If you can’t do the simple things you once did, you may be suffering from a shoulder condition.

Marc Kowalsky MD

Marc Kowalsky, MD.

Dr. Kowalsky is 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.

Posted in Greenwich Hospital, Injury Prevention, Joint Replacement, Medical, Medical Expertise, Neck Pain, Orthopaedic Conditions, Orthopaedic Research, Seminars, Uncategorized | Leave a comment

Stem Cells: The Potential

2015 Paul SethWEB

Paul Sethi, MD

The following educational blog about stem cells and their potential was written by Dr. Sethi, a leading research physician at ONS. He speaks at academic and instructional medical conferences in the US and abroad and his research on surgical advances for the shoulder, elbow and knee is regularly published in leading medical journals. He also collaborates with outside companies for education and research purposes and to develop medical procedures on the shoulder, elbow and knee, and is President of the ONS Foundation for Clinical Research and Education.

Most cells in our body develop into a specific cell type, for example, cells that populate the kidneys.  Similar to our staying on a “career path,” these cells stay in the same line and continue to produce and generate cells to function within the body part.  In contrast, stem cells are basic human cells that have not chosen a cell type (job) but have the potential to give rise to many different cell types in the body. This is exciting because stem cells may be able to create new cells in existing healthy tissues and may help to repair tissues in those structures that are injured or damaged.

As orthopedic surgeons, we have focused our attention on mesenchymal stem cells. Unlike embryonal stem cells, mesenchymal stem cells are obtained from living adult tissue: from bone marrow in your pelvic bone and sometimes from blood or adipose tissue.  Bone marrow stromal cells are the specific mesenchymal stem cells that, in the proper environment, can differentiate into cells that are part of the musculoskeletal system. They can help to form bone, tendon, articular cartilage or even ligaments – all critical elements of musculoskeletal regeneration.

At this point, stem cell procedures in orthopedics are at an experimental stage.  It is expected, however, that as more knowledge of tissue engineering is obtained, stem cell procedures will become more common.  Active research and current clinical applications show promise in three specific areas of orthopedic regeneration surgery. These areas are:

Bone Fractures and Nonunions:  Traditionally, bone defects have been treated with solid bone, material placed at the site of the fracture or nonunion. Stem cells and progenitor cells are now placed along with the bone graft to stimulate and speed the healing. These may be used in the absence of a bone graft, avoiding a potentially painful surgical procedure.

Articular Cartilage and Arthritis:  The lining of joints is called the articular cartilage. Damage to the articular cartilage can frequently lead to degeneration of the joint and painful arthritis. Current techniques treat articular cartilage damage by grafting and transplanting cartilage to fill the defects. It is hoped that stem cells, injected into the joints, will create growth of primary hyaline cartilage to restore the normal joint surface.

Ligaments and Tendons
:   Mesenchymal stem cells may also develop into cells that are specific to connective tissue leading to faster healing of ligament and tendon injuries, such as quadriceps or Achilles tendon ruptures. In this case, stem cells would be included as part of a primary repair process.  We anticipate our future ability to repair the ACL instead of surgically replacing the ligament.

Overall the use of stem cells holds a lot of promise but the research is still ongoing. ONS is here to heal as well as educate so keep an eye out for more blogs related to this and other insightful academic topics.

Posted in Orthopaedic Research, Uncategorized | Tagged | Leave a comment

PRP: A step forward in regenerative medicine

Dr Kessel

Dr. Tamar Kessel, physiatrist, with a C-arm

Dr. Kessel is a physiatrist who specializes in non-operative treatments of musculoskeletal injuries and has an interest in the use of ultrasound to target medications to the precise location of tissue damage. One procedure that optimizes on ultrasound technology is the new and progressive treatment in regenerative medicine, PRP (Platelet Rich Plasma). Utilizing therapeutic injections, like PRP, has been shown to be safer and to greatly improve treatment results.  The treatment has even received significant attention from the media and has been used by members of the New York Football Giants, other NFL players and elite athletes. Dr. Kessel is committed to providing the highest quality medical care and achieving the best outcomes for her patients.

PRP is a new treatment in regenerative medicine that uses the patient’s own blood and platelets to promote healing and helps the body optimize on its own natural processes. The patient’s own blood is drawn then placed in a centrifuge machine that separates the blood, leaving the platelet rich plasma ready to be removed. Afterwards, the PRP is placed right into the area of damage using ultrasound. Most people benefit from one injection but depending on the severity of the damage, it could take up to three. This method can help heal injuries including tendon/ligament injuries (Achilles Tendonitis), tennis elbow, cartilage loss, arthritis, and small tears (rotator cuff tears and meniscal injuries).

