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volume 9 2018/2019

“Quality Care from People Who Care”

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www.missoulaboneandjoint.com

Phone (406)721-4436

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

| www.missoulaboneandjoint.com |

Satellite Clinics

Polson

Missoula

Stevensville

Hamilton

P o l s o nFoot & Ankle Specialty Clinic

Dr. Glenn Jarrett2nd & 4th Friday of the month

P l a i n sOrthopedic Clinic

Dr. Jeff LaPorte Every Tuesday

s t e v e n s v i l l eFoot & Ankle Specialty Clinic

Dr. Brent Roster1st Friday of the month

H a m i lt o nHand & Wrist Specialty Clinic

Dr. Charlie Sullivan3rd Thursday of the month

• Spine & General Orthopedics Clinic

Dr. Michael Woods1st Friday of the month

Plains

To schedule an appointment call our Missoula clinic at (406) 721-4436 x2 or visit www.missoulaboneandjoint.com and

m i s s o u l a2360 Mullan Road, Suite C Missoula, Montana 59808

(406) 721-4436 x 21-866-721-4436 Toll Free

(406) 721-6053 Fax

Quality Patient Care Closer to Home

| www.missoulaboneandjoint.com | 3

In This Issue...2 MBJ Satellite Clinics4 Running Gait Analysis6 Effectively Treating Patellofemoral Joint Pain7 What is ACI?8 Sacroiliac (SI) Joint Pain10 Get to Know Your Doc! Dr. Rob Amrine11 Urgent Care at MBJ12 MBJ Physicians & Physician Assistants14 MBJ Services15 A Different Approach for Total Hip Joint Replacement Surgery17 DXA Bone Density Scans18 Get to Know Your Doc! Dr. Brent Roster19 Total Ankle Replacement – TAR20 Breathing Matters22 Proper Cast Care23 Body Composition Scans

Missoula Bone & Joint magazine is designed and published by Custom Medical Design Group, Inc. To advertise in an upcoming issue please contact us at 8 0 0 . 2 4 6 . 1 6 3 7 or visit us online at www.CustomMedicalMagazine.com. This publication may not be reproduced in part or whole without the express written consent of Custom Medical Design Group, Inc.

ortHoPedic clinicMonday-Thursday 8:30am-5:30pm

Friday 8:30am-5:00pm

2360 Mullan Road, Suite C Missoula, Montana 59808

(406) 721-44361-866-721-4436 Toll Free

(406) 721-6053 Fax

ortHoPedic urgent care Walk-in clinic

Monday-Thursday 8:30am-7:00pmFriday 8:30am-5:00pm

Saturday 9:00am-2:00pm

2360 Mullan Road, Suite C (406) 721-4436

Urgent Care Direct(406) 829-5581

PHysical tHeraPyMonday-Thursday 7:00am-7:00pm

Friday 7:00am-6:00pm

2360 Mullan Road, Suite D(406) 542-4702

(406) 541-8240 Fax

Dear Friends,Quality care from people who care is the core of Missoula Bone & Joint. We truly care about our patients and the community we all live in. We strive to accommodate your orthopedic needs in a timely manner. Our Urgent Care walk-in clinic has been successful in helping people with acute orthopedic injuries for initial evaluation and to start an appropri-ate treatment plan.

Our surgeons replaced their surgical tools with shovels for a ground breaking ceremony of the new Surgery Center in June 2018. The site of the new and improved surgery center is the vacant grassy lot between our clinic and Mullan Road. The surgery center will continue to pro-vide services and care for our day surgery patients having surgery to the shoulder, knee, hip, hand, wrist, foot and ankle. Outpatient total joint replacement procedures and outpatient spine procedures will be added to our services as the new facility will have the capability of extending a patient stay up to 23 hours. If your doctor anticipates you needing more than 23 hours of specialized care after surgery, your surgery will be scheduled at one of the local hospitals.

We will continue quality care for patients with bone and joint injuries and conditions, as we have done for over 60 years. Our new state of the art facility will allow us to expand our services and still continue to provide compassionate, cost effective care to a wide variety of patients.

