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Stem Cells Therapy

Autologous stem cells

An emerging therapy for orthopedic conditions is the use of your own body’s regenerative cells. These regenerative cells are called mesenchymal stem cells (MSCs). MSCs are multipotent, meaning they can differentiate into many different types of cells including bone cells, cartilage cells, smooth muscle cells, nerve cells and other tissues.

MSCs are reservoirs of repair cells that preserve healthy tissues and are also anti-inflammatory and regenerative.

MSC therapy is being studied to treat lesions of articular cartilage (the cartilage at the ends of bones). Cartilage lesions are the main cause of joint pain. But cartilage has insufficient inherent ability to repair itself because it contains no blood vessels. And, many rotator cuff repairs fail because the type of cartilage that connects the rotator cuff with bone is incapable of regeneration. Augmenting the healing capacity of this cartilage with MSC therapy may increase the strength of regenerated tissue.

MSCs are under study to improve meniscus healing. The meniscus is made of cartilage and has low or no potential for regeneration because it lacks blood vessels.

MSCs are being studied to accelerate healing from bone fractures. Results are promising but more studies are needed.

Arthritis profoundly impacts quality of life. Currently there are no accepted methods to stop the joint destruction from Osteoarthritis. Current treatments only offer symptomatic relief not regenerative outcomes. Studies are showing promising outcomes with MSC therapy.

Tendon and ligament lesions are common. Tissue grafts are currently used to reconstruct tendons and ligaments. But grafts have problems like the potential for poor healing and the poor quality of new tissue formed during the healing process. Studies are investigating whether MSCs have the ability to regenerate and repair lesions of the Achilles tendon, patellar tendons, and for ACL reconstruction.

The ACL has no ability to repair itself, so surgical reconstruction with grafts is critical to successful surgery. MSC therapy may enhance graft success.

Shoulder Fracture

A break in a bone that makes up the shoulder joint is called a shoulder fracture.

Types of Fractures

The clavicle and end of the humerus closest to the shoulder are the bones that usually get fractured. The scapula, on the other hand, is not easily fractured because of its protective cover by the surrounding muscles and chest tissue.

Causes of Shoulder Fracture

Clavicle and humerus fractures can occur by a direct hit from a motor vehicle accident, collision or fall. A fracture of the scapula can occur by high-energy trauma during an accident from a high-speed motor vehicle.

Signs and Symptoms of Shoulder Fracture

The common signs and symptoms of a shoulder fracture may include:

Pain

Swelling

Bruising

Difficulty in lifting your arm

Numbness, tingling or coldness of the hand and forearm

The popping sound also referred to as crepitus, heard or felt at the time of the fracture

Diagnosis of Shoulder Fracture

A shoulder fracture is usually diagnosed based on a thorough physical examination, and imaging studies such as X-rays and CT scans.

Treatments for Shoulder Fractures

The treatment for a shoulder fracture is based on the type of fracture. Treatment can include non-surgical and surgical methods.

A broken clavicle bone usually heals without surgery. Non-surgical treatments for shoulder fractures may include immobilization by placing your arm in a sling, pain medication and physical therapy. If the fracture has led to the displacement of the bones, then surgery may be required to correct and fix them with pins, plates or screws.

Post-surgery, physical therapy may be recommended to aid in the recovery and improve range-of-motion and strength of the arm.

Shoulder Joint Replacement

Total shoulder replacement surgery is performed to relieve symptoms of severe shoulder pain and disability due to arthritis. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.

Shoulder Anatomy

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

What is Arthritis?

When the cartilage is damaged, the two bones rub against each other causing pain, swelling and stiffness of the joint. This condition is called arthritis. There are many types of arthritis. Osteoarthritis (wear-and-tear brought about by old age) and rheumatoid arthritis (autoimmune disease) are two forms of arthritis.

What are the Indications for Shoulder Joint Replacement?

Total shoulder joint replacement is a surgery indicated for conditions such as osteoarthritis or rheumatoid arthritis when medication, injections, physical therapy, and activity changes do not help relieve pain. Your doctor recommends surgery when you have the following symptoms:

Severe shoulder pain that restricts daily activities

Moderate to severe pain during rest

Weakness and/or loss of motion

Preparation for Shoulder Joint Replacement

To decide whether total shoulder replacement is a good option for you, Dr. Gomez will evaluate your condition thoroughly.

