Free Publication – Please Take One
Feature Story
OrthoIndy and IOH Launch New Campaign: Meet the featured patients
Also in this issue: Girl from Kenya receives lifesaving spinal surgery
Volume 3, Issue 1
Letter from the CEO At OrthoIndy and IOH, we are committed to our patients. That's why we have created the semi-annual publication, Beyond Your Bones. We hope that you find the information in this publication resourceful. In this issue, learn about OrthoIndy and IOH's newest advertising campaign called, "My Scar Means." This campaign allows our patients to tell others about his or her experience at our facilities. Additional stories include healthy eating habits, corporate updates and a number of uplifting patient testimonials. We hope you find the information in this issue educational. We welcome suggestions and comments by emailing us at suggestions@orthoindy.com. Best wishes and good health, Jane Keller Chief Executive Officer
Chief Executive Officer Jane Keller President of the Board, OrthoIndy Frank Kolisek, MD Chairman of the Board of Directors, IOH John Dietz, MD Editor Kasey Prickel Graphic Designer Jackie Bilskie Contributing Writers Chris Bales, MD Emma Baxter Jack Farr, MD Judy Porter Kasey Prickel Michael Shea, MD Chelsea Tuttle Contributing Photographers Jackie Bilskie Zach Dobson Kasey Prickel Nadia Scott
Tell us your story. Are you an OrthoIndy and IOH patient? Tell us your story at
MyScarMeans.com.
Want to know more? Give us a call at:
(317) 802-2000 or follow us on:
On The Cover:
Meet Lauren, one of our featured patients in our new campaign
Table of Contents 4. OrthoIndy and IOH Launch New Campaign
22. Award Winning
7. Going for the Gold
24. Now Open
Meet our featured patients
Member of the U.S. Paralympic Women’s Sitting Volleyball Team recovers from ACL injury
10. Saving Salma
Girl from Kenya receives lifesaving surgery
16. The OrthoIndy Story
Celebrating 50 years of service
18. Healthy Habits that Improve Arthritis IOH nutritionist discusses healthy choices
20. Ask the White Coat
OrthoIndy physicians answer your questions
IOH receives national and state recognition
New OrthoIndy office opens in Lafayette
25. Kickin’ It
Marian soccer player recovers from injuries
28. My Journey
Ice skater shares her experience
30. Early Intervention
Clinical study of damaged knee cartilage
33. Carpal Tunnel Syndrome
Nail tech goes back to work after carpal tunnel surgery
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OrthoIndy and IOH Launch New Campaign
"My Scar Means…" By: Kasey Prickel and Chelsea Tuttle
To many patients, it may seem like hospitals and emergency care providers are focused on pushing patients through the system as quickly as possible with minimal interaction. Needs and wants of a patient are often overlooked or worse, ignored. Founded over 50 years ago, OrthoIndy has set out to create a patient experience unlike any other in Indiana, the result, the Indiana Orthopaedic Hospital (IOH). Owned and operated by the OrthoIndy physicians, OrthoIndy and IOH strive to provide exceptional care and build a meaningful relationship with each patient because every individual has a story. 4 | Summer 2012
With over 17 locations in Indiana, OrthoIndy and IOH have clients from all over the state, country and even the world. No one patient is the same. People come from all different walks of life, backgrounds and most importantly, reasons as to why they seek bone, joint, spine or muscle care. “My Scar Means” is a movement to show the individuality of each patient and to share their story of why they come to one of the largest private, full-service orthopaedic groups in the United States. Creating a positive patient experience not only within our facility,
but also outside the facility is important to us. We want to hear from our patients about their experiences, help them answer questions and continue a relationship beyond treatment and recovery. When we are out in the community, we find each person wants to share their unique experience and that each person is proud of his or her injury or surgery scar because of what it represents. Meet some of our patients and learn what his or her scar means to them.
“My Scar Means...nothing will hold me back.” -Lauren Gerbick
Recent Marian University graduate and former member of the university’s soccer team, Lauren Gerbick, thought her season was over when she tore her ACL and meniscus. She knew right away after meeting with her OrthoIndy physician that he was the only surgeon she’d consider for her surgery. Because of the care she received at OrthoIndy and IOH, Lauren was able to step back on the turf and wear the number 14 jersey again.
“My Scar Means...I can still farm.” -Jack Maloney
Jack Maloney comes from a family of farmers. During a typical workday, an accident occurred that left Jack’s arm nearly unusable. After getting his upper arm rebuilt from the elbow up, Jack had to learn how to live with the use of only one arm. He later sustained a shoulder injury which he had to have repaired immediately to continue to work. Jack is back to his go-getter self, taking care of business and doing what he loves.
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“My Scar Means...a better quality of life.” -Gene Huey
Former Indianapolis Colts player and coach, Gene Huey, had suffered a greater portion of his life dealing with a nagging pain in both of his hips. He knew he needed hip replacements but continued putting off surgery. The pain became so severe that he couldn’t enjoy leisure activities like playing golf or even sleeping. Gene had both hips replaced at OrthoIndy and IOH and was able to get back to his leisure sports without pain.
“My Scar Means...we’re together.” -Rosie and Phoebe Plunkett
Unfortunately, accidents happen in life. Luckily, OrthoIndy provides trauma care for those unforeseen events. Mother and daughter, Rosie and Phoebe Plunkett expected their family holiday to be filled with laughter and good memories. After a head on auto collision, the mother-daughter pair was left with threatening injuries, such as crushed growth plates and broken tibias and fibulas. After intensive surgery and therapy at OrthoIndy and IOH, both are back to walking and running marathons and more importantly, alive.
“My Scar Means...I can be a kid.” -Aidan Fitzpatrick
Aidan Fitzpatrick was born with cerebral palsy (CP). Individuals with CP may develop orthopaedic conditions that will require treatment. Aidan’s OrthoIndy physician has performed a number of orthopaedic surgeries over the years to help improve his quality of life. He also receives Botox injections for his muscle spasms. Aidan’s mom, Kim, believes the care Aidan has received at OrthoIndy and IOH has improved the overall quality of her son’s life.
Tell Us What Your Scar Means…
All of these stories are different and unique in their own way. OrthoIndy patients wear their injury or surgery scars with pride because of what it represents: a better quality of life and a positive experience. Are you an OrthoIndy and IOH patient? We want to hear from you. Visit us at MyScarMeans.com and tell us what your scar means to you. Or visit us on Facebook or Twitter and use #MyScarMeans to tell your story or to talk to other patients.
By: Kasey Prickel Kendra Lancaster was like any other girl who enjoyed sports. Growing up, sports were a natural fit for her. She has always been athletic and really competitive, enjoying softball, kickball, basketball, track, soccer, volleyball and horseback riding. The only difference from Kendra and other girls her age was that she was born without a left arm. “My arm never held me back and I never used it as an excuse to get out of something,” said Kendra. “If anything, it just made me work harder and made everything a little more interesting.” As a kid, Kendra tried every sport, but volleyball became her passion. In high school she started playing the sport year-round and during her sophomore year she discovered the Paralympic team and decided to try-out. March 2004, at the age of 16, Kendra became the second youngest member of the U.S. Paralympic Women’s Sitting Volleyball Team. That same year, Kendra’s team won the bronze medal in Athens. Four years later, they took home the silver medal at the 2008 Paralympic Games. On May 7, 2011, while preparing for the 2012 games, Kendra was injured in a head on collision with another vehicle. She sustained a number of injuries, including a torn ACL, which brought her to OrthoIndy where she saw orthopaedic sports medicine surgeon, Dr. Scott Gudeman.
