Rotator Cuff Pain

Posted September 23, 2014 by Orthopaedic Specialists

Why do rotator cuff tears and rotator cuff tendinitis hurt so much?

As a shoulder specialist, one of the most frustrating situations is trying to control a patient’s pain, when they present with a rotator cuff tear or rotator cuff tendinitis. Rotator cuff pain, after rotator cuff surgery, can be significant. Rotator cuff pain often tends to intensify at night, especially if a person is sleeping on their injured side.

As physicians, we are unsure as to why rotator cuff pathology causes so much rotator cuff pain and have not been very good at controlling it.

High dose pain medications such as Percocet, hydrocodone, or even oral Dilaudid, have been used without great success.

A scientific break through in identification of one of the sources of rotator cuff pain has been identified in a study conducted at the University of Oxford published in the August 2014 American Journal of Sports Medicine. Authors Sarah Franklin PhD et al. looked at the role of glutamate and the glutaminergic system. (more…)

Posterior Shoulder Dislocation

Posted September 15, 2014 by Orthopaedic Specialists

Posterior Dislocations of the Shoulder

There are several types of shoulder dislocations. They are named based on the direction of the dislocation.

The most common type is the anterior dislocation where the shoulder comes out the front. Another type of shoulder dislocation is posterior: this is where the shoulder dislocates out the back.

A posterior shoulder dislocation is rare. Anterior shoulder dislocations occur 15-21 times more often than a posterior shoulder dislocation but the etiology of the posterior dislocations are consistent. We see this in people who have had seizures, high energy trauma such as an auto accident, or have been electrocuted.

The posterior shoulder dislocation gets missed or has a delay in diagnosis up to 79 percent of the time.

The orthopedic doctor should be suspicious of additional injuries associated with a posterior shoulder dislocation. Up to 55 percent of the time there is an associated neck injury and 23 to 42 percent of the time a fracture involving the shoulder bone (greater and lesser tuberosity) occurs at the time of the posterior shoulder dislocation.

If the dislocation is caught early after the injury, a closed reduction can be performed in the emergency department. This is performed with a light anesthetic. (more…)

Knee Surgery Among College Athletes

Posted September 8, 2014 by Orthopaedic Specialists

Effects of knee surgery on a subsequent injury and surgery among NCAA college athletes

Dr. Sharon Hume et al. published a very interesting article in the April 2014 issue of the American Journal of Sports Medicine. She and her colleagues studied 456 Division 1 athletes at UCLA who had a history of an orthopaedic surgery procedure.

They identified a 6.8 fold increased chance of sustaining another knee injury if the athlete had a history of prior knee surgery. There was a staggering 14.4 fold chance that the athletes with a history of a prior knee surgery would end up undergoing another knee surgery.

ACL Reconstruction May Increase Risk Of Additional Knee Surgery for College Athletes

The group of college student athletes that was at extreme risk of an additional knee surgery were the student athletes that had undergone an ACL reconstruction prior to starting their collegiate career.

If a student had an ACL reconstruction before starting college, there was an 892 fold increased risk that they would undergo a second knee surgery during college while playing D-1 sports. There was a 19.6 fold chance that those athletes would experience an additional knee injury.

These research findings suggest that teaching young athletes about ACL injury prevention is more important than ever to reduce the risk of knee injuries (more…)

The Louisville Ironman Experience: From Viewpoint of a Doctor

Posted August 26, 2014 by Orthopaedic Specialists

Dr. Stacie Grossfeld, sports medicine specialist and orthopaedic surgeon in Louisville, Kentucky, interviewed Dr. Brittney Richardson regarding her experience heading a medical team at the 2014 Louisville Ironman. Dr. Richardson is a second year medical resident with the University of Louisville Department of Family Medicine. She is currently doing her orthopedic rotation with Dr. Grossfeld.

2014 Women’s Ironman Winner: Nina Kraft from Germany. Winning her third Louisville Ironman at age 46 in 9:31:19. Dr. Richardson is in the first row right with her team of nurses .

Interview with Dr. Brittney Richardson by Dr. Stacie Grossfeld

Dr. Grossfeld: “Describe what it was like at the Kentucky International Convention Center in Louisville, Kentucky, working the medical treatment area for the 2014 Ironman?”

Dr. Richardson: “It was like a war zone. There were athletes spread out over 200 plus cots in a make shift hospital located in one of the large rooms in the convention center. Many of the athletes were laying down on portable cots hooked up to I.V.s. Athletes were being brought in by medical personnel in wheelchairs and stretchers by the nursing staff and EMS workers. Massage therapists were working on finishers with muscle cramps and spasms.

Dr. Grossfeld: “What was the general appearance of the athletes and how did they compare to other athletes you have taken care of at the end of other endurance races such as the Louisville Marathon and the Triple Crown?”

Dr. Richardson: “I have never seen athletes so sick in appearance at the end of a race. Some of them looked like they were going to die. At times it was scary. We had a full lab at the site so we could draw blood and check electrolytes to help guide in treatment. There was also a full pharmacy present so we could administer drugs. I had four nurses working under me in a pod of eight hospital cots. The beds were always at least 50 percent full during my shift.”

