• Patient of the Month Miranda Der Ohanian

    Posted by Orthopaedic Specialists

    Meet this month’s patient in the spotlight (and newlywed) Miranda Der Ohanian!

    Miranda Der Ohanian

    When asked what it was like to plan a wedding during the pandemic, she said, “Planning a wedding during a pandemic meant throwing all our plans out the window. Thankfully my husband and I wanted a small wedding and our church was equipped to accommodate the number of guests for both the ceremony and reception with social distancing measures. With the help of family and friends we made all the decorations and made the main dishes for the reception. To support our local community we purchased sides from our favorite restaurants. We were thankful to have help from friends at church to serve food and keep everyone safe and healthy. In the end, we had a perfect day sharing our love before God and our family and friends.

    In addition to her wedding, Miranda recently endured several foot fractures.

    “Having never broken a bone before, living through 6 fractures in my foot has been a learning experience. The first few weeks I lived in a recliner. Most days were counted in hours from pain meds, ice, heat, repeat. The knee scooter was an unexpected blessing. I felt a measure of independence having it. After 8 weeks of no walking and using the scooter, I was afraid to try to put weight on my foot, but did it anyway. After another month, I started PT. Even now, walking and going up and down stairs is difficult for me. PT continues and movement is slowly returning. The worst part of recovery for me was not being able to help my family. We had just moved into a new house and instead of helping, my parents and (then) fiance now had to care for me AND unpack. I am blessed to have a loving family who helped me through this process and made our home beautiful in the process.”

    “Dr. Grossfeld and Angel have been instrumental in my recovery. Without their medical care and encouragement, I would not have been able to make such progress. They communicated all the possibilities to me along the way and kept me safe so I could heal properly. When it was time they allowed me to work, then add light pressure to my foot and eventually walk. They knew I was getting married and did what they could to make sure I would walk down the aisle to my husband and do so without a boot on my foot. I am eternally grateful to them for the progress I have made and that my bones have healed!”

    Pandemic Injuries

    Posted by Orthopaedic Specialists

    The pandemic has changed the way we live, work, and play. Because of this, there are a multitude of emerging injuries due to changes in how we move and position our bodies. Let’s take a look at some of the most common non-coronavirus related pandemic injuries.

    Injuries Working from Home

    Many workers have found themselves working from home due to the pandemic. Our homes may not be the best setups for office work, and this can lead to several different injuries. Makeshift home workspaces have replaced office setups. This can mean less supportive chairs, weird table heights, and more. Unsurprisingly, back pain, neck pain, and other musculoskeletal injuries are on the rise.

    For many people, un-ergonomic setups have led to overuse injuries as the pandemic stretches on. If your chair or table is an improper height, you may be looking up or down too much to view a computer screen or positioning your arms awkwardly while you write, type, or create.

    Additionally, you might find yourself moving around less during the day than you did at the office. This means longer stretches of time in the same position, which can be devastating if it’s a harmful one.

    To avoid issues, try your best to create an ergonomic setup. Avoid leaning over or hunching and try to have a table height that matches where your elbows fall. Try to use an office chair if you are sitting too. Also, try to work in some movement throughout the day to break up long bouts of being stationary.

    Exercising Too Much, Too Fast

    Being cooped up inside has led to an increase in people trying new (or long-forgotten) activities. While this can be a healthy decision, doing too much too quickly can easily lead to overuse injuries. Many people have experienced injuries from doing just that during the pandemic. As a general rule of thumb, always ease yourself into a new activity and gradually build up your intensity and time. Your body takes a long time to get used to the strain of a new activity. Too much new exercise too quickly can cause undue musculoskeletal stress. You should also focus on proper form early on- developing good form from the start can help you avoid overuse injuries.

    Trauma Injuries on the Rise

    There have also been more of certain exercise-related trauma injuries during the pandemic. For example, with fall sports starting up in many places, injuries are more common than usual. Some of this is linked to higher rates of sedentary behavior throughout the pandemic. Starting back up with exercise all at once puts our bodies at risk.

    Some are overuse injuries as alluded to before. Others, though, are trauma injuries like ankle sprains, torn ligaments, and fractures. This has some link to the same sedentary patterns: our bodies are less durable if we are not continuously performing an activity. Going back into a sport that involves quick movements, for example, can lead to a higher risk of ankle-related injuries. Muscles and tendons are not as developed, leading to less stability. With less stability comes that risk of injury.

