July 13, 2011

Non-Steroidal Anti-Inflammatory Drugs: To Take, or Not to Take?

Sanjeev Suratwala, MD

The use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, is considered the cornerstone of medical treatment of osteoarthritis. A new study has recently suggested that there may be a tie between the duration and use of NSAIDS and recurrent heart attacks. These medications are comprised of ingredients known to reduce pain and fever, and in higher doses, have anti-inflammatory properties. They are favored because they are non-narcotic and not considered to be habit-forming. They are also available over the counter in lower strengths.

These medications work by affecting the cyclooxygenase enzymes, which are important in the process of inflammation. Most NSAIDs affect both types of this enzyme, but newer medications like Celebrex only affect one type of this enzyme, potentially reducing the side-effect of gastrointestinal (GI) bleeding. The most common side effects of NSAIDS are ulcer formation, bleeding, and affect on the kidneys. Recent studies have suggested that these medications can increase the risk of heart attacks in patients with coronary artery disease.

A recent article in the journal Circulation reviewed the duration of treatment with non-steroidal anti-inflammatory medications in relation to the risk of death and recurrent heart attacks in patients with prior heart attacks. Over a 10 year period, a total of 102,138 patients were admitted with a first-time heart attack, and of these 83,675 (81.9 percent) were included in the study. Diclofenac (brand names Cataflam, Voltaren XR, Arthrotec) was associated with increased risk from the beginning of treatment, whereas Ibuprofen showed an increased risk when used for more than one week, and Celebrex after 14 to 30 days. Naproxen (brand names Aleve, Naprosyn) was not associated with increased risk for the entire duration treatment. Full Post - to Detail View

March 02, 2011

Ankle Sprains: Common Injury Can Cause Persistent Symptoms

Mark Drakos, MD

Ankle sprains are the most common athletic injury, with an estimated 30,000 per day in the United States alone and a particularly high prevalence in certain sports, such as basketball. Despite such a high frequency, conventional wisdom has resulted in most physicians recommending various forms of conservative management with the adage “all these injuries get better.” More recently, however, careful assessment of these injuries has revealed that 10-40 percent can result in persistent symptoms, which can be due to a number of different problems including tendon tear or dislocation, underlying cartilage damage and recurrent ankle sprains.

Depending on severity of the injury, the time tested gold standard in treatment of ankle sprains remains non-operative management, which is a well accepted and typically successful treatment choice for most patients. This includes the RICE protocol (Rest, Ice, Compression and Elevation), early range of motion, progressive weight bearing guided by symptom tolerance, and physical therapy. It is very important to reduce swelling in the immediate post-injury period by applying a compressive wrap, icing for 20 minutes at least twice daily and protected weight bearing with a walker boot or ankle brace. This will expedite healing and protect the ankle while it is still vulnerable. More importantly, reducing the swelling will help the ankle ligaments assume their natural position. If the ankle remains swollen for longer periods, the ligaments may heal in a stretched out position making them less functional.

The vast majority of patients who undergo conservative treatment will have an uneventful post-injury course and return to sport and/or routine activity within 6 weeks. However, some patients will go on to develop persistent symptoms including recurrent sprains and pain. A rehabilitative program should always be considered the first-line treatment in any patient with recurrent ankle sprains, with patients usually reaching a maximum benefit at 6-12 weeks. Any patient who exhibits recurrent sprains or episodes of giving way after that time or has associated injuries such as swelling, locking or catching may be a candidate for surgery. Such patients should be evaluated by an orthopedist to discuss options to decrease the risk for future ankle problems such as arthritis.

The orthopedic surgeons at North Shore-LIJ offer a comprehensive approach to the treatment of a broad range of foot and ankle conditions. If you have persistent ankle pain or loss of motion/ weight bearing ability due to recurrent sprains or other associated injuries, please visit orthopedicscience.com for more information on scheduling an appointment with an orthopedic surgeon. Full Post - to Detail View