Monterey Joint - Christopher Meckel - orthopedic surgeon, fellowship trained

Orthopedic problems | Arm & hand | Joint replacement | Sports medicine

Orthopedic problems
Do I need to see an orthopedic surgeon only when I need to have surgery?
No. Monterey Joint treats many bone and joint problems that do not require surgery. Conservative treatments such as physical or occupational therapy, injections, cast or splint applications, and prescription orthopedic medicine are often the appropriate solution. Since many operations are elective, you and your physician should jointly decide whether surgery is the correct option.

I recently had surgery in which screws and plates were used and were left inside of me. Do they need to be removed?
Usually, screws and plates will not have to be removed after surgery since they do not corrode or deteriorate over time. Unless there is a medical reason to do so, or they are bothering you, there is no reason to remove them.
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Arm and hand
I perform repetitive activities at work. Could this cause carpal tunnel syndrome?
Work-related activities are thought to play a small role in developing carpal tunnel syndrome. Non-work-related activities such as sports, hobbies and your daily activities also play a key role in the development of carpal tunnel syndrome. Other contributing factors can be body dimensions and other medical conditions.

I'm in my 40s, and I think I have arthritis. I am too young for this, aren't I?
Arthritis in your 40s is not uncommon. However, your condition may not be arthritis. Most shoulder problems involve the soft tissues — muscles, ligaments and tendons — rather than bones. Most of these problems fall into three major categories: tendinitis/bursitis, injury/instability, and arthritis. A tendon is the cord which connects muscle to bone. Sometimes, excessive use of the shoulder leads to inflammation and swelling of a bursa, a condition known as bursitis. Bursitis often occurs in association with rotator cuff tendinitis. There are many types of arthritis, but generally it involves wear and tear changes with inflammation of the joint, causing swelling, pain and stiffness. Arthritis may be related to sports/work injuries or simple aging.
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Joint replacement surgery
Will I need to continue to take antibiotics after I have had a total joint replacement?
If you are in good health, it is normally not necessary for you to take antibiotics following the procedure. It is, however, advisable to take antibiotics prior to dental or any other medical procedure within the first year following a joint replacement in order to prevent infection. Your specialist will be able to properly advise you.

After having joint replacement surgery, will I need the assistance of a walking device such as a cane or a walker?
After surgery, you should be able to walk without the assistance of a device, and you should be essentially pain-free after your rehab and a successful recovery. If there is overuse of the new joint, muscle fatigue may occur, causing you to require the use of a cane for a short period of time.

I am planning joint replacement in the near future. What should I take care of prior to having surgery?
Good nutrition and dental care are two important things to prepare for surgery. We prefer that our joint replacement patients wait three months after surgery before having their teeth cleaned to protect from any possible infection, so a trip to the dentist prior to surgery could be beneficial. Another area that should be attended to is the foot. Toenails should be trimmed, and the foot should be free of infection. If you have an infection anywhere in the body, be sure to see your doctor before having any surgery.

Is joint replacement a good idea at my age (82)?
We think of age as only one of the parameters when determining candidacy for joint replacement. Many patients who are chronologically in their seventh and eighth decades are physiologically much younger. More important than age are the underlying medical conditions that might shorten life expectancy or the lack of any underlying diseases and a genetic predisposition to a long life span. In any case, if you maintain an active lifestyle at 82 and desire long-term pain relief, you certainly would be a candidate for the procedure. Assuming there are no medial contraindications to knee replacement, joint replacement at your age is generally safe.

My doctor told me that I have advanced arthritis in my knee. At what point should I consider having a total joint replacement?
We recommend waiting to have a total joint replacement until your pain becomes unbearable, normal activity can no longer be completed, and nonsurgical treatments have failed. While waiting for a joint replacement, you can minimize your discomfort with several nonsurgical options such as medication, cortisone injections, activity modification, weight loss, and the use of a cane or knee brace.

After having joint replacement surgery, will I need the assistance of a walking device such as a cane or a walker?
After surgery, you should be able to walk without the assistance of a device, and you should be essentially pain-free after a full recovery. If there is overuse of the new joint, muscle fatigue may occur, causing you to require the use of a cane for a short period of time.

Which types of home workout equipment are safe for a patient with moderate osteoarthritis of the knee?
An exercise program is an important part of non-drug therapy for patients with osteoarthritis of the knee. Exercise programs often include aerobic, range-of-motion, stretching and strengthening exercises. Stair-steppers are usually not recommended for patients with moderate or severe osteoarthritis of the knee joints.

Regardless of the specific exercise or equipment used, remember to perform exercises in a sequential order:

An initial warm-up involving range-of-motion and strengthening exercises
An aerobics program
A cool-down period of stretching exercises

I am thinking of having hip replacement surgery. How long should the new total joint implant last?
Studies show that more than 90 percent of total joint replacements last 15 years if appropriate care is taken and all necessary precautions (as explained to you by your surgeon) are followed.