    You should seek diagnosis and treatment from a qualified medical professional like Dr. Stacie Grossfeld if you are injured and want to get back to the activities you love. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

    Exercising Safely During the Pandemic

    Posted by Orthopaedic Specialists

    Keeping active during the pandemic is important for your health and wellness. It can be hard to evaluate what the level of risk is with different activities, though. You may have questions like: when do I need to wear a mask, what should I avoid doing, and is it safe to go to a gym? Let’s take a look at the facts to help you make the best decisions as you stay active.

    General Considerations During the Pandemic

    As with many decisions in the pandemic, a lot of your choices will have to be in context locally. Where you are has a huge impact on what sorts of activities are more or less safe. So, for starters, make sure you follow your state and local-level guidelines. If certain activities are temporarily halted, like going to a gym or gathering with a group to work out outside, heed the advice of your public health officials. If there’s a lot of disease spread in your area, you should be a bit more careful than if community transmission is largely under control where you live.

    Additionally, you should take your own risk level into account when deciding between different activities. For one thing, the risk of severe illness from the coronavirus increases with age. A 70 year old is at a higher risk for severe illness than a 20 year old. Additionally, any existing medical conditions may increase your risk. There are several conditions that increase risk, from heart conditions to cancer and obesity. See the CDC’s guidelines here for more information.

    With all of that in mind, you can start to think through your options. Now let’s take a look at some of the risks associated with different types of activity.

    Outside Activities

    In general, we know that interactions outside are much safer than those inside relative to coronavirus spread. Still, it’s important to think through how close you may need to get to other people outside during exercise. If you are running, walking, or cycling by yourself or with a small trusted group, that’s relatively low risk. However, a crowded walking path or park may be a higher risk if you have to be close to other people.

    Plus, if you are going to exercise with others, there is a level of risk associated if you get too close with them. Depending on the activity, you may be able to distance or wear a mask to mitigate risk. Keeping any group sizes as small as possible, distancing, only exercising with people you trust, and masking if needed can all help you keep yourself and others safe.

    Indoor Activities

    Being inside with others is higher risk compared to outside during the pandemic. In many places, indoor spaces like gyms and studios have reopened with many precautions in place. You should consider the layout and precautions for the space you may exercise in. For example, some fitness businesses have been able to keep windows open, increase airflow, enforce good distancing, and require mask-wearing. If these precautions are in place, they create a safer space for exercising.

    To conclude, any decision you make about exercising around others is very contextual during the pandemic. Your own risk factors, disease spread in your community, and the specifics of where and how you will be exercising around others all come into play. There is no one size fits all answer here- just make sure you take everything into account as you decide what’s best for you.

    You should seek diagnosis and treatment from a qualified medical professional like Dr. Stacie Grossfeld if you are injured and want to get back to the activities you love. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

    Broken Bone Versus Fracture: What is the Difference?

    Posted by Stacie Grossfeld

    Broken Bone Versus Fracture

    A broken bone versus a fracture: what is the difference?https://orthoinfo.aaos.org/en/diseases–conditions/fractures-broken-bones/ They both mean the same thing. You will probably hear doctors or health care providers use the word fracture more often than broken bone. https://louisvillebones.com/

    For instance, different types of fractures or broken bones occur based on the degree of injury.

    Stress fractures

    Stress fractures are typically not seen on plain x-rays. They are best visualized on MRI scan. A stress fracture will show up on an MRI as a black line . In addition, a stress fracture will have fluid surrounding the fracture site on MRI. First of all , a plain xray is obtained in the doctor’s office . Secondly , if the fracture is not seen a MRI will be ordered. A stress fracture is typically from repetitive use and not a single traumatic event.

    Education to show a stress reaction of a bone on a MRI scan

    The image reveals a stress fracture in a calcaneous . The white arrow shows the stress fracture. The yellow circle surrounds the region of bone edema . Which is bleeding or swelling in the bone. The red circle is normal bone and normal appearance on a MRI scan.

    Stress Reaction

    Stress reaction is a pre stress fracture. Therefore a MRI is also needed to visualize the pathology. A stress reaction is never seen on plain x-ray. In addition, stress reaction typically occurs from repetitive use.

