New York magazine: Top Doctors 2021

Congratulations to the NEOSM physicians named Top Doctor by New York magazine! We’re #NEOSMproud to have you on our team!

Orthopedic Surgery

Kenneth Austin, MD
William Davis Jr, MD
Doron Ilan, MD
Barry Kraushaar, MD
Mark Medici, MD
Patrick Murray, MD
Steven Renzoni, MD
Richard Semble, MD
Jordan Simon, MD

Physical Medicine & Rehabilitation

Michael Robinson, MD

Rheumatology

Shivani Purohit Mehta, MD

Sports Medicine

Richard Popowitz, MD

Congratulations all! To make an appointment for consultation with one of our talented physicians, please call an office near you.

THANK YOU TO OUR MANAGERS!

In times where we were all faced with so much uncertainly, we all looked to leaders around us to guide us through. This has been true at NEOSM, where our group of managers demonstrated true leadership. They’ve shown such grace while working tirelessly to make sure our practice could continue to provide world-class care to our patients in a safe environment.  Throughout the last year, they’ve navigated and adapted through continually changing guidelines, staffing challenges and many unexpected obstacles thrown their way – all the time, keeping the safety of our patients and staff their number one priority. We’re so grateful for this remarkable team!

Cheyeene Bravo
Heather Gerdes
Helene Kraushaar
Lea Reale
Jennifer Toone

Arthritis Pain Flaring Up In Summer?

Extreme weather can be brutal to those suffering with arthritis. We’ve written before on how bitter winter cold can affect symptoms, but you may notice summer heat bringing its own troubles to your joints. High temperatures and humidity are typical of summers in the northeast. How do these conditions contribute to increased arthritis pain and what can you do to combat them?

Increased Swelling

With humid weather, many people are naturally prone to swell. This swelling increases pressure on joints and associated pain. To combat swelling, limit time spent outside in hot and humid weather. Try taking a cooler than usual shower to bring down your body temperature if swelling is becoming particularly bothersome.

Hydration

As we sweat in the heat, we lose fluid from our body. Our bodies rely on this fluid for different functions, including lubrication of our joints. So it’s important to replenish our bodies with plenty of water throughout the day. On particularly hot days, double your normal water intake. Set a hydration goal each day to help you stay on track.

Barometric Pressure

Changes in weather throughout the year can have an effect on arthritis. And in the summer, weather can change quickly with a rolling thunderstorm passing by suddenly. Some studies have shown that the barometric pressure in the atmosphere has a connection to joint pain. As pressure drops before a storm, joint and tendons can expand and contract, exasperating existing arthritis symptoms. Once pressure is normalized, you should see some comfort, but during heightened episodes try elevation and icing to relieve pain.

Summer is a time for fun, and we hope with this information, you can make the most of our warm weather days. If your symptoms continue or you’d like to learn more, the joint specialists at Northeast Orthopedics and Sports Medicine are here to help you live your life to the fullest.

What Everyone Needs To Know For A Safe Pool Season

There’s really nothing better than taking a dip in a cool pool on a long, hot summer day.  With a nice swim, we can relax, exercise or just have fun with friends. We wouldn’t want anyone to miss out on a good time – or, more importantly, suffer a serious injury – so we’re sharing some easy-to-follow tips to think about next time you’re planning a day poolside.

Before You Plunge

Before you get into a pool, it’s important to evaluate first and foremost if you actually should. Ask yourself: Am I alone? Do I not see a lifeguard present? Is the weather report calling for lightning? Have I consumed alcohol? Am I too tired or too overheated? If you can answer ‘yes’ to any of these questions, reconsider.

Know Your Depths

Make sure you know how deep the water is. Look out for depth indicators throughout the pool, as depths can vary in different sections. NEVER dive in shallow water and always check depth markers before you go in headfirst. More on diving in our next section. If you are an inexperienced swimmer, avoid depths where you cannot stand comfortably with your head above water.

Diving

It bears repeating: NEVER DIVE IN SHALLOW WATER. Serious spinal cord injuries, including paralysis of all four limbs, can and do occur. Never dive headfirst in above ground pools or water that is murky and where you can’t see the bottom. Dive only off the end of a diving board and swim away from the diving area immediately to avoid the next diver.

