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.

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.

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.

You may experience dull, aching pain around the front of the kneecap, where it connects to the lower end of the thighbone (e.g., the femur). The pain may worsen when going up or downstairs, squatting, or kneeling.

If you’re experiencing pain or a dull aching in one or both knees, Dr. Robert A. Kayal and his elite team of NJ orthopaedic surgeons will assess your injury and pinpoint the source of your symptoms.

Treatment of patellofemoral pain depends on the underlying cause. The most important way to improve your condition is rest, rehabilitation or knee bracing. It is important to modify activity. Keeping the knee as straight as possible can help relieve underlying irritation. Physical therapy can help to strengthen the quadriceps muscle and allow your kneecap to track properly. In some cases, surgery can correct the underlying condition and improve support to the knee. Arthroscopy, which involves the use of a small, pencil-sized camera, can be used to smooth fragments of kneecap cartilage. Realigning the kneecap is also an alternative, and this is done by opening the knee and reducing the abnormal pressures on the cartilage.

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.

Although you can develop FAI at any time between your teen years and middle age, it occurs most often in young athletes, typically after they suffer minor trauma. It is possible to have hip impingement for years without knowing it, because it doesn’t always cause pain in the early stages. At first, you might experience periodic pain in the front of your hip or your groin. If you overburden your hip by exercising or sitting for long periods, your pain could grow worse. Other symptoms can include:● Trouble walking uphill● Pain after sitting for a long time● Pain after exercise or sports● Pain in the groin, particularly when walking or flexing the hip● Decreased range of motion● A chronic dull ache● A catching or popping sensation

Your surgeon at one of our centers in Bergen County, NJ, or Stony Point, NY, will begin by examining your hip, looking for signs of limited range of motion. You also will undergo X-ray and MRI testing. An X-ray can show any excess bone on the acetabular rim, femoral head or femoral neck. An MRI can identify labrum and cartilage tears. Your specialist also may order a CT scan to help determine whether you require surgery.

We will explore nonsurgical treatments first, including:● Rest● Activity modification● Exercise to strengthen the muscles that support the hip● Anti-inflammatory and pain medications
If these treatments are not effective, your surgeon may recommend hip impingement surgery. FAI is treated using hip arthroscopy, a minimally invasive procedure in which a lighted scope and thin tools are inserted through small incisions over your hip. Or your situation may require a more invasive surgical procedure.

The type of surgery depends on the cause of hip impingement and the amount of cartilage damage. However, the goal of both approaches is pain relief and hip preservation, which involves repairing damage to preserve the natural hip structures.

During hip arthroscopy, your torn labrum is repaired and the prominent part of the bony malformation of your hip may be decompressed. Femoral acetabular osteoplasty is a more invasive procedure that is done to remove the prominent bony area from the femoral neck. Both procedures restore femoral neck clearance and restore free range of motion in your hip.

Those who are too young for total hip replacement surgery and those with arthritis that hasn’t advanced are good candidates for surgical treatment. However, every patient is unique. You and your surgeon will determine the course of treatment that is best for you. Early diagnosis and surgery improve your chances of a full recovery. However, even surgery performed later can lessen pain and improve range of motion.

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.

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

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).

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.

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.

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

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

Treatment for repetitive motion injuries is focused on helping the patient return to their daily lifestyle with the highest level of function and independence 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 therapyFor more severe cases, our physicians may recommend steroid injections or minimally invasive surgery to repair or remove inflamed tissue.

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.

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.