See you in the beautiful Montana outdoors,

Michael Woods, M.D. 2018/2019 President, Missoula Bone & Joint “Quality Care from People Who Care”

one location – many services

surgery center (asc)Monday-Friday 6:00am-5:00pm

2360 Mullan Road, Suite B(406) 542-9695

(406) 542-9703 Fax

| www.missoulaboneandjoint.com |4

Running Gait Analysis

Have you ever thought about how you run and how your body moves with each foot strike? Kristina Pattison is passionate about helping runners to move stronger and faster and avoid injury. Running Gait Analysis is the best way to develop a program specific for you. Kristina says "maintaining full joint range of motion and functional stability required for running takes a small investment of time that pays off with reduced risk for injury and improved performance."

Gait is the way in which we move our whole body from one point to another. Therefore, Gait Analysis involves walking or running on a treadmill under the watchful eye of Kristina. A video recorder will also be utilized to capture your walking and running style. She will analyze the way you move, closely observing your feet, ankles, knees and hips. Kristina can then show you what is happening to your joints at the different phases in your walking and running motion using slow motion video and freeze frame. Kristina can identify areas of weakness and poor biomechanics and then

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

Kristina on Holland Peak in the Bob Marshall Wilderness

develop a corrective program to improve your running performance and reduce your risk for injury.

Running and walking is a repetitive action. Many injuries are often caused, at least in part, by poor biomechanics. The following are a list of common overuse injuries associated with poor gait biomechanics.

• shin splints

• plantar fascitis

• Illiotibial band syndrome (runners knee)

• Patella tendonitis (jumpers knee)

• Patellofemoral knee pain

• Achilles tendonitis

• Lower Back Pain

Biomechanical problems are usually caused by muscular imbalances - tight muscles working against weak muscles. Sometimes they can be caused by structural problems, for example leg length discrepancies resulting in hip hiking.


Examples of biomechanical abnormalities include:

• Overpronation

• Oversupination

• Increased Q angle

• Hip hiking - lifting the hip on one side

• Limited ankle dorsiflexion

• Pelvic Tilt

Kristina Pattison is an ultra-distance mountain runner, doctor of physical therapy, board certified clinical specialist in orthopedics and certified strength and conditioning specialist in Missoula, Montana.

Keep your stride strong and your running swift! Call today to schedule your appointment with Kristina at Missoula Bone & Joint Physical Therapy (406) 542-4702.

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(406) 523-2500

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Hyaluronic Acid Injections for Knee Joint Osteoarthritis

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 cartilage and can provide pain relief for 6-12 months. Speak to your orthopedic provider to learn what is best for your condition.


Effectively Treating Patellofemoral Joint Pain

• Training errors may be the most prevalent cause of PFJP. Increasing activity or exercise intensity or duration too rapidly results in tissue breakdown.

• History of prior injury contributes to the health and function of our joints. Prior fractures, orthopedic surgeries, and trauma predispose the knee joint to degenerative changes.

• Body mass index (BMI) and social factors must not be overlooked when treating PFJP. BMI is the ratio of height to weight. Simply put, the higher your BMI, the greater the impact load through the patellofemoral joint.

treatment:

Physical therapy alone will not cure patellofemoral joint pain. The correct physical therapy intervention over a period

1705 Bow St. • Missoula, MT 59801549-5283 • Early & Late Appointments Available

See us at www.sapphirept.com

SERVING ACTIVE MISSOULIANS FOR 22 YEARSSPECIALIZING 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

John Fiore, PTJesse Dupre, DPT

Holly Warner, DPTKate Hughes, DPT

Patellofemoral joint pain (PFJP) is familiar to individuals of all ages and activity levels. Named for the joint formed by the patella (knee cap) and the trochlear groove of the femur (thigh bone), PFJP may be referred to as runner’s knee, anterior knee pain, or chondromalacia. Patellofemoral joint pain accounts for 25% of all knee disorders1 and 42% of all running injuries2. The difficulty in treating PFJP lies in the numerous causes and complex structures involved.

Symptoms are usually located beneath the patella, in the patella tendon (below the patella), or along the medial-lateral sides of the patella. Symptoms may include crepitus (clicking, cracking), swelling, tender-ness to touch, and pain with squatting, descending stairs, running, or prolonged sitting.

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 torsional forces through the patellofemoral joint.3


of time coupled with appropriate diagnostic testing will. A physical therapist trained in effective evaluation of strength, functional movement, medical history, and sport or activity demands can narrow the cause of one’s unique PFJP symptoms.

