Understanding Osteoarthritis vs. Rheumatoid Arthritis

Arthritis is extremely common. In fact, over five hundred million people worldwide show symptoms associated with the condition. But not all arthritis is the same. The two most prevalent types are Rheumatoid Arthritis (RA) and Osteoarthritis (OA), and understanding the distinctions between the two can help patients manage their symptoms more effectively and seek the appropriate treatment.

What is Rheumatoid Arthritis?

Rheumatoid Arthritis is an autoimmune disorder, meaning the body’s immune system mistakenly attacks its own tissues, specifically the synovium–the lining of the membranes that surround the joints and help it move smoothly. This causes inflammation that can lead to joint damage and deformities over time. Patients might also experience systemic symptoms like fatigue, fever, and loss of appetite. Onset can occur at any age, but RA is most commonly diagnosed in adults between age 30-60. 1.5 million people in the U.S. have RA, and women are three times more likely than men to develop the condition. The exact cause is unknown, but genetic and environmental factors play a significant role.

Treatment for rheumatoid arthritis may include physical therapy and low impact exercise to improve mobility, anti-inflammatory medications to alleviate pain, steroids, corticosteroids to reduce inflammation, disease-modifying antirheumatic drugs (DMARDs) or biologics to slow the progression, and joint replacement surgery. There is no cure for RA, but the goal of treatment is to limit joint damage and put the disease into remission.

What is Osteoarthritis?

Osteoarthritis, on the other hand, is a degenerative joint disease that primarily affects the cartilage–the tissue that covers the ends of the bones in a joint. Over time, the cartilage breaks down, causing bones to rub against each other. This leads to pain, swelling, and decreased mobility. Unlike RA, OA is generally associated with wear and tear of the joints. Symptoms, including pain, tenderness, stiffness, and loss of flexibility, are typically localized to the affected joints. Risk factors for osteoarthritis include age, joint injuries, repetitive stress on the joint, and obesity.

Atlantic Orthopaedics’ Dr. Akhil Sastry is a board-certified orthopedic surgeon who specializes in hip and knee joint replacement. He is a pioneer of robotic-assisted total knee replacement and has performed the surgery over 1,000 times. A recent patient had this to say about his experience with Dr. Sastry:

“I had an excellent experience and result with Dr. Sastry. He worked with me prior to surgery to ensure I could continue the activities important to me despite having osteoarthritis in the knee. After a year and a half, we agreed that I needed surgery and Dr. Sastry gave me a partial knee replacement. The pre op communication and approach were not only effective but used the latest practices to minimize pain and recover quickly. The entire surgical team helped make the surgery itself a success. But the proof is in the result, after 8 weeks of physical therapy, I am back doing the sports I love like tennis and bike riding. I am very grateful to Dr. Sastry and his team.”

Below, Dr. Sastry answers a frequently asked question about osteoarthritis.

What are the best ways to handle osteoarthritis in my knee and what are the options for treatment for a very active senior who wants to stay active?*

Treatment options range from weight loss, low impact exercises (biking, elliptical, swimming), over the counter anti-inflammatory medications, injections, and joint replacement surgeries. Depending on the severity of disease and the limitations that are inflicted, an orthopedic surgeon can implement a treatment program that would be the most suitable for your needs.

Managing Osteoarthritis in the Knee: Treatment Options for Active Seniors

Physical activity: Staying active is one of the most effective ways to manage knee osteoarthritis. Gentle exercise like walking or swimming can help maintain joint flexibility and strengthen the muscles around the knee, providing better support and joint stability.
Weight management: Maintaining a healthy weight reduces the stress on your knees. Even a small amount of weight loss can significantly decrease the load on your knee joints, alleviating pain and slowing the progression of OA. A diet rich in anti-inflammatory foods like fruits, vegetables, and omega-3 fatty acids can also help improve symptoms.
Physical therapy: A physical therapist can create a personalized exercise program to improve your knee’s strength and flexibility. They can also teach you techniques to modify your movements to reduce pain and prevent further damage.
Injections: Corticosteroid injections can provide temporary pain relief by reducing inflammation in the knee joint. Hyaluronic acid injections, which mimic the natural fluid in your knee, can also help lubricate the joint.
Surgical options: If conservative treatments aren’t providing sufficient relief and your mobility is impaired, surgery may be advised. Arthroscopy, a minimally invasive procedure, can be used to remove damaged cartilage or bone fragments. In more severe cases, partial or total knee replacement surgery might be necessary. These procedures can significantly reduce pain and improve function, allowing you to remain active.

