Category Archives: General

Resolved to Exercise … Next Steps

Teacher and active senior women yoga class on chairs

Anytime is a perfect time to make a resolution including moving more through exercise. Make an exercise plan that includes small, achievable goals that encourage and motivate you as you succeed. It takes 90 days to build a habit, so be sure to add the critical ingredient of patience to your mix of planning and activity. And be sure to include an attitude of flexibility, and adapt and change your exercise routines to keep them fresh and motivating. Combining different types of activities, such as Pilates with running, or yoga with cycling, can help you maximize muscle strengthening while bolstering your commitment.

Here are some thoughts to consider.

  • Get cleared by your doctor first. Get the go-ahead for exercising and learn if you have any physical limitations to consider or work around to avoid orthopedic injury.
  • Make a plan and stick to it. Just starting out? New to exercise? Be patient. What do you enjoy doing? Do you want to exercise by walking more? Set an appointment on your calendar to walk and invite a friend, or listen to music, or walk a dog. Want to take up golf? Make an appointment for an introductory lesson. Call a local gym or YMCA for a tour and check out the exercise room, pool, or aerobic and yoga classes they offer. Being a loner is a preference for some, but others enjoy camaraderie while exercising.
  • Think strong muscles to support your skeletal system and aid in weight loss. If you want to build strength through a weight lifting routine, work to avoid injuries by asking for help from a trainer or manager at the gym. Learn the correct form, technique, and how to adapt an exercise for a preexisting condition, such as a knee issue or arthritis.
  • Cross train. Consider cross training so you use a variety of your muscles and don’t overuse any one muscle group.
  • Be safe.
    • Include a warm-up to get your body ready for exercise. Start slowly for 5 to 10 minutes.
    • A cool-down after exercising can help remove any lactic acid build-up in your muscles and reduce soreness.
    • Stretch after your warm-up and cool-down.
    • Go slow – ease into your new routine.
  • Drink water to stay hydrated. Sweating can dehydrate so it’s important to replenish water. Here’s a hydration calculator to help you figure out the right level of hydration for you.
  • If pain occurs at any point in exercise – stop and assess. Icing an injury can help prevent inflammation. Be proactive about getting help if you need it – and consult your orthopedic physician in a timely manner.

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you need assistance with your exercise plan, getting advice for orthopedic or musculoskeletal limitations, or if you’ve injured yourself. Contact us today for an appointment and #getmovingCT!

De-stress this holiday season with a gentle yoga practice

Group of women in a yoga class, using blocks to assist in pose.

Practicing yoga can be a great way to get exercise and stay calm during the stressful holiday season. A consistent yoga practice has so many incredible benefits, including reducing heart rate, lowering blood pressure, reducing anxiety and depressive tendencies, and easing back pain — not to mention the stretching and muscle strengthening benefits to the body.

Understanding Joint Anatomy

Yoga uses every muscle and joint of the body. One key thing to remember is that each joint functions differently. For example, the knee is a hinge joint, meaning it allows the leg to extend and bend back and forth with minimal side-to-side motion. Its motion during yoga should remain within the natural back and forth movement of this “hinge”. The hip, on the other hand, has a unique anatomy which enables it to be both extremely strong and amazingly flexible, so it can bear body weight AND allow for a wide range of movement.  The hip joint allows the leg to move back and forth (flexion and extension), out to the side (abduction) and inward toward the other leg (adduction). It also enables rotation, allowing us to point our toes inward (internal rotation) or outward (external rotation) and moving the straight leg in the direction of the toes.

