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

Study finds success in treatment for Frozen Shoulder.Dr. Katharine Vadasdi, Shoulder Surgeon

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

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

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

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

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

The Dangers of Sports Specialization

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

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

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

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

Professional level injuries

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

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

Overuse injuries

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

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

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

How can we prevent injuries?

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

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

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

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

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

ONS Surgeon Named Doctor of Distinction

Paul Sethi, MD, was named one of Fairfield County’s Doctors of Distinction by Westfair Communications.

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

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

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

 

An Added Level of Safety to Young Athletes

The Ortho Access program at ONS offers an added level of safety to young athletes who are injured on the field.

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

 

 

Regenerative Medicine Benefits

Dr. Christopher Sahler
Dr. Christopher Sahler

ONS pain management specialist, Christopher Sahler, MD, will discuss the benefits of regenerative medicine at Greenwich Hospital talk.

Does your own blood hold the key to healing your medical condition? The evolving field of regenerative medicine uses biomedical materials, often from your own body, to regenerate cells and rebuild diseased and damaged tissues. Join Dr. Christopher Sahler to learn about this exciting new medical field that uses therapies from blood, platelets and stem cells to treat pain and cure complex, often chronic conditions of the musculoskeletal system.  Healing Yourself: The Promise of Regenerative Medicine for Chronic Pain and Orthopaedic Care will take place on Thursday, March 10 at Greenwich Hospital’s Noble Auditorium.  6 – 7:30 pm. Free.  To register, call 203-863-4277 or go to greenwichhospital.org.

ONS is awarded AIUM Ultrasound Practice Accreditation

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

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

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

 

ONS Featured in Greenwich Sentinel

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

 

Tips to Prevent Back Injury from Shoveling Snow

If the local forecasts are to be believed, many of us will be doing a fair amount of snow shoveling this weekend. Before you bundle up and head out, though, Dr. Jeffery Heftler, an interventional pain Blog-shoveling show 300 pxspecialist at Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, has a few words of advice to protect your back from strain and injury.

“The most important thing is to stay ahead of the accumulation of snow. It’s much easier on your back to shovel after every few inches has fallen than to wait and lift heavier loads of snow for a longer period of time,” he advises. Waiting can make the task even harder if the snow melts and then freezes over. Dr. Heftler also recommends investing in so called “push shovels” that are specially designed for pushing the snow aside while shovels with bent handles can help ease the tension on back and shoulders.

Without a doubt, Dr. Heftler sees more patients with back pain following a large snow storm. One reason, he suggests, is that people tend to think of shoveling snow as a nuisance and chore, when in fact it is an intense and strenuous exercise. “All too often, people who are generally inactive underestimate the physical challenge involved in clearing snow. Even someone in good shape can strain their back from the rotation of lifting the snow and throwing it over their shoulder,”   he says.

To protect your back, it’s best to take a few moments to warm up your muscles before going out in the cold. When shoveling, maintain the correct posture and technique to minimize the pressure on your weaker back muscles. Avoid rounding your lower back, for instance. Instead, go through the motions with a straight back leaning forward and your knees slightly bent. Use your core, hips and hamstrings to provide strength and stability instead of relying on your back and shoulder muscles to do the heavy lifting.

People with pre-existing back conditions are most vulnerable to shoveling related injuries and should avoid the activity altogether. “Even if you have to hire someone to clear the snow for you, it will pay for itself in terms of avoiding pain and days lost from work and winter sports,” Heftler says.

If you do experience pain while shoveling, Dr. Heftler says to stop, go inside and rest in a comfortable position until the discomfort passes. He recommends anti-inflammatory medications such as Advil or Aleve, and using ice or heat directly on the area where the pain is most acute. If the pain is severe and persists through the next day, consult with a physician.

15 ONS Physicians Rated Among Top Doctors in Connecticut

 

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

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

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

 

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

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 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).

USA Rugby National Team Physician Marc Kowalsky, MD: Injury Prevention Strategy

Kowalsky MD World Rugby 2015 Pacific Nations CupONS Orthopedic Surgeon, Marc Kowalsky, MD, USA Rugby National Team physician returned from the Pacific Nations Cup this week.

“The USA Rugby National Team lost to Samoa in the first round of the Pacific Nations Cup, 21-16 at Avaya Stadium in San Jose, California. This match was a preview of the match-up between these two teams in pool play for the Rugby World Cup this fall. While the Samoans, ranked 9th in the world they jumped out to an early lead in the first half. The Eagles battled valiantly in the second half, but fell short of victory by only five points.” (more about the game)

Dr. Kowalsky traveled with the team during their week of preparation, and served as team physician for the match. The Eagles contended with a tough Samoan team, known for their physical style of play. Fortunately, neither team sustained catastrophic injuries during the match.

Now back in Connecticut, Dr. Kowalsky looks forward to the fall season of high school, collegiate, and men’s rugby, passing along to athletes these tips for injury prevention strategy:

  1. Adequate nutrition and hydration are imperative not only to optimize performance, but also to avoid overuse injuries during training and competition.
  2. A supervised strength and conditioning program is essential.
  3. Athletes must respond early to symptoms of impending injury when possible, and seek the care of their training staff and team physician.

Dr. Kowalsky is not only team physician for USA Rugby National Team but also for Iona College Rugby Football club and White Plains Rugby Football Club.