If you are suffering from joint pain due to arthritis, don’t delay getting treatment. There are many options, both non-surgical and surgical, that can improve your quality of life and get you back to doing the activities you love. Schedule a consultation with Dr. Sastry to discuss a treatment plan tailored to your needs and lifestyle.

*Medical Disclosure: The information provided on this blog is for educational and informational purposes only. While we strive to provide accurate and up-to-date information, we do not dispense medical advice or treatments to individuals who have not been seen by a healthcare professional.

It’s crucial to understand that every individual’s medical situation is unique, and what may work for one person may not necessarily work for another. Additionally, individuals may have underlying health conditions, allergies, or other factors that require personalized attention and consultation with a qualified healthcare provider.

Therefore, we strongly advise individuals to consult with a licensed healthcare professional before initiating any new treatments, making changes to their current treatment regimen, or addressing any medical concerns. This includes seeking professional guidance for managing allergies, assessing potential medication interactions, and ensuring overall safety and efficacy of any suggested treatments.

We are not liable for any actions taken based on the information provided on this blog. The responsibility for healthcare decisions lies solely with the individual and their healthcare provider. If you have any questions or concerns regarding your health, please consult a qualified healthcare professional promptly.

Relief From Lower Back Pain With SI Fusion

Living with chronic lower back pain can have a profound impact on not just your physical well-being, but your overall quality of life. Many people suffer from back pain due to dysfunction in the sacroiliac (SI) joint, which connects the bottom of the spine (sacrum) to the pelvis (ilium). These two joints, one on each side act as a shock absorber for the spine and play a crucial role in stability and weight bearing ability, transferring pressure from the lower back to the legs. The SI joint can be damaged by traumatic injury, a degenerative condition, or tissue loosening from things such as connective tissue disorders and pregnancy. Patients with SI dysfunction will feel pain in the low back, especially when walking, standing up from a seated position, or lifting. Other symptoms can include numbness or tingling in the lower extremities; pain in the pelvis, hip, or groin; pain radiating down the legs; or buckling in the legs.

Diagnosing SI Dysfunction

Because low back pain can be a symptom of other conditions like sciatica, diagnosis is usually done with a physical exam, followed by an injection that will temporarily block the pain if it’s originating in the sacroiliac joint. In some cases, the pain can be managed with anti-inflammatory medications, physical therapy, or steroid injections, but for patients who haven’t responded to those treatments there is a minimally invasive procedure called SI Fusion that may offer sustained relief.

What is the SI Fusion Procedure?

SI Fusion, short for sacroiliac joint fusion, is a minimally invasive procedure in which the surgeon inserts an implant into the SI joint space. Guided by real-time imaging, a small incision is made and the implant is fixed in place, fusing the sacrum to the ilium in order to limit movement. This fusion, by restricting excessive motion in the SI joint, restores stability and alleviates pain.

What Does the Recovery From SI Fusion Involve?

Because the procedure is minimally invasive, the risk of complications is low and recovery times are quicker than with traditional open surgery. Patients can expect to be mobile immediately after the procedure, and most experience rapid pain relief. Post-operative physical therapy may be recommended to restore function in the joint and aid recovery.

Below, a Q&A about SI Fusion with pain management specialist Dr. Lehn:

How does this procedure benefit your patients?

15-30% of low back pain comes from the SI joint. The SI joint can be a difficult pain to treat as many times PT, medications, and injections only provide temporary relief.

Who is a good candidate for an SI fusion?

If a patient has 90% relief of pain from a SI injection and the pain keeps returning despite exercise, medications, and repeated injections, then they can be considered for SI fusion.

Where do you perform this procedure?

The procedure is performed in the operating room but is done with minimal sedation, and the patient can walk out of the recovery room and go home the same day as the procedure.

Do you have a recent patient success story to share?

One patient had her left side done in June and felt so good she came back in September to have the other side done! She is very happy and back to her very active lifestyle.

Anything else you’d like current or future patients to know about this procedure and how it could benefit them?

This is a very minimally invasive procedure with minimal downtime. The pain from the procedure is minimal. Unfortunately, intense activity is limited for 6 weeks but patients are up and walking the same day. Fusions sound really big and dangerous, but it is essentially a stabilization procedure. SI joints are often painful due to excessive movement. The SI stabilization procedure takes away the additional movement and helps return the patient to a normal functioning joint.For patients grappling with chronic lower back pain caused by SI dysfunction, the SI Fusion procedure can provide long-term pain relief and renewed quality of life. If you suffer from pain that hasn’t responded to non-surgical treatments, schedule a consultation with Dr. Lehn to explore whether SI Fusion is right for you. Take your first steps toward a pain-free future!