Pool Deck

If you sit by a pool with children long enough, you’re sure to hear a lifeguard or parent yell “Don’t run!” at least once. It’s for good reason. The area around a pool will naturally be wet, creating a slick surface that is easy to slip on. Add in flimsy flip flops or bare feet and running, and chances of a fall increase. So walk carefully. Also, if swimming at night, make sure the area is well lit to avoid any hazards for trips or falls.  

Swimming for Fitness

If swimming is your go-to for aerobic exercise, you’ve made a great choice. It’s an activity that can be continued as you age, is gentle on your joints and is simply a great workout. As with any form of exercise, injuries can occur, so make sure to warm-up your body before you start, stretch often and include weight bearing exercises in your program to strengthen your shoulders and back.

With these basic guidelines, you’re sure to have a summer full of poolside fun, hopefully injury-free. However, should you encounter an issue, as always, the specialists at NEOSM are here to help.

Keeping Tennis and Golfer’s Elbow at Arm’s Length

By: Dr. Barry S. Kraushaar

Tennis Elbow and Golfer’s Elbow are names for similar tendon injuries that occur at the tendon attachments on the outer (lateral) and inner (medial) sides of the elbow joint. If you have pain on or near the points of bone that serve as the origins of the muscles of the forearm, you may have this diagnosis. The forearm muscles, which give power to your grip, attach to these anchoring points called epicondyles. They can tear off of the bone or within their fibers. Tendons are injured throughout our lives, but they usually heal themselves, making it rare to need medical help. When a tendon attachment to your elbow tears and fails to heal it can be Tennis or Golfer’s Elbow.

TENNIS ELBOW is an injury at the outer (lateral) bony prominence of the elbow. You can have this diagnosis even if you do not play tennis, but the name comes from the observation that tennis players get it as part of the sport. This is because the grip of a long tennis racquet and the wrist motions of the tennis swing put strain on the muscles which originate at the lateral epicondyle. Expert tennis players rarely get tennis elbow because they have powerful forearms and good swing mechanics. If you have the wrong grip size, string tension, timing (late swing), racquet type, or stroke mechanics (wrist motion), you are at risk for Tennis Elbow. In fact, any type of forearm overuse can cause tennis elbow, and the treatment options, described below, are the same.

GOLFER’S ELBOW refers to pain on the inner, medial side of the elbow. In this sport, the problem is caused by the combined effect of the long club length being gripped by the trailing arm (the right arm in a right-handed swing) as the club-head strikes the ground, such as in the rough, the sand or when taking a divot to get under the ball. The forearm is driving forward as the hand is held back, causing strain in the muscles that control the wrist. The damage occurs at the tendinous origin on the inner side of the elbow. Ironically, golfers can also get Tennis Elbow, because the leading arm sees strain on the outer, lateral side during the same movement.

Treatment

There are many additional reasons for tendon injuries about the elbow, usually involving pulling or twisting motions during exertion. It can happen from low level stresses or big motions. From an orthopedic view, the approach is to identify the causes and help the patient adjust activities to allow the tendons to heal themselves.  This may involve a period of partial or complete rest from the aggravating activity. It may involve different equipment or technique. During a flare-up, you may benefit by using a brace. If you wear a wrist brace it may help the elbow by limiting the motions that are traumatizing the injured tendon. A tennis elbow strap is different, as it works by re-directing forces coming up the forearm and deflecting the pulling effect on the tendon origin. Pills, such as non-steroidal anti-inflammatory drugs (NSAIDS like ibuprofen) or analgesics (acetaminophen, Tylenol) may temporarily help the symptoms, but they do not cure tendon injuries. Similarly, a steroid (cortisone) injection may relieve pain for now, but the chemical may damage tendon, and after a few months the problem can come back even worse. Sometimes, a small injection is used as part of a bigger plan.

The most effective and lasting way to manage Tennis or Golfer’s Elbow is to perform exercises to strengthen the forearm. Since the elbow is injured, the exercises need to be rehabilitation type, which is different than fitness exercise. Doctors often prescribe Physical Therapy because a therapist should know the gradually increasing exercises that achieve the goal of lasting recovery without a setback. While many videos exist online, there is no substitute for personal guidance. Once you learn these exercise you can do them yourself. 

