Ronald E. Glousman, M.D.

The shoulder is a “ball-and-socket” joint made up of the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). This joint is the most flexible one in the body and allows for a full range of motion, but also makes the shoulder a common source of injury and instability. While many of these conditions can be effectively managed through nonsurgical techniques, surgery is often needed to thoroughly correct the condition and allow patients to maintain an active and healthy life. In order to determine the cause of your pain, your doctor will ask for details about your symptoms and medical history, and also perform a physical examination to evaluate the shoulder. An X-ray or MRI scan may also be performed in order to examine the bones and soft tissues of the shoulder. Conditions Arthroscopy Broken Collarbone (Clavicle Fracture) Frozen Shoulder (Adhesive Capsulitis) Rotator Cuff Tear Labral Injury Shoulder Instability Shoulder Impingement Arthroscopy Arthroscopy is a minimally invasive procedure that can be used to treat many shoulder conditions by inserting a fiber-optic device and tiny surgical instruments into small incisions. Patients can benefit from less tissue damage, shorter recovery times and less scarring with arthroscopic techniques. This procedure can also be used for diagnostic purposes after a physical examination and other imaging procedures have been performed. Shoulder arthroscopy can be used to treat rotator cuff tears, labral tears, impingement, biceps tendonitis and AC joint arthritis. The type of repair performed depends on each patient’s individual condition, but often involves removing inflamed tissue, reattaching torn tissue or replacing damaged cartilage. Clavicle Fracture The clavicle, commonly known as the collarbone, is the bone of the shoulder joint that connects the arm to the rest of the body. Clavicle fractures most frequently occur as a result of trauma from a blow to the shoulder, fall or motor vehicle accident. They are most common in young children and older adults who are more susceptible to fractures. The terms “fracture” and “break” are often confused for terms of severity. In the medical community, however, a “fracture” is a break, and a “break” is a fracture. The terms are used interchangeably without any bearing on severity. Clavicle fractures cause the shoulder to slump downward and a bruise to appear over the fractured area. Some patients may hear a snapping sound when the fracture occurs. Pain is often experienced at the time of fracture and when the area is touched. Patients may also experience pain while trying to move the arm. Many fractured collarbones can be treated through conservative methods such as immobilization, ibuprofen, and a sling. Clavicle fractures will most often heal on their own, with little intervention, but there are fractures that are best treated surgically and therefore the need to have the fracture evaluated. You may be instructed to wear a sling until pain subsides, which can take two to six weeks depending on your age and the severity of your fracture. Adhesive Capsulitis (Frozen Shoulder) Frozen shoulder, also known as adhesive capsulitis, is a common condition that causes pain and stiffness in the shoulder as a result of a tightening or thickening of the capsule that protects the structures of the shoulder. Although the specific cause of this condition is not known, it most often occurs after recent immobilization of the joint or as a complication of diabetes. Frozen shoulder most often affects patients between the ages of 40 and 60. Patients with frozen shoulder often experience pain, stiffness and limited range of motion that gradually worsens as the joint becomes more and more frozen. Eventually, the shoulder will shift into its thawing phase, during which pain and stiffness subside and range of motion is slowly restored. Your doctor can diagnose frozen shoulder after a thorough evaluation of your condition, as well as an X-ray or MRI examination, which helps rule out other possible shoulder conditions. Treatment for frozen shoulder usually focuses on managing pain and other symptoms as the condition progresses. This may include anti-inflammatory medications, corticosteroids and physical therapy. Minimally invasive surgical procedures, such as arthroscopy and manipulation, may also be performed with a goal of stretching or releasing the contracted joint capsule. Rotator Cuff Tear The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and or trauma leading to pain, weakness and inflammation. Surgery is typically indicated to repair complete tears.

