OSS

On July 10, 2010, Orthopedic Specialists of Seattle (OSS) opened an office on Mercer Island. Two orthopedic surgeons from the practice, Charles Peterson II, MD and Wayne Weil, MD – both residents of Mercer Island – will have weekly office hours on Tuesday and Thursday afternoons.

The only orthopedic group on the island, Orthopedic Specialists of Seattle-Mercer Island offers sports medicine, general orthopedic and fracture care, hand and wrist surgery, and minimally-invasive and arthroscopic joint reconstruction and replacement. The new office joins two other OSS Seattle locations in Ballard and Wallingford.

Orthopedic Specialists of Seattle (OSS) is a full-service orthopedic practice with offices in Ballard, Wallingford and Mercer Island. OSS specializes in the treatment of injuries and conditions of the hip, knee shoulder, hand and wrist, foot and ankle. The group also provides arthroscopic procedures, joint replacement, and fracture care. Patients have access to some of the latest advances in orthopedic care, including minimally-invasive joint replacement procedures that help speed patient recovery. Orthopedic Specialists of Seattle’s main facility, Seattle Orthopedic Center, is equipped with MRI, a fully accredited ambulatory surgery center, and physical therapy.

Formerly Ballard Orthopedic and Fracture Clinic, the group became Orthopedic Specialists of Seattle in 2007. Today, OSS consists of six board-certified orthopedic surgeons, Philip Downer, MD, Jon Franklin, MD, Charles Peterson II, MD, Joel Shapiro, MD, Michael Watt, MD, and Wayne Weil, MD. In September, Scott Ruhlman, MD, will join the group. The clinic also has four dedicated physician assistants on staff.

OSS hand specialist Dr. Wayne Weil is now performing a new arthroscopic procedure called “endoscopic cubital tunnel release” – treating patients dealing with ulnar (elbow) nerve compression with a state-of-the-art surgical option that demonstrates excellent results including with less pain, quicker recovery time, and fewer complications.

Dr. Weil is one of only a few surgeons in Seattle who perform this innovative procedure, in addition to performing endoscopic carpal tunnel release surgery. In both procedures, Dr. Weil performs the procedure through much smaller incisions than needed for similar traditional surgeries, which leads to less pain and shorter healing times for patients. In fact, endoscopic cubital tunnel release is only a 30-minute outpatient surgical procedure, done with regional anesthetic while the patient is awake. Following the surgery, patients need to wear bandages on the elbow for several days and can usually return to light duty work within two or three days.

Ulnar nerve compression, or cubital tunnel syndrome, is the second most common peripheral nerve compression syndrome, causing numbness in the ring and small fingers, weak grip, pain at the elbow, and difficulty sleeping at night because of pain and numbness in the hand.  This condition has recently been termed “cell phone elbow” as prolonged hyperflexion or bending of the elbow can increase pressure on the ulnar nerve and can cause the hand to go numb.

Oftentimes, ulnar nerve compression can be treated entirely without surgery, through strengthening exercise regimens or physical therapy techniques.  In general, frequent bending of the elbow from using a phone, computer keyboard and mouse, or any other repetitive work where the elbow remains bent for extended periods of time should be balanced with counter-stretches and periods of time where the joints can be relaxed to avoid compression and pain.

When ulnar nerve compression become serious, though, Dr. Weil’s expertise in endoscopic cubital tunnel release surgery provides a new and excitingly low-impact treatment for troublesome elbows.

The rotator cuff is a group of four tendons and muscles – supraspinatus, infraspinatus, teres minor and subscapularis. These muscles not only provide power to the shoulder, but also stabilize the shoulder joint, keeping the head of the humerus (upper arm bone) in place against the shoulder blade. Rotator cuff injury is a tear that occurs to one or more of these four tendons or muscles.

What are the Causes and Symptoms of Rotator Cuff Injuries?

The two main causes of a rotator cuff injury are acute tears, caused by trauma such as a fall, and chronic tears which are caused by degeneration of the tendon over time. Acute tears are more noticeable because they result in immediate pain and you may experience a snapping sensation or weakness of the arm. You may have developed a chronic tear if you notice some or all of these symptoms: pain while working, lifting, or reaching over your head, pain when sleeping on the affected shoulder, or a weakness in your arm. Both chronic and acute tears can worsen if not treated properly.

How do I Prevent a Rotator Cuff Injury?

One of the best ways to avoid rotator cuff injury is through adequate conditioning before putting strain on your shoulders with vigorous activities of any kind. Warming up is an essential routine before participating in any sporting activity. Stretching and strengthening exercises are very important when it comes to prevention of a rotator cuff injury.

Stretching and Strengthening Exercises

To help avoid injury to your shoulder muscles, try the following exercises. While conducting these exercises, take care to proceed gently and slowly.

* Stand upright, clasp your hands behind your back, and then keep your arms straight while you slowly lift them upwards until you feel resistance. Hold this position for 15 to 20 seconds and repeat it 3 to 4 times.