Top: World Championships 2010 vs. the Netherlands. Photo courtesy of Rocky Chen. Bottom: World Championsips 2010 vs. Russia. Photo courtesy of USA Volleyball.
Anterior Cruciate Ligament (ACL) injuries are one of the most common knee injuries. The ACL can be injured in several ways, including: changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly or like in Kendra’s case, direct contact or collision. There are a couple of symptoms that indicate you may have injured your ACL, including hearing a “popping” noise at the time of the injury, pain with swelling, loss of full range motion and discomfort while walking. | 7
According to Dr. Gudeman, for an athlete, the main concern is being able to get the individual back to his or her pre-injury level of performance and confidence. “Sitting volleyball is a misnomer,” said Dr. Gudeman. “The athlete sits but does not remain in a stationary position. Kendra needed knee stability to push off and turn her body suddenly while in the sitting position. These physical requirements presented a different challenge in her rehab.” “Finding out about my ACL was probably one of the more devastating pieces of news I received after my accident,” said Kendra. “It's every athlete's worst nightmare, and after everything else that I had gone through it was the last thing I wanted to hear. As a Purdue student and a fan of Robbie Hummel, a torn ACL comes with some extra baggage too. The possibility of it not holding up scared me. But the very first thing that crossed my mind was the possibility that I wouldn't be healthy enough to play before the London Games.” An ACL injury will not heal without surgery and therefore Kendra underwent an ACL reconstruction. The ligament must be reconstructed by replacing the torn ligament with a tissue graft. Dr. Gudeman obtained the graft from Kendra’s patellar tendon, which runs between the kneecap and shinbone. This procedure Dr. Gudeman, Kendra, Cindy and Eric meet for her final follow up appointment.
8 | Summer 2012
is done with an arthroscope using small incisions. The benefits of this less invasive surgical technique include less pain from surgery, less time spent in the hospital and quicker recovery times. Kendra had a great support system throughout her entire treatment. “I learned a lot as a result of my injury,” she said. “I had the opportunity to work with some wonderful athletic trainers and physical therapists who helped me to get my knee strong and get back into shape. I learned a lot about my body and how it worked and also about myself. My recovery taught me to be strong and dedicated and having the success I have had with my knee after all of the work I put in has been the best reward.” One member of her support team is Cindy Wells, RN, CCM. Cindy is a Medical Services Consultant for Quality Case Management, Inc. who served as Kendra’s nurse case manager. Cindy believes that Kendra’s outcome was truly a team effort. “Kendra is not only an injured worker, she is also a valued team member of the Paralympic Volleyball Team. Throughout this claim/injury, Kendra has been so motivated that on several occasions I had to remind myself that she was born without a left arm,” said Cindy.
Due to the team effort and hard work of Cindy, Kendra’s employer and worker’s compensation adjuster, her physical therapists and Dr. Gudeman and his physician assistant, Eric Frazier, Kendra has been cleared to participate in the 2012 Paralympics. “Kendra was one of my most motivated athletes I have ever treated,” said Dr. Gudeman. “She pushed herself to the limit during her rehab and was always upbeat. I always looked forward to her appointments because her positive attitude is very inspiring.” Kendra’s experience with Dr. Gudeman has been extremely positive. “Ever since I first met him, I've felt at ease with him and was able to put my full trust in him because he's so personable, which to me is huge,” she said. “He answered all of my questions, explained the procedure and the recovery to me, and just made me feel at ease with everything because he helped me know what to expect. Coming to Greenwood to see him was always the highlight of my week; I really enjoyed working with him. His support and involvement in all of this is something that I will forever be thankful for. He really cares about my success and me. As a patient, something I have a lot of experience in, that means everything.” Since her surgery, Kendra has been working on getting stronger. Her team will compete in London this fall and hopefully come home with Gold! In addition to her volleyball career, Kendra is finishing her master’s degree in Youth Development and AG Education at Purdue University. OrthoIndy wishes her and the U.S. Paralympic Women’s Sitting Volleyball team the best of luck in London.
“Kendra, the London Olympics are your reward for the tremendous sacrifices you have made and the obstacles you have overcome. Please enjoy and relish every moment of this once in a lifetime experience. You are very deserving. Best of luck!” – Dr. Gudeman | 9
10 | Summer 2012
Salma
saving
The amazing story of Salma Suleiman, a 12-year-old girl who received life saving surgery thanks to OrthoIndy surgeon, Dr. David Schwartz. By: Kasey Prickel
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Being accustomed to the many opportunities available in the United States, we sometimes take for granted the many resources that are available at our fingertips. Our healthcare system for example, while ever changing and not exactly perfect, is one luxury we might take for granted. In the US, most of our children are given the opportunity for healthcare and because of this care, many conditions or diseases may be found early on, before it progress to a serious or critical nature. Salma Suleiman is a 12-year-old girl who unfortunately did not have the means to identify her scoliosis before it became too severe, let alone treat it. Because of the severity of her condition, it would have only been a matter of time until her condition claimed her life. Thanks to OrthoIndy, Peyton Manning Children’s Hospital at St.Vincent and NuVasive Spine Foundation, Salma received another chance at life. Salma grew up in Nairobi, Kenya, in Africa’s second largest slum, Kibera. Comprised of about one million people, Kibera’s conditions are extremely poor. Until October 2011, Salma lived with her mother, Zaituni Yusef Suleiman and her two younger brothers.
12 | Summer 2012
Salma’s mother and grandmother brought her to Dr. Soren Otieno, an orthopaedic surgeon at the National Spine Injury Hospital in Nairobi. “I examined her and from the start, I could see that her deformity was really gross,” said Dr. Otieno. “We could not really figure out how she would get help locally because we had never done such a thing in Kenya.” Luckily, the NuVasive Spine Foundation has mission trips to Kenya where they perform spine surgeries and run a clinic for general health care. Salma’s mother heard that the physicians from America were there and she brought Salma to the clinic. “I met the surgeons from the USA and they told me they could help my daughter,” said Salma’s mother. “Once they sit down with the other surgeons from America they will help her. And she’ll get better.” The NuVasive Spine Foundation tried finding surgeons and hospitals around the country that would be willing to perform surgery on Salma, with no luck until Dr. David Schwartz, an orthopaedic spine surgeon at OrthoIndy was told about Salma.
Salma lives in a slum known as Kibera.
Salma with her care team at Peyton Manning Children’s Hospital at St.Vincent. “The first time I saw pictures of Salma and her condition, I was shocked, horrified and almost couldn’t really figure out how I was going to fix her,” said Dr. Schwartz. “I was also saddened because I saw this cute little girl with this horrible deformity.” Dr. Schwartz agreed to perform surgery on Salma and approached the Peyton Manning Children’s Hospital at St.Vincent, who graciously agreed to participate. All services were donated free of charge. Two months before her journey to America, sadly, Salma’s mother died due to complications from childbirth. On December 28, 2011, Salma traveled with Dr. Otieno and his wife and Salma’s guardian, Precious Mbabazi, to Indianapolis, Indiana to start treatment. “On the long trip, Salma was overwhelmed, hopeful and missing her mother and facing much pain,” said Precious. Upon arriving, Salma went to OrthoIndy Fishers for her first consultation with Dr. Schwartz. Dr. Schwartz diagnosed Salma with congenital scoliosis with a 170-degree curve of the spine. The severity of her condition caused compression of her lungs and pulmonary hypertension. After her consultation, Dr. Schwartz sat down with Precious and Salma to explain the surgery and the risks involved. He explained that there was as high as 20 to 30 percent chance of paralysis with a surgery of this magnitude. After hearing this, Salma immediately began to cry. Images of Salma’s spine before surgery. Salma’s spine had a curvature of 170-degrees.