Dr. Gomez reviews your medical history and performs a physical examination of your shoulder to assess the extent of mobility and pain. Imaging tests such as X-ray or MRI (magnetic resonance imaging) are ordered.

Shoulder Joint Replacement Procedure

The surgery is performed under regional or general anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The surgery may be performed as an open surgery, where a large incision is made, or minimally invasive, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and surgical tools.

The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with cement. A metal ball with a stem is gently press-fit into the humerus.

Next, the arthritic part of the socket is prepared. The plastic glenoid component is fixed in the shoulder bone.

After the artificial components are implanted, the joint capsule is stitched, and the wound is closed.

Robotic Assisted Knee Replacement

Robotic-assisted knee replacement surgery is an alternative to the conventional knee replacement procedure. It is performed using robotic-arm technology that allows your surgeon to precisely perform the surgery through a smaller incision as compared to traditional surgery.

Knee Arthritis

The knee is made up of the femur (thighbone), the tibia (shinbone) and the patella (kneecap). The two menisci, the soft cartilage between the femur and tibia, serve as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Osteoarthritis is a type of arthritis.

Total Knee Replacement

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial implants.

Indications of Robotic-Assisted Knee Replacement

Robotic-assisted knee replacement is indicated if you are suffering from degenerative knee diseases such as osteoarthritis. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve your symptoms.

Robotic-Assisted Knee Replacement Procedure

The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee. Robotic-assisted knee replacement utilizes X-rays and CT scans to determine the damaged areas of the joint that need to be removed for the precise placement of the knee implant. Then, the damaged portions of the femur bone are cut at appropriate angles using specialized jigs. The femoral component is attached to the end of the femur with or without bone cement.

Your surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws.

Your surgeon will place a plastic piece between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, like the original meniscus cartilage.

The femur and tibia with the new components are then put together to form the new knee joint.

To make sure the patella (kneecap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. All these steps are performed with the help of the robotic arms.

With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed; drains are inserted and a sterile dressing is placed over the incision.

Shoulder Joint Replacement

Total shoulder replacement surgery is performed to relieve symptoms of severe shoulder pain and disability due to arthritis. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.

Shoulder Anatomy

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Shoulder Arthritis

When the cartilage is damaged, the two bones rub against each other causing pain, swelling and stiffness of the joint. This condition is called arthritis. There are many types of arthritis. Osteoarthritis (wear-and-tear brought about by old age) and rheumatoid arthritis (autoimmune disease) are two forms of arthritis.

the Indications for Shoulder Joint Replacement

Total shoulder joint replacement is a surgery indicated for conditions such as osteoarthritis or rheumatoid arthritis when medication, injections, physical therapy, and activity changes do not help relieve pain. Your doctor recommends surgery when you have the following symptoms:

Severe shoulder pain that restricts daily activities

Moderate to severe pain during rest

Weakness and/or loss of motion

Preparation for Shoulder Joint Replacement

To decide whether total shoulder replacement is a good option for you, your doctor will evaluate your condition thoroughly.

Your doctor will review your medical history and perform a physical examination of your shoulder to assess the extent of mobility and pain. Imaging tests such as X-ray or MRI (magnetic resonance imaging) may also be performed.

Shoulder Joint Replacement Procedure

The surgery is performed under regional or general anesthesia. An incision is made over the affected shoulder and the underlying muscles are separated to expose the shoulder joint. The surgery may be performed as an open surgery, where a large incision is made, or minimally invasive, where small incisions are made to insert an arthroscope (a thin tube with a camera and light source) and surgical tools.

The upper arm bone (humerus) is separated from the glenoid socket of the shoulder bone. The arthritic or damaged humeral head is cut and the humerus bone is hollowed out and filled with cement. A metal ball with a stem is gently press-fit into the humerus.

Next, the arthritic part of the socket is prepared. The plastic glenoid component is fixed in the shoulder bone.

After the artificial components are implanted, the joint capsule is stitched, and the wound is closed.

Postoperative Care for Shoulder Joint Replacement

After the surgery, medications and antibiotics are prescribed to control pain and prevent infection. Your arm may be secured in a sling or cast. The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. You may be able to perform gentle daily activities two to six weeks after surgery.

