Submitted by Maria Hendon from 8445 Sw 156 Street

Q: My daughter plays competitive soccer (11yrs old) and is the goalie for the team. She was kicked in the left wrist during the game and reaggravated it during practice. Now it has become a chronic throb and occasional numbness in her pinky finger. What is the best medical procedure for her now? She has never seen a doctor for the original injury. Thank you!

Answered 06/25/09 18:34:32 by Dr. Harlan Selesnick

A: I recommend you see a hand specialist or orthopedic surgeon to determine the severity of the injury. It could be as simple as a bruised nerve that will recover or more serious such as a fracture or ligament tear.

Submitted by B from ATL

Q: Dr. Selesnick, I am a professional basketball player in Europe and I recently finished a season where I found success. However, after resting for 3 weeks I have found a severe pain in my knee/quad tendon. I tried rehab for a couple weeks and I also got a scope on my knee bc the doc thought it might have been some "junk" built up from an old ACL injury. After finding no relief, the ultra sound showed a deteriorated quad tendon or as they called it severe tendonosis, so I recieved the PRP treatment on it. I was unaware of the downtime of the procedure. I had this done on June 4th. I am still having pain but I am told it is part of the procedure. Do you see me being ready for the season start in August? Anything to speed this up? It is a majory problem for me, bc the pain is too much to play on. Thanks in advance

Answered 06/25/09 18:32:17 by Dr. Harlan Selesnick

A: Severe quad tendonosis is dterioration or partial tearing of the tendon as it attaches to the kneecap. Many patients will get better with rehab and time. Recently some physicians have started injecting the area of damaged tendon with the patients own concentrated blood products (PTP) to stimulate a healing response. Although safe,medical trials are still being done to determine the success rate of this treatment. Therefore it is difficult for me to predict whether you will be ready to play in August. If this fails other treatment options include orthotripsy(high energy shock wave therapy) or surgery. Good luck.. Harlan Selesnick

Submitted by Anonymous from Miami

Q: Sharp pain in shoulder when I reach out to get something or I let my arm drop suddenly. I had started working out and everything was fine over the past four weeks, and I woke up this past week with this pain that does not go away. The pain is in the front and rear deltoid. I have full movement of my arm just the sharp pain as I indicated. Should I get this looked at or does it sound like a sprain?

Answered 05/24/09 21:44:56 by Dr. Harlan Selesnick

A: You may have an overuse injury to your deltoid muscle or rotator cuff tendons. I think you should see an orthopedic surgeon to establish a correct diagnosis and modify your work out program so you are doing exercises to help rather then hurt the shoulder.

Submitted by Alfred Luckerbauer from Naples / Sunny Isles

Q: Dear Dr. Selesnick, could we meet to demonstrate a P.E.R. 2000,which is used by many athletes to accelerate healing and "Get them back faster", see also http://per2000.blogspot.com/ and http://pulsedenergytech.com/friends.html Best Regards Alfred 239-821-9477 Cel 239-642 6852 home

Answered 05/24/09 21:42:57 by Dr. Harlan Selesnick

A: You could mail some information including scientific studies to my office 1150 Campo Sano Ave., coral gables, Fl. 33146 and I will review it. Thank you. Harlan Selesnick

Submitted by Paula Fuller from McDonough GA

Q: On 8-15-08, I had an injury at work that tore my right knee ACL and additional caused a multiple directional tear of my miniscus. I had arthroscopic surgery on Dec.8th. My healing has been slow because I am 60 years old and have arthritis, so I am still trying to rid myself of fluid and inflammation to my knee. I am in physical therapy and use weights there on a chair to help my quad muscles strenghtened, along with ice therapy and deep tissue ultrasound massage. I am wondering if there are any specific exercises I can do at home to help strenghtened my quad muscles to both my right and left leg, because I have great difficulty in manuevering any decline (including stepping off of a curb or stairs) movement including just walking downhill. Thank you for you answer. Paula Fuller

Answered 05/24/09 21:40:34 by Dr. Harlan Selesnick

A: Exercise regimens vary depending upon the degree and location of your arthritis and the stability of the knee. Your physical therapist and surgeon should be the ones to reccomend a safe home exercise program to meet your goals. Good luck. Harlan Selesnick

Submitted by Max Timmons from Lincoln, CA

Q: Can you rent a gyro cuff to use after shoulder surgery. Or can you recommend something to take the swelling down. thanks

Answered 05/24/09 21:38:01 by Dr. Harlan Selesnick

A: There are a variety ice type post op shoulder devices that wrap around the upper arm and decrease pain and swelling. Your surgeon can arrange for you to obtain one. Harlan Selesnick

Submitted by Sue from Wahoo,NE

Q: Due to meniscal tears I developed a popliteal cyst. It ruptured and left me with severe swelling from my knee to the tip of my toes. Being on blood thinners, I also had deepplum purple bruising from my knee to my toes and the bottom of my foot. I was in so much pain that I was unable to use my leg. Pain was so excruciating that even morphine was just a tease. I was on crutches the whole time, which was many weeks. Now I have numbness down the lower part of my shin and also the ankle area and up. Will I ever get the feeling back in my leg?

