KSF Orthopaedic

Ethics in Sports Medicine

noemail@ksfortho.com — Tue, 01 May 2007 15:00:00 GMT

(ABSTRACT) Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

American Journal of Sports Medicine 2007, May;35(5):840-4. Epub 2007 Jan 11.

1-May-07 10:00 AM

Suture Anchors in Arthroscopic Rotator Cuff Repair

noemail@ksfortho.com — Fri, 30 Mar 2007 19:00:00 GMT

(ABSTRACT)

The use if suture anchors in shoulder surgery has facilitated the rapid advancement of arthroscopic rotator cuff repair techniques. Innumerable anchor types have been developed which allow stronger, rapid, more effective arthroscopic rotator cuff repairs. Abundant research has been performed to maximize the efficacy of suture anchors in arthroscopic rotator cuff repair. The article reviews the literature regarding implant designs, technical considerations, clinical results, and complications of suture anchors in the arthroscopic treatment of rotator cuff tears.

Operative Techniques in Sports Medicine: Vol. 12, Iss.4; October 2004 (210-214)

30-Mar-07 2:00 PM

Locked knee caused by meniscal subluxation: magnetic resonance imaging and arthroscopic verification.

noemail@ksfortho.com — Fri, 30 Mar 2007 17:00:00 GMT

(ABSTRACT)

Subluxation or dislocation of an intact lateral meniscus is a controversial and rarely reported cause of knee pain and locking. We report a case of knee locking caused by lateral meniscal subluxation in the absence of a meniscal tear or true discoid meniscus, with both magnetic resonance imaging (MRI) and arthroscopic verification. A 9.5-year-old child experienced multiple episodes of locking in full flexion of the knee. After 6 months of symptoms, arthroscopy was performed and showed no meniscal tear or a discoid meniscus. The patient's knee locking recurred after arthroscopy. MRI was performed when the patient presented acutely with the knee locked. MRI showed anterior dislocation of the posterior horn of the lateral meniscus with the knee in the locked position. The MRI was immediately repeated after the author reduced (manipulated) the locked knee into extension. On the repeat MRI, the lateral meniscus had returned to a normal position. On repeat arthroscopy, the posterior horn of the lateral meniscus was hypermobile and could be displaced into the notch and did not show a frank tear. The meniscus was repaired to the capsule with sutures. At the 2-year follow-up evaluation, the patient had no complaints and no clinical signs of locking.

Arthroscopy. 2003 Oct;19(8):885-8

30-Mar-07 12:00 PM

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture.

noemail@ksfortho.com — Fri, 30 Mar 2007 16:00:00 GMT

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture. (ABSTRACT)

This retrospective study evaluated the results of the Darrach procedure and the Sauve-Kapandji procedure for the treatment of distal radio-ulnar joint derangement following malunion of dorsally displaced, unstable, intraarticular fractures of the distal radius in patients under 50 years of age. Twelve of 18 possible patients in the Sauve-Kapandji group completed the disabilities of the arm, shoulder, and hand survey at a mean of 4 years postoperatively and nine of the 18 returned for a follow-up examination at a mean of 2 years. Twenty-one of 30 possible patients in the Darrach group completed the disabilities of the arm, shoulder, and hand survey at a mean of 6 years postoperatively and 13 of these 30 returned for follow-up examination at a mean of 4 years. The Darrach procedure and the Sauve-Kapandji procedure yielded comparable and unpredictable results with respect to both subjective and objective parameters.

Journal of Hand Surgery (Br). 2004 Dec;29(6):608-13

J Hand Surg [Br]. 2004 Dec;29(6):608-13

30-Mar-07 11:00 AM

Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction

noemail@ksfortho.com — Thu, 29 Mar 2007 13:00:00 GMT

Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction (Abstract)

Failed anterior cruciate ligament (ACL) reconstruction presents a difficult clinical challenge. Successful revision ACL reconstruction depends on identifying the causes of failure and correcting technical or diagnostic errors. Failed ACL reconstruction may be either traumatic or atraumatic. Atraumatic failures may be attributable to technical errors, diagnostic errors, or failure of graft incorporation. Published outcomes of revision ACL reconstruction have been worse than for primary ACL reconstruction. The preoperative evaluation, surgical techniques, and clinical outcomes of revision ACL reconstruction are reviewed.

American Journal of Sports Medicine:2006 Dec;34(12):2026-37.

29-Mar-07 8:00 AM

Shoulder Impingement Syndrome

noemail@ksfortho.com — Thu, 29 Mar 2007 13:00:00 GMT

Shoulder Impingement Syndrome (Abstract)

Subacromial impingement syndrome is a common cause of shoulder pain. The purpose of this article is to review the clinical presentation, physical examination findings, and differential diagnosis of impingement syndrome. Using an evidence-based approach, we propose an algorithm for the management of subacromial impingement syndrome including indications for nonoperative management, advanced imaging, and operative management.

American Journal of Medicine:2005 May;118(5):452-5.

