Download Volume 3, Issue 2 of Body Wise here - The Orthopaedic ...

Download Volume 3, Issue 2 of Body Wise here - The Orthopaedic ...

Volume 3, Issue 2

Bo d y Wi s e

A Publication of T h e Or t h o p a e d i c In s t i t u t e

Fe at u r e d Art i c l e s:

Co m p u t e r As s i s t e d Nav i gat i on

in To ta l Kn e e Re p l a c e m e n t

b y Ed wa r d M. Ja f f e, M.D.

Br o k e n Wr i s t s: Di s ta l Ra d i u s Fr a c t u r e s

b y Ja s o n Sh in n, M.D.

Ro tat o r Cu f f Te a r s

b y An d r e w F. Ro c c a, M.D.

Ge t Ac t i v e to St ay Ac t i v e: Ex e r c i s e f o r Ag in g Ad u lt s

b y Ba i l e y A. Sm i t h

Volume 3, Issue 2

Bo d y Wi s e

A Publication of T h e Or t h o p a e d i c In s t i t u t e

Fe at u r e d Art i c l e s:

Co m p u t e r As s i s t e d Nav i gat i on

in To ta l Kn e e Re p l a c e m e n t

b y Ed wa r d M. Ja f f e, M.D.

Br o k e n Wr i s t s: Di s ta l Ra d i u s Fr a c t u r e s

b y Ja s o n Sh in n, M.D.

Ro tat o r Cu f f Te a r s

b y An d r e w F. Ro c c a, M.D.

Ge t Ac t i v e to St ay Ac t i v e: Ex e r c i s e f o r Ag in g Ad u lt s

b y Ba i l e y A. Sm i t h

Th e Or t h o pa e d i c In s t i t u t e

sincerely appreciates

the following businesses

who partnered with us to

support this publication:

• Crime Prevention

Security Systems


A Message from

Th e Or t h o pa e d i c In s t i t u t e

e are pleased to present our sixth issue of Body Wise.

This publication is dedicated to patient education with

articles addressing timely topics in health, sports and medicine. The

“Featured Physician Articles” written by members of our group focus on

the prevention and treatment of common musculoskeletal conditions and

injuries. In this issue are articles related to:

• Compass Bank

• DonJoy - Aircast

• Exactech

• FLA Orthopedics

• Gentiva Health Services

• Gold Cup Coffee

• Interventional

Medical Associates

• J. McLauchlin &


• James Moore

& Company

• McKesson

• North Florida Regional

Medical Center

• Mitek-Surgical

Concepts, Inc.

• North Florida

Rehabilitation, Inc.

• Computer Assisted Navigation in Total Knee Replacement

• Broken Wrists: Distal Radius Fractures

• Rotator Cuff Tears

• Get Active to Stay Active: Exercise for Aging Adults

If you are not familiar with The Orthopaedic Institute, we are a private

practice group of 21 fully trained, experienced specialty physicians that

have been proudly providing quality musculoskeletal care to North Central

Florida for over 25 years. We have three full service clinic locations

offering same day and next day appointments in Gainesville, Alachua and

Lake City.

We hope the information contained in Body Wise is fun to read, assists

you in making educated decisions regarding your health and supports

your decision to select The Orthopaedic Institute when in need of quality

musculoskeletal care.


The Orthopaedic Institute Physicians

Table of Contents

Th e Or t h o pa e d i c In s t i t u t e

• Senior Home Care, Inc Get Active to Stay Active: Exercise for Aging Adults..................... 5

Body Wise is designed and

published by

Custom Publishing Group.


Interested in Advertising in an

upcoming issue of Body Wise?

Contact Rebecca Reed at

(904) 242-7182.

Rules of Thumb: Successful Vegetable Gardening........................ 8

Broken Wrist: Distal Radius Fractures............................................. 12

Rotator Cuff Tears.......................................................................14

Don’t Let Falls Trip You Up.............................................................. 21

Stay Well Hydrated for Peak Performance...................................... 24

Body Image Preventative Medicine................................................. 26

Getting the Most Out of Your Doctor’s Visit................................31

Computer Assisted Navigation in Total Knee Replacement............ 33

“ I played

with my



Improving the lives of patients

is Exactech’s ultimate goal.

Exactech is one of the nation’s fastest-growing orthopaedic device

manufacturers. We develop innovative orthopaedic implants and surgical

instrumentation and are shaping the future of bone repair with our biologic

materials. Our products assist surgeons in the restoration of joints and

bones that have deteriorated as a result of injury or disease. We are proud to

be a part of the Gainesville community as we improve the lives for patients

here and around the world.


Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

Ge t Ac t i v e to Stay Ac t i v e: Ex e r c i s e f o r Ag i ng Ad u lt s

by Bailey A. Smith

Aging can be a pain in the

neck! It can also be a pain in

the back and knees and hands

and feet. Age-related aches

and pains can put a damper on

the golden years, but it doesn’t

have to be that way. Knowing

what to expect and taking steps

to counterbalance the effects of

aging can help you maintain a

young spirit and an independent

life. Regular check-ups with

an orthopaedist and a healthy

lifestyle can help delay the onset

and slow the progression of many

age-related changes.

As you age, you lose muscle and

bone mass and may develop

problems in your muscles, joints,

and bones, such as back pain,

osteoarthritis, or osteoporosis.

Regular exercise slows the loss of

muscle mass, strengthens bones,

and reduces joint and muscle

pain. Moreover, strengthening

the muscles that cross your joints

helps them act more effectively

as stabilizers, improving mobility

and balance and reducing the risk

of falling and suffering a serious

injury, such as a hip fracture.

In addition to maintaining strong

muscles and bones, regular

exercise is a great way to control

one’s weight. As we age, our

metabolism naturally slows,

making it increasingly challenging

to keep off the extra pounds.

Being overweight can cause a

host of health problems, such

as heart disease and diabetes,

but can also lead to orthopaedic

conditions. Excess weight places

added pressure on joints, causing

pain and eventually wearing

away cartilage. Losing weight can

lessen the stress on the back,

hips and knees and alleviate

much of the joint pain associated

with aging. “Due to muscle forces,

the joints are greatly impacted by

weight,” states Andrew Rocca,

M.D., orthopaedic surgeon with

The Orthopaedic Institute. “For

example, the knee joints may

experience more than three times

a person’s body weight during

typical daily activities. Loosing

only ten pounds can reduce the

stress on each knee joint by more

than 30 pounds.”

Scientists used to think that

strenuous exercise was the only

way to improve your health.

However, new research suggests

that just 30 minutes of moderate

physical activity, such as a brisk

walk or washing your car, can

provide the same health benefits as

more intense exercise. While some

people may enjoy participating in a

regularly scheduled exercise class,

others may find it easier to just

increase their daily activities. The

key is to make strength training,

cardiovascular exercise and

stretching a regular part of your life.

The Orthopaedic Institute 5

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

Strength training is the use of resistance to build

the strength, size and endurance of muscles. This

resistance can come from your own body weight,

weight machines, free weight, resistance bands, a

stability ball, or water. The advantages of strength

training are numerous; it increases bone density and

reduces the risk of osteoporosis, increases stamina

and makes everyday activities easier, and improves

balance and coordination. Furthermore, adding lean

muscle mass through weight bearing exercise can

also increase the body’s ability to burn calories while

at rest, making it easier to maintain a healthy weight.

Ideally, you should aim to strength train 2-3 times per

week, with an emphasis on core strength. Be sure

to vary workouts by alternating between the upper

and lower body and between pushing and pulling

motions, leading to a more balanced body. Full-body

exercises that strengthen multiple muscle groups at

a time, like Pilates, can also be highly effective.

