Category: Medical Expertise

ONS: Fairfield’s Top Doctors

Posted on January 17, 2020

ONS is proud to announce that 16 physicians from the practice have been named

2020 Top Doctors in Fairfield County by Castle Connolly Medical Ltd., a respected national medical data research company. Fifteen of the designees have received this accolade for several consecutive years.  However, physiatrist Christopher Sahler, MD, joins the elite roster after becoming eligible for nomination in 2019.  David Nocek, MD, who retired last year, received the designation as well.

WHAT IT TAKES TO BE TOPS

The Castle Connolly Top Doctors are nominated by their peers for talent and expertise in their medical specialties.  A Castle Connolly physician-directed research team then reviews the credentials of each nominee. They give special scrutiny to medical education, training, board certification, hospital appointments, administrative posts, professional achievements, years in practice and reputation, according to the organization’s website.

Moffly Media published the results of the annual survey in the January issues of Greenwich Magazine, Stamford Magazine and New Canaan/Darien Magazine. As in past years, ONS has the most physicians ranked than any other practice.

ONS TOP DOCTORS IN FAIRFIELD

In the field of Orthopedic Surgery, the following physicians and Dr. Nocek were singled out as the best in Fairfield:

Elsewhere, Mark Vitale, MD was recognized as Fairfield’s Top Hand Surgeon.

The entire ONS Spine Center team was identified as the best in neurosurgery: Paul Apostolides, MD; Mark Camel, MD; Amory Fiore, MD, and Scott Simon, MD.

Along with Dr. Sahler, Jeffrey Heftler, MD, at the ONS Interventional Sports and Spine Center, was ranked on top in the category of Physical Medicine and Rehabilitation.

 

ONS Doctors Speak to Sell Out Crowd

Posted on November 26, 2019

Dr. Paul Sethi and Dr. Marc Kowalsky were presenters at the prestigious American Shoulder and Elbow Surgeons 2019 Resident Course: Essentials of Shoulder and Elbow Surgery. The sold out event took place on November 22 and 23 at the Orthopaedic Learning Center in Rosemont, Illinois.  The course consisted of lectures and surgical exposure to arthroscopic and open procedures.  It is offered annually to 55 residents and fellows planning careers in shoulder and elbow surgery.

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.

ONS Shoulder Surgeon Katherine B. Vadasdi, MD, is Published

Posted on August 4, 2016

STUDY FINDS SUCCESS IN TREATMENT FOR FROZEN SHOULDER.Dr. Katharine Vadasdi, Shoulder Surgeon

Promising results of a new study by ONS orthopedic shoulder surgeon Katherine Vadasdi, MD and other researchers were published this month in the Journal of Shoulder and Elbow Surgery. The study, The Effect of Myofibroblasts and Corticosteroid Injections in Adhesive Capsulitis, was conducted to investigate the effect  that steroid injections administered directly into the shoulder joint would have on the painful and limiting condition called Adhesive Capsulitis.

Also known as Frozen Shoulder, Adhesive Capsulitis is a common, severely painful condition that leads to stiffness and reduced range of motion in the joint.  In the study, Dr. Vadasdi and the research team evaluated the changes in the lining of the joint that contributes to or causes Frozen Shoulder. They discovered an increase in a certain cell type called myofibroblasts, which cause the capsule surrounding the shoulder joint to contact and form scar tissue, leading to pain and increasing stiffness.  Steroid injections directly into the joint, however, reduced the increase in myofibroblasts, and helped reverse and prevent progression of the condition.

Frozen Shoulder most commonly affects women between the ages of 40 and 60 years.  Most cases of Frozen Shoulder can be resolved non-operatively through stretching, physical therapy, anti-inflammatory medications and cortisone injections.  In severe cases, a procedure known as arthroscopic capsular release is performed to break up the adhesions. The findings in Dr. Vadasdi’s study suggest  a more rapid resolution of the condition and possibly a decrease in cases needing surgery.

The Effect of Myofibroblasts and Corticosteroid Injections in Adhesive Capsulitis, Carolyn M. Hettrich, MD, MPH, Edward F. DiCarlo, MD, Deborah Faryniarz, MD, Katherine B. Vadasdi, MD, Riley Williams, MD, Jo A. Hannafin, MD, PhD. 1274-1279. Journal of Shoulder and Elbow Surgery (25) 2016

Dr. Vadasdi is an orthopedic surgeon and sports medicine physician who specializes in conditions of the shoulder, knee and elbow. She is the Director of the Women’s Sports Medicine Center at ONS and is a sought after speaker on the topic of women and sports injury and prevention.  Her chosen area of medical specialty reflects her personal interests.  She is an accomplished triathlete, having completed Ironman competitions in 2007 and 2009. Dr. Vadasdi is also an alpine climber and has ascended Mount Kilimanjaro, Mount Rainier, and the Grand Teton, among others.