* Stand with your arm out in front of you with your forearm pointing upwards at right angle (90°). Place a stick or pole in your hand and let it fall behind your elbow. Pull the bottom of the stick forward with your other hand. Hold this stretch for 15 to 20 seconds, and then repeat it 3 to 4 times.

* Lie on your stomach on a table, keeping your left arm at shoulder level with your elbow bent at right angle, slowly raise your left hand to level with your shoulder. Lower your hand slowly and repeat it with your right arm.

* Lie on your right side with a rolled-up towel under your right armpit and stretch your right arm above your head. Your left arm should be at your side with your elbow bent at 90°. Roll your left shoulder out while raising the left forearm to level with your shoulder and then lower the arm slowly (like the backhand swing in tennis)

* Lie on your right side and keep your left arm along the upper side of your body with the right elbow bent at right angle. Let the right forearm rest on the table. Roll your right shoulder in while raising your right forearm up to your chest and then lower it slowly (like the forehand swing in tennis)

* Stand upright and move your right arm halfway between the front and the side of your body, thumb down. Raise your right arm to 45° angle. (the way you empty a can). Make sure not to lift beyond the point of discomfort or pain. Slowly lower your right arm and repeat the exercise with the left arm.

Lateral epicondylitis, commonly known as tennis elbow, is a painful condition where the outer part of the elbow becomes sore and tender due to repetitive motions that put a strain on the elbow. Tennis elbow is one of the most common repetitive stress injuries.

Common Causes of Tennis Elbow

While commonly referred to as tennis elbow, only 5% of the people afflicted with this injury are actually tennis players. In fact, the majority of people who suffer from tennis elbow are not athletes.

This condition can happen to anyone who uses their wrist repetitively. Some common activities known to cause tennis elbow are: typing, using a hammer or screwdriver, painting, as well as many activities performed by a plumber or gardener. The repetitive wrist movement causes degeneration in tendons that attach the forearm muscles to the arm bone.

Symptoms of Tennis Elbow

Symptoms and the intensity of pain may vary. People suffering from tennis elbow often have tenderness in the elbow and the back of the forearm, which worsens with repeated use of the elbow especially during twisting movements. Common symptoms of tennis elbow include:

• Pain while lifting or bending the arm

• Pain caused while twisting the forearm

• Pain when gripping small objects like pen especially while holding the pen and writing.

• Inability or difficulty in extending the forearm completely

• Persistent pain on the outside of the upper forearm just below the bend of the elbow and on certain occasions, radiating down towards the wrist.

My Elbow Hurts. Should I See a Doctor?

Tennis elbow most commonly affects people between the ages of 30 to 50. People may often attribute the pain to growing older and hope that by ignoring it, the pain will go away. However, if left untreated, tennis elbow can progress into a debilitating injury that could eventually require surgery.

Another common misconception about tennis elbow is that taking anti-inflammatory medications or using topical creams can cure tennis elbow. These methods only cover the pain, and rarely solve the underlying problem. Anti-inflammatory medication may still be used to help manage the pain, but it’s best to seek medical attention and get a plan of action first. If you find yourself experiencing the symptoms described above, it’s best to talk to a physician to receive a proper diagnosis and course of treatment.

What is the Treatment for Tennis Elbow?

Doctors can prescribe many different treatment options, ranging from modalities such as braces or physical therapy, all the way up to surgery or changing jobs to avoid the repetitive motion. Your doctor will most likely start with conservative measures, such as resting the affected arm, icing the elbow, or giving you a brace. They may also instruct you to take anti-inflammatory medication to reduce the swelling and manage pain. If these options do not resolve your tennis elbow, your doctor may recommend surgery, however surgery is only necessary in about 5% of cases. If you follow your doctors suggestions and refrain from straining the tendons even further, your tennis elbow should go away within a few weeks, but could last several months.

On October 20th, Mark Berkowitz, M.D., a board-certified orthopedic surgeon, will join Orthopedic Specialists of Seattle. He has expertise in operative and non-operative treatment of all aspects of foot and ankle surgery, including arthroscopy, sports-related conditions, bunions, arthritis, and trauma. He joins the physician staff of Phillip Downer, M.D., Jon Franklin, M.D., Charlie Peterson, MD., Joel Shapiro, M.D., J. Michael Watt, M.D., and Wayne Weil, M.D.Dr. Berkowitz received his undergraduate degree at Princeton University where he graduated Summa Cum Laude and was recognized as Academic All-Ivy and Academic All-American as Captain of the varsity football team. He obtained his medical degree at Case Western Reserve University where he was elected to the prestigious Alpha Omega Alpha medical honor society.

After completing residency training, Dr. Berkowitz served as Chief of Foot and Ankle Surgery at Tripler Army Medical Center where he gained extensive experience treating a wide range of sports-related injuries in our active duty military population. He also deployed to Iraq in support of Operation Iraqi Freedom for which he received a Meritorious Service Medal.  He subsequently completed the prestigious Tampa Foot and Ankle / Lower Extremity Trauma Fellowship.

Dr. Berkowitz has completed numerous marathons and triathlons and currently enjoys tennis, running, and biking and especially playing with his two young children.

