What is Telemedicine? We answer your questions.

While our nation confronts the spread of the coronavirus, Northeast Orthopedics and Sports Medicine (NEOSM) is now offering Telemedicine appointments to continue our commitment to provide exceptional care for our patients and community. Although Telemedicine has been around for years, the recent COVID19 pandemic has taken Telemedicine from a rarely used mode of seeing your doctor to a necessity of social distancing. With Telemedicine, you have access to NEOSM’s team of orthopedic specialists from the comfort of your home. 

What exactly is Telemedicine? And what can you expect from your virtual appointment? Here are some answers to commonly asked questions. 

What is Telemedicine?

Telemedicine allows for patients to be evaluated, diagnosed and treated by a physician through video conference. By using this technology, Telemedicine allows access to care when an in-person visit is not the preferred option. This is very similar to common apps like FaceTime, but Telemedicine applications are typically HIPPA compliant and may have other features that assist in a patient visit, such as digital waiting rooms, ability to review xray/MRI images, integration with home blood pressure monitor, etc.

Why choose Telemedicine?

Several studies have shown that in many cases a Telemedicine visit is as good as an in-person visit.  While there are some elements of a physical exam that cannot be done via video, many of the elements can still be performed.  Under normal circumstances there are many benefits of Telemedicine to the patient including convenience, but during COVID19 the benefits are immense and critical to getting healthcare to the patients who need it most and who are at highest risk from COVID19. 

Do I need special equipment or technology to use Telemedicine?

All that is required is a computer, tablet or smartphone with a camera and microphone enabled. No software is needed to be downloaded and you don’t need to create an account. 

How do I make a Telemedicine appointment? 

Call any one of our locations and our staff will schedule your virtual appointment. 

I have made a Telemedicine appointment with NEOSM, what do I do next?

Prior to your appointment, NEOSM will email or text to you a ‘doxy.me’ link. At the time of your appointment, just click on the link. The first time you enter, you will be prompted to allow doxy.me access to your camera and microphone. After doing so, enter your FULL name to check-in. You’ll then enter the virtual waiting room and the doctor will be notified you have arrived. That’s it! As soon as the doctor is ready, they will start your visit. 

Does insurance cover Telemedicine visits?

Telemedicine visits are covered by insurance as a regular doctor’s visit. Co-pays, referrals, etc. would apply as normal. Some insurance companies have waived copays during the Covid-19 pandemic for telemedicine visits. Please contact your carrier for more information.

What if an in-person visit is necessary?

If during your Telemedicine appointment the doctor determines that an in-person visit is necessary, we will have you schedule an appointment in one of our offices. Please note, NEOSM is taking many precautions to make sure our patients are as safe as possible when visiting our offices, like minimizing the number of patients in our waiting rooms and increased disinfecting of surfaces, to name a few. 

If you have additional questions on Telemedicine or would like to schedule your appointment, please call our offices and we’d be happy to help!

COVID-19: NEOSM Patient Safety Measures

To our patients:

As dedicated healthcare professionals, all of us at Northeast Orthopedics and Sports Medicine (NEOSM) are committed to the health and well-being of our patients, staff and community. During the current spread of the Coronavirus (COVID-19) in our area, our focus on safety is even more paramount. We have taken the following measures to ensure that all those in need of immediate orthopedic care are able to be consulted while limiting unnecessary exposure to others. 

Visitor Policy:

All NEOSM offices are open for orthopedic appointments for patients who need to be seen in person. Priority scheduling (first hour of day) is available for older patients and those immunocompromised. Only the patient is permitted to enter our offices. If the patient requires assistance or a parent (for minors), the accompanying visitor must be in good health. All patients and visitors are required to wear a face-covering.

All visitors are pre-screened for any signs of illness or contact with coronavirus. Those who do not pass our pre-screening will be restricted from our office. All non-essential visitors are not permitted. 

In-Office:

We are limiting the number of patients and staff in each office. In our waiting rooms, we have separated chairs to allow proper distancing and are providing the opportunity to wait in your car until your doctor is ready for your visit. We are also providing the option to fill out forms online prior to visiting and minimal wait times to see a doctor.

All staff are in proper Personal Protective Equipment (masks, etc) and all staff sanitized hands before and after each patient. All patient areas are wiped down/sanitized after each patient. Hand sanitizer is available throughout our offices for use.

