Orthopedic Associates of Meadville, P.C.
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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 January 2015

Dr. Galey - What is a bunion?

What is a bunion?

A bunion is one problem that can develop due to hallux valgus, a deformity of the foot. The Latin meaning of “hallux valgus” is:  turning outward (valgus) of the first toe (hallux). The bone which joins the first toe, the first metatarsal, becomes prominent on the inner border of the foot. Shoe pressure on this prominence causes inflammation and pain.

Other problems can develop along with hallux valgus. The metatarsal bones can become prominent in the ball of the foot, and the lesser toe joints can become contracted. With shoe pressure, corns and calluses develop.

What is the cause?

There is no single cause of hallux valgus. High-heeled, pointed-toe shoes are not the primary cause of the deformity, but they do cause it to be painful. They cause bunions, corns, and calluses to develop where there is a deformity.

What is the treatment?

Before treatment of a painful bunion can begin, medical evaluation is needed. Osteoarthritis, rheumatoid arthritis, infection, and gout can cause pain in the first toe.

Treatment may be surgical or non-surgical. The goal of non-surgical treatment is to relieve pressure on the foot and to prevent sores and ulcers. This is accomplished by prescribing accommodative shoes, sandals, or extradepth shoes with soft molded insoles.

The goal of surgery is different. Surgery attempts to realign and balance the first toe to restore normal function. Corns on the lesser toes are treated by straightening and shortening the toes.  Arthritis in the first toe can be treated by resurfacing the joint or removing the joint and fusing the toe.


 

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 August 2014

Dr. Stephanie Galey - Ankle Arthritis

The ankle joint is susceptible to arthritis. The most common types of arthritis affecting the ankle are:

  1. Osteoarthritis, which is a degenerative joint disease.
  2. Rheumatoid arthritis, which is an inflammatory process.
  3. Post traumatic osteoarthritis, which is arthritis that may develop as a result of a prior injury or with a history of ankle instability.

The most common is osteoarthritis. It occurs when the cartilage of the bones in the joint deteriorate and as a result, the bones in the ankle joint rub together causing pain and loss of motion to occur. Rheumatoid arthritis is an autoimmune disease due to the body's immune system activity. The joint lining becomes inflamed. Rheumatoid arthritis tends to be the most serious and disabling type and it affects primarily women.

Symptoms of ankle arthritis include pain, swelling, giving way or locking sensation, stiffness and in more severe arthritic situations, deformities of the ankle can occur. X-ray is used to assess the severity of the arthritis. An x-ray study may reveal a joint space narrowing, bony cyst or spurs. It may also reveal hardening or sclerosis of the cartilage.

Treatment for arthritis depends on the severity. Prescription anti-inflammatory medication helps to reduce pain, swelling and warmth associated with arthritis. Inflammation can also be reduced with the use of injection therapy with Cortisone type medication.

If there is a problem with giving way due to ankle instability, bracing can be helpful. Bracing helps to stabilize walking activity and to prevent injury. Physical therapy may help to strengthen and improve overall ability to ambulate.

Finally, surgery is considered after failure of the above mentioned nonsurgical measures. Possible surgical options include arthroscopy for joint debridement of any bony spurs or defects and/or to remove any loose bony bodies that occur with arthritis. Ankle arthrodesis/fusion surgery is used for more severe cases of arthritis. A total ankle arthroplasty/replacement is becoming a more accepted surgical option. The possible advantage is allowing for greater range of motion compared to the ankle fusion procedure. A CT scan of the ankle may be ordered to determine the most appropriate surgical option.


 

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 February 2014

Dr. Frndak - Dental Hygiene/Joint Replacement

Whether you are considering joint replacement surgery or have already had a joint replacement, good oral hygiene is of the utmost importance. There are hundreds of different types of bacteria found in the human mouth. It is believed that there is a link between the bacteria in your mouth and one's overall health. After joint replacement surgery, infection in the mouth can seed into the blood stream and settle into the artificial joint causing a septic joint. If this occurs, the implant usually has to be removed and a "cement spacer" impregnated with antibiotics is placed into that joint. IV antibiotics are also administered for 6 weeks to eradicate the infection. After the infection has been eradicated, the joint can then be reimplanted. Once infection has occurred in an artificial joint the patient has an increased risk of repeat infection.

Joint replacement surgery is an elective surgery. Patients need to be proactive to make sure there are no dental issues before surgery and continue with routine dental appointments after surgery to minimize their risk of developing a septic joint.


 

Spotlight January 2014

Dr. Galey - Morton's Neuroma

What is Morton's Neuroma?

