← Older posts Posted on 5/10/13 by commonwealth

How to Read Your Bill

We know that sometimes it is hard to read a medical bill.  Download this PDF of a sample bill from Commonwealth Orthopaedics.  We hope it will help you understand your bill  a little better.

Commonwealth Orthopaedics’ Patient Bill Explanation

Posted in Uncategorized | Leave a comment Posted on 4/9/13 by Almas Abbas, PA-C

Achilles Tendon Ruptures

“I felt someone kick the back of my leg, and when I turned around no one was there.”

It happens to all weekend warriors…we get older, we still try to keep up with the sports we love, and then our body reminds us that maybe our plans need to get adjusted just a bit, almost like a little kick in the head (or in this case, a kick in the calf!)

The Achilles tendon is both the strongest and, unfortunately, most likely torn tendon in the body. Your Achilles tendon attaches the calf (or gastrocnemius) muscles to your heel bone (or calcaneus).

An Achilles tendon rupture (or tear) is most likely to occur with activities involving planting and pushing off of the foot especially in sports. Though not usually very painful, ruptures often will have associated swelling, bruising, and patients will have difficulty rising up on their toes.

Risk factors: Achilles ruptures occur most commonly in males (in, at best, a 4 to 1 ratio), as well as most often in the 30-50 age bracket. Previous history of Achilles tendinitis, overuse, sudden increase in activity level, and recent fluoroquinolone antibiotic use can all increase the risk of rupture.

Treatment options most often include surgery and casting/splinting.

For more information, please click here

Posted in Foot and Ankle Surgery, Sports Medicine | Comments Off Posted on 3/27/13 by Meghan Heins, PA-C

Heel Pain In Children

Injury to the growth plate of the heel, also known as Sever’s Disease, can be a common cause of heel pain in children and adolescents. It is rarely seen after the early teenage years as the foot is one of the first body parts to grow to full size. During periods of rapid growth, bones often grow at a faster rate than muscles and tendons. As a result, the Achilles tendon, which attaches to the back of the heel, can become tight and painful during exercise and sports. This condition usually responds well to conservative treatment measures such as calf and Achilles stretching, heel pads, icing, rest, and over-the-counter pain relievers such as Tylenol or ibuprofen.

Click here to learn more about this condition.

Posted in Children and Adolescents | Leave a comment Posted on 3/15/13 by Maureen Cook, Chief Operating Officer

Patient Satisfaction: Make Your Voice Heard

We have a question or concern about a service experience and we want answers. Usually the issue is resolved. But sometimes – if we don’t get a timely or respectful response – the situation escalates and communication becomes unproductive.

At Commonwealth Orthopaedics, we are proud that a vast majority of our customers would recommend our physicians and services to a friend or loved one. Our patient satisfaction scores are consistently strong: 94% of patients and family members are very satisfied or extremely satisfied with our physicians and offices; more than 96% feel that way about our outpatient surgery centers; and 99% of physical therapy patients are satisfied customers.

But what happens when a customer isn’t happy? Perhaps it’s a billing question or dissatisfaction with an interaction with an employee or physician. Regardless of the issue, when a patient or family member has a legitimate concern, there are simple things we can all do to produce a positive result.

Commonwealth has the responsibility to listen carefully to every issue, treat customers with respect, provide accurate information and respond in a timely way.

Customers have responsibilities, too! Here are some tips to resolve issues effectively:
• Assume the person you are talking to is acting in good faith and wants to help.
• Approach the problem with an attitude of cooperation rather than confrontation.
• Keep the conversation fact-oriented and focus on resolving the problem.
• If the first person you talk to can’t help, ask to speak to a supervisor. Keep reaching up the chain until you find someone with the information and authority to address your concern.

At Commonwealth, we are always working to improve the customer experience. We recently implemented a system-wide electronic medical record, which provides fast and easy access to patient records. We are about to open a centralized scheduling center with a single phone number patients can call to make appointments at any of our office locations. And plans are in the works for a patient portal on our website where patients can fill out paperwork in advance of appointments, reducing office wait times.