Answered 04/25/09 15:11:13 by Dr. Harlan Selesnick

A: YOU NEED TO DISCUSS THIS WITH YOUR ORTHOPEDIC SURGEON TO DETERMINE WHETHER TIME AND PHYSICAL THERAPY WILL RESOLVE THE STIFFNESS, PAIN AND NUMBNESS. A NEUROLOGIST MAY ALSO BE NECCESARY TO TEST WHICH NERVES ARE INVOLVED.

Submitted by Sandy Kimura from Shoreline, WA

Q: Dear Dr. Selesnick, I am a 46year old ICU/PACU nurse and a runner. Since started running about two years ago, I did 4 marathons last year. I started to wake up with low back pain in Jan'09, and it was painful in the morning getting up and getting ready in the morning. I went to a chiropractor and it really didn't help my pain. I got an initial xray and it showed two disc areas with (L4-L5 and L5-S1)narrowing. I had an MRI done and it showed this result: L4-L5: broad based disc bulge w/small central disc protrusion and annular tear. No significant canal or neural foraminal narrowing. Mild ligamentum flavum hypertrophy w/o significant facet hypertrophy. L5-S1: Broad based disc bulge w/mild right fight neural foraminal narrowing. No significant left neural foraminal or central canal narrowing. No significant facet disease. Impression: Degenerative disc disease at L4-L5 and L5-S1 with small central L4-L5 anuular tear and mild right L5-S1 neural foraminal narrowing. No significant canal or neural foraminal narrowing. I am getting regular PT w/ MedX treatment for the lower back, as well as regular massage therapy. I wanted to know what are my chances of running again with the above information. I just want to run recreationally, and not so much of the races, although I love running marathons. My back pain is usually in the morning after I get up, and the stiffness and sorenee usually goes away as I start moving. Thank you very much.

Answered 04/25/09 15:08:46 by Dr. Harlan Selesnick

A: USUALLY, MOST BACK PROBLEMS GET BETTER WITH TIME, REHAB AND ACTIVITY MODIFICATION. SINCE YOU ARE STILL HAVING SYMPTOMS, PARTICULARLY MORNING STIFFNESS I WOULD RECOMMEND YOU SEE A RHEUMATOLOGIST TO RULE OUT INFLAMMATION OF YOUR SACROILIAC JOINTS. ALSO, EVALUATION BY AN ORTHOPEDIC SPINE SPECIALIST WITH SPORTS MEDICINE EXPERIENCE MAY ALSO BE HELPFUL. GOOD LUCK. hARLAN sELESNICK

Submitted by Anthony Velez from North Brunswick NJ

Q: On Sept. 15th 2008 I had surgery on my left knee. I had cracked my patella and had taken a quarter size chip out of my femur. Prior to the surgery the knee would get "stuck" then pop back in place with some pain involved. After rehabbing the knee after the surgery the 'Locking" has increased and is more painful than before. I am a police officer and was injured in the line of duty. I have been told by the surgeon that there is nothing else that can be done for me and that i should think about retirement. I am 42 years old and in good shape. Is this my only option? I have consulted with a docor out of NY who informed me of two proceedures, one a chondraplasty with drilling, and secondly a OATS proceedure. Will either of these help, or is it to late. Please help!!!

Answered 04/01/09 17:59:23 by Dr. Harlan Selesnick

A: There may be other options to improve your symptoms. It needs to be determined whether your kneecaps sits properly in its groove in the femur with motion. Also, the size and location of the carilage defect is important in determining whether cartilage can be grown or transferred from elsewhere in the knee. You may want to research a knee cartilage expert at one of the major hospitals in New york for another opinion and effective treatment options. Good luck. Harlan Selesnick

Submitted by Blake Forman from Marblehead, MA

Q: Hi I have patella tendonitis. Last year I had a surgical repair in hopes of releaving the pain. It felt good for a time but as soon as I started running on it during Football conditioning the pain quickly returned. I have heard from a fellow teamate, about a eletro-stimulation treatment which has been getting some great results do you recommend this.

Answered 04/01/09 17:51:27 by Dr. Harlan Selesnick

A: High energy extracorporal shockwave therapy(Ossatron) has been used to treat various tendonosis condtions. The FDA has approved it for tennis elbow and plantar fascitis. It is being researched for other conditions such as patellar tendonitis, rotator cuff tendonitis and achilles tendonitis. It is used routinely for these conditions in Europe and Canada. You may want to contact the company for physicians in your area that perform the procedure and see whether it would benefit you.

