• Shoulder Exam: How To Do a Crank Test for Labral Tears in the Shoulder

    Posted by Orthopaedic Specialists

    Shoulder Crank Test for pain

    Key Takeaways:

    • The Crank Test is a non-invasive movement test that doctors can use to help identify labral tears in the shoulder.
    • This is only one of several movement tests, like the Mayo Shear test, that your doctor may perform to identify where pain is originating from.
    • Labral tears usually result from acute trauma or repetitive shoulder motion and are common in swinging or throwing athletes, or workers who lift heavy objects every day.

    Similar to the Mayo Shear Test, the Crank Test is another movement-based test that requires no medical instruments and can be performed anywhere.

    How To Do a Shoulder Crank Test

    1. Bring the patient’s arm to a 90 degree from their body
    2. Bend the elbow to 90 degrees, with the hand facing up
    3. Apply an axial load to the humerus (push the elbow into the shoulder)
    4. Internally and externally rotate the arm as you maintain the axial load

    If you feel a clunk or a click, particularly when externally rotating the arm, there may be a labral tear in the shoulder.

    What is the Difference Between a Crank Test and a Mayo Shear Test?

    The three most common types of labral tears include:

    1. SLAP Lesion – a tear that occurs on the upper part of the socket. This kind of tear also affects the bicep tendon.
    2. Bankart Lesion – a tear that occurs at the bottom of the socket. This normally results from a shoulder dislocation.
    3. Posterior Labrum Tear – a tear that occurs at the back of the socket. Wear and tear or acute injuries are commonly the culprits for this type of tear.

    Mayo Shear tests usually help to identify Bankart Lesions (Lennard Funk, Shoulder Examination Tests) and posterior labrum tears while Crank tests help to identify SLAP lesions. They utilize different movements and body mechanics, and the results target pain in different areas of the shoulder.

    Frequently Asked Questions About the Crank Test and SLAP Tears

    1. What is a SLAP Lesion?
      1. A SLAP lesion is also known as a SLAP tear, which stands for Superior Labrum, from Anterior to Posterior tear. It occurs on the upper part of the glenoid socket. This kind of tear also affects the bicep tendon. Damaged or torn labrums often result from either acute trauma or repetitive shoulder motion (OrthoInfo). In many cases, this leads to shoulder pain (especially with overhead activities), shoulder instability, and other symptoms such as:
        1. Dislocations
        2. Sensations or noises of catching, locking, popping, or grinding
        3. Increased shoulder pain at night
        4. Decreased range of motion
        5. Loss of strength
    2. What are the next steps if a Shoulder Crank Test generates pain?
      1. If a Crank Test is causing pain, there is a possibility that you have torn your labrum. SLAP tears that are left untreated may lead to chronic shoulder pain and instability. If this test causes pain and a click, it is best to contact a doctor for a diagnosis. In the meantime, it is recommended that you rest your shoulder and abstain from activities that require overhead motion or heavy shoulder lifting.
    3. How is a SLAP lesion treated?
      1. SLAP lesions can take up to a year to heal, and can be treated either conservatively or surgically.
        1. Conservative treatments should be the first thing that a doctor prescribes. This can include rest or modified activity, physical therapy, and over-the-counter pain medication.
        2. Surgical treatments may be recommended if the pain gets to a point that it interferes with daily activities. The operation reattaches the torn labrum to the shoulder socket, which improves stability.

    If you or someone you love has suffered a shoulder labrum tear in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Shoulder Exam: How to Do a Mayo Shear Test for Labral Tears in the Shoulder

    Posted by Orthopaedic Specialists

    Shoulder Labrum Tears and the Mayo Shear Test

    Key Takeaways:

    • A Mayo Shear Test is a noninvasive motion test that can help to identify labral tears in the shoulder.
    • If a labral tear is present in the shoulder, the patient will normally feel pain in the back of the shoulder and/or hear a clicking sound.
    • A labral tear occurs when the specialized cartilage tissue in the shoulder is torn or damaged, usually from throwing, pushing, or doing overhead tasks.

    The labrum is a special piece of cartilage that cushions the ball-and-socket joint of the shoulder. This joint is made up of the humeral head from the arm (the ball) and the glenoid (the socket). The labrum lives on the rim of the glenoid and serves as an attachment location for the ligaments that connect the humerus and and the glenoid.

    How Do You Know If You Have a Torn Labrum in Your Shoulder?

    Damaged or torn labrums often result from either acute trauma or repetitive shoulder motion (OrthoInfo). In many cases, this leads to shoulder pain (especially with overhead activities), shoulder instability, and other symptoms such as:

    • Dislocations
    • Sensations or noises of catching, locking, popping, or grinding
    • Increased shoulder pain at night
    • Decreased range of motion
    • Loss of strength

    There are three types of labral tears that are most common:

    1. SLAP Lesion – a tear that occurs on the upper part of the socket. This kind of tear also affects the bicep tendon.
    2. Bankart Lesion – a tear that occurs at the bottom of the socket. This normally results from a shoulder dislocation.
    3. Posterior Labrum Tear – a tear that occurs at the back of the socket. Wear and tear or acute injuries are commonly the culprits for this type of tear.

