Dr. Howard D. Routman talks to WPTV

About Reducing the Risk of Opiod Dependency After Surgery

Dr. Howard Routman discusses his innovative new technique to reduce use of pain medication after shoulder replacement surgery with Ashley Hinson of WPTV News. This technique minimizes the risk of developing dependency to pain medications that are sometimes necessary after orthopedic surgery to stimulate patient recovery.

read more

About Shoulder Repair Techniques

Dr. Routman talks about shoulder repair

In this video, Dr. Howard Routman talks about the different procedures he uses to treat conditions of the shoulder, including minimally-invasive arthroscopic rotator cuff repair, traditional shoulder replacement therapy, and a ground-breaking technique pioneered by Dr. Routman using a reverse shoulder replacement strategy. This procedure is successfully used to treat patients with problems in the rotator cuff that could otherwise not be addressed with traditional shoulder surgery.

read more

As published on The Palm Beach Post and Palm Beach Daily News

Sports Orthopedics — Surgery

by Brian K. Reiter, MD
Avoid pain, injury when starting new exercise regimen

Question: I recently joined a gym because I want to exercise regularly again. But after a week of working out, my knee is painful and swollen. Should I continue?

Answer: As often happens when my patients begin exercising after having not done it for awhile, they often run into problems.

You see, newer specialty gyms (including boot camps and CrossFit) have surged in popularity in recent years.

Along with these exciting new methods to stay fit comes injuries for those who are not accustomed to their intensity or movements.

Many of these new workouts involve high intensity, heavy weights, and motions that may put your muscles and joints at risk for injury. Not every person’s body responds the same to these workouts.

One individual may be better able to tolerate specific exercises more than others. If you have a history of knee, shoulder or back pain, certain movements may be more harmful than helpful.

I have seen incredible results for those who have the dedication to challenge themselves with these workouts; however, I also have patients who have given up regular exercise altogether because of injuries sustained after joining a new gym.

When done safely, exercise can improve overall health and help prevent injury. If you have a new ache or pain or have any concerns prior to beginning a new type of exercise, consult a sports medicine orthopedist.


Orthopedics — Foot and Ankle

by Rommel Francisco, DO
Understanding stress fractures

Question: How do stress fractures develop?

Answer: Stress fractures do not occur from one specific injury — they are overuse injuries. When muscles become fatigued or overworked, the bones begin absorbing more stress, leading to the fracture.

Most stress fractures occur in the weight-bearing bones of the lower leg and foot. They most often occur after increasing the amount and/or the intensity of a certain activity.

Other risk factors include steroid use, osteoporosis, endocrine disorders, menopause or amenorrhea, rheumatoid arthritis, vitamin-D deficiency, and estrogen-deficient conditions.

Most stress fractures present with swelling, pain with weight bearing, and tenderness in the affected bone. Along with careful examination by your orthopedist, diagnosis can be made by plain X-rays, MRI or bone scan.

The hallmark of treatment of stress fractures involves activity restriction. Immobilization with a cast or walking boot may also be required. Addressing the previously mentioned risk factors is also important. Return to activity is allowed once healing is evident on X-ray and/or the affected bone is no longer tender and painful. Stress fractures can take anywhere from four to eight weeks to heal.

The majority of patients can return to their previous level of activity as long as adequate healing has been allowed to occur. Those suffering from recurrent stress fractures should talk to their doctor about the possibility of a metabolic or endocrine disorder.

read more

Orthopedics — Hip

by Lyall Ashberg, MD
What to do when you feel 'hip snapping'

Question: My hip is snapping and I think it’s dislocating. What should I do? Help!

Answer: Patients often present complaining of snapping of their hip. Sometimes they can demonstrate the maneuver causing the snap. Occasionally, it is visible and other times audible. It can be painful, but frequently it is not. Other times people present very concerned that their hip is dislocating or “popping out of the socket.” What causes this?

In most incidences, painless snapping about the hip is harmless. It is usually caused by one of the tendons that move the hip joint sliding over the pelvis or femur (thigh bone) creating the sensation of snapping. When it occurs in the groin, the iliopsoas tendon may be the cause and when on the outside of the hip, it may be the iliotibial band (IT band). The latter is frequently visible whereas the former is audible.

Painful snapping can represent a problem with the hip joint itself, such as a tear of the cartilage around the hip socket (the labrum), micro-instability or trochanteric bursitis. Importantly, it is unlikely that your hip is dislocating. This usually only happens after significant trauma such as after a car accident. If you have painful snapping, referral to a hip specialist is suggested.

read more

Orthopedics — Shoulder

by Howard D. Routman, DO, FAOAO
What makes arthroscopic surgery different

Question: How is arthroscopic surgery different than normal surgery?

Answer: Classic surgical techniques for the shoulder typically involve making a large enough incision to see and work through, and repairing the involved structures while directly looking at them. Shoulder arthroscopy is a minimally invasive surgical procedure that involves inserting a high-definition camera with fiber-optic lighting into the shoulder through tiny holes in the skin. Initially, it was only a way to see what was happening inside the shoulder on a TV screen and a larger incision was then required. Pioneering surgeons gradually developed more tools and techniques. Nowadays, many procedures that could only be performed in the 1980s-90s through standard incisions can be performed arthroscopically with fantastic results.

As surgeons gained experience with this technology, more and more procedures could be accomplished through tiny holes in the skin and the patients were able to go home on the same day of surgery. Arthroscopic rotator cuff repair, for example, can have a success rate of up to 94 percent, with durable results and minimal complications.

As with any procedure, the surgeon’s experience is a critical factor for patient outcomes – but not the only factor. Protection of the repair work that is done inside the shoulder, and appropriate rehabilitation are also very important if you want a great result. I have performed more than 2,000 arthroscopic shoulder procedures, and the best outcomes are the result of teamwork between the surgeon, patient and therapist.

Arthroscopic shoulder surgery has really come a long way – so far, in fact, that most patients would be surprised how much work can be done on the inside through those tiny holes in the skin.


Interventional Pain Management

by Gary Laux, DO
Qualifying conditions for medical marijuana treatment

Question: What are the qualifying conditions for medical marijuana treatment? What is the process to obtain the medication? What is Low THC cannabis?

Answer: The list of qualifying conditions in the state of Florida includes: cancer, epilepsy, glaucoma, HIV, AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis, medical conditions of the same class or kind, and terminal conditions.

Each patient must be diagnosed with a qualifying condition by a qualified ordering physician. An extensive review of the patient’s medical records is part of the process, along with a physical exam. The patient should have failed all conservative treatment measures prior to consideration. All risk and benefits of the treatment are discussed with the patient and a standard informed consent form is signed by the patient. The physician enters the patient into the medical marijuana use registry so that the patient may apply electronically for a medical marijuana use registry card.

Once patients receive the card, they may pick up the recommended order by their physician at a medical marijuana treatment center. The physician makes the recommendation electronically. There are no handwritten prescriptions for treatment. The medication may be recommended for vaporization, sublingual, oral use, suppositories, or topical use.

Low THC cannabis contains less than 0.8 percent THC. THC is the psychoactive component of cannabis. The CBD (or cannabidiol) is the active component of the low THC medication. CBD is best for treating anxiety, PTSD, Parkinson’s, ALS, seizures, chronic inflammation, and epilepsy.

read more