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PRACTICE NEWSLETTER | FALL 2013

Diagnosing anD TreaTing Common runner injuries orlando orthopaedic Center Foundation making a Difference in Central Florida Community PAGE 4

TLiF Procedure Helps Patient Function Pain Free PAGE 11

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achilles Tendinitis and Plantar Fasciitis

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ith running season in full swing throughout Orlando, area physicians tend to see more patients complaining of foot/ankle pain and injuries. Two of the most common running conditions seen by Foot and Ankle Center Specialists and avid runners Joseph D. Funk, D.P.M., and Daniel L. Wiernik, D.P.M., at Orlando Orthopaedic Center are Achilles tendinitis and plantar fasciitis. Achilles Tendinitis Overview Achilles tendinitis occurs when the tendon that connects the back of the

leg to the heel becomes swollen and ultimately painful near the back of the heel or leg, says Dr. Funk. It is typically diagnosed as a result of “overuse” by the runner; and it is often brought about by increasing pace, distance, frequency or speed work. “In the early stages, runners may only feel it after their run,” says Dr. Wiernik. “As it worsens, they have pain during their run.” If there is no swelling or bruising present, the runner is advised to work through the injury by making minor adjustments to their routine. CONTINUED ON PAGE 3


ORLANDO ORTHOPAEDIC CENTER

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Same Day, Next Day Appointment Scheduling Available With Our Orthopaedic Specialists Call 407.254.2500 and we’ll schedule you to be seen at one of our 6 conveniently located Central Florida area offices either later the same day or by the next business day. 2 | Orlando Orthopaedic Center | Fall 2013


Diagnosing anD TreaTing Common runner injuries: aCHiLLes TenDiniTis anD PLanTar FasCiiTis

An illustration of Achilles tendinitis. Note the swollen tendon that connects the back of the leg to the heel.

An illustration of plantar fasciitis. Note the inflammation of the thick tissue at the bottom of the foot.

CONTINUED FROM PAGE 1

Diagnosing anD TreaTing aCHiLLes TenDiniTis If the problem persists or becomes more severe, it is suggested that physician intervention be considered. During this initial appointment, an assessment is performed to determine if the patient is genetically or chronically tight in the calf. “If it’s too painful and conservative methods fail, then boot immobilization may be considered until the tendon heals,” says Dr. Funk. If further measures must be taken, the patient is referred for an MRI to help determine the precise cause of the issue. Dr. Wiernik notes that Achilles tendinitis rarely results in any kind of surgical correction.

PLanTar FasCiiTis overvieW Plantar fasciitis is an inflammation of the thick tissue on the bottom of the foot caused by microtearing (strain). Pain associated with the condition is most commonly localized to the bottom of the heel. The most common cause of plantar fasciitis is again “overuse” by the runner as a result of rapid increases in pace, mileage, distance, speed work and plyometrics. “With the increase there is a tightness within the calf, and limited dorsiflexion through the gait pattern of walking or running,” says Dr. Funk. “This causes more pronation stress on the plantar fascia and allows the inflammatory process to begin.” According to Dr. Wiernik, pain is most pronounced when getting out of bed in the morning or rising from a seated position. “Generally the pain subsides after walking for

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a few minutes, but it usually gets worse again as the day progresses,” he says.

Diagnosing anD TreaTing PLanTar FasCiiTis When deemed severe enough to see a specialist, the first step for treating plantar fasciitis is an assessment of calf mobilization and localization of pain to the inferior heel and/or plantar medial heel. If the initial treatment protocols listed above do not help, Dr. Funk suggests using oral antiinflammatories and/or injection therapy. Plantar fasciitis resolves 90-95 percent of the time with conservative measures and rarely needs surgical intervention.

joseph D. Funk, D.P.m. Orlando Orthopaedic Center Foot & Ankle Specialist

Daniel L. Wiernik, D.P.m. Orlando Orthopaedic Center Foot & Ankle Specialist

TreaTing aCHiLLes TenDiniTis anD PLanTar FasCiiTis aT Home if a patient is experiencing symptoms of either achilles tendinitis or plantar fasciitis, Dr. Funk suggests: n n n n n n

Wearing tennis shoes and avoiding bare feet Aggressive calf stretching or rolling of the calf Ice NSIADs (Advil, etc.) Decreasing mileage, pace and/or distance Stopping speed work, hills or interval training Fall 2013 | Orlando Orthopaedic Center | 3


2012 Year in Review: Some of the Lives We’ve Impacted The Orlando Orthopaedic Center Foundation is a nonprofit 501(c)(3) organization dedicated to the improvement of the lives of our Central Florida neighbors by implementing three main initiatives: orthopaedic research, injury prevention in youth athletics and community education and outreach.