Platelet-Rich Plasma (PRP) Injections Help the Body Heal Itself

What Are Platelet-Rich Plasma (PRP) Injections?

PRP injections are a treatment that separates the platelets in a patient’s own blood and uses them to promote healing. A small sample of blood is collected and placed in a centrifuge, a machine that spins at high speeds to separate the platelet-rich plasma from the other components, like red and white blood cells. Guided by ultrasound imaging to ensure accuracy and precision, the concentrated PRP is then injected directed into the affected area. The entire procedure takes about an hour.

Post-injection care may mean avoiding certain movements or activities for a period of time to optimize the healing process and minimize potential side effects. It’s normal for the injection site to become inflamed and may be quite painful for one to three days following treatment. The swelling and soreness are part of the healing process, and patients should avoid taking anti-inflammatory medication like Aspirin or ibuprofen, which can make the injection less effective.

What conditions do PRP injections treat?

PRP injections are frequently used to treat musculoskeletal injuries and orthopedic conditions like tendonitis, ligament sprains, bursitis, and partial rotator cuff tears, and tennis elbow. The injections can also be used to reduce joint pain, stiffness, and inflammation caused by arthritis.

How long will it take for me to see improvement?

Because the bioactive substances in the platelet-rich plasma need time to stimulate tissue repair and cellular regeneration, it can take a few weeks to start noticing the effects of PRP injections. Patients with musculoskeletal injuries like tendonitis or ligament sprains may experience improved functionality and pain relief quicker than patients with more severe or chronic conditions. Factors like age, overall health, and adherence to post-injection instructions all influence the speed of the healing process. It’s crucial to follow your doctor’s recommendations to maximize treatment benefits.

We recently sat down for a Q&A with our Sports Medicine provider and PRP expert, Dr. Andrew McMahon.

Q: In your own words, how does this procedure benefit your patients?
A: Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient’s own healing system to improve musculoskeletal problems.

Q: Who is a good candidate for a PRP Injection?
A:

Patients with overall good health
Patients with mild to moderate arthritis, partial tears, or chronic wear and tear injuries
Patients with decreased function due to pain, stiffness, or lack of mobility
Failure with more conservative treatment methods

It’s important to note that while PRP injections are generally considered safe, they may not be suitable for everyone. The treatment can’t be used if the tendon is torn completely and though PRP injections can address symptoms of arthritis, they can’t reverse pre-existing damage. The treatment’s efficacy and appropriateness depend on the specific condition being treated and individual patient factors. It’s important to consult with a specialist to evaluate whether PRP injections are appropriate for your specific needs.

Q: Where do you perform this procedure?
In our Portsmouth, NH office only, some of the surgeons use it intraoperatively.

Q: Do you have a recent patient success story you can share?
A: Recently, I have had a lot of success with PRP treating knee arthritis. Peter S. is a 68-year old gentleman who is very active in tennis/pickleball and is an avid skier. His moderate arthritis has given him a lot of stiffness and some pain which resulted in him cutting back on these activities at times, affecting his happiness and mental health. He had a consult for treatment options and we ultimately opted to inject PRP into both knees. Within 4 weeks, he had regained a significant amount of his function and he was able to play more tennis, and he successfully took a week long ski trip to Colorado.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: In the appropriate patient, PRP can offer a nice treatment option for patients with musculoskeletal problems who have failed conservative treatment options like PT, bracing, and cortisone injections. PRP can help heal soft tissue injuries (a torn tendon, for example), potentially avoiding surgical repair. PRP also provides patients with arthritis a treatment option that decreases pain and increases mobility and function. It typically lasts 2-3 times longer than cortisone injections and does not contribute to deterioration of the joint like a cortisone injection can.

Think PRP Injections may be right for you? Schedule a consultation with our specialist Dr. McMahon to learn more.

Pain Relief for Rotator Cuff Tears–Introducing the Stryker InSpace Balloon

What is a Rotator Cuff Tear?

The rotator cuff is a group of four tendons that surround and stabilize the shoulder joint, connecting the muscles of the upper arm to the shoulder blade. When a rotator cuff tear occurs–from acute trauma, repetitive stress, or degeneration over time–the tendon becomes separated from its attachment point on the bone. Rotator cuff tears are painful and cause weakness in the joint and limited shoulder mobility. Common symptoms of a tear include difficulty lifting your arm, a popping or crackling sensation in the shoulder, and pain both at rest and with movement.

