This study found that the risk of having hip or knee arthritis was 85% higher in high contact professional athletes.  For athletes that have had to undergo knee or hip surgery, the risk was doubled.  In comparison those men who had participated in little to no exercise, the amount was only 19%.  This seems to match with my professional experience over the years as a hip surgeon in San Francisco.

The study interviewed more than 700 retired Swedish athletes between the ages of 50 and 93 who had played professional and Olympic level sports.  This group was then compared against a group of 1,400 men of the same age who exercised some or not at all.  The retired pro athletes included male athletes involved in high contact sports like soccer and hockey.

The Swedish study found that in particular hockey players had triple the risk of developing arthritis.  While handball and soccer players had double the risk for developing arthritis.  I like to point out that osteoarthritis is also known as “wear and tear” arthritis.  This wear and tear occurs as the cartilage that cushions the joints begins to wear down.  This loss of cartilage causes the bones to rub together, which causes pain, swelling and limits the range of motion.

It is important to remember that regular exercise is important for a healthy well being and staying fit throughout life.  However, as this study points out it is wise to keep in mind that certain kinds of exercise or sport does may have negative affects later in life.  But, as in most cases, the benefits of a healthy exercise routine outweigh the risk of arthritis.

Don’t let arthritis or other hip pains limit your way of life! If you’d like an initial consultation with one of the top hip surgeons in San Francisco, call my office today.

Dedicated to getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

Unfortunately, even though I have been an orthopedic surgeon for over thirty years I wouldn’t be very helpful with such a vague description. However, what I would say is; if you find that you have discomfort, whether mild or major, when you are putting on socks, pulling a t-shirt over your head or reaching behind you then you may have slight damage to the infraspinatus muscle-tendon which is a part of your shoulder. If it is only slight discomfort then it might just be a little strain to the tendon. Booking a free consultation with an orthopedic surgeon or shoulder doctor in San Francisco, like myself, will give you the opportunity to have the injury assessed.

As with most injuries, once my patient starts to explain what hurts and when, i.e. the types of actions that trigger the pain, I will have a pretty good idea of what is happening even before doing the physical assessment. As part of the assessment process an orthopedic surgeon or shoulder doctor in San Francisco will first ask you about your symptoms and when you experience them. If you are not in too much discomfort you may even be asked to demonstrate the actions, of course if you do not want to, you can refuse and the assessment will continue.

The difficulty with injuries to the infraspinatus muscle-tendon is that they can sometimes disguise themselves as other injuries to the rotator cuff itself. The most efficient way to assess whether or not you have damaged the infraspinatus muscle-tendon is to perform a simple resisted lateral rotation. If you visit a shoulder doctor in San Francisco this is the test that will more than likely be used. You will be asked to stand with your feet shoulder length apart and the affect arm bent at a 90 degree angle at the elbow. The rest of your arm, from your elbow to wrist should be pointing straight ahead in the direction that you are standing.

The doctor will then place one hand just above your elbow and the other on the back of your hand, just by your wrist. He will ask you to gently lift your arm away from your body but at the same time he will apply pressure the keep your arm in place. If there is a positive result, i.e. you feel pain, it means that your infraspinatus muscle-tendon has been damaged, however if you felt nothing the doctor will do the test again with your arm in a slightly different position. If these tests do not have a positive result chances are your infraspinatus muscle-tendon is fine, but you are suffering from an injury to the rotator cuff. As a shoulder doctor in San Francisco I see many cases of injury to both areas, but it doesn’t make it any easier to differentiate between the two.

The infraspinatus muscle and tendon is responsible for the lateral rotation of the shoulder. In most people this muscle is quite weak, unless it is frequently used, for example if you are a tennis player, swimmer or body builder. In these professions the muscle will be much more built than in the average person’s shoulder. The infraspinatus muscle covers the lower area of the scapula and its tendon attaches to the back of the greater tubercle of the humerus at the posterior upper arm. The tendon can be quite wide and thick depending on the size of the person.

Assuming that you have injured the infraspinatus tendon, the next common step for a shoulder doctor in San Francisco will to be to do further tests to try to determine where on the tendon the injury is located.

The treatment for infraspinatus tendinitis is generally non-surgical. In most cases I advise patients to rest the shoulder for two or three months in order to allow it to heal. Although I have found that active lifestyles do not tend to allow this to happen. Certainly, tennis players and body builders are the worst offenders as the backhand movement, pull ups and chin ups all work the infraspinatus structure. Other common treatments include, massage, friction and exercise therapy.

