New Pain Reducing Procedure Studied by ONS Orthopedic Surgeons

Greenwich orthopedic surgeon Dr. Paul Sethi and the ONS practice were featured in an article in Greenwich Patch for using a new pain-reducing procedure that can reduce or eliminate the need for narcotics.

In the article, Greenwich Surgeon Strives to Combat Opioid Epidemic with New Procedure, Greenwich Patch staff writer, Rich Scinto, wrote that oftentimes opioid addiction begins after surgery. 

Following is the article in its entirety:
Opioids post-surgery have become a double-edged sword in the wake of an increasing addiction epidemic. While they have great pain-reducing powers, they also carry the risk of addiction and the chance that pills can fall into the hands of an addict.

A group of orthopedic surgeons based in Greenwich are using a new pain-relieving method that helps reduce a patient’s reliance on opioids.

Dr. Paul Sethi with Orthopaedic and Neurosurgery Specialists recently has seen collegiate athletes in need of surgery who are willing to suffer great amounts of pain if it means staying off of opioids post-surgery.

“Young people are becoming more aware of how dangerous of a problem it is,” Sethi said about opioid addiction.

It is also frightening as a surgeon to think that an opioid prescription that is intended to help a patient recover could lead to death or a lifelong battle with addiction, he said.

Sethi has been performing shoulder replacement surgeries with the use of Exparel, which is an injection of long-lasting liposomal bupivacaine that can last for three days post-surgery. Some patients have used no narcotics or a greatly reduced amount after the surgery, Sethi said.

Instead of prescribing 30 narcotic pills post-surgery generally there is only a need to prescribe 10, he said. That translates to less pills that could fall into an addict’s hands.

The prescription of opioid pain relievers has skyrocketed. In 2013 health-care providers wrote 259 million prescriptions, enough for every American adult to have a bottle of pills, according to the CDC.

About 70 percent of opioids used for non-medical reasons are obtained through family or friends and 18 percent through a prescribing doctor, according to the Substance Abuse and Mental Health Services Administration.

Sethi and others are conducting a peer-reviewed study about Exparel’s effectiveness in reducing pain after surgery.

Sethi and others at the practice plan to expand the use of Exparel to other types of shoulder surgery and there is potential to use it in operations such as ACL repairs. The injection has to be specifically tailored to each surgery in order for it to be effective, he said.

Surgeons should spend a good amount of time educating their patients about pain management and the potential for opioid abuse.

“In medicine we are pressed for time, but I think this is one of the most important things we teach our patients about,” he said.

The injection costs about $300 extra, which is a bargain if it can save a person from an overdose death or a long struggle with addiction, Sethi said.

For now narcotics still are prescribed in case pain comes back after Exparel wears off.

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.

Regenerative Medicine and Chronic Pain

Is regenerative medicine the answer to your chronic pain?

In the past, most cases of damaged tissue within the body were considered irreversible, but developments in regenerative medicine hold the potential to change all that, writes Christopher Sahler, PRPMD, an interventional pain management specialist at ONS, in this week’s edition of the Greenwich Sentinel.  Although research into harnessing the body’s own healing process using amniotic fluids, blood, tissues, growth factors and stem cells is ongoing, certain biomedical therapies are in use today to help ordinary people suffering from orthopedic conditions and chronic pain.  The most common treatment, using platelet rich plasma collected from a patient’s own blood, is administered in a physician’s office using ultrasound guided injections directly into the diseased or damaged tissue to restart and increase the healing process.  Read the full article in the April 1 edition of Greenwich Sentinel.

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

 

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).

Joint Replacement Symposium at Greenwich Hospital

hip replacementOn Wednesday, April 22nd, at 6:00 p.m., orthopedic surgeon/ joint replacement specialists from ONS and Greenwich Hospital will present a joint replacement symposium in the Noble Conference Center at Greenwich Hospital located at 5 Perryridge Road. Knee and hip specialists Frank Ennis, MD and Brian Kavanagh, MD; and shoulder specialist Seth Miller, MD will present information about the latest advances in joint replacement, including computer-assisted and minimal incision, muscle sparing techniques. Information about preparing for joint replacement, pain management and what to expect from the recovery process will be addressed by hospital anesthesiology, nursing and physical therapy department staff.

