A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E
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FALL 2018
Total knee replacement patient journals his innovative treatment Minimally invasive TENEX procedure helps patients avoid major surgery MORE Foundation’s Human Motion Lab improves orthopedic outcomes
Keep on Rolling
Valley woman turns to The CORE Institute to overcome years of pain, adversity
Robots are helping replace your knee FULL PAGE 7.25 X 9.875 Robotic-assisted technology improves knee replacement surgery
10 YEARS AGO
Patient was required to stay in hospital 1-2 NIGHTS
NOW
Patient goes home the SAME-DAY
10 YEARS AGO
Patient was required to stay in hospital 3-4 NIGHTS
NOW
Patient may stay 1 NIGHT
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10 YEARS AGO
SEVERAL MONTHS
NOW
6-8 WEEKS,
patients encouraged to walk the same day of procedure
Sources: Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:5-8, American College of Sports Medicine, Exercise and the Older Adult, US Department of Health and Human Services, Osteoporosis Research, Education and Health Promotion, Annals of internal medicine (Impact Factor: 16.1). 04/1996; 124(6):568-72, J Am Geriatr Soc. 1995 Jul;43(7):756-60, J Am Geriatr Soc. 2004 May;52(5):657-65, Health Day March 11, 2014, Journal of Strength & Conditioning Research: October 2012, Volume 26, Issue 10, p 2806-2811, Archives of Internal Medicine August 6, 2012, Nutrition & Metabolism May 17, 2012
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WELCOME VOLUME 9, ISSUE 3 – FALL 2018
FROM THE CHAIRMAN
On a mission to deliver world-class care Fall is back, bringing with it the prospect of cool days, crisp nights, snowbird migrations, football season, school, and lots of subsequent orthopedic and medical activity. Why does this one season have more than one name? One person’s Fall is another’s Autumn, while still others speak of the Harvest. Historians say the season never really had an “official” name until independence-minded Americans started to rebel against Britain. “Autumn” (still favored in England) was cast overboard like the tea in Boston Harbor. Americans went all-in for “Fall.” And we hope that you’re all in for the Fall Issue of CORE Ink and all we have to talk about this season. Our cover story features Maria Tostado, an amazing woman who has spent a lifetime overcoming challenges. Born with Achondroplastic Dwarfism, Maria has battled against social stigma and stereotypes to build a life filled with love and laughter. When the physical challenges that come with her condition threatened to derail all that, Maria turned to Dr. Mellissa Galli and The CORE Institute. The outcome, as you will read, is both historic and heartwarming. On page 7, we have an inside look at some of the lifesaving and limb-saving work being done by Dr. Amalia
DeComas, an orthopedic oncologist in our Arizona market. Operating on patients ranging from babies to senior citizens, using the very latest technology, Dr. DeComas is achieving outcomes unimaginable only a decade ago. Are you suffering from tennis elbow? Aching knees or shoulders? Achilles tendon pain? Be sure to read page 16, where Dr. Nina Patel-Hinkle describes a minimallyinvasive TENEX procedure which is putting patients on the road to recovery without major surgery, and no general anesthesia. Plus, Dr. Brian Seeto has advice if you’re worried about ‘frozen shoulder’ and, on page 22, we take you inside the Motion Lab, to see the very latest on the groundbreaking research being conducted by the MORE Foundation. That’s a lot of ground to cover, but it’s just a sample of what’s happening here at The CORE Institute, where we are totally committed to delivering best-in-class care to each one of our treasured patients. And you can count on that every Winter, Spring, Summer, and Fall/ Autumn/ Harvest!
Keep Life in Motion!®
David J. Jacofsky, MD Chairman & CEO
A P U B L I C A T I O N O F T H E C O R E I N S T I T U T E
CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE Editor: Jim Williams, JLWilliams@republicmedia.com Design: Rachel Tullio
®
Contents
8 COVER STORY
Keep on rolling Valley woman turns to The CORE Institute to help end years of adversity, hardship. See page 8.
22 20
PATIENT CARE
Documented Success Total knee replacement patient journals his innovative treatment. See page 12.
D E PART M E N T S What’s New?