29-Mar-07 8:00 AM

Endoscopic versus Rear-Entry ACL Reconstruction: A systematic Review

noemail@ksfortho.com — Tue, 27 Mar 2007 15:00:00 GMT

George MS, Huston LJ, Spindler KP. Endoscopic versus Rear-Entry ACL Reconstruction: A systematic Review. Clinical Orthopaedics and Related Research 2007 Feb;455:158-61 Vanderbilt University Medical Center, Nashville, TN 37232-8774, USA. Anterior cruciate ligament reconstruction is commonly performed using the all-endoscopic (also known as all-inside or single-incision) method or the rear-entry (also known as outside-in or two-incision) method. We report a systematic review of four prospective, randomized clinical trials comparing these two operative techniques. Operative time was shorter in the all-endoscopic groups in two studies. A higher percentage of patients in the rear-entry group had a difference of 3 mm or less on the KT-2000 arthrometer, although the two surgical techniques were similar in the other studies. A higher rate of return to full activity was achieved in patients undergoing the rear-entry technique in one study. All four studies were similar in pain medication...

27-Mar-07 10:00 AM

Shoulder Labral Tears

noemail@ksfortho.com — Wed, 14 Mar 2007 15:00:00 GMT

SHOULDER LABRAL TEARS The shoulder joint is composed of a ball (humeral head) and a socket (glenoid). The glenoid has a greater radius of curvature than the humeral head, making the shoulder inherently unstable. A rim of fibrous tissue (labrum) surrounds the socket and acts as a bumper to help keep the shoulder joint stable. The labrum also serves as the attachment of the biceps tendon as well as several stabilizing ligaments of the shoulder. Injuries to the shoulder such as dislocations and falling on the outstretched arm can cause the labrum to tear off of the bone. What are the symptoms? Tears in the front of the socket are called Bankart tears and lead to recurrent instability of the shoulder. This leads to shoulder weakness and a feeling that the joint is slipping out of place. Tears at the top of the labrum near the biceps tendon attachment are called SLAP tears, which stands for Superior Labrum Anterior to Posterior. SLAP tears can cause pain with lifting and...

14-Mar-07 10:00 AM

Patellofemoral Syndrome

noemail@ksfortho.com — Wed, 14 Mar 2007 15:00:00 GMT

PATELLOFEMORAL SYNDROME
   Patellofemoral syndrome (formerly known as chondromalacia patellae) is a dysfunction of the mechanics of the patella (knee cap). The patella normally rides in a groove in the femur known as the trochlea. The quadriceps muscle in the front of the thigh and the hamstring muscle in the back of the thigh control the motion of the patella. When the muscles become imbalanced, the patella does not ride normally in the trochlea, causing pain and sometimes a feeling of instability around the patella.

Where is the pain?
   Patellofemoral pain is typically most pronounced in the front of the knee or behind the patella, although pain in the back of the knee and in the muscles around the knee is also frequently seen. The pain tends to be worse with running, going up and down stairs, and when the knee muscles are tight.

How is it treated?
   Physical therapy is aimed at rebalancing the muscles that control the patella by stretching the quadriceps and hamstring muscles and strengthening the specific muscles around the knee that centralize the patella. Braces and anti-inflammatory medications may also be beneficial. If conservative treatment is unsuccessful, surgery is rarely necessary to realign the patella.

14-Mar-07 10:00 AM

Basal Joint Arthritis

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Basal Joint Arthritis
   Arthritis is a disease that causes inflammation and stiffness in the joints.It often affects the joint at the base of the thumb. This joint is called the carpometacarpal joint.
   CMCJ arthritis occurs as a result of wear and tear on the joint. It is more likely to occur at a younger age if you have fractured or injured your thumb. Repeated gripping, twisting, or turning objects with your hand may make symptoms worse.
   If you have CMCJ arthritis, you may notice pain in the lower part of the thumb associated with swelling and stiffness. You may frequently drop things due to the pain.
   Your doctor can diagnose CMCJ arthritis by examining your hand and by taking x-rays.

If arthritis is diagnosed early, it may respond to conservative treatment which includes:
• A thumb spica splint that you wear all the time (except when bathing) for 6 weeks. This splint prevents movement of your thumb and helps reduce the inflammation.

• Oral anti-inflammatory medication.

• A small injection of cortisone into the thumb joint to help reduce the inflammation.

    If this treatment does not relieve the pain and stiffness, or if arthritis has destroyed the joint, your doctor may recommend surgery. The diseased joint is removed and rebuilt with a piece of tendon (graft) taken from your wrist.
   The approximate recovery time for this surgery is 3 months, but that does not mean that you can’t use your hand at all for that time. It means that you will be limited in motion and strength during the healing process.
   Arthritis does not have to prevent you from doing the things that you enjoy most. Successful treatment is available.

