As one of three event chairs, Dr. Sethi opened with a review of the principles of shoulder and elbow anatomy to help the attendees further their skills and mastery of surgical approaches and procedures of the shoulder and elbow. Dr. Sethi also gave a presentation called, 10 Technical Tips: Arthroscopic Bankart/Posterior Repair.
Dr. Kowalsky’s presented the following day on How to Take an Elbow Apart and Put it Back Together! Posterior Family of Approaches – Sparing, Trap, Osteotomy.
Watch the panel presentation, The Well-Balanced Athlete, delivered by ONS physicians at Byram Hills High School in Armonk, NY on February 13, 2018. Sports medicine experts Dr. Marc Kowalsky and Dr. Demetris Delos were joined by sports psychologist Dr. Alex Diaz, to address such issues as injury prevention, the dangers of sports specialization, sleep and nutritional requirements, and the importance of mindfulness training. The school’s television station recorded the 90-minute program. If you would like to see the presentation live, the panel will be addressing the Briarcliff Manor school district coaches, parents and students at the Briarcliff Middle School Auditorium on Tuesday, March 13 beginning at 7:00 pm. There will be time for Q & A at the end of the presentation. You can also view the PowerPoint presentations given by Dr. Delos and Dr. Kowalsky.
If pain in your knee, hip or shoulder joint is interfering with your quality of life, it may be time to consider joint replacement.
Join shoulder replacement surgeon Seth Miller, MD, and hip and knee replacement surgeon Frank Ennis, MD, to learn all about the advances in joint replacement procedures and what to expect from your first office visit through the recovery process. Dr. Miller and Dr. Ennis will be joined by Greenwich Hospital staff who will outline the particulars of your hospital stay. There will be time to have your questions answered at the conclusion of the program.
DEMETRIS DELOS, MD AND CHRISTOPHER SAHLER, MD OF ONS TO DISCUSS EFFECTIVE TREATMENTS FOR CHRONIC PAIN.
Maintaining quality of life while living with chronic pain is no easy feat. Two orthopedic specialists from ONS will discuss effective new treatments to help people with relentless pain return to the activities they enjoy. Join Demetris Delos, MD, an orthopedic surgeon who specializes in sports medicine an comprehensive knee and shoulder, and interventional pain management physiatrist, Christopher Sahler, MD for this informative talk on Wednesday, May 11 at The Inn at Waveny, 73 Oenoke Ridge in New Canaan. Doors open at 4:00 pm for refreshments. Presentation begins at 4:30. RSVP at 203-594-5310 or [email protected]
“Arthritis affects more than 52 million adults in the United States and is the most common cause of disability,” according to the CDC. The pain from arthritis can set the stage for a decline in physical activity and make it difficult to prevent chronic health problems. Unfortunately, some who suffer from this ailment stop their activity and become depressed from thoughts of the mobility they once had.
Jane E. Brody, author of the “Keep Moving to Stay a Step Ahead of Arthritis” article in The New York Times recently attempted to relate to those suffering from arthritis by speaking of her own battle with having to put down the tennis racket after decades of enjoying the sport, and her story did not end there. Two years after that, she had joint replacement surgery, picked up an assortment of other activities that successfully replaced tennis as a main source of activity. Therefore, encouraging others to do the same and not succumb to the depression that can sometimes come in hand with arthritis.
The reality is that the majority of people dealing with arthritis do not fully understand what they are capable of. Less than 10% of participants with arthritic knees in a 10-year study met the national guidelines of doing two and a half hours of moderate physical activity a week. Yes, you read that correctly, a week! It gets better though. Participants did notice a significant improvement of function when the amount of activity per week was increased. Additional weight on the body creates unnecessary stress on the major joints as well, leaving a 10% decrease in weight able to make a noticeable difference. With this fact a recommendation of starter exercises were mentioned, including walking laps in a swimming pool and then increasing activity as the muscles gain strength.
On Wednesday, April 22nd, at 6:00 p.m., orthopedic surgeon/ joint replacement specialists from ONS and Greenwich Hospital will present a joint replacement symposium in the Noble Conference Center at Greenwich Hospital located at 5 Perryridge Road. Knee and hip specialists Frank Ennis, MD and Brian Kavanagh, MD; and shoulder specialist Seth Miller, MD will present information about the latest advances in joint replacement, including computer-assisted and minimal incision, muscle sparing techniques. Information about preparing for joint replacement, pain management and what to expect from the recovery process will be addressed by hospital anesthesiology, nursing and physical therapy department staff.
