Understanding Shoulder Anatomy

The shoulder is one of the most complex joints in the human body and has the largest range of motion among all other joints. This intricate structure is comprised of several key components, including bones, muscles, tendons, ligaments, and eight distinct planes of motion. Let’s take a deep dive into each of these components to gain a better understanding shoulder anatomy.

Bones of the Shoulder Anatomy

The shoulder is primarily made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). These bones work together to provide stability and mobility to the shoulder joint.

– Humerus: The humerus is the long bone in your arm that extends from the shoulder to the elbow. Its rounded head fits into the shallow socket of the scapula, forming the ball-and-socket joint of the shoulder that allows the shoulder to have a 360 degree range of motion.

– Scapula: The scapula is a triangular-shaped bone located on the upper back. It provides attachment points for several muscles and forms the back part of the shoulder socket.

– Clavicle: The clavicle is a long, S-shaped bone that connects the scapula to the sternum (breastbone). It helps to support the shoulder and allows for a wide range of motion.

Together, these bones create the Glenohumeral Joint and the Acromioclavicular Joint.

Bones of the shoulder, glenohumeral joint, acromioclavicular joint

Muscles of the Shoulder

The shoulder is supported by a group of muscles known as the rotator cuff, along with several other muscles that help to stabilize and move the shoulder joint.

–  Rotator Cuff Muscles: The rotator cuff is made up of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles work together to stabilize the shoulder joint and facilitate rotational movements. An example of an external rotational movement would be the backstroke when swimming. As the swimmer’s arm moves out of the water and rotates back into position for the next stroke, the shoulder is externally rotating. Alternatively, during a front crawl / freestyle stroke in swimming, when the swimmer’s arm exits the water and moves forward to re-enter the water, the shoulder internally rotates. Give this a shot as you’re reading this blog and notice the natural change in direction your hand takes as your shoulder moves through these motions.

– Deltoid: The deltoid is a large triangular shaped muscle that covers the glenohumeral joint. It is responsible for lifting the arm and giving the shoulder its rounded shape. This muscle can be divided into three heads: the anterior head, lateral or middle head, and the posterior head, each of which originate from the clavicle or scapula, and connect to the humerus.

– Trapezius: The trapezius is a large muscle that extends from the neck to the middle of the back. It helps to stabilize and perform many movements of the shoulder such as elevating and depressing the shoulders and internally and externally rotating the arm.

– Rhomboids: The rhomboids are two muscles located in the upper back that aid in retraction of the shoulder blades.

– Pectoralis Major: The pectoralis major is a large muscle located in the chest that helps to flex, rotate, and move the arm towards the midline of the body.

Tendons and Ligaments in Shoulder Anatomy

Tendons are tough, fibrous tissues that connect muscles to bones, while ligaments are thick, fibrous bands that connect bone to bone. Tendons and ligaments work together and play crucial roles in providing stability to the shoulder joint:

– Rotator Cuff Tendons: The tendons of the rotator cuff attach the rotator cuff muscles to the humerus and stabilize the shoulder joint during facilitated movements.

– Ligaments of the Shoulder: The shoulder joint is supported by several ligaments, including the glenohumeral ligaments, the coracoclavicular ligament, and the acromioclavicular ligament. These ligaments help to reinforce the shoulder’s stability and prevent injuries such as a dislocation.

ligaments of the shoulder

Shoulder Planes of Motion and Movement Patterns

As mentioned, the shoulder joint is capable of an impressive range of motion and movement in multiple planes. The primary planes of motion of the shoulder include:

– Flexion and Extension: Flexion is the action of bringing the arm forward, while extension moves the arm backward. An example of this is when you are running, the motion you perform with your arms is flexion and extension of the shoulder.

– Abduction and Adduction: Abduction raises the arm away from the body, while adduction brings the arm toward the body.  Think of when you perform a jumping jack, when you raise your arms over head, you are performing abduction of the shoulder. When you bring your arms back down to your sides, you are performing adduction of the shoulder.

– Internal and External Rotation: Internal rotation involves rotating the arm inward, while external rotation involves rotating the arm outward.

– Horizontal Abduction and Adduction: Horizontal abduction is the movement of moving the arm away from the midline of the body, while horizontal adduction is the movement of bringing the arm back toward the midline. Think of opening your arms to hug a loved one, that is horizontal abduction of the arms. When you hug your arms around that person, this motion is horizontal adduction.

The shoulder’s intricate structure of bones, muscles, tendons, and ligaments makes it an incredibly impressive joint, essential for many daily activities and athletic pursuits. However, this same complexity also makes the shoulder susceptible to numerous injuries. Understanding the components and movement patterns of the shoulder is crucial for maintaining its health and preventing potential issues.

Learn more about the shoulder and the different treatment options available for many common injuries and conditions by visiting our blog page

If you or a loved one are experiencing shoulder pain that just won’t go away, give us a call. Our experts are all fellowship trained, board certified, and equipped to help you get back to the things you love to do as efficiently as possible.

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Understanding Adult Scoliosis

Scoliosis, a condition characterized by an abnormal curvature of the spine, is often associated with adolescents. However, adults can also develop scoliosis, and it can significantly impact their quality of life without proper management. Come with us as we dig into adult scoliosis, the various types, its causes, treatments, even a few physical therapy exercises you can try at home.

Types and causes of Adult Scoliosis

Adult Scoliosis can be classified into four primary types, each classified by the diagnosed cause:

  1. Degenerative scoliosis: This is the most common type in adults and is caused by the degeneration (wear and tear) of the spine’s discs and joints. It typically occurs after the age of 40 and can worsen over time.
  2. Idiopathic scoliosis: While this type is more commonly associated with adolescents, it can also persist into adulthood. Idiopathic scoliosis has no known cause.
  3. Secondary scoliosis: This type is caused by another condition or factor, such as a spinal injury, muscle weakness, or neurological disease.
  4. Kyphoscoliosis: This is a combination of scoliosis and kyphosis, where the spine has both a lateral curvature (scoliosis) and an abnormal outward curvature of the upper back (kyphosis).

Adult-onset scoliosis is a more general term for Adult Scoliosis used to describe any form of scoliosis that develops or is diagnosed in adulthood, encompassing degenerative, idiopathic, and secondary types.

Symptoms of Adult Scoliosis

 

Symptoms of adult scoliosis can vary in severity, however common signs include:

  • Uneven shoulders or waist
  • One hip higher than the other
  • Back pain or discomfort
  • Numbness or weakness in the legs
  • Difficulty standing upright or walking for extended periods

Treatment Options for Adult Scoliosis

The primary goal of treatment for adult scoliosis is to relieve pain, improve function, and prevent the progression of the spinal curvature. Options include:

Non-Surgical Treatments:

  • Physical Therapy: Tailored exercises to strengthen the core and improve posture.
  • Bracing: In some cases, a brace may be recommended to support the spine.
  • Medications: Pain relievers and anti-inflammatory drugs can help manage discomfort.

Surgical Treatments:

  • Spinal Fusion: This procedure involves fusing two or more vertebrae to correct the curvature and stabilize the spine.
  • Decompression Surgery: This surgery relieves pressure on spinal nerves caused by the curvature.

Physical Therapy Exercises for Adult Scoliosis

Physical therapy plays a crucial role in managing adult scoliosis. Below are a few exercises that have proven to be effective for many individuals:

Pelvic Tilts:

  • Lie on your back with your knees bent and feet flat on the floor.
  • Tighten your abdominal muscles and press your lower back into the floor.
  • Hold for a few seconds and then relax. Repeat 10-15 times.

Cat-Camel Stretch:

  • Get on your hands and knees.
  • Arch your back towards the ceiling (cat position) and then lower it towards the floor (camel position).
  • Perform this stretch slowly and repeat 10 times.

Latissimus Dorsi Stretch:

  • Stand with your feet shoulder-width apart.
  • Raise your arms above your head and lean to one side, feeling a stretch along the side of your body.
  • Hold for 20-30 seconds and switch sides. Repeat 3-5 times on each side.

Birddog PT Exercise for Scoliosis

Plank:

  • Lie face down and lift your body onto your forearms and toes.
  • Keep your body in a straight line and hold for 20-30 seconds, gradually increasing the duration as your strength improves.

Bird-Dog Exercise:

  • Start on your hands and knees.
  • Extend one arm forward and the opposite leg backward, keeping your back straight.
  • Hold for a few seconds, then switch sides. Repeat 10-15 times on each side.

 If you or a loved one is experiencing symptoms of adult scoliosis, Colorado Springs Orthopaedic Group Spine Center Is here to help! Our specialists ensure each patient’s treatment plan is personalized to their individual needs helping them manage their specific condition and improve their quality of life. Our team is dedicated to getting you back to the activities you love, close to or completely pain-free.

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Spine Anatomy: A Comprehensive Guide to Exploring the Backbone

The spine, often referred to as the backbone, is a remarkable structure that provides structural support and flexibility to the human body. From the intricate cervical spine at the top to the sturdy sacroiliac joint (SI joint) towards the hips, each segment plays a crucial role in maintaining posture, supporting movement, and protecting the delicate spinal cord. Let’s dive into the intricacies of spine anatomy, exploring each section from the cervical spine down to the sacroiliac joint.

Anatomy of a Single Spinal Segment

Before we discuss the various levels of the spine, let’s take a look at the components that make up a single spinal segment, otherwise known as vertebrae.

Each spinal segment includes two vertebrae, separated by an intervertebral disc. Each vertebrae includes:

  • Body: The large, cylindrical part at the front, which bears most of the weight.
  • Vertebral Arch: Encloses the vertebral foramen (the canal through which the spinal cord passes).anatomy of spinal vertebra
  • Pedicles and Laminae: Form the sides and back of the vertebral arch.
  • Spinous Process: A projection where muscles and ligaments attach, extending backward from the junction of the two laminae.
  • Transverse Processes: Projections on each side where muscles and ligaments attach.
  • Facet Joints: The articulations between the inferior articular processes of the upper vertebra and the superior articular processes of the lower vertebra. These allow for motion and stability.

The intervertebral disc sits between the vertebral bodies and acts as a cushion and shock absorber.

  • Annulus Fibrosus: The tough, outer layer of the disc made of concentric rings of collagen fibers.
  • Nucleus Pulposus: The gel-like, inner core that provides the disc with its cushioning properties.

The spinal cord runs through the spinal canal formed by the vertebral arches. It ends around the L1-L2 level, where it tapers into the conus medullaris and then the cauda equina (a bundle of nerve roots).

  • Spinal Cord: The major conduit for signals between the brain and the rest of the body.
  • Nerve Roots: At each segment, pairs of nerve roots emerge from the spinal cord.
    • Dorsal (Posterior) Root: Contains sensory (afferent) fibers that carry information to the spinal cord.
    • Ventral (Anterior) Root: Contains motor (efferent) fibers that carry information from the spinal cord to muscles.
    • Spinal Nerve: The dorsal and ventral roots combine to form a mixed spinal nerve, which exits the spinal column through the intervertebral foramen.

Cervical Spine

The cervical spine consists of seven vertebrae, labeled C1 to C7, and is located in the neck region. This highly mobile section allows for a wide range of head movements, including nodding, shaking, and tilting. The first two vertebrae, atlas (C1) and axis (C2), have unique structures that enable the pivotal motion of the head. Understanding the cervical spine is crucial not only for comprehending neck-related issues but also for recognizing its impact on overall spinal health.

Common Conditions of the cervical spine include: Cervical Radiculopathy a compression of nerve roots causing pain, numbness, or weakness in the arms. Cervical Spondylosis is another common condition and is generally age-related with wear and tear affecting the spinal disks in the neck. As you might have guessed, whiplash is another common injury to the cervical spine that occurs from a rapid back-and-forth movement, such as a car accident.

The Cervical spine innervates (supplies) many regions of our upper body with nerves and is why injury to any of the discs within, can have a dramatic impact

Cervical Spine

on functionality. The nerve innervations include:

  • C1-C2: Head and neck movements
  • C3: Diaphragm (breathing)
  • C4: Neck and shoulder movement
  • C5: Deltoid muscle, biceps (shoulder, upperarm)
  • C6: Wrist extensors, biceps
  • C7: Triceps, wrist flexors, finger extensors
  • C8: Finger flexors

Of course, there are many muscles that help stabilize and provide intentional motion to the cervical spine including:

  • The Sternocleidomastoid: Responsible for rotating and flexing the neck.
  • The Trapezius or ‘Traps’: Moves, rotates, and stabilizes the scapula (shoulder blade).
  • Levator Scapulae: Elevates the scapula and tilts its glenoid cavity downward.
  • Scalenes: Assist in breathing by elevating the first and second ribs.

Thoracic Spine

The next level of the spine is the Thoracic Spine, comprised of twelve vertebrae, T1 to T12. This region is the connection point for the rib cage, providing stability and protection for our vital organs. The thoracic spine is less mobile than the cervical spine however, still plays a pivotal role in maintaining an upright posture. Issues in this area can affect breathing, posture, and even contribute to conditions like scoliosis.

Similar to the Cervical spine, the Thoracic spine innervates many regions of our body with nerves including:

  • T1: Hand muscles.Thoracic Spine Anatomy
  • T2-T6: Chest muscles.
  • T7-T12: Abdominalmuscles.

A few of the common conditions associated with the Thoracic spine include:

  • Thoracic Outlet Syndrome which is a compression of nerves or blood vessels in the thoracic outlet an a ring-shaped area in the lower neck and upper chest, between the clavicle (collarbone) and the first rib
  • Kyphosis which is diagnosed when there is an excessive outward curvature of the spine, leading to a hunchback appearance.
  • Scoliosis, termed when there is an abnormal lateral curvature of the spine, which can develop during adolescent growth spurts or even into adulthood.

Some of the muscles that help initiate movement with the thoracic spine are: the Rhomboids, the Latissimus Dorsi, the Erector Spinae, and the Serratus Posterior Superior.

The Rhomboids (major and minor) retract the scapula while the Latissimus Dorsi that extends, adducts, and medially rotates the arm. The Erector Spinae which is a group of muscles that help extend the vertebral column. Lastly, the Serratus Posterior Superior elevates the ribs and aids in respiration.

Lumbar Spine

Lumbar Spine

The lumbar spine, consisting of five vertebrae, L1 to L5, is commonly referred to as the lower back. This region bears the majority of the body’s weight and is crucial for everyday movements such as bending, lifting, and twisting. The lumbar spine innervates many aspects of the lower body with nerves including:

  • L1-L2: Hip muscles.
  • L3: Knee extensors (quadriceps).
  • L4: Knee extensors, ankle dorsiflexors.
  • L5: Ankle and toe dorsiflexors.

Common Lumbar Spine Conditions include Herniated Discs, Sciatica, and Lumbar Stenosis.

The Muscles Involved in movement initiation include the Quadratus Lumborum which help with lateral flexion of the vertebral column, the Psoas Major that flexes the hip joint and provides stability to the lumbar spine and the Iliacus which works with the psoas major to flex the hip.

Sacrum and Coccyx

Sacrum and Coccyx Anatomy

The Sacrum and Coccyx form the bony structure at the base of the spine. The sacrum, a triangular bone, connects the spine to the pelvic bones, contributing to the stability of the entire vertebral column. The coccyx, often referred to as the tailbone, consists of small, fused vertebrae and serves as an attachment point for various muscles and ligaments of the lower body.

The Sacrum and Coccyx innervate one primary aspect of the lower body, the Sacral Nerves located from S1-S5 and affect the buttocks, genitalia, thighs, and calves. These nerves are critical for bowel and bladder control.

Common Conditions stemming from injury of the Sacrum and/or Coccyx are Sacroiliac Joint Dysfunction diagnosed as pain due to abnormal motion or inflammation of the Sacroiliac joint and Coccydynia, tailbone pain usually caused by trauma to the coccyx.

The Gluteus Medius and Minimus, Piriformis, and Coccygeus muscles are the primary muscles enabling movement within the Sacrum and Coccyx.

Sacroiliac Joint (SI Joint)

The Sacroiliac joint, often referred to as the SI Joint, located where the sacrum and ilium meet, plays a crucial role in transferring forces between the spine and the pelvis. While limited in movement, the SI joint is essential for shock absorption during activities like walking, running, and jumping. SI Joint Dysfunction, diagnosed as pain and inflammation in this joint, is a common cause of lower back pain affecting many aspects of a person’s biomechanics

The SI Joint is innervated by the sacral nerve roots and provides sensory information from the lower back, buttocks, and legs.

The Iliopsoas, Hamstrings, Adductors, and Tensor Fasciae Latae are the SI Joints primary muscles, responsible for many movements within the hips.

SI Joint

Overall, understanding spine anatomy from the cervical spine to the SI joint is fundamental for healthcare professionals, exercise physiologists, researchers, and individuals alike who seek to maintain spinal health. Each segment contributes uniquely to the spine’s overall function, and recognizing the intricacies of these structures helps to address issues related to posture, movement, and pain.

If you or a loved one are experiencing any type of back or neck pain, give us a call to find out how the specialists within the CSOG Spine Center can help

Looking to learn more? Visit our blog page to find more articles about the world of orthopedics

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The Link Between BMI and Joint Health: How Weight Impacts Hip and Knee Joint Longevity

As we’ve heard many times before, maintaining a healthy body weight is crucial for overall health, however the impact of a healthy body weight on specific body parts, specifically the hip and knee joints, is often underestimated. Body Mass Index (BMI), a measure of body fat based on height and weight, along with the measure of relative muscle mass, can significantly affect the health and longevity of these weight-bearing joints. Today, we’ll discuss the correlation between BMI and joint health, with focus on the hip and knee joints, and how weight management plays a crucial role in preserving joint function and longevity.

It is important to note, muscle mass has a great influence on BMI measurements as BMI is factored upon height and weight and does not differentiate between muscle mass and fat mass. Muscle tissue is denser than fat tissue, therefore a person with a high muscle mass, but relatively low fat mass may have a higher weight resulting in a higher BMI measurement. This does not necessarily mean that the individual is overweight or unhealthy. The impact of BMI on weight-bearing Joint Longevity discussed within this article, does not pertain to those of high muscle mass with low fat mass measurements. 

The Impact of BMI on Hip Joints

The hip joint is one of the largest weight-bearing joints in the body and is responsible for supporting our body weight during both sedentary activities and when facilitating movement. Studies have shown that a higher BMI is associated with an increased risk of hip osteoarthritis, a degenerative joint disease characterized by the breakdown of cartilage and bone within the joint. This is because the excess body weight places additional stress on the hip joint, accelerating the wear and tear process and increasing the risk of developing osteoarthritis. Maintaining a healthy BMI through a nutrient dense diet and consistent exercise regimen can help preserve joint function and longevity.

The Effect of BMI on Knee Joints

Similar to the hip joint, the knee joint is also susceptible to the effects of excess body weight. Studies have demonstrated a clear link between higher BMI and an increased risk of knee osteoarthritis. The excess weight puts pressure on the knee joint, leading to cartilage damage and inflammation, which are key indicators of osteoarthritis onset. Additionally, higher BMI is associated with an increased risk of knee injuries, such as tears in the ligaments or meniscus, further compromising joint health. By maintaining a healthy BMI, individuals can help protect the integrity of their knee joints, reducing the risk of developing knee osteoarthritis and either delaying the need for a total joint replacement or avoiding one altogether.

The Role of Weight Management in Joint Health

Weight management plays a crucial role in preserving the longevity of the hip and knee joints. For individuals who are overweight or obese, losing even a modest amount of weight can significantly improve joint function. 

Maintaining a healthy weight and BMI measurement is especially crucial when looking to qualify for a total joint replacement as BMI is one of the several factors considered when determining a patient’s eligibility for a hip replacement or knee replacement. Although there is not a specific BMI ‘cutoff’ that qualifies or disqualifies a patient, risks such as infections, blood clots, and anesthesia complications, exponentially increase in those with higher BMIs. Generally, a BMI below 40 is preferred as qualification for a total joint replacement to reduce these risks.

The decision to move forward with a hip or knee replacement surgery is inevitably up to the individual and their orthopedic specialist who will complete a comprehensive evaluation of the patient’s overall health, the severity of joint damage, pain during daily activities, and functional limitations. If recommended to reduce one’s BMI measurement, a combination of regular physical activity, such as low-impact exercises like swimming or cycling, or resistance training combined with a nutrient dense diet can help individuals achieve and maintain a healthy BMI, reducing the burden on their joints and maintaining joint health for the long run. 

To schedule an appointment with one of our Board Certified and Fellowship Trained specialists, give us a call at 719-632-7669 or visit us at www.CSOG.net to learn more.

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Anterior Hip Arthroplasty, Advancing Hip Replacement Outcomes and Longevity

Hip replacement surgery has come a long way since its inception with new techniques continuously evolving to improve outcomes, patient satisfaction, and implant longevity. One such advancement is the use of the anterior approach hip replacement surgery, a technique that differs from traditional approaches (posterior and lateral) and offers many unique benefits. Today, we’ll delve into:

– What Anterior Hip Replacements are
– The History of Anterior Hip Replacements
– How they differ from other techniques
– What recovery generally looks like
– Candidacy for this innovative procedure

What are Anterior Hip Replacements?

Anterior hip replacement surgery is a minimally invasive surgical technique used to replace a damaged hip joint with an artificial implant. Unlike traditional hip replacement surgeries that access the hip joint from the side or back (lateral or posterior approaches), the anterior approach accesses the joint from the front (anterior aspect) of the hip, through a small incision.

A Brief History

While the anterior approach to hip replacement is often considered a modern innovation, its roots can be traced back to the early 20th century. Dr. Marius Smith-Petersen, an American orthopedic surgeon, first discussed the anterior approach in the 1940s. However, it was not widely adopted due to technological challenges and the popularity of other approaches. The first anterior hip replacement surgery was performed in 1947. It wasn’t until the late 20th and early 21st centuries that advancements in surgical techniques, imaging technology, and implant design made anterior hip replacement a more feasible option. Since these advancements, the procedure has gained immense popularity among surgeons and patients alike.

How Anterior Hip Replacement Differs

The anterior approach offers several advantages over traditional lateral and posterior approach hip replacement techniques including:

  • Muscle Preservation: One of the key benefits of the anterior approach is that it allows access to the hip joint without detaching muscles from the pelvis or femur. A muscle-sparing technique such as this, can lead to faster recovery times and in many cases, less postoperative pain compared to other techniques..
  • Stability: Thanks to this muscle preservation, the anterior approach shows an increased stability of the implant due to the preservation of the surrounding soft tissues and muscles. This added stability can reduce the risk of dislocation.
  • Additional Accuracy: The anterior approach provides excellent visualization of the hip joint, allowing for even more precise placement of the implant during surgery.
  • Faster Recovery: Patients who undergo anterior hip replacement surgery may experience a quicker recovery compared to other techniques. This is primarily due to the muscle preservation benefits, which can lead to less damage to the surrounding structures and a faster return to normal activities.

Video credit to Stryker Orthopedics

Anterior Hip Replacement Recovery

Studies show recovery from Anterior Approach Hip Replacement Surgery enables the potential for:

  • Early Mobility: One of the primary advantages of the anterior approach is that it typically allows for early mobility. Patients may be able to walk with a cane or walker soon after surgery, often times within a couple hours of surgery. This is due to the muscle preservation nature of the approach, again, leading to less damage to the surrounding structures and a faster return to normal activities.
  • Decreased Postoperative Pain: Because the surgery involves less disruption of muscles and soft tissues, patients undergoing an anterior approach often experience less postoperative pain compared to those undergoing a lateral or posterior approach.

While hip precautions are often recommended for all types of hip replacement surgeries to prevent dislocation of the new hip joint, the specific precautions may vary depending on the surgical approach. For example, patients undergoing an anterior approach may be advised to avoid certain movements that could strain the front of the hip joint especially within the initial recovery period.

Rehabilitation following an anterior approach hip replacement surgery typically focuses on restoring range of motion, strength, and function. To kickstart the recovery process, Physical therapy begins soon after surgery to help patients regain mobility and strength in the hip joint and return to normal activities, including driving, quickly and efficiently.

It’s important to note that the recovery process can vary from patient to patient due to individual factors regardless of the surgical approach. Factors such as age, overall health, and the extent of joint damage can all impact the recovery timelines and overall outcome. Patients should follow their surgeon’s postoperative instructions and participate in any rehabilitation programs as prescribed to optimize their recovery.

Who Would Be a Candidate?

While anterior hip replacement surgery offers many benefits, not everyone is a candidate for this procedure. Ideal candidates for anterior hip replacement surgery typically include those who are:

  • Physically Active: Patients who are physically active and in good overall health may benefit from the faster recovery times associated with the anterior approach.
  • Of Healthy BMI: Patients who are within a healthy BMI generally have better outcomes with the anterior approach, as excess body weight can put additional stress on the hip joint and may impose greater risk of complications during and after surgery. Tune into our blog discussing The Link between BMI and Joint Health
  • Motivated Patients: Patients who are motivated to actively participate in their recovery process, including following postoperative rehabilitation protocols, achieve better results with the anterior approach.

Candidacy for any hip replacement technique ultimately comes down to what is best for the individual patient and their lifestyle as discussed with their orthopedic specialist.

In conclusion, Anterior Hip Arthroplasty surgery is a modern hip replacement technique that offers several advantages. With its muscle preserving technique, increased stability, and faster recovery times, it has become an attractive option for many surgeons and patients seeking hip replacement surgery with hopes of returning to activities.

If you’d like to discuss your candidacy for an anterior hip replacement, give us a call at 719-632-7669 to schedule with one of our board certified Joint Replacement specialists.

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The Fellowship Trained and Board Certified Difference

When it comes to Orthopaedic care, choosing the right physician is crucial for ensuring optimal treatment and recovery outcomes.

Amongst Orthopaedic physicians, there are different levels of training and certifications. Each can significantly impact their level of expertise and capacity for providing the full spectrum of comprehensive care. When looking at a physician’s bio, especially those that are apart of the team here at CSOG, you’ve likely seen the terms: fellowship trained and board certified. But what do these terms actually mean? What type of training has the physician gone through to receive these credentials?

Fellowship Training:
Specialization and Expertise

What does fellowship trained mean? Fellowship training is an additional period of intensive, specialized training that orthopaedic surgeons pursue after completing their residency program. During this fellowship, physicians focus on a specific area within orthopaedic surgery, such as sports medicine, joint replacement, spine surgery, foot and ankle surgery, or hand and upper extremity surgery, among others. These fellowship programs require physicians to participate in hundreds of specialized surgeries to develop advanced skills and expertise in their chosen subspecialty before they’re eligible to receive the fellowship trained credential.

Benefits of Fellowship Training

  • Enhanced Knowledge and Skill Set: Fellowship-trained orthopaedic physicians possess a deeper understanding of their specific area of focus due to their additional, rigorous training that allowed them to gain extensive hands-on experience from leaders within the orthopedic world. This experience enables them to address complex cases and provide highly specialized, individualized care.
  • Leaders of Orthopedic Advancements: Fellowships provide consistent access to the latest research, techniques, and technologies in the specific subspecialty. Not only does this exposure keep physicians abreast of recent advancements, it allows them to continue development upon such innovation to ensure patients receive the most effective and lasting treatment options.
  • Collaboration and Networking: Fellowship programs often foster collaboration and networking among specialists, enabling physicians to consult with colleagues and share knowledge across the nation. This collaborative environment further enriches their expertise and promotes the exchange of best practices.