The Dangers of Sports Specialization

Posted on July 14, 2016

Every young athlete dreams of the pride and exhilaration of hitting the game winning home run, or scoring the goal that clinches the championship.  In today’s competitive sports environment, youth are under more pressure than ever to train harder and longer to excel in their sport, often with debilitating consequences, writes sports medicine specialist and orthopedic surgeon, Demetris Delos, MD in the latest issue of The Magazine for Greenwich Hospital.Sports Medicine Discussion

The greatest shift in youth sports in the last generation has been the trend toward sports specialization and year-round training. Twenty years ago, young athletes typically played a particular sport only during that sport’s season (i.e. football in the fall, baseball in the spring and summer), and most kids sat out a season or a summer.  Today’s young competitors don’t seem to enjoy that luxury.  Unfortunately, this has also led to a surge of sport specific injuries.

A recent study at the Departments of Kinesiology, Orthopedics and Rehabilitation at the University of Wisconsin-Madison, for instance, found that high school athletes who trained in one sport for more than 8 months were more likely to report a history of overuse knee and hip injuries, than those who had played a variety of sports throughout the year or played sports at less intense levels.

The results of this study reflect what orthopedists have noticed in the last decade with the increasing number of kids showing up in our offices with throwing injuries, torn knee cartilage and stress fractures.

PROFESSIONAL LEVEL INJURIES 

 The growing corps of young adolescents and pre-adolescent baseball pitchers is now throwing excessive numbers of pitches during an unusually high number of innings for immature arm muscles. This has led to an epidemic of young athletes suffering ulnar collateral ligament (UCL) injuries, requiring the so-called Tommy John Surgery. Tommy John was a left handed pitcher for the Los Angeles Dodgers in the 1970’s, who was the first baseball player to undergo UCL reconstruction surgery.  His successful recovery and return to achieve a record of 288 career victories.

Anterior cruciate ligament (ACL) tears in youth athletes are also increasing at an alarming rate. While ACL tears are not so closely related to a particular sport statistic the way  UCL injuries are tied to pitch count, clearly the rapid rise of sports that involve running and sudden pivoting – think soccer, lacrosse, football, basketball and rugby – increases the likelihood of season ending ACL tears and reconstructive surgery.

OVERUSE INJURIES 

Unlike ACL injuries, which can be dramatic on-field experiences with players being helped off the field, the vast majority of injuries associated with excessive specialization and training are overuse injuries. Overuse injuries develop slowly over time, starting perhaps as a mild twinge before progressing into relentless, often debilitating pain.  Ironically, these injuries are relatively easy to treat with a period rest and activity modification.  All too often, players, their coaches and, sadly, parents, are often reluctant to have the athlete sit out a few practices and games.  Left untreated, overuse injuries can lead to tears in the muscles and tendons of the affected area, which require a lengthier rehabilitation and sometimes surgery.

Overuse injuries are typically sport specific. In baseball, the upper extremity is most often affected.  With Little league shoulder, the growth place of the humerus (arm bone) becomes inflamed by the repetitive motion of throwing with excessive force.  Similarly, Little league elbow involves injury to the growth plate along the inner portion of the elbow.

In the lower extremity, overuse injuries of the knee and ankle are very common. Osgood Schlatter and Jumper’s knee are injuries to the growth plate of the knee that can be a frustrating source of pain. These injuries are typically associated with repetitive impact activities (running, jumping, etc.) as seen in basketball, soccer and track.  In the ankle, Sever’s disease can lead to pain in the back of the heel.

HOW CAN WE PREVENT INJURIES?

The solution is simple but that doesn’t mean it is easy. Rest and activity modification can be difficult to execute in the middle of the season when the athlete is invested in playing and when parents have already invested much time and money to the sport.

Nevertheless, it is incumbent upon parents to insist their child rest to give the body the opportunity to heal before more serious injury occurs. If a week or two of rest doesn’t resolve the condition, the young athlete should be evaluated by an orthopedist or sports medicine specialist.

Repetitive activities such as throwing or running can lead to changes in the development of growing bones and joints. It has been known for some time now that significant amounts of pitching during adolescence can change the rotation and shape of the shoulder.