Morton's Neuroma is a common cause of pain in the ball of the foot. In 1876, Thomas Morton described it as a pain caused by inflammation of a nerve in the foot. The inflammation is caused by entrapment of the nerve between the metatarsal heads and most commonly occurs between the third and fourth toes. "Neuroma" means nerve tumor. Tumor in this case simply means, enlargement of the nerve, not malignancy (not cancer).

The cause of the nerve inflammation is related to nerve enlargement due to repeated injury. The nerve becomes trapped between the metatarsal heads when standing and walking. This most often occurs with wearing of high-heeled shoes or thin hard soles shoes, but can also occur in any walking or standing situations.

The symptoms of Morton's Neuroma are described as pain and numbness in a specific spot in the ball of the foot that sometimes radiates into the toes. The pain may come and go. At other times, it may be described severe enough to cause the individual to stop or take off their shoes. It may feel like a marble or a stone under the foot, moving around and sometimes causing a "snap" sensation. During the exam, the pain can often be reproduced by pressing on the foot. Nerve testing with a monofilament pin may reveal numbness in the toes.

Diagnosis may be difficult, especially at first. Examinations will be necessary to rule out other causes of foot pain. The condition tends to get worse with time. With repeated injury, the nerve becomes larger and it becomes more easily injured.

Initial treatment is to modify the shoes. An appropriately placed pad in the shoe and extra wide soft shoes will often help to relieve the pain symptoms. Cortisone injection around the nerve may help reduce swelling and inflammation. This will also help localize the problem.

Surgery to remove the Neuroma can be done when necessary. It is successful around 80% of the time. During surgery, the nerve is removed. There will be numbness in the toes and in the ball of the foot after surgery. However, the severe pain should be relieved making it possible to return to routine standing and walking activity. The residual numbness sensation is not usually a problem and it generally becomes less with time.

After surgery, if pain persists, it may be due to irritation at the cut end of the nerve, referred to as a stump Neuroma. This may require additional surgery for those who do not get pain relief.

Complications of foot surgery include post-operative swelling and bleeding that could lead to infection. An adequate period of rest and elevation after surgery is needed to prevent this complication.


 

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 August 2013

Dr. Stephanie Galey - Ankle Arthritis

The ankle joint is susceptible to arthritis. The most common types of arthritis affecting the ankle are:

  1. Osteoarthritis, which is a degenerative joint disease.
  2. Rheumatoid arthritis, which is an inflammatory process.
  3. Post traumatic osteoarthritis, which is arthritis that may develop as a result of a prior injury or with a history of ankle instability.

The most common is osteoarthritis. It occurs when the cartilage of the bones in the joint deteriorate and as a result, the bones in the ankle joint rub together causing pain and loss of motion to occur. Rheumatoid arthritis is an autoimmune disease due to the body's immune system activity. The joint lining becomes inflamed. Rheumatoid arthritis tends to be the most serious and disabling type and it affects primarily women.

Symptoms of ankle arthritis include pain, swelling, giving way or locking sensation, stiffness and in more severe arthritic situations, deformities of the ankle can occur. X-ray is used to assess the severity of the arthritis. An x-ray study may reveal a joint space narrowing, bony cyst or spurs. It may also reveal hardening or sclerosis of the cartilage.

Treatment for arthritis depends on the severity. Prescription anti-inflammatory medication helps to reduce pain, swelling and warmth associated with arthritis. Inflammation can also be reduced with the use of injection therapy with Cortisone type medication.

If there is a problem with giving way due to ankle instability, bracing can be helpful. Bracing helps to stabilize walking activity and to prevent injury. Physical therapy may help to strengthen and improve overall ability to ambulate.

Finally, surgery is considered after failure of the above mentioned nonsurgical measures. Possible surgical options include arthroscopy for joint debridement of any bony spurs or defects and/or to remove any loose bony bodies that occur with arthritis. Ankle arthrodesis/fusion surgery is used for more severe cases of arthritis. A total ankle arthroplasty/replacement is becoming a more accepted surgical option. The possible advantage is allowing for greater range of motion compared to the ankle fusion procedure. A CT scan of the ankle may be ordered to determine the most appropriate surgical option.


 

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 April 2013

Dr. Philip A Frndak - Patellofemoral Arthritis

The patella, commonly known as the knee cap, runs in the groove on the top of the femur. The patella connects the muscles in the front of your thigh (quadriceps muscles) to your tibia. The under surface of the patella is covered with articular cartilage. When this cartilage wears down, it exposes bone causing inflammation and painful movement located in the front of the knee. Sometimes people will notice crepitus or cracking in the front of the knee. Activities that are most likely to cause pain in people who have patellofemoral arthritis include squatting, kneeling, climbing stairs or getting up from a low position.

