• MRI Research Reveals Cause of ACL Injury

    Posted by Orthopaedic Specialists

    ACL injuries are responsible for pain, surgery and lots of physical therapy. Most of these injuries occur through non-contact sports or accidents sustained off of the courts or field. Researchers and physicians are working tirelessly to understand the cause of ACL injury to develop preventive programs to reduce this knee injury. Because of the current known information and a recent study that was published, athletes are learning how to lower their risk of sustaining an ACL injury.

    We know at the time of ACL injuries, there are bone bruises that occur during MRI results. The bone bruises tell us that there has been contact with the femur and the tibia at the time of the ACL injury. A very interesting study published in the American Journal of Sports Medicine in October 2015, examined the position of the knee during non-contact ACL injury determined from the bone bruise location. The study was performed at Duke University with the lead author, Sophia Kim.

    ACL and Knee Position Explain Cause of ACL InjuryRemember that the most common way to sustain an ACL injury occurs through non-contact situations, such as the basketball player dribbling the ball down the court, stopped quickly, and tears his ACL. This is similar to the soccer player who is running down the field and she stops and pivots quickly and tears her ACL. A contact ACL injury occurs when there was actually contact from another player to the injured athlete’s knee, which is less common that the previous examples.

    The researchers looked at MRI results of eight subjects with a non-contact ACL injury. They examined MRI results from a subject who suffered a non-contact ACL injury and created a 3D model of each subject’s knee and its position during the MRI position. (more…)

    What Are Rotator Cuff Treatment Options for Patients with Massive Rotator Cuff Tears?

    Posted by Orthopaedic Specialists

    For athletes involved in sports like baseball, tennis and swimming, there is often a common fear of sustaining a shoulder injury like tearing a rotator cuff. As a board certified orthopedic surgeon and shoulder doctor, Stacie Grossfeld MD offers effective rotator cuff treatment to people in the Louisville, Kentucky area. Rotator cuff tears can become severe and may even halt a person’s athletic career. Shoulder Injuries and Rotator Cuff Treatment OptionsAthletes are not the only one’s susceptible to this type of injury, but their level of activity and repetitive movements put athletes at a higher rate of risk for sustaining this injury. Fortunately there

    The rotator cuff is a group of tendons and muscles that form around the shoulder joint that is located at the top of the humerus. All of these parts work together to form a “cuff” that is responsible for stability and moving the arm in different directions. Too much stress, repetition and fatigue can cause the tendons to swell and tear.

    This type of injury produces pain, fatigue, reduced range of motion and other symptoms. It is important to seek medical attention if you suspect a shoulder injury that may require rotator cuff treatment. This could help you get back out on the playing field or pool much more quickly and successfully than if you try to ignore your symptoms. For athletes that have been diagnosed with this injury, it is important to discover all of your rotator cuff treatment options.

    What are the Surgical Options for Rotator Cuff Treatment?

    With massive rotator cuff tears, this often requires surgical treatment to repair the tear to allow the patient to heal properly before returning to their sports. There have been several studies performed and research has uncovered the outcome of massive rotator cuff repairs through surgery.

    As an experienced orthopedic surgeon and shoulder doctor, Dr. Grossfeld explains that patients with massive cuff tears, greater than 3 cm or the involvement of two of the four rotator cuff tendons, have high risk for their tendons not healing or re-tearing very quickly after rotator cuff surgery. (more…)

    Study Finds that Vitamin D is a Risk Factor for Stress Fractures

    Posted by Orthopaedic Specialists

    Stress Fracture Treatment and Vitamin D

    Stress fractures are known for causing tiny cracks in a bone and pain to the affected area. This type of injury is often sustained through repetitive movements or overuse common in sports like long-distance running. Many individuals and athletes that run long distances or those that engage in activities that Stress fractures are a result of vitamin D inefficienciesinvolve a lot of jumping can be prone to developing stress fractures. Also, those with osteoarthritis often developed stress fractures due to their weakened bones.

    Stress fractures frequently occur in the weight-bearing bones of the lower leg and foot. This type of pain tends to worsen over time and could potentially cause swelling to the affected body part.

    Stress fractures are a common sports injury, and treating stress fractures typically involves a simple treatment plan of resting the area. Additionally, there is new information that has been found to reduce a person’s risk of developing stress fractures.

    Latest Research on Stress Fracture Treatment Identifies Vitamin D as Key

    An article published in the American Journal of Sports Medicine in August 2015 looked at serum 25-hydroxyvitamin D levels and stress fractures in military personnel. Dr. Dyda Dao and a team of researchers began this study by searching multiple databases and doing a meta-analysis on nine studies looking at lower extremity stress fractures and Vitamin D levels. They found that military people that sustained stress fractures had a lower Vitamin D level than the military personnel with normal level of Vitamin D.

