Download rthopaedic Digest - Orthopaedic Clinic of Daytona Beach

O rthopaedic Digest
A Publication
of the Orthopaedic Clinic of Daytona Beach, P.A.
Inside This Issue
��
Osteoporosis
��
The BIRMINGHAM HIP™ Resurfacing System
��
Tears of the Meniscus in Athletes
��
Shoulder Pain
Volume 2
Learn about Minimally
Invasive Surgeries, General
Problems, Child and
Adult Orthopaedics, Pain
Management and much more with
our articles, videos and interactive
virtual joint replacement surgeries
Visit us online at
www.ORTHODB.com
�� Surgery
�� Foot Disorders
�� Bone Density Studies
�� Arthritis
�� Spine Surgery
�� Second Opinions
�� Joint Disease
�� Kyphoplasty
�� Physical Therapy and
�� Hand Disorders
�� Osteoporosis
�� Carpal Tunnel
�� Birmingham Hip Resurfacing
�� Shoulder Problems
�� Reconstructive Surgery
�� Total Joint Replacement
�� Unicondylar Knee Replacement
�� Fractures
�� Back & Neck Pain
�� Soft Tissue Injuries
�� Sprains
Rehabilitation
Welcome
Orthopaedic Clinic of Daytona Beach - Total Orthopaedic Care Since 1961
Main Office:
1075 Mason Ave.
Daytona Beach, Florida
(386) 255-4596
•
Physical Therapy:
(386) 252-5534
•
Palm Coast Office
4 Office Park Dr., Pod #1
Palm Coast, Florida
(386) 255-4596
•
Physical Therapy:
(386) 445-9546
•
Twin Lakes Office
1890 LPGA Blvd.,
Suite 240
Daytona Beach, Florida
(386) 255-4596
•
Physical Therapy:
(386) 274-1244
•
Port Orange Office
1165 Dunlawton Ave.,
Ste. 102
Port Orange, Florida
(386) 255-4596
•
Physical Therapy:
(386) 756-8677
•
Our Physicians:
General Orthopaedic & Spine Care Sports & Adult Reconstruction Specialists Providing Surgical
& Non-Surgical Treatment. Radiology Services Available at All Locations.
Contents
Osteoporosis............................................................................................................................................................................ 5
The BIRMINGHAM HIP™ Resurfacing System:.............................................................................................................. 7
The Rewards and Risks of Total Hip Replacement..................................................................................................... 8
Tears of the Meniscus in Athletes.................................................................................................................................... 10
Meet the Physicians.............................................................................................................................................................. 12
Dr. Thurman Gillespy, Jr.
Physical Therapy..................................................................................................................................................................... 14
Dr. Gilbert A. Martin, Jr.
The Five Rules of FITNESS................................................................................................................................................... 15
Dr. Albert W. Gillespy
Dr. Mark C. Gillespy
Dr. Malcolm D. Gottlich
Dr. James M. Bryan
Knee Injuries............................................................................................................................................................................. 18
Hip Fractures In The Elderly............................................................................................................................................... 20
Shoulder Pain.......................................................................................................................................................................... 22
Dr. Jeffrey W. Martin
Dr. Todd A. McCall
Orthopaedic Clinic of Daytona
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Daytona Beach
1320 Mason Ave.
Daytona Beach, FL 32117
386-258-0401
Orange City
938 Saxon Blvd., Suite 103
Orange City, FL 32763
386-775-1266
e-mail: [email protected]
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Osteoporosis
by Albert W. Gillespy, M.D.
steoporosis is a silent disease until it is
complicated by fractures – fractures that can
occur following minimal trauma. Fractures and
their complications are the relevant clinical
sequelae of osteoporosis. The most common
fractures are those of the vertebra (spine),
proximal femur (hip), and distal forearm (wrist).
However, most fractures in older adults are due in
part to low bone mass, even when they result from
considerable trauma.
Osteoporosis-related fractures create a heavy
economic burden, causing more than 432,000 hospital
admissions, almost 2.5 million medical office visits, and
about 180,000 nursing home admissions annually in
the United States. The cost to the health care system
associated with osteoporosis-related fractures has been
estimated at $17 billion dollars for 2005; hip fractures
account for 14 percent of incident fractures and 72
percent of fracture cost.
Osteoporosis can be prevented and can be diagnosed
and treated before any fractures occur. Importantly,
even after the first fracture has occurred, there are
effective treatments to decrease the risk of further
fractures. Prevention, detection, and treatment of
osteoporosis is imperative for all patients to lead long,
productive and healthy life.
The National Osteoporosis Foundation has the
following recommendations for the evaluation and
management of osteoporosis. Recommendations
apply to post-menopausal women and men age 50
and older.
�� Counsel on the risk of osteoporosis and related
fractures.
�� Check for secondary causes.
�� Advise on adequate amounts of calcium (1200 mg.
to 1500 mg. per day) and vitamin D (800 to 2000
IU’s per day), including supplements if necessary for
individuals age 50 and older.
www.orthodb.com � 5
�� Recommend regular weight-bearing and musclestrengthening exercise to reduce the risk of falls
and fractures.
�� Advise avoidance of tobacco smoking and excessive
alcohol intake.
�� In women age 65 and older and men age 70 and older,
recommend bone mineral density (BMD) testing.
�� In post-menopausal women and men age 50 to 69,
recommend BMD testing when there is concern based on
the risk factor profile.
�� Recommend BMD testing to those who have had a
fracture, to determine degree of disease severity.
�� Initiate treatment in those with hip or vertebral
(clinical or morphometric) fractures.
�� Initiate therapy in those with BMD T-scores less than
or equal to -2.5 at the femoral neck or spine by dual-energy
X-ray absorptiometry (DXA), after appropriate evaluation.
�� Initiate treatment in post-menopausal women and
men age 50 and older with low bone mass (T-score between
-1.0 and -2.5, osteopenia) at the femoral neck or spine and
a 10-year hip fracture probability of greater than or equal to
3 percent or a 10-year major osteoporosis-related fracture
probability of greater than or equal to 20 percent based on
the US-adapted WHO absolute fracture risk model (FRAX).
�� Current FDA-approved pharmacologic options
for osteoporosis prevention and/or treatment are
bisphosphonates (alendronate, ibandronate, risedronate
and zoledronic acid), calcitonin, estrogens and/or
hormone therapy, parathyroid hormone (teriparatide) and
estrogen agonist/antagonist (raloxifene).