The constant use of the lower extremities makes them an easy target for injury and overuse, specifically in the knees. Walking, sitting, and standing all put pressure on our knees and most athletic activities rely on a health knees. Knee pain from injuries and other ailments effect thousands of people in the US each year. It is important to diagnose the source of the pain in order to successfully treat these conditions. Conditions Knee Osteoarthritis Meniscal Tear ACL Tear Bursitis Patellar Femoral Pain Runner’s Knee Jumper's Knee Knee Osteoarthritis Osteoarthritis, also known as wear-and-tear or degenerative arthritis, is the most common form of arthritis, affecting millions of people in the US each year. This condition is most common in older patients whose bone surface cartilage has worn down over time due to age, and in athletes who have worn down their cartilage from overuse and repetitive injuries. Patients with osteoarthritis may experience pain, swelling and stiffness within the joint, which tend to worsen as the condition progresses. Your doctor can diagnose this condition after evaluating your symptoms and performing an X-ray examination of the knee. Several other factors should be taken into consideration when diagnosing osteoarthritis, including evaluation of the patient's spine, nearby joints, posture and gait. Treatment for osteoarthritis initially focuses on relieving pain and other symptoms, and may include rest, physical therapy, bracing and anti-inflammatory medication. Arthroscopic surgery may be used to remove torn and loose fragments of cartilage and meniscus creating mechanical symptoms of catching and locking. More severe cases of osteoarthritis may require surgery to reposition the bones or replace the joint. Meniscal Tear Made of a cartilage shock absorbing disc between the femur (thighbone) and tibia (leg or shin bone) bone, the C-shaped meniscus performs many functions in the knee. Besides absorbing stress the meniscus helps the knee to stabilizes the joint, helps it carry weight, facilitates turning in many directions, and keeps the femur and tibia from rubbing together. Athletic injury (trauma) or daily stress on weakened tissue associated with age and degeneration can tear the meniscus. Movements most likely to result in a meniscal tear are twisting the knee, pivoting, cutting and rapidly decelerating. A meniscal tear may occur at the same time as a knee (ACL) ligament tear. Symptoms of a meniscal tear include stiffness, swelling, pain, tightness, tenderness, and fluid build-up frequently described as "water on the knee." If a piece of the meniscus breaks off in the joint, the knee may pop, slip or lock (become stuck at a 45-degree angle until physically moved out of the position). Meniscus tears do not heal. When they cause ongoing symptoms they are best treated with out-patient arthroscopic surgery. In younger pateints with tears that still maintain a blood supply they are repaired with sutures. The majority of tears occur in a portion of the meniscus that does not have a blood supply to allowing healing and in these cases the loose or torn meniscus fragment is removed to relieve symptoms and also to prevent the tear from enlarging over time. ACL Tear The anterior cruciate ligament (ACL) works together with the other ligaments in the knee to connect the femur to the tibia and support the knee joint. A tear in the ACL is one of the most common knee injuries, causing the joint to become unstable and slide forward and twist out of normal position. This injury occurs most often in athletes and causes pain, swelling, tenderness and limited motion. Individualy who are engaged in pivoting activities (athletics or work) are best treated with surgery. Stabilizing the knee with surgery restores normal knee function and prevents persistant giving way episodes that cause pain, swelling, and progressive damage to the joint. Those who are not engaged in pivoting activities on a regular basis may do well without surgery and these patients are treated with rehabilitation and the use of a ACL ligament brace. ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. Once torn the ACL will not heal, and different from other ligaments, simply repairing the torn ends will not cause the ACL to heal. The torn ACL ligament is removed at surgery and replaced with a graft that comes from the patient, such as the patella tendon or hamstring tendon, or is replaced with a cadavar tendon. Deciding on which type of ligament reconstruction is best is determined by evaluating the injury, patient age, and life style of the patient. ACL surgical reconstuction is now performed as an out-patient procedure using arthroscopic techniques rather than through open surgery. Rehabilitation is required after surgery.

