In This Issue
6. Conditioning for the
Debunking the distance running myth
The purpose of conditioning activities
for pitchers should be to build a superior
athlete. Stan Skolfield, ATC, CSCS, debunks
the myth that distance running results in
a better pitcher.
8. Finding Relief
for Your Arthritic Thumb
Diagnosing and treating thumb arthritis
Thumb arthritis develops when the cartilage
covering the bones wears out. Dr. Sacha D.
Matthews provides an overview of thumb
arthritis and its multiple treatment options.
10.Why a Second Opinion?
Don’t hesitate to ask for
There are frequently multiple ways to
treat a given condition and second
opinions can be helpful and reassuring.
Patients should never be afraid to ask
for a second opinion.
12.Try a Tri
Trio of activities leads to
better fitness health
There is no better way to get in shape than
to try a triathlon. Dr. Eric Hoffman offers
tips for how to start triathlon training.
16. Experience in
Surgical advancements offer
more benefits to patients
Most shoulder procedures are now done on
an outpatient basis thanks to advancements
in arthroscopic techniques and safe
outpatient perioperative pain management.
20. Understanding Sports-
Frequently asked questions
The best way to prevent difficulties with
a concussion is to manage the injury properly
when it does occur. Dr. Lucien R. Ouellette
answers some of the most common questions
regarding sports-related concussions.
5. OA in Motion: What’s New? News and notes on people, places and happenings in the organization.
The OA Update is published by Oser-Bentley Custom Publishers, LLC, a division of Oser Communications Group, Inc., 1877 N. Kolb Road, Tucson, AZ 85715. Phone (972) 687-9035 or (520) 721-1300, fax (520) 721-6300, www.oser.com.
Oser-Bentley Custom Publishers, LLC specializes in creating and publishing custom magazines. Inquiries: Tina Bentley, email@example.com. Editorial comments: Karrie Welborn, firstname.lastname@example.org. Please call or fax for a new
subscription, change of address, or single copy. This publication may not be reproduced in part or in whole without the express written permission of Oser-Bentley Custom Publishers, LLC. To advertise in an upcoming issue of this
publication, please contact us at (972) 687-9035 or (520) 721-1300 or visit us on the Web at www.oser-bentley.com. July 2009
The OA Update 3
The physicians and staff of OA Centers for Orthopaedics (OA) welcome you to the latest issue
of The OA Update. In publishing this magazine, OA hopes to create an opportunity for educating
patients and their families about various orthopaedic conditions, preventative strategies for avoiding
injury and treatment options should an orthopaedic problem arise. We believe that offering
information on new and evolving techniques and treatments enhances our patients’ ability to
participate in making educated treatment decisions.
In this issue, we’ve included information ranging from bone health to hip arthroscopy to
preparing for your first triathlon. We hope you find this issue informative and helpful, and welcome
any suggestions for future publications. We’ve already heard from some of you and are appreciative
of your comments and feedback!
The Physicians at OA Centers for Orthopaedics
15 Lund Road
Saco, ME 04072
OA Centers for Orthopaedics
33 Sewall St.
Portland, Maine 04102
(207) 828-2100 • (207) 828-2190 fax
John Wipfler Chief Executive Officer
OA is the premier orthopaedic practice in Maine.
Our 23 highly specialized physicians are experienced
in the latest techniques and innovations. OA
specialty centers include sports medicine; hand
surgery; joint reconstruction of the hip, knee and
shoulder; foot and ankle surgery; and complex fracture
treatment. OA—Experience in motion!
4A Commons Ave. Rte. 302
Windham, ME 04062
Joint Replacement Center
Orthopaedic Trauma Center
Foot and Ankle Center
Sports Medicine Center
Orthopaedic Surgery Center
Physical Therapy Center
The information contained in this publication is not
intended to replace a physician’s professional
assessment. Please consult your physician on matters
related to your personal health.
4 The OA Update
OA in Motion
AAAHC Best Performer
OA again participated in a performance measurement
initiative evaluating best practices for knee
arthroscopy with menisectomy, with the purpose of
collecting data on key processes and outcomes for this
procedure. The information obtained is used for
clinical quality improvement efforts and to provide
organizations with alternatives in practice to provide
a better value in quality and cost to their patients.
The Institute for Quality Improvement, a
not-for-profit subsidiary of the Accreditation
Association for Ambulatory Health Care
(AAAHC), identified OA’s Surgery Center as a
“Best Performer” in the following categories:
• Lowest Pre-procedure
(No. 1 rank, top 3 percent)
• Lowest Procedure Time
(No. 1 rank, top 3 percent)
OA Sports Center Open House
OA Centers for Orthopaedics and MHG Ice
Centre have joined together to create a fully
integrated state-of-the-art facility, which includes
OA’s orthopaedic and sports medicine clinic, OA
Physical Therapy Center, the OA Performance
Center featuring the Parisi Speed School and a
biomechanical research center, as well as a yearround
indoor ice arena and home of the Portland
Junior Pirates. An open house celebration was held
in March, and the event was attended by 2,000
guests including Governor John Baldacci and Bill
Parisi, founder of Parisi Speed School.