Cardiovascular exercise, which temporarily speeds

up your heart rate, can lead to weight loss and

improved heart and lung function. Additional benefits

are increased energy levels, improved mental clarity,

reduced stress and greater self-esteem. Walking,

running and bike riding are great cardiovascular

exercises but other activities can be just as effective.

Try working in the yard for thirty minutes, walking the

fairways when you golf, taking the stairs instead of

the elevator, doing housework, swimming or taking

dance lessons. The key is to find something that you

enjoy doing and do it regularly, 3-4 times a week for

at least thirty minutes.

In addition to strength training and cardiovascular

exercise, stretching is vital to preventing aches

and pains because it improves the pliability of the

muscles and tendons that support the joints. Keeping

limber, an area of conditioning that many people

neglect, is a fundamental piece of the fitness puzzle.

Stretching lengthens muscles and increases range

of motion, improves circulation and posture and can

reduce your risk of injury. The more prepared your

muscles, tendons and ligaments are for an activity,

the more protected you are from getting hurt.

“Stretching should only be done to the point where

you feel a pull- not pain- and then hold for 10 to 15

seconds. No bouncing! Gradual loading and progression

is the best way to avoid injury,” advises

Herb Anding, physical therapist and Clinical Director

6 The Orthopaedic Institute

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

of The Physical Therapy Center

at The Orthopaedic Institute.

A final suggestion, especially if

you are starting a new exercise

plan, is to start slow. Nothing can

curtail your activity or your motivation

faster than an injury. Be

realistic with yourself about your

fitness level and ability. If you

are unsure, ask your doctor. It is

always a good idea to consult a

physician before beginning an

exercise regiment.

As you age, remaining active can

be one of the most significant

factors in maintaining an independent

lifestyle. But it is important

to get active now so that you can

stay active later, no matter what

your age. It’s never too late to

start improving your fitness level

for a happier, healthier life.

The Orthopaedic Institute 7

Ru l e s o f Th u m b

Su c c e s s f u l Ve g e ta b l e Ga r d e n i ng


Nothing tastes better than homegrown foods. Planting

a crop, nurturing it and watching it mature provides a

fulfillment often missing from the modern world. The funny

thing is, whether you live on a property that stretches as

far as the eye can see or in an apartment building with a

small shared garden, it’s quite easy to do it yourself. You’ll

find quickly that it’s well worth 8the effort - and that the

most convenient thing in the world is harvesting a salad

from your own backyard.

We live in a world of convenience. Refrigerators in our

kitchens keep our food fresh. Supermarkets down the

street stock everything we want. Restaurants dot the

landscape to feed our desires, whatever they may be.

With such well-established amenities at our disposal, it’s

easy to forget that food initially comes from the land - and

that it’s possible to grow it ourselves.

by Chuck Baker

8 The Orthopaedic Institute

Ru l e s o f Th u m b

Planting Intelligently

The first step in developing a vegetable

garden is to determine where it should go.

Clearly, a sunny space that sees little foot

traffic works ideally. If you’ve got the space,

then clear it of weeds, turn over the soil and

get your hands dirty immediately. Even if

you’ve only got a small area in which to grow

vegetables, you’re still in business.

8In either situation, consider using raised

beds. By using a specific growing space

for your vegetables, you can more easily

keep weeds and grasses from creeping into

your garden. To make a raised bed, first

lay a sheet of chicken wire flat against the

ground where you plan to grow your crops.

Then take the boards that you will use as

walls - generally 1 or 1 and 1/2 feet tall - and

set them on edge atop the wire. Fashion

the boards into a rectangle and nail them

together. The resulting space will hold good

soil in place over the existing ground. The

wire keeps rodents from climbing up through

the bottom and destroying your plants’

primary roots. Root tendrils can still work their

way around the wire, and water will be able to

drain naturally through the wire as well.

Create footpaths around the boxes - or

around the area of your garden designated

for the vegetables - so as not to step upon

and compress developing roots. Use material

such as wood chips or bricks on the path to

keep weeds from forming.

Building Strong Soil

Now you’re ready for the soil. Fill the growing

space with good materials, either varieties

purchased from a nursery or garden store or

by using a mix of compost and soil from your

yard. An organic planting mix can include

such ingredients as fir bark, mushroom

compost, perlite, gypsum (which adjusts

a soils pH levels) and peat moss. You can

also choose to mix ample compost and

all-purpose fertilizer with good new soil and

existing soil.

The Orthopaedic Institute 9

Ru l e s o f Th u m b

Pour the mixture loosely into your raised beds,

allowing it to settle itself into place without

packing down. Till the soil between six inches

and a foot deep. Rake the surface out to

eliminate low spots.

After the soil has been established, it’s time to

insert baby plants or seeds into the raised beds.



Growing Effectively

Before actually planting the young vegetables

Worm castings fertilize plants richly. As little as

or seeds, you should look around. Identify the

cardinal directions in your plot so that you know

one tablespoon provides enough plant nutrients

where the sun will come from. Position your

to feed a six-inch plant for two months. Plants

plants in order of increasing height from south

can absorb castings immediately, and the

to north (if you live in the northern hemisphere). use of castings around plants enhances the

The shortest plants should be located to the

soil’s ability to retain water. Also, this natural

south in order to receive unimpeded sunlight.

byproduct breaks down gradually, due to a

Mid-sized plants are best grown between these surrounding oil produced in worms’ alimentary

shorties and taller plants to the north.


Use this sample guide to determine the

A great thing about worm castings is that you

expected height for your plants:

can develop them yourself. Find a corner of your

backyard (or–if you have no yard–use a large


SMALL: garlic, herbs, lettuces, onions

sealed container with airholes) to designate for

the worms. Turn soil over in the area to freshen

MEDIUM: bush beans, eggplants, peppers

it up. Then cover the ground with organic

leavings such as dead weeds or grasses or

LARGE: cucumbers, squash, sweet basil,

even ripped up newspaper. Dampen the organic


materials–they provide the worms’ bed. Now

TALL: corn, peas, pole beans

you’ve got to get the worms. You can order

worms by the pound from fishing shops or some

You may choose to grow different vegetables– garden centers. Once you’ve got the worms,

be sure to know how much space you’ll need to and they’ve got their space, they’ll need food.

leave them. Bunching smaller plants prevents

That’s where you come in. The worms will eat

burning from full-exposure to sunlight. Larger

just about anything, except for meat products.

plants, such as tomatoes, should be allowed to Those coffee grounds and eggshells that you

spread widely.

throw out every morning? Feed your little


When young seedlings grow, thin the plants out

and give each strong plant sufficient space -

The worms take care of your leavings, and you

generally, 8 to 12 inches apart. Otherwise, the

take care of theirs by sprinkling them into your

plants will compete for light and water, resulting

garden. It’s the perfect symbiotic relationship–

in improper growth.

and it happens naturally!

Gardening Holistically

As the world becomes more aware of itself,

10 The Orthopaedic Institute

Ru l e s o f Th u m b

multiple methods of taking

care of the environment,

personal health and, of

course, gardens have come

into consciousness. One

method utilizes multiple

vegetables, as well as some

flowers, in one bed to create

a holistic environment for

optimal growth.

Vegetables can be planted in

single rows (two foot beds),

or in double rows (four foot

beds) so that you can tend

the plants from the front or

the back. Combining crops

has multiple positive effects

in that bunched plants crowd

out weeds; also, bees and

beneficial insects drawn to

certain plants can pollinate


Consider planting the

following crops with their

recommended partner. Your

eventual yield can as much

as double. The following

sample list should help:

Beans - Celery and


Beets - Lettuce and onions

Cabbage - Celery, dill,

onions and potatoes

Carrots - Lettuce, onions,

radish and tomatoes

Corn - Beans, cucumbers,

peas, potatoes and


Cucumbers - Beans,

corn, peas, radishes and


Lettuce - Carrots,

cucumbers, onions,

radishes and strawberries

Onions - Beets, lettuce,

strawberries and tomatoes

Peas - Beans, carrots, corn,

cucumbers, herbs, potatoes

and radishes

Squash - Cucumbers, corn

and radishes

Tomatoes - Carrots, onions

and parsley

Also, consider adding certain

flowering plants to your

vegetable garden. Marigolds,

for example, help tomatoes

grow well. As an added

benefit, including flowers can

add lovely color to a green


Developing Your

Green Thumb

Long-time gardeners always

find their own ways to work

best with their environments.