The elbow is a complex joint that consists of the upper arm bone (humerus) and one of the lower arm bones (ulna) connected by a hinge, or a joint that only moves in one direction. Although many of these conditions can be treated through conservative methods, but some may require surgery to effectively relieve pain and restore function to the joint. Your doctor will decide which type of treatment is best for you after a thorough evaluation of your condition. The elbow is not protected by muscle or fat like most other joints which makes it more vulnerable to injury. The elbow is one of the most important joints in the body as it allows the arms to bend and twist. Some of the most common elbow conditions we treat include: Tennis Elbow (Lateral Epicondylitis) Golfer’s Elbow (Medial Epicondylitis) Olecranon Bursitis Cubital Tunnel Syndrome Tennis Elbow (Lateral Epicondylitis) Tennis elbow, also known as lateral epicondylitis, is an elbow injury that occurs as a result of overuse. The pain associated with this condition affects the lateral epicondyle, the area where the forearms’ tendons connect with the bony outer portion of the elbow. While named from the tennis injury, this condition can occur from any activity that involved repetitive grasping, lifting, and even typing. While tennis elbow typically affects adults aged 30 to 50, anyone who continually stresses their elbow and forearm are at risk of developing this condition. Treatment of lateral epicondylitis may include the following and typically resolves with simple non surgical care along with rest. Anti inflammatory medication, icing of the affected area, forearm band or brace, and physical therapy exercises typically provide a cure. The use of a cortisone injection by rapidly reducing inflammation may speed the healing process. Surgery if rarely required and is only recommended after failure of non surgical care or the rare case where there is a significant partial tear of the tendon. Golfer’s Elbow (Medial Epicondylitis) Medial epicondylitis, more commonly known as Golfer’s Elbow, is a form of tendonitis that manifests on the inner side of the elbow. It is caused by the tendon in the forearm being stressed from constant use. While it is named from the golfing injury it can occur in any activity that places stress on the forearm muscles including other sports and work. Golfer’s elbow is generally treated using anti-inflammatory medication, as well as rest from the activity causing the injury, and rehabilitation of the elbow. This along with Lateral Epicondylitis typically responds well to a cortisone injection which often promotes a rapid reduction of the inflammation and healing. Surgery is rarely required for this condition and is only considered when non surgical treatment fails. Olecranon Bursitis Olecranon bursitis, also called elbow bursitis, involves the development of a fluid-filled sac between the loose skin and bone of the back of the elbow. This condition typically occurs after a fall onto the elbow, or from prolonged pressure on the elbow, and may cause pain, swelling and limited motion of the elbow joint. Rarely the bursa sac may become infected causing fevers, chills, sweats and redness. Treatment for olecranon bursitis depends on the cause and severity of the condition, but may include applying ice, rest, fluid drainage and cortisone injection. When there is an associated infection the treatment requires antibiotics. Severe cases or those that do not respond to conservative treatment may require surgery to remove the bursa sac. Cubital Tunnel Syndrome Similar to carpal tunnel syndrome, cubital tunnel syndrome causes pain and numbness as a result of long-term nerve inflammation. In cubital tunnel syndrome, the ulnar nerve is affected at the site of the cubital tunnel, located along the inner (medial) aspect of the elbow. Inflammation of the nerve may occur as a result of frequent bending of the elbow or direct pressure and trauma to the nerve. Patients with this condition often experience pain and numbness on the outside of the hand and wrist, especially after the elbow has been bent for a long period of time. Your doctor can diagnose this condition through a physical exam and nerve conduction velocity test. Treatment for cubital tunnel syndrome may involve anti-inflammatory medication, splints, braces or life changes to relieve symptoms or prevent them from recurring. For symptoms that do not respond to conservative methods, surgery may be needed to relieve pressure on the ulnar nerve, which can be done through ulnar nerve transposition (surgically placing the nerve in a different protected location).

Most common hip conditions and injuries may be treated with simple non surgical care. Critical to treatment is establishing the correct diagnosis done by evaluation and appropriate diagnostic studies. When non surgical care fails hand surgery may be required. Some of the more common hip conditions and we see are: Trochanteric Bursits Hamstring Strain Labral Tears Trochanteric Bursitis Trochanteric Bursitis is a condition that involves the outer hip prominence (Greater Trochanter) bursal sac inflammation causing pain. Mild cases can often be treated through conservative methods such as rest, anti inflammatory medications, stretching exercises and avoiding repetitive movements. Persistent symptoms will benefit from a cortisone injection and on occasion with failure of treatment minor surgery may be required. Hamstring Strain Straining the hamstring which is the large muscle group on the back of thigh is a common condition involving pain, tightness, spasm and loss of strength. While most hamstring injuries are strains or partial tears, it is critical to be evaluated to rule out a complete hamstring tear which requires surgical intervention. Most hamstring strains and partial tears respond to a period of rest with anti-inflammatory medications, followed by rehabilitation with stretching and strengthening exercises. Labral Tears The hip socket (Glenoid) has a cartilaginous ring around its perimeter similar to the shoulder. Do to overuse or a traumatic injury the hip labrum may tear causing pain, swelling, and catching. In addition tears of the hip labrum may be associated with abnormalities of the bone and socket anatomy placing abnormal stress on the labrum. These conditions need careful evaluation by a orthopaedic specialist. Many of the tears can be treated without surgery, but those that do require surgery typically can be treated through arthroscopic procedures.

