Shoulder and Elbow Archives - Orthopaedic & Neurosurgery Specialists

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.

Biceps and Shoulder Pain

Posted on April 9, 2018

People with shoulder pain often assume they’ve injured their rotator cuff, but sometimes that is not the only culprit. Shoulder specialist and orthopedic surgeon Dr. Marc Kowalsky of ONS notes that an injury to the tendon of the biceps, the prominent muscle in the upper arm that made Popeye and spinach famous, can cause shoulder pain and other uncomfortable symptoms such as clicking or popping.

“The biceps tendon is an often-misunderstood structure of the shoulder and arm,” said Dr. Kowalsky. “We now know that damage to that tendon is often the primary cause of shoulder pain in active people.”

Anatomically, the biceps muscle has two tendons, called heads, that attach it from the elbow to the shoulder. The tendon of the short head attaches to a bone on the shoulder blade outside of the joint. The long head, usually the source of the pain, takes a circuitous path into the shoulder joint. It then attaches to the top of the socket and the glenoid labrum.

As with any other tendon in the shoulder, the biceps can develop tendonitis and tears. It can be a result of repetitive, strenuous overhead activities. Pain from biceps tendonitis or partial tearing typically occurs over the front of the shoulder. It radiates toward the biceps muscle. If the biceps tendon fully tears or ruptures, patients may notice bruising and a cosmetic deformity as the muscle descends and becomes more prominent, in what is known as a “Popeye sign”. Lastly, you can affect the biceps tendon by instability, particularly in certain overhead athletes including swimmers. Biceps instability can also occur in association with a particular tear of the rotator cuff tendon in the front of the shoulder. When this happens, pain is caused because the biceps has slipped from its bony groove of the upper humerus (head of the arm bone).

Moreover, most patients with tendonitis, a partial, or complete rupture of the long head of biceps can be treated conservatively. You can use a combination of ice, anti-inflammatory medication, physical therapy, and corticosteroid injection, said Dr. Kowalsky. Although the cosmetic deformity from a complete rupture will persist, once the pain from the acute rupture improves, strength and overall function of the shoulder should return to normal. If conservative measures fail to relieve symptoms from biceps problems, surgery may be recommended. If you experience shoulder pain, consult with a fellowship-trained shoulder specialist at ONS.

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

Posted on August 4, 2016

STUDY FINDS SUCCESS IN TREATMENT FOR FROZEN SHOULDER.

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.

Shoulder and Elbow Throwing Injuries Rise for Young Athletes

Posted on June 20, 2016

SURGE IN ELBOW AND SHOULDER INJURIES FOR YOUTH INVOLVED IN THROWING ACTIVITIES.

For youth involved in repetitive throwing activities, there is an epidemic of elbow and shoulder injuries, usually due to overuse, poor training, improper throwing mechanics, and fatigue, according to sports medicine physician, Demetris Delos, MD, who specializes in shoulder and knee conditions.

The dreaded injury to the ulnar collateral ligament (UCL) is usually caused by excessive pitching. If the UCL is injured, it can sometimes be difficult to repair or rehabilitate and may require the so-called Tommy John procedure in order to return to competitive pitching. The surgery is named after Tommy John, the first baseball pitcher to undergo successful UCL reconstruction surgery in the 1970’s.

Other common throwing-related injuries include Little League shoulder, which occurs when the growth plate of the humerus (arm bone) becomes inflamed by the excessive forces produced by repetitive throwing. Similarly, Little League elbow involves injury to the growth plate along the inner portion of the elbow.

In addition to acute injuries, repetitive activities such as throwing can lead to physical changes in the development of growing bones and joints. Significant amounts of pitching during adolescence can change the rotation and shape of the shoulder which may leave the player vulnerable to shoulder injury and arthritis in adulthood.

Studies show that children and adolescents who pitch competitively for more than 8 months in a year are the most prone to injury. Throwing more than 80 pitches per game, a fastball that consistently exceeds 85 mph, or pitching while fatigued are also risk factors for injury.

