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Spotlight for June & July 2015

What is ICD-10 and how will it impact YOU, our patients?

Effective October 1, 2015 the number of diagnosis codes used by our orthopedic providers will increase from about 17,000 to approximately 70,000. Needless to say, the new diagnosis codes demand a great deal more specificity. This new set of diagnosis codes is known as ICD-10 – International Classification of Diseases, 10th edition. For the past 36 years providers in the United States have been using ICD-9 which is the 9th edition of the disease codes. But that is about to end.

The insurance industry and the medical industry which, of course, includes Orthopedic Associates of Meadville, PC have been preparing for this change for the past five years. This is a very welcome change as it will allow the medical industry to provide much more detailed information regarding a patient's condition.

However, as with any large change, there may be some temporary challenges. It has been projected that it will initially take insurance companies longer to process claims. As a patient you may see a delay in the processing of your claims. Our providers and medical assistants may need to ask you some additional, clarifying questions regarding your injury and/or condition.

At Orthopedic Associates of Meadville, our goal is to make this major transition as seamless as possible for our patients. But we appreciate your patience as the medical and insurance industries in the United States take this leap forward.

Thank you and if you have any questions regarding this information, please do not hesitate to call, email, or post your questions.

 

 

Spotlight April 2015

Orthopedic Associates to Move to New Vernon Place in 2016.

For more information and to watch the construction progress, visit these webistes:

weather.weatherbug.com/PA/Meadville-weather/weather-cams/local-cams.html?zcode=z6286


 


 

Spotlight December 2014

Dr. Paczkoskie- Rotator Cuff Tear

The shoulder is made up of three bones, the upper arm bone (humerus), the shoulder blade (scapula), and collarbone (clavicle). It is a ball-and-socket joint where the head of the humerus fits in a shallow socket on the scapula. The shoulder joint is held in place by the rotator cuff, which is a network of four muscles and tendons that come together and insert onto the head of the humerus and encapsulate the shoulder joint. The rotator cuff holds the ball of the shoulder in the socket and helps in lifting and rotating your arm.

There are different types of rotator cuff tears. A partial rotator cuff tear means the tendon is only partially torn and does not fully detach from the humerus. Full-thickness tears means the tendon is completely torn into two pieces.

The two main causes of rotator cuff tears are injury and degeneration. An acute tear typically occurs from a trauma such as falling, lifting something heavy, or dislocating your shoulder. Degenerative tears of the rotator cuff are the result of wear and tear of the tendon over time, which occurs naturally with age. Several factors contributing to degenerative or chronic rotator cuff tears include repetitive stress to the shoulder, lack of blood supply to the tendons, which lessens with age, and bone spurs off the acromion, which can cause impingement on the rotator cuff tendons.

Because rotator cuff tears often occur as a result of wear and tear with age, people over the age of 40 are at greatest risk. People who do a lot of repetitive lifting or overhead activities also have an increased risk.

The most common symptoms of a rotator cuff tear include pain at rest and at night, particularly with lying on the affected side and pain with specific movements such as lifting and lowering your arm. Some people also report weakness in the affected arm. You may also experience some crepitus or a cracking sensation in your shoulder with certain movements.

There are several treatment options for a rotator cuff tear and the best option may be different from person to person dependent on your age, activity level, general health, and the type or size of the rotator cuff tear. Many people do well with nonsurgical treatment, which may include rest, activity modification, non-steroidal anti-inflammatory medication, strengthening exercises and physical therapy, and possibly cortisone injections. If your symptoms do not improve with nonsurgical methods or if you have an acute large rotator cuff tear, surgical intervention may be recommended to repair the torn rotator cuff.


 

Spotlight November 2014

Dr. Wheeling -What is a Physiatrist?

A Physiatrist is a physician who is trained in Internal Medicine and Physical Medicine and Rehabilitation. (PM&R)

They possess knowledge of neuromuscular and musculoskeletal diseases and disorder and how they impair somebody's ability to function on a day to day basis.

Physiatrists take care of patients in Rehabilitation hospitals and see trauma patients in the hospital for their rehabilitation needs.

They are very good diagnosticians because they look at the whole person and try to ensure that the correct diagnosis is made. They then focus on how to get a person to function to the best of their ability with whatever condition is impairing them.

They treat patients with a whole host of problems from strokes, head injuries, spinal cord injuries, neuromuscular diseases, arthritis, sports injuries, nerve injuries, balance problems, amputations and many other conditions. The specialty itself is broad; some physiatrists are generalists and some have subspecialty training. Most are board certified in the specialty and their subspecialty. This is very important!

Dr. Wheeling is board certified in PM&R and Electrodiagnostic medicine. She specializes in diagnosing neuromuscular disorders, nerve injuries and muscle disorders using a test called EMG/NCS. She can give your doctor recommendations as to how best to proceed to treat conditions that have nerve damage or muscle disease.

