+ Shoulder Arthroscopy

Shoulder arthroscopy is a form of minimally invasive surgery that uses two small incisions in the shoulder to pass a miniaturized camera into the joint. A surgeon can use this technique to diagnose the cause of shoulder pain, and can also perform corrective procedures at the same time using minimally invasive instruments. Arthroscopic surgery is the basis of most shoulder procedures involving the cartilage, labrum, shoulder impingement, or rotator cuff injury.

After The Surgery : Shoulder arthroscopy is a standard procedure with a low complication rate. Shoulder arthroscopies are typically classified as outpatient procedures, and patients return to their home the same day. Recovery depends on the type of repair that was done, but may involve pain medications, physical therapy, or a sling.

+ Total Shoulder Arthroplasty and Reverse Total Shoulder Arthroplasty

The shoulder is the most flexible joint in the body and consists of one major joint called the glenohumeral joint where the humeral head means the socket of the scapula, called the glenoid. In some people, over time, the cartilage between these two bones can wear down, causing osteoarthritis. This can cause pain, decrease range of motion, and can limit function. This is typically treated with conservative measures, but over time if someone’s activities of daily living continue to be limited then a shoulder arthroplasty, or total shoulder replacement, may be recommended.

A total shoulder arthroplasty is done under general anesthesia. This procedure begins with an incision and a gentle separation of the muscles and bones of the shoulder joint. The damaged humeral head is cut, hollowed out and then filled with cement. A new metal ball with a stem is placed in the bone. On the other side of the joint, near the glenoid, an artificial component is also implanted. Finally, the capsule of the shoulder, muscle and skin are carefully closed with stitches.

Reverse total shoulder arthroplasties are similar to total shoulder arthroplasties but are used in patients with both osteoarthritis of the shoulder and a rotator cuff tear. Instead of placing the metal ball in the humeral head and the cup in the glenoid as in a total shoulder, the metal ball and cup are switched. This allows patients with rotator cuff tears to use their deltoid muscle instead of the rotator cuff to continue to have full ROM of shoulder.

After this procedure, the patient is typically kept in the hospital for 24 hours and began on pain medications and antibiotics to prevent infection. Afterwards, they are placed in a sling, and are able to gently begin returning to activities with the aid of an expert physical therapist. Therapy typically takes about 3-6 months after surgery.

+ Rotator Cuff Repair

The rotator cuff consists of four tendons called the supraspinatus, infraspinatus subscapularis, and teres minor that help stabilize the shoulder and aid in strength and overall range of motion of the shoulder. A rotator cuff injury includes partial or complete tearing of the tendons of the rotator cuff. An acute injury generally causes rotator cuff tears, but, in some cases, more chronic tears can be associated with age-related degenerative changes, overuse, and daily wear and tear over time. Injuries to the rotator cuff can cause pain and weakness of the shoulder and can occasionally require surgery. Advanced minimally invasive arthroscopic techniques have been created for rotator cuff repair. They involve visualizing the shoulder arthroscopically then using sutures to anchor the tendon to the bone. Afterwards, patients are typically gently aided in returning to strengthening and ROM exercises with the help of an expert physical therapist.

+ Labral Repair/Capsulorraphy

The labrum is the cup shaped rim of cartilage that sits on the glenoid and reinforces the bones of the shoulder. The labrum can get torn in acute injuries or over time due to repetitive use or wear and tear of the shoulder. Depending on the tear, the biceps tendon can also be affected. This is called a SLAP tear. Depending on extent of the tear and on symptoms, a labral tear is typically treated conservatively beginning with rest, physical therapy, anti-inflammatories, and possibly a corticosteroid injection. If symptoms do not improve then a labral repair or capsulorraphy may be recommended.

A labral repair is a minimally invasive arthroscopic surgery where the portion of the labrum that is torn is removed or repaired. In cases of a SLAP tear, where the biceps tendon is affected, absorbable sutures are used to also repair the biceps tendon. After the surgery patients may be placed in a sling, then will gradually return to range of motion and strengthening exercises.