    Hairline Fracture

    A hairline fracture is seen on plain x-ray. It is a simple line that can sometimes be difficult to identify .

    Educational purpose to show a hairline fracture

    The black arrow points to the hairline fracture in a tibia. The yellow circle outlines the location .

    Occult Fracture

    You cannot see an occult fracture on plain x-ray. This is typically from a traumatic event. In other words, if an occult fracture is suspected we treat it like it is broken. On the other hand, if you want to know for sure,  an MRI scan will show the occult fracture.  MRI is very sensitive when it comes to fracture identification.

    Compound or Open Fracture

    A compound or open fracture is when the bone has come through the skin. Therefore if the  trauma is so severe,  the bone tears through the skin at the time of the injury. A compound or open fracture is a surgical emergency. Surgery is used to clean out the wound and open fracture. In addition, there is a high infection rate with open or compound fractures.  Conversely,  a closed fracture is a broken bone that does not stick out through the skin.

    Comminuted Fracture

    A comminuted fracture has more than two pieces . These are typically high energy injuries. Because of this many comminuted fractures require surgery to realign the pieces of bone.

    Education to show a comminuted fracture of a tibia

    The image reveals a comminuted fracture of the tibia. The tibia is the shin bone. A comminuted fracture has more than two pieces

     

     

     

    Injection Options for Knee Osteoarthritis

    Posted by Stacie Grossfeld

     

    Injection Options for Knee Osteoarthritis

    Different injections therapy used to treat knee arthritis range from cortisone, hyaluronic acid to PRP (platelet rich plasma ) . The injections do not replace the damaged cartilage in the knee. However , the injections work well to control the symptoms of knee arthritis. Therefore, they reduce swelling, decrease stiffness, reduce giving way, improve range of motion and reduce pain.https://louisvillebones.com/

    To educate what an arthritis knee xray look like and the detail of bone on bone

    A knee x-ray that shows advanced knee arthritis. The red circle shows the bone on bone area on the x-ray where the advanced osteoarthritis is located.

    Cortisone Injections

    Cortisone is a short acting injectable anti inflammatory medication. Because of this, cortisone  typically reduces systems of knee arthritis up to and sometime beyond three months. The medication is giving via an injection in the office. Above all, it is a very simple and almost painless procedure . Therefore getting a cortisone injection in the knee feels like a flu shot. First of all, the provider easily identifies the knee joint and the injection is preformed. Because the knee joint is very superficial it is easy to inject. A provider that is familiar with knee injections doesn’t need ultrasound guidance to accurately inject a knee joint. Cortisone typically takes 2-5 days to start reducing symptoms.

    An image of different bottles of cortisone used for injection

    Cortisone is an injectable to treat arthritic knees.

    Hyaluronic Acid Injections

    Hyaluronic Acid also know as the chicken injection or the chicken fat injection. My practice uses Gel one when insurance covers. The single shot injection only requires on office visit. It. Sodium hyaluronate (hyaluronan) is the active ingredient . Hyaluronan comes Gel–One® comes from chicken combs and is highly purified. https://www.zimmerbiomet.com/medical-professionals/biologics/product/gel-one.htmlHyaluronan is  a natural substance in the human body and is present in very high amounts in healthy joints that do not have arthritis . This injection will typically  last 6 months to a year. Medicare covers 80% of the cost and the secondary insurance typically picks up the remaining 20%.

    An image of a syringe with Gel one an injection that is used to help reduce the symptoms of knee arthritis . The photo is for education purposes

    Gel-one is hyaluronic acid that is an injection used to reduce the symptoms of knee osteoarthritis

     

    PRP Injections

    PRP is Platelet Rich Plasma treats the symptoms of knee arthritis. It is experimental per some insurance carriers. Tricare , which is for active duty military personal will cover the cost. Most other carriers will not cover the cost. We use the patient’s own blood for the procedure . A centrifuge separates out the platelet rich plasma from the other blood components . After that, we inject the PRP into the knee joint. The whole process takes about 30 minutes. The PRP helps to reduce the inflammation in the arthritic knee joint . Therefore,  the patient has less symptoms .

    The Importance of Staying Active During the Pandemic

    Posted by Orthopaedic Specialists

    The coronavirus pandemic has left many of us feeling isolated, stressed, and anxious. The negative impacts of this isolation can be significant in relation to all aspects of health and wellness. Fortunately, by structuring some physical activity into your day, you can improve your health outlook significantly. Here are a few ways staying active during the pandemic is beneficial for your health and wellbeing.

