- Arthritis
- Primary CareYou should discuss your overall health with your primary care provider (PCP) prior to planning surgery. Your PCP can estimate and discuss your relative risk associated with a major surgery, and may want to perform further tests before granting you “clearance†for surgery.
- Emergency Care
- Mental HealthRelative energy deficiency in sport (RED-S) is a syndrome in which a person’s energy intake does not meet their energy requirements. It is an umbrella term that encompasses what is known as the female athlete triad (menstrual dysfunction, decreased bone density, and low energy availability). For many people, this can manifest as any combination of irregular or absent periods, stress fracture, and low BMI. Recent research has shown that RED-S affects much more than just those three areas of health though. It can affect immune function, fertility, mental health, endurance, and digestion among others. Equally as important, RED-S can affect both males and females.
- UltrasoundUltrasound may be performed in the office to evaluate the cuff tissues. An ultrasound is very good at picking up inflammation or calcification in the cuff tissue, and a well trained physician can accurately identify both partial thickness and full thickness tears. It is harder to tell if the muscle tissue is atrophied or has fatty infiltration. It can also be harder to evaluate a rotator cuff that has previously undergone repair.
- MRIIn some instances, if this is the first time you have dislocated or subluxated your patella, it may not happen again. However, if there is significant damage caused by the dislocation or subluxation it is possible it may happen again. Your surgeon should evaluate you in clinic and will likely get an MRI to evaluate the degree of damage. If there is a significant amount of damage, especially of the cartilage, you may be indicated for surgery to fix this.
- X-Rays
- Orthopedics
- ArthroscopyHistorically, rotator cuff repairs were performed through large incisions to expose the tendons and overnight hospital stays. Today, with the aid of the arthroscope, most surgeries are performed in the outpatient setting with patients going home the same day. The arthroscope allows excellent visualization of the rotator cuff from its underside within the joint (articular side) and from above in the subacromial space (bursal side) and allows for placement of repair devices through small plastic cannulas. This is performed through 3 or 4 small incisions (portals). The cuff is repaired using small anchors in the bone with the attached sutures passed through the cuff tendon. Suturing the tendon to the bone seals the tear from the joint fluid and the compression of the tendon on the bone encourages healing of the tendon to the bone. If the tissue quality is less reliable or the tear pattern is complex, after the initial arthroscopy it may be helpful to expand one of the small incisions into a slightly larger one, splitting but not cutting any muscle fibers (“mini-open†technique), to perform a reliable repair.
- Joint ReplacementThe main goal is to improve your quality of life. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, regain range of motion, and help you resume normal daily activities. Many people are able to return to pain-free sleep, walking, hiking, biking, water sports, skiing, golf and doubles tennis, among other activities.
- ArthroscopyTreatment of a meniscus tear typically involves an arthroscopy (scope) where the work is done through two small portals (poke holes) in the front of the knee.
- Hip ReplacementTotal hip replacement surgery takes approximately 1.5 hours in the operating room. Most patients elect to have a spinal performed which is a near painless injection near the spine which results in the legs “falling asleep†so to speak. The patient is then given medication which allows a similar sleep to general anesthesia but does not require placement of a breathing tube as the patient is breathing on their own. There are just two main components to a hip replacement: a femoral stem and acetabular (pelvic) cup. Both are sized specifically to match the patient’s anatomy. Limitations following surgery are much less rigid than they used to be secondary to cup dual mobility.
- Knee ReplacementA TKA (total knee arthroplasty) and a TKR (total knee replacement) are the same thing. In a “total,†all the worn cartilage surfaces are removed with a saw (about one centimeter thick cuts) and similar thickness metal implants are used to cap the remaining bone. There are high quality plastic liners that separate the metal implants. You keep many aspects of your native knee including the joint capsule tissue, quadriceps tendon, patellar tendon and patella, the medial and lateral collateral ligaments and often the posterior cruciate ligament. The remaining meniscus and the anterior cruciate ligament (ACL) are removed, but the knee is stabilized by other functions of the implant. The cartilage surface of the patella may be left alone or resurfaced with a plastic implant depending on the individual situation. Once the procedure is performed you cannot go back to your native knee, as key tissues have been removed.
- Reconstructive SurgeryIf you have injured just the PCL, the injury may heal without surgery. If there are additional injuries to the knee, surgery may be recommended. If the PCL does not heal back tight enough to provide adequate stability for your activities, then the PCL may need reconstructive surgery.
- Cyst
- Sports MedicineA Tommy John injury is an injury to the ligament on the medial (inside) part of the elbow. It most commonly occurs in overhead throwing athletes such as baseball pitchers and quarterbacks but can also occur in other sports such as gymnastics, javelin throwing, tennis, volleyball, and softball. The reason it is nicknamed the “Tommy John†injury is because he was the first baseball pitcher to have the surgery to fix the injury. This surgery was done in 1974 by Dr. Frank Jobe, a pioneer in sports medicine. After the surgery, he went on to play in the majors for another 15 years!
- Physical TherapyA shoulder replacement is called a total shoulder arthroplasty (TSA). This surgery is most commonly performed when osteoarthritis has become so severe that more conservative treatments such as injections, physical therapy, and medications are no longer effective in treating the symptoms. Osteoarthritis can occur in all joints and is best thought of as progressive thinning of your articular cartilage.
- Shoulder Pain
- Ankle SprainIf an ankle sprain is severe enough or fails to improve with conservative care surgery is indicated. The surgery is done as an outpatient through a small incision. The ligaments that are damaged are repaired with a combination of sutures and anchors. The ligaments that may require stabilization include the ATFL, deltoid ligament, or the syndesmotic ligament in a high ankle sprain. The rehabilitation after surgery will vary depending on which ligaments have been damaged but typically requires about 6 weeks in a boot followed by a strengthening program. It may take 4-6 months to completely rehabilitate the ankle but in some instances athletes may get back to their sport using a more accelerated recovery program.
- Back Pain
- Achilles TendonitisAchilles tendonitis is usually due to repetitive injury that leads to irritation and pain of the tendon. If this persists, this can lead to chronic changes in the tendon called tendinopathy. Different things can contribute to repetitive injuries such as tight-fitting shoes, being flat-footed, having particularly high arches, tight calves, or a marked increase in activities such as walking, running, or hiking. Achilles tendon issues have even been associated with certain yoga poses. You can also develop tears in the Achilles tendon, which can be related to long-standing Achilles tendinopathy or a traumatic injury.
- Ankle SprainA high ankle sprain is different from what is described above. This is when an injury occurs to a joint in the ankle where the two bones of the lower leg meet. There is generally injury to a ligament, as well as a thick connective tissue, called a syndesmosis, between the two bones. This usually occurs if someone’s ankle is forced into an upward and outward position. With high ankle sprains, most people experience pain in the front and inside of their ankle and may even have a sensation of instability. These injuries are generally more severe and may benefit from early evaluation by a physician with x-rays and possibly a boot since lack of treatment of this injury can lead to ankle arthritis and instability of the ankle joint.