An individualized rehabilitation program should address joint mechanics, quadriceps, hip, gluteal, and foot-ankle strength exercises. Gradual eccentric (muscle lengthened) loading of the patellofemoral joint at varying degrees of knee flexion will improve tensile strength of the patella tendon and supporting structures. Utilizing visual and verbal feedback while performing single leg strengthening exercises, has been shown to be effective in reducing compensatory movements of the hip, pelvis, and knee which contribute to PTJP.4 Finally, simulating the necessary functional demands through a return to sport or activity program will insure long-term success. Utilize Missoula’s medical and training experts to enjoy our incredible recreational opportunities without patellofemoral joint pain.

references:

1. Mullaney MJ, Fukunaga T. Current concept sand treatment of patellofemoral compressive issues. Int J Sports Phys Ther 2016 Dec;11(6):891-902.

2. Taunton, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2000;36:95-101

3. Lankhorst NE, Bierma-Zeinstra SM, VanMiddelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med 2013; Mar;47(4):193-206.

4. Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J Orthop Sports Phys Ther; 2011 Sep;41(9):625-632.

By John Fiore, Physical Therapist Sapphire Physical Therapy

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 arthroscopy. 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.

What is ACI?By Dr. Michael Wright Missoula Bone & Joint Orthopedic PhysicianSpecializes in Sports Medicine and General Orthopedics


Sacroiliac (SI) Joint Pain

of your pain. If SI joint dysfunction is diagnosed early, nonsurgical treatment options may include activity modification, optimized pain medication, physical therapy and SI joint injections. The goal is to help you manage the pain, ease stress on the SI joint, and balance supporting musculature. If non‐surgical treatments fail there is a surgical solution.

Dr. Woods says, “since the minimally invasive SI joint fusion procedure became popular over the last 7‐8 years, there have been a number of other companies that have developed implants using

screw‐based systems. However, the triangular iFuse Implant, available since 2009, is the

only SI joint fusion device with multiple clinical studies demonstrating improvement in pain, patient function and quality of life. I am a firm believer in the science behind the triangular, porous‐surface iFuse Implant and I have seen the success with the iFuse Implant first hand with patients in my practice.”

Dr. Woods understands that sacroiliac joint pain is very real and very painful. He has been interested in 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 conditions. He follows research and outcome-based practices in collaboration with several major national and international universities. Dr. Woods has performed over 100 iFuse surgeries. He says, “it is so rewarding to see my patients get back to doing what they love to do - pain free.”

Want to learn more? Watch this video of a patient get-ting their life back! www.youtube/channel/missoulabo-neandjoint. and visit www.missoulaboneandjoint.com/specialties/spinesiJoint/siJoint.aspx

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Dr. Michael WoodsMissoula Bone & Joint Orthopedic PhysicianSpecializes in Spine Surgery and General Orthopedics

SI Joint pain typically begins with an injury to the ligaments that are meant to hold the SI joint in place. The injury can occur as the result of a fall on the buttocks, simple misstep off a curb, car accident, pregnancy, or any other injury to the pelvis. Another common cause of SI joint pain can be previous back surgery, especially fusion. Like other joints, SI joints are subject to wear and tear and arthritis can develop.

The SI joint is formed by the connection of the sacrum (triangular bone at the base of the spine) and the right and the left iliac bones (part of the pelvis). Their primary function is to transfer weight from the upper body to the lower body. The normal SI joint allows for a small amount of motion, called nutation, and is stabilized by a network of ligaments and muscles. With injury or deterioration, that small rocking motion can lead to very painful low back, buttock, groin and thigh symptoms.

If you think you may have SI joint pain, finding the right physician who can identify SI joint pain and serve as a good detective is important. Dr. Michael Woods employs a wide range of diagnostic examinations to determine the source

Dr. Woods works with physical therapists in our community to share his knowledge of the diagnosis and treatment of SI Joint dysfunction.

Triangular Implant


Get to Know Your Doc! Dr. Rob Amrine

Why did you choose a career in medicine or orthopedics?I became interested in sports medicine due to my personal interest in sports performance. I already had an interest in mechanical design, but as a wannabe athlete I became fascinated in the concept of designing and maximizing the human machine for sport.