After a few seasons,

you’ll want to make some

adjustments that work for

your own climate and space.

Ultimately, you’ll find that

paying attention to your

garden reaps far greater

rewards than just the harvest.

Spending the time outside is

reason enough to grow your

own food. When the crops

do come in, the convenience

of getting your exercise, as

well as your own vegetables,

self-sufficiently will provide

you with reason to grow year

after year.



Proper soil and location are crucial for

a successful garden. Planting crops

during the appropriate season is just as


The best time to plant depends on

your region and climate. You can find a

good guide in the form of the Farmer’s

Almanac. When the time is ripe,

planting seeds or small plants every few

weeks will result in a continual harvest

when the plants mature.

Always start planting outside after the

season’s first frost. At this point the soil

warms, providing a healthy bed for your

vegetables. Here’s an idea of some of

the vegetables you may want to plant,

as well as the time of year for optimal


















Sweet Potatoes






In summer, after the growing season

of mild weather, cover your dormant

garden with compost and mulch.

Planting winter crops keeps worms

satisfied. Continuing to water and mulch

keeps the garden from drying out so it

will be ready for you next season.

The Orthopaedic Institute 11

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

Br o k e n Wr is t s: Di s ta l Ra d i us Fr a c t u r e s

by Jason Shinn, M.D.

One of the most common

places to break a bone in your

body is in your wrist. Usually,

broken wrists occur because of

a fall on an outstretched hand.

Although there are many small

bones in the wrist, usually it is

the end of the forearm bone (the

radius) that breaks. We call this

a “distal radius fracture” (to an

orthopaedic surgeon, a break

and a fracture are the same

thing). Frequently there is also

a chip off the end of the other

forearm bone, the ulna.

In the past, orthopaedic

surgeons treated most broken

wrists in casts. Recently, this

practice has been changing due

to the results of many scientific

studies. We have found that

although wrists usually do heal

in a cast, they may develop

problems over the long term,

including arthritis and wrist

instability. To prevent these

problems, it is very important for

the wrist to heal in the proper

alignment. Often the surest way

to ensure that the wrist heals in

its proper position is with surgery.

Because of the risk of future

problems, orthopaedic surgeons

across the country have been

more and more frequently

recommending surgery for broken

wrists. The surgery involves

opening the wrist, putting the

bones in the right position, and

then holding them in that position

with a plate and a number of

screws. The plate and screws

hold the bone until it heals.

After the bone heals, they are

no longer necessary. However,

because it means additional

surgery to take the plate out we

usually leave it in forever.

If you break your wrist your doctor

will look at the x-rays and

decide if the wrist is in a good

Dr. Shinn specializes in Orthopaedic Surgery. His areas of clinical interests include

shoulder and knee arthroscopy, hand and wrist surgery, sports medicine and joint

replacement surgery. Dr. Shinn attended medical school at The University of Florida

and completed his residency in Orthopaedic Surgery at The University of Texas-

Southwestern. He is a member of the American Academy of Orthopaedics as well as

the American Medical Association. In his free time, he enjoys biking, music, running,

watersports and spending time with his wife and family.

12 The Orthopaedic Institute


Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

position. If it is, sometimes a cast

and close observation is all that

is necessary. If the bone is not

in the correct position, there are

two options. One is to “set” or

“reduce” the break and then place

a cast. If your wrist is treated in a

cast you may need to come back

for frequent x-rays to make sure

the bone has not changed position.

The other option is surgery.

After breaking your wrist or

having surgery for a broken wrist,

there are some things to watch

for. The median nerve is one of

the major nerves to the hand and

crosses the wrist in a vulnerable

area. It can be compressed or

damaged by a broken wrist. For

this reason it is very important

to notify your doctor of any

numbness or weakness in your

hand. You may need a carpal

tunnel release to decrease

the pressure on the nerve and

decrease the risk of permanent

nerve damage.

Occasionally, in spite of our best

efforts, the bone still heals in the

wrong position. If this happens,

you and your doctor will need to

weigh the risk of future arthritis

and instability against the risks

of surgery. Sometimes the best

solution is surgery to re-break the

bone, line up the wrist, and then

place a plate and screws to hold

the new position. A bone graft

may also be taken from the hip to

help with the reconstruction.

Breaking a bone is never fun.

The good news is that with proper

treatment, most broken wrists

heal with no long term problems.

Surgery may be the best way to

make this happen, but you and

your doctor will decide what is

right for you.

The Orthopaedic Institute 13

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

Do you experience pain

with everyday tasks such as

vacuuming and lifting? If so, you

may have a rotator cuff tear.

Rotator cuff tears are a common

source of shoulder pain in adults.

They are most frequently injuries

from wear, rather than trauma.

Our busy lives and everyday

activities over time take their toll

on our tendons, ligaments, and

joints. Consequently, as our

bodies age, we become more

prone to these wear-type injuries.

If you are suffering from shoulder

pain, a rotator cuff tear may be

the problem.

The pain from a rotator cuff tear

may develop suddenly or over

time—in the beginning it may

be noticed only with overhead

activities such as reaching or

lifting. At first, you may find relief

by resting your shoulder or taking

Motrin or aspirin. Over time,

however, the pain may become

noticeable even when you rest.

You may also experience stiffness

and loss of motion. Rotator

cuff tears are more common in

your dominant arm and can be

present in the opposite shoulder

even if there is no pain. These

tears are often seen in individuals

who perform frequent overhead

activities such as construction

work or painting. Certain

athletes, such as swimmers,

Ro tat o r Cu f f Te a r s

Andrew F. Rocca, M.D.

pitchers and tennis players also

seem to be at increased risk.

Unlike the slow progression of

the wear injury, when the tear

occurs traumatically there may be

sudden acute pain, a snapping

sensation, or even a immediate

weakness of the arm.

The rotator cuff itself is an

intricate part of the complex

shoulder anatomy that allows

the shoulder to move in many

directions. It is made up of

four tendons- supraspinatus,

infraspinatus, subscapularis, and

teres minor- and their muscle

units. These tendons combine

to form a “cuff” over the upper

end of the arm. The muscles

originate from the shoulder blade

and together form a single tendon

that helps to lift and rotate the

arm and to stabilize the ball of the

shoulder within the joint.

Your orthopaedic surgeon can

help you determine if you might

have a rotator cuff tear based on

a combination of your symptoms,

examination, and special tests

such as radiographs or MRI.

During the exam, the doctor will

look at your shoulder for areas

of tenderness or to see if there is

a deformity. He or she will also

measure the range of motion of

your shoulder in several different

directions and test the strength

of the arm. The doctor will also

check for instability and problems

with another part of your shoulder

called the AC (acromioclavicular)

joint. The doctor may also

examine your neck to make sure

that your pain is not coming from

a pinched nerve in your cervical

spine and to rule out other

conditions such as arthritis.

Plain X-rays of a shoulder with a

rotator cuff tear are usually normal

or show a small spur. For this

reason, your doctor may order

an additional study called an MRI

(magnetic resonance imaging).