Dr. Brown as “Godfather”
This past April, OA's Dr. Douglas Brown was
traveling with the fellowship program of the
American Orthopaedic Society for Sports Medicine
to Japan, South Korea, Taiwan, Thailand and
Singapore. The traveling fellowship program is an
annual scientific and cultural exchange among
orthopaedic sports medicine physicians in North
America, Europe, Latin America and the Pacific
Rim. Three fellows are selected to visit foreign sports
medicine centers for three weeks and are
accompanied by a “Godparent”—a well-known
senior orthopaedic sports medicine specialist
selected by the president of the national sports
medicine organization. The Godparent for this year’s
trip was our very own Dr. Brown. This is an honor
for Dr. Brown, and the OA Team is proud of him!
Dr. Charbonneau receives
2008 Caregiver of the Year award
In recognition of her extraordinary commitment
to the delivery of care to patients and their
families, Dr. Elissa Charbonneau was presented
with New England Rehabilitation Hospital
(NERH) of Portland’s Caregiver of the Year
award. Dr. Charbonneau shares her time between
NERH and OA Spine Center. Congratulations
to Dr. Charbonneau!
Relocation of Satellite Office Services
As part of our commitment to providing the best in
integrated orthopaedic care and treatment for our
patients, OA Centers for Orthopaedics has
relocated clinical services from our
Scarborough and Yarmouth locations
to the new Saco location at 15 Lund Road.
Along with the Saco location, OA’s
physicians will continue to provide services
at our other locations in Portland and
Windham. While appointments with all of
OA’s physicians are not available at every
location, our appointment specialists will
work with the individual to schedule with
the appropriate physician at the most
Joint Lecture Series
The physicians from the OA Joint Replacement
Center are offering educational lectures on
contemporary options in total joint surgery. These
sessions will highlight leading options for fast
recovery, durable results, high activity and less
pain after joint replacement surgery. For more
information, email email@example.com
or call (207) 710-5509.
Lecture Schedule (6:30 p.m.–7:30 p.m.)
• May 6: What is the Right Type of Hip
Replacement for You?
Brian McGrory, MD
• May 20: Your Total Knee Replacement Options
Steve Kelly, MD
• June 3: The 24-Hour Minimally Invasive Total
George Babikian, MD
• June 17: Minimally Invasive (MIS) Knees
Peter Guay, DO
• July 1: 5000 Total Knee Replacements
Michael Becker, MD
• July 15: Shoulder Replacement Surgery
Donald Endrizzi, MD
OA as a Community Partner
The 18 staff members who constitute the OA
Events Committee coordinate programs and
events to encourage socializing across the
organization and get employees involved in the
community. In the past year, OA physicians and
staff have generously supported the following local
organizations through this committee’s efforts:
• The Root Cellar (Portland) and People’s
Regional Opportunity Program (South Portland):
Thanksgiving dinner donations for three families
• Salvation Army adopt-a-family program
(Portland): Christmas family dinner and gift
donations for four families
• Animal Refuge League of Greater Portland: Inkind
donations to support the animals at the
shelter and group project work at the shelter
• American Red Cross: Blood Drive at OA
• United Way of Greater Portland: Annual
The OA Update 5
Conditioning for the
By Stan Skolfield, ATC, CSCS
Warmer weather has returned, and that
means baseball season is underway. Boys and
girls will be running around throwing
baseballs and softballs as well as swinging the
bat. Coaches will also be busy preparing their
athletes for the demands of the season. Over
the years the training methods for developing
the superior ballplayer have changed, yet
many coaches are still doing things the “old
way” because that is the way they were taught
when they played competitive sports. I want
to share with you the biggest training myth
out in the game today in hopes that you will
not make the same mistake with your athlete.
The most common training myth that
baseball coaches and trainers fall into is: Pitchers
should run long or poles to get themselves in great
shape and recover from training.
The common view of most baseball
coaches is that distance running helps pitchers
by building strength in their legs, enhancing
their endurance, developing mental toughness
and improving their overall physical fitness. I
completely disagree—when was the last time
you saw a marathoner throw at 95 mph?
Not only is this far from the best use
of training time, it is proven to be
counterproductive. It is one of the worst
things you can do to train an explosive
athlete. After all, pitching is an explosive
action and to be good at it requires a
tremendous amount of recruitment and
development of fast twitch muscle fiber.