Dr. Grossfeld: “What was the scariest athlete you treated?”

Dr. Richardson : “There was a finisher that was somewhat incoherent. She was having intermittent tremors and had a hard time answering simple questions. Her pupils were dilated and my team thought she might have a seizure. One of the emergency department physicians saw her from across the room and came over to asked me if I needed any help because she looked so bad. I pumped 2 liters of fluids into her and gave her some IV Ativan for her severe muscle spasms. She then perked up. The really critical patients we sent out to one of the local hospitals for more comprehensive treatment.”

Dr. Grossfeld : “What is a catcher?”

Dr. Richardson : “A ‘catcher’ is a healthcare worker that is located at the finish line and they literally catch the athletes that stagger or fall across the finish line. The athletes are completely depleted and cannot walk or even crawl. The catchers were primarily nurses that would transport the finishers into the medical area.”

Dr. Grossfeld: “What were some interesting things you learned from the athletes?”

Dr. Richardson: “It is an amazing commitment to compete in an ironman. I got to spend some time talking to athletes as I was starting their IVs and treating them. It’s not only a 9 month time commitment but a 5 hour a day training schedule. The competitors’ families completely re-work their schedules and routines to allow the athlete to train.” (more…)

Louisville Orthopaedic Specialists Hires Two Certified Physician Assistants

Posted August 25, 2014 by Orthopaedic Specialists

Orthopedic surgeon and sports medicine physician Dr. Stacie Grossfeld and the entire staff at Orthopaedic Specialists in Louisville, Kentucky, are excited to welcome two Certified Physician Assistants to the team, Melissa Edds PA- C and Angel Porter PA-C.

Orthopaedic Specialists hires Melissa Edds

Melissa Edds PA-C will work part-time at Orthopaedic Specialists as a Physician Assistant.

With a combined experience of more than 20 years, Melissa Edds PA-C and Angel Porter PA-C are certified by the National Commission on Certification of Physician Assistants and are licensed to practice in the Commonwealth of Kentucky. While working with Louisville orthopedic surgeon Dr. Stacie Grossfeld at Orthopaedic Specialists, Ms. Edds PA-C and Ms. Porter PA-C will be closely involved in many facets of patient care.

Angel Porter PA-C joins Louisville Orthopedic and Sports Medicine Practice, Orthopaedic Specialists.

Responsibilities for Ms. Edds PA-C and Ms. Porter PA-C will include obtaining medical histories, performing physical exams, and ordering and interpreting lab work and diagnostic studies. They will also be performing certain medical procedures, and helping to educate clients about recommended treatment options. Learn more about our new physician assistants in this press release.

Kentucky State Fair 2014 Kicks Off

Posted August 17, 2014 by Orthopaedic Specialists

The 2014 Kentucky State Fair is happening in Louisville, Kentucky, from August 14 – August 24, 2014. Dr. Grossfeld’s son Adam entered two categories this year (painting and drawing). Find out more about the Kentucky State Fair Daily Schedule including competitions, concerts, horse shows, contests, entertainment options, and more here.

Preventing Common Soccer Injuries

Posted August 11, 2014 by Orthopaedic Specialists

The Effectiveness of Preventive Programs on Decreasing the Risk of Soccer Injuries in Belgium

The FIFA 11+ injury prevention program reduced soccer related injuries 21% in Belgium and has been reported to reduce injury rates 30-50 % in Norway. Dr. Bollar and colleagues from Belgium’s University of Leuven published an excellent research project in the March 2014 American Journal of Sports Medicine.

Soccer, also known as “football” in Europe, is the most popular sport in the world. FIFA has 270 million players registered. Even though it is the most popular sport in the world it has a high rate of injury.

A group of physicians in Belgium studied the effects of injury reduction in soccer after the initiation of the FIFA 11+ injury prevention program was introduced. According to the authors, Belgium has 420,000 licensed soccer players, 16,500 plus teams with approximately 7500 games played per week and 232,000 games per year.

In Belgium there has been extensive data recorded in reference to soccer players: injury type, diagnosis, mechanism of injury, and treatment. Detailed demographics on the players were also recorded such as age, gender, division of the soccer club, profession, and level of activity at the time of injury.

Preventing Soccer Injuries with Injury Prevention Program

The injury prevention program designed to prevent soccer injuries consisted of the FIFA 11+ protocol . This 20 minute activity protocol involves a standardized set of warm up tasks: ranging from plyometrics, running, strength training and balance exercises. This was completed before every practice and soccer games. (more…)

Suffering from an Ankle Sprain?

Posted July 25, 2014 by Orthopaedic Specialists

Did you know that an ankle sprain is one of the most common types of injuries? People of all ages may experience an ankle sprain and they can be very painful, even making it walking difficult.