Nutrition
6 The CORE Institute pleased to Introduce Alex Renshaw, DO and Michael Amini, MD
18 Simple steps to a healthier Thanksgiving
Specialty Spotlight 7 Committed to care: Reconstructing bones after cancer or trauma is surgeon’s passion
connect with us 1.866.974.2673
www.thecoreinstitute.com
Trends
Research 20 Studying human motion improves orthopedic outcomes
Ask the Expert 22 Frozen shoulder? Orthopedic surgeon, Dr. Brian Seeto has answers
16 Minimally invasive TENEX procedure helps patients avoid major surgery
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WHAT’S NEW
ALEX RENSHAW, DO
NEW PROVIDERS
The CORE Institute is pleased to announce additions to our Arizona provider team.
Less Pain. More Glory. That’s ATI For more than 20 years, ATI Physical Therapy has been a trusted leader for millions of patients nationwide. For a complimentary injury screening or to find a location near you, call 855-MY-ATIPT or visit ATIpt.com
Corporate Office 790 Remington Blvd | Bolingbrook, IL 60440 855-MY-ATIPT • ATIpt.com © 2018 ATI Holdings, LLC and its subsidiaries. All rights reserved.
Alex Renshaw, DO, is a fellowship-trained orthopedic surgeon specializing in arthroscopic and reconstructive surgery of the shoulder and elbow. His experience includes helping in the evaluation and treatment of shoulder and elbow problems for Southern Methodist University and the Dallas Mavericks of the National Basketball Association. He is a member of the American Osteopathic Association.
MICHAEL AMINI, MD
Michael Amini, MD is a fellowship-trained orthopedic surgeon, specializing in arthroscopic and reconstructive surgery of the shoulder and elbow. He practices minimally invasive surgical techniques, with a background that includes caring for professional athletes, including players on the NBA’s Memphis Grizzlies. Dr. Amini is a member of the American Academy of Orthopedic Surgeons and the American Orthopedic Association Emerging Leaders Program.
SPECIALTY SPOTLIGHT
Committed to Care Reconstructing bones after cancer or trauma is surgeon’s passion By TJ Gibson Dr. Amalia DeComas remembers one of her favorite patient stories: A tiny 3-year-old child with Ewing’s sarcoma, a rare type of cancerous tumor that grows in bones or the soft tissue around bones. The tumor was in the little girl’s leg, just below the knee. “So much of the surgery was complicated and involved longrange planning. The patient was small, still growing, and needed to still go through an oncology regimen like chemo and radiation,” recalls Dr. DeComas, one of The CORE Institute’s premier musculoskeletal oncologists. She works in tandem with entire teams of surgeons and specialists to help restore patient limbs when cancer or tumors affect their life. Amalia M. DeComas, MD “In this case, we removed a segment of the child’s bone and replaced the affected section with a piece of her own fibula—the other leg bone. A plastic surgeon worked on the small blood vessels of her leg to restore blood flow to the bone, which is gives the bone ‘life’. She’s now 5 and a half years old and disease free. Which is exactly why I go to work in the morning.” RESTORING QUALITY OF LIFE Dr. DeComas’ skill as a surgeon is matched only by her ability to create close relationships with her patients. Which is exactly what her patients need: support in what is likely the most harrowing time of their lives—whether the tumor is cancerous or just a cartilage lesion. Specializing in orthopedic oncology, she is deeply committed to working on limb and bone salvage. Dr. DeComas has advanced training in removing cancer from soft tissues and bones, safely removing tumors while preserving the healthy tissue around it. “Sometimes, I am working to restore my patient’s quality of
life. I don’t want my patient to be in a wheelchair because of pain or weakness,” she says. “It may not always extend their life, but being able to walk or move pain free definitely affects their quality of life. Seeing someone walking or able to hang out with their grandchildren, graduate college, or travel without pain is my reward.” Dr. DeComas always enjoyed orthopedic surgery, but the more she learned about oncology, she was hooked. “I love the interdisciplinary nature of it—from medicine to pathology and processes—I work with everyone like radiologists, plastic surgeons and oncologists.” ADVANCING TECHNOLOGY The evolution of bone and soft tissue reconstruction is improving at a rapid pace thanks to technology advancements. “Some of the things we are able to do now are much more progressive and exciting,” Dr. DeComas says. Endoprostheses, skeletal support structures made of metal and plastic, allow surgeons to reconstruct entire bones and joints without the need for amputation in many patients. Another innovation is a telescopic prosthesis of sorts, critical in addressing a growing child’s need for flexibility and expansion. “Implants that can grow with the kids who are still growing instead of putting the child through multiple surgeries to adjust an implant to their growth not only serve to limit surgeries but also assist in limb salvage and avoid amputation.” Often Dr. DeComas is called upon to stabilize a bone before a patient begins cancer treatments, so they can avoid fractures, allowing radiation oncology to do their work. “Again, it’s all about quality of life for me. I can help patients function and limit their pain. Just because you have cancer doesn’t mean you can’t have a meaningful life.”
