• 10 Differences Between Osteoarthritis and Meniscal Tears

    Posted by Stacie Grossfeld

    Knee Osteoarthritis and meniscal tear types of knee painOsteoarthritis and meniscal tears are injuries that both occur in the knees. Both knee injuries tend to become more probable to occur with age; however, there are significant differences between osteoarthritis and meniscal tear injuries. The pain associated with both injuries require different treatment approaches. A big factor that decides treatment is if the pain is a result of a particular injury or health factor. To understand these two distinct injuries that occur in the knees, here are 10 major differences between the two.

    1. Pain Type

    You will be able to identify the type of injury you have as a result of the pain that occurs. Pain from osteoarthritis is a dull pain that aches constantly. Meniscal tears, on the other hand, give off sharp, stabbing pain in the knee area.

    2. Location

    Identifying where your pain is coming from will also help to differentiate between osteoarthritis and a meniscal tear. Meniscal tears are right on the joint line with very distinct localized region of pain. Osteoarthritis has a more generalized pain affecting the whole knee joint and is difficult to pinpoint with one finger.

    3. Symptoms

    A torn meniscus tends to have a clicking and popping along with mechanical symptoms where the knee will catch. Osteoarthritis produces a dull throbbing aching pain yet has no mechanical symptoms.

    4. Diagnostic Imaging

    Meniscal tears are diagnosed with an MRI scan while osteoarthritis is detected through a plain standing knee x-ray.

    5. Definition

    Meniscal tears involve the meniscus which is a shock absorber between the two bones in your knee joint that functions to cushion both bones. Osteoarthritis is the breakdown of the cartilage that covers the ends of your bones within the knee joint.

    6. Age of Onset

    Meniscal tears tend to occur in a younger population between ages of 40 and 60. Osteoarthritis more commonly occurs in patients over age 60.

    7. Signs

    Meniscal tear patients tend to have knee swelling with sharp stabbing pain which is localized. Patients with osteoarthritic knees may appear to be bow legged or knock-kneed with palpable bone spurs or osteophytes at the joint line.

    8. Gender Predisposition

    No gender predispositions effect either types of injury.

    9. Genetic Predisposition

    No data proves there is genetic predisposition to meniscal tears. Osteoarthritis has a strong genetic component.

    10. Treatment

    Treatment for meniscal tears in a young active patient involves surgery. However, osteoarthritis treatment involves oral NSAIDS, cortisone injections, hyaluronic acid injections, bracing, and physical therapy. When all else fails joint replacement surgery becomes an option.

    If you suspect either type of injury or pain, call Dr. Grossfeld’s office today at 502-212-2663 to schedule an appointment. These injuries require a physical exam and possible further testing to determine either type of knee pain.

    Cost Effectiveness of Weight Loss Surgery Prior to Total Knee Replacement In Morbidly Obese Patients

    Posted by Stacie Grossfeld

    Weight Loss Surgery Knee ReplacementWith changes in healthcare, one new policy will be in effect in upcoming years that affects doctors and patients alike. A new policy will rate physicians based on their patient’s post surgery complications. This means that doctors will be treating patients’ current issues, and other contributing factors to receive a positive outcome. 

    We know from the literature and studies that one common reason for post-surgical complications is the patients’ weight or BMI. The higher the BMI and the more obesity is present, the higher the risk of complications.

    With patients undergoing joint replacement surgery it has been found that patients that had BMIs greater than 40 are at higher risk for complications than patients with a BMI <40. Because of this, surgeons will be recommending weight loss surgery prior to knee replacement.

    Study Results

    A study published in the Journal of Bone and Joint Surgery, December 2016 issue took computer model based evaluations and determined it is cost effective for patients that are morbidly obese to undergo bariatric surgery prior to knee replacement. The complications that occur secondary to the patient’s morbid obesity in a dollar value are more than the cost of the patient undergoing bariatric surgery.

    Post-surgical complications reduce significantly when patient’s BMIs are less than 40. Therefore, in the future, your orthopedic surgeon may be recommending bariatric or weight loss surgery prior to knee replacement surgery.

