Our dedicated team at the groundbreaking of the new surgery center Determination magazine

volume 9 2018/2019

“Quality Care from People Who Care”

Free Copy www.missoulaboneandjoint.com Please Take Phone (406)721-4436 Satellite Clinics Quality Patient Care Closer to Home

Polson Polson & Specialty Clinic Plains Dr. Glenn Jarrett 2nd & 4th Friday of the month

Plains Missoula Orthopedic Clinic Dr. Jeff LaPorte Stevensville Every Tuesday Hamilton

Stevensville Foot & Ankle Specialty Clinic Missoula Dr. Brent Roster 2360 Mullan Road, Suite C 1st Friday of the month Missoula, Montana 59808 (406) 721-4436 x 2 1-866-721-4436 Toll Free Hamilton (406) 721-6053 Fax Hand & Wrist Specialty Clinic To schedule an appointment Dr. Charlie Sullivan call our Missoula clinic at (406) 721-4436 x2 3rd Thursday of the month or visit www.missoulaboneandjoint.com and • Spine & General Orthopedics Clinic Dr. Michael Woods 1st Friday of the month

| www.missoulaboneandjoint.com | One Location – Many Services

Orthopedic Clinic Orthopedic urgent care Physical Therapy SURGERY CENTER (ASC) Monday-Thursday 8:30am-5:30pm Walk-in clinic Monday-Thursday 7:00am-7:00pm Monday-Friday 6:00am-5:00pm Friday 8:30am-5:00pm Monday-Thursday 8:30am-7:00pm Friday 7:00am-6:00pm 2360 Mullan Road, Suite B 2360 Mullan Road, Suite C Friday 8:30am-5:00pm 2360 Mullan Road, Suite D (406) 542-9695 Missoula, Montana 59808 Saturday 9:00am-2:00pm (406) 542-4702 (406) 542-9703 Fax (406) 721-4436 2360 Mullan Road, Suite C (406) 541-8240 Fax 1-866-721-4436 Toll Free (406) 721-4436 (406) 721-6053 Fax Urgent Care Direct (406) 829-5581

In This Issue... Dear Friends, 2 MBJ Satellite Clinics Quality care from people who care is the core of Missoula & . 4 Running Gait Analysis We truly care about our patients and the community we all live in. We 6 Effectively Treating strive to accommodate your orthopedic needs in a timely manner. Our Patellofemoral Joint Pain Urgent Care walk-in clinic has been successful in helping people with acute orthopedic injuries for initial evaluation and to start an appropri- 7 What is ACI? ate treatment plan. 8 Sacroiliac (SI) Joint Pain Our surgeons replaced their surgical tools with shovels for a ground Get to Know Your Doc! 10 breaking ceremony of the new Surgery Center in June 2018. The site Dr. Rob Amrine of the new and improved surgery center is the vacant grassy lot between 11 Urgent Care at MBJ our clinic and Mullan Road. The surgery center will continue to pro- 12 MBJ Physicians & Physician Assistants vide services and care for our day surgery patients having surgery to the 14 MBJ Services shoulder, , , hand, wrist, foot and ankle. Outpatient total joint 15 A Different Approach for replacement procedures and outpatient spine procedures will be added to our services as the new facility will have the capability of extending Total Hip Surgery a patient stay up to 23 hours. If your doctor anticipates you needing 17 DXA Bone Density Scans more than 23 hours of specialized care after surgery, your surgery will be 18 Get to Know Your Doc! scheduled at one of the local hospitals. Dr. Brent Roster We will continue quality care for patients with bone and joint injuries 19 Total Ankle Replacement – TAR and conditions, as we have done for over 60 years. Our new state of 20 Breathing Matters the art facility will allow us to expand our services and still continue to 22 Proper Cast Care provide compassionate, cost effective care to a wide variety of patients. 23 Body Composition Scans

Missoula Bone & Joint magazine is See you in the beautiful Montana outdoors, designed and published by Custom Medical Design Group, Inc. To advertise Michael Woods, M.D. in an upcoming issue please contact us at 800.246.1637 or visit us online at 2018/2019 President, Missoula Bone & Joint www.CustomMedicalMagazine.com. This publication may not be reproduced in part or whole without the express written “Quality Care from People Who Care” consent of Custom Medical Design Group, Inc.