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“Only God can make perfect bodies. The surgeons that try to fix the imperfect ones are heroes.” -Precious
Salma's Grandmother and Mother “Salma didn’t understand that being paralyzed was a possibility,” said Precious. The family struggle, the recent death of her mother, the long trip and now the surgery risks became a lot for Salma to deal with; expected out of any 12-year-old going through this situation. “Salma has gone through quite a lot being a young girl at 12-years-old,” said Dr. Otieno. “A correction of this will really improve her self esteem and bring back the hope that had been diminished in her.” The week after her arrival, everyone prepared for Salma’s surgery. The morning of January 4, 2012, Salma was wheeled back to the operating room to fix her spinal condition. In surgery, Dr. Joseph Riina, an orthopaedic spine surgeon at OrthoIndy, assisted Dr. Schwartz with a posterior spinal fusion with instrumentation. “Initially we were going to try and do an osteotomy, where we cut through it and remove some bone and then realign the spine,” said Dr. Schwartz. “But once we saw her spine we realized that her spinal cord was in such a bad condition that we were worried during the case that she would become paralyzed if we proceeded with that particular procedure. Her bone was very soft so we got as much correction as we could. We opened her chest wall and lungs and leveled her out so she wouldn’t have heart failure if untreated.”
14 | Summer 2012
Salma at her school in Kenya The major concerns of the surgery, other than paralysis, was blood loss and whether or not they would be able to correct her spine. The surgery lasted a total of 12 hours, resulting in 15 levels of spinal fusion. Before surgery, Salma would become out of breath after walking 12 feet, she couldn’t carry a bag, lift her arms or use her hands. She also had to walk on a tiptoe to accommodate the curvature in her spine. Precious said, “Salma will be taller, she will walk better, her heart and lungs will work better. She just wants to be a normal little girl.” Precious was right. After surgery, Salma’s curvature went from 170-degress to 70-degrees, making her ten inches taller. One week after surgery she was walking the full length of the hospital hallways. Three weeks after surgery, she progressed even further.
“I can walk a long distance,” said Salma. “I can rest my hands straight. Before I used to not rest my hands that straight. I used to be bent, but now I’m much straighter than before.”
After rehabilitation, Salma called Dr. Schwartz from the airport on her way home to tell him she was in no pain and she was excited to see her family. She is very optimistic about her future.
Salma is very grateful to Dr. Schwartz and the care she received. “I was losing my hope and Dr. Schwartz brought my hope back,” she said. “My hope is I become like other children. It has given me hope, lots of hope. Before I used to not have that hope, but now I have it more than ever.”
“When I grow up I want to be a surgeon who takes kids, helps kids like me, even other kids who are not like me,” said Salma. She also told Dr. Schwartz that she wants people to come to her country and help her people, not just by doing surgery, but training them on how to take care of themselves.
Salma isn’t the only one who is grateful. Salma has touched more lives than she will ever know. Everyone who had the privilege of meeting this brave little girl will never forget her. One such individual is Dr. Schwartz. “I can’t tell you how excited and happy I am for Salma,” said Dr. Schwartz. “She’s touched my life in ways I can’t even tell you. My hope is I can give her a good life in the future. I think we’ve saved her, we’ve really saved her.”
Dr. Schwartz plans to go to Kenya in June and September with the NuVasive Spine Foundation to help other people in need. While there he plans on visiting his patient and friend, Salma.
The end of January, Salma headed to NuVasive’s headquarters in San Diego where she underwent rehabilitation. “Now her recovery is really just walking and becoming a kid again,” said Dr. Schwartz.
Salma goofing around with Dr. Schwartz post surgery.
Precious says it best, “Only God can make perfect bodies. The surgeons that try to fix the imperfect ones are heroes.” Meet Salma and Dr. Schwartz – Watch Salma’s journey to recovery at OrthoIndy.com.
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The OrthoIndy Story:
Celebrating 50 Years of Service
By: Kasey Prickel
This year marks a very important milestone for OrthoIndy, its 50th Anniversary. For half a century, OrthoIndy has offered Indianapolis and surrounding areas quality bone, joint, spine and muscle care. While most practices only specialize in one or two areas of orthopaedics, OrthoIndy provides complete orthopaedic care. With more than 70 physicians, OrthoIndy is the largest private, full-service orthopaedic practice in the Midwest, and one of the largest in the country.
general orthopaedics, hand and upper extremity, hip, knee, non-operative spine, pediatric orthopaedics, physiatry and pain management, shoulder, sports medicine, spine, total joint replacement and trauma.
Serving patients from over 14 locations, OrthoIndy’s specialties include: bone tumor and soft tissue oncology, cartilage restoration, foot and ankle,
OrthoIndy has also opened three Walk-In Clinics with extended hours for immediate access to orthopaedic care.
1962
1967
1969
1971
• Founded by Drs. Blackwell and Brueckmann • Opened office downtown
Opened office on Lafayette Road
Blackwell/ Brueckmann Corporation becomes OrthoIndy (OI)
Consolidated two locations into one office downtown
16 | Summer 2012
In 2005, OrthoIndy opened Indiana’s first subspecialty hospital with a direct focus on orthopaedics. What started as one location has now turned into three IOH facilities, located in Indianapolis, Brownsburg and Greenwood.
1978 Opened OI Danville
1991
1992
Opened OI Eagle Dr. Joseph Randolph elected Highlands office president of OI
1997
2
Northwest Surgery Center and Northwest office opened
Pract to 67 with addi prac
The physicians and staff of OrthoIndy would like to thank all or our patients, local businesses and community for their support and we look forward to serving you for another 50 years.
History
In 1962, Dr. Donald Blackwell and Dr. F. Robert Brueckmann founded the Blackwell and Brueckmann Partnership, which became the foundation for a unique medical practice that now spans over five decades. Today, that group is known as OrthoIndy. Within the United States, OrthoIndy ranks among the largest private full service orthopaedic groups and is the largest orthopaedic group in Indiana and the Midwest. OrthoIndy physicians are involved in producing quality outcomes on the leading edge of research and development of new procedures and techniques.
7
2000
ter est d
Practice grows to 67 physicians with two additional practices
2001
2002
2005
• Opened Indiana • Dr. Frank • Dr. David Kolisek elected Fisher elected Orthopaedic president of OI Surgery Center president of OI (IOSC) • IOH opens • Opened OI • Consolidated • NW Surgery Fishers two smaller Center closes locations into and is converted the South office into clinic space
As OrthoIndy continues to grow, the commitment to quality care that was the foundation of the corporation back in 1962 remains firmly intact. What began as a two-physician group dedicated to orthopaedic trauma has evolved into a consortium of the finest orthopaedic surgeons in the nation and one of the most technologically advanced orthopaedic hospitals in the Midwest, IOH. IOH is a physician-owned hospital model, which provides patients with high quality care with the physician involved in every aspect of the patient’s treatment. With the physicians playing the role of the patient advocate, they personally decide what type of treatment is most appropriate and beneficial, putting the care of their patients first and not focusing on the financial bottom line.
