← Older posts Posted on by Ben Kittredge, MD

Hamstring Repair

Dr. Kittredge practices in our Alexandria and Springfield offices.

Proximal hamstring repair is a simple procedure that involves re-attaching the hamstring tendon to the bone using suture anchors. It’s similar to rotator cuff repair, but in a location where surgeons don’t operate as much. Although proximal hamstring rupture is relatively rare, the diagnosis and surgical treatment are becoming more common as this injury is more recognized. Awareness is increasing among physicians and radiologists who know it’s a potential problem and look for it during physical exams and on MRIs.

Almost all proximal hamstring ruptures occur from an accident that creates forceful hip flexion with simultaneous knee extension. The injury is often sustained playing sports or waterskiing. Ideally, repair should be performed within the first few weeks of a rupture, so prompt diagnosis is important. Patients who wait to see a doctor, or opt for non-surgical treatment, risk problems down the road, including knee and hip weakness, sitting difficulties, deformity and sciatica. In addition delaying surgery increases the chance that the tendon will retract and the muscle will atrophy, making repair more difficult.

Read about one of my patients who had a successful hamstring repair.


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Posted in Sports Medicine | Leave a comment
Posted on by Amanda Trucksess, MD

New Treatment for Chronic Tendonitis — Tenex FAST Technique

FAST, which stands for fasciotomy and surgical tenotomy, is a new, non-opeative, FDA-approved treatment option for patients with chronic tendinopathies. At Commonwealth, we’ve used this technique to successfully treat patients with tennis elbow and golder’s elbow, as well as tendonitis in the kneecap, rotator cuff and Achilles tendon.

For more specific information about who is a good candidate, how FAST works, what are the benefits and recovery, watch the video below or read the entire article on our website.

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Posted in Uncategorized | Leave a comment
Posted on by Mark Madden

TRUMATCH Customized Knee Replacements

TRUMATCH is a made-to-measure implant that is transforming total knee replacement surgery. Benefits include:

  • Faster, safer, more efficient surgery. In many ways, surgeons perform the operation before they even enter the OR. TRUMATCH uses a simple CT scan to develop a 3-D computerized model of the entire leg structure and create a customized surgical guide, based on each patient’s unique anatomy. With fewer surgical steps and less equipment in the OR, surgery is quicker and safer, the risk of infection is significantly lower, and patients spend less time under anesthesia, which reduces the chance of complications such as blood clots.
  • Precise alignment for better wear resistance. The customized surgical guide improves the placement and positioning of the implant, which is critical for overall performance and long-term success. “This level of precision improves alignment and stability which will, hopefully, result in less wear and tear down the line,” explains Dr. Madden. “One of the biggest problems in total joint replacement is that the bearing surfaces eventually wear out. But the TRUMATCH process should help the implant last longer, which is the ultimate goal.”


Good candidates for TRUMATCH are men or women with knee deformities or previous fractures, as well as those with arthritis.  Almost all patients with knee arthritis are good candidates for TRUMATCH.  It can be especially helpful with patients with severe deformities where conventional alignment techniques can be challenging.

Watch this video about a TRUMATCH patient’s experience

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Posted in Total Joint Replacement | Leave a comment
Posted on by commonwealth

Elbow Arthroscopy

Peter Thomas and his patient Chuck talk about Chuck’s recent complex elbow arthroscopy. For more information you can read the complete article on the Commonwealth Orthopaedics website.

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Posted in Arthroscopic Surgery, Hand & Upper Extremity Surgery | Leave a comment
Posted on by Andrew Parker, MD

