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Occupational Injuries

Don’t Suffer in Silence

Generally related to repetitive motion during work-related tasks, occupational injuries are approached differently than injuries resulting from a single incident or accident. Patients suffering from an occupational injury often perform daily tasks that are repetitive and involve the same joints, tendons, and muscles in a targeted region—such as computer operators, assembly line workers, construction workers, or factory workers.
Injuries at the workplace may affect any part of the body and, at times, at multiple locations. Based on the body part affected, occupational injuries can be classified as injuries to the head, neck, upper extremities, lower limbs, and so on.
Common occupational injuries include:● Ankle sprains● Neuropathies● Repetitive motion injuries● Soft tissue injuries● Wrist sprains



Reduce your risk.

Ergonomic specialists recommend the following adjustments to avoid workplace injuries, including back, neck, and shoulder pain:● Change your body position periodically throughout the day● Rearrange your work area to avoid excessive bending, stooping, and reaching● Try to relax, as many occupational injuries and painful episodes arise from continuously tensing your neck and shoulder muscles while working● Alternate tasks so that you can pause from repetitive motions for several minutes● Take short breaks that involve active exercise (walking, stretching, etc.)● Keep the top of your computer monitor at eye level and your elbows bent at a 90 degree ankle in order to reach the keyboard



Pinpoint your pain.

Workplace injury symptoms coincide with the specific injury incurred. However, the most frequently reported symptoms of repetitive motion injuries include:● Red skin that’s warm to touch● Pain reproduced when moving or flexing the affected area● Pain when resting the affected area● Tenderness● Decreased range of motion● Swelling● Joint stiffness● Tingling in the affected area



Get the answers you need.

At our practice, occupational injuries are diagnosed using X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.



Life’s too short to put up with pain.

Helping patients manage work-related injuries and illness, our orthopaedic surgeons offer award-winning care to manage pain and expedite recovery. Non-invasive treatment options include:● Elevation and icing of the affected area● Heat or cold applications● Use of braces or splints to immobilize the affected area● Non-steroidal anti-inflammatory drugs● Exercise programs to stretch and strengthen the area● Conditioning exercises to prevent further injury● Physical therapyDepending on the type and severity of injury, Dr. Robert Kayal, MD, and his orthopaedic team may treat occupational injuries by applying laser therapy to trigger points or larger tissue regions. As a result of these scientifically proven laser techniques, patients experience expedited rehabilitation and faster return to employment. A depomedrol injection may also be used for more stubborn work-related injuries.For more acute workplace injuries, surgery may be recommended.


Carpal Tunnel Syndrome

Our Carpal Tunnel Specialists in Bergen County Can Restore Feeling, Eliminate Pain

The “carpal tunnel” is a narrow passageway that runs from the base of the hand through the wrist. The median nerve, which controls our sense of touch in the palm, and touch and fine movement in the thumb and three larger fingers, passes through the carpal tunnel along with several tendons. If any of those tendons become irritated, or any other swelling encroaches on the space within the tunnel, the median nerve can become compressed. Compression of the median nerve may cause symptoms that range from tingling in the fingers to pain radiating up the arm.

  • Causes

    Carpal tunnel syndrome is caused by a combination of factors that increase pressure on the median nerve. People who genetically have smaller carpal tunnels are more vulnerable to the condition. Three out of every four people who develop carpal tunnel syndrome are women, most likely due to the anatomy of having smaller carpal tunnels than men. The stature of the smaller carpal tunnel leaves very little room for irritated tendons to swell without putting stress on the medial nerve, making the medial nerves in smaller tunnels more susceptible to experiencing pressure frequently and swiftly. Although carpal tunnel syndrome is more commonly considered a workplace injury, it can also happen to athletes. Kayal Orthopaedic Center’s experts in sports medicine will properly diagnose and treat carpal tunnel syndrome.

    Other contributing factors include:
    ● Trauma or injury to the wrist, such as a sprain or fracture● Overactive pituitary gland● Hypothyroidism● Rheumatoid arthritis● Mechanical problems in the wrist joint● Repetitive work-related wrist activity● Repeated use of vibrating hand tools● Fluid retention during pregnancy or menopause● Development of a cyst or tumor in the canal

  • Symptoms

    Carpal tunnel syndrome symptoms often begin gradually and typically stem from the thumb side of the hand. Initially, symptoms may be intermittent, but without intervention, they may become chronic. The two most common forms of arthritis—rheumatoid and osteoarthritis—raise your risk for carpal tunnel syndrome.

