News At AOC

MAKOplasty Partial Resurfacing

June 15, 2021

MAKOplasty Partial Knee Resurfacing

Partial knee replacement is a treatment option for people with early to mid-stage osteoarthritis (OA) that has not yet impacted their entire knee. Only the diseased portion of the knee is replaced, sparing healthy bone and the ligaments known as the ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament).

MAKOplasty Partial Knee Resurfacing is an advanced partial knee surgery performed with the RIO® Robotic Arm Interactive Orthopedic System. It can be performed as a unicompartmental procedure to address OA in any of the three compartments of the knee: the medial (inner), patellofemoral (top), or lateral (outer) compartments. There is also a bicompartmental option for OA in both the medial and patellofemoral compartments.

What are the benefits of MAKOplasty?

Partial knee replacement can be a challenging procedure to perform accurately on a consistent basis using manual techniques. Robotic arm assisted MAKOplasty enables consistent results and more accurate implant placement – which is an important factor in the life expectancy of implants. In an ongoing study, MAKOplasty resulted in both greater accuracy in implant placement and less pain in the first eight weeks post-surgery compared to manual partial knee replacement using Oxford® implants. Another study found that unicompartmental MAKOplasty patients who received RESTORIS® MCK Medial Onlay implants, showed a very low failure rate of only 0.4% at two years2, which is nine times lower than that of manual surgery. The study was conducted by four surgeons, who evaluated 201 patients (224 knees).

How does MAKOplasty work?

Before surgery, a CT scan is taken of the patient’s knee, and a 3D model created using the RIO system’s software. From this model, a pre-surgical plan is developed for the positioning of implants based on that patient’s unique anatomy.

To ensure implants are optimally positioned and that the soft tissues of the knee are balanced for a good surgical outcome, surgeons can test and fine tune the plan before surgery by moving the leg through different ranges of motion. The RIO provides measurements and visualization, and the surgeon adjusts the plan as needed.

Once the surgical plan is finalized, it is programmed into the RIO, which creates a safety zone for bone removal. While the surgeon guides the robotic arm and is in control of it at all times, the RIO ensures that bone removal stays with the safety zone of the surgical plan, providing auditory, visual and tactile feedback, stopping the robotic arm if necessary before bone can be removed outside the planned area. Once the bone preparation is complete, the implants are placed in the knee.

As a knee arthroplasty procedure, MAKOplasty® is typically covered by Medicare- approved and private health insurers.


Tennis Elbow

You don’t have to play tennis to be diagnosed with tennis elbow.

Elbow pain can be caused by a variety of problems. A common cause in adults is tendinitis, an inflammation and injury to the tendons — soft tissues that attach muscle to bone.

Tennis elbow is a condition that produces severe, burning pain over the bone at the side of the elbow. The medical term for tennis elbow is lateral epicondylitis. The pain results from inflammation of the tendon that attaches muscle to the bony projection (called the epicondyle) on the outside of the elbow.

Tennis elbow usually begins with mild pain and can worsen over time. The pain is worsened by pressing on the affected area, by lifting objects particularly with extension of the wrist. Using a screwdriver can worsen the injury and cause pain. In advanced cases, even simple movements of the elbow joint can produce pain.

While tennis elbow affects up to half of people who participate in racquet sports, most people who develop tennis elbow do not play racquet sports.

Work activities that involve frequent use of the forearm muscles, such as meat cutting, painting, plumbing, or weaving are also associated with the development of tennis elbow.

The treatment of lateral epicondylitis may include ice packs, resting the involved elbow, stretching exercises and anti-inflammatory medications. Anti-inflammatory medications typically used include aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen. Bracing the elbow can help. Simple braces for tennis elbow can be found in community pharmacies and athletic goods stores. Local cortisone injections are given for persistent pain. Activity involving the elbow is resumed gradually. Ice application after activity can reduce or prevent recurrent inflammation. Occasionally, supportive straps can prevent re-injury. In severe cases, an orthopedic surgical repair is performed.

To learn more about Dr. Steve Johnson, click here.


What About My Aching Knee

“What About My Aching Knee?”

As an orthopaedic surgeon, this is one of the most common complaints I hear from patients.

Many knee problems occur during sports or recreational activities, work-related tasks, or home projects.

Knee problems may also manifest due to injury, disease, overuse, or just every day wear and tear. Knee issues affect people of all ages from children to the elderly, and most everyone will experience knee problems at some point in their lives.

Knee problems can be caused by many factors such as injury, arthritis, disease, aging, and being overweight. Some of the most common causes of knee pain in adults include arthritis and injury. Injury is usually in the form of overuse causing tendonitis, torn cartilage or ligament, and bone fracture.

  • Osteoarthritis is a disease that gradually causes the cushioning cartilage within your knee to wear away resulting in pain when bone rubs against adjacent bone.
  • Rheumatoid arthritis usually affects younger people and is an auto-immune disease.
  • Other common forms of arthritis of the knee include gout (uric acid waste crystals in the joints), lupus (another autoimmune disease), psoriatic arthritis (inflamed joints as a precursor to psoriasis), and infectious arthritis (brought on by infectious agents such as bacteria or viruses).

Treatment for arthritis is determined by the type and severity. Early stages sufferers use over-the-counter pain relievers and lifestyle modifications like weight loss and performing mild exercises that strengthen the muscles that support the knee. If osteoarthritis has progressed, a knee resurfacing, partial knee replacement, or total knee replacement may be the solution to ending the pain.

The most common structures to be injured or damaged are the cartilages (meniscus) within the joint and the 4 ligaments which keep the two bones of the knee (femur and tibia) together and functioning properly.

