• Pediatric ACL Injuries and Sports-Related Injuries

    Posted by Orthopaedic Specialists

    Pediatric ACL Injuries and sports-related injuries are a concern to parents, coaches, teachers, kids and physicians. As part of my work as a physician, I focus on trying to educate young athletes about injury prevention. For more information on ACL injury prevention, check out my recent video series.

    Preventing Pediatric ACL Injuries

    Louisville orthopedic and sports medicine physician Dr. Stacie Grossfeld is an expert at diagnosing and treating ACL injuries. Watch her new video series to learn more about ACL injuries and ACL injury prevention.

    Follow along for more information about the latest research on pediatric acl injuries and sports injuries published in the JBJS, by Dr. D.M. Kelly and colleagues in February 2017, titled: Pediatric ACL Injuries and Sports Related Injuries in the Young Adult Patient.

    Research Highlights on Pediatric ACL Injuries and Sports Injuries:

    • Overuse injuries in children and adolescents who compete in sports continues to be a serious issue.
    • High school athletes who specialize early reported more overuse injuries than those who did not.
    • Athletes in a large school were more likely to specialize in a single sport (over 8 months per year). They were also more likely to report more knee injuries and overuse injuries.
    • ACL injury prevention programs along with general sports injury prevention programs will reduce injury rates.
    • Girls are 1.6 times more likely to sustain an ACL tear than boys, based on the research.
    • The highest risk sports for ACL injuries are: soccer, football, basketball and lacrosse.
    • Participation in competitive sports significantly increases the risk of an ACL tear for youth.
    • Competitive female athletes carried 5 times the risk of tearing an ACL compared with their noncompetitive female counterparts.
    • Competitive male athletes carried a 4 times higher risk of sustaining an ACL injury compared to their non competitive counterparts.

    The risks associated with an ACL injury or sports injury for youth athletes are a serious concern. If you are a parent (more…)

    Dr. Stacie L. Grossfeld, Orthopedic Surgeon at Orthopaedic Specialists, Welcomes Spanish Speaking Patients to Her Office in Louisville, KY

    Posted by Orthopaedic Specialists

    Louisville, KY. March 8, 2017. Louisville orthopedic surgeon and sports medicine physician Dr. Stacie L Grossfeld is welcoming Spanish speaking orthopedic patients to her private medical practice Orthopaedic Specialists. In order to make this easier, Dr. Grossfeld recently hired staff member Ashley Milburn to join her team. Ms. Milburn, who is fluent in both English and Spanish, assists Spanish speaking orthopedic patients with communicating with the doctor, understanding doctor’s orders, translating paperwork and more.

    spanish speaking orthopedic

    Ashley Milburn (right) and Dr. Stacie Grossfeld stand in the Orthopaedic Specialists office. Dr. Grossfeld is excited to offer treatment to Spanish speakers in the Louisville area thanks to Ashley.

    Ashley Milburn graduated from ATA College in Louisville, Kentucky. She completed the Limited Medical Radiography with Medical Assisting program (LMRMA) with an impressive 4.0 grade point average. During her time as a student, she did an externship at Dr. Grossfeld’s medical practice, Orthopaedic Specialists. And when she finished her degree, Dr. Grossfeld invited her to join the team.

    Ms. Milburn’s Spanish Speaking Background

    Originally from Willisburg, Kentucky, Ms. Milburn grew up helping her family on a tobacco farm. During this time working with many Spanish-speaking farm employees, she became very interested in learning Spanish. Though she never received formal training, she is now a fluent Spanish speaker. She explains: “If you want to know what people are saying, you try hard to learn.” Realizing the many benefits of speaking both English and Spanish, Ms. Milburn is also raising her three children to be bilingual.

    Along with working as a translator for Spanish speaking orthopedic patients, Milburn is currently working on translating all of the paperwork at Orthopaedic Specialists into Spanish including: surgery packets, pre-op and post-op instructions, sign in slips, new patient paperwork, and worker’s compensation paperwork.

    Right now, Orthopaedic Specialist is accepting all new patients including those who are Spanish speakers.

    To read more, click here and get access to the entire press release.

    What is Symphysis Pubis Dysfunction?