14-Mar-07 9:00 AM

Meniscus Tears

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Meniscus Tears
   The meniscus is a specialized C-shaped cartilage in the knee. The medial (inner) meniscus and the lateral (outer) meniscus act as a cushion in the knee to prevent the joint cartilage surfaces from grinding against each other. Meniscus tears in young patients are usually caused by a traumatic twisting injury to the knee and may be seen in combination with other ligament and cartilage injuries to the knee. In older patients, the meniscus can tear over time without any specific injury.

How are they diagnosed?
   Signs of meniscus tears include pain on the inner or outer part of the knee, swelling, tenderness, popping, locking, and buckling of the knee. Xrays do not show the meniscus, but they can show fractures, arthritis, or other causes of knee pain. MRI can show tears in the meniscus as well as injuries to the ligaments and tendons around the knee.

How are they treated?
   Arthroscopic surgery is usually recommended for painful meniscus tears. Most tears involve the central part of the meniscus and are treated with removal of the torn portion (partial meniscectomy). Some tears in young patients involve the outer rim of the meniscus and can be repaired with sutures (meniscal repair). Full recovery can usually be expected in 4-6 weeks.

14-Mar-07 9:00 AM

DeQuervain’s Tenosynovitis

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

DeQuervain’s tenosynovitis
   Many different problems, from a simple sprain to severe arthritis, can cause pain or swelling
of the wrist. One of the more common causes of wrist pain and swelling is DeQuervain’s tenosynovitis.
   DeQuervain’s tenosynovitis is inflammation of tissue on the thumb side of the wrist. Tendons (cord-like fibers that attach muscle to bone) and synovium (a slick membrane that covers tendons and allows them to move easily) become irritated, causing pain. The pain is felt on the thumb side of the wrist and swelling is often present.
   Your doctor can tell, from examining the wrist and hand, whether the tendons are inflamed
   Causes of DeQuervain’s include repetitive motion of the wrist, overuse, direct trauma, and inflammatory diseases such as rheumatoid arthritis. DeQuervain’s often occurs in new mothers, as they overuse their wrists lifting little ones.

Treatment includes:
• Rest (taking a break from activities that cause pain).
• Oral anti-inflammatory medications (to decrease inflammation).
• A thumb spica splint (to rest the thumb and wrist and to decrease inflammation).
• A small injection of cortisone in the wrist (to decrease inflammation).
   If other treatments do not relieve the pain, then surgery may be recommended. The ligament tunnel that surrounds the tendons is released so the tendons can move easily.
This helps to reduce the inflammation and pain. Sometimes, hand therapy is needed after surgery to regain strength and motion and to help decrease swelling and pain.
   Many patients’ pain and swelling resolve with non-operative treatment. If surgery is required, the recovery period is short with minimal limitation in using your hand.

14-Mar-07 9:00 AM

Rotator Cuff Injuries

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Rotator Cuff Injuries The rotator cuff is the group of four tendons (supraspinatus, infraspinatus, teres minor, and subscapularis) that helps rotate the shoulder and aid in overhead reaching. It also acts to depress the top of the humerus, opening the space between the humerus and the bone above it, known as the acromion. What is the difference between rotator cuff tendonitis and a rotator cuff tear? Rotator cuff tendonitis (also known as “bursitis” or “impingement”) is an inflammation of the rotator cuff tendon. As a result of the weakness and inflammation in the rotator cuff, the humerus rides up against the acromion above it, leading to painful scar tissue, bursitis, and bone spurs. A rotator cuff tear is a condition in which a part of the rotator cuff, usually the supraspinatus, is torn from its attachment to the humerus. Rotator cuff tears can be partial thickness, where some fibers have torn and some are still intact, or full thickness, where a...

14-Mar-07 9:00 AM

ACL Tears

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Anterior Cruciate Ligament (ACL) Tears The anterior cruciate ligament (ACL) is the main ligament that controls the rotation of the knee. The ACL is important in providing stability during cutting and pivoting motions of the knee. What are the other main ligaments of the knee? The other main ligaments of the knee are the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). These ligaments provide stability to the knee in all directions of motion. How is the ACL torn? ACL tears occur when the knee is twisted inwardly such as in a sports injury or a twisting fall. The knee usually becomes immediately swollen and painful. When the ACL tears, other structures inside the knee such as the meniscus and other ligaments can tear as well. The ACL does not repair itself after it is torn. What are the symptoms? Immediate pain and swelling usually occurs. The knee becomes unstable because the torn ACL no longer controls the...

14-Mar-07 9:00 AM

Tennis or Golfer's Elbow

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Lateral Epicondylitis (Tennis Elbow) Epicondulititis is an irritation or inflammation of the tendons around the elbow joint. Lateral Epicondylitis (tennis elbow) is a painful condition on and around the bony prominence (epicondyle) on the outside (lateral side) of the elbow. Pain may radiate down your arm. Gripping or extending your wrist may intensify the pain. Medial Epicondylitis (golfer’s elbow) describes a similar condition. The pain focus is the knobby bump on the inside of the elbow closest to the body (the medial side). Both tennis elbow and golfer’s elbow typically result from repetitive arm movement. Over-using the muscles in your arm can lead to tiny tears (micro tears) in the tendons that attach the muscles in your forearms to the epicondyles. If you continue to do the activity without allowing the tears to heal, the tendons can become inflamed and very painful. This condition can be caused by excessive use of your arm such as long sessions...