The ligaments are the bands of soft tissue that act as restraints connecting the bones and providing stability in the joint.

Treatment involves applying ice packs, elevating the knee, and immobilization. Severe injuries may require surgical repair and stabilization.

Patients who have an injured their meniscus may experience some pain when the knee is fully straightened and on weight bearing. There may also be some swelling if there was a significant injury. Symptoms of meniscal injury may sometimes disappear on their own, but frequently persist or return months or years later and require treatment, particularly if the knee is injured a second time.

Treatment of meniscal tears is usually knee arthroscopy, an outpatient, minimally-invasive procedure that takes less than 30-40 minutes in most cases. Results for this type of procedure usually reveal a 90-95% success rate with very high level of return to activity.

Knee problems can, and are likely to occur in most people, and can be caused by many factors. Although knee problems as a result of an accident cannot be avoided, other knee problems can be lessened or avoided by:

  • Warming up your muscles before sports by walking and stretching.
  • Avoiding sudden changes in the level of exertion in exercises and activities you’re currently enjoying.
  • Wearing shoes that fit correctly and are in good condition.
  • Strengthening your leg muscles through exercise such as walking up stairs or working out with weights.
  • Maintaining a healthy weight as extra weight puts additional pressure on your knees.

Hand Numbness and Tingling

Do your hands ever go numb and tingly? Do you wake up at night with a “dead” hand and have to shake it out to get it to “wake up?” Do your hands fall asleep while driving a car or holding a cell phone? If so, then you may have increased pressure on a nerve in your palm – a condition called Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome (CTS) is the most common cause of numbness and tingling in the hand.

As a result of pressure on the median nerve, one may experience pain, weakness, and numbness in the hand and fingers. This typically affects some combination of the thumb, index, middle, and ring finger. The causes of carpal tunnel are varied, but most of the time there is no obvious reason. Women are more commonly affected than men, and the incidence increases with age. CTS can be associated with a number of prevalent medical conditions including: obesity, diabetes, hypothyroidism, rheumatoid arthritis, alcoholism, and drug toxicity. Pregnancy has also been associated with CTS – typically during the third trimester and may be related to fluid retention.

The diagnosis of CTS is based largely on the symptoms experienced as well as the exam performed by a physician. As mentioned above, most people relate symptoms that wake them from their sleep. Daytime activities such as holding a steering wheel or a book for an extended period of time may exacerbate the numbness and tingling as well. It is common for both hands to be involved – though one side may be more symptomatic. With longstanding compression, patients often complain of decreased grip strength and difficulty holding on to objects.

During a visit to your physician, you may be asked to perform several tests that will help determine whether or not CTS is the correct diagnosis.

Your doctor will search for other possible causes of numbness and tingling including pinched nerves in the neck or elbow. They will also test the small muscles in your hand for any loss in strength (more commonly seen in chronic cases), as well as the feeling in your finger tips for any loss in sensation.

If your physician is concerned about CTS, he/she may send you for a nerve study. This test involves stimulating the median nerve and taking measurements which tell us how well the nerve is conducting its signal. The second portion of the test involves testing the electrical activity of the small muscles in the hand.

Treatment of CTS typically begins with nonsurgical options (except in longstanding cases with muscle weakness or significant loss of sensation). Most commonly this will involve wearing wrist splints at night time and intermittently during the day. Other treatment options include: anti-inflammatory medications (ibuprofen, naproxen, etc.), steroids (either oral or injections), ultrasound, and occupational therapy.

When these conservative measures fail to relieve symptoms, your physician may recommend surgery. While there are several different techniques to performing a carpal tunnel release, they all involve releasing the pressure on the nerve by cutting the ligament that sits above the nerve. This can be done with modern, minimally invasive techniques that serve to relieve symptoms (especially at night) and ease recovery.

If you have hand numbness and tingling, you may have CTS. Contact us at 706-549-1663 or contact us to request an appointment with our hand specialists.


NCV/EMG Information

What is an NCV/EMG?

An NCV/EMG test is a diagnostic test that your doctor may order to assist in obtaining additional information in order to assist him/her in making the right diagnosis regarding your medical condition. The test has two components, the first is the NCV (nerve conduction test), the second component is the needle examination called an electromyogram. An electromyogram, or EMG, is a test that checks the response of muscles to messages sent by the nerves.

What type of patient needs an NCV/EMG?

Patients present with a lot of complaints, but the ones that require a nerve test (NCV/EMG) are those that complain of neck or back pain with radiating pain in the arm or legs, muscle weakness or involuntary twitching of muscles. Patients that complain of burning pain in the feet, hands or fatigue with minimal exertion are excellent candidates for the test.

What types of conditions are diagnosed with NCV/EMG?

Patients that have neck pain hand or arm numbness or tingling are usually referred for the test. Your doctor may want to exclude the following:

  • Wednesday 10:00am to 12:00pm for Don Joy Braces.
  • Carpal tunnel syndrome,
  • Ulnar neuropathy at the wrist or elbow,
  • Pinched nerve (cervical radiculopathy),
  • Brachial plexus injury,
  • Radial neuropathy,
  • Thoracic outlet syndrome,
  • Myopathy (muscle weakness), or
  • Myofascial referred pain.

Patents that have back pain with lower extremity pain may have the following:

  • Lumbosacral radiculopathy,
  • Peroneal neuropathy,
  • Sciatic neuropathy,
  • Tarsal tunnel syndrome, or
  • Lumbosacral plexopathy.