Think about it. If you wanted to
optimally train an athlete for an activity that
involves one to nine sets (innings) of 15–20
6 The OA Update
full body explosions (pitches) lasting one
second and then 20 seconds of recovery, then
a 15-minute block of rest recovery between
sets, does running slowly for two to three miles
sound like the best method for creating a more
explosive athlete? Would you train a 100 or
200 meter sprinter by running long distance?
Of course not. Don’t do it with pitchers either!
The purpose of conditioning activities for
pitchers should be to build a superior athlete.
Help them become more durable, effective and
explosive. Running long distance is a giant
waste of training time, recruits the wrong
energy system (aerobic vs. anaerobic), recruits
the wrong muscle fiber type (slow twitch vs.
fast twitch) and adds an unnecessary and
repetitive stress to the hip, knee, ankle and
foot. Distance running conditions ballplayers
to trot instead of bounce.
For those of you who want to argue that
it builds mental toughness, I beg to differ.
Running at a very slow pace for a prolonged
period of time is a great way to build mental
toughness if you’re a very weak-minded
individual. If you want to better condition
your pitchers, have them do 10–15 by 40- or
60-yard sprints. You could also have them use
ladders, do agility drills, perform series of
body weight exercises with short rest intervals.
The possibilities are endless as long as the
activity is brief and intense. I promise you, if
you program the workout correctly then by
the 8th or 9th rep of 60-yard sprints the
athletes will be sufficiently challenged
mentally. Compared to that workout, running
10 poles would seem like a vacation!
Pitchers should develop a great base of total
body strength in the weight room. Develop
lower body strength with squats, lunges, single
leg squats and step ups. Promote great core
strength through stabilization exercises (planks,
side planks, bridges) and rather than crunching
movements. Finally, promoting upper body
strength with chin ups, rows and push up
variations is a great way to lay the foundation
needed to develop a more explosive athlete.
So I challenge you to change your
mindset when it comes to conditioning your
ballplayers. Some of the points I have made
may go against the grain of old school
baseball, but the game has changed and so has
the athleticism it takes to be a superior athlete.
I will take an athlete who has developed him
or herself to be much more explosive over an
athlete who has a high VO2 max any day!
Stan Skolfield is a Certified Athletic Trainer
(ATC) through the National Athletic Trainers
Association (NATA) as well as a Certified
Strength and Conditioning Specialist (CSCS)
through the National Strength and Conditioning
Association (NSCA). He has been involved with
the training, nutrition and rehabilitation of
athletes at multiple levels. He has worked for the
Boston Red Sox, providing injury prevention and
rehabilitation for in-season teams. Stan is the
Manager for the OA Performance Center.
The OA Update 7
for Your Arthritic Thumb
By Sacha D. Matthews, MD
Thumb arthritis involves the joint at the base of
the thumb, the carpometacarpal (CMC) joint.
This joint is made of two bones—the trapezium
and the metacarpal. Thumb arthritis develops
when the cartilage covering the bones wears out.
As a result, the bones rub together causing pain,
swelling and stiffness. Anyone can develop
thumb arthritis, but it is seen more often in
women. It is more common as we age. Patients
experience an achy pain, which can wake them
up, and which is worse with pinching or gripping
such as opening jars. In advanced cases, patients
can develop weakness and a grinding sensation
with gripping. The thumb may appear deformed
with a “bump” at its base. The diagnosis of
thumb arthritis is made by a trained health care
professional. A history of pain in the base of the
thumb, worse with pinching, is suggestive of the
diagnosis. On physical exam, the CMC joint is
tender to touch and twisting causes a painful
grinding. X-rays can confirm the diagnosis.
Treatment begins with avoiding pinching
and gripping, heat in the morning to loosen the
joint, and ice at night to decrease swelling.
Mechanical jar openers and tools with larger
handles can be quite helpful. Splints that
support the thumb reduce pain. Cortisone
injections can lessen the pain for a time. If these
things fail, then surgery may be considered. The
type of surgery is determined by the treating
surgeon. Most commonly, surgery involves
fusion of the CMC joint, where the metacarpal
and trapezium are joined together, or a
Ligament Reconstruction Tendon Interposition
Arthroplasty (LRTIA), where the trapezium is
removed and a tendon is used to rebuild the
ligaments with the remaining tendon placed as
Arthritic Carpometacarpal Joint.
a spacer. These procedures are successful in
increasing motion and strength, while
eliminating pain. Don’t let thumb arthritis slow
you down—solutions are available.
Dr. Matthews is a hand surgeon in the OA Hand
Center, which provides comprehensive coverage for
the diagnosis, treatment and rehabilitation of all
types of hand and wrist problems. He is a fellow of
the American Academy of Orthopaedic Surgeons
and a member of the American Society for Surgery
of the Hand. He also has a Certificate of Added
Qualification in Hand Surgery.