    If you play a sport that involves a lot of throwing or a similar motion to it, or your daily activities require you to repetitively lift heavy objects, your shoulder pain might be a torn labrum. The only way to determine with any certainty that you have torn your labrum is with imaging tests like CT scans or MRIs. However, in order to narrow down the possible origin of your shoulder pain, doctors may perform simple, non-invasive movement tests like the Mayo Shear Test.

    How To Do a Mayo Shear Test

    For this labral tear of the shoulder test, you will:

    1. Adduct the affected arm
    2. Bend the elbow so the arm is at 90 degrees with the arm externally rotated and your hand on the back of their shoulder
    3. Bring up to about 120 degrees of forward flexion
    4. Then pull the arm down to about 60 degrees

    If the up and down movement produces a click or other noise, and produces pain along the posterior (back portion) of the shoulder, they may have a labral tear, usually a Bankart lesion or posterior labrum tear.

    Frequently Asked Questions About Labral Tears in the Shoulder

    1. Will a torn shoulder labrum heal completely?
      1. If the tear is mild and proper steps to rehabilitation is followed, most patients will have full function of the shoulder and return to their activities with few or no restrictions. In the case of Burkart lesions, some patients report feeling like their shoulder will dislocate again. Focusing on rebuilding the muscles of the shoulders will be very helpful for stabilization.
    2. Can a labral tear in the shoulder heal on its own?
      1. In some cases, conservative treatments like rest, over-the-counter pain killers, and physical therapy can be enough to heal a labrum tear. However, it is not recommended that no action be taken, as this will increase the possibility of reinjury, or worsening the tear.
    3. How do you fix a labral tear in the shoulder?
      1. Common treatments for shoulder labrum tears include activity restrictions, physical therapy, anti-inflammatory medication, corticosteroid injections for pain management, or in more severe cases, shoulder arthroscopy surgery to trim or reattach the labrum to the glenoid.
    4. How long does it take to recover from a labrum tear in the shoulder?
      1. Without surgery, this will vary case-by-case. Healing can be unpredictable due to factors like how rigidly the patient adheres to a recovery plan and how severe the tear is. With surgery, there is more structure, and patients usually have a minimum recovery period of 12 weeks, but it will take 4-6 months to return to activities at full-strength.

    If you or someone you love has suffered a shoulder labrum tear in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Shoulder Exam: How To Do a Shoulder Adduction Test for Acromioclavicular Pain

    Posted by Orthopaedic Specialists

    Shoulder Adduction Tests and AC Joint Pain Shoulder Diagram

    Key Takeaways:

    • The shoulder is made of two joints: the glenohumeral joint and the acromioclavicular joint.
    • The acromioclavicular joint is where your collarbone connects to your shoulder blade.
    • A shoulder adductor test can help identify if shoulder pain originates from the acromioclavicular joint.

    If you are feeling pain in your shoulder, your doctor may conduct a shoulder adductor test. Because the shoulder is made up of two joints, the glenohumeral joint and the acromioclavicular joint, this test can help identify which of them may be producing the pain. A shoulder adduction test determines if someone has acromioclavicular pain, or pain at the AC joint.

    The shoulder adduction test is very simple:

    1. The patient will raise their hand and arm 90 degrees in front of themselves.
    2. A doctor will move it across the chest horizontally, or adduct it.
    3. If there is pain can be reproduced in the AC joint area, the test is positive.

    What is the Acromioclavicular Joint?

    The acromioclavicular joint, also known as the AC joint, is one of two joints in the shoulder. It connects the clavicle (collarbone) to the top part of the scapula, called the acromion (Washington University Medicine). When you move your shoulder, the AC joint helps it move from back to front as a planar joint, or a joint that lets two bones glide past each other.

    Its primary job is to support your shoulder and act as a connection point for the surrounding ligaments. It is a passive joint, so it does not move by itself. Any movement of the AC joint is performed by the muscles, tendons, ligaments, and the other joints. The AC joint includes the following components:

    • Collarbone
    • Shoulder blade
    • Cartilage
    • Nerves
    • Blood vessels
    • Acromioclavicular ligament
    • Coracoclavicular ligament, made up of the trapezoid and conoid ligaments

    Most Common Ways the AC Joint is Injured

    The AC joint is susceptible to injury from both the shoulder and the collarbone. Stretched, strained, or torn ligaments are possible, especially with acute shoulder trauma associated with (Mass General Brigham):

    • Falling directly on the shoulder
    • Sustaining a hard hit to the shoulder
    • Lifting heavy objects

    Arthritis can also develop if the cartilage sustains damage or wear-and-tear. The most common sport injuries for AC joints are heavy-hitting sports like American football, martial arts, hockey, skiing, snowboarding, and biking.