Board Certification:
Recognized Expertise and Quality Assurance

What does Board Certified mean? Board certification is a rigorous process that evaluates a physician’s knowledge, skills, and clinical experience in a particular medical specialty. To become board certified, orthopaedic surgeons must complete a specific number of postgraduate training years. Then, they are eligible to complete a comprehensive oral and written examination administered by the American Board of Orthopaedic Surgery (ABOS) or an equivalent board such as the American Osteopathic Association (AOA) for Doctor of Osteopathic Medicine (DOs).

Importance of Board Certification

  • Expertise Verification: Board certification serves as an independentOrthopaedic Surgery Board Certified Logo validation of an orthopaedic surgeon’s knowledge and expertise in their specialty and demonstrates that the physician has met the meticulous standards set by the ABOS or the equivalent certifying body.
  • Commitment to Continuous Learning: Maintaining board ce
    rtification requires ongoing professional development through continuing medical education (CME) credits. These CME requirements ensure that certified physicians stay current with advancements in their field and provide patients with the most up-to-date care.
  • Quality Assurance: Board certification acts as a quality assurance measure for patients, as it signifies that the orthopaedic physician meets or exceeds the established standards of practice.

The Doctor’s Timeline

Becoming a physician is no easy feat. Especially one with high distinctions of Fellowship Training and Board Certification. On average, in addition to completing a four-year undergraduate degree, a physician must complete four years of medical school. After medical school, they will complete a five-year residency program. Orthopedists such as ours within CSOG, then apply for a fellowship program. Only the best candidates are granted participating into these fellowships that typically last an additional year. To become board certified, the physician must meet their respective board’s mandated training hours. Depending on the board, this can take between 3-7 years. Added together, a fellowship trained and board-certified Orthopaedic physician has undergone anywhere between 17-21 years of training and education.

With their Fellowship training and the addition of a Board certification, physicians are focused extensively on specific subspecialties, with the advanced skills necessary to ensure high quality outcomes backed with quality assurance to their commitment of providing high-quality care. In the realm of orthopaedic care, patients can rest assured they’re in qualified hands when seeking specialized or complex treatments through fellowship-trained and board-certified orthopaedic physicians.

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What is Osteoporosis?

Osteoporosis is a disease that occurs when bone density and/or the quality of your bone decreases, causing weak bones. It occurs when the density and quality of bone are reduced. Normally, bones go through a process called “Remodeling” where old bone is broken down and new bone is built in its place. However, in osteoporosis, the creation of new bone is unable to keep pace with the removal of old bone, resulting in a net loss of bone mass.

Who is at risk for Osteoporosis?

There are several clinic risk factors that can contribute to the development of osteoporosis including:

  • Age: Around the age of 40, the bone building part of the remodeling process begins to slow down which results in a net loss over time. This imbalance becomes even more prevalent after menopause.
  • Gender: Women are more likely to develop osteoporosis than men due to hormonal changes during menopause.
  • Genetics: A family history of osteoporosis can increase the risk.
  • Hormonal changes: Low estrogen levels in women and low testosterone levels in men can lead to bone loss.
  • Unhealthy Lifestyle Habits and Vitamin Deficiencies: Lack of physical activity, a diet poor in calcium and vitamin D, smoking, excessive alcohol consumption, and certain medications can all contribute to bone loss.
  • Medical Conditions: Some medical conditions, such as celiac disease, rheumatoid arthritis, and hormonal disorders, can increase the risk of osteoporosis.
  • Medications: Long-term use of certain medications, such as corticosteroids and some anticonvulsants, can weaken bones.

Each of these, especially when compounded, can ultimately result in a fracture or at minimum, an increased risk of fracture which can occur even with minor trauma or stress on the bones. The most common sites of an osteoporotic fracture are wrists, hip, and spine. Fractures, particularity those of the hip, have potential for serious consequences for older adults and can lead to decreased mobility and independence.

How is Osteoporosis Prevented and Managed?

Preventing and managing osteoporosis typically involves lifestyle changes including adopting a nutrient dense diet and vitamin regimen, regular weight-bearing exercise, smoking cessation, alcohol moderation, and possible medication management. It is important to know this is a lifelong diagnosis with several possible treatment pathways that are individualized to each patient. A detailed interview along with imaging and labs will help determine treatment recommendations.

Regular bone density testing can help diagnose osteoporosis early and help guide the treatment process as well. Early detection and proactive management are essential in reducing the risk on further onset and the risk of potential fractures.

What is Bone Density?

Bones density, also known as Bone Mineral Density, is the total amount of bone mineral within boney tissue. Bone Density is measured using low-dose x-ray tests called DEXA or DXA scans that measure calcium and additional minerals within the bones. This measurement helps determine the strength and thickness (density) of bone which then helps providers predict a patient’s fracture risk.

Osteoporosis bone density visual

Stay tuned as we continue our Bone Health series and further discuss treatment methods, FRAX scores, and much more.

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Hip Anatomy and Functions of the Hip

Hip Anatomy

The hips and structures within the hips are some of the most important and complex structures in the human body. They play a crucial role in our everyday movements, from walking and running to sitting and standing. Understanding Hip Anatomy is essential to maintaining optimal hip health and longevity. Join us as we explore the fascinating intricacies of the hips, from the bones and joints, to the muscles, ligaments and primary functions that support our everyday movements.

Bones of the Hip

There are five bone structures that make up the hip. Three of which come together to form the primary hip structures: the Ilium, the Ischium, and the Pubis, with the other two, the Femoral Head and the Acetabulum, forming the hip joint.

  • Ilium: This large, wing-shaped bone forms the upper part of the hip, providing stability and support for the joint.
  • Ischium: The ischium is the lower and posterior part of the hip bone. It forms the “sit bones” and supports our body weight when we sit.
  • Pubis: The pubis is the anterior part of the hip bone and is responsible for connecting the two hip bones at the front of the pelvis.

The Hip Joint

The hip joint is a ball-and-socket joint, designed for both mobility and stability. It consists of two primary components:

  • Femoral Head: The rounded head of the femur (thigh bone) fits into the acetabulum, creating the ball part of the ball-and-socket joint. This structure allows for a wide range of motion in multiple directions.
  • Acetabulum: The acetabulum is the socket or cup-shaped structure in the hip bone that receives the femoral head and provides stability to the joint.
Bones of the Hip,

Ligaments of the Hip

Within our hip anatomy, we have several ligaments that hold the bones of the hip together and provide stability to the joint.

  • Iliofemoral Ligament (Y-shaped ligament): This ligament is the strongest in the body and helps to prevent overextension of the hip joint.
  • Pubofemoral Ligament: This ligament reinforces the front of the hip joint and assists in preventing hyperextension.
  • Ischiofemoral Ligament: Located on the back of the hip joint, this ligament stabilizes the joint during internal rotation and extension.
Ligaments of the Hip, hip anatomy
Ligaments of the Hip, hip anatomy

Muscles of the Hip

Now that we’ve covered the bones and ligaments that form the hips’ basic structures, let’s dive into the anatomical components that give us the strength and support to move and stabilize ourselves through space: the muscles of the hip.

 

The hip joint is surrounded by a complex network of muscles. Some of the key muscles include:

  • Gluteus Maximus: This is the largest and most powerful hip muscle, responsible for hip extension (extending the leg backwards) and external rotation (moving the leg outwards).
  • Gluteus Medius and Minimus: These muscles lie on the outer side of the hip and are responsible for hip abduction (moving the leg away from the body), internal rotation (rotating the leg inwards) and external rotation (rotating the leg outwards).
  • Iliopsoas: This is a group of muscles responsible for hip flexion (bending the hip joint), helping you lift your knee towards your chest or hinging over to pick something up.
  • Adductors: The adductor muscles on the inner thigh allow for hip adduction (moving the leg toward the midline of the body).
  • Iliotibial Band (IT Band) is a thick band of muscle fascia that originates at the lateral portion of the iliac crest and inserts at the lateral condyle of the tibia (shin bone). Its main function is the provide stabilization to the pelvis and aid in posture control.
Muscles of the hip, gluteal muscles
Adductors, iliopsoas, muscles of the hip
Iliotibial band (IT Band), muscles of the hip, anatomy of the hip

Movements of the Hip

These muscles help facilitate the four primary movements of the hip: Flexion, Extension, Internal Rotation, and External Rotation.

  • Hip Flexion: involves lifting the thigh toward the abdomen or vice versa, bringing the abdomen closer to the thigh. This movement is essential for activities like walking, running, lifting the leg, walking up stairs, hinging over to pick something up, sitting in a chair, etc.
  • Hip Extension: involves extending the leg backward and is executed when your back leg is straightened as you walk. You execute hip extension anytime you stand up from a seated position or run.
  • Hip Internal Rotation: occurs when the thigh is rotated or turned inwards towards the midline of the body. Anytime we cross our legs, we are performing hip internal rotation.
  • Hip External Rotation: occurs when the thigh is rotated or tuned outwards, away from the body. We perform this movement when we take a turn during a walk or sit in the butterfly stretch position during a yoga class.

It’s no wonder, when we injure even a small structure in our hips, it can take its toll on our everyday movements. This is why, we at Colorado Springs Orthopaedic Group emphasize strengthening your hip muscles, core, and leg muscles in efforts of preventing injury during activity. Strengthening these muscles through a full range of motion will also aid in maintaining your mobility.

Whether you’re an athlete or just someone who values their joint health, be sure to check out our Healthy Hips series on our website at https://www.csog.net/blog/ to learn more about hip anatomy. Tune into our Youtube channel to learn how taking an interest in ways to optimize hip strength and mobility can dramatically affect your hip and overall physical longevity.

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Healing Connection

Healing Connection with Eric Jepson, DO

with Eric Jepson, DO , written by Alyssa Shikles of Colorado Springs Magazine. Photography by: Meegan Dobson

It takes a skilled doctor to ease a worried patient’s mind. After all, no one visits the doctor for fun. You go because something’s wrong or because you’re afraid something’s wrong. You’re looking for hope in the midst of pain, for answers when your own body feels unknown and uncertain. In these moments of stress and anxiety, a good doctor—with a comforting word and a desire to meet patients where they are—can have an incredible emotional and physical impact.

For Eric Jepson, MD, an orthopedic surgeon at Colorado Springs Orthopedic Group (CSOG), this is the most critical and challenging facet of his job. For him, fixing the body is easy; the hard part is gaining trust and making patients feel cared for.

When I sat down to talk with Dr. Jepson in CSOG’s south office a few weeks ago, I experienced first-hand how relational he is. There’s something about him that exudes not only kindness and understanding but relatability and genuine interest in others. He has a keen listening ear, and though I came to his office to interview him, I was surprised when he often flipped questions back on me. How long have I lived in Colorado Springs? Do I love the outdoors? How did I handle my first Colorado winter? He wanted to get to know me, and I felt seen.

This small interaction is just a sampling of how Dr. Jepson interacts with patients daily. But to him, making patients comfortable and being present for them is fundamental to his day-to-day work. Anyone can work with a scalpel or heal a wound if they study hard enough, but learning to connect with others relationally? That’s what makes a stand-out physician.

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The Fight Against Human Trafficking

As the world’s fastest growing crime, generating over $100 billion per year, Human trafficking is a tragedy taking place everyday, everywhere, including here in our home town of Colorado Springs.

What is Human Trafficking?

Human trafficking involves the use of force, fraud, or coercion in exchange for labor, services, or a commercial sexual act.

Causing someone under the age of 18 to engage in a commercial sexual act, regardless of using force, fraud, or coercion is human trafficking under US Law. Traffickers will use various forms of force, fraud, and coercion to control and exploit victims including imposing of debt, fraudulent employment opportunities, false promises of love or better life, phycological coercion, and violence or threats of violence. This tragic crime hinges on the exploitation of another person. Often people think human trafficking must involve the victim being transported from one place to another however, this is not the case at all. It does not require transportation to be considered a crime and can be committed against an individual who has never left his or her hometown.

Victims can be of ANY race, gender, age, ethnicity, and socioeconomic class. Many victims do not seek help either due to extreme feelings of vulnerability, fear, and even guilt, absorbing the responsibility for the crime as their own. Traffickers will many times exploit these vulnerabilities to victimize people.

The primary industries, legitimate and illegitimate include those of forced labor and sex trafficking.

DHS law enforcement alone identified hundreds of girls, boys, women, and men as victims of human trafficking in the US every year.

Identifying Human Trafficking

Often ‘hidden in plain sight’, recognizing the signs of human trafficking is the first step in identifying victims. No single indicator is proof this crime is occurring however, when compounded may indicate a potential situation.

Reclaiming Hope - Journeying with survivors of Human Trafficking

Reclaiming Hope

is a local non-profit organization journeying with the survivors of Human Trafficking. They help victims at the point of recovery, during restoration and reintegration by addressing their physical, emotional, and spiritual needs.

When a survivor is recovered, their first connection with Reclaiming Hope comes through their Hope Bags program. These bags are distributed through law enforcement partners when a victim is recovered. Each bag includes new clothing, hygiene items, a blanket, comfort items, snacks and a personal note. Over 5K bags have given survivors a sense of comfort and dignity.

Reclaiming Hope helps survivors past the point of recovery into restoration and reintegration through their Hopeful Women Mentor Program, where women are matched with trained, accountable mentors dedicated to walking along side victims.

To learn more about identifying the signs of Human Trafficking and how you can get involved in putting a stop to this tragic crime within our local community, visit Reclaiming Hope

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8 Tips to Help with Recovery from Shoulder Surgery

Shoulder surgery can be a daunting experience and the day to day can be quite challenging post-surgery. However, in addition to following the essential instructions provided by your doctor to ensure a full and proper recovery, being ready at home can dramatically help reduce any anxiousness and make the process more comfortable.

Below are eight at-home success tips to help you to prepare and make the most out of your recovery from shoulder surgery.

1. Follow Your Doctor’s Instructions

After surgery, your doctor will provide you with detailed instructions on how to care for your shoulder. It’s essential to follow these instructions to ensure that you recover as quickly as possible. Some of the instructions may include initial physical therapy exercises, pain medication recommendations, and keeping your shoulder immobilized with a properly fitted sling. Instructions vary per procedure so be sure to diligently read through all information provided to you.

2. Consider Which Arm Your Surgery Will Be On

If surgery is taking place on your dominant arm, you’ll want to prepare by practicing daily tasks with your non-dominant arm.

As most people do not practice being ambidextrous, everyday tasks such as brushing your teeth, going to the bathroom, drinking from a cup, eating, opening doors, etc. all may be a learning curve for the first few weeks. Practicing these types of tasks prior to surgery may help ease this learning curve once surgery has taken place.

3. Prepare to Get Dressed and Do Your Hair

Throughout the first few weeks after surgery, you may not be able to:

  • lift your arm above your head
  • lift your arm out in front of you
  • lift your arm out to the side of you

To help with this, loose-fitting shirts, button-downs, and zip-ups are highly recommended for use after surgery. There are post-surgical shirts available at various online retailers if that’s an option you’d like to use as well.

It’s also recommended to practice doing your hair with one hand for those who may need to do this independently post-surgery. If you do a google search for “how to put hair in a ponytail with one hand” or something similar, you will find many tutorials to help get the hang of these tasks.

4. Build Your At-home Recovery Supply

Many patients find having little everyday items (such as those listed below) can make a big difference during shoulder surgery recovery. So you don’t have to worry about venturing out soon after surgery, it is recommended to stock up on a few weeks’ worth of food and toiletries as well.

  1. Long-handled back scrubber
  2. Detachable shower head
  3. Shower chair
  4. Frozen meals
  5. Multiple button-down shirts, front closure bras, zip-up sweaters or hoodies, oversized t-shirts, looser fitting pants
  6. Pillow wedge

5. Get Plenty of Rest and Reduce Stress

Getting plenty of rest is crucial to a successful recovery. Your body needs time to heal, and rest is the best way to facilitate that process. It’s normal to experience fatigue after surgery, so be sure you rest whenever you feel tired. Sleeping in a recliner or propping yourself up with multiple pillows can help reduce pain and inflammation.

Additionally, it’s important to reduce your stress throughout recovery. Dialing back on your daily responsibilities should be a priority. Prepare those who are typically dependent upon you so they are ready when the time comes, and you can truly optimize your recovery.

6. Focus on Nutrition and Hydration

Following a whole food nutrition plan is essential for recovery from surgery. Be sure to eat a well-balanced diet that includes:

  • plenty of fruits and vegetables
  • lean proteins
  • whole grains

This will ensure you’re receiving all the essential vitamins and minerals necessary for proper healing.

Hydration is also a very large component of ensuring a full recovery. Approximately 60% of our bodies are composed of water. Consuming enough water helps to avoid any potential complications such as infections and helps to boost the immune system that is typically weakened after surgery. The US National Academies of Sciences, Engineering and Medicine recommends adults consume between 92oz – 124oz of water per day. This equates to about 3-4 32oz bottles throughout the day.

7. Take It Slow and Be Patient

Recovery takes time, and you shouldn’t rush the process. Remember that taking it slow doesn’t mean you can’t do anything; it simply means for the first few weeks you’ll want to opt for light activities or adventures. With doctor guided permission, you can gradually increase the intensity of everyday activities. Remember to avoid any activities that put pressure on your shoulder, don’t lift anything heavy until your doctor gives you the go-ahead, and ask your loved ones for help when necessary.

8. Handling Setbacks

Throughout your recovery journey, you may experience setbacks. This is normal and you shouldn’t get discouraged. A few tricks that have helped many patients push through recovery are:

  1. Keeping a positive attitude and focusing on your recovery goals.
  2. Celebrate small victories, like being able to move your arm a little more each day.
  3. Remember, your body is healing, and it will take time.
  4. Embrace this period of more down time than you’re used to, and remember recovery is temporary. You’ll be back to doing the things you love to do soon.

We understand the process of recovering from shoulder surgery is not easy. It requires patience, perseverance, and following your doctor’s instructions to a T. As mentioned, it is temporary and ultimately will be the vehicle to get you back to living pain free. Prepare ahead of time, get plenty of rest, focus on your nutrition and hydration, and you’ll be back to the swing of things.

At Colorado Springs Orthopaedic Group, our teams are always here for you whenever you need us throughout your recovery journey. If you have any questions or concerns, simply send a message to your surgical team through your patient portal or give us a call at 719-632-7669. We’ll be back in contact with you as soon as possible.

Meet Our Sports Medicine Providers

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Craig A. Yager, MD Sports Medicine Specialists at Colorado Springs Orthopaedic Group

Craig Yager, MD

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Anatomy of the Knee

Anatomy of the Knee

A comprehensive guide detailing the bones, muscles, tendons, and ligaments of the knee

Running, jumping, walking, hiking, our knees support us through it all. To help provide these high-impact functionalities, the knee’s structure is one of the most complex and critical joints within the human body. Let’s take a closer look at the anatomy of the knee to better understand the knee and its many functionalities.

Bones of the knee anatomy of the knee

Bones of the Knee

The knee joint is formed by the femur (thighbone), the tibia (shinbone), and the patella (kneecap). The femur is the largest bone in the body and it forms the upper part of the knee. The tibia forms the lower part of the knee and is the weight-bearing bone of the lower leg. The patella is a small, flat bone located in front of the knee. It slides along a groove in the femur as the knee bends and straightens.

Ligaments of the Knee

Within the knee, we have four primary ligaments: the ACL, PCL, LCL, and MCL. Ligaments are strong, fibrous tissues that connect boLigaments of the kneene to bone and provide stability within the joint.

  • The Anterior cruciate ligament (ACL) is located in the center of the knee. The ACL helps prevent the tibia from moving forward excessively.
  • The Posterior cruciate ligament (PCL) is located in the center of the knee. The PCL helps prevent the tibia from excessively moving backwards.
  • The Lateral collateral ligament (LCL) is located on the outside of the knee. The LCL helps prevent the knee from bending outward too an excessive degree.
  • The Medial collateral ligament (MCL) is located on the inner most side of the knee. The MCL helps to prevent the knee from bending inward to an excessive degree.

Bursae of the knee and menisci of the knee

Bursae of the Knee

Bursae are small, fluid-filled sacs. They can be found in many areas of the body and serve as friction reducers for the tissues surrounding a joint. In the knee, we have three primary bursas: The Suprapatellar bursa, the Prepatellar bursa, and the Infrapatellar bursa.

 

Menisci of the Knee

Between the Femur and Tibia, there are two cushion like structures. These structures are referred to as the Menisci, or Meniscus in singular context. The Menisci act as shock absorbers when performing activities such as running, jumping, walking, etc. and help to distribute our body weight evenly across the knee joint.

Tendons of the Knee

Let’s start by addressing what tendons are and what they do. Tendons are fibrous tissues that connect muscles to bones and help initiate movement as our muscles contract and relax.

For example, as you take a step forward, your quadricep muscles contract. The quadriceps tendon that’s attached to the quadricep muscles then helps initiate movement within the patella, the patellar tendon and tibia so that the entire lower leg moves forward in congruency.

You may have heard of a condition called Patellar Tendonitis. This refers to an injury of one of the primary tendons within the knee, the Patellar Tendon. The Patellar Tendon connects the patella to the tibia and with the help of the quadriceps tendon, is responsible for extending the knee when you kick, run or jump. It is one of the most injured tendons especially amongst those who frequently run or jump on hard surfaces.

Tendons of the knee

The second most primary tendon within the knee is the Quadriceps Tendon. This tendon connects the quadricep muscles to the patella and in conjunction with the patellar tendon, helps to extend or straighten the knee.

To recap Tendons vs Ligaments:
  • What they connect:
    • Tendons connect muscles to bones
    • Ligaments connect bone to bone
  • What they do:
    • Tendons help initiate movement between muscles and bones
    • Ligaments help hold structures together and provide stability within those structures

The Iliotibial Band (The IT Band)

You’ve probably heard of the IT band before. But what is it and what does it do? The IT band is a band of thick fibrous tissue that runs from the hip down to the lateral aspect of the Tibia. This band of tissue helps to provide stability to both the knee and hip and as it runs down to the top of the Tibia, helps to prevent dislocation of the knee as well.

Muscles of the Knee

Quadriceps and how the quadriceps support the knee

The knee is surrounded by several muscle groups, each of which help maintain stability and move the knee joint through motion in conjunction with ankle and hip joint movements when performing daily activities.

The Quadriceps

Starting from the top and front (anterior) side of the knee, we have the four quadricep muscles that attach at the base of the femur, just above the knee joint:

  1. The Rectus Femoris
  2. The Vastus Lateralis
  3. The Vastus Medialis
  4. The Vastus Intermedius

 

The Hamstring muscles and how the hamstrings support the knee

 

The Hamstrings

On the back (posterior) side of the leg are the three hamstring muscles:

  1. The Biceps Femoris
  2. The Semimembranosus
  3. The Semitendinosus

The hamstrings attach at the base of the femur and top of the tibia. If you touch the back of your knee, you may be able to feel where these insertion points are located. The hamstrings are the muscles that control flexion or bending of the knee and help to stabilize the knee when it’s extended (when the quads are contracted and the leg is straightened). They also assist in turning the knee inwards (referred to as internal rotation) and outwards (referred to as external rotation).

 

The Calf Muscles

Moving down to the lower part of the knee, we have the Anterior Tibialis on the front side and the Gastrocnemius and Soleus muscles on the back side.

The Anterior Tibialis

The Anterior Tibialis originates at the top of the tibia and is responsible for deceleration during activities. When strengthened appropriately, it reduces the amount of force our knees experience when slowing ourselves down. An easy way to remember the Anterior Tibialis is to remember ‘anterior’ refers to the front side. So the Anterior Tibialis is on the front aspect of the tibia (shin bone).

 

Moving to the back or posterior side of the lower leg, the Gastrocnemius has two muscle heads, the medial (inner) head, and the lateral (outer) head. Both of which originate on the back of the femur and run down to the Achilles tendon. Similarly, the soleus muscle originates at the base of the femur, runs down to the heel bone via the Achilles tendon, and lies underneath the lateral head of the gastrocnemius. Both the Soleus and Gastrocnemius (gastroc for short) support the hamstrings in knee flexion and provide stability to the knee when you jump, run, flex or extend the knee during activities.

The Gastroc or Gastrocnemius Calf Muscle
The Soleus calf muscle

The anatomy of the knee is a very complex but with these complexities come numerous functionalities. These features make the knee truly one of the most amazing joints and allow us to perform so many daily activities from walking up stairs, to hiking, biking, and everything between. It is however, important to note that with great complexities, comes great need to take care of these joints as the risk for injury to any of the structures within is increased substantially.

Tune into our knee blogs to learn more about the knees, some of the most common injuries and conditions we see here at Colorado Springs Orthopaedic Group, injury prevention techniques, and when it’s recommended to see an orthopaedic specialist for further evaluation.

If you or a loved one are struggling with chronic knee pain, give us a call to schedule an initial evaluation. Our board certified and fellowship trained orthopedic specialists want nothing more than to see you back doing the things you love to do.

Visit our providers page to meet our specialists.

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Why Can’t I Find Relief from Plantar Fasciitis?

Why Can’t I find Relief from Plantar Fasciitis?

Are you asking yourself this question but don’t know where to turn? We’re here to help. Plantar fasciitis is a common condition affecting people of various ages. To understand what plantar fasciitis is and why it occurs, a brief overview of the anatomy of this region of the foot can be very useful. To begin, we will breakdown the anatomy of the plantar fascia and how it relates to daily activities.

Is Plantar Fasciitis a Tendon or Ligament?

The Plantar Fascia is a connective tissue structure that originates from the heel bone and inserts at the flexor tendons at the base of the toes. The plantar fascia consists of three bands, the medial band, central band, and lateral band. These help to support the arch of the foot and assist with normal foot mechanics while walking. While individual anatomy may vary, most people have a broad ledge of bone at the base of the heel where the plantar fascia begins. This is commonly referred to as a “heel spur” but is a normally occurring structure that does not contribute to development of Plantar Fasciitis symptoms.

Plantar Fasciitis anatomy useful to learn how to treat plantar fasciitis and techniques used in physical therapy for Plantar Fasciitis

Why Won’t My Pain Go Away?

Plantar fasciitis refers to symptoms of pain on the bottom of the heel. Often people experience heel pain with the first steps out of bed in the morning, when standing for long periods of time, or with transitioning from sitting to standing positions. These symptoms often occur from wearing non-supportive shoes or from an increase in weightbearing activities. Symptoms may also arise spontaneously. Treatment is often required to help symptoms resolve.

Who Treats Plantar Fasciitis?

Plantar fasciitis is often diagnosed clinically by an orthopedic provider who specializes in Foot and Ankle conditions. The provider will evaluate your symptoms and likely order radiographs, otherwise known as X-rays, to help diagnose and treat plantar fasciitis. If needed, an MRI may be ordered to rule out any other potential causes of pain.

How to Treat Plantar Fasciitis

running shoes to help with plantar fasciitis. Techniques used in physical therapy for plantar fasciitis helped this runner learn how to treat plantar fasciitis

A multitude of treatment options may be utilized to resolve or lessen plantar fasciitis symptoms. Many people respond well to conservative therapy. Therefore, this is often the first course of action for the treatment of plantar fasciitis. A major component in conservative treatment is supportive footwear. Walking barefoot on hard floors or walking in non-supportive shoes may exacerbate symptoms. Due to this, sneakers with thick, cushioned soles are commonly recommended for plantar fasciitis as they provide extra support to the heel with weightbearing. Some recommended shoe options include the brands HOKA and Oofos.

plantar fasciitis night splint. sometimes recommended when learning how to treat plantar fasciitis

In addition to supportive shoes, other devices may also be incorporated for additional relief. A gel heel cup can be added to shoes for extra cushion.