Status-Post Carpometacarpal Suspension Arthoplasty.
8 The OA Update
The OA Update 9
Why a Second Opinion?
By Thomas F. Murray Jr., MD
In the practice of medicine, there are
frequently multiple ways to treat a given
condition. In many cases, there are different
recommendations and treatments that can be
offered for the same orthopaedic problem.
Practice styles can vary considerably, even
within a group practice, depending on where
and with whom the physicians trained. When
faced with the decision for proceeding with
surgery, many patients feel that another
opinion will be beneficial in verifying that a
diagnosis is correct and the treatment plan is
reasonable. In some cases, a patient may have
already initiated treatment with a provider, but
not be progressing as expected. Again, another
opinion may be reassuring or provide another
option not previously considered. A patient’s
physician may also request a second opinion
from another specialist to assist in providing
care to that patient. Finally, as is common in
work-related injuries, an insurance provider
may request a confirmatory second opinion to
be sure an employee’s care is reasonable.
The physicians at OA Centers for
Orthopaedics receive a number of requests
for second opinions. When requesting an
appointment for a second opinion, it is
important to provide the physician with a full
summary of prior evaluations, diagnostic tests
and treatments. While some patients may feel
that having access to this information may
negatively impact the new physician’s evaluation
and treatment recommendations, this is simply
not the case. This information is essential, not
only to provide the physician with a more
“complete” journal of the patient’s situation, but
also to minimize the need to duplicate studies
and incur unnecessary medical costs. In many
cases, the patient will be asked to gather
information and provide it to the physician he
or she is requesting to see prior to the
appointment. This will expedite the scheduling
process and make for a more comprehensive
While another opinion can be helpful in
some situations, multiple opinions can be very
confusing and counterproductive to a patient’s
recovery. To help with making the decision
to pursue a second opinion, the patient may
benefit from having a discussion with his
or her primary care physician. The primary
care physician may provide insight to the
recommended treatment plan and guide you
in seeking another opinion, or address your
concerns enough to proceed without one.
Remember that physicians may in fact have
different opinions on the treatment of a
problem, and while it is appropriate to explore
those differences with the providers, don’t
expect to reconcile the differences. The goal of
another opinion should be to confirm care
recommendations or to learn more about other
options. In the end, you may need to make a
choice based on the information provided.
Finally, patients can sometimes be reticent
to ask for a second opinion. This should never
be the case. Physicians themselves request such
consultations and realize it is an important
part of medical practice. So if you are not sure
about your treatment course or results, don’t
hesitate to ask for another opinion.
Dr. Thomas Murray Jr. practices sports medicine
and arthroscopic surgery at OA Centers
Top 10 Reasons
for a Second Opinion
The diagnosis or treatment seems to be in question
Treatment fails to provide relief
Unusual or complicated procedure is recommended
Out-of-work time or expense seems unreasonable
Recovery seems prolonged, delayed or incomplete
Your physician has little or no experience with a
A complication or mishap has occurred
A patient is told “nothing else can be done”
Physician-patient communication problems
Anytime you think it might help you
10 The OA Update
The OA Update 11
12 The OA Update
Try a Tri
By Eric D. Hoffman, MD
There is no better way to get in shape than to
try a triathlon. The combination of swimming,
biking and running leads to excellent upper
and lower body fitness health. Running helps
boost cardio health, speed and vitality. Biking
boosts endurance with low impact. And
swimming works the upper body, core and
helps to “stretch out.”
First-time triathletes usually target a sprint
distance race. This involves a short pool swim
or an open swim of approximately 1/3 mile,
biking 12–14 miles and ends with a 5K run.
Anyone can complete a sprint distance race, and
getting started is easy.
Start by signing up for an event. This will
give you goal-oriented exercise motivation.
Second, find an individual or group with which
to train. Having a “buddy” or group of friends
to work out with can make this a fun activity
that you look forward to. Third, begin work on
your fitness in a well-thought out manner given
your current fitness level.
Anyone in reasonable shape can get
ready in as little as six to eight weeks. It is
preferable to prepare over a longer period of
time, however, and most athletes end up
doing year-round exercise to maintain their
“tri” fitness. Some athletes prefer more
guidance and supervision as part of a
training program so that they can meet
their performance goals without injury.
OA Performance Center in Saco offers
the Parisi speed and strength program that
can serve as an excellent base for triathlon
competition/participation. OA can provide
you with an excellent bike fit and gait
analysis to ensure that the “foundation” is
sound. For the more serious triathletes, there
is a human performance lab offering
physiologic testing, lactate threshold, VO2
max and more. In the future, OA will be
expanding their triathletes offerings to
include endurance programs and camps.