She also treats patients with amputations, arthritis, back and neck pain, scoliosis, sports injuries and balance disorders. She makes recommendations for any prosthetics, bracing, assistive devices, or therapies that can help some deal with or overcome their impairing condition. She prescribes medication and discusses alternative treatments and educates patients about their problems. She uses very little narcotic medication in managing her patients. If necessary, she makes referrals to appropriate pain management specialists or other specialists to treat your conditions.

She works very closely with your primary care physician.

She really does not treat patients with spinal cord injuries or traumatic brain injuries in her office as they require specialized physicians. But she can refer you to those you need.

Please call for an appointment or have your doctor refer you: 814-459-0202


 

Spotlight October 2014

Dr. Macielak - Lower Back Pain and the Sacroiliac Joint

Condition: Lower Back Pain and the Sacroiliac Joint

Where is the sacroiliac joint?

The sacroiliac joint connects the last segment of the spine, the sacrum, to the pelvis.  The integrity of the sacroiliac joint depends on strong ligaments that encase and cover the joint.  These ligaments compress and stabilize the joint.

Lower Back Pain and the Sacroiliac Joint

How the sacroiliac joint causes lower back pain?

The ligaments that encase the sacroiliac joint may be disrupted due to injury or degenerate due to age, allowing the joint to have excessive motion. This excessive motion may inflame and disrupt the joint and surrounding nerves. 

Your physician may also refer to sacroiliac joint pain by other terms like sacroiliitis, SI joint degeneration, SI joint inflammation, SI joint syndrome, SI joint disruption and SI joint strain.

How do the symptoms of sacroiliac joint pain present?

The most common symptom of sacroiliac joint disorders is pain in the lower back, buttock and legs.  This can present as sciatica like symptoms (leg pain, burning, numbness, and tingling) that mimic lumbar disc or radicular low back pain, pain that radiates down into the legs.

Causes of sacroiliac joint disorders

Causes of sacroiliac joint disorders can be split into five categories:

  • Traumatic (lifting, fall, accident)
  • Biomechanical (leg length discrepancy, prior lumbar fusion)
  • Hormonal (pregnancy / childbirth)
  • Inflammatory joint disease (sacroiliitis)
  • Degeneration (age related wear and tear)

 

Diagnosing sacroiliac joint pain

In order to diagnose the sacroiliac joint as the pain generator, your physician will typically start with a history and a physical examination.  During the physical examination, your physician may try to determine if the sacroiliac joint is the cause of pain through movement of the joint. If this joint movement recreates the pain, the SI joint may be the cause of the pain. 
Your physician may also use X-rays, CT-scan or MRI to help diagnose the sacroiliac joint. It is also important to remember that more than one condition (like a disc problem) can co-exist with sacroiliac joint disorders.

Finally, your physician may request sacroiliac joint injections as a diagnostic test.  Sacroiliac joint injections involve injecting a numbing medication into the sacroiliac joint. If the injection alleviates your symptoms, then your sacroiliac joint may be the likely source of your pain.

Dr. Macielak - Treatment Options for Sacroiliac Joint Disorders

Treatment Options for Sacroiliac Joint Disorders

Treatments can vary depending on the severity of your symptoms and how much they limit your everyday activities. Below are some of the treatment options you may want to discuss with your doctor, depending on your symptoms.

Nonsurgical Treatment for Sacroiliac Joint Disorders

As a first line of treatment, your doctor may prescribe any one or more of the following:

  • Medications like non-steroidal anti-inflammatory drugs may help relieve pain and reduce inflammation.
  • Physical therapy can help provide strengthening and pelvic stabilization exercises to reduce the movement in the SI joint.
  • SI belt wraps around the hips to help squeeze the sacroiliac joints together. This supports and stabilizes the pelvis and sacroiliac joints.
  • SI joint injections can reduce inflammation and relieve the pain. 

Surgical Treatment of Sacroiliac Joint Disorders

If symptoms persist due to instability, your physician may recommend stabilizing your joint with sacroiliac joint fusion.

Sacroiliac Joint Fusion with the iFuse Implant System®

The iFuse Implant System is a minimally invasive option for patients suffering from sacroiliac joint disorders, including SI joint disruptions and degenerative sacroiliitis.

The iFuse procedure takes about an hour and involves three small titanium implants inserted surgically across the sacroiliac joint. The entire procedure is done through a small incision, with no soft tissue stripping and minimal tendon irritation. Patients may leave the hospital the next day after surgery and can usually resume daily living activities within six weeks, depending on how well they are healing and based on physician’s orders.

