Thursday, December 1, 2011

Managing Lower Back Pain

By Robert A. Kayal, MD, FAAOS 

Low back pain stemming from sciatica, spinal stenosis or other causes is a common debilitating condition. According to the National Institute of Neurological Disorders and Stroke (NINDS), it is also the most prevalent cause of work-related disability. Lower back pain is not just uncomfortable, though. If left untreated, it can lead to potentially serious medical problems. Don’t put off having a qualified NJ orthopedic surgeon address your low back pain to determine its causeand the best course of treatment for your symptoms.

SCIATICA: Sciatica is a type of low back pain found most commonly in adults between the ages of 30 and 50 years old. Sciatic pain can be chronic and tends to affect one or both legs as well as your back. Sciatica is the result of sciatic nerve compression. The affected nerve runs from the lower back, past the buttocks and down through each leg. Symptoms of sciatica can include:
  • Long-lasting pain intensified by sitting
  • Tingling, burning or numbness
  • Weakness in the affected leg 
A herniated disc in the low back is a common cause for nerve compression. Bulging or herniated discs are often just a sign of aging, but can result from trauma such as a car accident. Sciatica that is related to disc problems can be treated non-surgically through rest, physical therapy and medication. In some cases, surgery is required to manipulate the disc into its proper position and provide pain relief. Expert NJ back surgeons can repair herniated discs and guide you in post-surgical rehabilitation exercises to strengthen core muscles. Stretching and exercises can alleviate and prevent low back pain in many people.

SPINAL STENOSIS: Another possible cause of low back pain is spinal stenosis. Your spinal cord is surrounded by a number of protective structures, including vertebrae, muscles and ligaments. Spinal stenosis is the narrowing of these structures; picture a tunnel that has suddenly grown smaller inside. The primary cause of this spinal stenosis is arthritis. During arthritis, the discs in your back lose fluid and harden. This reduces the diameter of the space surrounding your spinal cord while causing symptoms similar to sciatica. These include:
  • Burning or tingling in the buttocks, thighs or lower back
  • Weakness in the legs and feet
  • Low back pain that increases upon standing or walking
The experts at Kayal Orthopaedic Center may suggest a variety of treatment options for spinal stenosis. All are designed to relieve your low back pain and to increase your daily level of function. Lumbar traction and other forms of physical therapy can manage your symptoms and decrease associated nerve compression. Anti-inflammatory medications reduce swelling around the spinal nerve, and may be taken orally or through a series of steroid injections. Alternative therapies such as acupuncture may also be beneficial to spinal stenosis patients, and your Kayal Orthopaedic specialist can provide information about these options.

Kayal Orthopaedic Center surgeons often perform laminectomy and fusion procedures to correct severe cases of spinal stenosis. During a laminectomy, your NJ back surgeon removes fragments of bone and soft tissues that are causing nerve pain. Back fusion permanently attaches two or more vertebrae together to create a stronger spinal structure. This may offer pain relief when alternative therapies have not been successful.

Don’t let low back pain interfere with work, family and activities! Call Kayal Orthopaedic Center today at 201-447-3880 to schedule an appointment with our NJ orthopedic specialists. Online appointment scheduling is also available through Sage Intergy Practice Portal: a convenient way to manage all of your orthopaedic healthcare needs.

Wednesday, October 5, 2011

Ask the Kayal Orthopaedic Center Expert:

By Robert A. Kayal, MD, FAAOS

It’s no secret that, while exercise and recreation keep us healthy, they occasionally lead to nagging aches, injuries and musculoskeletal pain. When left unaddressed, these conditions may become chronic, requiring a long-term hiatus from offending activities. To prevent this, it’s important to discuss pain and immobility with a qualified NJ orthopedic expert.

Whether caused by (1) overuse, (2) wear and tear, (3) repetitive motion, or (4) sports and conditioning, a slow-healing elbow injury is frustrating and restrictive. Our orthopedic surgeons see a variety of elbow conditions, and two of the most prevalent are golfer’s elbow and tennis elbow. It is not unusual to see increasing elbow injuries during the NJ autumn, since the mild weather spurs enthusiasts to spend their time outdoors.
GOLFER’S ELBOW: Also known as medial epicondylitis, golfer’s elbow impacts patients who are overusing forearm muscles and tendons. The condition begins when microscopic tendon tears lead to ongoing inflammation and pain—which can come on gradually or quickly. Golfer’s elbow is typically caused by repetitive, improper technique in your golf swing, baseball pitch, racquet sport or weight training regimen. Pain may become worse as you grip a club or racquet, throw a ball, twist a doorknob or flex wrist to forearm.