According to one study, pitchers who pitched more than 100 innings in a calendar year were 3.5 times more likely to sustain serious injuries requiring elbow or shoulder surgery or retire due to the injury. This is why USA Baseball and Major League Baseball now recommend that youth pitchers of all ages and abilities take a minimum four month break from overhead throwing, with at least two months off consecutively.

However, athletes and their parents should be reassured that numerous studies have shown that kids who are exposed to a range of sports that utilize different muscle groups and mechanical skills have greater overall success in athletics than those who specialize early on. In addition, they are less prone to injury and burnout than those who focus on a single sport exclusively.

Treatments for Tennis Elbow

Posted on May 19, 2016

ONS DR. DAVID WEI TALKS ON TREATMENT FOR TENNIS ELBOW.

Tennis season is in full swing and so are the risks of overuse injuries such as Tennis Elbow.

Tennis Elbow typically happens when a repetitive swinging motion pulls on the extensor tendons that connect the muscles in the forearm to the elbow, creating microscopic tears. Despite its name, there are many types of activities that can injure these tendons, especially those involving repetitive wrist motion. Although it continues to be a mystery as to why some patients develop Tennis Elbow while others are not affected, we do know that the end result is an abnormal change in the quality of the tendon itself, called angiofibroblastic hyperplasia.

Typical symptoms are pain along the outer side of the elbow with wrist motion and with gripping. The pain can be especially exacerbated by activities involving lifting objects with your elbow extended and the palm of your hand facing downward.

Recent data suggests that nearly all cases may resolve spontaneously, and the mainstay of treatment always begins with non-operative options. Avoiding aggravating activities or modifying the way you perform them can help decrease pain. For instance, lift things closer to your body, with your palms up. A splint or a counterforce brace can also help by relieving the strain on the tendon. In some cases, a physical therapy program and possibly injections will help the condition.

Most people don’t require surgery for Tennis Elbow. If, however, non-operative measures fail and the pain persists beyond six months, it may be time to consider surgery to repair the damaged tendons. Recovery time from surgery is relatively fast, but the tendons need time to regenerate, requiring approximately six to eight weeks.

Dr. Wei discusses tennis elbow in greater detail in this video.

Double Shoulder Replacement Restores Mobility

Posted on May 5, 2016

SHOULDER REPLACEMENT REGAINS HIS ACTIVE LIFESTYLE JUST MONTHS FOLLOWING SURGERY.

Arthritis had taken its toll on Dave’s shoulders. He was in constant pain. Sleeping was difficult and it was nearly impossible for him to take part in activities that he loves. Then, two friends with similar shoulder issues referred Dave to shoulder surgeon, Dr. Seth Miller at ONS. “When I met him, I immediately knew he was the doctor I wanted to care for me. He was thorough, thoughtful and patient. He has a great bedside manner and took the time to completely answer all my questions,” he recalled.

Dave had his first shoulder replacement in January, 2013; the second one was done a year later. In both instances, the therapists had him doing exercises the day after surgery, which he continued at home within the week. Through a physical therapy program over the next few months, Dave was able to build muscle mass to help support his new shoulders.

Just 16 weeks after surgery, Dave was back on the water kayaking pain free. These days, he goes to the gym 2- 3 times a week and kayaks quite a bit on ponds, lakes and streams. He can even carry his kayak.

“I am so grateful to have my active life back, thanks to ONS!” he said.

Shoulder replacement surgery and reverse shoulder replacement surgery is not for everyone. In many cases, treatment such as icing, anti-inflammatory medication and physical therapy can help get shoulder pain from arthritis under control. However, if pain persists, as it did with Dave, it may be time to consider a surgical option, notes Dr. Miller.

With arthritis and some fractures and injuries, the cartilage of the shoulder gradually wears away, creating a situation where bone is rubbing against bone. The resulting inflammation is extremely painful and makes shoulder mobility progressively more difficult. This condition typically develops later in life and gets worse over time.

The shoulder replacement procedure replaces the damaged joint with a highly-polished metal ball attached to a stem and a plastic socket. As long as a patient has an intact functioning rotator cuff, it can be an extremely successful procedure.