OrthoConnecticut recommends a few tips to as you enjoy your yoga practice this season:

  1. Keep the natural direction of the joint’s motion in mind as you practice – this goes a long way to preventing injury and strain. Be mindful of each joint, its muscles and your skeleton as a whole and how it is designed to move and not move. Work with your skeleton and joints, and not against them, for safe alignment and motion.
  2. Use care to listen to your body to help avoid overstretching your neck, shoulders, spine or legs. Common yoga injuries include muscle strains, torn ligaments and even more serious injuries, so start slowly. The American Academy of Orthopedic Surgeons (AAOS) recommends several steps to prevent yoga-related injuries. Read more here.
  3. Engage in mindful breathing – being present and enjoying the now is restful and recuperative. Here are some breathing exercises to get you started from
  4. Learn and practice yoga at your own speed, with a good teacher. Share information with them about any injuries or illness so they can adapt your practice to your needs. Don’t be afraid to ask questions.
  5. Warm up before yoga. Wear comfortable loose clothing and hydrate! Here’s one helpful floor routine to review from Wettravel and Melina Meza.
  6. Age is not a factor. If standing or floor yoga is not for you, enjoy a class of Chair Yoga as in this routine.

OrthoConnecticut Can Help

Our physicians and physician assistants are available to help you if you’ve injured yourself this holiday season. Contact us today for an appointment and #getmovingCT.

Tips to Avoid Back Pain During Leaf Clean-Up

Fall in New England is synonymous with beautiful changing leaves, but it also a time for yard work, slippery leaves, and avoiding ticks.

Here are some tips from OrthoConnecticut to protect you during leaf season.

  1. Know where the leaves need to go and use the right tools. Are you bagging, mulching, composting, or preparing leaves for citywide leaf curbside collection? Decide upfront what is best for you based on your physical ability.
  1. Mow regularly. Chopping up deciduous leaves, or mulching, as part of regular mowing is both good for your lawn and back. During the heavy leaf falling period, you might want to mow twice a week.
    • Self-propelled or push mower posture is important. If using a push mower, the best posture for mowing is pushing with your legs and arms to reduce strain on back. A self-propelled mower lets you walk behind the mower as it mainly does the work.
    • Take a break every 15-20 minutes to rest. 
  1. Use the right equipment. Here are some ideas for the right tools.
    • Rakes: be sure your rake is the correct fit, that it is proportional to your height and size to avoid straining posture or muscles, and a padded handle.
    • Leaf blowers: save time and energy by considering lightweight gas or electric leaf blowers to blow leaves either into a pile for bagging or onto a tarp for easier moving. Some leaf blowers rest on your back and ease the need to move the blower from arm to arm.
    • Work gloves: protect your hands from blisters and ticks.
    • Good shoes: protect yourself from wet leaves, slipping, skidding and possibly falling with arch-supportive shoes and anti-slip soles.
    • Tarp: helpful for moving leaves from one spot to another for composting.
  1. Posture for raking and lifting leaves: The National University of Health Sciences recommends:
    • Warm up with stretches first
    • Rake in sections, don’t do a large yard all at once, spread out work over several days. Take breaks every 15-20 minutes.
    • Keep your back straight and avoid repetitive motions by switching arms and pulling in different directions to work out different parts of your body equally.
    • Practice proper lifting. BEND AT YOUR KNEES (not at your waist), feet shoulder-width apart. Tighten your abs when lifting, straighten your knees and keep your back straight.
    • For turning, you should avoid twisting at the waist by moving your feet instead.
  1. Avoid ticks. Put pants inside your socks to create a barrier for ticks. Complete a body check following working with leaves and grass.
  1. Drink water … stay hydrated.
  1. Cleaning gutters … ladders, slippery leaves and roofs can add up to big falls. Consider hiring a professional for this task – they’ll have the right equipment and protective gear.

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you’ve strained your muscles or back during Fall Leaf Season. Contact us today for an appointment and #getmovingCT.

