Specialties

Knee

Patella (Kneecap) instability

 

In the front of the knee the kneecap slides up and down in a groove in the thigh bone. Sometimes it can slip out causing pain, swelling and cartilage injury.

How does it feel?
It can feel unstable and in severe cases it can be difficult to fully extend the knee. Sometimes patients have to go to the ER to get the patella back into the groove. Often these injuries are accompanied by swelling and it can take weeks to months to feel normal again.

How does it happen?
In some patients it happens without any trauma and at a young age. In others it can occur playing sports with or without a contact injury. It can recur especially when it first happens before the age of 25.

How can it be fixed?
In most cases it can be fixed by reconstructing the MPFL (Medial PatelloFemoral Ligament) which is a minimally invasive surgery with a 4-6 month recovery. In patients who have suffered cartilage damage the surgery may be more complicated with the addition of a bone re-aligning surgery such as a tibial tubercle osteotomy and/or a cartilage replacement surgery.

Patellar pain and arthritis

 

In the front of the knee the kneecap slides up and down in a groove (trochlea) in the thigh bone. Sometimes it can be malaligned or arthritic causing pain, swelling, and cartilage injury.

How does it feel?
It can feel unstable and hurt especially going down stairs, sitting for a long time, wearing high heels or doing squats or lunges. Often these conditions have caused pain for years and a change in weight or activity level can make it feel much worse.

How does it happen?
In some patients it happens without any trauma and at a young age. In others it can occur when they either get out of shape or ramp up activity quickly in an effort to get back in shape.

How can it be fixed?
In most cases it can be fixed by avoiding exacerbating activities, going to physical therapy, using injection treatments such as cortisone, hyaluronic acid and PRP. In some cases surgery is required to realign the patella within the groove (tibial tubercle osteotomy) or to replace the cartilage on either the kneecap or the front of the thigh bone (trochlea).

Knee Chondromalacia, Arthritis, and Tendonitis

 

How does it feel?
The knee can feel painful after activity due to cartilage thinning or early arthritis or due to chronic tendonitis. Often these conditions have caused pain for years and a change in weight or activity level can make it feel much worse.

How does it happen?
It happens without any trauma often when ramping up activity quickly in an effort to get back in shape.

How can it be fixed?
In most cases it can be fixed by avoiding exacerbating activities, going to physical therapy, using injection treatments such as cortisone, hyaluronic acid and PRP. In some cases, stem cell injections are useful in order to decrease symptoms.

Meniscal Tear

On both sides of the joint, between the cartilage femur and tibia surfaces, are the medial meniscus and lateral meniscus. The menisci act to absorb shock and work with the cartilage to reduce stresses between the tibia and the femur.

How does it feel?
It can feel unstable and swollen, and sometimes stuck. Other times it may just hurt on the sides or back of the knee especially with squatting and twisting.

How does it happen?
The meniscus can tear with a twisting injury. However, in patients over 40 it can sometimes tear without any specific trauma.

How can it be fixed?
When the meniscus (the cushion) tears within the knee, you can often help it to quiet down with time, anti-inflammatory medication or a cortisone injection, and physical therapy. However, if symptoms such as pain, swelling and instability persist, I recommend arthroscopic meniscectomy. This is a clipping or smoothing of flaps of unstable meniscal cartilage within the knee. The procedure takes about 30 minutes and is done under spinal anesthesia. Patients typically return to work within a few days and active sports in 4 to 8 weeks.

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Anterior cruciate ligament (ACL)

 

Athletes who participate in high demand sports such as skiing, soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

How does it feel?
When the ACL tears it is typically quite traumatic, necessitating a stop to the game or a ski patrol ride to the base of the mountain. You may feel a pop with acute pain and then a feeling of instability such that you cannot bear weight, followed by swelling.

How does it happen?
An ACL is injured during a twisting non-contact event or secondary to a contact injury where the knee is hit on the lateral or posterior side. Most ACL injuries occur in cutting sports such as basketball, soccer, lacrosse as well as skiing.