Submitted by PC Cabrera from Miami Florida

Q: I've had an hamstring problems for several years now,which has never really heel correctly , I also had two knee surgeries along the way on the same leg , I think that my hamstring now has scare tissue which nver hell correctly and that is why I continue to have problem with this hamstring.. I know we have four muscles which make up the hamstring if the two inside ones are the ones with the problem how can this be fix and what is the recovery time ??? Thank you Doctor for putting me back together several times now.

Answered 03/07/09 14:21:43 by Dr. Harlan Selesnick

A: Most hamstringtears will heal without surgery and can be rehabbed and strenghtened over time. Hamstring injuries where the muscle is torn off of the pelvis however may require surgery to fix. Certainly knee problems can also make hamstring strenghtening more difficult. I recommend you discuss the location size and type of hamstring injury with your orthopedic surgeon to determine as to what can make you as close to normal as possible. A high resolution MRI scan may also be helpful in your docor's diagnosis and prognosis. Harlan Selesnick

Submitted by Delbina from montreal

Q: Wow! What you are doing is so great. It is very kind of you to answer all these questions for everyone and to share your knowledge how you do. I wish you were in Montreal! I ripped my patellar tendon snowboarding. I am 27 and its a Partial tear(MRI). Im a strong believer in that my body has the power to heal itself. I healed a horse with a broken leg a couple years ago and he's ripping now so its my motivation. I tore it in Dec... 3 months later the pain at its max is still a 10 (1-10) .... hurts just as much as a couple months ago( when i lift my foot up from sitting on the floor with my legs out in front of me ). But ive improved in many other areas. i can fully bend it when that used to be impossible, i can climb stairs, off my cane, stronger quad, much less limping and pain when i touch "the spot". Physio 3 times a week with McGill Sports, icing every day with Gyro cuff... lots of time and effort into it. I need to heal naturally. its what i believe in. Im going thru a phase of frustration and giving up tho because i still cant run let alone snowboard. If there were three things to focus on for my natural healing and recovery what would they be? Do you think i am wasting my time? Kindest regards, Delbina Potenza

Answered 03/07/09 14:17:22 by Dr. Harlan Selesnick

A: A lot depends upon the size and location of the tear. Large tears usually will not heal well without surgery and may result in weakness and a limp. Smaller tears may respond to a rehab program and time. You may want to discuss the signifince of your injury with your orthopedic surgeon as not all injuries can heal well naturally. Good luck. Harlan Selesnick

Submitted by Mira Kovacic from Miami Beach Fl.

Q: I have extensive rupture of medial posterior meniscus, i have gotten two different advices on it. One to deffinitly have a surgery, and other vaguely saying that is up to me to decide. The injury is seven month old and i feel pain with lateral pressure. I am able to walk and bike with little or no problem, but i stoped doing yoga couse of discomfort. I wonder if there is an alternative to surgery,preferably something wholeistic. i am very concerned with recovery time, because of nature of my work,massage therapy. Please let me know what is your opinion on my case. Thanks.

Answered 02/19/09 09:16:06 by Dr. Harlan Selesnick

A: The neccesity for surgery with a meniscal tear depends upon your age, activity level, size fo the tear, location of the tear, and whether mechanical symptoms such as locking, swelling or catching are present. Some patients can have meniscal tears and function normally. However, no holistic treatments, injections or supplements will actually get the tear to heal as the healing depends upon the blood supply to the meniscus which is limited.

Submitted by mark from Buffalo,NY

Q: Dear Doc, I am about to undergo a surgery for a rapture patella tendon on my left knee. May i know what are some permanent disabilities and side effects? Thank YOu

Answered 02/19/09 09:11:14 by Dr. Harlan Selesnick

A: A torn or ruptured patellar tendon needs surgical repair otherwise you will be left with weakness on knee extension and a permanent limp. The tendon is usually fixed back to the bone where it has torn from. Post op you will be immobilized in a cast or a brace followed by a rehab program. Rehab is important to regain as much motion as possible and restore strenght. Most athletes are out at least 6 months after surgery and it is at least a year to you know how well you will ultimately do. Most people however can return to their sports and have good function. The specifics of your tear and liklihood of success without complications should be discussed with your surgeon. Good luck. harlan Selesnick

Submitted by Scott Zambarano from Cranston, RI

Q: I had ACL surgury in october 2007. I returned to work (POLICE OFFICER) in March of 2008. In the Summer of 2008 I developed a bakers cyst. I had is aspirated 4 time and one burst causing my calf to enlarge. I then returned to my doctor who did another surgury carving some of my meniscus back. I had this on January 22nd, 2009. I now have another bakers cyst in the rear of my knee. WHY???????? My knee also pops alot as cracking your knuckles