| www.missoulaboneandjoint.com | 3 Running Gait Analysis

Kristina Pattison, DPT, OCS, CSCS Missoula Bone & Joint Physical Therapist

Kristina on Holland Peak in the Bob Marshall Wilderness

Have you ever thought about how you run and develop a corrective program to improve your running how your body moves with each foot strike? Kristina performance and reduce your risk for injury. Pattison is passionate about helping runners to move Running and walking is a repetitive action. Many stronger and faster and avoid injury. Running Gait injuries are often caused, at least in part, by poor Analysis is the best way to develop a program specific biomechanics. The following are a list of common for you. Kristina says "maintaining full joint range of overuse injuries associated with poor gait biomechanics. motion and functional stability required for running • shin splints takes a small investment of time that pays off with reduced risk for injury and improved performance." • plantar fascitis Gait is the way in which we move our whole body • Illiotibial band syndrome (runners knee) from one point to another. Therefore, Gait Analysis • Patella tendonitis (jumpers knee) involves walking or running on a treadmill under the • Patellofemoral knee pain watchful eye of Kristina. A video recorder will also be • Achilles tendonitis utilized to capture your walking and running style. She will analyze the way you move, closely observing your • Lower Back Pain feet, , and . Kristina can then show Biomechanical problems are usually caused you what is happening to your at the different by muscular imbalances - tight muscles working phases in your walking and running motion using slow against weak muscles. Sometimes they can be caused motion video and freeze frame. Kristina can identify by structural problems, for example leg length areas of weakness and poor biomechanics and then discrepancies resulting in hip hiking.

4 | www.missoulaboneandjoint.com | Examples of biomechanical abnormalities include: • Overpronation A Professional Limited Liability Partnership • Oversupination • Increased Q angle A full service law firm built upon a strong tradition of • Hip hiking - lifting the hip on one side providing exceptional legal • Limited ankle dorsiflexion representation to business and • Pelvic Tilt individuals across Montana. Kristina Pattison is an ultra-distance mountain runner, doctor of physical 350 Ryman Street therapy, board certified clinical specialist in orthopedics and certified strength Missoula, MT and conditioning specialist in Missoula, Montana. (406) 523-2500 Keep your stride strong and your running swift! Call today to schedule www.garlington.com your appointment with Kristina at Missoula Bone & Joint Physical Therapy (406) 542-4702. Attorneys at Law Since 1870

Hyaluronic Acid Injections for Knee Joint

Hyaluronic acid (HA) can be injected in to the knee joint to work right at the source of your pain. In healthy knees, HA is a thick, slippery fluid that helps cushion, lubricate and protect the joint tissue. The injected HA helps protect your existing and can provide pain relief for 6-12 months. Speak to your orthopedic provider to learn what is best for your condition.

| www.missoulaboneandjoint.com | 5 Effectively Treating Patellofemoral Joint Pain

Patellofemoral joint pain (PFJP) is familiar to • Training errors may be the most prevalent cause of PFJP. individuals of all ages and activity levels. Named for Increasing activity or exercise intensity or duration too the joint formed by the patella (knee cap) and the rapidly results in tissue breakdown. trochlear groove of the femur (thigh bone), PFJP may • History of prior injury contributes to the health and be referred to as runner’s knee, anterior knee pain, or function of our joints. Prior fractures, orthopedic chondromalacia. Patellofemoral joint pain accounts , and trauma predispose the knee joint to 1 for 25% of all knee disorders and 42% of all running degenerative changes. injuries2. The difficulty in treating PFJP lies in the numerous causes and complex structures involved. • Body mass index (BMI) and social factors must not be overlooked when treating PFJP. BMI is the ratio of height Symptoms are usually located beneath the patella, in the to weight. Simply put, the higher your BMI, the greater patella tendon (below the patella), or along the medial- the impact load through the patellofemoral joint. lateral sides of the patella. Symptoms may include crepitus (clicking, cracking), swelling, tender-ness to touch, Treatment: and pain with squatting, descending stairs, running, or Physical therapy alone will not cure patellofemoral joint prolonged sitting. pain. The correct physical therapy intervention over a period Possible Causes: • Poor joint kinematics or poor tracking of the patella over the trochlear groove of the patella combined with excessive or repeated joint loading may cause PFJP. • Poor strength and stabilization in the supporting musculature results in increased compression and-or 3 torsional forces through the patellofemoral joint. John Fiore, PT Holly Warner, DPT Jesse Dupre, DPT Kate Hughes, DPT SERVING ACTIVE MISSOULIANS FOR 22 YEARS SPECIALIZING IN:

• Joint Pain & Overuse Injuries for Athletes of All Ages • Running & Athletic Injury Experts • On Site High Speed 2D Video Running Gait Analysis • Pre & Post-Operative Rehabilitation • Back & Neck Pain Treatment • Work-Related Injury and Work Hardening • Functional Capacity Evaluation • Core & Functional Strengthening for Athletes • Manual Therapy & Dry Needling • Biomechanical Movement Evaluation • Total Joint Replacement Rehabilitation

1705 Bow St. • Missoula, MT 59801 549-5283 • Early & Late Appointments Available See us at www.sapphirept.com

6 | www.missoulaboneandjoint.com | What is ACI?