Don’t let shoulder pain limit your way of life! If you’d like an initial consultation with one of the top shoulder doctors in San Francisco, call my office today.

Dedicated to getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

Shoulder X-ray

Despite my many years of medical experience I would be the first to admit that it is easy to confuse a shoulder separation with a shoulder dislocation, and I am sure that many other shoulder surgeons in San Francisco (and further afield) would admit the same. In fact without a visual investigation, such as an X-rays, it can be difficult for the most experienced medical professionals to distinguish between the two.

The shoulder one of the most moveable joints in the body and is made up of three bones; the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The shoulder blade has a shallow socket into which the ball of the upper arm fits. The joint then has a network of soft tissue, including muscle, ligaments and tendons which keeps all of the bones in place.

Many shoulder surgeons in San Francisco will agree that the danger with the shoulder joint being so mobile is that it is prone to instability and dislocations. When a shoulder dislocation occurs the arm bone becomes separated from the shoulder blade. This can be caused by repetitive strain especially where the motion is overhead, for example in sports like tennis or swimming. A blow to the shoulder can also cause a dislocation depending on how the joint is sitting at the time. My main concern with shoulder dislocation is that in severe cases the surrounding tissue may become badly damaged which results in chronic instability. This means that the strong tissue that usually keeps the bones in place are weakened to the point that they allow the arm bone to slip out of its socket easily. Chronic shoulder instability can be very unpleasant but in some cases can be treated non-surgically. The most common treatments suggested by shoulder surgeons in San Francisco are physical therapy, which includes specific strengthening exercises to help keep the shoulder in place and prescribing non-steroidal anti-inflammatory medications.

A shoulder separation occurs when the clavicle is allowed to come away from the shoulder blade due to the connective ligaments being torn or damaged. This is most common in athletes who take part in contact sports such as football, rugby or martial arts where they are likely to suffer falls or aggressive tackles. A shoulder separation can occur in degrees of severity, ranging from a sprain or partial tear to a complete tear of the supporting ligaments. The Rockwood classification, which is a numerical scale ranging from i to vi, is used to define the severity of the damage based on a physical examination (and sometimes X ray results). Most shoulder separations cause some level of deformity as the shoulder blade sags with the weight of the arm and creates a bulge over the shoulder.

As with shoulder dislocation, shoulder separation can also be treated without a surgical procedure. The arm will have to be reset and immobilised in a sling to allow the tissue to rest and recover. Ice packs and medication will probably be needed to alleviate pain and discomfort from swelling. Shoulder surgeons in San Francisco have progressed in treating shoulder separation however in some cases there may be significant deformity in the shoulder even if it returns to full mobility.

Many patients who have had a shoulder separation experience pain in their shoulder due to the bones rubbing on each other in a way that they shouldn’t because of the deformity. In cases where the bones are not rubbing abnormally, some doctors believe that the ‘pain’ that patients complain about is more psychological than anything else. It is believe that the seeing the deformed shoulder subconsciously causes patients to believe that they should be in pain. I am not sure if this is actually viable, however, I do believe that it is something that should be investigated.

For patients I would advise that they wait a reasonable amount of time for everything to ‘settle’ but if the problem persists after therapy, then it may be necessary to undergo surgery. My personal preference is to try all non-invasive treatments before suggesting surgery. Some shoulder surgeons in San Francisco feel that performing surgery sooner rather than later will fix the problem straight away, however the recovery time can be up to 6 months, whereas depending on the damage, physical treatments can have a patient up and about in as little as 4 weeks.

Don’t let shoulder pain limit your way of life! If you’d like an initial consultation with one of the top shoulder surgeons in San Francisco, call my office today.