    Posted by Orthopaedic Specialists

    symphysis pubis dysfunctionDuring pregnancy, a lot of different things happen to women’s bodies that don’t occur at any other time in their life and that men will never experience. One occurrence is that the pelvic bone alignment tends to become relaxed, and even stretchy, due to a hormone called Relaxin.

    A woman’s body releases this hormone so that their ligaments lose rigidity to prepare for childbirth. While this is a completely normal thing to happen to someone that is expecting a child, if it occurs too early on in the pregnancy, the symphysis pubis, or pelvic joint, becomes unstable and causes abnormal sensations and even pelvic pain. This is known as symphysis pubis dysfunction.

    This disorder is pretty common in pregnancies and experts have diagnosed symphysis pubis dysfunction (further referred to as SPD) in about one in every 300 pregnancies. More than 2 percent of women are affected by SPD, but it is misdiagnosed often.

    Signs and Symptoms of SPD:

    It is important for pregnant women to understand the difference between acute pain related to the birth of their child and pregnancy-related discomfort. The  pain that accompanies SPD is localized to the pubic area and can spread into the upper thighs and perineum. Typically the pain is worsened by physical activities such as walking, going up or down stairs, getting dressed, and sometimes even moving in bed.

    When SPD occurs, there is the small possibility that the joint could open up and gape apart. This is called diastasis symphysis pubis or symphysis separation. This tends to cause serious pain in the pelvis, groin, hips, and buttocks. In serious cases, SPD can make a vaginal delivery impossible and narrow down delivery options to only a Caesarean section.

    While pain from SPD can continue shortly after delivery, a woman’s body eventually stops producing Relaxin and their ligaments  return back to normal.

    Treatment Options:

    If you have never experienced this type of pain and are reading up on possible issues that could occur during pregnancy then it might be a good idea to seek medical guidance. Your physician can ease your mind and let you know that you and your child will be healthy and fine even if you do end up suffering from SPD. If you are experiencing this kind of pain currently and found this article researching pain relief for SPD then it’s time to find you that relief. Here are some easy ways you can help relieve the pain:

    • Rest

      Avoid doing any weight bearing activities or making any movement that isn’t completely necessary.

    • Do Kegels or Pelvic Tilts

      These do not require any heavy lifting or straining and help strengthen the muscles located around your pelvis and hips.

    • Ask for Pain Relief

      Consult your physician on safe pain relief medications to use during pregnancy that will help to alleviate the symptoms.

    • Try Wearing a Pelvic Support Belt

      You can find several of these belts online. While they tend to look like a corset, they work to move your pelvic bones back in place.

    A healthy pregnancy is extremely important for mothers and babies though not always in a mother’s control. If you are pregnant and notice any unusual discomfort, make sure you speak with your physician as soon as possible. Dr. Grossfeld wants all women to have happy and safe pregnancies. If you are experiencing unusual joint pain or symptoms related to symphysis pubis dysfunction, call 502-212-2663 to schedule a visit.

    Louisville Medical Doctors Present Posters at the 2017 Annual Meeting for the American Medical Society for Sports Medicine

    Posted by Orthopaedic Specialists

    Dr. Brown submitted a poster that focused on hip pain in an older adult which aligns nicely with his residency focus on geriatrics within UofL’s Department of Family & Geriatric Medicine.

    (PRLEAP.COM) March 1, 2017 – Louisville, KY – Louisville orthopedic surgeon and sports medicine physician Dr. Stacie Grossfeld of Orthopaedic Specialists PLLC collaborated with U of L medical school residents Drs. Steve Brown and Brent Bohlig to help facilitate their poster submissions to the 2017 American Medical Society for Sports Medicine Annual Meeting. The poster submissions were based on real-life case studies with two of Dr. Grossfeld’s patients.

    This year’s Annual Meeting held by the American Medical Society for Sports Medicine is being held in San Diego, CA. The two day session, which runs through the weekend of May 12th, is the 26th annual meeting held by the AMSSM. This year’s theme focuses on Medicine in Motion which applies directly to sports medicine – a focal point for both resident doctors and practicing physicians.

    Dr. Grossfeld, a double board certified orthopedic surgeon and sports medicine physician with a private medical practice in Louisville, Kentucky, enjoyed the opportunity to serve as mentor and adviser to Dr. Bohlig and Dr. Brown during their research and

    Dr. Bohlig (center) – a resident at UofL’s Dept. of Physical Medicine & Rehabilitation – focused his submission on proximal leg pain in one of Dr. Grossfeld’s patients who is a long distance runner.

    work on the poster submissions accepted at the 2017 AMSSM meetings.