How do I prepare for an electromyogram?

Tell your health care provider before the test if:

  • You have any bleeding problems,
  • You have a pacemaker,
  • You have allergies, or
  • You are taking any medicines.

On the day of the test, take a shower to remove body oil and do not use body lotion.

How is the test performed?

The first part of the test requires the doctor to isolate specific nerves with precisely placed electrodes and then he /she will provide a low voltage electrical stimulus to activate or depolarize the nerve. The doctor will evaluate different nerves in the extremity, protocols vary, but be prepared to have about 4-6 nerve stimulated. The second phase of the test is the needle examination study in which the doctor places a thin needle into 4-6 different muscles to look for muscle abnormality.

When can I expect the results of the test?

The typed EMG results can be faxed to your doctor within 24 hours.


Is it Broken or is it Fractured?

This is a common question asked of many orthopedic practitioners. The two words mean the same thing. Clinicians speak in terms of different kinds of fractures to describe how a bone is broken. Determining how a bone is fractured will help to tell what type of treatment is needed in many cases. There are several types of fractures, which are classified into two categories: Complete and Incomplete.

Incomplete Fractures

Incomplete fractures are breaks in the bone that do not go all the way through the bone. Two forms of incomplete fractures are a bucklefracture and a greenstick fracture.

Buckle fractures (also known as Torus fractures) are usually caused by a fall on an outstretched hand resulting in a wrinkle in the bone much like what happens to a drinking straw when it is bent in half. Like the straw, the bone is weaker at the level of the wrinkle and is treated with a cast to allow the bone to heal in the proper position and to protect the area from further injury.

Greenstick fractures are most often a result of a force being applied to a bone from the side. The result is a fracture much like what happens when a young tree branch is snapped and with one side only bending while the other splinters. This injury is also treated with a cast to allowing for proper healing.

Complete Fractures

Complete fractures are usually caused by a larger force and result in a complete break through the bone. Complete fractures are further classified into simple and complex fractures.

Simple fractures result in bones being broken into two pieces and are described by the way they travel through the bone. A transverse fracture goes straight across the bone.  An oblique fracture travels at an angle through the bone. Lastly, a spiral fracture is at an angle that has been twisted through the bone. Most of the time these fractures can be treated with a cast alone; however, sometimes extra steps are necessary to push the two fractured pieces back together. Occasionally, surgery is needed to put the bone back together with the help of pins, screws, rods and plates.

Complex fractures (also known as Comminuted) occur when a bone is struck with a great force causing the bone to break into three or more pieces. This more commonly happens to older children and adults; although, younger children can have complex fractures as well if enough force is applied. Treatment is often similar to simple fractures.

Growth Plate Injuries

In general, children have softer bones than adults, in part because they are still growing. This makes them more likely to have fractures than sprains and strains. In order for children to grow they must have bones that are big enough and strong enough to allow them to grow. This growth happens at a place in the bone called the growth plate. Also known as the physis, a growth plate is a place near the end of children’s bones where cells are rapidly produced to make the bone longer and bigger. Since the bone is new in this area, it is also softer (weaker). Unlike adult bones, which have hardened, children’s growth plates are actually weaker than the tendons that attach muscle to bone and the ligaments that attach the bones together. This is the very reason children are have more fractures than torn muscles, tendons and ligaments. During an injury, the muscles, tendons and ligaments hold strong. This puts a large amount of the force from a traumatic event (such as a sporting injury or an automobile accident) into the growth plate resulting in a fracture.

Growth plate fractures can present in many ways. They can be displaced (when one end of the growth plate has slid out from under the other end) and non-displaced (when both ends of the fracture are in line with the bone). Displaced fractures are much easier to diagnose on x-ray and sometimes require reduction (bone realignment) and/or surgery to make sure the bone heals in the proper position. Non-displaced fractures are harder to diagnose on x-ray and require the trained hand of a medical provider to discover. With the knowledge of anatomy and through clinical training, orthopedic clinicians are able to assess non-displaced fractures by touch over the injured area.

Growth plate fractures are among the quickest fractures to heal due to the rich blood supply and healing factors to the area. Because children are still growing, they have the ability to remodel fractures faster than adults. For this reason, orthopedists are able to use more conservative treatment (casting and splinting) to treat children’s fractures in most cases.

Bone Remodeling

Children have a thick covering around their bones call periosteum. Adults have periosteum also, but as a person ages the periosteum gets thinner. In children, this thick periosteum acts as scaffolding to allow new bone to form in and around a fracture. As a fracture heals in a child, new bone forms a “callus” around the fracture site. The callus consists of bone material and acts as a re-enforcement to the fracture on the outside. Within the bone, the body also places new bone to act as “super-glue” to help stabilized the fracture on the inside.

This is similar to callus formation on the skin. If you wear shoes that rub on your heal, you get a callus at the point of greatest friction. This is your body’s way of preventing injury to your heal. A boney callus is similar in that it is the body’s way of insuring healing and preventing further injury. In other words, your body does not know if another injury will happen any time soon, but it is going to lay down more bone to decrease the chance for another fracture. Overtime, the combination of the periosteum and new bone growth, the bone is able to remodel back to its original form. This may take months to happen. Depending on the age of the child, remodeling can often prevent the need for surgery to repair fractures.

Most Common Fracture in Children

Many studies have evaluated children’s fractures to determine what is the most common fracture in children. It has been determined the wrist (distal radius and ulna) is the area most often fractured in young people.  This injury is most often seen in adolescent males; however, this injury is commonly seen in all age groups and genders. In fact, more than 25 percent of all fractures present in this area.1

Fractures at the distal radius and ulna are usually treated with a short-arm cast for 4-6 weeks. Occasionally, the use of a long-arm cast is needed to help stabilize more severe wrist fractures. Rarely, the use of screws, plates and pins are used but are more common in adults than children.


