• Knee Osteoarthritis: 3 Types of Recommended Exercise

    Posted by Stacie Grossfeld

    knee osteoarthritisKnee Osteoarthritis is a common type of arthritis that often occurs in older people, but can affect younger people, as well. Osteoarthritis of the knee is a degenerative disease that occurs when the flexible, sponge-like tissue between joints wears down. When this tissue wears down, joints no longer have padding between them and bone rubs on bone causing extreme pain. Osteoarthritis can occur in hands, the lower back area, wrists, hips, the neck, and in the knees. Quite a lot of people think that the only resolution to Knee Osteoarthritis is to take it easy on using the knees, but that is actually not true. Exercise in small, monitored doses is commonly recommended by doctors as the first approach to treating Knee Osteoarthritis.

    Dr. Stacie Grossfeld of Orthopaedic Specialists in Louisville, KY recommends three types of exercise to help patients with knee osteoarthritis. The three exercises that she recommends include: flexibility exercises, resistance exercises, and cardiovascular exercises. Follow along to learn more about each type of recommended exercise.

    Flexibility Exercises for Knee Osteoarthritis

    Flexibility exercises include stretching of the neck, upper body, lower body, and back, upper arm raises, and yoga. These types of exercise are very good for easing stiff joints and if the exercises focus on the knees then they will help relieve tension and pain caused by Knee Osteoarthritis. Dr. Stacie Grossfeld recommends that patients suffering from Knee Osteoarthritis complete their stretching exercises in the morning. When stretching is performed soon after waking up, your body is loosened up for the rest of the day and can make moving through it much easier. If joint stiffness is extremely bad in the morning, Dr. Grossfeld recommends performing flexibility exercises in warm bath water.

    Resistance Exercises for Knee Osteoarthritis

    Resistance exercises are important because not only do they help to ease arthritis pain, but they also help to build muscle back around the arthritic joints. Building muscle back helps to absorb shock in the knees and protects the joints from further injury. There are two types of resistance exercise: isometric and isotonic. Isometric exercises are typically the easier resistance exercise for patients with Knee Osteoarthritis because the joint angle and muscle length stay the same. Isometric exercises include: plans, push ups, wall sits, quads, and squat holds. In contrast, isotonic exercises maintain equal muscle tone while the muscle length shortens and lengthens during exercise. Isotonic exercise are mainly used to strengthen muscles and Dr. Grossfeld recommends sticking to isometric for improving joint flexibility.

    Cardiovascular Exercises for Knee Osteoarthritis

    Cardiovascular exercises use large groups of muscle while simultaneously raising your heart rate. Dr. Grossfeld highly recommends that patients with Knee Osteoarthritis looking to partake in cardio fitness try water aerobics or cycling – either indoor or outdoor. Both of these forms of cardiovascular exercise are highly effective, but low impact on joints. This ensures that patients will get the exercise they need to rebuild joint health and not hurt themselves further. Dr. Grossfeld also recommends visiting the website of The National Arthritis Foundation and using it as a resource for exercise DVDs.

    If exercise doesn’t seem to be helping, Dr. Grossfeld recommends a referral to a local physical therapist. Physical therapy can be helpful, especially for patients who like personalized instructions and the ability to focus on maintaining technique through fewer exercises. If you feel like you are suffering from Knee Osteoarthritis with older age or as a younger person, contact Orthopaedic Specialists today and make an appointment with Dr. Stacie Grossfeld.

    Top 10 Things You Should Know About Shoulder Dislocation Injuries

    Posted by Stacie Grossfeld

    Shoulder dislocation injuries can be painful and debilitating if one does not seek proper medical attention following the injury. For most, this injury occurs due to a traumatic event or during a sports game. In sports like football, hockey and basketball, shoulder dislocations are more prevalent due to the level of contact involved. While this injury is usually very simple to treat, it does require some healing time and possibly physical therapy or even surgery. If you dislocate your shoulder, immediately seek medical attention in order to readjust your arm and begin the healing process. Shoulder Dislocation Injuries

    Due to the fact that shoulder dislocations injuries are common in sports, Dr. Grossfeld has created a list of the top 10 facts patients should understand about shoulder dislocation injuries.