Many people suffer from severe pain caused by arthritis, a fracture or other conditions that make common activities such as walking, putting on shoes and socks or getting in and out of a car, extremely difficult. Today, over 900,000 hip and knee replacement surgeries are performed each year in the United States. An additional 53,000 shoulder replacements are performed. Deciding if and when it’s time to consider joint replacement surgery are important decisions. This educational symposium is designed to provide anyone who is considering joint replacement with pertinent information to assist them in making the right decision for them.
Frank Ennis, MD specializes in hip and knee replacement and is fellowship trained in adult reconstructive surgery. Dr. Ennis is among the first orthopedic surgeons in the New York area to perform computer-assisted joint replacement. He completed undergraduate studies at Yale University and post-baccalaureate pre-medical studies at Harvard University. He graduated from Duke University School of Medicine and completed a residency at Yale University Department of Orthopaedic Surgery. He received his fellowship training at New England Baptist Hospital in Boston.
Brian Kavanagh, MD has performed over 6500 joint replacement surgeries in the past 25 years. He graduated Princeton University and earned a medical degree at University of Connecticut School of Medicine. He did his internship and residency at the Mayo Clinic, Mayo Graduate School of Medicine in Rochester, Minnesota, and served on the faculty at the Mayo Graduate School of Medicine for seven years. Dr. Kavanagh was on the teaching staff at Yale University School of Medicine in New Haven for five years. Dr. Kavanagh was also an instructor in the hip and knee total joint fellowship program.
Seth Miller, MD is a graduate of Mount Sinai School of Medicine in New York. After his residency at New York Columbia-Presbyterian Medical Center, he completed a research fellowship at the Hospital for Special Surgery in New York and a shoulder surgery fellowship at Columbia-Presbyterian Medical Center. He served as an orthopaedic consultant to the New York Mets for more than eight years. He is the current President of ONS.
All three surgeons are on staff at Greenwich Hospital, a recipient of The Joint Commission’s “Gold Seal of Approval™” for total hip and knee replacement surgery and spinal fusion. The certification for hip and knee replacement procedures recognizes the hospital’s commitment to maintain clinical excellence and patient satisfaction, while continuously working to improve patient care. Greenwich Hospital’s total joint replacement program offers a level of continuity that sets it apart from other facilities. A clinical resource nurse helps patients every step of the way – before, during and after surgery and throughout rehabilitation and recovery. Patients receive the practical information, emotional support and follow-up care they need to guide them through the entire process.
You will have the opportunity to ask questions at the conclusion of the talk. The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.
Remember last week’s post?Dr. Kowalsky ended the last installment with listing a multiple options one could take to repair a rotator cuff tear due to the fact that it is very unlikely for the condition to heal on its own. The following is a more in depth description of what makes up this part of the body and what to do after the symptoms of arthritis of the shoulder appear.
The glenohumeral joint of the shoulder includes the humeral head, or ball, and the glenoid, or shallow socket. Both joint surfaces are coated with articular cartilage, the pearly-white, smooth surface that allows near friction-free, painless movement of one surface on another. Typical wear-and-tear osteoarthritis occurs due to the degeneration of the joint surface. As the articular cartilage erodes, the underlying bone can become exposed, change in shape, and create symptoms. Patients typically present with pain deep within the joint. The pain can be associated with mechanical symptoms, such as catching, clicking, or grinding, as well as loss of motion. For some patients, typically those with mild or moderate arthritis, there is a role for conservative management.
However, the most reliable means for pain relief, improved motion and function for patients with moderate or severe arthritis is shoulder replacement. This procedure is performed by removing and replacing the arthritic ball with a metal implant, and by resurfacing the socket with a plastic implant, restoring low-friction, pain-free motion. Implant design and surgical technique for the treatment of both rotator cuff tears and shoulder arthritis continue to evolve. These innovations empower shoulder and elbow surgeons to individualize the treatment plan to a specific patient and problem.
Tonight, March 12 at 6:30 pm at Greenwich Hospital, Dr. Kowalsky will give a health talk on “Common Causes and Solutions to Chronic Shoulder Pain” will discuss the causes, symptoms, and treatment of rotator cuff tears and shoulder arthritis. The event will highlight important recent advances in the management of these conditions that have been associated with improved long-term outcomes.
