Mystery Solved!

Transcription

Mystery Solved!

t all )
ien , c 63
at ts (26
r p en E
Fo intm ON
po -B
ap 277
370
Spring 2015
Mystery
Solved!
Diagnosing and Treating
Unusual Knee Conditions
see page 20
Alexandria • ANNANDALE • Arlington • Burke • FAIR OAKS • Fairfax • Herndon • Reston • Springfield • Tysons Corner
President’s Message
Corporate Office
11240 Waples Mill Rd., Ste. 403
Fairfax,VA 22030
(703) 810-5200 • (703) 383-6465 fax
www.orthovirginia.com
Office Locations
Alexandria
Annandale
Arlington
Burke
Fairfax
Fair Oaks
Herndon
Reston
Springfield
Tysons Corner
President
Ben Kittredge, MD
Chief Executive Officer
William L. Harvey
Chief Operating Officer
Maureen M. Ruddy
Chief Financial Officer
Richard T. Givens
Director of Physical Therapy
Jo-Anne Burton, DPT
Undoubtedly, you’ve noticed something different on the cover
of this magazine – our new name: OrthoVirginia. The change
is the result of a merger with Richmond-based OrthoVirginia
in January. The merger creates the largest orthopaedic specialty
group practice in the state, with more than 80 physicians, 21
office locations, and multiple physical therapy clinics and surgery
centers. All of us at OrthoVirginia are pleased to be working with
our peers in Richmond to expand orthopaedic care to patients
throughout Virginia.
You can read more about the merger in this issue of the magazine, as well as meet some
of our satisfied patients: a high school football player who came to us with mysterious
knee pain; a devoted triathlete who returned to ironman competition following complex
cervical spine reconstruction; and a young mother who is also on the triathlon circuit after
intricate surgery to repair a severely broken humerus.
Commonwealth Orthopaedics may have a new name, but we have the same commitment:
to provide your patients with personalized, high quality orthopaedic care so they can
get back to their lives. Thank you for your continued support as we work to strengthen
orthopaedic services throughout the region. We appreciate the opportunity to serve you
and look forward to a bright future together.
Sincerely,
Ben Kittredge, MD
President, OrthoVirginia
Contents
Directors of Marketing
Suzanne M. Kelly
Deborah R. Martin
Commonwealth Orthopaedics is now OrthoVirginia.........4
Living the Ironman Lifestyle.......................................................6
Editorial Mission: OrthoVirginia Commonwealth Orthopaedics magazine is an
educational and informative resource for
physicians, health care professionals, employer groups, and the general public. This
publication provides a forum for communicating news and trends involving orthopaedic-related diseases, injuries, and treatments,
as well as other health-related topics of interest.
Identifying and Preventing Adolescent Overuse Injuries.....8
Back on His Feet....................................................................... 10
Endoscopic Surgery Offers Less Invasive
Option for Carpal Tunnel Patients........................................ 12
Employee Spotlight: Community Ambassador.................... 13
A Walk in the Park.................................................................... 14
On the cover:
OrthoVirginia
Commonwealth
Orthopaedics magazine Medical
is designed and
published by
Custom Medical Design Group, Inc.
To adver tise in an upcoming issue
please contact: 800.246.1637 or
CustomMedicalMagazine.com
This publication may not be reproduced
in par t or whole without the express
written consent of Custom Medical
Design Group, Inc
Read how student athlete,
Sean, was diagnosed with
Arthroscopic Surgery for
Hip Impingement in Young Adults ......................................... 16
A Viable Option: Reverse Shoulder Replacement.............. 17
an unusual knee condition
Conquering New Horizons.................................................... 18
called Osteochondroma.
Mystery Solved!......................................................................... 20
After successful surgery, he
is back to competing in the
Minimally Invasive Spine Surgery
Promotes Rapid Recovery...................................................... 22
Discus Throw at his high
Treatment Options for Rotator Cuff Tears......................... 24
school.
New Hand Surgeon Joins OrthoVirginia............................. 25
See story page 20.
Physical Therapy Program
Addresses Women's Health Needs....................................... 26
A New Name: The Same Commitment
Commonwealth Orthopaedics
is now OrthoVirginia
I
n January, Commonwealth Orthopaedics and OrthoVirginia
merged their practices to create the largest orthopaedic specialty group in Virginia. Commonwealth is now known as
OrthoVirginia.
Q: Why did the two organizations decide to merge?
The merger positions both organizations to be successful in today’s volatile and rapidly changing healthcare environment.
We share a common mission and vision: to provide comprehensive, high quality, cost-effective care to patients, and promote
medical excellence in the community. The merger supports these
core values, as well as the business strategy of both organizations
to protect the private practice of orthopaedic medicine in Virginia.
Q: How does the merger benefit patients?
By joining forces, we’ve expanded the delivery of orthopaedic care
to patients throughout Virginia. Individuals and families have access to a larger and stronger network of high quality orthopedic
surgeons and specialists, as well as a broader array of services and
office sites. The new practice has more than 80 physicians,
21 office locations, an MRI facility, and multiple therapy
clinics and outpatient surgery centers.
As healthcare continues to evolve, larger medical
groups will be better able to invest in state-of-the-art technology. As a result, our
January 1, 2015
4 OrthoVirginia | www.orthovirginia.com
patients will benefit from the latest clinical and administrative
tools to enhance care and communication.
The merger enables us to remain an independent practice,
which means physicians are in control of our patients’ medical care, not a corporation. In addition, we can share knowledge and best practices to improve quality, cost, safety and
outcomes.
Q: What is different?
Only the new name: OrthoVirginia. Otherwise, it is business
as usual for both organizations. Day-to-day operations continue in our offices, physical therapy clinics and outpatient
surgery centers.
OrthoVirginia Central:
100% Employee-Owned
Five Decades of
Excellence
OrthoVirginia Central is a 45-physician orthopedic specialty group practice serving patients in Richmond and
central Virginia. When it first opened its doors back in the
early 1960s, it consisted of three surgeons, one location and
a different name: West End Orthopaedic Clinic. Since then,
it’s grown to include the full range of orthopaedic surgical
specialties and subspecialties, 11 offices, seven hand and
physical therapy centers, an MRI center and two outpatient
surgery centers. To reflect its size and scope, the practice
changed its name to OrthoVirginia in 2011.
Visit orthovirginia.com to learn more about the merger.
Are you prepared
for a cyber breach?
Do you have enough
coverage if the Federal
Government ran an
audit on your medicare
billing or found a
HIPAA violation?
Are you receiving the
attention you deserve?
Purchasing the right malpractice
insurance for your practice can be
a pain, but it doesn’t have to be.
We have your back.
LAMBERT, RIDDLE
SCHIMMEL & COMPANY
(Established 1917)
Serving the Business and Personal Insurance
Needs of Northern Virginia for Over 90 Years
Thomas P. Schimmel, C.P.C.U. & James D. Riddle
Partners
(703) 691-1300
3931 UNIVERSITY DRIVE • FAIRFAX, VIRGINIA 22030
[email protected] • [email protected]
800-318-9930
Connect With Us!
profRISK.com
About Professional Risk
Professional Risk helps practices manage their bottomline when it comes to purchasing and maintaining their
medical professional liability insurance, and assists with
improving the quality of their outcomes through strong
patient safety services. We are an ESOP corporation,
providing a level of owner accountability that
constantly renews our commitment to our clients.
OrthoVirginia | www.orthovirginia.com 5
After successful cervical spine
reconstruction, Stephen has
returned to competing in
Ironman triathlons.
Living the Ironman Lifestyle
Cervical Spine Reconstruction Returns
Triathlete to Competition
B
y the time he was 30, Stephen was a spine surgery veteran.
It began in college when he was diagnosed with arteriovenous malformation, an abnormal tangle of blood vessels
in his spinal cord. To remove the tumor, neurosurgeons had to cut
open the back of his neck and take out part of his cervical spine.
The resulting pressure reversed the curvature of Stephen’s neck, a
condition known as cervical kyphosis. Despite a second surgery
to relieve his symptoms, the degeneration and kyphosis worsened.
Stephen stayed active as long as he could. He even participated in
his first triathlon. But neck pain radiating down his arms made
competition difficult. A few years earlier, Stephen’s father had undergone successful cervical spine fusion with Thomas Mazahery,
MD, an OrthoVirginia surgeon specially trained in cervical spine
