Collier Sports Medicine and Orthopaedic Center

AdhesiveCapsulitis(FrozenShoulder) Adhesive capsulitis, also known as frozen shoulder, is a chronic inflammation of the shoulder capsule that causes abnormal tissue growth around the area, significantly restricting movement. Other symptoms associated with this condition include pain and overall stiffness, often worsening at night and when it is cold. The cause of the condition is unknown, although some believe it may be linked to autoimmune complications. It occurs very rarely in individuals under the age of 40 and somewhat more frequently in those who exhibit risk factors such as: Connective tissue disorders Treatment for this condition varies widely from simple non-steroidal anti-inflammatory drugs (NSAIDs) and light physical therapy, to invasive surgery designed to release the excess scar tissue. The doctor may opt for manipulation under anesthesia (MUA) as a sort of middle ground to break up scar tissue without an invasive procedure. This also stimulates fluid circulation into the shoulder, which is very helpful in progressed cases of frozen shoulder. ReverseShoulderReplacement Reverse shoulder replacement is a surgical intervention that aims to repair a condition known as rotator cuff tear arthropathy. This is different than total shoulder replacement because it switches the formation of the glenoid-humeral joint. Naturally, the “ball” of the joint exists as the terminal end of the humerus, but after this procedure the glenoid will be changed into a spherical object that the humerus head can articulate around. This allows the deltoid muscle to lift the arm instead of the torn rotator cuff. Although this is a very effective method for relieving pain at the shoulder joint, it is normally the last option considered. It is still an invasive surgery that resurfaces the bones, which can be very risky, especially in patients most likely to require this surgery. The bones of elderly individuals are continually weakening as they age, so it is important for doctors to take this into account when determining if the surgery is worthwhile. Additionally, the patient may no longer be able to lift their arm more than a 90 degree angle after this procedure. RotatorCuffRepair 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 can lead to pain, weakness and inflammation. Surgery is often needed to treat this serious condition. ShoulderInstability(Dislocations) A shoulder is deemed unstable when it frequently dislocates or slips partially out of joint (subluxation). People with unstable shoulders may experience pain and limited motion in the joint and feel that moving in the wrong way will cause their shoulder to dislocate. shoulder impingement One of the most common causes of shoulder pain, impingement occurs when the front of the shoulder blade rubs against the rotator cuff as a person lifts his/her arm. The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. If the rotator cuff weakens or is injured, the bone of the upper arm (humerus) can lift up, pinching the rotator cuff against the shoulder blade. The muscles can then swell further, creating a vicious cycle of pain and weakness that will not improve without intervention. In addition to rotator cuff injuries such as tendonitis and tearing, impingement may be the result of bursitis, an inflammation of the cushioning sac between the rotator cuff and the shoulder blade. Impingement worsens over time. At first, you may feel mild pain in the shoulder, which may radiate from the front of the shoulder to the side of the arm. The pain may worsen when you lift your arm, reach for something, or throw or serve a ball while playing a sport. There may be some swelling and tenderness at the front of the shoulder as well. As impingement progresses, pain and stiffness worsen until you may not be able to lift or lower your arm. Eventually, if left untreated, the condition may severely limit arm motion to the point that the shoulder becomes "frozen." People most at risk for developing impingement are athletes, especially those who swim or play baseball or tennis, and people whose occupations include repetitive lifting or overhead movements, such as painting and construction. Sometimes, impingement occurs after a minor injury, or even without a discernible cause. shoulder replacement Severe shoulder conditions with persistent symptoms that have not responded to conservative treatments may benefit from shoulder replacement surgery. Shoulder replacement surgery replaces the damaged joint with an artificial one that allows patients to enjoy painless motion and resume their regular activities.