2008 OI West and IOH West open in Brownsburg
2009
2010
2011
OI North Meridian OI and IOH • OI South and announce IOH South open clinic moves to St.Vincent Carmel partnership with in Greenwood St.Vincent Health • OI opens offices at St.Vincent Clay, St.Vincent Jennings • Opened OI Greenfield • OI opens three Walk-In Clinics
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Healthy Habits that
Improve Arthritis By: Judy Porter
Eating a well-balanced diet and maintaining a healthy weight can have a huge impact on your arthritis, not to mention the quality of your life. Carrying extra weight is a common problem in people with arthritis. Losing weight can be extra challenging due to a number of factors. Top on the list is pain, which reduces the ability to exercise. Medications commonly used to treat arthritis, such as steroids, can lead to weight gain. Non-steroidal anti-inflammatories (NSAIDS) can irritate the stomach making healthy meal choices more difficult. There is a lot of information out there on diet and arthritis. Although certain foods do impact the symptoms of arthritis more than others, it is most important to focus on a nutrient dense diet and reduce your calorie intake if weight loss is needed. Most women will see weight loss on 1400 to1600 calories/day and most men will reduce their weight by limiting calories to 1600 to1800 calories/day. Eat Less Sugar and Refined Carbohydrates Sugary foods and drinks have been deemed one of the leading causes of obesity today. Most foods and drinks high in sugar and refined carbohydrates are empty calories, meaning they contain very little nutrients such as vitamins and minerals.
Limit Concentrated Sweets Cakes • Donuts • Candy • Cookies • Pies Sodas • Fruit Drinks • Fruit canned in heavy syrup Foods/drinks made with: Sugar • Sucrose • Dextrose High Fructose Corn syrup Corn syrup • Brown Sugar • Honey Limit carbohydrates to 25% of your plate at meals Choose whole grain carbs most of the time: 100% Whole Grain Bread • Whole Grain Pasta Wild Rice • Brown Rice • Sweet Potatoes Red Potatoes • Whole Grain Cereal Multigrain Crackers Choose refined carbs less often: White Bread • White Crackers • White Rice Sugar Sweetened Cereal (>10 g sugar) Pancakes • Waffles • Bagels French/Italian Bread Eat More Fruits and Vegetables Fruits and vegetables should fill half your plate, at least 2 ½ cups daily. Fruits and vegetables provide a wide range of vitamins, minerals and are excellent sources of antioxidants. Antioxidants reduce inflammation in the body and can help protect the joints. Brightly colored fruits and vegetables are the highest in antioxidants.
Anti-inflammatory Fruits and Vegetables Pineapple • Cherries • Blueberries Oranges • Spinach • Broccoli Consume More Calcium-rich Foods/Drinks Calcium is a mineral that is important for healthy bones and strong teeth. People with rheumatoid arthritis are at a higher risk of developing osteoporosis and adequate calcium intake reduces this risk. Three servings from the low-fat dairy group will help you meet your calcium needs. Dairy products are also a great source of Vitamin D, protein and B Vitamins. Good Sources of Calcium Low-fat Milk • Low-fat Cottage Cheese Low-fat, Low-sugar Yogurt Cheese (made with skim or 2% milk) Green Leafy Vegetables • Calcium Fortified Soy Products Calcium Fortified Fruit Juice Consume More Healthy Fats Evidence is building that the Omega 3 fatty acids found mainly in oily fish and some seeds and nuts can benefit those with arthritis by reducing inflamation in the body. If you have gout, fish may need to be limited however because purine levels in the blood increase with fish consumption. Elevated purine levels can aggravate gout so you will need to focus on other sources of Omega 3 fatty acids. Good Sources of Omega 3 Fatty Acids Fish (Salmon, Sardines, Mackerel, Tuna) Aim for 8 ounces of fish per week Flaxseed oil • Avocados • Nuts • Seeds Move! Research shows that people with all forms of arthritis can exercise. Regular exercise can help to: • Achieve healthy weight • Decrease bone loss • Reduce pain
• Improve joint motion and function • Enhance coordination and balance • Improve cartilage health Talk to your doctor about which exercise is most appropriate and safe for you and get moving today! Exercise to Consider Flexibility exercises such as stretching, yoga and Pilates can improve range of motion and reduce joint stiffness. Recommendation: Stretches done 5 to 10 times daily. Strengthen exercises such as weight lifting can reduce bone loss, improve function, provide support to the joint and reduce load and stress to a painful joint. Recommendation: 8 to10 exercises done 2 to 3 times per week. Aerobic exercise such as biking, swimming, walking or elliptical trainer can help control weight, improve muscle function, enhance mood and sleep. Recommendation: 150 minutes of moderate activity on a weekly basis as a minimum. Sample Healthy 1600 Calorie Menu Breakfast: ¾ cup oatmeal • ¼ cup dried cherries ¼ cup slice almonds • 1 cup skim milk Hot green tea or coffee Snack: 1 orange, 2 cups water Lunch: Chicken Caesar Salad • 2 cups greens 1 grilled chicken breast, sliced 1 T parmesan cheese • 2 T Light Caesar Dressing 1 whole grain dinner roll • 2 tsp. light margarine 2 cups unsweetened tea Snack: ½ cup low-fat cottage cheese • ½ cup pineapple Dinner: 4 ounce Salmon filet, baked or grilled 1 cup steamed broccoli • ½ cup wild rice 2 cups water Snack: 6 ounces low-fat Greek yogurt ½ cup blueberries
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Ask The White C Question:
How is an ankle sprain treated?
Answer:
Ankle sprains are one of the most common orthopaedic injuries. An ankle sprain is an injury/tearing of the ligaments about the ankle; usually the outside or lateral ankle. Anyone can sprain their ankle. Typically this occurs when the foot rolls inward from the leg area. This is common in jumping/landing or cutting type sports, such as basketball or volleyball. Also activities such as running or even walking on uneven ground can cause one to sprain their ankle, such as a hole in the grass or misstepping on a curb. There are three separate ligaments, which compromise the outer, or lateral ligaments, of the ankle. They are generally torn from the front of the back in order of severity. Ankle sprains are characterized by which ligaments are involved, and how significant the involvement.
Treatment consists of resting the injured ankle. Generally icing 10 to 15 minutes every one to two hours, as well as keeping the limb elevated above your heart level, and compressions such as an Ace wrap or a compression stocking, all to control the swelling and pain, as well as allow a quicker functional return. Occasionally a lace-up ankle brace or Velcro wrap brace may be of help to allow quicker return or increased activity level sooner. Several days to a few weeks of conservative care is generally indicated unless there seems to be no improvement, at which point in time a physician should be seen. Seventy percent of lateral ankle injures are improved by six weeks, and 90 percent are improved by ten weeks. Those that do not improve, a physician may recommend prolonged immobilization or possibly more formalized therapy or even decreased weightbearing depending on the severity of the ankle injury. Usually MRIs are not ordered until at least four to six weeks post injury in most ankle sprains. Complications of ankle sprains include instability, which would lead to chronic recurrent giving out of the ankle. This could be improved with bracing and physical therapy or one may need to have surgery. After recovery from an ankle sprain, one will need to prepare for the next season. Usually six weeks prior to the start of the sport’s season one should start an aggressive strengthening program, as well as a balance/proprioceptive exercise program to try and avoid recurrent injuries.
Michael Shea, MD Practice Focus Foot and Ankle General Orthopaedics
Locations OrthoIndy Northwest OrthoIndy West
To schedule an appointment with Dr. Shea, please call (317) 802-2821.
e Coat
OI Physicians answer your orthopaedic questions
Question:
What is tennis elbow and how is it treated?