ACL Reconstruction

Anterior cruciate ligament (ACL) reconstruction is a surgical procedure to replace a torn or damaged ACL ligament in your knee with a new ACL tissue graft obtained most commonly from your own body (autograft) or in rare cases from a deceased donor (allograft).

The most common autografts are the patellar tendon (tendon of the kneecap) or one of the hamstring tendons (tendons located at the back of the thigh). In some instances, the quadriceps tendon located above the kneecap is utilized. Tendons are cords of strong fibrous tissue that connect muscles to bones. Ligaments are tough bands of tissue that connect one bone to another bone.

ACL tears or injuries most often occur during sports activities that involve pivoting, cutting, and turning movements as in football, soccer, skiing, tennis, and basketball.

Anatomy of the ACL

The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee, running from the femur (thighbone) to the tibia (shinbone). The ACL is one of the four major ligaments of the knee that connects the femur to the tibia and helps stabilize your knee joint. It prevents excessive forward movement of the tibia in relation to the femur as well as limits rotational movements of the knee. When this ligament tears, unfortunately, it does not heal on its own and often leads to the feeling of instability in the knee, requiring reconstruction to correct the abnormality.

Indications for ACL Reconstruction

An ACL tear or injury is the main indication for ACL reconstruction surgery. An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyper-extended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down suddenly while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also result in injury to the ACL.

Preparation for ACL Reconstruction

In general, preparation for ACL reconstruction surgery will involve the following steps:

A review of your medical history and physical examination are performed to check for any medical issues that need to be addressed prior to surgery.

Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.

You will be asked if you have allergies to medications, anesthesia, or latex.

You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.

You may be asked to stop taking certain medications, such as blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two.

You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.

You should not consume any solids or liquids at least 8 hours prior to surgery.

You should arrange for someone to drive you home after surgery.

A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

KNEE ARTHROSCOPY

Knee arthroscopy is a common surgical procedure performed using an arthroscope, a viewing instrument, to diagnose or treat a knee problem. It is a relatively safe procedure and you will usually be discharged from the hospital on the same day of surgery.

Knee Anatomy

The knee joint is one of the most complex joints of the body. The lower end of the thighbone (femur) meets the upper end of the shinbone (tibia) at the knee joint. A small bone called the patella (kneecap) rests on a groove on the front of the femoral end. Another bone of the lower leg (fibula) forms a joint with the shinbone.

To allow smooth and painless motion of the knee joint, articular surfaces of these bones are covered with a shiny white slippery articular cartilage. Two C-shaped cartilaginous menisci are present in between the femoral end and the tibial end.

Menisci act as shock absorbers, providing cushion to the joints. They also play an important role in providing stability and load-bearing to the knee joint.

Bands of tissue, including the cruciate and collateral ligaments, keep the different bones of the knee joint together and provide stabilization to the joint. Surrounding muscles are connected to the knee bones by tendons. The bones work together with the muscles and tendons to provide mobility to the knee joint. The whole knee joint is covered by a ligamentous capsule, which further stabilizes the joint. This ligamentous capsule is also lined with a synovial membrane that secretes synovial fluid for lubrication.

Indications for Knee Arthroscopy

The knee joint is vulnerable to a variety of injuries. The most common knee problems where knee arthroscopy may be recommended for diagnosis and treatment are:

Torn meniscus

Torn or damaged cruciate ligament

Torn pieces of articular cartilage

Inflamed synovial tissue

Misalignment of the patella

Baker’s cyst: a fluid-filled cyst that develops at the back of the knee due to the accumulation of synovial fluid. It commonly occurs with knee conditions such as meniscal tear, knee arthritis, and rheumatoid arthritis.

Certain fractures of the knee bones

Hip Anatomy

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and the pelvis (acetabulum) join. It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage that cushions and enables smooth movements of the joint.

Hip Arthritis

Hip arthritis is one of the painful and common diseases of the hip joint caused by damage to the cartilage.

What is Minimally Invasive Total Hip Replacement Surgery?

Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.

Traditionally, total hip replacement will be performed through a 10–12-inch long incision made on the side of your hip. A minimally invasive approach has been developed in recent years where surgery is performed through one or two smaller incisions rather than the single long incision as in the traditional approach. Advantages of the newer approach are lesser muscle dissection, minimal pain, quicker recovery, and faster rehabilitation.

