Find a League In Your Area
Submitted by Tom Evans Krause, Puget
Sound League President
One of our longtime players is an orthopedic surgeon
who occasionally writes informative blogs for our membership. David ‘Doc’
Kuechle is also an excellent outfield/hitter and his teams have won several MSBL titles as well as a bunch of PSSBL divisional championships. Below is one of his most recent articles he
supplied for our members. It addresses
arthritic conditions and some methods of treatment. Enjoy!
David K. Kuechle, MD is a board-certified orthopedic surgeon
at Edmonds Orthopedic Center and a member of the Smoky A's and the Everest
2018-Does your elbow not bend or straighten as far as it once did and does it
hurt at the end of your range of motion? Does it feel like you pulled your
groin 2 years ago and is it hard to get your foot up high enough to put on your
shoes and socks? Have your knees become so bow-legged that your friends call
you Cowboy Bob? If so, you probably have arthritis. In this blog post, I’m
going to discuss arthritis - what it is and what can be done for it.
arthritis is inflammation of a joint. In practice, though, we use the term
arthritis to specifically mean damage to the cartilage joint surface. The ends
of our bones are covered with hyalin cartilage - a durable, smooth, white
rubbery substance that cushions the bones that form the joint. Some joints,
like the knee, also contain structures that contain another type of cartilage
(fibrocartilage) such as the meniscus. The terminology can be a bit confusing.
A "torn cartilage” refers to the meniscus, not the hyalin joint cartilage. The
lining of the joint, called the synovium, makes a lubricating and cushioning
fluid called, you guessed it, synovial fluid. Normal joints are amazingly
durable and smooth. We’ve never been able to manufacture surfaces that come
close to matching the low friction of healthy joints, even with advanced
machining techniques and the best industrial lubricants.
of conditions can cause arthritis. The most common is called osteoarthritis and
is basically wear and tear arthritis, although it also has a strong genetic
component. If one or more of your parents have osteoarthritis, chances are, you
do too (lucky you!). Trauma, such as fractures through the joint, especially if
the bones heal in such a way that make the joint surfaces irregular, can also
cause arthritis. A third group is inflammatory arthritis, which is associated
with autoimmune conditions like psoriasis and rheumatoid arthritis.
general, arthritic conditions tend to be slowly progressive because cartilage
has limited ability to repair itself. Early symptoms tend to be episodic pain,
stiffness and swelling. As time goes on, the symptoms become more constant and
severe. The joint can change shape as bone spurs form at the margins of the
joint, or the joint can become crooked as cartilage erodes from one side of the
joint more than the other.
depends on the severity of the arthritic symptoms. Most of the non-surgicaloptions provide partial relief. However, if enough of the treatments are
combined together, patients can sometimes enjoy significant relief of their
pain. Over the counter medications like acetaminophen or anti-inflammatories
like naproxen or ibuprofen can lessen pain and in the case of the
anti-inflammatories, swelling as well. Ice can help too. Topical medications
containing capsaicin or ingredients that cause local irritation can reduce
perceived pain. Physical therapy can improve range of motion and strengthen
muscles that cross joints and provide some shock absorbing function. The use of
a brace is a bit of a double-edged sword because they do some of the work we
want the muscles to do, potentially leading to weakness, but at the same time
can support the joint and reduce pain. In the knee, there is a special type of
brace, called an unloaded brace, that can dampen the stresses of weight bearing
and thereby improve pain.
several injectable options. Cortisone reduces pain and inflammation, but
doesn’t treat the underlying cartilage damage. A standard cortisone injection
typically only lasts a few weeks. However, there is a brand new
sustained-release version of cortisone that reportedly lasts 4 months or more.
A potentially longer acting "gel shot” injection for the knee uses a synthetic
version of one of the proteins found in normal synovial fluid (hyaluronate) in
an attempt to reduce symptoms. A series of 3 or 4 injections performed a week
apart can reduce pain for as much as 8 months to a year. Not all insurance
companies cover this injection (notably Regence and Premera can be hit or miss)
but fortunately most do. This injection doesn’t work in everyone, but many
patients get at least a partial response. It can be done in joints other than
the knee, but that would be considered an "off-label” use in the U.S. and would
again not be covered by insurance.
the newer injections attempt to address the underlying cartilage damage and
perhaps promote some repair. Platelet rich plasma or PRP, entails taking a
small blood sample from the patient, spinning it down and pulling off the
platelet layer (cells involved in healing response), then injecting that into
the joint. Again, this is considered experimental and has a significant out of
pocket cost as most insurances don’t cover it. In my opinion, PRP has other
uses for which it is better suited than the treatment of arthritis. Stem cell
injections are another potentially reparative injection that’s received a fair
amount of publicity lately. This technology uses immature cells from fat or
bone marrow, then injects them into the arthritic joint. The idea is that
immature cells can become whatever cell is found in the area where they are
injected - in this case cartilage - and perhaps resurface the damaged area.
This is a technology in its infancy as I don’t think we have all the details
worked out yet as to how best to deliver it. Arthritic joints provide an
inhospitable environment for tender stem cells to take root. There is also a
lot of misinformation about this treatment and much direct to consumer
advertising - again insurances don’t cover it and it costs thousands of dollars
out of pocket. In my opinion, it’s not yet ready for prime time and I would
advise you save your money for now until we learn more about how to best
utilize this promising technology.
joint replacement is a technique that can be life-changing for people suffering
with arthritic joint pain. Joint replacement can often restore motion and
function, while reducing or eliminating pain. With newer techniques and
prostheses, artificial joints can last decades, if patients are reasonable with
their activity level afterwards. If patients are not reasonable, they can look
forward to many repeat visits with their friendly orthopedic surgeon, while he
frowns at their X-rays. The decision to undergo joint replacement is a personal
one. I tell my patients that they generally will know when they’re ready for
this option. I’ve also been surprised over the years at how often the severity
of a patient’s arthritis on X-ray does not correlate to the intensity of their
symptoms. There is basically one reason to have joint replacement surgery and
that is pain.