Furthermore, some doctors may recommend a brace to find relief. Bracing involves the use of a night splint while you sleep, which helps to keep the foot in a neutral dorsiflexed (toes toward your head) position and assists with reducing morning symptoms

Physical Therapy for Plantar Fasciitis Pain

Physical therapy is another vital component of conservative treatment for Plantar Fasciitis. Tightness in the Plantar fascia is often found in association with tightness in the calf muscles and the Achilles tendon. A program specific to stretching the plantar fascia and the Achilles tendon may provide marked relief for your plantar fasciitis symptoms. Other modalities in physical therapy such as ultrasound or dry needling can also be utilized. Often a 4–6-week program is initially recommended, although additional physical therapy may be required. Recovery time with conservative management varies based on severity of symptoms, lifestyle, and compliance to the treatment regimen. Click here to learn 3 stretches you can do at home to help with Plantar Fasciitis pain.

How to Relieve Plantar Fasciitis Pain at Home

In addition to your prescribed Physical Therapy exercises, oral NSAIDs (non-steroidal anti-inflammatories such as ibuprofen, Aleve, Advil, etc.), rest, and ice can aid in providing symptom relief while at home. The use of supportive house shoes and avoidance of walking barefoot can also help alleviate symptoms and prevent pain.

Additional Treatments Options

If conservative treatments fail, an injection may be the next best step. Steroid injections are a common treatment option; however, they are associated with increased risk of plantar fascia rupture and fat pad atrophy. Due to these risks, steroid injections should be avoided if possible. A safer alternative to steroid injections is a treatment called PRP or Platelet Rich Plasma. PRP for Plantar Fasciitis involves collecting plasma from your own blood and then injecting this nutrient rich substance into the plantar fascia to help promote healing. While not yet FDA approved, this has been shown as a very effective treatment option for many patients struggling with Plantar Fasciitis symptoms. There is a brief period of down time following PRP injections. This typically involves patients being placed into a cast for a couple of weeks followed by a walking boot. Physical therapy is utilized in conjunction to optimize improvement. After 6-8 weeks most patients will begin gradual return to full activity.

Mechanism of Injury for Plantar Fasciitis

The plantar fascia can also be susceptible to rupture or tear with sudden insult or injury to the tissue. Often, plantar fascia rupture or tear occurs in patients with a history of steroid injections. This is a further indication to caution the use of steroid injections as a treatment modality. Symptoms of a Plantar Fascia rupture includes a sudden popping sensation in the arch of the foot followed by tenderness and bruising. If you happen to experience such symptoms, please seek out attention from an orthopedic specialist. An MRI may be ordered to confirm the tear and then a conservative treatment program will be prescribed for you. Treatment of a Plantar Fascia rupture typically involves a period of immobilization and management of symptoms with ice and NSAIDs. Recovery can take a couple of months and some patients may still have chronic symptoms as a result of the injury.

CSOG FOOT AND ANKLE CENTER PROVIDERS

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Cubital Tunnel Syndrome

Cubital Tunnel Syndrome

Terms to know:

  • Physiologic effect: activities that affect body movement without any relation to a specific disease.
  • Physiologic cascade: sequence of repeated activation reactions due to a series of developments from a specific initial stimulus – example: compressing a nerve can cause muscles to involuntarily spasm due to a lack of blood flow and neurological control over the signal sent to the muscles in which that specific nerve controls.
  • Sensory Nerve Fibers: transmit sensations, such as temperatures and pain, to the brain and spinal cord. These fibers control the sensations you feel on your skin or within your body.
  • Peripheral Motor Nerve Fibers: transmit signals from the brain and spinal cord to muscles. These fibers tell your body how to move and function.
  • Vascularized Fat Flaps: fatty tissue that has blood vessels capable of delivering nutrients to cells within the tissue.  
  • Muscle Atrophy: muscle weakness or loss of muscle mass

What is Cubital Tunnel Syndrome?

“Cubital tunnel syndrome” is a collection of symptoms of the upper limb caused by increased pressure within or on the ulnar nerve as it passes along the backside or inside aspect of the elbow. This is indicated within the illustrations below.  It is one of many “compressive neuropathies” in which our nerves contribute to symptoms of pain, numbness, and/or motor dysfunction. These symptoms occur from a physiologic cascade of breakdown within the nerve triggered by reduced blood flow to the lower arm.

A way to demonstrate this physiologic breakdown is to take your finger and press on your skin. You’ll notice, your skin will temporarily turn white as pressure is applied due to the lack of blood flow to that specific area. The same thing happens with our nerves when there is external pressure applied to a nerve that reduces the local blood flow into the area. This can also occur when there is internal pressure within the nerve. Nerves typically display a surge of dysfunction symptoms that are initially temporary but can lead to irreversible long-term changes if not addressed.

Cubital Tunnel Syndrome

Nerve Compression

For those interested in this sequence of breakdown and dysfunction, nerve compression in short produces diminished local blood flow from pressure placed on the compressed area. Reference back to pressing your finger on your skin for any amount of time. This reduction of local blood flow then creates altered signals to your brain. Similarly, consider the times your foot falls asleep when one leg is crossed over the other. This painful tingling and perhaps muscle clumsiness, is rapidly reversed when you simply change the position and “shake it out”. In other words, when you restore local blood flow.

However, over time chronic nerve compression leads to swelling within the nerve. This results in an alteration of the protein transport sequence necessary for proper nerve fiber function along the length of the nerve. See the illustrations below. In addition, compression on the “insulation” (called Myelin) around our peripheral nerves that promotes faster conduction, reduces the ability for nerve fibers to transmit a signal to the muscle to operate. After prolonged periods, this can lead to muscle atrophy.

Normal-Neuron-Signal-Transportation-from-Cell-to-Muscle
Compressed-Neuron-Signal-Transportation
Muscle Atroph

Nerve Breakdown and Dysfunction 

Sensory nerve fibers tend to display breakdown and dysfunction first, with motor nerve fibers secondarily. Eventually, with prolonged compression, the normal connective tissue around the nerve fibers becomes thick and scarred resulting in reduced capacity of the fibers themselves. Once this occurs, there is potential that these fibers may not recover full function, even if the nerve is later decompressed through surgical intervention.

Unfortunately, although this sequence has been well defined in animal studies, it is difficult to predict the timing of this deterioration in humans.  There are several variables that may contribute to either the resiliency or vulnerability of individual patients to progress to the endpoint of permanent nerve fiber scarring and dysfunction. Because of this, if you are experiencing ongoing symptoms of any form of nerve compression, it’s recommended to be seen by an orthopedic specialist.

Carpal Tunnel Syndrome vs Cubital Tunnel Syndrome

The well-known Carpal tunnel syndrome is the most common compressive neuropathy in the upper extremity and involves compression of the median nerve at the wrist. Alternatively, Cubital tunnel syndrome, as discussed here, is slightly less frequent and results from compression of the ulnar nerve as it travels along the inside of the elbow.  We have normal structures that surround and support the location of the ulnar nerve as it travels behind the medial epicondyle. The medial epicondyle is that bony prominence on the inside of your elbow. However, with cubital tunnel syndrome, these normal structures, along with a normal increase of tension along the ulnar nerve as the elbow bends, can create diminished local blood flow and initiate the breakdown and dysfunction cascade mentioned above.

Cubital-with-Muscle-Illustration
Carpal-Tunnel-Syndrome
Upper-Extremity-Nerves-Carpal-vs-Cubital-Graphic

The symptoms resulting from this breakdown are usually quite easily recognizable.  Patients usually complain of:

  • Numbness along the ulnar border of the hand (ring and small finger)
  • Tenderness along the inside portion of the elbow
  • Clumsiness and weakness in the hand

Many patients will experience the symptoms of numbness along the side of the hand and elbow pain during the night, as most of us sleep with our elbows bent.  Symptoms may also occur with similar positions during the day. These can be activities such as talking on the phone, typing, leaning on a surface, or vigorous pushing and pulling.  Most patients will notice numbness, typically around the inside of the elbow first. Clumsiness may emerge later.  Over time, with chronic compression, the numbness will persist around the clock and patients will exhibit actual atrophy of the smaller muscles within the hand.  When addressed soon enough, we can aim to stop the process before it reaches this stage.

Some patients can have these problems secondary to instability of the ulnar nerve. You’ll notice when the nerve is instable, it will snap back and forth over the bony prominence on the inside of the elbow whenever flexing or extending the arm.

Hand-Numbness-Symptoms

Cubital Tunnel Syndrome Treatment

It is important to note that not all patients will manifest these exact symptoms. There are obviously variant presentations that require your physician to be attentive to symptoms and additional examination findings.  Let’s discuss the process of what goes into the diagnosis of Cubital Tunnel Syndrome and the various treatment methods available.

Diagnosis

Aside from taking your injury history and listening to your symptom patterns, your clinician will perform a physical exam. This exam will include isolating the level of the injury to the nerve, the degree of nerve dysfunction, and other contributing factors.  Consider that these symptoms may also be manifestations of compression of a cervical nerve root in the neck, compression of a group of nerves passing underneath your clavicle. This condition is specifically referred to as Thoracic Outlet Syndrome.

Additionally, compression elsewhere along the ulnar nerve within the arm, or compression of the ulnar nerve within the wrist, could be potential causes for your symptoms.  Furthermore, sometimes symptoms of hand clumsiness or muscle atrophy is a manifestation of peripheral neuropathy, an intrinsic disease of the nerves themselves, independent of compression. Diabetic neuropathy is one form of this potential cause.

To help distinguish your diagnosis, your physician may also employ electrodiagnostic studies (often referred to as an “EMG”). These EMG’s are performed by an outside provider to help “map out” locations and severity of your nerve compression. From here, your physician will work with you to build a treatment plan suitable for your individual needs.

Initial Treatment

Initial treatment for patients with early symptoms and findings, involves avoiding compression and traction (pulling) on the ulnar nerve. For example, you will want to avoid leaning on your elbow or activities such as heavy weightlifting where weight is pulling on the affected arm.

The simplest initial treatment for pain relief is to use a nighttime splint to block hyperflexion of the elbow.  Hyperflexion while sleeping is often the main contributor of symptoms for patients with this problem. For many patients, “Nerve glide” exercises such as the below, may also be helpful. There may, however, be some patients who do not respond to these exercises.

This condition, in its earliest form, is often reversible and over 50% of patients do not require surgery. Improvement in symptoms may be gradual and take a few months.

Cubital Tunnel Syndrome Surgery

If symptoms persist or if you exhibit more advanced phases of nerve compression, your physician may recommend surgical treatment to decompress the nerve and enhance blood flow. The most basic surgical measure is “decompression” of the ulnar nerve as it passes through the cubital tunnel. Sometimes, this is enough, allowing the nerve more mobility with less local compression as it glides through the cubital tunnel. However, this procedure may not be effective for every case.

The most common procedure performed is the decompressing of the nerve followed by “transposition” of the nerve to the front of the elbow, just anterior to the medial bony prominence.  With this maneuver, the nerve is both decompressed and placed in a position where it is no longer subjected to stretching or tension. In some cases, the nerve may be left lying just superficial to the muscle on the inside of the elbow. Alternatively, the nerve can also be buried within that musculature to further decrease tension.

Whatever the procedural method selected, the nerve needs to glide freely with minimal tension or kinking around anatomic structures.

Ulnar nerve glide floss

Ulnar-Nerve-Glides
Ulnar Nerve Glides

Cubital Tunnel Surgery Recovery 

Our physicians rarely immobilize, or restrain, the elbow following ulnar nerve decompression or transposition surgery. This is because we want your nerve to glide freely and limit potential for scarring.  However, we do not want any form of violent pushing, pulling, or twisting over the initial 4-to-6-week window. To provide protection against these violent movements, we will prescribe for your surgical dressings to be in place for the initial 7 days. After those 7 days, you will typically be able to remove the dressing and allow running water (faucet or shower) over your wound. We usually have patients return for a follow up visit within 10-to-14-days post operation to complete a wound check and suture removal.

Most patients do not require formal physical or occupational supervised therapy after cubital tunnel syndrome surgery. However, we may provide instructions for simple exercises that you can perform independently at home.  If further supervised visits are needed, our occupational therapists are certainly available to accommodate as such.

Things to Know Before Cubital Tunnel Syndrome Surgery

All surgical procedures incur some risk. However, those specific to ulnar nerve surgery are localized to:

  • Wound infection (fortunately the risk for infection is quite low)
  • Direct injury to the ulnar nerve
  • Persistent or even temporary worsening of symptoms
  • Numbness on the posterior aspect of the elbow (due to a small sensory nerve branch separate but overlying the ulnar nerve)
  • Recurrent symptoms

Let’s discuss why symptoms would occur again. This is because some patients are genetically more predisposed to developing scar tissue around nerves. Unfortunately, we are not able to identify those who are predisposed to such scaring before surgery. However, the good news is, those of us surgeons seasoned in peripheral nerve surgery are quite familiar with patients exhibiting this phenomenon. In the event this scarring occurs, it may require further surgery. This additional surgery would include concurrent measures with use of different materials to encase the nerve. Alternatively, we can utilize vascularized fat flaps to surround the nerve and limit further scar formation.

What to Expect After Cubital Tunnel Syndrome Treatment

Nerve recovery and symptom resolution varies widely. Some patients note resolution of burning and tingling within just a few days or weeks.  For others, depending on the degree and chronicity of nerve compression pre-surgery, this may take a few months.  This is particularly the case with patients who demonstrate muscle atrophy changes pre-surgery. Unfortunately, many of those patients will not regain normal muscle function. With this, the goal with nerve compression surgery is to stop the process of ongoing muscle atrophy from lack of neural input. Neural input is in essence, the lack of brain neurons that tell the muscle to function. Fortunately, sensation for less severe cases may recover over a few months. For patients who have had severe or chronic compression, sensation is estimated to take anywhere between six to nine months.

If you are experiencing any symptoms of Cubital Tunnel Syndrome or any other nerve injury, call us today. Our physicians will develop a treatment plan to ensure you do not suffer from any further muscle atrophy and sustain as much normal motor function as possible.

Developed by the Colorado Springs Orthopaedic Group Hand and Upper Extremity Center

Meet Our Providers

Dale Cassidy, MD, MBA Hand and Upper Extremity Center Hand Doctor; Colorado Springs Orthopaedic Group

Dale Cassidy, MD

Jeffry T. Watson, MD Hand and Upper Extremity Center Hand Doctor at Colorado Springs Orthopaedic Group

Jeffry Watson, MD

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Total Knee Replacement vs Partial Knee Replacement

Total Knee Replacement vs Partial Knee Replacement

Joint Replacement surgeries, specifically Knee Replacement surgeries, have become some of the most common procedures performed across the globe. This is due to many types of arthritis affecting our joints and causing joint damage. Much like the end of a chicken bone, our bones are covered with a thin but resilient layer called Hyaline Cartilage. Arthritis can be thought of as the progressive deterioration, or wear, of this layer. As this happens our underlying bones begin to rub against each other causing the substantial pain so many experience. These various types of arthritis can be caused from previous injuries, autoimmune conditions, or even simple wear and tear from activities and aging. Whatever the cause, the results can be debilitating.

Hyaline-Cartilage-2-600x491
Osteo-Progression-600x324

Symptoms of Arthritis

Symptoms of Arthritis range from mild stiffness and soreness to the loss of proper anatomical (muscular and skeletal) function, severe pain consistently felt within the joint, and the inability to walk. As a result, many ask when is it time to see a doctor to seek pain relief for arthritis? In short, if the pain is keeping you from performing your day-to-day activities, we recommend scheduling with a fellowship trained orthopedic joint specialist to see what treatment options will suit your individual symptoms and needs.

Bi-Lateral-Osteoarthritis-in-Knees-x-ray-with-detail-600x479
Osteo-x-ray-detail-600x473

Treatment for Arthritis

For those who come to us with various symptoms of arthritis, there are a few initial steps that need to occur so we can appropriately diagnose your pain as arthritis pain and thus develop a suitable treatment plan for you.

The first step in diagnosis is taking you through a full examination of the joint in question and taking x-ray images. From here, you and your physician will work together to develop a treatment plan specific for the patients needs and lifestyle. In many cases, conservative treatments such as physical therapy or injection therapy, will be recommended as a starting point. If conservative treatment options are unable to help settle the arthritis pain, surgery is often our next best option.

Over the years, the surgeries used to treat arthritis pain have become very commonplace, exceptionally reliable, and tremendously rewarding for both the patient and surgeon when the patient returns to the activities they we’re limited from prior to treatment.

Total Knee Replacement vs Partial Knee Replacement

In most cases “Knee Replacement” can be thought of as a “Knee Resurfacing”. Essentially, the surgeon will remove the worn cartilage layer from the knee and replace (resurface) it with a new layer made of a very smooth hard metal and a medical-grade plastic to restore the joint.

Total Knee Replacement

In the knee, there are three main areas where our bones come in contact with each other. The femur, (thigh bone), the tibia (shin bone) and patella (kneecap). Restoring all three of these areas at one time is what we medically classify as a Total Knee Replacement. In many cases, by the time a patient comes to see us, their cartilage damage is severe enough, a Total Knee Replacement is the most appropriate treatment.

Total-Knee
Total-Knee-pot-op-x-ray-2

Partial Knee Replacement

Alternatively, there are some instances where only one of these three areas is the culprit for arthritis pain. In this case, a less invasive Partial Knee Replacement may sufficiently relieve the patient’s pain.

A Partial Knee Replacement procedure involves the removal of the one area of damaged cartilage and replacing it with a similar yet more localized hardware. The knee’s unaffected areas are left alone. With most cases, this procedure can be accomplished through smaller incisions causing less surgical injury to the knee. In other words, a Partial Knee Replacement could be classified as a minimally invasive surgery with less harm done to the knee compared to a Total Knee Replacement.

Partial-Knee
Partial-Knee-x-ray-post-op

What to Expect with a Knee Replacement?

One thing to always remember, just because a procedure CAN be performed, does not mean it is always the correct choice. Always thoroughly discuss treatment options with your surgeon when making decisions to undergo surgery. To elaborate, there are some cases where you may not a good candidate for either one of these procedures. Your size, age, weight, overall health, outcome expectations, and  physical limitations or abilities all play a role in whether a knee replacement will be the correct procedure for you. With this, no matter if a partial knee or a total knee replacement is chosen, the procedure must be able to:

  • Be performed safely
  • Improve your function
  • Improve your quality of life
  • Meet your physical ability expectations and support most tasks that you will place on it after surgery.

Furthermore, each procedure requires a visit to either a hospital or a surgery center, where the surgery is performed through an incision over the front of the knee. During the procedure you will be under anesthesia.

Keep in mind, a Total Knee Replacement and a Partial Knee Replacement will both involve some amount of downtime and commitment to a rehabilitation period after surgery. However, with technology advancements we are now able to have most patients up walking with assistance immediately after surgery. Additionally, in many cases we can perform the procedure as an outpatient procedure and send you home to recover the same day as surgery.

Knee Replacement Recovery Time

Although a partial knee replacement may be slightly less painful and overall an easier recovery than a total knee replacement, they are both very dependent on a strict and crucial rehabilitation period. The patient’s diligence with their postoperative physical therapy protocols is critically linked to the success of their surgery. Also, as mentioned previously, your preoperative condition and overall health status greatly affects success of the surgery as well as the time to reach full recovery. If post operative rehabilitation is adhered too, many patients are walking independently within days to weeks following the procedure. Likewise, some patients are able to go back to work within four to ten (4-10) weeks as well. After either type of knee replacement surgery, you can expect to see progressive improvement in your knee’s pain and function for up to a year.

If you are suffering from pain and stiffness in your knees that is not adequately controlled with a conservative treatment, talk with your orthopedic surgeon or call us today to schedule your initial evaluation.

Developed by the Colorado Springs Orthopaedic Group Joint Replacement Team

Meet Our Providers

Tyler Bron, MD specializing in Joint Replacement, specifically Knee Replacement and Hip Replacement Colorado Springs Orthopaedic Group

Tyler Bron, MD

Michael Feign, DO specializing in Joint Replacement, specifically Knee Replacement and Hip Replacement; Colorado Springs Orthopaedic Group

Michael Feign, DO

Eric Jepson, DO specializing in Joint Replacement, specifically Knee Replacement and Hip Replacement. Colorado Springs Orthopaedic Group

Eric Jepson, DO

Dr Michael Van Manen, DO Orthopaedic Surgeon Joint Replacement Specialist Colorado Springs Orthopaedic Group

Michael VanManen, MD

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How to Treat a Sprained Ankle

How to Treat a Sprained Ankle

Symptoms, Diagnosis, Treatment, and Recovery

What is an Sprained Ankle?

An ankle sprain usually occurs when the ankle is twisted, causing injury to the soft tissue of the ankle. This occurs most commonly during athletic activities or with awkward falls from a curb or a step. They are one of the most common injuries that we treat in our practice. It is also estimated that millions of people suffer an ankle sprain each day.

Ankle Sprain Grades

Graphic displaying various grades of a Sprained Ankle

Within the ankle there are numerous tendons and ligaments however, when an Ankle Sprain occurs, it typically involves the ligaments specifically.

To define, a ligament is a thick band of tissue that connects bone to bone. A sprain of the ankle results in the stretching or tearing of one or more of these ligaments.

There are a few different severities, otherwise referred to as ‘grades’, of an Ankle Sprain. These grades range from one (1) to three (3).

A Grade One (1) ankle sprains is a stretch of the ligaments.

Grade Two (2) ankle sprains are partial tears of the ligaments within the ankle.

A Grade Three (3) ankle sprain is a complete tear of the ligaments.

High Ankle Sprains vs Low Ankle Sprains

If you’ve injured your ankle before, you may have heard the terms ‘High Ankle Sprain’ and ‘Low Ankle Sprains’. To differentiate the two, a High Ankle Sprain is when the sprain damage occurs at the high ankle ligaments that connect from the tibia to the fibula.

Sprained Ankle Types. Example of High Ankle Sprain from the lateral view and front view detailing grades of ankle sprains

Alternatively, a Low Ankle Sprain involves the ligaments just below the ankle joint, commonly referred to as the subtalar joint. Click here to learn more about the subtalar joint and additional Ankle Anatomy.

Low ankle sprains can be further classified as Inversion Sprains or Eversion Sprains. The majority of ankle sprains tend to be inversion ankle sprains and occur when the ankle rolls inwards. Whereas, an eversion ankle sprains occurs when the ankle rolls outward.

Low inversion ankle sprain from lateral view. Including grades of ankle sprains
low eversion ankle sprain including various grades of low ankle sprains and how an ankle sprain can occur

How to Treat a Sprained Ankle

Sprained Ankle Symptoms

Soon after the initial injury occurs, the ankle will become swollen, painful, and can be accompanied by excessive bruising. You will also notice moving or walking on the ankle can be very difficult due to the pain and swelling.

Image of Sprained Ankle Symptoms, localized to low ankle not high ankle sprain

Ankle Sprain Diagnosis

At Colorado Springs Orthopaedic Group (CSOG) and within our orthopaedic urgent care, CSOG Express Care, we can help make the initial diagnosis of an ankle sprain through an in-person examination. In conjunction with this exam, we will take X-ray images of your ankle to confirm that there is not a break in any of the ankle bones.  Many patients ask if an MRI is needed to confirm the degree of an ankle sprain. To answer this, an MRI of your ankle is not always apart of the initial image ordering. It can however, be warranted and ordered if your ankle fails to improve after a period of prescribed physical rehabilitation.

Sprained Ankle Treatment and Recovery

Treatment can begin by using the PRICE principle: Protection, Rest, Ice, Compression, and Elevation.

In addition to using the PRICE principle, a walking boot or brace is used to protect your ankle and allow the ankle ligaments to rest in a favorable position.

Crutches can also help prevent any weight bearing on the ankle, and casts may be used in severe ankle sprain cases. The healing of the ligaments usually takes around six (6) weeks, but the swelling may be present for several months.

After one (1) to three (3) weeks of rest and rehabilitation, we can begin Physical Therapy and proceed based upon the sprain’s severity. Depending upon the degree (grade) of the ligament damage, long term physical therapy and/or surgery may be suggested.

How to treat a sprained ankle including a high ankle sprain

Chronic Ankle Sprains

Chronic ankle sprains are generally considered those that occur repeatedly however, they can also be sprains that have failed to improve over a significant period of time. This is usually the result of inadequate initial treatment of a recent ankle sprain or due to a very severe original ankle sprain.

When the ankle is not treated correctly after the initial sprain, then the ligaments can heal in a stretched out fashion leading to what’s known as a “loose” ankle. Those with loose ankles tend to have a lack of confidence in their ankle stability and suffer from weak ankles that may hurt and give out frequently.

If this is the case, when you are seen by a physician at Colorado Springs Orthopaedic Group, they may refer you to our in-house orthotic team at Audubon Orthotics and Prosthetics Services, to fit you with a stabilizing ankle brace in efforts of preventing future re-injury.

If you have suffered an ankle sprain or have experienced multiple ankle sprains, do not hesitate to reach out to the Foot and Ankle Center at CSOG. After a thorough evaluation to include X-Ray and potentially MRI imaging, our team will work with you to develop an individualized plan to make sure you regain confidence in your ankle stability for the long term.

Developed by the Colorado Springs Orthopaedic Group Foot and Ankle Center Team

Meet Our Providers

Dr. Alex Simpson, DO Orthopaedic Foot and Ankle Doctor

G. Alex Simpson, DO

Kristina Hoffmann, PA-C

Kristina Hoffmann, PA-C

Jasmine Wohlman, NP

Jasmine Wohlman, NP

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What is Frozen Shoulder? Causes, Symptoms, and Treatment Options

What is Frozen Shoulder? 

Causes, Symptoms, and Treatment Options

Terms to know:

  • Humerus: upper arm bone
  • Scapula: shoulder blade
  • Clavicle: collarbone
  • Shoulder Capsule: group of strong connective tissues that encapsulate and secure the shoulder’s ball and socket joint
  • Contracture: when a soft connective tissue around a joint becomes stiff, constricted, or shortened.
  • Manipulation under Anesthesia (MUA): when the patient receives general anesthesia and a series of stretching, traction, and mobilization is performed by the surgeon.
  • Arthroscopy: a minimally invasive surgical technique that involves using a camera and specially designed instruments that are inserted into the joint via several small incisions.

Shoulder Anatomy

The shoulder is a ball-and-socket joint that is made up from three bones: the Humerus (the upper arm bone), the Scapula (commonly known as the shoulder blade), and the Clavicle (collarbone). The humerus fits right into a shallow socket that is formed within the scapula, right under where the clavicle sits above the scapula. Strong connective tissues surround this joint and hold these boney structures in place. These tissues are referred to as the Shoulder Capsule in medical terms. Additionally, Synovial fluid resides within the shoulder capsule and shoulder joint to help the shoulder move with ease.

Adhesive-Capsulitis-anatomy-normal-vs-inflammed-600x373
Adhesive-Capsulitis-anatomy-600x531

What is Frozen Shoulder?

Frozen shoulder, also known as Adhesive Capsulitis, is a condition where the shoulder capsule surrounding the shoulder joint becomes stiff and in turn causes pain in the shoulder. It is a relatively common cause of disabling shoulder pain and dysfunction.  Although it is not as common as a rotator cuff problem, the pain it causes is typically much more severe.

Adhesive Capsulitis

Frozen Shoulder Stages

There are three (3) stages of Frozen Shoulder.

Stage one (1) is referred to as the ‘Freezing” stage. This is when pain can worsen and range of motion becomes more limited. This stage typically lasts between six (6) to nine (9) weeks.

Stage two (2) is the ‘Frozen” stage. In many patients, pain may subside to some degree however, stiffness typically remains. Day to day activities can also be very difficult during this stage that can last anywhere between four (4) to six (6) months.