The iFuse procedure offers several benefits compared to traditional sacroiliac joint surgery:

  • Minimal incision size
  • Immediate post-operative stabilization
  • Minimal soft tissue stripping
  • Potential of a quicker recovery

 

Treatment Options for Sacroiliac Joint Disorders

Download available at: www.box.com/s/f817fc81f94b5085da09

iFuse Implant System Indications and Risk Statement

The iFuse System is intended for sacroiliac joint fusion for conditions including sacroiliac joint disruptions and degenerative sacroiliitis. As with all surgical procedures and permanent implants, there are risks and considerations associated with surgery and use of the iFuse Implant. You should discuss these risks and considerations with your physician before deciding if this treatment option is right for you.

 

 


 

Spotlight July 2014

Dr. Paczkoskie- Shoulder replacement procedures pain?

Are you living with chronic shoulder

Chronic shoulder pain can limit your arm and shoulder movement, interfere with your daily activities, and make it difficult to sleep at night. With a shoulder replacement, you may be able to improve your range off motion, reduce or eliminate shoulder pain, and get back to your everyday activities.

The shoulder is a ball and socket joint connecting the upper arm to the body. The joint is held in place by ligaments and muscles including the group of muscles that make up the rotator cuff. Common conditions that may cause shoulder problems include arthritis, fractures, shoulder dislocation, and rotator cuff injuries.

Treatment options for chronic shoulder pain include NSAIDS, physical therapy, injections, or shoulder replacement surgery. There are three procedures for a shoulder replacement- primary total shoulder replacement, reversed total shoulder replacement, and shoulder resurfacing. We specialize in all shoulder replacement procedures.

A primary total shoulder replacement involves replacing the ball of the shoulder joint, called the humeral head, with an implant that includes a stem and a metal head. The socket, also known as the glenoid, is replaced with a plastic cup that fits over the new metal humeral head.

In a reversed total shoulder replacement, the structure of the shoulder is reversed. The ball implant is attached to the scapula, where the socket of the shoulder joint normally is, and the artificial socket is attached to the humeral head, where the ball normally is. This method allows the deltoid muscles to take over most of the work of moving the shoulder and increases joint stability. This procedure is often indicated for patients with compromised rotator cuff function.

Shoulder resurfacing is another option for some patients. With shoulder resurfacing, the damaged humeral head is replaced with a new metal cap which functions as a new, smooth humeral head. This procedure can provide pain relief and is less invasive than a total shoulder replacement.


 

Spotlight June’s 2014

Dr. Wheeling -What is a Physiatrist?

A Physiatrist is a physician who is trained in Internal Medicine and Physical Medicine and Rehabilitation. (PM&R)

They possess knowledge of neuromuscular and musculoskeletal diseases and disorder and how they impair somebody's ability to function on a day to day basis.

Physiatrists take care of patients in Rehabilitation hospitals and see trauma patients in the hospital for their rehabilitation needs.

They are very good diagnosticians because they look at the whole person and try to ensure that the correct diagnosis is made. They then focus on how to get a person to function to the best of their ability with whatever condition is impairing them.

They treat patients with a whole host of problems from strokes, head injuries, spinal cord injuries, neuromuscular diseases, arthritis, sports injuries, nerve injuries, balance problems, amputations and many other conditions. The specialty itself is broad; some physiatrists are generalists and some have subspecialty training. Most are board certified in the specialty and their subspecialty. This is very important!

Dr. Wheeling is board certified in PM&R and Electrodiagnostic medicine. She specializes in diagnosing neuromuscular disorders, nerve injuries and muscle disorders using a test called EMG/NCS. She can give your doctor recommendations as to how best to proceed to treat conditions that have nerve damage or muscle disease.

She also treats patients with amputations, arthritis, back and neck pain, scoliosis, sports injuries and balance disorders. She makes recommendations for any prosthetics, bracing, assistive devices, or therapies that can help some deal with or overcome their impairing condition. She prescribes medication and discusses alternative treatments and educates patients about their problems. She uses very little narcotic medication in managing her patients. If necessary, she makes referrals to appropriate pain management specialists or other specialists to treat your conditions.

She works very closely with your primary care physician.

She really does not treat patients with spinal cord injuries or traumatic brain injuries in her office as they require specialized physicians. But she can refer you to those you need.

Please call for an appointment or have your doctor refer you: 814-459-0202


 

Spotlight April 2014

Dr. James R. Macielak - Cervical Radiculopathy

The cervical spine is the portion of the spine located in the neck. The cervical spine consists of seven vertebra (bones) with discs in between which act as shock absorbers or cushions. The bones form a column which protects the spinal cord and nerves. Cervical nerves exit at each level of the cervical spine, and transmit information to and from the skin and muscles of the neck, shoulders, and arms.

