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General Office Questions
Orthopaedic/Health Questions
Golf Related Questions
Q. How can I reach my physician? Q. How do I get my prescription medication refilled? Q. Do your offices have parking available? Q. How do I go about scheduling surgery? Q. What are the various types of arthritis affecting an individual?
Q. Why are epidural steroids used? In general, this is a relatively benign procedure with a low instance of problems. Potential problems include injury to the neural elements, infection, and unfavorable reaction to the various medications used. There is no necessity for using epidural blocks. The purpose in using them is to decrease the patient's pain. If your pain is severe enough and all other methods have been exhausted, such as activity restriction and anti-inflammatory medications, this is a reasonable alternative. Epidural steroids are known to give temporary, not permanent, relief. Headache is by far the most common side effect that occurs in about one in twenty patients. Q. What is a Morton's neuroma and how is it treated? The nerves of the foot run into the forefoot and out to the toes between the metatarsal bones of the feet. When the nerves reach the ends of the metatarsal bones, they split and continue to the ends of the toes. Each nerve is split and supplies feeling to half of two different toes. A Morton's neuroma occurs just before the nerve splits into two branches. The cause of a neuroma formation is not entirely understood, but probably results from chronic injury to the nerve in this area. Diagnosis is usually made on history and physical examination alone. X-rays are only useful to be sure that the pain is not coming from another area. In some confusing cases, injection of Xylocaine and Cortisone into the area may help decide if the diagnosis of a Morton's neuroma is correct. This treatment should result in a temporary reduction of symptoms. Treatment of Morton's neuroma usually begins with shoe wear adaptation. Sometimes simply changing to a wider shoe or using a special insert will reduce or limit symptoms. An injection of Xylocaine and Cortisone into the area may help temporarily. If this fails to resolve pain, surgery may be recommended. Surgery involves removal of the neuroma. Since the neuroma is part of the nerve, the nerve is removed as well. This results in permanent numbness in the area supplied by the nerve. To remove the neuroma surgically, a small 2-inch incision is made in the skin between the two toes that are affected by the neuroma. The neuroma is located and removed by cutting the nerve. The skin incision is repaired with sutures and a dressing is applied. The incision must be kept dry for several days following surgery. The foot will remain tender for several days, but the patient is usually able to immediately walk without a cane or crutches. Q. What is spinal stenosis? The usual treatment is activity modification, anti-inflammatory medication and pain medication. Since the pain is intractable, epidural steroids are frequently used. If necessary, surgery may then be performed. Surgical treatment involves making the spinal canal larger by removing the bony elements that compress the nerve. Recovery depends upon the extent of the procedure and the patient's pre-operative status. If a patient does not have a cardiovascular condition, recovery is relatively brief. Typically, hospitalization for a decompression fusion procedure would be 4 to 5 days. The patient is independent for self-care but has limited endurance at the time of discharge. Q. What is a meniscal tear and how is it treated? The meniscus acts like a gasket between the femur and the tibia to spread out the weight being transferred from the femur above to the tibia below. The articular cartilage is a tough, very thick material that allows the surface to slide against one another without damage to either surface. The ability of the meniscus to spread out the force on the joint surface as we walk is important because it protects the articular cartilage from excessive force occurring in any one area of the joint surface. Without the meniscus, the concentration of force into a small area of the articular cartilage can damage the surface, leading to degeneration over time. Remember also that the meniscus helps the stability of the knee joint. The meniscus converts the tibial surface into a shallow socket. The meniscus can be torn in several ways. The entire inner rim of the medial meniscus can be torn in what is called a "bucket-handle tear." The meniscus can also have a flap torn from the inner rim, or a tear can be degenerative when a portion of the meniscus is frayed and torn in multiple directions. Degenerative tears of the meniscus are commonly seen as part of the overall condition of osteoarthritis in the older population. In many cases, there was no injury associated to the knee that leads to meniscal tear. The most common problem caused by torn meniscus is pain. Pain may be felt along the joint line where the meniscus is located or may be more vague and may involve