    Degrees of Injury to the AC Joint

    There are 6 classifications for injury to the AC joint and its ligaments (National Library of Medicine, Acromioclavicular joint injuries: diagnosis, classification and ligamentoplasty procedures):

    • Type I is a sprain injury of the AC ligament. There is no complete tear and both AC and CC ligaments are intact.
    • Type II is a tear of the AC ligament but not of the CC ligaments.
    • Type III involves tears of both the AC and CC ligaments, with 25% to 100% displacement of the clavicle compared with that on the contralateral side.
    • Type IV is when both the AC and CC ligaments are torn and there is posterior displacement of the distal clavicle into the trapezius fascia.
    • Type V involves the AC and CC ligaments and both the origin of the deltoid and insertion of the trapezius tearing, causing extreme instability of the AC joint. It is a complex injury where the deltotrapezial fascia is stripped from its attachment and displacement of the clavicle is more than three times the diameter of its distal part. The CC distance is increased to 100% to 300%.
    • Type VI injuries are the result of inferior displacement of the distal clavicle into the subcoracoid position.

    Frequently Asked Questions About the AC Joint and Shoulder Adduction Tests:

    1. How accurate is the shoulder adduction test?
      1. A shoulder adduction test is a non-invasive tool that people can use to help get a sense of where pain is coming from. It is not meant to formally diagnose any specific condition, so accuracy depends mostly on pinpointing the origin point of pain and then taking the correct steps.
    2. What should you do if a shoulder adduction test causes pain?
      1. If you perform a shoulder adduction test and find that you have pain at or around the AC joint, the next steps would be to identify how much pain you are in and make a decision to see a doctor or treat the symptoms yourself. However, if treating your AC joint pain with OTC pain medications, ice, and rest does not help within a few days, see a doctor.
    3. What AC joint conditions does a positive shoulder adduction test implicate?
      1. A positive shoulder adduction test does not implicate a specific condition. However, common injuries and conditions that may cause your test to be positive include arthritis, sprains, torn ligaments, or a dislocated joint.

    If you or someone you love has suffered an AC joint injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Surgical Needle Sizes

    Posted by Orthopaedic Specialists

    Key Takeaways:

    • Steroid injections will hurt less if given with a 25 gauge needle.
    • The larger the gauge size of a needle, the thinner the diameter of the needle.
    • Corticosteroids are not particularly viscous injections, so pain-management doctors can normally use thinner needles for them.

    When it comes to surgical needles, like most other medical equipment, there are different sizes. The most common sizes range from 16-27 gauge, which is the unit of measurement used for needle thickness. The diameter of a needle gets smaller as the gauge number increases. So, a lower gauge will be a thicker needle, and a higher gauge will be thinner. Additionally, needles will vary in length, usually from .375″ – 3.5″ (Abdul Karim, Medsitis).

    Surgical Needle Size and Uses

    16-18 Gauge Needles

    These needles are on the thicker side of the scale. Insertion may be painful, and a large vessel is required. They are often used for IV infusions:

    • in adults and adolescents
    • of viscous fluids
    • of a large volume
    • at rapid infusion rates

    19-20 Gauge Needles

    These needles are slightly thinner, but still may be painful upon insertion and require a large vessel. They are normally as large of a needle as doctors will use for intramuscular injections (IMs), but will rarely be used for them. They are most commonly used for IV infusions:

    • in adults
    • of blood products and other viscous fluids

    21 Gauge Needle

    These needles wobble on the scale. They are the thinnest of the “thick needles” but are the thickest of the “thin needles.” Common uses for 21 gauge needles are:

    • in IV injections or infusions for most ages
    • for intramuscular injections

    22-23 Gauge Needles

    These needles are thin enough that a large vessel isn’t required for use. They are suitable for small or fragile veins, but insertion through tough skin may be difficult. Infusion control devices may be required. Uses for 22-23 gauge needles are for:

    • IV infusions in all ages, including infants, toddlers, and the elderly
    • IV infusions of non-viscous fluids
    • IV infusions at a slow to moderate infusion rate
    • Intramuscular injections

    24-27 Gauge Needles

    The final group of commonly used needles are 24-27 gauge. They are very useful for small veins, but insertion through tough skin may be difficult and infusion control devices may be required. Common uses include:

    • IV infusions in all ages, including infants, toddlers, and the elderly
    • IV infusions of non-viscous fluids
    • IV infusions at a slow to moderate infusion rate
    • Subcutaneous (SC) injections
    • Intradermal (ID) injections

    Surgical Needles and Cortisone Injections

    One of the most common uses of surgical needles in orthopaedics is for cortisone shots, or injecting corticosteroids. We use corticosteroids to help manage pain and inflammation. They help mitigate the symptoms of several different chronic conditions, like rheumatoid arthritis, bursitis, gout, back pain, osteoarthritis, tendonitis, and more.

