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Blue Ridge Orthopaedics

Associates, PA

10630 Clemson Blvd., Ste. 100

Seneca, SC 29678

Phone: (864) 482-6000

Fax: (864) 482-7000

Blue Ridge Surgery Center

10630 Clemson Blvd., Ste. 200

Seneca, SC 29678

Phone: (864) 482-5100

Fax: (864) 482-9100

Blue Ridge Orthopaedics

Associates, PA

AnMed Cardiology &

Orthopaedic Center

100 Healthy Way, Ste. 1200

Anderson, SC 29621

Phone: (864) 260-9910

Fax: (864) 328-1451

Founder

Larry S. Bowman, MD

President

Sean McCallum, MD

Secretary/Treasurer

John H. Murray, MD

Blue Ridge Orthopaedics is an educational

and informative resource for

physicians, health care professionals,

employer groups, and the general

public. Blue Ridge Orthopaedics’ goal

for this publication is to introduce

its staff and facilities and provide a

forum for communicating news and

trends involving orthopaedic-related

injuries and treatments, as well as

other health-related topics of interest.

Blue Ridge Orthopaedics is published by

QuestCorp Publishing Group, Inc., 885 E. Collins

Blvd., Ste. 102, Richardson, TX 75081. Phone

(972) 447-0910 or (888) 860-2442, fax (972) 447-

0911, www.qcpublishing.com. QuestCorp specializes

in creating and publishing corporate magazines

for businesses. Inquiries: Victor Horne,

vhorne@qcpublishing.com. Editorial comments:

Brandi Hatley, bhatley@qcpublishing.com. Please

call or fax for a new subscription, change of

address, or single copy. Single copies: $5.95. This

publication may not be reproduced in part or in

whole without the express written permission of

QuestCorp Publishing Group, Inc.

QC Creative is a full-service graphic design firm,

www.qccreative.com. Creative services inquiries:

Jalynn Turner, jturner@qcpublishing.com.

Opening Remarks

OOn behalf of all the physicians and staff at Blue Ridge

Orthopaedics, I would like to welcome you to the inaugural

issue of Blue Ridge Orthopaedics, a publication created to

explore the many facets of our practice and provide a forum

for issues and interests in the orthopaedic community.

As the articles in this issue attest, medicine changes rapidly. Physicians and

other medical professionals work continuously to improve surgical and diagnostic

techniques. In doing so, they enhance medical outcomes, decrease patient discomfort,

and improve quality of life. At Blue Ridge Orthopaedics, we’ve made staying at the

forefront of orthopaedics and sports medicine our primary goal.

Meeting that objective in the coming years is a welcomed challenge. South Carolina

is one of the most rapidly growing states in the country. We enjoy the abundant natural

beauty of our lakes and mountains, a temperate climate, and a convenient

lifestyle. The future has never looked brighter, so it’s not surprising that more and

more people would like to be a part of that future. As our population increases, the

need for quality medical care will also grow.

Blue Ridge Orthopaedics remains committed to providing the highest quality

orthopaedic care. With our two new office locations in Seneca and Anderson, as well

as the Blue Ridge Surgery Center in Seneca, we stand ready to support upstate South

Carolina, North Carolina, and northern Georgia. We also intend to strengthen and

expand our collaborative ties to referring physicians in the community, local industries,

universities, and athletic teams.

After more than two decades of service, our physicians and staff continue to strive for

the highest standard of care for our patients. We appreciate the trusting

support of the upstate community over the last 24 years and the privilege of serving

its residents. Blue Ridge Orthopaedics looks forward to a vibrant future.

We hope you find this issue of Blue Ridge Orthopaedics informative and enjoyable.

Sincerely,

Sean McCallum, MD

President

In This Issue

4

5

6

8

11

13

Caring for a More Active Population

Primary Care Sports Medicine Physicians

The Game Plan

Team Physician Helps Players Rebound from Injuries

Take the Hitch Out of Your Swing

Simple Exercises Can Prevent Golfer’s Elbow

Putting Knowledge, Skill, and Dedication to Work

A Quick Look at Blue Ridge Orthopaedics

Revolutionizing Outpatient Surgery

Blue Ridge Surgery Center Takes a Patient-Centered Approach

Don’t Throw in the Towel with Shoulder Pain

Arthroscopic Surgery Offers Relief from Rotator Cuff Tears

Blue Ridge Orthopaedics

3


Primary Care Sports Medicine Physicians

Caring for a More Active Population

By Len Reeves, MD

Over the past two decades, Americans

across the board have dramatically

increased their interest and participation

in sports — from youth soccer leagues

and Little League baseball to organized

high school and college sports, from tai

chi classes at the local gym to a round of

weekend golf.

Traditionally, orthopaedic surgeons have

dealt with musculoskeletal injuries sustained

by athletes. However, as athletic

activities rapidly expanded within our culture,

it became clear that medical treatment

for those participating required

more than just orthopaedic care. In

response to the growing popularity of

sports and exercise, the medical community

developed the concept of primary care

sports medicine.