     

     

    Shoulder and Rotator Cuff Tears – Latest Research

    Posted by Stacie Grossfeld

    Rotator Cuff TearsWe know that rotator cuff tears commonly affect one shoulder, especially in patients who are over age 55. However, there is a group of patients that not only tear one shoulder, but end up tearing their contralateral shoulder as well. There was a study published in the American Journal of Sports Medicine in May, 2015, that specifically looked at patients undergoing rotator cuff repairs and tears on the contralateral side, that is the other shoulder.

    The study was completed through the Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea. The first author was Dr. Kyung-Han Ro. Looking at 140 patients who underwent a rotator cuff repair, researchers found that 38.6 percent of them had a rotator cuff tear on the contralateral shoulder.

    Understanding Different Sizes of Rotator Cuff Tears

    Dr. Ro divided the patients into three groups: 1) patients that had a small rotator cuff tear, 2) patients who had a medium sized rotator cuff tear, and 3) those with a large size rotator cuff tear. Researchers compared each of the patient groups to determine the chance of suffering a cuff tear on the contralateral shoulder.

    Researchers found that the patients that had a bigger rotator cuff tear, had a higher incidence of tears involving their contralateral shoulder. The patients that had small tears had a lesser chance of having a tear on the contralateral shoulder compared to the group that had large or massive rotator cuff tears. The conclusion of the study showed that the prevalence of rotator cuff tears of the contralateral shoulder tends to be higher in patients who are more symptomatic and have a larger rotator cuff tear on one side. (more…)

    Study on Vitamin D Levels in Pro Football Players

    Posted by Stacie Grossfeld

    Vitamin D Deficiencies Vitamin D deficiency is epidemic that affects an estimated one billion people worldwide. This nutrient is associated with many functions and organs in your body. Research shows that insufficient levels are associated with a greater rate of heart disease and mortality. Vitamin D levels less than 20 ng/mL are associated with a risk increase to 30 to 50 percent for developing colon, prostate, and breast cancer as well as an increased mortality from these cancers. In addition, vitamin D helps to maintain the health of your bones and muscles.

    Dr. Joseph Maroon studied the vitamin D levels in 80 professional football players. The department of neurosurgery at the University of Pittsburg Medical Center performed the investigation. The American Journal of Sports Medicine reported the finding in their May 2015 issue.

    Before looking into this study any further, you might need to know more about the science behind vitamin D. While this nutrient is used to maintain a healthy musculoskeletal system it’s also converted to 25-hydroxyvimtain D in the liver. Then it is further converted to its active form which is 1, 25(OH)2D. This happens in any of the kidneys or other tissues such as breast, colon, prostate gland, and the knee itself. The production of vitamin D in local tissues regulates cell growth, controls immune function, and affects gene expression. It is also used for calcium and phosphorus metabolism.

    We know that calcium and phosphorus are very important to bone and muscle health. Adequate calcium and phosphorus levels promote bone mineralization and also cause increased absorption of calcium and phosphorus from the intestines. It has been shown that phosphorus imbalance from low vitamin D causes muscle weakness, but can be reversed with supplementation. There is a direct effect of vitamin D on the muscle cells and receptors that induces new protein synthesis.

    Vitamin D deficiency is at level of less than 20 ng/mL, it becomes insufficiency when your level is between 20 and 32 ng/mL, and normal levels will be greater than 32 ng/mL.

    Vitamin D deficiencies have been documented in risk groups including: children, elderly, women wearing burqas, and those with dark skin. More recently, studies have indicated that athletes especially professional ones have an increased incidence of deficiencies.

    In the study listed above concerning the 80 professional football players, vitamin D levels range from extremely low to 8 up to 59 ng/mL, with 68.8 percent of the team having levels that were less than adequate. The ages of the athlete range from 22 to 37 years. The majority of these athletes were Afro-American making up 67 percent of the 80 athletes studied. The Afro-American athletes have significantly lower vitamin D levels than the Caucasian athletes.