Many people suffer from severe pain caused by arthritis, a fracture or other conditions that make common activities such as walking, putting on shoes and socks or getting in and out of a car, extremely difficult. Today, over 900,000 hip and knee replacement surgeries are performed each year in the United States. An additional 53,000 shoulder replacements are performed. Deciding if and when it’s time to consider joint replacement surgery are important decisions.  This educational symposium is designed to provide anyone who is considering joint replacement with pertinent information to assist them in making the right decision for them.

Frank Ennis, MD specializes in hip and knee replacement and is fellowship trained in adult reconstructive surgery. Dr. Ennis is among the first orthopedic surgeons in the New York area to perform computer-assisted joint replacement. He completed undergraduate studies at Yale University and post-baccalaureate pre-medical studies at Harvard University. He graduated from Duke University School of Medicine and completed a residency at Yale University Department of Orthopaedic Surgery. He received his fellowship training at New England Baptist Hospital in Boston.

Dr. Kavanagh
Dr. Kavanagh

Brian Kavanagh, MD has performed over 6500 joint replacement surgeries in the past 25 years. He graduated Princeton University and earned a medical degree at University of Connecticut School of Medicine. He did his internship and residency at the Mayo Clinic, Mayo Graduate School of Medicine in Rochester, Minnesota, and served on the faculty at the Mayo Graduate School of Medicine for seven years. Dr. Kavanagh was on the teaching staff at Yale University School of Medicine in New Haven for five years. Dr. Kavanagh was also an instructor in the hip and knee total joint fellowship program.

Seth Miller, MD is a graduate of Mount Sinai School of Medicine in New York. After his residency at New York Columbia-Presbyterian Medical Center, he completed a research fellowship at the Hospital for Special Surgery in New York and a shoulder surgery fellowship at Columbia-Presbyterian Medical Center. He served as an orthopaedic consultant to the New York Mets for more than eight years.  He is the current President of ONS.

All three surgeons are on staff at Greenwich Hospital, a recipient of The Joint Commission’s “Gold Seal of Approval™” for total hip and knee replacement surgery and spinal fusion. The certification for hip and knee replacement procedures recognizes the hospital’s commitment to maintain clinical excellence and patient satisfaction, while continuously working to improve patient care.  Greenwich Hospital’s total joint replacement program offers a level of continuity that sets it apart from other facilities. A clinical resource nurse helps patients every step of the way – before, during and after surgery and throughout rehabilitation and recovery. Patients receive the practical information, emotional support and follow-up care they need to guide them through the entire process.

You will have the opportunity to ask questions at the conclusion of the talk.  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

Shoulder Pain? (Part I)

Marc Kowalsky MD
Marc Kowalsky, MD.

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

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

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

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

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

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

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.

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 Giants along with 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.

Suffer from Bunion Pain? Dr. Clain Offers Solutions

Michael Clain, MD
Michael Clain, MD

Bunions are a common deformity encountered in the foot where the big toe is out of alignment. This creates pain in that toe and often in the lesser toes as well. The deformity makes it difficult to find shoes that fit comfortably.  Ill-fitting shoes can contribute to the situation but the underlying deformity is genetic. This is why most patients can recall a parent or grandparent that had the problem.

In consultation, I often tell patients that the options are to accommodate the foot with wider shoes, gentle arch supports and sometimes padding or I encourage them to consider surgery.  The decision to proceed with surgery should be based on the overall level of discomfort and deformity.  This will differ from patient to patient.  It is rare that the patient that must have bunion surgery.  Most people will choose surgery due to the accumulation of annoyances, discomfort, pain and deformity in other toes.

