Psoriatic Arthritis

What Is Psoriatic Arthritis & How Do You Treat It?

What is Psoriatic Arthritis

Arthritis describes any condition where cartilage in the joint breaks down. Normally, a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and glide against one other. Arthritis can result when these smooth surfaces become irregular as the cartilage breaks down. This results in surfaces that don’t fit well together anymore, essentially “wearing out.

Psoriatic arthritis is a condition in which the lining of the joint gets inflamed and swollen.  Because this inflammation stretches the tissues that keep the joint strong, the joint may become loose or crooked.  Also, the smooth ends of the bones wear out, and the bone may lose its normal shape.  Psoriatic arthritis can affect any joint in the body, and it affects men and women equally.

Psoriasis is a skin condition where people’s skin becomes dry, red, and flaky (Figure 1).  It can affect any part of the body. Up to 30% of people with psoriasis develop psoriatic arthritis, according to the National Psoriasis Foundation.

Arthritis can be debilitating when it affects the hands and fingers.  The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infections, gout, and psoriasis.

The changes in the joints with psoriatic arthritis are a lot like those in rheumatoid arthritis. These symptoms can include:

  • Red and swollen joints
  • Joints that sometimes feel warm
  • Decreased joint motion and stiff-feeling joints

With this condition, the hands may not be affected equally.  It may be hard to tell psoriatic arthritis from other types of arthritis because most types of arthritis have symptoms of stiffness, swelling, and pain.  In psoriatic arthritis, the swelling often affects the whole finger but more at the middle joint (figure 2).  There may be pitting, ridging or crumbling of the fingernails.  The joint at the end of the finger may become deformed (figure 3).  Other parts of the hand and wrist are not usually affected.

Diagnosis

Psoriatic arthritis is suspected when people have psoriasis and develop problems with their joints.  The doctor will mainly look at and feel the hand and look at x-rays.  X-rays may show loss of the normal shape of the bone, mainly at the end joint.  X-rays may also show swelling around the bone, and the space between the bones may become narrow.  The bones may fuse together at a joint.  There is no special blood test to find out if one has this arthritis.  A piece of skin can be removed to help find out if a person has psoriasis.

Treatment

There is no cure for psoriatic arthritis, but there are medications available to help lessen swelling, redness, and pain to keep the hands functioning as well as possible.  Different medical specialists usually work together to help with the treatment of this arthritis, including physicians and therapists.

Surgery may help treat the problems of psoriatic arthritis.  The type of surgery needed depends on the problems one has with use and pain.  A hand surgeon will help guide you to the best treatment for your particular concerns.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Shoulder Fracture Treatments at Ortho Sports Med in Portland Oregon

Types of Shoulder Fractures

Shoulder fractures can result from a fall on the shoulder, a motor vehicle accident, contact sports, etc.

The shoulder is a complex joint connecting the arm to the body. The shoulder bones include the humerus (upper arm bone), the scapula (shoulder blade) and the clavicle (collarbone) (Figure 1). The upper end of the humerus has a ball-like shape that connects with the socket of the scapula, called the glenoid. Disruption of any of the parts of the shoulder can create difficulty with its function.

Types of Shoulder Fractures

The type of fracture varies by age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is of the top part of the humerus (proximal humerus). Some types include:

  • Clavicle Fractures: This is the most common shoulder fracture, frequently the result of a fall (Figure 2).
  • Scapula Fractures: Fractures of this bone rarely occur. They usually result from high-energy trauma such as motor vehicle accidents or a far fall.
  • Proximal Humerus Fractures: Fractures of the upper part of the arm are more common in the older (over 65 years of age) population. Sometimes, there are just cracks in the bones, but they have not moved very far out of their normal position.

Some fractures are diagnosed using x-rays. Sometimes, a CT scan is needed to see more detail.

Treatment

Treatment for these fractures can vary. Some options include:

  • Simple sling or “figure 8” strap worn for three to eight weeks, depending on the patient’s pain.
  • Surgery, which may include placing plates and screws or wires and sutures (Figure 3). This is more often needed when there is injury to the glenoid (shoulder socket) or when broken bone pieces are severely out of place.

Once healed, there may be a bump over the fracture site which may decrease with time, but sometimes a bump will remain permanently. Shoulder movement can begin as soon as pain goes away; return to sports cannot occur until full shoulder strength returns. Return to contact sports would be considered only when the fracture is fully healed as shown on an x-ray.

Selection of treatment depends upon the patient’s activity level, the location of the fracture and the severity of the fracture.

