The Foundry Orthopedics & Sports Medicine Blog

Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain.
Shoulder replacement surgery was first performed in the United States in the 1950's to treat severe shoulder fractures. Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis. Shoulder replacement is the third most common type of joint replacement, after knees and hips. Today orthopedic surgeons who specialize in shoulders are using advanced techniques and materials to relieve pain and restore mobility in patients with compromised shoulder function. Today, about 53,000 people in the U.S. have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality. This compares to more than 900,000 Americans a year who have knee and hip replacement surgery.

If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.

If you have an appointment with us on a Friday, you may have seen many of us wearing our Foundry Free Agent slow pitch softball jerseys. If your appointments are on Monday you have probably heard many of us analyzing our softball games as if we are sports analysists on SportsCenter or, walking around with ice on our shoulders or sore muscles. Doctors, physical therapists, occupational therapists, medical assistants, physical therapy assistants, athletic trainers, physical therapy and hand therapy aides, and x-ray techs have joined forces with significant others and friends for some Foundry Fun on Tuesday and Friday nights. We are about halfway through our slow pitch softball season, trying to relive the days of being an all-star, high school or college athlete, anxiously waiting for our moment to make that diving catch or turn a double play. Slow pitch softball has been a fun and active way to spend time with friends and co-workers, but we are quickly learning the good, the bad, and the ugly about this deceitfully, grueling sport.

Although it is considered taboo to discuss politics and religion, I have decided to share some of my thoughts about the impact of politics on healthcare. My disclaimer is that these are my opinions, and do not necessarily reflect the views of my partners or of Foundry Orthopedics…....

I have been a practicing Orthopedic Surgeon for many years. I received my MD degree in 1979, which was 34 years ago for those of you who do not have a calculator handy. I served proudly in the US Navy, I have worked in the VA system during my residency training, I have worked for an HMO (RIGHA and then Harvard Pilgrim Health Plan for you local folks), I have worked in an academic setting, I have worked as a solitary provider with my own S-Corp status;  my most recent iteration has been as a partner at Foundry Orthopedics and Sports Medicine.

All bone breaks are, technically, fractures.  These fractures come in many different flavors:  green stick or complete, simple vs open (bone fragments have come through the skin; "compound" was used in the past to describe this type of fracture), comminuted (multiple fragments), displaced (fragments are separated from where they belong), or angulated.  But, all these fractures share in the process by which they heal.

Weighing Your Hip Replacement Options
If you are suffering from hip problems, learning about hip replacement may be your first step toward returning to an active lifestyle. Hundreds of thousands of people have received hip implants that restore their ability to stand, walk and run without the excruciating pain they experienced in the past.
It’s important to learn about the different hip replacement procedures available, the risks involved with certain implants, and what happens during surgery.

Hip Replacement Surgery

We have all heard it before… “Laughter is the best medicine”.  However, the question still remains; is this statement true or just an old wives tale?  Does laughter or happiness in general really have the power to cure what ails us?  How much does someone’s mood and state of mind truly affect their overall well being?  Well, here goes…..

My colleagues and I wear lots of different hats to help patients cope with post-surgery rehabilitation. There are so many phases one passes through to reach that moment when we can say - “you’ve successfully completed your therapy, congratulations and we wish you well on your recovery outside of Foundry Sports Medicine and Fitness and getting back to your normal activities.”

This month’s topic answers a question several friends have asked me. "I'm a new rider, what should I get to help stay warm when it's cold outside?"   (Disclaimer - The rest of this blog is all based on personal experience. There is no scientific method or any method to my madness - just sharing what has worked for me…)
 
So, how do you cope with the cool weather? The key concept is to dress in layers. Layering has several benefits - You can use lightweight layers so your clothing is not heavy - 2-3 layers plus the air in between makes a very effective insulation system.  Another key benefit - you can fine tune your layers as you warm up and roll up a layer and put it in your back pocket.  One related cold weather rule - if you are comfortable when you start your ride, you WILL overheat unless you have layers you can unzip and/or stop and shed as you warm up.
 
I'm going to break this down into vertical groupings from toe to head but first, I'm going to mention the items that I have gotten the most use out of - my "Top 3". Those of you with short attention spans can quit after this and go stock up…
 
1 - Gore Windstopper Jacket (& Shell)
This has been my favorite, most used, cool weather item - I started with a Windstopper running shell. The Windstopper fabric is a lot more reasonably priced than full Gore-Tex, breathes as well and is said to be slightly less waterproof but I can't tell the difference.  A couple of years ago, I got a second cycling specific Gore Windstopper jacket and it has displaced the shell as my top pick.  It is more fitted and has long sleeves that can zip off so it is very flexible for riding and doesn't flap in the wind.
 
The Windstopper tops keep me warm but doesn’t let me get too hot (they unzip). I can't say enough good things about Gore fabric technology - they really work as promised - keep the wind out, keep you warm, but allow your perspiration to escape so you stay comfortable.  You should be able to find these locally - it's worth trying on to confirm the fit - bring your proposed inner layers to test the entire combination.  My shell is a running shell.  The new Gore jacket came from a bike shop.  Both are excellent - very highly rated for the wind/waterproof aspects and great comfort level - cold, wet or both!
 
2 - Smart Wool "Base layer" long sleeve top
Remember the layering concept - the base layer is as critical as the outer layer.   This can be worn under a shell or under a jersey.  It is definitely worth the modest additional investment to get a good fabric here - it wicks your body moisture away, stays warm and relatively dry against your skin.  I'm not a fabric expert, I try these on - this is an item you want to try on to see what feels good to you.  I do have a long sleeve wool jersey I got by mail and it is scratchy against my skin.  I do use it as a middle layer at times but I learned to try on the base layer if it's a new fabric before buying.
 
