• Surgical Needle Sizes

    Posted by Orthopaedic Specialists

    Key Takeaways:

    • Steroid injections will hurt less if given with a 25 gauge needle.
    • The larger the gauge size of a needle, the thinner the diameter of the needle.
    • Corticosteroids are not particularly viscous injections, so pain-management doctors can normally use thinner needles for them.

    When it comes to surgical needles, like most other medical equipment, there are different sizes. The most common sizes range from 16-27 gauge, which is the unit of measurement used for needle thickness. The diameter of a needle gets smaller as the gauge number increases. So, a lower gauge will be a thicker needle, and a higher gauge will be thinner. Additionally, needles will vary in length, usually from .375″ – 3.5″ (Abdul Karim, Medsitis).

    Surgical Needle Size and Uses

    16-18 Gauge Needles

    These needles are on the thicker side of the scale. Insertion may be painful, and a large vessel is required. They are often used for IV infusions:

    • in adults and adolescents
    • of viscous fluids
    • of a large volume
    • at rapid infusion rates

    19-20 Gauge Needles

    These needles are slightly thinner, but still may be painful upon insertion and require a large vessel. They are normally as large of a needle as doctors will use for intramuscular injections (IMs), but will rarely be used for them. They are most commonly used for IV infusions:

    • in adults
    • of blood products and other viscous fluids

    21 Gauge Needle

    These needles wobble on the scale. They are the thinnest of the “thick needles” but are the thickest of the “thin needles.” Common uses for 21 gauge needles are:

    • in IV injections or infusions for most ages
    • for intramuscular injections

    22-23 Gauge Needles

    These needles are thin enough that a large vessel isn’t required for use. They are suitable for small or fragile veins, but insertion through tough skin may be difficult. Infusion control devices may be required. Uses for 22-23 gauge needles are for:

    • IV infusions in all ages, including infants, toddlers, and the elderly
    • IV infusions of non-viscous fluids
    • IV infusions at a slow to moderate infusion rate
    • Intramuscular injections

    24-27 Gauge Needles

    The final group of commonly used needles are 24-27 gauge. They are very useful for small veins, but insertion through tough skin may be difficult and infusion control devices may be required. Common uses include:

    • IV infusions in all ages, including infants, toddlers, and the elderly
    • IV infusions of non-viscous fluids
    • IV infusions at a slow to moderate infusion rate
    • Subcutaneous (SC) injections
    • Intradermal (ID) injections

    Surgical Needles and Cortisone Injections

    One of the most common uses of surgical needles in orthopaedics is for cortisone shots, or injecting corticosteroids. We use corticosteroids to help manage pain and inflammation. They help mitigate the symptoms of several different chronic conditions, like rheumatoid arthritis, bursitis, gout, back pain, osteoarthritis, tendonitis, and more.

    Injection sites are normally located at the joints, so ankles, elbows, hips, knees, shoulders, spines, and wrists are all common sites. To help our patients be comfortable, we normally use the thinner 24-27 gauge needles.

    Frequently Asked Questions About Corticosteroid Shots

    1. How long do corticosteroid shots take to work?
      1. Depending on the area of the injection, it may take anywhere from a few hours up to a week to start feeling the effects of a corticosteroid shot.
    2. Are corticosteroid shots painful?
      1. If using the correctly sized needle, the injection shouldn’t hurt too much. However, there is a risk of a flare period a day as your body might react with an inflammatory response before the medication starts working (Hospital of Special Surgery).
    3. How long do corticosteroid shots last?
      1. The average amount that pain relief from cortisone shots last is around 3-6 months. However, it can be dependent on several factors, including:
        1. How long the condition has been present
        2. Which part of the body is receiving the injection
        3. What condition is being treated

    If you or someone you love has suffered an injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Do You Need Knee Replacement Surgery for Severe Arthritis of the Knee?

    Posted by Orthopaedic Specialists

    Severe Arthritis of the knee Unloader Knee Brace

    Key Takeaways:

    • Even if arthritis looks bad on an x-ray, you don’t always need a total knee replacement surgery.
    • Knee replacement should be a last resort after all conservative treatments fail to help manage pain.
    • Common conservative treatments include hyaluronic acid and cortisone injections, physical therapy, and topical anti-inflammatory medications.