Telemedicine Appointments (Virtual):

We are offering all patients the opportunity to consult with our physicians virtually through telemedicine appointments. Just call our office as you would to make a regular appointment and this option will be available. A web link will be sent to you to access the virtual appointment. All you need is either a smartphone, tablet or computer, with a camera and the microphone enabled. Telemedicine appointments are covered by insurance as a regular visit and all referrals, etc, would remain the same.  Click here to learn more about Telemedicine.

We will continue to monitor the evolving situation and regulations in place during this time. We encourage you all to continue to practice social distancing, regular hand washing and sanitizing, and to remain up-to-date on and adhere to your local guidelines. 

Thank you and stay safe. 

Northeast Orthopedics & Sports Medicine

Updated April 2020

Which approach is right for your hip?

By: Dr. Barry Kraushaar

When a patient has arthritis of the hip, there really are only a few choices available for treatment. Most people try to ignore pain or live with it as long as they can.  Once daily life is affected, it becomes necessary to discuss other options. 

The non-operative care of the arthritic hip is rather limited. Options include:

  • Oral non-steroidal anti-inflammatory (NSAID) pills. 
    • These can help briefly, but they do not address the underlying problem, and they can cause bleeding, ulcers, kidney disease and high blood pressures,
  • Physical therapy 
    • This may help especially if there are surrounding thigh and low back issues
  • Hip joint injections 
    • Cortisone may briefly help
  • Less traditional measures 
    • Acupuncture, topical ointments and rubs, chiropractic care, prolotherapy, stem cell treatments, etc., though these are not proven to work by scientific standards

For those patients who do not improve with conservative measures, hip replacement surgery may be necessary. When this decision is made, a patient has two general choices about the surgical approach to the hip: Anterior or Posterior

  • Anterior hip replacement – this procedure is done with the patient lying face upward on the table. A special table may (or may not) be used to help the surgeon optimize the procedure. The approach allows the use of a video-type fluoroscope imaging system which permits real-time optimization of the process of implanting the joint. The surgery is performed by entering the hip between muscles, and no muscle is cut in the process. This procedure is optimal for some patients – ask your surgeon. Some patients report a more rapid return to walking and activities after the anterior approach – compared to the posterior approach. Also, after this approach there is no restriction to bending over, and patients are not required to follow “hip precautions” as is necessary in the posterior approach. Some patients feel the anterior approach is less painful in the early post-operative time period.
  • Posterior hip replacement – this approach has been the more traditional method, and the duration of a routine case may be a bit shorter than the anterior approach. The posterior approach does not require any special table to perform. It is “tried and true” and some surgeons perform only this procedure because it is so reproducibly good that they prefer to stay with it exclusively. The posterior approach involves crossing some fine-control muscles on the way into the hip joint. The ligaments in the rear of the hip are opened, so after the procedure is done, patients need to observe hip precautions, usually for three months. They are not allowed to bend past 90-degrees and should sleep with a pillow between the knees, among other restrictions. The fluoroscope cannot be used real-time during the case, but plain x-rays can be taken during the case to confirm that components are going in correctly. The posterior approach is felt by some surgeons to be best in difficult cases because it is easier to manage difficulties (such as a stress fracture) from this direction.

By 6 weeks most patients with either approach are doing similarly well. Infection rates are similarly low. Dislocation rates are slightly less with the anterior replacement according to some reports. Blood thinners are used in the same manner postoperatively for either approach.

Northeast Orthopedics and Sports Medicine has surgeons who perform both the anterior and posterior approaches to hip replacement. We are happy to answer your questions, so contact us today to schedule your consultation.

Is Rehab Right For You?

By: Dr. Barry Kraushaar

Many patients who see an Orthopedic Surgeon arrive with a concern that the prescription for treatment is surgery. The fact is, surgery is a small part of the entire care of an orthopedic patient. While it is true that a surgeon may need to perform procedures to repair some injuries, there is an important role for Physical and Occupational Therapy in all the phases of patient care.

Many patients have discomfort due to muscle imbalances. These can be recently acquired, or they can be developing over decades.

