Maximum Orthopaedics and Sports Medicine

There are many types of metabolic bone diseases. The most common are:

• osteoporosis, or loss of bone (bone “thinning”)

• Paget's disease, which affects the way a bone remodels its tissue

• thyroid-related bone disease, most commonly caused by underproduction of hormones (hypothyroidism)

• osteomalacia and rickets, softening of the bones most commonly caused by a lack of vitamin D

• kidney problems

• bone loss caused by chemotherapy

• other disorders affecting the levels, availability and absorption of calcium and phosphorous, essential elements for building strong bone tissue

Different diagnostic methods such as bone density tests and blood tests can be used to diagnose most metabolic bone diseases.

Metabolic bone diseases cause loss of bone strength, typically caused by loss of bone tissue or abnormal remodeling of bone tissue. Most diseases are related to a lack of minerals or poor absorption of minerals such as vitamin D and phosphorous. People of all ages can suffer from bone diseases and disorders, and left untreated, they can lead to an increased risk of fracture.

Not every type of surgery can be performed using a minimally invasive technique. Dr. Tyorkin will review your case and your health and make a recommendation based on your unique health profile so you can understand which approach is better for your needs.

Minimally invasive techniques are used to effect repairs to torn ligaments, cartilage or other soft tissues, to repair joint lining or address inflammation, to treat carpal tunnel syndrome, and even to replace joints in the knee, shoulder or other areas.

Because it doesn't require big incisions, minimally invasive techniques typically are associated with speedier healing, less postoperative pain and a reduced risk of complications. Many patients also report their joint feels more “normal” following a minimally invasive procedure. Minimally invasive procedures can also eliminate the need for hospitalization or when hospitalization is required, shorten the stay.

Minimally invasive surgery is a surgical technique that relies on the use of very small incisions, tiny cameras and specially-designed instruments to perform surgeries. The doctor uses one small incision to access the surgical site with the tiny camera, which is located at the end of a very thin tube called a cannula. The camera transmits images from the inside of the body to a video monitor so the doctor can visualize the area without needing to open the area using a long incision through skin and muscle tissue. One or two additional tiny incisions are used to insert the special instruments so procedure can be performed.

Dr. Tyorkin understands the critical role rehabilitation plays in helping patients relieve pain and discomfort and regain range of motion, strength and flexibility, he works individually with each patient to develop a plan of rehabilitative care that addresses the patient's unique needs as well as their individual health profile and goals. During your consultations, he'll help you understand your options so you can feel confident you're getting the care you need for optimal recovery.

That depends on the extent of your injury and how quickly your body responds to rehabilitation. Dr. Tyorkin will explain the average length of rehabilitation during your office visit so you know what to expect.

Yes, there are many different types of rehabilitation programs and techniques developed to address patients' varying physical needs and capabilities, different types of injuries, and end goals. For instance, some types of rehabilitation are aimed at helping patients regain specific types of strength required by their occupations so they can return to work as quickly as possible. Other types of rehabilitative services are aimed at older patients including those with chronic health issues such as osteoporosis.

Orthopedic rehabilitation is a critical part of orthopedic surgical care because it helps patients return to pre-surgery levels of mobility whenever possible and as quickly as possible. Plus, a skilled orthopedic rehabilitation specialist can help patients understand the steps they can take and techniques they can use to avoid injury in the future, such as techniques for improving flexibility or for specific activities such as lifting or standing or sitting for long hours.

That depends on the extent of the treatment that is being performed. Many patients can return home within a few hours of their procedures, while others may need to remain in the hospital for a day or two.

Once you've been sedated or anesthetized and the incision sites have been prepared and sterilized, Dr. Tyorkin will make incisions near the joint and insert a thin, flexible tube called a cannula. A tiny camera is mounted on the end of the cannula to enable him to see the joint and the area around the joint. Once Dr. Tyorkin is able to visualize the problem, he'll use the same tiny incisions to insert specially-designed instruments to perform the corrective procedure.

You'll be asleep during your arthroscopy procedure. Depending on the location and extent of your procedure, you may be sedated with a spinal block in place or you may be placed under general anesthesia.

Arthroscopy is used to diagnose and treat a wide number of conditions, including:

• damage to the cartilage

• torn ligaments

• rotator cuff tears

• carpal tunnel syndrome

• inflammation of the joint membrane, or synovitis

Arthroscopy is a minimally invasive surgical technique that uses tiny incisions to diagnose and treat injuries of the joints, including knees and shoulders. The technique relies on a tiny camera inserted through an incision to provide clear pictures of the area that are viewed on a television-type screen. The doctor is able to see the area, diagnose problems and perform corrective procedures without the need for large incisions. Since it's minimally invasive, patients tend to heal much more quickly and the risk of complications is reduced.

The type of treatment depends on the type, location and severity of the fracture and may include casting, splinting, bracing or surgery to place pins or screws into the bone to help stabilize it. Many fractures require physical therapy to build strength and regain mobility.