14-Mar-07 9:00 AM

Ganglion Cysts

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Ganglion Cysts
   Have you noticed any lumps or bumps on your hand or wrist? You may have a ganglion cyst. A ganglion cyst is a firm, fluid-filled mass that may appear on the back of the wrist, palm side of the wrist, or at the base of the fingers. These cysts usually come from a nearby joint or around a tendon. Although ganglion cysts are common, they do not spread, do not become cancerous but can often change in size and sometimes disappear by themselves.
   A ganglion cyst may be painful, especially when using your wrist and hand. Most often, there is no specific cause, however, ganglion cysts may occur after an injury to the wrist.
   Your doctor can usually diagnose a cyst by examining your hand. He may order an x-ray to rule out other problems such as arthritis.
   Some ganglion cysts will shrink and become painless without treatment. If the cyst becomes unsightly or painful, your doctor may recommend:

•Extracting fluid from the cyst with a needle followed by an injection of cortisone to relieve
the irritation.
•A pressure dressing worn at all times, except when bathing, for 2 weeks.
•A wrist splint worn at all times, except when bathing, for 4 weeks.

   If other treatments do not relieve your symptoms or if the cyst returns after conservative treatment, your doctor may recommend outpatient surgical removal.

14-Mar-07 9:00 AM

Carpal Tunnel Syndrome

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Carpal Tunne Syndrome
Carpal tunnel syndrome (CTS) is a common problem that affects the hand, wrist and fingers. This condition occurs when there is increased pressure on the median nerve at the wrist.
   The median nerve travels from the forearm into the hand through a “tunnel” in your wrist – the carpal tunnel. Wrist bones form the bottom and sides of the tunnel and a ligament covers the top. This tunnel also contains nine tendons. Increased pressure within the carpal tunnel squeezes the median nerve. Eventually the pressure affects the functioning of the nerve which may result in numbness, tingling and pain.
   Your doctor may confirm the diagnosis of CTS by the following: a physical examination, an x-ray and an EMG (electromyography)or NCS (nerve conduction study) will be ordered to determine the severity of the CTS.
   Causes include anything that causes swelling of the tendons or decreases the space in the carpal tunnel, such as, repetitive use of the hand and wrist or regular use of vibrating instruments. Some other causes could be, fractures (broken bones in the hand or wrist) arthritis, thyroid disease, diabetes and pregnancy.
   Symptoms of CTS may include: numbness and tingling in the hand (often at night or after use), aching or pain that may radiate up the forearm towards the shoulder, a feeling that you have “poor circulation” making you shake your hands to try and restore the circulation,
and clumsiness or weakness in handling objects.

Treatment includes:
• Wearing a wrist splint to keep the wrist from bending may treat mild cases.

• Non-steroidal anti-inflammatory medications may be prescribed to decrease
swelling and pain.

• A small cortisone injection into the carpal tunnel may be given to decrease inflammation.

    If these simple measures fail to control your symptoms, a carpal tunnel release may be required to reduce the pressure on the median nerve and prevent irreversible damage.
   The surgery is an outpatient procedure. The procedure itself takes approximately 15
minutes, although you will be at the hospital for a total of approximately 3 hours.

14-Mar-07 9:00 AM

Total Shoulder Replacement

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

TOTAL SHOULDER REPLACEMENT
What is shoulder arthritis?
   The shoulder joint is a ball and socket joint. The joint surfaces are normally covered by a smooth cartilage layer. Arthritis is a degeneration of the joint cartilage. Over time, the cartilage becomes thin, sometimes to the point that bone rubs on bone inside the joint. This process eventually leads to bone spurs and painful scar tissue in and around the shoulder joint.

What are the symptoms and treatments of shoulder arthritis?
   The pain associated with shoulder arthritis may be gradual in onset, or may be worsened by an injury to the shoulder. Symptoms of shoulder arthritis include stiffness, pain with motion,popping, and pain at night. The severity of the arthritis can usually be determined on xray and physical exam. MRI and CT scan can be useful to evaluate the arthritis as well as other potential causes of shoulder pain.
   Initial treatment of shoulder arthritis includes anti-inflammatory medications, physical therapy, and injections. When nonoperative treatments do not relieve the pain, surgery may be necessary.

What is total shoulder replacement?
   Shoulder replacement is similar to joint replacement in other joints such as the knee and hip. The arthritic joint surface of the humerus is replaced with a metal ball connected to a metal stem that fits inside the humerus. The arthritic socket is replaced by a plastic socket that is secured by bone cement. Recovery typically includes an overnight stay in the hospital and several weeks of physical therapy. Excellent motion and shoulder function is usually seen after full recovery.