Answer:
Tennis elbow, or lateral epicondylitis, is a common cause of elbow pain that originates off the lateral (outside) part of the elbow. It was initially named tennis elbow due to its association with this sport but it is more commonly found in manual laborers and people that perform repetitive lifting tasks at work and home. It is thought to be due to overexertion of the arm with repetitive wrist extension and forearm rotation. This leads to microtrauma of the extensor tendons of the wrist that originate on the lateral part of the elbow. Because of a poor blood supply at this area, the tendon fails to heal correctly. Common complaints include difficulty with lifting objects such as a gallon of milk or even a coffee cup. People may also complain of pain when making a fist or shaking someone’s hand. Classic physical exam findings include tenderness over the lateral epicondyle of the elbow and pain with resisted wrist extension and passive wrist flexion while the elbow is extended. A variety of treatment options are available to reduce pain and allow time for healing. Initial treatment commonly includes a period of relative rest with avoidance of aggravating activities and anti-inflammatory medications. A physical therapy program focusing on stretching and strengthening of the extensor origin is also incorporated. Bracing options such as a tennis elbow strap have also been utilized to help decrease tension at the extensor origin and allow time for healing. For tennis players proper equipment is also helpful
to prevent this problem from occurring. A heavier racquet that isn’t over tensioned with a larger handle that isn’t stiff is recommended. Steroid injections have also shown to be an effective treatment for pain relief in the early period but risks can include skin depigmentation, fat atrophy and in rare cases tendon rupture. Recently, attention has focused on platelet rich plasma (PRP) injections as a treatment option for tennis elbow and other musculoskeletal injuries. Several high profile athletes such as Tiger Woods, Kobe Bryant and Alex Rodriquez have received PRP injections for various ailments. PRP is obtained from the patient’s own blood which is ‘spun down’ with a centrifuge to obtain the platelet rich component. The PRP is rich in growth factors which are then injected into the area of the lateral epicondyle to stimulate healing of the tendon. The treatment of tennis elbow is usually successful with conservative management however 5 to 10% of patients will require surgery after failure of nonoperative management for a period of 6 to 12 months. A variety of surgical options are available to treat tennis elbow including arthroscopic and open techniques. Open treatment involves a small incision over the lateral aspect of the elbow. The degenerative tissue of the extensor tendon is then sharply excised and local blood supply is stimulated. The remaining tendon is then repaired. The arm is immobilized for a short period of time after surgery in a splint or sling. Progressive return to work and sporting activities occurs earlier than six weeks.
Chris Bales, MD Practice Focus Knee Shoulder Sports Medicine
Locations OrthoIndy West OrthoIndy at St.Vincent Clay
To schedule an appointment with Dr. Bales, please call (317) 268-3632.
IOH Receives National and State Recognition for Patient Satisfaction By: Kasey Prickel The Indiana Orthopaedic Hospital (IOH) is proud to announce that Press Ganey Associates, Inc. has named it a 2011 Summit Award® winner. This is the third year in a row that IOH has received this award for sustaining the highest level of performance for three or more consecutive years. Press Ganey currently partners with more than 10,000 health care facilities — including 50 percent of all U.S. hospitals — to measure and improve the quality of their care. The Press Ganey Summit Award is the health care performance improvement industry’s most coveted symbol of achievement bestowed annually. IOH is one of 98 organizations to receive this prestigious honor in 2011, and one of 87 to receive it for achieving and sustaining excellence in patient satisfaction.
According to Jane Keller, chief executive officer at IOH, the award represents important recognition within the industry of its efforts. “We are honored to receive this award for the third year in a row, as it demonstrates that a physician-owned hospital model provides quality outcomes for patients,” said Keller. “By instituting patient focused initiatives, our staff continues to provide the highest level of customer service, ensuring patient satisfaction.” For more information on the Summit Award and Press Ganey, please visit www.pressganey.com.
For patient safety, IOH is ranked #1 in the State for Major Orthopaedic Surgery by CareChex, a division of The Delta Group, the nation’s largest privately-held healthcare information service company. The “Major Robert Draughon, Press Ganey’s CEO noted, “We are Orthopedic Surgery” clinical category consists of major proud to partner with IOH, whose innovative approach surgeries such as spinal fusion, hip or knee replaceto patient satisfaction helps to advance the quality of ments, major shoulder replacements and major health care in Indianapolis.” joint replacements.
The IOH inpatient staff take a break to pose for a picture with their award.
®
22 | Summer 2012
Inpatient room at IOH
IOH main campus founded in March 2005
In addition to being rated #1 in the State, IOH is also rated: • #1 in the State for Overall Hospital Care for Patient Safety • #1 in the State for Overall Surgical Care for Patient Safety • #1 in the State for Joint Replacement Surgery for Patient Safety • Top 10 percent in the Nation for Overall Medical Care for Patient Satisfaction • Top 10 percent in the Nation for Overall Hospital Care for Patient Satisfaction • Top 10 percent in the Nation for Overall Surgical Care for Patient Satisfaction • Top 10 percent in the Nation for Joint Replacement Surgery for Patient Safety • Top 10 percent in the Nation for Spinal Fusion for Patient Safety • Top 10 percent in the Nation for Spinal Surgery for Patient Safety
IOH South opened in 2010 in Greenwood
CareChex provides clinical, financial and patient satisfaction findings to consumers, providers and purchasers of US medical care. CareChex provides a comprehensive evaluation of all components of medical quality including process of care, outcomes of care and patient experiences. “At IOH, our physicians and staff are committed to providing 5-Star superior service, focusing on patient safety and overall patient satisfaction,” said Jane Keller, chief executive officer at IOH. “We are honored to receive recognition for what our hospital values the most: providing quality care to all we serve.” For more information on CareChex and how they rate hospitals, please visit: www.carechex.com.
IOH West opened in 2008 in Brownsburg | 23
OrthoIndy Opens Clinic in
Lafayette
Scott Lintner, MD
Daniel Lehman, MD
Jonathan Shook, MD
Meredith Langhorst, MD
Andrew Vicar, MD
Timothy Dicke, MD
We are pleased to announce that our newest location, OrthoIndy Lafayette is now open! OrthoIndy Lafayette offers residents of Lafayette and surrounding areas quality bone, joint, spine and muscle care. The clinic is located in the Sagamore Medical Complex at 2403 Loy Drive, Suite 204. OrthoIndy Lafayette includes: three exam rooms, digital imaging and casting. Outpatient procedures will be performed at the Sagamore Surgery Center.
2403 Loy Drive, Suite 204 Lafayette, IN 47909 To schedule an appointment, please call: (765) 250-3679.
“OrthoIndy is excited to offer our orthopaedic services to Lafayette and the surrounding communities,” said John Martin, chief executive officer at OrthoIndy. “As a member of the community, OrthoIndy’s fellowshiptrained surgeons will provide residents with convenient access to quality orthopaedic care.” Six of OrthoIndy’s fellowship-trained surgeons are now accepting patients at OrthoIndy Lafayette.
