Services

Shoulder Services

  • Shoulder Arthroscopy

    Rotator cuff repair, instability repair for recurrent dislocations, labral repairs (including "SLAP" lesions of the superior labrum), subacromial decompression or "bone spur removal" for impingement syndrome, distal clavicle excision for acromioclavicular arthritis, repair of proximal biceps tears.

  • Shoulder Arthroplasty (Joint Replacement)

    Hemi arthroplasty and total shoulder arthroplasty for fractures and arthritis."Reverse" total shoulder arthroplasty for rotator cuff tear arthropathy and certain proximal humerus fractures.

  • Rotator Cuff Tears, Tendonitis, Bursitis and Impingement Syndrome

    These are among the most common and painful conditions that affect the shoulder. They usually occur in middle aged patients and beyond, often without any injury (a “wear and tear” process.) Pain is often worse at night and with overhead activities.

    Nonoperative treatments like cortisone injections and physical therapy often provide good pain relief and return to function. When needed, arthroscopic “cleanout” surgery to remove bone spurs and inflamed tissue, along with repair of torn tendons typically has good to excellent results.

  • Shoulder Arthritis

    Arthritis of the ball and socket joint of the shoulder is less common than hip and knee arthritis, but can be equally painful and disabling. As with rotator cuff disease, nonoperative management like cortisone injections and physical therapy can be used to delay or avoid surgery. When needed, total shoulder replacement typically provides excellent pain relief and improved function.

    “Rotator Cuff Tear Arthropathy” is a specific type of shoulder arthritis that results from large rotator cuff tears. This usually cannot be treated with adequately with standard total shoulder replacement. “Reverse Total Shoulder” replacement surgery uses a newer, specially designed type of implant to address this difficult problem, with superior outcomes.

  • Shoulder Instability

    The ball and socket joint of the shoulder is more prone to dislocation than most other joints in the body. After the first injury, the joint will frequently continue to slip out of socket over time, causing pain and dysfunction. This often requires surgery to stabilize the joint, which usually can be done arthroscopically through a few small incisions, as an outpatient procedure.

  • Labral Injuries of the Shoulder

    The socket of the shoulder joint is surrounded by a rim of tissue call the labrum. This frequently tears at the top of the shoulder, causing a “SLAP tear.” This happens to overhead athletes like pitchers and volleyball players, but also from ordinary injuries like a fall. In addition to pain, symptoms of “catching and popping” are often present. When nonoperative treatment fails, arthroscopic outpatient surgery can be a very effective treatment.

  • Separated Shoulder

    The end of the collar bone can dislocate in an upward direction wear it makes a joint with the tip of the shoulder blade. This injury can be treated nonoperatively at times, but more severe injuries do better with surgical repair. This is an outpatient procedure that usually requires an open approach.

  • Fractures of the Collar Bone and Shoulder

    These are very common, especially in the older population, and often can be treated without surgery. However, more severe injuries do better when surgically repaired, usually with implantation of metal plates and screws as an outpatient procedure.

Elbow Services

  • Elbow Arthroscopy

    Lateral epicondyle debridement for tennis elbow. Loose body excision and debridement for mechanical symptoms.

  • Elbow Arthroplasty (Joint Replacement)

    Total elbow arthroplasty for fractures and arthritis. Radial head arthroplasty for fractures and arthritis.

  • Tennis Elbow

    This is a very common cause of pain on the outside of the elbow, usually affecting people in middle age. Despite the name, it often occurs without any history of injury or sports participation. It is considered to be a “self limiting” condition, because it often goes away on its own after months to years. Many people find it too painful to tolerate for that long. Cortisone injections and/or physical therapy often provide good long term relief. When necessary, “clean out surgery” on the damaged tendon, either through a small open incision or arthroscopically, usually provides good long term relief.

  • Golfer's Elbow

    This can be thought of as tennis elbow on the inside part of the elbow. The history, exam and treatment options are all very similar to tennis elbow, except that it is much less common.

  • Distal Biceps Tendonitis / Ruptures

    The biceps muscle forms a tendon that crosses in front of the elbow, where it can become inflamed and painful. Over time, this can weaken the tendon , causing it to tear away from its attachment in the upper forearm. This is most common in men in their 30’s and 40’s, after the elbow is forcefully extended against resistance. Immediate pain, swelling, and then bruising usually occur, with a “popeye” deformity from bunching up of the muscle. Reattachment of the tendon with surgery is usually indicated.

  • Olecranon Bursitis

    Swelling and pain over the tip of the elbow in the back is usually caused by inflammation of a layer of tissue called the olecranon bursa. This often responds to simple use of an elbow pad for a few weeks. Occasionally, removal of the bursa as an outpatient procedure is required.

