The Hows and Whys of Three Common Shoulder Injuries

Shoulder injuries are common because of how frequently the area’s utilized in day-to-day life and how many joints are involved. We often think of our shoulder as one unified area of our arm, but it is actually made up of many different muscles and tendons. These factors make it particularly vulnerable to injury. Because of the many structures it can often be difficult to pinpoint exactly which part is injured. If you are experiencing shoulder pain and aren’t sure what’s causing it, here are examples of common shoulder injuries.

Understanding AnatomyThe shoulder is vulnerable to injury

Before trying to determine the category of injury, it is first necessary to understand the anatomy of your shoulder. It is comprised of three different bones: upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The rotator cuff secures your arm within the socket of your shoulder. It also maintains fluid movement with the help of a lubricating sac called the bursa. The bursa is located in between the top of your shoulder (acromion) and the rotator cuff. All of these elements need to work together for you to fully use of your arms without feeling any pain.

Impingement Syndrome

Often referred to as “swimmer’s shoulder” or “thrower’s shoulder,” impingement syndrome happens when the acromion rubs against the tendon and the bursa, resulting in painful irritation. This injury often appears in athletes who participate in tennis, baseball, and swimming. It can also affect individuals whose jobs require repetitive lifting or keeping their arms overhead for lengthy segments of time.

One common symptom of impingement syndrome is experiencing pain in the shoulder while doing activities that include overhead movement, such as reaching, throwing, or swimming. The type of pain associated with impingement syndrome is more dull than sharp and often lingers which can lead to difficulty sleeping at night.

Frozen Shoulder

Frozen shoulder is named for the freezing of mobility and overall stiffness that affected individuals experience. This feeling is caused by the thickening and tightening of the shoulder capsule which, if left untreated, can lead to the development of stiff bands of tissue called adhesions. The pain is usually a dull and aching variety and is enhanced whenever the arm is moving.

Adhesive capsulitis, or frozen shoulder, can be a consequence of a specific injury or it can be linked to diseases like diabetes, or hypothyroidism. It can also occur as a result of long-term immobilization due to surgery, or another kind of injury that would inhibit any arm movement.

Rotator Cuff injuries are some of the most common shoulder injuries Rotator Cuff Tear

Injuries to the rotator cuff are very common. According to the American Academy of Orthopedic Surgeons, in 2013 almost 2 million people in the U.S. went to their doctor because of a rotator cuff issue. If you’re having pain in your rotator cuff it can greatly inhibit your ability to carry out even minor tasks.

There are multiple ways that a rotator cuff can be torn. An acute injury would happen as the result of one specific event such as lifting a heavy object improperly. More commonly, rotator cuff tears happen over time as a consequence of the tendons wearing down. This can be caused by repetitive stress in terms of constant and repeated movements, or sometimes due to lack of blood supply which happens more frequently as we grow older.

 

Just because these shoulder injuries are common does not mean that you should have to endure the pain they cause. There are many options available for healing. For those of you living in the Louisville area, Dr. Stacie Grossfeld is an expert orthopedic surgeon with years of experience treating patients who have sustained shoulder injuries. She specializes in shoulder reconstruction, arthroscopic rotator cuff repairs, as well as sports medicine. If you’re in pain, or struggling to maintain mobility in your arms and shoulders, don’t hesitate to ask for help. Call our offices at (502) 212-2663 to set up an appointment today!

How Does Sleep Impact Health?

Love Your Sleep

Sleep plays a vital role in good health and wellbeing throughout your life. Getting enough quality sleep at the right time can help protect your mental health, physical health, quality of life and safety. The way you feel while you are awake depends in part on what happens while you are sleeping. So follow along for answers to the question: How does sleep impact health?

how does sleep impact healthDuring sleep your body is working to support healthy brain function and maintain your physical health, according to the National Institute of Health. Sleep helps your brain work properly. While you are sleeping, your brain is preparing for the next day. Studies have shown that sleep improves learning, problem solving skills, controlling behavior and coping with change.

Sleep also plays an important role in your physical health. For example, sleep is involved in the healing and repair of your heart and blood vessels. Further, ongoing sleep deficiencies are linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes and stroke.

5 Tips for Improving Your Sleep 

Looking for ways to improve your sleep? Here are a few tips to consider:

  1. Get more exercise. Getting regular physical activity can greatly improve the quality of your sleep. According to a new study published in the Journal of Mental Health and Physical Activity, getting at least 150 minutes of exercise a week significantly improves a person’s sleep, and makes them feel more alert throughout the day. 
  2. Exercise at the right time day. The timing of your exercise is important. Exercising right before you are planning on going to sleep is not a good idea. However, exercise will help you sleep if done in the morning, afternoon or early evening.
  3. Watch what you eat and drink. What you eat or drink can also affect your sleep. Any sort of caffeine, sodas or sugar-rich foods are bad food / drink choices before you go to sleep.
  4. Sleep on a regular schedule. Going to sleep and waking up at similar times each day is important for the sleep cycle.
  5. Get the temperature right for sleep. While personal preferences vary, the suggested ideal bedroom temperature for sleep is typically between 60 and 67 degrees Fahrenheit (as noted on www.sleep.org).

How Much Sleep Do I Need?

The National Sleep Foundation recommends 7 to 9 hours of sleep for adults including young adults.  Teenagers need more sleep, generally between 8 and 10 hours a night. And young school age children need the most sleep (an average of 9 to 11 hours a night). (more…)

Nine Facts/Tips about Hamstring Injuries in Soccer Players

When it comes to sports injuries, hamstring injuries in soccer players are very common.  As a board certified sports medicine doctor, Stacie Grossfeld M.D. has treated many soccer players suffering from hamstring injuries.

According to the American Journal of Sports Medicine, hamstring injuries are the most common type of sports injury. Hamstring strains are often caused by sprinting. And once you injure your hamstring, the rate of re-injury is estimated to be over 15 percent.

If you are an athlete, educating yourself about hamstring injuries is a good idea. Follow along for facts and tips about hamstring injuries in soccer players. And keep in mind that this information could really apply to all athletes.

Nine Facts/Tips on Hamstring Injuries in Soccer Players

  1. Hamstring strains are the single most common sports injury in the male soccer player.
  2. Your hamstring is made up of three muscles/tendons: the biceps femoris, the semitendinosus and the semimembranosus.
  3. The most common tendon/muscle injury within your hamstring is your biceps femoris.
  4. Your hamstring muscles are most likely to sustain injury during explosive running accelerations and kicking activities. This is because of the high biomechanical Soccer Players Hamstring Injury Factsdemands placed on the muscle tendon unit throughout the front swing phases in running and kicking.
  5. Researchers currently think that the biceps femoris is the most commonly injured muscle in the group of your hamstring muscles/tendon because of the way it is shaped and the amount of stretch and load that occurs during the front swing kicking or running.
  6. Research has also proven that when the three muscle bellies: biceps femoris, semitendinosus, and semimembranosus are not capable of engaging in a synergistic adequate contraction, it may cause one of the muscles to fatigue prematurely and cause the injury to occur.
  7. The important risk factor for sustaining a hamstring strain injury is the presence of having a prior hamstring strain injury.
  8. The risk of sustaining a second hamstring injury is more than twice as high as the risk of sustaining a third hamstring injury.
  9. Prevention for hamstring injuries can occur through strengthening of the hamstring muscles/tendons with a weightlifting regimen.

Pediatric ACL Injuries and Sports-Related Injuries

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

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?

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

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

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

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?

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…)