However, there is a group of patients that not only have significant cartilage damage in their shoulder, but also have a torn rotator cuff that is beyond repair. The rotator cuff is a group of muscles that run from the shoulder blade to the upper arm and allows patient to elevate their arm. Twenty years ago, treatment options were limited. In 2004, the FDA approved a reverse shoulder replacement procedure that was being used successfully overseas.

The surgery takes about two hours and involves a small incision, usually about three to four inches in length. Patients can expect to stay in the hospital somewhere from one to three days. Further, patients will be released with their arm in a sling, and undergo exercises to reestablish range of motion with the joint.

Between four and eight weeks after surgery, patients should be able to raise their arms above their heads without pain. Three to four months after surgery, patients are gradually resuming the activities of daily living. Many patients remark after recovery that they feel like they’ve been given their life back.

ONS’ Dr. Seth Miller was one of the first in the metropolitan area to perform reverse shoulder replacement surgery. He will take part in a Joint Replacement Symposium at Greenwich Hospital with ONS colleagues and joint replacement surgeons Drs. Frank Ennis and Brian Kavanagh.

The event will be held on Wed. May 11 starting at 6 p.m. To register, call 203-863-4277 or online.

Paul Sethi, MD, Returns from International Teaching Engagement in India

Posted on August 14, 2015

Dr. Sethi teaching “Shoulder Surgical Techniques" in a live operating room setting, Dehli, India. — Dr. Sethi teaching “Shoulder Surgical Techniques” in a live operating room setting, Dehli, India.

Dr. Paul Sethi, ONS Orthopedic Surgeon and President of ONS Foundation for Clinical Research and Education, recently returned from an international teaching engagement at the 2015 Delhi Arthroscopy Course in Delhi, India. The annual live surgery course draws physicians and residents from around the world to learn new techniques and methodologies for difficult surgical steps. Surgeries are performed by prominent national and international faculty with the opportunity for physicians to observe complex operating techniques and solutions during live surgeries. The forum also provides the opportunity to interact with the teaching surgeons and to ask pertinent questions.

Dr. Sethi specializes in sports medicine and shoulder surgery and was invited to teach “Shoulder Surgical Techniques” to 170 attendees from across India. This was his first teaching engagement in India, however he is accustomed to the international platform having previously instructed in Canada and Europe.

During the course, he performed three shoulder procedures: rotator cuff repair, labrum repair and reverse shoulder replacement. Being unfamiliar with the particular instrumentation used at the Sports Injury Centre, Safdarjang Hospital, Dr. Sethi adapted his techniques to the instruments available to perform complex surgeries. Dr. Sethi emphasized the importance of finding solutions to a variety of situations that a surgeon may encounter in any operating room. The result of his work speaks to his medical knowledge and skill that spans nearly twenty years of experience. Arthroscopy Course Organizational Secretary, Dr. Deepak Joshi recently reported, “The tips and ease with which these complex cases were done have been well appreciated by the faculty and delegates.”

Dr. Sethi’s experience traveling and teaching has led him to a better understanding of the challenges and solutions used by surgeons in other parts of the world. He says, “ten years ago the platforms were very different from one another, not because one is more advanced than the other, but because methods, thought processes, techniques and instruments differ. Today platforms are more aligned.” Teaching allows him to consider why some methods are used and also to learn from other accomplished surgeons.

Dr. Sethi honored by Dr. Prasad, Director General of Healthcare Services in India.

Dr. Sethi said he feels “privileged to have had the opportunity to meet and be honored by Dr. Prasad, Director General of Healthcare Services in India.” He was also thanked by Dr. Deepak Chaudhary, Director of the Sports Injury Center for his valuable contribution to this important educational event and hopes Dr. Sethi will assist in planning future courses.

Later this year, Dr. Sethi will teach in Dubai, Bangkok, and in Florida, Los Angeles and Las Vegas in the United States. Being informed and at the cutting edge of medical research and technology motivates him to travel and teach. He was recently the lead author on the article, “Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery” that appeared in The Journal of Shoulder and Elbow Surgery, Volume 24, Issue 7 (July 2015).