    When we see x-rays, it can be easy to draw the worst conclusions if a condition like arthritis looks bad on a scan. Severe arthritis, also known as late-stage, grade 4, or bone-on-bone arthritis, is one of these. Arthritis affects over 53 million US adults (CDC), and one of the treatments available is a total knee replacement. If you see bone-on-bone arthritis in your x-ray scans, does that mean you need a knee replacement surgery?

    The good news is that the answer is: not always!

    When Do You Need a Knee Replacement?

    While x-rays can help us to diagnose and track conditions like arthritis, treatment is not so straightforward as other medical issues like a broken arm. Treating chronic conditions like arthritis depend a lot on how the patient feels, not what their x-ray looks like.

    If someone breaks their arms, and it shows up on an x-ray, then there is a process to heal it. Arthritis cannot be healed, only managed. And, the pain that should be managed is the pain that the patient feels, not whatever an x-ray shows, necessarily. If a patient is doing well with conservative treatments, surgery should not be recommended lightly, if at all.

    Knee replacement surgery should only be a last resort, when nothing else works. If the patient has done all they can and still finds their daily activities to be interrupted by pain from arthritis, then knee replacement might be the next step.

    Non-Surgical Treatments for Severe Arthritis of the Knee

    Conservative, or non-surgical, treatments for severe arthritis of the knee are aimed at mitigating symptoms, not curing the condition. Arthritis is not a condition that can be cured. At Orthopaedic Specialists, our most common non-surgical treatments for arthritis include:

    Hyaluronic Acid Injections

    Hyaluronic acid is a naturally occurring fluid in your body that cushions your joints and fuels your skin, eyes, and connective tissues. Arthritis can cause it to deteriorate. Injections can replace that deteriorating fluid and add supplementary lubrication to your joints to help with pain and movement.

    Cortisone Shots

    Cortisone shots, or corticosteroid injections, are anti-inflammatory medications that are injected directly into arthritic or painful areas of your body. Because some forms of arthritis, like rheumatoid arthritis, are caused by an inflammatory response in your body, this injection can help mitigate pain in 2-5 days.

    Physical Therapy

    Many people might not realize that physical therapy isn’t only for injury rehabilitation. Seeing a specialist who knows about body movement and mechanics can help you learn how to move with less pain. Engaging the muscles around joints can strengthen them and help take some of the load off of the afflicted joint.

    Daily Exercise

    In addition to physical therapy, daily exercise works to help in the same way. Strengthening your body helps to reallocate how you bear weight. Muscles are just as important as joints, and play a huge part in keeping them safe. Low-impact activities like riding a spin bike, walking, swimming, and yoga are all recommended exercises for knee pain.

    Unloader Knee Brace

    An unloader knee brace can help you resume activities that may otherwise be too painful to do with severe knee arthritis. It provides levels of compression, stabilization, and weight redistribution to help unload the side of your knee that is affected by arthritis. There are a few types of unloader braces. You should consult with your doctor to discuss which type would be best for your pain.

    Topical Anti-inflammatory Gel

    Topical anti-inflammatory medications come as creams or gels that are applied to the skin around painful joints. The medication then soaks into the skin. Because of this, topical anti-inflammatory medications are best used on joints close to the skin, like the knees, hands, and wrists. Common medications you’ll see are Diclofenac sodium (Pennsaid, Voltaren) and Triamcinolone (Kenalog, Triderm).

    Frequently Asked Questions About Knee Replacement Surgery

    1. How long does it take to recover from knee replacement surgery?
      1. Recovery time will depend on factors like age, health, and rehabilitation adherence. However, most patients go home the day or the day after their surgery, regain mobility by three months, and recover fully within a year (Penn Medicine).
    2. How long will a knee replacement last?
      1. A knee replacement can last up to 20 or 30 years if taken care of properly. Those who are more active may wear their replacement out faster.
    3. What is the difference between a total knee replacement and a partial knee replacement?
      1. The knee joint comprises three areas: medial, lateral, and patella. In a partial knee replacement, a surgeon will replace one or two of these areas. In a total knee replacement, they will replace all three areas.

    If you or someone you love suffers from severe arthritis of the knee in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Patient of the Month: Michelle Durham

    Posted by Orthopaedic Specialists

    Meet this month’s patient in the spotlight, Michelle Durham!

    Michelle Durham Louisville, KY

    If there is one thing to know about our patient of the month, Michelle Durham, it is that she is the dictionary definition of resilient.