Stage three (3) known as the ‘Thawing’ stage, is when the shoulder stiffness starts to decrease and motions begins to slowly improve. It is within this stage when a patient will begin to return to their normal or close to normal strength as well. This stage is the slowest progression stage and can take anywhere from six (6) months to three (3) years.

Frozen Shoulder Stages

What Causes Frozen Shoulder?

Frozen shoulder affects approximately three (3%) percent to five (5%) percent of the general population and tends to affect patients between the ages of forty (40) and sixty (60) years old.  The cause of this problem is not well understood however, it involves scarring and contracture of the joint capsule. This scarring and constriction leads to limited mobility of the shoulder joint.

Many who are affected by frozen shoulder do not have any predisposing conditions, however those with diabetes, hypothyroidism or hyperthyroidism, cardiovascular disease, fibrocystic breast disease, or Parkinson’s disease may be more at risk.  Additionally, Frozen Shoulder can also develop following trauma to the shoulder, or even after a previous shoulder surgery.

Frozen Shoulder Symptoms

The hallmark physical examination involved with the diagnosis of frozen shoulder is assessing the loss of passive and active mobility in the shoulder joint.  Patients often do not acknowledge the significant loss of motion when it occurs as it usually develops slowly and many unconsciously compensate by using more scapular (shoulder blade) motion when performing day to day activities.

Frozen Shoulder Treatment

The good news is that Frozen Shoulder will usually get better without any formal treatment.  The bad news is that it can take a very long time (up to several years), and patient symptoms will often trigger them to seek treatment to shorten the course of this problem. To help with this, there are a variety of conservative treatment options available with surgical treatments typically utilized as a last resort for the appropriate patients.

Conservative Treatment Options

Conservative treatments include modalities such as physical therapy for joint mobilizations, oral non-steroidal medications, and steroid injections that can help improve the pain level and restore functional motion.  With this, the primary objective in the conservative treatment of frozen shoulder is to control pain while the problem resolves on its own. Studies have shown that, approximately more than ninety percent (90%) of patients see substantial improvements with these various conservative treatments.

Moreover, additional conservative treatment methods have been developed in recent years. These methods however, remain considered as experimental procedures and are not yet approved through the FDA. To learn more about these alternative treatments, we recommend that you further discuss with your physician.

As an alternative to conservative methods if pain and functional limitations are not responding to these conservative treatments, surgery or a Manipulation under Anesthesia can be considered to restore proper mobility. Both conservative and operative treatment methods have shown great success in relieving pain from Adhesive Capsulitis and restoring mobility within the shoulder joint.

Surgical Treatment Options

There are two general operative treatment options to help treat Frozen Shoulder: Manipulation under Anesthesia (MUA) or Arthroscopic Surgery.

Manipulation under Anesthesia

The first, Manipulation under Anesthesia, is performed with the patient completely sedated by an anesthesiologist with intravenous medication.  After the patient is asleep, the surgeon simply manipulates the shoulder in a very specific manner to break apart the scar tissue and restore the shoulder’s range of motion.  The key to success with this procedure is for the patient to participate in physical therapy and maintain the range of motion after the manipulation.

Arthroscopic Surgery

Secondly, surgery can be performed as an outpatient procedure where the patient will return home the same day as surgery. Typically an Arthroscopic technique is used during this operation.  To define, Arthroscopy is a minimally invasive surgical technique that involves using a camera and specially designed instruments that are inserted into the joint via several one quarter inch (1/4”) incisions.  The instruments are utilized to cut and remove the scar tissue that is restricting movement.  This approach is very effective in restoring normal, or near normal, range of motion. The key with this procedure is that the patient does their part with following their prescribed post-operative physical therapy protocols.

Following surgery of this kind, the arm is kept out of the sling and full range of motion is encouraged from the day of surgery.  Daily physical therapy is typically prescribed for the first couple weeks after surgery to help maintain the motion attained during surgery and strengthen the muscles around the joint.  This procedure is effective in restoring and maintaining the motion of the shoulder in over ninety (90%) of the cases that require surgery.

If you believe that you are suffering from symptoms of a frozen shoulder, call our office today to schedule with one of our Fellowship Trained Shoulder Specialists. Let’s get you on the road to recovery!

Developed by the Colorado Springs Orthopaedic Group Sports Medicine Team

Meet Our Providers

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Craig A. Yager, MD Sports Medicine Specialists at Colorado Springs Orthopaedic Group

Craig Yager, MD

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Ankle and Foot Anatomy Basics | CSOG

Ankle and Foot Anatomy Basics

Basic anatomy for any joint structure within the body includes bones, joints, muscles, tendons, and ligaments. For our purposes, we will be discussing anatomy of the ankle and foot structures specifically.

Terms to Know:

  • Lateral: outside
  • Posterior: backside
  • Anterior: frontside
  • Medial: inside
  • Distal: situated away from the center of the body
  • Proximal: situated closer to the center of the body than distal

Anatomy of a Joint Structure

A joint is a part of a body where two or more bones meet. The ends of these bones are covered by Cartilage. To define, Cartilage is a connective tissue structure that helps provide shock absorbing properties when performing activities. In addition to cartilage, Synovial Fluid presents within each joint space and promotes smooth movement of the joint. There are also important connective tissues called Tendons and Ligaments that make up each body structure. A tendon is a tissue that connects muscle to bone. Similarly, ligaments connect bone to bone.

Ankle Anatomy

The ankle joint is formed where the bones of the lower leg, the Tibia and Fibula, meet the Talus. With this, the portion of the fibula, located at the ankle level, is referred to as the Lateral Malleolus while the portion of the tibia at the ankle level is referred to as the Medial Malleolus. These two (2) ankle bones are commonly fractured in injuries. Additionally, just below the ankle joint is the Subtalar Joint, which is located between the Talus and the Calcaneus. The Calcaneus is also known as the heel bone.

Each of these joint junctions are responsible for allowing movement of the ankle in four different directions: Plantarflexion, Dorsiflexion, Inversion, Eversion. To demonstrate these directions, point your foot. Your ankle is in the Plantarflexed position. Now, bring your toes towards your head. This is the Dorsiflexion position. From here, if you move your toes inwards you will be in the Inverted position. Alternatively, if you move your toes outwards, you will be in the Everted position.

In many cases, normal wear and tear from aging can predispose the ankle joint to arthritis. However, wearing appropriate footwear for your activities and performing ankle strengthening and stretching exercises can delay the onset of arthritis. Tune into our blog Osteoarthritis vs Rheumatoid Arthritis to learn more about the causes of arthritis and ways to prevent or delay its onset.

Bones-of-the-Foot-and-Ankle ankle bones

Muscular and Tendon Anatomy of the Ankle

The posterior side of the lower leg houses the calf muscles. These muscles attach to the Achilles tendon, which is the largest tendon in the body. This is exposed to large amounts of force in activities such as running or jumping, making it prone to injury. The Tibialis Posterior muscle also lives in the posterior side of the lower leg. Continuing, the tendon associated with this muscle crosses over the middle portion of the ankle and is called the Posterior Tibialis Tendon. Those with flat feet may be at risk for additional strain on this tendon, which if not addressed, can lead to tendonitis.

Ankle Anatomy, Achilles-Tendon-Diagram
ligaments and tendons of the foot, Ankle anatomy, ankle bones Achilles-Tendon-Conditions

The lateral compartment of the lower leg contains two muscles, the Peroneal Brevis and the Peroneal Longus muscles. Subsequently, the tendons of these muscles travel on the outside of the ankle and can also be subject to strain with overuse. Other important structures over the lateral ankle include three (3) lateral ligaments: the Anterior Talofibular Ligament (ATFL), the Calcaneofibular Ligament (CFL), and the Posterior Talofibular Ligaments (PTFL). These structures are vital for stability of the ankle. Injury to these ligaments, as commonly seen with ankle sprains, can lead to long-term instability if not treated properly. Visit our blog What to do for a Sprained Ankle to learn more about how to treat an ankle sprain.

Ankle Bones, ankle anatomy, Ankle-Joint-Ligaments ankle bones, ligaments and tendons of the foot

Foot Anatomy

The feet each contain 26 bones as well as many soft tissue structures including tendons, ligaments, nerves, and vascular structures. In medical discussion, the foot is often broken down into three (3) portions: the Hindfoot, Midfoot, and Forefoot.

Foot anatomy, foot bones, oot and Ankle Bones Mid-Hind-Forefoot-Diagram-lateral-view-High-Contrast

The Hindfoot

The Hindfoot contains the talus and calcaneus, otherwise known as the ankle bone (Talus) and heel bone (Calcaneus). As mentioned previously, these two (2) bones join to make up the Subtalar Joint and allow the foot to rotate in multiple directions at the ankle level. Additionally, the Plantar Fascia Tendon runs from the calcaneus to the end of the metatarsal bones located in the forefoot.

The Midfoot

The midfoot houses the five (5) tarsal bones and three (3) ligaments. These ligaments are referred to as the Lisfranc Joint Complex and connect the midfoot to the forefoot. The five metatarsal bones, to include the navicular, cuboid, and three (3) cuneiform bones, all help to form the arches of the foot. Alone, the midfoot bones do not provide all the stability for the midfoot. The Midfoot Ligament Complex is also responsible for providing stability. This complex of Lisfranc ligaments includes the Dorsal Lisfranc Ligament, the Interosseous Lisfranc Ligament, and Plantar Lisfranc Ligament. These ligaments help maintain alignment of the tarsal and metatarsal bones and act as shock absorbers during activity.

The Forefoot

Within the forefoot, you will find the metatarsals and the toe bones, medically known as the Proximal, Medial, and Distal Phalanges. The Distal Phalanges are located at the end of each toe while the Proximal Phalanges are situated closest to the metatarsals and allow the toes to bend. You will also find the four (4) deep transverse metatarsal ligaments within the forefoot. These ligaments help to stabilize the metatarsal bones and prevent the foot’s arch from widening or collapsing. These forefoot structures are key to navigating various surfaces and maintaining balance when performing activities such as walking, running, pivoting, or jumping.

Mid-Hind-Forefoot-Diagram-High-Contrast

Due to their weightbearing capacities and vital function in performing day-to-day activities, the feet and ankles can be subject to many different conditions that may cause discomfort. Because of this, Arthritis in the joints of the feet can occur secondary to routine wear and tear or following injuries. Additionally, different deformities such as flat feet, high arches, bunions, hammertoes, or mallet toes may occur. These deformities can result in pain, calluses, and difficulty wearing shoes. If you are experiencing any of these symptoms or conditions, please give our office a call and we will design a treatment plan based on your personal needs and get you back to the lifestyle you enjoy.

The intrinsic anatomy of the ankle and foot can cause various injuries or conditions to become very complex. For more information on conditions of the foot and ankle and treatment options available, check out our blog series developed by our providers within the Foot and Ankle Center.

Developed by the Colorado Springs Orthopaedic Group Foot and Ankle Center

Meet Our Providers

Brad D. Dresher, MD Orthopaedic Foot and Ankle Doctor
Kristina Hoffmann, PA-C

Kristina Hoffmann, PA-C

Dr. Alex Simpson, DO Orthopaedic Foot and Ankle Doctor

G. Alex Simpson, DO

Jasmine Wohlman, NP

Jasmine Wohlman, NP

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New FDA Approved Drug-Free Treatment for Painful Diabetic Neuropathy

New FDA Approved Drug-Free Treatment for Painful Diabetic Neuropathy

HFX

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What is Diabetic Neuropathy? 

Diabetic Neuropathy is chronic nerve damage in the upper and lower extremities caused by constantly high blood sugars. It is a chronic debilitating condition which can interfere with a person’s sleep, their functionality, and their overall quality of life.

Around 34 million Americans have diabetes (CDC, 2020) and roughly half of all adults with diabetes will suffer from Diabetic Neuropathy in their lifetime (Hicks, 2019). Of those, it’s estimated approximately 2.3 million will suffer from Painful Diabetic Neuropathy (PDN) with no relief by using current treatments and conventional medical management (Schmader, KE., 2020).

Male-Fire-Feet-400x345

What are the Typical Symptoms of Painful Diabetic Neuropathy (PDN)? 

Those who suffer from Painful Diabetic Neuropathy typically have daily continuous pain. Typical symptoms of include tingling, numbness, and pain in the extremities. This nerve damage can make patients more vulnerable to falls, burns, infections, ulcers, and long-term complications.

cons-13_ReduceNumbness

What Treatment Options are there to Relieve Chronic Pain from Diabetic Neuropathy?

Current treatment options aim to relieve the chronic pain that is frequently seen with Diabetic Neuropathy. These treatments often include pain medicines such as Tylenol or Aspirin. NSAIDS such as Ibuprofen or Advil, however, are not recommended for diabetic patients. Some patients with Diabetic Neuropathy are also treated with nerve medications including Neurontin (Gapapentin), Lyrica, and Topomax.  When patients don’t respond to these medications, narcotics or opioids are often used.

Although narcotics can lessen pain, they have significant long term consequences including dependence, decreased benefit over time, and abuse.  New federal guidelines aimed at reducing opioid misuse and abuse have resulted in many physicians denying or limiting opioid therapy for some chronic pain patients. Physicians are constantly looking to improve clinical and interventional tools to treat complex chronic pain. One of these advancements includes the development of Spinal Cord Stimulation (SCS).

Digital Image of Spinal Cord Stimulator calming Diabetic Neuropathy pain signals to the brain

Spinal cord stimulation has been available since the 1960s and uses a device called a Spinal Cord Stimulator to treat chronic pain. This small device is placed on the spinal cord to calm the spinal nerves and suppress the pain responses to the brain. As a result, pain lessens for the patient. Each device is programable to the individual patient’s needs. Additionally, Spinal Cord Stimulation allows for patients to go through a weeklong trial period to test their response to the device before permanent implantation.

There are many types of Spinal Cord Stimulators and the technology and programming options that come with them have made many advancements in recent years. These advancements have shown to provide better pain relief for many chronic pain conditions. Most recently, Spinal Cord Stimulation for Painful Diabetic Neuropathy (HFX™ for PDN) developed by Nevro, received FDA indication and approval to treat Painful Diabetic Neuropathy.

Who is HFX™ for PDN for and what does Spinal Cord Stimulator Surgery entail?

Graphic Illustrating where a spinal cord stimulator is placed on the low back to treat Diabetic Neuropathy

Patients suffering from Painful Diabetic Neuropathy specifically, who have not responded well to conventional medicine treatments are typically good candidates for a Nevro HFX™ for PDN Spinal Cord Stimulator trial. During this trial period, a temporary version of the stimulator is placed through a needle without undergoing surgery. The patient will then use this device for one week and monitor their pain levels, activity level improvements, and their need for pain medicine. At the end of the trial, the device is removed.  Ninety percent (90%) of patients who go through the trial have enough to success to make the decision to move forward with a permanent stimulator (Diabetes Care, 2021).

Once this decision has been made, a permanent spinal cord stimulator can be implanted with a quick outpatient surgery. With any outpatient surgery, the patient is able to go home and recover the same day as surgery. The permanent implant procedure is done through two small incisions. After the incisions are made, a paddle with metal contacts is placed against the spinal cord and a rechargeable battery is placed below the skin.

What is the Average Recovery Time from Spinal Cord Stimulator Surgery?

Moderate activity is limited, and strenuous activity is restricted for approximately six weeks post-surgery. This recovery time ensures that the device is received well, and the body has time to heal. However, despite this dedicated recovery time, many patients can feel pain relief in as little as a few days after their operation.

Recovery is quick with approximately eighty six percent (86%) of patients with Painful Diabetic Neuropathy experiencing substantial, long-term relief after 12-months (JDST, 2021). Additional details of the study can be found here.

Infographic

Stay tuned, ongoing studies are showing great success using Spinal Cord Stimulation (SCS) to help treat additional types of Neuropathy such as Peripheral Neuropathy.

Click Here for additional Data on Nevro’s HFX™ for PDN or visit https://www.hfxforpdn.com/

Dr. Roger Sung, MD Colorado Springs Orthopaedic Group

Roger D. Sung, MD

Dr. Sung is a Fellowship-Trained and Board-Certified Orthopedic Surgeon who specializes in Cervical, Thoracic, Lumbar, and Sacroiliac surgery, Microsurgery, and Minimally Invasive Spine Surgery techniques. He also performs complex spine reconstruction using minimally invasive techniques.

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Cartilage Restoration: Innovative Treatment for Knee Pain in Active Individuals

Cartilage Restoration: Innovative Treatment for Knee Pain in Active Individuals

What is Cartilage?

Articular (or hyaline) cartilage is a tissue in the body that lines the ends of the bones, providing a smooth surface for movement of the joint.  It also serves as a shock absorber during activities.  When there is an injury to the cartilage in a joint, it does not heal on its own as there is no direct blood supply to aid in this process.  Instead, cartilage continues to deteriorate over time, especially with continued activity.  This leads to a disease called Osteoarthritis.  Fortunately, there are now procedures available to restore the cartilage in a joint without having to go through a joint replacement.  The most common joint for a Cartilage Restoration procedure is the knee.

Treatment Options for Cartilage Disorders

There is a spectrum of treatment options for treating cartilage disorders including palliative, reparative, resurfacing, and reconstruction.  Palliative treatment is known as Chondral Debridement, where the uneven surface of damaged cartilage is smoothed out during arthroscopic surgery.  This does not replace injured cartilage but may relieve pain as there is no longer a loose flap of tissue moving abnormally in the joint.  This may be an option for a patient with only a partial thickness cartilage injury or an older patient who does not participate in demanding activities.  The recovery time for this procedure is minimal.  The patient can be full weight bearing and does not have any range of motion restrictions after surgery.

When there is a very small, focal lesion of missing cartilage, the patient may be a candidate for a reparative procedure known as Marrow Stimulation.  This procedure is sometimes referred to as Microfracture.  With this procedure, holes are made directly into the lesion allowing bone marrow to escape into the defect.  This allows for healing of the lesion with a substance known as Fibrocartilage, which acts similarly to innate articular cartilage when in a small area.  This is a simple arthroscopic procedure but does require some restrictions during subsequent rehabilitation to allow the Fibrocartilage to develop and heal.

Cartilage Restoration for Active Individuals

When we think of true “Cartilage Restoration” procedures, there are really two different types – Resurfacing and Reconstruction.

Resurfacing: “Repaving the Street”

When the lesion is too large for microfracture but still only involves the surface of the bone, then a resurfacing procedure is warranted.  There are several ways to resurface the end of the bone with new cartilage.  One technique is to take the patient’s own unused cells out during an arthroscopic procedure and send them to a lab to be grown into new cartilage cells, which would then be placed over the lesion that is missing cartilage.  This process is known as Autologous Chondrocyte Implantation and requires two surgical procedures – one to harvest the cells and another to put them into the defect.  The benefits of this procedure are that it uses the patient’s own cells and is able to resurface a large area of damage.  The recovery depends on where in the knee these cells are placed, but generally range of motion is encouraged early as cells adhere to the bone and proliferate right away.  Patients are able to ride a bike within weeks and even start running after just a few months.

Another resurfacing technique is done by Allograft Implantation.  Rather than two separate surgeries, this can be done in one arthroscopic or minimally invasive procedure.  The defect is debrided, and the donor cells are pasted into place and fixated with a type of biologic glue.  Similarly, patients progressively return to their normal activities within several weeks as the cells grow into real articulating cartilage.

Pre Cartilage Resurfacing Of The Patella

Pre Cartilage Resurfacing Of The Patella

Post Cartilage Resurfacing Of The Patella

Post Cartilage Resurfacing Of The Patella

Reconstruction: “Filling the Pothole”

When a cartilage defect extends beyond the surface to involve the underlying bone, a structural graft is necessary in a reconstructive procedure to restore the cartilage.  The size of the injured cartilage determines whether the cartilage can be obtained from the patient or must come from a donor.  If it is a smaller lesion, then a cartilage plug (includes underlying bone) may be taken from a place in the joint that does not need it and placed into the defect.  This procedure is called Osteochondral Autograft Transplantation and is typically done with a minimally invasive open incision.  However, when the size of the defect is too large to take it from another place, donor tissue is required.  In this case, a plug can be made to fit the size of the void after the missing cartilage and damaged underlying bone is removed.  Even an oval shaped plug can be fashioned to fill a large, long defect over the weightbearing surface of the knee, which is termed a BioUni.  These procedures are called Osteochondral Allograft Transplantations and may be an alternative to partial or total joint replacement for the right patient.  Although they do take longer to heal compared to a cartilage resurfacing procedure, the patients generally return to activity within a few months and have excellent outcomes.

Large Cartilage Defect Of The Medial Femoral Condyle

Large Cartilage Defect Of The Medial Femoral Condyle

Cartilage Graft Being Placed Into Defect

Cartilage Graft Being Placed Into Defect

Cartilage Graft Placed Into Defect

Cartilage Graft Placed Into Defect

Small Cartilage Defect Of The Medial Femoral Condyle

Small Cartilage Defect Of The Medial Femoral Condyle

Harvested Cartilage Graft Ready for Placement

Large Cartilage Defect Of The Medial Femoral Condyle

Cartilage Graft Placed Into Defect

Large Cartilage Defect Of The Medial Femoral Condyle

Reconstruction Innovation

There is a very exciting new procedure using the Osteochondral Allograft Transplantation concept to replace the entire undersurface of the patella (kneecap).  The patella cartilage is especially vulnerable to injury in athletes, specifically runners.  Here in Colorado Springs, we see many patients with this problem who are told that their only options are to stop being active, live with the pain, or get a partial or total knee replacement.  This procedure provides an opportunity to restore their cartilage and get them back to activities within a matter of months.  We are excited to announce that Dr. Jamie Friedman is the first orthopaedic surgeon to bring this technology to the state of Colorado.  The first patient to undergo this procedure here in Colorado Springs is currently doing his physical therapy and has registered to run a marathon this coming June.

Pre Total Biologic Resurfacing Of The Patella

Pre Total Biologic Resurfacing Of The Patella

Pre Total Biologic Resurfacing Of The Patella

Pre Total Biologic Resurfacing Of The Patella

Donor Patella Ready For Placement

Donor Patella Ready For Placement

Post Total Biologic Resurfacing Of The Patella

Post Total Biologic Resurfacing Of The Patella

Cartilage Restoration and Joint Deformity: Knocked-Kneed and Bowlegged

Finally, one aspect of Cartilage Restoration that is often overlooked is the alignment of the joint itself.  Many people are born either knock-kneed or bowlegged, but if there is too much of this deformity in the joint, it puts additional pressure on one side of the knee.  If the underlying problem of leg malalignment isn’t addressed, it can cause continued damage to the existing cartilage and a cartilage restoration procedure may fail.  In this case, the patient may be a candidate for realignment surgery to balance out the knee joint in conjunction with restoring the damaged cartilage.  If the patient is too knock-kneed (Genu Valgum), then they may need what is called a Distal Femoral Osteotomy.  This is when the bottom end of the thigh bone (Femur) is cut and straightened out with an opening wedge.  If the patient is too bowlegged (Genu Varum) then they may need what is called a High Tibial Osteotomy.  This procedure involves cutting the top end of the shin bone (Tibia) to straighten out the joint with an opening wedge.  Although these deformity correction procedures require the longest recovery (several months), they save the patient from a joint replacement and have great long-term outcomes.

Valgus Malalignment Pre Distal Femoral Osteotomy Surgery For Knocked Knee

Valgus Malalignment Pre Distal Femoral Osteotomy Surgery For Knocked Knee

Valgus Malalignment Post Distal Femoral Osteotomy Surgery For Knocked Knee

Valgus Malalignment Post Distal Femoral Osteotomy Surgery For Knocked Knee

Varus Malalignment Pre High Tibial Osteotomy Surgery For Bow Legged Knee

Varus Malalignment Pre High Tibial Osteotomy Surgery For Bow Legged Knee

Varus Malalignment Post High Tibial Osteotomy Surgery For Bow Legged Knee

Varus Malalignment Post High Tibial Osteotomy Surgery For Bow Legged Knee

Is Cartilage Restoration right for you?

So, who is the right candidate for a Cartilage Restoration procedure?  The ideal patient is young, active, and motivated.  These patients are typically considered too young for a partial or total knee replacement (18-45 years old) and are still involved in an active lifestyle such as team sports, running, hiking, biking, skiing, etc.  Patients who currently have pain in their knee with these activities are first assessed in the clinic and with x-ray images.  Typically, advanced imaging with an MRI is necessary to fully characterize the cartilage and the underlying bone.  If the surgery does not require a donor graft, then the surgical procedure can be scheduled right away.  If a donor graft is necessary, then this graft must be ordered, and surgery is not scheduled until a match is found, which usually takes 4-8 weeks.

Cartilage Restoration Recovery

Cartilage Restoration procedures do take some time to recover from – weeks to months – but the patients who are determined to follow the rehabilitation protocols have great outcomes.  The goal of Cartilage Restoration is to get patients back to the activities that they love to do without having a joint replacement.

Developed by the Colorado Springs Orthopaedic Group Sports Medicine Team

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The Anterior Cruciate Ligament (ACL) and Sports Injuries

The Anterior Cruciate Ligament (ACL) and Sports Injuries

We have all seen it before.  An athlete is running and attempts to change directions and suddenly falls to the ground.  They instinctively grab their knee.  What could have possibly caused an athlete who has made that same maneuver many times to fall so suddenly?  Before we answer the question, lets take a closer look at how our knees and the Anterior Cruciate Ligament are made and how they function.

knee anatomy, acl tear, acl anatomy, anterior cruciate ligament

ACL Anatomy

We often think of a knee as a simple hinge joint.  One that straightens and bends or extends and flexes.  The reality is much more complicated than that.  The knee has three planes of motion with six different directions!  Beyond flexion and extension there is also side to side motion as well as rotation.  Each step involves varying degrees of each of these motions.

Ligaments are the structures that attach bone to bone and provide stability to the knee while still allowing the freedom of movement needed to walk, jump, skip, or run.  There are four ligaments in our knee, the medial and lateral collateral ligaments on the inside and outside, and the anterior and posterior cruciate ligaments located in the middle of the knee.  The medial and lateral collateral ligaments keep the knee from bending too far inside or outside.  Alternatively, the anterior and posterior cruciate ligaments keep the knee from sliding too far forward or backward.  This combination of all four ligaments is what keeps our bones appropriately aligned and provides stability to our knees.

Functions of the ACL

Now let’s go back to our athlete.  One of the most common causes of sudden instability when changing directions is a tear of the Anterior Cruciate Ligament (ACL).  This happens because the ACL has two primary functions.  We have already talked about the first function, to keep the knee from sliding too far forward, this is medically known as Anterior Translation.  The other function of the ACL is to keep the knee stable during rotation.  The ACL and PCL are called “cruciate” ligaments because they cross over one another.  This orientation gives significant stability to rotation in the knee.  When an athlete plants their foot to change direction, the ACL is at maximum tension preventing both rotation and anterior translation.  When the force from the athlete’s pivot is too much, the ligament fails.  This causes sudden instability in the knee which can damage other structures in addition to the ACL.

One of the earliest symptoms of an ACL tear is significant swelling inside the knee joint.  Because the ligament is located inside the knee, the tear causes bleeding inside the joint resulting in large amounts of swelling.  It is often very difficult to walk immediately following an ACL injury.  Patients with torn ACLs will often say their knee feels tight and it may be difficult to bend or straighten their knee.

acl tear, acl anatomy, anterior cruciate ligament

Treatment Options for an Anterior Cruciate Ligament Injury

In the days following an Anterior Cruciate Ligament tear, the swelling will often subside, and motion will return.  Many people can walk without needing crutches or a brace.  Patients will often describe a sensation of feeling like their knee is unstable when they walk.  Unfortunately, a torn ACL will not heal on its own.  Our knee joint is filled with lubricating fluid that allows the joint to move smoothly.  This is great for motion but limits the ability of structures inside the knee to heal.  Because of the limited healing ability, the most typical treatment recommendation is an ACL reconstruction, or “rebuilding”, of the ligament, commonly performed using arthroscopic techniques.

