Category Archives: Orthopedics & Spine

Elbow Pain: It’s Not-So-Funny

Posted on: July 15, 2015

Elbow Pain: It’s Not-So-Funny

By Dr. Michael Gott

Elbows can be surprisingly problematic—pain can plague tennis players, golfers, and even Elbowgardeners. Although elbow pain can limit your activities, plenty of solutions exist for resolving the pain.

If you experience elbow pain after a fall, an accident, or the pain comes on suddenly, you should head to the emergency room right away. You could have a fracture or dislocation. Other signs that you should see a doctor are numbness, tingling, sudden swelling, or difficulty moving your arm.

Patients often end up in my office due to more chronic concerns. Arthritis, bursitis (inflammation of a fluid cushioning sac in the joint), and pinched nerves (especially the ulnar nerve—your “funny bone”) can all create the kind of persistent pain that will lead patients to seek medical help. The most common complaints I see are tennis or golfer’s elbow. The pain is usually a form of tendonitis—inflammation in the tendons that connect forearm muscles to bone.

The first step for patients to try is RICE: Rest, ice, compression, and elevation. Resting your arm and applying ice for 15 to 20 minutes, three times a day will help reduce inflammation and ease the pain. You can achieve compression with elbow braces and wraps easily found at the drugstore; these will help take pressure off the tendon. Finally, keeping your elbow elevated above your heart will also help reduce swelling.

To help manage pain, I recommend starting with over-the-counter pain relievers such as ibuprofen or naproxen. However, if you don’t find relief with these measures, your doctor may suggest a cortisone (steroid) injection, especially for tennis or golfer’s elbow. This can provide immediate pain relief and, with physical therapy, allow patients to gradually return to play. If the pain persists, surgical solutions also exist. A surgeon can perform arthroscopic surgery to address structural problems like bone spurs.

An exciting new option is platelet-rich plasma (PRP), a therapy used by athletes such as Tiger Woods and Rafael Nadal. Blood is drawn from the patient and platelets—which contain proteins called growth factors—are separated, concentrated, and then re-injected into the problem elbow. The concentrated growth factor seems to speed healing. We’ve had some excellent success in treating chronic tennis and golfer’s elbow with PRP.

Editor’s Note: Michael Gott, MD is the Medical Director of Northern Westchester Hospital’s Orthopedic and Spine Institute at Yorktown. Dr. Gott specializes in conditions of the shoulder, elbow, wrist, hip, knee and ankle including traumatic and sports related injuries as well as arthritic conditions.

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Leg Injury After Hip Replacement Surgery

Posted on: June 19, 2015

Impact of Leg Injury After Hip Replacement Surgery

Dr. Eric Grossman details the impact of a leg injury following hip replacement surgery, in light of U.S. Secretary of State John Kerry’s recent broken femur and subsequent surgery.

Eric L. Grossman, MD, FAAOS; Co-Director, Joint Replacement Surgery, Orthopedic and Spine Institute Northern Westchester Hospital

Eric L. Grossman, MD, FAAOS; Co-Director, Joint Replacement Surgery, Orthopedic and Spine Institute, Northern Westchester Hospital

As we’ve seen in the case of Secretary Kerry, if you fall or sustain a major accident, individuals can break the bone around a hip implant. Typically the implants of a hip replacement reside in the patient’s bone without compromising the bone’s strength. However when a fall or traumas strike the leg, the bone can still be vulnerable to breaking.

The location of the break also determines the impact on the hip implant. A fracture in the femur below or above the implant typically does not jeopardize the implant. Yet a fracture closer to or occurring around the implant could disrupt the implant’s fixation and therefore its stability. This will result in the need for a “re-do” or revision surgery where a new hip implant is placed. These procedures are typically performed by a Joint Replacement Specialist as they are more complex than first time hip replacements.

“Hip replacement patients should feel
optimistic about their future physical abilities.”

Secretary Kerry is a great example of how most hip replacement patients return to a high level of physical functionality. Whether it is a “normal” return to physical activity, or rigorous exercise, hip replacement patients should feel optimistic about their future physical abilities.

Editors Note: Eric L. Grossman, MD, FAAOS is Co-Director of Joint Replacement Surgery at tge Orthopedic and Spine Institute at Northern Westchester Hospital. Dr. Grossman specializes in all aspects of hip and knee joint replacement surgery including primary and revision total joint replacement, with a focus on the Anterior Approach to Total Hip Replacement.  

Watch Dr. Grossman discuss the Anterior Approach to Total Hip Replacment and hear what several patients have to say about Dr. Grossman, the anterior approach and their experience at Northern Westchester Hospital, www.nwhorthoandspine.org/DrGrossman.