By Dr. Michael Wright Missoula Bone & Joint Orthopedic Physician Specializes in Sports Medicine and General Orthopedics

Autogenous Chondrocyte Implantation (ACI) is a procedure used to treat painful cartilage defects, primarily in the knee. This procedure is best suited for young patients without preexisting arthritis in their joint. The procedure is performed in two stages. In the first stage, a small sample of cartilage is harvested during knee . The sample is then sent to a lab where the cartilage cells are expanded. The new, amplified tissue is sent back to the surgeon. In the second stage of the procedure, the tissue is implanted into the articular cartilage defect in the patient’s knee with the goal of creating a stable cartilage filling and alleviating the knee symptoms. Prior generations of this technique, which were popularized in Europe, required the cells to be in liquid form which made implantation tedious and challenging. The newest generation of this technology (matrix autogenous chondrocyte implantation or MACI) utilizes a porcine membrane to contain the newly grown cells and allow more effective implantation. of time coupled with appropriate diagnostic testing will. A physical therapist trained in effective evaluation of strength, functional movement, medical references: history, and sport or activity demands can narrow the cause of one’s unique PFJP symptoms. 1. Mullaney MJ, Fukunaga T. Current An individualized rehabilitation program should address joint mechanics, concept sand treatment of patellofemoral quadriceps, hip, gluteal, and foot-ankle strength exercises. Gradual eccentric compressive issues. Int J Sports Phys Ther (muscle lengthened) loading of the patellofemoral joint at varying degrees 2016 Dec;11(6):891-902. of knee flexion will improve tensile strength of the patella tendon and 2. Taunton, et al. A retrospective case-control supporting structures. Utilizing visual and verbal feedback while performing analysis of 2002 running injuries. Br J single leg strengthening exercises, has been shown to be effective in reducing Sports Med 2000;36:95-101 compensatory movements of the hip, pelvis, and knee which contribute to PTJP.4 3. Lankhorst NE, Bierma-Zeinstra SM, Finally, simulating the necessary functional demands through a return to sport VanMiddelkoop M. Factors associated or activity program will insure long-term success. Utilize Missoula’s medical with patellofemoral pain syndrome: a and training experts to enjoy our incredible recreational opportunities without systematic review. Br J Sports Med 2013; patellofemoral joint pain. Mar;47(4):193-206. 4. Willy RW, Davis IS. The effect of a hip- strengthening program on mechanics By John Fiore, during running and during a single-leg Physical Therapist squat. J Orthop Sports Phys Ther; 2011 Sapphire Physical Therapy Sep;41(9):625-632.

| www.missoulaboneandjoint.com | 7 Sacroiliac (SI) Joint Pain

Dr. Michael Woods Missoula Bone & Joint Orthopedic Physician Specializes in Spine Surgery and General Orthopedics

SI Joint pain typically begins with an injury to of your pain. If SI joint dysfunction is diagnosed the ligaments that are meant to hold the SI joint early, nonsurgical treatment options may include in place. The injury can occur as the result of a activity modification, optimized pain medication, fall on the buttocks, simple misstep off a curb, physical therapy and SI joint injections. The goal is car accident, pregnancy, or any other injury to to help you manage the pain, ease stress on the SI the pelvis. Another common cause of SI joint joint, and balance supporting musculature. If non‐ pain can be previous back surgery, especially surgical treatments fail there is a surgical solution. fusion. Like other joints, SI joints are subject to Dr. Woods says, “since the minimally invasive wear and tear and arthritis can develop. SI joint fusion procedure became popular over the The SI joint is formed by the connection of the last 7‐8 years, there have been a number of other sacrum (triangular bone at the base of the spine) companies that have developed implants using and the right and the left iliac (part of the screw‐based systems. However, the triangular Triangular Implant pelvis). Their primary function is to transfer weight iFuse Implant, available since 2009, is the from the upper body to the lower body. The normal SI joint only SI joint fusion device with multiple clinical studies allows for a small amount of motion, called nutation, and is demonstrating improvement in pain, patient function and stabilized by a network of ligaments and muscles. With injury quality of life. I am a firm believer in the science behind or deterioration, that small rocking motion can lead to very the triangular, porous‐surface iFuse Implant and I have painful low back, buttock, groin and thigh symptoms. seen the success with the iFuse Implant first hand with If you think you may have SI joint pain, finding the right patients in my practice.” physician who can identify SI joint pain and serve as a good Dr. Woods understands that sacroiliac joint pain is detective is important. Dr. Michael Woods employs a wide very real and very painful. He has been interested in range of diagnostic examinations to determine the source the SI joint and its impact for years. He participates in SI joint study and research groups, helping to establish best practices for the diagnosis and treatment of SI joint Dr. Woods works conditions. He follows research and outcome-based with physical practices in collaboration with several major national and therapists in our international universities. Dr. Woods has performed over community to share 100 iFuse surgeries. He says, “it is so rewarding to see my his knowledge of patients get back to doing what they love to do - pain free.” the diagnosis and Want to learn more? Watch this video of a patient get- treatment of SI ting their life back! www.youtube/channel/missoulabo- Joint dysfunction. neandjoint. And visit www.missoulaboneandjoint.com/ Specialties/SpineSIJoint/SIJoint.aspx