There are two primary ways to rebuild the ligament.  For younger patients, the preference is typically to use the patient’s own tissue to reconstruct the ACL.  The most common tissue types used are the patellar tendon underneath the kneecap, hamstring tendon from the back of the thigh, or quadriceps tendon from the front of the thigh.  Each tissue, or graft, has its own strengths and weaknesses and all have been used with great success.  Surgeon and patient preference is often the deciding factor on which graft is best.  Another commonly used tissue is called an allograft.  This comes from a donor and is sterilized prior to the procedure to limit risk of infection or rejection.

Surgery typically takes 1-2 hours depending on the type of graft chosen and if any additional procedures need to be done at the same time as the reconstruction.  Treating an ACL tear without surgery is rare.  The lack of stability and increased motion in the knee following ACL injury is thought to increase risk of arthritis and additional damage in the future.

ACL Recovery Time

Postoperative ACL rehabilitation focuses on early range of motion and appropriate strengthening exercises to increase function while protecting the graft.  Full graft incorporation is thought to occur 6 months following surgery although some studies show that the graft continues to evolve even up to 1 year following surgery.  Objective criteria are typically used to guide return to sport protocols such as return of normal motion, strength the same as the other leg, and an appropriate time interval.

Good news for our athlete, Anterior Cruciate Ligament tears are commonly treated successfully, and athletes often return to the same type of sports activities.  While the road to recovery may take several months, we can often expect to see that athlete competing at a high-level by the next season.

Developed by Dr. Craig Yager, Board Certified Sports Medicine Surgeon

ACL Injury Prevention with Tessa Kothe, DPT

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Spinal Cord Stimulation (SCS) for Diabetic Neuropathy

Spinal Cord Stimulation (SCS) for Diabetic Neuropathy

In this Medical Minute, Dr. Roger Sung discusses a new drug-free treatment, Spinal Cord Stimulation (SCS) for diabetic neuropathy. We will discuss what diabetic neuropathy is, what spinal cord stimulation (SCS) is and how it works to treat Diabetic Neuropathy, and what to expect post-operation.

What is Diabetic Neuropathy?

Diabetic neuropathy is a type of nerve damage that is caused by high blood sugar within the body. This high level of blood sugar can injure nerves most commonly the nerves in the legs and feet. Symptoms generally include numbness or pain, but can also include digestive track issues, urinary tract issues, and issues with the blood vessels and heart.

For some individuals, symptoms are mild, but in some, more extreme cases can be extremely painful and disabling. According to the Mayo Clinic, nearly 50% of individuals with diabetes experience burning, tingling, and numbness associated with diabetic specific neuropathy.

If you or someone you know is struggling with painful diabetic neuropathy, this new drug-free treatment offered at Colorado Springs Orthopaedic Group may be an option.

What Drug-Free Treatment for Diabetic Neuropathy is available?

Spinal Cord Stimulation (SCS) for Diabetic Neuropathy. Man in flannel and jeans putting on new shoes while old shoes while struggling with neuropathy symptoms. Potential candidate for spinal cord stimulation trial

In collaboration with Nevro, a medical device company focused on individualized solutions for those suffering from chronic pain, we at Colorado Springs Orthopaedic Group are proud to offer the latest technology advancement, HFX™ for Painful Diabetic Neuropathy (PDN), a drug-free treatment addressing PDN through use of advanced spinal cord stimulation technology. Spinal cord stimulators (SCS) are electronic devices implanted against the spinal cord to disrupt nerve signals that are sent to the brain and cause pain. Through settings on the device’s remote control, patients can independently control their pain levels and find relief from living with PDN.

Studies have shown patients who have tried HFX™ for PDN, received 76% pain relief within the first six months of implantation. While there are some medication options to treat diabetic neuropathy, these medications generally have side effects. We believe this innovative treatment is a great Drug-free option for patients experiencing the pain and discomfort associated with PDN.

What does the Spinal Cord Stimulator Operation Entail?

After a thorough evaluation with one of our Board-Certified Spine Surgeons, they will determine if a patient is an appropriate candidate for HFX™ for PDN. If the patient and Surgeon agree to move forward with this treatment option, the surgeon will schedule the patient for an initial 7-day trial of the device. During the trial procedure, the surgeon will implant a temporary spinal cord stimulator along the patient’s spine and provide them with the tools and education to independently manage their pain throughout the next week. These trials allow patients to experience the device before they commit to receiving the permanent implant.

If the trial spinal cord stimulator implant is determined be an effective treatment for that patient, they will schedule the patient for their outpatient procedure that implants the permanent version of the device.

What is the Recovery Time for Spinal Cord Stimulation (SCS)?

The recovery time for the spinal cord stimulation implant operation is about six weeks however, many Patients are only generally sore for about one week. Moderate activity is limited during this time and strenuous activity is restricted for approximately six weeks post-operation to ensure that the device is received well, and the body has time to heal. Despite this recovery time, patients can feel pain relief in as little as a few days after their operation.

If you would like to see if this drug-free treatment can benefit you, call the Colorado Springs Orthopaedic Group at (719) 632-7669 to schedule a consultation!

Dr. Roger Sung, MD Colorado Springs Orthopaedic Group

Roger D. Sung, MD

Dr. Sung is a Fellowship-Trained and Board-Certified Orthopedic Surgeon who specializes in Cervical, Thoracic, Lumbar, and Sacroiliac surgery, Microsurgery, and Minimally Invasive Spine Surgery techniques. He also performs complex spine reconstruction using minimally invasive techniques.

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Nevro Testimonial

Spinal Cord Stimulation Review: Nevro Testimonial

Spinal Cord Stimulation review answering the question, does spinal cord stimulation work?

“Thanks to HFX*, I no longer manage my day based on when I need to take the next pain pill,”

said John, whose back pain began in 2003 when he was injured while overseas with the military. In 2016, thirteen years after his initial injury, John underwent a spinal fusion but was then in a serious car accident that caused his back and leg pain to return.

John had been an active guy who played competitive hockey, participated in highly physical activities during his military career and kept up with his four young children. “However, my progressive back and leg pain reduced my activity level to almost nothing,” he explained. “I had to walk with a cane and take medication to control my pain level.”

After many other attempts to find relief, John was referred to Dr. Roger Sung, who recommended an HFX trial. “I had such significant pain relief during my April 2019 trial that it was like night and day,” John said. “I was even able to drastically reduce my doses of pain medications.” He decided to move forward with his HFX implant in June 2019.

“I have had 60-70% pain relief consistently with HFX and no longer walk with a cane or take medication,” John said. “I have truly regained my life with HFX.”

This is just one spinal cord stimulation review on the Nevro SCS system specifically.  See what other patients have to say as they give their Spinal Cord Stimulation Reviews on our YouTube channel. Learn More about the Nevro SCS systems at www.NevroHFX.com

Spinal cord stimulation review

#NevroHFX #ChronicPain

Results may vary. Important safety & risk information: www.nevrohfx.com/safety

*HFX is a comprehensive solution that includes a Senza spinal cord stimulation system and support services for the treatment of chronic pain

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What is an MRI and When is an MRI Needed?

What is an MRI & When is an MRI Needed?

Welcome to a Medical Minute segment with Dr. David Matthews a board-certified physician at the Colorado Springs Orthopaedic Group as he discusses what is an MRI is & when MRIs are needed.

What is an MRI?

MRI (magnetic resonance imaging) is a way of using magnetic gradients and radio waves to capture images within specific areas of the human body.

When does a patient need an MRI?

Dependent upon the location and severity of an injury, there are cases where an x-ray image cannot detail the condition of soft tissues such as ligaments or tendons. Therefore, your physician may order an MRI to deeper evaluate the condition of such tissues.

How are they used in orthopedics?

MRIs are often ordered by your physician soon after your initial evaluation to capture detailed images of the injured body part and assist your physician with developing your individualized treatment plan.

An MRI machine to see what an MRI is and when an MRI is needed

What are the risks of an MRI?

As MRI machines are comprised of extremely high-powered magnets, it is required to remove any metals from your body prior to entering the machine. This may also include any implants or pacemakers therefore, it is crucial for patients to inform their physician and MRI technician of any implanted devices prior to scheduling an MRI. If the metal on your person is removable and all metal objects are removed prior to entrance, then the risks of having an MRI are minimal. Please call our MRI department at 719-867-7315 with any questions you have or to schedule your appointment.

Visit www.CSOG.net to learn more.

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What is Arthroscopic Surgery?

What is Arthroscopic Surgery? Medical Minutes with Dr. Jones

Welcome to a Medical Minute segment with Dr. Christopher Jones, a board-certified physician at the Colorado Springs Orthopaedic Group as he discusses the common question: ‘What is Arthroscopic Surgery?’

What is Arthroscopic Surgery?

Arthroscopic surgery is a minimally invasive technique where the physician accesses the joint through small incisions with a pencil-sized camera. This small camera allows the surgeon to see within the joint and repair the injured structures without making large incisions. This allows for quicker recovery times, and studies have shown improved long-term patient outcomes using this technique. Arthroscopic surgery is typically used to treat larger joints such as the shoulder, hip, knee, ankle, and some cases the thumb joint.

Is arthroscopic surgery better than traditional surgery?

Dr. Jones believes it depends on what injury needs to be treated and the severity of such injury when deciding between traditional or arthroscopic surgical techniques. There are some surgeries that provide better outcomes when using arthroscopically such as rotator cuff tears, ligament tears within the shoulder, and meniscus tears within the knee. However, other surgeries such as joint replacements or spinal surgeries are typically performed by way of traditional or alternative minimally invasive surgical methods.

To learn more about arthroscopic surgery options or to schedule an appointment with any one of our 16 fellowship-trained Orthopedic Physicians, call us at (719) 632-7669.

Meet Our Providers

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Dr. Stockelman’s professional interests include simple and complex problems of the shoulder and the knee.

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Joint Cartilage Restoration in Colorado Springs

Joint Cartilage Restoration in Colorado Springs

Many Colorado Springs patients may wonder if joint cartilage restoration is the best treatment option for their joint issues. Joint pain and stiffness can be quite debilitating and worsen over time. Most people experience cartilage problems in their knees. However, it can also occur in the shoulder, elbow, hand, wrist, ankle, or hips. Unfortunately, cartilage does not heal on its own due to the lack of direct blood supply. One treatment for a cartilage injury or disease is to restore the cartilage rather than replace the joint.

If you are experiencing joint pain caused by cartilage damage, call us today to schedule a consultation and discuss treatment options with one of our Cartilage Restoration Specialists at Colorado Springs Orthopaedic Group. We can provide you an accurate diagnosis to determine the cause of your problem. We can also recommend an optimal treatment plan to help you become pain-free and active again. Call 719-632-7669 to schedule.

Below you will find additional information on the various Cartilage Restoration treatment options for joint pain offered at Colorado Springs Orthopaedic Group.

Causes

The general causes of cartilage damage include chronic or acute injury, trauma, disease, or degeneration. In all cases, the cartilage has been compromised and no longer provides smooth gliding or cushioning of the joint.

Cartilage Injury or Trauma:

If you fall or sustain a traumatic sports injury, you can tear or separate joint cartilage. Usually, the pain will be sharp and sudden. It is also possible to damage ligaments or tendons in the joint area at the same time. Thus, the pain, inflammation, and stiffness you experience could be caused by compounding injuries. Your joint may also lock-up, give way, or feel unstable when trying to bear weight on it.

Cartilage Disease or Degeneration:

Arthritis, specifically osteoarthritis, is the most common cause of joint pain. With arthritis, the cartilage is damaged and inflamed from long-term wear and tear. Sometimes the pain is persistent. Other times it can come and go, even while resting. Most often, the pain worsens when you try to use the joint or place weight upon it. You may also experience a grinding or clicking sensation. These symptoms can be exasperated by living a high-impact, rigorous lifestyle or by carrying extra body weight. To some degree, cartilage degeneration can be genetic.

Other Joint Issues That Have Similar Symptoms

Rheumatoid arthritis: Rheumatoid arthritis (RA) is a disease where your immune system attacks the lining of your joints. RA can cause pain and disfigurement.

Gout: Gout is caused by the buildup of uric acid in the joint. The acids crystalize and cause a flare-up of sudden and intense pain. Gout is common in the knees, fingers, and toes.

How to Restore Cartilage in Joints Naturally

Cartilage does not have a direct blood supply to bring healing nutrients to the tissue therefore, it generally does not heal on its own. In some cases, conservative treatment methods such as physical therapy can help with strengthening a joint, taking pressure off of the damaged cartilage however, if the damage or degeneration is too severe, surgery may be required to restore function and decrease the associated pain.

Cartilage Restoration Joint Surgery

With Cartilage Restoration Joint Surgery, your physician may elect to repair the damaged cartilage in one of two ways:

Cartilage Repair
The damaged cartilage may be removed using certain techniques, and the bone is resurfaced, like “repaving a street.” During the operation, the physician may use different innovative systems to accomplish this such as MACI©, DeNovo© (Zimmer-Biomet), or Biocartilage/Cartiform© (Arthrex). When the MACI© procedure is used, cartilage cells are retrieved from the patient, sent to a lab for processing, and later implanted back into the same patient to provide a smooth surface of their own cartilage. With the other options, cartilage cells from a donor are used to fill in the defect and provide an even cartilage surface. In both cases, the joint biology is restored, leaving no area of damaged cartilage.

Cartilage Reconstruction
If the bone underneath the cartilage is also damaged, the physician may perform a cartilage reconstruction procedure, similar to “filling in the pothole.” If the lesion is small, then healthy cartilage from an unused part of the knee may be transplanted to the area that needs it. This procedure is called an Osteochondral Autograft Transplant (OATs). For larger areas of damage, you may need a donor “plug” to fill in the defect. This procedure is called Osteochondral Allograft Transplantation (OCA). In both cases, the joint surface is restored with new cartilage and underlying bone.

Procedure

Typically, cartilage restoration joint surgeries can be done arthroscopically or with minimally invasive techniques. This means your physician will insert a camera called an arthroscope through small incisions made around the joint allowing the physician to see in detail within the joint. Minimally Invasive procedures are procedures where smaller incisions, compared to traditional open surgeries, are made allowing for less damage to the surrounding structures and for the body to heal at an accelerated rate, inevitably shortening the recovery time. These minimally invasive procedures also decrease the chance of infection and typically reduce scarring.
A typical joint restoration surgery can take anywhere between 1 to 4 hours to complete and is usually an outpatient procedure that allows you to recover in the comfort of your own home, the same day as surgery.

Our Cartilage Restoration Doctors

At Colorado Springs Orthopaedic Group, we are fortunate to have highly skilled and compassionate cartilage restoration joint surgeons who specialize in the diagnosis and treatment of all conditions affecting the joints and associated cartilage.

Jamie L. Friedman, MD

Jamie L. Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.
> Jamie L. Friedman, MD

 

 

Cartilage Restoration Near Me

We have two cartilage restoration surgery centers in Colorado Springs:

North Location
4110 Briargate Parkway, Suite 300,
Colorado Springs, CO 80920
(719) 867-7320

South Location
1259 Lake Plaza Drive, Suite 100,
Colorado Springs, CO 80906
(719) 622-4524

Is Joint Cartilage Restoration Right for You?

Contact us today at 719-632-7669 to schedule a consultation and learn if cartilage restoration for joint pain is right for you. We are ready and dedicated to helping you get pain-free!

Visit us at www.csog.net to learn more.

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Rotator Cuff Injuries & Surgery with Dr. Jones

Rotator Cuff Injuries & Surgery with Dr. Jones

Welcome to a Medical Minute segment with Dr. Christopher Jones, a board-certified physician at the Colorado Springs Orthopaedic Group as he discusses rotator cuff injuries & surgery and what to do if you suspect an injury to your rotator cuff.

What muscles are involved within the rotator cuff?

The rotator cuff is composed of four muscles that surround the shoulder joint and keep it in place. Those four muscles are:

    • Supraspinatus
    • Infraspinatus
    • Teres minor
    • Subscapularis

The Supraspinatus is by far the most common tear that Dr. Jones’ sees in patients. This is the tendon that is right on top of your shoulder.

What is the difference between a rotator cuff tear and a rotator cuff tendonitis?

Most rotator cuff tears result from overuse or recurrent injuries. Over time, without proper treatment, these recurring minor injuries can result in rotator cuff tendonitis. Most patients who have rotator cuff tendonitis experience pain, especially when weightlifting or when lifting objects in specific directions such as overhead or in front of the body. Those with suspected rotator cuff tears may experience a much more intense pain and can sometimes feel a crunching or popping when they move the shoulder in various directions.

Does a rotator cuff tear require surgery?

There are patients who have rotator cuff tears who do not need surgery. Some may not even know when they have a rotator cuff tear as pain intensities will vary person to person. Dr. Jones’ believes the first step to recovery is to always try conservative treatment options prior to discussing surgery. These conservative treatment options may include physical therapy or injection therapy to control pain and strengthen the supporting shoulder muscles.

What is the timeframe for athletes to play sports again after a rotator cuff tear?

All patients should take excessive caution for the first three to four months after surgery as the shoulder joint will take time to mature and heal. Additionally, the better the patient’s overall health, the better the healing process will go. Recovery time to get back to full activity without restrictions is estimated to take between six to twelve months.

What are the symptoms of a rotator cuff tear?

Symptoms of a rotator cuff tear include pain with lifting, especially if a patient is lifting something out away from their body or overhead. Another symptom is pain at night that either wakes them from their sleep or prevents them from falling asleep entirely.

To learn more about rotator cuff injuries and custom-tailored treatment options visit us at www.CSOG.net. To schedule an appointment, please call (719) 632-7669.

Meet Our Providers

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Dr. Stockelman’s professional interests include simple and complex problems of the shoulder and the knee.

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Accelerated Recovery Knee Replacement Surgery

Accelerated Recovery Knee Replacement Surgery

Welcome to a Medical Minute segment with fellowship-trained, board-certified Joint Replacement Surgeon, Dr. Michael Feign, DO of Colorado Springs Orthopedic Group (CSOG). Join Dr. Feign as he discusses accelerated recovery knee replacement surgery and how technology advancements of Total Knee Replacement have accelerated the recovery processes as well as how to determine a successful surgery. Learn more about how to schedule an initial consultation with one of the Joint Replacement Specialists within the Comprehensive Joint Replacement program at CSOG.

Within the last 15 years, there have been many innovative technological advancements specific to Total Knee Replacement procedures. Since their initial development, a knee replacement surgery generally entails resurfacing an arthritic surface by placing an implant on top of the surface, providing the patient with better mobility, smoother motion within the joint, and less overall pain. With a 96-98% success rate, these procedures are used to help qualified patients get back to the activities they love to do as quickly as possible. The method of replacing an arthritic joint with an implant has not changed significantly in recent years however, advances in the material used for implants and the customization of each implant have shown to drastically improve patient outcomes when accompanied by advancements within pre- and post-operative patient care.

With traditional procedure technologies, patients were required to stay within the surgical facility for upwards of 5-6 days after surgery with little to no movement or physical therapy performed during at least the first 3-4 days. Now, with new technological advancements, patients may be required to stay at the facility for one night, with many patients capable of going home on the same day. This allows for those patients to recover in the comfort of their own home. In most cases, patients will now move around and perform low intensity physical therapy just hours after surgery. Incorporating this movement immediately after surgery is a key piece in initiating the recovery process.

The most influential changes within Total Joint Replacement procedures and the piece that has helped accelerate the recovery process, has been advancements within individualizing pre- and post-operative patient care. These advancements include how surgeons are able to prepare and customize implants prior to surgery, improvement within the process of preparing the patient for surgery when administering anesthesia, optimizing the patient’s health, strength and mobility before surgery through individually prescribed physical therapy, as well as improvements in post-operative pain management through the use of temporary nerve blocks and pain pumps.

Even though the outcome of these surgeries has been great for many years, Dr. Feign and his team are always trying to improve techniques to ensure the best outcomes and overall patient satisfaction. Measurement of a successful procedure can vary from physician to physician. Dr. Feign believes success occurs through use of a quality implant, the surgeon being well trained, the implant being well balanced, the right size and right positioning for the patient, as well as optimizing the patient and their individual needs to obtain their most optimal health. He personally measures a procedure’s success by frequently checking in with patients, even years after their procedure, and ensuring that same person is doing well with the same knee replacement and continues to do so 10 -15 years down the road.

The average recovery time for a knee replacement generally takes about one year. Within two to three months, most patients are back to doing normal day to day activities without assistance from others.

For more information or to schedule an appointment with one of the Joint Replacement Specialists of the Comprehensive Joint Replacement Program at Colorado Springs Orthopaedic Group, call (719) 632-7669 or visit www.CSOG.net.

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Orthopaedic Walk-In Clinic Colorado Springs

Orthopaedic Walk-in Clinic in Colorado Springs

Welcome to a Medical Minute segment with Dr. Eric Jepson, fellowship-trained, board-certified Orthopedic Joint Replacement specialist as he discusses the walk-in orthopaedic Express Care clinic at Colorado Springs Orthopedic Group where no appointment is needed and we’ll have you in and out within half the time of the ER.

Express Care is an Orthopedic Urgent Care located within Colorado Springs Orthopedic Group. We are here to help expedite the treatment process of any acute or sudden-onset injuries.

Come on into our Walk-In Clinic

Often times, after someone has experienced an injury, they will go to the emergency department and wait upwards of several hours to be seen. Instead, you can be evaluated and initially treated by the providers at CSOG’s Express Care for the same injuries in half the time. After initial evaluation and treatment, each patient seen in Express Care is then scheduled for a follow up visit with one of our 18 fellowship-trained orthopedic specialists. During this follow-up visit, our specialists will review any x-ray images and further develop your customized treatment plan.

Please note, if you have a significant and emergent injury, it is recommended that you go to the emergency department.

Some of the many common injuries we see within our Express Care clinic include:

  • Ankle sprains and fractures
  • Hand, wrist, and upper extremity injuries
  • Sports injuries
  • We can also help if a new back pain symptom presents itself.

Sports Physicals

We also offer Sports Physicals for all local school districts for only $25. No insurance or appointment needed.

When seen within Express Care, you are guaranteed to be treated properly and efficiently by one of our highly trained orthopedic providers. Additionally, you do not need a referral to be seen within Express Care.

Where to find us

Our Express Care clinic is located at 4110 Briargate Parkway. Across the parking lot from Memorial North and Children’s Hospitals on the first floor within suite 145.

We are open Monday through Friday from 9 a.m. to 5 p.m., Saturdays from 8 a.m. to 12 p.m., and are closed on Sundays.

To learn more about the Express Care at Colorado Springs Orthopaedic Group, call us today at (719) 632-7669 or visit www.csog.net.

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Knee Cartilage Restoration In Colorado Springs

Knee Cartilage Restoration in Colorado Springs

Colorado Springs Orthopaedic Group is now offering several advanced knee cartilage restoration procedures to save patients from an early joint replacement. With knee cartilage restoration, the joint can be reconstructed or resurfaced, which helps the patient return to normal activities without pain. These surgical procedures have been successful in elite athletes and active adults, allowing them to return to their sport without any restrictions.

You might ask, ‘can cartilage be restored?’ Cartilage lacks a direct blood supply necessary to heal on its own; however, cartilage restoration procedures provide a viable option to restore cartilage to a fully functional state.

Below you will find additional information on the various Cartilage Restoration treatment options for joint pain offered at Colorado Springs Orthopaedic Group.

Cartilage Restoration Surgery in Colorado Springs

Dr. Jamie Friedman, fellowship-trained Sports Medicine physician is specifically trained to perform advanced Cartilage Restoration procedures.

Surface Cartilage Lesions
These occur when the cartilage damage extends only to the surface of the cartilage and has not affected the underlying bone. There are two primary procedures to address this type of injury:

  • Biocartilage allograft transplantation:: is a single procedure that can be done arthroscopically or as an open procedure. During the operation, Dr. Friedman utilizes one of several innovative systems to take cartilage cells from a donor and places them within the area of damaged cartilage to fill in the defect, providing an even cartilage surface for the bones to move smoothly across. This restores the joint biology, leaving no damaged cartilage.

Procedure 1

Cartilage defect of the trochlea
(underneath the knee cap)

Procedure 2

Cartilage defect debrided for clean edges

Procedure 1

New cells implanted and sealed with fibrin glue

  • Autologous Cell Implantation:This is a two-stage surgery however allows the patient’s own cells to be used. During the operation, Dr. Friedman utilizes an innovative system called MACI©. When the MACI© system is used, cartilage cells are biopsied from the patient, sent to a lab, and later implanted back into the same patient to provide restored cartilage. The surgery to harvest the cells is done arthroscopically, while the implantation is done as a minimally invasive open surgery through a small incision.

Below are examples of MACI© on the Medial Femoral Condyle:

Biopsy of cartilage from a place that doesn’t use it

Biopsy of cartilage from a place that doesn’t use it

Debridement of two separate lesions on the condyle

Debridement of two separate lesions on the condyle

Implantation of the cells grown from the biopsy

Implantation of the cells grown from the biopsy

Structural Cartilage Lesions

When the damage extends past the cartilage and affects the underlying bone, there are two types of procedures to treat this injury:

  • Osteochondral Autograft Transplantation (OATs):used for smaller lesions and is not used on the patella. As shown below, the Osteochondral Autograft Transplantation takes a cartilage “plug”, or a bone graft with cartilage, from a different place in the patient’s knee, and Dr. Friedman puts it into the defect.
  • Osteochondral Allograft Transplantation (OCA):This procedure works for larger lesions. In fact, this procedure can be used to do BioUni, which covers the entire condyle similar to a partial knee replacement. This method can work on almost any surface of the knee, including the patella. The Osteochondral Allograft Transplantation works by taking a cartilage “plug” from a donor that matches the same contour and places it into the defect. Below is an example of OCA on a patella:

Large cartilage defect under the patella

Large cartilage defect under the patella

The defect is debrided to make room for the graft

The defect is debrided to make room for the graft

A cartilage graft is placed into the defect

A cartilage graft is placed into the defect

Below is an example of OCA on the medial femoral condyle:

Large cartilage defect of the medial femoral condyle

Large cartilage defect of the medial femoral condyle

Debridement of two separate lesions on the condyle

A cartilage graft is placed into the defect

Malalignment of the Leg

There are two types of coronal malalignment of the leg:

  • Valgus Malalignment of the Knee:This is where a patient is too “knock-kneed”, which causes excessive pressure on the outside, or lateral, part of the knee. Dr. Friedman uses a distal femoral osteotomy to correct this. Below are before and after images of the distal femoral osteotomy procedure.

This leg is too “knock-kneed”, which causes too much pressure on the outside of the knee

This leg is too “knock-kneed”, which causes too much pressure on the outside of the knee

After the procedure, the leg is more straight

After the procedure, the leg is more straight

  • Varus Malalignment of the Knee:This is where a patient is too “bow-legged”, which causes a lot of pressure on the inside, or medial, part of the knee. Dr. Friedman uses a high tibial osteotomy to correct this. Below are before and after images of this procedure.

This leg is too “bow-legged”, causing too much pressure on the inside of the knee

This leg is too “bow-legged”, causing too much pressure on the inside of the knee

After high tibial osteotomy, the leg is more straight

After high tibial osteotomy, the leg is more straight

Our Cartilage Restoration Doctors

At Colorado Springs Orthopaedic Group, many of our physicians have extensive training and experience in knee cartilage restoration surgery and will ensure your treatment is a seamless process.