Actual X-ray of patient of Dr. Clain before bunion surgery
X-ray of patient of Dr. Clain before bunion surgery
Same Patient. Post-Bunionechotmy
Same Patient. Post-Bunionechotmy

It is very important, from my point of view, to communicate realistic expectations for the procedure and the ultimate result. I try hard to be very specific about the time involved in recovery and give every patient a written “expected surgical recovery.” It is obviously difficult to remember everything when you as the patient are given a great deal of information so it’s helpful to have a summary to refer to.

Not all bunions are the same. Routinely, I perform about six different surgical procedures.  The goal is to do the most appropriate operation for your particular foot and circumstance.  With careful communication and a well thought-out plan it is highly likely that we should be able to get a great result for almost any foot.”

For more information about Dr. Clain, click here.

If you suffer from bunions and would like to attend a free seminar on foot pain Dr. Peden of ONS and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage is an orthopedic surgeon specializing in foot and ankle surgery. He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.

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

Seth Miller, MD
ONS Orthopaedic Surgeon, Seth Miller, MD

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

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

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

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

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

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

ONS Physical Therapist Betsy Kreuter’s P is for Posture When Sitting or During Chores!

OSTEO_graphicMost Americans spend too much time sitting and should take advantage of these tips to help keep good posture.

First, when sitting in a chair make sure your buttocks is all the way to the back of the chair. Using a lumbar roll in the small of your back will help to keep optimal alignment.

Second, if you  sit at a computer, your monitor should be at eye level, feet firmly on floor, hands and wrists in a straight line, shoulders back and elbows at 90 degrees. A break from sitting every 30 minutes will relieve your back of stresses placed on it while sitting. For a more detailed guide to improve seated posture, download Work Station Ergonomics  as a reference.

Posture is equally important when doing chores. While working, make sure your lower back is in a neutral position to avoid a forward curve in your spine. Watching your posture over the years will help avoid vertebral compression fractures due to osteoporosis.

Osteoporosis, or thinning bones, can result in painful fractures. Risk factors for osteoporosisosteoporosis include aging, being female, low body weight, low sex hormones or menopause, smoking, and some medications.

To learn more about osteoporosis, bone anatomy, fracture prevention exercises to promote bone health, updates on treatments, measures to promote strong bones and personal risk factors, register to attend a free health seminar on October 14, 2014 at Greenwich Hospital in the Noble Conference Room.  The panel of speaker include ONS Orthopedic Surgeon Steven Hindman, MD, Greenwich Hospital Endocrinologist Renee Ileva, MD and ONS Physical Therapist Betsy Kreuter, PT, CLT . After the seminar you will be able to ask the doctors and therapist questions.

ONS Orthopedic Surgeon and Hand Specialist, Mark Vitale, MD Presents at 69th Annual American Society for Surgery of the Hand (ASSH)

Dr Vitale Portrait -sm web
Mark Vitale, MD

September 19, 2014, ONS orthopedic hand surgeon Dr. Mark Vitale traveled to Boston at the 69th annual American Society for Surgery of the Hand (ASSH), the premier annual hand surgery meeting where the nation’s leading hand surgeons gather to present new research and techniques for the care of hand, wrist, nerve and upper extremity problems.

Dr. Vitale presented two of the conferences’ 84 podium presentations to the community of hand surgeons in the U.S. and abroad. One of his presentations entitled, “Intra-articular fractures of the sigmoid notch of the distal radius: an analysis of progression to distal radioulnar joint arthritis and impact on upper extremity function in surgically treated fractures,” was a study that looked at fractures of one of the understudied joints of the wrist. This study will help surgeons guide treatment of these fractures to optimize wrist function in surgically treated fractures.