1. Herring J. Tachdjian’s Pediatric Orthopedics, Fourth Ed.

2. Pictures from


Finger Catching and Locking

Do your fingers ever lock or catch? Do you ever wake up in the morning with a finger stuck in your palm?

Do you ever have to use your other hand to pull the finger straight again? If so, you may have a condition known as trigger finger.

Trigger finger, or stenosing tenosynovitis, involves the tendons in the hand that bend the fingers. These tendons can be thought of as ropes that connect the muscles in the forearm to the bones of the finger. As the tendon moves into the finger, it runs through a tunnel of sorts that we refer to as the flexor sheath. The entrance to the tunnel is actually a small pulley that helps to keep the tendon close to the bone. This system is truly a well oiled machine, as any disturbance to either the tendon or the tunnel can create difficulty in finger motion as well as pain.

Fingers begin triggering when the pulley (i.e. the tunnel entrance) or the tendon becomes thickened.

This makes it hard for the tendon to glide in and out of the tunnel. With increased resistance, one may feel pain, popping, or catching with bending and straightening of the finger. As the tendon triggers, it can lead to increased thickening in the system which can lead to worsening of this condition.

The cause of trigger finger is not always known. It can be associated with medical conditions such as diabetes, rheumatoid arthritis, and gout. Occasionally patients recall some minor trauma to the area; however, the majority of the time there is no obvious cause.

The symptoms of trigger finger often start with pain or tenderness at the base of the finger where it meets the palm. Some of the time a small nodule can be felt in this area. Frequently patients report pain in one of their knuckles; however, the problem is actually occurring in the pulley.

Treatment of trigger finger is geared towards eliminating the catching while restoring pain free motion of the finger.

This typically begins with nonsurgical options such as small splints, anti-inflammatory medications, or injections. Swelling around the tendon in the sheath must be reduced in order to improve gliding. Steroid injections can often be very helpful in decreasing the inflammation and relieving the triggering. Diabetics must be careful when receiving these injections, as they can temporarily raise their blood sugar levels.

If non-surgical means fail to completely relieve the symptoms, your physician may recommend surgery. The surgery is performed as an outpatient, often with local anesthesia and minimal sedation. A small incision is then made in your palm overlying the site of the thickened pulley. Your surgeon will then cut open the pulley to allow the tendon to glide freely. You may even be asked during the operation to move your finger to ensure the triggering has ceased. Immediately after the procedure, most patients find they are able to bend their fingers without further catching or locking. Typically you may resume light use of the hand right away. It is very normal to have some degree of soreness over the surgical site afterwards. Occasionally your doctor may recommend hand therapy to optimize motion.

If you notice catching or locking of one of your fingers, ask your doctor if these symptoms are from trigger finger.


Decrease your post-operative pain

Following the program below will greatly decrease your post-operative pain.

Surgery Day AM

Take 1 Aleve 220 mg* (or generic naproxen sodium 220mg) and 1 Tylenol Arthritis 650 mg** (or generic acetaminophen 650 mg “arthritis” or “extended release”), with just a sip of water, prior to leaving your house.

Surgery Day PM

Take 1 Aleve 220 mg and 1 Tylenol Arthritis 650 mg the afternoon/evening after surgery (with food and water).

Days After Surgery

Take 1 Aleve 220 mg twice a day and 1 Tylenol Arthritis 650 mg three times a day (with food and water) for 2-3 days after the surgery.  After 2-3 days, take the Aleve and Tylenol Arthritis only as needed.


  • Aleve plus Tylenol Arthritis is a case of 1+1=3, not 2. That is, they work together as a team to make each other stronger.
  • Only take the narcotic pain medicine if needed (this contains acetaminophen). Do not exceed 4g of Tylenol (acetaminophen) over a 24 hr period.

*Patients with a history of heart disease, stroke, stomach ulcers, reflux, kidney disease, a known allergy to aspirin or other nonsteroidal anti-inflammatory drugs, or who are currently taking blood thinning medication or are pregnant should consult their primary care doctor before taking Aleve (or naproxen sodium).

**Patients with a history of liver disease or significant alcohol consumption should consult their primary care doctor before taking Tylenol (or acetaminophen).

According to a 1999 Pain Study performed by Board Certified Hand Surgeon David Lincoln Nelson, MD, the above regimen is proven to reduce post-operative pain among hand surgery patients.  It is also preferred by patients versus taking narcotic medications to address pain.  Dr. Katz cares about your pain and is interested in providing only the best treatment available.


Do your hands hurt? Have they become stiff and painful?

Do your hands hurt? Have they become stiff and painful? Do you find yourself asking for help with opening jars? Have you started to notice a decrease in your pinch and grip strength? If so, you may have wearing out of the small joints in your hand – a very common condition known as arthritis.

Arthritis literally means “inflamed joint.” Normal joints in the body consist of two bones with a smooth cartilage end caps in between them. Arthritis results when this cartilage begins to wear out and the bone ends become irregular. While arthritis can affect any joint in the body, it is often most noticeable in the small joints in the hand given their relatively minimal soft tissue envelope. This condition can be very painful and disabling – especially when left untreated.