$5,000

Donated to UCF Scholarships Annually

Orthopaedic Conferences

Each year we present two educational orthopaedic conferences that offer educational opportunities for attendees while providing scholarship dollars for UCF students studying to be athletic trainers and physical therapists.

EmBrace Our Community Donation Drive Through Orlando Orthopaedic Center offices we collected gentlyused durable medical equipment (braces, crutches, etc.). These were donated to Grace Medical Home, a nonprofit offering medical assistance to Central Florida residents residing at or below Over 200% of the federal poverty level.

$10,000

of Equipment Donated to Patients in Need

EmBrace Our Communit y

3,600

Student Athletes Received Pre-Participation High School Physicals

High School Athletic Physicals/Game Coverage

Our volunteer team of physicians, athletic trainers and physician assistants donated over 1,500 hours to provide 14 Central Florida Schools with free high school athletic physicals. The schools then charged a nominal fee to help support their respective athletic department.

4 | Orlando Orthopaedic Center | Fall 2013


Coins For KiDs As a result of the Coins for Kids donation drive, 46 underserved local children attended a summer sports camp thanks to spare change donations from patients and community partners.

46

unDerserveD CHiLDren WenT To summer sPorTs CamP

jusT For KiCKs

Coins For Kids

Summer Camp Program

over

The Just 4 Kicks campaign raised more than $5,000 to provide properly fitted sneakers to identified homeless children in Orange County allowing them to start 2013 on the right foot.

400

HomeLess CHiLDren reCeiveD a neW Pair oF sHoes

WaLT Disney WorLD maraTHon Team Orlando Orthopaedic Center Foundation raised money and awareness while competing in the 2013 Walt Disney World Marathon Weekend.

$7,000

Was raiseD To suPPorT orTHoPaeDiC ouTreaCH Programs

goLF anD gaLa WeeKenD Our annual Golf and Gala Weekend included a fabulous gala event and golf tournament that celebrated the progress we have made. We also recognized how much work still needs to be done.

$65,000 Was raiseD For youTH aTHLeTiC injury PrevenTion iniTiaTives

orLanDo orTHoPaeDiC CenTer FounDaTion | 407-418-0570 | WWW.orLanDoorTHoFounDaTion.org

407.254.2500 • www.OrlandoOrtho.com

Fall 2013 | Orlando Orthopaedic Center | 5


Common CarPaL TunneL synDrome TreaTmenTs

estimated to be currently affecting between four and 10 million americans, carpal tunnel syndrome is arguably one of the most common nerve disorders diagnosed today according to the american College of rheumatology. Carpal tunnel syndrome can be treated effectively with medications, splinting, injections and, if all other treatment methodologies fail, surgery. WHaT is CarPaL TunneL synDrome?

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arpal tunnel syndrome is a condition in which there is progressive pain, numbness and eventually weakness in the hand and wrist, caused by increased pressure on the median nerve in the wrist. The carpal tunnel is a narrow space through which nine tendons and one nerve cross the wrist to reach the hand. “It’s important to note that tendons are not bothered by increased pressure; but the median nerve gets very irritated (Figure 1) and will therefore cause the discomfort of carpal tunnel syndrome when the pressure goes up in the tunnel,” says Lawrence S. Halperin, M.D., a board certified orthopaedic surgeon at Orlando Orthopaedic Center sub-specializing in the hand and upper extremities.

The diagnosis is most often seen in people who have already reached middle-age. It is much more common in women than men. There is also an increased risk in diabetics, people with rheumatoid arthritis and during pregnancy.