Strengthening the quadriceps muscles is beneficial for people who suffer from patellofemoral arthritis. Low impact activities such as walking or swimming are recommended. Weight loss always helps to decrease inflammation and manage pain. Patients should always check with their primary care physicians to make sure NSAIDS are appropriate for them. Injection therapy into the knees with cortisone or hyaluronic acid can also help manage symptoms.


 

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 November 2012

Dr. Frndak - Hyaluronic Acid Joint Injection "The Chicken Shot"

Hyaluronic Acid Joint Injection "The Chicken Shot"

Getting hyaluronic acid joint injections is one treatment that may ease the pain and stiffness of knee osteoarthritis. Hyaluronic acid injections are quick and relatively painless. They have been on the market for more than a decade. Studies of effectiveness show mixed results.

Hyaluronan occurs naturally in the synovial fluid that surrounds all joints. Hyaluronan is a thick liquid that helps lubricate joints, making them work smoothly.

In people with osteoarthritis, the consistency of Hyaluronan becomes thinner. The idea behind hyaluronic acid joint injection is to replace the natural supply that has been lost.

There are a variety of brands of hyaluronan including Euflexxa, Hyalgan, Orthovisc, Supartz and Synvisc.

The procedure is an injection into the capsule surrounding the knee joint. The typical course is one injection a week for 3 to 5 weeks. It has only been FDA approved for the knee joint. As mentioned, the effectiveness varies. Pain relief can last up to 6 months. It has been more beneficial in some people than others. People who have more advanced osteoarthritis may be less likely to see improvement.


 

Spotlight October 2012

Dr. Galey - What is a bunion?

What is a bunion?

A bunion is one problem that can develop due to hallux valgus, a deformity of the foot. The Latin meaning of “hallux valgus” is:  turning outward (valgus) of the first toe (hallux). The bone which joins the first toe, the first metatarsal, becomes prominent on the inner border of the foot. Shoe pressure on this prominence causes inflammation and pain.

Other problems can develop along with hallux valgus. The metatarsal bones can become prominent in the ball of the foot, and the lesser toe joints can become contracted. With shoe pressure, corns and calluses develop.

What is the cause?

There is no single cause of hallux valgus. High-heeled, pointed-toe shoes are not the primary cause of the deformity, but they do cause it to be painful. They cause bunions, corns, and calluses to develop where there is a deformity.

What is the treatment?

Before treatment of a painful bunion can begin, medical evaluation is needed. Osteoarthritis, rheumatoid arthritis, infection, and gout can cause pain in the first toe.

Treatment may be surgical or non-surgical. The goal of non-surgical treatment is to relieve pressure on the foot and to prevent sores and ulcers. This is accomplished by prescribing accommodative shoes, sandals, or extradepth shoes with soft molded insoles.

The goal of surgery is different. Surgery attempts to realign and balance the first toe to restore normal function. Corns on the lesser toes are treated by straightening and shortening the toes.  Arthritis in the first toe can be treated by resurfacing the joint or removing the joint and fusing the toe.


 

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 May 2012

Dr. Galey - An ounce of prevention is better than a pound of cure

An ounce of prevention is better than a pound of cure

Ulceration, infection and gangrene are the most common foot and ankle problems that the patient with diabetes faces. As a result, thousands of diabetic patients yearly require amputations.

There are two major causes of foot problems in diabetes:

  • Nerve damage (neuropathy): This causes loss of feeling in the foot, which normally protects the foot from injury. However: GOOD FOOT CARE MAY OFTEN PREVENT ULCERS AND INFECTIONS.
  • Loss of circulation (ischemia): If circulation is poor, gangrene and amputation may be unavoidable. However: GOOD FOOT CARE MAY OFTEN DELAY THE NEED FOR AMPUTATION.

DO THIS TO PROTECT YOUR FEET

  • Examine your feet daily: use your eyes and your hands, have a family member help, if necessary and don’t forget to check between toes.
  • Examine your shoes daily: using your hands, check the insides of your shoes feeling for irregularties or foreign objects.
  • Daily washing and foot care: Avoid water that is too hot or too cold – use lukewarm water, dry the feet after washing, especially between the toes.
  • Fitting shoes and socks: Shoes and socks should not be too tight, the toe box should have extra room and be made of soft upper material that can “breathe”.
  • Medical care: Ask your physician to check your feet and shoes at every visit and contact your physician if you observe any of the above danger signs.

DO NOT DO THESE DANGEROUS ACTS

  • Do not walk barefoot.
  • Do not use heat on the feet – heat can cause a serious burn, especially if sensation is abnormal.
  • Do not use chemicals or sharp instruments to trim calluses – this can cause blisters that may become infected.
  • Do not cut nails into the corners.
  • Do not smoke – smoking prevents oxygen from getting to your feet.