    The authors concluded that normalizing Vitamin D levels could potentially lead to a lower rate of sustaining a stress fracture. (more…)

    Doctor, What Happens to My Harvested Hamstring Tendon After ACL Surgery?

    Posted by Orthopaedic Specialists

    The most common graft used for ACL reconstructions is a hamstring tendon graft.  Once you’ve torn your ACL, you cannot sew the end of the ACL back together.  A ligament needs to be reconstructed. Most ligament reconstructions use the semitendinosus and gracilis tendons. These make up part of your hamstrings: the central part of your patellar tendon also known as bone-patellar-bone graft, and the mid region of his quadricep tendon. This decision comes with less anterior knee pain or kneecap pain after surgery and it also requires a smaller incision compared to other types of grafts.Hamstring Tendon Regeneration

    Many patients often wonder about the outcome of a hamstring tendon, if it is used as a graft to replace the ACL. Many studies have shown that the hamstring tendon will regenerate within a year after ACL reconstruction after using the hamstring tendon as an autograft.

    Researchers Study Hamstring Tendon Regeneration After Harvesting

    There was an excellent article that did a systematic review of the worldwide literature looking at hamstring tendon regeneration after harvesting. This was published in the October American Journal of Sports Medicine in 2015.

    The lead author, Dr. Suijkerbuijk, BSc, reviewed 18 publications that met the inclusion criteria. The researchers found that the majority of athletes (70%) that had their ACL reconstructed with a hamstring autograft had regenerated the tendon. They noted that in some of the studies, tendon regeneration started at approximately one month post-op, but in all cases, regeneration occurred within one year of surgery.

    Though the authors were not able to identify the exact time frame upon which the tendon most likely regenerated, they did note that in 100% of the cases, by a year, if tendon regeneration was going to happen, it had occurred.

    So, to answer the question: What Happens to My Harvested Hamstring Tendon After ACL Surgery?The answer is in 70% of the patients, the hamstring tendon will regenerate and this occurs within a year after surgery.

    ACL Reconstruction Surgery and Sports Participation in Athletes

    Posted by Orthopaedic Specialists

    We’re constantly learning new information regarding ACL injuries and sports participation. This common sports injury requires extensive rehabilitation, handwork and commitment. And there is always the fear of tearing the ACL again for athletes that gotten back out on the court or field. While ACL Reconstruction Surgery Return to Sportevery case is specific for each athlete and injury, new information about ACL reconstruction surgery has been published to provide a better insight into this type of injury.

    The American Journal of Sports Medicine published an article written by Dr. Clare Ardern, PT, PhD, assessing athletes that had undergone ACL reconstruction surgery and had not returned back to play one year post-injury. The authors wanted to decide why these athletes had not returned back to playing their sport. The ACL injury is a common injury among young, active and otherwise healthy athletes.

    Typically, this group of athletes would like to return back to their pre-injury sport. Recognizing this is generally an important part of the recovery process. After ACL reconstruction surgery most athletes are not released to return back to twisting, turning, jumping sports until six to 12 months post-injury, and there is a constant need for more information on this process. (more…)

    The Mayo Clinic Studies the Epidemiology of Tennis Elbow

    Posted by Orthopaedic Specialists

    Lateral epicondylitis, also known as tennis elbow, is a commonly seen condition in general practice clinics and has been reported to affect 1 to 3 percent of adults in the U.S. each year. A study conducted at the Mayo Clinic in Rochester, Minnesota, with lead author Dr. Thomas Sanders, Jr. was reported in the Journal of American Sports Medicine in May, 2015.

    An Overview of the Latest Tennis Elbow Research by Mayo Clinic Researchers

    This study noted that the right elbow is more likely to be affected than the left elbow, 63 percent of the time versus 25 percent. The researchers also found that 12 percent of patients had both elbows affected. Twenty-five percent of the patients were referred to a specialist, such as an orthopedic surgeon like Dr. Stacie Grossfeld in Louisville, Kentucky.

    The researchers found that the highest incidents of tennis elbow is among individuals age 40 to 49 years, with the majority of them being female -10.2 per 1000 female patients versus Tennis Elbow Study Mayo Clinic7.8 per 1000 male patients. The second highest incidents were among those ages 50 to 59 years of age, where the distribution of male and the female patients was equal.