    There was a much higher rate of deficiency or insufficient vitamin D levels. In fact, all  of the athletes with deficient vitamin D levels were Afro-American, as were 90 percent of the athletes with insufficient levels.

    The authors looked to see if there was an increased incidence of fracture among the Athletes with low vitamin D levels. The researchers found the levels were significantly lower in the athletes who experienced a fracture. Thirty-seven percent of the NFL players have experienced a fracture, 9 of which experienced more than one fracture.

    In conclusion, the author stated that the deficiency and insufficiency was significantly greater among Afro-American football players as compared to Caucasian players. Low vitamin D was associated with increased number of bone fractures. The overall prevalence of this deficiency in the studies was 26.3 percent which was comparable with 30.3 percent found in another study authored by Dr. Shindle. When combining patients with this deficiency and insufficient levels, the amount of players in this category was 68.8 percent.

    Consistent prior literature, African-American football players have a much higher prevalence of inadequate levels when compared to Caucasian players, 77.6 percent versus 23.1 percent.  Due to inhibited ultraviolet absorption and increased amount of melatonin in the skin pigmentation, dark skin is a known risk factor for low levels.

    Additionally, researchers found the vitamin D levels were inversely related to fracture prevalence. The authors recommended based on their findings of their research that routine monitoring and optimization of these levels should be considered as part of the routine care of NFL players with special attention to African-American athletes.

    If you are an athlete suffering from multiple fractures then a Vitamin D deficiency may be the problem. Contact Dr. Stacie Grossfeld of Orthopaedic Specialists today at 502-212-2663.

    Orthopedic Practice Owner Receives Small Business Owner of the Year Award

    Posted by Stacie Grossfeld

    Dr. Stacie Grossfeld Award RecipientThe 22nd Annual National Association of Women Business Owner EPIC Awards dinner was held on Thursday, March 3, 2016, at 5:30 p.m. at the Mellwood Arts & Entertainment Center in Louisville, Kentucky. Louisville orthopedic surgeon and sports medicine doctor Stacie Grossfeld M.D. received the Small Business Owner of the Year Award.

    Dr. Grossfeld is the owner of Orthopaedic Specialists, an orthopedic and sports medicine practice with two area locations in Louisville, Kentucky. Other NAWBO EPIC award categories included: Large Business Owner of the Year, Humanitarian Award, Supporting Partner Award, Phoenix Award and Associate Owner Award.

    Business Owners Award RecipientsThis special event, designed to recognize and celebrate the accomplishments of women business owners, included a cocktail reception compliments of Hilliard Lyons and a three-course dinner. Twelve award finalists gave brief speeches (complete with live voting from the audience) while Tim Laird, Chief Entertainment Officer of Brown-Forman Corporation, served as Master of Ceremonies, and Heather Howell, Director of Innovation at Brown-Forman, was the guest speaker.

    Orthopedic Practice Wins Award

    Reflecting on her success as a female business owner, and her receipt of this special award: Dr. Grossfeld explains: “At the end of the day, my advice to all women business owners is to follow the golden rule: do onto others as you would have others do onto you.” She also emphasizes the importance of having a great team, stating: “If I didn’t have the crew of people I have working with me, I would not have received this award. They make all the difference.”

    And the staff at Orthopaedic Specialists share similar sentiments when talking about Dr. Grossfeld’s success as Small Business Owner of the Year. For example, as explained by Marti Spencer, a medical receptionist at Orthopaedic Specialists: “Words cannot express how incredibly honored I am to work for this woman. She is an amazing boss and a phenomenal physician. We really do have such a wonderful group of people at work and it feels so much like family. I am so proud of my doctor and I want to give her major accolades for doing so well for herself. Dr. Stacie Grossfeld thank you so much for being you and for being such a wonderful boss. Congratulations you deserve this award!”

    Award recipient and sonOther 2016 EPIC Award recipients included Summer Auerbach, Owner of Rainbow Blossom, who received the Large Business Owner of the Year Award (for companies with more than 50 employees). EPIC stands for: Excellence as a woman business owner. Professional accomplishments during the past 5 years. Initiative and creativity in addressing major business challenges. Civic and community involvement.