Nine tips to help with Osteoarthritis

Arthritic seniors hands cutting flowers

If you’re middle-aged or older, it’s likely you have some Osteoarthritis in your hands, fingers, hips, knees, feet or spine. The most common form of arthritis, Osteoarthritis occurs when cartilage between joints and bone gradually wears away causing joint swelling, pain, stiffness, deformity, and reduced range of motion. Most often X-rays are used to diagnose and assess the amount of joint loss, or other issues that can occur like thinning bone, reduced joint space, joint fluid, or bone spurs. If you have osteoarthritis, here are some options your Orthopedist might recommend.

If you’re in pain, seek treatment and get help!

Nonsurgical treatment for joint mobility, strength and pain relief can include:

  • Lifestyle changes
    • Lose weight to reduce joint stress
    • Rest and ice when swollen
    • Include low-impact exercise such as stretching, walking, water exercise, swimming, muscle strengthening and cycling to help strengthen your muscles, joints and keep you active.
  • Medications to ease pain and swelling
    • Use oral NSAIDs (non-steroidal anti-inflammatory drugs)
    • Use corticosteroid or hyaluronan injections in the joint to provide pain relief and cushioning.
  • Walking aids as needed
    • Use supportive/assistive devices – braces, splint, elastic bandage, cane, crutches, or walker.
  • Physical therapy
    • Improve balance, flexibility, range of motion, reduce pain and strengthen the muscles supporting the joints.

OrthoConnecticut recommends you consult your orthopedist surgeon for advice on surgical options, which might include:

  • Arthroscopy
    • In some cases, can temporarily improve pain
  • Osteotomy
    • To realign and reduce joint pressure
  • Joint fusion
    • To fuse bones together and eliminate joint flexibility
  • Partial or complete joint replacement / arthroplasty
    • Resurfaces the arthritic bones with manmade components to eliminate the arthritis and substantially reduce or even eliminate pain.

OrthoConnecticut Can Help

Our physicians and physician assistants are available to diagnose and advise you on the best ways to treat your Osteoarthritis,. Contact us today for an appointment and #getmovingCT.

Girls and Sports is a Win-Win

Schoolgirl baseball team in a team huddle with their coach

Girls participating in sports is a win-win that stretches far beyond known physical aerobic benefits. Being part of a team encourages cooperation, self-reliance, confidence/self-esteem, friendships, adventure, fun, health benefits and the joy of movement and teamwork that carries into adult life.

Are there obstacles? Yes! There are fewer obstacles because of Title IX, but disincentives such as cost, access, and “throws like a girl” comments still exist. Even so, the benefits certainly outweigh them.

What are some of the benefits? According to momsTEAM, a trusted source for parents, sports benefits girls in many ways including getting through the trials of adolescence:

  • Better physical health including better self-reported health, healthier menstruation, stronger bones, and fewer chronic illnesses later in life. Even reduced cigarette/drug use and less sexual activity are linked to playing sports for girls.
  • Higher body esteem plus lower risk of obesity and sedentary lifestyle – Harvard Medical School studied girls between 5th and 12th grade and found a positive relationship between girls playing multiple sports and developing healthy eating habits with good body images.
  • Stronger grades, lower dropout rate – studies have shown higher organization in setting priorities and budgeting time, and better performance in math and science. “High school athletic participation significantly lowers the dropout rate for white females in suburban and rural schools and Latina athletes in rural schools.”
  • Deeper social networks and higher peer acceptance – team sports help develop close friendships and greater entry into the complex social hierarchies of high school. Physical activity is also linked to reduced stress, depression and teen suicides.
  • Enhanced career benefits – team sports nurtures leadership and teamwork skills, self-confidence, and broadens the ability to speak sports vernacular. Donna Lopiano, CEO of the Women’s Sports Foundation, observes, “Sports is nothing more than organizing a group for high performance. And that’s what businesses do.”