Timothy Dicke, MD Practice Focus: Hand and Upper Extremity
Scott Lintner, MD Practice Focus: Knee, Shoulder and Sports Medicine
Meredith Langhorst, MD Practice Focus: Non-Operative Spine
Jonathan Shook, MD Practice Focus: Knee, Shoulder and Sports Medicine
Daniel Lehman, MD Practice Focus: Foot and Ankle
Andrew Vicar, MD Practice Focus: Hand and Upper Extremity
24 | Summer 2012
Kickin’ It
Marian Soccer Player Recovers from Injuries By: Kasey Prickel
Already the most popular sport internationally, soccer is still gaining popularity in the United States. With more and more people gravitating to the sport, it’s not a surprise that the number of soccer-related injuries is also increasing. According to the US Consumer Product Safety Commission, in 2009, nearly 570,000 athletes were injured while playing soccer.
2011-2012 Marian University Women’s Soccer Team
The most common soccer-related injures are sprains and strains of the knee and ankle. Overuse injuries, such as Achilles tendonitis and shin splints are also common injuries. However, due to the possibility of collision between players, any number of injuries could occur. Unfortunately, the women’s soccer team at Marian University has had their share of injuries among their players. Luckily, they have an OrthoIndy surgeon for their team physician.
Dr. Stephen Kollias, an orthopaedic surgeon at OrthoIndy and IOH, has been the team physician for the Marian girls soccer team for the past eight years and enjoys every minute of it. “The players are great, hard working and spirited,” he said. “They have taught me a lot about patience and perseverance with their great effort and passion for playing soccer and through their camaraderie as teammates.”
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2011-2012 Marian University Seniors – five of whom were patients of Dr. Kollias (Jessica Fisher, Kathleen Spears, Katy Toth, Lauren Gerbick and Lacey Hersman)
One of the teammates he has had the pleasure of treating is Lacey Hersman. Lacey is a senior at Marian University, studying Mathematics with minors in Secondary Education, Spanish and Global Studies. Lacey was a four-year Varsity starter at Center Grove High School, but started playing the sport when she was only five years old. “My parents signed me up for a recreational soccer league,” said Lacey. “The jersey, shin guards and cleats were a package deal for 25 dollars. I fell in love with the game of soccer and never looked back.” In her junior year, during the first 20 minutes of a game against Spring Arbor, Lacey tore her ACL and injured cartilage in her knee. In that year, Lacey, along with four teammates all experienced serious injuries. Two of her teammates also needed ACL repairs, while two others had surgery to repair injuries in their knees. All five of the girls saw Dr. Kollias for treatment. Lacey’s injury affected her immediately. “After my injury, I was unable to walk for two weeks and could not run at all,” she said. “My knee felt normal but if I tried to run or cut side-to-side, my knee would collapse.” If Lacey ever wanted to play again, she would have to undergo surgery. Dr. Kollias performed an ACL graft reconstruction from her hamstring and a microfrature procedure. Going into the surgery, Lacey was confi26 | Summer 2012
dent in Dr. Kollias. “I could not have chosen a better doctor,” she said. “Dr. Kollias learned quickly that I ask many questions and wanted to know all the details of my surgery. He broke out pictures and showed me step by step what would happen. He understood my personality and did a wonderful job of making me feel comfortable.” Lacey had an ACL reconstruction with hamstring tendons, microfracture of her medial femur and a partial lateral meniscus tear. According to Dr. Kollias, the ACL surgery is common; however, the microfracture of her medial femur is uncommon in players her age. It requires stimulating new cartilage patch to grow over an area of exposed bone. Lacey’s surgery was a success and she was pleased with the care she received from her team physician and his staff at OrthoIndy. “The staff at OrthoIndy could not have been more wonderful to me and my family,” she said. “The staff were constantly checking on me after surgery and making sure I was comfortable.” Since her procedure, Lacey, as well as her teammates, have recovered and were cleared to compete in their senior soccer season. Lacey is very grateful for Dr. Kollias. “Dr. Kollias gave me back my soccer career,” she said. “I could not be more grateful to Dr. Kollias,
the staff, my athletic trainers and my physical therapist for helping me get back out on the field. When I first found out I had torn my ACL, I was crushed and concerned I would not make it back in time for my last season. Dr. Kollias made the dreams I had for my senior year possible.” For each home game, the Marian Women’s Soccer team honors a member of the community that has impacted their lives. Indiana Wesleyan is a big rival in the team’s conference and the girls figured it was only appropriate to honor Dr. Kollias as the “Honorary Knight” for the game. “Dr. Kollias sat in on
our pre-game talk and led the march out to the field,” said Lacey. “He even helped cheer us on to a victory from our bench.” Lacey adds, “Dr. Kollias formed a bond with our team that cannot be broken. During the game, he was jumping up and down, cheering, yelling at the referee, and acting like we were his own. I have never had a doctor take such an interest in my treatment and success but my teammates and I found that with Dr. Kollias.”
"Dr. Kollias gave me back my soccer career. He made the dreams I had for my senior year possible." -Lacey
Jessica Fisher and Lacey Hersman ready to meet with Dr. Kollias the morning after surgery. Lacey Hersman prepped and ready for surgery.
Stephen Kollias, MD Specialties Sports Medicine Shoulder and Knee Reconstruction Arthroscopy
Locations OrthoIndy Fishers OrthoIndy Northwest
To schedule an appointment with Dr. Kollias, please call (317) 802-2817. | 27
my Ice Skater Receives Spine Surgery By: Emma Baxter At OrthoIndy and IOH, it’s important for us to tell our patients’ stories. Each issue of Beyond Your Bones, we will tume inderella cos C in a m m allow one of our E Ice. n o y e n is D r fo patient’s to tell their own story. Meet Emma Baxter, an ice skater who suffered from scoliosis. Dr. Michael Coscia, an orthopaedic spine surgeon at OrthoIndy performed surgery on Emma, allowing her to continue her ice skating career. I was diagnosed with scoliosis at the age of seven, but didn’t receive help until I was 15 years old. That's when I went to see Dr. Coscia. Scoliosis didn’t really affect my life drastically until I was about 23 to 25 years old. I have been a figure skater since I was 2 years old. At 18, after I graduated from Columbus North High School, I decided to join Disney on Ice. I skated with the show for six years, and in the last three years I struggled with many different injuries preventing me from performing. Having scoliosis at the degree I had, made it more and more uncomfortable, but I was still able to skate. My condition made it difficult to wear some of my costumes and I was really bothered by the way I looked in them. My right hip stuck out like a piece 28 | Summer 2012
was missing between my rib cage and the top of my hipbone. Sometimes, if the costumes were long, every time I would skate to the left the material would catch under my blade causing me to fall. I had to laugh but it started to be very frustrating to have to be careful. It started to become difficult to stand or sit for long periods of time or even short periods of time. There would be some days where we would have hours of rehearsals and my back would be so sore. The things that used to be so easy became very exhausting. The last two years in the show were the most difficult. One day I was walking in my normal day shoes and I felt a really sharp pain in my right heel. I had no idea what it was or why I had this kind of pain. I have never had it before. Eventually after a couple hours, it went away. I continued skating, and then it came back, and worse. It got to a point where I couldn’t walk at all. And obviously if I couldn’t walk I couldn’t skate. I was in and out of the show so many times. I decided to have surgery for planter’s fasciitus. After I recovered I went back to the show and things were okay for a while but then it came back again preventing me once again from performing. At this point I was devastated. This was my life. Skating, performing meant everything to me and it was falling apart. I realized that the planter fasciitis was caused from the curve of my spine, (the difference in the length of my legs). I kept trying to fix everything around it but the truth was I had to do something to fix my spine if I wanted to keep doing what I love to do: skate.