    Michelle has been playing sports since she was a child, including 6 during her years at Sacred Heart High School, and was fortunate enough to have the opportunity to attend the University of Montevello in Alabama for her talents in volleyball. When she graduated, though, she sought out different opportunities. Along with lifting weights that landed her in the bodybuilding business, in the early 2000s, Michelle found an opportunity in the form of a semi-professional women’s tackle football team, for which Dr. Grossfeld was the team doctor for.

     Michelle Durham Bodybuilder Louisville KY

    From Active to Injured

    Michelle has a long history of being active, but that also comes with a long history of injuries. She has been seeing Dr. Grossfeld since she injured her meniscus before her first season with her football team. But, since then, she has incurred a number of injuries, including:

    • An injured rotator cuff
    • Two torn ACLs
    • Injured elbow ligaments
    • A shoulder surgery

    Every time Michelle needed to see a doctor, she sought out Dr. Grossfeld.

    “One of the things that I love about Dr. Grossfeld is that she is a straight-shooter. She doesn’t sugarcoat things and gets straight to the point. I like that she speaks your language and isn’t uptight about how she interacts with you,” Michelle says.

    With a shoulder surgery and elbow rehabilitation also in her past and cortisone injections in her knee now, Michelle feels that Dr. Grossfeld has saved her a lot of pain and movement over the years. “With I can squat again, and my leg feels functional again, instead of just dead weight. I really appreciate Dr. Grossfeld, not only as a doctor, but also as a good human being that I would consider a friend.”

    Michelle’s Continued Battle

    Michelle Durham as a Yard Worker for Jack Harlow's family

    At 57 years old, Michelle hasn’t let her injuries stop her from living the life she loves. She might not be tackling anyone on the turf anymore but, with the help of Dr. Grossfeld and cortisone injections in her knee, she is able to tackle yard work for her long-time friends, the Harlows. She loves going to support the different professional sports teams that call Louisville home, especially Louisville Cardinals sports, Racing Louisville, and Louisville City FC, where she sometimes plays a different role than just spectator.

    As a semi-retired employee of the Louisville Water Company, she loves her role as their de facto mascot at events around Louisville. If you see their sentient glass of water, Tapper, know that Michelle is probably under the costume, giving her favorite character life.

    Michelle Durham as Tapper Louisville Water Company

    However, what makes Michelle even more of a rockstar is that, after having been in remission for breast cancer for 6 years, she is now fighting metastatic breast cancer in the lung. She still hasn’t let that dull her spark, though, and we really admire the grit and spirit that she continually shows every day.

    Michelle Durham Breast Cancer Survivor Louisville Cardinals Basketball Game

    We appreciate you, Michelle!

    If you or someone you love has suffered an injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Who Should Get an ACL Reconstruction Surgery?

    Posted by Orthopaedic Specialists

    ACL Reconstruction Surgery

    Key Takeaways:

    • People who are active, or whose knee gives out on them as they perform regular activities like walking should consider an ACL reconstruction surgery.
    • People who are not active and don’t experience any knee symptoms or people with advanced knee arthritis do not need to get an ACL reconstruction surgery.
    • If your knee regularly gives out, there is a higher risk of injury to the meniscus and the knee cartilage.

    If you have been diagnosed with a torn ACL, you might be wondering: what’s next? Both conservative treatments and surgical reconstruction are available for most who tear their ACL. But, there are factors that might affect which recovery path you take.

    What is the ACL?

    The ACL, or anterior collateral ligament, is a ligament in the middle of the knee. Most ACL injuries result from twisting, sudden stops or changes in direction, jumping, and landing. The symptoms of a torn ACL are:

    • A popping sound when the injury occurs
    • Knee pain, specifically on the outside of the knee
    • Knee swelling
    • Knee instability

    ACL tears often limit the range of back-and-forth motion of the knee. Fully straightening the knee is particularly painful. These tears can be a grade 1, 2, or 3, depending on how severe the tear is.

    Grade 1 is a mild sprain. Grade 2 is a partial tear. Grade 3 is a complete tear.

    Who Should Get an ACL Reconstruction Surgery?

    When surgically treating a torn ACL, it must be a reconstruction surgery, not a repair. Reconstruction surgery entails “making” a new ACL from a graft of replacement tissue. This tissue usually comes from a portion of the patient’s own iliotibial band, hamstring, quadriceps or patellar tendon (Hospital of Special Surgery). Recovery can take up to a year or more.