Tips to keep girls in the game as they grow into adulthood

  • Make sure she is hydrating and participating in safe muscular warm-ups, stretching, and cool downs to reduce risk of injury.
  • Pace participation and training to her body strength and stamina.
  • Help her maintain balance between athletics in her overall repertoire of activities, R&R time, and schoolwork.
  • Keep an eye on stress and seek to main balance on girls wanting to achieve a certain level of advancement – let it be fun and a natural progression to wanting to be physically active as adults.
  • Show your girls, through your activity, that aging does not mean less activity or enjoyment of sports! And if there is pain, how to rest, ice and get help.

OrthoConnecticut & OrthoCare Express Can Help

Our physicians and physician assistants are available to advise on sports safety. We know accidents happen, that’s why walk-in orthopedic specialist care is available 7-days a week at our urgent care service,  OrthoCare Express. Download our vCard so the contact information is already in your address book, should an emergency happen.

10 Tips for Managing Knee Pain When You Travel

Close up of woman leg with pain - long driving on the way.Knee pain while traveling is common, but if you’re prepared you don’t have to be sidelined. Sitting in tight, no-room-to-stretch airline seats, bouncing trains or buses, and sitting in one position in a car for too long can exacerbate pre-existing knee conditions or create knee stiffness and muscular cramping.

Whether it’s arthritis, runner’s knee, kneecap, meniscus, ligament, or other knee conditions causing you discomfort, employing these helpful strategies can reduce or eliminate knee pain while traveling.

General Strategies

  • Dress comfortably in loose or stretchy clothing, wear supportive shoes and compression socks to increase circulation and help prevent blood clots.
  • Plan breaks in your schedule so you can minimize long stretches of travel. Shorter hops mean more walking and stretching – – and the breaks can enhance your explorations at different destinations along the way.
  • Don’t sit too long, move and stretch more. Get up and walk around to avoid stiffness or cramping and to relieve pain. Slide your feet/legs forward and back while seated to stretch your muscles and knee joints – be sure to repeat often.
  • Seat location can help. Reserving an aisle seat (preferably a bulkhead) on planes, trains and buses makes it easier to stretch legs (periodically) into the aisle.
  • Know your cars cruise control. If safe, periodically use cruise control while driving to stretch your legs out. Make frequent rest stops to stretch and move.

Tips to Prepare for Travel

  • Ask your Orthopedist about preventative treatment. Would a knee brace, assistance device, compression socks, corticosteroid or hyaluronic acid injection (to reduce pain or lubricate your joint), or anti-inflammatory medication be of help for your knee condition.
  • Keep all advised medications in a handy location and in the prescription or over-the-counter bottles for easy identification and safety instructions. Ask if premedicating 30 to 45 minutes before travel is helpful.
  • Be prepared for icing or heating your knees. Why not pack a reusable hot or cold bag for relieving sore knees. Ask your doctor which is appropriate for your condition.
  • Ask your Orthopedist for knee strengthening exercises. Some examples include:
    • Pull your heels. Strengthen your hamstrings by lifting your toes with your helps on the floor until you feel tension in your hamstrings. Hold for 10 seconds.
    • Lift your legs. Do straight leg lifts if room allows to strengthen your quadriceps (or front thigh)
    • Slow and careful backward walking to strengthen hamstrings and stabilize knees over time.

Tips Post Travel

  • Keep moving, if possible, to avoid stiffness. If in pain consider applying heat or ice as appropriate, rest and elevate your knee. Does your hotel have a hot tub? Go and enjoy for stiff muscles. Most importantly, enjoy your travels.

OrthoConnecticut Can Help

Our physicians and physician assistants are available for travel consults in advance of your journey. Contact us today for an appointment and enjoy a safe and wonderful trip!

Reference: thepointsguy

What You Should Know – Running Right to Avoid Common Injuries

By Ross Henshaw, M.D., Sports Medicine Specialist, OrthoConnecticut

RUNNING-1024x576Running is a wonderfully efficient way to improve your health, except when it produces chronic injuries. The best way to safely enjoy a running program is to gradually build the intensity of your workouts.