I have known Dr. Coscia for about seven years. For me he is a hero. He is kind and so helpful. About a little over a year ago I told him I wanted to have the surgery. He was very hesitant. He knew how much I loved to skate and understood what my life was like on the road with the ice show. He didn’t want there to be a chance that I could no longer skate. I told him I already couldn’t skate like I used to with this pain and all the problems that come with it. I trusted him and finally he said he would do the surgery and I couldn’t have been happier. I had my surgery at the Indiana Orthopaedic Hospital with Dr. Coscia and his wonderful team. The nurses prepared me for surgery and were so kind and made me feel as comfortable as possible. I can remember being so excited; more excited than nervous. My life after treatment was tough. It was really painful for a while but normal after such a big surgery. I was leaving for Spain shortly after the surgery to live with my husband, coaching pair skating. When I left I wasn’t feeling that great and a whole day of traveling wasn’t the best idea but I made it. Dr. Coscia told me the best thing I could do is walk as physical therapy. That was a relief. I live in a very small town in Spain called Jaca and we walk everywhere we go so I think the healing process went quite smoothly. I was on the ice within two months after my surgery and jumping after six months. Now I am jumping and spinning without any problems. The truth is, I couldn’t be happier. Dr. Coscia is the best orthopaedic surgeon in my opinion. I would recommend him to anyone and everyone.
Emma performin
g for Disney on Ic
e.
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Chondrofix
Clinical Study for Early Intervention of Damaged Knee Cartilage Knee cartilage injuries are a major cause of pain and functional impairment in young to middle age adults and can lead to progressive joint degeneration, that is, arthritis. In response to challenges with current cartilage repair options, Chondrofix® Osteochondral Allograft (Zimmer, Warsaw, IN) was developed as an innovative osteochondral allograft treatment option. In the past, the only means for osteochondral allograft transplantation was to use fresh stored tissue that only had a narrow time window for implantation—often at inconvenient times for patients. On the other hand, Chondrofix Allografts are sterilized, “off-the-shelf” osteochondral allografts that may be used at the patient’s convenience, which adds to the variety of cartilage reparation options already available at the OrthoIndy Cartilage Restoration Center of Indiana (www.CartilageRestoration.org). Currently, the Orthopaedic Research Foundation, Inc. (ORF) in conjunction with the OrthoIndy Cartilage Restoration Center of Indiana is enrolling patients in a Chondrofix Osteochondral Allograft Clinical Study for the treatment of early intervention of damaged knee cartilage. The overall study objective is to evaluate Chondrofix Allograft for the repair of osteochondral lesions in the knee. The study hypothesis is that Chondrofix Allograft will provide pain relief and functional improvement at 24 months as compared with pre-operative baseline levels. The ORF functions as the research and education arm for the physicians of OrthoIndy. Founded in 1986, its mission is, “To advance the scientific body of knowledge associated with musculoskeletal disorders, for the scientific and public communities, through research and education. ” The Cartilage Restoration Center of Indiana was founded in 1998 and has provided more cartilage restoration procedures than anywhere in the state and regularly participates in national and international multi-center cartilage studies. Orthopaedic surgeon at OrthoIndy, Dr. Jack Farr, is the investigator of the study. His CV may be reviewed at www.OrthoIndy.com. The center has implanted more Chondrofix Allograft implants than any other study center. 30 | Fall 2012
Two implanted Chondrofix plugs resurfacing a prior defect in the knee cartilage Based on this early experience, Dr. Farr commented, “Patients enjoy the fact that they are able to have implants that match their defects and there is no need to be placed on a transplant waiting list.” The procedure used in this study uses the Chondrofix Osteochondral Allograft, which is made of bone and cartilage tissue recovered from a human donor (allograft). This allograft is used to repair cartilage damage that is limited to a specific area in the knee. The graft is cylindrical in shape and comes in a variety of sizes depending on the size of the defect in the knee. The graft replaces your damaged natural bone and cartilage tissue, except it has been thoroughly cleaned of blood, fat and other living tissues to decrease the chances of an immunologic response. No anti-rejection drugs are necessary. Chondrofix Allograft is an available medical product that does not require the patient to be in a study to receive it. Keep in mind, however, that by enrolling in the clinical study, patients may be able to help other people in the future who have similar problems with their knee. Participation in the Study Unlike some other studies that compare one treatment to another, in this study all patients who qualify will receive the Chondrofix Allograft and their baseline function and comfort will be followed closely over the course of the study. Dr. Farr performs the clinical study
Chondrofix Allograft with cancellous bone and cartilage cap which turns blue during processing at OrthoIndy South. If chosen, the patient must sign a consent form for the study, undergo implantation of Chondrofix Allograft and meet certain criteria during surgery. As with similar surgical treatments, a prescribed rehabilitation schedule will be followed. The patient will be required to return for follow-up visits for up to five years following surgery and will undergo X-rays and MRIs during the follow-up period. During the follow-up visits, the patient will have an examination and complete questionnaires about the patient’s health background. Who Qualifies for the Study? Participants of the study can be either male or female and must be between the ages of 18 to 70 years old. Inclusion Criteria: Generally, the following inclusion criteria must be met, however, this is not a complete list. • Male and non-pregnant female subjects between 18 and 70 years; subject must be skeletally mature • If female, subjects are not pregnant at time of surgery and do not plan on becoming pregnant during the first 24 months of the study • Up to two (2) cartilage lesion(s), each measuring less than 8 cm2, of the femoral condyle or trochlear groove of the knee | 31
• Localized knee pain unresponsive to conservative treatment (e.g., medication, bracing, physical therapy) and/or previous surgical intervention Exclusion Criteria: Generally, if a potential participant meets any of the following criteria, they will not be eligible for this study. Additionally, more criteria will be evaluated to confirm eligibility as this list is not a complete list of criteria. • Concurrent participation in another clinical trial • Cartilage lesion location is such that the implanted graft(s) will not be adequately shouldered • Bipolar articular cartilage involvement (or kissing lesions) of the ipsilateral compartment (i.e., > than ICRS Grade 2 on the opposing articular surface) • Is receiving pain medication other than NSAIDs or acetaminophen for conditions unrelated to the index knee condition • Subject had any other cartilage repair procedure other than debridement performed in conjunction with or six months prior to implantation of a Chondrofix Osteochondral Allograft
• Prior or concurrent total meniscectomy of the index knee • Uncorrected mal-alignment of the index knee • Have smoked or used nicotine products within the past six months • Body Mass Index > 35 (BMI=kg/m2) • Has any contraindications for MRI • Prior HA or cortisone injection in index knee within three months of Chondrofix Allograft implantation • Requires any of the following concomitant procedures performed in conjunction with or has had performed within six months prior to implantation of a Chondrofix Allograft: distal realignment, high tibial osteotomy, ligament reconstruction and/or patellar realignment procedure • Septic or reactive arthritis or systemic disease (e.g., rheumatoid arthritis, gout or prior history of gout or pseudo gout) • Sickle cell disease, hemochromatosis or autoimmune disease • Unstable cardiovascular, renal, hepatic, endocrine and/or pulmonary disease, cancer or uncontrolled diabetes • HIV or other immune-deficient state including subject on immunosuppressant therapies • Deficiency limiting ability to perform an objective functional assessment of the operative knee or an inability to adhere to a post-operative rehabilitation protocol For more information on the clinical study, please contact Vicki Snodgrass Miller at (317) 884-5230.