    Surgery is only recommended if:

    • The patient is young.
    • The patient experience lasting pain and instability in their knee.
    • The patient finds their knee giving out during normal activities like walking, which threatens the other ligaments in the knee.
    • The patient is very active, or regularly participates in twisting motions, jumping, or changing directions.
    • It is a grade 3 tear.

    Who Should NOT Get an ACL Reconstruction Surgery?

    ACL reconstruction surgery is not for everyone. Surgery presents risks like infection, anesthetic complications, worsened joint stiffness, nerve damage, or ongoing pain. For these reasons, some people might decide themselves that they do not want surgery. Surgery is NOT recommended for:

    • Patients with advanced or early-onset arthritis in their knee, which contraindicates ACL reconstruction surgery.
    • Patients that are not particularly active and do not experience pain or instability.
    • Patients with a Grade 1 sprain.

    Frequently Asked Questions About ACL Reconstruction Surgery

    1. How long does the surgery take?
      1. This surgery usually lasts 60–90 minutes, depending on complexity and whether other repairs like meniscus surgery are performed at the same time.
    2. Is ACL reconstruction painful?
      1. During the surgery, you will be placed under general anesthesia. Post-operative discomfort is common but manageable with pain medication, ice therapy, elevation, and early controlled movement. Pain typically improves within the first 1–2 weeks.
    3. Will I regain full strength in my knee after an ACL reconstruction surgery?
      1. While there is a chance that the reconstruction will fail, most patients regain near-normal strength and function with proper rehabilitation. However, returning to competitive sports too early greatly increases the risk of re-injury. Don’t be hasty!

    If you or someone you love has suffered an ACL injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Can You Cure Osteoarthritis VS Osteoporosis?

    Posted by Orthopaedic Specialists

    Osteoarthritis vs osteoporosis

    Key Takeaways:

    • Osteoarthritis is an active, or progressive, disease that gets worse with time and cannot be cured.
    • Osteoporosis is a curable disease.
    • To treat osteoporosis, patients will use a combination of additional vitamins, weight-bearing exercises, and prescription medication in some cases.

    Osteoporosis and osteoarthritis are two conditions that patients may get mixed-up about. Both are having to do with the bones, as denoted by the shared “osteo-” prefix. However, these conditions are very different from each other. One of the biggest differences is that one is curable, and one is not.

    Progressive vs Non-Progressive Conditions

    When a condition is progressive, it means that you cannot reverse or cure it. Osteoarthritis, which is when the cartilage around the joints and ends of bones wears away, is one of these conditions. Because it cannot be reversed, treatment focuses on slowing the progression of the condition and managing symptoms instead of eliminating them altogether.

    On the other hand, non-progressive conditions are reversable. Osteoporosis, or the softening of the bones, is an example of a non-progressive condition, despite the fact that the symptoms can worsen if the condition is left untreated.

    What are the Symptoms, Treatments, and Risk Factors for Osteoarthritis?

    Osteoarthritis usually presents symptoms in the knees, hips, hands, and spine. These can include:

    • Joint pain that worsens with activity
    • Stiffness (especially in the morning or after inactivity)
    • Swelling around the joint
    • Reduced flexibility and range of motion
    • Grinding or clicking sensation
    • Bone spurs in advanced stages

    Since it is a progressive disease, treatment focuses on managing symptoms, not curing osteoarthritis. Most of these methods are non-medicinal lifestyle changes like losing weight, implementing weight-bearing exercises into your routine, and monitoring your diet for inflammatory trigger foods.

    Factors that increase the risk of osteoarthritis are:

    • Age
    • Hormonal shifts like menopause
    • Obesity
    • Joint Injuries
    • Genetics
    • Repeated joint stress
    • Sex assigned at birth

    What are the Symptoms, Treatments, and Risk Factors for Osteoporosis?

    Osteoporosis is a silent disease, meaning that it doesn’t show many symptoms. In the case of osteoporosis, many people don’t know that they have the condition until they experience a break or fracture due to brittle bones, most commonly in the hips, wrist, or spine. However, other symptoms may include:

    • Back pain
    • Loss of height
    • Stooped posture, also known as kyphosis

    Treatment of osteoporosis focuses on strengthening bones, muscles, and slowing bone loss. Focusing on a diet rich in vitamin D and calcium, as well as implementing weight-bearing exercises, strength training, and balance training to reduce fall risks into routines are common treatments. Medication could be used in some cases. Regular DEXA scans, or bone density tests, are usually also recommended to track progress and risk.