TreaTmenT Since the pain and numbness associated with carpal tunnel syndrome is a result of increased pressure on the nerve, treatments are designed to lower the pressure. “The most common early treatments include using a splint to keep the wrist in a position that lowers the pressure in the tunnel,”

Watch a recent Orlando Orthopaedic Center patient discuss her carpal tunnel procedure on www.OrlandoOrtho.com.

Simple tasks can be done the day of surgery. Typing on a keyboard can start shortly thereafter, but it can take several weeks until full activity is tolerated. Not surprisingly, it can take a bit longer to get back to a job that puts a lot of pressure on the palms (such as jackhammer operators or construction workers). “Today the surgery requires an incision of about an inch or less and has incredibly high success rates,” says Dr. Halperin. “Patients respond very well to surgery and they are usually very pleased with the results. Helping someone get back to work or to the activities they enjoy is one of the most rewarding parts of my job.”

Causes anD signs oF CarPaL TunneL synDrome Most people with carpal tunnel syndrome complain of intermittent tingling in the hand. For some, the numbness can be very mild and minimally bothersome. But for others it can be so painful it makes simple tasks such as reading a book, typing on a keyboard or holding a jug of milk difficult and cumbersome. It can cause patients to wake up throughout the night preventing restful sleep. Tapping on the carpal tunnel and seeing the response is part of how the carpal tunnel syndrome diagnosis is made.

A dissection of the wrist showing that three sides of the carpal tunnel are bone and the fourth side is ligament.

6 | Orlando Orthopaedic Center | Fall 2013

says Dr. Halperin. “We often use anti-inflammatory medicines such as naproxen and steroids to control inflammation as well.” For the people who don’t improve from a splint and/or medication it’s time to discuss surgery. As evident in Figure 1, three sides of the carpal tunnel are bone and the fourth side is ligament. Surgery cuts this ligament and lowers the pressure inside of the tunnel, thus taking pressure off the nerve and allowing the nerve to heal. “Carpal tunnel surgery only takes about 15 minutes, and fortunately, the nerve almost always heals just fine. However it can take longer to heal in older people, diabetics and those with long-term severe symptoms,” says Dr. Halperin. “Many people report feeling relief from numbness the day of surgery.”

Lawrence s. Halperin, m.D. Orlando Orthopaedic Center Hand Specialist

Watch Dr. Halperin discuss carpal tunnel syndrome treatments options at www.orlandoortho.com.


ouTPaTienT ToTaL sHouLDer rePLaCemenT surgery ProCeDure ProviDes muLTiPLe beneFiTs To PaTienTs, surgeons Thanks to advances in modern medical technology, many patients are now experiencing the benefits of having total shoulder replacement surgery in an outpatient setting.

patients are urged to establish a close-knit post-op support group prior to surgery. “The ideal patient needs to be healthy, motivated, well-informed, and fully-prepared for a home recovery,” says Dr. Reuss. “Having a good support system – friends and family – at home is imperative.”

ouTPaTienT beneFiTs To PaTienTs According to Dr. Reuss, patients are the major benefactors when it comes to having a total shoulder replacement done in an outpatient setting. Although not all patients will meet the requirements to have the surgery done in the outpatient setting, those who do usually elect to undergo this minimally-invasive route to recovery. “The outpatient setting is generally a more safe, convenient and less stressful environment for patients,” says Dr. Reuss. Other benefits to patients include:

Dr. Reuss studies a recent outpatient total shoulder replacement surgery patient’s X-ray.

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rlando Orthopaedic Center’s Bryan L. Reuss, M.D., a board certified orthopaedic surgeon and sports medicine specialist, performs many of these outpatient procedures at the Orlando Orthopaedic Outpatient Surgery Center. The joint specialist says outpatient surgeries offer multiple benefits to patients in addition to going home the same day.

n Returning home the same day as surgery, compared to several days in the hospital with an inpatient procedure. n Easier access – entering, checking-in and checking-out at an outpatient center is often easier than at a hospital. n Decreased risk of infection. n Increased comfort as a result of performing rehabilitation almost exclusively at home. n Reduced recovery time due to the minimally invasive nature of the procedure. n Quicker return to recreational activity. “Patients who have their surgery performed in an outpatient setting experience numerous short-term benefits without sacrificing any longterm results,” says Dr. Reuss. “It’s easy to see why this is the preferred option for patients.”