This test better visualizes soft

tissue structures such as the

rotator cuff tendon. An MRI can

also help to distinguish between

a full thickness (complete) tear of

the tendon and a partial tear. It

can show the doctor where the

tear is located and how much

of the cuff is involved. Once a

diagnosis of rotator cuff tear has

been made, your orthopaedic

Dr. Rocca is Board Certified in Orthopaedic Surgery. Prior to joining The Orthopaedic

Institute, he practiced three years with the United States Navy. Dr. Rocca attended

medical school at the University of Pennsylvania and completed his residency in

Orthopaedic Surgery at the National Naval Medical Center. He also performed a

fellowship in Hyperbaric Medicine at the Naval Undersea Medical Institute. Dr. Rocca

is a member of the American Academy of Orthopaedic Surgeons, Florida Orthopaedic

Society, Florida Medical Society, and Society of Military Orthopaedic Surgeons.

14 The Orthopaedic Institute

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

surgeon will recommend the most

effective treatment.

Treatment for a rotator cuff tear

can be operative or non-operative.

In many instances nonsurgical

treatment can provide

pain relief and can improve the

function of your shoulder. Nonoperative

treatment may include

rest and limited overhead activity,

use of a sling, anti-inflammatory

medications such as Motrin or

Aleve, steroid injections, and/

or physical therapy. It may

take several weeks or months

to restore strength and mobility

to your shoulder and then only

about 50% of patients will obtain

satisfactory relief with this type

of treatment. Given this fact, the

treatment you select will probably

be based on a thorough discussion

with your doctor regarding

the overall advantages and

disadvantages in your specific

case. Some of the most obvious

advantages of non-operative

care include the fact that you may

avoid surgery and its inherent

risks, such as infection, stiffness,

and anesthesia complications.

In addition you may have less

“down time.” The disadvantages,

on the other hand, are

strength does not improve, tears

may increase in size over time,

and you may need to decrease

your activity level.

If non-operative management is

selected, a multimodal program,

which often progresses to

include supervised physical

therapy, will most likely be

initiated. Ultimately, however,

if non-operative treatment does

not relieve your symptoms

your orthopaedic surgeon may

recommend surgery. Surgical

management is indicated

for rotator cuff tears that do

not respond to conservative

management and/or are

associated with weakness, loss

of function, and limited motion.

Because there is no evidence

of better results in early versus

delayed repairs, many surgeons

consider a trial of non-operative

management to be appropriate.

Surgery may also be considered

if the tear is acute and painful,

if it is the dominant arm of an

active individual, or if you need

maximum strength in your arm for

overhead work or sports.

The type of surgery performed

depends on the size, shape, and

location of the tear. A partial tear

may require only a trimming or

smoothing procedure called a debridement.

A complete tear within

the substance of the tendon is

repaired by suturing the two sides

of the tendon. If the tendon

is torn from its insertion on the

humerus, it can be repaired

directly to bone. Sometimes a

combination of procedures is

also appropriate. In the operating

room, your surgeon may also

remove part of the front portion

of the scapula, the acromion,

as part of the procedure. The

acromion and the spurs that form

in this area are thought to cause

impingement on the tendon. This

may lead to a tear. Other conditions,

such as arthritis of the

AC joint, or tearing of the biceps

tendon may also be addressed at

the same time.

Operative treatment of a completely

torn rotator is designed

to repair the tendon back to the

humeral head (ball of joint) from

where it is torn. This can be accomplished

in a number of ways.

Each of the methods available

has its own pros and cons; all

have the same goal- getting the

tendon to heal to the bone. The

three commonly employed surgical

techniques for rotator cuff

repair are open surgical repair,

mini-open repair, and arthroscopic

repair. The overall complication

rate following rotator cuff

surgery is estimated to be about

10 percent. The most frequent

complication is tendon re-tearing,

followed by joint stiffness, deltoid

detachment (which can be avoid-

The Orthopaedic Institute 15

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

ed by arthroscopic techniques),

nerve injury, and infection.

The choice of surgical technique

depends upon several factors including

the surgeon’s experience

and familiarity with a particular

procedure, the size of the tear,

patient anatomy, quality of the

patient’s bone and tendon tissue,

and the patient’s needs. Regardless

of the repair method used,

each repair type shows similar

levels of pain relief, strength improvement,

and patient satisfaction.

Many surgical repairs can

be done on an outpatient basis.

A brief overview of the most common

methods used for repair of

the rotator cuff follows.

Op e n Re pa i r

Open repair is performed without

arthroscopy. The surgeon makes

an incision over the shoulder

and detaches a portion of the

deltoid muscle to gain access

to and improve visualization of

the torn rotator cuff. In addition,

through this approach, the

surgeon can also remove bone

spurs from the undersurface of

the acromion- a procedure known

as acromioplasty. The incision is

typically several centimeters long.

Al l-Ar t h r o s c o p ic Re pa i r

A fiber optic scope and small

instruments are inserted through

small puncture wounds instead

of an open incision. The scope is

connected to a television monitor

and the surgeon can perform the

repair under video control. This

technique uses multiple small incisions

(portals) and arthroscopic

technology to visualize and repair

the rotator cuff. In addition, the

acromioplasty is also performed

arthroscopically. All-arthroscopic

repair is usually an outpatient


Min i-Op e n Re pa i r

As the name implies, mini-open

repair is a smaller version of the

open technique, but not entirely

performed arthroscopically. This

technique does incorporate

arthroscopy to visualize the tear

and treat damage to other structures

within the joint, such as with

the all-arthroscopic approach,

however, once the arthroscopic

portion of the procedure is completed,

the surgeon proceeds to

the mini-open incision to repair

the rotator cuff itself.

Regardless of procedure, after

the surgery, the arm is immobilized

to allow the tear to heal.

Therapy then typically progresses

in stages. Initially, the repair

needs to be protected until adequate

healing of the tendon to

bone occurs. For this reason,

most patients use a sling for the

first 4 to 6 weeks after surgery

and are instructed to limit active

use of the arm during this period.

Passive range of motion exercises

are begun with a therapist.

Progressive strengthening and

range of motion exercises continue

during the next 6 to 12 weeks.

Most patients have a functional

range of motion and adequate

strength by 4 to 6 months after

surgery. A strong commitment

to rehabilitation is important to

achieve a good surgical outcome.

The doctor will advise you when it

is safe to return to overhead work

and sports activity.

In summary, rotator cuff tears

can be a source of pain in the

shoulder and their incidence

increases with patient age. Initial

treatment is often non-operative

and can result in decreased pain

and improvements in range of

motion; however, strength will not

be recovered. Surgical repair

results in pain reduction and

improved function and strength

in more than 80 percent of patients.

Three primary methods of

repair are available and include

open surgery, all arthroscopic

techniques, and the mini-open

approach. Each technique has

similar results in terms of satisfactory

relief of pain, improvement

in function, and patient satisfaction,

although less invasive

surgery frequently results in an

easier rehabilitation process and

less postoperative pain. In addition,

certain factors have been

identified that can decrease the

likelihood of obtaining a satisfactory

result, regardless of the type

of procedure, and include poor

tissue quality, large or massive

tears, advanced patient age, and

poor compliance with post-operative

rehabilitation and restrictions.

Ultimately, however, management

decisions for how best to treat

your shoulder is a personal decision

involving many factors that

are best discussed on a case by

case basis with your orthopaedic


16 The Orthopaedic Institute



352-336-6000 • WWW.TOI-HEALTH.COM

Ou r Ph y s i c i a n s

The Orthopaedic Institute is a private practice group of 21 fully trained, experienced,

specialty physicians providing the complete spectrum of musculoskeletal care from

prevention and diagnosis to treatment and rehabilitation

James W. Berk, M.D.

Board Certified

FP & Sports Medicine

W. Preston Blake, M.D.

Board Certified

Orthopaedic Surgery

Frank D. Ellis, M.D.