Osteoathritis (OA) is the most common form of arthritis encountered in the hand (others such as Rheumatoid, Psoriatic, and post-traumatic are beyond the scope of this article). It typically results from simple “wear and tear” over time. It is characterized by a degeneration or thinning of those smooth cartilage end caps. This creates direct or “bone on bone” contact causing in pain and deformity.

OA is most commonly found in three areas in the Hand: the base of the thumb (CMC joint), the end joint on the finger (DIP joint), or the middle join on the finger (PIP joint). Pain, stiffness, and swelling are the most common symptoms of all forms of hand arthritis. However, there are some specific symptoms to each of these joints.

The base of thumb joint (CMC) is one of the most common joints to develop arthritis in the hand. This joint is known as a “saddle” joint which allows for a great deal of motion for the thumb. OA in this joint is most commonly seen in women over the age of 40; however, men are unfortunately not immune to it! Pain is typically the first symptom of this potentially disabling condition. This is especially prevalent with opening jars, turning door knobs, and writing. As the arthritis progresses, patients can even develop a bump at the base of the thumb from the deformed joint.

Arthritis is diagnosed from a combination of a clinical exam by your physician as well as X-rays. While X-rays are important in the diagnosis, they only tell part of the story in OA of the hand. As your doctor can explain to you, some patients have very bad arthritis on X-rays, but are not very symptomatic. On the other hand, some patients have relatively minimal arthritis on X-rays, but have a tremendous amount of pain. It is not always clear the reasons for this discrepancy.

Treatment of OA of the hand is aimed at minimizing pain and restoring as much function as possible. Your physician may recommend the use of anti-inflammatory medicines (NSAIDS) like Ibuprofen and Naproxen. There are also topical medications that can be useful. In addition, the use of braces (both soft and hard) can be helpful in managing OA – especially in the base of thumb (CMC) joint. Warming up the joint with water or paraffin wax might help with the symptoms. Hand therapy is often an important part of the treatment algorithm. Cortisone injections can relieve some of the pain and inflammation – at least for a period of time. Finally, if symptoms persist despite these nonoperative modalities, your doctor may recommend surgery – of which there are often good options available when the time comes.


Common Summertime Orthopedic Injuries

Common Summertime Orthopedic Injuries: Shoulder

Here comes Spring and Summer! With the warmer weather, people of all ages begin to enjoy participating in outdoor sports and activities, exercise, and vacation. Sports such as baseball, softball, tennis, swimming and volleyball and activities that involve a lot of repetitive arm and shoulder motion (ie, painting, roofing, yard work, and gardening) can often lead to the development of common shoulder conditions.

As an Orthopedic Surgeon and Sports Specialist, I see an increased incidence of injuries associated with these endeavors during the warmer months of the year. A large number of these injuries can be prevented and cured if risk factors are recognized early, if the signs and symptoms are properly identified, and if quick and appropriate diagnosis and treatments are provided. My goal for this article is to describe some of these common injuries that occur in people of all ages during these warmer months, and hopefully point out what to watch for regarding the signs and symptoms of these conditions, and what we can do to effectively treat these problems.

Shoulder Conditions/Injuries:

Some of the most common shoulder conditions that occur in the warmer months include Impingement Syndrome, Bursitis, Tendinitis, and Tendon Ruptures or Tears. These conditions are often associated with repetitive activity, new onset of activity, change in activity, overhead activity, injury from a fall, or heavy lifting. All of these conditions can cause significant pain and disability in the shoulder and upper extremity. Very commonly, individuals can develop these conditions and not really be aware of the severity of the condition, and in an effort to “work or play through the pain,” they tend to brush it off and keep participating, therefore aggravating the shoulder even further. The most common activities that lead to these conditions are as follows:

Common Activities That Cause Shoulder Injury

  • Sports (tennis, baseball, swimming, volleyball)
  • Yard work (digging, planting, raking, weed-eating, spreading straw)
  • Painting
  • Hammering
  • Moving heavy objects
  • Repetitive overhead lifting/movements (spring cleaning)

Impingement Syndrome:

Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.


Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.

Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis. Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.


A tendon is a cord that connects muscle to bone. Most tendinitis is a result of a wearing down of the tendon that occurs slowly over time, much like the wearing process on the sole of a shoe that eventually splits from overuse.

Generally, tendinitis is one of two types:

  • Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
  • Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.

The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.

Tendon Ruptures or Tears:

Splitting and tearing of tendons may result from acute injury or degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears may be partial or may completely split the tendon into two pieces. In most cases of complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are among the most common of these injuries.

What to watch out for:

  • Minor pain that is present both with activity and at rest
  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain with lifting and reaching movements
  • Athletes in overhead sports may have pain when throwing or serving a tennis ball
  • Pain at night and difficulty sleeping on the affected side
  • Loss of strength and motion
  • Difficulty doing activities that place the arm behind the back, such as buttoning or zippering


Initial treatment usually includes rest, ice packs, medication such as ibuprofen, aspirin, naproxen, etc, and range of motion exercises.  For more serious injuries physical therapy may be helpful. For severe pain, your doctor may suggest a cortisone injection.

Fortunately, most of these conditions can be treated very successfully without needing surgery. However, for those severe injuries where the rotator cuff is torn, or injuries that do not respond to conservative treatments, surgical repair may be required.


Fingertip Injuries in the Workplace

Fingertip injuries are unfortunately a common occurrence in many different places of employment.

They are especially common in young men who perform manual labor. The fingertip is exposed in a variety of occupations where it can be crushed by heavy objects, lacerated by knives, or injured by power tools such as table saws. These injuries can lead to damage to the bone, tendon, nerve, nail bed, finger pad (pulp), and skin. Tendons (both flexor and extensor tendons) are the key structures that bend and straighten the finger. Nerves provide feeling to the tip of the finger, while the nail bed (germinal matrix) is responsible for making the nail.