 

Likely treatment and rehab that U.S. Secretary of State John Kerry will Face

Posted on: June 2, 2015

The Road Ahead: What Treatment and Rehab Options Might Look Like for Secretary Kerry

Dr. Victor Khabie, Chief of the Department of Surgery and Chief of Sports Medicine at

new york orthopedist, orthopedic surgeon westchester

Dr. Victor Khabie, Co-Chief of Orthopedic Surgery,  Orthopedic and Spine Institute, Northern Westchester Hospitl

Northern Westchester Hospital in Hospital in Mount Kisco, NY explains the likely treatment and physical rehabilitation that U.S. Secretary of State John Kerry will receive after breaking his right femur in a bicycling accident.

Dr. Khabie says, “While it might take a full year for Secretary Kerry to completely heal, with advances in surgical procedures, he should be up and walking with crutches the same day as the surgery to repair his broken leg.”

Options to fix the femur
“While there are two options, it really only comes down to one option, and that is surgery. The other option would be to remain bedridden for six weeks as the broken bone heals, but that is not a good idea. People can develop bed sores, blood clots, and even pneumonia if they stay in bed that long. This should be fixed surgically by stabilizing the bone with a rod, plates, or screws, depending on the pattern of the fracture,” says Dr. Khabie.

How long will it take to heal?
Dr. Khabie says, “Typically, the broken bone will take six to eight weeks to heal, and a year for a full recovery.”

What is to be expected when it is time for physical rehabilitation?
“This injury will require months of physical rehabilitation,” says Dr. Khabie. “The muscles in the leg will atrophy, meaning they will wither and shrink in size. When the bone is healed, he will begin a more aggressive rehabilitation to include strength training. It’s a good thing he likes bicycling. He will start rehab using a stationary bike in about six weeks.”

Are there added concerns since Secretary Kerry had hip surgery on his right side as well?
“That previous surgery on his right hip makes this surgery more delicate,” says Dr. Khabie. “Care must be taken that the rods and screws used to fix his femur fracture do not interfere with his prior procedure. It is wise that he is having the same team of doctors perform both surgeries.”

Editor’s Note:
Dr. Victor Khabie, MD, FAAOS, FACS is a member of the Somers Orthopedic Surgery and Sports Medicine Group. Dr. Khabie received his medical degree from Harvard Medical School and completed his fellowship in sports medicine at the world-renowned Kerlan-Jobe Orthopaedic Clinic in Los Angeles, California, where he served as assistant team physician to professional sports teams including the LA Lakers, Dodgers, Kings, Mighty Ducks, LA Sparks, and the USC Trojan football team.

Manny Pacquiao, Punching Power and the Rotator Cuff

Posted on: May 8, 2015

Manny Pacquiao, Punching Power and the Role of the Rotator Cuff

Dr. Victor Khabie, Chief of the Department of Surgery and Chief of Sports Medicine at
Northern Westchester Hospital in Mount Kisco, NY dispenses advice on rotator cuff surgery in light of professional boxer Manny Pacquiao’s shoulder injury.

When Dr. Khabie is not performing orthopedic surgery, he is a Ring Side Physician for the New York State Athletic Commission where he cares for professional boxers and has been present at ringside for numerous world championship bouts.

Dr. Khabie says, “I will be very difficult to box at a high level with a rotator cuff tear. The rotator cuff is critical in generating the punching power that boxers require to fight effectively. I believe that his injury significantly influenced the outcome of the recent high-profile fight against Floyd Mayweather.”

He adds, “The good news is that rotator cuff surgery is generally a very successful operation but can take one year to fully heal. A rematch in one year may be of interest to fight fans as Pacquiao would be at full force and would probably make a more competitive opponent. Mayweather will want to prove that he can beat Pacquiao when Pacquiao is back at full force and injury free.”

A lot of people, not just professional athletes, tear the rotator cuff in their shoulders. Dr. Khabie shares his thoughts on the signs of an injury, and what to expect when having rotator cuff surgery.

Signs of a rotator cuff injury

“If an individual has pain in their shoulder for more than seven days, experiences pain in their shoulder while he or she is trying to sleep at night, or has trouble lifting their arm above their head, it is time to see an orthopedic surgeon to see what is going on.”

Dr. Khabie adds that, “If someone sustains an injury while engaging physical activity, or a heavy object falls on the shoulder, he or she should have it looked at by an orthopedic surgeon to get to the bottom of the injury sustained.”

Can this surgery be avoided?

“Sometimes,” says Dr. Khabie. “If there isn’t in fact  a tear, physical therapy can often help along with exercises at home using an exercise band.”