Note: Because PRP is given in the hopes of optimizing the initial inflammatory response of healing, anti-inflammatory medications should likely be stopped at the time of PRP treatment. Please consult your physician before any procedure.

Posted in Greenwich Community, Medical, Medical Expertise, Orthopaedic Research, Sports Injury, Sports Medicine, Treatment, Women's Sports Medicine | Tagged , , , , , | Leave a comment

“Maximizing Your Child’s Athletic Potential” Success

Delos_Houston_

Dr. Delos with Allan Houston

Last Thursday’s talk on “Maximizing Your Child’s Athletic Potential” was a success. A big thank you goes out to the Junior League of Greenwich for making it possible with their focus on improving the community and empowering others to further health and education! Ultimately they brought together the perfect combination of experts to inform the public about the youth and the sports they love.

Dr. Delos, of ONS and Greenwich Hospital, was a panel speaker at this event. He specializes in sports medicine and arthroscopic treatment of knee and shoulder disorders. Before ONS, Dr. Delos was the Assistant NFL Team Physician for the New York Giants and was team physician for a number of local high school and college athletes.

Other panel members consisted of Andy Barr, Director of Performance and Rehab for the New York Knicks, Mubarak “Bar” Malik, Head of Strength and Conditioning for the New York Knicks, and Allan Houston, one of NBA’s all-time greatest long range shooters and Olympic gold medalist, as the moderator. Each participant reinforced the importance of parents taking interest in the development of their young athlete and properly guiding them to the path of success. Parents attending this event were very attentive, and came prepared with questions.

Conversations covered the fundamental topics, like proper sleep habits and nutrition. For example, a young athlete’s nutrition should increase in relation to the amount of activity they experience daily. This may be common knowledge to an adult but for an adolescent, proper amounts of sleep and good nutrition that balances the amount of activity should be added to their routine.

Aside from the basic topics of discussion, there was a myth to be busted as well; to find out the details of the myth and for more information about the questions that were asked at the event, please read the article written by the Greenwich Freepress.

Delos_Group_2

Photography credit goes to the Delos family, thank you!

Posted in Adolescent, Community Outreach, Greenwich Community, Greenwich Hospital, Health Seminar, Management, Medical, Medical Expertise, News and Announcements, Physical Medicine, Prevention, Throwing Injuries, Uncategorized, Women's Sports Medicine | Tagged , , , , , , , , | Leave a comment

Overuse Injuries: Recovery Time (Part II)

Elbow_Pain_WebRemember last week’s post? Dr.Cohen’s knowledge of “overuse injuries” does not stop at what causes the condition; she has valuable insight on the treatment and prevention as well.

The Mystery is in the History
Careful history taking and examination helps the sports medicine physician diagnose the condition. It is helpful to know what maneuver produces the pain; or when the pain occurs. Many times with an overuse the injury the symptoms will first occur after the activity; then earlier and earlier into the activity until you become symptomatic at rest. It is important to seek medical attention long before that occurs. It is not normal to have pain with the activity. It is important to consult a physician regarding your symptoms, and to find the cause of the injury so that re-injury does not occur once the present injury is treated.

What are the treatment principles for Overuse Injuries?
Management of the condition depends on the severity. Relative rest, which is stopping the aggravating activity while maintaining cardiovascular activity with another activity is one aspect of the treatment program. For example, use of a stationary bicycle or elliptical, or swimming, which are nonimpact activities, might be an alternate activity for a runner while the injury is healing. One needs to individualize the modified activity for the patient and their injury. Other aspects of the treatment plan are pain management with nonsteroidal anti-inflammatory medication as indicated if no contraindication; physical therapy to include instruction in stretching and strengthening exercises; use of an appropriate brace or support for the injured body part; correction of predisposing factors; and modification of biomechanics.

Are there some injury prevention guidelines?
We would all like to prevent an injury from occurring and to maximize our athletic endeavors. Some key points to remember to help get you there are: appropriate training and conditioning for the sport; check your biomechanics for the sport; allow for adequate recovery and do not engage in your sport when you are tired or in pain. Engage in a variety of sports and activities so that you are not always using the same muscles in the same way. Many elite level athletes complement their specialized sport training with another sport. For example, a cyclist might skate or play hockey in the off season to maintain muscle balance of the quadriceps and hamstring muscles of the thigh. It is best to be proactive and prevent the injury from happening.