8 | www.missoulaboneandjoint.com | | www.missoulaboneandjoint.com | Get to Know Your Doc! Dr. Rob Amrine Dr. Amrine is a board certified, fellowship trained sports medicine physician at Missoula Bone & Joint. He specializes in non-surgical acute and chronic issues for athletes of all ages.

Why did you choose a career in medicine or orthopedics? lines between chores or paid jobs of changing pipe, bucking I became interested in sports medicine due to my personal bales or building fence. Basically doing all the jobs that my interest in sports performance. I already had an interest parents or friends parents didn’t want to do, but would give in mechanical design, but as a wannabe athlete I became us kids some cash. fascinated in the concept of designing and maximizing the human machine for sport. Who do you look up to? I admire anyone who strives to put the interests of others What do you like to do for fun? before their own. Like many, I look to my family, my Honestly, most of my fun is directly correlated to what I wife, and my friends to guide me. I also feel fortunate do for a living. I still pretend to be a bike racer and dream to have so many teammates at MBJ that emulate this of a day of the “eternal winter” and endless days of skiing. selfless behavior on a daily basis. I still try to dunk at any chance possible, I still look for ad- miration when I do a wheelie, and still wonder why it feels What are your favorite movies? so good to rub dirt on a fresh wound after crashing hard. Shawshank Redemption continues to hold my interest with Some of the most fun I have is sharing these recreational so many great quotable lines, but Andy Durfresne said it experiences with those that have battled injuries, but have right, “Hope is a good thing, maybe the best of things, and returned to the mountains to play again. no good thing ever dies.”

What was your first car? Any other fun facts? I didn’t really have a car of my own until medical school I had a former coach prophetically tell me, “If you can’t when I purchased a Subaru Legacy Wagon. Before then, I play, then coach. If you can’t coach, then ref. And if you drove whatever my mom generously shared with me. The stink at all that, then go into sports medicine, Rob.” He majority of the time this was a minivan. sure was right!

Bucket list item? Japan skiing, Mountain biking Scotland, Cross country skiing in Norway...These are the highest on the list right now.

Where were you born? Or Tell us a little about your family and childhood. Dr. Michael Wright I was born in Missoula and went to school here until 7th completes the Missoula grade. I then moved to Hamilton where I transitioned from Half Marathon, July 2018, being a classic ball sport kid to being more of a mountain sport kid with skiing, hiking, and biking becoming a strong and is greeted at the finish part of my life. line medical tent by his colleague Dr. Rob Amrine, What was your first job? Medical Director for the My first real job with a W-2 was as a student athletic trainer Missoula Marathon. at the University of Washington working primarily with their football team. However, my first jobs were blurred

10 | www.missoulaboneandjoint.com | Urgent Care at MBJ

When Your Injury Can’t Wait Come Straight to the Specialists

Urgent Care is staffed by experienced Physician Assistants and backed by our Orthopedic Physicians

Walk-In Hours: Contact: Monday-Thursday 8:30am-7:00pm 2360 Mullan Road, Suite C MBJ Urgent Care Friday 8:30am-5:00pm (406) 721-4436 Saturday 9:00am-2:00pm Urgent Care Direct (406) 829-5581

| www.missoulaboneandjoint.com | 11 2018/2019 MBJ President Missoula Bone & Joint Physicians

Missoula Bone & Joint is dedicated to ensuring the highest level of professional care to each of our patients. We offer specialized care in many areas including sports medicine, joint replacements, Michael Woods, M.D. , hand and microvascular surgery, Spine Surgery Total Joint Replacement spine, foot & ankle, and general orthopedics. Sports Medicine

David Allmacher, M.D. Robert Amrine, M.D. Mark Channer, M.D. Glenn Jarrett, M.D. Total Joint Replacement - Hip & Knee Primary Care Total Joint Foot & Ankle Reconstruction Revision Total Joint Replacement - Hip & Knee Sports Medicine Replacement Surgery General Orthopedics

Jeffrey LaPorte, M.D. Christopher Price, M.D. P. Andrew Puckett, M.D. Brent Roster, M.D. Sports Medicine Sports Medicine Hand & Microvascular Surgery Foot & Ankle Surgery Joint Replacement General Orthopedics Shoulder Injuries