Hip Labral Tear

The labrum is a type of cartilage that surrounds the socket of ball-and-socket joints. A labrum is found in both the shoulder and the hip joint. The labrum forms a ring around the edge of the bony socket of the joint. It helps to provide stability to the joint by deepening the socket, yet unlike bone, it also allows flexibility and motion.
There are two general types of hip labral tears: degenerative tears and traumatic injuries. A degenerative tear is a chronic injury that occurs as a result of repetitive use and activity. Degenerative labral tears can be seen in the early stages of hip arthritis.
A traumatic hip labral tear is usually an acute injury as a result of a sports injury, fall, or accident. Hip labral tears can be seen in association with episodes of hip dislocation or subluxation. They are commonly associated with sudden, twisting maneuvers that cause immediate pain in the hip.
Typical symptoms of a hip labral tear include groin pain, clicking and snapping sensations in the hip and limited motion of the hip joint. Your doctor can use an MRI with contrast to help diagnose a labral tear.
The treatment of hip labral tears is rest, anti-inflammatory medications, physical therapy, and cortisone injections. If those measures do not relieve the pain, a hip arthroscopy may be needed. Recovery from a hip arthroscopy depends on the extent of work that needs to be completed, but usually lasts 6 to 12 weeks.
For more information on hip labral tears, visit Dr. Parker’s bio page on our website.

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Posted in Sports Medicine | Leave a comment
Posted on by Daniel Weingold, MD

Shoulder Pain

Dr. Weingold practices in our Alexandria, Burke and Springfield offices.

The shoulder is the most mobile joint in the body and as a result
allows us to do many athletic activities at a high level, but sometimes repeated use can create problems.
Shoulder disorders can be due to overuse, injury related, or degenerative. Shoulder pain can be due to issues with the bone or cartilage that protects the bone; or problems with the soft tissues including the ligaments that stabilize the shoulder, or the muscles and tendons that provide strength and stability. The rotator cuff muscles become tendons that can be overworked or irritated by bone spurs, which lead to tendonitis, bursitis, pain and weakness. This can be managed with rest, NSAIDs, physical therapy and occasionally a cortisone injection.

Surgery can be performed for persistent pain through minimally invasive
arthroscopic surgery, which is often needed if the rotator cuff becomes torn.
Shoulder instability relates to torn or loosened ligaments after dislocating your shoulder.
This can improve with periods of rest, a sling and physical therapy along with some
adjustments in activities. Surgery is performed to reconstruct and tighten the ligaments
for patients who don’t improve.

Some individuals who fall can sustain a broken bone (fracture) of the clavicle (collarbone) or separate it from the shoulder blade, or can fracture the humerus (arm). Once again, some of these injuries can be treated with rest, a sling and physical therapy and some require surgery to realign and stabilize the bone. Chronic pain and stiffness related to advanced arthritis of the shoulder can be treated with surgery called a joint replacement operation. Individuals who develop shoulder pain should visit their orthopedist to have an assessment that usually includes a physical examination and x-rays for starters.
For more information about Dr. Weingold read his bio on our website.

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Posted in Shoulder | Leave a comment
Posted on by Amanda Trucksess, MD

Tenex FAST Technique: An Exciting New Treatment Option for Chronic Tendinitis

Dr. Trucksess practices in our Reston office.

What is the FAST™ Technique?
FAST, which stands for fasciotomy and surgical tenotomy, is a new, non-operative, FDA-approved treatment option for patients with chronic tendinopathies. At Commonwealth, we’ve used this technique to successfully treat patients with tennis elbow and golfer’s elbow, as well as tendinitis in the kneecap, rotator cuff and Achilles tendon.

Who is a good candidate for the FAST procedure?
Anyone who has had tendinitis for more than three months is a good candidate. In addition, anyone who has failed more conservative measures such as therapy or cortisone injections for their tendinitis symptoms should consider the procedure.

How does FAST work?
The procedure uses ultrasound waves inserted through a small incision in the skin to identify and break up calcification and chronic tendinosis. It is quick and minimally invasive and provides patients an effective treatment option without an open surgical procedure.

How many treatments are involved?
Just one. FAST is a permanent fix that successfully removes pain-generating soft tissue.

What are the benefits?
The entire procedure takes only about 15 minutes. It is performed under local anesthesia, which means the patient remains completely awake throughout. The incision is tiny – just 3 mm, which is about one-eighth of an inch. All of this makes recovery fast and easy.

What is involved in the recovery process?
Recovery time is minimal and most people can return to work the following day. Exercise can be resumed in one to two weeks in most cases.

What are the outcomes?
At Commonwealth, our patient outcomes have been excellent. A vast majority of patients see a significant improvement right away in their tendinitis, with no recurrence of symptoms.

Where is the procedure performed?
Currently, FAST is performed at Commonwealth’s Outpatient Surgery Center. In the future, we hope to offer this option in the office.