    Known positive health outcomes

    Physical activity helps your body stay healthy in a variety of ways that are particularly important in relation to coronavirus. Regular activity can reduce blood pressure, help you manage weight, and reduce your risk of heart disease, type 2 diabetes, cancer, and stroke, just to name a few things. All of these are positive impacts in relation to coronavirus, as these conditions are risk factors that increase your susceptibility to the coronavirus.

    Focus on mental health: managing anxiety, stress, depression, and more

    We know that in general, physical activity has positive benefits for mental health as well. There are myriad potential benefits including stress reduction, better management of depressive symptoms, elevated self-esteem, better sleep, and anxiety management. It’s not just general positive benefits that are in play, though. There may be some benefits specifically in our pandemic context. Take the findings of one preliminary study from May 2020 that looked at behavior during initial lockdown in the United States in April. It found that people who remained active during weeks of sheltering in place were more mentally resilient and less depressed than people who decreased in activity level.

    Another intersection: substance use reduction

    Activity can help with another important phenomenon that intersects with mental health in this pandemic: substance abuse. We know that some activity can reduce the use of substances. This is crucial during our current pandemic. Take alcohol use for example. Alcohol sales increased 26% across the country between March and June (compared to last year), and many people have increased their alcohol consumption. A study from RTI in June surveyed 1,000 adults in the US about their daily alcohol intake in April compared to February. On average, respondents drank significantly more in April, with a higher incidence of excessive drinking as well. Women, unemployed people, parents, adults with mental health concerns, and Black people experienced some of the largest increases in consumption.

    Reducing substance use can help increase immunity, and can lead to more positive mental health outcomes. Activity can play a key role here, and is particularly important in our pandemic context.

    Ways to be active

    It can seem like physical activity is harder than usual with so many ongoing social distancing and lockdown protocols. In some ways, this is true. Fortunately, though, there are a lot of creative ways you can still be active either by yourself or with others. Many businesses are leaning into online delivery for fitness programs. Yoga, meditation, spin classes, and many other opportunities are more and more available for you to engage with online. You don’t have to be online access to be active either- getting outside in your neighborhood or creating an in-home training setup are great options too. Check out these great resources on staying active during the pandemic from the ACSM for more ideas.

    If you are trying to return to activity after being sick with the coronavirus, you should seek guidance and treatment from a qualified medical professional like Dr. Stacie Grossfeld. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

    What is Knee Arthritis ?

    Posted by Stacie Grossfeld

    What is Knee Arthritis?

    What is knee arthritis? Knee arthritis is when the cartilage in the knee breaks down. The articular cartilage in the knee protects the joint. Therefore in an arthritic knee, the cartilage slowly or in some cases quickly, detaches from the underling bones that make up the knee joint. Above all , arthritis occurs when the articular cartilage detaches or breaks off the ends of the bones. When this occurs the underlying bone is exposed.https://louisvillebones.com/

    To teach and show what knee osteoarthritis looks like during a knee arthroscopy

    The upper left image reveals an arthroscopic picture of knee with normal cartilage and no arthritis . The upper right hand image , within the area where the green dots are located reveal complete loss of articular cartilage demonstrating advanced arthritis . The lower images also reveal advanced arthritis.

    Who Gets Knee Arthritis ?

    Most arthritis is age related. However, another cause is obesity. Thirdly, genetics also plays a role. Arthritis may occur if there is a injury that damages the articular cartilage of the joint. This occurs when an intra articular fracture occurs.

    Obesity is a cause of osteoarthritis. This occurs because  abnormal forces are placed on the knee. For example , when you walk , every step places approximately three pound of force of the knee joint. Therefore, if you weigh 100 pounds , as you walk, 300 pounds of force is placed on the knee joint with every step. If you are 100 pounds overweight , you are placing 300 extra pounds of force on the knee joint with every step. Running also increases the force on the knee joint .

    How Do you Diagnosis ?

    The most common way to diagnosis  is with an x-ray.

    To educate what an arthritis knee xray look like and the detail of bone on bone

    A knee x-ray that shows advanced knee arthritis. The red circle shows the bone on bone area on the x-ray where the advanced osteoarthritis is located.