Colin Sherrill, M.D. Charles Sullivan, M.D. Gary Willstein, M.D. Michael Wright, M.D. Arthroscopy Hand & Microvascular Surgery Total Joint Replacement Sports Medicine, Sports Medicine General Orthopedics Sports Medicine Arthroscopic Surgery of the General Orthopedics Shoulder, Hip and Knee General Orthopedics

12 | www.missoulaboneandjoint.com | Missoula Bone & Joint Physician Assistants

Meagan Auch, PA-C Joan Bond-Deschamps, PA-C Scott Doherty, PA-C Physician Assistant Physician Assistant Physician Assistant

Jesse Doll, PA-C Douglas Henry, PA-C Wade Hudson, PA-C Vincent Keeney, PA-C Physician Assistant Physician Assistant Physician Assistant Physician Assistant

Clyde Kidd, PA-C Gregory Murray, PA-C Louis Westenfelder, PA-C Physician Assistant Physician Assistant Physician Assistant Resources for Patient Education:

Website Facebook YouTube Channel www.missoulaboneandjoint.com www.youtube.com Patient Information Search: Missoula Bone & Joint

| www.missoulaboneandjoint.com | 13 Missoula Bone & Joint Services

General Orthopedics Diagnosis and treatment of common injuries and diseases of the musculoskeletal system including bones, joints, ligaments, muscles and tendons. Sports Medicine Diagnosis and treatment of sports related injuries including ligament tears, cartilage injuries, joint instability, and overuse injuries. MRI is available on-site for your convenience Spine Disorders Diagnosis and treatment of spine disorders including thoracic and lumbar disorders, spinal stenosis, fractures due to osteopenia, hospital. Candidates for outpatient surgery are generally disc problems. healthy individuals whose surgeries do not need to be Hand and Microvascular Surgery done in the hospital setting. Diagnosis and treatment of hand, wrist and forearm conditions Creating a standard in Missoula of safe surgical practices, including trauma (fractures, nerve/tendon/ligament injuries), advanced techniques, and boasting extremely low infection arthritis, and nerve compression. rates, it’s easy to see why many patients choose having Foot and Ankle their surgery done at MBJ. Diagnosis and treatment of foot and ankle conditions including Bone Health Clinic ligament and tendon injuries, fractures, arthritis and deformities. Our Bone Health Clinic is led by Joan Bond-Deschamps, Joint Replacement PA-C, who provides comprehensive care for Diagnosis and surgical intervention for end stage osteoarthritis and low bone density. We offer on-site DXA scans to of knees, hips, ankles and/or shoulders including total joint measure bone density. replacement surgery. Revision of the hip & knee. Hospital Surgical Procedures • Joint replacement surgery Depending on your condition and diagnosis, you may require a • Joint replacement revision surgery surgical procedure. • Spine surgery Surgery Center Urgent Care Outpatient surgery at MBJ happens in our surgical suite adjacent Our Orthopedic Urgent Care Walk-In Clinic offers same to our clinic. Founded in 2011 and certified by the Accreditation day and next day appointments for urgent orthopedic Association for Ambulatory Health Care (AAAHC), our injuries. freestanding surgery center specializes in orthopedics, plastic, and reconstructive outpatient surgeries. Our doctors perform a On-Site Services wide variety of surgical procedures ranging from knee, hip, and In keeping with our objective of providing full orthopedic shoulder arthroscopies, hand & wrist surgeries, foot & ankle care to our patients, the following services are also available surgeries, ACL repairs, and rotator cuff repairs. Outpatient on site: surgery at an Ambulatory Surgery Center (ASC) is beneficial • Body Composition Scans to both the surgeon and patient. It is designed to facilitate an • Direct Digital X-Ray efficient and cost effective flow that centers around patient care. • Durable Medical Equipment The smaller environment creates a “family atmosphere” that is • DXA Bone Density Scans pleasant for both staff and the patient. Best of all, patients are • MR Imaging (See image above) able to go home to recover, rather than stay overnight in the • Physical Therapy

14 | www.missoulaboneandjoint.com | A Different Approach for Total Hip Joint Replacement Surgery

By Dr. Mark Channer Missoula Bone & Joint Orthopedic Physician Specializes in Total Knee and Surgeries

Unlike traditional minimally invasive hip replace- ment techniques that access the hip from behind (Posterior Approach), the Anterior Approach (or Anterior Supine Intermuscular Approach) uses an incision at the front (anterior) of the hip. By ap- proaching the hip joint from the front the surgeon can go between the muscles that surround the hip joint, reducing trauma to the tissues surrounding the hip. The goal for the patient is a shorter hospital stay and earlier mobilization. When non-operative treatment fails to control the discomfort and stiffness from arthritis of the hip, your surgeon may recommend total hip replacement. Pre-total hip Post-total hip replacement surgery replacement surgery

Joint replacement implants, typically made from metal alloy and polyethylene (plastic), are used to resurface the joint. This surgery replaces the upper end of the femur (thighbone) and resurfaces the acetabulum (socket). The desired outcome is to restore function and eliminate as much discomfort as possible while allowing you to return to a more active lifestyle.