techniques. “My dad was very happy with the outcome, so I decided to see Dr. Mazahery for my issues as well,” Stephen says.
Dr. Mazahery recommended revision reconstruction spine surgery to take pressure off the nerves and relieve Stephen’s arm pain.
During the procedure, he removed the previous instrumentation,
as well as the affected discs and bone spurs, and fused the curvature at those levels. Scar tissue and hardware from earlier surgeries
made the procedure challenging.
Dr. Mazahery routinely performs revision cases such as Stephen’s,
as well as more complex cervical spine reconstructions that involve
corpectomies to remove full vertebrae from the neck and correct deformities. Many of these cases include intricate front-back
combined reconstructive procedures. Dr. Mazahery is fellowshiptrained in these advanced techniques, having studied under the
tutelage of acclaimed spine surgery pioneer Henry Bohlman, MD. “Candidates for complex spine reconstruction procedures include
patients with severe deformity or major compression of the spinal
cord,” Dr. Mazahery says. “A surgeon who has expertise in methods including minimally invasive surgery, disc replacement and
major reconstruction is the best person to determine the most appropriate surgical option for each patient.”
When Stephen woke up from his procedure, he felt instant relief.
His pain was gone and he was able to walk down the hospital hall
that evening. With his neck now fully fused from C3 to C7, he set
about training for his first half ironman, known as Ironman 70.3.
Within 10 months of his procedure, he completed not only the
half ironman in Raleigh, but also a full ironman in Maryland.
“Ironman Maryland was such a huge thing for me; it gave me so
much joy,” he says. “As I got closer and closer, I had no back or
neck issues. It was the most pain free I’d been in 15 years.” He
credits Dr. Mazahery’s skill, as well as his understanding of his
capabilities as an emerging athlete, for such a successful recovery.
Stephen was highly motivated in his rehabilitation and other patients may not experience such a dramatic result. “Because of its
intricacy, complex spinal reconstruction often requires a longer
recovery time than other spinal surgeries,” says Tushar Patel, MD,
an OrthoVirginia spine specialist. “It can easily take patients six
months or more for maximal recovery. Specific return to work and
activities and athletics varies by patient and the type of procedure
performed.”
Ironman triathlons are no longer a hobby for Stephen, they are a
lifestyle. He and his wife train together and plan to participate in
multiple races later this year, including the Timberman in New
Hampshire and Ironman Maryland, where Stephen will try for a
personal record. “For me, it’s all about taking full advantage of
what I’m able to do physically and maximizing my opportunities,”
he says. “I’m always striving for a better number and a faster time.”
B. Thomas Mazahery, MD, received a BA in Biology
from the University of Virginia and earned his
medical degree from the Medical College of Virginia.
He then completed a general surgery internship and
an orthopaedic surgery residency at Northwestern
University. Additionally, Dr. Mazahery completed a
spine fellowship at Case Western Reserve University.
Tushar Ch. Patel, MD, earned his medical degree
from the University of Pennsylvania in Philadelphia
and completed his orthopaedic surgery residency at
George Washington University Medical Center. He
then went on to do a fellowship in Spinal Surgery
at the Cleveland Clinic Foundation in Cleveland,
Ohio.
For full biographies and a complete directory of the physicians at
OrthoVirginia who perform these and other procedures visit our
website at orthovirginia.com.
Identifying and Preventing
Adolescent Overuse Injuries
A Growing Epidemic
O
veruse injuries are a rapidly growing concern among
young athletes. The rate of injury is increasing while
the average age of children affected is decreasing.
According to the Centers for Disease Control and Prevention,
more than 3.5 million children under the age of 14 are treated
for sports-related overuse injuries each year, and that number
is climbing.
Even the definition of the term ‘overuse’ has evolved, says
COL(R) Kathleen McHale, MD, OrthoVirginia’s dedicated pediatric orthopaedic surgeon. “It used to mean using a body part
too much and wearing it out. Now the body part is being used
to an extent where humans never used it. Overuse refers to time
spent doing an activity and the intensity of that activity. Kids
are playing the same sport too aggressively for too many hours
for too many months out of the year.”
This intense focus, coupled with high competitive expectations
from parents, coaches and peers, puts extra pressure on children to perform outside their comfort zone. It raises the likelihood of injury and can lead to burnout, often discouraging
future sports participation.
Common Overuse Injuries
Stressing a child’s premature bones, tendons and ligaments can
produce short- and long-term injury, affecting athletic performance and possibly impairing growth. Some of the most common overuse injuries affect the following:
Shoulders. Baseball and softball players are susceptible to Little
League shoulder (proximal humeral epiphysitis) – an injury to
the growth plate at the shoulder that can result from pitching
and throwing too much. Swimmers, and tennis and volleyball
players, can develop rotator cuff tendinitis and impingement,
even at very young ages.
Elbows. Repetitive throwing and swinging motions make baseball players prone to Little League elbow (medial epicondoylitis) – a traction injury to part of the elbow growth plate at the
origin of the flexor muscles of the wrist. In adolescents 13 to 17,
osteochondritis dissecans, a localized injury to the bone at the
joint line, can result from recurring compression. Older stu-
Spotting an Overuse Injury
Watch for these symptoms to identify, and help prevent, an overuse
injury:
Stage 1: Pain after activity; no functional impairment
Stage 2: Pain during and after activity; minimal functional
impairment
Stage 3: Pain during and after activity that persists throughout the
day; significant functional impairment
Stage 4: Significant functional impairment with all daily activities
How Much is Too Much?
The American Academy of Pediatrics Council on Sports Medicine and Fitness recommends that children play only
one sporting activity a maximum of five days a week, with a minimum of one day off per week. Giving children
an additional two to three months off per year from a particular sport will allow the body to heal and recharge the
mind. The council also recommends playing multiple sports, especially before puberty. Children who do so have
fewer injuries and continue to play longer and at higher levels than children who specialize.
dent athletes can sustain sprains or tears to the ulnar collateral ligament, which is a problem at the collegiate and professional levels.
Hips. Dr. McHale sees an increasing number of young children,
especially girls, with hip pain and labral tears. “This is most common in sports with repetitive, high intensity hip movements,
such as track and gymnastics,” she says. In addition, snapping hip
syndrome can occur after too much flexion and extension in any
single sport.
Knees. Patellar tendinitis (also known as jumper’s knee) arises
from inflammation of the patellar tendon that connects the kneecap to the shinbone.
Ankles. Dr. McHale notes a huge rise in heel pain and ankle tendinitis among gymnasts and ballet dancers. “Many of these children
are too young to be going en pointe, or they are en pointe too
much, and they develop inflammation in the Achilles tendon,” she
says.
Prevention Tips
Taking the necessary precautions will not only keep young athletes healthy, but also increase their performance and enjoyment
for years to come. Here are some ways parents, coaches and players can work together to prevent overuse injuries:
Set realistic expectations. Activities should be fun, with an emphasis on teamwork and sportsmanship.
Teach the proper technique. “Poor body mechanics and improper
technique are two primary causes of overuse injuries,” Dr. McHale
says. “It puts unsafe pressure on the tendons, bones and joints.
When you add repetition, you increase the risk of injury.”
Train gradually. Take it slow, especially when beginning a sport.
Doing too much too soon, failing to stretch properly or trying to
advance without building strength can lead to trouble.
Take a rest! Allow the body adequate time to recover after a workout and between workouts. (See sidebar, below).
Reduce excessive training. Decrease the intensity, duration and
frequency of practice.
Cross train. Competing in several different sports throughout the
year can prevent sport-specific repetitive stress injuries. “Children
are playing three to four seasons of the same sport because parents and coaches believe that’s the only way to become proficient
at something,” Dr. McHale says. “But trying out other things is a
good idea, both mentally and physically.”
Let injuries heal. It used to be easier to sideline young athletes to
let injuries heal. Now they face pressure to perform year-round.