The ACL (anterior cruciate ligament) is one of the most commonly injured ligaments in the knee. Running diagonally through the middle of the joint, the ACL works together with three other ligaments to connect the femur (upper leg bone) to the tibia (lower leg bone). People who play sports that are likely to damage the knee -- such as basketball, football, skiing and soccer -- are at greatest risk for injuring the ACL. Only about 30% of ACL injuries result from direct contact with another player or object. The rest occur when the athlete decelerates while cutting, pivoting, or sidestepping; lands awkwardly; or plays recklessly. About half of ACL injuries are accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee. Signs that you may have injured your ACL include pain, swelling and instability immediately after the injury, followed hours later by greater swelling and pain, limited motion, tenderness and an inability to walk comfortably. common type of knee injury is damage to the articular cartilage, the smooth substance that covers the ends of the bones and keeps them from rubbing together as you move. Cartilage, or chondral, damage is known as a lesion and can range from a soft spot on the cartilage (Grade I lesion) or a small tear in the top layer to an extensive tear that extends all the way to the bone (Grade IV or "full-thickness" lesion). Sometimes a piece of cartilage breaks off and causes more damage to the cartilage and bone as it is ground in the joint. Common chondral lesions in the knee are: Chondromalacia / Degenerative Chondrosis (Cartilage tears away unevenly, with shallow walls) Osteochondritis Dissecans / Osteochondral Fracture (Cartilage breaks away with a piece of the bone) Chondral Flap (Cartilage separates from the bone and moves like a door with a hinge at one end) Chondral Fracture (Cartilage separates from the bone and floats free) Chondral lesions may be degenerative (a "wear and tear" problem) or traumatic (caused by an injury such as falling on the knee, jumping down, or rapidly changing direction while playing a sport). They do not always produce symptoms at first because there are no nerves in the cartilage. Over time, however, lesions can disrupt normal joint function and lead to pain, inflammation and limited mobility. The lesion may gradually worsen or cause other problems in the joint. Cartilage also lacks blood supply, so the body cannot usually repair chondral lesions on its own. However, some severe tears that injure the bone can promote the growth of scar tissue known as fibrocartilage, a tough material that replaces the missing articular cartilage but does not provide as smooth a gliding surface. KneeOsteoarthritisTreatment Osteoarthritis, also known as wear-and-tear or degenerative arthritis, is the most common form of the disease, affecting millions of people in the US each year. This condition is most common in older patients whose cartilage has worn down over time, and in athletes who have worn down their cartilage from overuse and repetitive motions. 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. More severe cases of osteoarthritis may require surgery to reposition the bones or replace the joint. Most procedures can be performed through arthroscopy, which significantly reduces bleeding, scarring and recovery times. Arthritis and certain knee injuries and diseases can damage the cartilage that normally cushions the knee joint, leading to pain and stiffness. A knee replacement may be recommended when more conservative treatments -- such as anti-inflammatory medications and cortisone injections -- fail to relieve pain or improve movement. Made of cushioning cartilage, the C-shaped meniscus performs many functions in the knee: it stabilizes the joint, helps it carry weight, facilitates turning in many directions, and keeps the femur (thighbone) and tibia (shin) from rubbing together. Athletic injury (trauma) or weakened tissue associated with aging or illness (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 an ACL tear.

Also known as femoroacetabular or FA impingement, hip impingement is an abnormality in the way the ball of the femur (thighbone) and the acetabulum (hip socket) fit together. It is a fairly common condition that affects more men than women. An improper shape of both the ball and the socket creates excess friction in the joint and may cause the hip to "jam" in front when bending forward. Over the years, hip impingement can tear or wear down hip cartilage (osteoarthritis), causing pain, swelling, stiffness and loss of mobility. The condition may be present at birth but cause no symptoms until later in life. Athletic activity-particularly soccer, football, hockey and running-may exacerbate the problem. If left untreated, the person may require total hip replacement. HipBursitisTreatment Bursitis is the painful swelling of the bursae, fluid filled sacs on the cushion areas where tendons and muscles slide across bone. Specific to the hip is trochanteric bursitis (also known as greater trochanteric pain syndrome or GTPS), which refers to the bursa by the head of the femur. This shock absorbing sac can become agitated and swollen for unknown reasons or as a symptom of other issues such as gluteal tendon infections, uneven leg length or Iliotibial Band Syndrome. Steps can be taken to prevent bursitis by strengthening the core and hips through a moderate training program. Orthotic inserts for people with flat feet can also help. The condition can be treated by: Rest NSAIDs or steroids to reduce swelling Physical therapy Surgical removal of the bursa (bursectomy) HipOsteoarthritisTreatment The most common type of arthritis of the hip is osteoarthritis. In this disease, the cartilage in the hip, especially the acetabular labrum, gradually wears away with use and time. Treatments for osteoarthritis include: Medication to reduce pain, such as aspirin and acetaminophen Medication to reduce swelling and inflammation, such as ibuprofen and nonsteroidal anti-inflammatory drugs (NSAIDs) Exercises to improve flexibility and strength Maintaining healthy body weight HipReplacement The hip is a "ball-and-socket"" joint where the "ball" at the top of the thigh bone (femur) fits inside the "socket" in the pelvis (acetabulum). A natural substance in the body called cartilage lubricates the joint. When the bone and/or cartilage of the hip becomes diseased or damaged from arthritis, hip fractures, bone death or other causes, the joint can stiffen and be very painful. A total hip replacement may be recommended for patients who experience severe, chronic hip pain and can't do what they want or need to do in daily life. The hip socket, or acetabulum, is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilize the joint. The labrum may tear due to a traumatic injury (e.g. hip dislocation), repetitive movement (e.g. twisting or pivoting, such as in golf) or tissue degeneration (e.g. osteoarthritis or hip impingement). Sometimes, a labral tear causes no symptoms and doesn't require treatment. However, tears may cause pain in the hip as well as stiffness, limited motion, and a sense that the joint is locking, clicking or catching.