    Injection sites are normally located at the joints, so ankles, elbows, hips, knees, shoulders, spines, and wrists are all common sites. To help our patients be comfortable, we normally use the thinner 24-27 gauge needles.

    Frequently Asked Questions About Corticosteroid Shots

    1. How long do corticosteroid shots take to work?
      1. Depending on the area of the injection, it may take anywhere from a few hours up to a week to start feeling the effects of a corticosteroid shot.
    2. Are corticosteroid shots painful?
      1. If using the correctly sized needle, the injection shouldn’t hurt too much. However, there is a risk of a flare period a day as your body might react with an inflammatory response before the medication starts working (Hospital of Special Surgery).
    3. How long do corticosteroid shots last?
      1. The average amount that pain relief from cortisone shots last is around 3-6 months. However, it can be dependent on several factors, including:
        1. How long the condition has been present
        2. Which part of the body is receiving the injection
        3. What condition is being treated

    If you or someone you love has suffered an injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Do You Need Knee Replacement Surgery for Severe Arthritis of the Knee?

    Posted by Orthopaedic Specialists

    Severe Arthritis of the knee Unloader Knee Brace

    Key Takeaways:

    • Even if arthritis looks bad on an x-ray, you don’t always need a total knee replacement surgery.
    • Knee replacement should be a last resort after all conservative treatments fail to help manage pain.
    • Common conservative treatments include hyaluronic acid and cortisone injections, physical therapy, and topical anti-inflammatory medications.

    When we see x-rays, it can be easy to draw the worst conclusions if a condition like arthritis looks bad on a scan. Severe arthritis, also known as late-stage, grade 4, or bone-on-bone arthritis, is one of these. Arthritis affects over 53 million US adults (CDC), and one of the treatments available is a total knee replacement. If you see bone-on-bone arthritis in your x-ray scans, does that mean you need a knee replacement surgery?

    The good news is that the answer is: not always!

    When Do You Need a Knee Replacement?

    While x-rays can help us to diagnose and track conditions like arthritis, treatment is not so straightforward as other medical issues like a broken arm. Treating chronic conditions like arthritis depend a lot on how the patient feels, not what their x-ray looks like.

    If someone breaks their arms, and it shows up on an x-ray, then there is a process to heal it. Arthritis cannot be healed, only managed. And, the pain that should be managed is the pain that the patient feels, not whatever an x-ray shows, necessarily. If a patient is doing well with conservative treatments, surgery should not be recommended lightly, if at all.

    Knee replacement surgery should only be a last resort, when nothing else works. If the patient has done all they can and still finds their daily activities to be interrupted by pain from arthritis, then knee replacement might be the next step.

    Non-Surgical Treatments for Severe Arthritis of the Knee

    Conservative, or non-surgical, treatments for severe arthritis of the knee are aimed at mitigating symptoms, not curing the condition. Arthritis is not a condition that can be cured. At Orthopaedic Specialists, our most common non-surgical treatments for arthritis include:

    Hyaluronic Acid Injections

    Hyaluronic acid is a naturally occurring fluid in your body that cushions your joints and fuels your skin, eyes, and connective tissues. Arthritis can cause it to deteriorate. Injections can replace that deteriorating fluid and add supplementary lubrication to your joints to help with pain and movement.

    Cortisone Shots

    Cortisone shots, or corticosteroid injections, are anti-inflammatory medications that are injected directly into arthritic or painful areas of your body. Because some forms of arthritis, like rheumatoid arthritis, are caused by an inflammatory response in your body, this injection can help mitigate pain in 2-5 days.

    Physical Therapy

    Many people might not realize that physical therapy isn’t only for injury rehabilitation. Seeing a specialist who knows about body movement and mechanics can help you learn how to move with less pain. Engaging the muscles around joints can strengthen them and help take some of the load off of the afflicted joint.

    Daily Exercise

    In addition to physical therapy, daily exercise works to help in the same way. Strengthening your body helps to reallocate how you bear weight. Muscles are just as important as joints, and play a huge part in keeping them safe. Low-impact activities like riding a spin bike, walking, swimming, and yoga are all recommended exercises for knee pain.

    Unloader Knee Brace

    An unloader knee brace can help you resume activities that may otherwise be too painful to do with severe knee arthritis. It provides levels of compression, stabilization, and weight redistribution to help unload the side of your knee that is affected by arthritis. There are a few types of unloader braces. You should consult with your doctor to discuss which type would be best for your pain.

    Topical Anti-inflammatory Gel

    Topical anti-inflammatory medications come as creams or gels that are applied to the skin around painful joints. The medication then soaks into the skin. Because of this, topical anti-inflammatory medications are best used on joints close to the skin, like the knees, hands, and wrists. Common medications you’ll see are Diclofenac sodium (Pennsaid, Voltaren) and Triamcinolone (Kenalog, Triderm).