Separate pain from discomfort. Nerve endings are there for a
purpose: to differentiate between an uncomfortable feeling and
actual pain. Playing through real pain may lead to further injury
while playing through discomfort can build mental and physical
strength.
Stop, Look and Listen
If you suspect your child has an injury, have it assessed by a healthcare professional. Above all, listen to your children and support
them if they complain of pain and want some down time. Dr.
McHale routinely offers this advice directly to her young patients:
“I tell them ‘You are the best judge of how you feel. If something
hurts, and you can’t play, don’t play. You are not letting anybody
down.’ Even children as young as seven or eight get it. We just need
to make sure we pay attention to what they say.”
COL(R) Kathleen A. McHale, MD, MSEd, brings
more than 30 years of experience as a pediatric
orthopaedic specialist and medical educator to
OrthoVirginia. After earning a BS in Biology from
Villanova University and a medical degree from
Drexel University of Medicine, she completed a
surgical internship and first year residency at
Georgetown University, followed by an Orthopaedic residency at
George Washington University. She went on a fellowship in Pediatric
Orthopaedics at Children’s Hospital National Medical Center in
Washington, DC.
Back on His Feet
I
t began as a fun game of basketball with friends. It ended with
Dayquel on the ground, clutching his right foot in pain. “I
grabbed the ball, turned to sprint up court and felt a sudden
snap,” he recalls. Dayquel had ruptured his posterior tibial tendon, the
tendon that holds up the arch and supports the foot when walking.
Staff at a local urgent care center put a splint on Dayquel’s foot. Then
he set about finding an orthopaedic surgeon. An online search led
him to OrthoVirginia foot and ankle specialist Kevin Lutta, MD,
who diagnosed posterior tibial tendon dysfunction.
“In this condition, the foot progressively flattens as the medial arch
collapses,” Dr. Lutta explains. “An injury can cause pain, swelling
and inflammation, loss of the arch and flat feet, as well as inability
to rise on the toes.” In addition to trauma from sporting activities,
obesity, steroid injections and inflammatory diseases such as rheumatoid arthritis can lead to posterior tibial tendon dysfunction.
Treatment depends on the severity of the condition. In early stages
when inflammation is the main symptom, rest and anti-inflammatory medications, as well as a walking boot, may help. Arch supports and orthotics are then used once the inflammation resolves.
More advanced cases may require a rigid, custom-fitted brace.
With his pain gone and function restored, Dayquel can do everything he did before, but he chooses his pursuits carefully. “I bike
and do home exercise, but I haven’t played basketball since the injury because I don’t want to go through this again,” he says. “I’ve
broken many bones in my life, but this was different. It took a lot
longer to heal. The recovery was extremely challenging.”
Kevin C. Lutta, MD, graduated with a BA in Biology
from Clark University. He earned his medical degree
from Howard University College of Medicine, where
he was named to Alpha Omega Alpha Medical Honor
Society. He completed his residency in orthopaedic
surgery at Howard University Hospital and went on
to a fellowship in foot and ankle reconstruction at
Pennsylvania Hospital, part of the University of Pennsylvania Health
System.
The Freestyle™
OA knee brace:
If these conservative measures fail to bring relief, surgery is recommended. “For early stages, debridement of the inflamed tendon –
called a tenosynovectomy – is often effective,” Dr. Lutta says. “Later
stages might require a flat foot reconstruction, which includes a
tendon transfer to replace the damaged tendon, a calcaneal osteotomy to cut and re-align the heel bone, or a fusion of the hindfoot
if the foot is rigid and arthritic.”
Easy to use.
Easy to adjust.
Easy to like.
In Dayquel’s case, Dr. Lutta recommended surgery right away. Five
days later, he performed a complex tendon reconstruction, flexor
digitorum longus tendon transfer and osteotomy of the calcaneus
to correct his flat foot deformity.
Dayquel went home to Ashburn with a splint on his right foot to
keep his toes pointed downward and inward to relieve pressure on
the newly reconstructed tendon. He had to keep his foot elevated to
minimize swelling. Two weeks later, the staples were removed and
he was put in a cast. Several weeks after that, the cast was replaced
with a walking boot. Only then could Dayquel begin a four-month
course of physical therapy.
“I was pretty much out of commission for six months before I
started to feel normal again,” says the 32-year-old. Indeed, the more
severe the dysfunction, the longer the recovery time. For many
people, it may be 12 months before they fully return to all activities
and sports.
All Breg Braces Come with 360° Customer Care:
•
•
•
•
High quality products that are comfortable and easy to use
Tailored solutions to help reduce your workload
Unmatched service levels that exceed your expectations
A commitment you can count on to meet your needs, fast
Visit www.breg.com, or call Breg today at 800-897-BREG (2734).
©2014 Breg, Inc. All rights reserved. 0614
Freestyle is a trademark of Breg, Inc.
Proud partner of Commonwealth Orthopedics
Your GOALS.
Goals.
YOUR
OUR STRATEGY.
We are partners on your journey. Whether you are
growing your wealth, planning for retirement or securing
your children’s future, West Financial Services can help
you realize your vision. By combining personal service,
customized solutions and honest communication, we
have built a reputation as one of the premier fee-only
investment advisory firms in the Washington DC area.
If you have your destination set, we can help you
plot your course. Contact one of our financial
advisors today.
OURstrateGY.
STRATEGY.
our
Water Resistant
Cast Padding
Delta-Dry
allowsyour
yourphysicians
physicians
advanced
Delta-Dry®® allows
to to
givegive
advanced
carecare
while
while
their
freedom
to bathe
giving giving
patients
the patients
freedom the
to bathe
and swim
withand
theirswim
cast.
with their cast.
• CostEffective
• EasytoApply
• HighMoistureVapor
Transmission Rate
We are partners on your journey. Whether you are
growing your wealth, planning for retirement or securing
your children’s future, West Financial Services can help
703-847-2500
you realize your vision. By combining personal service,
westfinancial.com
customized solutions and honest communication, we
have built a reputation as one of the premier fee-only
investment advisory firms in the Washington DC area.
If you have your destination set, we can help you
plot your course. Contact one of our financial
advisors today.
703-847-2500
BSN medical Inc. 5825 Carnegie Blvd. Charlotte, NC 28209-4633
Tel. (+) 704 554 9933 Fax (+1) 704 358 4558 www.bsnmedical.com
westfinancial.com
60885 RN
©2011 BSN medical Inc.
REV 08/11
Endoscopic Surgery Offers
Less Invasive Option for Carpal
Tunnel Patients
C
arpal tunnel syndrome can cause
numbness or tingling in the fingers, and pain and weakness in the
hand. It can interfere with sleep, lead to difficulty performing fine motor tasks such as
buttoning buttons, and cause individuals to
drop objects.
The condition affects thousands of people each year. It occurs when the median
nerve – which runs from the forearm to
the palm – is irritated or compressed. The
nerve provides sensation to the thumb and
first three fingers of the hand. It also powers
the muscles of the thumb.
The condition is especially common among
people who repeat the same hand movements over and over. Typing on a computer, working on an assembly line, or
even playing a musical instrument for
long periods can increase risk. “Trauma,
sleeping position and activities that cause
vibration also contribute to symptoms,”
says Frederick Scott, Jr., MD, an OrthoVirginia hand and upper extremity specialist.
“Chronic or progressive carpal tunnel can
lead to permanent dysfunction.”
Treatment depends on the severity of
symptoms. Early, mild cases may respond
to non-operative options such as physical
therapy, anti-inflammatory drugs, injectable corticosteroids and wrist splinting (especially at night). If symptoms persist or
worsen, carpal tunnel release surgery may
be necessary. The goal is to relieve pressure on the median nerve by cutting the ligament at the top
of the carpal tunnel. Until recently, most release procedures were performed via open
surgery, which involves making an incision
in the palm of the hand over the carpal tunnel and cutting through the ligament to enlarge the tunnel and free the nerve.
Now, endoscopic carpal tunnel release offers certain patients a less invasive option. The surgeon uses an endoscope – a
device with a tiny camera attached to it – to
see inside the carpal tunnel and perform
the surgery through a single, small incision in the wrist. Endoscopic surgery provides effective relief from symptoms and,
because there is less tissue damage, allows faster recovery and less postoperative pain than an open release. Frederick D. Scott, MD, earned a BS in Chemical Engineering and