Last Thursday’s talk on “Maximizing Your Child’s Athletic Potential” was a success. A big thank you goes out to the Junior League of Greenwich for making it possible with their focus on improving the community and empowering others to further health and education! Ultimately they brought together the perfect combination of experts to inform the public about the youth and the sports they love.
Dr. Delos, of ONS and Greenwich Hospital, was a panel speaker at this event. He specializes in sports medicine and arthroscopic treatment of knee and shoulder disorders. Before ONS, Dr. Delos was the Assistant NFL Team Physician for the New York Giants and was team physician for a number of local high school and college athletes.
Other panel members consisted of Andy Barr, Director of Performance and Rehab for the New York Knicks, Mubarak “Bar” Malik, Head of Strength and Conditioning for the New York Knicks, and Allan Houston, one of NBA’s all-time greatest long range shooters and Olympic gold medalist, as the moderator. Each participant reinforced the importance of parents taking interest in the development of their young athlete and properly guiding them to the path of success. Parents attending this event were very attentive, and came prepared with questions.
Conversations covered the fundamental topics, like proper sleep habits and nutrition. For example, a young athlete’s nutrition should increase in relation to the amount of activity they experience daily. This may be common knowledge to an adult but for an adolescent, proper amounts of sleep and good nutrition that balances the amount of activity should be added to their routine.
Aside from the basic topics of discussion, there was a myth to be busted as well; to find out the details of the myth and for more information about the questions that were asked at the event, please read the article written by the Greenwich Freepress.
If golf or racket sports are in your plans for the spring you will want to hear tips from fellowship trained orthopedic foot and ankle specialist Mark Yakavonis, MD, MMS and fellowship trained hand/wrist/elbow specialist Mark Vitale, MD, MPH who will discuss common injuries seen in golf and racket sports. Special guest and local tennis pro Patrick Hirscht will also speak. Learn about common injuries, and how to choose footwear, braces and exercises to prevent injury and play your best; whether it’s the foot, hand, wrist or elbow, they’re all at risk for injury when you’re active. Dr. Yakavonis and Dr. Vitale will discuss nonsurgical and surgical treatments, along with ailments particular to racket sports. You will have the opportunity to ask questions at the conclusion of the talk. The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.
Join the Junior League of Greenwich and the Greenwich Library for a discussion moderated by two-time NBA all-star Allan Houston and featuring a panel of experts from the NBA and NFL on the prevention of adolescent sports injuries. Former Knicks star and Greenwich resident Allan Houston is one of the NBA’s all-time greatest long range shooters, an Olympic gold medalist, current Assistant General Manager of the NY Knicks and spokesperson for the National Fatherhood Initiative.
Panelists include Andy Barr – Director of Performance and Rehab for the New York Knicks, Mubarak Malik – Head of Strength and Conditioning for the New York Knicks and Dr. Demetris Delos – orthopedic surgeon at ONS (Greenwich Hospital) and formerly of the NY Giants.
The Junior League of Greenwich and the Greenwich Library aim to educate parents about helping their kids reach their full physical and athletic potential. Admission is free but seats must be reserved online at www.greenwichlibrary.org.
Remember last week’s post?Surprisingly enough, gymnasts share a lot in common with ballerinas, especially in terms of injuries of the feet.
Both gymnasts and dancers place a tremendous amount of stress on their feet for a significant amount of time per week – often greater than 10 hours a day. Because of this combination of stress and time, stress fractures are common. Stress fractures can occur almost anywhere in the foot or ankle, but the most common locations are the metatarsals, navicular, tibia, calcaneus, and fibula. A key to avoiding stress fractures is proper nutrition, avoiding disturbances in the menstrual cycle, and proper technique and amount of training. A gymnast who trains 4 hours a week that increases the workload to 10 hours a week in preparation for a performance without any ramp up is a setup for stress fractures. A better way to ramp up training would be to increase the workload by approximately 25% per week, or going from 4 hours a week to 5 hours a week and so forth. The treatment of stress fractures varies depending on the location and character of the fractures. It also depends on the patients demands and expectations. In most situations a period of immobilization and rest is all that is necessary.