Minimally Invasive Shoulder Joint Replacement

Shoulder joint replacement is a surgical procedure that replaces damaged bone surfaces with artificial humeral and glenoid components to relieve pain and improve functional ability in the shoulder joint.

It can be performed by a traditional open approach or through a minimally invasive approach. The incision of a minimally invasive shoulder joint replacement is about 5 cm compared to 17 cm with the traditional approach.

Indications for Minimally Invasive Shoulder Joint Replacement

When conservative measures such as medications, injections, physical therapy, and activity changes do not help relieve pain from conditions such as arthritis, avascular necrosis, and humeral head fractures, then shoulder joint replacement is considered as a treatment option.

The decision to perform shoulder replacement via the traditional approach or the minimally invasive approach depends on the pathology. Exposure of the glenoid is often difficult even when the incision is long as in the traditional approach. Therefore, if the pathology is such that more exposure to the joint is required for the surgical treatment then a traditional approach is preferred.

The minimally invasive approach is generally preferred when the problem can be rectified by replacement of only the humeral head such as with the following conditions:

Shoulder arthritis with not much damage to the glenoid and with only small bone spurs

Four-part humerus fractures with intact rotator cuff

Avascular necrosis of the humerus, resulting in tiny multiple fractures

Diagnosis

To determine the pathology, your surgeon orders an X-ray of the shoulder in the anteroposterior and axillary view. The axillary X-ray is especially important to check the condition of the glenoid. In case the condition is not very clear, your surgeon orders a CT scan of the shoulder to provide more detailed cross-sectional images of the bone and soft tissue of the shoulder including the glenoid.

Minimally Invasive Shoulder Joint Replacement Procedure

The surgery is performed under sterile conditions in the operating room under regional or general anesthesia.

You will lie in a beach chair position with the operated arm held by an arm positioner.

A 5-cm incision is made over the shoulder joint.

The muscle overlying the shoulder bones are cut just enough to expose the head of the humerus.

The humeral head is dislocated and released from the capsule.

The arthritic or damaged humeral head is cut at the neck and removed.

The humeral component is matched in diameter and thickness to the natural humeral head.

A bone tunnel is made in the humerus to take the humeral stem.

The humeral stem is then inserted into the humerus. This may be press-fit, relying on the bone to grow into it or cemented, depending on several factors such as bone quality and your surgeon’s preference.

If the glenoid also needs to be replaced, your surgeon then proceeds to the preparation of the glenoid component.

The glenoid is sized for the appropriate implant.

Next, the glenoid is prepared to take the artificial component by drilling holes in the glenoid to fix the plastic glenoid component.

Bone cement is placed in the holes and the glenoid implant is inserted.

Once the glenoid is replaced with the plastic component, your surgeon works on the humeral component.

The correct sized metallic humeral component is then fixed to the humeral stem.

The soft tissue covering the joint is sutured back together and the incision closed with absorbable sutures.

An X-ray is taken to verify the correct fit (size and position) of the implant.

The ankle joint connects the leg with the foot and provides free movement to the foot. It is formed by connecting the bones of the lower leg, tibia and fibula, with the talus, or ankle bone.

The surface of the ankle bones is covered with an articular cartilage. Damage to this cartilage leads to a condition called arthritic ankle, which results in pain and impaired movement of the ankle. Infection, bone fracture, connective tissue disorder, excessive stress, and certain disease conditions such as rheumatoid arthritis, and osteoarthritis are causes of ankle arthritis.

Diagnosis

Ankle arthritis is diagnosed by your physician after taking a history and performing an examination of the symptomatic ankle. Imaging such as X-ray and MRI may be ordered to confirm the diagnosis.

Treatment

Conservative treatment of ankle arthritis involves oral medications and joint injections. However, for patients who are unresponsive to conservative treatment, ankle joint replacement surgery is recommended.

Ankle joint replacement, also known as total ankle arthroplasty, is a surgical procedure performed to relieve pain and immobility due to ankle arthritis.

Ankle joint replacement is also recommended for elderly patients with a severe fracture from osteoporosis, or presence of a tumor in the ankle joint.