    Read the full article here.

    Core Conditioning – Why It’s Important and What You Can Do About It

    Posted by Stacie Grossfeld

    Your core is not just a 6-pack of abs or something that turned into a beer belly. Your core is responsible for some of the most basic functions your body is able to perform. While your core provides support and strength, it’s also responsible for reducing pain and accomplishing tasks. Your core affects the way you sit, walk, stand and exercise. Because your core is connected to your back, glutes, spinal cord and legs, this part of your body helps you balance and keep everything together.Core conditioning exercises are important

    Your core is made up of three areas of muscle: the upper abs, side muscles or obliques, and then a deep layer of muscle. These deep muscles help support your spine and the rest of your body.

    Core conditioning exercises are very important for every person, regardless of your fitness goals and abilities. When targeting your core during training sessions, it doesn’t always doesn’t always mean crunches. You can exercise your core through things like yoga, Pilates and other strength training activities. And you can always engage core muscles during popular exercises like squats and lunges. Keeping your stomach tight and clenched during these exercises creates an added benefit for your abdominals.

    6 Exercises You Can Do For Core Conditioning

    Here are some specific core conditioning exercises you can do at home or at the gym to strengthen your core:

    1. Crunches: Lie down on your back with your knees bent and feet flat on the floor. While keeping your feet firmly on the floor, move your upper body toward your knees, and then go back to the floor. Use only your stomach muscles to lift your upper body from the floor. Complete 12 to 15 reps for 3 rounds, if possible.
    2. Planks: While resting on your elbows, press up from your toes and balance in this position for 30-60 seconds for 3 rounds. Keep your hips in line with the rest of your body without letting them sag.
    3. Arms and Leg Raise with a Stability Ball: Using a stability ball, rest your hips on top of the ball, with your feet and arms touching the floor. Alternate between lifting opposite arms and legs at the same time. For example: tighten your core and raise your right arm and left leg. Complete 12 to 15 exercises for 3 rounds.

    For those stuck at a desk all day, there are some stretches and exercises you can incorporate into your workday to strengthen your core.

    1. Ab Squeeze: Sit upright in your chair. Squeeze your abs for as long and tight as possible for 2 to 5 seconds. Release and then repeat this for 12 to 15 reps for 3 rounds.
    2. Accordions: Balance on your chair without resting your back on your chair. Hold on to the arms for support while you move your legs out and in from your body. This will target your lower abs and get your blood pumping. Perform 12 to 15 reps for 3 rounds.
    3. Alternating Elbows and Knees: Just like the bicycle abdominal exercise, you can perform something similar from your office chair. Place your opposite arm on the side of your head and raise your opposite leg at the same time. Twist your upper half while moving your lower half to meet your elbow. Try 12 to 15 reps for 3 rounds.

    Core conditioning exercises are a great compliment to any fitness routine. (more…)

    A Broken Wrist – Signs, Symptoms and Treatment Options

    Posted by Stacie Grossfeld

    Common Symptoms of a broken wristAt some point in time, many people suffer from a broken wrist. Children and the elderly are at higher risk for this common injury. Follow along for more important information about symptoms and treatment options for a broken wrist.

    There are eight small bones that make up your wrist called carpal bones. And there are two longer bones attached in your forearm called the radius and the ulna. These bones work together to allow your wrist to move and bend.

    The wrist allows four different movements: Flexion, extension, adduction and abduction. Most wrist injuries occur after people try and catch themselves when falling. An unexpected and awkward landing causes the bones in a person’s wrist to break or crack after taking the brunt of the fall. Along with falls, sports injuries and motor vehicle crashes are common causes of a broken wrist.