14-Mar-07 9:00 AM

Trigger Finger

noemail@ksfortho.com — Wed, 14 Mar 2007 13:00:00 GMT

Stenosing Tenosynovitis (Trigger Finger)
   If you wake up in the morning and your thumb or finger is “locked” in a flexed position, you may have a trigger finger. Trigger finger or (Stenosing Tenosynovitis) is inflammation around the tendons to your fingers or thumb.
   Tendons (cordlike fibers that attach muscle to bone and allow you to bend your fingers) are held in place on the bones by a series of ligaments called pulleys. These pulleys form a series of arches through which the tendons run along the bone. To keep tendons moving smoothly through these pulleys, the tendons are wrapped in a slick membrane called tenosynovium.
   Irritation to the tendon or the tenosynovium may cause a nodule to form, which makes it difficult for the tendon to slide through the pulley. When the tendon catches and then suddenly releases, you feel a “triggering” sensation.
   The cause of a trigger finger is not always clear. Anything that irritates the tendons in the finger, such as repeated use of tools, rheumatoid arthritis, gout, or diabetes can lead to the development of trigger finger. When you have a trigger finger, you will feel discomfort or pain where the finger or thumb joins the palm. You may have swelling or thickening at the base of the finger or thumb. A clicking sensation is often felt when the finger is bent. The finger may lock in a bent or straight position.
   Your doctor can tell from examining your finger or thumb whether a tendon is inflamed and triggering is occurring.

    The treatment for a trigger finger is aimed at decreasing the inflammation around the tendon and tendon sheath.
This includes:
• Resting the finger or thumb. Sometimes a splint is used
• Taking oral anti-inflammatory medication.
• A small injection of cortisone into the area of inflammation.

     If other treatments do not relieve your symptoms then a trigger finger release may be performed to open the pulleyand allow thetendon to glide smoothly again.
    This is an outpatient surgery. Normal use of the hand can be resumed once comfort permits. Occasionally, hand therapy is indicated after surgery to help you regain your motion and strength.

14-Mar-07 8:00 AM

Listen to Dr. Michael S. George's Appearence on ESPN Radio

noemail@ksfortho.com — Mon, 26 Feb 2007 17:00:00 GMT

26-Feb-07 11:00 AM

Carpal Tunnel Syndrome

noemail@ksfortho.com — Tue, 28 Nov 2006 15:00:00 GMT

Carpal tunnel syndrome (CTS) is a condition that has become more well-known with the increase of computer usage in the workplace. CTS is a condition brought on by increased pressure or compression of the median nerve at the wrist. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers. The carpal tunnel is a space in the wrist where the median nerve and nine tendons pass from the forearm into the hand. The median nerve travels in the central portion of the wrist on the palm side and delivers sensation to the index, middle, and (half of the) ring fingers and the thumb. Carpal tunnel syndrome happens when swelling in the tunnel puts pressure on the nerve. When the pressure from the swelling becomes great enough to disturb the way the nerve works, the nerve flow into the fingers slows down and the above symptoms ensue. Causes Usually, the cause is unknown. Pressure on the nerve can happen several ways, including swelling of the lining of the tendons, called...

28-Nov-06 9:00 AM

“KNEES EASE” WITH SYNVISC

noemail@ksfortho.com — Tue, 28 Nov 2006 15:00:00 GMT

Running your daily race on arthritic knees? You have done your homework and targeted treatment modalities such as:

•    Maintaining an optimal weight
•    Strengthening the muscles supporting your knees
                        Build increased muscle in your thighs
                             Stretch your hamstrings, so you can touch your toes
•    Utilized oral anti-inflammatory agents such as Motrin, or Aleve
•    Received cortisone injections in your knees
•    Supplemented your diet with Glucosamine/Chondroitin

and still no relief? Have you read about viscosupplementation or Synvisc?
When knees degenerate due to age, injury, or genetic factors the lubricating fluid in the knee becomes thinner and less effective. The knee feels stiff, and is most symptomatic in the morning, in cold weather or just upon arising from a chair. Synvisc is an injectable supplement to the synovial fluid in the knee. It acts to bond to the fluid and make it thicker and more able to lubricate the joint. This treatment is given via injection into the arthritic knee or knees once a week for three weeks. It can be repeated,if effective ,on the recommendation of your physician.

KSF is now able to provide Synvisc for our patients needing this treatment. Medicare will cover the cost at their reimbursable rate if provided through the office. There is no financial help to patients who go to the pharmacy to purchase this medication. in most cases. Call us and schedule and appointment for an evaluation of your arthritic knees. Synvisc just might make your daily race easier.