  • Physical therapy is prescribed to assess as well as treat these imbalances. The field of Sports Medicine has been helpful in showing us the benefit of strength-balancing to restore function. The fact is, most patients with shoulder pain can be treated with this approach. A person can have a rotator cuff tendon tear or shoulder instability, yet they may avoid surgery if the remaining muscles are properly rehabilitated. Rehab takes time. With the supervision of a therapist a patient can be moved forward in a manner tailored to that specific person’s pattern of injury.

In order to rehabilitate properly, a patient must be comfortable enough to perform the exercises.

  • This is where the modalities of PT matter. Massager, electrical stimulation, TENS (transcutaneous electrical nerve stimulation) and ice/heat combinations are examples of comfort measures. Some patients need a gradual approach to rehab, and modalities are very helpful in the immediate postoperative period before exercises can begin.

Stiffness can be a separate category of difficulty that the therapist may need to address.

  • Muscle imbalances do not always explain loss of function. Sometimes stiffness is a separate issue that takes time to manage. A physical therapist can not only teach stretching, but they also can help the patient perform them. This can be especially true in patients with chronic shoulder or knee pain. The posterior (rear) position of the shoulder gets tight in some shoulders, especially baseball pitchers. The hamstrings tend to tighten up in patients with chronic knee pain. Therapists know to address this category of rehabilitation in addition to strength and comfort.

You are your own best friend in Rehabilitation.

  • The goal of Physical or Occupational therapy is to restore your function as close as possible to your pre-injured state. With your own participation the results are more likely to work. A good therapist will teach you techniques that you can use, and provide you with home exercises to make the improvements last.

Not everyone needs rehabilitation, and there is eventually a limit to the benefits achieved. The purpose of an Orthopedic Surgeon prescribing rehabilitation is to address the injured part and the surrounding region. So if your doctor prescribes therapy, there is probably a good reason for it.

Contact us today to speak to a Northeast Orthopedics & Sports Medicine physician to discuss how therapy may fit into your treatment plan.

The Rotator Cuff

By: Dr. Patrick Murray

The rotator cuff is a group of 4 muscles and tendons around the shoulder joint. The shoulder joint, like the hip joint, is a ball-and-socket joint. But unlike the hip joint, the ball is not constrained by the shape of the socket. The result is that the shoulder joint is capable of a greater degree and freedom of motion. The rotator cuff acts as a dynamic stabilizer of the shoulder joint, keeping the ball relatively centered in the socket as the shoulder “rotates.”

The 4 rotator cuff muscles are:

  1. Supraspinatus
  2. Infraspinatus
  3. Teres Minor
  4. Subscapularis.

The rotator cuff is subject to stress and injury from a variety of sources, ranging from shoulder dislocation to degeneration that occurs over time from use.

Symptoms and Diagnosis of Rotator Cuff Problems

There are many different ways that the rotator cuff can cause problems. These problems may also involve other associated structures, like the biceps tendon. Neck disorders, such as herniated discs, may also cause symptoms of shoulder pain. Symptoms that patients experience related to rotator cuff problems include pain, stiffness, weakness, and clicking or popping when moving the shoulder. Rotator cuff problems may or may not be caused by an injury. In some cases there is pain and inflammation, but no structural damage. In other cases, there may be structural damage to the rotator cuff. Making an accurate diagnosis requires obtaining an accurate history, performing a physical examination, and usually obtaining some imaging studies. Plain X-rays are very useful initially. Advanced imaging, such as ultrasound or MRI, may also be recommended. Once an accurate diagnosis is made, an individualized treatment plan can be constructed.

Impingement Syndrome

The supraspinatus tendon of the rotator cuff lies at the top of the shoulder joint, directly below a projection of the shoulder blade, or scapula, called the acromion.  When the arm is elevated overhead, the space between the acromion and the ball decreases, thereby putting more pressure on the supraspinatus tendon and the bursa that overlies it. This can frequently cause inflammation that is painful. This problem is called “Impingement Syndrome,” and is one of the most common causes of shoulder pain. Pain caused by inflammation of the rotator cuff is generally treated with therapeutic exercise, which may be done at home and/or under the direction of a physical therapist, and some form of anti-inflammatory medication. Cortisone injection may be required to alleviate pain, and in some cases, surgery may ultimately be necessary.