    Signs and Symptoms of a Broken Wrist

    If you have sustained an injury to your wrist, there are many signs and symptoms you might experience including the following:

    ● Pain when gripping or squeezing your hand
    ● Swelling
    ● Tenderness
    ● Bruising
    ● Deformity
    ● Stiffness
    ● Loss of motion
    ● Numbness

    All of the above symptoms can be indicators of a broken wrist. It is important to pay attention to these symptoms before your pain worsens. You will want to seek medical treatment immediately if you suspect a broken wrist.

    When you meet with a physician, you should be prepared to provide a detailed description of how the wrist injury occurred, as well as any past medical problems you have. If your doctor suspects a broken wrist, imaging scans like x-rays may be required to further examine the injury.

    If your doctor diagnoses you with a broken wrist, he or she will manipulate your bones to place them back to their proper alignment. After this process, your physician will most likely immobilize this area with either a splint or a cast. Your physician will also prescribe (more…)

    10 Tips to Avoid Running Injuries from a Sports Injury Doctor

    Posted by Stacie Grossfeld

    With the weather clearing up and daylight’s savings time approaching, it’s a great time to get back out on the roads and running trails. Running is a wonderful activity you can do almost anywhere, and in terms of cardio, it’s one of the best. In thirty minutes of jogging, you’ll burn upwards of 300 calories while exercising many different muscle groups.

    Whether you’re an experienced runner or relatively new to the sport, there is plenty to learn about injury prevention.

    Before you lace up your sneakers and sprint down your street, you may want to check out some of these tips so you can avoid running injuries that put many on the sidelines.

    10 Tips to Avoid Running InjuriesHow to Avoid Running Injuries

    1. Warm Up: A great run comes from a good warm up. Make sure that your muscles are warm and relaxed before heading out on a run. Running on cold legs can cause stiffness, discomfort and other injuries. A good warm up gets your blood pumping and leaves you a little sweaty. You can get in a great warm up by doing some jumping jacks, high knees or butt kicks before you hit the road.
    2. Stretch: Following a good warm up, don’t forget to stretch your legs, arms and back. You’ll want to not only loosen up your legs, but the rest of your body as well. Getting into a deep stretch may be too much before a big run, so keep your stretching to 10 to 30 seconds for each body part.
    3. Wear the Right Shoes: Running is low cost and pretty much available all 4 seasons. Because this is a comparatively inexpensive activity, don’t be afraid to spend a little extra money on some quality running shoes. Don’t skimp on support, durability and traction. Your feet and knees will thank you!
    4. Strength Training: Running can be great for stress relief and cardio, however adding weights into your routine will greatly improve your workouts. You don’t have to become a bodybuilder per say, but incorporating push-ups, dumbbells, and other basic weight training into your routine will help keep your muscles strong and balanced, reducing the risk of injury.
    5. Wear Proper Clothing: Spring in Kentucky presents a tricky wardrobe. One day you’re all bundled up and the next you’re in shorts. While running, it is best to keep your muscles warm by wearing the proper amount of clothing. But it’s also important to avoid overheating. Because it can be difficult to find the proper balance, layering is advisable.
    6. Don’t Run Every Single Day: Running all day, every day, can be exhausting and may quickly lead to an overuse injury. Give yourself a break by taking some days off to do other exercises. You don’t want to get mentally burned out while training for your next big race. And you’ll also find many physical benefits to cross-training.
    7. Start Slowly: When it comes to running, for many, it really is a marathon, and not a sprint. So take your time building up to more mileage. You will want to follow a running plan to help you safely work towards your running goals. This will help you avoid injuries and guide your routes.
    8. Take it Easy: Rest your tired muscles whenever you can. Some days you will be running on sore muscles. This is okay, but make sure that you give yourself a chance to relax. Try propping your legs up during off time, icing sore muscles legs and when necessary, taking anti-inflammatory medications.
    9. Mix it Up: Incorporating different speeds, distances, inclines, and surface-types, is a good way to improve your endurance and conditioning. And it is even more important if you are planning on competing in some of the upcoming running races. When you go out on your runs, try different routes. If you have limited options, consider going in the opposite direction or driving to an area park for a change in course.
    10. Relax: While it is wonderful to set personal goals and expectations, keep in mind that success in running can mean many different things. Listening to your body is an extremely important part of avoiding injury. Set realistic goals and stop if you feel pain. You don’t want to push yourself past your limits to be sidelined by a long-term running injury.