ONS Stamford: Off to a Great Start

Posted on June 24, 2015

On the evening of June 22, 2015, Orthopedic & Neurosurgery Specialists (ONS) held a grand opening celebration of a second ONS location at 5 High Ridge Park in Stamford, CT. The event was a first look at the new facility for the public, complete with informative stations about injury prevention, exercise tips and sports medicine stations with medical models and video presentations. Throughout the evening, around 200 guests toured the office, and learned about injuries and treatments of the foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine and Platelet Rich Plasma treatment. ONS physicians were available to answer questions. ONS Physical Therapy showcased injury prevention exercises for tennis, golf and running. Local businesses participated in the evening as guests enjoyed food and beverage and displays and a drawing of exciting prizes. The ONS physicians, clinicians and staff members were pleased with the opportunity to meet and greet the Stamford community! To learn more about our new Stamford office please visit http://onsmd.i9e.co/ons-stamford/.

Accomplished Orthopedic Surgeon joins ONS Sports Medicine Team

Posted on March 19, 2015

Orthopedic surgeon and fellowship trained sports medicine specialist Marc Kowalsky, MD has joined the ONS team. Dr. Kowalsky has expertise in conservative and operative treatments of upper and lower extremity sports injury, as well as complex shoulder and elbow pathology including degenerative disease, and trauma. He has a particular interest in the management of shoulder and elbow arthritis, instability, rotator cuff tears, labral injury, and cartilage disorders.

Dr. Kowalsky looks for rehab-focused, non-operative solutions whenever possible, recommending surgery when it will be most effective. His goal is to return patients quickly, safely and fully to their best function and performance.

Dr. Kowalsky earned his medical degree at Tufts University School of Medicine, Boston, MA where he also earned an MBA in Health Management. He did his residency in orthopedic surgery at Columbia University Medical Center, New York Orthopaedic Hospital in New York, NY. He also completed fellowship training in shoulder and elbow surgery at Washington University School of Medicine, Saint Louis, MO and in sports medicine at Lenox Hill Hospital, Nicholas Institute of Sports Medicine & Athletic Trauma, New York, NY.

He has authored original research manuscripts, review articles, and textbook chapters focusing on AC joint reconstruction, rotator cuff repair, and shoulder replacement. He currently serves as a reviewer for the Journal of the American Academy of Orthopaedic Surgery and the Journal of Shoulder and Elbow Surgery.

“Dr. Kowalsky will be a great asset to our practice as we meet the growing demand for musculoskeletal care in Fairfield and Westchester counties,” said Dr. Seth Miller. “His high level of training and accomplishments reflect the ONS standard of offering the highest level of care possible to our patients.” He is in network with Aetna and Oxford/United Healthcare.

ONS Orthopedic Surgeon Seth Miller, MD, Elected to Join Elite Medical Society

Posted on October 28, 2014

At the October Closed Meeting of the American Shoulder and Elbow Surgeons (ASES), held in Pinehurst, NC, ONS (Orthopaedic and Neurosurgery Specialists) orthopedic surgeon Dr. Seth Miller was elected to join the ASES organization. “Membership in ASES is a privilege and an honor” said Dr. Jim Cunningham, ONS Vice President. Membership in American Shoulder and Elbow Surgeons is by invitation only. Only experienced orthopedic surgeons who have completed a fellowship in shoulder surgery, elbow surgery, and/or sports medicine are considered for membership.

Dr. Miller, in his 25^th year in practice at ONS in Greenwich, has ascended quickly in his career being recognized with such a national honor. Candidates must meet strict academic and clinical requirements to become members of ASES.

“ASES is a remarkable collection of like-minded surgeons, and researchers who, through their collaboration and the sharing of techniques and outcomes, work together to solve the most complicated and pressing shoulder and elbow disorders. Founded on the premise that by such sharing of ideas we can determine the most efficient, cost effective, high quality shoulder and elbow care” said Dr. Robert Bell, ASES President.

The American Shoulder and Elbow Surgeons was created to enhance the study of shoulder and elbow surgery and to foster advances in the field, serving as an educational body responsible for scientific programs and advances. The Mission of the ASES is to support the ethical practice of evidence-based, high quality, cost-effective, shoulder and elbow care.