    Factors that increase the risk of osteoporosis are (Northwell Phelps Hospital):

    • Age
    • Sex assigned at birth
    • Genetics
    • Hormonal shifts like menopause
    • Ethnicity (White or Asian Descent)
    • Smoking
    • Alcohol use
    • Sedentary lifestyle
    • Pre-existing medical conditions

    FAQs About Osteoarthritis and Osteoporosis

    1. Does weather really affect osteoarthritis? Many people report that cold, damp weather worsens joint stiffness or discomfort. While research findings are mixed, changes in barometric pressure may affect joint tissues, which could explain why some individuals feel worse before rain or during colder months.
    2. Can young people get osteoarthritis? Yes. Although it’s more common after age 50, younger individuals can develop it, especially after sports injuries (like ACL tears), joint fractures, repetitive occupational strain, or congenital joint abnormalities.
    3. Is osteoarthritis only caused by “wear and tear”? No. While wear and tear contributes, osteoarthritis is now understood as a whole-joint disease involving cartilage, bone, inflammation, and biochemical processes.
    4. Is osteoporosis only a women’s disease? No. While post-menopausal women are at highest risk due to hormonal changes, men can also develop osteoporosis and suffer fractures, especially if they are over 70.
    5. How early should bone density be checked? Screening is generally recommended for women at 65+, for men at 70+, and for younger adults with heightened risk factors like family history, steroid use, early menopause, or low body weight.

    If you or someone you love suffers from a bone-related condition like osteoarthritis or osteoporosis in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Disc Herniation vs Lumbar Stenosis

    Posted by Orthopaedic Specialists

    Disc herniation Model

    Key Takeaways:

    • Identifying both where pain originates from and where it is spreading to can help diagnose underlying conditions.
    • If more than 50% of pain is felt going down the leg, disc herniation may be the cause.
    • If more than 50% of pain is felt in the lower back, lumbar stenosis may be the cause.

    Pain from injuries or conditions are sometimes local to one area of the body. However, sometimes it can also spread to connected limbs, especially if the pain originates in the back. Being able to identify those extraneous pain spots can help to diagnose the underlying condition. A good example of this is disc herniation vs lumbar stenosis.

    Both of these conditions can cause pain in the lower back and/or legs. But, as a general rule, if more than 50% of pain is felt going down the leg, it’s more likely to be disc herniation. If more than 50% of the pain remains localized to the lower back, it’s more likely to be lumbar stenosis.

    Overview of Disc Herniation

    Disc herniation can also be known as a slipped disc, ruptured disc, or bulging disc. It is characterized by one or more of the discs that exist between spinal vertebrae bulging out and pressing on the spinal nerves, which causes pain.

    Causes of disc herniation: A herniated disc can be caused by several factors. Unfortunately, not all of them are preventable. Age, genetics, lifestyle factors such as obesity and smoking, and repetitive overuse can all contribute to disc herniation (Ohio State University Wexner Medical Center).

    Symptoms of disc herniation: Lower back disc herniation, or lumbar herniation, symptoms include nerve pain in your leg, also known as sciatica, numbness, tingling, or weakness

    Treatment of disc herniation: Usually, conservative treatment like lifestyle changes, bed rest, heat, and over-the-counter pain medications can make a big difference. If the pain is insistent or limits your ability to complete day-to-day activities after trying conservative treatments, physical therapy, corticosteroid injections, or prescription pain medication may be implemented. Surgical treatments are rare and only a last resort (Harvard Health Publishing).

    Other Possible Conditions That Cause Leg Pain

    The sciatic nerve runs from the spine down the legs, which is why some back issues translate to leg pain. Disc herniation isn’t the only condition that can cause sciatic pain, though. Other common reasons that you may feel pain along your sciatic nerve are:

    • Cauda equina
    • Degenerative disk disease
    • Foraminal stenosis
    • Osteoarthritis
    • Pregnancy
    • Tumors, cysts or other growths

    Overview of Lumbar Stenosis

    Lumbar stenosis is a more specific diagnosis of the condition spinal stenosis, which can affect several different parts of your spine, not only the lumbar region. It is characterized by the narrowing of space within your spine, which puts pressure on the spinal cord and spinal nerves.

    Causes of lumbar stenosis: Osteoarthritis is the #1 cause of lumbar stenosis. However, age, genetics, prior injury or surgery, tumors, preexisting health conditions and diseases, and other forms of arthritis can contribute to risk (Harvard Health Publishing).