Jamie L. Friedman, MD

Jamie L. Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.
> Jamie L. Friedman, MD

 

Cartilage Restoration Near Me

We have two convenient cartilage restoration clinics in Colorado Springs:

North Location
4110 Briargate Parkway, Suite 300,
Colorado Springs, CO 80920
(719) 867-7320

South Location
1259 Lake Plaza Drive, Suite 100,
Colorado Springs, CO 80906
(719) 622-4524

Is Joint Cartilage Restoration Right for You?

Learn if you are a candidate to restore cartilage in the knee or another joint and call 719-632-7669 to schedule an appointment at CSOG for a medical evaluation and consultation.

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ACL Tears & Reconstruction with Dr. Jones

ACL Tears & Reconstruction with Dr. Jones

Welcome to a Medical Minute segment with Dr. Christopher Jones, a board-certified physician at the Colorado Springs Orthopaedic Group as he discusses ACL tears and reconstructions.

What is the ACL?

The ACL is one of the four main ligaments within the knee joint and is the commonly injured ligament within the knee. The ACL’s role is to provide stability when performing movements such as pivoting or twisting.

How does an ACL tear occur?

Many ACL tears arise from sports related injuries such as skiing, court sports, or field sports. These injuries can occur through non-contact and contact related incidents. An example of a non-contact ACL injury is when an athlete is running, they plant their foot and then pivot without rotating the planted foot with the upper leg causing excessive strain on this ligament. ACL injuries can also be from contact incidents such as a slide tackle in soccer, where another player hits the player’s knee in the opposing direction from which the player’s body is already moving.

How can an athlete prevent an ACL injury?

Proper conditioning and strengthening programs can help prevent ACL tears. There are even specific ACL prevention programs offered that teach how to jump, land, and cut, building the surrounding muscle tissue to support these ligaments within the knee. Training movement patterns in the lateral plane of motion is a great place to start with ACL injury prevention.

What do I do for an ACL tear?

One of the worst things you can do after an ACL tear is wait a few weeks until your knee starts feeling better, the swelling has dissipated and then the patient tries to perform the same activities that lead to injury. As ligaments have a reduced blood supply in comparison to their surrounding musculature, in many cases continuing activity without treatment could potentially lead to further extensive damage. Dr. Jones sees this occur quite often and urges patients to seek orthopedic medical attention, especially if you feel a ‘pop’ during initial injury. Our fellowship-trained Sports Medicine Program Physicians at Colorado Springs Orthopaedic Group specialize in ACL repairs and reconstructions. Give us at call at 719-632-7669 or visit our Walk-in Express Care Clinic if you suspect an ACL tear.

What are ACL treatment options?

The majority of ACL tears will require either an ACL Repair or ACL Reconstruction surgery to ensure proper healing and prevent future instability within the knee. Your physician will recommend the best ACL treatment option dependent upon the severity of the initial tear. With an ACL repair, the surgeon will reattach the torn ligament to its corresponding boney structure through use of minimally invasive arthroscopic techniques. During an ACL reconstruction, the most common ACL treatment, the surgeon will replace the damaged ligament with a new ligament either from another part of the patient’s body or from a donor using minimally invasive arthroscopic techniques.

To learn more about ACL injuries, or to schedule an appointment with one of our fellowship-trained orthopedic surgeons at Colorado Springs Orthopaedic Group, please call (719) 632-7669.

Meet Our Providers

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Dr. Stockelman’s professional interests include simple and complex problems of the shoulder and the knee.

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Shoulder Fractures with Colorado Springs Orthopaedic Group

Shoulder Fractures with Colorado Springs Orthopaedic Group

Welcome to a Medical Minute segment with Dr. Christopher Jones, MD, fellowship-trained, board-certified Orthopedic Sports Medicine Surgeon as he discusses shoulder fractures, how technology advancements have influenced the treatment process, and the typical recovery time to heal from a clavicle fracture.

What is the most common type of shoulder fracture?

The most common shoulder fracture that Dr. Jones’ and his team sees are clavicle fractures. Mountain biking is very common in the Colorado Springs community and people fall off their bikes and break their clavicles quite often.

If someone hurts their shoulder, at what point should they be seen by a physician?

If someone has broken their clavicle, they are going to feel it, hear it, and therefore know it. They are going to feel pain and there may be some visible evidence of deformity, significant bleeding, bruising, or tenting of the skin. Anyone experiencing these symptoms should be seen right away.

How has the treatment process of clavicle fractures changed over time?

There have been quite a few improvements to how clavicle fractures are treated now vs traditional methods. Historically, clavicle fractures were treated non-operatively. However, in recent studies, physicians are finding that these fractures typically do not heal as well as they thought they did when left untreated. During the injury evaluation process, there is a certain criteria that needs to be looked at such as x-rays, skin, and other things that would tell a physician if the patient needs surgery. Dependent upon these findings, the physician will develop a customized treatment plan to ensure efficient healing.

What type of procedure is used to treat clavicle fractures?

The clavicle will typically break in three different areas – either in the mid-shaft, which is the most common type of clavicle fracture, medial, and/or lateral segments of the bone. Treatment plans will vary drastically based on where the fracture is located however, plates and screws are the most commonly utilized tools to stabilize and piece the fracture back together. In some cases, a rod is inserted down the center of the bone.

What is the recovery time?

The average healing time of a clavicle facture that has not been treated operatively is approximately 16 weeks. Treating a clavicle fracture operatively significantly reduces the recovery time down to an average of 12 weeks. Recovery will vary dependent upon a patient’s diligence with their prescribed post-operative physical rehabilitation protocols.

To schedule your initial consultation, call us today at 719-632-7669.

To learn more about the comprehensive services available at Colorado Springs Orthopaedic Group, visit www.CSOG.net

 

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Minimally Invasive Foot Surgery with Dr. Alex Simpson

Minimally Invasive Foot Surgery

Welcome to a Medical Minute segment with G. Alex Simpson, DO, Orthopedic Foot and Ankle Surgeon with Colorado Springs Orthopaedic Group as he discusses the latest advancements in Minimally Invasive Foot Surgery and how these techniques can be used to treat many painful foot conditions.

What is Minimally Invasive Surgery?

Minimally Invasive Surgery (MIS) is described from Dr. Simpson as “how we can operate on a patient without making a big incision.” With smaller incisions, there is less damage done to any surrounding structures which allows for decreased recovery time, minimized pain, and a much lower risk for infection.

What conditions can Minimally Invasive Foot Surgery be used for?

There are many different types of painful foot conditions and injuries where minimally invasive foot surgery specifically can be used for treatment. Some of which include:

  • Hammertoes
  • Bunions
  • Tendon injuries
  • Cartilage injuries
  • Plantar fasciitis

Talk with your physician to see if you might be a candidate for minimally invasive foot surgery as eligibility may vary case to case dependent on the severity of injury as well as the patient’s overall health. In most cases minimally invasive surgeries are an outpatient procedure, allowing the patient to go home and recover the same day as surgery.

How do these innovative surgery techniques help recovery?

Minimally invasive surgery techniques have been shown to help accelerate the recovery and rehabilitation process as well as significant improvements in outcome longevity. Recovery timelines will vary as mentioned previously due to the patient’s overall health, the type of injury treated, and the severity of the foot condition. However, being that we are eliminating the need for a large incision, generally speaking recovery is typically a little bit shorter with minimally invasive surgery because we decrease the time it would take to heal a larger incision. Again this does depend on a number of case specific factors and is not quantifiable in set timelines.

Learn More

If Minimally Invasive Foot Surgery is of interest to your painful foot condition, give us a call today at 719-632-7669 to schedule with a specialist from our Foot and Ankle Center team. They will help determine if Minimally Invasive Foot Surgery is the right treatment for you.

Visit the CSOG Foot and Ankle Center to learn more.
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Ankle Replacement vs Ankle Fusion in Colorado Springs

Ankle Replacement Vs Fusion in Colorado Springs

Welcome to a Medical Minute segment with G. Alex Simpson, DO, Board Certified Orthopedic Foot and Ankle Specialist at Colorado Springs Orthopaedic Group where he discusses ankle replacement vs fusion procedures. In this segment Dr. Simpson also discusses injuries that can initiate the onset of arthritis in the ankle.

During an ankle fusion, the surgeon will fuse the ankle bones together disabling movement within the joint. The goal of this procedure is to decrease pain within the joint. Alternatively, an ankle replacement replaces the tibiotalar joint (ankle joint) where your shinbone (tibia) sits on top of your foot bone (talus). This procedure does allow for movement within the joint after surgery.

Both Ankle Fusions and Ankle Replacements can be used to treat arthritis in the ankle.

What to Expect

After discussing symptoms and reviewing diagnostic imaging, your physician will work with you to develop a detailed treatment plan comprised of the most efficient treatment method to fit your needs. The right treatment typically varies upon:

  • Your natural anatomical bone placement
  • Your body’s natural movement translation within the joint
  • Quality of bone density
  • Your routine physical activity habits.

For those not eligible for a replacement, an ankle fusion remains a great treatment option for ankle arthritis.

Some examples of injuries that may lead to the onset of ankle arthritis include:

  • A bad ankle sprain that was never been treated
  • An ankle break where the bones are out of position for any period of time and where they may have healed in an abnormal way.
arthritis in the ankle treated with Ankle Replacement vs Fusion

How We Can Help

At CSOG, we offer a wide variety of services that can help patients accelerate their recovery processes. At both locations, our Audubon Orthotic and Prosthetic Services team can custom fit you to any necessary braces, orthotics, or stability boots. We also offer injection therapies, such as cortisone injections and in-house physical therapy services as conservative treatment options. These conservative options, specifically physical therapy, can help delay the onset of arthritis in the ankle as well as help accelerate your rehabilitation post-surgery.

If you’re curious as to which procedure, an ankle replacement or ankle fusion, is best for you, give us a call at 719-632-7669 today to schedule a consultation with one of our Foot and Ankle Specialists.

Visit the CSOG Foot and Ankle Center to learn more.

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Cartilage Restoration Procedures in Colorado Springs

Cartilage Restoration Procedures in Colorado Springs

Articular cartilage is a smooth, white tissue that acts as a cushion between specific bones and allows your joints to move smoothly. When compromised due to traumatic or overuse injuries, you may experience significant pain and restricted mobility. Unfortunately, cartilage lacks a direct blood supply therefore, it does not heal on its own when damaged. Without treatment or alteration in perpetual activities, this can lead to the onset of early arthritis. However, with technological advancements, such as cartilage restoration procedures, joint preservation is possible for active individuals who may be too young to qualify for a joint replacement or would prefer not to receive a total joint replacement.

Fellowship-trained Sports Medicine Physician, Dr. Jamie Friedman of Colorado Springs Orthopaedic Group, is specifically trained in several advanced Cartilage Restoration procedures addressing:

  • Treatment for Surface Cartilage Lesions
    • Autologous cell implantation
    • Biocartilage cell allograft implantation
  • Treatment for Structural Cartilage Lesions
    • Osteochondral Autograft Transplantation (OATs)
    • Osteochondral Allograft Transplantation (OCA)
  • Treatment for Malalignment of the leg
    • High Tibial Osteotomy (HTO)
    • Distal Femoral Osteotomy (DFO)

With Cartilage Restoration, the joint can be resurfaced or reconstructed to a natural smooth surface allowing the patient to return to their normal activities with reduced or non-existent pain.

“I’m excited to bring Cartilage Restoration procedures to Colorado Springs. We have such an active population here, and nobody wants to be limited by joint pain. My goal is to get both the elite athlete and weekend warrior back to the activities they love. Cartilage Restoration makes this possible with minimally invasive techniques that provide many years of unrestricted activity without pain. Saving a patient from an early knee replacement is very rewarding.”
– Dr. Jamie Friedman, MD.

Cartilage Restoration Surgery

Cartilage Restoration is a treatment option that can delay or prevent the need for joint replacement surgery especially in younger adults. Each procedure type replaces the damaged cartilage and provides the knee joint with both the necessary shock absorbing and smooth gliding mechanisms to allow activities performed by the patient to occur without pain.

The best candidates for Cartilage Restoration surgery can range; however, are most commonly active young adults or those who have severe pain and are too young for a partial or total knee replacement.

Cartilage Damage Symptoms

Common causes of cartilage damage include repetitive wear and tear on the joint, a traumatic injury, or a sports injury. With sports or traumatic injuries, the twisting or jarring of the joint can cause the cartilage to tear or separate. It is common for cartilage damage to occur at the same time when ligaments or tendons around the joint are injured. For example, during an ACL or MCL tear, it is common to see a meniscus or articular cartilage injury.

Most symptoms present with increased pain or swelling after a particular activity or at the end of an active day. They may also have mechanical symptoms such as painful clicking or catching when the knee is bent or straightened. In very advanced cartilage loss, patients may be severely limited by this pain.

  • Symptoms indicating you may have cartilage damage include:
    • Stiffness or pain within the joint
    • Swelling of the joint
    • Reduced range of motion
    • Painful clicking or catching when you bend or straighten your knee
    • Weakness or the feeling of being unstable

The presentation of pain will vary from patient to patient. For some, the pain is a persistent ache. For others, the pain comes and goes, and can be induced when suddenly bearing weight on the joint. You might also notice that your joint does not bend or twist as far as it used to. This limited range of motion could be caused by swelling, discomfort, or a mechanical issue within the joint.

Types of Cartilage Restoration

Dr. Friedman specializes in arthroscopic or minimally invasive Cartilage Restoration procedures. The below details the three main types of Cartilage Restoration procedures that are performed at Colorado Springs Orthopaedic Group.

Surface Cartilage Lesions:
This can be thought of as ‘repaving the street’. Dr. Friedman uses this technique when the cartilage problem is only on the surface.

Structural Cartilage Lesions:
This can be thought of as ‘filling in the potholes.’ Dr. Friedman uses this technique when the cartilage problem involves the underlying bone.

Malalignment of the Leg:
There are two types of Coronal Malalignment of the leg. Someone may either be too ‘knock-kneed’ also called genu valgus or someone may be too ‘bow-legged’ also called genu varum. An osteotomy is the corrective procedure to realign the knee joint in either case.

Cartilage Restoration Recovery Time

Recovery time for a Cartilage Restoration procedure will vary dependent upon which surgery is performed, adherence to physical therapy protocols, and the overall health status of each patient. On average, a patient will be partially weight-bearing for six weeks; however, they will start their rehab right away. As the cartilage continues to heal, the patient will increase their range of motion, strength, and balance typically returning to normal activities within three months. Overall, you can anticipate between four to six months to fully recover and return to more rigorous activities and sports.

Cartilage Restoration Physician:

Jamie L. Friedman, MD

Jamie L. Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.
> Jamie L. Friedman, MD

 

Cartilage Restoration Near Me

We have two cartilage restoration surgery centers in Colorado Springs:
North Location
4110 Briargate Parkway, Suite 300,
Colorado Springs, CO 80920
(719) 867-7320

South Location
1259 Lake Plaza Drive, Suite 100,
Colorado Springs, CO 80906
(719) 622-4524

Is Joint Cartilage Restoration Right for You?

You do not have to live with pain. If you are suffering from joint pain and suspect cartilage damaged, contact us at 719-632-7669 to schedule your initial consultation.

Visit us at www.csog.net to learn more.

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CSOG Comprehensive Joint Replacement Program Medical Minutes

CSOG Comprehensive Joint Replacement Program

Welcome to a Medical Minute segment with Dr. Tyler Bron, MD, Orthopedic Joint Replacement Surgeon as he introduces the New Comprehensive Joint Replacement Program at Colorado Springs Orthopedic Group.

Comprised of our four fellowship-trained Joint Replacement Surgeons and their teams, you can guarantee we will be with you every step of the way through your entire treatment journey! From initial consultation to post-operative rehabilitation, our clinical and case management teams will have you back on your feet as quickly as possible. When you become a patient of the Comprehensive Joint Replacement Program here at CSOG, you can expect a customized treatment plan designed specifically towards the severity of your condition using the most innovative and effective treatment methods available today.

Not only do our surgeons specialize in traditional joint replacements methods, they also specialize in minimally invasive surgical (MIS) techniques such as robotic assisted minimally invasive joint replacement procedures.

Outpatient total joint procedures performed in our ambulatory surgery center, The Orthopedic and Spine Center of Southern Colorado or within our community hospitals, allow the patient to recovery in the comfort of their own home the same day as surgery. Discuss with your physician if outpatient surgery is right for you as eligibility for these procedures may vary upon the severity of your injury or condition as well as your overall health.

CSOG has the largest group of fellowship-trained joint surgeons in southern Colorado and together have a combined 72 years of joint replacement experience. They pride themselves on the team approach, especially with severe cases our team of joint surgeons will meet and discuss in depth the most efficient treatment options to accelerate your recovery and get you back on your feet, doing the things you love to do, as quickly as possible.

To schedule your initial consultation, call us at 719-632-7669 today!

Visit www.CSOG.net to learn more.

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ACL Injuries With Dr. Friedman

ACL Injuries With Dr. Friedman

Welcome to a Medical Minute segment with Dr. Jamie Friedman, Fellowship-trained Orthopedic Sports Medicine physician at Colorado Springs Orthopaedic Group as she discusses what an ACL injury is, how it is diagnosed, and what the typical recovery time after ACL surgery is.

What is an ACL injury?

An ACL, also known as the Anterior Cruciate Ligament, is a double bundle structure in the middle of the knee. It connects the femur to the tibia and one of the four main ligaments that provides stability within the knee. The ACL helps provide stability to the tibia, preventing it to slide too far forward as well as aids in stabilizing the knee during rotation and lateral movement patterns.

What are the most common ways to injure your ACL?

The most common way to injure your ACL is from a

non-contact activity where a pivoting action occurs. Activities that would cause this pivoting action include high intensity sports such as soccer, basketball, or skiing. Occasionally, ACL injuries can be caused by traumatic injuries such as a motor vehicle collision.

What are the symptoms of a torn ACL?

Typically, when a patient injures their ACL, they may feel or even hear a pop in their knee which is followed by immediate swelling of the knee joint. The swelling may be so severe that they have trouble bending or straightening their knee. They may also feel that their knee is giving away or that they can’t trust their knee to walk or do certain activities. This is a symptom caused by the instability from injuring this ligament.

ACL Injuries

How is an ACL injury diagnosed?

An ACL injury can be diagnosed through clinical examination and imagining, such as an MRI, to assess the integrity of the ACL and its surrounding structures.

When is surgery necessary for an ACL injury?

It is almost unavoidable to not have ACL surgery after a complete rupture.

What is the recovery time for ACL surgery?

After any ACL surgery, the patient will be placed in a knee brace and prescribed physical therapy exercises. During rehabilitation, the patient will work on range of motion, as well as strengthening of the lower extremity under supervision of their physical therapist. Typically, around the three-month mark, patients can return to light activities such as jogging or running in a straight line. From four to six months, dependent upon recovery progress, the patient can typically return to activities that involve jumping and pivoting. Most patients can return to normal activities after 6 months. For athletes, the recovery may be extending to nine to twelve months before they return to full sport competition to ensure proper recovery and strengthening.

To learn more about ACL injuries, custom-tailored treatment options or to schedule an appointment, call us at (719) 632-7669.

Meet Our Providers

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Dr. Stockelman’s professional interests include simple and complex problems of the shoulder and the knee.

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Physical Therapy for Sciatic Nerve Pain in Colorado Springs

Physical Therapy for Sciatic Nerve Pain in Colorado Springs

A woman holding her lower back as a result of sciatic nerve pain, pain in lower back. relief may be found with sciatica stretches.

Living in Colorado, many of us thrive off experiencing the outdoors. However, there are some instances where one may start to experience nerve pain in your lower back and leg while enjoying our great landscapes. If this occurs, you may benefit from specialized physical therapy for sciatic nerve pain.

Pinched human sciatic nerve, anatomical vision. 3D Render.

Sciatica is a pain that radiates down the leg along the sciatic nerve. The sciatic nerve starts in your lower lumbar spine, specifically between your L4-S2 segments. It runs down each leg, supplying the upper legs with motor functions and the lower legs with motor and sensory functions.

What Causes Sciatic Nerve Pain?

There are various reasons why you may be affected by sciatica. In many cases, it may be caused by a herniated disk or a bone spur, which can pinch or aggravate the sciatic nerve. Another cause may be due to a lack of strength within the gluteal and piriformis muscles of the hips which can compress on the sciatic nerve during certain activities. As with any condition, there are various severities in which Sciatica can present.

Typically, mild to moderate sciatica will go away on its own. However, if you experience sciatic nerve pain for longer than a week, we recommend contacting your physician as specific treatment may be needed to alleviate the pain. With most mild to moderate sciatic nerve pain, your physician may refer you to a physical therapist to strengthen the surrounding musculatures as an initial conservative treatment method. At Colorado Springs Orthopedic Group, Physical therapy for sciatica is one of the many neuromuscular conditions our Physical Therapists specialize in and treat daily. This type of rehabilitation has been shown to be a highly effective treatment for alleviating mild to moderate sciatic nerve pain.

Please note, if you are experiencing severe sciatica pain caused by a traumatic injury, such as an auto accident or sports injury, seek medical attention as soon as possible. Likewise, if your pain significantly worsens in a short amount of time, we recommend seeing an orthopedic physician promptly. Our walk-in orthopedic urgent care, Express Care is open Monday through Friday, 7 am-5 pm and Saturdays 8 am-12 pm.

Sciatic Nerve Pain Symptoms

Symptoms of sciatica include radiating pain in the lower spine, pelvis, and hips, or in the buttocks and down the back of your leg. Women who are in the mid to late stages of pregnancy may experience mild to moderate sciatic pain as well due to compression on the nerve.

Some patients may experience sudden sharp pain when sneezing or coughing, causing extreme discomfort. Long periods of sitting can also aggravate the sciatic nerve and may require specific stretching or physical therapy exercises to help alleviate this pain.

Chiropractor or Physical Therapy for Sciatica?

Most can typically achieve sciatic pain relief by seeing a chiropractor or physical therapist. The type of treatment you choose is primarily a personal preference depending on what you hope to accomplish. Both medical professionals have training specific to evaluating and treating sciatica. Chiropractors can assist by assessing where bones may be misaligned or pinching the nerve. Alternatively, Physical Therapists can assess where muscular imbalances may be present and help you gain strength in the lagging areas. This focus can show great results by alleviating any compensation that may be resulting from or causing sciatic pain.

Chiropractic Adjustments for Sciatica:

The purpose of a chiropractic adjustment is to achieve short-term pain relief and is a hands-on manipulation technique of the musculoskeletal system. These adjustments can provide temporary pain relief as it allows for the surrounding musculatures to relax and increases the mobility within the adjusted joint. For example, a lumbar spine adjustment may reduce pressure on the sciatic nerve, temporarily easing the pain. Depending upon the source of sciatic pain however, a patient may only see temporary relief as imbalances within correlating muscular structures may pull on the joint during various activities.

A Japanese woman getting a foot massage at a seitai clinic

Physical Therapy for Sciatica:

With physical therapy, the aim is to promote long-term healing and restore optimal function to the body. Physical therapy treatments may include hands-on mobilization of specific joints, muscles, tendons, and ligaments. By assessing where specific muscles may be compensating for lack of strength within other correlating muscles and diligently performing strengthening exercises to correct these compensations, physical therapy specific to the treatment of sciatica can drastically improve range of motion, total body strength, and blood flow to the affected extremities. For example, properly activating and strengthening the gluteal muscles, can help rehabilitate the symptoms of a herniated disk, reducing the severity of sciatic nerve pain.

Physical-therapy-for-Sciatica-300x200

Benefits and Outcomes of Physical Therapy for Sciatica:

The primary benefits of physical therapy for treating sciatica include pain relief, improved range of motion, and restored motor skills and body functionality. Physical therapy for sciatica is also less expensive and less invasive than other methods, such as surgery, injection therapy, or medications. Most patients who are diligent with their recommended restorative physical therapy plan state their pain has reduced dramatically within a few weeks to a few months. On average, these patients experience long-term pain relief with less chance of the pain recurring.

The total number and the frequency of your physical therapy sessions will depend upon the severity of your sciatica, adherence to treatment, and the pain relief experienced throughout treatment.

Our Colorado Physical & Occupational Therapists

At Colorado Springs Orthopaedic Group, we work with some of the most elite Physical Therapists in Colorado Springs. Our teams are highly trained and highly experienced in their specialties. Contact CSOG’s Physical Therapy department today to request a list of our physical therapists and their teams.

To make an appointment at our North Campus location call  (719) 867-7320

To make an appointment at our South Campus location call  (719) 622-4524

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Hip Labral Repair Vs Hip Reconstruction With Dr. Huang

Hip Labral Repair Vs Hip Reconstruction With Dr. Huang

Welcome to another Medical Minute segment with Dr. Michael Huang, Board-certified Orthopedic Sports Medicine physician at Colorado Springs Orthopaedic Group as he discusses the differences between labral repairs and reconstructions within the hip joint and when one surgery may be recommended over the other.

Hip labral repair vs hip reconstruction

The labrum is an O-ring shaped piece of cartilage surrounding the acetabulum, also known as the hip socket, that provides extra stability within the hip joint. The labrum can tear from overuse performing certain activities or from traumatic events. Unfortunately, a labral tear does not heal on it’s own due to the lack of direct blood supply as with any cartilage tear.
If conservative treatment options, such as physical therapy, injection therapy, or medications do not provide long-lasting relief, then surgery to repair the damaged cartilage may be the recommended next treatment option.

Both procedures, a hip labral repair and a hip reconstruction are surgeries utilized to treat labral tears within the hip. A Labral Repair is where the surgeon reattaches the labral tissue to the acetabulum. Once this is completed, the patient goes through an extensive rehabilitation process to ensure proper healing and restore functionality. Alternatively, when the tissue has been severely torn or a previous repair may have failed, surgeons may elect to perform a labral reconstruction. During this procedure, the surgeon will take a piece soft tissue, typically from the iliotibial band (IT Band) or hamstring tendon of either the patient or a donor and reconstruct the labral structure. This procedure can include either a partial or full reconstruction variant upon the severity of the initial tear.

What activities can lead to a labrum tear?

Labrum tears can occur in many ways however, many patients have a pre-disposition to a labral tear due to their hip anatomy. Athletic activities such as hockey, collision sports or general weightlifters who perform squats or box jumps on a routine basis may be at risk for a tear, especially if they have an anatomical pre-disposition.

Minimally invasive hip repair and hip reconstruction

Hip Labral Repair vs Hip Reconstruction, hip pain treatment, labral tear hip surgery

Both hip repair and a hip reconstruction are relatively new procedures to be done arthroscopically. Arthroscopy procedures allow the surgery to be performed in a minimally invasive manner, preserving as much soft tissue as possible. Hip reconstruction surgeries are naturally more involved than a labral repair surgery therefore, recovery may vary based on the procedure performed. Both procedures are typically classified as Outpatient surgeries where the patient can return home the same day without staying in the hospital or surgery center overnight.

What questions should a patient ask a hip surgeon?

Due to hip arthroscopy being a relatively new category in general, there are not a lot of orthopedic surgeons that do hip arthroscopy surgeries. Dr. Huang’s first piece of advice is ensuring that the surgeon has experience and is very familiar with the procedure.

Dr. Huang also recommends that if there is a decision that needs to be made between labral repair and consideration for reconstruction, then it would be advantageous for the patient to ask the surgeon if they do reconstruction surgery. This is necessary because even among the surgeons that do hip arthroscopy repair, not all of them do reconstruction because it is technically much more demanding.