Biochemistry from the University of Maryland-Baltimore County. He
received his medical degree from the University of Maryland School of
Medicine. Following two years in general surgery at the University of
Maryland Medical Center, he spent a year performing research in the
university’s Department of Orthopaedics. He went on to an orthopaedic
residency at the University of Medicine and Dentistry of New JerseyRobert Wood Johnson.
OrthoVirginia who perform these and other procedures visit our website
at orthovirginia.com.
12 OrthoVirginia
Commonwealth| Orthopaedics
www.orthovirginia.com
| www.c-o-r.com
The procedure is performed under general
or local anesthesia and does not require an
overnight hospital stay. During the healing process, the ligament tissues gradually
grow back together, allowing more room
for the nerve. After surgery, patients may
start light activities immediately. Heavy
gripping and lifting may be uncomfortable for several weeks. Endoscopic surgery is emerging as a viable treatment option for select carpal tunnel syndrome patients. But, as Dr. Scott
notes, it is not for everyone. Assessment
by a qualified physician is essential. “Good
candidates for surgery are those patients
who have failed non-operative treatment
of carpal tunnel syndrome or individuals with severe compression or pinching
of the nerve as measured by a study of the
strength and speed of the nerve signals,”
he says. Physician Advisory Services
& Practice Valuations
Prescription for a profitable practice
Contact:
Barbara J. Grant, CPA, MST, CVA
888.420.9876
Atlanta | Kansas City| Knoxville | Nashville | Tampa Bay
Employee Spotlight:
Community Ambassador
E
dna Padilla may not treat patients, but she keeps
her finger on the pulse of almost everything else at
OrthoVirginia. The 23-year veteran brings a strong
background in customer service to her job as office manager at three of OrthoVirginia’s busiest locations: Springfield, Burke and Alexandria. After working in the insurance
industry as an investigator and claims examiner, Edna transitioned to HMO member services. In 1991, she moved to
Northern Virginia and joined Alexandria Orthopaedic Associates. The practice became part of Commonwealth Orthopaedics in 2001 and Edna assumed her current position
one year later.
Her favorite part of the job? Versatility. “There’s really no
typical day,” she says. “I might do physician schedules, basic
reports, staff hiring and training, or just take care of problems that arise. You never know what the day will bring.”
Changes in the healthcare environment and Commonwealth’s recent merger with OrthoVirginia have created
fresh challenges. As office manager, Edna must learn every
new system and then train her staff. She’s mastered a new
electronic medical record, paperless billing system, electronic payroll system, auto report system and centralized
scheduling – all in the last two years.
Strong relationships with her fellow managers and OrthoVirginia’s physicians make her job easier. “We have a lot of
respect for the doctors and they have respect for us,” she
says. “We listen to each other. If something’s wrong, I’m not
afraid to speak up because the physicians know I have their
best interests at heart.”
Edna also likes to make sure things are running smoothly for OrthoVirginia’s patients. She frequently walks from her back office to
the lobby to talk to patients and gauge what’s going on. Many of
those patients are also her neighbors and much of Edna’s unofficial
work takes place beyond the office walls. As an active member of
her Springfield community, she has become the unofficial “ambassador” for OrthoVirginia every place she goes. “There are an awful
lot of referrals that take place by the pool,” she jokes. In fact, she’s
Edna Padilla, office manager for the Alexandria, Burke and
Springfield offices celebrates 23 years at OrthoVirginia
(formerly Commonwealth Orthopaedics).
more of an ambassador than the doctors themselves because she
can brag about them without sounding boastful.
When she’s not at work, Edna enjoys spending time with her three
children and four grandchildren. She’s also very involved in the
PTA and Sports Boosters at Robert E. Lee High School in Springfield, where her youngest daughter is a junior.
She’s proud to serve as OrthoVirginia’s community ambassador.
“We have the best physicians and a great reputation in Northern
Virginia,” she says. “There isn’t anywhere I go that I can’t hold my
head up high.”
A Walk
in the Park
A
fter spending a winter on the sofa, Alice decided she’d
had enough. The 70-year-old from Manassas was tired
of “gimping around” with worsening osteoarthritis in
her hip. The painful condition made everyday activities challenging and interfered with her quality of life. She knew it was
time for a hip replacement.
Alice did not come to this decision lightly. In fact, she did everything she could to postpone surgery. She tried over-the-counter
painkillers. Then she tried prescription medication. She tried
moving more. Then she tried moving less. Nothing helped.
Finally, she returned to OrthoVirginia surgeon Brantley Vitek,
MD, who had diagnosed her condition one year earlier. “I’d
spent so many hours out of commission and by now I had excruciating pain with every step I took,” she recalled. “I told Dr.
Vitek ‘I’m not going to put up with this anymore. I’m ready for
a replacement.’”
Hip arthritis occurs when cartilage in the hip joint gradually
erodes. Without the cushioning effect, the bones rub together
and the hip becomes stiff, swollen and painful. Also called “wear
and tear” arthritis, osteoarthritis is a progressive, degenerative
disease in which the surface layer of cartilage slowly wears away.
The disease is especially common among middle-aged and older
adults.
“Patients with osteoarthritis are encouraged to try non-operative
options, such as weight loss, activity modification, physical therapy and medication, to alleviate symptoms,” Dr. Vitek explains.
“If these fail to bring relief, hip replacement surgery is a safe and
effective procedure to relieve pain and help people resume normal activities.”
During total hip replacement, the surgeon removes the damaged
femoral head (the rounded end of the upper thighbone) and cartilage from the hip socket. The femoral head is replaced with a
metal or ceramic ball that is fixed solidly to a metallic stem inserted into the upper part of the femur (thighbone). The socket is
usually replaced with a plastic liner fixed into a metal shell. This
new artificial ball-and-socket assembly creates a painless, cushioning effect much like the original cartilage in the hip.
The standard of care for total hip replacement has improved dramatically in recent years with the development
of new minimally invasive approaches, improved implant
materials and design, and refined surgical techniques.
“Modern hip replacement surgery is now much less invasive, with smaller incisions, less tendon and muscle trauma, less bleeding, less pain and less life interruption,” says
OrthoVirginia surgeon Mark Madden, MD. “Patients are
up and walking immediately and return to activities and
work within weeks rather than months.”
Alice is a good example. Following her surgery, she
walked into her hospital room with assistance just a few
hours later. Soon she was walking on her own. From then
on, her recovery progressed quickly. Several months of
physical therapy improved her balance, strength and conditioning. Her new hip is now so strong she can support
herself on one leg. But her greatest success is something
most people take for granted: “I can walk!” she says.
She encourages anyone experiencing pain that interferes
with daily life to go ahead and have hip replacement surgery. And she is grateful to Dr. Vitek for doing such a
wonderful job. “The fact that he had done so many of
these procedures gave me confidence,” she says. “It’s not a
bad experience at all. I’m glad I did it.”
Employee Benefits
Insurance & Investment Planning
Risk Management
10600 Arrowhead Drive, Suite 190 | Fairfax, Virginia 22030 |
(703) 218-4015 | Timothy Danehower, CLU, [email protected]
Securities offered through qualified registered representatives of
MML Investors Services, LLC. Member SIPC.
Supervisory Office: 530 Gaither Road, Suite 350 • Rockville, MD 20850 (301-355-5800).
CRN201410-165021.
Mark P. Madden, MD, received a BS
from the University of Notre Dame before
going on to complete his medical degree
from Georgetown University. Dr. Madden
completed his training in orthopaedic
surgery at Georgetown University Medical
Center where he served as chief resident.
Brantley P. Vitek, MD, earned a BA in
Philosophy from the University of Virginia
before receiving his medical degree from the
Medical College of Virginia. He then went
on to complete a general surgery internship
at the University of Colorado followed by
an orthopaedic surgery residency at the
University of Texas Health Science Center in Houston.
For full biographies and a complete directory of the
physicians at OrthoVirginia who perform these and other
procedures visit our website at orthovirginia.com.
Arthroscopic Surgery for Hip
Impingement in Young Adults
Minimally Invasive Procedure Reduces Risk of Early Onset Arthritis
I