Traditional treatments for thumb arthritis involve removing the arthritic bone in the wrist called the trapezium which forms a joint with the base of the thumb and then using part of a patient’s own tendon to reconstruct the thumb. Dr. Vitale’s research revealed that the results with this more traditional “trapeziectomy” surgery are excellent and time tested.21

Dr. Vitale Speaking at the ASSH His second presentation, “A comparison of pyrolytic carbon hemiarthrioplasty versus Thompson suspensionplasty in the treatment of trapezial metacarpal arthritis,” was a study that compared a traditional treatment for thumb arthritis with a new pyrocarbon joint replacement for the thumb.

Pyrolytic carbon joint replacement is a synthetic implant to replace the arthritic thumb/wrist joint that was initially developed and first used in conjunction with hand surgeons at the Mayo Clinic in Rochester, MN. It resurfaces the base of the arthritic thumb metacarpal bone while leaving more of the native trapezium bone in place. The pyrolytic joint replacement implant has been used since the early 2000s. The result of this study found some improved function in patients treated with the pyrocarbon joint replacement, but also a higher risk of need for future surgeries in those treated with the newer joint replacement.

Hand surgeons today debate about what surgical procedures are most appropriate for severely arthritic thumbs. The results of Dr. Vitale’s research will now help guide surgeons around the country to better treat patients.

Dr. Vitale commented, “The ASSH conference was a great success. The ONS Foundation for Clinical Research and Education has provided us with an incredible state of the art research and biomechanics lab from which we continue to drive the field of hand surgery, sports medicine and orthopedic surgery.”

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

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

UNDERSTANDING AND PREVENTING SURGICAL SITE INFECTION

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

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

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

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

Paul Sethi, MD
Paul Sethi, MD
Katie Vadasdi, MD
Katie Vadasdi, MD
Timothy Greene, MD
Timothy Greene, MD

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

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

ONS Foundation Awarded 2nd Place in AOSSM Poster Contest
ONS Foundation Awarded 2nd Place in AOSSM Poster Contest

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

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

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

 

 

Is the Screwball Pitch Hard on the Arm? ONS Orthopedic Surgeon Paul Sethi, MD Weighs In

BaseballWhen you think of baseball pitchers, what comes to mind? Fastball? Curveball?

These are common terms used to describe pitches thrown during Major League Baseball games. Professional pitchers that have perfected these two conventional styles may not have the special skill and expertise to pull off one of the most, if not the most difficult pitches in baseball history, the screwball.

New York Times article The Mystery of the Vanishing Screwball,” by Bruce Schoenfeld, describes the “screwball” as “erratic, irrational or illogical, unexpected.”

In his article, Schoenfeld writes about the screwball technique gleaning inside information from Hector Santiago of the Los Angeles Angels who says the secret to the pitch is “like driving with your right wheels going around a curve.”

Schoenfeld goes on to write that “Unlike the knuckleball, which is easy to throw but hard to master, the screwball requires special expertise just to get it to the plate. The successful screwball pitcher must overcome an awkward sensation that feels like tightening a pickle jar while simultaneously thrusting the wrist forward with extreme velocity.”

Chicago White Sox pitching coach Don Cooper is quoted in the article saying “the word on the street is that the screwball is hard on the arm.” Although there is no documentation of this, many experts continue to debate as to whether or not the intensity of such a throw is harmful to the arm.

According to the article, Schoenfeld found no existing research to help answer the screwball pitch question. That’s when he contacted ONS Orthopedic Surgeon and Sports Medicine Specialist Paul Sethi, MD.

Dr. Paul Sethi, a Connecticut orthopedist, was willing to help generate some new data. Sethi is a disciple of Dr. Frank Jobe, the man who did an ulnar collateral graft in Tommy John’s elbow in 1974 and so created the most famous baseball-medical connection since Lou Gehrig’s disease.

Dr. Paul Sethi
Paul Sethi, MD

I met Sethi at the Center for Motion Analysis in Farmington, Conn., in a 108-foot-long room as bright as an operating theater. A dozen cameras were mounted on the walls. A tattooed 26-year-old named Matt Bartolomei stood on a portable pitcher’s mound while technicians adhered sensors to his body.”