Do patients come for an office visit before scheduling the procedure?
Do they need a referral?

We do have patients come for an office visit first. If the assessment determines that FAST is an appropriate treatment option, we go ahead and schedule the procedure at the outpatient surgery center . Patients do not need special referrals for either the office visit or FAST procedure unless required by their insurance plan.

Is FAST covered by insurance?
The FAST procedure is FDA-approved, so it is covered under most insurance plans. However, it is considered an outpatient procedure and some insurance plans may require a co-pay. Patients should check with their insurance companies for specifics.

Dr. Trucksess is the only surgeon at Commonwealth Orthopaedics who performs the FAST™ Technique and one of the only physicians in Northern Virginia to offer this innovative option. If you have questions about FAST, call Melissa Bryon at 703-810-5202/X1426. To learn more about Dr. Trucksess, read her bio

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Posted in Uncategorized | Leave a comment
Posted on by Katie Canestrano, OTR/L, Certified Hand Therapist

Specialized Therapy for Tendon Injuires to the Hand

Katie Canestrano, OTR/L, Certified Hand Therapist

What types of tendon injuries do you see?
Tendon injuries can be isolated, such as a laceration from a knife; or in tandem with other traumas, like fractures and nerve lacerations. Some tendon injuries are the result of a cut, so there is an open wound. Others are called avulsions, when a finger is wrenched aggressively, and the tendon pulls out of the bone, but there is no bleeding or skin tear.  


What is involved in therapy?

Therapy addresses all aspects of the injury: wound care, pain management, caring for the healing scar, motion recovery and, most importantly, restoring function to the hand.  


What is the goal? 

The goal of rehabilitation is to maximize the post-operative recovery, give the patient the best outcome possible, restore hand use and promote a return to independence: self care, work, leisure activities and activities of daily living. 


Why is therapy so important for these patients? 

Therapy for tendon injuries is very specialized. There is a delicate balance between controlled stress to strengthen the healing tissues, and proper positioning and rest to protect the repair. Too much motion can cause the repair to rupture; too little and scar adhesions develop and the tendon won’t function properly.   


How does Commonwealth excel in this area?

Strong communication between surgeon and therapist is of vital importance. At Commonwealth, we have three certified hand therapists (CHTs) on staff who are in constant contact with our four hand surgeons. Because the surgeons and CHTs are all in-house, it promotes easy access. It’s not unusual for a surgeon to call me from the operating room to update me on a patient and initiate a treatment plan. This does not happen with other therapies.


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Posted in Uncategorized | Leave a comment
Posted on by Peter Schunk, ABC Orthotist

Orthotics Can Improve Back Pain Associated with High Arches

Very high arches can cause you to alter your gait, which can result in back pain.  With high arches, the feet tend to supinate, or roll out.  This results in the ligaments and skeletal structure exerting an external rotational force on the tibia & fibula, which continues at the knee joint, femur, pelvis, and possibly even the spine.  


If your back pain is the result of high arches, my recommendation is to see an Orthopaedic physician who specializes in Sports Medicine.  They may refer you to a Physical Therapist or someone like myself, an Orthotist.  An Orthotist can fit almost any brace on the body, from the head to the foot, excluding the teeth.  If the plan includes seeing an orthotist, it most likely is because the doctor has written a prescription for a pair of custom foot orthotics. For someone with high arches, the orthotics would most likely include a lateral post, along with an arch support that is fabricated to your specific arch.  The goal of the lateral post is to reduce the amount your foot supinates, while the arch support allows limited flexibility.  The flexibility reduces the shock that the ground reflects back to your foot as it moves through the gait cycle.  The reduced movement that the custom arch support and lateral post provide helps restrict the excessive rotating of the skeletal structure and connecting joints from the foot through the spine.


Back pain can be the result of many variables, however, the best way to determine what is causing your back pain is with the help of an Orthopaedic physician who specializes in Sports Medicine, and possibly a physical therapist.  They are best suited to help you determine the cause(s) of your back pain.  


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Posted in Foot and Ankle, Uncategorized | Leave a comment
Posted on 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

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Posted in Uncategorized | Leave a comment ← Older posts