Find Relief from Sprains, Strains, Tears & More
Muscles and tendons are the tissues that move joints. The muscles are the “red meat” of the body. When they receive a signal from the brain via the nerves, the muscles contract. This pull is transmitted through the tendon to the bone so that the joint moves.
Muscle strain, muscle pull, or even a muscle tear refers to damage to a muscle or its attaching tendons. You can put undue pressure on muscles during the course of normal daily activities, with sudden heavy lifting, during sports, or while performing work tasks.
Muscle damage can be in the form of tearing (part or all) of the muscle fibers and the tendons attached to the muscle. The tearing of the muscle can also damage small blood vessels, causing local bleeding, or bruising, and pain caused by irritation of the nerve endings in the area.
Reduce your risk.
● Stretch daily● Start an exercise program in consultation with your doctor● Do a ‘cool down’ program after you exercise● Establish a warm-up routine prior to strenuous exercise, such as gently running in place for a couple of minutes
Pinpoint your pain.
Symptoms of injured muscles, tendons, and ligaments include:● Swelling, bruising, or redness due to the injury● Pain at rest● Pain when the injured muscle or tendons are used● Weakness of the muscle or tendons● Inability to use the muscle at all
Get the answers you need.
The diagnosis is usually made based on history and physical exam. The examining physician may also require an X-ray or magnetic resonance imaging (MRI).
Life’s too short to put up with pain.
Pioneering the region’s most advanced musculoskeletal treatments, our physicians are experts in the use of minimally invasive biologic therapy for many types of orthopaedic injuries. From chronic tendon and ligament pain to acute muscle and soft tissue injury, orthobiologics may be recommended to reduce complication risk and facilitate enhanced healing. For more acute injuries, our experts can perform minimally invasive surgery.
Say ‘Goodbye’ to Pain & Stiffness
The largest tendon in the human body, the Achilles tendon is connected to the calf muscles and allows feet to flex during walking, running, and jumping. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendonosis, a condition associated with overuse and degeneration.
Achilles tendonosis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendonosis, too. These factors include:● Sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance● Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon● Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain
Many changes can be seen when the Achilles tendon becomes inflamed. Most of the time, there is no trauma or injury, but rather a slow progression of pain. Common symptoms of Achilles tendonosis include:● Pain and stiffness along the Achilles tendon● Pain along the tendon or back of the heel that worsens with activity● Severe pain the day after exercising● Swelling that is present all the time and gets worse throughout the day with activity
If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.
To diagnose Achilles tendonosis, a thorough medical history is taken and an examination is performed. Patients will usually have pain right on the tendon or at the back of the heel. They may also have swelling and thickening of the tendon. X-rays may be taken to see if there are any bone spurs. A MRI or ultrasound may also be performed to further evaluate how much of the tendon is affected and to look for any tears.
Our foot and ankle doctors treat Achilles tendon injuries using cutting-edge techniques, such as radiofrequency coblation, platelet rich plasma injections and minimal incision surgery. These types of procedures expedite the healing process and allow patients to resume regular activities faster than conventional surgery options. In severe cases, the surgeon may recommend surgery to reattach a torn Achilles tendon or to remove the bone spur. Our foot and ankle surgeons will evaluate each patient’s medical history and customize a treatment plan to suit their individual needs.
Achilles Tendon Tear & Rupture
The Best Achilles Treatment in the Tri-State Area
The Achilles tendon is the largest tendon in your body. It connects the muscles in the back of your lower leg to your heel bone (e.g., the calcaneus) and must withstand large forces during sporting exercises and pivoting. There are two main types of injuries that affect the Achilles tendon: overuse and inflammation, called Achilles tendonosis, and, a tear of the tendon.
Your Achilles tendon may tear if it is overstretched, usually while playing sports. The tear may be partial or complete, and it most commonly occurs just above your heel bone. A snap or crack sound may be heard at the time of injury.
To reduce your chance of developing Achilles tendon problems, follow these tips:● Stretch and strengthen calf muscles. Stretch your calves to the point at which you feel a noticeable pull, but not pain. Don’t bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon to absorb more force and prevent injury.● Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities.● Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels.● Increase training intensity slowly. Achilles tendon injuries commonly occur after abruptly increasing training intensity. Increase the distance, duration, and frequency of your training by no more than 10 percent each week.
A person with a ruptured Achilles tendon may experience one or more of the following:● Sudden pain, which feels like they have been kicked or a stabbed, in the back of the ankle or calf—often subsiding into a dull ache● A popping or snapping sensation● Swelling or bruising on the back of the leg between the heel and the calf● Difficulty walking, especially upstairs or uphill, and difficulty rising up on the toes● Inability to bend your foot downward or to walk normally
In diagnosing an Achilles tendon rupture, a foot and ankle surgeon will ask questions about how and when the injury occurred, and whether the patient has previously injured the tendon or experienced similar symptoms. Your surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle, as well. If the Achilles tendon is ruptured, the patient will have less strength in pushing down, as on a gas pedal, and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, your surgeon may order a MRI or other advanced imaging tests.