Board Certified

Orthopaedic Surgery

Edward M. Jaffe, M.D.

Board Certified

Orthopaedic Surgery

Adil Kabeer, M.D.

Board Certified

Plastic Surgery

Th e Or t h o pa e d i c In s t i t u t e

Kipp W. Kennedy, M.D.

Board Certified

Orthopaedic Surgery

Rodger D. Powell, M.D.

Board Certified

Orthopaedic Surgery

Timothy Lane, M.D.

Board Certified

Orthopaedic Surgery

Phil Rhiddlehoover, M.D.

Specializing In

Sports Medicine

Amanda G. Maxey, M.D.

Board Certified

Orthopaedic Surgery

Andrew F. Rocca, M.D.

Board Certified

Orthopaedic Surgery

Phillip L. Parr, M.D.

Board Certified

Orthopaedic Surgery

Jason J. Rosenberg, M.D.

Board Certified

Plastic Surgery

Mark A. Petty, M.D.

Board Certified

Orthopaedic Surgery

Edward J. Sambey, M.D.

Specializing in

Sports Medicine

Arthur M. Sharkey, M.D.

Board Certified

Plastic Surgery

Jason Shinn, M.D.

Board Eligible

Orthopaedic Surgery

James B. Slattery, M.D.

Board Certified

Orthopaedic Surgery

John C. Stevenson, M.D.

Board Certified

Neurological Surgery

D. Troy Trimble, D.O.

Board Certified

Orthopaedic Surgery

Th e p h y s i c ia n s o f Th e Or t h o pa e d i c In s t i t u t e h av e b e e n p r o v i d i ng

q u a l i t y m e d i ca l c a r e to No r t h Fl o r i da f o r o v e r 25 y e a r s. Ea c h

p h y s i c ia n pa r t i c i pat e s in l o c a l a n d n at i o na l m e d i ca l a s s o c i at i o n s

a n d e n d e av o r s to r e m a i n u p to d at e o n t h e l at e s t t r e at m e n t a n d

s u r g i ca l t e c h n i q u es.

J. Stephen Waters, M.D.

Board Certified

Orthopaedic Surgery

Ou r Se r v i c e s

Ge n e r a l Or t h o pa e d ic s

Diagnosis, treatment, and rehabilitation

of common injuries and diseases of the

musculoskeletal system including: bones,

joints, ligaments, muscles, and tendons.

Sp o r t s Me d ic in e

Diagnosis, treatment, and rehabilitation of

sports injuries including: ligament tears,

cartilage injuries, joint instability, overuse

injuries, and muscle weakness.

Oc c u pat i on a l Me d ic in e

Diagnosis, treatment, and rehabilitation of

the wide range of orthopaedic problems that

can occur in the workplace due to traumatic

injuries and repetitive stress disorders.

No n-Su r g ic a l Or t h o pa e d ic s

Diagnosis, treatment, and rehabilitation

of non-surgical injuries including: sprains,

fractures, and acute or chronic pain of the

extremities. Non-surgical orthopaedics

focuses on proper exercise and rehabilitation

techniques as treatment rather than surgery.

Sp in e Di s o r d e r s

Diagnosis, treatment, and rehabilitation of

spine disorders including: cervical and lumbar

disorders, spinal stenosis, and scoliosis.

Su r g ic a l Pr o c e d u r e s

Depending on the severity of your condition

and diagnosis, you may require a surgical

procedure. Below are the categories of

the surgical procedures provided by the

physicians of The Orthopaedic Institute:

• Hand Surgery

• Shoulder Surgery

• Knee Surgery

• Hip Surgery

• Spine & Neurosurgery

• Foot & Ankle Surgery

• Joint Replacement Surgery

• Plastic & Reconstructive Surgery

• Arthroscopic Surgery

• Minimally Invasive Surgery

Ot h e r Se r v i c e s

In keeping with our objective of providing

the complete spectrum of musculoskeletal

care, the following ancillary services are

available on site:

• Digital X-Ray


• EMG / Nerve Conduction Studies

Orthopaedic Rehabilitation Services

• Work Comp Pharmaceutical Program

• Outpatient Surgery

Fa s t Ac c e s s -

Or t h o pa e d ic & Sp o r t s Me d ic in e Cl in ic s

Our Fa s t Ac c e s s Clinics offer same and next

day appointments Monday through Saturday*

in the following three convenient locations:

• Gainesville - Phillip L. Parr, M.D.

• Lake City - Edward J. Sambey, M.D.

& Phil Rhiddlehoover, M.D.

• Alachua - James W. Berk, M.D.

Our Fa s t Ac c e s s Clinics provide the following

clinical services:

• Treatment of all Musculoskeletal Injuries

• Treatment of Cuts (minor suturing),

Abrasions, Needle-sticks*, Chemical

Exposures* and other Workplace Injuries

• X-Rays, Casting and Splinting performed

in office

• Ongoing Treatment and Follow-up of

Non-Surgical Patients

• Referrals to Orthopaedic, Hand and Spine

Specialists, as appropriate

• Referrals to Physical Therapy and Hand

Therapy, as appropriate

• Referrals to Other Specialists, as


Wo r k e r’s Co m p Pr o g r a m

The Orthopaedic Institute provides a

dedicated work comp department available

8 am - 5 pm Monday - Friday. Our physicians

& staff realize the importance of prompt

service and effective communication to

efficiently serve injured workers.

*Lake City Only

Th e Or t h o pa e d i c In s t i t u t e

w w w .TOI-h e a lt h.c o m

A Pr e s c r i p t i o n f o r Pa t i e n t Ed u c a t i o n

Th e Or t h o pa e d ic In s t i t u t e’s w e b s i t e is a va l u a b l e r e s o u r c e

p r o v i d in g in f o r m at i on o n t h e f o l l o w i n g:

• Profiles of our 21 Fully Trained,

Specialty Physicians

• Comprehensive List of Services

• Conditions & Procedures Animation


• Physician Articles

• Workers Compensation Program

• Referral Services Program

• Fast Access Clinics

• Detailed Maps of Our 3 Locations

• Useful Links

• New Patient Information

-Patient Registration Forms

-Appointment Requests

• Insurance Information

• Informational Video about TOI

• Contact Information

• News & Events

• Employment Opportunities

Co n d i t i on s a n d

Pr o c e d u r e s Animation

Li b ra ry

On the home page of our

web site, you can Click

Where It Hurts. This feature

allows you to choose the

part of the body that is

bothering you. You can

then learn more about

your condition and related

procedures through 3D



Wireless Internet

now Available in

Patient Waiting


Do n’t Le t Fa l l s Tr i p Yo u Up

“It can take just one fall to lead to the loss

of a person’s independence and mobility,”

explained Richard F. Kyle, MD, first vice

president of AAOS. “It is important to minimize

obstacles in the home that often contribute to

slips and falls. When simple safety measures

are put in place, these mishaps can decrease


AAOS recommends following the below

home safety checklist to fall-proof your


• Get rid of clutter. Don’t pile up items on the

floor, stairway or pathways between rooms.

• Keep appliance, lamp and telephone cords

out of areas where you walk. Don’t put them

under rugs.


surgeons provide

tips to prevent

deadly falls


Whether it is caused by a wet floor, slippery

throw rug, loose cord or objects in the wrong

spot, falls in the home happen. The truth is,

falls are not only the most common cause

of injury among American adults age 65 and

over, but are also the leading cause of death

in the home, according to the National Safety

Council. One in three adults over age 65 falls

every year, and 90 percent of the 350,000

hip fractures that occur in the U.S. each

year are the result of a fall. According to the

American Academy of Orthopaedic Surgeons

(AAOS), fall-related injuries can be reduced

by removing clutter and items from the home,

learning how to fall properly, and performing

exercises that strengthen muscles and

improve balance.