The relative lack of soft tissue at the tip of the finger, as well as the presence of the nail bed, makes these injuries often complicated to treat. While some people may disregard the importance of the nail itself, it plays a key role in the function of the hand. Nails protect the fingertip, provide a counterforce when picking up small objects, and contribute to the tactile sensation of the fingertip.

When evaluating an injury to the fingertip, the degree of damage as well as the physical demands of the patient are taken into account when devising a treatment plan.

Blood often collects underneath the nail (subungual hematoma) after a crushing injury. When there is a significant amount of blood, as well as a break of the underlying bone, surgery is often recommended to drain the hematoma, wash out the open fracture, and to repair the nail bed. The fracture itself is often amenable to nonoperative treatment with a splint - only occasionally requiring surgical treatment with a metal pin or screw.

Some fingertip injuries can be treated with simple daily dressing changes with antibiotic ointment. These patients often only have soft tissue loss of the fingertip, without the severe damage involving bone, tendon and nail bed as described above. With some persistence, the end result of this non-surgical treatment in select patients can be excellent.

While most patients with fingertip injuries are able to regain much of their pre-injury function, it is important to note that many of these patients will report residual numbness, cold sensitivity, and nail growth abnormalities. Finally, the involvement of a certified hand therapist is an integral part of optimizing functional outcomes for the long term with or without surgical treatment.        

Author: David Katz, MD

[1] Sorock GS,Lombardi DA, Hauser RB, Eisen EA, Herrick RF, Mittleman MA: Acute traumaticoccupational hand injuries: Type, location, and severity. J Occup EnvironMed 2002;44(4):345- 351. [1] DaCruz DJ, Slade RJ,Malone W: Fractures of the distal phalanges. J Hand Surg Br 1988;13(3):350-352.


Preparing the Body for Exercise is Important at any Age | Warming Up |

September 5, 2022

If you are younger, you may think that your body is very limber and is quickly able to adapt and thus you can jump straight into exercise with no sequela. Likewise, if you are on the other end of the spectrum, you may think that the type of exercise you do is so low impact, that you will do no harm by getting right into it. However, it is important to prepare the body for exercise at any age. Preparing for exercise requires a minimum of these three things: hydration and nutrition, warming up and proper clothing.


Preparing the Body for Exercise is Important at Any Age | Hydration & Nutrition |

If you are younger, you may think that your body is very limber and is quickly able to adapt and thus you can jump straight into exercise with no sequela. Likewise, if you are on the other end of the spectrum, you may think that the type of exercise you do is so low impact, that you will do no harm by getting right into it. However, it is important to prepare the body for exercise at any age. Preparing for exercise requires a minimum of these three things: hydration and nutrition, warming up and proper clothing.

Hydration & Nutrition

It is vital to hydrate and eat well prior to exercising. It is important to remember that you will lose both nutrients and water during activity. Plain water is essential for maintaining our body's water balance and for replacing what is lost during exercise. Sports drinks, protein shakes and smoothies are all advertised as a great way to replenish your nutrients after exercise, however, these usually only playa role in high intensity exercise. It is wise to consult a doctor, nutritionist or trainer prior to high intensity exercise to determine what is best for your body and activity level before and after exercise.

Warming Up

Warming up before exercising allows your muscles and heart to prepare for activity. The CDC recommends 150 minutes of activity per week for the average adult. That comes down to about 30 minutes a day for 5 days. Of that 30 minutes, about 5-10 should be spent warming up. A warm up is a low-intensity activity to prep your body for a higher level of activity. Low intensity exercise can include swimming, jumping rope, walking, jogging, or really anything you enjoy! After a short warm up, you will want to stretch your muscles as well. Be sure to target all muscle groups including the extensors, flexors, power muscles, and stabilization muscles. Stretching should always be done after a warm up to avoid injury.


Shoe Tips

Whether you're a novice or a seasoned runner, having the "right" pair of running shoes can make a world of difference in not only the health of your feet but your enjoyability during and after the sport.

All shoes are not created equal.

Plain sneakers can quickly lead to injury due to support issues. Find a store that specializes in running shoes and invest in a quality pair that fits the needs of your goal and the unique shape of your feet.

Also, keep in mind, feet tend to swell in the afternoon. Buy new running shoes late in the day to ensure they will fit comfortably even when your feet are swollen.

Good socks.

Wearing plain cotton socks can lead to painful blisters. Good quality socks designed for running are a great investment to keep your feet healthy.

Practice good hygiene.

Overgrown toenails are potential hazards. Keep your feet clean and dry and trim your toenails regularly.


Stem Research yields exciting results for spine community

May 22, 2020

VAST Clinical Trial: Safely Supplementing Tissue Lost to Degenerative Disc Disease

by Douglas P. Beall, MD, Gregory L. Wilson, DO, Randolph Bishop, MD and William Tally, MD. 


  • This is the first study of any size to demonstrate significant and objective clinical benefit from treating the anatomic site that is by far the greatest source of back pain.
  • There was statistically significant improvement in function in the entire treated cohort.
  • There was statistically significant improvement in pain in the cohort of patients who had a greater than 20-point pain reduction.
  • Almost 60% of the patients had no back pain.
  • The results from the VAST trial is even better than the study that first created excitement for cellular therapy (MesoblastPhase 2).
  • VAST vs. Mesoblast Phase 2:
  • No Back Pain : 59% with VAST, 52% with Mesoblast Phase 2
  • More than 15-point reduction in ODI: 77% with VAST, 50% with Mesoblast Phase 2
  • As good as Basivertebral Nerve Ablation(Rhizotomy).