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COVER STORY
Keep On Rolling! How a Valley woman overcame adversity after years of hardship By Meghann Finn Sepulveda | Photos by Rick D’Elia
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www.thecoreinstitute.com
U
pon meeting Maria Tostado, you would never guess the 48-year-old had a long history of dealing with pain. Her infectious laugh and bubbly personality aren’t the only traits that make her unique. At birth, Maria was diagnosed with Achondroplasia Dwarfism, a genetic bone growth disorder. In addition to a few social setbacks, Maria faced several health problems throughout her life, including severe bone and joint pain. Following years of failed attempts to correct an ankle deformity, including joint replacement, Maria finally turned to The CORE Institute and Melissa Galli, DPM, a fellowship-trained reconstructive foot and ankle surgeon. Last year, Maria was the first patient in Arizona to receive an INVISION™ Total Ankle Arthroplasty implant, an advanced and highly adapt-
able new implant that aims to relieve ankle pain and improve mobility. HOPE ON THE HORIZON Maria had bowed legs her entire life. At 4 feet, 5 inches tall, her bones and joints are smaller than those who are not of short stature, which is a common characteristic found in individuals with Achondroplasia Dwarfism. For years, Maria had experienced pain and swelling in her left ankle because of a limb deformity. But with time, the pain became increasingly worse and Melissa Galli, DPM eventually prevented her from doing the activities she loved most. Maria had explored a number of treatment options, including cortisone injec-
tions, bracing and total ankle replacement surgery, to alleviate the pain. “I tried everything, but nothing seemed to work,” she recalled. “I was desperate for a solution and decided to seek a second opinion at The CORE Institute.” Last spring, Maria met with Dr. Galli. A CT scan revealed there was a significant amount of bone loss and a fusion was recommended. Dr. Galli wanted to provide Maria with the best option available in an effort to improve her overall quality of life. “I was aware of a new ankle implant that soon would be available, allowing me to have a more appropriate sized implant,” Dr. Galli explained. “Although Maria was the perfect candidate, she
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FOR MORE INFORMATION Learn more about total ankle replacement surgery at thecoreinstitute.com.
would have to wait several months to receive it.” The prosthetic ankle implant was the INVISION™ Total Ankle Revision System, now available at The CORE Institute, which was designed for patients just like Maria who need revisions after previously failed ankle replacement surgeries. THE WAIT Before the surgery, Maria had another CT scan to measure the bones in her ankle, feet and legs. “We needed to ensure we could build the implant to match the exact length of her leg,” Dr. Galli said. “In Maria’s case, being off by even a few millimeters could greatly impact the way that she would walk in the future.” Several weeks later, Dr. Galli met with representatives from the implant device company in Phoenix to go over the new instrumentation, review Maria’s CT scans, and discuss potential complications, in preparation for the procedure the follow-
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ing day. An expert in her field who has performed nearly 80 total ankle replacements during her career at The CORE Institute, Dr. Galli was confident but fully aware that Maria’s case was exceptional. SURGERY SUCCESS Finally, on December 18, 2017, Maria underwent total ankle revision replacement surgery. “It went very well,” Dr. Galli said. “I had to get a bit creative and make several modifications to properly implant and align the device given her short stature.”