Moreover, there is a growing body of evidence indicating certain sports played excessively during adolescence are associated with the development of femoroacetabular impingement syndrome (hip impingement), which can lead to hip problems often requiring surgery in adulthood.

In addition, numerous studies have shown that exposure in youth to a range of different sports that utilize different muscle groups and mechanical skills lead to the greater overall athleticism and better athletes.

ONS Surgeon Named Doctor of Distinction

Posted on April 20, 2016

PAUL SETHI, MD, WAS NAMED ONE OF FAIRFIELD COUNTY’S DOCTORS OF DISTINCTION BY WESTFAIR COMMUNICATIONS. 

Dr. Sethi, a sports medicine specialist and orthopedic surgeon at ONS, will be presented with the Cutting Edge Award  at the annual Fairfield County Doctors of Distinction Awards ceremony on Tuesday, May 3.  Dr. Sethi has received this recognition from Westfair Communications for his ongoing research into improving orthopedic surgical procedures  and help in creating international orthopedic surgical standards.  Doctors of Distinction

As President of the  ONS Foundation for Clinical Research and Education, Dr. Sethi’s research has recently included the establishment of  better methods for surgical skin preparation (cleaning) to lower the risk of surgical infection; development of a new technique to repair chronic or weakened biceps tendons; and the evaluation of surgical needles in tendon surgery to establish international guidelines on needle use. Additionally, Dr. Sethi has recently contributed a textbook chapter on shoulder fractures, and two chapters on treating elbow injuries in throwing athletes.

Learn more about Dr. Sethi’s outstanding career here.

 

An Added Level of Safety to Young Athletes

Posted on April 19, 2016

THE ORTHO ACCESS PROGRAM AT ONS OFFERS AN ADDED LEVEL OF SAFETY TO YOUNG ATHLETES WHO ARE INJURED ON THE FIELD. 

If you missed yesterday’s  Well column in The New York Times, it focused on the lack of national safety standards to protect student athletes from crippling or fatal injuries.  Individual states and theinjured on the field schools within them, for the most part, haven’t yet adopted injury prevention and treatment policies or procedures for children who play organized or league sports either. The responsibility is all too often left to coaches and parents to assess what measures to take when a young athlete is injured and when they can return to play. 500 student athletes died last year due to poor decisions made immediately following injury, according to the article. The ORTHO ACCESS program at ONS is designed to add an extra layer of medical support and injury prevention education for coaches, athletes, and parents. During the first critical moments after a player is hurt,  ONS ORTHO ACCESS sports medicine physicians helps to determine the best immediate course of action to take. Read  more.

 

 

ONS is awarded AIUM Ultrasound Practice Accreditation

Posted on February 2, 2016

The Ultrasound Practice Accreditation Council of the American Institute of Ultrasound in Medicine (AIUM) has awarded ONS with ultrasound practice accreditation in the area of MSK Print(Ultrasound-guided Interventional Procedures).

ONS achieved this recognition by meeting rigorous voluntary guidelines set by the diagnostic ultrasound profession. All facets of the practice were assessed, including the training and qualifications of physicians and sonographers; ultrasound equipment maintenance; documentation; storage, and record-keeping practices; policies and procedures to protect patients and staff; quality assurance methods; and the thoroughness, technical quality and interpretation of the sonograms the pracitice performs.

The AIUM is a multidisciplinary medical association of more than 9900 physicians, sonographers, and scientists dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines and accreditation.

 

ONS Featured in Greenwich Sentinel

Posted on January 25, 2016

sentinel_logo_transparentYou can learn about the early days of ONS and the philosophy that made us the most comprehensive and advanced practice the region. The writer, Sara Poirier Correa, did an excellent job explaining that with 22 top sub-specialty trained physicians, ONS is able to provide personalized services to patients. The article also highlights the Women’s Sports Medicine Center and the ONS Foundation for Clinical Research and Education, which has published internationally and competes among researchers at larger universities such as Harvard, Yale, and Johns Hopkins. http://bit.ly/1PNTkfh

 

15 ONS Physicians Rated Among Top Doctors in Connecticut

Posted on January 11, 2016

 

ApostolidesWhite  CamelWhite
 ClainWhite CunninghamWhite EnnisWhite
FioreWhite  HeftlerWhite  HindmanWhite  KavanaghWhit3  Miller
 NocekWhite  Sethi_White  SimonWhite  VadasdiWhite  CroweWhite

Fifteen orthopedic surgeons with Orthopaedic & Neurosurgery Specialists (ONS) were named among Connecticut’s Top Doctors in a report published this month by Moffly Media. The doctors were selected by Castle Connolly Medical, Ltd, a well-respected national healthcare research and information company.

