• Treatment for a Torn Achilles Tendon

    Posted by Stacie Grossfeld

    Treatment for a torn Achilles’ tendon is typically surgery. Surgery has been showing to increase the patient’s strength compared to non-surgical treatment. The risk of the tendon re-tearing after surgery is less. Patients’ power in the leg is greater when surgery is used to treat the torn Achilles. The non-surgerical treatment has a higher re-rupture rate and less chance of returning back to the strength of the affected leg.

    Who’s is a Poor Surgical Candidate for Achilles Tendon Repair Surgery?

    Poor surgical conditions for treatment of a torn Achilles’ tendon fall into two groups. These patients are diabetics and morbidity obese patients. Therefore these two groups have a much higher risk of infection and wound complications.  Because of this, as orthopaedic surgeons, we typically recommend treatment in a cast for the diabetic and morbidly obese patient.

    What is the Achilles Tendon?

    The Achilles’ tendon connects the calf muscle to the heel bone. Secondly, it is a very superficial tendon. In addition, the achilles tendon is easy to palpate and see. Inflammation can occur in the tendon.

    Who Tears Their Achilles Tendon?

    Most commonly, men (85%) between the ages of 25-45 years old, tear their Achilles’ tendon. This most commonly occurs  while playing sports, as shown in this video. The typical story is the man is playing basketball or tennis. While playing,  they push off with their foot. In addition, they feel a pop. Because of injury, acute onset of pain occurs and its difficult to walk of the court or field  . Within hours the area of the Achilles’ tendon swells.

    Achilles Tendon Tear, Best treatment for Achilles Tendon Injury

    How the Achilles Tear Diagnosed?

    The most common way to diagnose an Achilles’ tendon tear is by physical examination. A defect in the tendon is felt by the healthcare provider. Placing the patient in a prone position makes it easiest to feel. The provider runs their finger down the tendon. There will be a palpable defect in the tendon.  Thompson test is a physical exam To diagnosis an Achilles’ tendon tear.  MRI scan is the best imaging study for documentation. See more info here.

    Achilles Tendon Surgery

    Achilles Tendon Surgery is performed as an outpatient procedure. The surgical procedure involves repairing the two ends of the torn tendon back together. There are many different techniques. The results are excellent in most patients. It takes 6-8 weeks for the tendon to heal. The rehab after the tendon to heal takes another 2-3 months. Above all, there is a very low re-rupture rate after surgery. Most patients will return back to the same types of sporting activities prior to the Achilles’ tendon tear.

    Preventing Overuse Injuries

    Posted by Orthopaedic Specialists

    Overuse injuries. They can stop you in your tracks and prevent you from moving your body the way you want to. Fortunately, there are a few things you can do to mitigate your chances of developing an overuse injury. Read along to find out some general rules you can follow to stay healthy.

    Gradual Increases

    One of the most common ways people can experience an overuse injury is by taking on too much too fast. It’s all too easy to get in over your head with a new type of exercise or activity. Doing too much of an unfamiliar exercise in a short timeframe puts a lot of stress on the body, in ways it is not adapted to yet. To avoid this, you should always gradually build up your intensity in and time spent on a new activity.

    Adequate rest time is an important practice here as well. Your body needs time to recover from hard work, particularly when it is not used to a certain type of work. When you start out with something new, it’s always smart to err on the side of caution and incorporate plenty of rest between workouts. Over time, as your body adapts, you may be able to adjust the amount of rest you take.

    Develop Good Form to Prevent Overuse Injuries

    Improper form is another way that overuse injuries can occur. If you are moving your body in an inefficient and improper way, it’s easy to overload specific muscles, tendons, and joints. Just like you should gradually build up your workload for a new exercise, you should slowly develop proper form right from the beginning. This way, as you practice more you will develop sustainable movement and help prevent chronic issues from arising.