Maria was thrilled with the outcome of the surgery and determined to quickly get back on her feet. She completed five weeks of physical therapy to build strength in her ankle and learn how to walk again. Today, Maria is doing well. She no longer has pain in her ankle and the swelling is almost completely gone. She began doing aerobics, started riding a bike, and even went roller skating with family and friends, an activity she thoroughly enjoys. While Maria may need a minor maintenance ankle surgery in about 10 years, she says the procedure was well worth the wait. “I’m finally healthy and able to focus on living my life,” she said. “Dr. Galli is amazing, she’s truly my hero!”
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PATIENT CARE
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DOCUMENTED
success B
BY DEBR A GELBA RT
y the end of 2016, Morris M. of Mesa was exasperated. His right knee had been deteriorating for years, probably because he worked as an automobile mechanic for most of his career and standing and bending so often had put way too much stress on his joints. Now, trying to enjoy his retirement, arthritis had set in within his knee and he noticed that he couldn’t walk more than a quarter of a mile at a time without resting because his knee pain had become so debilitating. He decided he wanted to investigate a total knee replacement and was referred to The CORE Institute by his primary care physician. Among the leading reasons Morris, 78, said he chose to have his surgery at The CORE Institute with Dr. Steven Myerthall is because of his reputation as an orthopedic surgeon and The CORE Institute’s use of the MAKO robotic-assisted technology from Stryker Orthopedics to improve the accuracy and precision of sizing and placement of joint implant components. And for Morris, the approach Dr. Myerthall took with the February 2017 surgery resulted in a speedier recovery than Morris was expecting.
DR
>>>
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PATIENT CARE
KEEPING TRACK Morris’s recovery so amazed him that he documented it on a weekly basis in a journal he kept. And that has impressed Dr. Myerthall, “I don’t think any other patient of mine has kept as extensive a record of recovery. I would love to see him make at least part of his journal available to future patients to help them prepare for surgery.” “I wanted to be able to look back and see my progress week to week,” Morris said. “But it was intended to be more reflective than simply a summary of how I was doing.” His surgery began at 4 p.m. “An hour after my surgery began, I woke up in the recovery room, and an hour after that, I was walking down the hall.” Morris was told he had to walk 100 feet in one direction and 100 feet back in the other direction. And he did it. The next day, he was discharged from the hospital and walked to the car. Morris was delighted by how kind the staff is at The CORE Institute. “I cannot say enough how nice they all were,” he said, Steven Myerthall, MD “during the office visits and during physical therapy. I was amazed by how concerned everyone was about me and by how much they cared.” GETTING GOOD ADVICE Dr. Myerthall recommends making sure surgery is right for you. First, he said, try non-surgical solutions, such as losing weight and exercising to see if the pain diminishes. If it doesn’t, you still shouldn’t consider surgery unless your functional impairment is significant enough that you no longer can do the things you want to do. Before proceeding with surgery, Dr. Myerthall suggests you ask yourself the following questions: Does exercise increase your pain? Do you have to take increasing doses of pain medication to manage the discomfort? “These are the criteria that suggest surgery may help your situation,” he said. “But keep in mind that total knee replacement is not a relatively pain-free procedure. It may not be as traumatic as it used to be, because robotics result in less soft tissue dissection (cutting) and we have better pain management protocols now, but it’s still major surgery.” “Once you decide to have a total knee replacement surgery, look for a surgeon whom you are comfortable with and have a
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good rapport,” Dr. Myerthall said. Properly preparing for surgery can really speed up recovery. “My dad worked out a lot before his surgery, working through the pain (but not overdoing it) so he could strengthen his muscles as much as possible beforehand,” said Lisa Simpson, Morris’s daughter. “He lost about 15 pounds before the surgery, too.” “Make sure you’re in the best physical shape possible before surgery,” Morris emphasized. “It will make your recovery a lot better.” Life is infinitely better now than before the surgery, Morris said. “Before, my daughter and I couldn’t really hike very far. Now I can walk anywhere without any pain. I can climb stairs, climb a ladder and I rarely ever feel like I have a knee replacement.” “Now I have trouble keeping up with him,” Lisa said.