    Abstracts are carefully selected through a very strict peer review process. The fact that this research was chosen among many qualified submissions underscores the fact that perhaps contrary to popular belief, even in private practice settings there are patients with interesting and unusual pathology that is noteworthy enough to be presented at a national meeting. Describing her involvement, Dr. Grossfeld explains: “I especially enjoyed this unique opportunity to work with medical residents in multiple medical fields.”

    Poster Submissions for the 2017 AMSSM by U of L Medical Residents

    Dr. Brent Bohlig is currently completing his residency through the Department of Physical Medicine and Rehabilitation. He is focusing on working in a family-centered family practice serving families and the elderly. Dr. Bohlig’s 2017 abstract submission focuses on proximal leg pain with activity in the avid distance runner.

    In his submission, Dr. Bohlig found that his 63-year-old patient who is an avid long distance runner started to experience pain during training. After cutting back on her training regimen and seeing no resolve in the sharp pain in her left anterior superior iliac spine, the patient sought medical attention. Dr. Bohlig, after many tests and examinations, determined that the patient had a stress fracture in her iliac crest which is incredibly rare in the field of Sports Medicine. Dr. Stacie Grossfeld and colleague, Dr. Jennifer Thomas, assisted Dr. Bohlig on his case, examinations, and diagnoses.

    To read the rest of the original press release, click here.

    Osteoarthritis and Your Heart Health

    Posted by Orthopaedic Specialists

    Frequently my patients ask me about being able to manage heart health and osteoarthritis at the same time. Heart health is extremely important, but it can be struggle to keep up with, especially when paired with issues that may affect mobility.


    According to The American Heart Association, being physically active is essential in the prevention of heart disease. Before committing to an exercise routine, be sure to speak with your primary care doctor or cardiologist to make sure there are no medical limitations for you.

    The AHA recommends at least 150 minutes of moderate exercise, or 75 minutes of vigorous exercise, per week. That may seem like an intimidating amount at first, but you can break down your exercises into daily segments to make them more manageable.

    Low-Impact Exercises for Heart Health

    Heart health and osteoarthritis can be a tricky pair; you should be wary of exercises that put too much weight on your kneecaps. A few forms of exercise that won’t be too strenuous include, cycling, swimming, yoga, and light jogging. (more…)

    Sacroiliac Joint Disease: 5 Things You Should Know

    Posted by Orthopaedic Specialists

    sacroiliac joint diseaseSacroiliac Joint Disease is a serious case of inflammation that affects the sacroiliac joint. In the past, the sacroiliac joint has been thought to be the cause of lower back and leg pain; however in the past three decades, that pain is now associated with herniated disks.

    Estimates suggest that sacroiliac (SI) joint pain affects anywhere from 15% to 30% of the general population. However women are considerably more likely than men to experience this pain.

    Sacroiliac joint disease remains difficult to diagnose. Make it easier to know when you’re suffering from sacroiliac joint disease by knowing as much as possible. We’ve outlined 5 things you should know about sacroiliac joint disease that will make it easier to understand and identify.

    5 Things to Know about Sacroiliac Joint Disease

    1. What the Sacroiliac Joint Is

      The Sacroiliac Joint is actually two joints that are both small and firm. The joints are located on either side of the bottom of the spinal cord below the lumbar section and above the coccyx. The joint is known to be extremely strong given the ligaments surrounding it and it’s a joint that does not incur much motion. The main responsibility of the sacroiliac joint is to transfer forces from the upper part of the body to the legs and hips and it also absorbs shocks from jumping, falling, or lifting heavy objects.

    2. Why Sacroiliac Joint Disease is Hard to Diagnose

      There are plenty of factors that contribute to Sacroiliac Joint Disease being hard to diagnose including: the fact that it is difficult to apply pressure to the joint or manipulate it in any way, there are few tests that completely isolate the joint for further testing, X-Rays, CAT Scans, and MRIs read normally more often than not, and there are multiple other issues that can cause symptoms similar to those related to Sacroiliac Joint Disease.