    Get the Right Gear

    Depending on the activities you enjoy, you may need more or less specialized equipment to stay healthy. In general, though, the right gear can be a significant factor in your chance of developing an overuse injury. For instance, if you take up cycling and ride on a bike frame that’s too small for a while, you may develop a sore back, knees, and ankles, among other things. Or, if you’re taking up walking or running but do not have well-fitting supportive shoes, you might develop joint pain. Make sure you get the right fit for your activities- it can make a huge difference.

    Cross-training is Your Friend

    Regularly doing different types of activity that work different parts of your body is key to prevent overuse injuries. Variety is a powerful tool to help you both stay active and healthy. For example, if you love to run, you could consider cross-training with some cycling, core work, weightlifting, and climbing, just to name a few options. It can be tempting to simply put in more time with what you are really focused on. However, that can be a recipe for an overuse injury. When you cross-train, your body uses different muscle groups and is less likely to overload any one area.

    If you are injured and you are concerned that you may have an overuse injury, you should seek diagnosis 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.

    Injury Heat Versus Ice? What is the Best One to Use?

    Posted by Stacie Grossfeld

    What is the Best Way to Treat an Injury or Joint Pain: Heat Versus Ice?

    why does my knee hurt

    What is the best way to treat and injury or joint pain: heat versus ice? Ice versus heat is a common question I get asked as an orthopaedic surgeon on a a regular basis https://louisvillebones.com/Acute injuries that produce swelling are best treated with ice. Arthritis flare ups are best treated with heat. Ice can actually make an arthritic joint hurt more. The cold from the ice will cause the blood vessels to constrict. Therefore it will slow the inflammatory process down right after an injury occurs.

    How Long Should the Ice Be Applied ?

    There is a myth that ice should only be left on for 20 minutes at a time. Ice can be left on for hours. In other words, the longer it is on the better it will work. The only caution is make sure the ice does not have direct contact with the skin. Because of this,  it can in extreme cases , cause frost bite.

    What is the Best Way to Keep Ice on an Injuried Area?

    The best way to apply ice to an injured joint is with a motorized ice machine. There are different models on the market https://www.breg.com/products/cold-therapy/devices/cube-cold-therapy/. The ice machine is basically a ice cooler that plugs into the wall. First of all, the ice cooler plugs into the wall, the motor pushes the ice cold water into a rubber tube that attaches to a neoprene water proof wrap. The wrap is placed around the joint. Typically insurance companies will not over the cost of the unit. I highly recommend the ice machines to my patients that have had surgery. The ice machines can give you 9 hours of constant cold therapy. They can help reduce post operative pain medical use.

    However, if you prefer not to spend the money on a motorized ice machine there are other options. My favor is a   ziplock bag with ice and water. The water will allow greater contact and molding around the joint. Another good option is a bag of frozen peas or corn. Alway keep extra bags in the freezer for easy and quick trade outs.

    When Should Heat Be Used?

    What is the Best Way to Treat an Injury or Joint Pain: Heat Versus Ice? Heat typically works best for an osteoarthritic joint that has had a flare. Arthritis is a condition that will have symptoms that wax and wan. It cycles through inflammatory phases and non-inflammatory phases. People with arthritis can have very minimal symptoms when the arthritis is in a non-inflammatory phase. For example, arthritis  can enter an inflammatory phase from a change in weather, activity or an injury. In addition, heat can help reduce the symptoms of arthritis when it is is the inflammatory phase. Heat to the painful joint will increase blood flow. Natural anti-inflammatory factors are located  in the blood stream. Above all, these factors will help reduce the pain, swelling and stiffness.

     

    What is the Best Way to Apply Heat ?

    A moist heating pad is a great way to apply heat to a painful joint. A heating pad that emits a moist heat tends to give patients better relief https://www.bestadvisor.com/moist-heating-pads      For instance, if you do not own a heating pad there are homemade options. For example, a moist towel thrown in the microwave then placed in a ziplock bag is a way to apply heat to a painful joint.

    Why Does My Knee Hurt?

    Posted by Stacie Grossfeld

    Why Does My Knee Hurt?