    Top 10 Facts About Shoulder Dislocation Injuries

    1. Most commonly occurs from a traumatic event.
    2. In patients under age 18 years and younger, males are more likely to undergo a shoulder dislocation compared to females.
    3. The highest rate of recurrent dislocation among younger athletes occurs in the 14 to 16 year old group.
    4. Athletes that are age between 10-13 years of age have a low risk of recurrent dislocation after initial shoulder dislocations.
    5. In general, patients younger than 20 years of age are at highest risk of sustaining a primarily anterior shoulder dislocation as well as to develop recurrent glenohumeral joint instability, i.e., recurrent dislocations.
    6. Patients that involve in contact sports are at highest risk for repeat discoloration after their initial dislocation.
    7. The most common dislocation is where the shoulder comes out the front, also known as an anterior dislocation. The most common dislocation among linebackers while playing American football is a posterior dislocation where the shoulder is dislocated out the back.
    8. Posterior dislocations are also associated with electrocution and seizures.
    9. For healthy patients, shoulder dislocations heal within 12 weeks of the injury.
    10. In summary, males, aged 20 years or less, in a contact sport are most likely to sustain a shoulder dislocation and sustain recurrent dislocations if returning back to the contact sport.

    If you think your shoulder is dislocated you should seek emergency medical treatment immediately. Dr. Grossfeld is available to help assess the injury, determine treatment options and help you get back out on the field, court or life!

    Concussions in the NFL: A Study in Review

    Posted by Stacie Grossfeld

    Concussions occur frequently in the NFLThe frequency in which concussions occur in the National Football League (NFL) is an issue of concern. In the March issue of the American Journal of Sports Medicine, authors Michael Clark, Breton Asken, et al. explore the relationship between concussions and the mechanisms by which they occur. The authors state that although there is a significant amount of information regarding the prevalence of concussions in the NFL, there isn’t as much about the manner of those occurrences.

    Below we compiled pertinent statistics mentioned in the AJSM article. Also other relevant found data, and the findings that Clark, Asken, et al. provide in their compelling conclusion.

    • From 1945 to 1999, there were 497 reported deaths directly resulting from football participation.
    • Between 1965 and 1974, the highest number of football related fatalities occurred; 36 out of the 167 brain injuries happened in 1968 alone. These fatalities led to a rule prohibiting dangerous tackling techniques. A safety standard for football helmets was also implemented by the National Operating Committee on Standards of Athletic Equipment.
    • Concussions are a concern in every contact sport.  However, football accounts for the highest proportion of these sports related injuries.
    • A concussion is reported almost every other game in the NFL.  Also a substantial portion of football concussions have historically been under-diagnosed and under-reported.
    • In 2007, and again in 2009, the NFL implemented a revised concussion management policy. Since 2009, several rule revisions have been introduced to address goals of player protection:
      • In 2010, 2011, and 2012, language regarding defenseless receivers was broadened. Helmet to helmet contact was strictly prohibited and violent players were subject to fines.
      • In 2011, the kickoff line was moved up by 5 yards to reduce the number kick returns. The running start was reduced by 5 yards in hopes of decreasing the force of collision.
      • In 2013, crown of the head impacts were also made illegal.
      • Starting in 2009, any player with the common symptoms of a concussion was to be withheld from play until fully asymptomatic and cleared by both his team physician and an independent neurologist consultant.
    • Starting in 2011, independent certified athletic trainers began to watch from the press box for possible injuries during the game.
    • In 2013, an NFL PA mandated that a neurotraumatologist consultant should be on the sideline of every game to evaluate players with suspected concussion. They required that the neurotramatologist be unaffiliated with the NFL to avoid any collusion.
    • More concussions happen in the second half of play. Fatigue most likely causes the players to neglect proper technique. The risk of concussion increases by about 24% in in the second half of a game.
    • Just up to 2013, nearly 5,000 former NFL players brought lawsuits against the NFL for concussion-related injuries.
    • One of the most common issues is chronic traumatic encephalopathy (CTE). CTE is a degenerative disease caused by repetitive blows to the head. Frequently CTE is found in professional football players as well as boxers, wrestlers, rugby players, and other participants in contact sports.
    • As of 2016, 90 out of 94 former NFL players that underwent an autopsy were diagnosed with CTE.

    CTE caused by concussionsIn an attempt to combat the frequency of concussions, the NFL implemented concussion management policies, and changed rules to place greater emphasis on penalizing players for aggressive behavior. However, there is still an urgent need to further strengthen policies and introduce concussion prevention and management programs.

    The AJSM authors conclude their article with: “In-game concussions in the NFL occurred through a diverse variety of mechanisms, surprisingly tended to be well-anticipated, and, also surprisingly, occurred with <10 yards of closing distance. The impacts causing concussion were broadly distributed over the helmet.” While there is more and more research regarding concussions in the NFL, there is obviously still much more to be done. Safety in sports is extremely important, and those who participate in contact sports should be extra vigilant. Learn more about safety and concussions in an earlier Orthopaedic specialists blog here.

    For more information about concussions or other sports injuries, Dr. Stacie Grossfeld and Orthopaedic Specialists are here to help. For an appointment with a board certified orthopedic surgeon and sports medicine doctor in Louisville, Kentucky, call 502-212-2663 today!