Colorado Springs Orthopaedic Group is fortunate enough to have experience in arthroscopic repair and reconstruction and have multiple physicians with a vast amount of experience performing both procedures. To learn more or to schedule an appointment, call us at (719) 632-7669.

Meet Our Providers

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

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Platelet-Rich Plasma Therapy (PRP) With Dr. Jones | CSOG

Platelet-Rich Plasma Therapy (PRP) With Dr. Jones | Colorado Springs Orthopaedic Group

Welcome to a Medical Minute segment on platelet-rich plasma therapy (PRP) with Dr. Christopher Jones, a board-certified physician at the Colorado Springs Orthopaedic Group.

The video below will cover what platelet-rich plasma therapy (PRP) is and how it can help heal an injury and avoid possible surgery.

What is PRP Therapy and where is it derived from?

PRP stands for Platelet-Rich Plasma and is derived from a patient’s blood. By way of centrifuge, the physician will separate out the platelets which are cells within our blood that help promote clotting and healing as they possess essential growth factors. There are two types of PRP. PRP that are made up of white blood cells, and PRP that do not include any white blood cells. If a patient is utilizing PRP the process is simple; the patient comes in for their appointment, the physician or physician assistant will draw the blood, and the blood is then spun within a centrifuge to separate out the different cells. That process takes between 7-20 minutes. Once the cells are ready, the physician will then inject the cells within the patient’s injured body part. The injection process typically takes less than one minute to complete.

What injuries can PRP help heal?

For ligament or tendon injuries, PRP can help a patient’s ability to heal by increasing the growth factor concentration. Injuries such as MCL tears or tennis elbow are commonly treated with PRP. PRP can also be used to treat arthritis or cartilage injuries because it helps diminish inflammation in the joint, which then diminishes pain symptoms.

How is PRP associated with Stem Cells?

Stem cell treatments have become popular and are in the same treatment family as PRP due to a similar goal of enhancing the patient’s ability to heal injuries or to fight off inflammation. However, stem cells do not exist within PRP.

What is the typical outcome or success rate for those patients who have underwent PRP treatments?

Dr. Jones has seen outstanding outcomes from patients who have utilized PRP treatments. He was an early adopter of the treatment and started using PRP treatments 12 years ago. PRP treatments have advanced over the years and additional literature has shown great success with their use. For example, in tennis elbow, PRP treatment studies have shown a 90% success rate.

If you have been experiencing pain, or have additional questions about PRP, call us today to schedule an appointment with Dr. Jones at Colorado Springs Orthopaedic Group!

Meet Our Providers

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

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General Orthopedics at CSOG

General Orthopedics at Colorado Springs Orthopaedic Group

At Colorado Springs Orthopaedic Group, our physicians specialize in General Orthopedics and are trained to thoroughly assess a wide variety of bone conditions. These conditions range from head to toe and are conditions that may have affected surrounding structures within the joints, such as muscles, cartilage, tendons, and ligaments.

As one of our patients, you can expect to have very detailed and thorough discussions with your physician regarding your diagnosis and treatment options available to fit your general orthopedic needs. Our providers share information in easy to understand terms and actively encourage you to participate in your treatment’s decision-making process. Your care is about you and we want you to feel comfortable with the decisions made to help you get back to your pain-free lifestyle.

The most common General Orthopedics disorders and diseases include:

  • Fractures
  • Arthritis
  • Sprains and strains
  • Bursitis and tendonitis
  • Ligament and tendon tears
  • Cartilage Tears

Many injuries or conditions can be resolved with non-surgical treatment options such as physical or occupational therapy, cortisone injections, viscosupplementation, or PRP therapy. However, if you and your doctor determine that surgery is the best treatment option, our surgeons specialize in a number of minimally invasive procedures proven to accelerate the recovery process.

Arthroscopy

Arthroscopic procedures allow the surgeon to operate through smaller incisions with use of a miniature camera, also known as a scope, which enables the surgeon to view the joint with great detail while preserving the surrounding tissues, such as muscles and tendons. Arthroscopy has shown a number of recovery and longevity benefits compared to traditional surgical methods such as:

  • Smaller incisions enabling the surgeon to cut through less surrounding tissues, decreasing the chance for severe scarring.
  • Accelerate the recovery process as the surrounding musculature is not damaged to such great extents
  • Shorter recovery period
  • Decreased risk of infection

As with any procedures, candidacy for an arthroscopic procedure may vary dependent upon the severity of the injury and the patients overall health status. Discuss with your physician to see if arthroscopy is the best treatment option for you.

Call us at 719-632-7669 to schedule your initial consultation.

Cycling Sports Medicine Image
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Orthopedic Trauma & Fracture Care in Colorado Springs

Orthopedic Trauma & Fracture Care in Colorado Springs

Trauma can occur from any injury that endured enough force to cause a fracture or significant damage within the body. Care for simple fractures (such as a transverse, longitudinal or stress fractures) may require only casting or splinting. Common causes of fractures include motor vehicle accidents, sports injuries, and falls. Care for severe or complex fractures (such as open fractures, pelvic fractures, femoral, tibial, etc.) often require surgical intervention.

The types of orthopedic trauma & fracture care we see include but are not limited to:

  • Simple Fractures:
    • Transverse fractures
    • Longitudinal fractures
    • Stress fractures
  • Complex Fractures, to include but are not limited too:
    • Open fractures
    • Femoral fractures
    • Non-healing fractures
    • Fractures with deformity/angulation
    • Fractures of the pelvis and acetabulum (hip joint)
    • Joint (intra-articular) fractures
    • Foot and ankle fractures
    • Post-traumatic reconstruction

Every physician at Colorado Springs Orthopedic Group is trained to treat all types of traumas and fractures. After a thorough examination of the injury, your physician will order the appropriate imaging, such as x-rays or an MRI, to appropriately diagnose and develop a treatment plan best suited for the injury. Each treatment plan is customized to every patient and the needs of their injury.

Young girl wearing an arm brace seeking trauma & fracture care

For the highest quality orthopedic trauma & fracture care in El Paso County, call Colorado Springs Orthopaedic Group at (719) 632-7669.

Need to be seen today? Walk into our Orthopedic Urgent Care clinic, Express Care for immediate examination performed by one of our board-certified orthopedic trained Physician Assistants. With limited wait times and on-site imaging services, our Express Care team can have you on the road to recovery quicker and at a much lower cost than the ER. After your initial examination, you’ll be scheduled with one of our fellowship-trained orthopedic physicians to further discuss your customized treatment plan. Call 719-622-4550 or visit us at https://www.csog.net/services/our-express-care to learn more.

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Common Ski & Snowboarding Injury Treatments | CSOG

Common Ski & Snowboarding Injury Treatments with Dr. Huang

Welcome to a Medical Minute segment with Dr. Michael Huang, a board-certified physician at the Colorado Springs Orthopaedic Group, speaking today about common ski & snowboarding injury treatments.

The video below will cover how to best treat winter sports injuries such as injuries from skiing or snowboarding.

What are the most common ski and snowboard knee injuries?

The most common knee injuries are typically soft tissue injuries such as meniscus tears and ligament tears. Within the ligament tear category, the most common, and well known are anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries.

What happens if the ACL or MCL injury occurs while on skis or snowboards?

Skiing and snowboarding can cause ACL, MCL, or other injuries because the board under your feet puts a lot of strain on your knees. Skiing has been well studied and it has been found that the athlete gets in what is called the ‘backseat’ position which produces a rotational force across the knee that has been demonstrated to tear the ACL, MCL and sometimes the meniscus.

Exercises to prevent common ski and snowboarding injuries

Fallen person that is experiencing a common ski & snowboarding injury

Within the last few decades, there has been a lot of focus on preventing knee injuries. Before the ski season starts, gyms have even started to offer ski conditioning classes which Dr. Huang finds very beneficial. Courses such as these place an emphasis on building strength and coordination within plyometric movements, increasing cardiovascular fitness, as well as strengthening the core and hip stabilizer muscles.

To schedule an appointment with Dr. Huang, call our offices at: (719) 632-7669.
To learn more visit us at www.csog.net.

Meet Our Providers

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Dr. Stockelman’s professional interests include simple and complex problems of the shoulder and the knee.

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The Comprehensive Joint Replacement Program

The Comprehensive Joint Replacement Program

As Part of Colorado Springs Orthopaedic Group’s Comprehensive Joint Replacement Program,
our fellowship-trained joint replacement specialists will provide you with the
most comprehensive treatment possible to help you return to your active lifestyle.
We are here to help you get back out there, doing the things you love to do.

When you first visit us at Colorado Springs Orthopaedic Group, you’ll be introduced to our clinical team consisting of your Physician, Physician Assistant, Medical Assistant, Surgery Scheduler, and Case Manager. As part of the Comprehensive Joint Replacement Program, this group of individuals will be your direct line of contact to answer any questions or concerns you may have as you continue throughout your entire recovery process.

During your initial consultation, your physician will discuss recommended treatment options with you and design a comprehensive treatment plan to get you on the road to recovery. Our physicians will exhaust all conservative treatment options prior to recommending surgery. However, in severe cases or cases where conservative treatments have not provided adequate pain relief, surgery may be deemed necessary.

  • Schedule your inital consultation with one of our fellowship-trained Orthopedic Joint Specialists by calling 719-632-7669.
  • Consult with your physician for a proper diagnosis and recommended next steps. Our Total Joint Physicians will exhaust all conservative treatment measures prior to discussing surgery if your case allows.
  • If all conservative treatment options have been exhausted and your pain is still significant, surgery may be recommended. At this time you will be introduced to your case manager who will help you prepare for a smooth procedure and be your patient advocacy contact.
  • After surgery, you will be introduced to your post operative recovery team, including your lead physical therapist who will be with you every step of the way from the moment you leave the operating room to your post operative rehabilitation journey.

“Whether it’s from a recent surgery or surgery from years ago, our Comprehensive Joint Replacement Specialists can correct even the most complicated Total Knees and Total Hips.”

Our Comprehensive Joint Replacement Program Teams:

Clinical Team
Surgical Team
Post Operative Recovery Team

Specializing in:

Inpatient vs Outpatient
Total Joint Replacements
Accelerated Recovery
Joint Replacements

Arthritis and MAKO
Robotic Assisted Joint
Replacement Surgery
Complex Joint Revisions

Arthritis Team and MAKO Robotic Assisted Joint Replacement Surgery Complex Joint Revisions
Comprehensive Joint Replacement Program Specialists

What to Expect Pre-Operation

Have you ever walked into the hospital or medical practice intimidated and unsure of who would be taking care of you? Not anymore.  At Colorado Springs Orthopaedic Group you can expect to know exactly who to contact every step of the way. During your initial consultation, your physician will discuss your symptoms, order any appropriate imaging from our in-house MRI and X-Ray services, and diagnose your symptoms with the highest standard of education and care for your lifestyle. From here, you can expect to either:

a) Try various conservative treatment methods such as Physical Therapy, weight loss, or injection therapies.

b) Discuss surgical options dependent on the severity of your symptoms.

If surgery is the chosen path, our clinical team will work with your insurance to find the best options available and ensure you are ready to go upon the day of surgery. It is highly important to communicate with your clinical team and ask any questions or concerns you may have and diligently follow instructions as provided.

What to Expect Post- Operation

Within 24 hours after your surgery, you will be introduced to your Physical Therapist Lead who will guide you through initial rehabilitation exercises. At this time, you will be prescribed at-home exercises that are critical to a smooth recovery.

Inpatient vs. Outpatient Recovery

Inpatient Surgery means that you will stay a minimum of one night in the hospital or surgery center under the watchful eye of your nursing team.
Outpatient Surgery provides the capability for you to recover within the comfort of your home the day of surgery, eliminating facility fees and the stress of staying in an unfamiliar area.

Bones Horizontal

Case Management

Every patient in the Comprehensive Joint Replacement Program is dedicated to one of our board-certified Case Managers. They will be your direct patient care advocate from your initial consultation to graduation from post-operative Physical Therapy.

“Within about 24 hours after surgery, I never had another need for crutches, a cane, walker, anything like that and it has been absolutely fantastic.”

Accelerated Recovery Joint Replacements

One of the primary focuses of the Comprehensive Joint Replacement Program is to have patients mobile within hours after their surgery. Over the course of the last 10-15 years, advancements within surgical techinques such as smaller incisions and the anesthesia techniques, have enabled patients to recover not only much quicker but also recover in the comfort of their own home either the day following surgery or in many cases, the same day. Within hours after surgery, patients will be introduced to their post operative Physical Therapist who will demonstrate exercises enabling them to get up and move around the same day as their operation. Through extensive studies, ensuring same day mobility has proven to show drastically improved outcomes for patients and their overall recovery time.

Total Knee Replacements

There are three bones that come together to form your knee joint: the Femur (thigh bone), Tibia (shin bone) and Patella (kneecap). Attached to these bones are three primary muscles groups that assist in knee flexion, allowing you to walk, run, and step up and down stairs. These muscles are your quadricep, hamstring, and calf muscles. Lastly, your tendons and ligaments surrounding these structures help to keep the femur, tibia and patella secured within the joint.

Our physicians typically recommend conservative treatment options such as physical therapy, steroid injections, and weight loss prior to discussing surgical options. However, if all conservative options have been exhausted, your physician will discuss surgical treatment options such as a partial or total knee replacement. Once you and your physician have decided to move forward with surgery, your physician may elect to use traditional Knee Replacement techniques or Mako Robotic Assistance navigation software to customize your knee replacement implants specific to your individual anatomy. This customization process allows for a seamless implant fitting once in the operating room.

Total Hip Replacements

There are many conditions that can arise within the hip joint. Most commonly, patients complain of symptoms associated with bursitis, tendinitis, muscle strains, labral tears, and arthritis. Dependent on the severity of your symptoms, conservative treatment options may be recommended, with surgery as the last option. Our Joint Replacement surgeons specialize in both traditional Hip Replacement techniques as well as Robotic Assisted Hip Replacements.

Robotic-Assisted Minimally
Invasive Surgery: MAKO

Mako Robotic-Assisted Navigation has shown significant improvement in replacement longevity and overall patient outcomes for those patients who qualify for these procedures.

Did you know the average Total Joint Replacement can now last you over 20 years compared to the estimated 10-15 years in early 2000s?

Call us today at 719-632-7669 to learn how we can help you live a sustained pain free life.

Mako Robotic Joint Replacement Systems utilized for Knee Replacement and Hip Replacement

“From the onset of being treated within this group, I have been treated with the upmost respect and feel very fortunate to be a patient there. The entire staff is great. And I could not have asked for one of the best doctors there.” – patient of Dr. Tyler Bron

Complex Total Joint Revisions

In some cases, due to a variety of reasons, a Total Joint Replacement can fail. Some common reasons a failure may occur are normal wear and loosening of the joint while some causes may be due to infection within the joint. If this occurs, our Total Joint Replacement Specialists will assess and recommend revision procedures specific to your case.

Call us today at 719-632-7669.

Hip Image

Meet Our Providers

Dr. Tyler Bron, MD Colorado Springs Orthopaedic Group

Tyler R. Bron, MD

Dr. Bron has completed a fellowship in Adult Reconstruction, specializing in the treatment of arthritic hip and knee conditions.

Dr. Eric Jepson, DO Colorado Springs Orthopaedic Group

Eric K. Jepson, DO

As a board-certified orthopedic surgeon, Dr. Jepson’s specializes in the treatment of complex knee and hip problems, revision surgery, and new procedures for the treatment of arthritis.

Dr Michael Van Manen, DO Orthopaedic Surgeon Joint Replacement Specialist Colorado Springs Orthopaedic Group

Michael Van Manen, DO

Dr. Van Manen focuses on total joint replacement and arthritis management of the hip and knee.

Dr. Michael Feign, DO Colorado Springs Orthopaedic Group

Michael Feign, DO

As a Board-Certified Orthopaedic Surgeon, Dr. Feign specializes in the treatment of complex hip and knee injuries, hip and knee arthritis and Total Joint Replacements.

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Total Shoulder Replacement With Dr. Christopher Jones

Total Shoulder Replacement with Dr. Christopher Jones

Welcome to a Medical Minute segment with Dr. Christopher Jones, a board-certified physician at the Colorado Springs Orthopaedic Group. The video below will cover what a total shoulder replacement is, and when this surgery may be recommended.

 

What is a Total Shoulder Replacement Surgery?

A total shoulder replacement is when you are replacing the “ball and socket” of the joint with a metal humeral head and a metal-lined socket placed within the shoulder socket also known as the glenoid fossa. This surgery is typically necessary when a patient has a complete breakdown of all the cartilage within their shoulder joint, resulting in a loss of mobility and significant pain. Regaining shoulder mobility, functionality, and eliminating pain are the primary reasons to undergo a total shoulder replacement surgery.

What is the Lifespan of a Total Shoulder Replacement Surgery?

The vast majority of patients who require a total shoulder replacement have a genetic component of arthritis therefore, the younger a patient is when receiving a shoulder replacement, the more likely it is they may need a revision later in life. Current studies show that the average lifespan of a total replacement is approximately 20 years for 85% of patients. As these statistics are based on dated implant technologies, innovative advancements within implant technologies are showing drastic improvements in replacement longevity. Surgeons are hopeful these advancements will increase the lifespan of such implants.

Patient in blue shirt being given a shoulder checkup by a nurse after total shoulder replacement.

What is the Recovery time of a Total Shoulder Replacement Surgery?

The full recovery time for any shoulder surgery averages around a year and may vary upon the severity of the initial injury and the procedure used to treat such injury. With this, the vast number of patients who have had shoulder surgery notice significantly less pain within six weeks after surgery.

Total Shoulder Replacement Surgery Technology and Innovations

As total shoulder replacement technologies continue to advance, many of the newer implants have a strong focus on bone preservation. In addition to utilizing the latest implants, Colorado Springs Orthopaedic Group also utilizes a groundbreaking innovation tool of three-dimension operative planning. This technology allows the physician to customize the shoulder procedure to the individual patient’s needs on the computer prior to walking into the operating room. To do this, they download the patient’s imaging into the software allowing the physician to place the implants in precise alignment with the bony anatomy allowing the physician to know exactly where to place the implant prior to walking into the operating room. This optimizes the patient’s recovery outcomes and the replacement’s longevity.

Reverse Total Shoulder Replacement Surgery

With Reverse Total Shoulder Replacement Surgery, the physician will swap the ball and socket around. This surgery is completed when the patient does not have a rotator cuff.
Call us at 719-632-7669 to schedule your initial consultation with one of our fellowship-trained, board-certified Orthopedic Shoulder Specialists today!

Meet Our Providers

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

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Cartilage Restoration Procedures with Dr. Jamie Friedman

Cartilage Restoration Procedure With Dr. Jamie Friedman

Welcome to a Medical Minute segment with Dr. Jamie Friedman, Fellowship-trained Orthopedic Sports Medicine physician at the Colorado Springs Orthopaedic Group. Join Dr. Friedman in the video linked below as she discusses cartilage restoration procedures, what specific injuries they can be utilized as a treatment option for, and how they can help delay the need for a total knee replacement for the appropriate patients.

What is cartilage restoration?

Cartilage restoration, also known as Articular Cartilage Restoration, helps the bones articulate or glide smoothly against each other when the natural cartilage has worn or been previously injured. Articular cartilage also provides a shock absorber for the knee joint, especially since it is a weight-bearing joint. Unfortunately, when the cartilage is injured, it does not heal itself because there is not a direct blood supply to it. This can lead to early arthritis if not treated appropriately.

What are some of the symptoms of a cartilage injury?

Cartilage injuries can either occur with a traumatic injury or over time with a repetitive motion such as general wear and tear on the joint. A patient will typically have increased pain or swelling after a particular activity or at the end of an active day. They may also have mechanical symptoms such as painful clicking or catching when they bend or straighten their knee. In very advanced cartilage loss, patients may be severely limited by this pain.

Who is a good candidate for a cartilage restoration procedure?

The best candidate for a cartilage restoration surgery is typically an active young adult. This prevents them from going on and developing early arthritis. These are also patients that have severe pain and likely too young for a partial or total knee replacement.

What are the cartilage restoration procedures that CSOG offers?

X-ray with red highlighting knee joint pain that requires cartilage restoration procedures.

There is a wide variety of cartilage restoration procedures that CSOG is able to perform to help with joint pain. Some of the most advanced techniques are arthroscopic or minimally invasive surgery with a small incision near the joint. When the cartilage itself is the only thing involved, the physician will take cells from the patient, or from a donor, send them to a lab, and once the cells are returned, place them over the cartilage defect – kind of like filling in a pothole in the street. This is called Chondrocyte Implantation.

If the bone underneath the cartilage is also affected, then the physician will need to take a plug from the patient or a donor and put that into the defect. This is called Osteochondral Autograft Transplantation.

What is the recovery time for a cartilage restoration procedure?

It depends on what surgery is performed, but in general, the patient will be partially weight-bearing for six to eight weeks while allowing that cartilage to heal. At about two to three months, more range of motion gets added along with strength and balancing activities. It takes about four to six months to get back to a patient’s normal activities. Even though this is a longer recovery period than some of the other surgeries available, it has been shown to be greatly beneficial to eliminate the patient’s pain and save them from an early knee replacement.

To schedule an appointment with Dr. Friedman, call our offices at (719) 632-7669.

Physicians:

Jamie L. Friedman, MD

Jamie L. Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.
> Jamie L. Friedman, MD

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Jammed Fingers & Finger Injuries

Jammed Fingers & Finger Injuries with Dr. Dale Cassidy

Welcome to a Medical Minute segment with Dr. Dale Cassidy, a Board-Certified Orthopedic Hand physician at the Colorado Springs Orthopaedic Group. The video below will cover jammed fingers & finger injuries that we commonly see from our Colorado Springs clients.

Types of Finger Injuries

Sports injuries, falls, or hitting your finger the wrong way are some of the most common finger injuries seen here at Colorado Springs Orthopaedic Group. These experiences can result in jammed, sprained, or even broken fingers.

Jammed Finger & Finger Injury X-Rays & Treatment

Dr. Cassidy and his team utilize various imagining such as x-rays as the first step in the diagnosis process. Often times a patient may think they have a jammed finger. However, the x-ray images can show a more serious diagnosis. Depending on the severity of the injury it could be treated with a splint or brace. More extreme injuries may result in the need for physical therapy or could even require surgery.

Man in a green shirt holding jammed fingers in a brace.

Contact Colorado Springs Orthopaedic Group for Jammed Finger & Finger Injury Treatment

Colorado Springs Orthopaedic Group’s Hand and Nerve Center comprised of our two fellowship-trained board-certified physicians and physician assistants can put help provide a diagnosis and custom treatment options for even the most complex hand and nerve injuries.

Visit www.CSOG.net or call us at 719-632-7669 to schedule your initial consultation today!

Physicians:

Dale Cassidy, MD, MBA

Dale Cassidy, MD, MBA

Dr. Cassidy is a fellowship-trained orthopedic surgeon specializing in conditions affecting the hand and upper extremity, and in orthopedic trauma.
> Dale Cassidy, MD, MBA

 

 

Jeffry T. Watson, MD

Jeffry T. Watson, MD

Dr. Watson’s clinical interests include adult and pediatric conditions of the upper limb, such as arthritic and post-traumatic reconstruction, microvascular surgery, and treatment of complicated fractures.
> Jeffry T. Watson, MD

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Physical Therapy Exercises for Hip Pain

Physical Therapy Exercises for Hip Pain with Cristin McGetrick

Welcome to a Medical Minute segment with Cristin McGetrick, DPT, CSCS, TSAC-F at the Colorado Springs Orthopaedic Group. Tune into the video linked below as Cristin demonstrates 5 physical therapy exercises for hip pain that can be performed in the comfort of your home.

When the hips are weak, many patients notice a significant decrease in their ability to balance as well as increased pain in their knees and feet. Therefore, when we see this type of weakness, we want to focus primarily on strengthening those hips as they provide stability throughout the entire body.

Contact Colorado Springs Orthopaedic Group for More Information About Physical Therapy Exercises for Hip Pain

To learn more, visit www.csog.net or call us today to schedule your initial evaluation. A referral may be necessary depending upon your insurance coverage.
To schedule a physical therapy appointment at our North Campus location call. (719) 867-7320
To schedule a physical therapy appointment at our South Campus location call. (719) 622-4524

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Arthritis Types, Symptoms & Treatments with Dr. Tyler Bron

Arthritis Types, Symptoms & Treatments with Dr. Tyler Bron

Welcome to a Medical Minute segment with Dr. Tyler Bron, one of four fellowship-trained Orthopaedic physicians at Colorado Springs Orthopaedic Group. The video below will cover what arthritis is and discuss the different arthritis types, symptoms & treatments available at CSOG.

Arthritis Types: Osteoarthritis vs. Rheumatoid Arthritis

Arthritis comes in several different forms including Osteoarthritis and Rheumatoid arthritis. Osteoarthritis causes the cartilage, that lies between and protects the bones, to break down. Once this cartilage wears down, the bones become exposed to each other causing them to then rub against each other. This rubbing can cause inflammation and send pain signals to the brain. This is contrasted with Rheumatoid arthritis, which is caused by your body’s own immune system degrading the cartilage.

Who does Arthritis affect?

Arthritis can affect those of any gender or age, however, is most commonly seen when people get older. Arthritis, specifically Rheumatoid Arthritis, has a strong genetic component. Osteoarthritis is the most common form of arthritis and is known as “wear and tear arthritis” where previous joint injuries, overuse injuries, or obesity can be the primary cause.

Man sitting alone on his sofa at home and suffering from arthritis types in his hand

Arthritis Symptoms

The most common symptoms of arthritis include an ache or dull pain that is constant and gets worse throughout the day depending on how active you are. As it progresses, the pain becomes more debilitating. Occasionally, arthritis progresses to the point where individuals are not able to live their desired active lifestyle. We recommend seeing an orthopedic specialist prior to this point.

Arthritis Treatment Options

There are non-surgical treatment options to treat arthritis. At Colorado Springs Orthopaedic Group, our physicians believe that in most cases, non-surgical treatment is the best place to start. Non-surgical interventions include weight loss, activity modification, avoiding high-impact sports activities, physical therapy, and the prescription of anti-inflammatory medications. Depending on the severity of your case, your physician may suggest a steroid injection that acts as an anti-inflammatory treatment. Once a patient has tried the above non-surgical options without experiencing long-lasting relief, then surgery may be a recommended option.

Colorado Springs Orthopaedic Group’s board-certified and fellowship-trained joint physicians can put together a custom-tailored program for both diagnosis and treatment.

Meet Our Providers

Dr. Tyler Bron, MD Colorado Springs Orthopaedic Group

Tyler R. Bron, MD

Dr. Bron has completed a fellowship in Adult Reconstruction, specializing in the treatment of arthritic hip and knee conditions.

Dr. Eric Jepson, DO Colorado Springs Orthopaedic Group

Eric K. Jepson, DO

As a board-certified orthopedic surgeon, Dr. Jepson’s specializes in the treatment of complex knee and hip problems, revision surgery, and new procedures for the treatment of arthritis.

Dr. Theodore Stringer, MD Colorado Springs Orthopaedic Group

Theodore L. Stringer, MD

Dr. Stringer focuses on total joint replacement and arthritis management of the hip and knee.

Dr. Michael Feign, DO Colorado Springs Orthopaedic Group

Michael Feign, DO

As a Board-Certified Orthopaedic Surgeon, Dr. Feign specializes in the treatment of complex hip and knee injuries, hip and knee arthritis and Total Joint Replacements.