ouTPaTienT ToTaL sHouLDer rePLaCemenT surgery overvieW Total shoulder replacement is generally presented as a treatment option for patients suffering from joint dysfunction as a result of osteoarthritis, rheumatoid arthritis or, in rare cases, a severe shoulder injury. Prior to surgery there is a conservative management period that involves physical therapy, cortisone injections, and oral medications to relieve the pain. If those methods fail, a patient is considered for surgery. During the surgery, a small incision will be made on the front or top of the shoulder to access the shoulder joint. “The head of the humerus or ‘ball’ of the joint will be removed and replaced with a round metallic implant, while the glenoid or ‘socket’ will be replaced with a new, plastic socket,” says

407.254.2500 • www.OrlandoOrtho.com

A rendering of a completed total shoulder replacement procedure.

Dr. Reuss. “This replaces the painful bone-onbone rubbing a patient feels with a painless metal-on-plastic articulation.”

ouTPaTienT ToTaL sHouLDer rePLaCemenT surgery reCovery According to Dr. Reuss, recovery for most patients is completed within three months from the date of surgery. Because much of the rehabilitation process will take place at home,

Dr. bryan L. reuss, m.D. Orlando Orthopaedic Center Sports, Knee & Shoulder Specialist

For a complete listing of knee, hip and shoulder treatment options, including the procedure listed above, visit www.orlandoortho.com Fall 2013 | Orlando Orthopaedic Center | 7


PHYSICIAN INFORMATION Six Convenient Locations • Downtown, Winter Park, Lake Mary, Oviedo, Sand Lake and Lake Nona • 407.254.2500

G. Grady McBride, M.D.

Jeffrey P. Rosen, M.D.

• Orthopaedic Surgery • Adult Spinal Reconstruction • Cervical/Lumbar Spine Surgery • Scoliosis

• Orthopaedic Surgery • Joint Replacement Knee, Shoulder, & Hip Surgery

Stephen R. Goll, M.D.

Samuel S. Blick, M.D.

• Orthopaedic Surgery • Adult Spinal Reconstruction • Cervical/Lumbar Spine Surgery

• Orthopaedic Surgery • Knee & Shoulder Surgery • Knee Replacement Surgery

Tamara A. Topoleski, M.D.

Daniel L. Wiernik, D.P.M.

NPI# 1780655597 Downtown • Winter Park • Lake Nona teammcbride@orlandoortho.com

NPI# 1689645426 Downtown • Winter Park • Lake Mary teamgoll@orlandoortho.com

NPI# 1356312284 Downtown • Sand Lake • Lake Mary teamtopoleski@orlandoortho.com • Orthopaedic Surgery • Pediatric Orthopaedics

Bryan L. Reuss, M.D.

NPI# 1881613081 Downtown • Oviedo • Lake Mary teamreuss@orlandoortho.com • Orthopaedic Surgery • Sports Medicine • Knee & Shoulder Surgery

NPI# 1063483980 Downtown • Winter Park • Lake Mary teamrosen@orlandoortho.com

NPI# 1316918246 Downtown • Sand Lake teamblick@orlandoortho.com

NPI# 1275504110 Downtown • Winter Park • Lake Mary • Oviedo teamwiernik@orlandoortho.com

• Foot & Ankle Surgery • Podiatry

Michael D. McCleary, M.D. NPI# 1063627230 Downtown • Sand Lake Lake Mary • Oviedo • Lake Nona teammccleary@orlandoortho.com

• Non-surgical Orthopaedics • Sports Medicine • Musculoskeletal Medicine

Bradd G. Burkhart, M.D.

Travis B. Van Dyke, M.D.

• Orthopaedic Surgery • Sports Medicine • Knee & Shoulder Surgery

• Orthopaedic Surgery • Knee, Shoulder & Hip Surgery • Joint Replacement • Sports Medicine • Trauma

NPI #1619072899 Downtown • Sand Lake • Lake Mary teamburkhart@orlandoortho.com

8 | Orlando Orthopaedic Center | Fall 2013

NPI#1467413070 Downtown • Sand Lake • Lake Nona teamvandyke@orlandoortho.com


saturday Clinic hours are Available until 1:00 p.m. at Our Oviedo Office CRAIG P. JOnes, M.d.

lAWRenCe s. hAlPeRIn, M.d.