The abilities of primary care sports

medicine physicians come from thorough

knowledge of how athletic

activity can affect any aspect of the

human body — from cardiovascular

and respiratory to dermatological

and immunological.

4 Blue Ridge Orthopaedics

Adding a Little Something Extra

to Primary Care

Primary care sports medicine physicians

have special training in promoting

lifelong fitness and wellness as well

as preventing illness and injury. These

physicians understand

the causes

behind and the

nonsurgical and

surgical treatment

options for musculoskeletal

injuries.

They also understand

the nonmusculoskeletal

aspects

of sports medicine

and can deal with

conditions such as

mild brain

and head injuries,

chronic or acute illnesses

experienced

by athletes, and

nutrition and performance

issues.

In addition, primary

care sports medicine physicians

work with patients to develop exercise

regimens, provide counsel on injury prevention,

help sick or injured athletes

make return-to-play decisions, give

advice regarding strength training and

conditioning, and promote a healthy

overall lifestyle. They also perform

preparticipation exams for high school

and college athletes and for those

embarking on exercise programs.

Primary care sports medicine physicians

care for general health needs,

perform injury assessment and management,

and deal with sports-psychology

issues. Other services they provide

include coordinating care with athletic

trainers, physical therapists, and coaches

and making referrals to orthopaedic

surgeons when needed.

Primary care sports medicine physicians

know how to care for athletes of all ages,

no matter what the sport or competition

level. Their extra training and interest in

musculoskeletal and sports-related medicine

allows them to provide comprehensive,

quality care for all active individuals

— not just athletes but also “weekend

warriors,” industrial workers, and

nonathletes with vigorous physical

lifestyles. They practice in a variety of

settings. Many work in their own

primary care clinics, while others offer

care from within an orthopaedic group.

Providing Health Resources for

Organized Sports

Primary care sports medicine physicians

treat athletes of all stripes within their

practices. Some also take on extra

responsibilities as team physicians at all

competitive levels. In this role, they often

lead the sports medicine team, which

includes trainers, coaches, therapists,

other specialty physicians and coaches,

and, of course, the athletes.

Many primary care sports medicine

physicians are or were athletes themselves,

and their firsthand experience of

how injuries and illnesses specifically

affect athletes enhances their knowledge

and treatment approaches.

Training for an Active Future

The abilities of primary care sports medicine

physicians come from thorough


knowledge of how athletic activity

can affect any aspect of the human body

— from cardiovascular and respiratory

to dermatological and immunological.

These physicians usually complete a primary

care residency in family practice

before going on to qualify in sports

medicine. Some, however, complete

residencies in pediatrics, internal medicine,

emergency medicine, or physical

medicine and rehabilitation.

The Game Plan

Team Physician Helps Players

Rebound from Injuries

By Diane M. Calabrese

Athletes dread hearing the words “you

can’t play” only slightly less than a team

physician dislikes saying them.

Empathy makes all the difference when

treating injured athletes. And Len

Reeves, MD, Team Physician for

Clemson University’s men’s and women’s

basketball teams, has it, says J. “Raz”

Razayeski, ATC, Assistant Athletic

Trainer at the school.

“He came in and gained a strong rapport

with the players,” says Razayeski of Dr.

Reeves. “They trust him, so if Dr. Reeves

tells a Clemson player he or she must sit

out to prevent further injury, the athlete

understands and complies.”

Dr. Reeves of Blue Ridge Orthopaedics is

in his fifth year as Primary Care Sports

Medicine Physician at Clemson — the

same school from which he earned his

undergraduate degree and worked as an

athletic trainer. His time in college helping

athletes keep in shape proved a pivotal

experience. “I decided I wanted

work with team sports as part of an

orthopaedic specialty,” says Dr. Reeves.

Dr. Reeves appreciates athletes’ goals

because he played many sports himself.

Athletes often get restless while overcoming

an injury. “The most challenging

part is understanding the athlete’s need

to get back out and play again,” says

Dr. Reeves.

After their initial training, the physicians

complete a one- or two-year fellowship

in sports medicine. Most primary care

sports medicine physicians are board certified

in their primary specialties and are

also eligible to receive subspecialty certificates

in sports medicine.

Focusing on Fitness

Primary care sports medicine physicians

give a little something extra to anyone

The trainer and team

physician share the

same goals, explains

Razayeski. It’s to keep players fit and help

them avoid injury through proper physical

preparation. Of course, if an athlete does

sustain an injury, the trainer and team

physician collaborate to get the player back

in the game as soon as possible.

Common Basketball Injuries

Basketball injuries fall into two general

categories — overuse injuries and traumatic

injuries. Overuse injuries are caused

by repeat stress to an area until it is damaged

and painful. Patellar tendinitis, or

“jumper’s knee,” Achilles tendonitis, and

rotator cuff injuries are common overuse

injuries in basketball players.