Typically, a running coach or trainer will recommend increasing distances no more than 10 percent a week. If you have an underlying health condition or are new to exercise, make your first step a consultation with your physician. If you have a history of orthopedic injury or joint pain, seek the advice of an orthopedic surgeon.


Hip Bursitis – This is an overuse injury caused by friction between the iliotibial tendon band and the hip bone. This large tendon travels over the bony prominence on the outside of the hip, goes all the way down to the leg and attaches just below the outer side of the knee. When we run, this band rubs back and forth over the outer hip bone; over time the friction creates inflammation. Our bodies have natural “cushions” called “bursa” that are designed to reduce this friction, but if they have not had time to adapt they can swell and hurt, causing pain in the front of the knee. This condition is common among runners.

Kneecap Pain and Patella Tendonitis – This results in pain in front of the knee and is common among runners. The quadriceps muscle in the front of the thigh powers our ability to straighten the knee. It works by using the kneecap or “patella” for leverage across the knee. This generates pressure and can cause the kneecap to become sore. The quadriceps muscle tapers to become a tendon that attaches to the kneecap and then to the shin bone (tibia) via the patella tendon. When strained, the quadriceps and patella tendons can also develop micro tears and become inflamed. Treatment includes rest, anti-inflammatories, strengthening exercises, cross training and progressing back to running while avoiding hills.

Shin Splints – This can occur on one or both shins, but most commonly on the dominant leg. This condition is caused by inflammation where the Soleus muscle in the calf attaches to the tibia. As the muscle helps runners with “pushing off,” it pulls on the attachment site, which may become inflamed and swollen. This pain usually hurts only when running. Treatment for this overuse is rest and cross training.

Achilles Tendonitis – The strong Achilles tendon is prone to inflammation when starting a running program. Our calf muscle tapers off to become the Achilles tendon that inserts into the heel and powers the push-off of the running stride. Running uphill demands more stretch from the calf, forcing it to work harder. This can lead to micro tears of the small Achilles fibers.

Micro tears do not become full tendon ruptures, but cause inflammation and swelling as the body tries to repair and regenerate the area. The usual treatment is rest, stretching, strengthening, cross-training and as the pain dissipates, a gradual return to running with limited hills.

Plantar Fasciitis – The most common early symptom of this comes with morning’s first step. The plantar fascia is a tight band of tissue that supports the foot arch. It attaches to the heel and traverses across the sole, attaching broadly across the end of the foot.

When we run, the plantar fascia can become overstressed at the smaller attachment on the heel, especially in individuals with tight calf muscles. Initially, inflammation starts after the run and hurts upon standing after a period of inactivity. When the foot and ankle bend to stand flat, the fascia stretches and hurts. The best treatment is to recognize it early and rest.


Most of us can enjoy running without ever suffering from these common maladies. My best advice is to cross train and to recognize symptoms early and not ignore the pain. If you pay attention to symptoms, you can help avoid painful injuries and stay active.

About OrthoConnecticut
OrthoConnecticut is the region’s premier, multi-specialty orthopedic and pain management practice. Thirty-one fellowship- trained, board-certified physicians offer patient care at nine offices in Danbury, Darien, New Canaan, New Milford, Norwalk, Ridgefield, Sharon, Southbury and Westport. The practice’s urgent care service, OrthoCare Express, is open 7 days a week for emergencies and is available in Danbury, Darien, Norwalk and Westport. To make an appointment with Dr Henshaw, or to learn more about OrthoCare Express, please visit, or call 1.833.ORTHOCT (1.833.678.4628).

