INJURY PREVENTION HAS NEVER BEEN MORE IMPORTANT.

If you are one of the many people using virtual exercise classes to stay fit while confined at home, you are putting yourself at risk for a strain, sprain, or inflammatory condition. That is the message ONS Sports Medicine Specialist, Dr. Katherine Vadasdi, delivered during a teleconference with members of the Women’s Business Council of Westchester.

“Whether you are exercising using an app or live streaming a yoga class from your favorite studio, injury prevention is more important than ever,” warned Dr. Vadasdi, “You don’t want to end up with tendinitis or other orthopedic problems at a time like this when it may be difficult to get treatment.”

LISTEN TO YOUR BODY

Dr. Vadasdi, who is the director of the ONS Women’s Sports Medicine Center, noted that in times of stress, people should exercise in moderation and listen to their bodies, particularly if they are doing something new. “Now is not the time to push yourself.  If you feel any pain while doing an exercise, stop doing it.”

Before starting an at-home routine, Dr. Vadasdi advised finding programs that emphasize correct body positioning throughout each individual exercise. That guidance can help reduce the risk of developing inflammation in a joint, muscle or tendon from doing an exercise incorrectly.  Exercises available online from the American Academy of Orthopedic Surgeons (AAOS) was one source she recommended. When exercising inside the house, make sure there is enough clear space to do the activity without banging into a coffee table or tripping on a loose area rug.

Dr. Vadasdi noted that while it’s important to find ways to stay healthy and fit during quarantine, people should be equally focused on injury prevention.  “A hospital emergency room is the last place you want to be right now,” she said.

People who suffer a serious musculoskeletal injury who would otherwise seek treatment at an ER, can make an appointment to receive immediate orthopedic diagnosis and treatment at the ONS Greenwich office at 6 Greenwich Office Park.  Non-essential office visits have been temporarily suspended until the COVID-19 crisis is abated. As an added safety measure, all urgent patients, and visitors accompanying them, will be temperature screened upon arrival.  Call 203-869-1145  for an emergency orthopedic appointment.  Patients who wish to consult with an ONS physician on issues that are not truly urgent can schedule a telemedicine appointment by calling the same number.

All Urgent Care Visits By Appointment Only

In response to the alarming rise in the number of coronavirus cases in our area, Orthopaedic & Neurosurgery Specialists (ONS), has designated all in-office appointments for patients who are truly in need of emergency orthopedic diagnosis and treatment. Those patients will be seen by appointment only at the Greenwich office at 6 Greenwich Office Park, on Monday through Saturday, from 12:00 PM to 4:00 PM. The practice suspended all non-essential office visits and elective surgeries in early March.

Safety is the Top Priority

Until the COVID-19 crisis abates, the new requirement for urgent care appointments reduces the risk of infection from a crowded waiting area and complies with social distancing guidelines. As an added safety precaution, patients and individuals who accompany them to the office, will be temperature screened upon arrival. If possible, adult patients are asked to come to his or her appointment alone.

“Ensuring the safety of patients is of paramount importance,” said James G. Cunningham, MD. “Prioritizing patients who are in serious need of emergency orthopedic care provides them with a safe alternative to a hospital ER.”

ONS TeleHealth

The new telemedicine service, ONS TeleHealth, further reduces patients’ risk of exposure while providing a continuity of care from a safe distance. ONS TeleHealth videoconferencing appointments to discuss such matters as X-ray and MRI test results, progress of a treatment plan, and other consultations, provides patients with remote access to a virtual face-to-face visit with an ONS physician from the safety and comfort of home. It also allows the physician to determine if a patient needs to schedule an immediate in-office visit for casting or diagnostic imaging tests. These services can be scheduled at the Greenwich office.​

Essential Physical Rehabilitation

ONS Physical Therapy is still available for individuals requiring essential physical rehabilitation at the Greenwich location and at the Stamford office, at 5 High Ridge Park, 3rd floor, on Monday – Friday from 12:00 PM – 4:00 PM.

In the current environment, Dr. Cunningham said that ONS is taking every possible precaution to protect the health and well-being of patients, staff and the wider community.

For that reason, patients in need of emergency ortho care who have cold or flu-like symptoms, have travelled within 14 days, or are under a directed quarantine or who have a household member under quarantine, must seek treatment at a hospital ER.

Patients can speak to an ONS representative at 203-869-1145 to learn which appointment is appropriate for their condition, or learn more about the temporary changes in policy, hours, locations and the new telemedicine service on our website.

 “VIRTUAL VISITS” ARE NOW AVAILABLE

For your convenience and the safety of all our patients and staff during this unprecedented healthcare crisis, ONS is pleased to now offer ONS TeleHealth.