Traumatic injuries are caused suddenly

and forcefully. Jammed or broken fingers

and pulled or torn leg muscles often

occur, but ankle sprains are the most

commonly sustained basketball injury.

Recovery is often difficult with continued

use, but immediate evaluation and treatment

of a sprained ankle is key.

Elevating, icing, and taping the ankle

right away prevent swelling, which is a

limiting factor in recovery time. Often,

preventing a sprained ankle from the

start by ensuring players’ shoes are supportive,

snug, and have nonskid soles is

the goal. Ankle braces can also offer

further support.

interested in an active way of life. These

physicians recognize and fulfill the need

for providing athletes, exercising individuals,

and teams with comprehensive,

continuous care for their orthopaedic,

medical, nutritional, and psychosocial

issues. In doing so, they help their

patients achieve physical fitness and

performance goals that enhance their

enjoyment of life and improve their

overall health. BR

Len Reeves, MD, attends to players of 21 varsity sports at

Clemson University.

Traumatic injuries of the knee are often

the most serious for basketball players,

especially a torn anterior cruciate ligament

(ACL), which has occurred with

increasing frequency in recent years. A

collision with another player or someone

falling on the knee can tear the ACL as

easily as twisting the knee when coming

to a sudden halt or landing after a

rebound. Players can try to avoid these

situations by keeping their guards up

during games and practices.

Winning Ways

Although Dr. Reeves’ main responsibility

is to the men’s and women’s basketball

teams, he is present for on-campus games

of other sports as well, says Razayeski. In

fact, Dr. Reeves’s responsibilities extend

to 21 varsity sports at Clemson.

Razayeski has a great deal of interaction

with Dr. Reeves because both men have a

primary responsibility to basketball. “We

exchange ideas for keeping our players

their best,” says Razayeski.

With a team physician and trainer working

together and guiding players in the

optimum ways to exercise, prevent

injury, as well as increase stamina and

performance, the players can concentrate

on winning. BR

Blue Ridge Orthopaedics

5


Take the Hitch Out of Your Swing

Simple Exercises Can Prevent Golfer’s Elbow

By Jim Stoker, MA, PT, CSCS, Clemson Sports Medicine and Rehabilitation

Amateur golfers in South Carolina enjoy

a mild climate and endless days on the

links. Of course, along with that enjoyment

comes the pain from shanked

drives, excursions into sand traps, and

putts that stop just shy of the cup.

Many frequent golfers experience real

pain, however. For some, it’s fleeting and

occasional; for others, it can point to

minor injuries that may worsen eventually

and inhibit performance. One prevalent

injury is commonly referred to as

golfer’s elbow.

Medial view of the collateral ligaments of the elbow

Golfer’s elbow, or medial epicondylitis, is

a common inflammatory condition

among amateur golfers. The muscles and

tendons that bend the wrist (flexors) start

down from the elbow and tighten during

a golf swing. Repeated stress from swinging

a golf club can tear these muscles,

and repeated tears can turn into painful

scar tissue.

Recognizing Golfer’s Elbow

Golfer’s elbow symptoms include pain

and soreness at the medial, or inner,

aspect of the trailing arm (the right one

for right-handed golfers), sometimes

made worse when the wrist bends.

Initially, a general ache occurs after activity,

but as the condition worsens, golfers

can experience pain and weakness while

playing, particularly when striking the

6 Blue Ridge Orthopaedics

ball. Symptoms can also occur during

daily activities, such as opening a jar

or car door.

Several factors contribute to golfer’s

elbow. The most common causes are

poor swing mechanics, overuse, failure to

warm up properly, and traumatic events,

such as striking an unseen root or rock or

hitting the ball fat (striking the ground

behind the ball during the swing).

Treating Golfer’s Elbow

Initial treatment includes icing and

stretching the injured area as well as

taking over-the-counter, nonsteroidal,

anti-inflammatory medications such as

ibuprofen. Icing involves applying a small

ice bag to the inner aspect of the elbow

for 15 to 20 minutes after activity. As an

alternative, you can freeze water in a

paper cup and rub the ice over the painful

area for five to eight minutes. (Do not

apply ice directly to the “funny bone” to

avoid the ulnar nerve just under its

surface.) As the pain and weakness

Surgical Repair

Surgery is available to treat golfer’s

elbow, but it is usually reserved as a

last resort. Typically performed as an

outpatient surgery, the procedure

consists of releasing the tendons

that attach to the medial epicondyle

through a small incision on the

inside of the elbow, allowing them to

loosen. The tendons are then split to

expose and remove the area of

angiofibroblastic tendinosis (scar

tissue that never fully forms and

causes pain and weakness). Any

bone spurs are removed as well,

revealing smooth, healthy bone to

which the tendon can reattach itself.

Full postsurgery recovery usually

takes about three months.

subside, exercising the wrist flexors can

restore strength and prevent recurring

symptoms. For more severe cases, surgery

is sometimes an option (see blue box).

