- Orthopaedic & Neurosurgery Specialists PC (ONS)

Platelet-Rich Plasma Injection Therapy for Elbow Tendonitis

Lynn Surprenant of Greenwich is an athletic 51-year-old mother of two, who has enjoyed sailing, skiing, golf and other sports over the course of her life. Two years ago she developed painful tendinitis in her left elbow. It got better after resting it over the winter and then reoccurred after she went kayaking during a winter vacation. Her elbow became so painful that even picking up a glass of water was excruciating.

The following June, Dr. Seth Miller gave her a cortisone injection into the joint which brought her initial relief. Unfortunately, the benefit wore off after about eight weeks. When she returned to Dr. Miller, he suggested she try a new treatment option called PRP (Platelet Rich Plasma). Although not FDA approved, the treatment is increasingly being used by orthopedic surgeons and physiatrists to treat soft tissue problems such as tennis elbow, hamstring strains, MCL strains and patellar tendonitis.

At ONS, PRP is administered by physiatrist Dr. Jeffery Heftler, who explained the procedure, “First, 10 milliliters of blood was drawn from Lynn’s arm and then spun in a centrifuge for five minutes. This separates out the platelets from the rest of the blood. Then two to four milliliters of the separated blood is drawn out and injected it back into the injury site.” The theory behind the treatment is the platelets release growth factors which stimulate a healing response. Unlike a steroid injection, it can take up to six weeks to notice the full benefit of the injection. However, PRP seems to be effective in cases where steroids have failed.

Lynn was instructed not to use her arm for anything strenuous for two weeks but by the third week, she could tell it was feeling better. She started physical therapy to help get back the strength in her arm and by three months she was entirely pain free.

Ms. Surprenant says, “I am a big fan of PRP. I am now free of pain and back to doing all my normal activities.”
 

Arthroscopic Repair of Torn Rotator Cuff

After Greenwich resident and Brunswick Academy teacher Ted Stolar seriously injured his shoulder, he sought relief from the disabling pain and loss of mobility from leading shoulder specialist Dr. Seth Miller. "I'd been taking lots of anti-inflammatory medication," said Ted Stolar, who enjoys recreational softball and kayaking adventures with his students. "I kept trying to work through the problem but eventually realized I was losing strength in my arm." Dr. Miller determined that his patient had torn a tendon of his rotator cuff, but an arthroscopic surgical procedure could repair the damage and end his pain.

By using the latest arthroscopic technique, the tendons heal at about the same rate as in traditional surgery, but the less-invasive procedure has several big advantages. Arthroscopy is a same-day surgery and can be performed with local anesthesia. Patients experience substantially less pain after arthroscopy, which allows them to get back to their normal routine quicker.

"Almost all rotator cuff tears can be repaired with arthroscopy and there are clear benefits," says Dr. Miller. "Ted had same day surgery and returned to his classroom the following day with his arm in a sling. Two months after surgery, he had regained complete range of motion and had full use of his shoulder. He was able to resume all his normal activities and even went on a rafting trip with his students."

Total Knee Replacement Surgery

Cynthia Cottman of Greenwich was just 49 when she began to feel intermittent pain in her right knee. Occasionally the joint would even lock in place. Eventually, the pain worsened. She consulted her doctor who told her it was probably arthritis, which is prevalent in her family. X-rays of her knee did not reveal any irregularities so she tried to continue with life as usual.

Cynthia was a very physically active person and she was discouraged by how difficult even walking had become. When the pain elevated to "sharp and shooting" she became alarmed and made an appointment to see Dr. Brian Kavanagh at ONS. He ordered another set of x-rays but this time he wanted her to be standing. The difference was dramatic. The new images revealed that, in fact, no cartilage remained between the bones in her knee. "Dr. Kavanagh explained that the condition of my knee would not improve," said Cynthia "Sooner or later, I would need a knee replacement."

Cynthia had the surgery and remained in Greenwich Hospital for three and a half days, followed by seven days in a rehabilitation center. Her progress was steady. By the time she came home, she was walking without a walker or cane. "I did physical therapy three times a week, which was tough work but the continual progress was very motivating." After six months Cynthia was completely recovered and back doing all her normal activities.
 