Answered 02/19/09 09:05:57 by Dr. Harlan Selesnick

A: A bakers cyst is a fluid collection in the back of the knee. It usually occurs secondary to a problem insidethe knee joint that results in extra joint fluid production that collects in the cyst. Since surgery was so recent it is not unusual to have enough swelling for the cyst to persist. Usually once the knee problem is corrected(ie menisectomy, synovectomy, chondraplasty,etc) excess joint fluid is no longer produced and the cyst shrinks and is no longer a problem. Rarely are bakers cysts removed. I recommend you see how you improve over the next few weeks and discuss this with your surgeon. Good luck. Harlan Selesnick

Submitted by marsha from miami

Q: After 2 MRI's, I've been diagnosed with bilateral labral tears in my hips. I play tennis, walk/jog, rollerblade, folk dance, etc., but only to stay fit and I don't overdue anything. My pain is mostly along my thigh,my lower back is very tight, and i do have some bursitis, though physical therapy has helped somewhat. I stretch alot and ice occasionally. Will surgery help?

Answered 01/20/09 17:49:41 by Dr. Harlan Selesnick

A: Mri scans are sometimes difficult to interpret and labral cartilage tears are not always diagnosed correctly. However, if your orthopedic surgeon is comfortable mwith the diagnosis and all other non surgical treatments have failed than arthroscopic hip surgery may be an effective option to help your symptoms. Age, activity level, and the degree of arthritis present may also affect the decision. Good luck. Harlan Selesnick

Submitted by Brooke from Illinois

Q: I am looking for other ways to reduce the peroneus tendonitis pain without surgery... To date, I have tried ice, anti inflamitories, cold stim, massage. Additionally and I going to have a type of lateral support put in my orthotic. Got any other ideas as this mostly hurts while pushing off or relaxed. Thanks. Brooe

Answered 01/20/09 17:45:54 by Dr. Harlan Selesnick

A: It appears that you are treating the inflammation of your peroneal tendons correctly. As you know the peroneals allow you to bring your foot outwards(evert). Treament includes orthotics, rehab, massage, medications, and activity modification. If these fail to relieve your symptoms than an MRI scan may be helpful to diagnosis whether a tear of the tendons exist that may require surgical repair. Good luck. Harlan Selesnick

Submitted by leslie_kauffman@keyb from buffalo, ny

Q: My 5yr old son has pes planus and his right foot goes quite far out the right. Getting orthotics this week through a podiatrist, peditrician says there is no need. He has trouble running with the other kids. Pls tell me if there is anything I can do to further help him

Answered 01/20/09 17:42:06 by Dr. Harlan Selesnick

A: Most likely your pediatrician is correct and no treatment is neccessary. However, since one foot is different from the other I recommend you see a pediatric orthopedic surgeon to make certain that there is no other problem with the hips, ankles, feet, etc. that could require furthewr testing and treatment. Harlan Selesnick

Submitted by LUIS LOSADA from MIAMI, FL

Q: I AM 59 YEARS OLD AND I HAVE RELIGIOUSLY WORKED OUT SINCE MY TWENTIES... ABOUT A YEAR AGO I PICKED UP SPINNING, REALLY GOT INTO IT BUT I HAD TO STOP BECAUSE I DEVELOPED A PROSTATE INFECTION FOR WHICH I HAD TO TAKE MASSIVE ANTIBIOTIC DOSAGES. IT SEEMS THE ANTIOBIOTIC HAVE AFFECTED MY JOINTS, ESPECIALLY NECK, HIP AND FEET. IT HAS BEEN THREE MONTHS AND I SEE NO IMPROVEMENT. WHAT SHOULD I DO?

Answered 01/01/09 21:58:13 by Dr. Harlan Selesnick

A: I recommend you see a rheumatologisst who can help determine the cause fo your joint pains. These may or may not be related to the medications. Also the rheumatologist will likely have several treatment suggestions to help the pains and hopefully get you back working out. Good luck. Harlan Selesnick

Submitted by spencer karbin from miami,fla

Q: dear doc i have been treated for tendonitis on the inside of my elbow for the last year,i have had two shots and it is worse than ever with me not using it at all not driving or even closing the door what can you suggest any input would be greatly appreciated. thanks spencer

Answered 01/01/09 21:54:59 by Dr. Harlan Selesnick

A: Tendonitis on the inside of the elbow(medial epicondylitis) is usually caused by overuse such as weight training, golf or tennis. When this tendon becomes inflamed it is slow to heal as this area has a poor microcirculation. I recommend you see an orthopedic surgeon to confirm the diagnosis and see what other treatment options exist such as physical therapy, modification of your exercise program, etc. Occasionally conservative non surgical treatment is ineffective and surgery to correct the problem is neccessary.