Avoiding Golfer’s Elbow

Fortunately, there’s a simple way to avoid

this injury — strengthening and stretching

the flexor muscles.

Stretching Exercises:

• Fully extend or straighten your

involved arm with your palm facing

up. Grasp your palm with your

opposite hand and gently bend your

wrist down toward the floor until

you feel a moderate stretch. Hold

this position for 20 seconds and

repeat the step five times twice a day

or before and after playing golf.

Strengthening Exercises:

• Wrist flexion — Hold a small

weight with your arm relaxed at

your side and your elbow slightly

bent. Bend your wrist and hand in a

palm-up direction. Return to the

starting position.

• Elbow flexion — Hold a moderate

weight with your arm relaxed

at your side. Bend your elbow

fully, turning your hand and palm

toward your shoulder. Return to the

starting position.

• Forearm rotation — Hold a weight

with your arm at your side, elbow

bent at a 90-degree angle, and

forearm resting on a table or other

level, sturdy surface. Begin with

your thumb up and rotate your

hand palm up and palm down.

Perform all strengthening exercises

with a weight that allows you to

complete three to five sets of 10 to 12

repetitions with moderate fatigue. If

you experience pain, decrease the weight.

If pain or weakness persists, contact

your physician, orthopaedic surgeon, or

physical therapist. BR


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Blue Ridge Orthopaedics

7


Putting Knowledge, Skill,

A Quick Look at Blue Ridge

Orthopaedic medicine is almost as old as the

human race. Fossil evidence suggests primitive

humans likely devised ways to immobilize and

support fractured limbs.

The ancient Egyptians made splints out

of bamboo and linen and invented

crutches. Between 430 and 330 B.C.,

Greek physician Hippocrates published a

volume describing, among other things,

how to reduce shoulder, knee, hip, and

elbow dislocations.

In 1741, French physician Nicholas

Andry coined the term “orthopaedics”

(derived from the Greek words for

“straight” and “child”) and published

Orthopaedia: or the Art of Correcting

and Preventing Deformities in Children.

The orthopaedist now treats a wider

range of musculoskeletal disorders in the

entire patient population from newborns

with clubfeet to young athletes requiring

arthroscopic surgery to older patient

with arthritis.

As one of the upstate’s leading health

care organizations, Blue Ridge

Orthopaedics is just as dedicated to raising

the bar for health care as its sometimes

distinguished, sometimes unknown

predecessors. Founded in 1982, Blue

Ridge has worked hard to create a family

of health care professionals who

use state-of-the-art equipment and

techniques to reach a common goal:

continually advance diagnostic methods

and treatment procedures to improve

outcomes and ensure patient satisfaction.

In September 2002, after obtaining a

Certificate of Need, Blue Ridge opened

its Ambulatory Surgery Center and office

at its present location at 10630 Clemson

Boulevard in Seneca, South Carolina.

The dedication shown by Blue Ridge

earned official recognition from the

Joint Commission of Accreditation of

Healthcare Organization in 2002. This

organization sets standards for safety,

quality, and overall performance for

medical groups. With dual energy x-ray

absorptiometry (DEXA scan), magnetic

resonance imaging (MRI), x-ray services,

and the surgery area contained,

physicians are able to practice more

efficiently and effectively.

Blue Ridge offers a variety of

orthopaedic services, including:

• Arthroscopic Surgery

• Total Joint Replacement

• Sports Medicine

• Knee Surgery

• Shoulder Surgery

• Foot and Ankle Surgery

• Hand and Upper Extremity Surgery

• Arthritis Diagnosis and Treatment

• Pediatric and Adolescent

Orthopaedics

• Sports Injury Clinic

• Treatment of Workers’

Compensation Injuries

• Osteoporosis Detection

and Treatment

Blue Ridge’s comprehensive services are

exemplary of its commitment to provide

unmatched patient care.

8 Blue Ridge Orthopaedics


and Dedication to Work

Orthopaedics

Meet Our Physicians

All Blue Ridge physicians are board certified or board eligible by the American Board of Orthopaedic Surgery (ABOS), and all are

up to date on the latest diagnosis methods, treatment trends, and breakthroughs for orthopaedic-related problems, as well as

knowledge of pharmaceutical updates.

Larry S. Bowman, MD,

founded Blue Ridge

Orthopaedics in 1982.

Dr. Bowman earned his

Bachelor of Arts degree

at West Virginia University

and his master’s

degree in Bioengineering at Clemson

University. He began his medical career

as a flight surgeon in the U.S. Army at

Fort Lewis, Washington. Dr. Bowman

completed an orthopaedic residency at

Penn State’s medical school in Hershey,

Pennsylvania. Dr. Bowman is an Adjunct

Professor in Clemson’s Department of

Bioengineering as well as an Assistant

Professor in the Department of Family

Medicine at Medical University of South

Carolina. He is also Team Orthopaedic

Surgeon for Clemson University. Dr.