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Weightlifting After Shoulder Surgery

Weightlifting After Shoulder Surgery with Matthew Kudron

Welcome to a Medical Minute segment with Matthew Kudron, Physical Therapy Supervisor at the Colorado Springs Orthopaedic Group located off Briargate Parkway. The video below will cover the recommended timeframe and physical therapy needed to return to weightlifting after shoulder surgery.

 

Common Shoulder Surgeries

Common shoulder surgeries include rotator cuff repairs, labral repairs, and total shoulder replacements. Within these different surgeries, there are different timeframes in which a patient may return to activities such as weightlifting and high-intensity upper body activities. The progression through recovery after shoulder surgery may vary. However, a typical timeframe one can begin increasing their activity intensity, specifically with overhead weightlifting after shoulder surgery, can range between three to six months. We strongly recommend diligently following all physical therapy protocols prescribed by your physician and physical therapist to ensure proper recovery.

Recovery Milestones

Within these protocols prescribed by your physician and physical therapist, there are three main recovery milestones that need to occur before getting into weightlifting after shoulder surgery. The first is tissue healing, the second is achieving full range of motion and the third is building full strength of both the rotator cuff and the muscles that help stabilize the shoulder blade.

Male patient lying on a bed performing physical therapy weightlifting after shoulder surgeryWeightlifting Exercises After Shoulder Surgery

Some of the exercises that are generally safe after shoulder surgery include bicep curls, triceps pulldowns, and rotator cuff exercises. However please follow your physical therapist’s instructions prior to attempting any of these exercises. Some exercises to avoid are those exercises where you cannot see your hands, such as a triceps dip exercise, or exercises where your arms are in a position extended away from your body or in a wide-grip position. These exercises may put the shoulder in a vulnerable position as demonstrated in the video above.

Contact Us to Schedule Physical Therapy to Help with Weightlifting After Shoulder Surgery

To schedule a physical therapy appointment at our North Campus location call. (719) 867-7320
To schedule a physical therapy appointment at our South Campus location call. (719) 622-4524

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Physical Therapy Pain Management

Physical Therapy Pain Management with Danielle White

Welcome to a Medical Minute segment with Danielle White, one of 18 physical therapists at Colorado Springs Orthopaedic Group. The video below will cover how the brain experiences pain and helps one manage such pain through physical therapy pain management.

The definition of pain is an unpleasant sensory or emotional experience. Pain is caused by a stimulus to your tissues and is personalized for everyone. Chronic pain is defined as any pain that lasts for three to six months or more. If you have chronic pain the best thing is to focus on what you can do and not what you can’t. There are four main things to focus on that can help alleviate pain is to:

  • Educate the nerves
  • Create good sleep habits
  • Perform aerobic exercise
  • Set recovery goals

To learn more about pain management visit one of Colorado Springs Orthopaedic Group’s physical therapists today.

To schedule a physical therapy appointment at our North Campus location call. (719) 867-7320
To schedule a physical therapy appointment at our South Campus location call. (719) 622-4524

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Annie’s story: from debilitating pain to enjoying gardening, scuba diving, and hiking again

Annie’s story: from debilitating pain to enjoying gardening, scuba diving, and hiking again


Dr. Roger Sung is a board-certified and fellowship-trained physician who joined The Spine Center at Colorado Springs Orthopaedic Group in 2007. He believes in ‘making it a priority to provide all his patients with education and individualized treatment so they can return to the activities they love with the least invasive options possible’. Read through the following patient testimonials and watch the video to see how much Dr. Sung’s work is impacting lives throughout Colorado Springs.

Dr. Roger Sung Specializes in:

  • Cervical & Lumbar Spine Surgery
  • Minimally Invasive Spine Surgery
  • Adult Scoliosis/ Degenerative Spine
  • Artificial Disc Replacement
  • Lateral Spine Surgery
  • Spinal Cord Stimulation
  • Minimally Invasive SI Joint Fusion
  • Spine Trauma

Here are just a few patients testimonials and what they have to say about their experience with Dr. Sung:

“Dr. Sung did a spinal fusion on my back, because of severe pain in my legs, 6 months ago. I am totally recovered, have no more pain, and can hike, bike and garden again. I am over the top pleased with this outcome! During my recovery, the PA and MA were very helpful in answering questions and adjusting medications. I highly recommend Dr. Sung and his staff.”

“Sung is a straightforward doctor and a very good surgeon. He has my utmost confidence. He’s performed four spinal procedures on me and I would wholeheartedly recommend him.”

“Absolutely blown away by the level of caring and exceptional surgery I had with dr Sung and Colorado Springs Ortho! I felt as though I was the president of the United States with how I was treated by this amazing staff! Lower back fusion and disc replacement…..and I’m not joking when I say the most pain I had was the IV the day before. Don’t be scared or worried at all with Dr. Sung! He is an absolute ROCK STAR in his field and I can’t say enough positive words about him and CoSprings Ortho!”

 

Our Spine Physicians:

Roger D. Sung, MD

Roger D. Sung, MD

Dr. Sung is a fellowship-trained and board-certified orthopedic surgeon who specializes in cervical and lumbar surgery, microsurgery, and minimally invasive surgery.
> Roger D. Sung, MD

 

James M. Bee, MD

James M. Bee, MD

Dr. Bee’s interests include the full range of spinal disorders of the cervical, thoracic, and lumbar spine. Scoliosis and the treatment of spine shrinkage and fractures from osteoporosis are a couple examples.
> James M. Bee, MD

 

Paul Stanton, DO

Paul Stanton, DO

Dr. Paul Stanton is a board-certified orthopedic surgeon with surgical expertise in all aspects of spinal surgery, including minimally invasive techniques and complex reconstructive techniques for the cervical spine, adult spinal deformity, and degenerative scoliosis.
> Paul Stanton, DO

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Spinal Cord Stimulators for Chronic Pain with Dr. Roger Sung

Spinal Cord Stimulators for Chronic Pain with Dr. Roger Sung

Welcome to a Medical Minute segment with Colorado Springs Orthopaedic Group’s Dr. Roger Sung discussing chronic pain management through the use of spinal cord stimulators.

 

 

When a patient experiences chronic pain, what is the best option for them?

As every orthopaedic case is unique, if the pain begins to affect daily life we recommend scheduling an appointment with an orthopaedic doctor. With this, we recommend finding a doctor who specializes in the body region where pain is at it’s worst.

After a full evaluation to find the source of your chronic pain, our physicians at Colorado Springs Orthopaedic Group work diligently to create individualized treatment plans for every patient. From there, your physician will continue to adapt that individualized plan to best suit your specific needs as you work through the recovery process.

What is a spinal cord stimulator?

A spinal cord stimulator (SCS) is a battery-operated implant that sits along the spinal cord and aids in alleviating nerve tension by sending mild electronic pulses to the nerves. These pulses interrupt the transmission of pain signals to the brain and have shown great success in alleviating chronic pain.

The surgery for a spinal cord stimulator implant takes approximately one hour when performed in our outpatient surgery center, The Orthopaedic Spine Center of Southern Colorado (OSCSC).

Try before you buy?

The best news with this type of chronic pain treatment is that you can actually trial the stimulator before electing to have the permanent implant placed. This is a one-of-a-kind treatment option in that you and your physician can give the spinal cord stimulator trial implant a test run to see if this treatment will work for you. This trial run is typically between 5-7 days where you will have direct access to a qualified SCS representative who can help you learn the intricacies of the stimulator remote. This representative will be  your direct contact if any setting adjustments need to be made moving forward.

Doctor looking at spine x-rays in preparation for a spinal cord stimulator to help with chronic pain

How customizable is a spinal cord stimulator?

After meeting with your SCS representative, you are able to fully customize your device, independently choosing the intensity and schedule at which you prefer your device to operate at. With recent technological advancements, these adjustments can be made at the touch of your fingertips by utilizing an application on your phone. Patients will also receive a remote from which they can program their stimulator from as well.

What is the success rate of spinal cord stimulators?

Patients that respond well to this treatment are likely to see at least 50-75% improvement in their pain. These devices can last upwards of 10-25 years, while only requiring battery replacements as needed. Please contact your SCS representative or our office at 719-632-7669 if you are in need of a spinal cord stimulator battery replacement.

How long is the Spinal Cord Stimulator Recovery Time?

The surgical procedures for both trial and permanent stimulator implantations are performed as outpatient surgeries and can be completed within approximately one hour. Patients can expect to recover from the permanent implant procedures within 2-4 weeks. Many noticing significant chronic pain relief just days after surgery. Please note, these timelines will very case by case.

Think Spinal Cord Stimulation might be right for you?

Give us a call at 719-632-7669 to schedule an initial evaluation. Our Spine Center Doctors are ready to help get you back to living how you want to live.

 

Our Spine Physicians:

Dr. Roger Sung, MD Colorado Springs Orthopaedic Group

Roger D. Sung, MD

Dr. Sung is a fellowship-trained and board-certified orthopedic surgeon who specializes in cervical and lumbar surgery, microsurgery, and minimally invasive surgery.

 

 

 

Dr. James Bee, MD Colorado Springs Orthopaedic Group

James M. Bee, MD

Dr. Bee’s interests include the full range of spinal disorders of the cervical, thoracic, and lumbar spine. Scoliosis and the treatment of spine shrinkage and fractures from osteoporosis are a couple examples.

 

 

Dr. Paul Stanton, DO Colorado Springs Orthopaedic Group

Paul Stanton, DO

Dr. Paul Stanton is a board-certified orthopedic surgeon with surgical expertise in all aspects of spinal surgery, including minimally invasive techniques and complex reconstructive techniques for the cervical spine, adult spinal deformity, and degenerative scoliosis.

 

 

Dr. Robert Harper, MD Colorado Springs Orthopaedic Group

Robert Harper, MD

Dr. Robert Harper is a fellowship-trained orthopaedic spine surgeon specializing in cervical, thoracic, lumbar, and sacroiliac joint minimally invasive surgical techniques.

 

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Most Common Mountain Bike Injuries With Dr. Michael Huang

Most Common Mountain Bike Injuries With Dr. Michael Huang

Colorado Springs is known for beautiful mountains, parks, and reserves that are home to miles and miles of amazing trails, which attract mountain bikers from around the world. In this episode of Medical Minutes, we discuss the most common mountain bike injuries Dr. Michael Huang sees each year.

 

What are some of the most common mountain bike injuries that you see at Colorado Springs Orthopaedic Group?

One of the most common injuries seen at Colorado Springs Orthopaedic Group is clavicle fractures, more commonly known as collar bone fractures. These injuries generally happen when a mountain biker loses control and hits their shoulder after falling forward over their bike’s handlebars. Depending on if the break is well aligned or displaced can create a vast difference in the patient’s treatment plan. If the clavicle break is well aligned, there may not be a need for surgery. However, if the bones are displaced, surgery may be necessary to ensure proper healing.

What is the recovery time for a mountain bike clavicle bone fracture?

Mountain biker in red shirt flips on his head breaking his clavicle, which is the most common mountain bike injury.

The recovery time may vary depending on the location as well as the severity of the fracture. For example, a fracture located in the middle of the collar bone, also known as a mid-shaft fracture, may take anywhere between 3-4 months to heal fully. Treatments plans often include the use of a sling and rehabilitation.

What is an AC Separation caused by mountain biking?

AC Separation, or Acromial Clavicular Joint Separation, is often confused with a Shoulder Dislocation. However, AC Separations occur when the Acromial Clavicular Joint (AC Joint), located at the end of the collar bone, is separated. This injury can cause pain when reaching across the body as well as cause the shoulder to droop. Recovery timelines may vary depending upon the severity of the joint separation.

What is a rotator cuff tear?

The Rotator Cuff encompasses four muscles. These muscles include the subscapularis, supraspinatus, infraspinatus, and teres minor. Tears within the Rotator Cuff tendons that attach these four muscles to the shoulder bones are typically diagnosed through an MRI and are best treated through surgery as tendon tears do not heal on their own.

Meet Our Providers

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Dr. Stockelman’s professional interests include simple and complex problems of the shoulder and the knee.

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Medial Collateral Ligament (MCL) Injury

The Medial Collateral Ligament (MCL)

Doctor evaluating a patient to see if she will need MCL Surgery

ACL or MCL Injury? Image of a knee with possible ACL or MCL injury highlighted

Symptoms of an ACL injury differ from an MCL injury by:

1.) How the injury occurred.

2.) Location of the pain.

First, recognize ‘how‘ you injured your knee.

  • An ACL injury typically occurs with a sudden stop or turn or twist of the knee. ACL injuries are common in start-and-stop sports such as soccer, football, basketball, and skiing.
  • An MCL injury, in contrast, most often occurs with a hit to the outside of the knee. The impact causes the knee to buckle inward and strains the ligament.

Next, ‘where‘ you feel pain can be evidence of either an ACL or MCL injury. Both ligaments are on the front of the knee however, your anterior cruciate ligament (ACL) sits more towards the middle of your knee. So, you may feel a sharp pain ‘in‘ or ‘below‘ your knee cap. The medial collateral ligament (MCL) runs along the inner side of your leg thus, you will experience pain on the ‘inside‘ of your knee.

With both an ACL or MCL injury, you may hear or feel a ‘popping’ sensation, though ACL injuries traditionally having a more obvious ‘pop’ than MCL injuries.

Also, know that it is possible to injure your MCL and ACL at the same time. In that case, you could experience most or all the above symptoms.

MCL Injury SymptomsWoman sitting on the ground holding her knee with a possible MCL injury.

Symptoms of a less severe MCL sprain or tear may include:

  • Tenderness, aching
  • Swelling
  • Stiffness
  • Bruising

Symptoms of a more severe MCL tear may include:

  • Significant to unbearable pain
  • Instability or looseness of the joint
  • Excessive swelling
  • Excessive Bruising
  • Reduced range of motion

Patient and physical therapist working on MCL injury recovery therapy

Recovery time depends upon the severity of your MCL injury and whether you have surgery or not:

MCL Injury Recovery (No Surgery)

A mild to moderate MCL injury heals in a few days to several weeks. This is without surgery but is recommended to include rest, self-care such as ice and elevation, bracing or wrapping the knee, and physical therapy.

MCL Injury Recovery (With Surgery)

The sports medicine orthopedic physicians at Colorado Springs Orthopaedic Group believe in exhausting all conservative treatment options prior to discussing surgery. Some of the non-surgical options include physical therapy, cortisone injections, viscosupplementation, or PRP therapy.

If surgery is deemed necessary, then recovery could take four to six weeks after surgery to heal. At that time, you should be able to return to the majority of your normal activities as designated by your physician. However, it may take 6 to 12 months for the injury to heal to full health and integrity. We recommend that you follow your physician’s post-operative recovery and therapy protocols attentively. Once the MCL has fully healed, most experience successful long-term results including a full return to sports.

If you experience pain and stiffness on the inner side of your knee, it may be a medial collateral ligament (MCL) injury. The pain could be mild to severe, and the injury could be the result of an impact that caused the knee to violently bend or twist inward. Many MCL injuries occur during sports or rigorous physical activity. The ligament can also become injured through repeated stress such as running or jumping.

Your MCL (medial collateral ligament) is a thick band of tissue that runs from your thigh (femur) to your shinbone (tibia) about 4-6 inches from the knee. Its job is to keep the leg from bending too far inward. It also works with your ACL and PCL to stabilize your knee and allows rotation.

When strained too much, the ligament can sprain or tear. In some cases, the MCL can heal on its own and not even be that painful. But in severe cases, the pain can be excruciating, and surgery may be required to repair it.

If you suspect an MCL injury, visit our Express Care clinic to be seen the same day or call us at (719) 632-7669 to schedule with one of our Orthopedic sports specialized orthopedic physicians who specialize in MCL injuries to discuss the best treatment options for your specific situation. Contact our office today to schedule a medical consultation at:

CSOG: (719) 632-7669

Express Care- (719) 622-4550

Walk-in Clinic where you will be seen the same day by one of our board-certified Physician Assistants and scheduled with a fellowship-trained physician for a follow-up visit.

Types of MCL Injury

  • Grade 1: you have a ligament sprain, but not a tear. You likely do not need surgery.
  • Grade 2: you have a partial ligament tear. You may or may not need surgery.
  • Grade 3: you have a complete ligament tear. You are more likely to need surgery.

MCL Injury Testing

Assessment of an MCL injury should include:

  • Physical exam
  • MRI
  • X-rays

MCL Injury Home Therapy

Home therapy for an MCL injury may include:

  • Icing/cold packs
  • Elevating the leg while resting
  • Crutches
  • Knee brace
  • Anti-inflammatory medication
  • Specific stretches and therapy exercises

If MCL Injury Requires Surgery:

Generally, surgery is not required for an MCL injury unless it is a Grade 3 injury or does not heal with home care and therapy. You may also need surgery if you have other combined knee complications.

Cost for MCL Injury Surgery

Please contact your insurance carrier to discuss your specific cost estimates. You can reach our office at (719) 632-7669 to further discuss payment options.

Procedures

Surgery might be your best option to repair and/or reconstruct the knee:

MCL Repair

To repair the MCL, your surgeon will identify the torn portion of the ligament and reattach it to itself or the bone where it tore away from.

MCL Reconstruction

To reconstruct the MCL, your surgeon replaces the damaged ligament with a healthy tendon graft which will then become a new ligament.

Your surgeon may use minimally invasive surgery methods to complete your MCL surgery. This allows for faster recovery time and reduces the chance of infection and excessive scarring.

Benefits

The advantages and benefits of MCL surgery include:

  • Pain reduction
  • Improved mobility
  • Faster recovery
  • Reduced muscle atrophy
  • High patient satisfaction rates

Risks

The disadvantages and risks of MCL surgery include:

  • Infection
  • Scarring
  • Re-tear of the ligament

To prepare for your MCL surgery, your doctor will give you instructions for the following:

  1. Medical Exam: This is to make sure you are healthy enough for surgery. A medical clearance form will need to be filled out before surgery.
  2. Pre-op Appointment: Before surgery, a pre-op appointment will be scheduled to answer any questions you may have and understand the surgery in more detail.
  3. Medications: You may need to stop taking medications and supplements.
  4. Diet: You may need to limit certain foods and drink. You will also likely need to fast before surgery and stop consuming all tobacco products.
  5. Transportation: Arrange to have someone drive you home from the surgery center. This should be a close friend or relative you know well. The vehicle should be easy to get in and out of.
  6. Clothing: Wear comfortable clothing and shoes that are easy to take off and put on.
  7. Home: Prepare your home with safety and comfort features. This may include grab bars, ramps, and furniture to help you rest and move about.

What to Expect After MCL Injury

Your postoperative care and instructions may include:

  • Medications: CSOG will prescribe a variety of medications to help the recovery go smoothly. Remember that most of these medications are as needed.
  • Knee brace: Most knee arthroscopy procedures don’t require a brace however, if you are required one, it will be placed on you before leaving the operating room.
  • Control swelling: Elevate your leg and keep using cold compression/ ice packs
  • Suggested early rehabilitation exercises
  • Pain and anti-inflammatory medications
  • Follow up physical exams

Your physician will tell you when you are ready to return to normal activity. For your rehabilitation, your physician will prescribe specific rehabilitative exercises and stretches. This may include:

  • Hamstring stretches
  • Calf stretches
  • Quadriceps isometric strengthening
  • Straight leg raises
  • Ankle flexing and rotations
  • Knee flexion and sitting knee flexion

With these exercises, you do not need to stand or put weight on the surgery leg. As you progress throughout recovery, your physician will request for you to meet with a physical therapist to carry out your physician-prescribed rehabilitation protocols.

During rehabilitation, your exercises will progress with intensity. Be sure to listen to your body. If an exercise becomes painful, stop.

If You Suffer Pain from an MCL Injury

An MCL injury can heal on its own or with therapy; however, if you still have pain and discomfort after proper rest and at-home treatment, call us at (719) 632-7669 to consult with any one of our Fellowship Trained Knee Specialists to see what treatment options are available to restore pain-free knee function.

Related Articles:

o   Physical Therapy for the Knee
o   Meniscus Repair Therapy
o   Hip & Knee Replacement Testimonials

Meet Our Providers

Dr. Christopher Jones, MD Colorado Springs Orthopaedic Group

Christopher Jones, MD

Dr. Jones is fellowship-trained in the treatment of sports medicine injuries and disorders of the shoulder.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD

Dr. Friedman’s interests include treating a full range of sports injuries and specializes in complex injuries involving the shoulder and knee.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. John Redfern, MD Colorado Springs Orthopaedic Group

John Redfern, MD

In addition to general orthopedic care, Dr. Redfern has a particular interest in arthroscopic and open techniques for shoulder and knee disorders.

Dr. Richard Stockelman, MD Colorado Springs Orthopaedic Group

Richard Stockelman, MD

Dr. Stockelman’s professional interests include simple and complex problems of the shoulder and the knee.

Read More

Meniscus Repair Surgery

Meniscus Repair Surgery

Patient undergoing meniscus tear repair surgery with a doctor at Colorado Springs Orthopedic Group

Female radiologist holding an Xray of a possible meniscus injury. Localized pain, stiffness, and swelling in the knee are common symptoms of a torn meniscus. The pain may worsen with movement or bending of the joint. You might also feel a ‘catching’ sensation, giving way or buckling, or your knee might feel like it “locks up”. These can all be potential signs of a meniscus tear.

Your doctor will most likely use the following tests to confirm a meniscus tear:

  • Physical exam
  • MRI
  • X-ray
  • Arthroscopy

Woman laying on therapy bed after meniscus therapy as therapist bends her knee up during physical therapy.

Typically after a meniscus repair surgery, you can return to non-strenuous everyday activity within a few weeks however, it can take 3 to 6 months to fully recover. At that time, you should be able to return to your active lifestyle.

Of course, your total recovery time will depend upon your health and the severity of the injury. Diligent compliance with your post-operative Physical therapy program will also help reduce the time to full recovery.

Doctor holding up a model of a knee joint explaining meniscus repair proceduresMeniscus repair surgery is a common and highly successful procedure in the US. There are more than 750,000 orthopedic knee arthroscopy procedures performed each year and it has a better than 90 percent patient satisfaction rate.

The surgery to repair a meniscus tear is primarily arthroscopic or minimally invasive. The surgeon makes small incisions introduce the arthroscope (camera). He or she can then see and do the entire surgery ‘inside’ your leg. This reduces the chance of infection. It also reduces your recovery time. Your surgeon will insert sutures or fixation devices to mend the meniscus tear. Sometimes, the repair will require incisions as well.

Meniscus Tears

What is a meniscus? The knee has a specialized soft tissue structure called a meniscus.  It is made mostly of collagen.  It sits between the bottom of the femur (thigh bone) and the top of the tibia (shin bone) and acts as a cushion or pad.  A torn meniscus is a tear of this specialized structure. Unfortunately, when a meniscus tears, it does not heal due to its poor blood supply.  If you have a meniscus tear, depending on the severity of your tear, you may be a candidate for meniscus repair surgery. Meniscus repairs are typically an outpatient surgical procedure that aims to restore the full function of the knee through a variety of minimally invasive techniques. If conservative treatments have been exhausted to heal a meniscus tear, surgery may be the next best treatment to help you return to your active lifestyle.

The meniscus can be injured in various ways; however, the most common occur from rapid turning or twisting or applying high amounts of vertical load (weight) without proper activation of supporting muscles, such as squatting heavy weight without properly warming up or activating the appropriate muscles. Meniscus injuries may result from sudden trauma to the knee or can occur as a result of chronic wear and tear of the joint.

The meniscus tear will not heal on its own; however, the pain and inflammation can and often will decrease on its own with proper rest and cautious exercise. If you’re still experiencing pain after taking proper precautions, it’s recommended to speak with your orthopedic physician.  A torn meniscus needs immediate care when the knee “locks” or isn’t able to complexly bend or straighten. Contact our office today to schedule an initial consultation and learn if meniscus repair surgery is right for you:

Call (719) 632-7669

Meniscectomy vs. Meniscus Repair

Meniscectomy is another surgical treatment for injured meniscus. Rather than ‘repair,” the surgeon fully or partially ‘removes‘ or ‘trims‘ the meniscus. This is typically performed when the torn portion of the meniscus is small, or the tear pattern will not benefit from “repair” stitches.  Remember that the majority of the meniscus does not have a blood supply, so its ability to heal is severely diminished.

A meniscectomy may be your best treatment option if:

  • The meniscus has significantly deteriorated tissue
  • Parts of the meniscus are almost completely torn already

Types of Meniscus Repair

There are four basic types of meniscus repair:

  1. Open technique
  2. Inside-out technique
  3. Outside-in technique
  4. All-inside technique

The technique used will depend upon the severity and location of the meniscus tear.

What Types of Meniscus Repair Require Surgery?

You will likely need surgery to repair your meniscus if:

  • You have multiple tears
  • Your knee is ‘locked up’
  • You have advanced tissue deterioration
  • You have also damaged the MCL

What Is The Meniscus Tear Recovery Time Without Surgery?

You may recover from a meniscus tear without surgery within 4 to 8 weeks. Recovery times will vary upon your health, resting appropriately, and the severity of your injury.

Treatments

Surgery is just one treatment option to repair a torn meniscus. Other treatment options include:

  • Exercise and physical therapy
  • Anti-inflammatory medications
  • Joint aspiration and injection
  • Knee braces

Benefits

The benefits and advantages of meniscus repair surgery include:

  • Faster recovery
  • Pain reduction
  • Restored function and mobility of the knee
  • Mitigates further degeneration of the knee

Risks

The risks and disadvantages of meniscus repair surgery include:

  • Anesthesia
  • Infection
  • Scarring
  • Further medical complications and pain
  • Re-tear of the meniscus

Preparation for your meniscus repair surgery includes:

  • Medications: You may be required to stop taking specific medicines and supplements prior to surgery. Cutting down or stopping smoking will decrease the risk of infection and blood clots and improve healing.
  • Diet: Your physician may recommend a weight loss program and you will likely be required to fast for several hours before surgery.
  • Transportation: be sure to arrange your post-surgery transportation plan prior to surgery day.
  • Home: we also recommend making home arrangements for the first several days post-surgery since mobility will be impaired.

What to Expect After Meniscus Repair

You may or may not have a hospital stay after your surgery. Your doctor will give you post-operative care instructions. This may include:

  • Wound and bandage cleaning
  • Pain and anti-inflammatory medications
  • Diet and supplements
  • Therapy and exercises

You will also need a follow-up appointment to check progress and remove sutures. Contact your doctor immediately if you experience increased pain or other medical problems.

Your doctor will likely refer you to a physical therapist for post-surgery rehabilitation. Dependent upon your knee and overall health, your physical therapy program may last several weeks to a year.

Physical therapy aims to safely restore knee strength and mobility. Physical therapists receive special movement training to best provide you with exercises and stretches and work directly with your physicians to ensure you receive the best overall treatment. To help you recover from your meniscus repair surgery, CSOG offers on-site physical and occupational therapy.

Cost of Meniscus Repair Surgery

Please contact your insurance provider to discuss coverage details.

To make an appointment at our North Campus location call. (719) 867-7320

To make an appointment at our South Campus location call. (719) 622-4524

Our Orthopaedic Doctors

At Colorado Springs Orthopaedic Group, you have access to top knee repair surgeons. Our doctors are board-certified and committed to delivering the highest quality of care.

Dr. Michael Huang, MD Colorado Springs Orthopaedic Group

Michael Huang, MD

Dr. Huang specializes in treating orthopedic sports medicine injuries. His treatments involve both surgical and non-surgical options.

Dr. Jamie Friedman, MD Colorado Springs Orthopaedic Group

Jamie Friedman, MD