Unfortunately, rotator cuff tears don’t heal on their own. If an untreated tear results in arthritis in the joint, patients often require shoulder replacement surgery, but for patients who still have shoulder function and haven’t developed arthritis, there is a less invasive treatment option called the Stryker InSpace Balloon.

What is the Stryker InSpace Balloon?

The Stryker InSpace Balloon is a medical device used to treat rotator cuff tears. It’s made of biocompatible material–a substance that can be implanted in the body and tolerated without damaging existing tissue. The balloon creates more space within the subacromial area–the space between the bone at the top of the shoulder and the ball of the shoulder–reducing compression and friction caused by the torn rotator cuff.

What’s involved in the procedure?

The Stryker InSpace Balloon is placed arthroscopically, using a small incision and the guidance of a camera to precisely place the deflated balloon in the subacromial space. The balloon is then inflated with a sterile saline solution, causing it to push the acromion away from the rotator cuff tendons. This reduces impingement on the injured tissues to restore function and alleviate pain.

The procedure is minimally invasive and performed on an outpatient basis. Recovery time varies, depending on the individual patient and the extent of the injury, and rehabilitation may include physical therapy to help restore strength and mobility in the shoulder.

How do I know if the Stryker InSpace Balloon can help me?

If you’re experiencing shoulder pain, or have been diagnosed with a rotator cuff tear, it’s important to consult with a shoulder specialist as soon as possible. The specialist will evaluate your injury and medical history, and may recommend the Stryker InSpace Balloon procedure as a treatment option.

Below is our Q&A with Dr. Noerdlinger, an orthopedic surgeon specializing in the shoulder. Dr. Noerdlinger is a partner at Atlantic Orthopaedics with extensive experience performing the Stryker InSpace Balloon procedure.

Q: In your own words, how does this procedure benefit your patients?
A: This is a pain relieving procedure.

Q: Who is a good candidate for the Stryker InSpace Balloon procedure?
A: The procedure is indicated for patients with irreparable rotator cuff tears, with good shoulder function and minimal to no arthritis.

Q: Where do you perform this procedure?
A: I perform the procedure at NECOS (New England Center for Orthopaedic Surgery) in Portsmouth, and York Hospital in Maine.

Q: Do you have a recent patient success story you can share?
A: I performed the Stryker InSpace Balloon procedure on a 67 year old man with years of pain and an unfixable rotator cuff tear. He described his shoulder as getting worse despite physical therapy and injections. He had pain with an active range of motion, and stated his shoulder was 30% normal. Four months after his February surgery, he described his pain as a 2 out of 10 on a daily basis and rated his shoulder as 60% normal.

I also treated a 73 year old female patient who came to me with pain from an irreparable rotator cuff tear. She described her shoulder as 40% normal before the procedure and 70% normal 3 months after her March 1st surgery.

Another patient, a 60 year old man with bilateral irreparable rotator cuff tears, had the balloon placed in his right shoulder on March 1st, and his shoulder improved from 20% normal to 65% normal in 6 weeks. He then underwent left shoulder balloon placement May 10th.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: The rotator cuff is the one structure that, when torn, causes the most pain and dysfunction in the shoulder. Rotator cuff tears do not heal, get bigger over time, become unfixable, and cause arthritis. Rotator cuff repair surgery is very successful and can restore normal, pain-free function.

If the rotator cuff is irreparable, the painful shoulder is often treated with a reverse shoulder replacement. For patients with unfixable, painful rotator cuff tears with little to no arthritis and good function, an InSpace balloon is a good option.

If you’re suffering from shoulder pain from a rotator cuff tear that hasn’t responded to treatments like injections or physical therapy, schedule an appointment to find out if the Stryker InSpace Balloon procedure is right for you.

Torn Meniscus? Eliminate Knee Pain With This Procedure

The meniscus is a C-shaped piece of cartilage in the knee joint that plays a crucial role in function and stability. The two meniscii in each knee function as shock absorbers. They are composed of dense fibrocartilage, which is more flexible than bone but firmer than other types of cartilage. Meniscus pads play an important role in walking, running and jumping, and they aid in weight distribution and alignment. The meniscus also helps keep the knee joint lubricated to reduce friction between the femur (thigh bone) and tibia (shin bone).