    Frequently Asked Questions About Knee Replacement Surgery

    1. How long does it take to recover from knee replacement surgery?
      1. Recovery time will depend on factors like age, health, and rehabilitation adherence. However, most patients go home the day or the day after their surgery, regain mobility by three months, and recover fully within a year (Penn Medicine).
    2. How long will a knee replacement last?
      1. A knee replacement can last up to 20 or 30 years if taken care of properly. Those who are more active may wear their replacement out faster.
    3. What is the difference between a total knee replacement and a partial knee replacement?
      1. The knee joint comprises three areas: medial, lateral, and patella. In a partial knee replacement, a surgeon will replace one or two of these areas. In a total knee replacement, they will replace all three areas.

    If you or someone you love suffers from severe arthritis of the knee in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Patient of the Month: Michelle Durham

    Posted by Orthopaedic Specialists

    Meet this month’s patient in the spotlight, Michelle Durham!

    Michelle Durham Louisville, KY

    If there is one thing to know about our patient of the month, Michelle Durham, it is that she is the dictionary definition of resilient.

    Michelle has been playing sports since she was a child, including 6 during her years at Sacred Heart High School, and was fortunate enough to have the opportunity to attend the University of Montevello in Alabama for her talents in volleyball. When she graduated, though, she sought out different opportunities. Along with lifting weights that landed her in the bodybuilding business, in the early 2000s, Michelle found an opportunity in the form of a semi-professional women’s tackle football team, for which Dr. Grossfeld was the team doctor for.

     Michelle Durham Bodybuilder Louisville KY

    From Active to Injured

    Michelle has a long history of being active, but that also comes with a long history of injuries. She has been seeing Dr. Grossfeld since she injured her meniscus before her first season with her football team. But, since then, she has incurred a number of injuries, including:

    • An injured rotator cuff
    • Two torn ACLs
    • Injured elbow ligaments
    • A shoulder surgery

    Every time Michelle needed to see a doctor, she sought out Dr. Grossfeld.

    “One of the things that I love about Dr. Grossfeld is that she is a straight-shooter. She doesn’t sugarcoat things and gets straight to the point. I like that she speaks your language and isn’t uptight about how she interacts with you,” Michelle says.

    With a shoulder surgery and elbow rehabilitation also in her past and cortisone injections in her knee now, Michelle feels that Dr. Grossfeld has saved her a lot of pain and movement over the years. “With I can squat again, and my leg feels functional again, instead of just dead weight. I really appreciate Dr. Grossfeld, not only as a doctor, but also as a good human being that I would consider a friend.”

    Michelle’s Continued Battle

    Michelle Durham as a Yard Worker for Jack Harlow's family

    At 57 years old, Michelle hasn’t let her injuries stop her from living the life she loves. She might not be tackling anyone on the turf anymore but, with the help of Dr. Grossfeld and cortisone injections in her knee, she is able to tackle yard work for her long-time friends, the Harlows. She loves going to support the different professional sports teams that call Louisville home, especially Louisville Cardinals sports, Racing Louisville, and Louisville City FC, where she sometimes plays a different role than just spectator.

    As a semi-retired employee of the Louisville Water Company, she loves her role as their de facto mascot at events around Louisville. If you see their sentient glass of water, Tapper, know that Michelle is probably under the costume, giving her favorite character life.

    Michelle Durham as Tapper Louisville Water Company

    However, what makes Michelle even more of a rockstar is that, after having been in remission for breast cancer for 6 years, she is now fighting metastatic breast cancer in the lung. She still hasn’t let that dull her spark, though, and we really admire the grit and spirit that she continually shows every day.

    Michelle Durham Breast Cancer Survivor Louisville Cardinals Basketball Game

    We appreciate you, Michelle!

    If you or someone you love has suffered an injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Who Should Get an ACL Reconstruction Surgery?

    Posted by Orthopaedic Specialists

    ACL Reconstruction Surgery

    Key Takeaways:

    • People who are active, or whose knee gives out on them as they perform regular activities like walking should consider an ACL reconstruction surgery.
    • People who are not active and don’t experience any knee symptoms or people with advanced knee arthritis do not need to get an ACL reconstruction surgery.
    • If your knee regularly gives out, there is a higher risk of injury to the meniscus and the knee cartilage.

    If you have been diagnosed with a torn ACL, you might be wondering: what’s next? Both conservative treatments and surgical reconstruction are available for most who tear their ACL. But, there are factors that might affect which recovery path you take.

    What is the ACL?

    The ACL, or anterior collateral ligament, is a ligament in the middle of the knee. Most ACL injuries result from twisting, sudden stops or changes in direction, jumping, and landing. The symptoms of a torn ACL are:

    • A popping sound when the injury occurs
    • Knee pain, specifically on the outside of the knee
    • Knee swelling
    • Knee instability

    ACL tears often limit the range of back-and-forth motion of the knee. Fully straightening the knee is particularly painful. These tears can be a grade 1, 2, or 3, depending on how severe the tear is.