Most common hand conditions and injuries may be treated with simple non surgical care. Critical to treatment is establishing the correct diagnosis done by evaluation and appropriate diagnostic studies. When non surgical care fails hand surgery may be required. Some of the more common hand and wrist conditions and treatments we see are: Trigger finger Carpal Tunnel Syndrome deQuervain’s Tendonitis or Tenosynovitis Trigger Finger Trigger finger is a condition that involves one of the fingers becoming stuck in a bent position and then rapidly straightened like the trigger of a gun. This condition is caused by a narrowing of the sheath that surrounds the tendons in the finger, and is common in people who perform repetitive gripping actions. It is also more common in women and people with diabetes. Trigger finger causes stiffness, pain and may eventually lead to an inability to completely straighten the finger. Mild cases of trigger finger can often be treated through conservative methods such as rest, anti inflammatory medications, finger exercises and avoiding repetitive movements. Persistent symptoms will benefit from a cortisone injection and on occasion with failure of treatment minor surgery may be required. Carpal Tunnel Syndrome Carpal tunnel syndrome is a common condition involving numbness, pain, tingling in the wrist, hand and fingers. It occurs when pressure is put on a nerve in the wrist called the median nerve, which controls motor function in the wrist and hand. This pressure is due to constriction of the nerve in the tight carpal tunnel that passes along the wrist associated with repetitive use or injury, it may also be caused by bone spurs, rheumatoid arthritis, and fractures. Carpal tunnel syndrome can be diagnosed with tests such as an electromyogram or a nerve conduction study. It can often be effectively treated with nonsurgical therapies such as wrist splints, anti-inflammatory drugs or corticosteroids. In cases where pain and numbness persist, surgery may be necessary to relieve pressure on the nerve. DeQuervain’s Tendonitis or Tenosynovitis Wrist tendonitis (also called deQuervain’s tendonitis or tenosynovitis) is an inflammation of the tendons that cross the wrist and attach to the thumb. If you have deQuervain’s tendonitis, it hurts to bend, extend or turn your wrist or form a fist with the thumb tucked inside. Activities such as writing, knitting and gripping something with your hand become uncomfortable. Pain is usually located in the front of the wrist and worsens with activity. Other symptoms include sensitivity to touch, limited mobility, and wrist weakness. If detected early, tendonitis can be successfully treated with rest, bracing, anti-inflammatory medications and occasionally a cortisone injection. Advanced cases may require minor out-patient surgery.