Young gymnasts often complain of various painful lumps and bumps on the feet. Some of these are calluses, which are the bodies response to repetitive force on areas of weight bearing. Another extra bone in the foot – the accessory navicular, also thought to exist in about 10% of all people – can be a troublemaker for gymnasts in particular. It is a tender prominence on the inside of the ankle. Flatfooted patients will sprain or strain the ligaments that attach to the accessory navicular. Continued activity worsens the symptoms and the first line treatment is a period of immobilization to allow it to heal. When that fails, the extra bone is excised, and the damaged tendons and ligaments on the inside of the ankle are repaired or reconstructed.
Many of the problems in both ballet and gymnastics results from the nature of the sports – long hours and repetition in little to no footwear. These patients are predisposed to develop certain problems based on the alignment or posture of the feet. Feet come in two general shapes – flat and high arched. In reality it is a spectrum. So many problems can be treated simply by accommodating or adjusting a patient’s flat or high arch with a specific type of shoe or insert (orthotic). Unfortunately, the competitive gymnast and dancer cannot wear athletic shoes or orthotics. Some may be able to train in orthotics or custom shoes and that is important to keep in mind.
Dr. Yakavonis, MD, MMS,of ONS and Greenwich Hospital is an orthopedic surgeon specializing in foot and ankle surgery and treatments for adult foot conditions as well as youth sports injuries in field athletes, gymnasts and ballet dancers. He shares a two-part blog about conditions to be aware of for ballet dancers and gymnasts.
Ballet dancers feet are much like a musician’s hands – they earn a living with them. In addition to putting an amazing amount of stress on their feet, they also are often well below an ideal body weight – either because of the stress of an enormous amount of training or because of unrealistic expectations placed on them by the ballet community. This leads to several different and often unique foot and ankle conditions.
One fairly unique foot and ankle condition in ballet is caused by the en pointe position. In this position an enormous amount of strain is put on the dancer’s great toe, as it is essentially holding up the entire body weight through a small joint. The main flexor tendon of the toe, called the flexor hallicus longus – normally quite small, takes over the job of the largest tendon in the body, the Achilles. The flexor hallicus longus hypertrophies well in compensation for its new job, but unfortunately this tendon is forced through a tight tunnel in the back of the ankle. When it gets too large it will get pinched in the posterior ankle joint. Patients develop painful irritation of the bones and soft tissues in the posterior ankle. An extra bone in the posterior ankle called the os trigonum, which present in about 10% of all people, can be become very painful and irritated in many ballerinas. This constellation of problems is called posterior impingement of the ankle, and it is noticed by the patient as a vague deep pain in the posterior part of the ankle, in front of the Achilles, that is felt with plantarflexion, the position of pointing the foot and toes downward.
Ballet dancers suffer from numerous other problems of the foot & ankle, many of which are not unique. One of the less glamorous problems they deal with are corns, calluses, and blisters. These are necessary adaptations to allow a high level dancer to compete.
Similar to posterior impingement, which arises from dancers spending an inordinate amount of time and stress in an extreme position at the ankle, ballet dancers will develop anterior impingement at the ankle. This comes from repetitive forceful dorsiflexion – pulling the foot and toes upward, toward the shin. Landing from jumps and deep knee bends exacerbate this problem. Pain is felt in the anterior ankle.
Treatment for the above condition is customized to the patient. Often a minor activity modification, or period of rest, can dramatically improve the symptoms. Unfortunately, rest is not easy to come by in the competitive living of a gymnast. Many dancers will treat the symptoms with a combination of anti-inflammatory medications and occasional steroid injections in the region of maximal tenderness. Surgery is a last resort option for any ballerina – when symptoms persist for many months and are limiting, despite all other efforts. Surgery is typically very successful in these patients and can be done with arthroscopic or minimally invasive techniques.
The most common orthopaedic injury of all is also very common amongst ballet dancers: the lateral (traditional) ankle sprain. The mainstay of treatment for ankle sprains is rest, ice, compression, and elevation – mnemonic RICE. A short period of rest and immobilization (1-2 weeks) is followed by aggressive physical therapy, with strengthening of the muscles that stabilize the ankle. Recent research has pointed to improved short and long-term outcomes when early motion and weight bearing is initiated. There is promising early research on the role of stem cell injections – harvested from the patient’s own blood or bone marrow – in the setting of an acute ankle sprain. This is a technique we will offer for the highest level athletes and dancers in certain situations, understanding that the research data on this intervention is still in development.
… to be continued in the next segment, The Fragile Feet: A Gymnast Story (Part II)
Mark Yakavonis, MD, MMS, is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Yakavonis has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes. His practice will also focus on youth athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.