Bowman is board certified by ABOS. He

is a Fellow of the American Academy of

Orthopaedic Surgeons (AAOS) and is a

member of the Arthroscopy Association

of North America (AANA), the

American Orthopaedic Society for Sports

Medicine (AOSSM), the Orthopaedic

Reach Society, and the South Carolina

Medical Association (SCMA), as well as

its Board of Sports Injuries.

James C. McGeorge, MD,

joined Blue Ridge in

1989, earned his

Bachelor of Science

degree from Georgetown

University, and received

his medical training at

the University of Bologna School of

Medicine in Italy. He completed an

orthopaedic residency at Penn State’s

Milton S. Hershey Medial Center, where

he was involved in the care of Penn State

athletes and the Hershey Bears hockey

team. Dr. McGeorge is board certified by

ABOS and is a member of AAOS, the

American College of Sports Medicine

(ACSM), and AANA.

Steve L. Martin, MD,

joined Blue Ridge in

1994. He earned his

medical degree from the

Medical College of

Virginia and was selected

by the AOA honors society.

He completed an orthopaedic surgery

residency at the Campbell Clinic in

Memphis, Tennessee, as well as an

orthopaedic trauma fellowship at the

Elvis Presley Trauma Center, also in

Memphis. He then served four years in

the U.S. Army as Director of Sports

Medicine and Orthopaedic Trauma at

Brooke Army Medical Center in San

Antonio, Texas. He published recently in

Techniques of Orthopaedics and has

written a chapter for a forthcoming textbook

on major trauma. Dr. Martin is

board certified by ABOS and is a member

of ACSM, the Society of Military

Orthopaedic Surgeons, and AAOS.

P. Sean McCallum, MD,

joined Blue Ridge in

1995. He earned his

medical degree from the

University of Florida

College of Medicine and

was selected to the AOA

honors society. He completed an

orthopaedic surgery residency at Loyola

University Medical Center in Chicago,

Illinois, and an orthopaedic fellowship at

the American Sports Medicine Institute

in Birmingham, Alabama. He is a Fellow

of AAOS and is board certified by ABOS.

He is a member of AANA, AOSSM,

SCMA, and ACSM.

Brian J. Redmond, MD,

joined Blue Ridge in

2002. He graduated with

honors from the

University of Wisconsin

Medical School and completed

his orthopaedic

surgical training at the University of

Michigan. He completed a sports medicine

fellowship at the Minneapolis Sports

Medicine Center, where he treated athletes

for the Minnesota Vikings, the

Timberwolves, and the Twins. Dr.

Redmond is board certified by ABOS and

is a Fellow of AAOS and AOSSM. He is

also a member of SCMA and the

American Medical Association (AMA).

John H. Murray, MD,

joined Blue Ridge in

1997. He received his

medical training at the

University of Virginia

School of Medicine. Dr.

Murray completed an

orthopaedic surgery residency at Duke

University Medical Center. He completed

a sports medicine fellowship at

Hughston Sports Medicine Clinic. He is

board certified by ABOS and is a member

of AAOS.

W. Bruce Richmond II,

MD, joined Blue Ridge in

1999. Dr. Richmond

earned his medical degree

from the Medical

University of South

Carolina. After serving

two tours of duty in the U.S. Army, he

completed medical training at Erlanger

Medical Center of the University of

Tennessee College of Medicine,

Chattanooga Unit, with an orthopaedic

surgery residency and an orthopaedic

>>

Blue Ridge Orthopaedics

9


trauma fellowship. He is board certified

by ABOS and is a member of SCMA, the

South Carolina Orthopaedic Association

(SCOA), and AAOS.

J. Kirk Hensarling, MD,

joined Blue Ridge in

2003. He received his

medical training at the

Medical College of

Georgia. Dr. Hensarling

completed an orthopaedic

surgery residency at Greenville

Hospital System and a sports medicine

fellowship at Lake Tahoe Orthopaedic

Institute. He is certified by ABOS. He is a

member of AAOS, AANA, and SCOA.

Todd C. Swathwood, MD,

joined Blue Ridge in

2004. He received his

medical degree from

Wake Forest University’s

Bowman Gray School of

Medicine. He served in

the U.S. Air Force as a flight surgeon at

the F-16 squadrons based in Misawa,

Japan, as a staff orthopaedic surgeon,

and as Chief of Orthopaedics at Langley

Air Force Base. He completed an

orthopaedic surgery residency at Wilford

Hall Medical Center in San Antonio,

Texas. Dr. Swathwood led a team to the

Philippines as a part of Operation

Enduring Freedom, part of the global

war on terrorism. He is board certified

by ABOS and is a Fellow of AAOS.

W. Scott Brown, MD,

joined the Blue Ridge

team in August 2005. He

received his medical

degree from the Medical

University of South

Carolina. Dr. Brown

completed an orthopaedic surgery residency

at Tulane University in New

Orleans, Louisiana. He is board eligible

by ABOS.