Surgery is typically needed for a complete rupture. After surgery, your ankle will be kept stable in a cast or walking boot for up to 12 weeks. A torn ligament may also be managed non-surgically with a below-knee cast or boot, which would allow the ends of the torn tendon to heal on their own. This nonsurgical approach may take longer to heal, and there is a higher chance that the tendon could re-rupture. Surgery offers a better chance of full recovery and is often the treatment of choice for active people who wish to resume sports.
Diagnose, Treat Torn ACL Injuries & Get Moving Again
The anterior cruciate ligament (ACL) is a ligament that connects the femur (e.g., thighbone) with the tibia (e.g., shinbone). ACL injuries occur when a patient’s knee is hyperextended, twisted, or forced to the side. While female athletes are more prone to ACL injuries than male athletes, ACL injuries are fairly common in both genders. As a knee stabilizer, the ACL is placed at risk during basketball, hockey, skiing, soccer, and other sports that require running, kicking, and sharp turns. In total, more than 60,000 ACL reconstructions are performed in the U.S. each year.
Unfortunately, no single exercise can prevent injury to the ACL. The good news is that you can give yourself some protection by developing and maintaining strength and endurance in your lower extremities. To promote stability in the knee, perform closed-chain exercises—for example, leg presses, squats or lunges as part of your strength-training program. Also, add some cross-training to your cardiovascular workout using the stairclimber, stationary bike or ski machine. You can also help to prevent ACL injuries by practicing landing with the knees bent after jumps, and crouching when pivoting and turning.
Symptoms may include knee-buckling/instability, weakness, pain, or swelling, and may be caused by a partial or total tear of the ligament. In some cases, the ligament tears away a piece of the bone, resulting in an “avulsion fracture.” It is also fairly common for ACL tears to be accompanied by other knee injuries, such as cartilage, meniscus, or other ligament damage.
In order to diagnose an ACL tear, your physician will need a thorough medical history report and a physical examination. He or she may also require an X-ray or magnetic resonance imaging (MRI) of the knee joint.
Dr. Robert A. Kayal, MD, who is a pioneer in custom knee replacement, and his team of specialists in Bergen County focus on sports medicine, including the treatment and repair of knee injuries to the anterior cruciate ligament (ACL). Partially torn ACLs may be rehabilitated with physical therapy, rest, and anti-inflammatory medication. Severe or total tears, however, do not typically heal well without intervention from ACL surgeons. If a patient wishes to return to sports and normal activities, surgical treatment may be recommended. ACL surgery consists of replacing the ligament with a substitute tendon graft, which stabilizes the knee and reduces or eliminates pain. ACL surgery may be done arthroscopically—through small incisions—to reduce scarring and to expedite rehabilitation.If you’ve suffered several knee injuries due to an accident or sports-related trauma, ACL surgery may be more extensive. Dr. Robert A. Kayal and his team of knee specialists will examine your injury and tailor a treatment plan to suit your lifestyle and recovery needs.
Ankle Sprains & Strains
Stop the Pain & Get Back On Your Feet
Ankle injuries are often thought of as sports injuries—but you don’t have to be an athlete or even a “weekend warrior” to turn your ankle and hurt it. The truth is that a sprained ankle is a very common injury. A strained or sprained ankle can happen to athletes and non-athletes, children, and adults. It can happen when you take part in sports and physical fitness activities. It can also happen when you simply step on an uneven surface or step down at an angle.
Ankle sprains are caused by an injury that stresses a joint and overstretches or even ruptures the supporting ligaments, which connect bone to bone. Ankle strains, on the other hand, are typically caused when too much force is placed on muscles or tendons, which connect muscle to bone.
The best way to prevent ankle sprains and strains is to maintain good strength, muscle balance and flexibility. Plus, be sure to do the following:● Warm up before doing exercises and vigorous activities● Pay attention to walking, running or working surfaces● Wear good shoes● Recognize your body’s warning signs and slow down when you feel pain or fatigue
Sprains are usually noticeable when they occur. But sometimes, a minor sprain will happen without your noticing. The primary symptoms of sprains include limited mobility, inflammation, pain, swelling and bruising. Strains are often accompanied by pain, cramping, swelling, muscle spasms, and stiffness or soreness in the muscle. As with sprains, you may be aware of the exact movement or activity that created the strain, or you may notice symptoms only later.
To diagnose ankle sprains and strains, your doctor will look at the impacted area and ask questions about the injury or accident. He or she may also order X-rays to ensure that you don’t have a broken bone in the ankle or foot. A broken bone can have similar symptoms of pain and swelling. If there is no broken bone, the doctor may be able to tell you the grade of your ankle sprain based upon the amount of swelling, pain and bruising. The doctor may order a MRI, after the period of swelling and bruising resolves, if he or she suspects a severe injury to the ligaments, injury to the joint surface, a small bone chip or other problem. The MRI can make sure that the diagnosis is correct.
Minor ankle sprains and strains may heal on their own with rest, ice, compression and elevation (RICE). Over-the-counter or prescribed anti-inflammatory medications and bracing may also be used to alleviate discomfort and swelling. Moderate sprains may need to be immobilized with air splits or cast-boots for 1 or more weeks. If symptoms persist or your sprain is severe, surgery may be required to repair the fully torn ligament. Surgery involves reconnecting the ligament to the bone. Your doctor will discuss the surgical options that best meet the needs of your injury.