Achilles tendon ruptures will often not be discovered for months after the injury. In the months between injury and showing up at the doctor’s office, the torn tendon develops scar tissue which decreased the quality and elasticity of the tissue. Because of this, directly repairing the torn tendon, as is done in an acute injury, becomes is less than ideal. In this situation, we will supplement the tendon repair with a tendon transfer. Essentially, we borrow a tendon that bends the big toe (there is another tendon that compensates when it is borrowed), reroute it, and reattach it to the heel bone. This does two very important things:
1. It supplements the strength of the torn Achilles, allowing a quicker and better recovery.
2. It provides improved blood supply to the Achilles repair, providing healing factors to the area of diseased tendon.
In summary, ruptures of the Achilles tendon are increasingly common in our aging yet increasingly active population. In cases where an Achilles rupture is missed or the rupture cannot be repaired directly under normal tension, adding the flexor hallicus longus tendon transfer allows for significantly improved results with a shorter recovery.
If you suffer from foot and ankle pain and would like to attend a free seminar, Dr. Yakavonis of ONS is an orthopedic surgeon specializing in foot and ankle surgery, and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage . He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.
Christopher Sahler, MD of ONS and Greenwich Hospital, is an interventional physiatrist specializing in sports medicine. His focus is non-operative treatment of musculoskeletal injuries, restoring proper function, reducing pain and promoting active lifestyles.
If you are suffering from chronic pain, you are not alone. It is estimated that 100 million Americans are currently living with chronic pain. The pain may make it difficult just to get out of bed or do household chores, let alone be active and exercise. Studies have shown this inactivity can actually cause you to experience a worsened level of pain and for a longer period of time. Exercise actually improves your pain threshold. Even simple exercises such as walking can provide some benefit.
Join Dr. Sahler as he presents his first health Seminar “Exercise as Treatment for Chronic Pain” at Greenwich Hospital. Come learn how staying active and performing exercise may help treat an array of chronic pain conditions.
When: December 2nd, 2014 Time: 6:00 p.m. Place: Noble Auditorium at Greenwich Hospital
Christopher S. Sahler, MD of ONS is an interventional physiatrists specializing in sports medicine. His focus is non-operative treatment of musculoskeletal injuries, restoring proper function, reducing pain and promoting active lifestyles.
“Each year 50,000 people participate in the NYC marathon. If you are in that group and completed the race this past weekend, congratulations! It is an exciting accomplishment that you will remember for the rest of your life.
Now that the race is over, there are a few key points to remember that will help to maximize your recovery and minimize pain. Many athletes experience worsening soreness over the following days after the race. This is known as delayed onset muscle soreness and typically is most painful 48-72 hours later. After the race, your body is in a depleted state so it is important to take in plenty of water and healthy food. A combination of complex carbohydrates and protein help the muscles to repair themselves and re-build their energy stores. It is also recommended that you perform light, short duration activities such as walking, gentle jogging, biking, swimming etc. This helps to increase blood flow to the muscles and tissues that need the nutrients the most and helps to wash away the built up metabolic byproducts such as lactic acid. Gentle stretching and soaking in a warm bath may also help loosen up the muscles. Depending on your previous activity level, it is important to give your body time off before re-starting any intense exercise routines. Most runners should take at least one month off.
6:30pm to address Solutions for Foot & Ankle Pain: Beyond Foot Massage. Here is a summary of what he will present:
A painful foot or ankle condition can limit a patient’s function and quality of life with every step. Conditions from the toes to the Achilles tendon will be discussed with emphasis on surgical and nonsurgical options, including old standards and the most cutting edge new technologies. Topics covered will include foot and toe deformities such as bunions, hammertoes, flat feet, and high arches, with special attention to when and how these conditions should be treated or when they should be left alone. Plantar fasciitis and Achilles tendinitis will be discussed in detail with emphasis on the natural progression of the disease, what we know works and what is experimental. Arthritic conditions of the foot, ranging from the big toe to the ankle will be included.
A team approach is an important aspect of foot and ankle care. ONS physical therapist Alicia Hirscht, DPT, SCS, CSCS will discuss and answer questions about the role of physical therapy to improve foot and ankle pain and dysfunction.
Dr. Yakavonis will introduce an orthotic maker he typically works with and will discuss when and how orthotics are used, from inexpensive over-the-counter inserts to custom molded prostheses. Other options to be discussed will include stem cell technology and image-guided injections.