Radiculopathy refers to symptoms from a pinched or irritated nerve. When this occurs in the cervical spine (cervical radiculopathy) symptoms can include pain, headache, numbness, tingling, and weakness. This can be located in one area such as the neck or shoulder, or may radiate down the entire arm including the hand. Pain can vary and may be dull, achy, sharp, stabbing, etc. Symptoms often come and go but may be constant.

In younger people, cervical radiculopathy is often caused by a disc herniation. Similar to a tire, if too much pressure is placed on the disc, it can bulge or herniate pinching on the exiting nerve. Cervical radiculopathy in the middle-aged and elderly population often occurs due to degenerative ("wear and tear") changes. Degenerative discs, or discs that have become thin with age, can narrow the space for a nerve to exit. Bone spurs or osteophytes may form around the joints in the cervical spine and also irritate or pinch exiting nerves.

Patients affected by the condition are generally offered conservative treatment which successfully improves the condition in a majority of cases. Medications, such as anti-inflammatories, muscle relaxers, and pain medications may be utilized. Physical therapy, including cervical traction, is often prescribed. If pain is severe or persists despite the above treatments, nerve blocks or epidural injections may be performed. These injections introduce a steroid, a strong anti-inflammatory medication, around the irritated nerve root to reduce inflammation and pain. The injections are typically performed by a pain management physician, or anesthesiologist, with the help of a live xray or fluoroscope.

A small percentage of patients that do not respond to conservative treatment may consider surgery. A cervical discectomy and fusion involves removing the affected disc, unpinching the nerve, and placing a piece of bone graft between the vertebrae. This is often stabilized by inserting a plate and screws. Eventually, the vertebrae fuse together, eliminating the "bad" disc and retaining an open space for the previously pinched nerve.

Cervical discectomy and fusion procedures have been successfully performed by Dr Macielak in the Meadville area for over 20 years. For more information please discuss your symptoms and a referral with your family physician.


 



 


 

Spotlight December 2013

Dr. Paczkoskie - Leg Pain in the Running Athlete

Running is a complex biomechanical task that places unique strain on the musculoskeletal system. While injuries in runners most commonly result from overuse or abrupt changes in activity level, there are a variety of conditions that can cause leg pain in the running athlete.

Muscle soreness and delayed-onset muscle soreness are among the most common causes of leg pain in the running athlete. Muscle soreness is classified as a type I muscle strain and refers to the immediate soreness, which occurs while or immediately after participating in exercises. This may present as muscle stiffness, aching pain, or muscle tenderness. Delayed-onset muscle soreness is similar except that symptom onset occurs about 24 hours after completing the exercise.

Hamstring strains and tears are also very common in the running athlete and sports requiring sprinting, jumping, or quick acceleration or deceleration. This typically occurs as the result of sudden hip flexion with associated knee extension. Patients typically report acute onset of pain in the posterior thigh, pain with weight bearing, and typically ambulate with a stiff-legged gait to avoid hip and knee flexion.

Stress fractures are another commonly seen cause of leg pain in the running athlete. Stress fractures result from the repetitive, continuous, excessive forces placed on bone, which leads to bony microdamage and progresses to a stress fracture. Some risk factors for developing stress fractures include female gender, hormonal or menstrual disorders, decreased bone density, poor footwear, participation in running or jumping sports, rapid increase in physical training, and smoking. Patients presenting with a stress fracture typically present with a localizable pain of insidious onset and no specific injury. In the early presentation, the pain typically is not present at rest but occurs with running, particularly at the end of the run.

Some other causes of leg pain in the running athlete include the female athlete triad, medial tibial stress syndrome, chronic exertional compartment syndrome, and popliteal entrapment.

The female athlete triad is a syndrome of three interrelated conditions including energy deficit, menstrual dysfunction, and altered bone mineral density, which poses serious health risks to the affected individual.

Medial tibial stress syndrome is an overuse problem, which consists of pain over the distal two-thirds of the posteromedial border of the tibia. Pain is typically present with early activity and subsides with continued exercise.

Chronic exertional compartment syndrome is defined as reversible ischemia within a closed fibro-osseous space, leading to decreased tissue perfusion and ischemic pain. This is a recurrent problem in athletes associated with repetitive physical activity. Pain occurs at an exertion level where the elevation of pressure exceeds the rate of metabolism. As a result, the tissues become tight and painful. Pain typically subsides quickly with rest.

Popliteal entrapment is a rare overuse injury manifested by a complex of neuromuscular or ischemic symptoms in the lower extremity resulting from pathologic impingement behind the knee.

With the exception of popliteal entrapment, most causes of leg pain in the running athlete can be treated with conservative measures however many of these conditions may require prolonged treatment and rehabilitation.