The society global impact on quality shoulder and elbow care is achieved through leadership, medical education, scientific research, and patient advocacy. Congratulations to Dr. Miller on becoming an Associate Member of the society.

ONS is an advanced multi-specialty orthopedic and neurosurgery practice serving patients throughout Fairfield and Westchester Counties and the New York Metropolitan area. ONS physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. For more information, visit www.onsmd.i9e.co, or call (203) 869-1145.

ONS Sports Medicine Specialists and Orthopedic Surgeons awarded 2nd place at The American Orthopaedic Society for Sports Medicine Meeting for “Incidence of Culture Positive Propionibacterium Acnes in Shoulder Arthroscopy”

Posted on August 11, 2014

UNDERSTANDING AND PREVENTING SURGICAL SITE INFECTION

The American Orthopaedic Society for Sports Medicine (AOSSM) was founded primarily as a forum for research and education for orthopedic surgeons, physicians and health care professionals in the field of sports medicine. Each year the AOSSM holds a conference to highlight areas of recent research, surgical techniques and to debate and share clinical insights about hot topics in the field of sports medicine. Physicians are recognized and awarded for their efforts in research and presentations about sports medicine conditions.

At the annual AOSSM meeting held in Seattle, Washington this July 10^th-13^th, ONS orthopedic surgeons Timothy Greene, MD, Katie Vadasdi, MD, director of the ONS Women’s Sports Medicine Center and Paul Sethi, MD, President of the ONS Foundation for Clinical Research and Education, were awarded 2^nd place for research presented on “Incidence of Culture Positive Propionibacterium Acnes in Shoulder Arthroscopy.” This research is best described in a statement below from Dr. Paul Sethi:

“As the field of shoulder surgery and, particularly, shoulder replacement grows, the risk of developing shoulder infection increases. When treated imperfectly, infection may cause devastating complications. Our goal is to help develop a universal measure to absolutely minimize post-surgical infection. Reducing complications adds value to patient experience and avoids the costly road of infection eradication. The bacterium (Proprionibacter Acnes) most commonly attributed to shoulder infection is a very unusual organism. Until recently, it was not properly recognized because it was so difficult to identify.

Now that one of the greatest bacterial offenders (in the shoulder) has been more clearly identified, we are looking for ways to prevent it from infecting patients. In our last study we took over three hundred cultures and studied them. After careful analysis, we were able to identify when (during surgery) patients are most susceptible to this bacterial infection and were able to determine just how frequently this bacteria is present. Now that we know when this bacterium may gain its access to patients, we are developing ways to attack it at the patient’s point of vulnerability.”

Paul Sethi, MD

Timothy Greene, MD

Sethi PM, Greene T, Vadasdi K, Miller S. Incidence of P. Acnes Culture after Primary Shoulder Arthroscopy. AOSSM Annual Meeting. Seattle, WA. July 2014

Posters are judged by the AOSSM Education Program Committee. With just three poster awards available, we congratulate our physicians on their research and 2^nd place award.

ONS Foundation Awarded 2nd Place in AOSSM Poster Contest

For more information on the AOSSM Annual Meeting, please click here: http://www.sportsmed.org/Education/Meetings/Annual_Meeting_2014/2014_Annual_Meeting/

Program:
http://www.sportsmed.org/uploadedFiles/Content2/Education/Meetings/Annual_Meeting_2014/AOSSM%202014%20Final%20Program.pdf

Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.i9e.co.

ONS Docs Included in Castle Connolly New York Top Doctors Guide, 17th edition

Posted on July 2, 2014

14 Specialists from ONS included in New York Area Medical Guide Book top primary care and specialty care doctors in the tri-state metropolitan New York area.

Fourteen physicians from Orthopaedic and Neurosurgery Specialists (ONS) on Valley Drive are included in the latest edition of Castle Connolly Top Doctors, New York Metro Area guidebook. The resource directory, which is in its seventeenth edition, is a guide to finding the top primary care and specialty care doctors in the tri-state metropolitan New York area. It details information on over 6,400 physicians in 65 specialties. Physicians profiled in the guide were nominated by their peers and screened by a research team at Castle Connolly.