    Why does my knee hurt? This is a common question I get asked as an orthopedic surgeon  https://louisvillebones.com. For instance, common causes of knee pain are osteoarthritis, cartilage tears or  ligament injury. Knee pain can start after an injury . In addition, it can also start after overuse.  Knee pain may occur with changes in the barometric pressure.

    The ACL is a Common Ligament Torn in Sports Injuries

    An injury to the knee can cause a ligament tear https://orthoinfo.aaos.org/en/diseases–conditions/anterior-cruciate-ligament-acl-injuries. The most common sports related ligament that gets injured is the ACL (anterior cruciate ligament). This is the ligament that provides stability to the knee joint. Therefore  it prevents the knee from shifting forward. ACL injuries occur while running with quick change of direction . In addition, another  mechanism of injury can occur with landing from a jump or a sudden stop. Tearing of the ACL causes  a pop felt in the knee . The knee swells within 12 hours of the injury.

    The Meniscus is the Most Common Cartilage Torn in the Knee

    There are two different meniscus in each knee joint. Each one acts as a shock absorber in the knee. In other words, they help to cushion the joint. The meniscus typically tears from an injury. In contrast, as we age they can tear with normal daily activity and no trauma. A torn meniscus causes a sharp localized pain in the knee joint with twisting activity. In addition, it also cause swelling. Painful range of motion can also be present with a meniscal tear.

     

    Osteoarthritis Can Cause Knee Pain

    Osteoarthitis is a process where the cartilage that covers the ends of the bones in a joint breaks down. For instance , some symptoms  of knee arthritis range from morning stiffness, swelling, pain, lose of range of motion, and angular deformities of the knee joint https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-knee/. Above all, genetic predisposition causes osteoarthritis . Arthritis in the knee occurs from being overweight. The natural aging process causes knee arthritis . Trauma such an intra-articular fracture can cause post -trauma arthritis in the knee joint. The pain quality associated with osteoarthritis tends to be a dull throbbing aching pain that can also occur at night .

    An Overview of Radial Tunnel Syndrome

    Posted by Orthopaedic Specialists

    Radial Tunnel Syndrome (RTS) is a chronic condition caused by pressure on the radial nerve. This nerve runs the entire length of the arm, starting in the armpit and running along the outside of the arm to the hand. At the elbow, the nerve goes through what is called the radial tunnel, a thin space made of bone, muscle, and tendon. RTS can be caused by compression on any point along the length of the radial nerve. However, it is named after injury to the radial tunnel itself, where it is especially common.

    Symptoms and Causes of Radial Tunnel Syndrome

    RTS is often difficult to diagnose due to its similarity in symptoms to more common conditions such as Tennis Elbow and Carpal Tunnel Syndrome. Generally, RTS is characterized by dull, aching pain in the elbow or top of forearm, but can sometimes reach down the forearm and into the back of the hand and wrist. Besides pain, symptoms include weakness, tenderness, and tingling. Patients often have difficulty flexing fingers or rotating the wrist, due to the discomfort. The pain often gets worse at night, too.

    Common causes of RTS are repetitive motion and overuse of the arm. Routine pushing, pulling, and twisting can cause RTS, often through sports or physically repetitive jobs like manufacturing. Direct injury such as bone fractures or tissue damage can also cause RTS. Some diseases can make you more susceptible to RTS, such as diabetes or low thyroid.

    Treatment and Recovery

    If diagnosed with Radial Tunnel Syndrome, there are many forms of treatment available. Treatment is normally based on the cause and the severity of the RTS.

    If the RTS is caused by repetitive motions, simply removing those motions from daily life can provide relief. Splinting the arm or wearing a wrist brace to limit motion can also be beneficial. To build strength, physical therapy exercises may be added and continued over time. To reduce discomfort, electrical stimulation, icing, and anti-inflammatory medications are often recommended. Corticosteroid injections are often considered as a non-invasive treatment option to relieve pressure on the radial nerve.