    Four Layers of The Hip & How They Factor Into Athletic Injuries

    Posted by Stacie Grossfeld

    A recent article from the April edition of American Academy of Orthopaedic Surgeons focused on how hip injuries can lead to long-term negative effects within the athletic community. To thoroughly explain how these injuries occur, the authors Dean Lynch, Aseesh Bedi, and Christopher Larson discuss the hip joint according to four separate layers.

    The Osseous Layer

    Hip Joint Injuries in Athletes

    The first layer involves the femur bone, the pelvis and the hip socket. Hip injuries to this layer often include:

    • Static overload

    • Impingement

    • Dynamic instability

    Another less common hip injury is femoroacetabular impingement, or FAI. FAI is a condition that limits range of motion in the hip because of improper bone formation during childhood. The decrease in movement within the hip causes abnormal stress to the sacroiliac joint, pubic symphysis, and lumbar spine. Cam impingement is one variety of FAI where the femoral head is not round and therefore cannot rotate smoothly inside the acetabulum. A bump forms on the edge of the femoral head that grinds the cartilage inside the acetabulum. Also, if an anterior cam effect is present it can limit internal rotation. So it may cause levering of the femoral head which could also create posterior hip subluxation or dislocation and resultant labral tearing and cartilage damage.

    The Capsuloligamentous Layer

    This layer includes:

    • Labrum

    • Joint capsule

    • Ligamentum/capular complex

    • Ligamentous teres

    Asymmetric wear of the chondral surfaces of the femoral head and/or the acetabulum may result from stress of the Osseous layer. The authors noted in their study that the structure of layer one produces an injury pattern for the second layer. For example, if an athlete has FAI and hip pain then a labral tear is highly likely.

    The Myotendinous Layer

    Layer three includes all the muscles around the pelvis, lumbosacral and pelvic floor regions. Dynamic impingement from a cam deformity in layer one causes increased strain on the SI joints, pubic symphysis and ischium. Secondary strain is placed on muscles attached around the hip joint. Due to the increased strain of the muscles and tendons it can cause tendinitis of enthesopathies.

    The Neurokinetic Layer

    Layer four includes the nerves within the hip area:

    • Thoracolumbosacral plexus

    • Lumbo pelvic tissues

    • Ilio inguinal

    • Iliohypogastric

    • Genitofemoral

    The Neurokinetic layer is responsible for the posture and the ability to sense stimuli of the pelvis over the femur.

    Athletic Hip Injuries

    Common hip injuries for athletes include:

    Adductor Strains

    Specific muscles contribute to adductor strains. These muscles include: the adductor longus, adductor magnus, adductor brevis, gracilis, obturator externus and pectineus. The adductor longus is the most common muscle to sustain injury. On average, a soccer player with a strained adductor longus will lose 2 weeks of play time, and will have a 18 percent recurrence rate. It is important to take time to heal because player who return to practice too quickly will likely worsen their injury.

    Four layers of hip injuries

    Osteitis pubis

    This condition occurs from overuse and stress of the pubis symphysis. It can cause lower abdominal pain secondary to stress and abnormal motion of the joint. The rectus abdomens elevates the pubic bone and the adductor tensions depress the pubic bone. An imbalance can cause a stress injury to the pubic bone. Chronic pubic symphysis can cause chronic sclerosis and widening of the symphysis. The best imaging for diagnosis of the condition is a MRI.

    Athletic pubalgia/core muscle injury

    Athletic pubalgia/core muscle injury is commonly referred to as a sports hernia. There is no actual hernia associated with the condition, rather it’s more of a weakening or tearing of the abdominal wall. The pain radiates into the groin and proximal adductors during sporting activities. Pain will be reproduced with a resisted setup, palliation over the pubis and the abdominal obliques and or rectus abdominus. Most imaging studies will be normal. On occasion an MRI can pick up a thinning of the abdominal wall or a tear called a cleft sign. Management is done through activity modification, NSAIDS and physical therapy. Sometimes injections will help diagnosis and treat the condition. Sports hernias rarely resolve without surgical intervention. Surgical procedures fall under three classes. These classes include: open repair with or without mesh, scope repair, pelvic floor repair with or without adductor release/repair and neurectomy.

    Dr. Stacie Grossfeld is a double board-certified orthopedic surgeon in Louisville, KY with a specialty in sports medicine. If you are suffering from hip pain that is not going away or you have injured your hip and need medical attention from an experienced orthopedic doctor, contact Dr. Grossfeld today by calling 502-212-2663.

    Shoulder Dislocation Research Discovers Age as Biggest Threat

    Posted by Stacie Grossfeld

    Shoulder Dislocation Research News

    Competitive sports and accidents may result in shoulder dislocation injuries for some individuals. This type of injury is treated through rehabilitation, immobility, and sometimes surgery. Shoulder dislocations can be debilitating, uncomfortable and painful. Dr. Grossfeld has some of the latest research on shoulder dislocations to help you better understand this injury and further complications.