Posted in Patient Satisfaction | Leave a comment Posted on 3/13/13 by Frederick Scott, Jr., MD

Pregnancy Related Hand Problems

During pregnancy alterations in your body chemistry and the mechanical compression of the uterus on a major vein in your body can lead to changes throughout the body. These changes can result in several conditions that can cause problems in your hands and wrist.
These problems can cause numbness, pain, and even masses to develop. This blog will address carpal tunnel syndrome.


Carpal Tunnel Syndrome

Inflammation and swelling in the lining of some of the tendons in the wrist can lead to compression of the median nerve, a nerve that passes through the wrist. This can lead to numbness in the thumb, index, middle, and sometimes ring fingers. It can also lead to hand and forearm pain. This can lead to difficulty holding objects and sleep interruption. Repetitive actions and positioning of arms can lead to exacerbation of symptoms. This syndrome is called carpal tunnel syndrome.

Carpal tunnel syndrome in pregnancy is a condition that is initially treated with night bracing. Using nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), and diclofenac (Voltaren) are controversial and most healthcare prescribers will avoid using them. Corticosteroid injections can be used for moderate to severe symptoms. There is low risk that they will cross the placenta because there are injected locally. Injections may also increase blood sugar levels but these effects are transient.

Usually carpal tunnel syndrome symptoms related to pregnancy will resolve after delivery. If symptoms persists nerve tests should be performed to confirm diagnosis and potentially surgery may be needed.


Cubital Tunnel Syndrome

Cubital tunnel syndrome is a similar condition where the compression is on the ulnar nerve. This can lead to numbness in the ring and small fingers as well as pain in the hand or forearm. Individuals can experience symptoms that interrupt sleep as well cause weakness and fatigue. The site of compression most frequently happens at the elbow. Resting the inside of the elbow on hard objects or flexing elbow can exacerbate symptoms. This condition is treated with night bracing and activity modification.


DeQuervain Syndrome

Inflammation of tendons on the thumb side of the wrist can also develop. There are two tendons that travel together that are responsible for the movement of the thumb away from the rest of the fingers. They travel in a tendon sheath or tunnel that can pinch the already inflamed tendons when the wrist is placed in certain positions. DeQuervain syndrome is a condition that experienced more commonly after delivery. Repetitive actions, lifting children, or certain wrist positions can lead to exacerbation of pain. This is treated with bracing and corticosteroid injections.


Pyogenic Granuloma

All suspicious masses and lesions should be evaluated by the appropriate person. Pyogenic granuloma is a benign mass that develops during pregnancy with the highest likelihood during first trimester. It is a rapidly growing mass that can appear anywhere on the hand and easily bleeds. This lesion usually resolves after pregnancy, but in some cases needs to be cauterized or even surgically excised if it persists.


To learn more about Dr. Scott, read his bio on our website.

Posted in Pregnancy Orthopaedic Problems | Leave a comment Posted on 1/18/13 by Bruce Zimmer, MD

Tennis Elbow

One of the most common elbow problems is pain on the outside or lateral side of the elbow which is called tennis elbow familiarly or lateral epicondylitis in medical terms. Tennis elbow is an inflammation of the origin of the forearm muscles that extend the wrist, with some inflammatory tissue underneath the muscle attachment at the elbow. This can be caused by repetitive activities, such as sports or yard work, as well as after heavy lifting. In my practice about half the time, patients do not remember doing anything unusual or different in their daily activities.



Symptoms are usually some aching on the outside of the elbow which is worsened with lifting, gripping, and with repetitive activities. Direct pressure on the elbow such as hitting the elbow against a door or wall is exquisitely painful. Sometimes if the symptoms are severe enough, the pain can radiate down to the wrist, but rarely into the fingers. There is usually not any numbness or tingling into the hand or fingers.



The patient can treat this themself initially with nonsteroidal anti-inflammatories such as aspirin, Motrin, or Aleve taken on a regular schedule 2 or 3 times per day, depending on the medication. Also getting heat on the outside of the elbow and doing a gentle massage increases blood flow and speeds up the healing. Doing some elbow stretching can also help. A tennis elbow strap can be purchased at the store and this is worn about 2 inches below the elbow when doing repetitive type activities. If this does not help after a couple of weeks, see your orthopedic surgeon for possibly a cortisone injection or physical therapy. Almost all of these will get better without surgery and it is rare that I have to operate on a tennis elbow, although sometimes they can take a while to completely resolve.