�� BMD testing performed in DXA centers using
accepted quality assurance measures is appropriate for
monitoring bone loss. For patients on pharmacotherapy,
6 � www.orthodb.com
it is typically performed two years after initiating therapy
and every two years thereafter; however, more frequent
testing may be warranted in certain clinical situations.
Osteoporosis is the most common bone disease in humans,
and it represents a major public health concern. It is
characterized by low bone mass, deterioration of bone tissue
and disruption of bone architecture, compromised bone
strength, and an increase in the risk of fracture. According
to the WHO diagnostic classification, osteoporosis is
defined by BMD at the hip or spine that is less than or
equal to 2.5 standard deviations below the young
normal mean reference population. Osteoporosis
is an intermediate outcome for fractures and is a
risk factor for fracture just as hypertension is for
stroke. The majority of fractures, however, occur
in patients with low bone mass rather than
osteoporosis.
Osteoporosis affects an enormous
number of people, of both sexes
and of all races, and its
prevalence will increase
as the population ages.
The National Osteoporosis
Foundation estimates
that more than 10
million Americans have
osteoporosis, an additional
33.6 million have low-density
of the hip. About one out
of every two Caucasian
women will experience
an osteoporosis-related
fracture at some time in her
lifetime, as approximately
one in five men. Although
osteoporosis is less frequent
in African Americans, those
with osteoporosis have the
same elevated risk factors as
Caucasians.
The BIRMINGHAM HIP
Resurfacing System:
™
by Mark C. Gillespy, M.D.
ctive adults suffering from
difficult hip pain now have
access to the world’s leading
treatment technology for
their condition. Called
the BIRMINGHAM HIP™
Resurfacing (BHR) System,
this implant is an alternative to total
hip replacement that may last longer
and enable a more active lifestyle
than traditional total hip implants.
Rather than replacing the entire hip
joint, as in a total hip replacement,
the BHR hip simply shaves and caps
a few centimeters of bone within
the joint.
The bone-conserving approach of
the BHR hip preserves more of the
patient’s natural bone structures and
stability, covering the joint’s surfaces
with an all-metal implant that more
closely resembles a tooth cap than a
hip implant. This approach reduces
the post-operative risks of dislocation
and inaccurate leg length, and because the all-metal implant is made
from tough, smooth cobalt chrome, it
has the potential to last longer than
some traditional hip implants.
The BHR hip has been implanted
more than 100,000 times since being
introduced in Europe in 1997. And
outside of the US, approximately 1
in 10 hip replacement candidates
receive a hip resurfacing device.
In the US, the number is smaller
– approximately 3 out of 100 –
because the procedure is still
relatively new.
The Food and Drug Administration
approved the BHR hip for use in the
US in 2006, and it now represents
more than 80% of all hip resurfacings
performed in this country every year.
For patients concerned they may
need follow-up surgery later in life
because of their relative youth, data
from a respected British registry
of patients indicates that 10 years
after surgery, 95.4% of the BHR
hips studied are still performing
as designed. And according to the
definitive Australian Orthopaedic
Society’s registry of
patients, hip resurfacing
procedures actually last
longer that total hip
replacement in male
patients under the age of
65. And in that same British
registry, patients scored
their experience with the
BHR hip as “pleased” or
“extremely pleased” in
98.6% of cases.
stock. X-rays and examination may
help to determine if it is right for you.
The Birmingham Hip implant is
intended for patients suffering
from hip pain due to osteoarthritis,
dysplasia or avascular necrosis, and
for whom total hip replacement
may not be appropriate due to their
increased level of physical activity.
The BHR hip may not be appropriate
for people with impaired kidney
function or for women who are or
may become pregnant.
The BHR hip is not for
everyone. The Australian
registry also indicates that
90% of hip resurfacing
patients are under the age
of 65, and 73% are male.
This is due in large part to
the fact that men tend to
have greater bone density
than women, and that
bone density decreases as
you age—and the BHR hip
works best when implanted
in patients with good bone
www.orthodb.com � 7
The Rewards and Risks of
Total Hip Replacement
by Brian R. Hatten, M.D.
Many of us go about our activities
blissfully unaware of the importance
of our hip. Until it erupts in severe
pain, that is. If you are a sufferer, you
are not alone.
he hip joint is one of the
largest joints in your body.
Unfortunately, it is also one of
the most easily injured—and
not all at once. Osteoarthritis
(known as ‘wear-and-tear
arthritis’) can set in gradually
and can cause not only stiffness but
also excruciating pain.
What causes the hip to deteriorate
to the point where it needs
replacement? Sometimes
Osteoarthritis is the culprit, and it
may be that genetics play a role in
this. In other cases, the ball of the hip
joint (called the femoral head) loses
its blood and simply dies, leading to
degeneration.
At first, the discomfort might be
noticed only when bending or
when putting pressure on the
hip joint. This commonly occurs,
for example, when walking up
and down stairs. Eventually, the
pain can become nearly constant.
In time, the pain may affect the
sufferer’s ability to enjoy a full
and active life. A measure of relief
may come through medication
and walking aids, but sometimes
these remedies are short-lived. For
long-term treatment, the solution
might be total hip replacement. Hip
replacement surgery is becoming
8 � www.orthodb.com
more and more common as the
population of the world begins to
age. Hip replacement surgery has a
very high success rate and provides
reproducible results.
The hip joint is composed of two
parts: The ball and the socket.
During surgery, the two parts are
removed and replaced with artificial
surfaces. The ball is usually made of
metal or ceramic, while the socket
is usually composed of plastic. Ask
your orthopedist about newer
“alternative bearing” options that
may be available. The option of hip
replacement is completely up to the
sufferer. It is a function and lifestyle
matter. Your orthopaedic surgeon
will have recommendations, based
on such factors as your medical
history, weight, health status, and
hip condition. After considering
non-operative options, some
decide that the benefits of total hip
replacement far outweigh the risks
and complications.
True, the very idea of hip surgery
may seem daunting. But new
developments—mainly over the
past few decades—are changing
the face of hip replacement for the
better. For example, a procedure
known as minimally invasive total
hip replacement now allows surgery
to be performed with less trauma to
the soft tissues of the hip. It uses the
same implants that are employed in
traditional surgery. But one major
difference is in the incision. Whereas
traditional surgery requires a 12inch or longer cut, the incision made
with the muscle-sparing technique
is much smaller. It helps speed
up recovery and helps the patient
return sooner to normal activities.
having unequal lengths. A thorough
discussion of the risks and benefits
of hip replacement surgery will be
completed with your doctor prior to
deciding on surgical management.