Recovery

Shoulder fractures may leave a patient with permanent shoulder stiffness, regardless of how well the bones were repaired or joint replacement performed. Recovery may require the use of physical therapy to assist in improving motion and strength. Consult your physician for the best option.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

Dr. Petit Presents at the Vail International Shoulder Summit

Dr. Petit Presents at the Vail International Shoulder Summit

Dr. Petit gave lectures on complex shoulder replacement (arthroplasty) along with shoulder arthroscopy and biceps tenodesis to the international audience. Attendees included shoulder surgeons from around the world as well as physical therapists, athletic trainers, and primary care providers. Top shoulder surgeons from around the world making presentations during Summit at Sonnenalp Vail April 6th and 7th.

VAIL, Colo., April 6, 2018 – The latest and most up-to- date methods and technologies in shoulder surgery will be the primary topics of discussion at the Vail International Shoulder Summit on April 6th and 7th at the Sonnenalp Hotel in Vail. The Summit is sponsored by Steadman Philippon Research Institute (SPRI), with The Steadman Clinic’s own Peter Millett, MD, MSc serving as the primary host of the event.

The two-day session begins today, Friday, April 6th with SPRI clinical fellowship and International scholar alumni attending. The Summit continues Saturday the 7 th and is open to all orthopaedic surgeons, athletic trainers, physical therapists and professionals in orthopaedics and sports medicine.

Dr. Millett – who is a shoulder, knee and elbow specialist at The Steadman Clinic and has practiced sports medicine there since 2005 – looks forward to the variety of topics that will be discussed at the weekend’s Summit.

“The meeting is truly an international one with surgeons coming from all over the world to speak and present on their areas of expertise,” said Millett. “One of the benefits of the meeting is that, by design, there is ample time for discussion and one-on- one interaction between the presenters and the audience. It’s more like a think tank, incubator type of meeting than a convention, and that’s by intent.”

While Millett and SPRI have played host to numerous national and international conferences over the years that have focused on shoulder surgery and injuries related to the shoulder, this marks just the second time that they have included a day solely for returning alumni.

“Since so many of us know each other so well,” continued Millett, “it creates more openness and frank dialogue. This format allows us to be less reserved, more candid, and therefore more likely to get real advancements. It leads to some great discussion and helps us all learn more about the latest innovations in shoulder care.

“I think the venue in Vail really facilitates a lot of interaction, which no doubt creates a good cross-pollination of ideas,” added Millett. “Hopefully it not only serves as a forum where there is a lot of sharing of knowledge, but also spurs innovation.”

The Shoulder Summit begins Friday with presentations on the AC joint, bicep tendon, shoulder instability and rotator cuff tears. Saturday’s agenda includes segments on shoulder joint preservation and shoulder arthroplasty (total shoulder replacement surgery).

In addition to Millett, Burak Altintas, MD and Robert Boykin, MD will be serving as course directors for this year’s Shoulder Summit. Altintas, a German orthopaedic surgeon—originally from Turkey—is currently serving as an International scholar at SPRI, working closely with Millett and specializing in shoulder injuries and surgery. Boykin, who trained at Harvard, is a former sports medicine fellow at The Steadman Clinic and now practices as an orthopaedic surgeon in Asheville, N.C.

Other key presenters include The Steadman Clinic and SPRI’s own Matthew Provencher, MD and Johnny Huard, PhD. Provencher—a shoulder, knee and sports surgeon at The Steadman Clinic—will concentrate his talks on shoulder instability. Huard—Chief Scientific Officer and Director of the Center for Regenerative Sports Medicine at SPRI and recently named a recipient of the prestigious 2018 ORS (Orthopaedic Research Society) Kappa Delta Award—will talk about the use of biologics in the shoulder during Saturday morning’s discussion on shoulder preservation.

Treating Finger Fractures at Orthopedic Sports Medicine in Downtown Portland Oregon

Will I Need Surgery on My Broken Or Fractured Finger?

Although the bones in the hand are small, a broken (fractured) finger is not a minor injury. The bones in a normal hand line up precisely. They let you perform many specialized functions, such as grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can cause your whole hand to be out of alignment. Without treatment, your broken finger might stay stiff and painful.

Anatomy

Your hand consists of 27 bones: eight bones in your wrist (carpals), five bones in the palm of your hand (metacarpals), and 14 bones in your fingers (phalanges). Fractures of the metacarpal bone that leads to the little finger account for about one-third of all hand fractures in adults.

Cause

Generally, a fractured finger occurs as the result of an injury to the hand. You can fracture a finger when you slam your fingers in a door, when you put out your hand to break a fall, or when your finger jams while trying to catch a ball. Carelessness when working with power saws, drills, and other tools can result in a fractured finger.