    Whether you are hoping to break new records in some of the spring races, or to simply (more…)

    Sports Concussions for Children and Teens

    Posted by Stacie Grossfeld

    Management of Sports Concussions in the Pediatric and Adolescent Population

    Sports concussions for soccer playersThere is an excellent review in the January/February issue of Orthopedics by Dr. Aaron Provance et al. which covers the management of sports-related concussions in the pediatric and adolescent population. Below is a summary of the key points in managing sports related concussions.

    Concussions make up nearly 10% of all high school athletic injuries.  The high school athletes associated with the greatest risk for sports concussions are football players for males and basketball and soccer player for females. One in five high school football players will suffer a concussion each academic year.

    The majority of concussions do not involve loss of consciousness or observable neurological signs.

    Sports concussionsThe cardinal symptoms of a concussion presentation are: confusion and amnesia. Other post-concussive symptoms may include:  sleep disturbances, headaches, loss of consciousness, disorientation, increased emotion, irritability, slowed reaction time, difficulty with concentration or memory, fatigue, blurred or double vision, sleep disturbances, dizziness, poor balance, and sensitivity to light or noise.

    Part of the challenge involved in diagnosing and treating a concussion is that there’s great variability between each athlete and their presentation with their symptoms.

    Rules have changed significantly regarding treatment of concussions and return to play.  Prior to 2002, it was not uncommon to allow an adolescent athlete to return to the same game or practice if his or her symptoms resolved within 15 minutes from the time of the injury. Now with new legislation and state mandates, it is recommended that the healthcare provider does not allow an adolescent or pediatric athlete to return to play on the same day. It should be of note that the majority of young patients will have complete resolution of their symptoms within 7 to 10 days from the time of the injury.

    Concussion Management and Recommendations 

    If a sports concussion is suspected, the athlete should immediately be removed from play for evaluation by a medical professional such as their athletic trainer or a physician.  Many times, the players will self-report injuries, but the coaching staff also play an important role in recognizing on-field incidents or signs and symptoms that may indicate the need for player to undergo a concussion evaluation. For example, if a player comes off the field and does not remember the last play or forgets what they are supposed to do when they are on the field. (more…)

    Does Total Knee Replacement Take Away Knee Pain?

    Posted by Stacie Grossfeld

    total knee replacementThere have been recent studies assessing the incidence of knee pain after total knee replacement involving the operative knee. There was an article published in the Journal of Orthopedics, January/February, 2016 issue, offered by Dr. Thomas Sculco out of the hospital for special surgery at Cornell Medical Center in New York, New York.

    This research found that patients that were one to four years post-surgery after a knee replacement, or 39% of the patients, still reported chronic pain involving the operative site.  Their average pain score was 3/10 on the VAS pain scale, and the worst average pain score was 5/10 on the VAS pain scale. This research revealed that non-modifiable risk factors for chronic knee pain after knee replacement involved patients with diabetes, morbid obesity, and female gender.

    Researchers Identify Factor Linked to Higher Risk of Pain following Total Knee Replacement Surgery

    The researchers noted that whether the patient had a minimally invasive procedure such as a small or shorter incision did not make any difference compared to the patients that had a longer more standard incision for the procedure.  Interestingly, they did find that for every minute of an extended operative time, the odds of developing a chronic pain were increased by 1.013 times. It showed that longer operative procedures resulted in worsening pain. It is not known whether this is associated with the actual surgical time or the fact that the patient had a “worse” knee preoperatively which may result in a less favored operative result postoperatively.

    Typically, longer surgery means that the deformity is worse, there is more flexion contractures, more scar tissue, and that the patient may be morbidly obese. The authors were unable to comment as to why they felt the pain score worsened with longer operative time; however, based on my experience as an orthopedic surgeon and knee doctor, (more…)