Download article as pdf:
pdf(English) Running Right to Avoid Common Injuries
pdf(Español) Correr Correctamente para Evitar Lesiones Comunes
pdf(Português) Correr Corretamente para Evitar Lesões Comuns

de Quervain’s Tendonitis

By Michael G. Soojian, MD
Hand & Upper Extremity Surgeon

Living in a digital worldIF YOU ARE experiencing a shooting pain from your wrist into your thumb, you may be suffering from a common form of tendonitis called de Quervain’s tendonitis. This condition gets its name from Dr Fritz de Quervain who first described it in 1895, and is often referred to by other names such as texting thumb, gamer’s thumb, and mother’s wrist. Anatomically, two separate tendons start in the forearm and pass through a small sheath or tunnel as they cross the wrist, before they attach to the thumb. Repetitive movements can cause these tendons to experience friction and lead to a build-up of inflammation within this sheath, which manifests as pain, swelling and a feeling of weakness with routine daily activities. This condition usually occurs as a result of repetitive gripping and lifting, and other activities such as swinging a hammer, using a cell phone, working in the yard or even carrying a baby. Less commonly, this problem can result from trauma, i.e. a direct blow or a sudden yank to the hand or wrist.

This condition usually occurs as a result of repetitive gripping and lifting, and other activities such as swinging a hammer, using a cell phone, working in the yard or even carrying a baby.

DeQuervain’s tendonitis can usually be diagnosed by physical examination which can detect swelling and tenderness over the tendon sheath. Many patients feel as though their “bone is sticking out” but in actuality it is a thickening of the soft tissue sheath they are feeling. X-rays can be taken to rule out other sources of pain, but in most cases end up being normal. In its early stages, DeQuervain’s tendonitis can often be successfully treated with bracing and oral anti-inflammatories such as ibuprofen. Occupational/Hand Therapy can also help some patients. When these simple treatment options fail to provide relief, cortisone injection is usually recommended and can cure this problem about 75% of the time. When all else fails, a minor surgery can decompress the tendons and definitively treat the problem. This surgery entails a brief trip to the operating room and is performed under local anesthesia that is usually combined with an intravenous sedative (“twilight anesthesia”). After the surgery, the hand and wrist are wrapped in a soft bandage for a few days and routine activities are encouraged. The majority of the symptoms usually resolve within two weeks, and most patients are pain free within four to six weeks.

Keeping You Moving: Foot & Ankle Fractures

Story by Randolph Sealey, M.D.
Foot & Ankle Surgeon, OrthoConnecticut | Danbury Orthopedics

Dr. SealeyOne of the injuries that I see increase in frequency during the winter months are foot and ankle fractures. The slippery conditions can trigger a fall, which is the usual cause of these injuries.

Not only do falls occur during snowstorms or ice storms, but the snow or ice that gets left behind on sidewalks and parking lots will often result in twisting injuries around the foot and ankle that can lead to fractures. Winter sports such as skiing, snowboarding, and ice skating also predispose patients to foot and ankle fractures. In fact, something called a “snowboarder’s fracture” is a specific injury that happens because of the position of the foot and ankle on a snowboard.

Foot and ankle fractures are some of the most debilitating injuries that we see in orthopedics.  These injuries have both immediate and long-term effects.  The majority of patients who sustain an ankle fracture will go on to develop ankle arthritis.  The term arthritis means that there has been some damage or injury to the normal smooth cartilage in the joint.  There are many conditions that can damage the joint surface, including an inflammatory problem (rheumatoid arthritis) or the long-term wear and tear of the joint (osteoarthritis).  In the case of an ankle fracture, there is an acute and immediate traumatic event that leads to post-traumatic arthritis.  This means that the patient will have some permanent mobility limitation and also some level of discomfort or achiness.  While standing, the forces that ankles and feet experience can be up to 10 times the patient’s body weight and this can lead to severe discomfort if arthritis develops in those joints.

There are many unique features about foot and ankle fractures that make them very different from fractures in other parts of the body. One very important thing to consider is which foot or ankle is fractured, because if it is your right side you will unable to drive for 2 to 3 months after the injury. Swelling can be a significant problem that may take up to a year to completely resolve.  This not only leads to discomfort but may create some practical problems such as fitting into a normal shoe.  Swelling can also lead to severe blisters that traumatize the skin around foot and ankle fractures. The blisters indicate that there has been severe injury to the skin, which can sometimes take several weeks to heal.  Bruising is another feature that is very common around foot and ankle fractures—the result of bleeding from the bone that makes its way to the surface.