USA Rugby National Team Doctor from ONS

March 27, 2014; Atlanta, Georgia, USA; USA Men's Eagles training session before the second leg of the Rugby World Cup 2015 qualifier game against Uruguay at Life University
KOWALSKY, MD: March 27, 2014; Atlanta, Georgia, USA; USA Men’s Eagles training session before the second leg of the Rugby World Cup 2015 qualifier game against Uruguay at Life University

Rugby is one of the fastest growing sports in the United States, with a 33% annual increase in participation among youth athletes. In part, the popularity of rugby in the US can be attributed to an increased visibility of the sport at the high school and collegiate levels, and the recent success of the USA Rugby National Team. The US fields a “7s” and a “15s” team, characterized by the number of players on the field during competition. The 7s team recently qualified for participation in the 2016 Rio Olympics. This will be the first time the sport is featured in Olympic competition since 1924. The 15s team, otherwise known as the Eagles, is currently ranked 16th in the world, and qualified to compete this fall at the 2015 Rugby World Cup in England.

Orthopaedic & Neurosurgery Specialists have a long-standing tradition of providing orthopedic care for young rugby players. ONS doctors have served as team physicians for the Greenwich High School rugby team, one of the strongest high school teams in the country. Currently, orthopedic surgeon and sports medicine specialist Dr. Marc Kowalsky is the team physician for the USA Rugby National Team. Having played rugby himself at Dartmouth College he understands the game from a medical and player’s perspective. He also serves as team physician for the Iona College Rugby Team and the White Plains Rugby Football Club.

“Injuries that are typically encountered in rugby encompass the entire spectrum of injuries treated in any collision sport.  As with American Football, there has been a significant increase in attention to concussion and traumatic brain injury in the sport. World Rugby, the governing body of international rugby, and USA Rugby, have devoted a significant amount of time, energy, and resources to optimize the prevention, detection and care of concussion and traumatic brain injury among rugby players.

Two of the important measures to prevent concussion from occurring are, avoiding contact in the sport at a young age, and proper instruction about safe tackling as contact is introduced.  At the elite level, techniques for safe tackling are certainly reinforced. From the perspective of the medical team, all members of the USA Rugby medical staff are required to complete the IRB Level 2 Immediate Care in Rugby Course to prepare for the management of catastrophic injuries during training and competition.  Physicians and trainers are additionally required to complete extensive training in the assessment and management of concussion in particular. 

Another key tool is a baseline neurocognitive exam to measure an athlete’s cognitive function, or the ability to process information. All players complete neurocognitive testing once they join the team, to establish baseline values for each athlete, which become important in the assessment of an athlete who may have sustained a concussion.”

Rugby,calcioWorld Rugby and USA Rugby continue to improve the medical team’s ability to assess injured athletes during competition. Clear guidelines have been established to guide treatment and determine an athlete’s ability to return to play.  All of these measures will be in place as the USA Rugby National Team prepares for competition in the Pacific Nation’s Cup, July 18, 2015. Dr. Kowalsky will accompany the team and serve as team physician.

Are shoes the culprit of foot pain?

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

news12_Clain

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

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

ONS Stamford: Off to a Great Start

ONS_Stamford
5 High Ridge Park, 3rd floor, Stamford, CT 06905

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.com/ons-stamford/.

STAMFORD OFFICE GRAND OPENING

ONS_GRAND_OPENING_Website

Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, CT has opened an expanded, state-of-the-art medical office and physical therapy facility in North Stamford. The new office is conveniently located off the Merritt Parkway at exit 35 at 5 High Ridge Park on the 3rd floor. Patients who choose to see a physician at the new location will find an aesthetically comfortable and healing environment that features the latest technology in imaging and electronic medical records.

A public grand opening celebration, “Your Prescription for Success: A Sports Medicine Event” will take place on June 22nd from 6 to 8 p.m. at the new office located at 5 High Ridge Park, 3rd floor in Stamford.

Come visit our brand new Orthopedic, Sports Medicine & Spine Center and Physical Therapy facility in High Ridge Park.

  • Tour the new facility and enjoy food and beverages.
  • Check out our golf, tennis and running stations to learn injury prevention tips and exercises from ONS Physical Therapists.
  • ONS physicians will talk about sports medicine related conditions and treatments.
  • Enter our drawing for exciting prizes.

To schedule an appointment at the new office in Stamford with the following physicians call, 203-869-1145.

James Cunningham, MD
Demetris Delos, MD
Tim Greene, MD
Marc Kowalsky, MD
Sean Peden, MD
Scott Simon, MD
Christopher Sahler, MD
Katie Vadasdi, MD
Mark Vitale, MD

To schedule a physical therapy appointment call, 203-869-1145, option 3.

Directions

Northbound CT-15/Merritt Pkwy:

Exit 35 (CT-137/High Ridge Rd.), go straight at the light at the end of the exit ramp then continue on Buxton Farm Rd. In .7 miles, turn left onto Turn of River Rd. and continue into High Ridge Park. Building 5 is the 2nd building on the left.

Southbound CT-15/Merritt Pkwy:

Take Exit 35 (CT-137/High Ridge Rd.), at end of the ramp, turn right onto High Ridge Road (CT-137). In .1 miles, turn left onto Buxton Farm Road. In .7 miles, turn left onto Turn of River Rd. and continue into High Ridge Park. Building 5 is the 2nd building on the left.

  • Parking is in the rear of the building
  • Patient-drop off entrance and handicap accessible parking on lower level

ONS and ONS Physical Therapy are on the 3rd floor.

 

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

Sean C. Peden, MD
Sean C. Peden, MD

Sean Peden, MD is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Peden has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes and keeps up to date with the latest breakthroughs in the field. Most recently, the unnecessary reliance on the MRI compared to conducting a simple stress test has caught his attention. The following is what he wants you to know:

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

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

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

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

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

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

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

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