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Wine Food MONTERRA AT WESTWORLD SCOTTSDALE, AZ NOVEMBER 3-4, 2018 Join us for the 2018 azcentral Wine & Food Experience feautring Aarón Sánchez and Marcus Samuelsson! This savory culinary exploration showcases the best food, wine, beer and spirits from local and national chefs and mixologists.
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TRENDS
Finding Relief...Fast Minimally invasive TENEX procedure helps patients avoid major surgery By Julie Maurer Tendonitis, tennis elbow or a painful achilles tendinopathy were conditions that didn’t have a lot of relief in the past, unless they became severe enough to require major surgery. But now, with the TENEX procedure performed at The CORE Institute—these tendon problems can be addressed in less than an hour with minimal recovery on the patient’s part. Nina Patel-Hinkle, DO According to Nina Patel-Hinkle, DO, Primary Care Sports Medicine Physician at The CORE Institute, the TENEX procedure takes about 20 minutes from start to finish, depending on where the damaged tissue is located.
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MINIMALLY INVASIVE “There are no stitches at all, and the incision is very small,” Dr. Patel-Hinkle said. “It’s a minimally invasive procedure—in which we specifically identify the damaged tissue, cut and remove it.” She said the first step of the procedure is to use an ultrasound machine to identify where the tendon is damaged. “Then we use a local anesthetic to numb the area, and the patient does not go under general anesthesia at all,” Dr. PatelHinkle said. Next, they make a small incision into the skin and insert the TENEX device. “It’s the size of a pen or pencil, with a probe that moves in a back and forth motion. The probe delivers ultrasonic waves to remove the damaged tissue,” Dr. Patel-Hinkle said. “The total time for treatment is very minimal anywhere from a minute to three or four minutes.” Once the damaged tissue is removed, the physician removes the probe, and the incision is closed with steri-strips and a bandage.
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LESS PAIN “I’ve been really surprised with how little pain the patients have during the procedures. Most patients also make significant improvements in their symptoms within a week,” said Michael Slesinski, DO, an iterventtional spine Michael Slesinski, DO and sports medicine physician in our Michigan market. With the invasive surgeries that were performed prior to the TENEX procedure’s introduction, patients had to go under anesthesia and have larger incisions, which meant longer recovery times. “The most important benefit I’ve seen has been the ability to get the patient back to their desired activities quickly. Being a minimally invasive procedure, the recovery time is much faster,” Dr. Slesinski said. STAYING ACTIVE According to Dr. Patel-Hinkle, the recovery time from the TENEX procedure is about six to eight weeks, but patients can be more active than with open surgeries. “You’re not laid up, you’re still able to do some activities, but
“I’ve been really surprised with how little pain the patients have during the procedures. Most patients also make significant improvements in their symptoms within a week.” – Michael Slesinski, DO with certain restrictions,” she said. The surgery is performed on shoulders, elbows, knees, achilles tendon, and other locations. Prior to the use of TENEX, physicians recommended many non-surgical options to treat painful tissue damage. “Before Tenex it was basically conservative treatment which included physical therapy, avoiding activities that bother the condition, a brace or a strap, and cortisone injection,” Dr. Patel-Hinkle said. “Open surgery was an option for severe cases.” But now patients have an option that removes the problem with minimal fuss. “Once they hear about this procedure, a lot of people are definitely interested—they can get quick return back to a normal, pain-free life,” noted Dr. Patel-Hinkle.