Jack Farr II, MD Specialties Cartilage Restoration, Sports Medicine and Knee
Location South
To schedule an appointment with Dr. Farr, please call (317) 884-5163.
by: Kasey Prickel
We use our hands for almost everything. When tingling or numbness develops in your hands and wrists while doing something as simple as typing on the computer, writing a note or doing chores around the house, it may be a sign of carpal tunnel syndrome.
called the carpal tunnel is a portal of entry of the tendons of the forearm to the fingers. These tendons have a lining, which lubricate and nourishes the tendons. Any activity that causes swelling of this lining decreases the volume and space within the carpal tunnel. The carpal tunnel nerve is called the median nerve Meghan Roell is a massage therapist and is contained within the carpal tunnel and nail technician on the south side of on the palmar side of the tendons. Any Indianapolis. Because of her occupation, swelling of the lining around the tendons Meghan started developing pain and can cause pressure on the nerve which numbness in her hands and wrists from lies underneath a ligament called the the repetitive motion required by her job. transverse carpal ligament thereby, putDuring her last trimester of her second ting pressure on the nerve. That pressure pregnancy her symptoms dramatically causes pins and needles sensations and increased and didn’t change four weeks tingling in the fingertips. after giving birth to her son. The thickening of this tendon lining “After I came home from the hospital increases with age and repetitive use. with my son, I was unable to change his Other activities, including use of vibradiaper or button his onesie,” she said. “I tory tools, can also cause thickening of had to concentrate so hard to complete the transverse carpal ligament, which the simplest tasks because of the pain decreases the space within the carpal and numbness in my hand, wrist and tunnel in addition to the tendon lining up my arm to my shoulder.” swelling. All of this over time causes increased pressure around the nerve To relieve her pain, Meghan decided to especially with wrist flexion and extensee a neurologist who diagnosed her sion secondarily aggravating the nerve. with carpal tunnel syndrome and told Some medical conditions such as hypoher surgery was needed. thyroidism, diabetes and some connective tissue diseases may be associated or Carpal tunnel syndrome is a common predispose to the development of source of numbness and pain in the carpal tunnel symptoms. hands and wrists. According to OrthoIndy orthopaedic hand surgeon, Dr. Jeffery “The most common symptoms are those Whitaker, carpal tunnel develops over of tingling, burning and decreased a period of time. The space in the wrist sensation in the tips of the fingers
Meghan working with a client in her Greenwood studio.
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Special Offer Present this coupon to Meghan and receive $10 off any nail service on your first visit. Her business, Head to Toe Rejuvenation, is located at Greenwood Office Suites, 3209 West Smith Valley Road, Suite 130, Greenwood, IN.
usually involving the thumb, index, middle and one side of the ring finger,” said Dr. Whitaker. “These are most noticeable in the beginning phases of carpal tunnel syndrome. Later phases of carpal tunnel syndrome can cause symptoms of loss of dexterity and decreased grip strength. More advanced cases will notice radiation of pain up to the arm even into the shoulder.”
persons per year. However, prevalence in the general population reported by that same study is 50 cases per 1000 persons. The Bureau of Labor Statistics reports manufacturing as the industry division with the highest number of events and exposures.
“When I returned to work I could tell a big difference in trying to achieve the pressure I was used to practicing,” she said. “My hands would become numb and cramp while providing nail services to my clients. The strength I had was gone. I would have to take breaks and shake away the pain.”
In Meghan’s case, it was clear her pain was not going away. She found out about Dr. Whitaker from a family friend and a client who both work closely with him. Dr. Whitaker first tried cortisone shots for treatment, which helped relieve the pain and numbness for some time, but it became clear that if Meghan wanted to continue her work she needed to consider carpal tunnel surgery.
Symptoms are minimal in the beginning. However, it is important to consult with an orthopaedic physician When Meghan found out about her condition, she when symptoms worsen. “An individual should consult had a two-year-old daughter and four-week-old son an orthopaedic hand physician when someone notices she had to take care of, therefore, surgery was not their hand or fingertips tingling when holding an an option. Luckily, six object, when driving, when weeks after giving birth, awakening at night having “I had to concentrate so hard her condition improved; to flick the hand to get the to complete the simplest tasks however, she was still feeling back, those are warnexperiencing numbness ing signs,” says Dr. Whitaker. because of the pain and while she slept and once “Those early symptoms numbness in my hand, wrist she returned to massage should prompt someone therapy, she also experiand up my arm to my shoulder.” to seek evaluation by a enced numbness physician familiar with the during her client’s diagnosis and treatment of -Meghan massage sessions. carpal tunnel syndrome.”
According to the American Academy of Orthopedic Surgeons, an incidence of carpal tunnel syndrome in the United States is one to three cases per 1000 34 | Summer 2012
“Dr. Whitaker took his time explaining my condition, along with the treatment options,” said Meghan. “Every question I had he answered with an explanation. That is something I truly appreciated.” According to Dr. Whitaker, if the problem is addressed in its earliest stages, braces and occasional steroid injections, ergonomic workstation correction and activity modifications may be successful. In more advanced cases, conservative treatment may not be effective. If conservative treatment over a reasonable period of time ranging from two to three months is ineffective, surgery may be a reasonable option. Obtaining the correct diagnosis is of utmost importance. Electrical testing studies called EMG/NCV (electromyograph and nerve conduction velocity) testing can tell whether carpal tunnel syndrome is in a mild, moderate or severe stage. For moderate and severe stages there can be muscle changes resulting in weakness and atrophy of muscles controlling the thumb. Those cases usually require surgery although they may respond short-term to non-operative treatment. If surgery is the treatment, recovery is usually complete in less than three months total time. The surgery for carpal tunnel is about 15 minutes or less under an arm block as an outpatient. The minimally invasive surgery facilitates a rapid rehabilitation. Some people may require hand therapy for scar massage, desensitization and grip strengthening. Return to work is variable and depends on occupation. Less demanding occupations can return in a few days whereas some heavy manual labor occupations require a longer period of time usually less than eight weeks. If conservative nonsurgical treatment is chosen the patient needs to be observed overtime to make sure there is no progression and deterioration of hand function until all symptoms are gone.
Meghan started seeing Dr. Whitaker in August 2011 and after the non-operative treatment options were ineffective, Meghan was scheduled for surgery at IOH two months later. “The facility is great and the staff was very helpful and kind,” she said. Meghan’s hands and wrist have not been numb since surgery. “This is a true blessing for being able to continue my work and live without continuous pain,” she said. “I still do my stretches and ice on a weekly basis. I believe that taking care of your body as a whole is the best permanent result one can achieve.” Dr. Whitaker says that the most important thing for a patient with the symptoms mentioned is to not ignore those symptoms and seek medical attention sooner than later. “The earlier the correct diagnosis can be made the better the outcomes,” he says. “Carpal tunnel syndrome can sometimes be a precursor to some other medical condition that may need addressing and is not yet diagnosed.” If you are experiencing carpal tunnel symptoms, please contact us at (317) 802-2000 to schedule a consult with one of our hand specialists. Visit us at OrthoIndy.com/physicians to find a hand specialist near you.
Jeffery Whitaker, MD Specialties Hand and Upper Extremity Shoulder Sports Medicine
Locations Fishers South
To schedule an appointment with Dr. Whitaker, please call (317) 884-5168. | 35
8450 Northwest Blvd. Indianapolis, IN 46278
Tell us what your scar means at
MyScarMeans.com. #MyScarMeans
Watch Rosie and Phoebe’s story at MyScarMeans.com Rosie and Phoebe Plunkett, OrthoIndy and IOH patients