    The researchers evaluated 100 patients who had undergone shoulder dislocations and subsequently underwent a Bankart reconstruction. A Bankart reconstruction is used to repair the capsule and labrum that gets torn in a shoulder dislocation. The researchers were interested in the amount of recurrent dislocations that occurred after surgery. They also wanted to know the percentage of patients that then developed osteoarthritis and the severity of the osteoarthritis.

    It is a well-known fact that once you have had a shoulder dislocation, your shoulder is at risk for two future problems: 1) Recurrent dislocation and, 2) The development of osteoarthritis within the shoulder joint. The trauma sustained at the time of the dislocation can damage the cartilage that involved the shoulder joint which can result in early onset osteoarthritis involving the shoulder.

    There is scientific documentation that after shoulder dislocations, arthritis can occur. A study completed in Munich, Germany, specifically looked at how many shoulder dislocation patients developed osteoarthritis post-injury.

    This research was published in the American Journal of Sports Medicine in May, 2015 by Dr. Plath. The researchers included 100 patients that were available for evaluation. They found that 31 percent of the patients show no evidence of osteoarthritis in the shoulder joint at 10 years of follow up. Twenty-one percent of the patients sustained a recurrent dislocation even after undergoing a shoulder stabilization procedure, and 31 percent of the shoulder showed no evidence of glenohumeral joint arthritis.

    The researchers divided up the patients that had osteoarthritis after the shoulder dislocation and after undergoing surgery. They found that 41 percent of the patients had mild osteoarthritis, 16 percent had moderate osteoarthritis, and 12 percent had severe osteoarthritic changes.

    In Conclusion

    In conclusion, the researchers stated that on average, 13 years after arthroscopic Bankart repair, osteoarthritic changes were a common finding. They noted that the age of the patient seemed more relevant for long term dislocation arthropathy than the treatment. They felt that avoiding preoperative dislocations is more important for the prevention of osteoarthritis than short term treatment.

    Older age and initial dislocation and surgery appear to be a particular shoulder osteoarthritis development. In fact, age at the time of surgery is the most consistent risk factor in the literature to date. The findings related to the normal aging process found that older patients have a higher incidence of arthritis than younger patients; however, primarily shoulder arthritis is a rare condition, and given the strong correlation of osteoarthritis and age within the study, it is evident that an older joint is more susceptible to damage at the time of the shoulder dislocation.

    We also know that if you are over age 60 and you have a shoulder dislocation, 80 percent of the time there is a full thickness rotator cuff tear that occurs secondary to the injury.

    The number of dislocations before Bankart repair correlated with the grade of the dislocation osteoarthritis. This implies that regardless of surgery, the extent of the trauma likely decides the fate of the long-term joint injury/degeneration.

    If you have suffered a shoulder dislocation in the past and are suffering from osteoarthritis, we can help. Call Dr. Stacie Grossfeld at 502-212-2663 today or visit Orthopaedic Specialists in Louisville, KY to seek medical care.

    Are There Benefits in Undergoing ACL Reconstruction After 60?

    Posted by Stacie Grossfeld

    ACL reconstructionACL stands for Anterior Cruciate Ligament and this part of the human body runs between the femur and the tibia. It is one of a pair of cruciate ligaments in the human knee. The other is the Posterior Cruciate Ligament which is located deeper within the knee joint. When an ACL is injured, or torn, it is due to the ligament being overstretched. Most often, ACL injuries occur as a result of a sudden stop or twisting movement. The most common form of repair for a torn ACL is a complete ACL reconstruction. More often than not, the reconstruction is done by autograft and arthroscopically. Despite the repair tissue coming from the same body in which the injury has occurred and the invasiveness of the surgery being minimal, recovery time is set at anywhere between one to two years before a patient can return to normal sports activity.

    When Dr. Stacie Grossfeld was training, the idea of performing an ACL reconstruction on a patient over the age of 60 was unheard of. In the past, ACL reconstructions were only offered to patients who were much younger. This was in part due to the extensive recovery time. Over the years, Dr. Grossfeld has found that patients in their 60s who have remained active and show no signs of knee arthritis do benefit from ACL reconstruction. This is especially true in regards to patients that live very active lifestyles. The benefits of undergoing ACL reconstruction are evident when observing patients who are over the age of 60 and have undergone the surgery.

    In March of 2017, an article was published in the American Journal of Sports Medicine by authors Dr. Toanen, et al. This group of researchers conducted a study and observed patients who had ACL injuries. All patients were over the age of 60 and athletic with no signs of knee arthritis. These patients underwent ACL reconstruction and their recovery was observed by the group of researchers responsible for the article. What they found was that these patients benefited greatly from the reconstructive surgery. Not only were they able to return to their normal level of activities including: twisting, turning, jumping, and running; they also had no increased incidence of arthritis two years post reconstruction.