Douglas A. Reeves Jr., MD, joined Blue

Ridge in 2000. He received his medical

degree from the Medical University of

South Carolina. Dr. Reeves completed a

family practice residency

at the Anderson Area

Medical Center, where he

served as Chief Resident,

and a sports medicine fellowship

at the Eastern

Oklahoma Orthopaedic

Center in Tulsa, Oklahoma. Dr. Reeves

serves as Clemson University’s Athletic

Department’s Primary Care Sports

Medicine Physician. He is board certified

by the American Board of Family

Practice (ABOFP) and earned a certificate

of added qualification in primary care

sports medicine. He is a member of the

American Medical Society for Sports

Medicine (AMSSM), the American

Academy of Family Physicians (AAFP),

and SCMA.

In our next issue, you will meet

our physician assistants C. Stephen

Jackson, PA-C; G. Emmitt Carter III, PA-

C; Frank Mlinar, PA-C; and Wallace S.

Liggett, PA-C. BR

10 Blue Ridge Orthopaedics


Revolutionizing

Outpatient Surgery

Blue Ridge Surgery Center Takes a Patient-Centered Approach

By Margaret W. Crane

As a cost-efficient alternative to hospitalbased

care, ambulatory surgery centers

(ASC) represent an important trend in

today’s health care marketplace. Reliable

scheduling, less invasive procedures, faster

turnaround times, and overall operational

efficiencies have combined to fuel the

growth of ASCs — and their popularity.

Minimally invasive surgical techniques

are often safer, less traumatic, and

less costly.

For most people, the very word

“surgery” carries frightening connotations.

In decades past, patients could

expect large incisions, long hospital stays,

and extended recovery periods, all corresponding

to high costs and increased risk.

In recent decades, however, dramatic

advances in technology and service delivery

have changed those fears forever.

Minimally invasive surgical techniques,

high-tech imaging equipment, and

regional anesthesia have made surgery

safer, less traumatic, and less costly for

patients, physicians, and insurers alike.

In fact, technological improvements have

driven the growth of ASCs and the volume

of outpatient surgeries performed in

ASC settings.

Patient demand is another key to

ASC growth. In survey after survey,

patients report high degrees of satisfaction

with ASCs, specifying a superior

quality of service, lower out-of-pocket

expense, greater convenience, and better

outcomes when compared with hospitalbased

care.

ASC History in Brief

The first outpatient surgical centers were

introduced in the late 1960s, mainly to

ease the shortage of available hospital

beds. In 1969, Charles Hill, MD, of

Providence, Rhode Island, promoted the

idea of building an independent ambulatory

surgical center. The idea quickly

took hold. The American Medical

Association endorsed the use of ASCs in

1971, and the American College of

Surgeons soon followed suit.

The number of ASCs has grown steadily

since the 1980s. Currently, there are

more than 2,300 ASCs in the United

States, performing approximately 4.2

million surgical procedures yearly.

Growth is expected to continue, both in

the sheer number of centers and in the

capacity of those already established.

ASCs, like Blue Ridge’s, are subject

to stringent periodic licensure, certification,

and accreditation reviews much

like hospitals.

For the Good of All

Although hospitals are still central to the

American health care system, outpatient

surgery is increasingly commonplace and

for good reason. On the safety front,

ASCs can hold their own, subject to

stringent periodic licensure, certification,

and accreditation reviews much

like hospitals.

Blue Ridge surgeons are able to

minimize the time and anxiety inevitably

associated with surgery without

compromising individual attention,

thoroughness, and quality.”

Physicians, too, tend to favor ASCs. With

greater control over the design of surgical

suites and the hiring of specialized nursing

and ancillary staff, surgeons can

increase their productivity as well as trim

“red tape” and unnecessary overhead.

Absent the constant need to accommodate

emergency cases, scheduling

becomes easier as well. Ultimately, however,

the main beneficiary of the ASC revolution

is the patient.

A Winning Example

— Trent Mattison, Director of Business

Development at Amsurg

Specializing in orthopaedic and painmanagement

outpatient services, the Blue

Ridge Surgery Center serves as a prototype

for success in the ASC marketplace.

Trent Mattison, Director of Business

Development at Amsurg — a leader in

the single-specialty surgery center arena

— points to Blue Ridge’s patient-centered

approach as key to its success.

By definition, a strong focus on patientcentered

care rests on the quality of services.

“Our orthopaedic surgeons at the

center perform minimally invasive

>>

Blue Ridge Orthopaedics

11


surgery, allowing for less discomfort,

smaller scars, and quicker recovery

times,” says Mattison.

With a clinic and surgery center under one roof,

Blue Ridge offers patients one-stop care.

Blue Ridge also offers patients one-stop

care, housing both a clinic and a surgery

center under one roof. “Because the center

and the clinic are adjacent to one

another, the physicians have complete

managerial control over the entire continuum

of their patients’ care,” says

Mattison. “Since there is little separation,

physically and psychologically, between

the center and the clinic, the physicians

are able to ensure individualized care.”