• Orthopaedic Surgery • Orthopaedic Oncology • Sports Medicine

• Orthopaedic Surgery • Hand Surgery • Upper Extremity Surgery

AlAn W. ChRIsTensen, M.d.

JOsePh d. funk, d.P.M.

• Orthopaedic Surgery • Hand Surgery • Upper Extremity Surgery

• Foot & Ankle Surgery • Podiatry

sTeven e. WeBeR, d.O.

RAndy s. sChWARTzBeRG, M.d.

• Orthopaedic Surgery • Adult Spinal Reconstruction • Cervical/Lumbar Spine Surgery

• Orthopaedic Surgery • Sports Medicine • Knee & Shoulder Surgery

eRIC G. BOnenBeRGeR, M.d.

dAnIel M. fROhWeIn, M.d.

• Knee, Shoulder & Hip Surgery • Joint Replacement • Sports Medicine • Orthopaedic Surgery

• Interventional Pain Medicine • Diagnostic and Therapeutic • Spinal Injections

MIChAel d. RIGGenBACh, M.d.

MATTheW R. WIlley, M.d.

• Orthopaedic Surgery • Hand Surgery • Upper Extremity Surgery

• Physiatry • Pain Management

NPI# 1144296377 Downtown • Winter Park teamjones@orlandoortho.com

NPI# 1649241597 Downtown • Winter Park • Sand Lake teamchristensen@orlandoortho.com

NPI# 1528031606 Downtown • Sand Lake • Oviedo teamweber@orlandoortho.com

NPI# 1104898055 Downtown • Sand Lake • Oviedo • Lake Nona teambonenberger@orlandoortho.com

NPI#1013126861 Downtown • Oviedo • Lake Nona teamriggenbach@orlandoortho.com

407.254.2500 • www.OrlandoOrtho.com

NPI# 1750354809 Downtown • Winter Park • Lake Mary teamhalperin@orlandoortho.com

NPI# 1023089869 Downtown • Sand Lake teamfunk@orlandoortho.com

NPI# 1366413213 Downtown • Oviedo teamschwartzberg@orlandoortho.com

NPI# 17605012665 Downtown teamfrohwein@orlandoortho.com

NPI# 1619139755 Downtown • Lake Mary • Oviedo teamwilley@orlandoortho.com

Fall 2013 | Orlando Orthopaedic Center | 9


Multimodal Pain Management Techniques Key to Improved Recovery Following Knee Replacement Surgery Many joint specialists throughout the Orlando-area are now employing a multimodal pain management protocol to treat pain following knee replacement procedures. This method proves beneficial to patients by providing increased post-operative comfort and a reduced dependency for potentially addictive narcotics.

relief is provided via an intravenous pump allowing patients to administer their own pain medication (morphine or oxymorphone) following surgery. The machine has a control button that can be pressed 6-10 times per hour, however the settings are ultimately set by the surgeon. “Because the medication is administered directly into the intravenous line, it works quickly, making it very favorable for patients,” says Dr. Blick. “And contrary to popular belief, patients cannot become addicted to morphine by using a PCA in a controlled environment for a limited amount of time.”

Oral Medications

An X-ray of a patient’s knee prior to undergoing their total knee replacement surgery.

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dequate pain management has been shown to help in the post-operative healing process by leading to an expedited rehabilitation schedule. As a result, patients gain a return of muscle strength and range of motion at a faster rate, allowing them to heal in a shorter period of time. Many surgeons, such as Dr. Samuel S. Blick, a knee and sports medicine specialist at Orlando Orthopaedic Center, recognize that patients hear a lot about post-surgery pain and they are, understandably, concerned about their level of pain. “Previous studies have shown that more than 50 percent of patients undergoing surgery report

An X-ray of the same patient’s knee following their total knee replacement surgery.

postoperative pain as a major concern,” reports Dr. Blick. “Today there are a lot of options to help minimize and control pain for both partial and total knee replacements and patients shouldn’t worry.” Knowing that inadequate pain control may result in impaired patient rehabilitation and prolonged hospitalizations, Dr. Blick utilizes a multimodal method to treat his patients following surgery. Below are some of the techniques he employs to achieve the best pain control possible following knee replacements.