Other non-operative treatments exist but are less commonly used. One promising intervention is Stem Cell Injection Therapy. Currently, this technique involves having your blood drawn and spun in a centrifuge. The provider injects a small volume of your own special stem-cells back into you at the site of the pain, and you grow new tendon in the damage zone. Stem cells can also be harvested from your fat or marrow. The use of Stem Cells is usually not covered by insurance, and the statistics of success are still not high enough for many people to be willing to pay out of pocket (costs hundreds to thousands of dollars).  Ask your doctor if you want to know the current trends.

Ultimately, surgery may be necessary for tendon injury at the elbow. There is a minimally invasive technique that requires a brief, light period of sedation and/or local anesthetic injection. The doctor introduces a special needle through your skin over the injured area and activates a device that either causes the tip of the needle to heat up and melt the damaged tendon, or it injects a pressurized water jet into the tendon to break up the scar tissue and cause the tendon to react by developing scar tissue to replace the damaged area. During this process, the surgeon may also use stem cells, described above.

The open surgical technique for Tennis or Golfer’s Elbow is well established and has an excellent success rate. The operation is not usually very long, involves little or no risk to nerves and vessels, and recovers rather quickly, although you may need a period of protection and rehabilitation afterward to give the tendon a chance to heal and the muscle groups time to recover. Basically, the surgeon opens the tendon and removes the bad scar tissue, the tendon is given a chance to grow fresh tissue in the place of the old, painful region, which is usually right where the pain was. In my practice, fewer than ten percent of patients with Tennis or Golfer’s Elbow go to surgery, and nearly every patient reports real improvement from the intervention. Return to sports and full activities is possible in most cases.

Summary

If you think you have Tennis or Golfer’s Elbow, try to identify the causes and address them yourself. Try to gently strengthen your muscled without overdoing it. Consider a brace and careful usage of medicines, if you can do so safely. If you do need orthopedic care, you may be discussing physical therapy and the other treatments described above. Know that if you have to go to surgery, the options in most cases are likely to be effective. Hopefully, you can continue to enjoy your active lifestyle, doing what you need or want to do. The specialists at NEOSM are there to help along the way.

Watch Now: Rotator Cuff Injuries & Treatment

NEOSM’s Dr. Jason Fond sat down with Nyack Hospital to talk Rotator Cuff injuries and treatment. Check out the video for his expert presentation.

Click on the video below to watch the presentation.

To schedule a consultation with the experts at Northeast Orthopedics and Sports Medicine, give a call to one of our conveniently located offices.

When the Bones are Good: 5 Keys to Bone Health

You often hear “the bones are good” when people talk about the value of a house. It’s to say the structure is sound, that it can stand up to what it may face, that it can protect those who live there. Well, the same goes for when the actual bones in your body are healthy. They can protect you from falls and fractures, and support all the functions of your body.

Let’s talk about those bones. Did you know your skeleton rebuilds itself as we age? That right, about every 10 years, our bones regenerate where new bone tissue replaces the old. As we age, though, the amount of new bone can decrease, resulting in bone loss which leads to weaker bones, increasing the risk for fractures. Thankfully, there are proactive measures we can take to better balance the process and protect our bones.  

Understand your risks for bone loss

Many individual factors can affect bone density, namely age, family history, weight and related health issues. Age: The older you get the more bone loss is projected to occur. Women, in particular, experience rapid loss following menopause, putting them at risk for osteoporosis. Family History: Bone mass is determined by our genes, so it’s important for this and other reasons to have a good understanding of your family medical history. Weight: Overweight adults are at higher risk for falls which can lead to bone breaks, and being underweight can increase bone loss and risk of fractures. Health Issues: If you have diabetes, an autoimmune disease, or are taking medications that are known to cause bone loss, be sure to discuss your risks with your doctor.

Nutrition

The right combination of vitamins and nutrients is needed to promote healthy bones. We hear much about the importance of calcium for bone health, which is for good reason. Calcium is stored in our bones. When our body does not have enough to function, it will steal some from its storage in, you guessed it, the bones. So load up on green leafy vegetables and dairy products, and try supplements if you need increase your daily dosage. And grab some water instead of soda, specifically, since they decrease calcium absorption. Vitamin D is also super important, as it helps our bodies absorb calcium from our diets and build those strong bones. It’s hard to get enough Vitamin D through food, so look for supplements or help your body make some by sitting in some good sunlight – just don’t forget the sunscreen!