    Common symptoms include:
    ● Numbness, tingling and pain in the hand, especially at night● An electric shock-like feeling mostly in the thumb, index and long fingers● Strange sensations and pain traveling up the arm toward the shoulder● Delicate motions, such as buttoning a shirt, become increasingly difficult

  • Diagnosis

    In order to diagnose you properly, your doctor will consider your symptoms, examine your hand and wrist, and ask you to perform specific movements that reproduce the symptoms of carpal tunnel syndrome. Your doctor may also require you to have X-rays, an MRI or a nerve conduction test to look closely at the nerve function in your hand.

  • Treatment

    Without some form of treatment, carpal tunnel syndrome will progressively worsen. However, if diagnosed and treated early by our specialists, relief can be attained through the following non-surgical treatments. In cases where non-surgical treatments fail to resolve carpal tunnel syndrome, our physicians, who specialize in hand and wrist surgery, will use their knowledge and expertise to perform either open or endoscopic surgery. Open surgery is designed to increase the size of the carpal tunnel and decrease pressure on the nerve, while endoscopic surgery is performed through a small incision and aims to cut ligaments in order to alleviate the pressure that’s being put on the median nerve. The end result of these surgical options is parallel, but each condition has specific determinants that make it better suited for certain situations. Our physicians will thoroughly evaluate each carpal tunnel syndrome situation to decide which surgery option is best for each patient’s individualized condition.

Repetitive Motion Injuries

Reliable Treatment for Repetitive Stress Injuries

Repetitive motion injuries are among the most common injuries in the United States, making up a large portion of athletic and work-related injuries. This condition develops from microscopic tears in the body’s tissues or strains to the body’s muscles, nerves, ligaments or tendons that occur from performing daily activities and motions.
The most common types of repetitive motion injuries include tendinitis, bursitis, and carpal tunnel syndrome.

  • Causes

    Often, causes of repetitive motion injuries include:● Repetitive activity● Trauma● Friction● Crystal deposits● Systemic diseases, such as rheumatoid arthritis

  • Symptoms

    Repetitive motion injury symptoms coincide with the specific injury incurred. The most frequently reported symptoms include:● Red skin that’s warm to touch● Pain reproduced when moving or flexing the affected area● Pain when resting the affected area● Tenderness● Decreased range of motion● Swelling● Joint stiffness● Tingling in the affected area

  • Diagnosis

    Our physicians diagnose repetitive motion injuries through physical examinations and imaging tests, such as MRIs, X-rays and CT scans.

  • Treatment

    Treatment for repetitive motion injuries is focused on helping the patient return to their daily lifestyle with the highest level of function and independence as possible. Non-invasive treatment includes:● Elevation and icing of the affected area● Heat or cold applications● Use of braces or splints to immobilize the affected area● Non-steroidal anti-inflammatory drugs● Exercise programs to stretch and strengthen the area● Conditioning exercises to prevent further injury● Physical therapy
    For more severe cases, our physicians may recommend steroid injections or minimally invasive surgery to repair or remove inflamed tissue.

ACL Tear

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.

  • Prevention

    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

    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.

  • Diagnosis

    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.

  • Treatment

    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.

  • Prevention

    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

  • Symptoms

    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.

  • Diagnosis

    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.

  • Treatment

    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.

Dupuytren’s Contractures

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.

  • 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.

  • Diagnosis

    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.

  • Treatment

    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.

Golfer’s Elbow

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.

  • Prevention

    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

    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.

  • Diagnosis

    Golfer’s elbow is generally diagnosed after a thorough examination and a detailed description of the pain.

  • Treatment

    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.

  • Symptoms

    Hip labral tear symptoms include pain, usually in the groin, a “catching” sensation, grinding of the joint, and limited motion.

  • Diagnosis

    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.

  • Treatment

    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.

  • Symptoms

    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.

  • Diagnosis

    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

    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.

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