Restoring Dexterity, Improving Strength
Dupuytren’s contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin—eventually creating a thick cord that can pull one or more fingers into a bent position.
Although painless, the affected fingers can’t be straightened completely, which can complicate everyday activities, such as placing your hands in your pockets, putting on gloves or shaking hands.
Dupuytren’s contracture mainly affects the ring finger and pinky, and it is more common in men than in women. A number of treatments are available to slow the progression of Dupuytren’s contracture and relieve symptoms.
Dupuytren’s contracture symptoms usually occur very gradually:● Nodules. One or more small, tender lumps, or nodules, form in the palm of the hand. Over time, the tenderness usually goes away.● Bands of tissue. The nodules may thicken and contract, forming tough bands of tissue under the skin.● Curled fingers. One or more fingers bend toward the palm. The ring and little fingers are most commonly affected, but any or all fingers can be involved. As the bend in the finger increases, it may be hard to straighten your finger. Grasping large objects and putting your hand in a pocket becomes difficult.
Your doctor will examine your hand, and then test the feeling in your thumb and fingers. Your grip and pinch strength may also be tested. During the examination, your doctor will record the locations of nodules and bands on your palm. Using a special device, he or she will measure the amount of contracture in your fingers. Your doctor may also measure the range of motion in your fingers to determine whether there is limitation in your flexion. Your doctor will refer back to these measurements throughout your treatment to determine whether the disease is progressing.
There is no way to stop or cure Dupuytren’s contracture. However, it is not dangerous. Dupuytren’s contracture usually progresses very slowly and may not become troublesome for years. It may never progress beyond lumps in the palm. If the condition progresses, nonsurgical treatment, such as corticosteroid injections, may help to slow the disease. If the disease is progressing over time, surgery or an injection to release the cord may be recommended. After surgery, elevating your hand above your heart and gently moving your fingers help to relieve pain, swelling and stiffness. Physical therapy may be helpful during recovery after surgery. Specific exercises can help strengthen your hands and help you move your fingers.
Find Relief from Your Pain
Golfer’s elbow, also referred to as medial epicondylitis, is a painful condition that impacts athletes and non-athletes, alike. It occurs when there is inflammation or a partial tear to the area where forearm tendons meet the inside of the elbow.
The injury may be caused by a single traumatic action, but is more often caused by repetitive motions of gripping, twisting, or swinging during sports or certain types of work—such as carpentry and plumbing. Many competitive sports place significant strain on the joints of athletes, and the elbow is especially vulnerable to stress, considering the amount of swinging and throwing involved in many popular sports.
One of the best ways to avoid elbow problems is to strengthen your forearm muscles and slow your golf swing so that there will be less shock in the arm when the ball is hit.
The following simple exercises can help to build up your forearm muscles and help you avoid golfer’s elbow. For best results, do these exercises during the off-season, as well:● Squeeze a tennis ball. Squeezing an old tennis ball for 5 minutes at a time is a simple, effective exercise that will strengthen your forearm muscles.● Wrist curls. Use a lightweight dumbbell. Lower the weight to the end of your fingers, and then curl the weight back into your palm, followed by curling up your wrist to lift the weight an inch or two higher. Perform 10 repetitions with one arm, and then repeat with the other arm.● Reverse wrist curls. Use a lightweight dumbbell. Place your hands in front of you, palm side down. Using your wrist, lift the weight up and down. Hold the arm that you are exercising above your elbow with your other hand in order to limit the motion to your forearm. Perform 10 repetitions with one arm, and then repeat with the other arm.
Symptoms may include:● Tight muscles on the inside forearm● Wrist weakness● Joint tenderness● Radiating pain and burning inside the elbow● SwellingWorsening of elbow pain may occur when grasping objects, bending the hand at the wrist, or twisting the forearm.
Golfer’s elbow is generally diagnosed after a thorough examination and a detailed description of the pain.
Treatment for golfer’s elbow begins with a conservative approach. The first step is for the patient to discontinue the repetitive motions that are causing golfer’s elbow and to wear a brace to prevent injury aggravation. When pain persists, a cortisone injection may be performed.If these treatment steps fail to resolve golfer’s elbow, our physicians can perform minimally invasive surgery to remove damaged tissue and any bone spurs that have formed. Following surgery, your NJ orthopaedic surgeon will likely prescribe physical therapy to aid in a quick and complete recovery.
Your Hip Labral Tear Treatment Experts
Experiencing Hip Pain? Don’t Wait
A labrum is a soft, fibrous section of cartilage that surrounds the hip or shoulder socket. The labrum helps to stabilize joints, provide cushioning and attach ligaments, which allows for movement and flexibility. Sudden twisting or pivoting movements often cause a hip labral tear. In addition to these acute labrum tears, athletes can also suffer from a labrum degenerating over time, due to wear-and-tear. Labral tears are among the most common sports injuries. When you experience hip pain, you should not delay scheduling an appointment with us. It’s important to receive prompt hip labral tear treatment to relieve your pain and resolve any underlying problems.
Hip labral tear symptoms include pain, usually in the groin, a “catching” sensation, grinding of the joint, and limited motion.