Dr. Paczkoskie is board certified in sports medicine. If you are an athlete suffering from leg pain, please contact our office today for a consultation.


 

Spotlight November 2013

Compression Fracture

Compression FractureA compression fracture of the spine occurs when a back bone (vertebrae) partially collapses and loses height. The vertebrae, usually square-shaped, becomes compressed, usually toward the front of the bone. This results in a wedge-shaped appearance to the bone. The majority of compression fractures occur in the elderly due to weakened bone that has become less dense (osteoporosis). However, compression fractures can also occur at any age due to trauma. Osteoporotic compression fractures typically occur without a significant trauma. Minor falls, lifting, bending, & coughing are all potential causes.

The pain from a compression fracture typically starts suddenly. It is usually described as sharp, intense, breath-taking and worsens with movement and bending. Laying flat usually results in less pain. Although the pain is fairly localized, inflammation and irritation of surrounding nerves can cause radiation of pain to the ribcage, abdomen, hips and legs.

The diagnosis of compression fracture can be made by taking a patient's history and performing a complete spinal examination. Xrays, MRI, CT Scan, and bone scans may also be used to determine the location and age of the fracture.

The decision on how to treat a compression fracture considers factors such as the severity of pain, severity of fracture deformity, age of fracture, failure of conservative management, and the patient's health status. The pain from a compression fracture can be controlled by pain medications, ice, bracing therapy, and limiting activities. Patients should avoid lifting, bending, and twisting.

Kyphoplasty is a minimally invasive surgical technique used to treat compression fractures. The surgery requires one or two small incisions and the insertion of a surgical balloon into the vertebrae. A sample of bone is often obtained during the procedure for further testing. The balloon is inflated in order to create a space inside the bone which is then filled with bone cement (methylmethacrylate). The original deformity of the compression fracture can be at least partially reversed. The patient is typically observed in the hospital overnight. Recovery consists of light activities for the first couple weeks. Further screening of osteoporosis via a bone dexascan is usually recommended in patients suffering from a compression fracture.


 


 

Spotlight July 2013

Dr. Paczkoskie - Reverse Total Shoulder Replacement

Shoulder replacement is the third most common type of joint replacement and can offer new hope for people suffering from chronic shoulder pain.

The shoulder is a ball and socket joint where the head of the humerus fits in a shallow socket on the scapula. The joint is held in place by the rotator cuff, which is a network of four muscles and tendons that come together and insert onto the head of the humerus. The rotator cuff holds the ball of the shoulder in the socket and provides stability and mobility to the shoulder joint.

Some common causes of chronic shoulder pain are advanced arthritis and a chronic rotator cuff tear. Chronic rotator cuff tears are degenerative tears of the rotator cuff that often are the result of wear and tear of the rotator cuff tendon over time. This condition may lead to irreparable loss of the rotator cuff tendons and destruction of the normal joint surface in the shoulder. Because the rotator cuff tendons often cannot be restored following a chronic tear, the shoulder may become weak and painful.

Conservative treatment options for a chronic rotator cuff tear may include NSAIDS, injection therapy, or physical therapy however if symptoms do not improve with non-surgical treatment, you may want to consider a reverse total shoulder replacement.

In a reverse total shoulder replacement, the structure of the shoulder is reversed. The ball implant is attached to the scapula, where the socket of the shoulder joint normally is, and the artificial socket is attached to the humeral head, where the ball normally is. This method allows the deltoid muscles to take over most of the work of moving the shoulder and increases joint stability. This procedure is often indicated for patients with compromised rotator cuff function.

Dr. Paczkoskie specializes in all types of shoulder replacements, including the reverse total shoulder replacement. If you are suffering from chronic shoulder pain, please contact our office today for a consultation.


 

Spotlight June 2013

Dr. James Macielak Offering two Surgical Technologies

Now offering two new surgical technologies at Meadville Medical Center in the treatment of sacroiliac and low back pain.

Si - Bone LogoChronic sacroiliac pain is commonly overlooked as a source of low back pain. Its symptoms can mimic those of low back arthritis, disc herniation, and sciatica. Causes can be acute, such as a fall or strain, or chronic, such as arthritis or degeneration. In patients who have failed conservative management of sacroiliac pain (medications, physical therapy, chiropractic, bracing, injection) surgical fusion may be an option. iFuse Implant System is a minimally invasive approach to sacroiliac fusion and is highly successful in a patient with proven sacroiliac pain. For further information visit si-bone.com or call the office to schedule an appointment for further evaluation.