 

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 January 2012

Dr. Philip A Frndak - RHEUMATOID ARTHRITIS (RA)

Unlike osteoarthritis, rheumatoid arthritis (RA) is an autoimmune disease. An autoimmune disease is when the body’s defense system malfunctions and begins to attack itself.

Typically RA affects smaller joints first such as the ones in your hands and feet. Eventually it can progress to other joints. RA is more common in women than men and can start developing as early as age 20. Symptoms of RA include pain and swelling in and around joints as well as tenderness to touch, redness, and morning stiffness. Unlike osteoarthritis, RA can affect other parts of the body beyond joints. Firm bumps under the skin called rheumatoid nodules occur in 20% - 30% of RA patients. Other parts of the body that can be affected by RA are the lungs, eyes, and blood vessels.

Unfortunately there is not a cure for RA. Treatment goals are to relieve its symptoms and slow or prevent joint damage. This includes anti-inflammatory pain relievers like NSAID, a healthy diet, exercise and injection therapy. Speak to your doctor to see the best treatment options for your condition.


 

Spotlight December 2011

DR. Galey - Painful Heel Syndrome

The painful heel is a common complaint in both the non-athlete and the athlete. The painful heel syndrome (PHS) is also known as plantar fascitis or a heel spur. While the PHS does not produce severe or disabling pain, it is aggravating enough to limit or curb any walking, standing or running activities.

Many myths exist concerning the cause of PHS. It is still widely held by many physicians, and certainly the lay public, that this is secondary to a heel spur. Plantar heel spurs exist in patients with PHS at approximately a 50% rate and in the normal population without a history of heel pain at a 25% rate. Pain can be present with or without a spur and statistics alone refute spurs as the inciting cause of pain. A plantar heel spur probably represents evidence of a previous injury or a normal response of the calcaneus (heel bone) to traction from the plantar fascia (the tough tissue that supports the arch).

Often the pain is secondary to overuse or stress to the region of the attachment of the plantar fascia to the heel bone. This leads to chronic inflammation and irritation of tissues in the area. Commonly, PHS is associated with a tight Achilles tendon and plantar fascia. This tightness sets up a re-injury phenomenon which prolongs the duration of the patient’s symptoms.

An aggressive stretching program of the heel cord and calf often relieves stress on the plantar fascia and rehabilitates the tight and irritated tissue over time. If the pain persists further evaluation or treatment may be required.


 

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.


 

Spotlight August 2011

Dr. Philip A. Frndak - Osteoarthritis (OA)

Osteoarthritis (OA) is the most common form of arthritis in the United States. Approximately 27 million adults have reported being diagnosed with OA by their doctor. The cause of OA is unknown. It occurs when cartilage in a joint breaks down over time. It is often called “wear and tear” arthritis. OA is commonly found in knees, hips, hands and the spine, although it can occur in any joint.

The most noticeable symptom of OA is a feeling of pain in or around the joint. People also notice tenderness, stiffness, loss of motion and a grinding sensation in the joint.

While there is no way to reverse the cartilage loss of OA, there are many ways to treat the pain. These can include lifestyle changes such as weight loss. Also medications in the form of nonsteroidal anti-inflammatories could help. Your doctor may recommend injections, braces or physical therapy. You should always talk to your doctor to determine the best option for you.


 

Spotlight July 2011

Dr. Galey - What is a bunion?

What is a bunion?

A bunion is one problem that can develop due to hallux valgus, a deformity of the foot. The Latin meaning of “hallux valgus” is: turning outward (valgus) of the first toe (hallux). The bone which joins the first toe, the first metatarsal, becomes prominent on the inner border of the foot. Shoe pressure on this prominence causes inflammation and pain.

Other problems can develop along with hallux valgus. The metatarsal bones can become prominent in the ball of the foot, and the lesser toe joints can become contracted. With shoe pressure, corns and calluses develop.

What is the cause?

There is no single cause of hallux valgus. High-heeled, pointed-toe shoes are not the primary cause of the deformity, but they do cause it to be painful. They cause bunions, corns, and calluses to develop where there is a deformity.

What is the treatment?

Before treatment of a painful bunion can begin, medical evaluation is needed. Osteoarthritis, rheumatoid arthritis, infection, and gout can cause pain in the first toe.

Treatment may be surgical or non-surgical. The goal of non-surgical treatment is to relieve pressure on the foot and to prevent sores and ulcers. This is accomplished by prescribing accommodative shoes, sandals, or extradepth shoes with soft molded insoles.

The goal of surgery is different. Surgery attempts to realign and balance the first toe to restore normal function. Corns on the lesser toes are treated by straightening and shortening the toes. Arthritis in the first toe can be treated by resurfacing the joint or removing the joint and fusing the toe.

Spotlight for June & July 2015
What is ICD-10 and how will it
impact YOU our patients?
Dr.James Macielak
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