Diagnosis of a hip labral tear involves a physical examination to identify stiffness, limited range of motion, and areas of pain and inflammation. In addition, a CT scan or MRI may be used to identify hip labral tears.
For minor tears, rest and conservative approaches, such as physical therapy, anti-inflammatory medications, and cortisone injections, may be sufficient for successful hip labral tear treatment.
Our team is highly skilled in a broad range of state-of-the-art hip preservation techniques, which can be an extremely successful hip labral tear treatment. This approach also can be effective for femoroacetabular impingement (FAI), avascular necrosis, cartilage injury, femoral head fractures, hip dysplasia, osteonecrosis, osteoporosis, Perthes deformities, and certain sports injuries. Our hip specialists will explore every possible option to try to protect and save your hip.
One of our main goals at our practice is to use the latest hip preservation methods to correct minor hip problems whenever possible and to help prevent or delay the need for hip replacement surgery. You are in the best of care here. Our chief of hip services, Dr. Victor Ortiz, and our founder and CEO, Dr. Robert A. Kayal, have the training, skills and experience to pinpoint and execute the best plan of action for your unique situation.
For more severe injuries, our orthopaedic physicians conduct minimally invasive surgery to fix or reconstruct torn pieces of labrum. Hip arthroscopy can be an effective hip labral tear treatment as well as the right approach to hip impingement. Your orthopaedic surgeon may also prescribe physical therapy after surgery to accelerate your healing and help you regain strength and endurance.
Advantages of minimally invasive surgery include shorter procedures, no overnight hospital stay, less pain, minimal blood loss, smaller scars, speedier rehabilitation, and improved outcomes.
Stop the Pain & Heal Quickly
Medial collateral ligament (MCL) and lateral collateral ligament (LCL) sprains are knee injuries. The MCL is the ligament that’s located on the inside of your knee joint. It links your thighbone (e.g., femur) and shinbone (e.g., tibia). The LCL, on the other hand, is the ligament that’s located on the outside of your knee —linking the thighbone and calf bone (e.g., fibula). Similar to the medial collateral ligament (MCL), the LCL’s primary function is to stabilize side-to-side as the knee moves.
The most common symptoms of an LCL or MCL tear are pain, stiffness, swelling and tenderness along the outside part of the knee. Your knee may feel loose, as though it will give way under stress, or it may lock. More severe tears can cause numbness or weakness in the foot, which occurs in the peroneal nerve if it is stretched at the time of injury or squeezed by swelling of the surrounding tissues.
Your doctor will generally ask you to describe how the knee was injured, whether you have had other knee injuries and how your knee has felt since the injury. You may be asked about your physical and athletic goals. This helps your doctor decide what treatment might be best for you. During the physical exam, the inside and outside of the knee will be checked for pain or tenderness and pressure will be put on both while the leg is both bent and straight. Depending on the degree of pain or looseness of your knee joint, the injury will be classified as I, II or III. Grade I is a bruised ligament with no instability. Grade II injuries have mild to moderate instability and represent partial or incomplete tears. Grade III injuries are very unstable and are often associated with other injuries.
Treatment for Grade I and Grade II injuries are typically the same—ice, a knee brace and nonsteroidal anti-inflammatory medication (NSAIDs). For Grade III MCL or LCL injuries, Dr. Robert A. Kayal and his team of surgeons perform arthroscopic medial and lateral ligament replacements without cutting through any tendons or muscle. This minimally invasive surgical procedure is usually performed as an outpatient procedure, so patients can return home the same day as surgery.
Getting You Back on Your Feet
The knee joint functions when a myriad of complex parts—such as ligaments, tendons and bone—work in conjunction with one another. Unfortunately, many of these complex parts are prone to injury.
One of the most commonly injured parts of the knee is the menisci, which are two wedge-shaped cartilage pieces that pad the inside and outside of the knee joint. These rubbery, durable cartilage sections allow the knee to absorb shock and stabilize the knee.
A meniscal tear is a common sports injury, often occurring when an athlete squats or twists the knee. It also can be caused by a hard contact with another player. Aging is also a contributor to the breakdown of knee cartilage and tissue because older, worn tissue is more prone to tears.
You may have heard a popping sound when your injury first occurred. After that, pain and swelling or tenderness may set in. Other symptoms include an inability to move your knee normally, or an inability to walk without pain or a clicking, uncomfortable feeling. Symptoms are usually worse when a patient is going down stairs or squatting or bending the knee deeply. For some, an injured knee may occasionally get stuck, or lock, at a 45-degree angle temporarily.
Patients in the Bergen County, New Jersey, towns of Franklin Lakes, Glen Rock, Paramus, Westwood, Ridgewood and surrounding communities can rely on the experienced team of doctors at Kayal Orthopaedic Center, who specialize in sports medicine, to handle all of their orthopaedic concerns—from a meniscus tear to an ACL tear—and to develop the appropriate treatment plans.
In order to properly diagnose a meniscal tear, your doctor will consider your symptoms, ask you about your activity leading up to the injury, and examine your knee carefully. Because meniscus injuries can also be accompanied by injuries to the other soft tissue in the knee, your doctor will want to look at the big picture. In addition to examining your knee in specific positions and manipulating its movement, your doctor will likely want you to have X-rays, or a MRI (magnetic resonance imaging).
