New Pain Reducing Procedure Studied by ONS Orthopedic Surgeons


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 Orthopedic Surgeon and Sports Medicine Specialist, Timothy Greene, MD Gives Insight on Paul George Injury

Time Greene, MDTeam USA’s scrimmage this past Friday night was definitely one to remember; and not in a good way. ONS Orthopedic Surgeon and fellowship trained Sports Medicine Specialist, Timothy Greene, MD, gives us some insight on NBA Super Star, Paul George’s gruesome injury that caused jaws to drop and made an entire arena become strikingly silent.

“NBA star Paul George sustained a gruesome leg injury during Friday night’s Team USA basketball game in Las Vegas. While trying to contest a layup, George’s leg hit the basketball stanchion causing an open tibia/fibular fracture. The injury consists of a complete break of the shin bone and small bone in the lowerleg that penetrates through the skin. When the bone penetrates the skin, there is an increased risk of infection and thus an urgent surgery was preformed the night of the incident to clean and repair the ends of the bone and skin and place a rod in the shin bone.

The road to recovery will most likely be a long one for the NBA superstar. When the bone penetrates the skin, it increases the time for healing. Studies examining these types of injury show that it can take up to 6 months to get complete healing of the bone. Although we often see our professional athlete’s recover and return to a high level of play in a surprisingly rapid timeframe, it is not unreasonable to expect that Paul George may take an entire year to return to elite level basketball.”

To learn more about the incident, read this article by The Huffington Post.

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 

A Conversation with Orthopedic Surgeon Tim Greene, MD about skiing and snowboarding injuries

Tim Greene, MD is an orthopedic surgeon who is fellowship trained in sports medicine and hip arthroscopy, a cutting edge technique that has revolutionized the treatment of various hip problems. He graduated Princeton University and earned his medical degree at the Medical College of Georgia. He performed a residency in orthopedics at Emory University and served as associate team physician to the athletic teams at Georgia Tech.

Dr. Greene completed fellowship training at the Steadman Hawkins Clinic in Vail, Colorado under the direction of Dr. Marc Philippon. While there, he served as associate team physician for the U.S. Ski Team.

What are the most common ski injuries?

Orthopedic Surgeon and skier Dr. Tim Greene, has served as team physician to the US Ski Team.
Orthopedic Surgeon and skier Dr. Tim Greene, has served as team physician to the US Ski Team.

Although skiing might appear to be a high risk sport, the incidence of ski injuries has actually been declining for the past 20 years. This is partially attributed to better boot and binding technology and may partially be due to the raising awareness of common ski injuries and what can be done to prevent them. The risk of sustaining a fracture is now minimal since the advent of breakaway bindings.

Today, the knee is the most vulnerable body part for a skier. The most common injury is a tear to the MCL, the Medial Collateral Ligament that supports the inside of the knee, and in second place is a tear to the ACL (Anterior Crutiate Ligament), which runs through the center of the knee and is important for stability. In skiing, the knees serve as shock absorbers. They undergo a lot of stress, absorbing the bumps and turns as you navigate the mountain. Beginning skiers may be susceptible to a torn MCL due to the mechanics of the “snowplow” technique, ironically often the first method taught. When in the snowplow position with the skis forming an arrow and the knees bent inward, there is a lot of stress put on the inside of the knee. Falling in this position can result in a sprain or strain of the MCL.

The ACL is at greater risk during skiing because the ankle is locked into position by the boot and the knee is absorbing much of the turning motion. If a skier is thrown off balance and leans back, his skis will sometimes shoot out in front of him or her creating extra torque on the knees that may rupture the ACL. The ACL can also be torn by impact to the knee or severe stress from bouncing down hard on a bump.  This can also happen when turning hard and “catching an edge”. A quick jolt and rotation can also cause an injury.

Do you see the same kinds of injuries with snowboarders?

Generally the injuries are different. You don’t have the twisting motions in snowboarding that you have in skiing, so we don’t see nearly as many knee injuries as we see in skiing. Snowboarders do however tend suffer more upper extremity injuries like the shoulder or hand, which occur when they try to catch themselves during a fall.

Who is most susceptible to these injuries?

There are two sets of people who tend to get ski injuries; very beginning skiers who are not supervised on the slopes, and very experienced skiers who tend to take more risks with speed and terrain.

Why do they happen?

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. If the conditions are difficult, ski down a level. In other words, In poor visibility or icy conditions, a beginner trail becomes an intermediate, an intermediate slope becomes advanced and on and on.

Another reason injuries occur is fatigue. Most people only take one or two ski vacations a year, so they try to cram the most into each day. Their bodies aren’t accustomed to exercising of 6-8 straight hours and they get tired and weak. Most injuries happen at the end of the day and that’s because the light is poor and skiers are fatigued. The combination can be very bad.

What is the best way to prevent those kinds of injuries before hitting the slopes?

Starting a conditioning and strengthening program a few months before your first trip up the mountain is a very good way to help prevent injuries. By developing good core strength your body will be in better shape to handle the stress and strength needed in skiing. Leg strengthening and balance should also be central to a conditioning program. Aerobic training will help build stamina which will help prevent fatigue which is the cause of many injuries.

Are there any other precautions to take, once on the slopes?

Ski in control. Loss of control can lead to a crash, which is the cause of the most serious accidents.