Surgical procedure

Ankle joint replacement surgery is performed under general anesthesia. Your surgeon makes an incision over the front of the ankle. The muscles are retracted and tendons and ligaments are moved away to expose the ankle joint. The damaged part of the tibia, fibula, and talus bone are then removed using special instruments, and the remaining part of the bones are reshaped to fit the new artificial joint or prosthesis. A bone graft is inserted between the tibia and fibula to create a fusion of the two bones and prevent loosening of the prosthesis. The prosthetics are kept in position by using special bone cement and instrumentation such as screws to support the artificial ankle.

At the end of the surgery, tendons and other structures are placed back in position covering the new joint and the wound is sutured closed and covered with a sterile dressing...

Pediatric Dentistry

Pediatric dentistry is a subspecialty of dentistry that deals with the examination and management of dental health in children from birth through adolescence. It involves all aspects of dental health care for developing children. A pediatric dentist has 2 to 3 years of specialty training after dental school and confines his or her practice to treating children only. Pediatric dentists are primary and specialty dental care providers for infants and children through adolescence, including those with special health needs.

What Types of Treatments does Pediatric Dentistry Provide?

Pediatric dentistry offers comprehensive oral health care designed to meet the needs of growing children that includes the following:

Treatment for gum conditions, including advanced pediatric periodontal disease and mild gingivitis

Treatment for dental caries, commonly referred to as tooth decay or cavities

Correction of tooth development problems and other irregularities, such as a cleft lip and palate

Correction of dental erosion, also called enamel erosion

Early evaluation and treatment for straightening teeth and correcting an improper bite (orthodontics)

Care for dental injuries such as displaced, fractured, or knocked-out teeth

Preventive dental care, including fluoride treatments and cleaning, as well as diet and nutrition recommendations

Diagnosis of oral diseases connected with conditions such as congenital heart defect, diabetes, hay fever, asthma, and attention deficit hyperactivity disorder (ADHD)

Children should visit a pediatric dentist every 6 months for an oral exam and teeth cleaning. These measures help reduce the risk of disease by keeping the mouth and teeth healthy throughout life. Preventive dental treatments such as the use of sealants and fluoride help prevent cavity formation. Using fluoride regularly is crucial for every child, specifically in the early phases of life. Fluoride assists to decrease the risk of plaque buildup and help prevent tooth loss and tooth decay.

Shoulder Arthroscopy

The most common need for a shoulder arthroscopy (or shoulder “scope”) is torn tendons or ligaments/labrum. These conditions are usually a result of an acute injury, but can also occur from overuse or degeneration. “Impingement” is another need for arthroscopy, where shoulder pain is caused by irritation of the tendons in the shoulder by surrounding bony prominences, or by poor posture.

Ligaments are soft tissue structures that connect bone to bone. The shoulder capsule is a type of ligament that completely encircles the shoulder joint and connects the socket of the shoulder to the arm bone. The capsule assists in joint stability, and helps the shoulder to move and function properly. It can become torn from an acute injury, such as a shoulder dislocation. When the capsule is torn, symptoms of instability or recurrent dislocations may occur. The capsule can also be naturally lax in some patients, causing similar instability symptoms, even without a traumatic event of injury. In traumatic cases, the capsule needs to be surgically repaired to prevent the shoulder from continuing to dislocate. In non-traumatic cases, conservative treatment can be attempted first before considering surgery.

Deep to the capsule is the labrum. The labrum is a thick ring of cartilage that deepens the shoulder socket, assisting in joint stability. It also as works with shoulder joint ligaments to anchor the ball of the arm bone in the socket. When the labrum is torn, there is pain with certain movements, in addition to instances of locking, or a sensation that something is getting stuck inside the shoulder joint. Symptoms from most labrum tears can be relieved with conservative treatment, but large tears or tears causing persistent mechanical symptoms may require surgery to repair the tear.

There are additional ligaments that make up the acromioclavicular (AC) joint. These ligaments hold the collar bone in down in proper position to form part of the shoulder joint. Injury to these ligaments is referred to as a “separated shoulder”, and causes the end of the collar bone to become raised, resulting in a noticeable deformity, and pain over the top of the shoulder with reaching up or across. In more severe cases with significant deformity, surgery is needed to bring the collar bone back into position, and restore proper shoulder mechanics.

AC joint osteoarthritis can develop from normal use of the shoulder, and cause the end of the collar bone to rub at its connection to part of the shoulder blade, causing pain with movement and use of the shoulder. In cases where pain is not relieved with conservative treatment, arthroscopy can be considered.