Small meniscus tears along the outside of the knee may heal on their own with rest, ice, compression and elevation (RICE). Over-the-counter or prescribed anti-inflammatory medications may also be used to alleviate discomfort and swelling. If symptoms persist or your meniscus tear is severe, minimally invasive knee surgery may be required. During this procedure, using small incisions, your knee surgeon, who also specializes in knee replacement surgery, will insert a camera and tiny surgical instruments into the knee joint to repair torn menisci. Fortunately, many minimally invasive knee procedures are performed on an outpatient basis, and rehabilitation is much faster than with traditional incisions, with full weight-bearing immediately after surgery. In some situations, you may be made non-weight-bearing with the use of crutches. Your orthopaedic surgeon at Kayal Orthopaedic Center in Bergen County may also prescribe physical therapy after surgery to accelerate your healing and help you regain strength and endurance.
Find Relief for Painful Muscle Cramps
One of the body’s natural, protective response mechanisms, a muscle spasm is an involuntary, sustained contraction of the muscle fibers in response to injury or inflammation—either in the muscles themselves or the nerves that serve them. In the back, muscle spasms also may signal injury or damage to an underlying spinal structure, such as the vertebrae, discs or ligaments that connect the vertebrae.
Back spasms may occur for a variety of reasons: a sudden or extended trauma to the spine or the muscles and tissue that support it such as a strain or sprain, or some other type of mechanical disorder that may be causing spinal nerve compression or irritation.
To avoid future spasms, it’s important to build and maintain the strength and flexibility of the muscles, tendons, and ligaments. This can be done through:● Regular, low-impact cardiovascular exercises that don’t jar your back and are easy on the joints, such as bicycling, walking, or swimming. If exercising outdoors is not an option, consider using a treadmill, elliptical trainer, or stationary bicycle.● Core strengthening exercises. By conditioning your abdominal and back muscles, you can develop a “natural corset” to support your spine.● Gentle stretching to improve and maintain flexibility. Stretching also helps maintain good blood flow to the muscles.
The primary symptoms of a muscle spasm typically include acute back pain or neck pain, depending on the location of the underlying injury or condition, accompanied by a sensation of severe muscle tightening, which may occur in “cycles” that last from a few seconds to several minutes. The pain and stiffness actually serve a two-fold purpose: to signal that something’s wrong and to protect the affected tissues and structures from further injury by limiting motion. Symptoms tend to appear suddenly following physical activity, and usually ease up following a period of rest.
Whether you suffer from chronic or acute pain due to an injury or surgical procedure, our experts deliver pain relief through industry-leading techniques. Laser treatment programs vary with pain, cause and severity, but many patients experience pain relief in just a few short sessions. Trigger point injections can also be useful in relieving tension in cramping muscles. Your physician will recommend an optimal course of treatment for your situation, and will monitor the results of your program.
Get Back in The Groove
When things are “in the groove,” they’re going smoothly. That certainly is the case with your knee. As long as your kneecap (patella) stays in its groove in the knee, you can walk, run, sit, stand and move easily. When the kneecap slips out of the groove, though, problems and pain often result.
Injuries to the knee often include kneecap (patellar) dislocation or subluxation. The patella is a V-shaped bone that sits in a groove in the thighbone. A patellar dislocation occurs when the kneecap is displaced from the thighbone, and the joint surfaces are no longer touching. A subluxation is a similar injury, where the kneecap becomes displaced, but the joint surfaces are still touching. Patellar dislocations and subluxations are most common in adolescents and younger adults.
● Warm-up and stretch properly before activity● Maintain physical fitness● Strength, flexibility, and endurance● Cardiovascular fitness● For jumping or contact sports, protect the kneecap with supportive devices, such as elastic bandages, tape, braces, knee sleeves with a hole for the patella and a built-up outer side, or straps to pull the patella inward, or knee pads● Use cleats of proper length
● Knee buckles and can no longer support your weight● Kneecap slips off to the side● Knee catches during movement● Pain in the front of the knee that increases with activity● Pain when sitting● Stiffness● Creaking or cracking sounds during movement● Swelling
During the physical examination, your doctor may ask you to walk around or to straighten and bend your knee. The doctor may carefully feel the area around your kneecap and take measurements to determine if the bones are out of alignment or if the thigh muscles are weak. In addition, X-rays may be recommended to see how the kneecap fits in its groove. Your doctor will also want to eliminate other possible reasons for the pain, such as a tear in the cartilage or ligaments of the knee.
If the kneecap is only partially dislocated, your doctor may recommend nonsurgical treatments, such as exercises and braces. Exercises will help strengthen the muscles in your thigh so that the kneecap stays aligned. If the kneecap has been completely dislocated out of its groove, the first step is to return the kneecap to its proper place. This process is called reduction. Sometimes, reduction happens spontaneously. Other times, your doctor will have to apply gentle force to push the kneecap back in place. A dislocation often damages the underside of the kneecap and the end of the thighbone, which can lead to additional pain and arthritis. Arthroscopic surgery can correct this condition and restore normal patella alignment. If surgery is required, our surgeons may perform minimally invasive, arthroscopic procedures to limit postoperative pain and scar tissue buildup.
