Category: Treatment

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

Posted on August 4, 2016

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.

ONS MDs to Discuss Chronic Pain

Posted on April 22, 2016

DEMETRIS DELOS, MD AND CHRISTOPHER SAHLER, MD OF ONS TO DISCUSS EFFECTIVE TREATMENTS FOR CHRONIC PAIN. 

Maintaining quality of life while living with chronic pain is no easy feat. Two orthopedic specialists from ONS will discuss effective new treatments to help people with relentless pain return to the WavenyPain Flyer (2)activities they enjoy.  Join Demetris Delos, MD, an orthopedic surgeon who specializes in sports medicine an comprehensive knee and shoulder, and interventional pain management physiatrist, Christopher Sahler, MD for this informative talk on Wednesday, May 11 at The Inn at Waveny, 73 Oenoke Ridge in New Canaan.  Doors open at 4:00 pm for refreshments. Presentation begins at 4:30. RSVP at 203-594-5310 or mntiri@waveny.org.

 

Regenerative Medicine and Chronic Pain

Posted on April 1, 2016

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.

Kids and Concussions

Posted on March 11, 2016

Injury on the soccer field

IT TAKES A TEAM TO TREAT KIDS WITH CONCUSSIONS, PANEL CONCLUDES.

ONS physicians Paul Sethi, MD and Scott Simon, MD, took part in an important panel discussion for parents about kids and concussions at Greenwich High School on Wednesday night. If you missed this event, presented by ONSF, you can read about the highlights in the Greenwich Time here.

“Knowing your steps, resources and who to call and who to identify can really reduce the anxiety of the student and the family,” said panelist Dr. Paul Sethi, an orthopedic surgeon who is the team physician for Greenwich High. “You become empowered by understanding and when you know who’s on your team to help shepherd you through this event.”

While the best responses for responding to concussions have become clearer in recent years, panelist Dr. Scott Simon, a neurosurgeon, said preventing head injuries is a complex task. Some best practices, he said, include teaching heads-up tackling in football.

Regenerative Medicine Benefits

Posted on March 8, 2016
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

Posted on February 2, 2016

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.

 

Tips to Prevent Back Injury from Shoveling Snow

Posted on January 22, 2016

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.

ONS Stamford: Off to a Great Start

Posted on June 24, 2015
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 https://onsmd.com/ons-stamford/.

Joint Replacement Symposium at Greenwich Hospital

Posted on April 16, 2015

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.

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

Posted on March 26, 2015

Mark Yakavonis, MD, MMS, is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Yakavonis 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.

07/10/2019

Shoulder Pain? (Part II)

Posted on March 12, 2015

Shoulder_Pain_blogRemember last week’s post? Dr. Kowalsky ended the last installment with listing a multiple options one could take to repair a rotator cuff tear due to the fact that it is very unlikely for the condition to heal on its own. The following is a more in depth description of what makes up this part of the body and what to do after the symptoms of arthritis of the shoulder appear.

The glenohumeral joint of the shoulder includes the humeral head, or ball, and the glenoid, or shallow socket.  Both joint surfaces are coated with articular cartilage, the pearly-white, smooth surface that allows near friction-free, painless movement of one surface on another.  Typical wear-and-tear osteoarthritis occurs due to the degeneration of the joint surface.  As the articular cartilage erodes, the underlying bone can become exposed, change in shape, and create symptoms.  Patients typically present with pain deep within the joint.  The pain can be associated with mechanical symptoms, such as catching, clicking, or grinding, as well as loss of motion.  For some patients, typically those with mild or moderate arthritis, there is a role for conservative management.

However, the most reliable means for pain relief, improved motion and function for patients with moderate or severe arthritis is shoulder replacement.  This procedure is performed by removing and replacing the arthritic ball with a metal implant, and by resurfacing the socket with a plastic implant, restoring low-friction, pain-free motion. Implant design and surgical technique for the treatment of both rotator cuff tears and shoulder arthritis continue to evolve.   These innovations empower shoulder and elbow surgeons to individualize the treatment plan to a specific patient and problem.

Tonight, March 12 at 6:30 pm at Greenwich Hospital,  Dr. Kowalsky will give a health talk on “Common Causes and Solutions to Chronic Shoulder Pain” will discuss the causes, symptoms, and treatment of rotator cuff tears and shoulder arthritis.  The event will highlight important recent advances in the management of these conditions that have been associated with improved long-term outcomes.

The program is free and open to the public.
Registration Requested. Call (203) 863-4277, or register online at www.greenhosp.org.

PRP: A step forward in regenerative medicine

Posted on February 19, 2015
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.

Overuse Injuries: Recovery Time (Part II)

Posted on January 19, 2015

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.

The Fragile Feet: A Ballerina Story (Part I)

Posted on December 3, 2014
Ballerina
Ballerina in en pointe position

Dr. Yakavonis, MD, MMS, of ONS and Greenwich Hospital is an orthopedic surgeon specializing in foot and ankle surgery and treatments for adult foot conditions as well as youth sports injuries in field athletes, gymnasts and ballet dancers. He shares a two-part blog about conditions to be aware of for ballet dancers and gymnasts.

Ballet dancers feet are much like a musician’s hands – they earn a living with them. In addition to putting an amazing amount of stress on their feet, they also are often well below an ideal body weight – either because of the stress of an enormous amount of training or because of unrealistic expectations placed on them by the ballet community. This leads to several different and often unique foot and ankle conditions.