    3. How Orthopedic Surgeons Diagnose Sacroiliac Joint Disease

      There are two ways in which orthopedic surgeons can diagnose Sacroiliac Joint Disease. The first way is through a physical examination that can determine if the pain is caused by the Sacroiliac Joint. This test is usually performed by hanging a leg off of an examination table and rotating it. If this examination recreates the pain and there is no other explanation for the pain then the joint may be in question. Several physical examinations should be performed before the diagnosis is made. If a physical examination cannot determine the source of the pain then a sacroiliac joint injection may be useful. This is not often performed though due to the fact that the sacroiliac joint is so small and it takes a lot of experience to be able to correctly insert a needle into that area. If this process is taken though, a physician injects a numbing solution called lidocaine into the joint. If that relieves the pain then it is determined that the Sacroiliac Joint is the cause of said pain.

    4. What Treatments are Available

      Though Sacroiliac Joint Disease is hard to diagnose, treatment is easy as there are many options for treatment available. Initially, doctors will recommend ice, heat, and rest – three tried and true methods of recovery. Often, medication is included in this treatment plan. If a patient prefers to stay away from medication related relief, chiropractic manipulation may be suggested by a physician. Braces, supports, and physical therapy also fall under optional treatment plans along with injections. Though injections are mainly used to diagnose the disease in the Sacroiliac Joint, they can also be used to treat further pain and inflammation.

    5. When Surgery is the Right Option

      If all treatment plans fail and pain subsists in the Sacroiliac Joint then surgery is the next step. Surgery should only be considered after months of attempted treatment with no pain relief. During surgery, the Sacroiliac Joints are fused to eliminate the chance of recreating odd motions that may be the cause of pain.

    Diagnosis and treatment of Sacroiliac Joint Disease can be difficult to achieve. If you are experience severe pain in your pelvic region when you move certain was or excessively during sports, work, etc. then seek medical help. Contact Orthopaedic Specialists at 502-212-2663 and speak to Dr. Stacie Grossfeld who is double board certified in orthopedic surgery and sports medicine.

    Will My Child Develop Chronic Traumatic Encephalopathy or CTE?

    Posted by Orthopaedic Specialists

    Parents Express Concern over Chronic Traumatic Encephalopathy

    Many parents are increasingly concerned about chronic traumatic encephalopathy. In order to provide insight into this issue, Shawn Love B.S. and Dr. Gary Solomon at Vanderbilt University Medical Center in Nashville, Tennessee, wrote an informative article: “Pain Physicians’ Corner” published in the American Journal of Sports Medicine in May 2014.

    If you are interested in learning more about chronic traumatic encephalopathy, follow along for some helpful information.

    What is Chronic Traumatic Encephalopathy or CTE?

    Chronic traumatic encephalopathy is a condition developed from repetitive hits to the head or a concussion that can only be diagnosed postmortem. There is no testing that can be done at this point to diagnose CTE. There have been a series of studies conducted in football players that have died with early onset dementia, their brains have been evaluated by a pathologist and found to have abnormal TAU protein. CTE clinically can lead to neuropathic changes and development of a series of neuropsychiatric conditions, behavior changes, and cognitive deficits.

    Chronic traumatic encephalopathy and cognitive effects of CTEThe final diagnosis is made postmortem when the brains are identified and found to have increased TAU protein and widespread neurofibrillary tangles (NFTs). In the past, CTE was called punch drunk syndrome. Doctors, such as Ann McKee, and Dr. Bennet Omalu (is most famously known for his lead role in the movie Concussion, which Will Smith was the actor representing Dr. Bennet Omalu). These doctors have suggested that CTE has a clear environmental origin. The groups have proposed that head injury, both concussive and sub-concussive, leads to neuropathic changes and the subsequent development of a series of neuropsychiatric symptoms, behavior changes, and cognitive defects.

    What are the symptoms of CTE and when does it start?

    In general, CTE is described as comprising a broad set of clinical signs and symptoms including neuropsychiatric and behavioral changes such as depression, mood lability, agitation, impulsive behavior, and aggression, Parkinson’s disease, difficulty speaking, gait abnormalities, and cognitive defects including impairments in memory, attention, and language.

    CTE has been described as a syndrome that manifests within one to two decades after retirement from contact or collision sports. There are some studies that indicate CTE may start as late as 10 to 20 years after retirement.