Dedicated to getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

1. Best is not best
   The first thing to remember is that ‘best’ is not always best for you. There are a host of Oakland orthopedic surgeons who have all went to great schools and are well-regarded, however that doesn’t mean that you will work well with all of them. It is important that you do not under-estimate how important it is for you to feel comfortable with your surgeon.
2. Knowledge is power: know about your condition
   In the hunt for your orthopedic surgeon it would be useful for you to know a bit about your condition. This will help you to know the type of treatment that you may need and will therefore shorten the potentially very long list of orthopedic surgeons if you are searching for a specialist. This leads quite nicely into tip number 3.
3. What’s your orthopedic specialty?
   If you have a fairly good idea about the type of treatment that you need, you can search for an orthopedic surgeon who specializes in your treatment. It is true that all orthopedic surgeons are specialists in musculoskeletal medicine and surgery however, some surgeons, including myself, go on to become board certified, and even further on to completing fellowship training; both of which require a tremendous amount of dedication and drive. If you find an orthopedic surgeon who is claiming to be a specialist he/she should be more than willing and able to answer all of your questions regarding your ailment.
4. Ask around
   Musculoskeletal problems are so common that it is very likely that you would know someone who has at least had a minor, or even a major, orthopedic procedure. Speak to them. I am not suggesting that you ask for personal details, but certainly find out about their orthopedic surgeon and what his philosophies are on care. Many Oakland orthopedic surgeons tend to prefer to emphasize preventative care, such of lifestyle changes, and would only suggest surgery as a last resort.
5. Time is of the essence
   My final, but equally important tip is to remember that although there is absolutely nothing wrong with getting a second, third, or forth opinion, you must remember that while you are searching for your surgeon your problem is being left untreated and is probably getting worse. I am sure that any Oakland orthopedic surgeon would tell you that your relationship with your surgeon is like any other relationship; it takes time to develop.

Don’t allow joint pain to limit your way of life! If you’d like an initial consultation with one of the top Oakland orthopedic surgeons, call my office today.

Getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

Shoulder surgeons in the Bay Area are using shoulder arthroscopy more and more to perform procedures to treat shoulder damage, such as impingement syndrome, shoulder instability and rotator cuff problems. Shoulder arthroscopy is far less invasive compared to open surgery, which exposes the shoulder joint. It uses small incisions to access the joint and allows the shoulder surgeon to repair or remove any damaged tissue that is found. In some cases you may even be able to stay awake during the arthroscopic procedure. Shoulder surgeons in the Bay Area tend to recommend shoulder arthroscopy as the recovery time is usually shorter than open surgery and patients prefer the option of being able to stay awake (if possible).

A consultation with an orthopaedic surgeon will give you the chance to understand what has happened to your shoulder. It could turn out that the treatment you need is as simple as stabilizing your shoulder and taking aspirin, however if it is a more serious injury your orthopaedic surgeon will be able to advise you of the best treatment for you. I know that it can be overwhelming to decide whether or not to go through with any medical procedure, and it is important that you feel comfortable and confident in the surgeon who will perform the procedure. To take some of the anxiety out of your decision and show their commitment to the field, many shoulder surgeons in the Bay Area are listed on the Board Certified Orthopaedic Surgeons and are more than happy to guide you with whatever you choose.

Don’t allow shoulder pain to limit your way of life! If you’d like an initial consultation with one of the top shoulder surgeons in the Bay Area, call my office today.

Getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

Arthroscopy lets me examine your knee, including the adjacent leg bones, tendons and ligaments, and the meniscus—without the defacing incisions and invading probes normally used in exploratory or open knee surgical procedures.

A tiny incision the size of a buttonhole allows the arthroscope, about the diameter of a pencil, to enter the knee to tell me everything I have to know.  A light at the tip illuminates the area for the built-in, miniature video camera to project an image onto a TV monitor.

Images of the internal damage to the knee can then be examined by me and my associates from many different angles, and then I can determine the correct surgical course of action to be taken.

One of the most common injuries to the knee is a torn meniscus. The menisci are circular pieces of thick cartilage found on both sides of the knee joint between the tibia and femur leg bones.

What you should know about meniscus tears.

• Causes.  It’s all a matter of physics. You and your knee start out going in one direction and other outside forces meet causing your knee to go abruptly in the other direction. The counterforce can either be a twisting or a rotating motion. Torn menisci also occur in older adults with no traumas involved, other than severe arthritis or the degenerative wearing away of cartilage.

• Symptoms of tears.  Immediately after an accident or trauma has occurred or a gradual build up non-episodic pain located on one or both sides (may also be referred pain) of the knee cap. It may also be accompanied by swelling and red inflamed tissue.

• Advanced Symptoms.  The knee joint may not be able to be straightened or may lock up in a bent position. Slight movements of the knee joint may also produce a bone on bone clicking or popping sound indicative of a complete absence of cartilage .

• Degrees of tears.  A torn meniscus can vary from a tiny tear, with minimal loss of mobility, to a complete severing from the anterior surface to the posterior of the meniscal cartilage belt. Minor tears usually are addressed and sutured using arthroscopy. More extensive or multiple tearing may require open knee surgery.

• Treatment.  Always start with conservative efforts first: ice, wraps, bed rest and over-the-counter analgesics in moderation. Hey, if I can get you back in the game without doing any procedure at all, I’m all for it!