• Use a rubber mat or put adhesive texture

strips on the bottom of the tub or shower.

install grab bars on the walls for additional

support. Place a slip-resistant rug on tile floor

to safely get in and out of the bathtub.

• Attach non-slip treads to bare-wood steps,

and remove small area rugs at the top and

bottom of stairs.

• Good lighting is essential, so it is important

to install glow-in-the-dark light switches at

both the top and bottom of stairways. Also,

place a night-light along the route between the

bedroom and bathroom.

• Keep a flashlight and new batteries by the

bed in case of a power outage.

• Clean up spills in the kitchen immediately.

Use a step stool or low stepladder – not chairs

or boxes – to reach items in upper cabinets.

Use non-skid wax on the kitchen floor.

• Wear proper footwear around the home and

outside. Never walk around in stocking feet.

Consider sneakers and shoes with laces.

Avoid higher heels or platform shoes.

The Orthopaedic Institute 21

People of all ages can

reduce their risk of falls

through regular exercise,

as even moderate

physical activity can

help maintain strength,

coordination, agility

and balance

Of course, even the most careful

people are still susceptible to

trips and falls. With that in mind,

there are “correct” ways to fall

to minimize potential injury.

Below are some recommended

techniques to follow if you cannot

prevent a slip or fall:

• If possible, try to fall on your

side or buttocks. Roll over

naturally, turning your head in the

direction of the roll.

• Keep your wrists, elbows

and knees bent. Do not try to

break the fall with your hands or


• Take several deep breaths

after falling. If you feel you have

suffered an injury, do not try

to get up. Call 911 or a family

member for help.

• If you feel you are not injured

and are able to get up, crawl to a

strong, stable piece of furniture,

like a chair, that you can use as

a support to help pull yourself up.

Place both hands on the seat.

• Slowly begin to raise yourself

up. Bend whichever knee is

stronger, keeping the other knee

on the floor. Finally, slowly twist

and sit in the chair.

The Academy recommends that

everyone, especially seniors,

get regular physical checkups.

A healthcare provider may

discover problems that can make

someone more prone to falling.

A provider can also monitor side

effects from any prescriptions

and over-the-counter

medications, such as sleep aids,

that might affect balance. People

of all ages can reduce their risk

of falls through regular exercise,

as even moderate physical

activity can help maintain

strength, coordination, agility and

balance. Exercises that improve

balance and coordination are

the most beneficial. A sedentary

lifestyle – at any age – leads

to weakness and increased

chances of falling.


22 The Orthopaedic Institute


Medical Associates

Robert G. Valentine, Jr. MD

Practice Limited to Pain Medicine

What is Pain Management?

The practice of pain medicine is concerned with the identification,

treatment and rehabilitation of painful disorders. Focusing on

lessening the sense of suffering experienced by our patients, we

hope to blend physical and emotional education for individuals and

their families to aid patients in regaining control of their lives.

Special Interest In:

• Chronic Back Pain

• Flexion / Extension


Phone: 352.331.3353

Fax: 352.333.9035

7550 West University Ave, Suite A

Gainesville, FL 32607


The Orthopaedic Institute is pleased to

announce the ground breaking of its new

17,500 square foot medical office building

in Lake City. In addition to increasing

our clinic capacity, the facility will include

state-of-the-art imaging, physical and hand

therapy and will offer Saturday Fast-Access

services. By expanding our operations

to better meet the needs of our growing

community, we will be able to help more

patients reach their personal wellness goals.


The Orthopaedic Institute 23

St ay We l l Hy d r at e d f o r Pe a k Pe r f o r m a n c e

By Charles Hudson

Staying well hydrated during exercise is a crucial

goal of not only high-performance athletes, but

more casual ones as well. You can get dehydrated

very quickly if you don’t take proper precautions,

especially if you are involved in rigorous physical


Water is essential to the normal functioning of

muscles, and H2O acts as a coolant for the body.

Drinking enough fluid is crucial to avoid “bonking”

or loss of endurance and performance during

physical activity.

But beware: Drinking to thirst will not hydrate

properly. An athlete gets thirsty after becoming

dehydrated 1 percent of body fluid levels (the

body is approximately 60 to 70 percent water).

But performance loss also begins to appear at 1

percent. Runners dehydrated by 2 percent in 5K

and 10K timed trials were 6 percent and 7 percent

slower, respectively.

The popular rule of thumb for non-exercising

individuals is to drink eight glasses of water a day.

Athletes burn more calories, and their muscles

generate 8-10 times more heat than non-athletes.

With rigorous exercise and warm conditions, an

individual can lose 2 to 3 liters of water per hour.

Checking your body weight before and after

exercise is a simple way to determine your fluid

needs. If you have lost 1 pound during exercise,

you need to replace it with at least 16 ounces of

fluid (a pint a pound). Another rule of thumb is to

drink 8 to 12 ounces of water for every 20 minutes

of exercise.

amounts of juice or other sweetened beverages

because of their high concentration of sugars.

Carbonated soft drinks, alcoholic beverages and

caffeinated drinks can actually have a diuretic

effect, increasing fluid loss.

Fluid replacement should begin pre-event -- 8 to

12 ounces of water should

be consumed 3

hours before


Don’t forget:

* Water has

no calories, so

consume freely

* Drink water

before, during

and after


* Drink cool

liquids; your

body absorbs

water most

readily when it’s

50 to 60 degrees

* Drink 8 to 12

ounces of water

every 20 minutes

of exercise.

Carrying enough water to maintain proper

hydration can be a problem. If you’re at the gym,

carry a gallon of water with you. If you plan to

exercise for extended periods of time, a backmounted

hydration system is recommended.

Water is all that is needed for most workouts. Most

people drink what tastes good, so juices, sport

drinks and soft drinks have become very popular.

But it is not recommended to consume large

24 The Orthopaedic Institute


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The Orthopaedic Institute 25

Bo d y Im a g e Pr e v e n t i v e Me d ic in e

By Donald Davis

If you could predict the illnesses

that you might develop in the

future, would you want to know

now? Modern technology

has made it possible through

a technique known as body


Two types of scanners are

being used by commercial

organizations to give consumers

information about their insides.

One is a modern CT Scanner.

The other is called an Ultra

Fast CT Scanner, which uses

Electron Beam Tomography

(EBT) to snap images of internal

organs at speeds up to 10 times

faster than other state-of-the-art

CT scanners. The EBT costs

a bit more, but studies have

found it to be more effective

at recording images of moving

organs. With these technological

tools, medical technicians can

now gain three-dimensional

images of the torso. A look inside

a person’s major organs and

arteries can reveal blockages,

cancers and any number of other

abnormalities that previously

could not be determined

until they had become much

larger and significantly more


Many members of the medical

community, including some

national organizations,

believe that the treatment

itself represents the danger.

Acceptance of the technique

by the Food and Drug

Administration has led to

controversy, even as members

of the general public sign up for

four-month long waiting lists.

The question persists: if you

could look inside yourself to

determine potential diseases,

would you want to know? If the

answer is yes, then consider

this. We now bear witness to

one future of modern medicine:

the ability to accurately predict

diseases before they need to be


The Procedure

AmeriScan, Health View, Virtual

Physical and the other outfits

offering this internal glimpse

operate in similar ways using

the two types of scanners. You,

as a client, contact one of the

groups and receive instructions

for how to get ready. For most

procedures no preparation

26 The Orthopaedic Institute

whatsoever is required, but for some

scans, such as virtual colonoscopies,

a fluid must be drunk and diet

restrictions take effect.