Golfer’s elbow symptoms may include pain and soreness inside the elbow; stiffness when making a fist or straightening the arm; and numbness or tingling that radiates into the lower arm or hand. To diagnose this elbow condition, your orthopedic specialist will perform a thorough examination and discuss your activities/medical history.

After ruling out other damage using x-ray or MRI, our team may recommend rest, ice, physical therapy and brace immobilization. If symptoms persist, you may need one or more cortisone shots, in combination with rehab. In rare cases, surgery is recommended. Surgery for golfer’s elbow typically entails removing damaged tissue, shaving the bone and repairing or reattaching the tendon to take pressure off of the elbow joint.
TENNIS ELBOW: Similar to golfer’s elbow, tennis elbow occurs when microtendon tears develop into pain and inflammation. This pain occurs on the exterior of the upper arm near the elbow, and is often caused by racquet sports. However, tennis elbow may also be caused by repetitive wrist twisting—as when using a screwdriver, painting a wall or moving a computer mouse.

Tennis elbow symptoms include worsening joint pain, weakening grasp, and discomfort that radiates from the outer elbow into the forearm and hand. Pain typically worsens when the wrist is bent backward, or while grasping something and straightening the elbow. Extreme stiffness may also prevent full arm extension.
To diagnose this elbow condition, your Kayal Orthopaedic surgeon will examine your arm, discuss your activity and medical history—and may recommend an x-ray to rule out other joint conditions. Like golfer’s elbow, the best treatments for tennis elbow include rest, ice, physical therapy, anti-inflammatory medications and immobilization. However, persistent or recurring tennis elbow may need surgical debriding, or “cleaning up” of damaged tissue. Your surgeon can also clean out scar tissue and repair/reattach the extensor tendon to take stress off of the elbow joint.

Are You Limited by Elbow Aches, Pains and Immobility? 

If elbow pain, stiffness and numbness are preventing you from enjoying your favorite activities, it’s time to call our team of leading NJ orthopaedic surgeons. Our helpful staff can arrange an initial consultation, schedule elbow imaging and return you to the links, court or baseball diamond quickly and safely. Call 201-447-3880 today—or login online to request an appointment through our Sage Intergy Portal.

Wednesday, August 10, 2011

Shoulder Problems? Ask the Kayal Orthopaedic Center Expert!

By Robert A. Kayal, MD, FAAOS

FAQs about Shoulder Injuries
Your shoulder joint is composed of a variety of bones, muscles, tendons and ligaments. Because of its extreme range of motion, it is an inherently unstable joint that is prone to injury. Shoulder pain occurs for a variety of reasons, including degeneration, arthritis, falls, impacts or traumatic accidents. 

Kayal Orthopaedic Center, PC is a leader in NJ shoulder repairs. Successfully treating hundreds of cases of shoulder pain, restricted mobility and structural damage each year, we’ve developed a unique treatment approach that’s customized to the individual needs of each patient. Educating patients in a detailed, easy-to-understand manner, we then perform thorough assessments and outline possible treatment options—so you can decide which course of action you’d prefer to follow. Most importantly, we prioritize aftercare to ensure complete rehabilitation and freedom from shoulder pain. 

Common Questions about Shoulder Injuries
In cases where acute trauma did not cause your shoulder injury, we look for underlying causes. These may include wear and tear on your shoulder muscles and joints, the presence of arthritic conditions, and lifestyle or occupational factors that have led to repetitive stress. You can also injure your shoulder without realizing it by incorrectly lifting something heavy or carrying heavy objects over long distances.
Some of the most frequently of the most frequently occurring shoulder conditions treated by the Kayal Orthopaedic Center include:

  • Tendonitis and bursitis: Tendonitis occurs when the shoulder tendons become inflamed, causing pain and mobility restrictions. Bursitis is a similar affliction that affects the bursa, a fluidic sac which shields and protects your shoulder.
  • Shoulder dislocation: A dislocated shoulder, which occurs when the humerus bone is physically separated from the socket of the shoulder, causes severe pain and impedes movement and range of motion.
  • Frozen shoulder: Generalized inflammation can restrict shoulder movement, typically leaving patients unable to raise the affected arm beyond a certain threshold.
  • Rotator cuff tears: Usually caused by repetitive stress, a rotator cuff tear occurs when tendons and muscles in the shoulder’s rotator cuff weaken and tear.
  • Sprains: A shoulder sprain occurs when shoulder ligaments tear, and is typically caused by acute stress.  
  • Labral tears: The shoulder’s labrum is a stabilizing tissue which compensates for the overall lack of support in the relatively shallow joint of the shoulder. A labral tear increases your likelihood of suffering a dislocated shoulder, and while this condition most commonly affects older patients, it can also occur suddenly as the result of an acute injury. Symptoms of a labral tear include aching pain in the shoulder joint, sudden restrictions of movement often described as a “catching” sensation, and activity-specific pain that occurs during shoulder movement.
  • Shoulder fractures and bone breaks: Both collar bone and shoulder bone fractures can cause shoulder pain, and usually occur as the result of heavy force being applied against the bone during an accident.
  • SLAP lesions: “SLAP” is an acronym for “Superior Labral tear, Anterior to Posterior.” It refers to an injury affecting the ball-and-socket joint of the shoulder, in which the superior labral ligament develops a lesion from overuse, typically as the result of strenuous or repetitive overhead movement. Symptoms include a constant but dull (rather than sharp) pain in the shoulder, and those affected by SLAP lesions typically report being awakened during the night by shoulder pain.
  • Shoulder problems for the “overhead athlete”: Athletes who engage in sports that require a lot of overhead movement, such as softball, baseball and tennis, often develop rotator cuff problems and are at increased risk of both SLAP lesions and labrum tears. Stretching both before and after activity—and taking care to use proper form—can help you avoid these conditions.

