens the joints and predisposes them to develop weakness or instability in the shoulder.

When is Surgery Needed?

The shoulder may be unstable or loose despite a full course of physical therapy in which shoulder strength or motion are restored. Treatment options may consist of surgery or activity modification. Activity modification is mainly recommended for patients that experience instability while performing certain activities. In such patients, avoiding the activity can eliminate the episode of dislocation or subluxation.

Surgical treatment is considered in patients that are not willing to give up sports or activities provoking the episodes. The surgery will involve a physical examination of the shoulder under anesthesia to assess the direction and extent of instability. Generally, an arthroscope is used for inspecting the inside of the shoulder joint for evaluating the joint and cartilage.

The arthroscope will allow direct assessment of the condition of the rotator cuff tendons and labrum. Arthroscopic techniques may be used for stabilizing the shoulder in a limited number of patients that have mild laxity or looseness in the shoulder.

Open Surgery

Open surgery is often required for correcting severe instability. An incision will be made on the shoulder and the muscles will be moved for gaining access to the join capsule, labrum, and ligaments. The structures are then reattached, repaired, or tightened depending on the injury.

The repair can be performed with simple sutures or sutures that are attached to metal or plastic anchors. The anchors are inserted in the bone for tightening or reattaching the ligaments. The anchors remain in the bone permanently.

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for dependable and proven orthopedic surgery procedures.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada

Chronic Tendinitis

Shoulder tendonitis is an inflammation of the biceps tendon or the rotator cuff. Rotator cuff consists of tendons and muscles in the shoulder, which are responsible for connecting the upper arm bone with the shoulder blade. An injury may range from mild to severe inflammation of the rotator cuff. Rotator cuff tenonitis is when the rotator cuff becomes thickened and inflamed.

The rotator cuff tendon may get trapped under the highest point or the roof of the shoulder, called the acromion. It is formed by a part of the scapula. Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Symptoms of Shoulder Tendonitis

These are a few common symptoms of shoulder tendonitis. However, you should know that symptoms are unique to different patients.

• Inability to hold the arm at certain angles or positions
• Tenderness or pain in the shoulder

Shoulder tendonitis symptoms may resemble other medical problems or conditions. You should always speak with a healthcare provider for a proper diagnosis.

Diagnosing Shoulder Tendinopathy

Your doctor will ask your medical history and symptoms. They will also perform a physical exam and get detailed images of the shoulder. Images may be taken with:

• Arthroscopy —a surgery that is done with a scope
• MRI scan
• CT arthrography—specialized x-ray
• X-rays

Treating Shoulder Tendinopathy

It may take months to resolve tendinopathy and associated pain. It is important that you follow through with your treatment. This can include:

1. Rest, Ice, Heat

You should avoid any activities that can cause pain in the shoulder. Your doctor may recommend using an ice pack for helping control swelling and pain. Ice packs are of particular help during the first 24 – 48 hours following exercise or injury. You should protect your skin by keeping a towel between the skin and ice.

Stiffness may decrease in a few days. You should ask your therapist or doctor before using heat for the first time. Make sure you use a towel to protect your skin from the heat source.

2. Medication

There are several medications that can help reduce pain and swelling. This includes:

• Topical pain medicines can be applied to the skin
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin for managing pain
• Steroid injections in the bursa for decreasing inflammation

Severe or persistent pain may require further treatment. Your doctor may use steroids in the area to temporarily relive pain. Frequent steroid injections can damage the tendons.

3. Rehabilitation

You would be able to regain a range of motion and strength with rehabilitation. It will also prevent future injuries. Rehabilitation may include:

• Exercises for maintaining normal range of motion
• Physical therapy for strengthening the muscles controlling the shoulder
• Gradual return to work and sports
• Exercises for specific muscles that are used in job activities and sports
• Learning ways to modify activities for preventing re-injury

Surgery may be required in case of severe injuries. Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for safe and proven orthopedic surgery procedures.

Contact Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Serving patients from and around greater Las Vegas, Lake Havasu, Bullhead City, Mesquite, Pahrump, Nevada