XLIF  LogoXLIF, or extreme lateral interbody fusion, is a new approach in lumbar spine fusion surgery. Patients with chronic low back pain from disc problems may choose to undergo surgical fusion of the affected levels, when other options of treatment have failed. Traditionally, fusion surgery is approached from an anterior (belly) or posterior (low back) incision. XLIF allows a surgeon to access the disc or level from a relatively small incision from the side. Since an incision through the low back muscles is avoided, this can offer quicker recovery and less post-operative muscle pain. For further information about XLIF visit spine-health.com or nuvasive .com. Please contact the office to schedule a consultation if you suffer from chronic low back pain.


 


 

Spotlight February 2013

Dr. Paczkoskie- Rotator Cuff Tear

The shoulder is made up of three bones, the upper arm bone (humerus), the shoulder blade (scapula), and collarbone (clavicle). It is a ball-and-socket joint where the head of the humerus fits in a shallow socket on the scapula. The shoulder joint is held in place by the rotator cuff, which is a network of four muscles and tendons that come together and insert onto the head of the humerus and encapsulate the shoulder joint. The rotator cuff holds the ball of the shoulder in the socket and helps in lifting and rotating your arm.

There are different types of rotator cuff tears. A partial rotator cuff tear means the tendon is only partially torn and does not fully detach from the humerus. Full-thickness tears means the tendon is completely torn into two pieces.

The two main causes of rotator cuff tears are injury and degeneration. An acute tear typically occurs from a trauma such as falling, lifting something heavy, or dislocating your shoulder. Degenerative tears of the rotator cuff are the result of wear and tear of the tendon over time, which occurs naturally with age. Several factors contributing to degenerative or chronic rotator cuff tears include repetitive stress to the shoulder, lack of blood supply to the tendons, which lessens with age, and bone spurs off the acromion, which can cause impingement on the rotator cuff tendons.

Because rotator cuff tears often occur as a result of wear and tear with age, people over the age of 40 are at greatest risk. People who do a lot of repetitive lifting or overhead activities also have an increased risk.

The most common symptoms of a rotator cuff tear include pain at rest and at night, particularly with lying on the affected side and pain with specific movements such as lifting and lowering your arm. Some people also report weakness in the affected arm. You may also experience some crepitus or a cracking sensation in your shoulder with certain movements.

There are several treatment options for a rotator cuff tear and the best option may be different from person to person dependent on your age, activity level, general health, and the type or size of the rotator cuff tear. Many people do well with nonsurgical treatment, which may include rest, activity modification, non-steroidal anti-inflammatory medication, strengthening exercises and physical therapy, and possibly cortisone injections. If your symptoms do not improve with nonsurgical methods or if you have an acute large rotator cuff tear, surgical intervention may be recommended to repair the torn rotator cuff.


 

Spotlight January 2013

Dr. James Macielak - What is sciatica?

What is sciatica?

Sciatica is pain extending down the leg caused by irritation of the sciatic nerve or one of the nerve roots originating from the low back (lumbar spine). Symptoms can include pain, aching, numbness, tingling, and weakness. Length of symptoms typically ranges from weeks to months. Depending on the specific cause, it can be associated with low back pain, however the nerve pain from sciatica can be predominant or worse. Different parts of the leg can be affected depending on the actual nerve root(s) that are pinched or inflamed. For example an L5 nerve sciatica can produce pain and weakness in the foot, as opposed to an L3 sciatica which typically produces symptoms in the upper thigh.

What are the causes?

Sciatica is caused by impingment (pinching) of one of the nerve roots in the lumbar spine and occasionally by irritation in the hip. A bulging lumbar disc or disc herniation can cause sciatica by placing direct pressure on a nerve root in the low back. Degenerative disc disease and arthritis of lumbar spine can cause sciatica from inflammation and narrowing of the space where the nerve roots travel. Although less common, tightness or inflammation of a hip muscle (piriformis syndrome) can place pressure on the actual sciatic nerve in the leg.

What are the treatments?

Typically sciatica lasts from several weeks to a few months. A short period of rest followed by slowly increased activities is recommended. Medications can include anti-inflammatories and pain medication. Patient specific and appropriate exercise, physical therapy, and chiropractic care can treat sciatica in a majority of patients. Treatments may take several weeks for benefit to occur. In more severe cases of sciatica, lumbar epidural steroid injections, can be performed. These injections, typically done in a pain clinic or hospital outpatient setting, introduce a steroid (strong anti-inflammatory) around the irritated nerve to alleviate pain. The relief of the injection can be temporary, but also can provide relief of severe pain allowing a patient to participate in appropriate exercises and physical therapy. It can provide more time for the body to heal.

Surgery, depending on the cause, can help relieve sciatica that does not respond to other treatment. More urgent or emergency surgery is rarely indicated, with the exception of sciatica associated with bowel or bladder incontinence or deficits or rapidly progressive weakness.

If you have symptoms of sciatica please discuss this with your family physician or contact our office for a consultation.