Symptoms

  • Swelling of the fracture site
  • Tenderness at the fracture site
  • Bruising at the fracture site
  • Inability to move the injured finger in completely
  • Deformity of the injured finger

Doctor Examination

If you think you fractured your finger, immediately tell your doctor exactly what happened and when it happened. Your doctor must determine not only which bone you fractured, but also how the bone broke. Bones can break in several ways: straight across the bone, in a spiral, into several pieces, or shatter completely.

Your doctor may want to see how your fingers line up when you extend your hand or make a fist. Does any finger overlap its neighbor? Does the injured finger angle in the wrong direction? Does the injured finger look too short? Your doctor may x-ray both of your hands to compare the injured finger to the uninjured finger on your other hand.

Treatment

Nonsurgical Treatment

Your doctor will put your broken bone back into place, usually without surgery. You will get a splint or cast to hold your finger straight and protect it from further injury while it heals. Sometimes your doctor may splint the fingers next to the fractured one to provide additional support. Your doctor will tell you how long to wear the splint. Usually a splint on a fractured finger is worn for about 3 weeks. You may need more x-rays over this time so that your doctor can monitor the progress of your finger as it heals.

Surgical Treatment

Depending on the type and severity of the fracture, you may need surgery to put the bones into alignment. Small devices, such as pins, screws, or wire, will be used to hold your fractured bones together.

Rehabilitation

You may begin using your hand again as soon as your doctor determines it is okay to move your finger. Doing simple rehabilitation exercises each day will help reduce the finger’s stiffness and swelling. You may be required to see a physical therapist to assist you in these exercises.


Orthopedic Sports Medicine Center of Oregon is located in Downtown Portland Oregon. Dr. Dominic Patillo, one of our Board-Certified Orthopedic Surgeons, specializes in hand surgery. His practice focuses on the treatment of both simple and complex hand and upper extremity conditions as well as general orthopaedic trauma. He is experienced with modern microsurgical techniques including nerve and vessel reconstruction.

Common problems treated include:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, please consult our hand specialist Dr. Dominic Patillo for a consultation.

GOLF INJURIES TO THE HAND, WRIST OR ELBOW

Golf Related Injuries to the Hand, Wrist, and Elbow

Description

Hand, wrist and elbow injuries are common for golfers of all skill levels. The golf swing is a complex, coordinated series of motions. Golf injuries can result from poor technique, overuse or a single direct blow, like hitting a tree root.

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Broken Arm: Signs, Symptoms, & Treatments

Broken Arm: Signs, Symptoms, & Treatments

Description

A broken bone is commonly known as a fracture. Any bone in the arm can be broken, but common areas for fractures in the arm are:

  • Wrist, specifically the distal radius
  • Forearm bones (radius and ulna) (Figure 1A)
  • Elbow
  • Humerus
  • Shoulder

Causes

Most broken arms are caused by trauma. In younger people, common causes are falls from a height, sports injuries and motor vehicle accidents. In older people with weaker bones, a trip and fall from a standing height is a common cause of a broken arm.

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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome: Causes, Symptoms, and Treatments

Description

Carpal tunnel syndrome is essentially a pinched nerve in the wrist. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand (Figure 1). Carpal tunnel syndrome happens when swelling in this tunnel puts pressure on the nerve.

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Fractures in Children

Fractures in Children: Causes, Symptoms, & Treatment

Description

Because children are still growing, their injuries need different evaluation, and sometimes different treatment.

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OSM expands to include new location in Providence Hospital

We are pleased to announce we have expanded our practice to three locations. You may now find us at:

Portland

1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Monday – Friday
8:00am – 4:30pm


Providence

5050 NE Hoyt, Suite 668
Portland Oregon 97213

Mon, Wed, Fri
8:00am – 4:30pm


Scappoose

51385 SW Old Portland Road, Suite A,
Scappoose Oregon 97056

Friday
8:00am – 2:00pm

We are currently accepting new patients at all three locations.

If you’re looking for orthopedic care in the Portland-Metro area, feel free to give us a call at 503-224-8399.

Dr. Switlyk Retirement Announcement

SubstandardFullSizeRenderWe are both happy and sad to announce that Dr. Paul Switlyk is now officially retiring from OSM.

About Dr. Switlyk

Dr. Switlyk graduated from the C.M.D.N.J New Jersey Medical School in 1979. He interned at the Medical Center Hospital of Vermont through 1980 and completed a four-year residency at Oregon Health & Science University in 1986. He completed a shoulder fellowship at University of Western Ontario with Richard Hawkins MD. Dr. Switlyk has practiced in Portland since 1987 and is board-certified with a special interest in the treating the shoulder and elbow. He has also served as a Clinical Senior Instructor in the Orthopaedics & Rehabilitation Department at OHSU.

OSM would like to thank Dr. Switlyk for his years of dedication and wish him a long and happy retirement!