Relief From Hip Pain – How Arthroscopy Can Alleviate Pain and Restore Function

Hip pain can be debilitating, affecting everything from mobility to sleep to overall quality of life. The hip joint is where the thigh bone (femur) connects to the pelvis and is used constantly when one walks, bends, and supports his/her upper body.

Who is a good candidate for Hip Arthroscopy?

Hip pain has varied causes; in young people the most common cause is a labral tear–damage to the soft tissue lining the inside of the hip socket (acetabulum). A Labral tear can occur from repetitive wear over time, impingement from an underlying problem with the joint structure, or trauma from a sports injury or accident.

For patients who suffer from a labral tear –and who have not found relief from conservative treatments like rest, over-the-counter pain relievers and physical therapy–hip arthroscopy may be the answer. It’s a minimally invasive procedure that can restore hip function and alleviate pain.

Patients with osteoarthritis, cysts, or ankylosis (fusion) of the hip joint are not good candidates for hip arthroscopy.

What is involved in the Hip Arthroscopy procedure?

First, an orthopedic specialist will determine whether hip arthroscopy is appropriate based on a physical exam and x-ray or MRI imaging. Unlike open surgery, arthroscopy only requires a small incision through which a camera (arthroscope) is inserted. This gives the surgeon a clear, magnified view of the interior of the hip joint during the procedure. The surgeon will then repair or remove the damaged labrum, bone impingement, or loose bodies. Performed in an outpatient setting , arthroscopic hip surgery usually leads to less post-operative pain and shorter recovery time than open hip surgery.

Surgical Expertise + State of the Art Technology

Dr. Tyler Welch is a board certified orthopedic surgeon who has performed approximately 300 hip arthroscopy procedures – In addition to his extensive experience, Dr. Welch utilizes state-of-the-art technology, including “HipMap” software that generates a detailed 3D image of the hip structure in advance of the procedure. Used as a planning tool, this advanced imaging enables him to precisely target the surgery and minimize disruption to surrounding tissue.

Another innovative device employed by Dr. Welch is the Guardian, a cutting-edge operating table designed to hold the patient comfortably and securely in place, while providing the surgeon greater range of motion and visibility during the procedure. Traditionally, achieving proper positioning for hip surgery required the use of a post between the patient’s legs, a technique that can cause groin pain . The Guardian table has eliminated post-operative groin pain.

Below, we asked Dr. Welch a few questions about hip arthroscopy.

Where do you perform this procedure?
I perform hip arthroscopy at NECOS and at York Hospital.

Are you still the only practice in the Seacoast that uses the Guardian Table for this procedure?
That’s right, I’m still the only surgeon on the Seacoast that uses the Guardian Table.

Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
What is nice about hip arthroscopy is that it is a relatively straightforward recovery. Crutches are only required for about one week, and most patients make significant gains within 4-6 weeks. It is not too painful, and I have found that most patients only require pain medication for the first 24-48 hours.

Also, surgery is reliable for the right patient. As long as the patient has hip impingement without any sign of arthritis, surgery typically alleviates pain and eliminates most symptoms.

If you suffer from hip pain, don’t ignore it. Atlantic Orthopaedics and Sports Medicine offers treatments–both surgical and non-surgical–that can alleviate hip pain and restore your quality of life. If you think that hip arthroscopy may be right for you, schedule a consultation with Dr. Welch to learn more.

A Solution for a Common Orthopedic Injury – Distal Radius Fracture Repair for Wrist Fractures

Along with cold weather, snow, and ice, winter in the Northeast means an increase in distal radius (wrist) fractures, most of which occur from landing on an outstretched hand after a slip and fall. These fractures result in pain, limited range of motion, and decreased wrist function. For patients with a fracture that is significantly displaced, surgical intervention may be recommended.

Our orthopedic surgeon, Dr. Meyer, specializes in treating upper extremity injuries (fingers, hand, wrist, and elbow), and understands the tremendous impact that wrist fractures can have on patients’ lives. In patients who are candidates for surgery, he has seen excellent outcomes from Distal Radius Fracture ORIF (open reduction and internal fixation, which means fixing the bone in its native position with a plate and screws).

Below, we asked Dr. Meyer some questions about the procedure.

Q: In your own words, how does this procedure benefit your patients?

A: Distal radius fractures are the most common fracture of the upper extremity (shoulder, elbow, wrist, and hand). The radius bone is part of the forearm, and the distal (end-portion) of the radius supports the bones of the wrist. Certain distal radius fractures are stable and will heal well with a period of immobilization in a cast. Other distal radius fractures are unstable and often benefit from surgery to align the fracture pieces in a more anatomic position.

When surgery is performed, a combination of a plate and small screws are used to hold the bones in the optimal position. Surgery for displaced distal radius fractures have been shown to lead to excellent outcomes, including near-complete return of motion and grip strength and very low rates of persistent pain and disability. The majority of patients sustaining these injuries are able to return to their jobs and hobbies without limitation.