What are some of the risks of
hip replacement surgery? There
are several important ones to be
aware of, including: Deep Venous
Thrombosis - DVT (when blood
clots in the large veins of the leg),
infection, dislocation (when the
ball comes out of the socket),
loosening of the joint, or the legs
When total hip replacement is
recommended, the outcome can be
positive. A total hip replacement will
provide complete or nearly complete
pain relief in 90 to 95 percent of
patients. It will allow patients to
carry out many normal activities of
daily living. The artificial hip may
allow you to return to sports or work
under your doctor’s instructions.
Most patients with stiff hips before
surgery will regain much of their
motion, and nearly all have improved
pain levels. Talk to your orthopaedic
surgeon if you have hip pain and find
out your options.
www.orthodb.com � 9
Tears of the Meniscus
in Athletes
by Jeff W. Martin, M.D.
enisci are crescent shaped fibrocartilage
structures that are triangular in cross section.
There is both medial (inside) and lateral
(outside) meniscus. These C-shaped cartilage
structures which deepen the articular surfaces
aid in shock absorption, stability, lubrication
and nutrition. In younger athletes meniscus
tears usually occur with a traumatic event, typically
involving twisting and compression. It is also more
common in younger athletes to see ligament injuries in
association with meniscus tears. Older athletes, because
the meniscus degenerates with age, may tear a meniscus
with trivial trauma such as squatting or twisting. It is
Meniscal (Cartilage) Tear
10 � www.orthodb.com
and popping. Some meniscus tears can “lock” the knee
if large enough. Orthopedic surgeons, by taking a good
history and performing a physical examination, usually
can make the diagnosis. At times Magnetic Resonance
Imaging (MRI) may be needed for a diagnosis.
It is important that a diagnosis is made promptly as some
tears can increase in size making treatment more difficult
or lead to additional damage inside the knee. Treatment
of a meniscus tear depends on the location and shape of
the tear.
Arthroscopy, which involves looking inside the knee joint
with a small scope, allows the surgeon to characterize
and treat the tear appropriately. The “Scope” requires
small incisions and anesthesia but usually can be done to
allow going home the same day.
also more common
to see arthritis in
combination with a
meniscus tear in the
older athlete.
With only the peripheral 20 to 30 % of the menisci
vascularized, most tears are located in a position that
lacks a blood supply. These degenerative tears usually
occur in older patients and can have an insidious onset.
Treatment typically involves removal of the torn piece
so that the rough edge no longer irritates the knee
joint. As little tissue as possible is removed in order to
preserve the function of the remaining meniscus. Tears
in the meniscus near the outer edge have the ability to
heal and can be relocated by suturing or tacking with
biodegradable anchors. Holding the meniscus in place
may allow for healing to occur thereby preserving the
function of the entire meniscus. This type of arthroscopic
surgery is technically more demanding on the surgeon
and has a slower recovery. Healing of repaired meniscus
tears is not 100%. The medial meniscus is torn three
times more frequently than the lateral meniscus.
When the meniscus
tears, it creates
a rough surface
irritating the knee
joint causing
swelling, pain,
stiffness, and
frequently catching
In conclusion, tears of the meniscus are common
amongst athletic individuals. The medial meniscus tears
more often than its lateral counterpart. Most often a
meniscus tear is symptomatic and requires arthroscopic
treatment. Though removal of a torn piece of meniscus
remains the most common intervention, we are
continually investigating methods to preserve the entire
meniscus and normal knee function.
Orthopaedic Clinic
of Daytona Beach, P.A.
Main Office - Daytona Beach
1075 Mason Avenue
Daytona Beach, Florida
(386) 255-4596
Physical Therapy:
(386) 252-5534
Port Orange Office
1165 Dunlawton Ave., Ste. 102
Port Orange, Florida
(386) 255-4596
Physical Therapy:
(386) 756-8677
Palm Coast Office
4 Office Park Dr., Pod #1
Palm Coast, Florida
(386) 255-4596
Physical Therapy:
(386) 445-9546
Twin Lakes Office
1890 LPGA Blvd., Suite 240
Daytona Beach, Florida
(386) 255-4596
Physical Therapy:
(386) 274-1244
Meet the Physicians of Orthopaedic
Dr. Thurman Gillespy, Jr., M.D., F.A.B.O.S., F.A.A.O.S.
Dr. Gillespy is a board certified orthopaedic surgeon. In 1961 he founded the Orthopaedic Clinic of Daytona Beach, P.A.
Dr. Thurman Gillespy practices general orthopaedic surgery, non surgical treatment of deformities, diseases and injuries
to the bones, joints, ligaments, muscles, tendons and other soft tissues, nerves and related structures of the human
body. He has specialized in total joint replacements since 1970 when he became one of the first surgeons in Florida to
perform these surgeries. Dr. Gillespy has performed more than 4,000 total joint surgeries.
He actively participates in the Jesus Clinic and the physician residency program at Halifax Medical Center. Twenty-five
years ago he initiated the spinal screening program for detecting scoliosis and other spinal deformities. Annually, the
surgeons from the Orthopaedic Clinic of Daytona Beach, PA examine students at all of the middle schools in the Halifax
area. Dr. Gillespy has also actively participated in the Childrens’ Medical Services Clinic (formerly Florida Crippled Childrens’
Commission) and has served as team physician for many high schools athletic programs. Dr. Gillespy has been a clinical
instructor for the Department of Orthopaedic Surgery at the University of Florida in Gainesville for more than forty (40)
years. Dr. Gillespy is a member of the Presidents Council of the University of Florida. Dr. Gillespy recently had The Gillespy
Orthopaedic Residents Education Commons named in his honor at the University of Florida.
Dr. Gillespy and his Wife, Elaine, have six children, three of whom are physicians. Two of his sons, Albert and Mark, joined
him in practice at the Orthopaedic Clinic of Daytona Beach, P.A.
Dr. Gilbert A. Martin, Jr., M.D., F.A.B.O.S., F.A.A.O.S.
Dr. Martin is a board certified orthopaedic surgeon. Dr. Martin has practiced general orthopaedic surgery including
treatment of diseases and injuries to the joints, ligaments, bones, tendons, muscles, fractures and related structures of the
human body in addition to joint replacement and spine surgery. He received appointments as Chief of the Department
of Surgery and served two terms as Chief of the Department of Orthopaedic Surgery at Halifax Medical Center. Dr. Martin
currently has a non-surgical orthopaedic practice and has hospital privileges at Halifax Medical Center. He has office
hours daily Monday through Friday at the Mason Avenue Office.