    Symptoms of lumbar stenosis: Lumbar stenosis can cause back pain and sciatica pain, but most of the pain is felt in the back. Other symptoms include numbing, tingling, cramping in the back and legs, foot drop, and erectile dysfunction (John Hopkins Medicine).

    Treatment of lumbar stenosis: Except in emergencies, most cases of lumbar stenosis do not result in surgery. Lifestyle changes, physical therapy, and medicines like NSAIDS or steroid injections are more common treatments.

    Other Possible Conditions That Cause Lower Back Pain

    • Pregnancy
    • Spondylolisthesis
    • Facet Arthritis
    • Annular tear

    FAQs about Disc Herniation

    1. How long does it take to recover from disc herniation? Recovery time depends on the severity of the herniation, but most cases resolve between 6-12 weeks.
    2. When do I need to see a doctor for disc herniation? You should see a doctor right away if you experience loss of bladder or bowel control, numbness in the groin, an inability to walk, or extreme weakness in the legs.
    3. Can I exercise with a herniated disc? Yes, but gentle exercises that strength your core and posture will be the best for long-term pain management. Exercises that involve heavy lifting, deep bending, extreme torquing of the back, or spinal impact can make pain worse and should be avoided.

    If you or someone you love suffers from nerve pain in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Reverse Shoulder Replacement vs Shoulder Replacement

    Posted by Orthopaedic Specialists

    Reverse Shoulder Replacement Surgery vs Traditional Shoulder Replacement Surgery

    Key Takeaways:

    • Traditional shoulder replacement surgery is done for patients with shoulder arthritis who have an intact rotator cuff.
    • Reverse shoulder replacement surgery is done for patients with shoulder arthritis who do not have an intact rotator cuff.
    • In a shoulder replacement surgery, the glenoid sphere is connected directly to the humeral shaft whereas in a reverse shoulder replacement, the glenoid sphere is connected to a glenoid, and then the humeral shaft.

    Reverse shoulder replacement and traditional shoulder replacement offer shoulder pain relief for many patients. In fact, more than 100,000 people in the United States choose shoulder replacement surgery each year (Yale Medicine).

    Shoulder pain often starts when arthritis damages joint cartilage or when the rotator cuff weakens. The shoulder is a ball-and-socket joint that depends on smooth cartilage and strong muscles. When cartilage wears away, movement becomes painful and restricted. Rotator cuff damage further limits strength and stability. These problems affect many adults, especially those over age 60, athletes, and manual workers.

    If possible, non-surgical care always comes first. Physical therapy can improve strength and flexibility, while medications and injections can reduce inflammation and pain. However, these options sometimes stop working or don’t work at all for certain conditions.

    After non-surgical options run out, surgery then becomes the recommended next step.

    What are the Key Differences Between Shoulder Replacement Types?

    Choosing the right surgery depends on joint damage and rotator cuff health. Traditional shoulder replacement copies natural anatomy. The artificial ball attaches to the upper arm bone, and the socket attaches to the shoulder blade. This option works best when the rotator cuff functions well.

    Reverse shoulder replacement changes the joint structure. The ball attaches to the shoulder blade, then the socket attaches to the upper arm bone. This design allows the deltoid muscle to power arm movement. Reverse shoulder replacement works well when the rotator cuff is torn or nonfunctional.

    Common conditions treated with reverse shoulder replacement include:

    • Chronic rotator cuff tears
    • Severe shoulder arthritis with weakness
    • Rheumatoid arthritis or inflammatory joint disease
    • Complex fractures
    • Failed previous shoulder surgery

    Many patients with these conditions regain overhead motion within weeks.

    What to Expect From Shoulder Replacement Surgery

    Both surgeries usually take less than two hours, and most patients go home the same day or after one night.

    Procedure: Surgeons often use 3D imaging to plan precise implant placement. Additionally, muscle-sparing techniques help protect surrounding tissue for the best results.

    Pain Control: Pain control includes general anesthesia and nerve blocks. These methods work to reduce discomfort and limit opioid use so that patients don’t need to worry about developing a reliance on them.

    Recovery: Recovery starts with light daily activities combined with guided rehabilitation. Physical therapy usually lasts about 12 weeks, and most patients reach overhead by three months.

    How Long Will My Shoulder Replacement Implant Last?

    Modern shoulder implants last several years. Over 90% still function well after ten years, especially now that surgeons use durable materials like titanium and polyethylene. New options include pyrocarbon components and patient-specific implants, which further advance the fit, movement, and longevity.