 


 


 

Spotlight September 2012

Dr. Vincent Paczkoskie - ACL Injuries

ACL Injuries

The bony structure of the knee joint is formed by the femur, tibia, and patella. The knee is supported by four primary ligaments including the medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL), and posterior cruciate (PCL) ligaments. The ACL runs diagonally in the middle of the knee and prevents the tibia from sliding out in front of the femur and also provides rotational stability.

One of the most common knee injuries is an anterior cruciate ligament sprain or tear. The ACL can be injured in several ways. People who participate in high demand sports such as soccer, football, and basketball are at a greater risk. It is often associated with mechanisms such as changing directions rapidly, stopping suddenly, direct contact or collision such as a football tackle, and landing from a jump incorrectly.

When someone injures their ACL, it is often associated with hearing a “pop” and feeling your knee give out from under you. It may also be associated with pain, swelling, and discomfort with walking.

Treatment of an ACL tear varies depending upon the individual patient’s needs.

Although a torn ACL will not heal without surgery, nonsurgical treatment may be an option for older individuals or those with a very low activity level. This may include wearing a knee brace to help your knee from instability and physical therapy to restore function to the knee and strengthen the leg muscles.

For younger athletes or those involved in agility sports, surgical treatment will most likely be required to safely return to sports. Surgical treatment involves reconstructing the ligament by replacing the torn ligament with a tissue graft made of tendon. The tissue graft used to replace the ACL may be obtained from the patient’s own patellar, hamstring, or quadriceps tendon (autograft), or may be obtained from a cadaver (allograft).


 

Spotlight August 2012

Dr. James Macielak - Osteoarthritis of the Spine

Osteoarthritis of the Spine

Osteoarthritis of the SpineOsteoarthritis is the form of arthritis which involves the breakdown of cartilage, or cushion, between two bones. In the spine, osteoarthritis involves the facet joints. Facet joints are the connections of one vertebra to another, allowing for bending of the spine. There are two facet joints at each level of the the spine, one to the right and one to the left side of the vertebra. The joint is formed by bony extensions off the vertebra, cartilage, joint fluid, and held together by a capsule. In osteoarthritis, the cushion or cartilage mechanically breaks down, leading to inflammation and stiffness of the joint. Long-term inflammation can lead to the formation of osteophytes (bone spurs) and cause enlargement of the joints, just as our knuckles enlarge with osteoarthritis of the hand. Not only can this cause back pain, but also leg pain (sciatica) as spinal nerves get pinched or inflamed by the surrounding joint arthritis.

Symptoms of osteoarthritis of the spine can include back pain and stiffness. Symptoms are often worse in the morning and again toward evening after one’s daily activities. Typically leaning or extending the back is difficult and painful. Aching, catching, and grinding are other common symptoms. Age, obesity, genetics, prior injuries, and the type of daily activities or work are all risk factors for osteoarthritis.

Conservative, or nonsurgical treatment of osteoarthritis of the spine is successful in the majority of cases. Nonsteroidal medications, or anti-inflammatories, such as ibuprofen (Advil, Motrin) and naproxen (Aleve) help reduce the pain and inflammation associated with arthritis. Physical therapy, home exercises, and chiropractic care can help to strengthen, reduce muscular tension, and help mobilize and improve joint function. Steroid injection therapy given into the facet joints (facet blocks) reduce inflammation and pain, and may also help localize the source of one’s pain. Although the majority of patients improve with the above treatments, some may have symptoms that incompletely respond to treatment. In these cases, surgical treatment may be an option. Spinal fusion, or arthrodesis, is the surgical fusion of two vertebrae, thus eliminating the motion of the painful arthritic joint. Spinal fusions are most successful when the arthritis primarily involves one or two levels of the spine.

If you have pain associated with osteoarthritis of the spine, discuss a referral with your primary care physician or contact Orthopedic Associates of Meadville for a consultation.


 


 

Spotlight April 2012

Dr. Paczkoskie- Impingement syndrome secondary to poor posture

The shoulder has four muscles which come together to make up the rotator cuff. These muscles encapsulate the shoulder joint and assist in elevating the arm. When you elevate your arm, the upper rotator cuff tendon, the supraspinatous, is pulled under the coracoacromial arch, which includes the coracoid process, the coracoacromial ligament, the acromion, and the acromioclavicular joint capsule.

Inflammation of the rotator cuff tendons and subacromial bursa is a common cause of shoulder pain. Factors contributing to inflammation and pain include repeated mechanical insult to the rotator cuff tendon as it passes under the coracoacromial arch, known as impingement syndrome.

Impingement syndrome characteristically causes a gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity. People also often complain of night pain and difficulty sleeping on the affected side.