HOW IT WORKS

ONS TeleHealth provides patients with remote access to an ONS physician for matters that do not require an in-office visit. Using a computer, tablet or phone, appointments for post-operative assessments, review of X-ray and MRI testing, and evaluation of treatment progress can be conducted through videoconferencing, without in-person contact.  It also helps your doctor to determine if you condition requires an in-person office visit or test.

Call our office at 203-869-1145 to find out if you are a candidate for a virtual appointment. If a telemedicine visit is appropriate for you, our experienced staff can help you get started.

Read more about ONS TeleHealth

THE MYTH OF ELECTROLYTE SUPPLEMENTS

Endurance events have increased in popularity over the last decade. However, as more and more athletes participate in these types of competitions, the risk of sodium imbalance during and after races should be given more attention.

Many athletes turn to electrolyte supplements to stay hydrated and improve performance. Yet a recent study involving ultra-marathoners, published in the Clinical Journal of Sports Medicine, reports that popular electrolyte supplements do not necessarily protect against hypernatremia, an increase in sodium levels, which is associated with dehydration.  Moreover, drinking too much of them may contribute to an extreme decrease in sodium levels, a condition known as exercise-associated hyponatremia (EAH). EAH is far more likely to result in serious complications, even death.

Moreover, the risk for sodium imbalances (both hyper and hyponatremia) and associated race-induced illnesses is particularly high if the race is taking place in hot climate and among those who have not properly trained for the event, who were heavy at the time of the event, and/or those who took longer to complete the event that majority of the other participants.

Along with proper training and conditioning, the study suggests that the best protection against dehydration or over-hydrations is to drink during the race only when you feel thirsty, not at pre-set regular intervals, which can dangerously dilute the body’s salt levels and lead to EAH.

Skiing can be one of the most enjoyable winter activities and is a great sport the entire family can enjoy.  But nothing can ruin a great day outdoors (or even the next 6-12 months) like a serious injury such as the dreaded anterior cruciate ligament (ACL) tear.

Skiers are at greatest risk to strain the ACL to the point of tearing in several ways: when they try to recover from a fall with their body weight in back of the skis; if they don’t land a jump correctly; or if improperly set ski bindings don’t release during a critical moment. ACL tears usually require surgery and a lengthy recuperation to repair.  In short, it’s an injury you want to avoid at all cost.

It almost goes without saying that proper fitting equipment, adequate rest, hydration, sleep and weather-appropriate, moisture-wicking attire are essential elements of injury prevention.

Physical preparation is also key.  Ideally, you started a conditioning program at least two or three months before your ski trip to build strength and stability in your core and lower body.  If you didn’t get around to it, or if this is your first trip of the season, it’s worth considering the following safety tips from ONS Sports Medicine Specialist, Dr. Demetris Delos.

1. Warm up: Some light stretching slope-side before you step into your skis can be helpful to stimulate the muscles that will play an important role in a day of skiing.  For example, try a few simple leg exercises such as leg circles and leg lifts to the sides, back and front of your body while engaging your core.  Mini squats, trunk twists and 30 seconds of quad and hip flexor stretches will also help with flexibility.
2. Acclimate: Take a few runs on an easy trail to put your mind and body rhythm in sync before you attempt more difficult terrain.
3. Cool down: When you break for lunch and at the end of the day, stretching (preferably by maintaining a certain pose for 15-20 seconds at a time, and repeating that for 3-5 repetitions) can loosen up the muscles and prepare them for the necessary recovery process.
4. Know Your Limits: Ski at your level. Don’t think about tackling a mogul-filled Double Black Diamond if blue runs are the height of your comfort zone. Ignore pressure from more accomplished friends or significant others.
5. Know When to Quit: Most skiers know that the risk of injury increases in the afternoon or early evening as fatigue sets in. So, if you’re feeling fatigued but want to do one last run, DON’T.
6. Respect Nature: The risk of injury increases when visibility is decreased by late afternoon shadows, during snowfall, and when ski conditions become very icy or very soft. When these factors are present, consider easier runs or call it a day.

A visit to the doctor can be stressful for many people, particularly if you are in pain.  There are forms to fill out, questions to ask, diagnostic tests to undergo and information to absorb. The staff at ONS is committed to providing a seamless, comfortable experience for every patient.  You can make it even easier and the time spent with your physician more productive by taking a few simple steps to prepare ahead of time.

 GET THE MOST FROM YOUR ONS VISIT

• Complete Forms in Advance of Your Appointment.

  Your medical history provides important information to your doctor about your overall health. After making an appointment, you will receive an email or text with a secure link to all the necessary forms online. Filling out the required forms prior to your office visit will reduce the amount of time you will be sitting in our reception area.