n a smooth-functioning hip, the rounded top of the thigh bone
(known as the femoral head) fits perfectly into the hip socket.
A thin layer of cartilage lines the ball and socket, cushioning and protecting the bones, and preventing them from rubbing
against each other. A ring of soft elastic tissue, called the labrum,
provides stability and helps keep the femoral head in place.
Hip impingement occurs when the bones in the hip joint develop
abnormally. Also called femoroacetabular impingement, it causes
the hip bones to rub against each other, breaking down the articular
cartilage and tearing the labrum. “If left untreated, this process can
lead to progressive pain, cartilage damage and premature arthritis
in young adults,” says OrthoVirginia surgeon Andrew Parker, MD.
Minimally invasive arthroscopic surgery is a promising treatment
for hip impingement. In this procedure, the surgeon makes several
small incisions around the hip joint and inserts a narrow fiber optic
scope (called an arthroscope) to view inside the hip. Tiny instruments are used to clean out or repair torn labrum tissue by sewing
it back together. The surgeon then re-shapes the bones of the hip
joint.
Arthroscopic repair of labral injuries allows surgeons a full view of
the hip without having to cut through nerves or muscles. Patients
experience less pain and blood loss and fewer complications. The
result is a more balanced, stable repair that helps restore full function.
Because hip arthroscopy is a minimally invasive procedure, the
typical recovery period is weeks rather than months. Rehabilitation
begins immediately after surgery and includes special exercises to
restore range of motion, strength and flexibility in the hip. Most
patients return to normal activities within a few weeks. For athletes,
full return to sports may take four to six months.
“Arthroscopic surgery is the standard treatment for hip impingement in young adults,” Dr. Parker says. “It reduces pain and allows
people to stay active. More importantly, it removes one of the major
risk factors for developing early onset arthritis of the hip.” He notes
that results are very good in patients whose cartilage damage is
minimal at the time of surgery. If arthritis already exists, the results
are not as favorable. If advanced arthritis exists, patients are better
served with hip replacement surgeries.
Because hip arthroscopy is
a minimally invasive procedure,
the typical recovery period is
weeks rather than months.
D. Andrew Parker, MD, earned a BS in Biology and
Chemistry from Wake Forest University. Dr. Parker
then graduated magna cum laude from medical
school at the University of Louisville. He then moved
to Chicago where he completed his internship and
residency in orthopaedic surgery at Northwestern
University. Dr. Parker concluded his formal medical
education by completing a fellowship in sports medicine at the Baylor
Sports Medicine Institute in Houston, Texas.
A Viable Option
Reverse Shoulder Replacement Offers Hope for
Patients with Rotator Cuff Arthropathy
N
either snow nor rain nor heat nor gloom of night kept
Gerald from his appointed rounds as a postal carrier in Alexandria. But more than 36 years of lugging
heavy mail bags eventually took its toll on his shoulder. “When
you’re younger, you think you’re superman and bullet proof,”
the 74-year-old says. “I was always pretty careless about lifting
things. When the pain started, I learned to work around it and
hide it, even from myself.”
When Gerald woke up from his surgery, the result was profound.
All his pain was gone. He spent one night in the hospital and returned to his Alexandria home to begin a well-planned rehabilitation program. For three months, he attended physical therapy
to restore range of motion and build strength. He has since joined
a health club to further improve his shoulder strength. He’s back
to all the activities he loves and, last fall, he fulfilled a promise to
his wife Jean to play golf with her again.
Eventually, the pain grew so intense that Gerald couldn’t even
do simple chores around the house. His physician referred him
to Ben Kittredge, MD, an OrthoVirginia surgeon whose areas of
specialization include the shoulder. Dr. Kittredge diagnosed rotator cuff arthropathy (also called cuff tear arthropathy) – a condition that involves both a large rotator cuff tear and debilitating
arthritis. The arthritis develops over time after the rotator cuff is
damaged.
“Gerald had an incredibly good outcome,”
Dr. Kittredge says. “Here’s a guy who can’t sleep
because of his shoulder pain and in the past we
used to say ‘sorry we can’t help you’ to patients
like him. Now we can treat a problem previously
untreatable.”
Gerald tried non-surgical options first, including cortisone injections and physical therapy. When both proved unsuccessful, he
knew what he must do. “I was at the end of the line. This was it.
The little baby better man up,” he says.
Because the loss of function in Gerald’s rotator cuff was so severe,
he was not a candidate for rotator cuff repair or conventional
shoulder replacement. Instead, Dr. Kittredge suggested another
option: reverse shoulder replacement. In this procedure, the
surgeon “reverses” the technique used in a conventional replacement, switching the position of the ball and socket so the ball is
on the socket side of the joint and the socket is on the ball side.
Afterwards, patients use their deltoid muscle, instead of their rotator cuff, to lift their arm overhead.
“Rotator cuff arthropathy is not uncommon in older people with
rotator cuff tears,” Dr. Kittredge says. “But until recently, these
patients had no solution because the damage was too great to
undergo a conventional shoulder replacement. Reverse shoulder
replacement restores their overhead motion, relieves pain and
stiffness, and helps re-establish a functional shoulder.”
Gerald has high praise for the professionalism of the OrthoVirginia team and appreciates Dr. Kittredge’s collaborative manner.
“When it came time to decide about surgery, the choice was entirely mine,” he says. “I could live with the pain or get it fixed. I
decided to get it fixed. He was happy with the results and so am I.”
Ben W. Kittredge, IV, MD, earned an
undergraduate degree from the University of
Virginia and a Masters degree in Physiology from
Georgetown University. Dr. Kittredge returned to
the University of Virginia to attain his medical
degree. He then completed a general surgery
internship at Roanoke Memorial Hospital and an
orthopaedic residency at the University of Virginia. Additionally,
Dr. Kittredge completed a fellowship in sports medicine at Jefferson
Medical College and Pennsylvania Hospital in Philadelphia.
Conquering New Horizons
C
areening down an indoor soccer field at high speed,
Lexie lost her footing and flew head first toward the
goal post. At the last second, she stuck out her arm and
turned her head. That lightning reaction probably prevented a
head injury, but it left her with a severely broken right humerus
(upper arm bone). “It was the worst pain I ever felt in my life,” says
the 31-year-old from Sterling.
Lexie’s mother rushed her to the Inova Fairfax Hospital Emergency Room where the triage nurse quickly moved her to the top of
the list. While she waited for her X-ray, Lexie consulted her old
soccer coach for advice. Her coach knew just who to call: H. Edward Lane, III, MD, an OrthoVirginia surgeon whose areas of specialization include sports medicine. Dr. Lane had treated Lexie’s
coach, several of her teammates, and even Lexie herself for various
sports-related injuries over the years.
Less than a week later, Dr. Lane performed surgery to repair Lexie’s broken arm. The procedure is known as an open reduction
and internal fixation (ORIF). First, the surgeon repositions the
two ends of the facture into their normal alignment. Then, special
pins, plates, rods or screws are inserted to hold the bones in the
proper position as they heal. ORIF is used to repair fractures that
would not heal correctly with casting or splinting alone.
Lexie’s procedure turned out to be even more intricate. When Dr.
Lane opened her arm, he discovered that the force of her injury
had not only broken her humerus, but also trapped her radial
nerve, which runs down the underside of the arm. “Lexie had a
major sports injury, and a very unusual one for soccer,” he says.
“We had to open her arm from shoulder to elbow to follow the
radial nerve and release it from the fracture.”
Back home, Lexie spent the first two weeks on the couch. Her arm
was in a brace and a sling. Eventually she began a rehab program to
restore movement and strength in her arm and hand. As the healing process progressed, she was able to do more. She returned to
work as a personal trainer and soccer coach. Within three months,
she was back on the soccer field, but it just wasn’t the same. “I was
much more cautious and reserved,” she says.
“Lexie had a major sports injury from
playing soccer,” says Dr. H. Edward Lane.
Then she got an offer that changed her life: her best friend
was training for a triathlon, would Lexie like to join her? It
became her new goal. And exactly one year after her surgery
– with seven screws and a plate in her right arm – Lexie completed her first triathlon. She’s never looked back.