During his years of practice in Daytona Beach, Dr. Martin has participated in and volunteered his services to the Halifax
Dunn Clinic (formerly Keech Street Clinic), scoliosis screening in the Volusia County middle schools, Childrens’ Medical
Services Clinic (formerly Florida Crippled Children’s Commission) and team physician for local high school athletic
programs. In additional, he is a supporter of the Work Oriented Rehabilitation Center for young physically and mentally
challenged adults.
Dr. Martin and his Wife, Kit, who is a retired physical therapist, are the parents of five grown children.
Dr. Albert W. Gillespy, M.D., F.A.B.O.S., F.A.A.O.S.
Dr. Gillespy is a board-certified orthopaedic surgeon and long-time resident of the Daytona Beach area. He practices
general orthopaedic surgery with special interest in spine. His orthopaedic practice includes surgical and non-surgical
treatment, spinal disorders, neck and back pain, arthritis, joint disease, total joint replacement, out-patient unicondylar
knee replacement, arthroscopic knee surgery, shoulder problems, shoulder rotator cuff tendon repair surgery, hand
disorders, carpal tunnel syndrome, foot disorders, bunion surgery, fractures, and osteoporosis. He performs surgery at
Twin Lakes Ambulatory Surgery Center, Halifax Medical Center, and Florida Hospital Memorial Medical Center.
Over the years, Dr. Gillespy has been involved in many community projects including the Halifax Dunn Clinic, scoliosis
screening in the middle schools, physician residency program at Halifax Medical Center, and physical and occupational
therapy training programs through the University of St. Augustine, St. Augustine, FL. He also served as the orthopaedic
surgeon on call and on site for the Daytona International Speedway from 1989 through 2004.
Dr. Gillespy and his wife, Doreen, have two teenage daughters. He coaches his daughters’ basketball team at St. James
Episcopal School.
Dr. Mark C. Gillespy, M.D., F.A.B.O.S., F.A.A.O.S.
Dr. Gillespy is board certified orthopaedic surgeon commonly is consulted for many musculoskeletal conditions
including fractures, muscle, ligament and joint injuries, and nerve entrapments. He specializes in spinal, hip, and knee
surgeries. He performs cervical, thoracic, and low back spinal operations using minimally invasive techniques. In
addition, he performs arthroscopic surgery of the knee, minimally invasive partial and full knee replacements, and
minimally invasive total hip replacements. He has developed and perfected less invasive approaches to management
of spinal disc conditions, spinal fractures and spinal fusion surgeries. Improved patient outcome generates his philosophy
that these approaches have become the standard of care in our community.
Following his training at the University of Florida, he returned to his hometown, Daytona Beach in 1992 to join
the Orthopaedic Clinic of Daytona Beach, P.A. He performs surgery at Twin Lakes Medical Center, Halifax Medical
Center, and Florida Hospital Memorial Medical Center. He maintains a courtesy affiliate professorship with the
Department of Orthopaedics at the University of Florida since 1995.
c Clinic of Daytona Beach, P.A.
Dr. Malcolm D. Gottlich, M.D., F.A.B.O.S., F.A.A.O.S.
Dr. Gottlich is a fellowship trained Orthopaedic Surgeon with a specialty interest in adult reconstruction. Although
being born in Brooklyn, New York he has grown up in the Daytona Beach area graduating from Spruce Creek High School.
He completed his undergraduate education at Duke University and went on to complete Medical School, Orthopaedic
Residency and Orthopaedic Fellowship at the University of Florida in Gainesville.
Dr. Gottlich has completed a fellowship in adult reconstruction at the University of Florida emphasizing not only total
knee and total hip arthroplasty, but revisions of the above procedures. He is also interested in sports medicine with
arthroscopic procedures as well as care of multi-trauma patients and routine orthopaedic fractures.
Dr. Gottlich joined the Orthopaedic Clinic of Daytona Beach on August 1, 1994 and provides care in and around Volusia
County including Daytona Beach, Ormond Beach, Port Orange and Palm Coast.
Dr. James M. Bryan, M.D., F.A.B.O.S., F.A.A.O.S.
Dr. James Bryan is a fellowship trained orthopaedic surgeon with subspecialty interests in shoulder and sports medicine
surgery. Dr. Bryan has been recognized by the American Board of Orthopaedic Surgery for subspecialty certification in
Orthopaedic Sports Medicine. He provides care for a wide variety of bone, joint, ligament and tendon disorders. He performs
both simple and complex arthroscopic procedures of the knee, shoulder, elbow, ankle and hip joints including anterior
cruciate ligament reconstruction, partial menisectomy, chondroplasty, arthroscopic rotator cuff repair, arthroscopic bankart
repair and multiple other mini-invasive procedures. He also brings a sports medicine perspective to reconstructive procedures
like total knee, hip and shoulder replacements. By using a less invasive technique the patient, hopefully, will experience less
discomfort and a quicker recovery. Dr. Bryan obtained his undergraduate education at Wake Forest University in WinstonSalem N.C. He completed both medical school and orthopaedic residency at the prestigious Rush University in Chicago, IL. Dr.
Bryan completed an Orthopaedic Sports Medicine Fellowship at the University of Florida, Shands Hospital, Gainesville, FL.
Dr. Brian R. Hatten, M.D., F.A.B.O.S., F.A.A.O.S.
Dr. Brian Hatten is a board certified orthopaedic surgeon with special interests in total joint replacements, arthroscopic
management of athletic injuries and complex fracture management. Dr. Hatten was born and raised in Long Island, New
York. He pursued his academic schooling at Cornell University followed by medical school at New York University. He
achieved distinction as a member of the Alpha Omega Alpha Medical Honor Society and graduated among the top of his
class. He further pursued surgical training at the University of Miami.
Dr. Hatten joined the Orthopaedic Clinic of Daytona Beach in 2004 and practices general orthopaedics including surgical
and nonsurgical management. He provides advanced surgical management for a wide variety of bone, joint, ligament and
tendon disorders. He employs minimally invasive surgical techniques to improve patient outcomes.
Dr. Hatten is involved in a variety of local community medical activities and currently serves as the Chief of Orthopaedic
Surgery at Halifax Medical Center and is on the Executive Committee of the Volusia County Medical Society.