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NUTRITION
Simple Steps to a Healthier Thanksgiving By Michelle Jacoby Just as sure as football fans cheer on the big game, a giant turkey balloon soars high over New York City, and eager shoppers gear up for the mad holiday rush, Thanksgiving guarantees a bountiful dinner feast of rich, sumptuous and, admittedly, calorie-laden dishes. No one ever said Thanksgiving dinner was healthy. But there are a few tricks to make it a little more wholesome and nutritious. “The most important thing to do when it comes holiday eating and drinking is to be mindful,” says Nicole Hahn, clinical nutrition senior manager at Banner Boswell Medical Center in Sun City. “It’s okay to enjoy what’s being served, just keep mindful tabs on what you’re eating.” When preparing Thanksgiving dinner, Hahn suggests simple tips to make dishes healthier. When buying or making bread, for instance, swap out whole grains for refined ones. You can also choose low-fat dairy products, and minimally processed sugars like honey or dehydrated cane juice sugar over granulated sugars. Another good tip is to reduce ingredient amounts and substitute ingredients, says Hahn. “When making desserts, use half the sugar the recipe calls for. You can also used mashed bananas or applesauce as sweeteners; or chia, which is packed with omega 3 fatty acids, as a substitute for eggs.” If you’re looking to put a healthy spin on your Thanksgiving dinner, here are a few dishes guaranteed to make your holiday happy and healthy. Source: allrecipes.com (all recipes)
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GOURMET SWEET POTATO CLASSIC 5 sweet potatoes 1/4 tsp. salt 1/4 cup butter 2 eggs 1 tsp. vanilla extract 1/2 tsp. ground cinnamon 1/2 cup white sugar 2 tbsp. heavy cream Topping 1/4 cup butter, softened 3 tbsp. all-purpose flour 3/4 cup light brown sugar, packed 1/2 cup pecans, chopped Preheat oven to 350 degrees. Lightly
grease a 9x13-inch baking dish. Bake sweet potatoes 35 minutes or until they begin to soften. Cool slightly, peel and mash. In a large bowl, mix the mashed sweet potatoes, salt, 1/4 cup butter, eggs, vanilla extract, cinnamon, sugar, and heavy cream. Transfer to the prepared baking dish. In a medium bowl, combine softened butter, flour, brown sugar, and chopped pecans. Mix with a pastry blender or your fingers to the consistency of course meal. Sprinkle over the sweet potato mixture. Bake 30 minutes in the preheated oven, until topping is crisp and lightly browned.
PUMPKIN FLUFF DIP 1 (16 oz.) container frozen whipped topping, thawed 1 (5 oz.) package instant vanilla pudding mix 1 (15 oz.) can solid pack pumpkin 1 tsp. pumpkin pie spice In a large bowl, mix together instant vanilla pudding mix, pumpkin and pumpkin pie spice. Fold in the thawed frozen whipped topping. Chill in the refrigerator until serving. Optional: Use dip as filling for mini pumpkin parfaits.
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FRESH SOUTHERN PEACH COBBLER
Mix together 3 tbsp. white sugar 1 tsp. ground cinnamon
Peaches 8 fresh peaches; peeled, pitted and sliced into thin wedges 1/4 cup white sugar 1/4 cup brown sugar 1/4 tsp. ground cinnamon 1/8 tsp. ground nutmeg 1 tsp. fresh lemon juice 2 tsp. cornstarch Cobbler 1 cup all-purpose flour 1/4 cup white sugar 1/4 cup brown sugar 1 tsp. baking powder 1/2 tsp. salt 6 tbsp. unsalted butter, chilled and cut into small pieces 1/4 cup boiling water
Preheat oven to 425 degrees. In a large bowl, combine peaches, white sugar, brown sugar, cinnamon, nutmeg, lemon juice, and cornstarch. Toss to coat evenly, and pour into a 2-quart baking dish. Bake in preheated oven for 10 minutes In a large bowl, combine flour, white sugar, brown sugar, baking powder, and salt. Blend in butter with your fingertips, or a pastry blender, until mixture resembles coarse meal. Stir in boiling water until just combined. Remove peaches from oven and drop spoonfuls of topping over them. Sprinkle entire cobbler with the sugar and cinnamon mixture. Bake until topping is golden, about 30 minutes.