A meniscus root tear is a relatively common knee injury that occurs when the meniscus separates from its attachment point on the tibia bone. This type of tear can be caused by the wear and tear that happens with age, or by trauma or injury, such as a sports injury. People who suffer a tear often feel a “popping” sensation in the back of the knee, followed by pain, instability, and a loss of function. Untreated, a meniscus root tear can lead to osteoarthritis and degeneration in the knee. Fortunately, there is a minimally invasive procedure available to fix the issue.

Atlantic Orthopaedics’ surgeon Dr. Welch specializes in meniscus root repair, having performed more than 100 successful procedures to restore function, eliminate pain, and prevent further damage. In this surgery, he makes three small incisions, prepares the torn end of the meniscus for repair, then securely reattaches the meniscus to the root attachment site on the tibia bone through a small tunnel in the tibia.

Following surgery, Dr. Welch places the patient’s knee in a brace to protect the repaired meniscus and allow it to heal. Physical therapy is an important part of the recovery process. Recovery from meniscus root repair takes time and it’s important to follow your surgeon’s instructions regarding weight-bearing and the use of crutches. It may take three months for the knee to fully heal, but the vast majority of patients have excellent outcomes and experience a return to normal knee function.

Below, Dr. Welch answers some questions about Meniscus Root Repair:

Q. In your own words, how does this procedure benefit your patients suffering from knee pain?

A. A meniscus root tear is a specific type of meniscus tear that is more serious than a typical meniscus tear. If the root tears, the meniscus becomes loose and unstable. Surgery involves repairing the meniscus back to the tibia bone. This procedure benefits patients because it restores the function of the meniscus, eliminates pain, and helps restore patient confidence in his/her knee.

Q. Who is a good candidate for a Meniscus Root Repair?

A. A proper candidate for meniscus root repair is a patient who sustains a root tear who does not have significant arthritis in the knee.

Q. Where do you perform Meniscus Root Repairs ?

A. I perform meniscus root repairs at New England Center for Orthopedic Surgery (NECOS) in Portsmouth, NH and at York Hospital in York, ME.

Q. Do you have a recent patient success story you can share?

A. I have dozens of patient success stories. Meniscus root repairs are very reliable; as long as the meniscus heals to the tibia, patients usually return to normal function with no issues. Previous studies have revealed success rates > 90%.

Q. Anything else you’d like patients to know about this procedure?

A. I have many patients (>100) who have had tremendous success after a meniscus root repair. Unfortunately, one issue with this procedure is that each patient must use crutches or a walker for the first 5-6 weeks after surgery. This is inconvenient, but necessary, so that the meniscus has time to heal.

If you’re suffering from knee pain and loss of mobility from a meniscus root tear, you may be a good candidate for this minimally invasive procedure. Schedule an appointment with Dr. Welch for an evaluation: https://www.atlanticorthopaedics.org/providers/tyler-welch-md/

Carpal Tunnel Release with Ultrasound Guidance –Rapid Relief With Minimal Recovery Time

What is Carpal Tunnel Syndrome?

The median nerve runs through the arm and forearm into the hand and controls feeling in the thumb and index, middle, and ring fingers. Carpal Tunnel Syndrome (CTS) occurs when this nerve gets compressed as it passes through the wrist, leading to symptoms that include weakness, numbness, tingling, and pain in the hand and first three fingers. The often debilitating condition is the most common workplace injury, affecting an estimated 13 million Americans.

How is Carpal Tunnel Syndrome Treated?

Patients with mild CTS symptoms may experience some relief by wearing a wrist splint, getting steroid injections, and avoiding activities that exacerbate the condition, but many cases will require surgical intervention to relieve the pressure on the median nerve. Traditionally, patients had two options: open, or mini-open, carpal tunnel release surgery, and endoscopic surgery. Open surgery, while effective, is an invasive procedure that can leave painful scars and require long recovery times. Endoscopic procedures are less invasive, but can be complicated by limited visualization.

What can I expect if I have Ultrasound Guided Carpal Tunnel Release?

Many patients delay carpal tunnel surgery because of concerns about having an invasive surgery and worry about the recovery time and being able to get back to work. Ultrasound Guided Carpal Tunnel Release is a minimally invasive procedure performed using local anesthesia and requiring a very small incision typically closed with just a bandage. The ultrasound guidance gives the surgeon a clear view of the carpal tunnel, allowing for greater precision and minimizing the risk of complications. Most patients don’t need post-operative physical therapy and return to normal activities within 3-6 days. Our hand and wrist specialist Dr. Quitkin is the 4th surgeon in New Hampshire, and the only one in the Portsmouth region, to offer Carpal Tunnel Release with Real-time Ultrasound Guidance.