Paul Apostolides, MD			Mark Camel, MD		Amory Fiore, MD	Scott Simon, MD
Michael Clain, MD			John Crowe, MD		James Cunningham, MD	Frank Ennis, MD

Brian Kavanagh, MD		Seth Miller, MD		Paul Sethi, MD
Katie Vadasdi, MD		Jeffrey Heftler, MD

Castle Connolly Top Doctors^® are nominated by their peers including physicians and hospital executives throughout the New York metropolitan region in an online survey process. Nominations are open to all board certified MDs and DOs. Nominated physicians are selected by the Castle Connolly physician-led research team based on criteria including medical education, training, hospital appointments, disciplinary histories and much more.

ONS physicians included in the 17^th edition of the guide are neurosurgeons Paul Apostolides, MD; Mark Camel, MD; Amory Fiore, MD; and Scott Simon, MD, orthopedic surgeons Michael Clain, MD; John Crowe, MD; James Cunningham, MD; Frank Ennis, MD; Steven Hindman, MD; Brian Kavanagh, MD; Seth Miller, MD; Paul Sethi, MD; and Katie Vadasdi, MD and physiatrist Jeffrey Heftler, MD.

“We congratulate our physicians who have been recognized as ‘Top Doctors’ by Castle Connolly,” said hand and wrist specialist Dr. John Crowe. “Having fourteen of our fine doctors included in this authoritative guide is a reflection of the commitment and quality of excellence of all our physicians and entire staff at ONS. The multidisciplinary nature of ONS makes it possible to provide patients with access to the most advanced care available in orthopedics, neurosurgery and physiatry.”

Survey recipients are asked to nominate those doctors who, in their judgment, are the best in their field and related fields– especially those to whom they would refer their own patients and family members.

Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.i9e.co.

Is tennis your game? Do you love the pace on the squash or paddle court?

Posted on April 22, 2014

If you love racket sports, you might already know what it’s like to experience a rolled ankle or shoulder strain. Injury prevention is the key to staying in the game and ONS is here to help you keep your swing healthy! On Tuesday, May 13^th at 6:30 p.m. in the Noble Conference Center at Greenwich Hospital, come hear sports medicine physician Gloria Cohen, MD, orthopedic surgeon Katie Vadasdi, MD, physical therapist Tatyana Kalyuzhny, PT, DPT, MDT and Patrick Hirscht, Tennis Pro, Round Hill Club in Greenwich discuss how to avoid the most common injuries in racket sports like Achilles tendon tears, shoulder and wrist injuries and rolled and sprained ankles. Learn to recognize injury warning signs and know when it’s time to see a doctor. The panel will discuss injury prevention and the latest orthopedic treatments.

Dr. Katie Vadasdi, head of the ONS Women’s Sports Medicine Center shares her medical expertise and experience in treating these types of injuries saying “racket sports can lead to overuse injuries due to the repetitive motions required in these sports. We most commonly see shoulder and elbow injuries including impingement of the rotator cuff and inflammation of the tendons in the elbow also known as tennis elbow. Early in the season, it is important to gradually increase intensity and duration of play to reduce the risk of developing such overuse injuries. If an athlete develops pain, it is important to rest in order to allow for appropriate recovery. This can often prevent the development of more serious injuries. If pain persists in spite of rest, then an athlete should reach out to a medical professional for further diagnosis and management options”.

Come to the seminar to learn more! Seminar is free. Registration requested.

For more information on shoulder injuries/surgery click here!

Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit http://onsmd.i9e.co/ or call 203.869.1145.

Country Club Injuries By Dr. Katie Vadasdi

Posted on August 7, 2012

Spending a day at the club can be like taking a mini vacation. Regular responsibilities are put aside to enjoy a game of tennis, a swim, a friendly round of golf or to work out. The gains for body, mind, and spirit are many, however along with the benefits come risks for injuries.

Golf Fore stretch — ONS PT Chalon Lefebvre demonstrates an effective golf stretch.

Many common injuries may get better on their own, while others require medical treatment. The repetitive motions of any sport can take a toll over time and if your technique isn’t always picture perfect, you may be creating unintended stress on joints and ligaments.