    In this epidemiological study, the researchers found the treatment options for most patients included some type of tennis elbow bracing and anti-inflammatory medication. A large percentage of patients receive ultrasound iontophoresis with the physical therapist. This treatment option uses ionic medicinal compounds through the skin with an electric current produced through an ultrasound machine. Less than 6 percent of patients being treated for tennis elbow need any surgical intervention.

    The study also found that after three months, 74 percent of the patients were no longer seeking care for their initial diagnosis. The researchers found that only 18 percent of the patients receive care six months after their first diagnosis. For the patients that eventually needed surgical intervention, this occurred about nine months after their initial presentation to their orthopedic surgeon or healthcare provider with a diagnosis of lateral epicondylitis/tennis elbow. (more…)

    Dr. Grossfeld and Team Attend PNC Workshop for Business Women

    Posted by Orthopaedic Specialists

    Orthopedic Medical Practice Leaders Attend Business Training for WomenThe Orthopaedic Specialists’ management team, including Dr. Stacie Grossfeld (orthopedic medical practice owner) Tisha Robison (orthopedic medical practice manager) and Dorothy Cochran (assistant practice manager)) enjoyed participating in a workshop for Louisville, KY-area businesswomen sponsored by PNC and held at the PNC tower downtown. A presentation by Susan Packard was streamed in live to the meeting. Susan discussed her book: New Rules of the Game: 10 Strategies for Women in the Workplace.

    Susan Packard has been on the ground floor helping to build powerful media brands including: HBO, CNBC, and HDTV. She is a co-founder of Scripps Networks Interactive and is the former Chief New Rules of the Game Book by Susan PackardOperating Officer of HDTV. Under Packard’s leadership, HDTV became one of the fastest-growing cable networks in TV history. Packard help build Scripps Networks Interactive into a market value worth over $10 billion. Now Susan works as a writer, speaker and consultant to business women in every stage of life. She serves as mentor and guide, helping women learn how to achieve success at home and at work.

    During her presentation, Susan Packard emphasized the point that there is a fundamental difference between men and women and how we communicate, how we do business, and how we interact. And she parallels business with athletics on so many different fronts. Not only does she emphasize the benefits of being an athlete, but she also explains the importance of thinking and acting like a winner.

    Gamesmanship, according to Packard, is a key to success. The way you stand, the way you sit, the way you look at people, even the words that you use — all of this is very important on the playing field and at the office. Here are some important takeaways from Susan Packard’s presentation that any women business leaders can use (including orthopedic medical practice managers).

    1. Be Clear and Concise: Women speak 21,000 words per day and men only speak an average of 7,000. Women are less inclined to “get to the point.” In contrast, men do not like a lot of words. The simpler women can communicate the better. Clarity is key. Make your words pack a punch. Do not speak a blast but speak efficiently.
    2. Play it Cool: Composure is necessary to win whether you are on the playing field or in the board room. It is a very important trait. It is about how you handle yourself so you can command the room. Women are being watched and evaluated all the time. Expect nonstop scrutiny from all angles.
    3. Take Care of Yourself: Know how many hours of sleep you need to feel good and think clearly. Make sure you eat a healthy diet, exercise regularly and limit alcohol, especially at work events. Massage, yoga and meditation may help relieve stress.
    4. Play Offense: Score points for your team and be a team player. Ask for and accept opportunities and promotions if you want to advance in your company. Ask and talk in a way that explains how the company (rather than just you alone) will benefit. And negotiate your salary upfront. Only 12% of women do this.
    5. Practice Artful Assertiveness and Verbal Finesse. It’s important to have backbone without breaking someone’s back; this means communicating directly and honestly with a smile. Learn how to ask for what you need, for yourself, your team, and your company. When you don’t use the right balance of finesse, women are often targeted with certain “b” words – e.g. bossy, bitchy. You need to be strong and use a certain voice but the right level of volume to be heard. Be polite but not painfully polite.
    6. Know How to Walk Away – The bluff is a strategic process for outsmarting your opponent. Know when to consider this tactic.
    7. Support your Fan Club: Build a network outside of your office that is encouraging and beneficial.
    8. Suit Up: Don’t dress provocatively but do dress appropriately for your position.
    9. Engage in Positive Practices: Emotional maturity, resilience, courage, respect, and inclusiveness.
    10. Come Prepared: Be ready for whatever the day brings.