The Pain Stops Here
A pinched nerve can put a serious damper on your life. Pinched nerves, also referred to as cervical radiculopathy, can occur in different parts of the body—from the neck down to the lumbar spine. Fractures, bulging or herniated discs, or diseased spinal disks may compress adjacent nerve roots: impairing the nerve’s function and sending radiating pain through the neck, buttocks and legs. Although injuries are common contributors to pinched nerves, other factors such as poor posture, obesity, pregnancy and repetitive back stress may cause nerve pressure and aggravation—leading to chronic headaches, tingling and numbness in the arms or legs.
In most cases, pinched nerve pain starts at the neck or back and travels down the arms or legs in the area served by the damaged nerve. This pain is usually described as burning or sharp. Certain movements—like extending or straining the neck or back, or turning/twisting—may increase the pain. Other symptoms include:● Tingling or the feeling of “pins and needles” in the fingers/hand or feet● Weakness in the muscles of the upper or lower extremities● Loss of sensation● For a pinched nerve in the neck, some patients report that pain decreases when they place their hands on top of their head. This movement may temporarily relieve pressure on the nerve root.
After discussing your medical history and general health, your doctor will ask you about your symptoms. He or she will then examine your neck and back, as well as your upper and lower extremities — looking for muscle weakness, loss of sensation or any change in your reflexes. Your doctor may also ask you to perform certain movements to try to recreate and/or relieve your symptoms. Our spine specialists will then schedule appropriate imaging tests, such as MRIs, X-rays and CT scans.
Surgeon Robert A. Kayal, MD and his team of specialists treat pinched nerve conditions with a wide range of alternative methods. If necessary, minimally invasive endoscopic procedures with small incisions can also be performed, instead of traditional open back surgery, which reduces recovery time and postoperative pain. Since surgery is typically performed on an outpatient basis, spinal patients often return home the same day of the procedure.
How to Deal, Heal & Get Moving Again
The alarm clock goes off, and it’s time to start your day. As you climb out of bed, though, you experience pain in your foot—as you do nearly every day.
If your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis, an overuse injury that affects the sole of the foot.
Stretching from the heel bone to the front of the foot, the plantar fascia is a long ligament that is responsible for supporting the arch and absorbing the stress that’s placed on the foot. In plantar fasciitis, the patient suffers from microscopic tears, inflammation, and stiffness of the ligament. Plantar fasciitis is common in middle-aged patients and impacts nearly 2 million people a year.
Potential risk factors for this type of heel pain include:● Obesity● High arches● High-impact sports, such as running● Improper athletic training● Shoes with poor cushioning● Prolonged standing
The most common symptoms of plantar fasciitis include:● Pain on the bottom of the foot near the heel● Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride.● Greater pain after (not during) exercise or activity
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs:● A high arch● An area of maximum tenderness on the bottom of your foot, just in front of your heel bone● Pain that gets worse when you flex your toes upward and the doctor pushes on the plantar fascia. The pain improves when you point your toes down● Limited “up” motion of your ankle
A majority of plantar fasciitis patients show improvement after non-surgical treatments, such as rest, regular stretching, custom-molded orthotics, supportive shoes and medication. Our doctors, may also recommend the following non-invasive treatments:● Cortisone injection therapy, to reduce inflammation of the fascia● Night splinting, which draws the toes back toward the body and allows a plantar fascia stretch● Platelet-rich plasma injections, which allow growth factors in the blood to improve tissue healing● Walking casts that immobilize the injured foot
Rotator Cuff Tear
Consult Our Expert Rotator Cuff Surgeons
Although injury to the rotator cuff can be the result of trauma, such as a dislocation or fracture, tears in any component of the rotator cuff are most often caused by overuse, which are commonly referred to as wear-and-tear injuries. Any sport or activity that requires repetitive arm movement, like tennis, weight lifting or painting, can lead to a rotator cuff injury. Those who develop tears through overuse may also have experienced several months of pain associated with inflammation—either bursitis, which is inflammation of the joint bursa, or tendonitis, which is inflammation of one or more tendons.
The symptoms of a rotator cuff tear depend on the cause. Tears caused by trauma may create an immediate and sharp pain in the shoulder, as well as weakness in the arm. Tears caused by overuse may create pain that begins as a minor twinge when lifting the arm. With overuse injuries, pain may develop into chronic distress in the shoulder that radiates and limits your arm and shoulder movements. Pain may even interrupt your sleep.
In order to diagnose you properly, your doctor will consider your symptoms and examine your shoulder and neck to ensure that your pain isn’t caused by a pinched nerve, arthritis or another condition. You will be asked to perform a few simple movements, too, so that your doctor can measure your range of motion. Your doctor may also require you to have X-rays to look for contributing bone issues, including spurs or calcifications and a MRI to look more closely at the soft tissue (muscles and tendons) of the joint.
Usually, tears need to be fixed by a rotator cuff surgeon. When Dr. Robert A. Kayal and his team of elite orthopaedic surgeons in Bergen County perform your rotator cuff surgery arthroscopically, the procedure is less traumatic to the body. In addition, you’ll experience reduced blood loss, small surgical scars, and a decreased need for narcotics or other pain medications. Minimally invasive surgery patients usually have less postoperative pain, scarring, and scar tissue buildup, too—which expedites rehabilitation and leads to a faster return to daily activities.