  • If you prefer to complete the forms at ONS, plan to arrive 30 minutes before your appointment. You cannot be taken to an exam room until all forms have been completed. You will need to bring the following information with you:

• • • The name of your primary care physician and referring physician, if you have come by referral.
    • A list of all your medications, dosages and frequency, including vitamins and herbal supplements.

• Bring Important Medical Reports to Your Appointment.

  If you have previously had diagnostic testing related to your symptoms, such as X-rays or MRIs, bring copies of the reports to your appointment. This may help your physician diagnose your problem and develop your individual treatment plan.

• Create a Symptom Log.

  To the best of your ability, create a timeline starting with the onset of symptoms and any activity that may have contributed to your condition. Your physician will want to know of the progression of symptoms and any activities that worsen or improve them.  Be sure to include treatments you have previously tried.

• Make a List and Take Notes.

  Compile a list of all your questions about your condition and treatment options, so your physician can address your concerns.  Be sure to take notes during the appointment. They will be useful as reference when you get home.

• Call if You Will Be Late.

  Please give us a call if you know you will be late for your appointment. We may be able to hold your appointment or will reschedule for another time or day.

  NOTE: 24 HOURS CANCELLATION NOTICE IS REQUIRED 

ONS Appoints Joint Replacement Specialist to Head the ONS Outpatient Joint Replacement Center

Orthopaedic & Neurosurgery Specialists (ONS) announced today the appointment of orthopedic surgeon and joint replacement specialist, Jonathan Berliner, MD, to the new position of Director of the ONS Outpatient Joint Replacement Center.

Dr. Berliner joined ONS in 2017. He is a fellowship-trained specialist in hip and knee joint replacement and revision surgeries, with an expertise in muscle-sparing anterior hip replacement, minimally invasive total knee and partial knee replacement, complex revision total hip and total knee replacement, computer-assisted surgery, and trauma of the lower extremity.

With a medical degree from the New York University School of Medicine, Dr. Berliner completed his residency in orthopedic surgery at the University of California, San Francisco (UCSF), followed by a fellowship in hip and knee replacement at Hospital for Special Surgery in New York City.

“ONS has been in the forefront of the trend toward outpatient joint procedures,” said ONS Medical Director, James Cunningham, MD. “Dr. Berliner has been an integral part of that effort. Under his leadership, patients can trust ONS to stay ahead of the curve in providing the best research-based options available. “

ONS makes this appointment at a time when the national trend for outpatient joint procedures is growing exponentially.  Currently, more than one million ambulatory joint replacement surgeries are performed annually in the United States.  That number is predicted to jump by 90 percent in the next decade.

At Home Recovery Gains Favor

The movement toward ambulatory joint replacement surgery is fueled by advances in minimally invasive surgical techniques and pain management protocols, and a younger demographic of patients who prefer to recover in the comfort of home.

There are many benefits to outpatient joint replacements versus similar inpatient surgeries as well. Research data indicates that patients have a more comfortable and quicker recovery at home with the support of family and friends.  Patients who recover at home are at reduced risk of infection and newer, long lasting intra-operative anesthetics help to limit the severity of post-operative pain.  The procedure is also less costly, as patients don’t incur charges for tests and services associated with one or two nights in a hospital. ###

About Orthopaedic & Neurosurgery Specialists

ONS has been one of the most advanced practices of its kind in the region for more than 20 years. Headquartered in Greenwich, Connecticut, ONS is a multi-specialty orthopedic and neurosurgery physician group with locations in Greenwich, Stamford, and Harrison. All offices feature fellowship-trained experts in orthopedics, sports medicine, joint replacement and physical medicine and rehabilitation, urgent ortho care services, physical therapy centers, digital imaging and, in Greenwich and Stamford, MRI. For more information visit www.onsmd.com.

About Stamford Ambulatory Surgery Center (ASC)

The Stamford ASC is an advanced outpatient surgical center owned and operated by the ONS partners.

PAIN AND TRAUMA ARE THE COMMON DENOMINATOR WITH THESE THREE SHOULDER INJURIES.

Anyone can suffer a shoulder injury, but athletes involved in contact sports such as rugby, football and hockey are particularly vulnerable to fractures, separations and dislocations caused by the combination of speed and contact force to the shoulder upon impact, according to ONS Sports Medicine Specialist, Dr. Marc Kowalsky.

“The three most common injuries I see in athletes playing contact sports are clavicle fractures, AC joint separations and shoulder dislocations,” Dr. Kowalsky said.

WHAT HAPPENS TO THE SHOULDER?