+ AC Joint Reconstruction

+ Knee Arthroscopy

Knee arthroscopy is a form of minimally invasive surgery that uses a small incision in the knee to pass a miniaturized camera into the joint. A surgeon can use this technique to diagnose the cause of knee pain, and can also perform corrective procedures at the same time using minimally invasive instruments. Arthroscopic surgery is the basis of most knee procedures involving the cartilage, meniscus, or cruciate ligaments.

Once a diagnosis is made, the surgeon can treat and repair the problem in the knee using various instruments through the arthroscopic ports. Repairs can include cartilage repair, meniscal repair or removal, removal of baker's cyst, removal of loose fragment of bone, removal of medial plica, and aiding in reconstruction or repair of a torn cruciate ligament.

After the surgery: Knee arthroscopy is a standard procedure with a low complication rate. Knee arthroscopies are typically classified as outpatient procedures, and patients return to their home the same day. Recovery depends on the type of repair that was done, but may involve pain medications, physical therapy, or a brace.

+ Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament (ACL) is one of key stabilizers within the knee and can get injured in pivoting injuries involving skiing, soccer, basketball or other sports. Depending on the patient's age and activity level the surgeon may recommend surgical fixation. Many full ACL tears in young active people are treated with arthroscopic surgical repair and graft placement.

ACL reconstructions are outpatient procedures that involve a minimally invasive knee arthroscopy followed by a graft placement. Grafts include cadaver tendon, patellar tendon or hamstring tendon. Graft choice is a careful individual decision that is made together by the surgeon and patient.

After the surgery: There is a recovery process that includes careful guidance by an expert physical therapist. Over time these patients return to a healthy, full, active lifestyle.

+ Meniscus Repair and Meniscal Debridement

The meniscus is a piece of cartilage in your knee that stabilizes the joint and helps cushion it from impact and twisting motions. The meniscus is one of the most commonly affected tissues in the knee and is susceptible to tearing if the knee joint gets twisted during physical activities. A torn meniscus can cause chronic pain and may need surgical fixation if symptoms continue despite conservative measures.

Using a minimally invasive arthroscopic procedure the surgeon can visualize the meniscus and further define the type, location, and extent of the tear. As the meniscus helps protect the knee from arthritis, the goal of the surgeon is to always repair the meniscus when possible. If the meniscus is repairable, a small suture will be placed. Depending on the type of tear and if repair is not possible, a portion of the meniscus that is torn and causing symptoms may be removed, called a meniscectomy.

After the surgery: Most patients are discharged the same day after this procedure. If meniscal repair was possible then the patient is placed in a knee brace for 6 weeks and will begin a gradual return to activity. After a meniscectomy patient will work with an expert physical therapist to gradually return to activity without a knee brace.

+ Cartilage Repair

Cartilage in your knee absorbs shock and allows for smooth movement. Common cartilage injuries include damage to the articular cartilage, which covers the ends of your leg bones, or a tear in the wedge-shaped cartilage between your leg bones called the meniscus.

Depending on the type of tear, debridement or replacement may be recommended. Common procedures involve the Matrix-associated autologous chondrocyte implantation (MACI) or others. Dr. Ephraim Dickinson and the team at Urgently Ortho are here to discuss the best option on an individual basis.

+ Multiligament Knee Reconstructions

The knee contains four main ligaments that work together to provide stability. There are two cruciate ligaments inside the knee joint and two collateral ligaments on the sides. Depending on the injury, more than one of these ligaments can get torn at once and can lead to overall instability within the knee.

Depending on the injury, a surgeon may recommend a trial of 6 weeks of conservative management to let one of the ligaments heal before proceeding with surgery, or they may recommend a surgical procedure that reconstructs all torn ligaments at once. Multiligament knee reconstructions are standard knee procedures that can be performed with minimal incision and low complication rates.

+ Distal Biceps Repair

The biceps is a powerful muscle in the anterior portion of the arm that allows flexion and rotation of the forearm. It is useful in lifting objects and during activities of daily living. Repetitive lifting can cause tendinitis of the biceps that can be treated conservatively. More acutely, the biceps tendon can partially or fully tear, causing a popping sound, deformity and pain. An MRI is typically ordered to confirm diagnosis of a biceps tendon tear. Depending on age and activity level this can be treated conservatively or surgically.