Dr. Jeffrey W. Martin, M.D., F.A.B.O.S., F.A.A.O.S.
Dr. Jeffrey Martin is a board certified orthopaedic surgeon who in addition is fellowship trained in sports medicine.
He performs arthroscopic and reconstructive surgery of the hip, knee, shoulder, elbow and ankle. His interests include
arthroscopic ACL and PCL reconstruction (anterior and posterior cruciate ligament), meniscal repair and cartilage
resurfacing techniques. Dr. Martin has also dedicated and focused his practice on arthroscopic and minimally invasive
treatment of rotator cuff tears, impingement syndrome and shoulder instability. Dr. Martin also provides orthopaedic
care for arthritis, fractures, joint replacements and various musculoskeletal conditions. He emphasizes supervised physical
therapy and rehabilitation for optimal outcomes in his patients. Dr. Martin participated in the 2005 NFL combine selection,
on behalf of the San Francisco 49ers as well as participating as team physician for the San Francisco 49ers and Stanford
Athletic Department.
Dr. Martin joined the Orthopaedic Clinic of Daytona Beach, P.A. in August of 2005. He provides care to patients in and
around Volusia County including Daytona Beach, Ormond Beach, Port Orange and Palm Coast and performs surgery at
Twin Lakes Medical Center, Halifax Medical Center and Florida Hospital Memorial Medical Center.
Dr. Todd A. McCall, M.D., F.A.B.O.S.
Dr. Todd McCall is a board certified orthopaedic surgeon with special interests and training in orthopaedic trauma,
complex fracture management, non-unions, and total hip replacement.
Dr. McCall was born and raised in southern Illinois. He obtained his undergraduate degree at the University of Illinois
and graduated with highest university honors. He then completed medical school at Southern Illinois University. After
medical school, he completed his surgical internship and orthopaedic residency at the University of Florida, and remains
an avid Florida Gator fan. After completion of his residency, he completed his sub-specialty orthopaedic trauma fellowship
at OrthoIndy in Indianapolis IN. His fellowship focused on complex fracture and trauma care including peri-articular, pelvic,
and acetabular fractures at Methodist Hospital, one of the busiest Level 1 Trauma centers in the United States.
Dr. McCall joined the Orthopaedic Clinic of Daytona Beach in 2007 and is the only surgeon specializing in
Orthopaedic Trauma in Volusia County. He currently practices out of the office at Mason Avenue and performs surgeries
at Halifax Medical Center, Florida Hospital Memorial and Twin Lakes Surgery Center. He focuses his practice on fracture
care, traumatic injuries, and hip reconstruction.
Physical Therapy
e offer Physical Therapy Services at our Mason Avenue, Twin Lakes
Medical Center, and Palm Coast offices.
State of the art facilities and licensed staff promote full
orthopaedic rehabilitation care. Our staff works hand in hand
with your doctor to develop a personalized rehab program for our
patient’s specific needs.
Paul Gulliksen, RPT is a graduate of Marquette University and has owned and
operated outpatient orthopaedic clinics for over 31 years. A member of the
American Physical Therapy Association, he has been with the Orthopaedic Clinic
of Daytona Beach since 1993 and is the Director of Physical Therapy.
Keith Stose, MPT is a graduate of the University of St. Augustine for Health
Sciences. He is a member of the American Physical Therapy Association,
Orthopaedic Section. He has been with the Orthopaedic Clinic since 1996.
Suzanne Danch, MPT, Port Orange Office
Suzanne Danch, MPT received her undergraduate degree from Bowling Green
State University in Bowling Green, Ohio. She earned her masters degree in
Physical Therapy from The Medical College of Ohio at Toledo in 2005. She has
been with the Orthopaedic Clinic since 2008 and is a member of the American
Physical Therapy Association.
Richard Keys RPT is a graduate of the University of Ulster at Jordanstown on the
north coast of Ireland. He graduated with a BSc (hons) in Physiotherapy in 1993.
Richard immigrated to the United States in 1997 and has since worked solely in
an orthopaedic setting.
Justin Gordon, DPT received his undergraduate degree at Oakwood University
in Alabama and then went on to obtain his Doctorate Degree in Physical
Therapy from Shenandoah University in Virginia in August, 2009. He has been
with The Orthopaedic Clinic since October, 2009. He is also a member of the
American Physical Therapy Association.
Paul Gulliksen, RPT, Director of Physical Therapy
Keith Stose, MPT, Twin Lakes Office
Richard Keys RPT, Palm Coast Office
Justin Gordon, DPT
The Five Rules of FITNESS
by Jeff W. Martin, M.D.
ll things complex have simple beginnings.
The decision to improve the condition of your
body seems simple enough at first, but the
complexities have derailed many a determined
soul. Before you suffer information overload,
build a foundation. In fitness, you will find that
all improvements come from certain basics.
These are the five ground rules that anyone serious
about personal health should employ in order to
continually improve himself or herself.
RULE ONE is that you need a goal. Deciding to “get in
shape” is like deciding to “buy low and sell high” on the
stock market; you need to be a bit more specific. The
good news is that fitness goals are easy to quantify.
For example, losing 3 percent body fat and gaining 15
pounds of strength on the leg press machine in a month
is a legitimate goal; it’s realistic and measurable.
RULE TWO is that you must pursue your goal with
intensity; you must train hard. If you don’t push your
body past its everyday level of exertion, you won’t
improve beyond your current condition. If 15 years of
little or no exertion hasn’t gotten you the body you
want, what makes you think that going to the gym and
not exerting yourself will? Remember, the process of
muscle conditioning starts with the muscle being broken
down. A muscle, if allowed to heal properly, will make
itself stronger than it was before. It is true that you will
experience some degree of soreness. Relish the ache as a
reminder of a workout well done.
RULE THREE is that you employ a variety of techniques
in your training. If you want a day away from the
weights, try rock climbing. If it’s the treadmill you
despise, then try running stadium stairs. As long as you
change your workout on a regular basis, your muscles
www.orthodb.com � 15
meal. A moderate
portion of protein and
carbohydrates each
would be roughly
the size of your fist. A
moderate fat portion
might be one-fifth
of that. A sample
meal might be the
following: scrambled
egg beaters (protein),
cheese (fat), and
strawberries
(carbohydrates).
will always be confused, and a confused
muscle is forced to adapt and become
better conditioned.
RULE FOUR is that you must eat specific
foods in specific portions to elicit the
desired response from your body.