How can it be fixed?
When you twist or pop your knee and it swells immediately, it is often due to a tear of the ACL. This injury is initially treated with physical therapy, rest and ice. Those who want to return to sports such as skiing and soccer usually require surgery. Occasionally, I have a patient whose goal is to run and cycle; these patients may only require non-operative treatment. However, the vast majority people with ACL tears opt for surgical intervention. This arthroscopic procedure drills tunnels through both the femur (thigh bone) and tibia (shin bone) in order to pass a tendon through the center of the knee. Patients can choose the type of graft used to reconstruct the ACL. For young, high demand athletes, I recommend using their own hamstring or patellar tendon. For less active or slightly older patients, I prefer the relatively less invasive allograft or cadaver tissue option. After surgery, patients need physical therapy for 4 to 6 months and return to cutting sports within 6 to 8 months.

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Knee arthritis

Three basic types of arthritis may affect the knee joint, Osteoarthritis (OA), Rheumatoid arthritis (RA) and Post-traumatic arthritis.

How does it feel?
Arthritis causes pain and sometimes swelling especially with prolonged activity, high impact sports, activities such as walking, stair climbing, or kneeling.

How does it happen?
Arthritis can happen 10 to 20 years after knee trauma or knee surgery. It can also run in families and often begins in the 40s or 50s. Arthritis can be due to a trauma at an earlier age, a genetic predisposition, or an inflammatory disease. Early on, the cartilage or smooth covering of the ends of the bones starts to thin; at this stage, there are many interventions that may ease pain.

How can it be fixed?
To begin with, weight loss, anti-inflammatory medications, and modification or new exercise programs can be quite effective. As the disease progresses, cortisone, hyaluronic acid, PRP and stem cell injections can provide months of improved function and decreased pain. Finally, when patients reach the point when conservative measures are no longer effective, they can elect to have a partial or complete knee replacement. The positive effects of these procedures include diminished pain and improved function, however, the risks of blood clot, infection, joint stiffness and implant loosening must be considered as well. Patients undergo these procedures under spinal/epidural anesthesia and leave the hospital in 1 to 3 days, with full return to low impact activities typically in 3 to 6 months.

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Shoulder

Labral tear and shoulder instability

Soft-tissue injuries are tears of the ligaments, tendons, muscles, and joint capsule of the shoulder, such as rotator cuff tears and labral tears.

How does it feel?
The shoulder may feel unstable or actually dislocate with certain activities. If the labrum is torn it may hurt with overhead sports.

How does it happen?
The labrum can tear due to a fall on an outstretched arm or a collision with the arm out at the side. When the shoulder is dislocated it often must be reduced in the emergency room or clinic.

How can it be fixed?
When you dislocate or injure your shoulder in a way that tears the labrum (cartilage rim on the socket of the shoulder), it often must be repaired. Unfortunately, the human body does not have a way to heal these injuries on its own. Depending on the symptoms and MRI findings, I often recommend labral repair. This is an arthroscopic procedure done under regional anesthesia with tiny incisions. Essentially, I repair the torn tissue with sutures attached to tiny plastic anchors inserted in the bone of the glenoid (shoulder socket). Following the operation, you must rest the shoulder in a sling for 4 to 6 weeks to allow healing. You also start a graduated physical therapy program, with the goal of returning to sports in 3 to 6 months.

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Rotator cuff

A rotator cuff tear is a common cause of pain and disability in adults. A torn rotator cuff weakens your shoulder, making many daily activities, like combing your hair or getting dressed, painful and difficult to do.

How does it feel?
When the rotator cuff is torn the shoulder will hurt and feel weak, especially when attempting to do activities at shoulder level. Furthermore, it may be difficult to sleep, wash oneʼs hair or put on a coat.

How does it happen?
The rotator cuff can tear due to overuse and overhead sports,however, it is a weak area that may wear out due to everyday wear and tear.

How can it be fixed?
This shoulder injury occurs for many athletes who enjoy overhead sports, however, it may also be the result of every day wear and tear. Since complete tears do not heal on their own, I treat them arthroscopically, using tiny incisions in the skin around the shoulder. I insert plastic anchors into the bone with sutures attached to sew the tendons of the rotator cuff muscles down to bone, so your own body can heal them. For most tears, I use a double row technique to maximize the fixation and strength of the repair. In the same surgery, I raise the acromion (roof or highest point in the shoulder) in order to take the pressure off the healing tendons and potentially release growth factors present in the bone to the healing tissues. Surgery is done under regional rather than general anesthesia and patients go home in a sling the same day. Physical therapy starts a week after surgery and patients continue to wear the sling for 6 weeks. Return to full activity typically occurs 4 to 6 months post-operatively.

