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. 6 OrthoVirginia | www.orthovirginia.com 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. OrthoVirginia | www.orthovirginia.com 7 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- 8 OrthoVirginia | www.orthovirginia.com 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. For full biographies and a complete directory of the physicians at OrthoVirginia who perform these and other procedures visit our website at orthovirginia.com. OrthoVirginia | www.orthovirginia.com 9 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. For full biographies and a complete directory of the physicians at OrthoVirginia who perform these and other procedures visit our website at orthovirginia.com. 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. 10 OrthoVirginia | www.orthovirginia.com 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. 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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. For full biographies and a complete directory of the physicians at 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.” OrthoVirginia | www.orthovirginia.com 13 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. 14 OrthoVirginia | www.orthovirginia.com 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. OrthoVirginia | www.orthovirginia.com 15 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. 16 OrthoVirginia | www.orthovirginia.com 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. For full biographies and a complete directory of the physicians at OrthoVirginia who perform these and other procedures visit our website at orthovirginia.com. 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. For full biographies and a complete directory of the physicians at OrthoVirginia who perform these and other procedures visit our website at orthovirginia.com. OrthoVirginia | www.orthovirginia.com 17 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. 18 OrthoVirginia | www.orthovirginia.com 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. 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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. OrthoVirginia | www.orthovirginia.com 19 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. 20 OrthoVirginia | www.orthovirginia.com 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. OrthoVirginia | www.orthovirginia.com 21 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.” For full biographies and a complete directory of the physicians at OrthoVirginia who perform these and other procedures visit our website at orthovirginia.com. 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 OrthoVirginia | www.orthovirginia.com 23 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. 24 OrthoVirginia | www.orthovirginia.com 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. For full biographies and a complete directory of the physicians at OrthoVirginia who perform these and other procedures visit our website at orthovirginia.com. 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 OrthoVirginia | www.orthovirginia.com 25 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. 26 OrthoVirginia | www.orthovirginia.com 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. OrthoVirginia | www.orthovirginia.com 27 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