The most common causes of trauma fractures include:

• auto accidents, including accidents where pedestrians are struck by vehicles

• slip and fall accidents, which occur most commonly among the elderly, young children and athletes

• overuse injuries such as continual contact with a hard surface; runners are prone to these types of fractures

• osteoporotic fractures that occur in people with low bone density

X-ray is the most common way to diagnose a fracture, although sometimes other types of diagnostic imaging may be used, especially when extensive soft tissue injury is suspected. The doctor will also look for telltale signs like swelling, pain and discoloration.

Fractures are most commonly referred to as “open” or “compound,” which means the bone has broken through the skin, or “closed,” which means the fractured bone remains within the body without piercing the skin. They may also be referred to in terms of how or where they occur. For instance:

• Transverse fractures occur across the width of the bone.

• Comminuted fractures involve three or more fragments; these fractures often require the use of pins or screws to hold bone fragments in place and provide added support.

• “Greenstick” fractures occur when bone is bent and “snapped;” they most commonly occur in children when bone tissue is relatively soft.

• Spiral or torsion fractures occur when the bone breaks as a result of being twisted by an intense force.

Making sure you get plenty of calcium and vitamin D is essential for helping bones replace calcium and improve density. Weight-bearing exercises also help build strong bones, and quitting smoking is critical. Dr. Tyorkin can work with you to develop a program of care to improve you bone density and help reduce your risk of fractures.

A bone density test is the preferred method for determining if someone has osteoporosis. It's a non-invasive test that uses x-rays to measure the amount of calcium and other minerals in a specific section of bone. Because osteoporosis results in mineral loss, low bone density may indicate the presence of osteoporosis and a higher risk for fractures. Bone density tests are also used for managing osteoporosis treatments.

Everyone loses bone mass as they age, beginning at about age 35. Over an average lifetime, women lose about 30 percent to 50 percent of bone mass while men lose from 20 percent to 30 percent. The underlying causes of osteoporosis are not entirely understood, but there are some risk factors that have been linked with a higher incidence of the condition including:

• sedentary lifestyle

• reduction in progesterone during menopause

• smoking

• excessive use of alcohol

• genetics

• thyroid problems

No matter how your injury occurs, if you enjoy any type of sport or physical activity, it's important to see a doctor who treats sports injuries so the treatment and rehabilitation you receive will help ensure you can continue to enjoy those activities. When you see the doctor for a non-sports-related injury, be sure to discuss your physical activity so your treatment can be planned for optimal return to your sport.

Yes, sports medicine doctors also provide education and guidance about how to avoid sports injuries, including information about proper training techniques that can improve speed, flexibility, endurance and strength.

Sports medicine doctors are not just for professional athletes. They have the specialized skills and training to help athletes of all levels enjoy their sports and activities, from weekend football or basketball to hiking, spelunking, kayaking, biking and more. A doctor with special sports medicine training understands the unique stresses involved in different types of activities and can customize your treatment to help ensure you can continue to enjoy your active lifestyle.

Sports medicine is an area of orthopedics that focuses on the care, treatment and rehabilitation of both professional athletes and “weekend warriors,” customizing care to each person's individual needs and abilities with the aim of enabling them to return to their activity once healing is complete. Orthopedic doctors who also specialize in sports medicine have the skills and experience to help athletes of all levels achieve the best recovery possible.

Joints form where bones meet. To keep bones from wearing away when a joint is moved, each bone has a protective layer of cartilage. Osteoarthritis occurs when this layer of cartilage begins to wear away, becoming rough and causing friction between bones when the joint moves. This friction causes pain, stiffness and swelling to occur. Eventually, the cartilage can wear away completely, leaving the ends of the bones exposed.

Risk factors for osteoarthritis include:

• Obesity: Extra weight places extra strain on joints, which can cause cartilage to wear away more quickly.

• Older age: Years of wear and tear can take their toll on joints, and so can the natural changes that occur during the aging process.

• Gender: Women have a higher risk of developing osteoarthritis compared to men.

• Genetics: Some people may have a higher risk of the disease if they have family members who also suffer from it.

• Repetitive motions: If your job involved repeated motion of a joint, it can cause the cartilage to wear away over time.

• Joint injuries and bone deformities: Both can increase the risk of osteoarthritis.

• Systemic disease: Diseases such as diabetes or rheumatic disease can increase the risk of developing osteoarthritis.

Arthritis is a degenerative disease, which means it tends to become worse over time. Symptoms may include:

• Pain in the joint, especially during movement

• Joint tenderness when it's touched

• Stiffness in the joint, especially after a period of inactivity

• Grating or scraping sensation when moving the joint

• Loss of range of motion in the joint

Arthritis is typically treated with medication to reduce swelling and pain and sometimes physical therapy. In advanced cases, surgery may be needed to replace, remodel or stabilize damaged joints.