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, but is not restricted to golfers; pitchers and even those not involved in sports can develop golfer’s elbow. Golfer's elbow is generally treated using analgesics and anti-inflammatory medication, as well as resting the elbow. However, professional athletes suffering from this condition may opt for more immediate relief in the form of glucocorticoid injections so as not to miss important career events. This treatment is risky because of the close proximity of the ulnar nerve to the affected area, damage to which could have severe ramifications. TennisElbowTreatment Tennis elbow, also known as lateral epicondylitis, is an elbow injury that occurs as a result of overuse, most commonly from playing tennis. 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 tennis elbow typically affects adults aged 30 to 50, anyone who continually stresses their wrists is at a higher risk of developing this condition. SymptomsofTennisElbow The symptoms of tennis elbow affect the inside of the elbow, and may include some of the following: Forearm weakness Pain when the wrist is extended Pain during various activities, such as turning a doorknob Pain that spreads from the outside of the elbow into the forearm and wrist DiagnosingTennisElbow Tennis elbow is usually diagnosed by examining the affected elbow and reviewing the patient's medical history. To assess pain, pressure may be applied to the elbow. In some cases, x-rays may be done to rule out other conditions that may be responsible for causing elbow pain. TreatmentforTennisElbow In many cases, tennis elbow heals on its own within two years. Initial pain can often be managed with rest, ice and over-the-counter painkillers. Cases that don't respond to the aforementioned measures may require additional treatment, in the form of exercises, orthotics, or corticosteroids. Severe, persistent cases of tennis elbow may require surgery; however, surgery is only necessary for about ten percent of those suffering from tennis elbow. Your doctor will develop a customized treatment plan based on your individual condition. PreventingTennisElbow To prevent tennis elbow from occurring, certain preventive measures can be taken. Individuals participating in sports should train sufficiently beforehand to strengthen the muscles around the elbow and wrist. It is important to keep the wrist straight during all lifting activities, including weightlifting, so that the stronger muscles of the upper arm do most of the work. Stretching exercises before and after use of the wrist can also minimize the occurrence of tennis elbow. To learn more about Tennis Elbow or to schedule an appointment, contact us today.

When tendons and ligaments are damaged as a result of injury or overuse, small microscopic tears may develop as part of a condition known as tendonosis. Although these tissues are strong and help us engage in all kinds of physical activity when they are healthy, they do not heal well when damaged by a sprain or by overuse, since they have a poor blood supply. Certain elements within the blood, specifically the platelets, help tendons and ligaments heal by stimulating a repair and growth response that accelerates the process of developing of new tissue. Unfortunately, the tendons and ligaments do not receive a rich supply of these valuable nutrients, which is why they often take a long time to heal and can cause patients severe pain within the elbow, shoulder, knee, ankle, and other areas. Platelet-rich Plasma has been used for over 20 years in the medical community mostly to enhance the healing response in cosmetic and ENT surgeries. Recently, there has been heightened interest and awareness in utilizing it to treat musculoskeletal injuries particularly in the sports medicine world. You likely have heard about Hines Ward receiving it 2 weeks prior to the Super Bowl to heal an injured ligament in his knee which allowed him to compete effectively and helped the Steelers win the Super Bowl. Countless other professional athletes have received it as well such as Rafael Nadal, and Tiger Woods just to name a few. Platelet-rich plasma (PRP) or Autologous Conditioned Plasma (ACP) is plasma with a high concentration of platelets, which contains a large amount of proteins which enhance the body’s natural healing response. These concentrated proteins or growth factors can initiate and accelerate new tissue growth within the tendons and ligaments to repair damage and relieve symptoms for patients with tendonosis, muscle injury, arthritis or other causes of chronic pain. Injecting platelet-rich plasma into damaged tissue is an effective yet minimally invasive treatment option used to relieve pain and other symptoms caused by this damage. By enhancing the body's natural healing abilities, patients are able to enjoy a faster and more thorough healing process that relieves symptoms and allows them to return to their regular activities. Whatisplatelet-richplasmausedfor? Platelet-rich plasma injections can be used to treat a wide range of orthopedic conditions, including: Tendonitis Muscle injuries Ligament sprains Arthritis Bursitis Joint pain This treatment can also be used to speed and enhance the healing process and reduce the risk of infection after surgery. It has been used to supplement rotator cuff repairs, ACL surgeries, Achilles repairs and joint replacement surgeries. The procedure is routinely performed in the office or after surgery in the operating room. During the PRP injection procedure, a small amount of blood (10 ml) is taken from the patient and placed in a unique, self-contained, sterile processing double-syringe system to separate the