Because traditional shoulder replacement surgery can reduce the range of motion and sometimes even increase pain, a reverse total shoulder replacement can be an option for patients with rotator cuff tears. The procedure is similar to conventional joint replacement because damaged tissue is replaced with a prosthetic joint. However, it differs because the position of the ball and socket is flipped, allowing healthy muscles and tendons to take over for a rotator cuff that can’t be repaired.
Shoulder Labral Tear
Symptoms & Treatment Options
The shoulder joint is a “ball and socket” joint that enables the smooth gliding movements of the arms. The labrum, a fibrous section of cartilage, helps the shoulder to stabilize, move and flex. The labrum also offers joint cushioning and aids in ligament attachment.
A shoulder labral tear, then, is an injury to the cartilage in the shoulder joint. Labral tears may result from injury, wear-and-tear, or sometimes as part of the aging process.
Common labral tear symptoms include:● Pain and grinding● Limited range of motion● A “catching” sensation in the shoulder● Inflammation and stiffness
Labral tear diagnosis involves a physical examination to identify stiffness, mobility problems, and areas of pain and swelling. CT scans and MRIs may also be used to confirm labral tears.
Minor tears may require rest and conservative treatments, such as anti-inflammatory medication, physical therapy, and steroid injections. For more severe injuries, however, our sports medicine physicians may perform arthroscopic surgery to shave or repair damaged labrum pieces. Your orthopaedic surgeon may also prescribe post-surgical physical therapy to accelerate healing and facilitate the return of strength and endurance.
Achieve Mobility Without Pain
Tendinitis is the inflammation and swelling of a tendon, which is the structure that connects to muscle to bone. While tendinitis can occur in any of your body’s tendons, it most notably develops in your shoulders, elbows, wrists, knees and heels.
The most common causes of tendinitis include:● Repetition of a particular movement over time● Recurring minor impact to a joint● Occurrence of a sudden injury or trauma● Loss of tendon elasticity due to aging
Though athletes are most frequently affected by this condition, individuals whose jobs or hobbies involve the occurrence of specific repetitive motions, such as gardening, painting, knitting, etc. are just as prone to developing tendinitis.
Because tendinitis can develop in various areas of the body, the symptom’s severity can range from a minor ache to an extreme, shooting pain throughout the joint. Common symptoms include:● A dull or extreme ache, especially when moving the affected limb or joint● Tenderness● Swelling
Typically, our physicians can diagnose tendinitis by listening to the patient’s description of discomfort and conducting a physical examination of the affected area, looking for inflammation and tenderness. Using applied resistance, our physicians can further assess the affected area to measure the patient’s austerity of pain and mobility limitations. Our physicians may order an X-ray or other imaging tests for additional diagnosis confirmation and to evaluate the severity of the condition.
Once a diagnosis has been made, the first step of tendinitis treatment is to discontinue the activity or repetitive motion that was determined to be causing the condition to develop. To reduce inflammation and swelling, our physicians may recommend the use of a splint or brace to immobilize the affected area. Other non-invasive treatments include taking non-steroidal anti-inflammatory medications to reduce inflammation and ease pain, and engaging in physical therapy to stretch and strengthen muscles and tendons. For instances where non-invasive treatments fail to resolve tendinitis, our sports medicine specialists may perform steroidal injections into the affected area to accelerate healing. In severe cases, our physicians may recommend minimally invasive surgery to remove the inflamed tissue.
Get the Support You Need From This Elite Team in Bergen County
Many sports place considerable strain on the joints of participating athletes, especially those requiring regular swinging and throwing. The elbow is especially vulnerable to this type of stress and injury.
Tennis elbow, or lateral epicondylitis, is a very common injury—not just to tennis players, as the name suggests, but to individuals who take part in activities involving repetitive motions. Athletes participating in racquet sports are common sufferers of tennis elbow, as are painters, plumbers, construction workers, cooks and computer technicians. Specifically, the injury is a tear or partial tear to the area where forearm tendons and muscles attach to the outside of the elbow.
The best way to prevent tennis elbow is to stretch and strengthen your arm muscles so that they are flexible and strong enough for your activities. Other ways to prevent tennis elbow include:● Staying in good overall physical shape● Using the correct techniques and movements during activities● Not overusing your arm with repeated movements that can injure your tendon (i.e., alternate hands during activities, if possible)● Wearing a brace, based on your doctor’s recommendation, during activities that require grasping or twisting arm movements
Symptoms of tennis elbow include inflammation, gradually increasing pain on the outside of the upper arm, and worsening of pain while squeezing objects.
If you experience any of these symptoms, you can contact our highly trained team of orthopaedic professionals for a thorough evaluation and complete medical workup. We will devise the treatment plan that is best for you and your unique circumstances. Surgery is not always necessary. When it is, we are often able to use minimally invasive techniques that reduce trauma, blood loss, scarring, hospital stays and pain. They also result in quicker recovery.
It is rare for tennis elbow to appear on an X-ray, so diagnosis is done through a physical examination and a thorough medical history report. Your doctor may order a MRI if further evaluation is warranted.