Q: Who is a good candidate for this procedure?

A: Anyone who sustains a broken wrist should be evaluated with a physical exam and a set of x-rays. A wide range of both patient-related factors (age, medical history, functional demands from jobs/hobbies, smoking status, etc.) and injury-related factors (mechanism of injury, fracture alignment/displacement, etc) are used to help guide the decision between treating a wrist fracture with a cast (no surgery) versus performing surgical fixation.

Q: Where do you perform this procedure?

A: I perform surgical fixation of distal radius fractures at the New England Center for Orthopedic Surgery (NECOS), Portsmouth Regional Hospital, and York Hospital.

Q: Tell us about a recent success story.

A: A 65 year old woman presented to my office after slipping on black ice and injuring her wrist. She had a displaced distal radius fracture that significantly limited her wrist motion. She is an elementary school teacher, and her two biggest goals were to optimize her long-term wrist function and to return to activity quickly. We discussed the treatment options, and she chose surgery in order to accelerate her rehabilitation, minimize her time in a cast, and give herself the best chance for healing her wrist injury in an anatomic position.

We fixed her wrist with a plate and screws. The surgery took a little over an hour and she was back to work the same week. Within two weeks, she was out of her splint and working on gentle wrist range of motion exercises. She is an avid pianist, and found that playing piano helped to improve her wrist and finger motion in the early post-operative period. Six weeks after surgery, we started gentle strengthening. By the 2.5 month-mark, she was cleared for full strengthening and return to all activities. Now, she is back to all school-related activities and does not feel limited at all by her wrist.

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

A: These fractures occur most commonly after a slip and fall onto an outstretched hand. Here in the Seacoast, we see a large upstick in the number of patients sustaining distal radius fractures during the wintertime. Whether it is slipping on ice or falling while skiing or skating, these injuries can unfortunately happen at any time. The best way to treat a wrist fracture is to not have one! So, my best advice is to make sure to tread carefully when walking, skating, and skiing. Furthermore, many patients in their 60’s and 70’s have osteoporosis (thin bones that are more prone to fracture). With several months of cold and cloudy weather in the Seacoast, many of us also have low calcium and Vitamin D levels. I would encourage patients to discuss their bone density and calcium and Vitamin D levels with their primary care physicians in order to make sure their bone health is optimized to start off the new year.

If you’ve suffered a wrist fracture, it’s important to consult with an orthopedic specialist as soon as possible. Dr. Meyer’s treatment philosophy centers on listening to patients and working together to find solutions, both surgical and non-surgical, that help them resume a pain-free active lifestyle. Contact us to schedule an appointment with Dr. Meyer today.

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!

Voted Best Podiatrist 2023

Since 1987, our team of board-certified orthopedic physicians have delivered the highest level of care to the Seacoast community. Serving athletes and residents alike, we operate as the area’s premier orthopedic and sports medicine practice. It’s what we love to do, and because of that we were recently voted “Best Podiatrist” by the Seacoast NH community in the 2023 Best of the Seacoast awards and we couldn’t be more proud of our foot and ankle team for this accomplishment.

If you’re suffering from foot or ankle pain, don’t ignore it. Come see our foot and ankle specialists in Portsmouth, NH, or York, ME, led by Dr. Eilts. Our teams will evaluate the extent and severity of your foot or ankle pain and recommend the treatment that’s best for you. Contact us with questions or schedule an appointment online to have your hip pain evaluated and treated. Our offices can be reached at 603-431-1121 (Portsmouth, NH) and 207-363-3490 (York, ME).

Will Injections Help or Do I Need Surgery? The Straight Facts About Cortisone Shots

Cortisone is a potent anti-inflammatory medication that can be used to treat a wide range of orthopedic conditions, but Cortisone shots are not a one-size-fits-all solution. For some patients, injections can be highly effective, but in other cases it may be time to consider surgery.

According to orthopedic surgeon Dr. Noerdlinger, there are three common misconceptions people have about cortisone shots:

1. Cortisone is Just Temporary

Although the effects can be temporary, there are cases where Cortisone can offer long lasting pain relief for years.

2. Cortisone Only Masks the Pain

Novocain, such as lidocaine, will mask pain, but Cortisone decreases the inflammation which is causing the pain. The analogy is taking a steroid to decrease the inflammation from a sore throat. The steroid effect of the Cortisone decreases the inflammation and allows the joint to move more freely, enabling the patient to rehabilitate the joint more effectively.

3. Cortisone Damages Tissue

Used judiciously, cortisone will not damage tissue. Just like taking a bottle of Tylenol will destroy the liver, large amounts of cortisone–in a short time period, in the same body part–can weaken the collagen fibers. But, like Tylenol, where it is ok to finish off the bottle over the course of a year, intermittent Cortisone injections are permissible.