“I’m a very competitive person, and triathlons didn’t seem in
my realm, but now I appreciate the exercise aspect of competition and the benefits I get from it, rather than just winning
Lexie returns to competing in triathlons after
recovering from a severely broken right humerus.
Advertiser Directory
Breg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
BSN Medical inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Depuy Mitek (Orthovisc). . . . . . . . . . . . . . . . . . . . . . . . . . 19
Lambert, Riddle, Schimmel & Company. . . . . . . . . . . . . . . 5
Martin Reddy Architects
Facility Planning and Design for Healthcare
2121 Wisconsin Ave., NW
Washington, DC 20007
202-457-0860
martinreddy.com
Novant Health Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
OrthoCare RN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Professional Risk Associates. . . . . . . . . . . . . . . . . . . . . . . . . 5
PYA Gates Moore. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Radiology Imaging Associates. . . . . . . . . . . . . . . . . . . . . . BC
Reston Hospital Center. . . . . . . . . . . . . . . . . . . . . . . . . . IFC
The Washington Group. . . . . . . . . . . . . . . . . . . . . . . . . . . 15
West Financial Services, Inc.. . . . . . . . . . . . . . . . . . . . . . . . 11
or beating my time,” she says. She does one or two triathlons
a year, including the occasional half ironman. Even though
she sustained an awful injury, it helped her turn the corner
into something new and different.
She is grateful to Dr. Lane for his expertise, care and support,
and she proudly shows off her 9-inch scar that runs from her
bicep to her elbow. “It’s very thin and done perfectly; people
always comment on how good it looks,” she says. Although
she’s no longer playing soccer, Lexie continues to conquer
new horizons. In February, she and her husband welcomed
their first baby.
LIFE ISN’T A SPECTATOR SPORT,
IT’S A GAME YOU NEED TO PLAY.
Even Dr. Lane, who routinely treats sports-related injuries
in athletes of all ages, is impressed. “Lexie is an exceptional
woman who brought the same personal endeavor and drive
to her recovery as she does to her athletic achievements,”
he says. “She worked very hard at it, she set goals and she
reached them. She had a wonderful result.”
If osteoarthritis (OA) of the knee is stopping you
from being active and your pain isn’t fully relieved by
medication, there is a non-surgical option to help you
keep moving.
By restoring the knee’s natural fluid, ORTHOVISC®
cushions, protects, and lubricates the knee for up to
6 months of relief with just three injections. Made
from ultra-pure natural hyaluronan, ORTHOVISC®
replaces what’s missing.
H. Edward Lane, III, MD, earned his medical
degree from Georgetown University School
of Medicine in Washington, DC. He then
completed his internship and orthopaedic
surgery residency at Georgetown University
Medical Center.
For full biographies and a complete directory of the physicians
at OrthoVirginia who perform these and other procedures
visit our website at orthovirginia.com.
Ask your doctor if ORTHOVISC® is right for you,
and visit our website at www.orthovisc.com
for more information.
Important Safety Information
ORTHOVISC® is for patients who do not get adequate pain relief from simple pain
relievers like acetaminophen or from exercise and physical therapy. ORTHOVISC®
is not for use in people with known allergy to hyaluronate preparations, to gram
bacterial proteins, with infections or skin diseases in the area of the injection site
Or joint. Common side effects include joint pain, back pain, headaches and pain
or redness at the injection site.
ORTHOVISC® is manufactured by and is a registered trademark of Anika Therapeutics, Inc.
Mystery Solved!
Diagnosing and Treating Unusual Knee Conditions
T
hroughout his childhood, Sean was plagued by a mysterious pain in his left knee. “It would flare up after a long
day of physical activity,” recalls his mother, Annmarie. “He
complained repeatedly, but we were told it was ‘growing pains’ and
to give him Motrin.”
A string of events finally solved the mystery. During football practice at West Springfield High School, Sean was tackled and heard a
loud pop in his knee. The team trainer thought it was a contusion
that would heal with time. But over the next two weeks, the pain
and weakness intensified until it was so bad the 16-year-old could
barely put weight on his leg. His pediatrician referred him to Daniel
Weingold, MD, an OrthoVirginia surgeon whose areas of specialization include the knee.
Sean competes in the Discus Throw
at his high school after a full recovery
from an unusual knee condition.
Dr. Weingold took one look at the X-ray and immediately made a
diagnosis: Sean had an osteochondroma, an abnormal growth on
the surface of bone near a growth plate. The condition develops
during childhood and can occur in any area of the body, but is most
common around the knee. “An osteochondroma usually presents as
pain because the growth is irritating the muscle or tendon around
it,” Dr. Weingold explains. “Sometimes you can feel a little bump.”
In 99% of cases, an osteochondroma is benign. But in very rare instances it can become malignant so it’s always a good idea to have
it checked out. Treatment varies depending on a child’s age. If the
condition is diagnosed in a young child, Dr. Weingold and his OrthoVirginia colleagues recommend waiting until the child is older
and has stopped growing before taking it out. If it is removed too
soon, it can grow back. “Generally, an osteochondroma can be left alone
unless a child is having a lot of pain or the tumor is interfering with activities,” says OrthoVirginia surgeon Robert Dombrowski, MD, who notes it is
a good idea to monitor the condition as the child grows.
In Sean’s case, the force of the football injury had caused most of the bony
growth to break off, which intensified the pain and swelling in his knee. Dr.
Weingold removed the piece of floating bone and smoothed down the jagged edges that were poking through the muscle. The outpatient procedure
was performed in the hospital and Sean went home the same afternoon.
His recovery was so fast and easy, he did not require physical therapy. His
pain is gone and his leg feels stronger than ever. “Last week, he bench pressed
250 pounds 13 times,” his proud mother reports. Sean has returned to all his
sports and activities, training with the football team in the off season and
track and field in the spring.
His parents are grateful to Dr. Weingold and everyone at OrthoVirginia for
the wonderful care their son received. “It was a great experience. Everyone
was very professional and courteous and made the entire thing as effortless
as possible,” Annmarie says.
An AP radiograph of the left knee above
and an MRI below shows a fracture
through osteochondroma on lateral
aspect distal femur.
Osteochondroma is just one of the unusual knee conditions that OrthoVirginia surgeons treat every year. Christopher Annunziata, MD, recently removed a cyst from a patient’s knee joint that had started to encroach on one
of the nerves. The procedure involved open surgery and decompression of
the nerve – an extremely rare combination.
“Most conditions we see involving the knee are common but there are sometimes unusual presentations such as bone or soft tissue tumors that are out
of the ordinary,” Dr. Annunziata says. “If a patient presents with pain unrelated to any specific injury – especially if there is pain at rest or at night – it’s
a good idea to have a qualified orthopaedic surgeon perform an assessment.”
Dr. Weingold agrees and says awareness and attention from parents can help
pick up on conditions such as osteochondroma. “If your child complains of
pain, don’t ignore it. Ask your pediatrician for an X-ray just to make sure it
is nothing serious,” he says. “It’s important that we all listen to what our kids
have to say.”
Christopher C. Annunziata, MD, earned a BS from Boston
College before graduating with his medical degree from
Georgetown University. He completed an orthopaedic surgery
residency at Georgetown University Medical Center and
went on to complete a fellowship in Sports Medicine/Knee
and Shoulder Surgery at the University of Pittsburgh Sports
Medicine Center.
Robert M. Dombrowski, MD, received a BA in Biology
from Washington and Jefferson College before going on to
Case Western Reserve University in Cleveland, Ohio, where
he earned his medical degree. He then completed his surgical
internship and residency training in orthopaedic surgery at
Georgetown University in Washington, DC.
Daniel E. Weingold, MD, earned an
undergraduate degree at Duke University
in Durham, North Carolina. He completed
his medical degree at the University of
Maryland School of Medicine and finished
his surgical internship and orthopaedic
residency training at George Washington
University Medical Center in Washington, DC.
For full biographies and a complete directory of the
physicians at OrthoVirginia who perform these and other
procedures visit our website at orthovirginia.com.
Back on His Feet
Minimally Invasive Spine Surgery
Promotes Rapid Recovery
W