    Are concussions the only cause of an abnormal TAU protein formation in the brain?

    The answer is no. There are actually 20 different neuropathic conditions that cause TAU protein aggregation in the brain including Alzheimer’s disease, which is dementia, front temporal dementia, and Lewy body disease, which is another form of dementia. All the brains that have TAU proteins have some type of degenerative brain disease.

    Another condition that can cause greater incidence of abnormal TAU protein deposition in the brain has been found in drug abusers, people who abuse opioids. There was a study that looked at opioid abusers less than 40 years of age compared with controlled who are not using opioids, and they found greater incidence of TAU protein deposition in their brains compared to the controlled group, 44% versus 19%, and at parallel findings. They found that more than half, 52%, of the 644 surveyed players (more…)

    Top 9 Things to Know About ACL Injuries

    Posted by Orthopaedic Specialists

    Things to know about ACL injuriesAnterior Cruciate Ligament, often referred to as ACL injuries, are the most common knee injuries athletes suffer. While an extremely active individual could possibly suffer this type of injury, an ACL tear is most common in athletes. This is because of the stop and start movements associated with sports such as football, basketball, hockey and more. The anterior cruciate ligament is on the inside of the knee joint and supports the shin bone. The ligament, knee, and shin work together to prevent the tibia from sliding out in front of the thigh bone.

    When Do ACL Injuries Occur?

    An ACL injury is most likely to occur if an athlete is hit hard on the side of their knee. The sudden force overextends the knee joint. This same pressure is recreated by stopping and changing directions during a run or jump which also causes ACL injuries. A “popping” noise is heard as a result of ACL injuries quickly followed by pain and swelling.

    ACL injuries are becoming more common among individual athletes for quite a few reasons including: increased level of competition, specialization in one single sport, and failing to take precautions against this injury. You can never prepare your mind for this type of injury or the amount of recovery and rehabilitation time is needed to overcome an ACL injury, but you can definitely prepare your body. Dr. Stacie Grossfeld at Orthopaedic Specialists wants to educate her clients on ACL injuries with some important information.

    Important Information About ACL Injuries:

    1. The Centers for Disease Control and Prevention (CDC) found that girls are 8 times more likely to suffer ACL injuries over boys because of the increased pelvic angles that put more stress on the knees.
    2. While many people think that ACL injuries most often occur in contact sports, about 70 percent of ACL injuries actually occur during non-contact sports.
    3. Half of people who suffer an ACL injury will develop osteoarthritis later in life.
    4. Sports like football, soccer, and basketball show a higher risk of ACL injury than most other sports due to the high amount of running and direction changing that occurs during these sports.
    5. It is best to treat the symptoms of an ACL injury with rest, ice, and elevation. Always consult a physician before returning to sports following a knee injury.
    6. Many famous athletes have recovered fully from ACL injuries and surgery like Green Bay Packers wide receiver Jordy Nelson, American soccer player, Olympic medalist, and FIFA Women’s World Cup champion Alex Morgan, and Russian tennis superstar Maria Sharapova.
    7. There are ways to prevent ACL injuries with strength, proprioception, and biofeedback training. Warming up for these exercises is crucial and all exercises should be completed regularly to reduce risk of injury. This training and exercise can help improve your knee strength while also enhancing one’s athletic performance. It’s a win-win.
    8. Surgery is recommended most of the time that an ACL injury occurs. This could be the beginning of a difficult recovery, but it allows athletes and active individuals to return to their game or workout at a much faster turnaround rate than other treatments.
    9. ACL surgery has a recovery period of anywhere from six to eight weeks or longer. Recovery requires a lot of rest, ice, and even physical therapy. It is best to begin recovery as soon as possible.

    If You Have An ACL Injury

    All of this information is important when it comes to ACL injuries. With this type of injury it is best to begin with prevention and then focus on recovering from injury if it arises. (more…)

    Does Diabetes Affect The Outcome Of An Arthroscopic Rotator Cuff Repair?

    Posted by Orthopaedic Specialists

    Diabetes affects individuals that have a high blood glucose or blood sugar. Either the insulin production is not enough or a person’s cells do not respond properly to insulin, or in some cases both. This disease can lead to complications later in life if it goes undetected. Because diabetes can affect every organ in the body, it is very important for individuals with diabetes to take proper care. If you have diabetes or this disease runs in your family, it is important to recognize its symptoms and control it.