Dr. Mark Channer is a board certified, fellowship trained orthopedic surgeon. He has been specializing in total hip joint replacement surgery for over 18 years. Dr. Channer now offers his patients the option of Anterior Approach for total hip joint replacement surgery.

| www.missoulaboneandjoint.com | 15 patient testimonial:

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16 | www.missoulaboneandjoint.com | DXA Bone Density Scans

Missoula Bone & Joint providers are working to raise awareness about the increasing prevalence of osteoporosis and the consequences of bone loss. Patients who meet certain risk factors for osteoporosis or low bone density are referred to our Bone Health Clinic for a complete evaluation. We assess all aspects of your bone health to help you better manage your osteoporosis and live a more active life. DXA bone density scans are available on-site at Missoula Bone & Joint Clinic. If you have any questions please call the DXA Technologist at (406) 721-4436 ext. 7115. We are here to help you navigate the best options for your comprehensive bone health. If you have already been diagnosed with, or are at risk for osteopenia or osteoporosis and are not being treated, our program A DXA (dual energy X-ray absorptiometry) bone density can help. If you have previously had a DXA scan at scan assesses your bone mineral density. The amount of bone another facility in the past 5 years, the International mineral density (BMD) relates directly to bone strength and is Society of Clinical Densitometry (ISCD) recommends very important in the prevention of fractures. The scanner uses that you continue assessment on the same DXA small amounts of x-ray to measure BMD and to produce images machine for continuity of care. If you have had a DXA of the spine, hip, and forearm. The spine and hip are typically scan at another facility you can still receive care at measured because that is where most osteoporotic fractures our Bone Health Clinic. We accept all primary care occur. To learn more visit www.missoulaboneandjoint.com/ physician orders for DXA scans. servicesandprograms/bonehealthclinic

Cortisone Injections for Joint Pain Relief

Cortisone injections typically provide short term pain relief and can be prescribed as part of a larger treatment plan. A Cortisone injection allows the orthopedic provider to deliver potent medicine directly into the inflamed joint. Depending on the patient and the condition being treated, a successful cortisone injection can help manage the joint pain anywhere from 1 week to 6 months. During this time most patients are also referred to Physical Therapy to stretch and strengthen their joints, muscles, and supporting soft tissue to help slow down the joint degeneration. Wearing a brace, losing weight and making lifestyle changes can also be helpful. When non-surgical options are unsuccessful you may be a candidate for a total joint replacement.

| www.missoulaboneandjoint.com | 17 Get to Know Your Doc! Dr. Brent Roster

Dr. Roster is a fellowship trained, board certified, orthopedic physician at Missoula Bone & Joint. He specializes in all conditions of the foot and ankle.

Why did you choose a career in medicine or orthopedics? Science and medicine has always interested me. I went to college thinking I'd be a small-town country veterinarian but changed my mind at some point during my first year. People are much more interesting than animals, and I couldn't imagine doing anything other than orthopedic surgery. What do you like to do for fun? I like spending as much time outside as possible hunting, fishing, camping, and exploring the great state of Montana. What was your first car? A 1992 Ford Explorer that I shared with my twin sister. What is on your bucket list? Most revolve around hunting. A big mature bull with my bow probably tops the list. I'm really looking forward to when my kids are old enough to hunt. At some point I'd like to visit New Zealand/Australia. Tell us about your family and childhood. I was born and raised in Klamath Falls, Oregon, a small logging/ farming town in Southern Oregon. I have a twin sister, Brooke. It was a great place to grow up and learn what it means to work hard and treat people well and with respect. I now have been married for 13 years and have 3 kids: Willa (7), Malin (5), and Wade (2). What was your first job? Double C Dog Kennel; I cleaned kennels, took care of boarded dogs and did a little grooming. Who do you look up to? My wife, Grace: the hardest-working person I know. I couldn't imagine my life without her. Best mom/wife around! What are your favorite movies? Tommy Boy, Dances With Wolves, Braveheart Any other fun facts? Everything clicked my senior year when my baseball team won the state championship; my college snowboard team took 2nd at Nationals.

