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.
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 bioUncategorized | Leave a comment 7/31/13
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.
Uncategorized | Leave a comment 7/19/13
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.
Foot and Ankle, Uncategorized | Leave a comment 5/10/13
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.Uncategorized | Leave a comment 4/9/13
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 hereFoot and Ankle, Sports Medicine | Comments Off 3/27/13
Click here to learn more about this condition.Children and Adolescents | Leave a comment 3/15/13
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.Patient Satisfaction | Leave a comment 3/13/13
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.
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.
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.
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. Hand & Upper Extremity Surgery, Sports Medicine | Leave a comment ← Older posts