    Surgical Option

    When the above methods fail to work within 4-6 weeks, surgery is an option. Surgical treatments aim to release the points of pressure on the radial nerve by cutting the compressing tissues, often directly at the radial tunnel itself. A week after surgery, patients can begin recovery exercises and continue physical therapy for several months.

    Recovery depends on one’s effort to uphold treatment guidelines and prevent opportunity for re-injury. Additionally, maintaining arm strength and properly warming up before exercise decreases risk of RTS. Reducing repetitive activities long-term can lower the odds of re-injury. Regular exams are also recommended to ensure prevention.

    If you are injured and you are concerned that you may have radial tunnel syndrome, you should seek diagnosis 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.

    Patient of the Month Brie Postema

    Posted by Orthopaedic Specialists

    brie postemaMeet our patient of the month Brie Postema! Brie is currently a freshman at Virginia Tech and a member of their Division 1 volleyball team!

    For Brie, the toughest part of having to navigate a new school during a pandemic, has been the lack of information about the upcoming season. “I’ve dealt with it by staying positive, working hard, being flexible, and focusing on what I can control.”
    Her team’s training routine has been altered to prevent the spread of COVID and keep everyone safe. For the first two weeks, the team of 20 was divided into 3 small groups. “All our workouts and lifts were outside, and our times were staggered so each group went at a different time. For the last two weeks, our team was divided into 2 groups, and we moved some of our workouts to the indoor facilities.” As far as the upcoming volleyball season, Virginia Tech is planning on playing as of this publication. September 1st is the official start date of the season. “But we do not have any idea as to what that will look like yet,” says Brie.
    Dr. Grossfeld has had the pleasure of helping Brie Postema work through sports injuries and return to training quickly. “She has helped me with sprained ankles, a broken arm, and a dislocated thumb. Dr. Grossfeld also brought F45 to Louisville, and F45 has been my main workout since it opened in 2019, especially during COVID when my volleyball season got cancelled. I credit F45 for increasing my fitness level and helping prepare me to hit the ground running when I started working out at Virginia Tech on July 9th.”

    How to Prevent Osteoarthritis

    Posted by Orthopaedic Specialists

    Over 30 million Americans suffer from osteoarthritis (OA), or chronic joint damage. Due to long-term use, the rubbery cartilage that provides a buffer between bones wears down. Thus, bones at joints start to rub against each other, causing pain, inflammation and other symptoms. Osteoarthritis can happen all over the body and becomes increasingly degenerative with time. Despite its common occurrence rate in late middle-aged to elderly Americans, osteoarthritis is controllable through effort. Here’s all you need to know about preventing the condition.

    Physicality

    One of the biggest preventative measures is living a healthy lifestyle through exercise and diet. Regular exercise strengthens and supports joint health, preventing OA. Moderate aerobic activity of any sort can benefit joint function, from walking your dog to a cycling class. Strength and flexibility training are also great forms of alternative exercise to build fitness. However, over-activity can be damaging. Giving your body plenty of rest and recovery between workouts prevents long-term degeneration. Stretching, warming up, and icing are all good ideas for athletic people to reduce joint damage and risk of injury. Staying active your entire life is shown to greatly reduce the effects of OA.

    Highly physical jobs also come with increased risk. Careers such as construction or manufacturing that require repetitive movements often put stress on joints and cause long-term OA. Changing/mixing up your movements for comfort can help prevent joint damage. Highly stressful jobs or lack of sleep can also be risk factors for developing OA, as they impact many aspects of your mental and physical wellbeing.

    Diet and Osteoarthritis

    Diet also plays a part in preventing osteoarthritis. Maintaining a healthy diet with necessary vitamins, hydration and high fiber strengthens joints and lowers the risk of developing OA. Having excess bodyweight puts more strain on joints, leading to higher risk of developing OA. High blood sugar can release molecules that sensitize and put stress on cartilage. Diabetes also leads to cartilage loss.

    Genetics

    Osteoarthritis is believed to be a largely genetic condition, meaning that you’re more likely to suffer from it if your parents or grandparents had it. By being aware of your familial history, you can receive a more informed diagnosis and treatment plan. If you are aware of osteoarthritis in your family, it may also be a motivating factor to make more drastic lifestyle changes for prevention.