    As diabetes can slow the progress of healing, many Surgical outcomes for patients with diabetes that undergo arthroscopic rotator cuff repairphysicians are concerned with surgical outcomes in patients with diabetes. Several studies, papers and research has been published on diabetes and surgery. In one example, a doctor wanted to take a closer look at the effects of arthroscopic rotator cuff repair and surgery in individuals with diabetes. Here is what was published in the American Journal of Sports Medicine in April, 2015.

    Diabetes and Arthroscopic Rotator Cuff Repair – Research Findings

    Dr. Cho, studied a group of patients that underwent arthroscopic rotator cuff repair surgery. They divided the patients into two groups. One group had insulin dependent diabetes, and the second group were non-diabetic patients. They found that the diabetic group, the incidence of recurrent rotator cuff tears after surgery was 35% compared to the re-tear rate in a non-diabetic group that was 14%.

    The authors/researchers then assessed a group of patients with diabetes, and analyzed whether their diabetes was under control or not. They found that the uncontrolled diabetic patient with poor glycemic control with a hemoglobin A1c that was elevated had a recurrent tear rate of 43.2% versus patients that had good glycemic control, the retear rate was only 25.9%. (more…)

    High Cholesterol and Rotator Cuff Repair Surgical Recovery

    Posted by Orthopaedic Specialists

    Does High Cholesterol Impact Rotator Cuff Healing After Surgery?

    Rotator cuff tears are a common condition that cause pain and functional disability. About half of the general population older than 60 years of age has either a partial or full thickness rotator cuff tear and they are completely asymptomatic.

    Surgery to repair the rotator is widely practiced and has been commonly accepted for treatment of full thickness rotator cuff tears or partial thickness rotator cuff tears greater than 50%. Despite the fact the surgeon performs an excellent surgery, 20 to 94 percent of rotator cuff repairs do not heal or they re-tear.

    Researchers Conduct Study to Understand Impact of High Cholesterol and Rotator Cuff Repair

    Dr. Chung performed a study looking the relationship between high cholesterol and rotator cuff repairs. He wanted to understand whether cholesterol levels play a role in reducing rotator cuff healing after surgery. The author published the study in the American Journal of Sports Medicine, May, 2016. It was a lab study performed with rabbits.

    High Cholesterol and rotator cuff repairResearchers note that fatty infiltration is one of the most important prognostic factors for anatomic and functional outcomes after rotator cuff surgery. The surgical repair of the torn rotator cuff may not be able to stop or reverse the process of fatty infiltration. Fatty infiltration is when the rotator cuff tendon and muscle turns to fat.

    Interestingly, a high serum cholesterol concentration greater than 240 mg/dL also occurs typically in people’s legs right around when there was a high incidence of rotator cuff tears. They thought that possibly this was a metabolic risk factor.

    What the researchers found is that if they reduced the high cholesterol in the blood level, it would promote rotator cuff healing.

    Study Overview: High Cholesterol and Rotator Cuff Repair Surgery

    The authors used the series of 48 rabbits that were randomly allocated into four groups. After four weeks of a high cholesterol diet in group A and group B, and a regular diet in group C and group D, the supraspinatus tendon was detached. That is, the rotator cuff was torn and left alone for six weeks, and then it was re-torn in a transosseous manner. This is the common way the rotator cuff is repaired in groups A and B which was a group that had the high cholesterol diet, and group C which was a group that had a regular diet. They used group D as a control.

    Group A continued to receive the high cholesterol diet until the final evaluation six weeks after the repair. Group D was changed to a general diet with administration of a cholesterol lowering agent-simvastatin.

    Researchers then performed histological evaluation of fat to muscle proportion. They found that high cholesterol levels had a deleterious effect on fatty infiltration. Additionally, lowering cholesterol seemed to hold or reduce the harmful effects in the experimental model based on the quality of tendon-to-bone repair.

    This study suggests that more needs to be done to understand the relationship between high cholesterol and rotator cuff repair. The conclusion of the study was that systematic diseases such as high cholesterol may need to be tightly controlled through the preoperative period of rotator cuff repairs.