When used properly, food can have an
enormously positive effect upon your
body. The portions of macronutrients
(protein, carbohydrate, fat) you need
from different foods is complex, to say
the least. Many nutritionists have been
recommending low-carbohydrate diets
for years. If counting carbohydrates,
fat, and protein is not realistic for you,
then simply try to take in a moderate
portion of each macronutrient at every
Once you gain an
understanding of
which foods have
which macronutrients
in them, you can further improve your
diet by committing yourself to eating
several small- to medium-sized meals
each day instead of the standard two
or three. This steady flow of food cranks
up your body’s fuel furnace. The result
is higher, more stable energy levels.
On the other hand, if you fast for long
periods between large meals, you are
sabotaging your healthy eating habits.
A large meal requires a large quantity of
blood to be diverted to your stomach to
aid in digestion, leaving you listless and
out of energy. To make matters worse,
you have taken in considerably more
calories than your body can use
at that point. (Think about trying to
force twenty gallons of gas into a car
with a ten gallon tank.) Those excess
calories have to go somewhere, so
they often are stored as fat. At some
point during your bloated fast, your
body will begin to worry that food
had become scarce, and will engage
its self-preservation mechanism. Your
metabolism will slow so that you burn
fewer calories, making it easier to store
the extra calories as, you guessed it, fat.
You also may have guessed that a slow
metabolism burns fewer calories and
supplies less energy, thereby rendering
you tired, weak and overweight.
You can further fine tune your diet by
eliminating as much of your sugar intake
as possible. Sugar causes a release on
insulin, the storage hormone. Excessive
insulin causes calories to be stored as fat
regardless of whether they were protein,
carbohydrate, or fat calories originally.
As if nutrition weren’t complex enough,
now you find out that even if you don’t
take in any dietary fat, you still can
gain body fat. Fried foods also should
be on the hit list. Most fried foods are
dangerously high in saturated (bad) fat.
“Good” (unsaturated) fat is found in such
things as nuts, fish and avocados.
RULE FIVE, the final rule, is that you
must be consistent in your training,
nutrition, and positive mental approach
to fitness and life. As cliché as it may
sound, it remains true that where the
mind goes, the body will follow.
Southeast
Medical
Products, Inc
“Specializing in Orthopedics”
P.O. Box 57613
Jacksonville, FL 32241
(904) 571-3974
Fax (904) 739-5649
e-mail: [email protected]
16 � www.orthodb.com
�
�
�
�
�
�
Casting
Splinting
Fracture bracing
Orthopedic softgoods
DME
And much more
800.330.0890
www.southeastmedical.com
lthough every amputee we see and every surgery
is different there is one thing that each patient
we see at American Ortho-Tech demands from
their prosthesis. Comfort. No matter what kind
of knee, foot, or cosmetics that we use when
we fabricate a prosthesis for someone, if the
socket is not comfortable the prosthesis will be
unacceptable. The socket is also the one portion of the
limb that is common to all amputees. The socket is the
custom made portion of the socket that provides the
interface between the patient and all of the components
of the prosthesis.
One of the best ways we have found to provide
maximum comfort and increase the health of patient’s
residual limbs is by using vacuum technology to create
an elevated negative pressure environment within the
socket. Using this technology allows us to increase
socket comfort by reducing movement within the
prosthesis and therefore reducing the sheer forces in
the socket that cause soreness, abrasions and blisters.
Our ability to reduce movement in the socket
leads to increased proprioception and allows
patient’s to feel what is happening at their foot
and walk more safely and confidently. The
elevated negative pressure increases oxygen
to the tissues in the residual limb and improves
blood flow. It is this increased blood flow that
helps maintain the volume of the residual limb
throughout the day and increases comfort and
a person’s activity level.
When making a socket using negative pressure
patient’s have a cast made of their residual limb
under vacuum in order to have a custom liner
made for them. Do to the precise fit of this type
of socket and the individuality of each person this will be
done to obtain the best results. After the custom liner is
made we take a second cast, but this time over the liner
for the fabrication of the socket. Initially a clear socket
or check socket will be made so the prosthetist can see
the residual limb and evaluate the fit. After the correct
fit is achieved the foot and other components will be
attached and the patient will begin their walking trails.
After both the patient and the prosthetist are satisfied
with the fit and function of the prosthesis a definitive
limb will be made. All prosthetics in our practice are
made using high strength carbon fibers, fiberglass braids
and laminated using epoxy acrylic resins to provide a
light weight yet extremely
strong product. Many
of our patients wish to
personalize their sockets
and can do so with various
fabrics that we incorporate into the socket.
American Ortho-Tech has
two locations in Volusia
County at 1320 Mason Ave
in Daytona Beach and 938
Saxon Blvd. #103 in Orange City. Please call either one
of our offices at (386)258-0401 or (386)775-1266 for a
free evaluation.
www.orthodb.com � 17
Knee Injuries
by Paul Gilliksen, RPT
nee injuries account for
more than 1.2 million visits
to doctor’s offices every year
and an estimated 200,000
to 250,000 of those injuries
involve the anterior
cruciate ligament or ACL.
There is a misconception that these
injuries are specific to only athletes
but can involve the athlete and
non-athlete alike and are usually
non-contact in nature.
Activities which involve jumping,
cutting and pivoting can promote
excessive stresses to the knee and
possible injury to the ACL. Some
sport activities such as basketball,
football (flag & tackle), soccer,
volleyball, tennis and skiing have
higher incidents of ACL injuries due
to the extreme forces placed on the
knee joint.
What are ligaments?
Ligaments are structures which
connect bone to bone and act
like stronger rubber bands which
have a slight “give” to them but
will usually return to their normal
length once pressure is taken off
of them. With stronger and more
forceful stresses, enough force can
be placed on these structures to
stretch, partially or even completely tear these structures.
What is the ACL?
The ACL crosses in the center
of the knee with the posterior
cruciate ligament (PCL). The ACL
inhibits forward movement of the
lower leg (tibia) in relation to the
upper thigh bone (femur) and also
limits rotation of the knee. Most
ligament injuries of the knee will
involve the ACL.
18 � www.orthodb.com
Injuries to the ACL may also involve
trauma to other structures of the knee
such as the meniscus (shock absorbers
between the tibia and femur), medical
collateral ligament (ligament on inside
portion of the knee to stabilize inside
movement of the joint) or even damage
to the joint surface (osteochondral
defects). Injuries of this magnitude
almost always require surgery.