28-Nov-06 9:00 AM

Brooks rebounds after freak injury OU sophomore set to challenge for national squad

Tue, 15 Aug 2006 14:00:00 GMT

By DAVID BARRONCopyright 2006 Houston Chronicle ST. PAUL, MINN. - In terms of reputation and accomplishments in gymnastics, Chris Brooks probably lags toward the latter half of the 10-man Houston contingent that will compete at the USA Gymnastics mens senior national championships this week. Thats not a knock, by the way. Houstons delegation includes reigning national all-around champion Todd Thornton, former national and world champion Sean Townsend, 2006 American Cup champion Jonathan Horton and two current or former national event champions in Sean Golden and Raj Bhavsar. Brooks is among the younger entrants in the fast field of gymnasts who live or train in Houston, but he stands second to none in the degree of hardship he had to overcome. A sophomore at Oklahoma and one of several gymnasts with Houston ties who helped OU win the 2006 NCAA title, Brooks, 19, has spent two years recovering from an injury that sends shudders through those who witnessed it or heard of it. The simple...

15-Aug-06 9:00 AM

Total Joint Replacements Of The Hand

Mon, 14 Aug 2006 18:00:00 GMT

Total joint replacement in the hand has recently undergone several significant advancements. The concept of joint replacement in the hand was first reported in 1959 with the goals to both relieve pain and correct deformity. Since that time a variety of implants have been developed and used for joint replacements in the hand with improvements in durability and materials with each new prosthesis. The primary prostheses used are fashioned from silicone. The original Swanson implant was met with great success and now there are newer implants made of pyrocarbon that simulate the true anatomy of the joint. The newer implants were designed to decrease implant failure and improve the functional arc of motion. The primary indication for arthroplasty in the hand at the metacarpophalangeal (MCP) joint is advanced painful destruction of the joint by arthritis. In rheumatoid arthritis the joint destruction is mediated by the formation of a pannus that affects both the soft tissues and the bone....

14-Aug-06 1:00 PM

What is New in Total Hip and Knee Replacement Surgery

Mon, 14 Aug 2006 18:00:00 GMT

Total hip and knee replacements have become the most prevalent surgical treatment for end stage arthritis of these anatomic areas. Joint replacements offer nearly complete relief of debilitating pain, improve function and in some cases improve lower extremity deformities. Replacement surgery is relatively fast, reproducible, and reliable. Many developments in surgical technique and implant technology have dramatically improved the durability and longevity of the prosthetic joint system. The design of implants from fiercely competing implant companies is converging indicating the ultimate implant solution is near. The definitive goal of hip and knee replacement surgery is to safely provide patients who have painful debilitating joint disease with lifelong pain relief and function. Many areas of hip and knee replacement surgery have been explored through research, development and clinical trials. The clinical considerations of replacement surgery deal with patient health and disease,...

14-Aug-06 1:00 PM

Total Ankle Replacement

Mon, 14 Aug 2006 18:00:00 GMT

Total ankle arthroplasty is the newest successful treatment for ankle arthritis. The historical standard ankle fusion has significant complications and long-term negative effects. Intermediate term results of second generation ankle replacement designs are excellent. KSF Orthopaedic Center, PA is proud to have one of the few surgeons in Houston with both the training and the experience in implantation of the Agility Total Ankle Replacement. Patients with ankle arthritis have gained a significant treatment option. The rate of a successful first time ankle fusion is 85%. In other words, 15% of patients will fail primary fusions and require a revision procedure. When a successful fusion is obtained, pain is eliminated from the ankle joint and patients are routinely satisfied with the early results of the procedure. However, lack of ankle joint motion wreaks havoc on the joints of the hindfoot and midfoot. Most patients with ankle arthritis are young and surrounding joint degeneration...

14-Aug-06 1:00 PM

Preventing, Treating Osteoporosis Improves Life After 50

noemail@ksfortho.com — Tue, 13 Jun 2006 15:00:00 GMT

Strong Bones for Life Preventing, Treating Osteoporosis Improves Life After 50 By Raul Sepulveda, MD, and Samuel Alianell, MD It’s called a silent disease because those who have it often don’t know — until it is too late. Osteoporosis, or “porous bone,” causes an estimated 1.5 million fractures among Americans every year. According to Raul Sepulveda, MD, at KSF Orthopaedic Center, osteoporosis becomes evident only when a small impact (or even no impact) causes a bone fracture that otherwise would not have occurred. “Osteoporosis is like high blood pressure, another silent disease, in that people often do not know they have it,” says Dr. Sepulveda. “A person may not be aware of high blood pressure until a stroke or heart attack happens. A woman may not know she has osteoporosis until she mysteriously falls to the floor from a simple standing position.” In the last decade, treatment and prevention of osteoporosis have risen to the...