    An image that shows a normal knee Xray. The purpose is the educate

    The image shows a normal knee x-ray without evidence of arthritis. The x-ray has a normal joint space.

     

    Secondly, MRI is also a diagnostic tests. Thirdly, a knee scope can also diagnosis knee osteoarthritis . CT imaging is a less common way to diagnosis knee arthritis. A three phase bone scan can suggest arthritis.

    What are the Symptoms of Knee Osteoarthritis ?

    When the cartilage is missing the bones in the knee joint are not protected. This causes swelling, loss of range of motion, stiffness, giving way and pain. Not all of these symptoms may be present at the same time.

    Options for Treating

    There are many options for treating the symptoms . There are non-surgical and surgical options. Try non surgical options prior to surgery . Total knee replacement is the most common surgical treatment for advanced knee arthritis . However, 23 percent of the people that undergo knee replacement are not happy with the results.

    Non-surgical treatment for knee arthritis ; injection therapy, physical therapy , oral NSAIDS , bracing and supplements .

    Injection therapy ranges from cortisone injections to hyaluronic acid . Others injections include PRP as know as platelet rich plasma.

     

    An image of a syringe with Gel one an injection that is used to help reduce the symptoms of knee arthritis . The photo is for education purposes

    Gel-one is hyaluronic acid

    https://www.zimmerbiomet.com/medical-professionals/biologics/product/gel-one.html

     

     

    Returning to Exercise After Having Coronavirus

    Posted by Orthopaedic Specialists

    The coronavirus pandemic continues to evolve, as does our understanding of what the virus does to our bodies. There is emerging research that points to potential harm if you exercise while infected or too soon after being infected. Let’s take a look at the research.

    Difficulty returning to activity after having coronavirus

    One area we have some insight on is related to return to activity after having coronavirus. People can have a range of symptoms with varying severity, with some not even having any symptoms at all. However, anyone who has had coronavirus should be cautious when returning to activity after the initial infection. With over two million people in the United States who have recovered from the virus, there are plenty of reports of people experiencing difficulty returning to their previous level of activity. Shortness of breath, lingering fatigue, and chest tightness seem to stick around a long time.

    What’s the safest way to return to exercising?

    We are still learning a lot about the coronavirus and how it impacts us. As such, guidance continues to evolve. In general right now, doctors are recommending you take it slow when getting back into any exercise or activity after being infected. Listen to your body and don’t push it too much. In more severe cases, even more caution is required when getting active again.

    The Hospital for Special Surgery Sports Medicine Institute recently laid out some more specific guidelines for recreational athletes who had mild and moderate cases, based on what symptoms you experienced from coronavirus. These are subject to change, of course, as we learn more. They currently recommend the following:

    • If you had blood or hematologic symptoms: start with low-intensity exercise and limit sedentary behavior to reduce blood clot risk.
    • For respiratory symptoms: rest for at least a week after symptoms go away, and gradually return to activity thereafter. Monitor your breathing as you do so.
    • If you had cardiac symptoms: rest for two or three weeks after symptoms subside. If you had myocarditis (heart inflammation), wait at least three to six months before returning to an exercise routine.
    • For gastrointestinal symptoms: monitor your fluid and caloric intake while returning to activity.
    • If you had musculoskeletal symptoms: take a gradual approach when returning to activity.
    • If you had no symptoms: gradually return to activity if it has been at least a week without symptoms showing up. Return at 50% of activity level to start with, and then increase slowly from there.
    • To reiterate, these are evolving guidelines for recreational athletes who had mild or moderate symptoms. Take it slowly, and consult your doctor to make sure you are returning to activity safely.

    The importance of taking it slow

    Why is all of this so important? The coronavirus appears to often take a significant toll on our bodies, even if we have a mild or asymptomatic case. For example, a study of 100 people who had recently recovered from coronavirus showed some troubling trends related to heart health. After undergoing cardiac MRIs, 78 of the 100 participants showed structural changes to their hearts, and 60 of the 100 had myocarditis. None of the participants had severe cases of coronavirus- half had mild or moderate symptoms, and 18% were asymptomatic. None of the participants had any cardiac symptoms while they were ill. Unaddressed, myocarditis can cause significant complications, including sudden death in severe cases.