ith 14 years’ experience as an OrthoVirginia
surgical technician, Wayne understands the
importance of prompt treatment for serious
orthopaedic conditions. But when it comes to his own
health, the 57-year-old admits to being a bit of a procrastinator. So when he first felt pain in his glute, he ignored it.
When it spread down his leg, he tried conservative measures including ice and steroids. Nothing worked. By then,
Wayne was also having trouble walking. He had developed
a condition called drop foot, which made it difficult for
him to lift his foot at the ankle. Drop foot is a sign of a
serious underlying neurological, muscular or anatomical
problem.
Finally, Wayne had an MRI. The image revealed severe stenosis, a narrowing of the spinal canal that puts pressure on
the spinal cord and nerves. While some people are born
with a small spinal canal, the most common cause of lumbar stenosis is degenerative changes in the spine related to
aging. These degenerative changes can cause spinal instability in which the bones shift and put extra pressure on
the nerves.
When Wayne’s doctors saw his MRI, they recommended
surgery right away. Two weeks later, OrthoVirginia spine
specialist Steven Hughes, MD, performed a minimally invasive lumbar fusion. The procedure joins, or fuses, two or
more vertebrae in the low back. Minimally invasive lumbar fusion takes a fraction of the ordinary surgical time
and avoids significant damage to the muscles and tissues
that surround the spine.
“Minimally invasive spine surgery is a safe and effective method to treat a wide range of spine disorders,” Dr.
Hughes says. “There are many definitions of minimally
invasive, such as the use of special retractors, scopes or
needles, but the main way to think of this is fast surgery
done with minimal incision into the body and rapid rehabilitation.”
The technique offers a host of advantages for patients, including:
■
■
■
■
■
■
■
■
■
Less time in the operating room
Less blood loss during surgery
Less damage to muscles and tissues that surround the spine
Reduced risk of infection
Minimal scarring from small incisions
Less post-operative pain
Faster recovery and a shorter hospital stay
Fewer complications
Improved function and quicker return to daily activities
“Good candidates for minimally invasive spinal fusion are patients with
stenosis or those with spondylolisthesis, a condition in which one vertebra
in the lumbar spine has slipped forward onto the vertebra below it. However, we always encourage non-operative measures first, such as over-thecounter pain medications, steroids and physical therapy,” explains OrthoVirginia spine specialist Ron Childs, MD, Medical Co-director of the Inova
Spine Institute at Inova Fairfax Hospital and Chief of Orthopedic Spine
Surgery. Dr. Childs holds a patent for a minimally invasive lumbar fusion
technique and trains visiting surgeons from around the world, including
Brazil, England and, most recently, Australia. 22 OrthoVirginia | www.orthovirginia.com
During Wayne’s one-hour procedure, Dr. Hughes placed an expanding disc space cage through a four-inch incision in Wayne’s
back. The cage provides extra support and helps prevent future
nerve compression in the area. Afterwards, Wayne couldn’t believe the difference. “I went into the hospital with excruciating
pain in my back and my leg. When I woke up, I had no pain at
all,” he says.
Ronald C. Childs, MD, a Major in the United
States Army Medical Corp, Dr. Childs earned a BA
in Psychobiology from Boston University before going
on to complete his medical degree and orthopaedic
surgery residency at Howard University. Dr. Childs
then pursued additional training in Chicago where he
completed a spine surgery fellowship program at RushPresbyterian – St. Luke’s Medical Center.
Determined to achieve a successful recovery, Wayne was up and
walking that evening. He left the hospital three days later and began taking daily walks in his Burtonsville neighborhood, starting slowly and working his way up to two walks a day. Often he’d
take his infant grandson out in his stroller, or walk in the evenings with his wife. After a couple of weeks, Wayne added weight
lifting and bending and stretching to his regimen.
Steven S. Hughes, MD, graduated summa cum laude
from the University of Rochester and completed his
medical degree with honors from the University of
Rochester School of Medicine. Dr. Hughes worked
as a surgical intern at Bethesda Naval Hospital and
was later honorably discharged after serving as a
Commander in the United States Navy. Following his
internship, he completed an orthopaedic surgery residency at Strong
Memorial Hospital in Rochester and a fellowship in spinal surgery at
Case Western Reserve Hospital.
“The main question patients have after spine surgery is how
quickly they can return to exercise and daily activities,” Dr.
Hughes says. “It depends on the patient and how many of these
procedures the surgeon has done. Wayne was highly motivated.
He had full nerve recovery and full exercise capability within
three weeks.”
When Dr. Hughes told him he could go
back to exercise and work so quickly,
Wayne thought it was “ridiculously optimistic.” But three and a half weeks later,
he returned to his job at OrthoVirginia.
He started with half days and gradually
added time each day. By the second week,
he was back on his feet for a full day.
Wayne has since left OrthoVirginia and
now works at a surgery center in Chevy
Chase, Maryland. He’s grateful to all of
his OrthoVirginia colleagues for taking
such good care of him. He reserves special praise for Dr. Hughes and his staff for
their expertise and support.
“Everything Dr. Hughes told me from day
one came to pass just as he said it would.
That and my faith in Jesus Christ were
what motivated me and got me through,”
he says. “I went into the surgery with optimism, and the surgery was a raving success.”
OrthoCareRN
HomeCare for BoneCare
When Home Rehabilitation Matters…
Select an Agency with Experience!
Services Provided
Orthopaedic Rehabilitation
PT/ OT/ RN/ LPN/ CNA
Ask your Doctor or Nurse about
requesting OrthoCareRN services.
Call 703.481.1919
www.OrthoCareRN.com
Treatment Options for
Rotator Cuff Tears
Y
our shoulder is the most mobile joint in your body. But
that mobility comes with a price: an increased risk of
pain and injury. Problems can result from trauma, overuse and arthritis, and can affect the bones, muscles, ligaments or
tendons.
Rotator cuff tears are among the most common pain-causing
conditions affecting the shoulder. The injury generally involves
damage to one or two of the four tendons of the rotator cuff muscle, which covers the shoulder joint and helps raise and rotate
the arm.
There are two different types of rotator cuff tears. A partial tear
damages the soft tissue, causing fraying and delamination. A
complete tear (also called a full-thickness tear) splits the soft tissue into two pieces. In many cases, the tendons tear off where
they attach to the upper arm bone.
“Most rotator cuff tears are due to injury
or degeneration,” says Kevin Sumida, MD,
an OrthoVirginia surgeon whose areas of
specialization include the shoulder.
“Common causes of acute tears include falling on an outstretched
arm, lifting something heavy or repetitive arm movements. Overhead sports can also lead to progressive tears. In older adults,
normal wear and tear can break down collagen in the rotator cuff
tendons and muscles. Calcium deposits or arthritic bone spurs
can pinch or irritate the rotator cuff.”
Symptoms of an acute tear include intense pain, a snapping sensation and immediate weakness in the upper arm. Degenerative
tears may result in pain and tenderness – particularly when lying
on the affected shoulder – pain at night, pain or weakness when
lifting and lowering the arm, or loss of range of motion in the
shoulder.
In addition to a physical exam and patient history, MRI is the
most effective test to confirm the diagnosis of a torn rotator cuff.
Rotator cuff tears can also be diagnosed using ultrasound techniques.
The decision to have surgery depends on the type of tear, its severity and the patient’s activity level. “Many partial rotator cuff tears
respond to non-surgical treatment such as rest, physical therapy,
non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone
injections.” Dr. Sumida explains. “If the injury is very severe or
if conservative measures fail to improve strength and movement,
surgery is recommended. It’s also a good option for patients who
are highly motivated to return to a very active lifestyle.”
Untreated full thickness rotator cuff tears can cause significant
instability of the shoulder, leading to arthritis, weakness and loss
of motion. For older patients with natural degeneration, the decision to have surgery is based on a number of factors including
symptoms, function and tissue quality.
Thanks to advancements in arthroscopic techniques and materials, Dr. Sumida and his colleagues at OrthoVirginia are able
to perform minimally invasive rotator cuff repairs on many patients. This approach offers numerous benefits including very
small incisions, less muscle and tissue trauma, less bleeding, less
pain and a much faster recovery. However, larger, more challenging tears may require open surgery.