Why would someone have the surgery?

“When a rotator cuff tears, it is no longer connected to the bone in the shoulder, called the humerus. It can only be reattached with surgery,” says Dr. Khabie.

How long is the hospital stay?

“Rotator cuff surgery patients go home the same day as the procedure. We operate on our patients arthroscopically, meaning we use only tiny incisions, which is much less invasive and speeds up the recovery time,” says Dr. Khabie.

What is the recovery like?

“Patients spend about four to six weeks with their arm in a sling. It takes several months to recover. After six months, most people are cleared to begin normal physical activity and exercise, or in the case of a professional athlete, they can begin training,” says Dr. Khabie. “After nine months, most patients feel back to normal.”

Editor’s Note:
Dr. Victor Khabie, MD, FAAOS, FACS is a member of the Somers Orthopedic Surgery and Sports Medicine Group. Dr. Khabie received his medical degree from Harvard Medical School and completed his fellowship in sports medicine at the world-renowned Kerlan-Jobe Orthopaedic Clinic in Los Angeles, California, where he served as assistant team physician to professional sports teams including the LA Lakers, Dodgers, Kings, Mighty Ducks, LA Sparks, and the USC Trojan football team.

Watch Dr. Khabie discuss the role of sports medicine in keeping athletes in competitive condition.

Hip Replacement Surgery on the Rise

Posted on: March 19, 2015

Hip Replacement Surgery on the Rise

By Dr. Eric Grossman

Researchers at the Centers for Disease Control and Prevention (CDC) recently released findings iStock_3875724_LoRezthat from 2000 to 2010, the number of hip replacements for those older than 45 more than doubled.

The CDC said: “The number and rate of total hip replacements among inpatients aged 45 and over increased significantly from 2000 through 2010. The greatest increase in absolute numbers was in the 55–64 age group, where the number of total hip replacements almost tripled, whereas the greatest percentage change was in the 45–54 age group, which experienced a 205% increase. The 45–54 age group also had the greatest increase in rate, which more than doubled from 45 to 117 total hip replacements per 100,000 population.” (February 12, 2015).

I am not surprised by these trends based on improvements in surgical technique, durability of the procedure, durability of the implants, and patients’ desired active lifestyles. In my practice, I use what is called the “anterior approach” which can result in a faster recovery time, without postoperative restrictions, less muscle damage and a more natural feel to the artificial hip.

Previous generations of general practitioners were reticent to suggest hip replacement to their patients because of longer hospital stays, unproven effectiveness and longer recovery times. There was a time when doctors did not suggest hip replacement due to arthritis pain until their patients could not bear to suffer any longer.

Now, with advances in the surgical procedure, primary care physicians are more inclined to suggest the surgery. This is in part driven by their patients’ expectations. Individuals with painful arthritis are taking a proactive approach – they do not want to suffer in pain any longer than necessary. Additionally, they want to engage in an active lifestyle, and many advances in the surgery since it began to be performed approximately 50 years ago have made the new hips more durable.

The CDC also found that “In 2010, the average length of stay was shortest for the youngest age group and longest for the oldest group. Among those aged 45–54, the average stay was 3 days, lower than for each of the other age groups, while the average among those aged 75 and over was 4 days, higher than for each of the other age groups. From 2000 through 2010, the average length of stay decreased for each age group.”

These findings studied patients until 2010. Now, in 2015, I am seeing much shorter hospital stays after hip replacement surgery. Approximately 80 percent of my patients go straight home from the hospital – not to an inpatient rehabilitation facility as had been routine in the past – within 24-48 hours after surgery. Some select patients are even able to go home the same day of surgery. Our rehab protocols include rapid mobilization where the patients are expected to walk the same day as their surgery.

Watch Dr. Grossman’s patients tell their stories of
living life without pain after hip replacement.
View patient testimonials.

Hip replacement surgery has become more routine and is now being offered to a much wider demographic of patient, particularly patients ages 45-64 and it is not only helpful for senior citizens. There is no need to suffer with painful and activity-limiting hip arthritis. Talk to your doctor to see if hip replacement surgery is an option to explore.

Editor’s Note:
Eric L. Grossman, MD, FAAOS is Co-Director of Joint Replacement Surgery at the Orthopedic and Spine Institute at Northern Westchester Hospital and a member of Mount Kisco Medical Group.

Dr. Grossman is a fellowship trained, board certified orthopedic surgeon who specializes in all facets of hip and knee joint replacement surgery including primary and revision total joint replacement, with a focus on the Anterior Approach to Total Hip Replacement.