The word ëmeniscusí means crescent shaped structure and owes its origin to Greek. The C-shaped meniscus made of tough cartilage is wedged between the cartilage surfaces covering the three bones that form our knee joint. Meniscus aids the function of the joint by distributing weight and improving its stability. The function of meniscus is of grave importance for the general health of the knee. Meniscus tear or torn cartilage can severely impair the mobility of the knee joint.

Meniscus tear is one of the most common knee injuries that results in severe pain in the joint. It is especially common among athletes and sportsmen who play contact sports such as football, boxing, and hockey. There are two chief causes for meniscus tear ñ It can be due to traumatic injury, primarily seen in athletes or due to degenerative processes that are seen in older patients who have more brittle cartilages. Sudden twisting and turning or bending the knee joint is sometimes responsible for torn meniscus. Rotating the knee while slightly bent can cause meniscus tear.

Symptoms and Signs of Meniscus Tear Mishap

The primary symptoms of a meniscus tear are usually that of pain and swelling in the knee that makes it worse for the knee to bear more weight while doing activities such as running, or jogging. Joint locking or incapacity to completely straighten the joint is another common complaint that is especially painful while trying to get out of the car. These are the signs to look out for when in doubt about the possibility of suffering from a torn meniscus:

* sharp pain in the knee caused by even a minor movement
* swelling of the knee
* stiffness of the knee
* obvious presence of fluid in the knee

While these signs can be rectified without medical intervention, the following severe symptoms of meniscus tear require professional medical attention:

* inability to move your knee
* loss of balance when trying to stand
* locking, clicking, or popping within the knee
* extreme difficulty in straightening the knee
* piercing sensation in the inner and outer edges of the knee

Clinical Testing of Symptoms

The symptoms can be clinically tested by a physician to determine if the pain is caused because of a torn meniscus. The McMurray test is conducted to examine the swelling by pressing on the joint line on the affected side of the knee while stressing the meniscus to determine if it has produced tenderness that is typical of a torn meniscus. Steinmann test and Appley test are similar tests where the patient is sitting in the former and the latter involves a grinding motion while the patient lies flat with the knee bent at 90∞. Squatting and bending the knee can be quite painful especially with a meniscus tear since the movement of the joint if the meniscus is torn is often restricted. Cooperís sign, which is a symptom of pain in the affected knee that is usually felt when turning over in bed, is present in over 92% of tears. The twisting motion of the knee affected by meniscal tear results in the capsular attachment getting stretched and the meniscal fragment getting strained that causes the pain.

Meniscus Tear Treatment

Nonsurgical treatment involves adequate rest, administration of ice pack to the affected area, compression, knee elevation, physical therapy, and even wearing a temporary knee brace. Surgical repair is to sew the tear together. Partial meniscectomy removes the torn section while total meniscectomy removes the entire meniscus. The last option is general avoided as it increases the risk of osteoarthritis in the knee.

In late January, hip arthroscopy, a procedure that Dr. Phil Downer of Orthopedic Specialists of Seattle performs, was featured in a King 5 article.  Dr. Downer’s website, Seattlehipsurgery.com, which features useful information about hip disorders and treatments, was also featured as a source.

What is hip arthroscopy?

Hip arthroscopy is a common treatment for hip impingement and labral tears (often the result of impingement conditions).

In hip arthroscopy, the surgeon uses small instruments and a small incision to perform various interventions, which might include removing pieces of scar tissue, repairing cartilage or removing bone. Recovery can vary, but typically if bone work is performed, the recovery is 2-3 months. One should remain active during this time, mainly taking part in low impact activities such as swimming and biking.

We see a lot of patients at Orthopedic Specialists of Seattle with hip impingement and labral tears who benefit from arthroscopy.

Many of us tense up just thinking about getting an MRI. The traditional enclosed tunnel or tube-like MRI units cause anxiety and claustrophobia. But did you know that Orthopedic Specialists of Seattle offers open MRI?

Open-Air MRI

Our open-air MRI is completely open on all four sides so patients don’t feel confined. Open MRI is a great option for those with claustrophobia or fear of small spaces, or for large patients.

Our MRI contains a padded bed on which you will lie during the exam. An MRI technologist will be in continual voice and visual contact with you. Exams normally last 45 to 60 minutes.

OSS’ advanced system has a powerful magnet, so the pictures of the inner body are clear, have great detail and allow our physicians to diagnose orthopedic issues and medical conditions early and accurately.

In addition to the comfort and precision, our open MRI lets patients relax without loud noises, common with many other units. We’re pleased to be able to provide a convenient and comfortable option for our patients who require MRIs.

Our MRIs are read by Seattle Radiologists, one of the leading radiology groups in the Seattle area.

Patients with Premara insurance have experienced some changes in their coverage recently. To view information concerning Proliance Surgeons’ contract with Premara, visit www.mydoctormydecision.com.

We are proud to announce the launch of our new website! Our new site aims to inform patients about orthopedic issues and keep you up-to-date on things happening at Orthopedic Specialists of Seattle. We hope you find it easy to use, and that it offers useful information about OSS physicians and services.

Stay tuned as we continue to add more content to our Education & Research section. We hope our new site helps you find the information you need!