Image credit: rehabmypatient.com

Rotator Cuff Tears

In addition to causing pain from inflammation, the rotator cuff may also be damaged, or torn. Small, partial thickness tears of the rotator cuff are generally treated in a similar way to inflammation. A full-thickness tear, in which the tendon is detached completely from the bone, can range in size from small to massive, and is more likely to require surgery to repair. Rotator cuff repair surgery requires that the tendon be reattached to the bone. It can be performed with traditional open surgery, or with minimally invasive arthroscopic surgery. Recovery time varies, but usually requires at least 3 months, and physical therapy.

Full Thickness Rotator Cuff Tears

Full thickness rotator cuff tears increase in size over time, and patients do not always have symptoms as this occurs. When a rotator cuff tears gets larger, the mechanics of how the shoulder joint moves changes, putting more stress on the cartilage surfaces in the joint. This may eventually cause the development of arthritis in the joint, which can itself be painful and disabling. If a patient has a large chronic rotator cuff tear that has caused arthritis in the joint, several treatment options exist. Physical therapy may help restore range of motion and strength. Medications can alleviate pain when needed. There are several types of injections that can be performed, including cortisone, for relief of symptoms. Hyaluronic acid, or “gel” injections, can also be used for symptomatic relief. These are more commonly used for the treatment of osteoarthritis of the knee. Other injections, such as platelet-rich-plasma (“PRP”) and stem cell injections are currently considered experimental for treatment of rotator cuff disorders and arthritis. The last resort for treatment of this problem is a type of shoulder replacement called a reverse total shoulder replacement.

Image credit:  https://orthoinfo.aaos.org/

At Northeast Orthopedics and Sports Medicine, our physicians have the knowledge and experience to diagnose and treat the full spectrum of rotator cuff disorders, using the most advanced and minimally invasive techniques, including an array of non-surgical treatments. If you think you have a rotator cuff problem, schedule a consultation with one of our talented physicians for an evaluation and treatment plan today

NEOSM Gives Back for the Holidays

With generous contributions from our staff and physicians, Northeast Orthopedics and Sports Medicine is proud to have donated an incredible amount toys and pantry items in support of the East Ramapo Central School District (ERCSD) Family Center. Donations will be distributed to those in our community in need this holiday season. A big THANK YOU to all for making this season a bit brighter for our neighbors!

Understanding Carpal Tunnel Syndrome

By: Alan Gotesman, MD

Are you experiencing pain in your hand waking you up at night?  Do you have tingling in the fingers when you are driving or holding your phone? Is it getting difficult for you to manipulate small objects like buttons or clasps? You may have carpal tunnel syndrome. 

Carpal tunnel syndrome occurs when the nerve crossing your wrist is compressed, usually due to swelling of the tendons, which can cause pain and diminished sensation in your hands, particularly the thumb, index, middle and half of the ring finger. Typical symptoms are pain that wakes people up at night that needs to be “shaken out”, numbness and tingling as well as weakness and difficulty performing activities requiring fine manipulation. The diagnosis can usually be made with a detailed history and physical examination but confirmation can be performed with a nerve test called EMG’s that can determine the severity of the nerve compression and rule out other causes.

In milder forms, carpal tunnel syndrome can be treated with bracing, anti-inflammatories and cortisone shots. Once the compression is more severe, releasing the pressure on the nerve can be crucial to relieve the symptoms and prevent permanent nerve damage which can occur with chronic compression of the nerve. Newer minimally invasive techniques are available that allow the procedure to be done through a quarter-inch incision with the assistance of a camera. This technique allows for a quicker recovery process as well as less postoperative discomfort.  Results of surgery are generally excellent with many patients going back to all of their activities within 6-8 weeks.

If you think you may be suffering from carpal tunnel syndrome, the first step is to have an evaluation so schedule your appointment with one of our board-certified specialists today for an evaluation. 

Hudson Valley Top Docs 2019

Northeast Orthopedics and Sports Medicine is beyond proud to announce that twelve of our physicians have been named Top Doctors by Hudson Valley magazine. Congratulations to our doctors for this recognition of their commitment to exceptional care!

Hudson Valley Magazine Top Doctors 2019

Orthopedic Surgery

  • Kenneth Austin
  • William Davis
  • Barry Kraushaar
  • Mark Medici
  • Patrick Murray
  • Steven Renzoni
  • Richard Semble
  • Jordan Simon

Physical Medicine & Rehabilitation

  • Michael Robinson

Rheumatology

  • Shivani Purohit Mehta

Sports Medicine

  • Mark Berezin
  • Richard Popowitz