Exercise

Committing to regular physical activity is a key component to a healthy lifestyle and the benefits extend to bone health. Weight-bearing activity helps your bones become stronger and can slow down bone loss after menopause. Brisk walks, dancing, tennis, jump roping, even hopscotch! Exercise in all forms is good for your skeleton. Also, as you grow stronger and gain balance through activity, you decrease your risk of falls leading to fractures. So get out there and keep moving!

Lifestyle & Environment

We all know smoking and heavy alcohol use are no good for your overall health, so it is no surprise that both can reduce bone mass. In fact, nicotine actually suppresses bone-forming cells. There may also be other everyday risks right under your nose. Tripping hazards and obstacles can lead to accidental falls, so be sure fix that loose step or tuck that computer cord away, for instance. And adding safety features around the house, like a grip bar in the tub for instance, is never a bad idea.

Consult with your doctor

If you are at risk for bone loss, be sure to consult with your physician. A bone density test may be in order to determine if prescription medicine may be necessary to help protect and build up bone tissue. It’s better to be proactive, than try to make up for severe bone loss down the road.

We hope that with this guidance, you can make your bone health a priority. The specialists at NEOSM are here to answer any questions you have in your journey.

Source: American Academy of Orthopedic Surgeons/orthoinfo.org

Tiger Woods’ Injuries: Defining Terms and Procedures

The recent news of Tiger Woods’ horrific car accident has been startling. Watching the images of the aftermath, we see how serious the incident and the injuries sustained by the golf great are. While news outlets have been reporting on details of the necessary emergency orthopedic surgery, fans are growing more and more concerned, so we thought it would be helpful to provide some expert insight into the meaning of some common terms and procedures being reported.

High-Energy Trauma/Fracture

Injuries sustained where a large amount of energy or force are at play are considered high-energy traumas. Accidents involving a moving vehicle, like in the case of Tiger Woods, or a fall from a significant height are examples. These traumas result in more complex injuries that generally involve more tissue damage.

Open Fracture

An open fracture, historically known as a compound fracture, is a fracture in which the bone has broken through the skin of the area at the time of injury. Because the wound is open, there may be contamination at the fracture site that increases the risk of infection. Severity of the injury depends on the degree of contamination and extent of damage to soft tissues such as muscles, tendons, nerves, and blood vessels. Open fractures should always considered an emergency and treated immediately due to the increased risk of infection.

Use of Rods, Plates and Screws

When a fracture cannot be adequately treated with conservative measures, such as setting the bone and casting or splinting, surgery is indicated. In the case of open fractures, surgery is necessary to clean the area to minimize the risk of infection. Fractures treated in this way usually need to be stabilized with metal hardware, such as rods, plates and screws. This is called internal fixation. Nails or rods are inserted into the center of long bones, such as the tibia, for stabilization. These are most often used for fractures near the middle of long bones. Some fractures may require a plate and screws to hold the bones in place while they heal. In some cases, wires or pins are utilized to treat fractures in smaller bones. Depending on the case, pins and wires are usually removed once the bone has healed adequately. Rods, plates and screws are often not removed.

Compartment Syndrome

Fractures can cause bleeding and severe swelling, which can create excessive pressure within muscle compartments. If this occurs, this pressure can cause damage to muscle and other soft tissue within that compartment, which may be irreversible. This is called compartment syndrome. If this occurs, emergency surgery must be done to prevent this tissue damage. If not properly treated, this problem may lead to amputation. Treating this requires a procedure called fasciotomy, during which surgeons incise the covering of muscles (called fascia) to relieve the pressure from the injury. This release is commonly achieved through large incisions, which may heal together once swelling is reduced or may require skin grafting. Sometimes fasciotomy is performed if the injury is felt to have a high risk for developing compartment syndrome.

Until more information is released about the specifics of Tiger Woods’ injuries and treatment, it is hard to speculate on what his recovery will look like. The focus now is on successful healing from surgery and combating any complications, should they arise. Traumatic injuries are devastating to those who have had the unfortunate experience. We hope through the support of his family and all his fans, Tiger Woods will make a full and healthy recovery. We wish him all the best in his journey.

To learn more about the orthopedic trauma specialists in our practice, visit our NEOSM physician profiles.