    Osteoarthritis and Gender

    Females have a much higher chance of developing osteoarthritis than males. This is due to a lack of estrogen following menopause. Estrogen increases bone growth, so without it many women in their 40s and 50s begin to experience symptoms of osteoarthritis, even mild. Also, the reduction in estrogen causes weight gain in many women, another key risk factor for developing OA. By taking measures to lead a healthy lifestyle, women can actively prevent OA.

    Conclusion

    Osteoarthritis has no cure but can be slowed by undertaking preventative activities, especially early in life. Consult your doctor for insight into your personal risk factors and measures you can take. Slightly changing one aspect of your lifestyle can have substantial long-term benefits.

    If you are worried that you or someone you love has Vitamin D deficiency, we can help! To contact an experienced double board certified orthopedic surgeon and sports medicine doctor serving patients across Kentucky and Southern Indiana, call Orthopaedic Specialists at 502-212-2663 to schedule an appointment with Dr. Stacie Grossfeld.

    The Benefits of Exercise for Your Immune System

    Posted by Orthopaedic Specialists

    Exercise has a lot of health benefits. There is significant data showing that it actually helps boost your immune system. Let’s take a look at the evidence.

    General Health Benefits of Exercise

    We know that regular exercise has a wide range of positive effects on the body. It helps lower blood pressure, improve cardiovascular health, protect against numerous diseases, and control body weight. Since it has such a significant impact on broad good health, it’s safe to say that it certainly has an indirect positive impact on immunity, as better health tends to lead to a healthier immune system.

    The wide range of benefits from regular exercise are so well-documented and important that there are clear public health guidelines related to exercise. The Physical Activity Guidelines for Americans recommends at least 150-300 minutes of moderate activity exercise or 75-150 minutes of vigorous activity exercise each week for substantial health benefits. Moderate activity includes many forms of daily movement like mowing your lawn, walking briskly, and light cycling. Vigorous activity includes running, hiking, and cycling at greater effort.

    Exercise and Your Immune System

    When it comes to the specific effects exercise has on immunity, there are a few things to know. In the short-term, exercise can help boost your immune defense. This is because exercising increases blood circulation, and subsequently increases the circulation of immune cells in your body. The immune boost, while temporary from acute exercise, builds over time. In fact, a study published in the British Journal of Sports Medicine in 2011 found that people who engaged in aerobic activity five or more days per week had about a 40% lower incidence of upper respiratory infections over a 12 week period than people who exercised one or fewer days per week.

    Additionally, exercise has an anti-inflammatory effect on the body. This is important for immunity, as it can help keep inflammation down. This prevents your immune system from getting into a state of over-inflammation that can hinder immune function.

    There is some evidence that overtraining or exercising too much too fast may hinder immune function. There doesn’t seem to be an exact measure for overdoing it. However, your body will tell you if you are overtraining. If you experience excessive fatigue, lower quality sleep, unusual muscle soreness, and/or unexplained mood swings, it could be a result of too much vigorous activity for your fitness level, and may negatively impact your immune system.

    Exercise and the Immune System: The Main Takeaway

    Overall, exercise has a profoundly positive impact on your immune system, as it does for your health in general. Particularly during a public health crisis like our current pandemic, exercise is critical. Regular exercise can help all aspects of your health as you cope with the unprecedented nature of the coronavirus.

    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.