Sometimes my patients respond so well to these simple palliative remedies we can re-assess the entire situation and see if they really need an orthopedic surgeon for knee surgery after all.

Either way, don’t let the pain and lack of mobility due to a torn meniscus continue to limit your way of life! If you’d like an initial consultation with an Oakland orthopedic surgeon to determine whether or not arthroscopic knee surgery is right for you, call my office today.

Getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

Knee Replacement Model

If you were to add up the number of my past hip, shoulder, and knee replacement surgery patients, I may well have operated on more joints than any other Fremont orthopedic surgeon. Thanks to ongoing advances in medical science, all of these procedures have become very commonplace. I know that nothing’s “run-of-the-mill” when you’re on the receiving end, though, so here are some of the usual questions I get from my patients. Many of whom had me replace their hips return to have me take care of their knees and vice versa. My answers should help to put you more at ease.

Q: How will I know whether I need a total knee replacement or a partial one? 

A: Before any type of surgery is decided on, I examine all joints and areas around the diseased knee. Replacing a knee joint that is adjacent to an extensively damaged joint has to result in a great improvement in function, otherwise I will not do a total replacement. If you can get satisfactory results with a partial, even though it will have moving parts, that’s the one we go for. In any event, you and I will make this decision together.

Q: How long can I expect the knee replacement to last?

A: I have patients who are still going strong after 20 years. In fact we joke about it sometimes in the office and say, “their knee will outlive them.”

Q: Can a person be rejected for knee replacement because of age?

A: Well, you won’t be rejected for being too old, as long as you’re in fairly good health and can handle mild post op discomfort. But ideally, you should be over 50. However, if you injured your knee in a trauma or accident of some sort, age is of no consequence there. Or if you blow out your knee as a fullback for the Raiders, or if sports or athletics is your livelihood, I will personally see to it that you’re back in the game!

Q: Have knee replacement surgery techniques improved?

They sure have! In the past 30 years, the improvements have been substantial. Procedures have become much less invasive and with a higher degree of patient customization. Plus, patient recovery time is faster, thanks to advances in the use of anesthesia nerve blocks and more precise prosthesis fittings.

Q: At what point should I see a doctor about my knee pain?

A: About the same time when you realize it’s not going to get better by itself. If your knee hurts for 2-3 weeks and you can’t put your finger on why, meaning you didn’t injure it in anyway– the time has come. Especially, if you can no longer do the simple movements in life, like walking or standing up without pain. I’ll be the last one to tell you you need something done unless there is no other way.

Don’t let the pain and lack of mobility continue to limit your way of life! If you’d like an initial consultation with a Fremont orthopedic surgeon to determine whether or not knee replacement surgery is right for you, call my office today.

Getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

Beat Shoulder Pain!

As an orthopedic surgeon in Hayward, I have to know how every bone relates to every muscle, tendon and ligament in the entire body, especially when performing an arthroscopy, the most delicate type of rotator cuff surgery.

Injuries to the shoulder may involve damage to one or more of four muscles known as the rotator cuff. These muscles and their tendons (fibrous tissues connecting muscles to bones) connect the humerus (upper arm bone) to the scapula (shoulder blade). When there is a minor tear in any of these muscles, arthroscopy is the safest and least-invasive procedure for corrective surgery.

In arthroscopy, I insert a miniature video camera through a tiny slit made in the shoulder, no bigger than a button hole. Then, I’m able to see on my television monitor exactly where and how big the tear is, and with other micro-instruments, repair it. You can watch the entire procedure too; since there is so little pain involved all you need is a local anesthesia — so you’re fully awake to watch the movie.

While I’m there, I remove any bone spurs and dead tissue. As long as it’s a minor tear that doesn’t extend from the outside of the muscle to the inside, then no further surgery is necessary and it can all be handled in one short arthroscopy session.

And it’s also possible that you could have a rotator cuff tear and not even need arthroscopy! Yes, we like to call it “watchful waiting” around here and it’s one of our most popular procedures! So, there’s a chance we can do it with:

1. Proper rest.  No, don’t try to “work it out” and don’t put your arm in a sling either, just don’t do anything overly strenuous.
2. Anti-Inflammatory Drugs.  Only when there’s pain, or it keeps you from sleeping. Try ice first, then over-the-counter drugs or NSAIDS (non-steroidal etc) should do the trick, if not we can try something stronger.
3. Steroid Injections.  Steroids don’t cure anything, but they usually can reduce the inflammation and pain enough so that sometimes they will jumpstart the tissue recovery process and allow the affected areas to recover on their own.
4. Physical Therapy.  Under the care and direction of a certified physical therapist administering specific exercises and movements for your condition.