    FAQs About Shoulder Replacement Surgery

    1. What makes reverse shoulder replacement different from traditional shoulder replacement?
      It reverses the joint structure and uses the deltoid muscle instead of the rotator cuff.
    2. Who benefits most from reverse shoulder replacement?
      Patients with severe rotator cuff damage or limited shoulder mobility benefit most.
    3. How long does recovery take?
      Most patients improve steadily over three to six months with physical therapy.
    4. How long do shoulder implants last?
      Most implants function well for at least ten years or longer.
    5. When should I consider surgery?
      Surgery may help when pain and stiffness prohibit your daily activities, even after conservative care.

    If you or someone you love has suffered a shoulder injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Leg Swelling and Pitting Edema

    Posted by Orthopaedic Specialists

    Leg Swelling and Pitting Edema in the Foot and Ankle

    Swelling on the body is a common symptom to experience. Normally, it is the result of inflammation as the body rushes blood and extra fluid to the site of an injury to help it heal. When your leg swells, it could be due to this response. However, there are other reasons for leg swelling that have to do with health conditions. In some of these cases, the swelling is sometimes known as pitting edema.

    When Leg Swelling Becomes Pitting Edema

    Pitting edema describes when someone has swollen legs due to a buildup of excess fluid to the point that pressure on the skin leaves temporary indentations (University of Maryland Medical Center).

    Pitting Edema Causes

    Fluid buildup can happen for a variety of reasons, according to Harvard Health Publishing from Harvard Medical School, including:

    • Prolonged standing or sitting, especially in hot weather
    • Venous insufficiency, or tiny valves inside the veins of the legs becoming weakened over time
    • Severe, chronic (long-term) lung diseases, including emphysema and chronic bronchitis
    • Congestive heart failure
    • Pregnancy or preeclampsia
    • Low protein levels in the blood caused by malnutrition, kidney disease, and liver disease
    • Certain medications like nifedipine, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Blood clots in the legs
    • An underactive thyroid gland (hypothyroidism)

    Pitting edema is oftentimes associated with systemic conditions where fluid retention is the main issue. This fluid is mainly composed of water (osmosis.org). This is different from non-pitting edema, which is normally associated with local conditions. In non-pitting edema cases, the fluid buildup is mainly composed of substances like proteins, salts, and water.

    Do You Need a Doctor for Leg Swelling or Pitting Edema?

    Some of the causes for leg swelling and pitting edema aren’t uncommon or caused by underlying health issues. Pregnant people can usually expect some degree of swelling without cause for worry. Those standing or sitting or long periods of time just need to get the fluid moving again.

    However, if you experience regular or prolonged periods of pitting edema without knowing the cause, it would be best to have a doctor eliminate the possibility of it being for an underlying health issue. Regardless of the fact that it can sometimes be caused by harmless factors, it is still a symptom.

    If you or someone you love has suffered from pitting edema in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Symptoms of a Torn ACL and a Torn MCL

    Posted by Orthopaedic Specialists

    Knee Injury

    The ACL (anterior collateral ligament) and the MCL (medial collateral ligament) are ligaments of the knee that are very close together. These two ligaments experience tears more commonly than the other two ligaments of the knee, which include the PCL (posterior cruciate ligament) and LCL (lateral collateral ligament. The reason for this is because of the ACL and MCL’s placement and the higher risk of damaging movements or impacts to them.

    Between the ACL and the MCL, an ACL tear is generally a more serious diagnosis. This is because the ACL is in the middle of the knee joint, where there is not a lot of blood flow that can heal the injury. Because the MCL is on the outside of the knee, these tears can sometimes heal on their own. Because ACL tears cannot heal on their own, they often require surgery.

    However, if you sustain a knee injury, there will be distinguishing symptoms for both a torn ACL and a torn MCL.

    Different Symptoms of a Torn ACL vs a Torn MCL

    Torn ACL

    Symptoms of a torn ACL can include:

    • A popping sound when the injury occurs
    • Knee pain, specifically on the outside of the knee
    • Knee swelling
    • Knee instability

    ACL tears often limit the range of back-and-forth motion of the knee. Fully straightening the knee is particularly painful.

    Torn MCL

    Symptoms of a torn MCL can include:

    • A popping sound when the injury occurs
    • Knee pain, specifically on the inside of the knee
    • Knee swelling
    • Knee stiffness
    • Knee instability

    MCL tears often limit twisting or torquing motions of the knee.