13-Jun-06 10:00 AM

Shoulder Issues Often Related to Rotator Cuff Degeneration or Injury

noemail@ksfortho.com — Tue, 13 Jun 2006 15:00:00 GMT

Pinpointing the Pain Shoulder Issues Often Related to Rotator Cuff Degeneration or Injury By Michael S. George, MD Rotator cuff tears are a common cause of shoulder pain. The rotator cuff is a group of four tendons that originate on the scapula and insert on the proximal humerus that act to rotate and elevate the shoulder. When functioning normally, the rotator cuff depresses the humeral head away from the acromion. Causes and Symptoms The most common tear of the rotator cuff is an avulsion of the supraspinatus tendon from the greater tuberosity. These injuries are often caused by acute traumatic injuries such as a fall on the outstretched arm or a traumatic glenohumeral dislocation. Chronic degenerative tears occur with overuse and are often associated with subacromial bursitis and bone spurs on the undersurface of the anterior acromion. Tears or dysfunction of the rotator cuff decrease the ability to rotate and depress the humeral head, causing weakness and pain. Rotator cuff tears...

13-Jun-06 10:00 AM

Kyphoplasty Restores Spine Height, Shape

noemail@ksfortho.com — Tue, 13 Jun 2006 15:00:00 GMT

Straightening the Curve
Kyphoplasty Restores Spine Height, Shape
By Raul Sepulveda, MD, and Samuel Alianell, MD

Vertebral compression fractures in patients with osteoporosis usually produce severe pain. Because of the loss of height of the vertebra, these fractures may produce changes in the curvature of the spine called kyphosis, or “dowager’s hump.”

The patient usually becomes shorter in stature. The spinal deformity, pain, impaired function, and decreased mobility can actually lead to more bone loss. Depending on the locations of the fractures, shortness of breath can also result. This is due to diminution in the chest size.

Due to the severity of the symptoms, some patients become increasingly dependent upon others. After the first vertebral compression fracture occurs, the risk of subsequent fractures is increased. Therefore, it is ideal to try to prevent osteoporosis and, if it develops, to treat it with proper exercise, diet, smoking cessation, and medication when necessary.

In patients who develop vertebral fractures that are not treatable with conservative measures, we have the option of a minimally invasive procedure call kyphoplasty, in which inflatable bone tamps are introduced into the vertebral bodies. Once inflated, the bone tamps at least partially restore the vertebral body back to its original height and create a cavity that can be filled with bone cement.

Frequently, this is very helpful in partially alleviating pain and also helping reduce fractures. The procedure diminishes the loss of spinal curvature and helps prevent the formation of the dowager’s hump. More than 17,000 kyphoplasty procedures have been performed nationally and internationally over the last several years.

13-Jun-06 10:00 AM

Rheumatoid Arthritis Causes Pain, Fatigue

noemail@ksfortho.com — Tue, 13 Jun 2006 15:00:00 GMT

Controlling System-Wide Symptoms Rheumatoid Arthritis Causes Pain, Fatigue Rheumatoid arthritis (RA) refers to a chronic disease that causes joint inflammation and deformity, as well as an array of symptoms throughout the body. In addition to joint swelling, tenderness, stiffness, and pain, patients may experience fatigue, fever, poor appetite, and general malaise. RA differs from the more common osteoarthritis in its system-wide involvement, pattern, and cause. RA often involves the wrist and finger joints. It typically affects the same joints on the left and right side of the body. Patients with RA generally suffer pain and stiffness for at least half an hour after they wake up. They often experience episodes with severe symptoms, called flares, followed by periods with fewer problems. Although there is no cure, RA sometimes will go into remission. More often, however, the inflammation permanently damages cartilage and bone tissue over time. The Cause RA is an autoimmune disease...

13-Jun-06 10:00 AM

Surgical Procedure Repairs the Knee Rather than Replaces It

noemail@ksfortho.com — Tue, 13 Jun 2006 15:00:00 GMT

The Truth About Total Knee Replacements Surgical Procedure Repairs the Knee Rather than Replaces It By Albert D. Cuellar, MD Often, when people hear of knee replacement surgery, they believe the entire knee is replaced. This is a common misconception. The surgery is actually considered a resurfacing procedure. That is, the diseased surfaces of the joint are shaved off and replaced with durable metals and plastic. Because our knees are subjected to large forces everyday, the cartilage in the knee can wear out over time. When we walk, twice our body weight is put on the knee with every step. If we participate in sports, fall, or injure the knee, changes can occur in the smooth cartilage surface and may ultimately result in a painful arthritic knee. In some cases, people can develop strong inflammation in the joint that can destroy cartilage, causing arthritis. A Joint Makeover A total knee replacement resurfaces the bone. During the surgery, a few millimeters of the end of the femur...

13-Jun-06 10:00 AM

Doctor Helps Weekend Warriors Get Back on the Field

noemail@ksfortho.com — Wed, 05 Apr 2006 21:00:00 GMT

You’re up to bat in your weekly Wednesday night softball league. You hit a line drive to left field. As the leftfielder charges to scoop up the ball, you decide to round first and try for a double. The throw comes into second base. With thoughts of glory you slide headfirst into second and ….crack! Your shoulder starts throbbing and you hope that your season is not over. How are you going make sure you can get back on the field? Recreational athletes frequently encounter sore muscles and joints that prevent them from competing. As people are staying active in athletics and fitness much longer than in the past, more athletic injuries are occurring. Doctors, athletic trainers, and physical therapists are seeing more and more injuries in weekend warriors. “The best way to stay on the field is to avoid injury in the first place. Good conditioning is the first step. Proper technique is also very important, from properly throwing a softball to hitting a drive on the...