What do you like to do for fun?Honestly, most of my fun is directly correlated to what I do for a living. I still pretend to be a bike racer and dream of a day of the “eternal winter” and endless days of skiing. 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 so good to rub dirt on a fresh wound after crashing hard. Some of the most fun I have is sharing these recreational experiences with those that have battled injuries, but have returned to the mountains to play again.

What was your first car?I didn’t really have a car of my own until medical school when I purchased a Subaru Legacy Wagon. Before then, I drove whatever my mom generously shared with me. The majority of the time this was a minivan.

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.I was born in Missoula and went to school here until 7th grade. I then moved to Hamilton where I transitioned from being a classic ball sport kid to being more of a mountain sport kid with skiing, hiking, and biking becoming a strong part of my life.

What was your first job?My first real job with a W-2 was as a student athletic trainer at the University of Washington working primarily with their football team. However, my first jobs were blurred

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.

lines between chores or paid jobs of changing pipe, bucking bales or building fence. Basically doing all the jobs that my parents or friends parents didn’t want to do, but would give us kids some cash.

Who do you look up to?I admire anyone who strives to put the interests of others before their own. Like many, I look to my family, my wife, and my friends to guide me. I also feel fortunate to have so many teammates at MBJ that emulate this selfless behavior on a daily basis.

What are your favorite movies?Shawshank Redemption continues to hold my interest with so many great quotable lines, but Andy Durfresne said it right, “Hope is a good thing, maybe the best of things, and no good thing ever dies.”

Any other fun facts?I had a former coach prophetically tell me, “If you can’t play, then coach. If you can’t coach, then ref. And if you stink at all that, then go into sports medicine, Rob.” He sure was right!

Dr. Michael Wright completes the Missoula Half Marathon, July 2018, and is greeted at the finish line medical tent by his colleague Dr. Rob Amrine, Medical Director for the Missoula Marathon.

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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

MBJ Urgent CareWalk-In Hours:

Monday-Thursday 8:30am-7:00pmFriday 8:30am-5:00pm

Saturday 9:00am-2:00pm

Contact:2360 Mullan Road, Suite C

(406) 721-4436

Urgent Care Direct(406) 829-5581

Urgent Care at MBJ

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David Allmacher, M.D.Total Joint Replacement - Hip & Knee

Revision Total Joint Replacement - Hip & Knee

Missoula Bone & Joint Physicians

P. Andrew Puckett, M.D.Hand & Microvascular Surgery

Christopher Price, M.D.Sports Medicine

Joint ReplacementShoulder Injuries

Mark Channer, M.D.Total Joint

Replacement Surgery

Michael Wright, M.D. Sports Medicine,

Arthroscopic Surgery of the Shoulder, Hip and Knee

General Orthopedics

Gary Willstein, M.D.Total Joint Replacement

Sports MedicineGeneral Orthopedics

Colin Sherrill, M.D.Arthroscopy

Sports Medicine

Charles Sullivan, M.D.Hand & Microvascular Surgery

General Orthopedics

Glenn Jarrett, M.D.Foot & Ankle Reconstruction

General Orthopedics

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, arthroscopies, hand and microvascular surgery, spine, foot & ankle, and general orthopedics.

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Michael Woods, M.D.Spine Surgery

Total Joint ReplacementSports Medicine

Robert Amrine, M.D.Primary Care

Sports Medicine

Jeffrey LaPorte, M.D.Sports Medicine

Orthopedic Surgery

Brent Roster, M.D.Foot & Ankle SurgeryGeneral Orthopedics

2018/2019 MBJ President


Missoula Bone & Joint Physician Assistants

Douglas Henry, PA-CPhysician Assistant

Clyde Kidd, PA-CPhysician Assistant

Jesse Doll, PA-CPhysician Assistant

Wade Hudson, PA-CPhysician Assistant

Joan Bond-Deschamps, PA-CPhysician Assistant

Meagan Auch, PA-CPhysician Assistant

Scott Doherty, PA-CPhysician Assistant

Louis Westenfelder, PA-CPhysician Assistant

Gregory Murray, PA-CPhysician Assistant

Vincent Keeney, PA-CPhysician Assistant

Resources for Patient Education:

Website Facebook YouTube Channelwww.missoulaboneandjoint.com

Patient Informationwww.youtube.com

Search: Missoula Bone & Joint


Missoula Bone & Joint Servicesgeneral orthopedics Diagnosis and treatment of common injuries and diseases of the musculoskeletal system including bones, joints, ligaments, muscles and tendons.

sports medicineDiagnosis and treatment of sports related injuries including ligament tears, cartilage injuries, joint instability, and overuse injuries.

spine disordersDiagnosis and treatment of spine disorders including thoracic and lumbar disorders, spinal stenosis, fractures due to osteopenia, disc problems.