Shoulder injuries are particularly common in racket sports. Injuries to the rotator cuff, a group of tendons within the shoulder joint, can range from inflammation (tendinitis) to a tear. Tendinitis can often be treated with rest and physical therapy; whereas a rotator cuff tear that can impact normal range of motion, often requires surgery to resolve. Persistent shoulder pain warrants an evaluation by a physician, ideally an orthopedic surgeon or sports medicine specialist.

Injuries to the elbow are common in both racket sports and golf. Tennis elbow is an injury to tendons on the outside of the elbow, while golfer’s elbow is an injury to the tendons on the inside. Both are common overuse injuries and are often caused by repetitive activities other than their names imply. They may improve with rest but often require bracing, physical therapy and anti-inflammatory medications. Less often, the problem persists and may require surgery.

A knee injury can result from a missed step on the tennis court or playing golf. The meniscus is a cushion of cartilage within the knee; one on the inside and one on the outside. They can easily be torn even without major trauma. In some cases just kneeling down to tie a shoe can cause a tear, so you might not recall a precipitating event. Many knee injuries improve with rest and therapy, but sometimes an arthroscopic procedure is needed to fix or clean up the damage.

The anterior cruciate ligament (ACL) is an important stabilizer in the knee. A tear or “rupture” of the ACL is usually caused by significant trauma or landing and twisting motions, such as from skiing or jumping in basketball. If you experience both pain and swelling in your knee, it’s important to have it evaluated by a doctor.

The Achilles tendon is also commonly injured with fast cutting moves, as in tennis, squash and paddle tennis. These injuries range from inflammation to a complete rupture of the tendon. Some patients feel a dull pain in the Achilles just before a rupture, but generally they describe it as a single moment. You’ll often hear people say they thought someone kicked them in the back of the calf when actually it was the tendon giving way.

Can injuries be avoided without giving up your club ranking? Maybe not entirely, but it is possible to minimize the wear and tear on your body by implementing a proper conditioning and stretching program that is specific to your activities. In general people sustain an injury when they don’t take the time to prepare their bodies properly, and when they don’t listen to their bodies and stop at the first sign of pain.

Tips to help prevent Country Club Injuries:

Adopt a conditioning and strengthening program that builds core strength and works on flexibility.
Start any sport with a warm up and gentle stretches. Don’t just walk onto the court and start slamming at tennis balls or swinging at golf balls.
Periodically check your mechanics. Take a lesson, or work with a coach to make sure your technique is good.
If you do get an injury or feel some pain, stop and rest and see if it subsides.
If pain persists, get checked out so you don’t make a small problem a larger one.

Get a grip on Tennis Elbow

Posted on June 26, 2012

Physical Therapist stresses strength building, flexibility and good mechanics

Along with the fun and friendly competition of a great game of tennis, comes the potential for tennis elbow, a degenerative condition of the tendon fibers which anchor the arm muscles used to extend or lift the wrist and hand. Those who suffer from tennis elbow will tell you that it can result in an abrupt end to your tennis season. Below, Tatyana Kalyuzhny, DPT, of ONS Physical Therapy offers the following precautions and tips on conditioning before you even make your first serve.

—Symptoms of tennis elbow often include persistent pain on the outside of the elbow. It usually begins with mild pain and can continue for weeks or months. The pain can be increased by pressing on the outside of the elbow or by a gripping or lifting motion. In severe cases, minimal movement of the elbow joint can send pain radiating into the forearm.

The first line of treatment for tennis elbow is usually rest, ice and anti-inflammatory medication. After an evaluation, a doctor may prescribe a physical therapy program to stretch and strengthen the muscles in forearm.

Players who lack proper conditioning are the ones who are most vulnerable to most injuries including tennis elbow. Even if you’re a great player with a beautiful swing, if you lack proper conditioning and core strength, you are putting your body at an increased risk for injury. Proper mechanics plays a crucial role in avoiding injuries. The slightest amount of improper alignment can place added stress on tendons and ligaments. You may not notice the ill effects initially, but damage may be cumulative and build to a problem over time.