Kevin D. Sumida, MD, graduated with a BA from
DePaw University in Greencastle, Indiana. Dr.
Sumida earned a medical degree from the University
of Kentucky College of Medicine in Lexington.
He completed his orthopaedic surgery training in
Lexington before completing a fellowship in Sports
Medicine at the University of North Carolina at
Chapel Hill. In addition to his orthopaedic practice, he is also a
clinical assistant professor at Georgetown University.
New Hand Surgeon
Joins OrthoVirginia
O
rthoVirginia is pleased to welcome hand surgeon
Daniel K. Laino, MD, to the practice. Dr. Laino
joins OrthoVirginia from the Seattle Hand Surgery Group in Washington State. He is based at the Reston
office.
The Cleveland Ohio native was originally drawn to orthopedics as an opportunity to repair acute and chronic conditions and improve patients’ quality of life. He chose hand surgery in particular because of the intricacy of hand anatomy
and the variety of conditions he can treat, including broken
bones, torn ligaments and tendons, carpal tunnel syndrome
and arthritis. “The most rewarding part of being a hand surgeon is helping to relieve pain and restore hand function so
patients can get back to their lives,” he says.
After earning a BA in Psychology from the University of
Notre Dame, Dr. Laino received his medical degree from The
Ohio State University College of Medicine, graduating magna cum laude. He completed an orthopedic residency at the
New York Hospital for Joint Diseases in New York City, and
went on to a fellowship in hand, upper extremity and microvascular surgery at Duke University Medical Center. He is a
member of the American Academy of Orthopaedic Surgeons
and the American Society for Surgery of the Hand.
Dr. Laino’s many outside interests include running, golf and
reading mystery novels. He and his wife, Catherine live in
Reston with their golden retriever, Cooper.
Dr. Laino will be practicing in the Reston office:
1850 Town Center Parkway, Suite 303
Reston, VA
Daniel K. Laino, MD
For patient appointments call
703-266-BONE (2663) or go online to
http://www.c-o-r.com/appointment-request.asp
Physical Therapy Program
Addresses Women’s Health Needs
A conversation with Sarah Wolbrom, PT, DPT
W
omen’s health is an area of physical therapy dedicated to evaluating and treating the unique conditions women experience
throughout their life span. The OrthoVirginia Woman’s Health
Physical Therapy program is designed for patients of all age ranges and functions to improve quality of life.
What are some of the common conditions you treat?
Common diagnoses include urinary incontinence, pregnancy-related musculoskeletal disorders, abdominal separation (diastasis recti), sacroiliac joint dysfunction, pelvic organ prolapse and pelvic pain.
How can a physical therapist help?
Physical therapists are experts on the human body as it relates to movement and
the ability to perform daily activities.
In young female athletes, we work on correcting body mechanics, regaining
strength after an injury, improving movement patterns and relieving pain.
Pregnant and post-partum women experience a wide range of physiological and
physical changes. Women can develop laxity in their joints, postural changes,
muscles weakness and poor body mechanics. These can contribute to low back
pain, tailbone pain, pelvic pain, sacroiliac joint dysfunction, sciatica – even carpal tunnel syndrome. A physical therapist can help to relieve these symptoms
during pregnancy and improve post-partum recovery so mothers can care for
their babies. We teach new moms proper body mechanics for lifting their babies
in and out of a crib and breastfeeding. We also help with core strengthening following a C-section. Many women are offered no guidance for retraining their
muscles post-partum and find our program useful.
Women’s Health
Physical Therapy Locations:
Herndon Physical Therapy
with Sarah Wolbrom, PT, DPT
703-810-5205
Springfield Physical Therapy
with Katie Kaiser, PT, DPT
703-810-5211
A physician referral is required.
Women of any age can experience pelvic pain,
which can present as vaginal pain, difficulty or pain
associated with urinating or having a bowel movement, pain with intercourse or pain in the pelvis
that radiates down the front or back of the thighs.
A physical therapist can help to decrease “trigger
points” or areas where muscles are tender or sore,
teach relaxation techniques to decrease tightness in
the pelvic floor muscles, improve core strength and
posture, and help to decrease pain.
Pelvic organ prolapse and urinary incontinence are
common conditions that occur postpartum and as
we age. Strengthening the pelvic floor muscles and
educating patients about bladder irritants can help
reduce symptoms significantly. We also help with
posture and core muscle conditioning, as well as
bladder re-training, soft tissue techniques and joint
realignment. Elderly women may experience functional incontinence, which is an inability to get
to the bathroom on time. We offer many of these
same treatments, as well as trip and fall prevention,
for this patient population.
Do you use any special equipment?
We have an EMG biofeedback machine that uses
surface electrodes or internal sensors to pick up
and measure activity of the pelvic floor muscles.
The machine sends a signal to a computer screen
so a patient can see when they are contracting and
relaxing these muscles correctly. This equipment
helps re-educate women who suffer from weakness
or hypertonia in the pelvic floor muscles.
What can patients expect?
We start with a thorough evaluation to assess a
patient’s condition and develop an individualized
plan of care. We make sure that each patient has a
Common Women’s Health Conditions
■ Stress Incontinence: Involuntary leakage on effort, exertion, sneezing, or
coughing.
■ Urge Incontinence: Involuntary leakage accompanied by urgency.
■ Mixed Incontinence: A combination of the above.
■ Dyspareunia: Pain with intercourse.
■ Prolapse: The descent of a pelvic organ, such as the bladder or uterus, into
the vaginal canal.
■ Pelvic Pain: Non-cyclic pain for more than six months duration from the
abdomen to the low back and pelvis to the inner thighs.
good understanding of her diagnosis, how many treatment sessions she needs, what
to expect during those sessions and the training to successfully manage the condition
at home. Patient education is a large part of the program.
Where are services provided?
We currently offer women’s health PT in our Herndon and Springfield locations. A
physician referral is required. It can be from an OrthoVirginia surgeon, an OB-GYN,
a primary care physician or other provider.
Is this type of program unique?
There is a growing awareness of women’s health physical therapy and, with that, a
need for more providers. Physical therapists undergo special training to work with
this patient population. Some orthopedic problems may originate from an underlying
women’s health issue, which a thorough evaluation can help determine.
Katie Kaiser, PT, DPT earned a B.S. in General Health
Sciences at Purdue University before continuing on to
Northwestern University in Chicago where she received a
Doctor of Physical Therapy degree in 2008.
Sarah Wolbrom, PT, DPT graduated from Penn State
University with a B.S. in Kinesiology. She received her
Doctorate of Physical Therapy degree from The George
Washington University where she was named to the Alpha
Eta Honor Society.
For full biographies and a complete directory of the physical therapists at OrthoVirginia
who perform these and other procedures visit our website at orthovirginia.com.
11240 Waples Mill Rd., Ste. 403
Fairfax, VA 22030
RIA has your
imaging covered
Multiple Advanced High-Field MRI systems:
• High-Field Open 1.0T and 1.2T
• Anti-Claustrophobic, Short-Bore 1.5T and 3.0T
A
t Radiology Imaging Associates (RIA) we don’t believe you have to sacrifice quality for
comfort. That is why we have a full range of MRI systems including the latest High-Field
Open Technology.
RIA has locations in both Virginia and Maryland. For your convenience, we offer early morning,
evening and weekend MRI appointments.
Open MRI | MRI | X-RAY | Computed Tomography (CT) | PET | 2D & 3D Mammography |
3D & 4D Ultrasound | Vascular Testing | Nuclear Medicine | Fluoroscopy |
Diagnostic Radiology | DEXA-Bone Densitometry |
Request an appointment at www.RIAssociates.com
RIA at Pembrooke
11335 Pembrooke Square
Suite 101, 104, 114 & 116
Waldorf, MD 20603
301-870-8434
RIA at Patuxent
230 W. Dares Beach Road
Suite 100 & 106
Prince Frederick, MD 20678
301-855-9754
RIA at Heritage
8926 Woodyard Road
Suite 301, 401 & 502
Clinton, MD 20735
301-856-3670
RIA at Sterling
4 Pidgeon Hill Drive
Sterling, VA 20165
703-450-5800
RIA at Lansdowne
19455 Deerfield Ave
Suite 102
Lansdowne, VA 20176
703-858-0001

Mystery Solved!

Transcription

Similar documents

MFI Employee Benefits

Awana Upcoming Events - Faith Baptist Church

Please register at helpforobesity@mcvh

Blood tests when you`re in the hospital

New Beauty talks to - Mokhtar Asaadi Plastic Surgery

199 1 at the bottom of the page by Karen Emerly. 2 Who does the

Aurora II Light 12

LaStalla Night

Your Guide to Laparotomy