For many years, I wore the high tech fabric base layers and still like them.  A friend told me about the Smart Wool shirt he had to get in Oregon when the ride temps were so cold.  I had tried a plain wool base jersey but it seemed itchy to me.  The Smart Wool, on the other hand is WONDERFUL!  The company uses a very fine fiber and does some magic because it is not scratchy, keeps you warm, wicks perspiration pretty effectively, doesn't overheat, and doesn't develop odors - this can happen with some of the tech fabrics.
 
My Smartwool base is the first layer that goes on when it's cold enough for layers.  When combined with a good shell and long or short sleeve jersey for the middle layer, I can handle the colder weather.  You may need to look around to find the Smart Wool items but it's worth the search!
 
 3 - Good pair of full finger gloves
There are many styles so, if possible, head to the local bike shops to look and try several on.  My most used pair has a Gore liner (waterproof, & breathe) and big "cuffs" that can fit over the sleeves on my jacket.  I also have a pair of funky "convertible" gloves that have a full thumb and open fingers.  They also have a mitten-like cover that can go over all four fingers or fold back so your fingers are exposed when the day warms up.  I usually combine these with a pair of lightweight liners for really cold days.  I always keep these in my bike bag until the weather warms up but I only wear them if it's 40 or below or cool and possibility of rain.  Cool hands don't bother me but cold & wet is not fun!
 
OK, that's my "Top 3" and I'm sticking to it!  Note that all these are upper body items. I'm not an expert but suspect that's because your legs stay warmer from the constant pedaling effort. If you ride at a more casual pace, you may want some leg protection in your top 3 - there is not a right/wrong answer here.
 
Now, more musings about the various components starting from the bottom up…
 
Feet
My feet seem less sensitive to getting cold, but I do have a few items I do appreciate for really cold rides:
 
- Wool socks - Definitely worth buying at least one pair, they do stay warm and dry.  Of course, I added a pair of Smart Wool socks to my wardrobe and again, they are the most used but my feet don't notice the wool itch as much as my upper body did so any form of wool helps keep your feet warm..
 
- Full cover insulated boots - If it's really cold and wet, these make the ride a LOT more pleasant  and are much easier to deal with than the “Toasties”.  The small insulated cover that slips over the front half of your shoe.

Legs
For many years, I just put a pair of running tights on under my cycling shorts and that worked fine. The benefits were less cost, lighter weight and many colors to choose from.  A few years ago,  I finally broke down and got a pair of insulated, full length biking tights with a chamois liner. I wore them for the first time on a 38 degree day rising to low 50's. I really enjoyed them and I never noticed my legs being cold early or warm later in the ride. My legs tend to stay warm since you use them so heavily to ride so this is still fairly low on my priority list but worth a small splurge if you have all the other layers covered.
 
Other leggings in my drawer

- Leg warmers - these extend from the knees to your ankles and are worn on cool days with shorts and usually removed after it warms up.  I very rarely use these - if it's cold, I prefer full tights - you may like this option for cool, but warming weather
- Waterproof leg covers (wear over tights) I've had these for 5 years and never worn them. 

Upper Body
As you can tell, I've collected quite a few base layer tops over the years and these have got a LOT of miles on them. My base layer tops vary from pretty light to fairly heavy and I select based on the temperature, top layer and color (on milder days when this layer will be exposed). 

Other items I've added fairly recently
- Light, water resistant shell - You've probably seen these, many are very bright yellow. They are quite good to have on mild days as they can easily fit in a back pocket as you warm up. Ideal for cool, but not cold days.

Arms/Hands
First my arms. I have a light and medium weight pair of arm warmers. I use these when it's sunny and the temps are in the low 50's at the start. They keep your arms warm but give you the flexibility to slip them off as the day warms up
 
As for my hands, I have three scenarios:
- Normal - 50 degrees and up - normal open finger bike gloves
- Cool - 40's - Light finger gloves w/ bike gloves over. The inner gloves usually come off at a rest stop
- Cold - 30's or cooler - My Gore lined gloves or my convertible gloves/mittens as noted in my Top 3 above.
 
I have an old pair of Gore-Tex mittens that I will wear over my gloves before the ride if it's really cold.  These are not good for riding but the Gore-Tex mitten keeps my hands quite toasty until I need to slip them off to ride and they are very small/light so they easily fit into a back pocket.

 
Head
I have a great lower face wrap  and a Smartwool baklava.  I really don’t get too cold in this area except for my ears which I tend to wear 180’s .  They seems to work fine even with my helmet on.

For those of you who are really hard core and ride in the dead of winter when the rest of us are on our rollers or trainers I found this related article with more specific items. Note that it's written by a rider in Minnesota so it's focused on REAL cold weather.

So, in order to ward off the Evil Spirits of Winter, I decided to purchase a snowblower in the Fall (seems like that didn’t work out – given the nearly 2 feet of snow which fell this past weekend). I have always been a shoveler, but I figure with children too small to really help, why not make it a little easier this year.

As the great blizzard of 2013 approaches, thoughts turn to the popular winter sports of skiing, snowboarding, and snowmobiling. These activities involve speed and a rush of adrenaline. Unfortunately, the faster you go, the greater the risk of significant injury. Head injuries are especially common in the higher speed winter sports. Skiers and snowboarders often move at speeds much higher than the average bicyclist, yet more people wear helmets while biking.