From neck and leg pain to scoliosis, the spine can be the source of many different ailments we experience. Athens Orthopedic Clinic’s fellowship-trained spine and scoliosis specialists provide each patient experiencing orthopedic spinal issues quality, state of the art care.

For more information on Athens Orthopedic Clinic’s SpineHealth team or to schedule an appointment, visit us at or call (706) 549-1663.


Arthritis Facts

In honor of National Arthritis Awareness Month, here are some facts to keep you in the know about the joint disease that can affect many areas of the body.


Did you know that 1 in 4 adults have arthritis?  That averages out to about 54 million Americans that have some form of the joint disease!  Of those who have arthritis, roughly 45% report limitations in physical activities due to symptoms.  And, despite popular belief, arthritis is not just an ‘old person’s disease.’  More than 32 million suffering from it are under the age of 65.


There a several signs and symptoms of arthritis but here are some of the most common:  Swelling, Stiffness, Pain, Deformity and Tenderness.  Quality of life is often greatly compromised by arthritis, limiting daily activities to perform simple tasks like climbing stairs, opening cabinets and doors, and bending over to pick up something.


Did you know that there are over 100+ types of arthritis?  The two most common types of arthritis, a painful condition caused by joint inflammation, are Osteoarthritis and Rheumatoid Arthritis.  Osteoarthritis is characterized by the breakdown of cartilage, stiffness and pain, while, Rheumatoid Arthritis is characterized by swelling, bone erosion and joint deformity.


Good news is Athens Orthopedic Clinic can help!  There are several conservative treatment options for the joint disease – arthritis, including, weight loss, assistive devices, low-impact exercises, medications and injections.


Arthritis is usually first diagnosed by a primary care physician through physical exam, imaging and blood tests.  Depending on the type of arthritis and severity, they may refer to either an orthopedic specialist or rheumatologists.

Our Family Serving Yours Since 1966

At Athens Orthopedic Clinic, we frequently prescribe exercise as a way to help treat arthritis.  The movement helps with flexibility and keeps joints well-lubricated.  Exercise is shown to help alleviate arthritis symptoms and pain by up to 40 percent.

If exercise is not enough, and you still have trouble managing your arthritis, please contact us for an appointment.




“Flowers always make people better, happier, and more helpful; they are sunshine, food and medicine for the soul.” - Luther Burbank

It’s May, the weather is beautiful, and with recent events, you might find yourself with a little extra time on your hands.  Gardeners all around will take full advantage of these elements and plant vegetables and sprinkle life back into their yards with bits of color here and there.  And, while most wouldn’t consider gardening a formidable activity, the realty is gardening can result in injuries just as a number of sports.

One of the top contributing factors to gardening injuries is it is widely considered a casual activity that doesn’t require a proper warm-up to prepare for the bending, stooping, twisting, turning and heavy lifting.  Just as you would before a workout, give your body and muscles a chance to warm-up with light stretches to help prevent neck and lower back pain.

In addition, repetitive tasks and repetitive positioning can result in injury, such as, Shoulder Tendonitis, Lateral Epicondylitis, Carpal Tunnel Syndrome, Pre-Patellar Bursitis and de Quervain’s Tenosynovitis of the Thumb.  Activating preventative measures like using a garden stool or pad for extended periods of weeding or planting and taking frequent breaks in order to mix up your positioning can help keep you healthy and your body happy.

“Gardening is great for the soul, but it can be tough on our joints!” Dr. Michael Shane Smith continues, “Avoiding violent repetitive overhead activities and deep squatting and twisting maneuvers can help protect our shoulders and knees from developing some of the more common joint problems often associated with yard work and gardening”

When lifting heavy items, always remember the general rules of thumb:

- Keep the load/item close to your body

- Use your legs (slightly bent) and not your back

- Don’t overload – make frequent trips if necessary

- Avoid twisting your body when lifting and setting item down; move your feet and hips to position placement

At Athens Orthopedic Clinic, we believe taking care of your body doesn’t have to be a chore.  Gardening is a great activity for children, beginners, families and experts.  Choose tasks that best fit your ability and rotate through them to avoid repetitive use type injuries.


Now is Great Time To Ride a Bike!

Cycling is a great way to enjoy the outdoors, get some exercise, and have some fun, all at the same time.  Whether you’re a cycling enthusiast or trying it for the first time, it’s important to review safety measures as well as tips to prevent common cycling injuries before you hop in the saddle.

Safety First – Top 3

  1. Always wear a properly fitted helmet.
  2. Verify your bike is the appropriate size and fit for you.
  3. Loose clothing can be a hazard – wear appropriate and bright (easily seen) attire.

This month, take the opportunity to check out the Cycling pros from around the globe at the 40th annual Athens Orthopedic Clinic Twilight Criterium in Athens, Georgia. Located just a short drive from Greensboro and Lake Oconee is the college town of Athens, GA. Most notably recognized as home to the University of Georgia and the beloved Bulldogs' athletic programs; however, if you are a professional cyclist, Athens is home to one of the most revered cycling events in the world, The Athens Orthopedic Clinic Twilight Criterium. This professional race, now in it's 40th year. takes place on the closed streets of downtown Athens and public spectators are welcome. Admission is free. Cycling teams from across the globe make the annual trek to the Classic City to participate in this evening race, hence the name "Twilight", and enjoy the charm and hospitality of the Classic City.  The 2021 AOC Twilight Criterium is set for August 20-21. Visit the Twilight website for a full calendar of weekend festivities, including child and amateur cycling races, 5K, live music, food court and expo. Fun for the entire family.