A shoulder arthroscopy is an option for patients with pain, locking, weakness, instability, and/or decreased shoulder motion and function that interferes with normal daily activities and recreational activities. In many situations, conservative treatment including physical therapy and possibly cortisone injections are considered first and relieve most symptoms. However, rotator cuff tears, and ligament/labrum tears do not heal themselves, so an arthroscopy is the most reliable solution for resolving mechanical symptoms, muscular weakness, or instability that does not improve with physical therapy. Surgery is only recommended first for very large tears that result from a traumatic injury.

Complex Arterial Surgery

Arteries are blood vessels that carry oxygen-rich blood away from the heart to tissues of the body. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body. The aorta divides into a network of smaller arteries that extend all over the body. The arteries' smaller branches are known as arterioles and capillaries. Numerous diseases and conditions can affect the functioning of the arteries increasing your risk of life-threatening events. Complex arterial surgery is a procedure performed for the treatment of complex and serious conditions of the arteries.

Indications for Complex Arterial Surgery

Your surgeon may recommend complex arterial surgery for treatment of conditions that affect your arteries such as:

Atherosclerosis: A condition in which the arterial wall of the blood vessels is thickened and narrowed due to the deposition of fat or cholesterol forming a plaque. Atherosclerosis in the arteries of the brain, heart, or neck can result in strokes and heart attacks.

Cerebrovascular Accident (Stroke): The brain requires a continuous supply of oxygen and nutrients from the blood in order to function properly. A blockage or rupture of one of the arteries supplying blood to the brain can result in a condition called a stroke. It is a medical emergency that leads to the death of brain cells within minutes of the interruption in blood supply.

Carotid Artery Disease: Carotid artery disease occurs due to the deposition of plaque (fatty substances) inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Due to plaque accumulation, the arteries become narrowed or even completely blocked. This reduces blood flow to your brain and creates oxygen deficiency, increasing your risk of having a stroke.

Aortic Aneurysm: This is a condition characterized by an abnormal ballooning or bulging of a section of the aorta due to weakness in the wall of the blood vessel. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body. An aneurysm can develop anywhere along the course of the aorta.

Peripheral Arterial Disease: Also known as peripheral vascular disease, this is a common vascular condition in which blood supply to the lower limbs is reduced due to the narrowing of arteries. This limitation in blood flow to the lower limbs may cause pain or poor wound healing.

Aneurysm that occurs in the section of the aorta that passes through the abdomen is called an abdominal aortic aneurysm.

Aneurysm that occurs in the part of the aorta that passes through the chest is called a thoracic aortic aneurysm.

Shoulder Injections

Ultrasound is a common imaging technique that employs high frequency sound waves to create images of organs and other internal structures of the body. These images provide valuable information of underlying pathology of the tissues and assists with diagnosis and planning the treatment of a condition. Ultrasound provides a clear view of the organs, tendons, muscles or joints and any associated disorders.

Ultrasound guided injection is a minimally invasive procedure used for treating various musculoskeletal painful conditions such as tendonitis, bursitis and neuritis or to perform cyst aspiration.

It is also an excellent tool for guiding the placement of needles for both diagnostic as well as therapeutic purposes.

Injection of a pain medication in combination with a local anesthetic directly to the site of injury helps to relieve pain. The advanced imaging of ultrasound provides high resolution images that enable the physician to precisely locate the injections deep into the target tissue without harming surrounding tissues.

Advantages

The advantages of ultrasound imaging compared to other imaging techniques include the following:

No patient exposure to ionizing radiation.

Able to assess tendons, ligaments and muscles under high resolution.

Provides direct visualization of the area being treated.

Ensures accurate placement of the needle to targeted areas.

Sports injuries occur when playing indoor or outdoor sports or while exercising. They can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. The most common sports injuries are sprains and strains, fractures and dislocations.

The most common treatment recommended for injury is rest, ice, compression and elevation (RICE).

Rest: Avoid activities that may cause injury.

Ice: Ice packs can be applied to the injured area, which will help reduce swelling and pain. Ice should be applied over a towel on the affected area for 15-20 minutes, four times a day, for several days. Never place ice directly over the skin.

Compression: Compression of the injured area also helps reduce swelling. Elastic wraps, air casts and splints can accomplish this.

Elevation: Elevate the injured part above your heart level to reduce swelling and pain.