While the most common cause of impingement syndrome is excessive use or repetitive motion of the affected arm, another common cause of impingement syndrome is poor posture. When people sit or stand with a rounded posture, improper positioning of the scapula in relation to the humerus creates a smaller joint space available for the rotator cuff and bursa to glide in the shoulder joint. This most commonly occurs in younger patients who participate in sports requiring a lot of overhead activity and in patients who sit in a kyphotic posture with a forward shoulder position such as people who work at a desk or computer related job.

People with impingement syndrome due to poor posture often benefit from a good stretching and exercise program in addition to anti-inflammatories and rest. They may also benefit from a subacromial corticosteroid injection followed by exercise, if they continue to have pain.


 

Spotlight March 2012

Dr. James R. Macielak - Cervical Radiculopathy

The cervical spine is the portion of the spine located in the neck. The cervical spine consists of seven vertebra (bones) with discs in between which act as shock absorbers or cushions. The bones form a column which protects the spinal cord and nerves. Cervical nerves exit at each level of the cervical spine, and transmit information to and from the skin and muscles of the neck, shoulders, and arms.

Radiculopathy refers to symptoms from a pinched or irritated nerve. When this occurs in the cervical spine (cervical radiculopathy) symptoms can include pain, headache, numbness, tingling, and weakness. This can be located in one area such as the neck or shoulder, or may radiate down the entire arm including the hand. Pain can vary and may be dull, achy, sharp, stabbing, etc. Symptoms often come and go but may be constant.

In younger people, cervical radiculopathy is often caused by a disc herniation. Similar to a tire, if too much pressure is placed on the disc, it can bulge or herniate pinching on the exiting nerve. Cervical radiculopathy in the middle-aged and elderly population often occurs due to degenerative (“wear and tear”) changes. Degenerative discs, or discs that have become thin with age, can narrow the space for a nerve to exit. Bone spurs or osteophytes may form around the joints in the cervical spine and also irritate or pinch exiting nerves.

Patients affected by the condition are generally offered conservative treatment which successfully improves the condition in a majority of cases. Medications, such as anti-inflammatories, muscle relaxers, and pain medications may be utilized. Physical therapy, including cervical traction, is often prescribed. If pain is severe or persists despite the above treatments, nerve blocks or epidural injections may be performed. These injections introduce a steroid, a strong anti-inflammatory medication, around the irritated nerve root to reduce inflammation and pain. The injections are typically performed by a pain management physician, or anesthesiologist, with the help of a live xray or fluoroscope.

A small percentage of patients that do not respond to conservative treatment may consider surgery. A cervical discectomy and fusion involves removing the affected disc, unpinching the nerve, and placing a piece of bone graft between the vertebrae. This is often stabilized by inserting a plate and screws. Eventually, the vertebrae fuse together, eliminating the “bad” disc and retaining an open space for the previously pinched nerve.

Cervical discectomy and fusion procedures have been successfully performed by Dr Macielak in the Meadville area for over 20 years. For more information please discuss your symptoms and a referral with your family physician.


 


 


 

Spotlight November 2011

Dr. Paczkoskie- Shoulder replacement procedures pain?

Are you living with chronic shoulder

Chronic shoulder pain can limit your arm and shoulder movement, interfere with your daily activities, and make it difficult to sleep at night. With a shoulder replacement, you may be able to improve your range off motion, reduce or eliminate shoulder pain, and get back to your everyday activities.

The shoulder is a ball and socket joint connecting the upper arm to the body. The joint is held in place by ligaments and muscles including the group of muscles that make up the rotator cuff. Common conditions that may cause shoulder problems include arthritis, fractures, shoulder dislocation, and rotator cuff injuries.

Treatment options for chronic shoulder pain include NSAIDS, physical therapy, injections, or shoulder replacement surgery. There are three procedures for a shoulder replacement- primary total shoulder replacement, reversed total shoulder replacement, and shoulder resurfacing. We specialize in all shoulder replacement procedures.

A primary total shoulder replacement involves replacing the ball of the shoulder joint, called the humeral head, with an implant that includes a stem and a metal head. The socket, also known as the glenoid, is replaced with a plastic cup that fits over the new metal humeral head.

In a reversed total shoulder replacement, the structure of the shoulder is reversed. The ball implant is attached to the scapula, where the socket of the shoulder joint normally is, and the artificial socket is attached to the humeral head, where the ball normally is. This method allows the deltoid muscles to take over most of the work of moving the shoulder and increases joint stability. This procedure is often indicated for patients with compromised rotator cuff function.

Shoulder resurfacing is another option for some patients. With shoulder resurfacing, the damaged humeral head is replaced with a new metal cap which functions as a new, smooth humeral head. This procedure can provide pain relief and is less invasive than a total shoulder replacement.


 


 

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Dr.James Macielak
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