Hand and microvascular surgeryDiagnosis and treatment of hand, wrist and forearm conditions including trauma (fractures, nerve/tendon/ligament injuries), arthritis, and nerve compression.

Foot and ankleDiagnosis and treatment of foot and ankle conditions including ligament and tendon injuries, fractures, arthritis and deformities.

Joint replacementDiagnosis and surgical intervention for end stage osteoarthritis of knees, hips, ankles and/or shoulders including total joint replacement surgery. Revision of the hip & knee.

surgical ProceduresDepending on your condition and diagnosis, you may require a surgical procedure.

surgery centerOutpatient surgery at MBJ happens in our surgical suite adjacent to our clinic. Founded in 2011 and certified by the Accreditation Association for Ambulatory Health Care (AAAHC), our freestanding surgery center specializes in orthopedics, plastic, and reconstructive outpatient surgeries. Our doctors perform a wide variety of surgical procedures ranging from knee, hip, and shoulder arthroscopies, hand & wrist surgeries, foot & ankle surgeries, ACL repairs, and rotator cuff repairs. Outpatient surgery at an Ambulatory Surgery Center (ASC) is beneficial to both the surgeon and patient. It is designed to facilitate an efficient and cost effective flow that centers around patient care. The smaller environment creates a “family atmosphere” that is pleasant for both staff and the patient. Best of all, patients are able to go home to recover, rather than stay overnight in the

MRI is available on-site for your convenience

hospital. Candidates for outpatient surgery are generally healthy individuals whose surgeries do not need to be done in the hospital setting.

Creating a standard in Missoula of safe surgical practices, advanced techniques, and boasting extremely low infection rates, it’s easy to see why many patients choose having their surgery done at MBJ.

Bone Health clinic

Our Bone Health Clinic is led by Joan Bond-Deschamps, PA-C, who provides comprehensive care for osteoporosis and low bone density. We offer on-site DXA scans to measure bone density.

Hospital

•Jointreplacementsurgery• Jointreplacementrevisionsurgery•Spinesurgery

urgent care Our Orthopedic Urgent Care Walk-In Clinic offers same day and next day appointments for urgent orthopedic injuries.

on-site servicesIn keeping with our objective of providing full orthopedic care to our patients, the following services are also available on site:

•BodyCompositionScans•DirectDigitalX-Ray•DurableMedicalEquipment•DXABoneDensityScans•MRImaging (See image above)•PhysicalTherapy


A Different Approach for

Total Hip Joint Replacement Surgery

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.

By Dr. Mark Channer Missoula Bone & Joint Orthopedic PhysicianSpecializes in Total Knee and Hip Replacement Surgeries

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.

Pre-total hip replacement surgery

Post-total hip replacement surgery

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.


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1.800.823.3355PO Box 6099Great Falls, MT 59405


PO Box 6099Great Falls, MT 594051.800.823.3355


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DXA Bone Density ScansMissoula 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 can help. If you have previously had a DXA scan at another facility in the past 5 years, the International Society of Clinical Densitometry (ISCD) recommends that you continue assessment on the same DXA machine for continuity of care. If you have had a DXA scan at another facility you can still receive care at our Bone Health Clinic. We accept all primary care physician orders for DXA scans.

A DXA (dual energy X-ray absorptiometry) bone density scan assesses your bone mineral density. The amount of bone mineral density (BMD) relates directly to bone strength and is very important in the prevention of fractures. The scanner uses small amounts of x-ray to measure BMD and to produce images of the spine, hip, and forearm. The spine and hip are typically measured because that is where most osteoporotic fractures occur. To learn more visit www.missoulaboneandjoint.com/servicesandprograms/bonehealthclinic

Cortisone Injections for Joint Pain ReliefCortisone 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.

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Get to Know Your Doc!

Dr. Brent Roster

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.