the whole knee. If the torn portion of the meniscus is large enough, locking may occur. Locking refers to the inability to completely straighten out the knee. Locking occurs when the fragment of torn meniscus becomes caught in the hinge mechanism of the knee and will not allow the leg to straighten out completely. There are long term effects of a torn meniscus as well. The constant rubbing of the torn meniscus on the articular cartilage may cause wear and tear on the surface, leading to degeneration of the joint. The knee may swell and become stiff and tight. This is usually because of fluid accumulated inside the knee joint, sometimes called "water on the knee". This is not unique to meniscus tears but occurs whenever the knee becomes inflamed. Diagnosis begins with a history and physical. The examination will determine where the pain is located, whether or not popping has occurred, and if there is any clicking or popping when the knee is moved. X-rays will not show a torn meniscus but are instead used to determine if other conditions are present. MRI scanning is very good at showing the meniscus. MRI does not require any needles or special dye and is painless. If there is uncertainty in the diagnosis following the history and physical exam, or if an other injury in addition to meniscal tear is suspected, the MRI scan may be necessary. If the history and physical examination strongly suggest that a torn meniscus is present, knee arthroscopy may be required to confirm the diagnosis and treat the problem. Initial treatment for a torn meniscus is usually directed towards reducing pain and swelling in the knee. The physician may recommend crutches for resting the knee for several days, and ice to reduce swelling. If the knee is locking and cannot be straightened out, surgery may be recommended as soon as possible to remove the torn portion of the cartilage. When the meniscus is torn, it most likely will not heal on its own. In some cases a meniscal tear can be repaired. The arthroscope is used to view the torn meniscus. Sutures are placed into the torn meniscus until the tear is repaired. Repair of the meniscus is not possible in all cases. Young people with relatively recent meniscal tears are most likely candidates for repair. Degenerative tears in the older population are usually not repairable. Q. What is an MRI? Q. What is continuous passive motion (CPM)? In most patients after extensive surgery, attempts at joint motion cause pain. As a result, the patient fails to move the joint. This causes the tissue around the joint to become stiff and allows scar tissue to form, resulting in a joint with limited range of motion. Often it may take months of physical therapy to recover the motion. Passive range of motion means that the joint is moved without the patient's muscle being used. CPM devices are machines that have been developed for patients to use after surgery. Applied post-operatively, this device may be used on an in-patient or out-patient basis. By using the motorized device to very gradually move the joint, it is possible to significantly accelerate recovery time by decreasing joint tissue stiffness and increasing range of motion. This allows for a healing of the joint surfaces and tissue and preventing development of motion limiting adhesions, also known as scar tissue. Interestingly, this is accomplished without patient effort, passively, as the machine moves a defined (described) range of motion for an extended period of time. Even more surprisingly, studies have shown that patients who use CPM devices require less pain medication than patients who have had the same type of surgery and are not using the device. There are CPM devices for the knee, ankle, shoulder, elbow, wrist and hand. Q. What is an ACL and how are these injuries treated? One of the common ways for the ACL to be injured is by a direct blow on the knee which commonly happens in football or skiing. In this case the knee is forced into an abnormal position that results in tear of one or more of the ligaments of the knee. However, most ACL tears actually happen without contact between the knee and another object. Such non-contact injuries happen when the athlete is planting the foot and cutting in a new direction, landing on a straight leg or making an abrupt stop. These injuries are common in basketball, football, volleyball and soccer. In many cases when the ACL is torn, the knee gives way and an audible pop is heard. The injury is usually associated with a moderate amount of pain and continued activity is usually not possible. Over the next several hours, the knee becomes very swollen and walking becomes difficult. The swelling and pain are usually worst for the first two days, then begin to subside. When visiting your physicians for a diagnosis, evaluation with an MRI or arthroscope may be necessary to completely evaluate the injury. The most frequently asked question after an ACL injury is, "Will I need surgery?" The answer varies from person to person. Many factors must be considered by the patient and the physician to determine the appropriate