    Based on these finding, the ground of researchers led by Dr. Toanen concluded that regardless of your age, ACL reconstruction is the best choice for repairing a torn ACL. Age is a factor that should in no way be considered when discussing options for reparation of a torn ACL. Other medical research papers and articles have been published in the past that reinforce Dr. Toanen’s team’s findings.

    In December of 2014 a study was done on the long-term outcomes after ACL reconstruction in patients 60 years and older. This team of doctors, led by Dr. Champ L Baker, found that all 13 patients within their study who underwent ACL reconstruction regained their full range of motion and made complete returns to their sports or exercise of choice. This led to the conclusion that “patients aged 60 years or older have good to excellent outcomes with ACL reconstruction and should not be excluded from ACL reconstruction opportunities based on age alone.”

    So, Are There Benefits in Undergoing ACL Reconstruction After 60?

    In conclusion, yes, there are benefits that come with undergoing ACL reconstruction after the age of 60. Benefits include complete return of mobility, the ability to return to daily sports activity, and the lack of increase in incidence of arthritis. Furthermore, age should not be considered when deciding if a patient is eligible for an ACL reconstruction. If a patient is active, healthy, shows no signs of arthritis in the afflicted knee, and is willing to undergo ACL reconstruction, they should be considered a candidate for the surgery.

    If you are 60 years old or over and an active adult who has suffered from a tear in an ACL, contact Dr. Stacie Grossfeld at Orthopaedic Specialists, PLLC in Louisville, KY. Dr. Grossfeld has been routinely performing ACL reconstruction surgeries for over 10 years. She is constantly staying up-to-date on the latest research findings surrounding ACL reconstruction. If you still have questions about ACL reconstruction for patients over the age of 60, call 502-212-2663 and make an appointment today.

    Loving Your Shoulders: 5 Shoulder Strengthening Exercises that Benefit Shoulder Health

    Posted by Stacie Grossfeld

    shoulder strengthening exercisesThis July, Orthopaedic Specialists is raising awareness about shoulder health through blog posts. These posts will focus on medical research regarding shoulder injuries as well as shoulder strengthening exercises and tips. If you struggle with pain and tightness in your shoulders that prevents you from living your life to the fullest, follow along for five exercises that are clinically proven to increase shoulder strength and benefit shoulder health.

    The human shoulder consists of three bones: the clavicle (more commonly called the collarbone), the scapula (shoulder blade), and the humerus (upper arm bone), plus multiple ligaments, tendons, and muscles. These bones, tendons, ligaments, and muscles all work together as a ball and socket joint. This construction makes the shoulder one of the most mobile joints in the body. This wide range of motion makes the shoulder unstable and prone to injuries including dislocations. The proneness to injury the shoulder is subjected to means it’s pertinent to integrate shoulder strengthening exercises into your life. It isn’t necessary to have a gym membership, or even at-home gym equipment, in order to practice the following five exercises and improve your shoulder health.

    5 Shoulder Strengthening Exercises that Benefit Shoulder Health

    1. The Body Saw

    While it sounds more like a magic trick than an exercise, the Body Saw benefits your core and scapular function. It can be performed on hardwood flooring or carpeting; however, if you do it on hard flooring than you need to wear socks and if you are working out on carpeting, you will need to place your feet on furniture moving discs. You will start out in the standard plank position and retract your shoulder blades together, so that your upper back is straightened out and not rounded. Push your body from your hands while maintaining a planking position. You will want your feet to slide about half of a foot back from the starting position. Pull your body back into the starting position and repeat for the number of reps that you choose to do.

    2. “Empty the Can”

    While it may sound more like a chore that you’d delegate to one of your children, this exercise is proven to work the muscles throughout your upper back and shoulders that are important in raising your arms above your head. It is recommended by Active.com to use a light weight when completing this exercise, but if you don’t have at-home weights then you can use anything from a bag of dry rice to a can of soup as a starting substitute.

    To complete this exercise, you will start with your feet set apart as wide as your hips with your knees relaxed and a weight in one hand with your thumb resting against your thigh. Lift your weighted arm up until it is in a 45 degree angle from your body and rotate your thumb to point down while raising your arm. This is where the motion gets its name – your movement should mimic pouring out a can. Continue to lift your arm until it is at shoulder height, hold, then move back to the starting position.

    3. The Classic: Push-Up

    The push-up is a great place to start if you are looking to strengthen your shoulders, but aren’t too savvy at exercising. This simple and straightforward exercise will also help you maintain shoulder strength over time. A push-up helps to strengthen multiple areas of your body including: your triceps, shoulders and chest and strengthens them all at the same time!