Recent studies indicate that female
athletes are 2 to 4 times more likely to
sustain an injury to the ACL than male
athletes and that females will account
for 2/3 of all ACL injuries.
There are varying opinions on why
the incidence of this injury is higher in
females than in males. Some theories
suggest that the female ACL is smaller
than the male ACL. It is also suggested
that the high estrogen levels in females
can promote weakening of the ACL.
Most recent studies have indicated that
the structure of the knee where the ACL
attaches to the tibia (lower leg bone)
and femur (upper thigh bone) is usually smaller in females than in males
and that the excessive contraction of
the quadriceps muscles (muscles which
straighten the knee) during jumping
and cutting activities place excessive
stress on the ligament and promote
trauma. Programs have been developed
to train female athletes to improve on
their jumping and running techniques
and to increase recruitment of other
muscle groups so as to counteract the
excessive contraction of the quadriceps
muscles. There is evidence that these
types of programs are affective in reducing ACL injuries.
If surgery is indicated, the surgeon will
discuss options with the patient regarding the type of procedures available
to the patient. If the ACL is completely
torn, the body is unable to heal or repair
this structure. The best clinical option is
to have the torn ligament removed and
surgically reconstructed.
There are many techniques used to
reconstruct the ACL. Some involve
taking tissue from the patient which is
called an autograft procedure. Some
areas of the body where the graft can
come from are the patellar tendon of the
knee or advancing one of the hamstring
tendons. Another technique is to take
tissue from a tissue bank (usually the
Achilles or posterior tibialis tendon)
which is called an allograft procedure.
The surgeon can then take the tissue and
prepare the graft to the length and size
they desire. The patient and surgeon will
discuss what type of technique will be
most suitable for their reconstruction.
In our office, physical therapy is usually
initiated 2-3 days following surgery.
Rehabilitation protocols are very specific
and the main goal is to protect and not
stress the graft. We usually see our patients in the office 3 days per week and
the patient is provided exercises which
are to be performed daily at home. The
patient is progressed from their crutches
and protective brace working towards
increasing range of motion and strength
while maintaining orthopedic specific
precautions and strict therapy protocols.
One of the biggest hurdles for the
patient is to “trust” the surgical knee.
Patients are sometimes hesitant to
bear or shift weight onto the surgical
knee. The physical therapist is not only
responsible for the patient regaining
their motion and strength but also the
confidence that their knee is “healthy”.
Length of supervised therapy can be
anywhere from 2 to 4 months but
the patient is advised and instructed
in exercise activities that need to be
continued on a regular and consistent
basis after supervised therapy is
completed. Patients are slowly returned
to running, jumping and cutting
activities and are usually cleared to
return to sport specific activities in 9-12
months after surgery. Sometimes their
surgeon will order a special brace for
the patient to wear while participating
in sports.
In any case, serious knee injuries are
becoming more common, particularly
involving the anterior cruciate ligament.
These injuries require proper evaluation
and treatment and many times surgery.
Specialized therapy protocols are
essential in returning the patient to prior
activities and function.
www.orthodb.com � 19
Hip Fractures
In The Elderly
by Todd A. McCall, M.D.
ach year, more than
300,000 people in the U.S.
are hospitalized with hip
fractures. The vast majority of
hip fractures (90%) occur in
persons over age 65. Women
are two to three times more
likely than men to sustain a hip
fracture. Of women who reach 90
years of age, nearly 50% will have
suffered a hip fracture at some
point in their life. Others at high-risk
for hip fracture include smokers,
heavy drinkers, those with low
calcium intake, unsteady balance,
and poor eyesight. Because of the
aging population, it is expected
that by the year 2050 the yearly
number of hip fractures will rise to
more than 650,000.
help after a fall. Hours may elapse
before an injured elderly person
is found which can result in other
serious medical problems.
According to the American Academy
of Orthopaedic Surgeons, the
diagnosis of hip fracture accounts
for more hospital stays than any
other musculoskeletal injury. Nearly
44 percent of hospital days due to
fractures are due to hip fractures.
The Hip—an Owner’s Guide
Most hip fractures occur as the result
of a fall. It has well been observed
that among the elderly a hip fracture
is more than a broken bone; it is a
potentially life-threatening event.
This can be especially true if the
person lives alone and cannot get
The hip is a true ball-and-socket
joint. It is made up of a deep cup
called the acetabulum (socket) that
surrounds the femoral head (ball).
The femoral neck attaches the
femoral head to the rest of the femur
(thigh bone). Articular cartilage
covers the surface of the femoral
head and the inside of the hip
socket. The cartilage reduces friction
and allows the joint surfaces to
slide against one another. Arthritis
results as a thinning or “wearing out”
of the cartilage.
Partial Hip Replacement
Surgical Repair of a Femoral Neck Fracture
20 � www.orthodb.com
Sometimes weakened bone—
perhaps the result of a condition
such as osteoporosis—can lead to a
fracture when too much stress is put
across the neck of the femur. Those
who have a family history of fracture
in later life are more susceptible to
develop the same problem.
Symptoms and Diagnosis
A hip fracture usually lands the
patient in a hospital emergency
room. There, the attending
physician will examine the patient
and obtain the patient’s medical
history. It is important to know the
patient’s overall condition, as
this will enable the doctor
to determine which mode of
treatment to recommend.
X-rays are usually taken to confirm
the presence of a fracture. However,
if the X-ray does not indicate that a
break in the bone has occurred and
the patient still feels pain, an MRI or
CT scan may detect a fracture that
was missed by the X-ray.
Surgical Repair of a Intertrochanteric
Femur Fracture
When it comes to hip fractures, an early and accurate
diagnosis is essential. Non-displaced fractures may become
displaced by walking on a fractured hip. A non-displaced
fracture is easier to treat and has fewer complications than a
displaced fracture.
Treatment
There are several different types of hip fractures based on
the anatomic location of the fracture. The most common hip
fractures are femoral neck fractures and intertrochanteric
fractures. Treatment of hip fractures is based on the location
of the fracture as well as the amount of displacement of the
fracture. They can be treated with the use of screws, a metal
plate or rod with screws, or by replacing the broken femoral
head with an artificial implant (called a hemiarthroplasty).
Occasionally a total hip replacement (replacing the ball and
the socket) is preferred if the patient has significant arthritis.
