Hip, Knee & Shoulder Osteoarthritis
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For decades, physicians have given patients the wrong advice about their joints: blaming age (“your knees hurt because you are over 50”) and activity (“if your keep playing tennis, you will wear out your hip”) for causing arthritis. Repetitive overuse and injury can lead to osteoarthritis. But genetics and musculoskeletal biomechanics play a much stronger role — although we can’t change genetics (yet!), enhancing musculoskeletal biology & mechanics can markedly reduce pain, improve function and, we believe, delay or halt arthritis progression.
Using detailed information from a careful history and examination, we will develop a multimodal plan to reduce pain, enhance strength, flexibility, endurance and normalize movement patterns to improve your physical capacity and quality of life. This comprehensive approach often involves:
Medications (oral, topical)
Steroid Injections (guided by ultrasound or fluoroscopy)
Biological products to stimulate cartilage & soft tissue healing, including platelet rich plasma (PRP) and stem cell treatments
Hyaluronate injections (such as Synvisc, Euflexxa and others)
New nerve ablation procedures for shoulder, hip or knee pain (such as IOVERA)
Physical therapy and Customized Exercise
Manual Therapy, Dry Needling & Trigger Point Therapy
Orthotics
Dietary modifications
Supplements & Natural Therapies
If surgery is indicated, we will discuss your various options, establish a pre-surgical treatment plan to help facilitate your recovery, give you guidance on selecting a surgeon, and work with your surgeon to give you the best of postoperative care.
Hypermobility Disorders/ Ehlers Danlos Syndrome
Benign Hypermobility Joint Syndrome (BHJS) is a common source of pain. BHJS is a connective tissue disorder associated with overly flexible joints, leading to pain, inflammation and recurrent joint and soft tissue injuries. The connective tissue abnormality also extends to tissues elsewhere in the body, leading to: flat feet or high arches, scoliosis, gastrointestinal problems, headaches, nerve pain, osteoporosis, difficulty with concentration/ learning disabilities, fatigue, malfunctioning of the autonomic nervous system. This is a genetic disorder, with symptoms often starting in adolescence.
The Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders that share many characteristics of BHJS but with more systemic features. These are generally characterized by joint hypermobility, excessive skin extensibility, and tissue fragility. The gene mutations causing some versions of EDS can be identified with genetic testing. EDS is associated with numerous known, and some unknown, body system problems, which include (but are not limited to): trigger points, joint injuries, flat feet/high arches, headaches, occipital neuralgia, spinal instability, pelvic floor dysfunction, osteoporosis, autonomic dysfunction (including POTS), gastrointestinal problems, gluten and dairy intolerance, frequent infections, brain fog, learning disabilities, chronic fatigue, drug intolerances and allergies, arrhythmias, aneurysms, varicose veins. and more.
People with EDS / BJHS fare best with a knowledgeable physician “quarterback,” along with a team of EDS-familiar specialists, to help guide their ongoing musculoskeletal needs. The team of specialists include physical medicine & rehabilitation, physical therapy, occupational therapy, pain management, cardiology, neurology, orthopedics, gastroenterology, urology, physical therapy, genetics, orthotists, nursing, social work etc. This is a chronic disease that, fortunately, if well managed, should not interfere with the ability to have a long, happy and productive life.
Occipital Nerve Ablation For Headaches
Headaches are frustrating and debilitating. A frequently overlooked (or misdiagnosed) cause of headache is Occipital Neuralgia, which is characterized by a piercing, throbbing, or electric-shock-like pain that usually starts at the base of the skull then extends across the top of the skull into the eye or behind the ear. There are trigger points in the scalp, base of the skull and forehead and eyes especially sensitive to light. Pain is caused by irritation of the occipital nerves, which can be the result of trauma to the back of the head, whiplash, overly tight neck muscles, degenerative disks or arthritis of the spine, instability of the spinal segments. Traditionally, these headaches have been treated, with limited success, using invasive spinal nerve blocks, BOTOX injections, migraine or pain medications.
We developed a novel minimally invasive, office-based treatment for occipital neuralgia — occipital nerve cryo-neurolysis at the base of the skull using IOVERA technique. Using a small, FDA approved, hand held device, focused cold therapy is administered directly on the occipital nerves at their most superficial point (where they cross the base of the skull). The device delivers a small stream of nitrous oxide to the nerve while measuring tissue temperature; when the nerve reaches the target temperature, it shuts down and immediately stops sending painful impulses to the brain. The effect is temporary, causing no tissue damage. More than 75% of patients report pain relief for an average of 5 1/2 months (range 3 - 10 months). The procedure is very safe, performed with only local numbing of the tissues, and can be repeated frequently.
Optimizing Joint Replacement Outcome
Joint Reconstruction Surgeries (particularly hip, knee or shoulder replacement) are among the best elective surgeries available, in most cases dramatically reducing pain and restoring high levels of physical functioning. Happy patients describe their result as miraculous. Sadly, for a variety of reasons, not all patients have this experience; nearly 1 in 15 patients report unacceptable pain one year after surgery. Others describe prolonged and unnecessarily painful recoveries, unstable, chronically inflamed or stiff joints that limit even basic daily activities. In many of these cases, the surgery went well and there is no discernible problem with the implant - frustrating both the unhappy patient and surgeon.
We offer a unique interest and specialization in problematic joint replacement recovery. We believe that the first step to healing requires an accurate diagnosis. In collaboration with our surgical colleagues, we diligently evaluate patients to identify the causes of pain or dysfunction and institute creative pain management and rehabilitative treatments to enhance recovery. These treatments might include medications, injections, nerve blocks, physical therapy/ exercise, manual therapy, dry needling, topical agents, orthotics and other medically indicated treatments.