Specialties - Additional Treatments

Arthroscopic Surgery

Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint.

The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint."

In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.

By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision rather than a large incision needed for surgery.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look, for example, throughout the knee. This lets the surgeon see the cartilage, ligaments, and under the kneecap. The surgeon can determine the amount or type of injury and then repair or correct the problem, if it is necessary.

Sports Medicine

Sports medicine is a subspecialty of orthopedics that deals with the prevention, diagnosis, treatment and rehabilitation of injuries suffered during athletic activity. The goal of treatment is to heal and rehabilitate the injury so patients can return to their favorite activities quickly, whether it’s Little League, recreational play or a high school, college or professional sport.

As with a sports team, there are many physicians who work together to help the patient regain maximum use of the injured limb or joint. "Players" on the team are typically the physician, orthopedic surgeon, rehabilitation specialist, athletic trainer and physical therapist – and the patient him/herself.

Common injuries treated include:
  • ACL Tears
  • Compartment Syndrome
  • Fractures
  • Heat Exhaustion

Therapeutic Joint Injections

What is done during a joint injection/aspiration?

Joint injections or aspirations (taking fluid out of a joint) are usually performed under local anesthesia in the office or hospital setting. After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. At this point, either joint fluid can be obtained and sent for appropriate laboratory testing or medications can be injected into the joint space. This technique also applies to injections into a bursa or tendon to treat tendonitis and bursitis, respectively.

What benefit is derived from a joint aspiration?

Joint aspiration is usually done as a diagnostic or therapeutic procedure. Fluid obtained from a joint aspiration can be sent for laboratory analysis, which may include a cell count (the number of white or red blood cells), crystal analysis (so as to confirm the presence of gout or pseudogout), and/or culture (to determine if an infection is present inside the joint). Drainage of a large joint effusion can provide pain relief and improved mobility. Injection of a drug into the joint may yield complete or short-term relief of symptoms.

What benefit is derived from a joint injection?

Joint injections are given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and occasionally osteoarthritis. Corticosteroids are frequently used for this procedure, as they are anti-inflammatory agents that slow down the accumulation of cells responsible for producing inflammation within the joint space. Although corticosteroids may also be successfully used in osteoarthritis, their mode of action is less clear. Hyaluronic acid (Hyalgan ®, Synvisc ®) is a viscous lubricating substance that may relieve the symptoms of osteoarthritis of the knee.

What is usually injected into the joint space?

Most joint injections utilize anti-inflammatory medications called corticosteroids (such as methylprednisolone or triamcinolone). These medications act locally and have few systemic side effects (such as a fever, rash, or a disturbance of an internal organ). In degenerative joint diseases such as osteoarthritis, a joint lubricant such as hyaluronic acid (described above) may be used with aim of relieving pain.

Which joints are usually injected?

Commonly injected joints include the knee, shoulder, ankle, elbow, wrist, thumb and small joints of the hands and feet. Hip joint injection may require the aid of an X-Ray called fluoroscopy for guidance. Facet joints of the lumbar spine (low back area) may also be injected by experienced rheumatologists, orthopedists, anesthesiologists, radiologists and physiatrists.

What are the risks of joint injections and aspirations?

Common side effects include allergic reactions (to the medicines injected into joints, to tape or the betadine used to clean the skin, etc). Infections are extremely rare complications of joint injections and occur less than 1 time per 15,000 corticosteroid injections. Another uncommon complication is "post-injection flare" - joint swelling and pain several hours after the corticosteroid injection - which occurs in approximately one out of 50 patients and usually subsides within several days. It is not known if joint damage may be related to frequent corticosteroid injections. Generally, repeated and numerous injections into the same joint/site should be discouraged. Other complications, though infrequent, include depigmentation (a whitening of the skin), local fat atrophy (thinning of the skin) at the injection site and rupture of a tendon located in the path of the injection.

Platelet Rich Plasma Injections

What is PRP?

PRP is "platelet-rich plasma," also known as autologous blood concentrate (APC). Platelets are a specialized type of blood cell that are involved in injury healing. With PRP, a concentrated platelet solution is injected into the injured are to stimulate healing.

Why Does PRP Work?

Human platelets are naturally extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments and tendons stimulates a natural repair process. But in order to benefit from these natural healing proteins, the platelets must first be concentrated. In other words, PRP recreates and stimulates the body's natural healing process.

What Conditions Benefit From PRP?

PRP treatment works best for chronic ligament and tendon sprains/strains that have failed other conservative treatment, including:

  • Rotator cuff injuries
  • Shoulder pain and instability
  • Tennis & golfer's elbow
  • Hamstring and hip strains
  • Knee sprains and instability
  • Patellofemoral syndrome and patellar tendinosis
  • Ankle sprains
  • Achilles tendinosis & plantar fasciitis

How is PRP Done?

In the office, blood is drawn from the patient and placed in a special centrifuge, where the blood is spun down. The platelets are separated from the red blood cells and are concentrated. the red blood cells are discarded, and the resulting platelet concentrate is used for treatment. While the blood is spinning in the centrifuge, the painful area is injected with lidocaine to numb it. The entire treatment, from blood draw, to solution preparation, to injection, takes 30-40 minutes.

How Often are Injections Given?

After the initial treatment, a follow up visit is scheduled 6-8 weeks later. Some patients respond very well to just one treatment. However, typically 1-3 treatments are necessary.

Is PRP Covered by Insurance?

Except for Medicare, PRP injections are covered by most insurance plans, though some require pre-authorization.

Do PRP Injections Hurt?

Because the injured area is first anesthetized with lidocaine, the actual injections are slightly uncomfortable. Once the lidocaine wears off in a few hours, there is usually mild-to-moderate pain for the next few days. For the first week after the injections it is critical to avoid anti-inflammatory medications, including Advil, Motrin, Ibuprofen, Aleve, Celebrex. These will interfere with the healing process. Tylenol is OK. Your doctor may prescribe pain medication also.

Are There Risks With PRP?

Anytime a needle is placed anywhere in the body, even getting blood drawn, there is a risk of infection, bleeding, and nerve damage. However, these are very rare, Other complications, though rare, can occur depending on the area being treated, and will be discussed by your doctor before starting treatment.

What is the Success Rate?

Studies suggest an improvement of 80-85%. Some patients experience complete relief of their pain. The results are generally permanent!

Additional Therapies

To get maximum benefit from the treatment, and to help prevent re-injury, a specially-designed home-based rehabilitation and exercise program is incorporated into your treatment. This helps the newly developing connective tissue mature into healthy and strong tendon or ligament fibers.