    Good leaders realize that it isn’t about the job title. Certain traits are common among good leaders including: excellent listening skills, a high level of engagement, and the ability to be fully present. (more…)

    Youth Sports Injuries and Sports Specialized Intensive Training

    Posted by Orthopaedic Specialists

    Nowadays many kids are focusing in on becoming very good in one sport. This often involves investing a considerable amount of time, effort and interest in this one sport. Additionally, many parents and teachers encourage a child to focus on one sport in order Sports Specialized Intensive Training and Youth Sports Injuriesto develop a higher proficiency. Yet sports specialization comes with physical complications for some young athletes including a higher risk of youth sports injuries. When children begin to practice and compete year-round in only one sport, certain muscles and joints tend to become overworked and youth sports injuries are a serious risk.

    Sports medicine physicians, orthopedics and others have noticed this trend in youth athletics. And researchers have studied the issues that may arise. Specifically, there was an excellent article published in the American Journal of Sports Medicine in April, 2015, written by Dr. Jayanthi. The article looked at 1,214 athletes. There were 822 injured participants and 368 uninjured participants. They found that the injured athletes were older than the uninjured athletes. Athletes that were older than 14 years of age were at a greater risk compared to athletes that were 12 years or younger.

    Understanding Risk Factors for Youth Sports Injuries

    Researchers also found that athletes that reported more total hours of physical activity, close to 20 hours per week, versus 17 hours a week, had a higher injury risk of youth sports injuries. Additionally, organized sporting activity was another risk factor for injury. If the athlete was participating in 11 hours per week of an organized sporting activity, they were at a higher risk for injury versus 9 hours per week.

    In conclusion, this study found that young athletes participating in more sports per week, combined with an older age and a greater than 2 to 1 ratio for organized sports to free play time had increased odds of having a serious overuse injury. They also found that there was a correlation and statistically significant difference in athletes with a serious overuse injury who specialized in a single sport.

    Louisville Sports Medicine Doctor Offers Info About Reducing the Risk for Youth Sports Injuries

    Based on this article, Dr. Grossfeld recommends that young athletes compete in more than one organized sport throughout the year.  Also, it’s beneficial to help reduce the risk of youth sports injuries from overuse by increasing the amount of time dedicated to free play. (more…)

    Louisville Doctors Present at the American Medical Society for Sports Medicine 2016 Conference

    Posted by Orthopaedic Specialists

    Dr. Grossfeld and American Medical Society for Sports Medicine

    Dr. Jennifer Thomas, Dr. Stacie Grossfeld, and Dr. Preeti Panchang collaborated on a poster accepted at the American Medical Society for Sports Medicine’s 2016 meeting.

    As the residents from the University of Louisville rotate through Dr. Grossfeld’s office they get to observe routine and sometimes very unique orthopedic cases. Over the years, some of the medical residents have used  these interesting and unusual cases to present at different medical conferences around the country. This year Dr. Brittney Richardson and Dr. Jennifer Thomas, two physicians who have worked very closely with Dr. Stacie Grossfeld at Orthopaedic Specialists, have had poster presentations accepted at the 25th annual meeting of the American Medical Society for Sports Medicine.

    Dr. Brittney Richardson, Chief Resident with the Department of Family Medicine and Geriatrics at the University of Louisville, had a poster presentation accepted at the American Medical Society of Sports Medicine conference titled: Ouch Mom, My Hip: Diagnosing Hip Pain in a Limping Child. This write up provided an overview of one of Dr. Grossfeld’s patients with a unusual pediatric condition.

    Dr. Brittney Richardson will present at the American Medical Society for Sports Medicine Conference

    Dr. Stacie Grossfeld and University of Louisville School of Medicine resident Dr. Brittney Richardson.

    Dr. Richardson’s presentation involves a 6 year old male who presented to Orthopaedic Specialists with a complaint of left hip pain for 3 days. According to his mother, she initially ignored his complaints until he woke up complaining that the pain was so bad, he could not stand up. He plays soccer and in his game 2 days prior to presentation he had a fall. He complained about the pain, but it initially did not seem to hinder his activity. The day after the fall, he went to baseball practice and went swimming with no complaint of pain. However, with the pain acutely worsening on the morning of presentation, his mother became concerned. Presenter Dr. Brittney Richardson will discuss the treatment plan and the patient’s final outcome. Authors on this are listed as follows: Brittney M. Richardson, M.D., Stacie L. Grossfeld, M.D., Jessica Stumbo, M.D., Jennifer Daily, M.D.

    Dr. Jennifer Thomas had a case study accepted for the conference, which she will present, titled: Biomechanical Evaluation: A Case of Delayed Diagnosis. This includes a case history and detailed discussion about an 18 year-old female competitive cross country runner who presented to the office with complaints of tightness, pressure and pain in the bilateral calves as well as numbness in the feet while running. She had been symptomatic for the past 6 months and treated for multiple different etiologies with no relief of her symptoms. She states these symptoms start within 15 to 20 minutes and resolve after resting for several minutes. She was treated for anterior tibialis tendonitis and medial tibial stress syndrome with physical therapy, rest, ice, and NSAIDs without relief. The authors on this project also include: Dr. Stacie Grossfeld and Dr. Preeti Panchang. The presentation details the treatment plan and final outcome of the patient.