platelets and plasma from the less desirous white and red blood cells. The double syringe system is then placed in a centrifuge and concentrated for 5 minutes at 1500 rpms/minute. The supernatant rich in plasma and platelets is the PRP and is aspirated into the second sterile syringe. The PRP is then injected into the targeted tissue to stimulate the healing process. This procedure is performed under local anesthetic, which numbs the injection site to minimize pain for patients. Most patients tolerate the injection well and experience little to no discomfort from the injection. Most patients require one to three PRP injections in order to achieve the desired results from this procedure. Your doctor will evaluate your condition a few weeks after the initial treatment to determine whether or not additional injections are needed. This treatment can be combined with exercise or physical therapy in patients with acute injuries. WhatcanpatientsexpectafterthePRPprocedure? After platelet-rich plasma injections, patients may experience soreness and aching for several days, which is a sign that the healing process has begun. Tylenol and ice may be utilized if needed to help alleviate these symptoms. Over-the-counter anti-inflammatory medications (Advil, Aleve, Ibuprofen and other NSAIDs) should be avoided for the first 48 hours after the injection so as not to inhibit the healing cascade put into effect by the PRP. Patients can return to work and other normal activities immediately after treatment, but should refrain from heavy lifting and strenuous activity for a few days. Whatarethebenefitsofthisprocedure? For many patients, platelet-rich plasma injections offer significant relief from pain and other symptoms, and may eliminate the need for surgery or long-term medications. This treatment also promotes the healing process and allows patients to return to their normal activities faster than with other nonsurgical treatments.

No longer reserved for professional athletes, Bone Marrow Aspirate Concentrate (BMAC) is quickly becoming the treatment choice for everyone. Whatisbonemarrow? Bone marrow are the soft spongy tissue that is found in the center canal of your large bones. In adults, bone marrow is the production center of your blood components: red blood cells, white blood cells, and plasma. Also found in bone marrow is the immature forms of your blood component cells, called stem cells. The immature stem cells found inside the bone marrow have the potential to develop into various mature cells such as muscle cells, the cells of a vessel, cells of cartilage or even bone cells. Two of the main stem cells found in marrow include hematopoietic stem cells and mesenchymal stem cells. Hematopoietic stem cells give rise to the three classes of blood cells that are found in the circulation: white blood cells, red blood cells, and platelets. These cells drive tissue regeneration and create supportive circulation. Mesenchymal stem cells are also known as Marrow Stromal Cells. These cells have the ability to form osteoblasts (bone structure), chondrocytes (cartilage), and myocytes (muscles). Istheprocessexperimentalornew? Bone marrow extractions have been conducted for several years and are commonly used in oncology and hematology fields. Stem cells were initially used for transplant purposes in patients with immune deficiencies, such as cancers or disorders caused by your own blood. Using your own bone marrow to extract stem cells prevents any rejection or allergic reactions; both the donor and recipient of this treatment is you! Arethereanyrisks? Bone marrow extractions are safe procedures when conducted by a trained professional in a sterile environment. Complications are rare but can include: Bleeding, particularly in patients with a low platelet count or clotting disorder Infection, in patients with weakened immune systems. Antibiotics can be given post extraction to prevent infection. Howlongisthehealingprocess? Bone marrow stem cell are the regenerative cells responsible for repair and rebuilding damaged tissue. The concentrated cells accelerate the healing process, promotes strength, offer pain relief an improve overall function. The healing cascade can be active and take place over a 4-6 week period. A follow-up PRP procedure may be recommended if the desired relief is not met. Howlongistheprocedure? Treatment can occur in an outpatient setting or in conjunction with surgery. The actual extraction can take up to ten minutes, but the concentrating process can take up to one hour, during which the patient will be waiting or having their surgical procedure performed. The area of extraction is locally numbed so no pain is felt. Bone marrow is extracted from the back of a patient’s pelvis or hip bone from an area called the posterior iliac crest. A suctioned syringe attached to a long needle is used to reach the posterior aspect of the bone, during which minimal discomfort is felt due to local anesthetic. The collected bone marrow is then filtered and spun in a centrifuge. Spinning the sample at a high speed separates the platelets and stem cells from the bone marrow. The combination of stem cells and healing components, collectively known as the bone marrow aspirate concentrate (BMAC), are reintroduced to the injured area via injection. WhatshouldIdoornotdo? There are few recommendations such as drinking plenty of fluids and eating a good meal. Please consult with your physician about medications or prior history of blood disorders. Pain control, if needed, will be given. Howlongisrecoverytime? The majority of patients are able to return to their daily activities within 1-2 days but some pain may be felt for up to one week.