Peak Performance Multisport in Portland
offers the “Nor’Easters,” an inexpensive club
membership that allows participation in
organized group workouts, usually with a
guide or coach. Peak Performance also offers
individual coaching and equipment advice
about needs for your first race—wetsuit,
goggles, bicycle, apparel, helmet and shoes.
This doesn’t have to be expensive; most firsttimers
will use a bike they already have or
The event itself is a blast. It is a fun
atmosphere with a very unassuming crowd. The
loudest cheer often goes to the last one out of
the water. So go ahead and take the challenge!
Sign up for a “tri.” You won’t regret it. Maybe
you will catch the “tri-bug” and keep it as part
of your everyday life. Lastly, enjoy your fitness!
Dr. Hoffman practices orthopaedic sports medicine
with a special interest in arthroscopic treatment
of knee and shoulder injuries. He is the team
physician for Falmouth High School, consultant
for other local high schools and Sunday River Ski
Resort, as well as an instructor for the Maine Medical
Center Sports Medicine Fellowship Program.
He is active in many sports including triathlons
and is a 2007 Ironman Lake Placid finisher.
VISIT THESE WEBSITES FOR MORE INFORMATION ABOUT TRIATHLON TRAINING
The OA Update 13
The Story Behind
By Carrie Bui with William Heinz, Heinz. MD
Osteoporosis is a silent disease until a fracture
occurs. The pathology of osteoporosis allows
bones to become weak and brittle, causing
them to fracture with very minor trauma.
An estimated 10 million Americans have
osteoporosis and another 34 million are at
risk, making osteoporosis the most common
bone disease, according to the National
Osteoporosis Foundation. Osteoporotic
fractures can heal completely or they may be
followed by chronic pain, disability and even
death. Hip fractures result in 10 to 20 percent
excess mortality within one year and are
associated with a 2.5 fold increased risk for
The disease is more commonly associated
with older women, but osteoporosis can
occur at any age and to both men and women.
Women are four times more likely than
men to develop osteoporosis, especially within
the first five to seven years after menopause,
when they lose significant bone mass. Risk
factors also include race and ethnicity
(Caucasians and Asians are more susceptible),
history of broken bones, inactive lifestyle and
diet (low calcium and vitamin D intakes).
It is recommended that all women age
65 and older and men age 70 and older be
screened for osteoporosis. Women with an
increased risk for osteoporosis should begin
screening at the time of menopause. To
diagnose osteoporosis or the potential risk for
it, the most common procedure is a dual
energy x-ray absorptiometry scan (DXA scan)
to measure the bone density of the spine and
hips. Alternative methods to measure bone
density are an ultrasound and a quantitative
computerized tomography (CT) scan. Bone
density tests measure how many grams of
calcium and other minerals are packed in a
segment of bone, and from that information
the relative risk of a fragility fracture (defined
as a fracture resulting from a fall from
standing height) can be estimated.
The National Osteoporosis Foundation
recommends five steps to healthy bones and
• A proper diet, making sure to include the
recommended daily amounts of calcium
and vitamin D. The recommended daily
intake of calcium for adult men and
women is between 1,200 and 1,500
milligrams and that of vitamin D is 1000
International Units (IU).
14 The OA Update
• Exercise, especially with a focus on weightbearing
and muscle strengthening exercises.
Examples of weight-bearing exercises
include jogging, hiking, gardening and
weight training. Strength training increases
muscle mass, leading to better coordination
and balance. Improved coordination and
balance can help prevent falls that can
result in fractures.
• Maintain a healthy lifestyle by avoiding
smoking and excessive alcohol consumption.
• Talk to a healthcare provider to discuss bone
health, prevention, risk and monitoring.
• Have a bone density test (DXA scan)
regularly. A bone density test can warn you
of low bone mass and track if bone density
is remaining stable or decreasing.
The effect of osteoporosis is fractures, most
often in the spine, hips or wrist. Often,
osteoporosis is not discovered until a fracture
occurs, but symptoms to note are back pain
and loss of height with accompanying
stooped posture. A comprehensive osteoporosis
treatment program would include maintaining
a proper diet, regular exercise and the
prevention of falls.
The pathology of
osteoporosis allows bones
to become weak and brittle,
causing them to fracture
with very minor trauma.
The U.S. Department of Health and
Human Services suggests that the best way
to achieve the required vitamin D intake
is through sunlight. Ten to 15 minutes
of sunlight to the hands, arms and face at
least three times a week should offer enough
vitamin D. (Be careful not to overdo
the sunlight as it will increase your risk for
skin cancer!) This vitamin is necessary for
the absorption of calcium. Recommended
calcium-rich foods include all dairy
products, such as yogurt, cheese, milk
and ice cream. Also, calcium-fortified
Am I at increased risk of having osteoporosis?