Recognize the condition of the terrain you’re on and of your own condition. Pay vigilant attention to your own level of fatigue and rest when you feel tired or weak. Weakened muscles can lead to a loss of control that can lead to a fall or a crash into another skier or stationary object like a tree or lift tower. If you are tired, take a break, if it’s icy or the snow is extra heavy, ski down a level and if you are inexperienced, take a lesson. You’ll have more fun, and the instructor will help you avoid mistakes that can lead to injury.

In addition to your own mindfulness, pay attention to weather conditions. When I was in Vail working at the Steadman Hawkins Clinic, we could tell from the weather what kinds of injuries we would see that day. If the snow was soft and powdery, you would typically see more ligament injuries from skis getting stuck in a bank. If the snow conditions were harder, you would have more fractures.

If someone is injured, what kind of treatment is involved?

Treatment depends greatly on what type of injury you sustain. Unless an injury requires emergency treatment, if you think you’ve been injured, have it evaluated by the ski patrol.  Many sprains and strains can be addressed by applying the RICE principle; Rest, Ice, Compress the area, and Elevate. It is always best to follow up with an orthopedic surgeon once you get back home, who will most likely access your injury by physical exam and sometimes x-rays or an MRI. Your doctor will make a determination of the best course of treatment depending upon the severity of the injury and your general physical condition. In the case of a ligament tear, surgery may be an option but that depends on how bad the tear is, your general health and your normal level of activity.





Enjoy your summer sports… but don’t get injured

Vary your activities and build a strong core to help prevent injuries

Most athletic injuries are not the result of accidents but are due to poor preparation for sports activity, overuse of joints or muscles, and missing the early warning signs of injury- according to sports medicine specialist Tim Greene, MD.


“Most sports injuries are preventable and can be traced to a lack of core body strength.  Core strength refers to the strength of the muscles of the torso that keep your stomach strong and support your back. Think in terms of a tree that has strong branches but a weak trunk. The imbalance of strength can cause strain, cracking and even collapse the trunk.  If your core is not strong and you engage in a running or jumping activity, your risk for injury is increased.”

When you play golf or tennis, swim, or cycle, Dr. Greene recommends varying your activities so your body doesn’t become unevenly strengthened and conditioned. “Incorporating programs like yoga, Pilates, and strength training can be very effective for developing your core and reducing the risk for injury.”

As you go about your summer sports activities, keep these injury prevention tips in mind:

  • Prepare your body for sports activity with sport-specific conditioning and muscle strengthening.
  • Strengthen opposing muscle groups to maintain balance of muscle strength.
  • Maintain proper hydration and give your body adequate nutrition.
  • At the beginning of your sport or workout, activate your body with a dynamic warm up- Begin at an easy pace to slowly increase heart rate, respiratory rate and blood flow to muscles.
  • Warm up both upper and lower extremities.
  • Know when to rest or stop. Many injuries occur from over-fatigued muscles.
  • Use properly fitting protective gear when appropriate, like helmets and wrist and shin guards.
  • Use properly fitting sports clothing and supportive sport-specific foot gear.
  • Vary your fitness routine. Repetitive use of muscles and joints can cause strain and injury.
  • If you feel persistent pain in your muscles or joints, stop exercising and have the pain evaluated.

This summer the ONS Blog will present a series on preventing summer sports injuries.  Check back regularly for valuable tips from our sports medicine experts that may just keep you out of the doctor’s office.

Talk on Shoulder Injuries and Treatments at Greenwich Hospital

The shoulder is the most mobile joint in the human body, with a range of motion of nearly 360 degrees.

Orthopedic Surgeon Tim Greene, MD of ONS on Valley Drive

The complex mechanics of the shoulder make it vulnerable to certain injuries.  Sports medicine specialist Tim Greene, MD, will discuss shoulder injuries, the common causes of shoulder pain and the most effective treatments from physical therapy to minimally invasive surgeries.


Speaker:  Tim Greene, MD Orthopaedic & Neurosurgery Specialists
Date:  Tuesday, October 4, 2011
Time:       6:00pm – 7:30pm
Location:  Noble Conference Center
Contact phone number:  203-863-4277 or 888-305-9253 or register online
Fee:  None

Focus on Ski Conditioning to Prevent Injury at ONS Foundation Seminar


As further impetus, the ONS Foundation is holding its annual Ski Conditioning and Injury Prevention Seminar on Tuesday, December 7 at 6:30 p.m. at ONS building, 6 Greenwich Office Park at 10 Valley Drive.  Dr. Hindman and orthopedic surgeon and sports medicine specialist Dr. Tim Greene will discuss the causes of common skiing injuries and how they may be avoided. The free seminar will include tips on safe skiing, and information on the latest treatments for common injuries such as a ruptured ACL. Chalon Lefebvre, PT of ONS Physical Therapy will talk about and demonstrate ski conditioning and strengthening exercises. Registration is requested. Call 203-869-3131 or email to register or for information.

Each year eager skiers and snowboarders head to the slopes but many do little to prepare for the physical demands of their sport. Even the best of athletes are susceptible to injury when under-prepared muscles engage in winter sports activity for the first time in many months. Physical conditioning can make all the difference.

According to Dr. Hindman, there is a lot that can be done to avoid the common aches and more serious strains to joints and muscles that many experience. “Most people go from their car to the ski lift without even a single stretch,” says Hindman. “Skiing requires muscles and muscle groups that are used very little the rest of the year. Ideally, strengthening and conditioning should begin two to three months before the first trip up the mountain, but it’s never too late to benefit from a program. Find one that’s geared to winter mountain sports. If you don’t prepare, your risk for injury increases.”

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