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

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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 a hinge to allow your foot to move up and down. Fortunately, the ankle joint is designed to be strong and sturdy. It must withstand 1.5 times your body weight when you walk and up to 8 times your 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 arthritis may be candidates for a total ankle replacement surgery (also called “TAR” or “ankle arthroplasty”). Ankle replacement surgery

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Total Ankle Replacement – TAR

is designed to relieve pain and preserve motion in the arthritic ankle joint, by replacing the arthritic joint with a metal prosthesis. This differs from another popular, but older procedure called ankle fusion (or “ankle arthrodesis”) referring to the bones growing together. Ankle fusion 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 outcome. Call to make an appointment and see what treatment options are best for you and your condition.

The STAR™ ankle replacement shown here, uses a 3 part, mobile bearing device.

Pre-surgery ankle x-ray Post-surgery ankle x-ray

Dr. Roster test drives the knee rollabout scooter, ideal for patients with foot or ankle conditions that require non-weight bearing for a period of time.


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.

Breathing Matters

Jason Miller, PT, MS, CSCS, PRC Missoula Bone & Joint Physical Therapist

Resistance training, done right, improves muscle strength and exercise endurance. For Physical Therapists treating patients with OA, the first step is to get the affected joint moving so the patient can participate in the prescribed therapy. The goal is about getting patients functional again and to educate patients on how they can help themselves at home.

Resistance Training for Knee Osteoarthritis

missoula Bone & Joint Physical Therapy

let’s get you back to doing what you love!Photo taken by Dan Weiss, MBJ employee


RESIDENTIAL - MULTIFAMILY - CIVIC COMMERCIAL - HEALTHCAREMissoula, Montana - www.mmwarchitects.com

Missoula Bone & Joint Ambulatory Surgery Center Coming 2019

thanks for br ing ing even more qual i ty care to Mis sou la

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Family, Business, Associate, Single, Social and Non-Resident Memberships are available.

Stop by for information or contact us at: 406-251-2404 or email: [email protected] FDIC. Equal Housing Lender.

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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:

• painful, especially with movement

• swelling and tenderness around the injury

• bruising

• deformity - a limb may look out of place or a part of the bone may puncture through the skin

During your recovery you will likely lose muscle strength in the injured area. Specific exercises will help you restore normal muscle strength, joint motion, and flexibility. Ask your orthopedic doctor if physical therapy can help with your recovery.

Casts don't heal broken bones on their own, they hold the affected area in place. It is very important that you also take care of your broken bone by restricting activity, keeping it clean, and eating a well balanced nutritious diet.

Dos and Don'ts of proper cast care:

• do not put any object inside the cast to scratch itching skin.

• do not use powder on itching skin.

• do not break off rough edges of your cast.

• do keep the cast dry (unless waterproof ) and clean. Use two layers of plastic to keep cast dry while showering. Use masking tape, never a rubber band.

• do keep dirt and sand out of cast.

• do elevate the joint and move the other joints regularly.

• do move your injured, but swollen fingers or toes gently and often.

• do apply ice to the cast. Place the ice in a dry plastic bag or ice pack and loosely wrap it around the cast.


Body Composition Scans are now offered at Missoula Bone & Joint. This is the gold standard test for body compo-sition analysis. It uses the same scanner used for DXA bone density tests.

This test is ideal for people who :

• Want to track changes in body composition in response to workout regimes.

• Have been diagnosed with cardiovascular disease and want to track the effects of lifestyle changes.

• Are embarking on a wellness challenge.

• Are competitive body builders.

Body Composition Scans

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• 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.

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. You can optimize your training to suit your body's specific needs. The results compare your scans to others your age based on nationwide statistics.

Start with a baseline scan to establish your goal. Assess progress midway through your goal. See visual comparisons of your results for each scan. Adjust your workout regime and/or diet to get the results you desire. It's what’s on the inside that counts!

To schedule your appointment please call (406) 721-4436 ext. 7115. For more information visit www.missoula-boneandjoint.com/servicesandprograms/bonehealthclinic/bodycomposition

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.

This new approach is just the kind of advanced treatment you’d expect from a hospital that’s rated Montana‘s #1 hospital for joint replacements by Becker’s Hospital Review.

communitymed.org

A NEW APPROACH TO HIP REPLACEMENT.

A NEW LEASE ON LIFE FOR YOU.

To learn more about hip replacement surgery and other options for hip pain, call (406) 327-4170.

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