Athens Orthopedic Clinic and Twilight remind all ages to remember the Top 3 safety measures above but also encourage you to be aware of the most common causes of cycling Injuries. Education and prevention is the key to happy, healthy rides!

Injury Prevention – Most Common Cycling Injuries

High speed

High speed is the most common cause and result in injury on a bike resulting in superficial soft tissue trauma and/or musculoskeletal trauma.  Wear your helmets, please!

Knee Pain

Not surprisingly, knees suffer the most overuse injuries in the sport. Be sure to verify you have the appropriate and proper saddle height, and if you are riding clipless pedals, make sure that your cleat position is correct.

Neck and Lower Back Pain

If you’ve heard it once, you’ve heard it time and time again on how important it is to maintain good posture.  Spending long amounts of time in a stationary position can cause stress on any muscle so be sure to relax your upper body and move around occasionally. Also, bend from the hips, not the lower back. Your back should look straight, not curved.

Achilles Tendonitis

This is another overuse injury and the cause of inflammation.  Always verify your body mechanics are properly positioned on your bike, such as proper saddle height in contrast to your pedals as well as well positioned cleats in pedals.

Muscle Tightness & Fatigue

Tightness can lead to tearing so establishing a thorough warm up and cool down routine to keep your muscles flexible is very important.  Remember also to allow time for your body to rest and recover.

A trusted orthopedic is also an essential piece of the puzzle to staying safe and healthy.  Athens Orthopedic Clinic is your partner, not only when you’re injured and seek care, but also as an advocate to deliver tools to keep you and your family injury free.

If you experience a cycling injury or have questions regarding a past injury, Athens Orthopedic Clinic’s team of expert physicians and physical therapists are ready and available to treat and help you recover.  Request an appointment online at  or call (706) 549-1663. AOC's Greensboro location is open 5-days a week and is conveniently located at 1000 Cowles Clinic Way.



HOOKED? We fix that.

As the days grow longer and the anglers are called to the waters, it’s important to have a plan in place for those unexpected injuries. You're excited and give your cast just a little more oomph than normal and suddenly you hear a screech! You’ve accidently hooked your fishing partner! What do you do?

First and foremost, prevention is always the key. You can avoid accidental hooking, especially those in the face, by wearing a hat and sunglasses. Also, always be mindful as to where your buddies are fishing before you throw your first cast.

Next, what do you do?  

Your skin is the largest organ on your body, protecting you by keeping fluids in and bacteria out. While a hooking injury can vary from minor to severe, it’s always best to consult a doctor for treatment options because even minor injuries can have a serious consequence. Best practice is to stabilize the hook in place and seek treatment at an urgent care.  

Never try to remove a hook that is in or near the eye.

“Injuries most often happen when we least expect it.  We hope that you always stay safe whether you are fishing, driving or just riding your bike.” Dr. David Katz continues, “But if an injury occurs, please do not hesitate to come get it taken care of at one of our Urgent Care locations.”

Athens Orthopedic Clinic offers three urgent care settings for accidental injuries like this in Athens, Loganville and Snellville. Expert care is in place to get you treated and back on the water doing what you love.

For more information on our urgent care locations, visit


Our Patients Say It Best!

Stellar orthopedic care
I have had three surgeries here in the past three years, two lower back and one neck. Dr. Tally and Skye are awesome, and they have provided excellent care. The front office staff is welcoming and incredibly efficient. When I went to Athens Neurological for neck and back issues, I was accustomed to waiting over an hour at each visit. At AOC, I have never waited more than ten minutes in the waiting room. For most visits, I have x-rays, see the doc, and out the door in less than 30 minutes total! I would highly recommend AOC to anyone looking for stellar orthopedic care.
Jeff, Lower Back Surgery
They all get an A+
I was a bit nervous about the whole knee replacement thing, but I am glad that I chose AOC. All of the staff have been awesome. Thanks Dr. Mandfredi for giving me a new knee and improved quality of life. Thanks to David and the nurses for constant care and encouragement. They have the best Physical Therapy group I believe I have ever been involved with. They are very professional and tough. Thanks a lot to Megan Stines for putting up with my complaining, but making me do the work, no matter how much I tried to get out of it. They all get an A+. I would recommend them all to anyone who is looking for an Orthopedic clinic to go to.
Rodney, Knee Replacement
A sincere thank you
My husband and I were more than pleased with the expertise and care that was given to me during my ACL surgery. We want to extend a sincere thank you to Dr. Register and all of the AOC staff members!
Kimberlee, ACL Surgery
I highly recommend them!
Dr. Register performed arthroscopic surgery on my knee. He was attentive and fixed me up. His PA, nurse and PT were always helpful. The anesthesiologist was awesome as was the clinical staff. Thank you! I highly recommend them!
Donna, Arthroscopic surgery
They all get an A+
I was a bit nervous about the whole knee replacement thing, but I am glad that I chose AOC. All of the staff have been awesome. Thanks Dr. Mandfredi for giving me a new knee and improved quality of life. Thanks to David and the Nurses for constant care and encouragement. They have the best Physical Therapy group I believe I have ever been involved with. They very professional and tough. Thanks a lot to Megan Stines for putting up with my complaining, but making me do the work, no matter how much I tried to get out of it. They all get an A+. I would recommend them all to anyone who is looking for an Orthopedic clinic to go to.
Knee replacement