Clavicle, or collarbone, fractures can occur along the bone anywhere between its attachment to the shoulder and the sternum. Direct trauma, and falling on an outstretched arm, are both common causes of a collarbone fracture.

A shoulder separation is the result of trauma at the acromioclavicular joint (AC joint), where the collarbone and the highest point of the shoulder blade, known as the acromion, meet. With this injury, the ligaments that hold the the joint together become stretched or torn from the force of the impact to the area.

A shoulder dislocation occurs when the head of the arm bone (humerus), or the ball of the shoulder joint, is driven out of the glenoid socket.  The injury is considered a complete, or locked, dislocation when the ball remains out of socket and requires manipulation in order to be put back in place.  A partial dislocation, a condition known as subluxation, occurs when the ball is forced out of its natural position in the socket, but is able to slip back in place on its own.

SYMPTOMS OF COLLARBONE FRACTURES, SHOULDER SEPARATIONS AND DISLOCATIONS

Trauma is the common denominator in these injuries, and they all can produce significant pain. Along with pain, these injuries typically cause an obvious deformity, including squaring of the shoulder with a dislocation, or a prominent bump or prominence with AC separations.  Injured athletes will also notice difficulty raising the arm, as well as tenderness, swelling, and eventual bruising.  In the case of a shoulder dislocation, the pain usually improves significantly when a physician performs a closed reduction, during which he or she puts the shoulder back in place.

DIAGNOSIS AND TREATMENT

Diagnosis is made initially by physical examination of the shoulder and an X-ray.

Early conservative treatment for mild injuries usually includes sling immobilization to protect the shoulder and minimize pain, along with ice, rest and Nsaids.  X-rays are used to assess alignment and the presence of a fracture.  An MRI will be considered, particularly for shoulder dislocations, if a soft tissue injury such as a labrum tear or injury to the rotator cuff tendons, is suspected.

Depending on the severity of the injury and the complexity of the treatment, physical therapy is usually prescribed to help patients gradually regain strength and mobility.  Surgery is typically considered only for significant injury with wide displacement, or for certain athletes at high risk for recurrent injury.

SHOULDER PROTECTION

Of course, some injuries are unavoidable, but having proper fitting upper body gear can go a long way to dissipate the impact.  Balanced strength and conditioning in the muscles that support the shoulder is also key to help prevent an injury, minimize the extent of the injury if one should occur. Additionally, studies have shown that pre-injury strength and conditioning is also your best shot at a fast return to play.

The shoulder has several muscles that attach the shoulder blade (scapula), humerus and clavicle.  While it is important to have balanced strength in all muscles in the shoulder, the muscles and connecting tendons that make up the rotator cuff are the front line for shoulder stabilization.

STRENGTH AND CONDITIONING TIPS

As with any new exercise, it’s important to consult with a professional therapist or trainer, particularly if you have a prior injury or limitation. Strength and conditioning programs are suitable even for our youngest athletes, but the program should be age-appropriate and supervised.  Start slowly, and gradually increase repetitions, sets and level of resistance. And it is particularly important to focus on proper form.  Exercises done improperly can put unintended stress on other parts of the shoulder or even elsewhere in the body.

Trainers and physical therapists can help develop a shoulder strengthening program that’s right for you.  Many exercises to strengthen the rotator cuff can be done using a resistance band, particularly for strengthening your internal and external shoulder rotation, and the muscles in your scapula. Your posture alignment and range of motion will also benefit.

Planks are good to strengthen the core, back and shoulders, as long you maintain proper alignment. You can challenge yourself with a variation on a push up, where you start at a low plank and push up to a high plank one arm at a time.

Stamford Ambulatory Surgery Center (ASC) has received a 2018 National APEX Quality Award for Excellence in Healthcare.

“ONS is honored to receive the 2018 National Apex Quality Award because it reflects our practice-wide commitment to the highest standards of quality care and patient satisfaction,” said Seth Miller, MD, a founding partner at ONS.

This national distinction recognizes outstanding healthcare providers who have demonstrated excellence in patient satisfaction and overall care during the previous calendar year, according to a statement from SPH Analytics, the national healthcare analytics firm behind the awards.

Apex winners represent the top 10% of SPH clients with the highest satisfaction scores for measures tied directly to care and are based solely on patient feedback and evidence-based success.

For eligibility, a minimum of 300 patient surveys from each SPH client were collected and analyzed from January 1, 2018 – December 31, 2018. In all, more than 633 healthcare facilities in the United States were eligible for the award; 96 were selected as winners.  The Stamford ASC was one of only three facilities selected from the state of Connecticut.

“We applaud all recipients of this year’s award for their exceptional impact in driving satisfaction for their patients,” said Amy Amick, President and CEO of SPH Analytics.