  • Cubital Tunnel Syndrome

    Pinching of the “funny bone” nerve or ulnar nerve on the inside of the elbow often causes pain, along with numbness and weakness in the hand. Sometimes a nerve test called an EMG is helpful in confirming the diagnosis and guiding treatment. Other than observation, nonoperative treatment for this condition is less useful than in many other upper limb conditions. Surgical release of pressure over the nerve is usually effective in relieving symptoms in the elbow and the hand.

  • Elbow Arthritis

    While much less common than in the shoulder, arthritis of the elbow can cause significant pain and dysfunction requiring treatment. Cortisone injections can delay or prevent surgery. When needed, surgery can be effective, including joint-preserving “clean out” procedures, and partial or total joint replacement when necessary.

  • Fractures and Dislocations around the Elbow

    There are dozens of injury patterns that can occur in the elbow. Depending on the injury and the patient, treatment can range anywhere from a few days in a sling, to major surgery. Surgical techniques include the use of metal plates and screws when possible, to replacement of part or all of the elbow joint when necessary. Early evaluation by an orthopedic surgeon who is experienced in elbow surgery is important, so that appropriate and timely treatment can begin, to minimize the chances of a poor outcome.

Wrist Services

  • Wrist Arthroscopy

    Diagnostic arthroscopy, arthroscopic ligament repair or debridement. Dorsal wrist ganglion excision.

  • Carpal Tunnel Syndrome

    Numbness, weakness and pain in the hand is often the result of a pinched nerve near the wrist, or CTS. It can occur at almost any age, but is more common in middle age and beyond. Although it can be related to injuries and repetitive activities, usually the cause is unknown. Symptoms often occur at night and interfere with sleep. Nonoperative treatment options include observation and splinting. Surgery to relieve pressure over the nerve typically provides good outcomes. The modern “open” approach is done through a less than one inch incision in the base of the hand, and closed with 2 or 3 stitches. The patient removes the dressing in 1-2 days and immediate light use of the hand is permitted. Sutures are removed in 8-10 days, after which normal use of the hand is resumed over 2-3 weeks. Short term and long term outcomes of “open” CTR are at least as good as those with endoscopic techniques. Advantages of “open” surgery over “endoscopic” techniques include direct visualization of tissues that are being cut and those being protected. This can minimize the chance of incomplete release, which requires repeat surgery. “Open” surgery also minimizes the chance of permanent nerve injuries that can occur with endoscopic techniques. These injuries are irreversible, resulting in a hand that is worse than it was before surgery.

  • Wrist Pain

    Pain on the thumb side (radial side) of the wrist is most often due to a tendonitis called “DeQuervain’s tenosynovitis.”  Two tendons that help extend your thumb away from the palm can become pinched near the wrist joint, similar to what happens in trigger finger.  It can occur at any age, but is somewhat more common in younger adults.  As with trigger finger, a cortisone shot can be curative, but when necessary, a minor outpatient procedure to release pressure from the tendons typically fixes the problem permanently.

    Pain on the pinky side (ulnar side) of the wrist is most often due to a tear in the ligament (or soft tissue structure) that connects the two forearm bones and helps support the wrist bones.  It can occur with or without an injury, and at any age, but more often in younger and middle aged patients.  The diagnosis is usually obvious with a physical exam, and can be confirmed on xray and MRI.

    A cortisone injection can give good pain relief, as can a splint and over the counter anti-inflammatory medication.  Failing that, surgery is usually quite effective, and involves either repair or “clean out” of the torn tissue arthroscopically, through tiny ¼ inch incisions.   Occasionally, a small amount of bone needs to be removed as well, if the forearm bone on that side of the wrist is too long.  Another option is actually shortening that forearm bone through a longer incision a few inches about the wrist, which takes pressure off the torn tissues in the wrist.  The choice of procedure depends on xrays and the type of tear that is present, but they are all outpatient procedures that take about an hour, and healing takes between 4-6 weeks on average.

  • Distal Radius Fractures

    The forearm bone on the thumb side of the wrist often breaks when people fall onto on outstretched hand.  These can cause immediate deformity that requires immediate straightening and splinting in the Emergency Department.  Although most of these injuries were treated in a cast many years ago, surgery using modern metallic implants allows more rapid rehabilitiation, less immobilization.  They also allow more predictable results in terms of alignment and prevention of deformity long term.   It is typically an outpatient procedure that takes less than an hour, and is done through a 2-3 inch incision.

  • Scaphoid (Navicular) Fractures

    One of the bones on the thumb side of the wrist, the scaphoid bone, is often broken in falls or other high energy injuries, especially in young adults.  Unfortunately, people often think they “just sprained” their wrist and wait for weeks to months, or even longer before seeking treatment.  Normal function can usually be restored with early surgery.  But without treatment, after several weeks healing rates go down, and complications like long term pain and even arthritis become more common.  The surgery is outpatient, typically done through a small incision in the top of the wrist, through which a screw is used to stabilize the fracture.  The screw usually never requires removal.