Before proceeding with treatment, an orthopaedic surgeon
will determine if the fracture is displaced or non-displaced,
and if it is stable or unstable. A non-displaced and stable
fracture can sometimes be treated without surgery. However,
most non-displaced and minimally displaced hip fractures
are treated with screws to hold the two parts of bone
together while the fracture heals. The problem with nonsurgical treatment is that there is a significant risk of the
fracture displacing. Non-operative treatment is also associated
with more activity restrictions and less mobility. Experience
has shown that this lack of mobility can be dangerous,
especially for the elderly. Prolonged confinement can lead to
serious complications, including blood clots, pressure ulcers
(bedsores), and mental confusion. Considering the physical
and psychological effects of being incapacitated, it is easy to
see why doctors recommend that patients get up and moving
as soon as possible after surgery. The goal of any surgical
procedure for hip fractures is to allow the patient to get out of
bed as soon as possible.
Hemi-arthroplasty (replacing the ball) is preferred when
fracture is displaced. When the fracture is displaced, there is
a higher likelihood that the blood supply to the ball has been
damaged, which can cause avascular necrosis. Avascular
necrosis is when an area of bone has no blood supply and the
bone tissue dies. This can cause significant pain and arthritis
and lead to need for further surgery (hip replacement).
Recovery
The prognosis for recovery is good when the fracture is treated promptly. Most hip fracture patients who previously lived
independently will require some assistance from their family
or home nursing care. The American Academy of Orthopaedic
Surgeons (AAOS) reports these sobering statistics:
�� only 25% of hip fracture patients will make a full return to
pre-injury activity level
�� 40% will require nursing home care
�� 50% will need a cane or walker;
�� 24% of those over age 50 will die within 12 months
With hip fractures, the surgeon and the patient is therefore
faced with a greater obstacle than mending a broken bone.
The real challenge is dealing with the complications that can
set in after surgery.
The situation is made even more critical by the fact that
elderly patients are more likely to suffer from mental
confusion following hip surgery. Being in a strange
environment, losing a degree of independence, taking
medication, and becoming immobile can spiral the elderly
patient into symptoms of dementia. For this reason, it is crucial
for the patient to receive regular visits of family and friends.
Prevention
Considering the critical effects that a hip fracture can have
on the elderly, education in accident prevention cannot be
overstressed. An inspection of the home can uncover a few
dangers that previously may have been unnoticed. For example: Are there slippery tiles or loose throw rugs in the home?
Is the lighting sufficient? Are any of the rooms cluttered, perhaps including small objects that are left lying on the floor?
Besides looking around the home, it’s good for the elderly to
regularly have their vision checked. Medications should be
evaluated for possible side effects, such as dizziness. Regular
exercise will help improve balance and promote overall
health. Bone density testing should be done to detect bone
loss (osteoporosis or osteopenia) in patients with risk factors.
Treatment of osteoporosis has been shown to decrease the
risk of fractures. Preventive measures can go a long way in
keeping the elderly in their place (at home) and where they
belong (on their feet).
www.orthodb.com � 21
Shoulder
Pain
by James M. Bryan, M.D.
houlder
pain can
occur in anyone
at any age from a variety of
different causes. The Shoulder
is composed of three bones:
the collar bone (clavicle), the shoulder blade
(scapula) and the upper arm bone (humerus). The
bones are supported by ligaments, tendons and
muscles which allows movement at the joints where
the bones meet. Shoulder motion occurs at three
different locations: at the ball and socket joint
(glenohumeral joint), between the collar bone and
the shoulder blade (acromioclavicular joint) and
between the shoulder blade and the back of the
chest wall (scapulothoracic motion). Pain can occur
at any of these locations.
Reasons for pain
Shoulder pain can arise from many different
reasons. Most of the causes fall into three major
categories:
�� Acute Injury/Instability
�� Chronic Inflammation/Degeneration
�� Arthritis
Often times the reason for the pain is a
combination of more than one category.
Discovering the cause of the pain
The first step in determining the cause of pain is
obtaining a detailed medical history including
the history of the shoulder symptoms. The
next step is a thorough physical examination
including observation, palpation, measuring
range of motion, ligamentous testing, and
strength testing and special provocative tests.
Usually x –rays are obtained to understand the
22 � www.orthodb.com
bony anatomy. Sometime
special imaging studies
like CAT scans or MRI scans
are required to more fully
understand the anatomy.
The diagnosis is determined
by combining the history,
physical examination and
the imaging studies.
Treatment by diagnosis
Acute Injuries
The treatment for acute
Torn Labrum
injuries like deep bruises
(contusions), fractures and
dislocation of the shoulder
usually progresses from a
period of immobilization
through a progressive
motion based supervised
therapy program. Antiinflammatory medications
are often used to help
control the pain. Sometimes
surgery is required for more
unstable fractures and
ligamentous injuries.
Chronic Inflammation
and Rotator Cuff Tears
Labrum Following Repair
Torn Rotator Cuff
The treatment for chronic bursitis
and rotator cuff tears is based on the
severity of the symptoms. Usually
simple stretching exercises and
therapeutic exercise will significantly
improve an individual’s symptoms.
Oftentimes anti-inflammatory
medications and corticosteroid
injections are required. Ultimately if
conservative management fails, then
arthroscopic or open shoulder surgery
may be required.
After Repair
generally involves activity modification
(avoiding overhead activities and
heavy lifting). However, movement
with the arm at the side is helpful to
the shoulder and decreases shoulder
pain. The best example is swinging the
arms while walking. For patients with
balance disorders, swing the arms at
the side in the sitting position is a good
alternative. Some patients require long
term anti-inflammatory medications to
help control the pain. Some patients
are provided pain relief with intra-
articular corticosteroid injections.
These injections can be repeated every
three to four months if needed for
pain control. Ultimately, total shoulder
arthroplasty (shoulder replacement)
or reverse shoulder arthroplasty may
be required to alleviate the painful
symptoms. The decision for surgery
should be based on how symptoms
affect the patient’s quality of life. With
realistic goals in mind, the patient and
surgeon both provide input regarding
the decision for surgery.
Shoulder X-Ray Before Surgery
Shoulder X-Ray After Surgery
Frozen Shoulder
The treatment for frozen shoulder
(adhesive capsulitis) is based on slowly
progressive improvement in range of
motion. This condition is probably the
most frustrating shoulder diagnosis and
treatment must be tempered with a
significant amount of patience.
Arthritis
Many types of arthritic conditions exist:
osteoarthritis, rheumatoid arthritis,
post-traumatic arthritis, rotator cuff
arthritis and others. The treatment
www.orthodb.com � 23