    About the American Medical Society for Sports Medicine:

    The American Medical Society for Sports Medicine (AMSSM) was founded in 1991. The organization is focused on supporting practitioners in sports medicine including primary care doctors and those offering non-surgical sports medicine treatment. The 25th Annual AMSSM Meeting is being held in Dallas, Texas, at the Sheraton Dallas on Friday April 15th through Wednesday April 20th 2016.

    20 Running Tips and Injury Prevention Methods

    Posted by Orthopaedic Specialists

    Running Tips To Keep You On The Roads

    Injury prevention is an important topic for runners at every level, from beginners to long-time veterans. Running tips and prevention methods for runners Louisville orthopedic surgeon and sports medicine physician
    Dr. Stacie Grossfeld has many years of experience treating common running injuries and helping runners continue to enjoy the sport they love. In this article, Dr. Grossfeld offers some helpful running tips to keep you on the roads, regardless of your level of ability and experience.

    Follow along for more information about common running injuries, and helpful running tips including: things you should do before you run, reasons for having your feet assessed before starting a running program and more, to keep you successful and injury free.

    Top Five Reasons Why I have Leg Pain When I Run:

    1. Shin splints
    2. Stress fracture
    3. IT band tendonitis
    4. Patellofemoral syndrome
    5. Meniscal tear

    Top Five Things That Are Key to do Before You Run:

    1. Make sure you have properly fitted running shoes. It is recommended that you are fitted with your running shoes at a store that is familiar with runners and it may help to have a gait analysis performed prior to you purchasing running shoes.
    2. Warm up properly. We like to tell our patients to warm up before you warm up, do a very light run, just where you break into a sweat or get on a bicycle till you break into a sweat and then actually do your stretches and then go out and do your true run.
    3. Make sure you are well hydrated, maintain hydration throughout the day prior to run.
    4. Listen to your bodies. This means as you start to have aches and pains in certain areas of your body and the pain is getting worse, do not try to run through them.
    5. Maintain enough caloric intake to keep up with your energy expenditure. If you are doing a lot of long distance running, you may want to keep a food log to make sure that you are taking enough calories and proper calories to keep up with your energy expenditure. The second most common reason for stress fractures is lack of proper caloric intake. The number one reason for stress fractures is too much training too quickly.

    Top Five Reasons to Have Your Foot Assessed Before You Begin a Running Program:

    1. It is a documented medical fact that if you are pronated, you are more likely to sustain a stress fracture involving your metatarsal, developed shin splints, and plantar fasciitis.
    2. If your foot is pronated, an over-the-counter semi-custom orthotics or custom orthotics would be indicated.
    3. If you have a wide forefoot or a narrow forefoot or narrow heel, it might be more difficult to be fitted in a running shoe; therefore, it is important to assess your foot and have somebody at the running shoe store also asses her foot to make sure that your running shoe fits you properly.
    4. Check to make sure there are no blisters on the bottom of your feet. If blisters start to form, that may mean your shoe is not fitting well, and care should be taken to make sure that the blisters do not become infected.
    5. If you are developing bunion deformity, it is helpful to have a custom pair of orthotics made to counterbalance abnormal forces on the plantar aspect of your foot that are created secondary to the bunion deformity.

    Top Five Things You Should do Before Starting a Running Program If You Haven’t Run Before:

    1. If you have any medical conditions such as hypertension or coronary artery disease, you should check with your primary care physician for medical clearance before you start a running program.
    2. It is recommended that you consult with a running coach to determine your fitness level to help formulate a program specialized to your baseline fitness. It is important to speak with a running coach or wellness coach through any local running club or even through the YMCA.
    3. It is helpful to follow a program to help guide you with increasing your mileage. Very common mistake that runners will make is they try to increase their mileage too quickly and then they become injured.
    4. If you are going to start a running program, it is also important to do some cross-training to allow the muscles to rest on the days that you are not running.
    5. Complete rest days are important and that should be discussed with your wellness coach prior to your running program to learn when and when not rest days should be utilized. It is helpful for new runners to set a goal, make the goal realistic. Even training for a race in the future can help motivate and keep you in your running program.

    Hopefully you have found these running tips from Dr. Grossfeld helpful and educational. (more…)