To learn more about Dr. Zimmer, read his bio on our website.

Posted in Hand & Upper Extremity Surgery, Sports Medicine | Leave a comment Posted on 1/2/13 by Alexander Croog, MD

Bicep Tendon Tear

The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your arm. It also helps keep your shoulder stable.


Tendons attach muscles to bones. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. If you tear the biceps tendon at the shoulder, you may lose some strength in your arm and be unable to forcefully turn your arm from palm down to palm up.
Many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms. Some people require surgery to repair the torn tendon.


Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).


The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.


The upper end of the biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process.


There are two main causes of biceps tendon tears: injury and overuse.
Injury If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon.


Overuse Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. This naturally occurs as we age. It can be worsened by overuse – repeating the same shoulder motions again and again.


Overuse can cause a range of shoulder problems, including tendonitis, shoulder impingement, and rotator cuff injuries. Having any of these conditions puts more stress on the biceps tendon, making it more likely to weaken or tear.
Risk Factors Your risk for a tendon tear increases with:
Age. Older people have put more years of wear and tear on their tendons than younger people.
Heavy overhead activities. Too much load during weightlifting is a prime example of this risk, but many jobs require heavy overhead lifting and put excess wear and tear on the tendons.
Shoulder overuse. Repetitive overhead sports – such as swimming or tennis – can cause more tendon wear and tear.


Smoking. Nicotine use can affect nutrition in the tendon.
Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.


For more information on the symptoms and treatment of a bicep tendon tear go to: http://orthoinfo.aaos.org/topic.cfm?topic=A00031

Posted in Shoulder | Leave a comment Posted on 12/5/12 by David Romness, MD

Exercising with Osteoarthritis

Osteoarthritisis the most common chronic disease affecting our population.  It causes pain and stiffness and can occur in any joint, but is most common in weight-bearing joints.  There is no cure.

 Exercise can help to improve the symptoms of arthritis. Joint motion helps to lubricate joints and increased muscle strength around arthritic joints helps to unload the joint.  Exercise can also improve joint flexibility. Weight loss can help arthritic joints by decreasing the load across the joint and can delay progression of arthritis.

 Start any exercise program slowly and progress as tolerated. Avoid high impact activities such as running and jumping.  Low impact activities such as walking, biking, swimming or elliptical trainers are easier on the joints.  Increased pain is an indication to cut back on the exercise.  Consult your personal doctor to confirm that exercise is safe for you.

For more information on osteoarthritis, visit the American Academy of Orthopaedic Surgeons at http://orthoinfo.aaos.org/topic.cfm?topic=A00227. To learn more about Dr. Romness, read his bio on our website.

Posted in Arthritis | Leave a comment Posted on 11/15/12 by Jennifer Ott, MPT

The Importance of Good Posture

The majority of the population now sits at a desk most of the day. Long periods of sitting make it challenging to maintain upright posture. Poor posture puts excessive strain on your spine and can cause unnecessary pain. Follow these guidelines to ensure upright posture:

• Head should be directly over your body, not out in front
• Shoulder blades should be slightly pulled together and your chest should raise up.
• Keep shoulders down away from your ears so the muscles along the sides of your neck remain relaxed
• Maintain a small curve in your low back, whether you are seated or are standing
• If standing, engage your lower abdominal/ core muscles to support your back
• Do not stand with both knees locked out, shift your weight from one leg to the other

Jennifer Ott, PT, MPT is the manager of Fair Oaks Physical Therapy Clinic.

Posted in Uncategorized | Leave a comment Posted on 10/26/12 by Mark Madden

New Technology for Knee Replacements

As an orthopaedic surgeon, I have been performing knee replacements for 24 years. I am very excited about a new technology called TruMatch which uses a CT scan to produce custom made knee cutting blocks specifically for the patient. This allows for very accurate placement of the implant and an improvement in patient outcomes. By improving the position of the implant, it can last longer and even prevent uneven wear on the joint. With average activity levels, this knee replacement should last at least 15-20 years. If you would like an evaluation on your knee, please call my office at 703-810-5202 for an appointment.

 

Mark Madden, MD specializes in total joint replacement and practices out of Reston office.

Posted in Uncategorized | Leave a comment ← Older posts