While Cortisone shots can be incredibly beneficial for some, there are situations where surgical intervention may be necessary:

1. Loss of Function

If your orthopedic condition has progressed to the point where it severely limits your ability to participate in daily activities and compromises your quality of life, it may be time to consider surgery.

2. Structural Damage

In patients with significant structural damage to a joint, such as advanced osteoarthritis with bone-on-bone contact, joint replacement surgery may be the best solution to restore function and relieve pain.

3. Repeated Injections are Ineffective

If you find yourself needing frequent Cortisone injections for the same issue, it indicates that the underlying problem can’t be managed with injections alone. If Cortisone offers only temporary relief, it might be time to have a discussion with your orthopedic specialist about surgical options.

Cortisone is a valuable tool in orthopedic care, providing pain relief and delaying the need for surgery in some patients. But it’s important to recognize the limitations of injections and to know when it’s time to consider the next step–surgical intervention like joint replacement. One scenario in which cortisone injections are not recommended is in the setting of fixable rotator cuff tears in patients considering surgery. Studies show that re-rupture rates and infection rates are higher in patients undergoing rotator cuff repairs who receive cortisone injections before surgery.

Your orthopedic specialist is your best resource in determining the most appropriate treatment plan for your specific condition, symptoms, and goals. Whether it’s cortisone injections or joint replacement surgery, the ultimate aim is to help you regain function, eliminate pain, and enjoy a high quality of life.

Knee Pain From a Dislocated Kneecap?

Patella Instability Surgery Can Provide Relief!

What Is Patellar Instability?

When the kneecap shifts out of its normal alignment, you may feel pain, trouble walking, a buckling or locking sensation, or a feeling of the knee “giving way.” Patella instability can impact daily life and make it difficult to stay active.

How Does the Patella Instability Procedure Work?

In this procedure, the surgeon carefully realigns the patella within the femoral groove to ensure proper tracking during knee movement. The specific surgical technique can vary based on factors like the patient’s age, and the severity of the injury. In the Medial Patellofemoral Ligament (MPFL) Reconstruction procedure that Dr. Welch describes below, the patient’s ligament was reconstructed to stabilize the patella on the inside of the knee. In cases of severe instability, the surgeon may also reposition the tibial tubercle–the bony bump below the patella–to improve patellar tracking.

What Can I Expect Post-Surgery?

Patients can expect to go home the same day as the procedure. Recovery time varies and patients will need to use crutches and wear a knee brace for a period of time, typically 4-6 weeks. Physical therapy is also an important part of the recovery process.

We sat down for a Q&A with our Orthopedic Surgeon and Sports Medicine Specialist Dr. Welch.

In your own words, how does this procedure benefit your patients?

Patella instability is a condition in which the patella (kneecap) dislocates from the femur (thigh bone). Most patients are young, often teenagers. Fortunately we can fix this condition surgically. This procedure benefits patients because it generally restores one’s confidence and his/her ability to play sports.

Who is a good candidate for the Patella Instability Procedure?

A good candidate for patella instability surgery is anyone who has had at least one patella dislocation or multiple subluxations (partial dislocations).

Where do you perform this procedure?

I perform this procedure at New England Center for Orthopedic Surgery (NECOS) in Portsmouth and at York Hospital in York, Maine.

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

Recently, a 15 year old male high school student came to see me with his family. The patient had sustained two dislocations prior to his visit with me. These dislocation events are painful and stressful, and the young man was apprehensive about playing sports ever again unless we fixed his knee. He underwent a procedure–a medial patella femoral ligament (MPFL) reconstruction–to stabilize his patella. Surgery was straightforward and he recovered nicely. He required crutches for 10 days and a brace for four weeks. After six weeks, he had normal motion and no swelling in his knee. I cleared him to return to sports three months after surgery.

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

There are a few important things to consider regarding patella instability surgery. The procedure is very reliable – dozens of studies have demonstrated success rates in the 90-95% range, and my experience has been similar. The vast majority of these patients are happy because they regain “trust” in their respective knees, and recovery is straightforward. Further, patients usually return to the same level of activity that they had prior to the dislocation(s).

If you have knee pain from dislocation, visit our website to learn more about Arthroscopic Knee Surgery or schedule a consultation with Dr. Welc h.

Is Pain in Your Thumb Holding You Back?

CMC Arthroplasty As A Solution For Thumb Pain

If you’re experiencing pain and stiffness at the base of your thumb, you might be dealing with CMC (carpometacarpal) arthritis. But don’t worry – you’re not alone. There are effective treatment options available for this common thumb condition that can provide much-needed pain relief and restore motion.

What are the symptoms of CMC arthritis?