Pre-Op Femoral Nerve Block Placed prior to surgery, the femoral nerve block catheter is placed alongside the femoral nerve (located in the upper thigh) and is used to deliver medication to put the nerve to sleep for up to 24 hours. This analgesic medication numbs the patient’s knee area by blocking pain signals to the brain. “The femoral nerve supplies sensation to the front of the knee where the incision is made,” says Dr. Blick. “By controlling pain in the first 16-24 hours, it allows the patient increased ease when starting rehab.”

Patient Controlled Analgesia (“Pain Pump”) Dr. Samuel S. Blick uses a multimodal approach to pain relief for patients following their total knee replacement surgery.

10 | Orlando Orthopaedic Center | Fall 2013

The Patient Controlled Analgesia (PCA) method for controlling post-operative pain is often referred to as a “pain pump.” Pain

As a patient’s recovery continues, the use of oral medications is introduced to help control post-operative pain. Using non-steroidal antiinflammatory drugs (NSAID), like Celebrex, patients are able to curb further discomfort they feel during the rehabilitation process. These non-narcotic NSAIDs are structurally similar to aspirin and will help a patient with “breakthrough pain.” A doctor may also order acetaminophen (Tylenol or similar medications) continuously to reduce the need for the use of rescue narcotics. Anti-inflammatories, such as Celebrex, may also be used to increase the effectiveness of other treatment modalities following knee replacement surgery. “Typically these medications have been demonstrated to have efficacy in patients while also reducing morphine requirements,” says Dr. Blick.

Multimodal Pain Management Conclusions The goal of each of these treatment methods is to manage post-operative pain, allowing patients to participate in their rehabilitation program as quickly as possible, thus maximizing the outcome following surgery. “Pain has different pathways to the brain,” says Dr. Blick. “We want to interrupt as many of those pathways as possible so patients can recuperate as safely and effectively as possible.”

Samuel S. Blick, M.D. Orlando Orthopaedic Center Joint Specialist


TransForaminaL Lumbar inTerboDy Fusion (TLiF) HeLPs PaTienT FunCTion Pain Free samantha swanson, 41, has had a love for softball for as long as she can remember. one day, while sliding into second base on a field near her home in orlando, she felt a sudden, uncomfortable pain in her lower back. Her pain refused to go away, even after a year of physical therapy and steroid injections to help manage the discomfort. samantha decided it was time to pursue surgery or risk being in pain for the rest of her life.

larger incision required for open surgery,” he says. “Secondly, the muscles surrounding the spine are gently separated or moved out of place, rather than cut, as they are with the traditional method.” Once completed, patients are typically discharged several days after surgery. For Samantha, she was released on the second postoperative day. “Right when I was released I began walking a mile a day,” she says with a smile. “I wanted to begin all of my physical therapy as fast as possible.”

resuLTs Studies on www.Spine-Health.com indicate that about 80 percent of those who undergo the TLIF procedure report positive results. In fact, many patients notice immediate improvement of many of their symptoms; however, other symptoms may improve gradually. Complete recovery time varies, but for most patients the spine is fully healed and recovered between three and six months. The tissue-sparing techniques used during surgery typically result in the patient experiencing a much shorter, less painful recovery following surgery. Seven weeks after Surgery, Samantha is still wearing her back brace, but she has no second thoughts about undergoing the procedure. “Some mornings [before surgery] I couldn’t even stand up or get out of bed,” she says. “Now, I can and I’m not in pain. The experience was nothing but great and I’m so happy that I had this done.” As for when she’s fully healed? “I can’t wait to start running and playing softball again,” she says.

Dr. Goll performing a spinal fusion.

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er surgeon, Stephen R. Goll, M.D., a fellowship-trained spine specialist at Orlando Orthopaedic Center, recommended the minimally invasive Transforaminal Lumbar Interbody Fusion (TLIF) procedure to help her get back to the life and activities she enjoyed before the injury.