Ankle sprains are generally graded by severity ranging from a grade 1 ankle sprain which is less severe to a serious ankle sprain or a grade 3. Ankle sprains often involve tearing to ligaments around your ankle. Sometimes if you experience a more serious ankle sprain, it may also be accompanied by a popping noise.

Athletes often end up with a sprained ankle while running or jumping, especially if they land unevenly or lose their balance. It is easier to sprain an ankle on trails and uneven ground or when you are physically tired and feeling more worn out.

After you experience an ankle sprain, you will likely see ankle swelling and experience discomfort. In more mild cases, you may still be able to walk, but with more severe ankle sprains, walking can be very difficult if not impossible.

It is advisable to apply ice to a an ankle sprain as quickly as possible. Rest and elevation are also often recommended and compression with an ace bandage can be helpful too to cut down on any swelling. (more…)

Clavicle Fracture, Concussion, and ACL Injury

Posted July 16, 2014 by Orthopaedic Specialists

Contact High School Fall Season Sports Injuries: Clavicle Fracture, Concussions and the ACL Injury

The training for the fall sports season officially starts July 15th. High School Fall Season contact sports (football and soccer) bring about many injuries ranging from bumps and bruises to more serious injuries requiring surgical intervention. Among the more common fall contact sports injuries seen are: clavicle fractures, concussions, and the ACL injury. A Clavicle fracture is typically caused from a direct blow to the collar bone.

Typically a clavicle fracture will heal without surgery. The fractures that are at risk for not healing or healing in a position that can cause dysfunction to the shoulder are the ones that are shortened greater than 2 centimeters, communition at the fracture site (fracture is in more than 2 pieces) and 100 percent displacement (no bone to bone contact at the fracture ends). The above mentioned clavicle fractures would be considered for surgery intervention.

If surgery is necessary to repair a clavicle fracture, a plate that is specially designed to conform to the shape of the clavicle is placed and held with a series of low profile screws. The surgery is performed as an outpatient procedure.

If the clavicle fracture does not exhibit the above mentioned findings on x-ray then conservative treatment is instituted. Conservative treatment typically consists of being placed in a sling for comfort, an oral NSAID medication for pain control, and ice being applied at the fracture site until the swelling has reduced. Sometimes short term use of pain medication is needed especially to help with sleep.

As the fracture fragments begin to heal the pain drops significantly. In patients with open growth plates this occurs very rapidly within 2 to 3 weeks. Return to a contact sport can range from 6 weeks to 3 months based on the type of the clavicle fracture pattern and the specific sport.

Concussions are also common in the fall high school sports. The highest incidence is among soccer and football players. In 2009 the Lystedt Law was passed in the state of Washington and has subsequently been adopted by all states except one. The goal of this law was to reduce the number of student athletes suffering from concussions. Concussions have been proven to cause short term and potentially long term permanent cognitive effects (brain damage).

In summary the Lystedt Law required athletes be removed from a game or practice when they developed symptoms that were consistent with a concussion. The injured student athlete could not return until they were seen by a healthcare provider that was trained in the diagnosis and management of concussions.

The law also requires that the student-athlete, parents and coaching staff undergo education on identifying and preventing concussions. A consent is also signed by both the coaches, the athletes and the parents annually.

There are some helpful resources available on preventing concussions. The Center for Disease Control has an excellent online program for education: “Heads Up: Concussion in Youth Sports.”

The ACL injury is a devastating knee injury that occurs most commonly in female soccer players. It is a season ending injury that can result in early onset osteoarthritis. It is associated 50 percent of the time with meniscal tears and can be associated with cartilage damage that causes long term pain and disability to the knee.

ACL prevention programs have been reported to reduce rates of the ACL injury by 60 percent. The PEP program or variations of it have been instituted in the high schools where I am the team physician. If a student athlete tears their ACL a reconstruction is recommended. (more…)

Frozen Shoulder Treatment Without Surgery

Posted July 14, 2014 by Orthopaedic Specialists

Best Non-Surgical Treatment for Frozen Shoulder

A frozen shoulder, also known as adhesive capsulitis, is a condition that occurs when the shoulder loses range of motion and becomes painful. A true frozen shoulder occurs when there is no other etiology for the loss of range of motion such as an underlying rotator cuff tear, impingement syndrome, or labral pathology.

Most frozen shoulders occur in Caucasian women between the age of 40 to 65. More resistance frozen shoulders occur in people with diabetes or hypothyroidism.

Frozen shoulders occur in three phases: 1. freezing, 2. frozen, and 3. thawing. The freezing phase occurs with a progressive loss of range of motion. Trying to place the shoulder in a position that stretches the shoulder past that range is very painful. Stiff shoulders are typically painful.

The frozen phase is marked by a plateau of the loss of range of motion.

The thawing phase of frozen shoulder occurs when the range of motion starts to improve and the pain is reduced. The condition may resolve on its on and be self limiting. There are some studies that show patients may continue to have symptoms up to 7 years after the condition starts and never resolve on their own.

Frozen Shoulder treatment options range (more…)