Common symptoms include pain at the base of the thumb, especially during pinch and grip activities. The joint also may become swollen and tender to the touch. Typically, CMC arthritis decreases mobility in the thumb, and weakness may develop that makes it difficult to grasp objects.

What causes CMC arthritis?

CMC arthritis is a degenerative condition, often attributed to the aging process. Other contributing factors can include:

Repetitive use: activities that require repetitive thumb movements can accelerate joint wear and tear.
Trauma: a previous thumb injury can increase the risk of developing CMC arthritis.
Genetics: genetic history may predispose some people to joint degeneration.
Inflammatory conditions: certain immune or inflammatory conditions can contribute to CMC arthritis.

Atlantic Orthopaedics’ hand surgeon Dr. Meyer answers some common questions about CMC Arthroplasty, a life-changing procedure for patients suffering from advanced thumb arthritis.

In your own words, how does this procedure benefit your patients?
Arthritis at the base of the thumb (CMC arthritis) is a common source of pain and disability for adults, affecting one in three women and one in eight men over the course of their lifetime. A variety of treatment options exist, starting with conservative management (bracing, therapy, anti-inflammatories, corticosteroid injections) and progressing to surgery. For advanced thumb CMC arthritis that does not respond to the above treatments, CMC arthroplasty can provide lasting pain relief and improvement in thumb strength and motion.

There are a variety of surgical techniques for CMC arthroplasty. Most involve the removal of the painful, arthritic bone at the base of the thumb (trapezium) and use of a nearby tendon to stabilize the thumb in its native position. Recent innovations in the field of hand surgery have allowed for the use of a non-absorbable suture instead of a patient’s own tendon to maintain the thumb’s resting position. This procedure, termed a suture-button suspensionplasty, avoids complications from harvesting nearby tendons and allows for accelerated rehabilitation and recovery after surgery. While most other techniques require between four to six weeks of immobilization in a cast, I allow my patients to start gentle motion after their first post-operative visit (approximately 10 days after surgery) when using this technique.

Who is a good candidate for this procedure?
Thumb CMC arthritis can affect anyone, but it becomes more prevalent with older age. This procedure is typically indicated for middle-age and elderly adults who have painful arthritis at the base of their thumb that limits their daily activities.

Where do you perform this procedure ?
I perform thumb CMC arthroplasty procedures at NECOS, Portsmouth Regional Hospital, and York Hospital.

Do you have a recent patient success story you can share?
A 65-year-old retired professional pianist presented to the office with painful thumb CMC arthritis that failed to improve with bracing and steroid injections. Alleviating pain and preserving thumb motion were her biggest priorities. Due to her activity level, we elected to perform a CMC arthroplasty using the suture-button suspensionplasty technique.

Her surgery and post-operative course both progressed very smoothly. She was seen at her first post-operative visit and transitioned to a removable brace that allowed for gentle motion. At six weeks, she began gentle strengthening under the guidance of our occupational therapy team. At three months, she was cleared to return to full activity. She is back to playing piano and feels that her motion is even better than before surgery because she is no longer limited by pain. We were thrilled to help her get back to one of her favorite activities and to enable her to keep teaching other aspiring pianists. Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
Thumb CMC arthroplasty yields excellent results, but it is not the only treatment recommendation for patients with thumb CMC arthritis. There are a variety of non-surgical and surgical treatments that can help with pain at the base of the thumb prior to considering a CMC arthroplasty. Every patient evaluation begins with a thorough clinical history, physical examination, and radiographs (x-rays) of the hand. From there, I work with each patient to understand their goals before we collectively decide on an appropriate treatment plan moving forward.

CMC arthritis can be a debilitating condition, but there is help available. For many patients, CMC Arthroplasty has proven to be an effective way to alleviate pain and restore quality of life. If you’re suffering from pain and limited function in your thumb, schedule a consultation with Dr. Meyer to discuss whether CMC Arthroplasty may be right for you.

Free Lunch & Learn with Dr. Meyer on Battling Hand Arthritis

Dr. Maximilian A. Meyer is a fellowship-trained hand and upper extremity surgeon who specializes in the treatment of both acute injuries and chronic conditions of the fingers, hand, wrist, forearm, and elbow.

Join him for lunch on Thursday, October 26th from 12:00-1:00pm at the York Public Library as he talks about arthritis of the hand and how he evaluates and treats this very common problem.

Lunch will be provided courtesy of York Hospital. Attendees will receive a boxed lunch to take home following the presentation.

Spots are limited. Click HERE to register today!

Dr. Meyer understands the tremendous impact that hand and arm problems can have on patients’ lives. His treatment philosophy centers on listening to and working together with patients to create individualized care plans -both surgical and non-surgical – that help them return to an active lifestyle. Using the latest scientific evidence and advanced techniques, Dr. Meyer is dedicated to delivering outstanding orthopedic care with compassion every day.

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.