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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

● 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.

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.

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

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.

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.

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.

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.

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.

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.