Seeing a specialist with experience in foot and ankle trauma is extremely important in order to have the best possible outcome after a serious injury. Any individual’s treatment will depend on the severity and stability of his or her specific foot and ankle fracture.  Most stable fractures are treated with a rigid cast, boot, or shoe, and patients can begin walking immediately with some assistance.  Some patients will need crutches, a walker, or a cane first, until most of the pain resolves, and then the treatment can continue in a fracture boot or shoe.  Patients will usually benefit from physical therapy or a home exercise program after their fracture has healed since the period of immobilization will create atrophy.

If the fracture is unstable, however, it will require surgical treatment with orthopedic implants, such as plates and screws.  A cast or splint will not be enough to keep an unstable fracture in the proper position for it to heal appropriately.  Patients are often upset by the idea of surgery, but it will provide immediate stability to the bone and may allow for a more predictable recovery.  Bones, on average, will take 6 to 8 weeks to heal; the timeframe for healing does not change with surgery but quicker movement is possible because of the stability provided by the hardware.  Two emergencies that require surgery are an “open fracture” (in which there is an open wound or break in the skin near the site) and a joint that is dislocated along with a fracture.  Open fractures lead to a high risk of infection and they need to be cleaned and stabilized immediately in the operating room.  Patients also will need to take antibiotics to prevent infection.  A dislocated joint must be put back in place, or “reduced,” immediately and this is usually followed by surgery to keep the joint in position.

It is often important to wait for swelling to decrease before proceeding to foot and ankle surgery.  It can be dangerous to operate on swollen tissues because this may lead to an infection around the incisions after surgery.  It is not uncommon for a patient to have to wait 10 to 14 days after a fracture has occurred for the actual surgery to take place.  Many times x-rays are the only studies that we need before surgery, but occasionally a CT or MRI is necessary to plan the procedure.

Although foot and ankle fractures can have devastating implications on a patient’s immediate quality of life, it is possible to return to many of the activities he or she enjoyed once the injury is healed.  There may be a “new normal” in terms of comfort level during weight-bearing activities, and it may be necessary to use an orthotic insert or an ankle brace for some activities.

There are some simple things that you can do to avoid foot and ankle fractures.  Wearing appropriate footwear, such as winter boots with strong grip and ankle support, is a simple measure that can help you avoid injuries… avoiding unpaved walkways and surfaces without salt can also prevent slip-and-fall events… and looking out for black ice during extremely cold temperatures is another step you can take to avoid injury.

About Dr. Randolph Sealey
Dr. Randolph Sealey, who is fluent in Spanish, specializes in the field of Foot & Ankle surgery and is the only fellowship trained orthopedic foot and ankle subspecialist in the greater Danbury area. He completed his fellowship training and gained his ankle reconstructive surgery expertise at the world-renowned Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, Maryland. In 2008, he became the recipient of the prestigious Roger A. Mann Award, the highest clinical research honor given by the American Orthopaedic Foot and Ankle Society. He is Board-certified by the American Board of Orthopedic Surgery.

About OrthoConnecticut | Danbury Orthopedics
OrthoConnecticut I Danbury Orthopedics is the premier provider of orthopedic care in the region. Thirty-one fellowship-trained, Board-certified physicians provide care in nine office locations. The goal of the practice is to help patients regain mobility, lead active lives, and attain optimal health. Offices are located in Danbury, Darien, New Canaan, New Milford, Norwalk, Ridgefield, Sharon, Southbury, and Westport. To schedule an appointment with Dr. Sealey, or any of the physicians at OrthoConnecticut, please visit or call 203.797.1500.