    Start by lying down on a mat and placing your hands where they are shoulder width apart. Get into a planking position and slowly bring your chest towards the ground using your upper body and arms. Lower your chest until it touches the ground and then push back up into the starting position. Repeat 10-20 times for 2-3 sets depending on your exercise experience.

    If you are working on building shoulder strength and are not experienced in exercising – you can also do push-ups with your knees on the ground. Just make sure that your back is straight and your buttocks is low to the ground, so you do not strain your back.

    4. Clasping Exercise

    This is an exercise that originated from a yoga pose and is an easy shoulder strengthening exercise to complete at home, at work, or in the gym. Additionally, if you are dealing with shoulder pain, this exercise will help to alleviate that pain quickly and naturally.

    To complete this exercise, start by standing up and clasping your hands behind your back. Inhale as you open up your chest and clasp your hands. Exhale as you bend forward at the waist, bringing your clasped hands up into the air. Hold this position for 4 seconds, and slightly pulse with your arms as you inhale again. Exhale and return to the standing position. Repeat for 10 reps and complete 2 or 3 sets of this exercise.

    It is recommended to complete this exercise in the morning or before bed depending on when your shoulders hurt. If you suffer from tight shoulders in the morning when you wake up, try this exercise out the night before. If your shoulders start to cause you discomfort midday, the morning may be a better time to complete this exercise.

    5. Shoulder Circles

    Another classic exercise that will take you back to middle school gym class and is a great shoulder strengthening exercise are shoulder circles. While it may be assumed that shoulder circles do not need explanation, it is important to complete this exercise correctly and avoid injury.

    Stand with your feet shoulder width apart and your knees slightly bent with your arms out and parallel to the ground. Instead of keeping your arms straight out, bend them slightly at the elbow. This helps to stave off fatigue and also concentrates the exercise on the shoulders. Once you are in this position, complete clockwise circles with your arms for 1 minute. Then reverse the direction and complete counter-clockwise circles for another minute. Repeat for 5-10 sets.

    If you want to increase the difficulty of the exercise, you can alternate standing on one leg for each set. This will include your core in the workout while you try to maintain balance.

    Shoulder strengthening exercises are not only important if you want to build and maintain shoulder strength. If you are recovering from a shoulder injury or shoulder surgery, shoulder strengthening exercises can benefit your recovery. As you progress in your exercise regimen, continue to encourage yourself and increase weights gradually in exercises where weights are involved. Before starting a workout regimen that involves shoulder strengthening exercises, consult your doctor. This is especially important if you are recovering from a shoulder injury or surgery.

    For More Information on Shoulder Strengthening Exercises

    Dr. Stacie Grossfeld is a double board-certified orthopedic surgeon in Louisville, KY with a specialty in sports medicine. She has successfully treated injured shoulders and performed shoulder surgeries for over twenty years. She commonly treats rotator cuff tears, dislocated shoulders, frozen shoulders, shoulder impingement syndrome, pitcher’s and swimmer’s shoulder injuries. Dr. Grossfeld also routinely performs rotator cuff repairs arthroscopically at both of her private practice locations. If you are suffering from shoulder pain that is not going away or you have injured your shoulder and need medical attention from an experienced orthopedic doctor, contact Dr. Grossfeld today by calling 502-212-2663.

    Lyme Disease Symptoms in Women

    Posted by Stacie Grossfeld

    lyme diseaseLyme disease is a bacterial infection that is transmitted by Ixodes ticks, more commonly known as deer ticks. These nymphal ticks are about the size of poppy seeds, yet they carry the dangerous Lyme disease in their bites. Ticks are thought of as insects, but they are actually arachnids that are related to scorpions and spiders. Deer ticks are found all over the United States and in more than 60 other countries. These ticks attach to one’s skin through questing and are able to feed for several days on one host. If left undisturbed, they are more likely to transmit Lyme disease and other pathogens into one’s bloodstream.

    The Center for Disease Control and Prevention has found that nearly 300,000 people are diagnosed with Lyme disease every year. It’s hard to believe, but that number is 1.5 times the amount of women diagnosed with breast cancer each year. And, that number is actually slightly higher, because many people are misdiagnosed with other similar diseases.

    Lyme disease has been called, “The Great Imitator,” because many of the symptoms are confused with conditions like fibromyalgia, multiple sclerosis and many other more common and easier to diagnose diseases. Lyme disease can become very serious if it is not diagnosed early and treated properly. Chronic lyme disease begins to affect organs and cause brain damage, heart problems as well as cognitive issues.  It is also very important to recognize symptoms of Lyme disease in small children or women that are pregnant as pregnant women have the ability to pass Lyme disease onto their child. Although it is not common, sometimes this transmission results in a stillbirth.

