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The following are some of the common conditions treated by Dr. Andrew Rokito
Impingement is one of the most common causes of pain in the adult shoulder. It results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. The pain may be due to a "bursitis," or inflammation, of the bursa overlying the rotator cuff or a "tendonitis" of the cuff itself. In some circumstances, a partial tear of the rotator cuff may cause impingement pain. Initial treatment is nonsurgical and may include physical therapy, anti-inflammatory medication and a cortisone injection. If nonsurgical treatment does not relieve pain, the doctor may recommend surgery. The goal of surgery is to remove the impingement and create more space for the rotator cuff. This allows the humeral head to move freely in the subacromial space and to lift the arm without pain.
The most common surgical treatment is arthroscopic subacromial decompression. In an arthroscopic procedure, two or three small puncture wounds are made. The joint is examined through a fiberoptic scope connected to a television camera. Small instruments are used to remove bone and soft tissue to relieve the impingement.
After surgery, the surgeon will provide a rehabilitation program. This will include exercises to regain range of motion of the shoulder and strength of the arm. It typically takes two to four months to achieve complete relief of pain.
Rotator Cuff Tears
The rotator cuff is the network of four muscles and several tendons that form a covering around the top of the upper arm bone (humerus). Rotator cuff tear is a common cause of pain and disability among adults.
The rotator cuff can be torn from a single traumatic injury. Most tears, however, are the result of overuse of these muscles and tendons over a period of years. Diagnosis of a rotator cuff tear is based on the symptoms and physical examination. X-rays, and imaging studies, such as MRI are also helpful. In many instances, nonsurgical treatment can provide pain relief and can improve the function of the shoulder.
Surgery may be recommended if nonsurgical treatment does not relieve symptoms. The majority of tears can be repaired using an arthroscopic technique in which the tendon is reattached to the humerus using small bone anchors. After surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. An exercise program will help regain motion Complete recovery may take several months.
Meniscal tears are among the most common knee injuries. Anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.The most common symptoms of meniscal tear are pain, stiffness, swelling, catching, locking.
One of the main tests for meniscal tears is the McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscal tear, this movement will cause a clicking sound. Your knee will click each time your doctor does the test. MRI scans are typically used to make the definitive diagnosis of a torn meniscus.
If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery.
Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision. This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other small incisions to trim or repair the tear.
For the most part, rehabilitation can be carried out at home, although your doctor may recommend physical therapy. Meniscal tears are extremely common knee injuries. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities.
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. Approximately 50 percent of ACL injuries occur in combination with damage to the meniscus, articular cartilage, or other ligaments.
It is estimated that 70 percent of ACL injuries occur through non-contact mechanisms while 30 percent result from direct contact with another player or object.
When a patient with an ACL injury is initially seen for evaluation in the clinic, the doctor may order X-rays to look for any possible fractures. He or she may also order a magnetic resonance imaging (MRI) scan to evaluate the ACL and to check for evidence of injury to other knee ligaments, meniscus cartilage, or articular cartilage. After a complete ACL tear, some patients are unable to participate in cutting or pivoting-type sports, while others have instability during even normal activities, such as walking. There are some rare individuals who can participate in sports without any symptoms of instability.
The torn ACL is generally replaced by a substitute graft made of tendon. The grafts commonly used to replace the ACL include: patellar tendon or hamstring autograft (autograft comes from the patient) or allograft (taken from a cadaver). The goal of the ACL reconstruction surgery is to prevent instability and restore the function of the torn ligament, creating a stable knee. This allows the patient to return to sports.
In the most common ACL reconstruction technique, bone tunnels are drilled into the tibia and the femur to place the ACL graft in almost the same position as the torn ACL. The graft is held under tension as it is fixed in place using interference screws. Physical therapy is a crucial part of successful ACL surgery, with exercises beginning immediately after the surgery. Much of the success of ACL reconstructive surgery depends on the patient's dedication to rigorous physical therapy. With new surgical techniques and stronger graft fixation, current physical therapy uses an accelerated course of rehabilitation.
The goals for rehabilitation of ACL reconstruction include reducing knee swelling, maintaining mobility of the kneecap to prevent anterior knee pain problems, regaining full range of motion of the knee, as well as strengthening the quadriceps and hamstring muscles.
The patient may return to sports when there is no longer pain or swelling, when full knee range of motion has been achieved, and when muscle strength, endurance and functional use of the leg have been fully restored.