Tennis Elbow

By Paul D. Protomastro, M.D.
Hand & Upper Extremity Surgeon, OrthoConnecticut

Mixed race Woman Playing TennisTENNIS AND GOLFER’S elbow are common orthopaedic conditions that lead to pain, weakness and disfunction of the elbow. Both conditions actually represent tears of the forearm tendons off of the humerus bone at the elbow. A tear on the outside (lateral) part of the elbow is known as Tennis elbow. A tear on the inside is known as golfer’s elbow. The muscles involved in this condition help to extend (tennis) and flex (golfer’s) the wrist. With both disorders there is degeneration of the tendon attachment usually following repetitive grasp or lifting activities and subsequent weakening of the anchor site leading to tendon detachment. Patients usually experience the insidious onset of elbow pain associated with activities in which this muscle is active, such as lifting, gripping, and/or grasping. Sports such as tennis, golf and weight training are common causes. The problem can occur with many different types of activities such as home renovation and gardening.

A direct blow to the bony prominence of the elbow may result in an acute tear or swelling of the tendon that can lead to degeneration. A sudden extreme action, force, or activity, such as starting a lawn mower, can also injure the tendon. The most common age group that this condition affects is between 30 to 50 years old. It affects both men and women with equal frequency. Pain is the primary reason for patients to seek medical evaluation. With tennis elbow the pain is located over the outside aspect of the elbow, over the bone region known as the lateral epicondyle, and is exacerbated by overhand lifting or power grip activities. With golfer’s elbow the pain is on the inside part of the elbow (medial epicondyle) and exacerbated by resisted wrist flexing or underhand lifting. The bone and tendon insertion often becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. Occasionally, any motion of the elbow can be painful.

The bone and tendon insertion often becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand.

There are several theories as to why the elbow is so prone to these tendon injuries. Firstly, these tendons are taut and under great stress with repetitive wrist and hand activity. Secondly, the tendon origin is very small relative to the muscles that attach to them which leads to high forces on a tiny insertion site. Thirdly, these tendons have a very poor blood supply and take a long time to heal. All these factors result in prolonged pain and dysfunction in most cases. On average a case of tennis or golfer’s elbow takes 12-18 months to fully heal. On rare occasions people can be pain free and return to their sports, work or hobbies in 2-3 months.


Activity modification
Initially, the activity causing the condition should be limited. Limiting the aggravating activity, not total rest, is recommended. Modifying grips or techniques, such as use of a different size racket and/or use of 2-handed backhands in tennis, may relieve the problem.

Anti-inflammatory medications may help alleviate the pain temporarily to make the tendon tear heal.

A tennis elbow brace, a band worn over the muscle of the forearm, just below the elbow, can reduce the tension on the tendon and decrease pain while using the arm and possibly allowing the tendon to heal.

Occupational Therapy
May be helpful, providing stretching and/or strengthening exercises. Ultrasound, lasers, deep friction massage and heat treatments may be helpful by increasing blood flow and decreasing pain.

Steroid injections
A steroid is a strong anti-inflammatory medication that can be injected into the area. These injections have been shown to temporarily decrease the pain of elbow tendonitis but do not help the tear heal. In fact, steroids may further harm the tendon and lead to chronic tendon damage. No more than (3) injections should be given.

Surgery is considered when the pain is incapacitating, has not responded to conservative care, and symptoms have lasted more than six months. Surgery involves removing the diseased, degenerated tendon tissue and then repairing healthy tendon back to the humerus bone. This 15-20 minute procedure is performed in the outpatient setting under sedation and local anesthesia.  Recovery from surgery requires physical therapy to first regain motion of the arm and then a strengthening program after 6 weeks. Most patients can return to usual activities by 3-4 months. Complete recovery, including a return to tennis, golf and high impact/repetition work, can be expected to take 4–6 months. The success rate of this surgery is over 90%.