Trauma Surgery

Louis Larizza was a 15-year-old Port Chester High School freshman when he broke both bones in his right forearm while playing football in a game in Chappaqua, NY. His mother easily recalled how excruciating her son's pain appeared to be as they raced to Greenwich Hospital.

Dr. Frank Ennis was on call in the Emergency Room that afternoon. When he saw the deformed appearance of Louis' forearm, he knew his patient had suffered significant fractures in both his right ulna and radius. The bones were out of alignment and very unstable. Urgent surgery was required. It took two and a half hours for Dr. Ennis to insert two permanent plates and eleven screws to align and secure the bones. Everything went as expected and Louis' recovery went smoothly.

Louis was a serious basketball player and he had worried he wouldn't be able to play on his school varsity team that November. After the surgery, Dr. Ennis gave him exercises to do at home and with conscientious effort, he regained full mobility of the arm in time to play the coming season with his team. Dr. Ennis attended his first game and congratulated Louis on his recovery.
 

Reverse Total Shoulder Replacement

At 73, Wilton resident Elmer Stannard still missed his sport, skeet and trap shooting.  He had been a serious competitor in skeet and trap shooting tournaments until twelve years earlier when he noticed his left shoulder "catching" as he followed his target. It didn't sweep in the smooth arc that he was accustomed to. Before long, the problem became painful and also began affecting other activities including putting on shoes and even driving a car.

After consulting an orthopaedic surgeon, he learned that years of wear and tear had resulted in a torn rotator cuff. A year later, after losing much of his arm's mobility and living with increasing pain, he underwent surgery to repair the tear. The result was only modestly successful and over the next nine years, he underwent two more surgeries. His condition continued to deteriorate, eventually forcing him to retire from his work as a plumbing contractor.

After the failure of his third surgery, Elmer was referred to Dr. Seth Miller, who was successfully using a brand new procedure known as a reverse shoulder replacement. Approved by the FDA in 2004, reverse shoulder replacement has been performed in Europe for nearly 20 years. The surgery uses a metal and plastic implant that works the opposite of a normal shoulder by placing the ball onto the shoulder blade and the socket onto the top of the upper arm bone. The reversed position of the ball and socket alters the mechanics of the shoulder, changing the center of the shoulder's rotation. The strength needed to move the arm is shifted away from the damaged rotator cuff muscles, allowing the deltoid muscle to take over.

A reverse shoulder replacement is a breakthrough for patients with a rotator cuff that has degenerated to the point it no longer functions and cannot be repaired. "Many of these patients are unable to raise their arm more than a few inches and a traditional shoulder replacement is not an option because the tendons aren't healthy enough to hold the shoulder ball into the socket," explains Dr. Miller. "Until the reverse shoulder replacement was invented, there was no solution for a patient with such a badly damaged shoulder."

Dr. Miller performed the surgery and Mr. Stannard remained in the hospital for three days. Soon after, he began a home exercise program to strengthen and train the deltoid muscle for its new job. In only a few weeks, he began to regain the ability to lift his arm and within two months, he was able to raise his arm well over his head, something he hadn't been able to do for years. 
 

ACL Reconstruction

Cos Cob resident Jason Mager was 24 when he was playing basketball with friends and tore his ACL. He jumped to reach a ball coming off the basket rim. As he grabbed the ball, his body twisted in the air. But when he came down, slightly off balance, his left foot planted hard on the court. He fell to the floor and pain shot through his left knee. Almost immediately, it swelled. An x-ray at Stamford Hospital indicated no broken bones but Jason was advised to see an orthopedist. The next day, he visited James Cunningham, MD. A physical examination determined he had most likely ruptured his ACL. An MRI confirmed the diagnosis.

"An avid basketball player and all-round athlete, Jason was a good candidate for an ACL reconstruction," said Dr. Cunningham who, in the surgery last April, used part of his patient's patellar tendon to reconstruct the ACL. The surgery also included work on a partially torn meniscus. The surgery lasted an hour and a half and Jason went home later the same day. His recovery was steady and his pain was managed with Advil. After five days he began a physical therapy program, which he followed three days a week for the first month and gradually reduced over the following few months. His knee regained full flexibility and before long he returned to playing basketball with his friends.