    This example goes to show how serious we are discovering the coronavirus’ impact to be. We are learning more and more each day. So, if you were sick and are itching to get back into your exercise regimen, take it easy and make sure you talk with your doctor.

    If you are trying to return to activity after being sick with the coronavirus, you should seek guidance and treatment from a qualified medical professional like Dr. Stacie Grossfeld. To schedule an appointment with Dr. Grossfeld, call Orthopaedic Specialists at 502-212-2663 today.

    ACL Treated with Hamstring Graft

    Posted by Stacie Grossfeld

    An ACL Tear Treated with a Hamstring Graft

    ACL tear needs to be reconstructed in most patients . People that are active in twisting and turning activities need an ACL https://orthoinfo.aaos.org/en/diseases–conditions/anterior-cruciate-ligament-acl-injuriesWe cannot suture the torn ACL back together. Therefore, the ACL must be reconstructed. I recommend the hamstring graft.  ACL tears reconstructed  with a hamstring graft is excellent. The hamstring graft is A strong graft. In addition, a hamstring ACL autograft , causes less pain at the time of surgery and has a smaller scar.  For example, other graft options include:  the central one third of the patellar tendon or a portion of the quad tendon. Most importantly, an autograft is used for ACL surgery. Similarly, autograft is tissue from your body. Graft selection is surgeon dependent . Because of these reasons, my first choice is the hamstring auto graft for ACL reconstruction surgery https://louisvillebones.com/

    ACL Auto Hamstring Grafts are the Strongest

    The autografts have the lowest re-rupture rate. In addition, allograft or a cadaver graft has the highest failure rate. Above all, is not recommend to use a cadaver graft for the first time ACL surgery . For instance, revision ACL surgery is commonly done with an allograft or cadaver graft.

    Dr. Stacie Grossfeld showing an ACL hamstring graft before it gets fashioned into an ACL auto hamstring graft

    Dr. Stacie Grossfeld is showing a hamstring from her patient, that is getting ready to be fashioned into a hamstring ACL graft . Autografts are a the strongest grafts with the lowest rate of re-rupture.

    The Hamstring Auto Graft

    An ACL tear treated with a hamstring graft gives great results. The hamstring graft has a cosmetic type and  small  incision. Secondly, obtaining the hamstring occurs with a tendon stripper. Thirdly, I then prep the graft on a device called a graft master. The next step involves, suturing  a device that attaches the graft to the femoral side of the ACL. The fixation of the graft to the tibia has many different hardware and device options. The fixation devices are surgeon dependent.

    Close up image of an ACL hamstring autograft

    Dr. Stacie Grossfeld has just harvested a hamstring graft . This is a close up image of an ACL hamstring autograft .

    The surgical procedure involves drilling one tunnel across the tribal and the femur. The surgical procedure takes about an hour to complete. The surgery is outpatient.

    Patient of the Month Sherry Hughes

    Posted by Orthopaedic Specialists

    Meet this month’s patient in the spotlight Sherry Hughes!

    Sherry Hughes
    Originally from Louisville, Sherry has been married for almost 49 years and has two grown and married daughters Ellen and Jane. In her spare time, she enjoys having the opportunity to care for her 4 grandchildren – 3 girls and 1 boy. “I love my role as “Grammy!”
    A graduate of the University of Louisville, Sherry followed her father’s footsteps by pursuing a career with South Central Bell. Now retired, Sherry has pursued several part-time jobs over the years, including Pottery Barn Kids and now at Hadley Pottery.
    “My passion for collecting all of my dinnerware first began while sitting in the bargain aisles and inspecting the remnants before I got married to very recently working in the retail store a few days a week now.”
    Recently, Dr Grossfeld helped Sherry through some painful episodes with her feet after an injury was misdiagnosed by another provider and she was recommended to the Orthopaedic Specialists. Luckily, since her treatment with Dr Grossfeld, Sherry’s discomfort has been kept to a minimum until her most recent shoulder injury.
    “This summer on June 1st, I tripped over our dog’s bed out on our deck and took a very ungraceful fall which caused my right shoulder to be dislocated.  I saw the doctor the following day and was given some pain medication and instructions on how to handle this new inconvenience. Since then I have seen Dr Grossfeld who prescribed physical therapy and also gave me a cortisone shot to alleviate the discomfort, especially while sleeping.  All of this has helped and the shoulder is improving!”