Immediately, this medical procedure

feels different from other clinical

experiences. There are no blood

tests to take or clothes to shed. At the

appointed time, you climb aboard a

clinical bed surrounded by what looks

like a high-tech donut. Once settled

in, a clinician provides instructions

to breathe in, hold it and breathe out

as the futuristic pastry (actually an

x-ray tube or an EBT tune) scans

and records three-dimensional

images. If you’re in a place using a

CT Scanner, it rotates around you

and the bed, snapping images from

different angles. If you’re under an

EBT machine, the scanner simply

sweeps its beam through your back

and around your organs for imaging.

In either case, after less than 15

minutes of high-speed data gathering,

the procedure is completed.

Then the fun begins.

You go into a room to discuss the

recordings with a medical consultant.

Images straight out of a middleschool

science book appear on a computer

screen - the primary difference being

that these pictures are not of some

faceless model but of you. A detailed

analysis of your internal organs

follows, each image looked over for

irregularities - calcified plaque on the

coronary arteries; spots on the lung;

growths on the liver or pancreas; or

maybe no problems at all. After an

hour or more of this, the consultation

is complete. You leave with a written

analysis, a CD-ROM of the imaging

and more knowledge of your innards

that you can probably deal with.

The Clients

Most body scanning centers

recommend the procedure for people

over 35 years of age who believe

they may be at some risk for health

problems down the line. Some clinics

refuse to test people in their 20s,

adhering to the stance taken by some

critics who believe the test does more

to raise health fears than to allay

them. For older individuals, centers

frequently suggest using the scan as

a complement to annual physicals.

It’s the philosophy of people like Dr.

Craig Bittner that Americans fail to

address diseases until they become

problems. Dr. Bittner, a cardiovascular

and interventional radiologist, founded

AmeriScan because, he says, he

wanted to revolutionize the health


“America spends more than any other

country on health care but is number

37 in overall health outcomes,” he

says. “As a physician, I am committed

to evolving the practice of medicine

to a more proactive, preventative

approach. I believe it is just as

important to preserve health as it is to

prolong life.”

That thought translates to frequent

recommendations based on the scans

to make lifestyle adjustments, such

as improving general diet and making

exercise a routine part of life.

Even though many people already

eat right and exercise regularly,

proponents of regular body scans

insist that annual clean checkups

alone do not mean inner health. In

fact, the man who began the first body

scanning clinic, Dr. Harvey Eisenberg

of Health Scan in Los Angeles, insists

that of the 15,000-plus clients that he

The Orthopaedic Institute 27

has served, he has never found

a perfectly clean bill of health.

That kind of statement - for

some an argument in favor of

conducting regular scans - also

serves as fuel for opponents of

the procedure.



Body scanning, being newly

introduced into American

culture, does not exist without

controversy. Some think that

making people aware of their

smallest physical irregularities

will result in widespread

hypochondria. Certainly, seeing

an image of a coronary artery

with a white speck of plaque

build-up will discourage a

lot of people from reaching

immediately for the nearest

cheeseburger. In this case, most

people would probably argue that

ignorance, while blissful, does

not encourage better health. Still,

watching one’s own guts working

on a monitor is probably not for

the most physically squeamish.

Critics have raised more

significant concerns as well.

The FDA has voiced concern

over the amount of radiation CT

scans emit, suggesting that body

scan receivers may literally be

doing more harm than good. An

average CT scan produces 100

times the radiation of a typical

x-ray. Looking around too much

in there for cancer could result in

cancer - not a very effective kind

of preventive medicine.

CT scanners have been around

for some two decades, and

much of the technology has

been greatly improved in that

time. The newest models

emit less than one-third the

radiation of the older ones. Jeff

Sorenson, marketing director

for Imatron, cites studies that

prove EBT Scanners are even

less dangerous, emitting 1/5

the radiation of modern CT

Scanners. And though many

doctors and organizations are

skeptical, preferring to err on the

side of caution concerning the

new procedures, others believe

that the threat of radiation has

no more merit than the idea

that the sky is falling. Medical

writer Michael M.D. and Dr.

Robert J. Cihak, president of

the Association of American

Physicians and Surgeons believe

attacks on scanning to be without

merit or balance. They approve

of the procedure because it is for

thoughtful adults, and because,

in their estimation, the levels

of radiation for each scan are

sufficiently low.

That does not mean scanning

is necessarily useful.

Manufacturers of EMT Scanners

say the CT Scanners take

images too slowly, recording

only blurred and useless pictures

of the heart. They aren’t the

only ones voicing criticism. The

American College of Radiology,

for example, has stated that,

“to date there is no evidence

that total body CT screening

is cost effective or effective in

prolonging life.”

28 The Orthopaedic Institute

The College’s ambiguous statement

implies that nothing can be said for

certain about the potential dangers,

and benefits, involved until time has

passed and more study has been

made. To that effect, the state of New

York has begun studying whether CT

scanning is an effective determiner of

lung cancer in smokers.

Other feedback comes from

clients who have experienced the

body scans. And according to the

proprietors, anyway, that feedback is

very positive indeed.

The Verdict

Because getting a body scan does

not require a doctor’s referral, the

final choice of whether to try out

this new procedure is up to you.

One factor may involve the cost

- a full body scan usually runs up

toward $1,000, and most insurance

companies do not cover the expense.

In deciding, your first thought should

be whether such a diagnostic effort

is necessary. Age and risk factor

both should be considered. Also, if

you decide to go through with it, be

prepared to see some potentially

unpleasant sights. A spot of plaque

in an artery or discolored dot on

a lung could cause you great

concern. The body scan only serves

to give a glimpse inside - further

examination could prove much

costlier and, ultimately, turn out to be


It’s up to you. If you’d like to see as

much as you can about your body, a

full scan can give you a pretty good

picture. When it comes to the future

of your health, you just have to ask

yourself whether or not you really

need to know.

Contact Information - 1-888-724-VIEW - 1-650-583-9964 - 1-866-V-PHYSICAL - 1-866-VITAL-1-1

The Orthopaedic Institute 29

General Contractor • Construction Manager • Design Build

3019 SW 27th Avenue, Suite 102

Ocala, Florida 34474

Phone: (352) 873-3900


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multiple clinic locations and ancillary

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only patient-friendly, functional and

efficient, but an award winning

landmark in the community as well.”

~~Eric J. Brill, CEO

Gainesville Orthopaedic Institute

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30 The Orthopaedic Institute

Ge t t i n g t h e Mo s t Ou t o f Yo u r Do c t o r’s Visit

The relationship

between a physician

and patient should

be viewed as a


Have you ever gone to the doctor and not

understood what you were told? Has he/she used

medical jargon that is over your head? Have you

left the physician’s office not understanding the next

steps? Or felt like your doctor doesn’t understand

what you are going through? Well, you are not


Many people have a hard time communicating

with their physicians. But research shows that

effective communication with your doctor, including

understanding your diagnosis and treatment plan,

plays an important role in your recovery time and

overall improvement. The American Academy of

Orthopaedic Surgeons (AAOS) recognizes this and

is taking steps to ensure that you get the most out

of your visit with the orthopaedic surgeon.

Most physicians have had limited training in

effective communication techniques, and some

physician groups are trying to change that. The

AAOS, in partnership with The Bayer Institute,

offers a training program to teach orthopaedic

surgeons that complete clinical care consists

not only of the thought to “find and fix it,” but

that communication skills such as empathy and

engagement are important to ensuring a successful

visit with a patient.

Orthopaedic surgeons want to connect with their

patients. They want their patients to trust and

respect them, which in turn will likely make their

patients more compliant with a treatment program,”

says William Schreiber, MD, orthopaedic surgeon

and patient-physician communications trainer. “In

order for this to happen, physicians need to learn

to communicate better and a communications

program like this will help them do that.”

