Samotin orthopaedics takes care of fractures from the simplest to the most complex throughout the body from the shoulder to finger, and from the hip to toe. Some fractures require slings, casts, manipulation, and last resort surgery. Dr. Samotin is well versed in using minimally invasive procedures when appropriate to ensure the best possible result for each and every one of his patients.
Dr. Samotin has performed several thousand knee arthroscopies. This is a minimally invasive way to fix many problems that develop inside the knee. There is special cartilage inside the knee called meniscus. This serves as a shock absorber between the bones and is different from the articular cartilage that lines the bones. The meniscus is easily torn from an accident as well as normal usage and because the blood supply is non-existent to most of the meniscus, it usually cannot heal itself. Going in arthroscopically to fix the tear or to shave it away is the most conservative and responsible recommendation that can be made for this type of problem in many situations. Usually the patient can fully weight bear immediately following this surgery and the recovery which of course can vary from patient to patient, typically is fairly quick.
Rotator Cuff Tears and Repairs
The rotator cuff consists of four separate muscles which work together to allow for movement in the shoulder. When you tear one or more of these muscles this is often accompanied by symptoms that range from an ache in the shoulder to significant pain with motion, weakness with motion, and inability to move the shoulder at all or in certain directions. Depending if you have a partial tear or a full-thickness tear, depending if one or more muscles is torn, will determine how bad the symptoms are.
In traumatic situations all tears partial or complete are notable. A partial tear has a better chance of healing with conservative treatment than does a full-thickness tear. Conservative treatment generally consists of rest, ice, cortisone shot, and physical therapy. If conservative therapy fails then surgery must be recommended. Tears that clearly need surgical intervention should not be ignored. Everyday that goes by without a surgical repair for a rotator cuff tear is another day that allows the tear to get bigger. A bigger tear means a more involved surgical procedure answer and often a less satisfying surgical result.
After surgery the shoulder and arm maybe immobilized in a brace for up to six weeks. Progressive exercises may be given during this time. At the six week mark patients will start formal physical therapy that will help them to regain as much motion and strength as possible.
A neuroma is an irritated nerve that can sit between any of the toes but most commonly in the second and third web space. The patient will typically have pain in this spot when weight-bearing, and that pain can shoot up the foot or down to the toes. Walking barefoot on hard surfaced floors or in shoes with a lot of flexibility or with very poor cushion is generally what causes the most pain. Carpeting, cushioned socks, shoes that have insoles with cushioning and good support make the problem more tolerable. The diagnosis is purely clinical. Conservative therapy involves rest, ice and most importantly a cortisone injection which is often curative. When conservative treatments fail, a small out-patient surgery can often cure this problem in eight minutes or less. Now, even though neuroma surgery requires a small incision, any foot incision must be treated very conservatively because feet like not to heal. A period of rest and not weight-bearing is mandatory for the best results.
Bunion Deformity AKA Hallus Valgus Deformity
When the big toe no longer sits straight but starts to angle toward the outside this is known as a bunion or hallus Valgus deformity. Bunion is Greek for onion and represents the prominence of the medial aspect of the first MTP joint. It is this prominence that often brings a patient to the doctor’s office because this usually causes rubbing and irritation in most shoes. Sometimes it is the angulations of the big toe either pressing against the second toe or over/under lapping that will cause symptoms. At any rate, there are a whole spectrum of bony deformities as well as soft tissue contractures that represent the bunion deformity. In other words, a bunion can come in many different varieties and the surgical answer is different for many of these problems.
Treatment for these problems involves either changing the world around the foot or changing the foot. Conservative treatment involves various pads that can cushion or make the problem more comfortable to live with. Special shoes that fit a bunion type of foot may also be helpful. For the right person who embraces these conservative modalities, we can accomplish a lot. Most people seem to not want to bother with pads on and off their feet everyday. Also, many people are not willing to wear the “sensible” shoes that may make them more comfortable because they are ugly.
If a patient has painful deformity that cannot be relieved with the above steps then surgery can be extremely beneficial. There are many different surgeries for many different deformities know as a bunion and I have the expertise to customize the right surgery for the right medical situation. Surgery often involves cutting bones that are out of position, angling them back into position, and holding this together with screws or wires. Some soft tissue is very tight and contracted, and needs to be surgically released other soft tissue is stretched out and loose and needs to be tightened. The surgery is performed as an out-patient and takes approximately one hour. Like many foot surgeries bunion correction involves six weeks of non-weight-bearing, elevation, and ice in order to allow the best healing of the bones, soft tissue, and skin.
Claw/ Hammer Toes
This represents a group of deformities involving contracture of the toe joints that lead to the lesser toes not sitting straight. People have pain wearing shoes when either the PIP joint is raised and rubs against the top of the toe box in the shoe or when the tip of the toe is contracted and instead of the fleshy pad of the toe hitting the ground the actual tip of the toe which does not have a great cushion hits the ground instead. In younger people this results in irritation to the affected tissue. In older people, this can result in ulceration which can be very dangerous and lead to loss of the toe, foot, leg etc. Much like the bunion deformity, the conservative treatment involves using pads or special shoes to help the pressure and reduce the discomfort. If this doesn’t work, surgery to straighten the toe can easily be performed. Six weeks of non-weight-bearing after surgery would be necessary for the best results.