Conditioning for tennis should include exercises in core and hip strength in multi-directional planes, exercises to strengthen the rotator cuff and elbow and eccentric strengthening, which involves contracting the muscles while simultaneously elongating them to help the body absorb shock. In addition to strengthening, players need to maintain flexibility of their calves, hips and shoulders for proper mechanical efficiency.

A good warm-up for a tennis player should include light stretching followed by a gentle, five- to ten- minute rally session on court that employs some lateral and forward shuffles. Warm-up should be gradual and should aim to slowly increase your heart rate and get the muscles ready for play. You should avoid walking onto the court and swinging with full power at the ball.

Six tips for preventing injuries

Use proper technique. Have your swing and overall technique evaluated periodically by a professional.
Incorporate a proper strengthening and conditioning program off the court.
Maintain flexibility by stretching after play.
Use proper equipment. Play with a racket that is the correct size, grip and weight for you.
Wear proper footwear designed for tennis and not worn out.
Avoid making sudden radical changes in your technique unless instructed by a professional.

Surgeons to hold Special Seminar on Shoulder Pain and Shoulder Replacement Surgery at Greenwich Hospital

Posted on November 18, 2011

On Thursday, December 8 at 1:30 p.m., orthopedic surgeons Seth Miller, MD and Paul Sethi, MD will present a free community health talk about the latest solutions for shoulder pain. The talk takes place in the Noble Conference Center at Greenwich Hospital on Perryridge Road. Registration is requested; call (877) 585-0125 to register.

“Severe shoulder arthritis and chronic shoulder pain can make daily-life activities, like combing hair, reaching for a lamp or putting on a sweater extremely difficult,” says Dr. Miller who is also a shoulder specialist and one of the foremost shoulder experts in the New York Metropolitan area. “If you can’t do the simple things you once did, you may be suffering from a shoulder condition. There are reliable solutions for chronic shoulder pain. It is important to learn about your options in order to make the best decision for you.”

Orthopaedic Surgeon Dr. Seth Miller of ONS

Many people are familiar with hip or knee replacement to treat chronic pain caused by advanced arthritis. In the last 25 years, shoulder replacements have been used by a select group of skilled orthopedic surgeons to help their patients with chronic shoulder pain, restore mobility and stop pain. Dr. Seth Miller and his colleague Dr. Paul Sethi have performed over 1000 shoulder replacements at Greenwich Hospital in the past 20 years, earlier than at any other hospital outside New York City. For their patients this means regaining the mobility they thought was permanently lost.

Doctors recommend shoulder replacement for patients with severe shoulder arthritis, who have not achieved pain relief from conservative treatments, or who have had a severe fracture. In the procedure, the surgeon replaces the damaged or arthritic joint surfaces with a highly-polished metal ball attached to a stem, and a plastic socket. In cases where the patient’s own ball is severely fractured and the socket is normal, the surgeon may replace only the ball.

In addition to being a staff orthopedic physician at Greenwich Hospital, Dr. Seth Miller serves as Clinical Associate Professor of orthopedic surgery specializing in shoulder surgery at the Hospital for Joint Diseases at NYU Medical Center. He is also assistant Attending Physician in orthopaedic surgery at New York-Presbyterian Hospital.

Dr. Seth Miller 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 has been an orthopaedic consultant to the New York Mets for more than eight years.

Paul Sethi, MD is a Board-certified orthopedic surgeon with sub-specialty training

in sports medicine and the shoulder and elbow. Dr Sethi graduated with honors from Cornell University. He received his medical degree from Mount Sinai School of Medicine and performed his internship and residency at Yale University. He completed a sports medicine fellowship at the Kerlan Jobe Orthopaedic Institute in Los Angeles, CA. His research on athletic performance while a resident surgeon at Yale, his studies on professional basketball players and his own experience as a college varsity athlete have provided Dr. Sethi with first-hand experience, and an invaluable perspective in understanding sports-related injuries and conditions.

Dr. Sethi is a former orthopedic consultant to the Los Angeles Dodgers baseball team and former assistant team physician of the Los Angeles Lakers basketball team, Los Angeles Kings hockey team, the Los Angeles Dodgers and University of Southern California football team.