Then we give it time. The body will heal itself if we remove the stress and provide the proper nutrition and environment. If the symptoms improve, no further treatment may be necessary. If symptoms worsen, we may schedule more x-rays, an MRI or an ultrasound just to see if there’s anything deeper in the tissues not visible before.

Now, how did you get this rotator cuff injury in the first place? An affliction that is common among swimmers, baseball, and tennis players—but, the closest some people get to any of those sports is on TV.

Aside from direct traumas and repetitive stresses to the cuff, other causes can come from: tendinitis, bursitis, poor posture, lifting or pulling, or just normal wear and tear. Some things you can’t prevent, some you can with: shoulder exercises, breaks from repeated arm motions during work or sports and using ice and heat for pain and inflammation.

If all else fails and you’re still experiencing shoulder pain, weakness and loss of motion, and you’re in the Hayward area, you need to see an orthopedic surgeon to discuss a possible rotator cuff surgery, an arthroscopy, or another treatment that’s best for you– call our office and ask to talk directly to me.

Getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688

Hip surgery restores mobility.

I’ve been an orthopedic surgeon in the San Leandro area performing hip replacement surgery for over three decades. It’s important for prospective patients to understand that we will explore every other type of non-invasive therapy or treatment before concluding that hip replacement surgery is the best option to get you back on your feet, pain-free and able to resume an active lifestyle again. Should hip surgery be necessary, here are a few qualifying criteria that will assure a successful outcome.

1. General Good Health.  A patient in good physical and mental health handles the procedure well, has little post op discomfort and has a fast recovery time. 

2. Not Excessive Overweight.  A few pounds won’t interfere, but losing excess mass means less weight to carry around during the healing period. 

3. Lab Tests Normal.  Blood and urine samples are taken, mainly to look for an infection or another condition which may postpone your procedure.

4. X-rays.  You’ve probably had x-rays recently, but a few more may be needed to aid us in determining the strategy for your procedure. 

5. No Infections.  Colds, flus, and other infections traveling throughout the body tend to settle in weakened areas, such as the hips. Precautionary anti-biotics given to prevent post op infections.

6. No Skin Conditions.  Skin infections, such as psoriasis, dermatitis, or rashes caused by bacteria, virus or fungus can influence healing time, scar visibility and skin pigmentation. 

7. Incomplete Dental Work.  The mouth is a source of systemic infections. If any dental treatment has been started, please finish your dental work or put it off until your hip procedure is done. 

8. Meds Interactions.  Certain medications may not react well with the meds needed for this procedure. Some you may have to discontinue for a short time. Our office will provide you with this information. 

From a post-operative perspective, there are some simply changes that you can implement to make your environment safer.  Soon after your procedure, you’ll be able to walk using crutches at first, then a walker. But, for a while, normal everyday chores and activities will be a challenge unless some temporary revisions are made. And, of course, they should all be installed and implemented before you arrive home. 

• Raised toilet seat to make getting up and down easier.
• Place chair in shower instead of taking baths.
• Install safety grab rails on walls of shower, bath and along stairways.
• Insert extra cushions to raise seat area of armed sofas, chairs and vehicles.
• Use a reach extender pole to grasp items stored too high or too low.
• Rig a long-handled shoehorn to aid in dressing without bending. 

Don’t try to do everything yourself. Get someone to help with the cleaning, meals and go shopping for you. After a few weeks you’ll need to rely on these aids less and less.

As soon as you feel up to it, we’ll set you up with some physical therapy sessions. This will get the stiffness out, the circulation going, and your mobility back.

Well you may not be eligible to be a linebacker for the Raiders, but you don’t have to remain an armchair quarterback either— there’s no reason why you can’t play a game of touch football with your child or grandchild.

When you’re ready to leave the sidelines and start living a full, active life again, let’s talk. You won’t find a more capable and caring orthopedic surgeon in San Leandro that performs hip surgery… at least that’s what my patients say.

If you or someone you love is suffering from hip pain, call my office today to schedule your initial consultation. San Leandro residents need to know that hip replacement surgery is not the only option!

Getting you back in the game,
Dr. K

Michael B. Krinsky, M.D., M.C.
20990 Redwood Road
Castro Valley, CA 94546
(888) 478-5688