We sat down for a Q&A with Atlantic Orthopaedics’ Hand & Wrist specialist Dr. Quitkin to learn more about this procedure.

Q: How does this procedure benefit your patients?

A: Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. It affects millions of people, with hundreds of thousands of new cases developing annually. In some cases, symptoms can be managed conservatively with splinting and activity modification. For patients whose symptoms cannot be adequately controlled with non-surgical treatment, carpal tunnel release offers lasting relief of symptoms. The standard mini-open carpal tunnel release, which I have done for more than 20 years, is an excellent operation that solves the problem of carpal tunnel syndrome. It’s only drawback is the palmar incision through which the procedure is performed. This incision leaves a scar in the palm that is initially firm and tender. While the scar eventually softens and the discomfort associated with it recedes, the scar symptoms may take weeks to as long as months to completely resolve. Carpal tunnel release with ultrasound guidance allows us to move the incision from the palm, where the tissue is thick and prone to developing stiff, tender scars, to the distal forearm, where the tissue is much thinner and more pliable. Scars in this area tend to heal very quickly and are minimally symptomatic. This effectively solves the only problem with the mini-open carpal tunnel release. The improvement in the carpal tunnel symptoms is the same, and the recovery is faster and less painful.

Q: Who is a good candidate for the procedure?

A: Most people are good candidates for the procedure. Prior to surgery, patients are evaluated with an ultrasound examination in the office to be certain they are good candidates for the procedure. The only contraindications are significant anatomic variations within the carpal canal or inability to adequately visualize the carpal tunnel under ultrasound.

Q: Where can a patient have this procedure performed?

A: Currently, carpal tunnel release with ultrasound guidance is being performed at NECOS. And, we are awaiting approval to begin doing cases at York Hospital as well.

Q: Tell us about a success story!

A: For most of my career, I have declined to do bilateral carpal tunnel releases on the same day, because the timing of palmar scar healing was sufficiently unpredictable that tying up both hands simultaneously could put patients in a very difficult position. With the ultrasound-guided technique, the recovery is sufficiently predictable and sufficiently quick that releasing both carpal tunnels on the same day is now feasible. Recently, a woman in her forties was having disruptive carpal tunnel syndrome symptoms in both hands. She has a seasonal job, and was very concerned about missing time during her busy season. With the ultrasound-guided technique, we were able to treat both hands on the same day and have her symptom-free for the start of her season a couple of weeks later!

Q: Is there anything else you’d like patients to know?

A: The use of ultrasound-guidance solves the only problem with an otherwise great procedure. This is a big step forward in hand surgery.

Carpal tunnel release with ultrasound guidance is a safe, effective, minimally invasive alternative to traditional CTR surgery. Its advantages include real-time visualization during the procedure, lower risk of complications, and shorter recovery time. If you’re experiencing symptoms of carpal tunnel, schedule an appointment to find out if carpal tunnel release with ultrasound guidance is right for you, so you can get back to doing what you love.

What is Collagen Augmented Rotator Cuff Repair?

Rotator cuff injuries are one of the most common causes of shoulder pain, affecting more than 2 million Americans each year. If you have a partially torn rotator cuff that hasn’t responded to non-surgical treatment like physical therapy and cortisone injections, you may be a candidate for a procedure called Collagen Augmented Rotator Cuff Repair, performed by our shoulder specialist Dr. Noerdlinger.

What is the rotator cuff?
Shoulders are not singular joints, but rather a complex arrangement of bones, cartilage, ligaments, muscles, and tendons. The rotator cuff is made up of four muscles, connected by tendons, that originate from the shoulder blade (scapula) and attach to the upper arm bone (humerus) to form a cover, or “cuff.” The rotator cuff provides stability to the shoulder joint and helps the arm lift and rotate.

What causes a rotator cuff tear?
A rotator cuff tear happens when the tendons pull away from the bone. With a partial tear, the tendon remains attached to the bone and with a full tear it separates from the bone completely. Tears most commonly happen as a result of normal wear and tear due to aging, with people over 40 at greatest risk. A tear can also be caused by an acute injury like a fall, from repetitive shoulder movement from jobs like carpentry or painting, or from sports like tennis or rowing. Untreated, a rotator cuff tear can worsen over time and may lead to chronic shoulder pain and limited range of motion.