18 | www.missoulaboneandjoint.com | Total Ankle Replacement – TAR

Your feet and ankles are extremely complex, with 26 bones, 33 joints, 107 ligaments, 19 muscles, 5 tendons, plus nerves and blood vessels. The large Achilles tendon extends from the calf muscles to the heel bone (calcaneus), and allows running, jumping, walking upstairs, and raising the body onto the toes. Ligaments attach bone to bone and are the stabilizers of the foot and ankle. The longest ligament is the Plantar fascia which forms the arch on the sole of the foot from the heel to the toes. The ankle joint is formed by the connection of 3 bones. The top of the ankle bone (talus) fits inside a socket that is formed by the lower end of the tibia (shin bone) and fibula. The Talus works like Dr. Roster test drives the knee rollabout a hinge to allow your foot to move up and down. Fortunately, the scooter, ideal for patients with foot or ankle ankle joint is designed to be strong and sturdy. It must withstand conditions that require non-weight bearing for 1.5 times your body weight when you walk and up to 8 times your a period of time. body weight when you run (www.eOrthopod.com). As weight-bearing structures, the feet and ankles are susceptible to all types of acute or chronic injures. People with severe ankle pain from is designed to relieve pain and preserve motion in arthritis may be candidates for a total ankle replacement surgery (also the arthritic ankle joint, by replacing the arthritic called “TAR” or “ankle ”). Ankle replacement surgery joint with a metal . This differs from another popular, but older procedure called ankle Pre-surgery ankle x-ray Post-surgery ankle x-ray fusion (or “ankle ”) referring to the bones growing together. can also alleviate pain; however, this procedure eliminates motion in the joint. Missoula Bone & Joint Foot & Ankle Specialists Dr. Roster and Dr. Jarrett have experience with multiple different implant designs and are very pleased with the surgery outcomes for their patients. Dr. Roster and Dr. Jarrett are passionate about the foot and ankle, and want to see their patients get their quality of life back. It is important to remember that patient selection and proper placement of the implant are key to an ideal The STAR™ ankle replacement shown here, uses a 3 part, mobile outcome. Call to make an appointment and see bearing device. what treatment options are best for you and your condition.

| www.missoulaboneandjoint.com | 19 Breathing Jason Miller, PT, MS, CSCS, PRC Matters Missoula Bone & Joint Physical Therapist Coming in a close second to the heart as our body's most important muscle, the diaphragm muscle serves as our air pump. It attaches to the ribs and spine, doming and relaxing as we exhale, flattening and contracting as we inhale. Due to its attachment to our skeleton, our body position influences how efficiently it can do its job. Often overlooked is the influence of spine and rib mobility. Without a neutral spinal position and adequate rib flexibility, the diaphragm’s efficiency decreases and stress increases on secondary breathing muscles of the neck and back. Increased tension in the neck and back can further alter spinal position and inhibit the trunk and hip rotation that needs to occur during daily movement. An ability to adequately depress (lower) and retract (pull in) your rib cage promotes good diaphragm movement and function of trunk stabilizers. Jason Miller, PT, MS, CSCS, PRC, is a physical therapist at Missoula Bone & Joint Physical Therapy. He recently became the first and only physical therapist in the state of Montana to be Postural Restoration Certified™, an approach to physical medicine that analyzes body position, movement, and breathing pattern to get to the root of dysfunction.

Resistance Training for Knee Osteoarthritis

Resistance training, done right, improves muscle strength and exercise endurance. For Physical Therapists treating patients with OA, the first step Missoula Bone & Joint is to get the affected joint moving so the patient Physical Therapy can participate in the prescribed therapy. The goal Let’s get you back to doing what you love! is about getting patients functional again and to educate patients on how they can help themselves Photo taken by Dan Weiss, MBJ employee at home.

20 | www.missoulaboneandjoint.com | Missoula Country Club No one will question your loyalty. Griz Banking debit card signals your die‐hard support Experience The Lifestyle for the University of Montana Grizzlies. Cardholders also receive special perks like on‐field access and invites to exclusive tailgates. Go Griz! It’s you and together. Find out more at firstinterstate.com

Benefits Include: Unlimited Golf on Montana’s Premier Championship 18 Hole Course • Free Golf Clinics – Men, Women and Juniors • Fully Stocked Pro Shop and Professional Club Fitting • Unlimited use of Driving Range and Short Game Practice Facility • Men’s, Women’s and Couples’ Leagues • Junior Golf Program • Club and Personal Cart Storage Available • Family Swimming Pool • Clubhouse, Lounge and Event Dining Family, Business, Associate, Single, Social and Non-Resident Memberships are available. Stop by for information or contact us at: Member FDIC. Equal Housing Lender. 406-251-2404 or email: [email protected]