THe TLiF ProCeDure When back pain is caused by spinal disorders such as herniated discs, spondylolisthesis or degenerative disc disease, a minimally invasive TLIF procedure may be recommended to help treat the patient and reduce discomfort once all other nonsurgical treatment methods are exhausted. “The purpose of a TLIF procedure is to restore disc height while permanently fusing damaged or displaced veterbrae in the lower back,” says Dr. Goll. “By fusing the vertebrae we are able to restore and enhance spinal stability, which alleviates nerve compression.” To achieve this stability, the affected vertebra/ discs are accessed from the side of the spinal canal. The intervertebral disc is then removed to allow access for a spacer. This spacer, made from a biologic plastic and packed with bonegraft, is specifically designed so the patient’s body

407.254.2500 • www.OrlandoOrtho.com

Samantha Swanson, 41, recently underwent the minimally invasive TLIF procedure to fuse vertebrae in her lower back.

will grow new bone material through it. Once healed, the fused discs create a longer section of solid bone in the spine, resulting in restoration in spinal stability. Several bone screws and rods are also inserted for extra support and fixation. “The TLIF procedure is considered minimally invasive for two reasons. For one, it allows the lumbar spine to be accessed through a small incision in the back rather than the much

stephen r. goll, m.D. Orlando Orthopaedic Center Spine Specialist

Check out a video of samantha sharing her complete story at www.orlandoortho.com Fall 2013 | Orlando Orthopaedic Center | 11


12 | Orlando Orthopaedic Center | Fall 2013


407.254.2500 • www.OrlandoOrtho.com

Fall 2013 | Orlando Orthopaedic Center | 13


WHaT sHouLD you Do iF your CHiLD Has a ConCussion? Did you know at least one player sustains a mild concussion in nearly every american football game? it’s true, and with football season just around the corner it’s important for many orlando-area coaches, parents and student-athletes alike to familiarize themselves with the signs and symptoms of a concussion as well as the new Florida Concussion Law.

ConCussion aWareness in aTHLeTiCs

a

concussion is a form of traumatic brain injury, typically caused by a blow to the head that shakes the brain inside of the skull. many concussions do not leave visible signs of injury (such as bruises or cuts), but that does not mean an internal brain injury did not occur.

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ith more than 248,000 children visiting hospital emergency departments for concussions and other traumatic brain injuries relating to sports and recreation in 2009, according to the Youth Sports Safety Alliance, parents should realize that concussions can happen during any sport and at any time.

signs anD symPToms Recognition and proper management of concussions when they first occur can prevent further injury or even death. Remember that just because a concussion may not have a physical sign, that doesn’t mean the athlete may not have a head injury. Here are some of the signs you should be aware of as an observer. The athlete may: n May appear stunned or dazed n Forget plays n Be confused about assignments or positions n Move clumsily n Be unsure of the game, score or opponent n Lose consciousness n Forget events immediately prior or after the hit n Show signs of behavior or personality changes

WHaT To Do iF you susPeCT a ConCussion If you think an athlete may have sustained a head injury, here are the immediate steps to prevent further injury: n Recognize the injury and the dangers of continued play n Remove the athlete immediately from activity – practice or a game n Refer the athlete for medical attention as soon as possible n Notify the athlete’s home and explain your obligation to them n Return the athlete to play only after they have provided necessary medical clearance Florida’s Concussion Law The Florida Youth Concussion Law was established in 2012 and requires that athletic trainers and/or coaches remove an athlete from a game or practice immediately following a suspected head injury. Prior to returning to play, the athlete must be evaluated and receive medical clearance from a physician. It’s recommended, however, that athletes be tested prior to injury to establish a clear baseline of neurological function. By having a baseline test and then comparing it to a patient’s ability to recall and process information after an injury, physicians can measure the brain’s functional level and detect abnormal brain patterns, which may be associated with a concussion even when there are no obvious signs or symptoms.

Florida Concussion Law THe FLoriDa youTH ConCussion LaW Was esTabLisHeD in 2012 anD requires THaT aTHLeTiC Trainers anD/or CoaCHes remove an aTHLeTe From a game or PraCTiCe session immeDiaTeLy FoLLoWing a susPeCTeD HeaD injury. Prior To reTurning To PLay, THe aTHLeTe musT be evaLuaTeD anD reCeive meDiCaL

michael D. mcCleary, m.D. Orlando Orthopaedic Center Primary Care Sports Medicine Specialist

14 | Orlando Orthopaedic Center | Fall 2013

CLearanCe From a PHysiCian.