    Patient of the Month Michele Chambers

    Posted by Orthopaedic Specialists

    Meet this month’s patient of the month Michele Chambers!

    michele chambers
    Originally from Ohio, Michele moved to New York City Manhattan in 1978 fresh out of college where she ran a flower and plant design business for over 25 years. “When I first moved to New York, I worked for probably half a dozen different short-term jobs. I had a bachelor’s degree in Fine Arts and an associates degree in floriculture. After working in a few flower shops, I went out on my own as a freelancer and then decided to start my own business.”
    In 2015, Michele moved to Louisville after her wife and business partner of 27 years died suddenly. A little over two years ago Michele married her second wife at the Cathedral on 4th Street, saying “It opened up a whole new dimension to living a happy life.”
    Currently Michele runs an antique toy shop. “I’ve always worked with my hands so I started buying vintage toys and working on them. This winter I opened up a vintage toy booth store at Fleur de Flea market. I love what I do! I love meeting people, talking about toys, selling toys, buying toys, it’s great fun!”
    Fun Fact: 80% of the toys Michele has in her shop she has repaired herself, often with dental tools!
    In 2014, Michele fell and broke her knee cap. In 2017, she discovered that the wires wrapped around her knee cap to help keep it in place had stretched and were growing into her ligaments. Michele immediately called Dr. Grossfeld who helped repair the problem. “Dr Grossfeld has helped me tremendously! I wouldn’t think of going to anyone else.”

    Vitamin D Deficiency: What You Need to Know

    Posted by Orthopaedic Specialists

    In recent years an increasing amount of attention has been given to the importance of vitamin D. Since vitamin D comes from exposure to the sun, and most full-time jobs require sitting at a desk all day, many people are deficient in this essential vitamin. In fact, a study documented in Medical Express found that around 80% of people who work a regular 9-5 job have a vitamin D deficiency. Furthermore, global lockdowns due to Covid-19 make the risk of Vitamin D deficiency even higher. This common affliction has few obvious symptoms at first but grows increasingly severe without treatment. Due to the chemical complexity of the vitamin, it plays roles throughout the entire body and is vital to maintaining good health.

    Vitamin D comes from UVB which is produced from the sun and absorbed by our skin. The energy is converted to vitamin D3. The D3 is carried to your liver, then kidneys, and is finally transformed into active vitamin D.

    What is a Vitamin D Deficiency?

    The obvious answer would be that a vitamin D deficiency occurs when your body does not receive enough of the “sunshine vitamin”. However, let’s dig a bit deeper. What symptoms can a vitamin D deficiency cause? Depending on the severity, it can cause a variety of symptoms including the following:

    • A weakened immune system (getting sick often)
    • Fatigue
    • Bone pain
    • Depression
    • Bone loss
    • Hair loss
    • Muscle and joint pain

    These symptoms vary from person to person and can have long-term implications that require medical treatment. For example, according to Harvard Medical School, one of the main roles of vitamin D is increasing the intestinal absorption of calcium which can aid in bone health. This means that conditions such as osteoporosis can be directly worsened by a vitamin D deficiency.

    Diagnosis and Treatment

    If you fear that you have a vitamin D deficiency, you should do is consult with your healthcare provider immediately. Even if you aren’t experiencing symptoms, it is recommended to check vitamin D levels during your annual blood test. The amount of daily vitamin D needed by a person varies depending on a number of factors including age, diet, health status, and UVB exposure. According to Medical News Today, a sufficient level is between 50-125 nmol/l.

    If you find that you have a deficiency, developing a plan with your healthcare provider is essential. Some modes of treatment include:

    • Taking daily or weekly supplements. Low-dose supplements can be bought over the counter, while higher doses may require a prescription.
    • Eating a diet rich in vitamin D. This includes foods such as fatty fish, egg yolks, seafood, etc.
    • Getting more exposure to natural sunlight.

    Even if you don’t have a deficiency, eating a well-balanced diet and spending 15-30 minutes outside at least three days a week is key. During long winter months with little sunlight, even more sun time is required. Many people don’t realize they are deficient until they receive a diagnosis. Anyone is susceptible to a vitamin D deficiency, but luckily treatment is available.

    If you are worried that you or someone you love has Vitamin D deficiency, we can help! To contact an experienced double board certified orthopedic surgeon and sports medicine doctor serving patients across Kentucky and Southern Indiana, call Orthopaedic Specialists at 502-212-2663 to schedule an appointment with Dr. Stacie Grossfeld.