How do I know if I have a rotator cuff tear?
The most common symptom of a rotator cuff tear is pain. A tear can also cause weakness in the arm and shoulder, difficulty raising your arm or lifting something, and a clicking or popping sensation in the shoulder. You may also experience swelling or tenderness in the shoulder joint. If you think you have a rotator cuff tear, a doctor will need to perform a physical exam and may confirm your diagnosis with an x-ray, MRI, or ultrasound.

What is Collagen Augmented Rotator Cuff Repair?
Collagen augmented rotator cuff repair is a surgical technique that uses a collagen implant to reinforce the rotator cuff repair. The implant is made of a biologically derived material similar to the collagen found in human tissue. It’s designed to provide additional strength and support to the healing tendon, reducing the risk of re-tear. The postage-size collagen patches are absorbed by the body within about 6 months, and patients generally experience shorter recovery times than with conventional rotator cuff surgery.

We recently sat down with shoulder specialist Dr. Noerdlinger and asked him a few questions about this procedure.

Q: How does this procedure benefit your patients?
A: Collagen implants can lead to quicker recoveries. Adding collagen facilitates the biologic healing of torn tendons in certain situations. They are used in two situations:

To repair a partially torn rotator cuff tendon. In this scenario, the collagen is laid on top of the partially torn tendon. The implant blends in with the thinned rotator cuff tendon, thickens it and allows it to heal. Patients, with partial tears, do not need to wear a sling after surgery.
To augment a repaired shredded tendon that may not heal on its own, particularly in the setting of a revision rotator cuff tear when the tendon did not heal after the first surgery.

Q: Who is a good candidate for the Collagen Augmented Rotator Cuff Repair Procedure?
A: Not everyone is a candidate for this procedure. Patients with irreparable rotator tears would not qualify for this procedure. Also, patients with good tissue may not need to augment their repairs.

Q: Where do you perform the Collagen Augmented Rotator Cuff Repair procedure?
A: The procedure requires anesthesia and is performed arthroscopically at NECOS and York Hospital.

Q: Can you tell us about a success story?
A: I recently saw a 56 year old female with worsening constant shoulder pain since April 2022. I performed a Partial Rotator Cuff Repair with collagen implant in January of 2023. She was seen in early March of 2023 and reported to be doing well with minimal complaints of pain.

NOTE: Shoulder surgery has a long recovery and often people take 4-6 months before they feel great. Having an expert shoulder surgeon like Dr. Noerdlinger may help speed up recovery.

Introducing MILD: life-changing relief from Spinal Stenosis

Does spinal stenosis make it painful for you to stand or walk for more than a few minutes? We’d like to tell you about a safe and effective treatment option called MILD, or minimally invasive lumbar decompression, offered by our pain management specialist Dr. Lehn.

What is spinal stenosis?

Inside the spine is a hollow channel called the spinal canal that contains the spinal cord and nerves. Spinal stenosis occurs when the channel narrows, putting pressure on the spinal cord and nerves. In addition to pain, symptoms may also include weakness, numbness, and cramping in the lower back and legs. It’s most often caused by the normal wear and tear that comes with aging, but factors like arthritis and protruded discs can also lead to spinal stenosis.

How is it treated?

Spinal stenosis is often a progressing problem and it is difficult to predict if a patient will ultimately return to normal once symptoms begin. Many patients will benefit from treatments like physical therapy or steroid injections but the duration of benefit varies patient to patient. Some people manage the problem with minimal treatment while others need surgical decompression to relieve the pressure on the spinal cord. Understandably, many patients are hesitant to undergo invasive surgery, and may be worried about a hospital stay and a lengthy recovery time.

What is MILD?

The MILD procedure for spinal stenosis is a minimally invasive alternative to traditional spinal surgery that has provided immediate relief and life-changing results for many patients. Guided by x-ray, Dr. Lehn inserts a spinal decompression device through a tiny incision in the back, using it to remove a portion of the tissue that’s pressing on the spinal nerves. The procedure takes less than an hour and, unlike traditional surgery, MILD is performed with local anesthesia and sedation, so you can go home the same day. Patients who undergo MILD typically experience minimal pain and much faster recovery times than with traditional surgery.

We sat down for a Q&A with Atlantic Orthopaedics’ Pain Management Specialist Dr. Lehn:

Q: How does this new procedure benefit your patients?