Missoula Bone & Joint Ambulatory Surgery Center Coming 2019

thanks for bringing even more quality care to Missoula

MMW ARCHITECTS RESIDENTIAL - MULTIFAMILY - CIVIC Missoula, Montana - www.mmwarchitects.com COMMERCIAL - HEALTHCARE

| www.missoulaboneandjoint.com | 21 Proper Cast Care

Bone fractures are common but require immediate and direct medical intervention to set the course for successful long term healing. A bone can break if the external force is greater than the strength of the bone. The most common way to evaluate a fracture is with x-rays, which provide clear images of the bones. A fracture can heal successfully if the ends of the break at the fracture site are realigned and immobilized so that new bone healing can take place. A plaster or fiberglass cast is typically used to keep the broken ends in proper position. The cast is applied over at least one joint, sometimes two joints, to limit the movement of that joint and allow the bones to heal in place. For example, in a wrist fracture the cast covers the wrist joint. If the fracture is higher up the forearm the cast may need to cover the wrist and the elbow. Depending on the severity of the fracture and the age of the patient, the healing time may be 6-12 weeks. Follow up x-rays will monitor correct alignment and proper healing at the fracture site.

Symptoms of many fractures include: Dos and Don'ts of proper cast care: • painful, especially with movement • Do not put any object inside the cast to scratch • swelling and tenderness around the injury itching skin. • bruising • Do not use powder on itching skin. • deformity - a limb may look out of place or a part • Do not break off rough edges of your cast. of the bone may puncture through the skin • Do keep the cast dry (unless waterproof) and clean. During your recovery you will likely lose muscle Use two layers of plastic to keep cast dry while strength in the injured area. Specific exercises will help showering. Use masking tape, never a rubber band. you restore normal muscle strength, joint motion, • Do keep dirt and sand out of cast. and flexibility. Ask your orthopedic doctor if physical therapy can help with your recovery. • Do elevate the joint and move the other joints regularly. Casts don't heal broken bones on their own, they hold the affected area in place. It is very important that • Do move your injured, but swollen fingers or toes you also take care of your broken bone by restricting gently and often. activity, keeping it clean, and eating a well balanced • Do apply ice to the cast. Place the ice in a dry plastic nutritious diet. bag or ice pack and loosely wrap it around the cast.

22 | www.missoulaboneandjoint.com | • Do inspect the skin around the cast periodically. If your skin becomes red or raw around the cast, contact your doctor. • Do inspect the cast periodically. If the cast becomes cracked, develops soft spots, or becomes lose, contact the clinic. When to call the doctor: • Increased pain. • Numbness and tingling in your hand or foot. • Burning and stinging. • Excessive swelling that does not respond to ice and elevation. • Loss of movement of toes or fingers. • Fever. • Any other concerns you may have. If you are a patient at Missoula Bone & Joint our on-call physician is always available after hours for emergencies. Call our clinic at (406)721-4436 and the after hours answering service operator will put you in contact with the on-call physician. Body Composition Scans

Scales are misleading as body weight is comprised of muscle, fat and bone. With this test you will receive a detailed report with precise analysis of fat mass, lean mass, and total body fat percentage. The results are divided into measurements of each limb, torso, abdomen and hips. The scans also accurately measure the visceral fat around your organs (VAT score) which identifies your risk of cardiovascular disease and type 2 diabetes. Consecutive scans allow us to pinpoint exact fat loss and lean mass gain in response to diet and exercise changes. Body Composition Scans are now offered at Missoula You can optimize your training to suit your body's specific Bone & Joint. This is the gold standard test for body compo- needs. The results compare your scans to others your age sition analysis. It uses the same scanner used for DXA bone based on nationwide statistics. density tests. Start with a baseline scan to establish your goal. Assess This test is ideal for people who : progress midway through your goal. See visual comparisons of your results for each scan. Adjust your workout regime • Want to track changes in body composition in response and/or diet to get the results you desire. It's what’s on the to workout regimes. inside that counts! • Have been diagnosed with cardiovascular disease and To schedule your appointment please call (406) 721- want to track the effects of lifestyle changes. 4436 ext. 7115. For more information visit www.missoula- • Are embarking on a wellness challenge. boneandjoint.com/servicesandprograms/bonehealthclinic/ • Are competitive body builders. bodycomposition

| www.missoulaboneandjoint.com | 23 A NEW APPROACH TO HIP REPLACEMENT.

A NEW LEASE ON LIFE FOR YOU.

Direct anterior hip replacement minimizes time from replacement to recovery. Hip pain is not only uncomfortable, it impacts your quality of life. Pretty much everything you do—and the things you enjoy most—can be a struggle.

Community Medical Center now offers direct anterior total hip replacement. With this new approach, the joint is accessed from the front of the hip, so there’s a smaller incision, less damage to major muscles and less post- operative pain. You’ll have a shorter hospital stay, faster recovery and less chance of hip dislocation later on. To learn more about hip This new approach is just the kind of advanced treatment you’d expect replacement surgery and from a hospital that’s rated Montana‘s #1 hospital for joint replacements by other options for hip pain, Becker’s Hospital Review. call (406) 327-4170.

communitymed.org