    Grade 1 is a mild sprain. Grade 2 is a partial tear. Grade 3 is a complete tear.

    Who Should Get an ACL Reconstruction Surgery?

    When surgically treating a torn ACL, it must be a reconstruction surgery, not a repair. Reconstruction surgery entails “making” a new ACL from a graft of replacement tissue. This tissue usually comes from a portion of the patient’s own iliotibial band, hamstring, quadriceps or patellar tendon (Hospital of Special Surgery). Recovery can take up to a year or more.

    Surgery is only recommended if:

    • The patient is young.
    • The patient experience lasting pain and instability in their knee.
    • The patient finds their knee giving out during normal activities like walking, which threatens the other ligaments in the knee.
    • The patient is very active, or regularly participates in twisting motions, jumping, or changing directions.
    • It is a grade 3 tear.

    Who Should NOT Get an ACL Reconstruction Surgery?

    ACL reconstruction surgery is not for everyone. Surgery presents risks like infection, anesthetic complications, worsened joint stiffness, nerve damage, or ongoing pain. For these reasons, some people might decide themselves that they do not want surgery. Surgery is NOT recommended for:

    • Patients with advanced or early-onset arthritis in their knee, which contraindicates ACL reconstruction surgery.
    • Patients that are not particularly active and do not experience pain or instability.
    • Patients with a Grade 1 sprain.

    Frequently Asked Questions About ACL Reconstruction Surgery

    1. How long does the surgery take?
      1. This surgery usually lasts 60–90 minutes, depending on complexity and whether other repairs like meniscus surgery are performed at the same time.
    2. Is ACL reconstruction painful?
      1. During the surgery, you will be placed under general anesthesia. Post-operative discomfort is common but manageable with pain medication, ice therapy, elevation, and early controlled movement. Pain typically improves within the first 1–2 weeks.
    3. Will I regain full strength in my knee after an ACL reconstruction surgery?
      1. While there is a chance that the reconstruction will fail, most patients regain near-normal strength and function with proper rehabilitation. However, returning to competitive sports too early greatly increases the risk of re-injury. Don’t be hasty!

    If you or someone you love has suffered an ACL injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Can You Cure Osteoarthritis VS Osteoporosis?

    Posted by Orthopaedic Specialists

    Osteoarthritis vs osteoporosis

    Key Takeaways:

    • Osteoarthritis is an active, or progressive, disease that gets worse with time and cannot be cured.
    • Osteoporosis is a curable disease.
    • To treat osteoporosis, patients will use a combination of additional vitamins, weight-bearing exercises, and prescription medication in some cases.

    Osteoporosis and osteoarthritis are two conditions that patients may get mixed-up about. Both are having to do with the bones, as denoted by the shared “osteo-” prefix. However, these conditions are very different from each other. One of the biggest differences is that one is curable, and one is not.

    Progressive vs Non-Progressive Conditions

    When a condition is progressive, it means that you cannot reverse or cure it. Osteoarthritis, which is when the cartilage around the joints and ends of bones wears away, is one of these conditions. Because it cannot be reversed, treatment focuses on slowing the progression of the condition and managing symptoms instead of eliminating them altogether.

    On the other hand, non-progressive conditions are reversable. Osteoporosis, or the softening of the bones, is an example of a non-progressive condition, despite the fact that the symptoms can worsen if the condition is left untreated.

    What are the Symptoms, Treatments, and Risk Factors for Osteoarthritis?

    Osteoarthritis usually presents symptoms in the knees, hips, hands, and spine. These can include:

    • Joint pain that worsens with activity
    • Stiffness (especially in the morning or after inactivity)
    • Swelling around the joint
    • Reduced flexibility and range of motion
    • Grinding or clicking sensation
    • Bone spurs in advanced stages

    Since it is a progressive disease, treatment focuses on managing symptoms, not curing osteoarthritis. Most of these methods are non-medicinal lifestyle changes like losing weight, implementing weight-bearing exercises into your routine, and monitoring your diet for inflammatory trigger foods.

    Factors that increase the risk of osteoarthritis are:

    • Age
    • Hormonal shifts like menopause
    • Obesity
    • Joint Injuries
    • Genetics
    • Repeated joint stress
    • Sex assigned at birth

    What are the Symptoms, Treatments, and Risk Factors for Osteoporosis?

    Osteoporosis is a silent disease, meaning that it doesn’t show many symptoms. In the case of osteoporosis, many people don’t know that they have the condition until they experience a break or fracture due to brittle bones, most commonly in the hips, wrist, or spine. However, other symptoms may include:

    • Back pain
    • Loss of height
    • Stooped posture, also known as kyphosis

    Treatment of osteoporosis focuses on strengthening bones, muscles, and slowing bone loss. Focusing on a diet rich in vitamin D and calcium, as well as implementing weight-bearing exercises, strength training, and balance training to reduce fall risks into routines are common treatments. Medication could be used in some cases. Regular DEXA scans, or bone density tests, are usually also recommended to track progress and risk.