    Because this disease is so similar to other types of conditions, it is important to get all of the facts about symptoms. If you have been outside recently and begin to feel any of these symptoms, it is important that you seek medical attention. You can also use the symptom checker worksheet lymedisease.org has createdto help with your diagnosis.

    5 Symptoms of Lyme Disease

    1. Fever

      Most of the time Lyme disease begins with flu-like symptoms such as fever, chills, sweats, muscle aches, and nausea. If you begin to run a fever after being in wooded areas or after camping, you will want to take over the counter medication, like Tylenol, to lower your fever and be sure to drink plenty of water. If your symptoms do not go away within 72 hours, you will want to assess yourself for the following symptoms as they may be related to Lyme disease.

    2. Rash

      Most patients who are infected by this disease develop a rash in the shape of a bull’s eye. This rash usually occurs on areas of the body that were not clothed while being outdoors. You may notice an asymmetrical rash on your arms or legs, but a recent study looked at the connection between rashes and Lyme disease and found that about 27-80 percent of people develop a rash when diagnosed with Lyme disease, so this symptom may not apply to every case. If you are suffering from a fever, but cannot find a rash then look for the following symptoms.

    3. Joint Pain

      Lyme disease tends to cause joint pain and muscle weakness in the knees, elbows, wrists, and shoulders. If you begin to notice a new development of pain in any of your joints, you will want to apply ice to the area and contact your physician.

    4. Fatigue

      Many people are often misdiagnosed when it comes to Lyme disease because of the reported fatigue. This disease is capable of affecting any organ of the body. But because it can be widespread, symptoms of fatigue are often misdiagnosed as chronic fatigue syndrome and sometimes depression. If you are suffering from a fever, fatigue and a third symptom on this list, get in contact with a medical professional immediately.

    5. Bell’s Palsy

      As Lyme disease begins to affect other areas of the body it has the potential to affect one’s facial nerves. Bell’s Palsy is a paralysis or weakness in facial muscles on one side of the face. This may cause one’s face to droop and holds the rise of potentially losing sense of taste for anywhere from a few days to weeks.

    All of these symptoms are specific to Lyme disease as a whole. When the symptoms come in stages, it is sometimes difficult for physicians to diagnose it. If you experience any symptoms, it is important to monitor your health and seek medical guidance from a physician. If you are pregnant woman and feel that you have one or more of these symptoms of Lyme disease seek help as soon as possible before the disease is passed to the fetus.

    Prevention is key in protecting yourself from Lyme disease. Next time you are doing activities outdoors make sure that you are clothed properly and always check the surface of your skin once you return inside following a shower. It is always best to treat early symptoms of Lyme disease with importance. If you suspect you could have this disease, do not hesitate to speak with your physician. If you have any more questions about Lyme disease or ways to relieve joint pain, call Dr. Grossfeld’s office today at 502-212-2663.

    Does Your Uninjured Leg Weaken After ACL Surgery?

    Posted by Stacie Grossfeld

    Dr. Grossfeld wants her patients to stay informed on the latest research that becomes available. Many patients that come in needing an ACL repair surgery fear the possibility of weakening the uninjured leg while healing. This common concern has prompted researchers to analyze and study this issue.Leg Weakness in Uninjured Leg following ACL

    An excellent study published in the American Journal of Sports Medicine in December, 2015 specifically looked at the question, “Does the non-injured leg after an ACL injury and subsequently surgery become weak?”

    The researchers out of the University of Seoul, Korea, with the lead author of Dr. Chung, found that patients with ACL injuries of one leg also experienced significant weakness that occurs to the non-injured leg. Their conclusion of the study was in addition to rehabbing the injured leg, the non-injured leg must undergo rehab, too.

    What they found is that by 24 months after ACL reconstructions, the isokinetic extensor muscle strength and functional status of the contralateral leg fell, but both measurements improved significantly as the follow up time progressed. It is important to not only strengthen the surgical/injured knee with the ACL injury, but also the contralateral leg.

    For those that may be undergoing ACL surgeries in the future, remember that this is a process. This information has proven that it is not only important to strengthen the injured leg, but this will also be required for the uninjured leg as well. Try to not get discouraged during this rehabilitation journey. Because this process requires double rehabilitation, it may be slow, painful and difficult at some times. Just remember that this process will help get you back on your feet and possibly on the playing field or court!

    More Information

    For more information about treatment of ACL injuries and the latest research, check out more blog posts from Dr. Grossfeld. After reading up on this material, if you still have questions, comments or concerns, call 502-212-2663 to make an appointment with Dr. Grossfeld today!

    Lower Extremity Avulsion Fractures in the Pediatric and Adolescent Athlete: A Study in Review

    Posted by Stacie Grossfeld

    Avulsion Fracture

    An X-ray of a knee joint affected by an avulsion fracture where the ligament tore a part of the bone away from the knee.