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RESEARCH
O STUDYING HUMAN MOTION IMPROVES ORTHOPEDIC OUTCOMES By Leigh Farr
DES
rthopedic specialists at The CORE Institute are working with the MORE Foundation’s Human Motion Laboratory to improve quality of life for people with mobility limitations. Using state-of-the-art technology, the team measures how the body moves to pinpoint optimal treatments for overcoming orthopedic disorders. “My goal for the Human Motion Laboratory is to provide the highest possible quality measurements of human motion during the performance of common daily movement activities,” says John McCamley, PhD, Director of the laboratory. “It is incredibly exciting to be able to provide specialists within The CORE Institute, sponsors and the wider population, with the information necessary to give those suffering from orthopedic impairments the best quality of life for the future.” PRECISION EVALUATION Musculoskeletal conditions affect one in two adults, according to a recent report from the United States Bone and Joint Initiative. Conditions and injuries affecting the bones, joints and muscles can reduce quality of life and can be painful and debilitating. The Human Motion Laboratory conducts ongoing research designed to provide precise biomechanical measurements of participants’ movements, helping specialists to improve surgical techniques and evaluate implant designs. The lab is equipped with infrared cameras designed to track the location of reflective markers worn by volunteer study participants during routine activities such as walking, climbing or descending stairs or rising from a chair. The lab also has pressure sensors embedded in the floor and sensors designed to detect the activa-
TO LEARN MORE about treatment options to improve your mobility, visit www.thecoreinstitute.com.
tion of muscles within the human body. “Measurement of these activities enable us to better understand the limitations of impairment and how different surgical techniques, orthopedic devices and rehabilitation programs can be used to achieve the best possible outcomes for patients,” says Dr. McCamley. Specialists from The CORE Institute are currently investigating the effectiveness of implants used for total knee replacement. One implant, known as a lateral pivot knee replacement, is designed to more closely mimic “natural” knee motion throughout the full range of knee flexion to improve patient outcomes, says Dr. McCamley. “It is inspiring to consider that the research performed by the Human Motion Laboratory will benefit future total knee replacement recipients,” he says. IN THE PIPELINE Future research will include the effect of rotator cuff tears on shoulder function, the influence of aging on gait in patients with total knee replacements and the design of innovative ankle replacements. “As our understanding of the human body and its movement patterns improves, medical specialists and device companies are continually striving to develop techniques and products which give better outcomes,” says Dr. McCamley. “These innovative products have the potential to improve the quality of life for all future patients.
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ASK THE EXPERT
Q&A
with Dr. Brian Seeto, orthopedic shoulder surgeon
Can’t Let it Go? By Stephanie Conner
Q: The motion in my right shoulder is limited, and I am experiencing a great deal of pain. Sometimes, my shoulder feels so stiff that it’s almost frozen, and my doctor thinks it might be frozen shoulder. What can I do? A: First of all, anytime you’re experiencing pain and limited range of motion, it’s important to make sure you get the right diagnosis. Until we know exactly what we’re dealing with, we can’t recommend the best treatment. An experienced orthopedic specialist can typically determine if it’s frozen shoulder through a physical examination of the joint and a simple x-ray. Frozen shoulder is also known as adhesive capsulitis. There is a sleeve of tissue that surrounds the shoulder joint called the capsule. When this capsule thickens and tightens, you can have a frozen shoulder.
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People always wonder what caused their frozen shoulder, and the truth is we often don’t know. It can happen out of the blue with no clear cause. But we do know that it’s more common in people with diabetes and thyroid problems and in those who have recently been immobilized. Frozen shoulder can cause intense pain (even at rest), which is followed by the ‘freezing’ stage, where the Brian Seeto, MD joint stiffens and may be less painful. Next comes the ‘thawing’ stage where mobility starts to return. To answer your question, there are treatments that can accelerate the process. To decrease pain, you can try oral anti-inflammatories such as ibuprofen. In my opinion, one of the best things we can do to help with pain is steroid injections. Sometimes we can
manipulate the joint to loosen it or expand the contracted capsule to help it move. Physical therapy is also a great option to help you get moving again. I recommend gentle PT rather than a particularly aggressive regimen. Simple range-of-motion exercises can help you return to movement and stretch out the joint. Working with a skilled physical therapist is important to help identify where you have the greatest deficit and then selecting exercises and stretches that are best for your particular situation. For the vast majority of people, frozen shoulder will go away on its own. It’s just a matter of time. But the good news is that we can help treat your pain and help you slowly get your range of motion back—most of the time without surgery.
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