William Ferris, a patient of Dr. Schreiber from

Holly Lake Ranch, TX, needed surgery to replace

his right knee. “I found it very easy to understand

Dr. Schreiber. He reassured me, answered all of

my questions and I felt that he really listened to

my concerns. I wasn’t afraid to ask questions, no

matter how simple or complex they were,” says


Ferris and Dr. Schreiber have a great relationship.

In fact, when Ferris started having problems with

The Orthopaedic Institute 31

* Before seeing the doctor, prepare a list of

questions and points you would like to

address. It may be beneficial to take

notes during the visit.

* Be honest and complete when talking with your

doctor. Share your point of view and don’t hold

back information about issues that you might

consider embarrassing.

* Make sure the physician explains medical

terminology that you don’t understand, as well

as recommendations regarding treatment and


* Ask what to expect from the treatment, the effect

it will have on your daily activities and what you can

do to prevent further disability.

* Make sure your doctor provides you with

handouts or brochures that you and your family

members can review at home.

his other knee, he went back to Dr. Schreiber

for a partial knee replacement on the left knee.

“I am used to playing golf and being active and

Dr. Schreiber helped me stay that way. I even

recommended him to my neighbors. Five of us

on my block have had knee replacements by Dr.

Schreiber in the past two years.”

Proper communication with a patient will ensure

that the best medical attention is given. “The

relationship between a physician and patient

should be viewed as a partnership,” Dr. Schreiber

says, “with each partner’s contribution considered

equal in importance.”

As a patient, there are certain actions you can take

to ensure a good relationship with your physician.

The following checklist and tips will help you and

your doctor discuss the issues most important to

help you get the most out of the visit.

* Ask a family member or friend to go with you to

your next visit. This person can help ask questions

and address concerns in areas where you have

forgotten or weren’t able to address.

* Follow the doctor’s instructions. Take the full

course of medication and make sure you follow the

prescribed diet and/ or exercise routine.

* If something is confusing or does not seem right,

call the doctor’s office for advice. His/her staff often

knows the answer.

* If you are not getting the answers you need, try to

communicate this to your physician. If he/she does

not respond, it may be beneficial to seek another


Your recovery is important. Physicians are there

to make your ailments better. Continued dialog

between you and your doctor will help you

establish a partnership, which in turn, may make

your recovery quicker.

32 The Orthopaedic Institute

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

Co m p u t e r As s i s t e d Nav ig at i o n in To ta l Kn e e Re p l a c e m e n t

Edward M. Jaffe, M.D.

I am very fortunate to have been

involved in orthopaedic surgery

over the last 20 years in a time

when wonderful new advances

have been made that allow us

to improve the care we provide

to patients. Scientific exploration

into musculoskeletal disorders

have led to better understanding,

improved materials, streamlined

procedures, better surgical techniques,

rehabilitation strategies

and improved outcomes.

One of the more recent advances

that I have started to use in my

practice is computer assisted

navigation in total knee replacement

(TKR). In TKR a surgical

approach is made to expose the

bone and worn cartilage surface

of an arthritic knee joint. Most

commonly there is also an angular

deformity of the joint. The goal

of knee replacement surgery is to

correct the angular deformity, i.e.

restore the normal mechanical

axis, and resurface the worn joint

surfaces with metal and plastic

surfaces. The goal is to achieve a

knee that has improved function

and less pain.

In order to do this, the ligaments

that hold the bones in relationship

to each other have to be restored

to their appropriate length (i.e.

balanced) and the ends of the

bones have to be cut at proper

angles. The cut bone surfaces

will then receive the artificial joint

surfaces known as the prosthetic


In conventional knee replacement

surgery, in order to make

the bone cut at the distal femur

(or the end of the thigh bone),

a hole is drilled into the canal of

that bone and then a rod is driven

into the canal. A cutting guide is

attached to the end of the rod,

the angle set, and the cut is made

with a saw.

In computer assisted knee

replacement surgery, the canal

of the femur is not entered. This

in itself has the advantage of

avoiding displacement of bone

marrow droplets, which can enter

the circulation and travel to the

heart or lungs. It may also help

limit blood loss into the knee.

A pointer and tracker system is

used instead of an intramedullary

rod, to send information about the

position of anatomic landmarks,

via infrared signal, to a computer

in the operating room. The

computer then sends signals

Dr. Jaffe is Board Certified in Orthopaedic Surgery. His areas of clinical

interest include arthroscopic surgery, joint replacement and reconstruction

surgery, minimally invasive surgery and sports medicine. Dr. Jaffe attended

medical school at The University of Florida, where he also completed his

residency training in orthopaedic surgery. In his free time, he enjoys spending

time with his family, fishing, scuba diving and attending UF sporting events.

The Orthopaedic Institute 33

Th e Or t h o pa e d i c In s t i t u t e - Im p r o v i n g Li v e s Ev e ry d ay

back to a tracker on the cutting

guide which helps the surgeon

place the cutting guide in the

proper position to make the bone

cut. Studies have shown that the

computer assisted navigation

improves the precision of the

angle of the cut. A similar

computer assisted technique is

then used to guide the bone cut

of the proximal tibia or the upper

shin bone.

Not all orthopaedic surgeons

who perform total knee replacements

agree that computer

assisted navigation enhances

the outcome of the procedure.

Certainly the overwhelming majority

of total knee replacements

performed in the conventional

manner turn out well. I see the

advantage in using the computer

navigation system in that it

should help decrease the number

of “outliers” or the few cases

that, for various factors of patient

anatomy, could otherwise end up

with less than ideal alignment.

One study showed that conventional

TKR techniques achieve

alignment to within 3 ◦ of the ideal

mechanical axis 92% of the time,

while computer assisted navigation

restores that alignment 98%

of the time.

One of the most positive outcomes

of using computer assisted

navigation has been a surprise

to me. Recently, patients have

been arriving to their one-month

post-operative visit doing remarkably

well. Of course this does not

apply to all cases, but compared

to my previous conventional TKR

patients, a much higher percentage

of my patients who have

undergone surgery with computer

assisted navigation are walking in

at this early visit without crutches,

walkers or canes, with very little

pain and with excellent range of

motion in their operated knee. I

attribute these surprisingly rapid

recoveries to the fact that with

the computer system we do not

violate the distal femur to place

an intramedullary alignment rod.

I believe this leads to less pain,

less bleeding, less swelling and

thus, better early results. “In my

opinion, my recovery has been

remarkable,” says Susanne Pennypacker,

a patient of mine who

underwent TKR with computer

assisted navigation. “I was the

ultimate reluctant patient. I endured

years of knee pain without

surgery because I feared dependency

following the procedure. If I

had known my recovery would be

so rapid, and that I would regain

my independence so quickly, I

would not have approached surgery

with such trepidation.”

Computer assisted navigation is

still relatively new in total knee

replacement and its final role and

full acceptance is yet to be determined.

Nonetheless, it has the

potential to improve our overall

results in total knee replacement.

It is indeed an exciting time to be

an orthopaedic surgeon.

34 The Orthopaedic Institute

Orthopaedic Surgery Center

This state-of-the-art

orthopaedic outpatient

surgical facility was

designed, equipped

and staffed to meet

the specific needs and

requirements of the

Orthopaedic Surgery

Center’s surgeons and

their patients.

• Over 10,000 square foot fully Licensed Ambulatory Surgical Facility

• Expansion planned for 2008 to better serve the Gainesville community

• Conveniently located on the Orthopaedic Institute campus

• Joint Commission Accredited

• Medicare Certified

• Accepts most major insurance plans

• Designed to meet all your orthopaedic and reconstructive outpatient surgery needs

Orthopaedic Surgery


4600 West Newberry Road

Gainesville, Florida 32607

Main: 352.367.2310

FAX: 352.367.2512

The Orthopaedic Institute 35