    ACL and MCL Tear Treatments

    Torn ACL

    Treatment for ACL tears usually require surgery. However, cases are determined by different factors. These include if your ACL tear is partial or complete, what your activity level is, and how bad your pain or other symptoms are.

    If you have a minor partial tear and your activity level is low, you may be treated with rest, anti-inflammatory medication, and physical therapy.

    Complete tears or ACL tears for those that partake in rigorous activity are normally recommended to undergo ACL reconstruction surgery and rehabilitation to avoid instability and other secondary knee issues in the future.

    Torn MCL

    Because torn MCLs have a higher rate of successfully healing themselves, these tears do not need surgery a majority of the time. Treatment usually include:

    • The R.I.C.E. method, or rest, ice, compression, and elevation
    • Physical therapy
    • Assistance devices like mobility scooters, crutches, or braces

    MCL and ACL Tear Doctor in Louisville, KY

    Knee pain can be debilitating, especially for those with high-activity lifestyles or careers. A torn ACL and a torn MCL may seem serious, but there are plenty of examples of high-level athletes returning to their game after recovering from a knee injury. Diagnosis, treatment, and plenty of time for recovery and rehabilitation are critical to returning without issues, though. Don’t skip your physical therapy, and if you think you have an ACL or MCL tear, get it checked out before it gets worse!

    If you or someone you love has suffered an MCL or ACL injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.

    Do You Really Need a Knee Replacement for “Bone-on-Bone” Arthritis?

    Posted by Orthopaedic Specialists

    Bone on bone arthritis

    Many patients are told they have “bone-on-bone” arthritis, or end-stage osteoarthritis, on their x-ray and immediately worry that knee replacement surgery is their only option. The truth is, imaging alone should never determine whether you need surgery or not. The real indication for a knee replacement is pain that limits your daily activities. In addition, the suggestion for surgery should only come after you’ve completed a full course of conservative, non-operative treatment. If the pain is still unbearable, then imaging and discussions with your doctor can help you make the decision of whether or not to get knee replacement surgery.

    Key Takeaway About a Bone-On-Bone Arthritis Diagnosis: An x-ray that shows severe arthritis does not automatically mean you need a knee replacement. Your symptoms and your response to conservative care matter far more than the image.

    What Are Non-Operative Approaches to Bone-On-Bone Arthritis?

    A comprehensive, non-operative approach can include treatments such as:

    • Physical therapy to improve strength and mechanics
    • Injection therapy such as corticosteroids or viscosupplementation to decrease inflammation
    • Bracing to unload painful areas
    • Activity modification to reduce stress on the joint.

    Many patients experience significant improvement with these treatments, even with advanced arthritis.

    What If I Still Experience Knee Pain After Non-Operative Approaches?

    If, after diligently trying all these options, you are still struggling with pain, stiffness, or loss of function, then knee replacement becomes an excellent and appropriate solution. The surgery is designed to relieve pain and restore quality of life. But, it should be considered only when other methods have failed. It takes a long time to recover from knee replacement surgery and, like all surgeries, there are certain issues that can arise from it.

    Allowing your body to heal itself naturally is often the best route. But, pain should never take away from your quality of life, especially with our advances in modern medicine.

    Frequently Asked Questions About Bone-On-Bone Arthritis

    1. What can be done for bone-on-bone arthritis? Treatment options for osteoarthritis include non-operative methods like physical therapy, corticosteroid injections, braces or other assistance devices, and lifestyle changes. Surgical treatment can include a partial knee replacement or a full knee replacement surgery.
    2. What stage of arthritis is bone-on-bone arthritis? There is no medical diagnosis for ‘bone-on-bone”. The term simply describes late-stage, advanced, or severe osteoarthritis. Some medical experts may also refer to it as end-stage osteoarthritis.
    3. Is bone-on-bone arthritis serious? End-stage arthritis is only as serious as the pain level and frequency of flare-ups. If imaging tells you that you have ‘bone-on-bone arthritis’ but you haven’t experienced any unordinary levels of pain, or your arthritic flare-ups don’t bother you often, it might not be so serious as to consider surgery.
    4. Can you live with untreated bone-on-bone arthritis? Yes, of course! Osteoarthritis is the most common form of arthritis and affects a large portion of adults as they age. There are several ways to offset the symptoms and manage the condition that don’t require a doctor’s prescription or any medical intervention.

    If you or someone you love has suffers from osteoarthritis in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.