Your chances of developing osteoporosis are greater if you are female and answer “yes”
to any of the following questions:
Do you have…?
Thin or small framed
Approaching or past menopause
Milk intolerant or have a low calcium intake
A cigarette smoker or drink alcohol in excess
Taking thyroid medication or steroid-based
drugs for asthma, arthritis or cancer
orange juice and broccoli are good
dietary sources of calcium.
To avoid fractures, consider fall prevention
strategies to reduce the risk of falling:
• Meet with your doctor to discuss whether
any medications or health conditions are
increasing your fall risk.
• Exercise to improve strength, balance,
coordination and flexibility.
• Wear sensible shoes to avoid falls. Tips for
sensible shoe buying include proper fitting,
non-skid soles and shoes with laces.
• Remove hazards within the home such as
cords, boxes or any kind of clutter blocking
walkways. Secure loose rugs, repair any loose
flooring immediately and use non-slip mats
in the bathroom and shower.
• Create plenty of light through lamps and
night lights to avoid falling or tripping
over items that can’t be seen in poorly lighted
or dark rooms.
The use of assistive devices can also help
prevent falls. Assistive devices include grab
bars mounted inside and just outside the
shower or bathtub, a plastic seat placed inside
the shower for sitting down, handrails on
both sides of a stairway and non-slip treads
for bare wood steps.
The key to understanding osteoporosis
is understanding the prevention of it.
Prevention of osteoporosis includes a proper
diet, with a focus on meeting calcium and
vitamin D requirements, exercise, with a
focus on weight-bearing exercises and careful
monitoring later in life.
A family history of osteoporosis
Chronic intestinal disorders
A sedentary lifestyle
Speak with your physician if you are concerned
about your bone health!
Dr. William Heinz works in the OA Sports
Medicine Center and specializes in the diagnosis
and non-surgical treatment of sports-related
musculoskeletal injuries. He has interest in bone
health and is a certified clinical densitometrist.
He performs diagnostic interpretations for all
bone densitometry scanning performed at OA
Centers for Orthopaedics.
The OA Update 15
Outpatient Shoulder Surgery
OA Orthopaedic Surgery Center
By Donald Endrizzi, MD; Linda Ruterbories, MS, ANP; Craig Curry, MD and Thomas Murray, MD
Over the last two decades, shoulder surgery has transformed from a
largely inpatient-based practice to a predominantly outpatient series of
procedures. Although some procedures continue to be inpatient-based
such as arthroplasty or open reduction with internal fixation (ORIF),
most shoulder procedures are now routinely done on an outpatient basis.
Advancements in arthroscopic techniques, with less extensive surgical
dissection, have decreased the overall pain of many procedures to
manageable levels that allow safe outpatient management of
perioperative pain. Economic factors such as decreasing reimbursement
for overnight hospitalization and the availability of outpatient surgical
facilities contributed to this transition, along with patient demand.
Perioperative pain management remains a crucial part of outpatient
surgery and can seriously impact the patient’s perception of their surgical
experience. At OA, the team is committed to the highest standards of
outpatient surgery services that are personal, safe and cost effective. Our
specialized orthopedic surgeons and our highly trained staff of
experienced RNs, physician assistants and anesthesiologists (from the
Spectrum Medical Group) work together to provide the highest quality
surgical care available anywhere in the country. This includes working
together to develop effective pain management strategies, evaluate how
services are delivered and how patients respond.
Regional anaesthesia refers to blocking the nerve supply to part of
16 The OA Update
the body so the patient cannot feel pain in that area. Regional blocks
have become an important adjunct to pain management in the
shoulder. However, regional blocks are not without risks and costs.
Many centers use regional blocks in combination with general
anaesthesia, which can add significantly to the cost of the procedure.
The rate of complications varies greatly in the literature, with lower
rates reported as institutional experience increases. Local anaesthesia
means putting local anaesthetic around the affected area to make it
pain-free and is often referred to as “freezing” the area. Dr. Donald
Endrizzi, Dr.Thomas Murray and Linda Ruterbories, MS, ANP, of the
Orthopaedic Surgery Center at OA and Dr. Craig Curry from
Spectrum Medical Group collaborated in evaluating the effectiveness
and benefits of local anaesthesic infiltration (LAI) and general
anesthesia for outpatient shoulder surgery.
From 1998 through 2007 the data on 3,115 patients undergoing
outpatient shoulder surgery was collected prospectively. This included
both arthroscopic and open surgical procedures performed by two
experienced shoulder surgeons. The surgical procedures included 757
rotator cuff repairs, 404 instability repairs, 996 acromioplasties, 165
acromioclavicular joint excisions, 290 SLAP repairs or debridements and
503 other shoulder surgeries. Patients were contacted on post-op day one
and assessed by nursing as to any post-operative difficulties or complaints.