    The April 2017 issue of the Journal of the American Academy of Orthopedic Surgeons features a compelling review article covering the topic of lower extremity avulsion fractures in pediatric and adolescent athletes. Drs. Jonathan Schiller, Steven DeFroda and Travis Blood discuss the effects of misdiagnosing lower extremity avulsion fractures. Avulsion fractures are more common in adolescents and happen when there is an injury to the bone in a place where a tendon or ligament is attached. The fracture causes the tendon or ligament to pull off a piece of bone.

    Types of Avulsion Fractures

    The JAAOS article discusses the most common places where the pediatric athlete will get avulsion fractures. The pediatric athlete has growth plates that are still open and attached to the tendon. Typically the growth plate is weak and when there is a traumatic event, the plate can often suffer an avulsion fracture. 

    The most common places where pediatric patients will have avulsion fractures are at the anterior superior iliac spine and the anterior inferior iliac spine along with the ischial tuberosity. It is extremely important for medical professionals to conduct a plain x-ray when physically examining a patient in this case. The physical examination could be consistent with a muscle strain or apophysitis.  Apophysitis tend to occur with overuse whereas an avulsion fracture tends to happen acutely. The athlete may describe a popping sensation at the time of the injury.

    Another avulsion fracture, tibial tubercle avulsion, is not very common, but requires immediate surgical fixation. A healthcare provider should be quite cognizant if their patient comes in with knee pain that could perhaps be the result of a tibial tubercle avulsion fracture.

    How to Treat Avulsion Fractures

    The most common way to diagnose an avulsion fracture is by x-ray. However, other injuries may require the use of a CT scan or MRI. CT imaging is more commonly used in the case of a tibial tubercle avulsion fracture. In general, treatment for this type of avulsion fracture is conservative unless there is a significant amount of displacement.

    Nonsurgical treatment is divided up into a five stage protocol, which consists of:

    1. Ice, rest, anti-inflammatories for the first week of the injury  
    2. From week one to week three, involves gentle passive range of motion and assisted partial weightbearing is performed
    3. Resistance training occurs
    4. Allows aggressive stretching and sport specific activity after one to two months
    5. Two months post injury when the athletes are returned back to sports without restriction

    Ischial Tuberosity

    The ischial tuberosity is the origin of the hamstring muscles which involve the long head of the biceps femoris, semitendinosus and semimembranosus. Avulsion fractures in this area are caused by a forceful flexion of the hip joint and extension at the knee. It typically takes place during sprinting or kicking. If the avulsion fracture is displaced more than 15 mm, surgery is recommended.

    Anterior Superior Iliac Spine 

    These fractures are secondary to increased force from the sartorius and tensor fascia lata. They both originate from the anterior superior iliac spine. Nonsurgical management is recommended except if displacement is greater than 2 cm. These typically occur as a result of sudden straining, twisting, such as in baseball, jumping, and sprinting.

    Anterior Inferior Iliac SpineAvulsion fracture of the spine

    AIIS fractures are secondary to an increased force from the rectus femoris.  AIIS injuries typically occur during forceful hip hyper-extension and knee flexion. Conservative treatment is recommended for these avulsion fractures unless displacement is greater than 2 cm.

    Pubic Synthesis and Iliac Crest 

    These avulsion fractures are rare and occur from increased activity or force from adductor tendons, which originate from the pubic synthesis. These tend to occur during kicking type activity.  An MRI scan is typically needed to facilitate a diagnosis in this area. The rectus abdominis muscles attached to the iliac crest and avulsion fractures can occur during forceful turning or lateral flexion of the area. If the fracture is greater than 3 cm of displacement, surgery would be recommended.

    Tibial Tubercle 

    These fractures occur with forceful contraction of the quadriceps. It is important to quickly diagnose this particular injury because nonsurgical treatment is not only ineffective, but can also cause the lower extremity to become dysfunctional. X-rays are sufficient to make the initial diagnosis, but CT scans are able to better classify the extent of the injury. Because of the strong contraction of the quadriceps causing fracture displacement, these injuries rarely heal without surgical intervention.

    Greater Trochanteric 

    Fractures of the hip are rare in the pediatric population and are typically encountered in obese patients. This type occurs with the hip in flexion and with external rotation. Nonsurgical treatment is recommended for all trochanteric fractures. Surgery should be considered if there was significant displacement at the site of the fracture greater than 2 cm.

    If you are feeling any significant pain in your joints, regardless of if you are an athlete or not, visit Dr. Stacie Grossfeld of Orthopaedic Specialists, PLLC in Louisville, KY. With the help of Dr. Grossfeld, you can prevent further damage to your ligaments, joints, and bones while starting a treatment plan to fix any existing damage. Contact Dr. Grossfeld here or by calling 502-212-2663 today!