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Carpal Tunnel Syndrome Diagnosis and Treatment

After undergoing carpal tunnel release procedure, this patient's arm pain was relieved

After undergoing a carpal tunnel release procedure, Chris Reed’s arm pain was immediately relieved.

Often, people with numbness and tingling in the hand may try to ignore their discomfort. All too soon, however, numbness and tingling may progress into swelling and pain, and work, family, and quality of life becomes negatively impacted. When the diagnosis is carpal tunnel, physicians at OrthoVirginia are poised to lend a helping hand.
What causes Carpal Tunnel Syndrome?
Carpal tunnel results from compression of the median nerve, one of the three major nerves that supply sensation and function to the hand. This nerve travels through a “tunnel” in the wrist, a narrow passageway comprised of the transverse carpal ligament and the carpal bones at the base of the hand, as well as some tendons connected to the fingers and thumb.

Some people are more predisposed to getting carpal tunnel syndrome than others. Women are three times more likely to experience carpal tunnel than men. Other risk factors or indicators, according to Alexander Croog, MD, orthopaedic surgeon at OrthoVirginia, are diabetes, rheumatoid arthritis or other inflammatory conditions, under-active thyroid or a previously broken wrist. Some
studies have linked certain careers with carpal tunnel pain, such as those requiring constant typing or handling of vibrating tools, such as a jackhammer.

Diagnosing Carpal Tunnel Syndrome
Diagnosing carpal tunnel syndrome often takes several steps. Many patients can be diagnosed from their medical history and a physical exam. “This is more typical for someone who has progressive symptoms, such as numbness and tingling in the hand, or numbness in the thumb, index finger, middle finger, or ring finger for a series of months,” said Dr. Croog.
A nerve conduction study can confirm the diagnosis. During nerve conduction tests, a neurologist uses small, acupuncture sized needles to test how well a nerve conducts a signal.
After completing the tests, the patient must decide whether to wait or request a carpal tunnel release procedure.
Treatment Options
Treatment for Carpal Tunnel Syndrome includes both operative and non-operative approaches. The easiest place to start is with a metal wrist splint. Patients wear it while they sleep at night and for any activities during the day which usually bring about the numbness. If the symptoms persist despite wearing a wrist splint, some patients may benefit from a cortisone injection. The cortisone acts to decrease the inflammation and pressure around the nerve.
Some patients require surgery for carpal tunnel syndrome. Several types of surgery are available at OrthoVirginia. Dr. Croog performs a minimal-incision carpal tunnel release. For this technique, the incision, which is usually about three centimeters, is made on the palm, close to the wrist.
Surgeons advise patients to return to normal activity as soon as possible after carpal tunnel release surgery. “When the stitches come out, the patients have no limitations,” Dr. Croog said.

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Posted in Hand & Upper Extremity Surgery, Uncategorized | Leave a comment
Posted on by OrthoVirginia

5 Osteoarthritis Myths


Patients with osteoarthritis should continue to exercise

Non-impact activities like swimming, cycling and elliptical training are excellent choices for patients with osteoarthritis.

Osteoarthritis – also known as “wear and tear” arthritis – is a common condition, affecting about 27 million Americans. But many people don’t fully understand the disease or its treatment. Here, the most common myths about osteoarthritis are debunked.
Myth 1: Arthritis is just aches and pains – not a serious health

Osteoarthritis is a progressive, degenerative disease in which the surface layer of joint cartilage slowly wears away. Cartilage is a rubbery tissue that allows bones to glide smoothly over one another. Without the cushioning effect of cartilage, the bones of the joint rub together. The joint can’t move easily and becomes stiff, swollen and painful. Osteoarthritis is especially prevalent among middle-aged and older adults. Obesity and genetics are also contributing factors.
Myth 2: There’s not much I can I do if I have arthritis.
While there is no cure for arthritis, there are many things you can do to slow its progression, reduce pain and improve function. One of the most effective remedies is weight loss. Maintaining a healthy body weight can reduce stress on the joints. If you’re overweight, losing just five percent of your current weight can improve your arthritis symptoms.
Myth 3: Exercise will increase disability.
Inactivity can actually worsen arthritis. Exercise is important to strengthen muscles and ligaments, reduce pain and control weight. Non-impact exercises are best, according to OrthoVirginia surgeon David Romness, MD. “The most beneficial forms of exercise are those that encourage motion without load and strengthen the muscles around the joint. Swimming, cycling and elliptical training are all excellent choices. Walking has some load but is low impact enough to be safe.” Your doctor or physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Myth 4: The only way to treat arthritis is with joint replacement.
Although some people with osteoarthritis do eventually need joint replacement, there are many non-operative options you can try first. Over-the-counter drugs and topical creams and sprays can combat pain and inflammation. Prescription anti-inflammatory drugs, corticosteroid injections or lubricating injections can provide temporary relief as well.
Myth 5: Joint replacement involves a long recovery and rehabilitation.
The standard of care for total joint replacement has improved dramatically in recent years. Patients are up and active sooner and function returns much more quickly. “The development of new minimally invasive approaches, enhanced implant materials and refined surgical techniques have significantly reduced recovery times,” says Mark McMahon, MD, who performs total hip replacement surgery at OrthoVirginia. “Long hospitals stays, long incisions and severe long-standing pain as experienced by prior generations of hip replacement patients are no longer part of today’s modern procedures. For minimally invasive total hip patients, the typical recovery period is now weeks rather than months.”

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Posted in Arthritis, Uncategorized | Leave a comment
Posted on by OrthoVirginia

Platelet-Rich Plasma (PRP) for Pain Relief

Platelet-Rich Plasma or PRP is a technique where patients use their own blood to help relieve chronic pain.

PRP can be used in patients that have failed conventional treatments.
Most patients who try PRP have tried multiple rounds of physical therapy or cortisone injections and have failed to progress. PRP is another non-surgical option that allows patients to return to normal activities without surgery.
PRP can be done as a one-time injection or in many cases will be done as a series of injections. For the series, up to three injections can be given several weeks apart.
PRP can offer pain relief from:

  • Chronic scarred tendon
  • Chronic tendinitis
  • Achilles tendinopathy
  • Golfer’s elbow
  • Tennis elbow
  • Osteoarthritis in the knee


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Posted in Arthritis, Foot and Ankle, Pain Management, Uncategorized | Leave a comment
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 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 OrthoVirginia

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 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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