Hand Services

  • Trigger Finger

    Pain and catching of the finger joints is often related to a problem with the tendons that pull the fingers down into the palm. The tendons run through a tunnel that runs from the base of the finger to the fingertip, and the opening of this tunnel can become thickenened, effectively pinching the tendons. Similar to carpal tunnel syndrome, this usually occurs without any injuries, and may be considered a “wear and tear” problem. A cortisone injection into the affected finger can cure the problem, or at least delay surgery for many months. Trigger finger release is a minor outpatient procedure that opens the tightened part of the sheath, and usually provides a permanent cure. It is done through a less than ½ inch incision, and recovery is similar to that for carpal tunnel surgery, if not somewhat faster.

  • Carpal Tunnel Syndrome

    Numbness, weakness and pain in the hand is often the result of a pinched nerve near the wrist, or CTS. It can occur at almost any age, but is more common in middle age and beyond. Although it can be related to injuries and repetitive activities, usually the cause is unknown. Symptoms often occur at night and interfere with sleep. Nonoperative treatment options include observation and splinting. Surgery to relieve pressure over the nerve typically provides good outcomes. The modern “open” approach is done through a less than one inch incision in the base of the hand, and closed with 2 or 3 stitches. The patient removes the dressing in 1-2 days and immediate light use of the hand is permitted. Sutures are removed in 8-10 days, after which normal use of the hand is resumed over 2-3 weeks. Short term and long term outcomes of “open” CTR are at least as good as those with endoscopic techniques. Advantages of “open” surgery over “endoscopic” techniques include direct visualization of tissues that are being cut and those being protected. This can minimize the chance of incomplete release, which requires repeat surgery. “Open” surgery also minimizes the chance of permanent nerve injuries that can occur with endoscopic techniques. These injuries are irreversible, resulting in a hand that is worse than it was before surgery.

  • Thumb Pain

    A very common cause of pain in the base of the thumb is “basal joint arthritis,” or wearing out of the the joint at the bottom of the thumb, near the wrist.  This can interfere with even simple grasping and pinching activities, like opening jars and using keys.   It occurs in middle aged and older patients, is usually easily diagnosed on physical exam, and confirmed with xrays.  Often, a single cortisone injection into the joint can relieve the pain indefinitely or for many months.  Splinting and over the counter pain medicine are other options.  When required, surgical removal of one of the small wrist bones at the base of the thumb gives excellent pain relief and restores function after a 6 week period of healing.  This is an outpatient procedure that takes about an hour, and long term results are usually good to excellent.

  • Dupuytren's Contracture

    "Nodules" (bumps) and "cords" can develop under the skin in the palmar side of the hand and fingers, which may cause discomfort with use. Over time, contractures of the fingers can develop and prevent opening of the hand. This interferes with function, and is an indication for treatment. Traditionally, open procedures to remove all of the abnormal tissue was the only treatment available.

    A newer, noninvasive method of treatment is Xiaflex (collagenase) injection, followed by manipulation. This is an office procedure, where a small amount of material that softens the diseased tissues is injected with a small needle and syringe. Two days later, the patient returns to clinic and the finger can be straightened out under local anesthesia, restoring function without need for surgery.

    Learn more about Xiaflex at http://factsonhand.com/

  • Finger Fractures

    The bones in the fingers and hand (the phalanges and metacarpals) are very frequently broken.  There is a lot of variation in how these are treated.  For example, a Boxer’s fracture, one of the most common hand fractures, is a break in the bone near the bottom of the pinky finger that happens when a person punches a wall or another person’s head.  They are usually adequately treated in a cast.  On the other hand, other breaks in the finger and hand bones frequently do better with surgery, which is done with temporary pins that are removed in the office after 4-6 weeks, or with permanent metal plates and screws.

Nerve Compression Services

  • Carpal Tunnel Release
  • Cubital Tunnel Release
  • Radial Tunnel Release
  • Pronator Release

Knee Services

  • Acute and chronic knee pain evaluation and management. Treatment most often is non-surgical, including physical therapy, bracing, injections etc. Operative treatments occasionally required, including arthroscopic management when possible.

  • Arthritis
  • Bursitis
  • Ligament tears, "strains and sprains"
  • Meniscal tears
  • Fractures

Fractures Services

  • Fractures of the Collar Bone and Shoulder
  • Elbow Fractures
  • Distal Radius / Wrist Fractures
  • Scaphoid (Navicular) Fractures
  • Hand / Finger Fractures
  • Hip / Thigh Bone Fractures
  • Knee / Lower Leg Fractures
  • Ankle / Foot Fractures