Dr. Sethi, along with a team of experts, were able to watch in slow motion and concluded that the force exerted on the elbow of the pitcher when he threw a screwball during the experiment was identical to that of a fastball or curveball.

“In fact, the screwball doesn’t exceed the fastball in any parameter.” The results were hardly definitive, especially given the data set of one. “But looking at the data compared to the normative data kind of makes me tingly,” Sethi said.

If he and Nissen could confirm the conclusions, Sethi believed they might rescue the screwball from near-extinction. While assisting Jobe in Los Angeles, he worked with Dodgers pitchers. He liked the idea of contributing to their cause. I was less certain, though, that a doctor could revive the flat lining screwball. For a pitch to be used regularly by major leaguers, or even Little Leaguers, it needed a stronger selling point than mere safety.”

Although the “screwball” has been somewhat “abandoned” by baseball, the research conducted by Dr. Sethi and the team he worked with could make for a comeback. In a phone message yesterday Dr. Sethi confirmed, “the “screwball” pitch isn’t a cause for higher risk of injury than that of a fastball or knuckleball. It puts the same amount of stress on the arm as the other pitches do.”

Paul Sethi, MD is a board-certified orthopedic surgeon who specializes in sports medicine, the shoulder and elbow. He served as an orthopedic consultant to the Los Angeles Dodgers baseball team. Sethi was also a former assistant team physician of the Los Angeles Lakers basketball team, Los Angeles Kings hockey team, Los Angeles Dodgers, and University of Southern California football team.

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

[Read Full New York Times Article]

Looks like more snow is in the forecast, we have some skiing tips for you!

skierThe knee is the most vulnerable body part for any athlete, including skiers. Downhill skiing produces large amounts of torque on the knee, challenging the integrity of ligaments and tendons. Whether from a fall or overuse, the most common injuries in skiers are tears to the MCL (Medial Collateral Ligament) or ACL (Anterior Cruciate Ligament), two important structures that give our knee stability.  When a skier is thrown off balance, his skis will sometimes shoot out in front of him, creating extra torque on the knees and damaging our stabilizing structures.

Both novice and experienced skiers are at risk of hurting their knees. We frequently see novice skiers hurt themselves when they do not know how to turn, stop or fall properly. Taking lessons and working with an instructor goes a long way in preventing knee injuries for beginner skiers. Experienced skiers frequently take risks and assume that they can manage faster speeds on any slope.  Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. In poor visibility or icy conditions, a beginner trail becomes an intermediate trail, and an intermediate slope becomes advanced slope. Keep injury prevention in mind, if the conditions are difficult, ski down a level.

A second reason injuries occur is fatigue. Most skiers’ bodies are not accustomed to exercising 6-8 straight hours. In addition, many skiers push their bodies to take advantage of the whole day, even when they start to feel tired and stiff.  For this reason, injuries tend to happen at the end of the day.

Having the knowledge of what places skiers at a higher risk for knee injuries, we are passing on recommendations about how to stay safe on the slopes.  Both beginners and experienced skiers can benefit from these tips!

  1. Start a conditioning program a few months before your first ski trip. Leg strengthening, flexibility and balance are important aspects of an adequate ski conditioning program.
  2. Ski with good technique. Maintain your balance and control, keep your hips above your knees, keep your arms forward, and maintain a safe speed.
  3. Learn how to fall correctly: keep your legs together, keep your chin to your chest and your arms up and forward.
  4. Pay attention to weather conditions and remember to ski down a level if conditions deteriorate.
  5. Listen to your body. If you start to feel pain or stiffness upon exiting the lift chair, then you should probably make that run your last. Head to the lodge and enjoy a warm drink by the fire.

Good luck and stay warm!

If you become injured, while skiing, remember, ONS sports medicine physicians are trained at the top universities and hospitals in the country and have expertise in the latest treatments for sports-related injuries in high-performance and recreational athletes.

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

 

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