What type of shoes may I wear after total hip surgery?
The best type of shoe to wear after total hip or total knee surgery is one with a low, wide heel. A shoe with good shock absorption is preferred, such as a tennis shoe. Dress shoes should have a wide heel (no spikes) and should not be higher than two inches. The higher the heel, the more it alters the weight-bearing forces on the joints, which can cause pain and wear on the joints.

Please tell me why some people will have a very stiff, unmovable leg for about a week after a total hip replacement, while others have no problems at all?
Some patients will have stiffness following a total hip replacement that may last even longer than a week. This depends on the type of underlying disease for which the joint was replaced and sometimes on what was done at the time of hip replacement. Some patients, such as those with ankylosing spondylitis or severe osteoarthritis who have long-term stiffness or contractures, will tend to have more stiffness in the early postoperative period. Also, in patients who need lengthening of the operated side, many times the tissues are stretched. This causes a feeling of stiffness until the scar tissues stretches. It is also somewhat dependent upon the amount of swelling of the tissues in the post-operative period. This has to do with the fragility of the blood vessels and the operative technique. Fortunately for hip replacement patients, even though there is a period of stiffness, many times this resolves with exercises. Should a small amount of motion not be regained, this is rarely limiting in everyday activities.
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Sports medicine
What is turf toe?
Turf toe comes from hyperextension of the MTP joint of the great toe. This can range from a mild sprain to complete dislocation. Predisposing factors include hard artificial playing surfaces such as Astroturf, soft soled athletic shoes that allow hyperextension of the forefoot, and pre-existing limited motion of the first MTP joint. Treatment is usually directed towards stiffening of the forefoot of the shoe, using an orthosis, or taping.

What is a Jones fracture?
This is a common fracture of the fifth metatarsal of the foot which commonly occurs from constant landing on the outer side of the foot in jumping types of sports. This has a high incidence of not healing, and needs to be treated with complete non-weight bearing initially. A large percent of these fractures eventually require surgical intervention.

I have a painful heel spur. Should it be removed?
Not necessarily. Initially, your treatment will be directed toward relieving the pain and inflammation. If these disappear, the bone spur will not need to be removed.

How do you treat skier's thumb?
This happens in many sports when an athlete falls onto their hand with the thumb stretched out. This tears the ligament which connects two joints in the thumb. To prevent weakness and instability, this typically needs to be repaired when a complete tear occurs. When it is a partial tear, it can be treated in a splint or cast.

Am I a candidate for cartilage transplantation?
Many of our patients have heard about cartilage cell transplantation. This is a new technology, which has been featured in the news recently. It is an exciting new procedure available now, but should only be used for special circumstances.

Every time I play tennis, I get a sharp pain in my elbow. I have been told I have "tennis elbow." What can an orthopedic surgeon do to treat this problem?
"Tennis elbow," or tendinitis, is a result of repetitive elbow motion and may occur even if you do not play tennis. Over 95 percent of all individuals experiencing "tennis elbow" improve with the use of anti-inflammatory medication, occasional steroid injections, a tennis elbow strap, and appropriate physical therapy and exercise. Very few cases actually require surgery. If conservative treatment fails to relieve the pain, injection of a steroid into the area of maximum tenderness is indicated.

I developed a bump on the inside of my wrist, and my primary care physician said it was not a tumor but a ganglion cyst, and I had nothing to worry about. What exactly is a ganglion cyst?
A ganglion is a fluid-filled cyst. It also is called a synovial cyst. It grows from the tendons or the lining (synovium) around bones. If the ganglion is small and does not bother you, there is no need to do anything about it. If it gets bigger or starts bothering you, you can have it removed by an orthopedic surgeon.

Ganglions are benign growths and not a form of cancer. They can grow almost anywhere there are bones and tendons, although most often they form on top of the wrist. A cyst is a sac, usually filled with fluid. The fluid in most cysts is thin and watery, but the fluid in a ganglion is thick and clear, almost like jelly. Ganglions sometimes resolve on their own. Occasionally a ganglion will break or rupture under pressure, and usually will clear up.

$knee fracture$

What causes a stress fracture?
Stress fractures are microscopic fractures of bone resulting from repeated "stress," usually from bearing your own weight. Unlike typical fractures, which involve bones snapping in two, stress fractures are microscopic cracks that are often too tiny to show up on a routine X-ray.

Stress fractures can be caused by trauma or overuse resulting from hiking, jogging, or even just being on your feet too long, particularly if you have osteoporosis — thinning of the bones.

Once your doctor diagnoses a stress fracture in your foot, you will have to keep weight off your foot as much as possible, and allow at least a few weeks for healing. In some cases, patients need a cast to give the foot extra support while it heals.
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