Predictability is yet another quality

associated with the ASC model. Able to

avoid delays and overbooking, Blue

Ridge’s 10-member orthopaedic group

keeps scheduling as smooth and reliable

as possible. Predictable scheduling, in

turn, makes the process easier for physicians

and staff, as well as patients

and families.

Personalized service and cutting-edge

technology often go hand in hand with

soaring costs, but ASCs like Blue Ridge

are able to keep overhead costs down

precisely because the center is so specialized.

Blue Ridge realizes savings by minimizing

the use of space, reducing redundancy,

and avoiding inefficiency.

Instead of billing patients for everything

from hospital gowns to surgical gloves,

the center charges patients one global fee

that is typically a fraction of the cost of

the inpatient alternative.

Ultimately, high-quality care, convenience,

and cost savings combine to

bolster the emotional well-being of

patients. “Blue Ridge surgeons are able

to minimize the time and anxiety

inevitably associated with surgery

without compromising individual attention,

thoroughness, and quality,” says

Mattison. “Patients arriving for outpatient

procedures do not have to worry

about the long waits, impersonal

service, and red tape common at inpatient

treatment facilities.”

Located in Seneca, South Carolina, Blue

Ridge Surgery Center opened in 2002

and offers a full range of orthopaedic and

pain-management outpatient services.

The center added ophthalmology services

in February 2005.

Most impressive of all, the center has

received a 98% overall satisfaction rate

based on patient surveys administered

four times a year, attesting to the soundness

of the patient-centered approach

that is at the heart of the

ASC revolution. BR

12 Blue Ridge Orthopaedics


Shoulder pain remains one of the most

common factors forcing patients to discontinue

activities that normally provide

quality exercise and enjoyment.

Recreational sports like tennis, golf, softball,

and bowling, as well as boating and

gardening, can become uncomfortable

with continued activity. With severe

forms of shoulder pain, even simple

activities of daily living and restful sleep

are often affected.

Symptoms, Causes, and Diagnosis

The rotator cuff tendons around the

shoulder’s ball and socket joint are the

most common source of shoulder pain.

This is often felt at the outer portion of

the upper arm. Pain that worsens with

shoulder function, especially when reaching

overhead or lifting, is usually present.

It is also common to experience aching

when not using the arm, especially pain

that awakens the patient at night when he

or she lies on the affected side, and associated

loss of strength in the shoulder.

Don’t Throw in the Towel

with Shoulder Pain

Arthroscopic Surgery Offers Relief from

Rotator Cuff Tears

By Sean McCallum, MD

referred from neck pathology, nerve-root

compression, or conditions in the upper

chest are sometimes felt in the shoulder.

With the completion of an appropriate

history and physical exam, as well as diagnostic

testing, the etiology of the shoulder

pain is usually determinable.

Treatment Options

The tendons of the rotator cuff have a

limited ability to heal when inflamed by

activity or an impinging calcific spur that

develops as a normal consequence of

aging. An avascular area near the tendons’

insertions to bone sometimes precludes

healing with continued injury.

This can lead to fraying of the tendon

with eventual failure of the tissue structure

at its connection to the humerus

bone — otherwise known as a rotator

cuff tear.

Initial treatment of a rotator cuff tear

focuses on medication, icing the area,

and modifying activity to decrease the

pain associated with the tear. After the

pain subsides, the patient and physician

can then evaluate their expectations for

shoulder use. Pain-free activities can

begin quickly, and home exercises with

or without a physical therapist’s supervision

are sometimes begun to evaluate a

patient’s ability to function with the tear.

However, pain often remains a limiting

factor, especially when activities requiring

a fully functioning rotator cuff

remain a priority for a patient’s quality

of life. In these cases, surgical repair of

the rotator cuff is often the most

desirable option.

Surgical Repair

The goals of rotator cuff surgery are to

reduce pain as well as regain strength and

function. During surgery, thickened,

inflamed bursal tissue is removed from

around the tendon, as well as any spurs

likely to cause mechanical wear to the

rotator cuff. After these structures are

removed, the torn rotator cuff tendon is

reattached to its insertion to bone.

Repairs are now performed on an

outpatient basis with excellent

results, using arthroscopic assistance

through a small incision that

splits the deltoid muscle to access

the rotator cuff. As the process has

evolved, so has the ability to leave

unaffected anatomy undisturbed,

both to decrease postoperative pain

and enhance the healing process.

There are several causes of rotator cuff

pain. These include strain from a sudden

Traditionally, rotator cuff surgery was

increase in activity, muscle fatigue in It is important to note that rotator cuff performed through an open incision on

throwing athletes, or a direct blow or tears do not heal on their own, but the the shoulder with the patient under general

anesthesia. The large deltoid muscle

other traumatic injury to the shoulder. symptoms of the tear are managed well

The most common cause of rotator cuff in some patients. Elderly patients or

on the side of the shoulder is partially

pain, however, is a slowly progressive those satisfied with a primarily sedentary

removed during the surgery to allow

process caused by cumulative degeneration

of the tendons with normal use of nonsurgical fashion with judicious use of

lifestyle are often treated in a supportive,

access to the rotator cuff for repair.