The constant use of the lower extremities makes them an easy target for injury and pain, specifically in the feet. Walking, sitting and standing all put pressure on our feet and most athletic activities rely on them as well. The causes of foot pain are typically due to common ailments that affect thousands of people in the US each year. It is important to determine the source of the pain in order to successfully treat these conditions. Achilles Tendinitis Achilles Tendon Rupture Ankle Sprain Shin Splints Treatment Options Most ankle and foot conditions can be treated with conservative methods like rest, ice, compression and elevation. Simply wearing different better fitting and supportive shoes can help relieve foot pain. Your doctor may also recommend other treatment options such as anti-inflammatory medications, physical therapy, corticosteroid injections, orthotics or braces. Surgery may be necessary for more severe cases. Minimally invasive, arthroscopic procedures are available for many ankle and foot conditions which helps minimize scars and recovery times. Achilles Tendonitis/Achilles Tendon Rupture Achilles tendonitis is an inflammation of the Achilles tendon, the strong band of tissue that connects the calf muscle to the heel. This condition frequently affects athletes and occurs when the stress placed on the tendon is too strong or for an excessive period of time. When too much stress is placed on the Achilles tendon, it may develop a partial tear and become inflamed as a result of improper technique, overuse, flattening the arch of the foot or trauma. As this stress occurs, symptoms may begin to appear gradually. Symptoms of Achilles tendonitis include: Dull pain while walking Tenderness Stiffness Swelling Soreness Achilles tendonitis increases your risk of rupturing your Achilles tendon, a condition that requires immediate surgical attention. A ruptured tendon will cause sudden, severe pain, swelling and difficulty walking. Your doctor can diagnose Achilles tendonitis or a ruptured tendon through a physical examination and imaging testing. If you are suffering from Achilles tendonitis, you may be able to treat the condition through rest, ice and over-the-counter pain medication. If these methods are ineffective, your doctor may recommend a heel lift to take pressure off of the tendon in additional to physical therapy to work on stretching and strengthening exercises. For more severe cases a walking boot, crutches or surgery may be required. You can reduce your risk for Achilles tendonitis by monitoring your physical activity and taking precautions to make sure you are physically fit which includes proper stretching and strengthening exercises. Ankle Sprain A sprain is a stretching or tearing of one or more ligaments, the tough fibrous bands that hold the ankle bones in place. Sprains can be caused by anything from a sports injury or accident to stepping on an uneven or sloped surface. Generally, the movements that can stretch a ligament beyond its normal range are twisting, rolling and turning of the foot. Sprains are divided into categories based on the severity of the injury, from Grade 1 (slight damage to the ligament) to Grade 3 (complete tear). Symptoms may include pain, swelling, stiffness and bruising. There may be a popping sound when the ankle is moved or touched. The ankle may be unstable or unable to bear weight. Sprained ankles should be examined by a doctor to rule out the possibility of a bone fracture. Professional diagnosis and care will also ensure that the joint heals properly, limiting the chance of further injury. Shin Splints Shin splints, or medial tibial stress syndrome, are a common exercise-related condition characterized by pain along or just behind the shins. Pain occurs about two-thirds of the way down the leg below the knee, spans several inches, and tends to worsen with activity. This discomfort results from inflammation of the thin layer of tissue covering the tibia, as well as from the bone itself and two of the muscles that attach to it (the soleus muscle and flexor digitorum longus, which help you push off your foot and flex your toes). Shin splints are common in people who begin a new training regimen after a period of inactivity. They may also occur when intensifying an existing training regimen. Contributing factors include running speed and distance, exercising on angled or very hard surfaces, and footwear with weak support or worn soles. Runners, aerobic dancers and military personnel are prone to shin splints because of the stresses placed on their lower legs, as are people with flat feet, rigid arches and “knock knees” or “bow legs.”

Dr. Glousman provides medical opinions and expert treatment for workers compensation injuries. He has extensive experience in treating the injured worker from numerous occupations. Dr. Glousman employs the latest methods to help the worker return back to their pre-injury state. Providing the most accurate diagnosis and best treatment in a timely manner is critical for every patient including the injured worker. Dr. Glousman’s experience allows him to provide efficient evaluation and treatment. His goal is always to create a fast but safe pathway for the patients to return to work and to recognize when a permanent injury has occurred. Workers’ Compensation Services Include: Second Opinion Consultations Evaluation and treatment Same day Status Reports

Sports medicine is an orthopaedic specialty that emphasizes the understanding of athletic injuries through diagnosis, treatment, and prevention. Years of research and education have provided sports medicine specialists with the ability to help prevent injuries. The rehabilitation programs developed to treat established injuries have allowed athletes to return back to their sport in a quick and safe manner. The knowledge and experience learned through athletic care has enabled Dr. Glousman to assist all patients in resuming their everyday lives. As a leading national and international expert in sports medicine, he has contributed to the field through research, lectures, publications, and education of other physicians and healthcare providers. Dr. Glousman treats all musculoskeletal injuries and conditions including the upper extremities, lower extremities, neck, and back. This includes treatment of the joints, muscles, ligaments, and tendons.