It has been the impression of the investigators that general
anaesthesia with local anaesthetic infiltration is a safe and effective
method for shoulder surgery. The advantages of this technique include
its low complication rate and acceptance by patients, with a high degree
of patient satisfaction after surgery. No significant complications related
to local anaesthetic infiltration were noted. There were no seizures or
cardiac disturbances related to the anaesthetic infiltration, in contrast
with some rare but significant complications reported with regional
blocks. The cost of local anaesthetic infiltration is low. Regional block
analgesia is often combined with conscious sedation or general
anaesthesia which can significantly raise the cost of the procedure.
Other alternatives to a regional block exist. Unfortunately there are
some patients and procedures in which local anaesthetic infiltration might
not be appropriate, such as longer, more extensive surgeries associated with
higher levels of pain with more tissue disruption.
There is a role for regional block in the post-operative
management of pain; however, its use as a routine part of shoulder
surgery can be questioned. The Orthopaedic Surgery Center team at
OA believes that selected surgical cases can be managed just as
effectively with a short-acting general anaesthetic agent and local
anaesthetic infiltration, lowering risk to the patient and costs to the
payer, without sacrificing post-operative pain relief.
Dr. Endrizzi specializes in shoulder surgery and is the Medical Director
at OA Orthopaedic Surgery Center (OSC). Dr. Murray specializes in
sports medicine and arthroscopic surgery at OA Centers for Orthopaedics.
Ms. Ruterbories is a nurse practitioner and serves as Director of OSC.
Dr. Curry is an anesthesiologist from Spectrum Medical Group and has a
special interest in regional anesthesia and pain management.
The OA Update 17
Provide New Option for Hip Pain
Explaining Hip Arthroscopy
By Benjamin H. Huffard, MD
Each year more than 7 million people visit their
doctor with concerns related to hip pain. For
many, the pain is so severe that simple things
like climbing stairs or bending to tie their shoes
are difficult. Some may even have back or groin
pain and not realize this pain is actually the
result of a hip condition.
Many patients find pain relief through antiinflammatory
medications, physical therapy or
the right kind of exercise. But for others, only
surgical intervention will help.
Thanks to recent medical advances,
patients with ongoing hip pain who don’t
require a hip replacement may now be treated
with minimally invasive surgery. The procedure,
called hip arthroscopy, allows surgeons to
diagnose and repair most injuries through tiny
incisions in the hip instead of larger incisions
like those needed for replacements. This less
invasive approach usually means less pain and a
quicker recovery for the patient.
While a hip replacement may be needed if
there is severe hip trauma or damage from
arthritis in the joint, hip arthroscopy is most
often used to treat a specific and less severe
condition that may be causing pain. This makes
it beneficial for younger, more active people.
Historically, active individuals in the 30–
50 age range with chronic hip pain were more or
less told to live through their pain until they
reached an age when a hip replacement was
feasible. Physicians used this approach because
Hip arthroscopy uses specialized instruments inserted
through small incisions to remove or repair damaged tissue.
18 The OA Update
a practical treatment option simply wasn’t
available. In some cases, doctors couldn’t even
determine the cause of a patient’s pain because
the injury wasn’t detectable on an x-ray.
As diagnostic techniques and instruments
for the hip have improved, more and more
doctors are now using hip arthroscopy to
diagnose and treat injuries such as labral tears,
the most common problem in the hip joint.
The labrum is the ring of cartilage that
surrounds the rim of the hip socket, also
known as the acetabulum, and acts as a
cushion. Labral tears can occur as the result of
an accident, through overuse or sometimes
through basic wear and tear.
In addition to labral tears, two other
injuries commonly treated with arthroscopic
procedures are hip impingement, a condition in
which a lack of room between the head of the
femur, or the ball, and the acetabulum, or
socket, causes painful friction when the hip is
flexed and the removal of loose bodies in the
joint—small pieces of soft tissue or bone that
are usually the result of trauma such as a fall,
accident or sports injury.
Similar to knee and shoulder arthroscopy,
which have been performed for many years,
hip arthroscopy includes the use of a narrow
scope and specialized instruments. The scope
is attached to a camera and is inserted into the
joint through a small incision, allowing the
surgeon to see the injury and the area
surrounding it. The hand instruments are
inserted through another incision and are used
to remove or repair the damaged tissue.
Because the whole procedure is performed
through keyhole-size incisions, the patient can
usually return home that same day. In many
cases, hip arthroscopy allows for a quick
return to activity, with the least amount of
pain possible, while also diminishing the risk
of arthritis and possibly even delaying the
need for a hip replacement.