Among the physicians recognized for medical expertise and excellence were ONS’s entire neurosurgery team — Paul J. Apostolides, MD, Mark H. Camel, MD, Amory J. Fiore, MD and Scott Simon, MD. Orthopedic surgeons, Michael R. Clain, MD, James G. Cunningham, MD, Francis A. Ennis, MD, Steven E. Hindman, MD, Brian P. Kavanagh, MD, Seth R. Miller, MD, David P. Nocek, MD, Paul M. Sethi, MD, and Katherine B. Vadasdi, MD, were ranked among the top in their category as was Jeffrey M. Heftler, MD, for Physical Medicine and Rehabilitation. John F. Crowe, MD, who retired from ONS at the end of 2015 after 30 years of practice, was one of the leading physicians in his area of specialty, Hand Surgery.

 

Are shoes the culprit of foot pain?

Posted on June 24, 2015

ONS orthopedic surgeon Dr. Michael Clain, who specializes in foot and ankle surgery met with News 12 On Health Reporter Gillian Neff to discuss whether the cause of foot pain is related to shoes.

news12_Clain

Dr.Clain says foot issues like bunions and hammer toes are exacerbated by shoes. Bunions may appear to be bumps growing on the foot, but they’re actually bones shifted out of place by frequent wear and tear and it is best to find shoes that can accomodate your feet comfortably. Watch the NEWS12 “What’s Ailing You: Aching Foot Pain” with Gillian Neff.

For more on bunion surgery and the results read: Suffer from Bunion Pain? Dr. Clain Offers Solutions.

An Arthritic Reality Check

Posted on May 7, 2015

“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.

Solutions for Knee Pain ArticleJane 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.

For more insightful tips, come to Dr. Delos’ talk about “Solutions for Knee Pain in Active Patients with Arthritis” tonight! The program is free and open to the public! Registration Requested. Aside from the talk, please consult your physician if this article has hit home and/or your quality of life is not what it once was; ONS provides excellent service and care for those in need, proudly keeping up-to-date with developments in the field.

Joint Replacement Symposium at Greenwich Hospital

Posted on April 16, 2015

hip replacementOn 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.

Dr. Kavanagh
Dr. Kavanagh

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.

Who is Tommy John and why did he have surgery?

Posted on April 3, 2015

Putting On White GlovesWhat is Tommy John surgery? Dr. Sethi and Yu Darvish of the Texas Rangers know. It is when an individual undergoes the reconstruction of a torn ulnar collateral ligament. Dr. Paul Sethi of ONS is a disciple of Dr. Frank Jobe, the man who did an ulnar collateral graft in Tommy John’s elbow in ’74 and so created the most famous baseball-medical connection since Lou Gehrig’s disease (also known as, ALS).

Another person to know in this field is Dr.Glenn Fleisig, a man who is well versed in this topic and has made a career out of arm injuries. He was recently interviewed in an article about the Tommy John surgery after a presentation at MIT Sloan Sports Analytics Conference about his collaborative study with Stan Conte of the Los Angeles Dodgers.

The research in the study noted that the Tommy John surgery is becoming more common, as more pitchers had the surgery in 2014 than in the 90’s combined. Although the success rate of the surgery is high, 20 percent of pitchers never regain a full level of performance even after PT. Other topics covered in the interview include:

  • What causes tears and the surgeries that follow

  • Whether it is the arm speed or the pitcher has his forearm cocked that far back

  • How long should we expect a pitcher to be out after TJ nowadays

  • Overuse of the ligament

  • Risk Factors and more

Read the Grantland article in order to enjoy the full interview about the Tommy John surgery.

MRI versus the Stress Test: Which one do you need?

Posted on March 26, 2015

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 and keeps up to date with the latest breakthroughs in the field. Most recently, the unnecessary reliance on the MRI compared to conducting a simple stress test has caught his attention. The following is what he wants you to know:

Nowadays, orthopedic surgeons will frequently order Magnetic Resonance Imaging (MRI) studies for patients suffering from acute or chronic musculoskeletal injuries. Radiographs, also known as plain films, show a two dimensional projection or shadow of bone. It is useful for diagnosing obvious displaced fractures, but subtle findings are often missed.

The MRI is advanced technology that provides information in three dimensions about bone, tendon, muscle, ligament, fat, swelling, fluid, etc., but are unlike plain films, which just show bone. Basically, it shows us just about everything we need to know short of nerves and other subtle dynamic findings. It uses no radiation and is incredibly safe.