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Elbow

Tennis elbow

Tennis elbow (lateral epicondyliti), is a painful condition, often caused by playing tennis or other racquet sports; several other sports and activities can also put you at risk.

How does it feel?
The elbow hurts along the outside when gripping or picking up objects; it can also ache at rest.

How does it happen?
Interestingly enough, tennis elbow is usually not a result of tennis and can be due to everyday activity, using a mouse, typing, and working out. The pain is caused by a degeneration of the tendons on the outside of the elbow.

How can it be fixed?
While over 90 percent of patients who suffer from lateral epicondylitis (tennis elbow) improve with physical therapy and activity modification, some patients continue to suffer from pain during daily living and sports activities. For these patients, an MRI shows a tear or significant degeneration of the origin of the deep wrist extensor tendons. This in-office procedure involves drawing one’s blood, using a special machine to separate out the platelet-rich plasma, and then injecting into the degenerated tendon. Activities progress thereafter, with full return to activity typically in 3 to 4 months.

Sabrina M. Strickland, MD has contributed to the following educational materials

Prior to Visit Information

We’re glad you’ve chosen to take action in order to feel relief. On behalf of Dr. Strickland, here are a few things you might consider doing before coming in for your consultation.

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Pay Attention

Take note of which activities worsen your symptoms and what makes you feel better. Keep track of recent changes in activity, whether you have new running shoes or old ones, and to determine what caused your injury.

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Gather Your STUFF

Please bring your MRI, CT, or X-ray images on CD to your appointment. Any results of relevant blood work, reports of previous surgeries, or other health information can help Dr. Strickland form an accurate picture of your history and current injury.

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Online Forms

We strongly encourage patients to fill out forms prior to their visit to reduce waiting time at the office. You should have received an email with a link to access your forms through our online portal. Please check your junk and spam folders if you believe you did not receive it.

If you are having difficulty with the online forms, please contact our office at 212.606.1725.

Post Surgery Information

Now that you’ve gone through the procedure, it’s important to know how to care for yourself. Follow these steps to ensure a healthy healing process.

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Keep it cold

Use the ice machine as directed or purchase several gel ice packs and apply with fabric next to the skin for 20 minutes every 60 to 90 minutes. Ice is most important during first week, but should still be used 3 to 4 times a day for 6 to 8 weeks, especially after a lot of activity.

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Keep it dry

The initial hospital dressing stays on for the first 48 hours, replaced by a waterproof dressing. You can cover small arthroscopy portals with Nexcare™ bandaids; these bandaids resemble plastic wrap and keep water out of the wound. Cover larger wounds with Tegaderm™, available in most pharmacies. I usually use absorbable sutures and glue, so it is unlikely anything will need to be removed.

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Elevate

Keep your foot up on a bed, sofa or coffee table when resting if you just had knee surgery. For shoulder surgery, it is much more comfortable to stay relatively upright, which means sleeping on the couch, a recliner, or with a lot of pillows in bed.

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Keep track of your medication

You will be prescribed a prescription pain reliever. This most often contains Tylenol®, which should not be mixed with over the counter pain relievers. Please write down when you take your medication so you take it at regular intervals to keep your pain level at a minimum. Also, please call our office or email [email protected] when you are starting to get low on medication; narcotics are impossible to obtain on weekends.

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Start your physical therapy

The physical therapy instructions come from the physical therapist at the Hospital for Special Surgery. Start these exercises immediately so you get moving; this helps you avoid stiffness and hopefully a blood clot. A staff member from Dr. Strickland’s office will call you the day after surgery to answer any questions you may have.

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NYC Office:

Hospital for Special Surgery
East River Professional Building
523 East 72nd Street, 6th Floor
New York, NY 10021

Phone: (212) 606 1725

E-mail: [email protected]

 

Stamford Office:
Stamford Chelsea Piers
1 Blachley Road
Stamford, CT 06902

Phone: (203) 409 3000

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