5-Apr-06 4:00 PM

Distal Humeral Replacement

noemail@ksfortho.com — Mon, 16 Jan 2006 21:00:00 GMT

Dr. Alan Rosen is “TOPS” in the Advancement of
Elbow Surgery

TOPS Surgical Specialty Hospital of Houston, Texas is proud to recognize one of our outstanding surgeons, Dr. Alan Rosen, for his role in the advancement of elbow surgery. Dr. Rosen recently performed a distal humeral replacement using a new, advanced hemi-arthroplasty implant, known as the “Latitude Total Elbow Replacement System”. This modular system enables replacement of different parts of the elbow and was developed at the Mayo Clinic in Rochester, Minnesota. Dr. Rosen is the first surgeon to perform an elbow hemi-arthroplasty outside the renowned research and development site.

Dr. Alan Rosen completed his residency in Orthopaedic Surgery at Stanford University Hospital in Palo Alto, California. He completed a Fellowship in Hand and Upper Extremity Surgery at the Hospital for Special Surgery at Cornell University in New York City. Dr. Rosen specializes in surgery of the hand and upper extremity and is an expert at both the repair of traumatic injuries and treatment of arthritic conditions. Dr. Rosen is a Board Certified Orthopaedic Surgeon, and is a member of the American Academy of Orthopaedic Surgeons as well as the American Society for Surgery of the Hand.

In the past, patients required a total elbow arthroplasty (replacement of both humeral and ulnar components) to relieve their pain and restore function. The hemi-arthroplasty implant enables restoration of function and relief of pain with only partial removal of the elbow joint. The surgical use of the “Latitude Total Elbow Replacement System” is limited and is only offered to Orthopaedic surgeons that are fellowship trained in hand and elbow surgery and are regarded as highly skilled in treating complex elbow problems.

Surgeons Sean O’Driscoll MD, Graham King MD, and Ken Yamaguchi MD, of the Mayo Clinic, dedicated 4 years to the development of the modular elbow implant system now used by Dr. Rosen. The implant is designed for use in patients with complex distal humerus fractures, severe elbow joint dysfunction and/or degenerative disease. The U.S. Food and Drug Administration approved the implant system in 2004. The system is manufactured by Tornier, Inc.

16-Jan-06 3:00 PM

Overuse Injuries in Adolescent Baseball Pichers

noemail@ksfortho.com — Mon, 16 Jan 2006 19:00:00 GMT

The elbow is the most frequent location for overuse injuries in children who play baseball. Even though girls who play high school softball have a higher injury rate than boys who play high school baseball, little league elbows associated
with repetitive pitching and improper technique is highest in boys.

Side arm pitching by little leaguers is three times more likely to cause elbow symptoms than overhead pitching. Curve balls produce more forces on the inside of the elbow than overhead throwing. Young children should avoid throwing side arm and curve balls until 14 years of age. Even then, it requires adequate training, coaching and exercises to throw curve balls safely.

By age 18, throwing a curve ball with regularity is not associated with an increased injury rate. The usual rule is to limit the number of pitches thrown at home and in practice to 200 or fewer pitches per week. The way a little leaguer pitches is extremely important. It is not just a matter of throwing the ball. Proper pitching and body mechanics will result in fewer injuries to the little league pitcher or child who throws a baseball. This requires not only strength training to increase power on the pitching arm, but also strength training for the legs.

In most cases the following rules apply:
Years of age         Pitches/Game
8-10*                           55
11-12*                       70-75
13-14*                         85
15-16*                        100
17-18                        110
*No More Than Two Games Per Week

16-Jan-06 1:00 PM

How Much Calcium is Enough?

noemail@ksfortho.com — Mon, 16 Jan 2006 19:00:00 GMT

Calcium and Vitamin D are essential for bone growth, fracture healing, and bone health. Adequate amounts of calcium can come from your diet or from calcium supplements. Foods high in calcium include low-fat milk, cheese, broccoli, as well as many others. Orange juice, cereals, and breakfast bars often have calcium added to them. Many of these foods also add Vitamin D. If you add powdered dry milk to foods such as gravy, casseroles, cookies, breads, soups or others, you can increase the amount of calcium with minimal increase in the amount of calories. Each tablespoon will add about 50 mg. of calcium to the dish. Vitamin D comes from exposure of your skin to the sun or from your diet. The recommended daily intake of Vitamin D is about 800 IU (international units). For more information on calcium and vitamin D, please contact the National Osteoporosis Foundation at www.nof.org. Age mg/day Birth-6mos. 210 6mos.-1 yr. 270 1-3 yrs. ...

16-Jan-06 1:00 PM