But in the setting of an ankle fracture – where either the fibula or tibia is broken near the ankle and our job as surgeons is to determine which ankles will be fine with a cast and which need a surgical correction – AN MRI IS OF NO ADDED BENEFIT. What I want to determine in this setting is whether the fracture is “stable.”

An unstable fracture will shift with time, even with a good cast, and certainly once a patient begins walking. Shifting is a very bad thing, especially in the ankle. It leads to abnormal pressures on the joint, cartilage wearing, degenerative changes, and stiffness, also known as post traumatic arthritis. In an active and healthy patient, that is unacceptable. A significantly better outcome is achieved with a one hour surgery to fix the fracture and restore anatomic alignment and stability.

The main problem with an MRI is that it is a static test. The images are taken with the patient lying flat on a table. There is no weight or force across the ankle joint. While an MRI can image the ligaments in the setting of an ankle fracture, these ligaments are always injured, but whether they are injured to the point of instability is indeterminable.

A simple test that costs very little and takes about 5 minutes is a stress radiograph. Using either gravity or the hands of a surgeon, a mild stress is placed across the ankle joint. If the joint widens or shifts I know that it will do the same in the future. The most up to date orthopedic literature supports stress x-rays are the best way to decide between surgical and non-surgical treatment, not MRIs.

The other problem with an MRI is cost and time. It is a 30-45 minute test and carries with it a significant cost. The burden of the cost is shared by the patient, the insurance company, and society as a whole. With the skyrocketing costs of healthcare in our country we should reject the notion of ordering tests when they should have no effect on our decision.

A 2014 article supports this from the Journal of Bone and Joint Surgery, the official scientific journal of the American Academy of Orthopaedic Surgeons.

07/10/2019

Shoulder Pain? (Part II)

Posted on March 12, 2015

Shoulder_Pain_blogRemember 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.

The program is free and open to the public.
Registration Requested. Call (203) 863-4277, or register online at www.greenhosp.org.

Shoulder Pain? (Part I)

Posted on March 6, 2015
Marc Kowalsky MD
Marc Kowalsky, MD.

ONS welcomes Dr. Kowalsky,  a board-certified orthopedic surgeon with expertise in rehab-focused, as well as operative treatments for upper and lower extremity sports injury, and complex shoulder and elbow conditions including degenerative disease, trauma, and revision surgery. He has also authored original research manuscripts, review articles, textbook chapters focusing on AC joint reconstruction, rotator cuff repair, and shoulder replacement, and now he is adding to the educational articles ONS provides.

Shoulder pain is the second most common musculoskeletal complaint to a primary care physician, behind only back pain. Twenty percent of the population will suffer from shoulder pain during their lifetime.  A variety of conditions can contribute to shoulder pain, ranging from rotator cuff problems to arthritis of the shoulder joint.

The rotator cuff tendon consists of the tendons of the four muscles that originate on the shoulder blade and insert on the humerus adjacent to the ball of the shoulder joint.  These muscles participate in rotation and elevation of the arm.  A bursa, or fluid-filled sac, lies on top of the rotator cuff tendon, and helps to protect or shield the tendon from the adjacent structures of the shoulder as the tendon glides.

Although most people who present to their physician with a rotator cuff problem likely have simple tendonitis, or bursitis, some may in fact have a rotator cuff tear.  At least twenty-five percent of people over the age of sixty may have a tear in the rotator cuff tendon.  Most of these tears are chronic and degenerative in nature, without any traumatic cause.  These patients experience shoulder pain with motion away from the body and overhead, typically along the side of the shoulder and arm.  They may also experience night pain that awakens them from sleep.

Some patients may also notice weakness, depending on the size of the tear.  A rotator cuff tear, once present, is unlikely to heal on its own, and may enlarge over time.  Nevertheless, many patients with a tear can be successfully treated with conservative means, including physical therapy, oral anti-inflammatory medication, and perhaps an injection of corticosteroid.  For those patients who do continue to experience pain due to a rotator cuff tear, operative repair is an option.  This procedure is typically performed arthroscopically, and consists of anchoring of the torn tendon to its attachment site with a series of small screws, or anchors.  Ultimately this procedure is effective in improving a patient’s pain and overall function. (…to be continued)

If this topic interests you keep an eye out for the next installment and attend Dr. Kowalsky’s upcoming seminar on March 12th at Greenwich Hospital. The program is free and open to the public.
Registration Requested. Call (203) 863-4277, or register online at www.greenhosp.org.