Dr.Cohen will be discussing Stress Fractures and Biomechanical assessment in future blogs.

Posted in Management, Medical, Medical Expertise, Orthopaedic Conditions, Physical Medicine, Prevention, Sports Injury, Treatment | Tagged , , , | Leave a comment

Ready for Spring Sports?

Golfer

Foot and ankle, hand and wrist injury prevention tips by orthopedics specialists

When: February 25, 2015 at 6:30 p.m.
Where: Noble Auditorium, Greenwich Hospital
SpeakersSean Peden, MDMark Vitale, MD, and Paddle and Tennis Professional Patrick Hirscht

If golf or racket sports are in your plans for the spring you will want to hear tips from fellowship trained orthopedic foot and ankle specialist Sean Peden, MD and fellowship trained hand/wrist/elbow specialist Mark Vitale, MD, MPH who will discuss common injuries seen in golf and racket sports. Special guest and local tennis pro Patrick Hirscht will also speak. Learn about common injuries, and how to choose footwear, braces and exercises to prevent injury and play your best; whether it’s the foot, hand, wrist or elbow, they’re all at risk for injury when you’re active. Dr.Peden and Dr.Vitale will discuss nonsurgical and surgical treatments, along with ailments particular to racquet sports. You will have the opportunity to ask questions at the conclusion of the talk. The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

Posted in Community Outreach, Foot and Ankle, Greenwich Community, Greenwich Hospital, Hand and Wrist, Health Seminar, Medical, Medical Expertise, News and Announcements, ONS Surgical Team, Orthopaedic Conditions, Orthopedics, Physical Medicine, Sports Injury, Sports Medicine | Tagged , , , , , , , , | Leave a comment

ONS Success Story: William McHale

William McHale TestimonialWilliam McHale started off as many other athletes did, full of energy and feeling invincible. As we all know, that feeling of invincibility is only a feeling. In the 7th grade, young William broke his ankle playing football; fortunately he was then referred to Dr. Paul Sethi.

Dr. Sethi considers all of the athlete’s needs which helps set the stage for a successful and timely recovery period and translates into an ideal patient-doctor experience.  When McHale got older, Will started as a linebacker in 30 consecutive games between his sophomore and senior years at  Yale University. During his senior year though, the labrums in both of his shoulders tore. Time was of the essence if he wanted to recover in time for his Pro Day in front of NFL Scouts. Who did he contact? None other than our very own Dr. Sethi.

The MRIs originally taken of the injury did not reveal the full extent of the damage but Dr. Sethi corrected all issues encountered during the surgery . After the procedure William was scheduled to go to physical therapy multiple times a week and overall it took about six to seven months for a full recovery. Since then William has not had any other issues regarding his shoulders.

Where is William McHale now? He played to his full potential on Pro Day, was invited to Minicamp with the New Orleans Saints, and just returned from playing football in France; congratulations!

Posted in News and Announcements, ONS Physical Therapy, Sports Injury, Sports Medicine, Surgery, Testimonial, Uncategorized | Tagged , , , | Leave a comment

Overuse Injuries: Cause and Effect (Part I)

Cohen headshot for letterGloria Cohen, MD is a specialist in non-operative sports medicine who believes in taking an integrative approach to medical management by considering a patients’ bio-mechanics, cardio-vascular and pulmonary function as it relates to athletic performance. Aside from her impressive medical career, Dr. Cohen is a successful competitive runner who has qualified twice for the New York Marathon and is also an off-road and road cyclist. Her academic insights are a combination of both research and real-world experience, the following article is her most recent commentary on the topic of “overuse injuries”:

What is an “overuse injury”?
An “overuse injury” is an injury that results when excessive stress is applied over a period of time to bones, muscles, tendons, and other supporting soft tissue structures of a particular body part.  This differs from an acute injury which happens quickly and is traumatic in nature. Too much stress to a body part will cause the tissues to break down faster than healing can occur, thereby resulting in an injury. A good analogy would be to consider what happens to a credit card or a piece of metal when you bend it back and forth repetitively – first you see the stress reaction, and then with continued stress the item breaks in two.  As you can appreciate, we want to avoid the latter situation when it comes to the body.

What are some common examples of “overuse injuries”?
Every body part can be affected by an overuse injury.  Some common examples you might be familiar with are: rotator cuff injuries of the shoulder; epicondylitis or tennis elbow; patellofemoral pain syndrome of the knee; and tibial stress syndrome or “shin splints” for the lower leg.  Here are a few case examples of classic overuse syndromes:

Jogging injury.