    Factors that increase the risk of osteoporosis are (Northwell Phelps Hospital):

    • Age
    • Sex assigned at birth
    • Genetics
    • Hormonal shifts like menopause
    • Ethnicity (White or Asian Descent)
    • Smoking
    • Alcohol use
    • Sedentary lifestyle
    • Pre-existing medical conditions

    FAQs About Osteoarthritis and Osteoporosis

    1. Does weather really affect osteoarthritis? Many people report that cold, damp weather worsens joint stiffness or discomfort. While research findings are mixed, changes in barometric pressure may affect joint tissues, which could explain why some individuals feel worse before rain or during colder months.
    2. Can young people get osteoarthritis? Yes. Although it’s more common after age 50, younger individuals can develop it, especially after sports injuries (like ACL tears), joint fractures, repetitive occupational strain, or congenital joint abnormalities.
    3. Is osteoarthritis only caused by “wear and tear”? No. While wear and tear contributes, osteoarthritis is now understood as a whole-joint disease involving cartilage, bone, inflammation, and biochemical processes.
    4. Is osteoporosis only a women’s disease? No. While post-menopausal women are at highest risk due to hormonal changes, men can also develop osteoporosis and suffer fractures, especially if they are over 70.
    5. How early should bone density be checked? Screening is generally recommended for women at 65+, for men at 70+, and for younger adults with heightened risk factors like family history, steroid use, early menopause, or low body weight.

    If you or someone you love suffers from a bone-related condition like osteoarthritis or osteoporosis in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Disc Herniation vs Lumbar Stenosis

    Posted by Orthopaedic Specialists

    Disc herniation Model

    Key Takeaways:

    • Identifying both where pain originates from and where it is spreading to can help diagnose underlying conditions.
    • If more than 50% of pain is felt going down the leg, disc herniation may be the cause.
    • If more than 50% of pain is felt in the lower back, lumbar stenosis may be the cause.

    Pain from injuries or conditions are sometimes local to one area of the body. However, sometimes it can also spread to connected limbs, especially if the pain originates in the back. Being able to identify those extraneous pain spots can help to diagnose the underlying condition. A good example of this is disc herniation vs lumbar stenosis.

    Both of these conditions can cause pain in the lower back and/or legs. But, as a general rule, if more than 50% of pain is felt going down the leg, it’s more likely to be disc herniation. If more than 50% of the pain remains localized to the lower back, it’s more likely to be lumbar stenosis.

    Overview of Disc Herniation

    Disc herniation can also be known as a slipped disc, ruptured disc, or bulging disc. It is characterized by one or more of the discs that exist between spinal vertebrae bulging out and pressing on the spinal nerves, which causes pain.

    Causes of disc herniation: A herniated disc can be caused by several factors. Unfortunately, not all of them are preventable. Age, genetics, lifestyle factors such as obesity and smoking, and repetitive overuse can all contribute to disc herniation (Ohio State University Wexner Medical Center).

    Symptoms of disc herniation: Lower back disc herniation, or lumbar herniation, symptoms include nerve pain in your leg, also known as sciatica, numbness, tingling, or weakness

    Treatment of disc herniation: Usually, conservative treatment like lifestyle changes, bed rest, heat, and over-the-counter pain medications can make a big difference. If the pain is insistent or limits your ability to complete day-to-day activities after trying conservative treatments, physical therapy, corticosteroid injections, or prescription pain medication may be implemented. Surgical treatments are rare and only a last resort (Harvard Health Publishing).

    Other Possible Conditions That Cause Leg Pain

    The sciatic nerve runs from the spine down the legs, which is why some back issues translate to leg pain. Disc herniation isn’t the only condition that can cause sciatic pain, though. Other common reasons that you may feel pain along your sciatic nerve are:

    • Cauda equina
    • Degenerative disk disease
    • Foraminal stenosis
    • Osteoarthritis
    • Pregnancy
    • Tumors, cysts or other growths

    Overview of Lumbar Stenosis

    Lumbar stenosis is a more specific diagnosis of the condition spinal stenosis, which can affect several different parts of your spine, not only the lumbar region. It is characterized by the narrowing of space within your spine, which puts pressure on the spinal cord and spinal nerves.

    Causes of lumbar stenosis: Osteoarthritis is the #1 cause of lumbar stenosis. However, age, genetics, prior injury or surgery, tumors, preexisting health conditions and diseases, and other forms of arthritis can contribute to risk (Harvard Health Publishing).

    Symptoms of lumbar stenosis: Lumbar stenosis can cause back pain and sciatica pain, but most of the pain is felt in the back. Other symptoms include numbing, tingling, cramping in the back and legs, foot drop, and erectile dysfunction (John Hopkins Medicine).