A surgical distal biceps repair typically involves making a small incision in the forearm, grabbing the retracted and torn tendon, and anchoring it down to the bone with stitches. Afterwards, the patient is placed in an elbow ROM brace and is able to gradually return to activity over the course of 3 months with the help of physical therapy.

+ Lateral Epicondyle Debridement/ Repair

+ Ulnar Nerve Transposition

+ Carpal Tunnel Release

Carpal tunnel syndrome is a repetitive use injury that can occur when the median nerve gets compressed in the carpal tunnel. This can cause pain and numbness in multiple fingers in the hand. The team at Urgently Ortho will typically recommend bracing, activity modification, anti inflammatories and a corticosteroid injection. Many patients improve with these conservative measures; however, for those that have continued symptoms, a routine surgical procedure can be performed.

The surgery involves making a small incision in the wrist then releasing the carpal tunnel. This will stop compression of the median nerve and ideally prevent patients from feeling the continued numbness and pain in their fingers. This is a quick outpatient procedure that has patients back to their home within a few hours.

This is a routine surgery with a low complication rate. After surgery, patients are typically wrapped in a bandage for about a week then are gradually able return to their everyday activities.

+ Trigger Finger Release

Trigger finger is a common condition that is caused by inflammation building up around the sheath of the tendon in the palm of the hand, called the A1 pulley. This can cause a locking sensation when a patient attempts to straighten their finger. This can be a frustrating condition that can affect daily activities. This condition is often treated conservatively with night splints, anti-inflammatories and corticosteroid injections.

If these conservative measures do not improve symptoms then a trigger finger release surgery is typically recommended. This surgery is a routine outpatient procedure that can be done under local or general anesthesia. A surgical release is done by making a small incision in the palm of the hand then cutting the inflammatory sheath in order to release the A1 pulley.

Patients typically have very good outcomes from this procedure and recover and return to all activities quite quickly.

+ Surgical Release of De Quervain's Tenosynovitis

De Quervain's tendinosis is a condition that causes pain at the level of the wrist on the thumb side due to inflammation of the tendons. The pain can travel from the thumb up the forearm and may make some activities more difficult, especially with bending the wrist or attempting to make a fist. This is a repetitive use injury that can occur to anyone but is especially prevalent in new moms.

If conservative measures fail, then a careful procedure called a surgical release can be done to release the tendons on the wrist near the thumb. It is a delicate procedure that involves making a small incision then releasing the soft tissue which allows the tendon to be freely mobile to decrease symptoms.

After surgery, patients are typically wrapped in a bandage for 1-2 weeks then gradually return to activities of daily living with the help of a physical therapist over the next 4-6 weeks.

+ Achilles Tendon Rupture

The Achilles tendon is a band of fibrous tissue that connects the calf muscle to the calcaneus and is paramount in flexion and extension of the ankle. The Achilles tendon can partially or fully tear in high impact and heavy loading sports injuries. Depending on the type of tear and activity level of the patient, these injuries can be treated with either conservative or surgical management.

If surgical management is chosen it is typically an outpatient procedure. This procedure involves making an incision in the back of the ankle then carefully suturing the ends of the tendon together.

Recovery for this procedure is a 3-6 month process involving non-weightbearing in a cast for around 6 weeks. This is followed by a gradual return to weightbearing in an elevated walking boot followed by extensive physical therapy. We recommend speaking to your orthopedic team to discuss if surgical repair versus nonsurgical protocol is better for you.

+ Ankle Fracture

The tibia and fibula are two of the bones that come together to comprise the ankle joint. At the ankle joint these bones are called the lateral and medial malleolus. They can easily get fractured in common inversion injuries. Depending on the type of fracture, these injuries can make the ankle joint unstable and can occasionally require surgical fixation to prevent instability of the ankle and help patients return to full activity.

Most of these procedures are open surgeries that require making an incision near the fracture and then placing a plate and screws over the fracture to promote healing.

Afterwards, patients are typically immobilized in a cast for 4-6 weeks then are gradually able to return to weightbearing and activities.