  1. A 40 year old male has recently increased the intensity and frequency of his swimming activity over the summer months. He now complains of pain in the front of his shoulder with overhead and rotation motion. Diagnosis: Rotator cuff tendinitis
  2. A 30 year old female has been playing tennis daily, now competing in matches at a more difficult level. She complains of increasing soreness in the outside aspect of her elbow. She had tried to play through the pain, but had to stop. She says that she can barely lift a coffee cup now because of the elbow pain. Diagnosis: Tennis Elbow /Lateral epicondylitis
  3. A 20 year college student takes up running during her summer break from school. When she returns to school, she decides to train for a half marathon. As she increases her mileage, and adds speed work to her training program, she develops pain in the inside aspect of one shin. She now complains of pain with just walking. Diagnosis: Shin splints/Medial Tibial Stress Syndrome

What are some of the specific causes of these “overuse injuries”?
As a primary care sports medicine physician I recognize that there are sport specific issues which may contribute to the resulting injury; but there are common “intrinsic” and “extrinsic” factors which play a major role in the development of these types of injuries. “Intrinsic” factors refer to the elements that we cannot control but that we can modify.  These include biomechanical alignment, such as knock knees, bowl legs, flat feet or high arched feet; leg length difference; muscle imbalance; muscle weakness; and lack of flexibility.  These factors can be modified to maximize the individual’s performance, and thereby treat or prevent injury.  An example would be a conditioning program and sport specific training. The “extrinsic factors” include training errors, such as doing “too much too soon”; training surfaces – running on too hard a surface, or playing on an uneven surface; shoes – it is important to wear the appropriate type of shoe for your foot mechanics and the sport; equipment; and environmental conditions. Paying attention to the “extrinsic factors” will help you modify the “intrinsic” ones.

… to be continued in the next segment, Overuse Injuries: Recovery (Part II)

Posted in Injury Prevention, Medical Expertise, Orthopaedic Conditions, Orthopedics, Prevention, Running, Sports Injury, Throwing Injuries | Tagged , , , , | Leave a comment

Maximizing Your Child’s Athletic Potential: Expert Advice on Training Smarter and Preventing Injuries

Demetris Delos, MD

Demetris Delos, MD

When: Thursday, January 22, 2015, 7 -9 p.m.
Where: Greenwich Library, Cole Auditorium
Speakers: Demetris Delos, MD, Andy Barr and Mubarak Malik, moderator Allan Houston

Join the Junior League of Greenwich and the Greenwich Library for a discussion moderated by two-time NBA all-star Allan Houston and featuring a panel of experts from the NBA and NFL on the prevention of adolescent sports injuries. Former Knicks star and Greenwich resident Allan Houston is one of the NBA’s all-time greatest long range shooters, an Olympic gold medalist, current Assistant General Manager of the NY Knicks and spokesperson for the National Fatherhood Initiative.

Panelists include Andy Barr – Director of Performance and Rehab for the New York Knicks, Mubarak Malik – Head of Strength and Conditioning for the New York Knicks and Dr. Demetris Delos – orthopedic surgeon at ONS (Greenwich Hospital) and formerly of the NY Giants.

The Junior League of Greenwich and the Greenwich Library aim to educate parents about helping their kids reach their full physical and athletic potential. Admission is free but seats must be reserved online at www.greenwichlibrary.org.

Read Press Release

Posted in Adolescent, Greenwich Hospital, Health Seminar, Sports Injury, Sports Medicine | Leave a comment

ONS SPONSORS: Waveny LifeCare Network Mixed Paddle Tournament

men playing paddle tennisWaveny LifeCare Network Mixed Paddle Tournament

When: February 28, 2015 from 5:30 – 9:30 p.m.
Where: Four Paddle Courts – Country Club of New Canaan, Field Club of new Canaan, Waveny Paddle Courts and The Lake Club

Sign-up to play: Call Joanne Boyer at 203.594.5416 or email jboyer@waveny.org

ONS sponsors Waveny LifeCare Network, a not-for-profit comprehensive continuum of care that has served the needs of New Canaan and the greater community since 1975. Waveny LifeCare Network offers a progression of therapeutic programs, services and living options to enhance the quality of life of those they serve.

Posted in Community Outreach, Paddle Ball, Sponsorships, Waveny LifeCare Network | Tagged , | Comments Off