Dr. Huffard spent a year as a sports medicine
fellow at the Steadman Hawkins Clinic in Vail,
Colo., training with Dr. Marc Philippon on minimally
invasive and arthroscopic treatment of soft
tissue injuries around the hip. Dr. Huffard
specializes in arthroscopic surgery of the shoulder,
knee and hip.
The OA Update 19
By Lucien R. Ouellette, MD
No athlete should return to sport or other atrisk
participation when symptoms of a
concussion are present and recovery is
ongoing. The best way to prevent difficulties
with a concussion is to manage the injury
properly when it does occur. Here are some
commonly asked questions and answers
regarding concussion injuries:
What is a concussion?
A concussion is any temporary change in how
the brain works caused by injury to the head
that may or may not involve a loss of
consciousness. This can be a direct blow to
the head or a hit to the body causing shaking
of the head. Another term for concussion is
mild traumatic brain injury (MTBI). A
sports-related concussion is specific to an
injury while playing sports and will
temporarily limit involvement with sports.
Is sports-related concussion common?
Yes, sports-related concussion is common
especially in collision sports like ice hockey,
boxing and football, but a sports-related
concussion can occur in any sport. Estimates
are that 5 percent of injuries in high school
sports are concussions, with a higher rate in
certain sports (60 percent in football).
Unfortunately, many more concussions go
unrecognized and untreated.
How do I know if I have a concussion?
Symptoms of a concussion can be very subtle
(irritability, ringing in the ears, nausea,
difficulty concentrating, difficulty sleeping,
personality changes, sensitivity to lights or
sounds or just not feeling right). Symptoms
can also be more obvious (headache, confusion,
loss of memory, clumsiness, change in vision,
appearing dazed). ANY change to normal
brain function is a concussion no matter how
minor the symptom may be or how long the
symptoms last. Even a “ding” or getting your
“bell rung” is a concussion.
What do I do if I have a concussion?
Tell your athletic trainer or team physician. The
only treatment for sports-related concussion is
rest. This will involve stopping all sport
participation until all symptoms have resolved
and to return with a slow increase in activity
without symptoms recurring. Sometimes rest
needs to include limiting school or work
activity. If the symptoms are prolonged (more
than seven days), your doctor may be able to
help the symptoms with some medications;
typically, no medications are needed.
Will my brain return to normal?
With a single concussion and appropriate rest,
typically you will regain all your normal brain
function within 7–10 days. Sometimes a
neuropsychological test (ImPACT) will be used
to help determine when normal brain function
has returned. We cannot determine how severe
a concussion is until all the symptoms have
gone away, and we have no way to predict when
they will resolve. We do not know how many
concussions one person can have in a lifetime
before permanent brain injury occurs. This
number is different for each person. We only
know if the damage is permanent when the
symptoms don’t go away.
Can I prevent a concussion?
The only way to prevent a concussion is to avoid
injury to your head. No equipment (helmet,
mouthguard) has been proven to decrease the
rate or severity of concussion, but they do
prevent other injuries (cuts, tooth damage, eye
injury, etc) and should be worn.
Dr. Ouellette serves as team physician for Bowdoin
College and Old Orchard Beach High School. He assists
with coverage for the Portland Pirates (AHL) and
the U.S. National Soccer Teams. He utilizes the Im-
Pact test on his athletes to ensure a safe return to sports.
20 The OA Update
The OA Update 21
OA Centers for Orthopaedics thanks the
following advertisers for making this
Berry, Dunn, McNeil & Parker ..................................page 9
ConMed Linvatec ................................................. page 21
DJO Incorporated .....................................................page 9
Ethos Marketing and Design ...............................page 23
Genzyme Corporation .................................. page 11 & 12
Hebert Construction, LLC ....................................... page 7
Ledgewood Construction ..................................... page 22
Maine Heart Surgical Associates ......................... page 17
Maine Medical Center ...........................................page 19
Marzilli’s Embroidery Plus
6 Marzilli Way
Windham, ME 04062
(207) 893-2948 • (207) 893-0558 Fax
Mercy Hospital ....................................................... page 2
New England Medical Transcription, Inc. ............ page 21
New England Rehabilitation
Hospital of Portland ............................................ page 22
Outdoor Service Company, Inc.
219 Roosevelt Trl.
Windham, ME 04062
PDT Architects.......................................................page 21
Pratt-Abbott Inc. ................................................. page 21
RBC Wealth Management. ................................... page 17
Spectrum Medical Group ................................. back cover
Surgical Systems. Inc. ........................................... page 9
22 The OA Update
The OA Update 23
OA Centers for Orthopaedics
33 Sewall St.
Portland, Maine 04102