The treatment for tennis elbow often involves rest, physical therapy, bracing and cortisone injections. However, in more severe cases, our physicians perform minimally invasive surgery to remove damaged tendons, muscle tissue and loose bodies in the elbow. Following elbow surgery, your orthopaedic surgeon will likely prescribe physical therapy to aid in regaining strength and achieving a full recovery.
Our team also specializes in other conditions such as rotator cuff tear; arthritis; neuropathy; and fractures of the ankle, hand and wrist. Our surgeons are experts at performing surgeries such as reverse total shoulder replacement, hip replacement and meniscus tear surgery.
Ulnar Collateral Ligament Injury
We Excel in Our Field, So You Can Excel On Yours
Ligaments are strong bands of tissue that hold bones together. In the elbow joint, the ulnar collateral ligament, or UCL, holds the ulna (e.g., lower arm bone) to the humerus (e.g., upper arm bone). When the ulnar collateral ligament gets torn due to injury, the elbow can become unstable.
The ulnar collateral ligament may become stretched or even torn due to a single traumatic episode—or more commonly, repetitive stress, such as throwing a baseball.
It is important for parents, coaches, and athletes to understand the risks of pushing too hard in an athletic arena.
Here are a few UCL injury prevention tips for athletes:● Understand the importance of “pitch counts” and limiting an athlete’s use of his arm● Schedule a full sports medicine physical in the off season to evaluate if the athlete has physical findings that might predispose them to injury● Do exercises to strengthen the muscles in the right places:● Hip, legs & core strengthening and flexibility exercises.● Rotator cuff strengthening exercises● Upper & lower extremity stretches● Work with a pitching coach who understands proper throwing mechanics
With a UCL injury, you may experience:● Pain on the medial side (inside, or pinky finger side) of the arm, from the elbow to the wrist● Soreness on the inside edge of your elbow● Minor swelling along the inside of your arm● Possible numbness and tingling in your arm● Occasionally, a baseball player who tears his UCL may feel a “pop” with intense pain after throwing
A torn ulnar collateral ligament is diagnosed by physical examination, which includes taking your medical history. Your orthopaedic surgeon may gently feel your elbow joint to locate the specific area of pain. Or, the surgeon may slightly bend your arm, while applying pressure along the outside of your elbow joint (valgus stress test) or ask you to mimic a throwing motion as he or she resists against it (moving valgus stress test). To provide a definitive diagnosis, your surgeon may order an X-ray or MRI scan to confirm the diagnosis and to rule out other possible damage.
Treatment for ulnar collateral ligament tear ranges from rest and physical therapy to surgery, depending on the severity of the injury. The doctors call it an ulnar collateral ligament reconstruction (UCLR); baseball players and fans call it “Tommy John surgery”—named after the Los Angeles Dodgers pitcher who was the first to have the surgery in 1974. It is designed to restore medial stability of the elbow, enabling athletes to make a full return to their previous activities.
Wrist Sprains & Strains
Get to the Root of the Pain
A sprain is an injury to a ligament, which is a strong band of connective tissue that connects one bone to another.
A wrist sprain is a common injury, as there are many ligaments in the wrist that can be stretched or torn. This occurs when the wrist is bent forcefully, such as in a fall onto an outstretched hand. Typically, these falls are the result of athletic or recreational activities, where an individual breaks their fall by bracing the ground with their hands.
Because wrist sprains usually result from a fall, be careful when walking in wet or slippery conditions. Wrist sprains also occur during sports, such as skating, skateboarding and skiing. Wrist guard splints or protective tape can be used to support the wrist and prevent it from bending too far backward.
Patients who experience wrist sprains or strains should schedule an appointment at one of our convenient Bergen County offices where we offer treatment including hand and wrist surgery: Franklin Lakes, Glen Rock, Westwood and Paramus. We are also located in North Bergen, Paterson and Garfield and in Stony Point, NY.
Symptoms of a wrist sprain may vary in intensity and location. The most common symptoms of a wrist sprain include:● Swelling in the wrist● Pain at the time of the injury● Persistent pain when you move your wrist● Bruising or discoloration of the skin around the wrist● Tenderness at the injury site● A feeling of popping or tearing inside the wrist● A warm or feverish feeling to the skin around the wrist
It is important in all but very mild cases for a doctor to evaluate a wrist injury. Proper diagnosis and treatment of wrist injuries are necessary to avoid long-lasting stiffness and pain. During your appointment, your doctor will discuss your medical history and any previous injuries to your hand or wrist. He or she will ask questions about how and when the current injury happened and will review all your symptoms, including any numbness in your hand. Your doctor will examine your entire arm and hand to make sure that there are no other injuries, as well. Your doctor may also order imaging tests to help determine whether your wrist is sprained, such as X-rays & MRIs.
Minor sprains and strains may heal on their own with rest, ice, compression, and elevation (RICE). Over-the-counter or prescribed anti-inflammatory medications may also be used to alleviate discomfort and swelling. Moderate sprains may need to be immobilized with a wrist splint for one or more weeks. If symptoms persist or your sprain is severe, surgery may be required to repair the fully torn ligament. Surgery involves reconnecting the ligament to the bone. Your doctor will discuss the surgery options that best meet the needs of your injury.