One fairly unique foot and ankle condition in ballet is caused by the en pointe position. In this position an enormous amount of strain is put on the dancer’s great toe, as it is essentially holding up the entire body weight through a small joint. The main flexor tendon of the toe, called the flexor hallicus longus – normally quite small, takes over the job of the largest tendon in the body, the Achilles. The flexor hallicus longus hypertrophies well in compensation for its new job, but unfortunately this tendon is forced through a tight tunnel in the back of the ankle. When it gets too large it will get pinched in the posterior ankle joint. Patients develop painful irritation of the bones and soft tissues in the posterior ankle. An extra bone in the posterior ankle called the os trigonum, which present in about 10% of all people, can be become very painful and irritated in many ballerinas. This constellation of problems is called posterior impingement of the ankle, and it is noticed by the patient as a vague deep pain in the posterior part of the ankle, in front of the Achilles, that is felt with plantarflexion, the position of pointing the foot and toes downward.

Ballet dancers suffer from numerous other problems of the foot & ankle, many of which are not unique. One of the less glamorous problems they deal with are corns, calluses, and blisters. These are necessary adaptations to allow a high level dancer to compete.

Similar to posterior impingement, which arises from dancers spending an inordinate amount of time and stress in an extreme position at the ankle, ballet dancers will develop anterior impingement at the ankle. This comes from repetitive forceful dorsiflexion – pulling the foot and toes upward, toward the shin. Landing from jumps and deep knee bends exacerbate this problem. Pain is felt in the anterior ankle.

Treatment for the above condition is customized to the patient. Often a minor activity modification, or period of rest, can dramatically improve the symptoms. Unfortunately, rest is not easy to come by in the competitive living of a gymnast. Many dancers will treat the symptoms with a combination of anti-inflammatory medications and occasional steroid injections in the region of maximal tenderness. Surgery is a last resort option for any ballerina – when symptoms persist for many months and are limiting, despite all other efforts. Surgery is typically very successful in these patients and can be done with arthroscopic or minimally invasive techniques.

The most common orthopaedic injury of all is also very common amongst ballet dancers: the lateral (traditional) ankle sprain. The mainstay of treatment for ankle sprains is rest, ice, compression, and elevation – mnemonic RICE. A short period of rest and immobilization (1-2 weeks) is followed by aggressive physical therapy, with strengthening of the muscles that stabilize the ankle. Recent research has pointed to improved short and long-term outcomes when early motion and weight bearing is initiated. There is promising early research on the role of stem cell injections – harvested from the patient’s own blood or bone marrow – in the setting of an acute ankle sprain. This is a technique we will offer for the highest level athletes and dancers in certain situations, understanding that the research data on this intervention is still in development.

… to be continued in the next segment, The Fragile Feet: A Gymnast Story (Part II)

Want to learn even more? Dr. Yakavonis will be giving a seminar on “Solutions for Foot and Ankle Pain: Beyond a Foot Massage.”  The program is free and open to the public. Registration Requested. Call (203) 863-4277 or register online at www.greenhosp.org.

07/10/2019

What do you do when you are diagnosed with an old (chronic) Achilles tendon rupture?

Posted on November 13, 2014

Mark Yakavonis, MD, MMS, is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Yakavonis has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes.  His practice will also focus on youth athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.

Achilles tendon ruptures will often not be discovered for months after the injury. In the months between injury and showing up at the doctor’s office, the torn tendon develops scar tissue which decreased the quality and elasticity of the tissue. Because of this, directly repairing the torn tendon, as is done in an acute injury, becomes is less than ideal. In this situation, we will supplement the tendon repair with a tendon transfer. Essentially, we borrow a tendon that bends the big toe (there is another tendon that compensates when it is borrowed), reroute it, and reattach it to the heel bone. This does two very important things:

1. It supplements the strength of the torn Achilles, allowing a quicker and better recovery.

2. It provides improved blood supply to the Achilles repair, providing healing factors to the area of diseased tendon.

In summary, ruptures of the Achilles Foot_AnklePictendon are increasingly common in our aging yet increasingly active population. In cases where an Achilles rupture is missed or the rupture cannot be repaired directly under normal tension, adding the flexor hallicus longus tendon transfer allows for significantly improved results with a shorter recovery.

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

07/10/2019

ONS Physiatrist, Christopher Sahler, MD presents “Exercise as Treatment for Chronic Pain”

Posted on November 6, 2014
Christopher Sahler, MD
Christopher Sahler, MD

Christopher Sahler, MD of ONS and Greenwich Hospital, is an interventional physiatrist specializing in sports medicine. His focus is non-operative treatment of musculoskeletal injuries, restoring proper function, reducing pain and promoting active lifestyles.

If you are suffering from chronic pain, you are not alone. It is estimated that 100 million Americans are currently living with chronic pain. The pain may make it difficult just to get out of bed or do household chores, let alone be active and exercise. Studies have shown this inactivity can actually cause you to experience a worsened level of pain and for a longer period of time. Exercise actually improves your pain threshold. Even simple exercises such as walking can provide some benefit.

Join Dr. Sahler as he presents his first health Seminar “Exercise as Treatment for Chronic Pain” at Greenwich Hospital. Come learn how staying active and performing exercise may help treat an array of chronic pain conditions.

When: December 2nd, 2014
Time: 6:00 p.m.
Place: Noble Auditorium 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.