A: The MILD procedure is specifically for people with spinal stenosis diagnosed with a MRI leading to Neurogenic Claudication. Spinal stenosis is another word for a kink or tightening around the spinal nerves and Neurogenic claudication is pain that is present with standing or walking that improves with sitting. The goal of the procedure is to remove a portion of the tissue that is causing the spinal compression with a special tool using x-ray guidance. Once the patient heals they should expect a great increase in their ability to walk and stand!

Other Benefits:

Almost immediate recovery from the procedure; full benefit takes 3-4 weeks.
1 cm incision, no implants.
Minimal sedation for 30-45 minutes; walking home same day.
This procedure does not inhibit future surgery from being done.
5-year studies show sustained relief of pain from this procedure.

Q: Do you have a recent patient success story you can share with us?

A: I just had a follow up with a 76 year old, male patient who is doing great! He was on the fence on whether he should do invasive surgery or the MILD. The patient had pain down both legs after standing and walking for just a short time.

His legs would also give out, and he had a tough time carrying things while walking. He was referred by Dr. Sutherland as he was very anxious about having a large surgical procedure so the MILD seemed like a great solution.

He is now walking a mile with minimal pain!

Q: Who is a good candidate for the Minimally Invasive Laminectomy (MILD) Procedure?

A: Patients who have trouble standing or walking, as long as the pain improves when they sit or lean forward on a shopping cart are good candidates for this procedure.

Q: What is the ideal age range for this procedure?

A: Any age. It is especially good for patients who do not consider themselves candidates for more invasive spinal surgery.

You might be a good candidate if:

1. You have Spinal stenosis confirmed by MRI.

2. You have difficulty standing and walking (but not pain lying down or sitting–that is something else.)

3. You’ve had epidurals that work but are not long lasting.

Q: Where do you perform the MILD procedure?

A: The procedure is performed in a surgery center. I currently perform the procedure at our state-of-the-art surgery center, NECOS.

Q. Is there anything else you’d like patients to know about this new procedure?

A. It is very safe, with a rapid recovery, and a great option for people anxious about having invasive surgery. For the right patient it can be life changing!

If you have Spinal Stenosis and think you may be a good candidate for the MILD procedure, we invite you to schedule an appointment with Dr. Lehn for an evaluation. Why wait to get back to doing the things you love?

What IS Pain Management?

Pain management providers see patients who are experiencing pain in the lower back, knee, head, hip, or neck, and who could be suffering from common conditions such as arthritis, fibromyalgia, migraines, sciatica, and much more. But what exactly is “pain management”?

We sat down with our board-certified interventional pain management provider, Dr. Andrew Lehn to ask him a few questions about his specialty: pain management.

Q. What is the most common reason patients come to see you?

A. I treat pain from head to toe but low back pain is the most common complaint. It is estimated that up to 80% of people will have significant low back pain at some point in their lives!

Q. What is pain management, in your professional opinion?

A. Pain management is restoration. Pain means something is not functioning correctly. My goal is to try and figure out the source of pain and direct treatment to that location. Some conditions require surgery to correct but many things can improve by decreasing inflammation and facilitating healing. My goal is to restore someone back to how they felt before the pain started.

Q. What advice would you give a friend or a loved one if they are experiencing back or joint pain?

A. Exercise! Most painful conditions will improve with time. The goal is to strengthen the muscles and joints around a painful area so hopefully the pain does not increase. I tell people to think about joint pain like you would think about your heart. Imagine what your cardiologist would tell you: exercise, lose weight, eat healthy, decrease stress, prioritize good sleep. All these things will help your pain as well.

Q. Can you share a patient success story?

A. Recently, I had an elderly patient who was experiencing significant low back and buttock pain. She was frustrated because she was having difficulty doing her exercises and could not participate in physical therapy. Her Lumbar MRI had some degenerative issues and spinal narrowing but nothing too specific for the pain she was experiencing. She had pain around her Sacroiliac joint and her pain worsened with manipulation of the joint. I decided to inject her SI joint and she came back with significant relief. While her pain was not entirely gone, she felt that she could now do her exercises and return to physical therapy. Ultimately, that is the goal! I work alongside my patients to help get them going again and then they are better able to rehabilitate their injury and get back to functioning again.

Pain management works best when the patient and doctor work together for the best solutions.

If you’re experiencing pain of any kind, talk to Dr. Lehn today to see how he can help you overcome your pain issues and get back to living a fuller, pain-free life.

Schedule a consultation HERE or give us a call, 603-431-1121.