    Treatment of lumbar stenosis: Except in emergencies, most cases of lumbar stenosis do not result in surgery. Lifestyle changes, physical therapy, and medicines like NSAIDS or steroid injections are more common treatments.

    Other Possible Conditions That Cause Lower Back Pain

    • Pregnancy
    • Spondylolisthesis
    • Facet Arthritis
    • Annular tear

    FAQs about Disc Herniation

    1. How long does it take to recover from disc herniation? Recovery time depends on the severity of the herniation, but most cases resolve between 6-12 weeks.
    2. When do I need to see a doctor for disc herniation? You should see a doctor right away if you experience loss of bladder or bowel control, numbness in the groin, an inability to walk, or extreme weakness in the legs.
    3. Can I exercise with a herniated disc? Yes, but gentle exercises that strength your core and posture will be the best for long-term pain management. Exercises that involve heavy lifting, deep bending, extreme torquing of the back, or spinal impact can make pain worse and should be avoided.

    If you or someone you love suffers from nerve pain in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Reverse Shoulder Replacement vs Shoulder Replacement

    Posted by Orthopaedic Specialists

    Reverse Shoulder Replacement Surgery vs Traditional Shoulder Replacement Surgery

    Key Takeaways:

    • Traditional shoulder replacement surgery is done for patients with shoulder arthritis who have an intact rotator cuff.
    • Reverse shoulder replacement surgery is done for patients with shoulder arthritis who do not have an intact rotator cuff.
    • In a shoulder replacement surgery, the glenoid sphere is connected directly to the humeral shaft whereas in a reverse shoulder replacement, the glenoid sphere is connected to a glenoid, and then the humeral shaft.

    Reverse shoulder replacement and traditional shoulder replacement offer shoulder pain relief for many patients. In fact, more than 100,000 people in the United States choose shoulder replacement surgery each year (Yale Medicine).

    Shoulder pain often starts when arthritis damages joint cartilage or when the rotator cuff weakens. The shoulder is a ball-and-socket joint that depends on smooth cartilage and strong muscles. When cartilage wears away, movement becomes painful and restricted. Rotator cuff damage further limits strength and stability. These problems affect many adults, especially those over age 60, athletes, and manual workers.

    If possible, non-surgical care always comes first. Physical therapy can improve strength and flexibility, while medications and injections can reduce inflammation and pain. However, these options sometimes stop working or don’t work at all for certain conditions.

    After non-surgical options run out, surgery then becomes the recommended next step.

    What are the Key Differences Between Shoulder Replacement Types?

    Choosing the right surgery depends on joint damage and rotator cuff health. Traditional shoulder replacement copies natural anatomy. The artificial ball attaches to the upper arm bone, and the socket attaches to the shoulder blade. This option works best when the rotator cuff functions well.

    Reverse shoulder replacement changes the joint structure. The ball attaches to the shoulder blade, then the socket attaches to the upper arm bone. This design allows the deltoid muscle to power arm movement. Reverse shoulder replacement works well when the rotator cuff is torn or nonfunctional.

    Common conditions treated with reverse shoulder replacement include:

    • Chronic rotator cuff tears
    • Severe shoulder arthritis with weakness
    • Rheumatoid arthritis or inflammatory joint disease
    • Complex fractures
    • Failed previous shoulder surgery

    Many patients with these conditions regain overhead motion within weeks.

    What to Expect From Shoulder Replacement Surgery

    Both surgeries usually take less than two hours, and most patients go home the same day or after one night.

    Procedure: Surgeons often use 3D imaging to plan precise implant placement. Additionally, muscle-sparing techniques help protect surrounding tissue for the best results.

    Pain Control: Pain control includes general anesthesia and nerve blocks. These methods work to reduce discomfort and limit opioid use so that patients don’t need to worry about developing a reliance on them.

    Recovery: Recovery starts with light daily activities combined with guided rehabilitation. Physical therapy usually lasts about 12 weeks, and most patients reach overhead by three months.

    How Long Will My Shoulder Replacement Implant Last?

    Modern shoulder implants last several years. Over 90% still function well after ten years, especially now that surgeons use durable materials like titanium and polyethylene. New options include pyrocarbon components and patient-specific implants, which further advance the fit, movement, and longevity.

    FAQs About Shoulder Replacement Surgery

    1. What makes reverse shoulder replacement different from traditional shoulder replacement?
      It reverses the joint structure and uses the deltoid muscle instead of the rotator cuff.
    2. Who benefits most from reverse shoulder replacement?
      Patients with severe rotator cuff damage or limited shoulder mobility benefit most.
    3. How long does recovery take?
      Most patients improve steadily over three to six months with physical therapy.
    4. How long do shoulder implants last?
      Most implants function well for at least ten years or longer.
    5. When should I consider surgery?
      Surgery may help when pain and stiffness prohibit your daily activities, even after conservative care.

    If you or someone you love has suffered a shoulder injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.