treatments. These factors include the activity level and expectations of the patient, whether there are any associated injuries, and the amount of abnormal knee laxity, or looseness. A young patient who wants to return to competitive sport and has a very unstable knee upon examination is more likely to need surgery for a satisfactory outcome than an older patient who wants to return to recreational jogging and has only a mild laxity. If surgery is not indicated, rehabilitation may begin with exercise to help restore full range of motion. This is followed by strengthening exercises for the muscles of the knee. A return to sports, with or without a brace, is allowed only after leg strength, balance and coordination have returned to normal. Many different surgical approaches have been tried for the ACL injured knee. Years of experience have shown that simply stitching the ligaments together is unsuccessful. Therefore, current techniques involve reconstruction of the ACL by building a new ligament out of tissue harvested from another tendon around the knee or from a cadaver. The tissue is passed through drill holes in the thigh bone and shin bone and anchored in place to create a new ACL. Over time, a new ACL regains blood supply and becomes a living ligament anchored to the bone at each end. Rehabilitation of the knee after ACL ligament reconstruction requires time and hard work. Time off from work depends on the type of job. Individuals who work desk jobs are able to return in one to two weeks. A construction worker is usually not able to return to the job for six months. The same is true for athletes, with returning to golf occurring more rapidly than returning to football. The overall success for ACL surgery is very good. Many studies have shown that over 90% of patients are able to return to sports and work place activities without symptoms of knee instability. Although some patient complain of stiffness and pain after surgery, these problems have been minimized by current surgical techniques and aggressive rehabilitation. Q. Is it true that ganglion cysts can be removed arthroscopically? Although the cause of these cysts remains obscure, they are the most common benign hand mass and more common in women than in men. These cysts become uncomfortable as they can cause compression of the adjacent structures and are cosmetically objectionable. Ganglion cysts are raised masses commonly seen on the dorsum of the wrist. They range in size from 1 to 4 cm. Aspiration and manual compression of the cyst is associated with an unacceptably high rate of recurrence. Traditional treatment to remove these cysts involves an open incision on the patient's wrist and removal of the cyst at the site of its attachment to the wrist joint. This approach is associated with a large incision, a two week period of immobilization, and a small but significant rate of recurrence. By arthroscopically removing the cyst, these drawbacks are minimized. Use of this method allows for a 2 to 3 mm incision, rather than the much larger incision necessitated by the more traditional approach. The electrothermal destruction of the cyst virtually eliminates the chance of recurrence. Your surgeon, however, will decide if your degree of pain and loss of use is severe enough to warrant the operation. Q. What are the most common golf injuries? Back injuries primarily affecting the lumbar spine are the most common golfing injury. The mechanism is related to the golf swing with the associated large shear, lateral bending, torsional and compression modes affecting the lumbar spine. On average, the professional golfer generates significantly lower peak lumbar spinal nodes, while achieving better results compared to the amateur. Professional injuries are related to the hours spent on the practice tee, honing their skills, while the amateurs are susceptible to injury due to their lack of conditioning and poor swing mechanics. The elbow injuries involve the medial and lateral epicondyles. Lateral epicondylitis is traditionally known as tennis elbow, while medial epicondylitis is related to golfing. Injury in the golfing population presents with lateral epicondylitis five times more often than medial epicondylitis. It almost exclusively occurs in the left elbow, due to the propensity of right-handed golfers, and is due to the pulling action of the left arm. Golfer's elbow is usually due to striking the ground and the associated forces. The shoulder injuries are primarily related to the rotator cuff and repetitive overuse syndrome. Special attention must be given to rotator cuff conditioning to avoid developing this problem. Learn how to help prevent golf injuries. Q. I recently had a total knee replacement (TKR). How long will it be before I'm back on the links? Most of these surgeons believe that the patient should not start playing for about three months after surgery when using any assistive devices, such as crutches or a cane. After that time, they can begin chipping and putting, and slowly progress to a full swing.  Top
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