Who suffers from Concussions?

Concussions affect athletes of all sports, but it is more prevalent in contact sports such as football, lacrosse and hockey.

At least one player sustains a mild concussion in nearly every American football game.

1997 15% 85%

2007

Concussion rates more than doubled among students age 8–19 participating in sports like basketball, soccer and football between 1997 and 2007, even as participation in those sports declined.

Concussion Related Injuries All Other Sports Related Injuries

A 2011 study of U.S. high schools with at least one athletic trainer on staff found that concussions accounted for nearly 15% of all sports-related injuries reported to ATs.

More than 248,000 children visited hospital emergency departments in 2009 for concussions and other traumatic brain injuries related to sports and recreation.

140,000 high school student-athletes suffer concussions annually nationwide.

Concussions can occur in any sport. Recognition and proper management of concussions when they first occur can help prevent further injury or even death.

signs observeD bserveD by CoaCHing sTaFF

symPToms oms rePorTeD by aTHLeTe a aTHL

WHaT To Do If you think an athlete has sustained a head injury:

WHaT To Do If you think you or another athlete may have a concussion:

★ Appears dazed or stunned ★ Is confused about assignment or position ★ Forgets sports plays ★ Is unsure of game, score, or opponent ★ Moves clumsily ★ Answers questions slowly ★ Loses consciousness (even briefly) ★ Shows behavior or personality changes ★ Can’t recall events prior to hit or fall ★ Can’t recall events after hit or fall

★ Recognize the injury and the dangers of continued play ★ Remove the athlete immediately from activity – practice or a game ★ Refer the athlete for medical attention as soon as possible ★ Notify the athlete’s home and explain your obligation to them ★ Return the athlete to play only after they have provided necessary medical clearance

★ Headache or “pressure” in head ★ Nausea or vomiting ★ Balance problems or dizziness ★ Double or blurry vision ★ Sensitivity to light ★ Sensitivity to noise ★ Feeling sluggish, hazy, foggy, or groggy ★ Concentration or memory problems ★ Confusion ★ Does not “feel right”

★ Notify your coach, athletic trainer and/or your parent immediately ★ Remove yourself from the game and seek medical attention ★ Do not return to play until being evaluated and receiving clearance from an appropriate medical provider

We can evaluate and clear your athlete to return to play. Our Concussion network services Include:

same Day, next Day appointments available

n Complete physician evaluation n Computerized neurological evaluation n Communication between physician, parent, athletic trainer and coach

CaLL 407.254.2500 To sCHeDuLe your baseLine TesT anD/or ConCussion evaLuaTion. 407.254.2500 • www.OrlandoOrtho.com

Fall 2013 | Orlando Orthopaedic Center | 15


same Day, nexT Day aPPoinTmenTs WiTH our orTHoPaeDiC sPeCiaLisTs Call 407-254-2500 today and you can be seen either on the same day or no later than the next business day at one of our six offices locations. DoWnToWn oFFiCe

sanD LaKe oFFiCe

25 W. Crystal Lake street, suite 200 orlando, FL 32806 407-254-2500 407-423-2789 (Fax)

7350 sandlake Commons blvd, suite 3315 orlando, FL 32819 407-354-3700 407-345-1146 (Fax)

WinTer ParK oFFiCe

ovieDo oFFiCe

2699 Lee road, suite 100 Winter Park, FL 32789 407-897-1363 407-897-1384 (Fax)

1000 W. broadway street, suite 200 oviedo, FL 32765 407-977-3500 407-977-1128 (Fax) Saturday Hours: 9:00 a.m. - 1:00 p.m.

LaKe mary oFFiCe

LaKe nona oFFiCe

766 n. sun Drive, suite 4000 Lake mary, FL 32746 407-834-1556 407-834-2789 (Fax)

9685 Lake nona village Place, ste. 102 orlando, FL 32827 407-418-0582 407-418-0583 (Fax)

407.254.2500 • www.OrlandoOrtho.com

Foundation 25 W. Crystal Lake Street, Suite 200 Orlando, Florida 32806


Practice Newsletter - FALL 2013