The deltoid is then reattached to its

the shoulder over time.

safe nonsteroidal medications, acetaminophen,

or occasional steroid injections to

normal position. Often, this surgical dissection

requires a brief hospital stay and

The physician’s first priority is to arrive at

the shoulder for severe pain.

an accurate diagnosis. Not all pain around

causes significant initial discomfort with

the shoulder comes from the joint or structures

surrounding it. For example, pain rotator cuff deficit are also encouraged. rotator cuff and deltoid function.

Gentle exercises to compensate for the prolonged rehabilitation for improved

>>

Blue Ridge Orthopaedics

13


Minimally Invasive Techniques

Over time, in an attempt to improve the

procedure’s significant morbidity, new

techniques were developed. Using the

operating arthroscope (a small microscope

to view joints through minimal

surgical incisions), the understanding of

the pathology of rotator cuff tears has

improved greatly, as has the ability to

treat them.

Superior view of the supraspinatus, the most

frequently injured rotator cuff muscle

Repairs are now performed on an outpatient

basis with excellent results, using

arthroscopic assistance through a small

incision that splits the deltoid

muscle to access the rotator cuff. Minimally

invasive techniques were perfected

to allow repair of the rotator cuff

through these very limited incisions

with the arthroscope.

Rotator cuff repair is usually accomplished

similarly in all forms of surgery

by using anchor implants to suture the

tendon back to the bone. As the process

has evolved, so has the ability to leave

unaffected anatomy undisturbed, both to

decrease postoperative pain and enhance

the healing process.

Recovery and Results

Tendon healing to bone remains the

time-limiting factor in rotator cuff

surgery. Pain relief progresses slowly and

continues to improve up to a year after

surgery with improvements in strength

and function sometimes taking even

longer. Patience remains a virtue in rotator

cuff surgery rehabilitation, but with

appropriate guidance and instruction by

trained physical therapists and progressive

home programs, patients can expect

and achieve excellent results.

New advances on the horizon involve

enhancing and speeding recovery and

healing of tendon to bone. Several new

genetically engineered components of

tendon growth factor and biologic reinforcements

of tendon tissue are undergoing

testing with very promising results. In

fact, preliminary data show healing times

are significantly reduced with almost

double the strength of the tendon repair.

The physicians and staff at Blue Ridge

Orthopaedics remain committed to providing

proven, top-quality care, such as

arthroscopic rotator cuff repair and many

other advanced techniques for the shoulder

and other joints of the body.

Minimally invasive techniques for joint

replacement surgery and fracture care are

also emphasized by Blue Ridge surgeons.

We welcome opportunities to discuss these

at our Seneca or Anderson offices. BR

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864-654-1771

402 College Avenue • Clemson, SC

Trust, Service, Dependability

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Compounding Pharmacy

Specializing in Custom

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864-654-9120

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14 Blue Ridge Orthopaedics


Advertiser Directory

Blue Ridge Orthopaedics

Associates thanks:

Accountants

Erwin & Duncan CPA Firm, PA . . . . . . . . . . . . . . see page 15

Computer Services

Complete On-Site Solutions . . . . . . . . . . . . . . . . . . see page 15

Financial Services

UBS Financial Services Inc. . . . . . . . . . . . . . . . . . . . . see page 7

Home Health Services

Interim Healthcare Inc. . . . . . . . . . . . . . . see inside front cover

Orthopaedic Implants & Supplies

Biomet Orthopedics, Inc.

1061-B Sparkleberry Ln. Ext. • Columbia, SC 29223

(803) 462-0504 • (803) 462-0097 Fax

DePuy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see page 10

OrthoPro, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . see page 12

Smith & Nephew . . . . . . . . . . . . . . . . . . . . . . . . . . see page 15

Zimmer, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see page 7

Pharmacies

Sammeth Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . see page 12

The Hubbard/Young Pharmacy, Inc. . . . . . . . . . . . see page 14

Physical Therapy

Clemson Sports Medicine and Rehabilitation . . . see back cover

Radiology

Mountainview Medical Imaging . . . . . . . . . . . . . . . see page 14

SourceOne Healthcare Technologies, Inc. . . . . . . . . see page 7

In Business since 1990

Providing IT Consulting

Sales & Service

• IT Support

• TurnKey Installations

• Medical Network Systems

• LAN & WAN Connectivity

• HIPAA Compliance

• PACS

• Practice Management

• Software Implementation

189 Beaver Lake Dr • West Union, SC 29696

(864) 985-7700 phone • (864) 638-1969 fax

rickdavis@on-sitesolutions.net

Blue Ridge Orthopaedics

15


Blue Ridge Orthopaedics Associates, PA

10630 Clemson Blvd., Ste. 100

Seneca, SC 29678

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