Shoulder Treatment

Shoulder injuries are a common complaint.  The two main areas of shoulder anguish are the subacromial space, relating to "bursitis" or impingement arthropathy, and the 'ball and socket' or glenohumeral joint.  Evaluation and treatment parameters vary accordingly.

Hand Treatment

Most treatment provided for hand injuries through this office is subacute and reconstructive.  Tendon and ligament repairs, joint replacements, and microsurgical procedures which have included replantation and toe-to-hand transplant surgeries have been employed. Surgical options through this office range from arthroscopic through open reconstructive nerve and tendon options, to arthrodesis (fusion) to total joint replacement arthroplasty. Wrist arthroscopic, nerve surgery, tenosynovectomies and ganglion excisions are also performed.

We often refer patients with hand injuries to a hand therapist, such as Golden Gate Hand Therapy or the St. Francis Hand Therapy clinic for strength, motion, and function acquisition.

Knee Treatment

Knee complains are very common, and Dr. Grotz cares for many patients with a variety of knee complaints. Considering that the average person takes 10,000 steps per day, or 2-4 million steps per year, naturally this amount of stress placed on the knee, even small problems can be exacerbated into painful conditions. 

Knee treatment begins with a careful evaluation through history and physical examination, and then strengthening.  The stronger one's leg gets, the less weight is actually passed through the knee joints ( both patella-femoral, and femoral-tibial).  Activity modification, braces, straps, taping, physical therapy, and NSAIDs may help as well .Various types of bracing and orthotics may be utilized, of which there are several types, including cho-pat straps, kneed-it braces, and unloading braces.  Orthotics include several types of shoe inserts, as well as custom-made shoes.

Another approach to treatment, usually following arthroscopy,  is an option which includes the use of a viscosupplement, including Hyalgan, Orthovisca Supartz, and Synvisc. These types of injections deliver Sodium Hyaluron, a natural component within the knee, directly into the knee joint via injection to cushion and lubricate the knee.  It requires a series of three to five weekly injections of a clear gel lubricant placed into the intra-articular area. According to the manufacturers and the FDA, pain relief can last for up to 6 months or longer.  Cortisone injections are typically not recommended, as the relief therefrom is short-lived, and cortisone can be deleterious to the knee cartilage structure.

Back Treatment

Although Dr. Grotz does not perform back surgery, he does treat the back through conservative means.  In addition to the various modalities discussed above to treat pain, treatment options will be dependent upon the severity and pathology of your specific injury symptoms. Physical Therapy or Aqua therapy may be recommended as a means to strengthen specific muscle groups. TENS units, or any of the above prescribed pain therapies couples with spine paravertebral muscle strengthening are often encouraged.

In cases of more severe pain, with radicular symptoms, epidural injections or Selective Nerve Root Blocks may be recommended following diagnostic studies, such as MRI, CT and/or EMG. Epidural treatment involves injecting a small amount of pain medicine to a precise location in order to 'numb the nerve' in an effort to alleviate pain, and often diagnostic information evolves.

When symptoms are severe and persistent, despite epidural injection, surgical considerations may be developed.  In such cases, you will be referred to a trusted Spine specialist for surgical consideration, such as Dr. Ken Light, Dr. Clement Jones, or Dr. Sigurd Berven of UCSF who partners with Dr.Grotz in varied invention technologies.

Viscosupplements, though only FDA cleared for use in the knee, may be a consideration in specific cases of ankle injury.  Current literature indicates that this is a safe and effective treatment modality for those with certain ankle injuries.

Physical therapy is a useful treatment for most injuries.  Various specialty types of therapy also exist and may be used instead of or in addition to traditional therapy.  Physical therapy should proceed two or three times a week until a plateau in recovery is accessed.  Such a plateau can usually be achieved in two and one-half months or thirty or fewer visits.  This information is based on the patient’s findings, in my experience with recommending the process of rehabilitation, to gain maximum strength, motion, and endurance in similar cases.

Aqua therapy is a useful alternative or adjunct to traditional therapy.  The buoyancy provided by the aquatic setting decreases the stresses upon the lower extremities and lower back.  Thus, Aqua therapy may be recommended for patients with lumbar, knee, and/or ankle injuries. 

In its basic level, the Feldenkrais Method improves posture, coordination, flexibility and suppleness.  Moreover, Feldenkrais alleviates pain by minimizing physiological and psychological stress associated with restricted functions.  Patterns of inefficiency, compromised self-expression, and forgotten ways of feeling can all be improved. 

The positive integration of the mind and body through the Feldenkrais Method enables people to live more comfortable and rewarding lives. With improved efficiency comes greater enjoyment and pleasure in daily living.  Ordinary problems associated with the work place or caused by aging are remedied.  Persons with orthopedic or neurological problems experience wonderful therapeutic benefits. Meanwhile athletes, actors, dancers and musicians substantially improve their performance skills through the Feldenkrais Method.

Dr. Grotz has also advocated martial arts as a rehabilitation option.  Consistent with his training as a blackbelt in taekwondo, with teaching experience pertaining to martial arts and aging, he believes that strength, balance, motion, and spiritual enrichment can accrue from studying taekwondo. Having owned a physical therapy center years ago, to which 270 physicians and surgeons referred patients, with Joe Montana as the spokesman, Dr. Grotz believes that taking responsibility for ones own strengthening and healing are important to achieve the best results.

Pain

Orthopedic injuries are typically accompanied by some level of pain. Through this office, a variety of treatment modalities are often invoked in order to help alleviate pain while the underlying injury is addressed.