In our clinic, we use cutting-edge imaging and diagnostic technologies which include arthrograms and arthroscopic examinations, CT scans, X-rays and MRI scans. These are used to supplement physical examinations, during which we will make an initial assessment of your injury.

It depends on the nature of the injury, but we favor minimally invasive and rehabilitative treatments before resorting to surgery. During your aftercare, we prioritize physiotherapy and range-of-motion recovery techniques to speed healing and minimize the possibility of further injury.


On behalf of my team of leading NJ orthopedic surgeons, I invite you to contact us if you have questions about shoulder pain, or wish to arrange a consultation appointment for shoulder pain or a shoulder injury. My staff has elite credentials and the breadth of experience to successfully treat any shoulder injury, no matter how minor or serious, with compassionate and attentive care. To schedule an appointment today, call 201-447-3880.

Friday, June 17, 2011

Knee Problems? Ask the Kayal Orthopaedic Center Expert!

By Robert A. Kayal, MD, FAAOS

During my years as an experienced NJ knee surgeon, I have helped hundreds of patients overcome the pain and immobility associated with debilitating knee injuries. My elite team of knee surgeons delivers patient-focused service that consists of: (1) educating patients, in-depth, about their knee injuries, (2) recommending the best treatment options, and (3) working to eliminate pain and achieve full rehabilitation. Whether your knee injury is sports-related—or was caused by a fall, an accident or a bone condition—we look forward to expediting your return to health. 

FAQs about Knee Injuries
Knee injuries are the most common joint injury, plaguing athletes and people of all ages. Knee injury complexity results from the joint’s elaborate anatomy, which consists of a sophisticated union of bones, cartilage, ligaments, tendons and muscle. Bones include the lower portion of the femur (thigh bone), the upper portion of the tibia (shinbone), and the patella (knee cap). Together, these elements flex and extend with the help of ligaments and tendons, which protect the joint against abnormal movement. In addition, the knee is cushioned by the meniscus (cartilage padding), which helps to absorb the shock of impact and activity. Each of these joint elements serves a critical purpose, and when one fails due to injury—the knee joint is no longer mechanically sound.  
Knee conditions (and their symptoms) vary from mild to severe, and may be caused by acute activity or long-term overuse. While the scope of knee injuries is too broad to cover within one blog, the following injuries are common: 
  • ACL Injury: The ACL, or anterior cruciate ligament, limits excessive rotation and forward movement of the knee. It is commonly injured during a sudden, impactful stop (i.e. – landing from a jump), during a twisting motion, or during a blow/force to the joint. ACL tears are common in basketball, skiing, football, and other activities that require jumps or rapid changes in direction.  
  • PCL Injury: The PCL (posterior cruciate ligament) limits excessive backward movement (or hyperflexion) of the knee joint. PCL injuries commonly occur during: (1) car accidents—when the shinbone strikes the dashboard and is forced backward, and (2) sports injuries, when athletes misstep—or fall on their knee with full body force.
  • MCL Injury: The MCL provides knee-joint stability, and prevents excess “opening” of the knee joint. It is commonly injured during sudden impact to the outside of the knee. This type of blow may be sustained during contact sports, or during a severe fall. 
  • Torn Meniscus: Torn knee cartilage usually refers to a tear in the meniscus, which is a rubbery cartilage section that attaches to the ligaments. The meniscus ensures even application of body weight across the knee joint, and absorbs shock during jumping, cutting, pivoting or impact. Traumatic injury (usually excessive bending and twisting of the knee) may cause a meniscus tear. This type of cartilage damage is also common with joint degeneration, since the meniscus can “wear out” over time.   
  • Fracture:  Fractures to any bone in the knee (patella, femur and tibia) generally occur during falls, car accidents or other traumatic blows to the joint.    
  • Osteoporosis: As you age, your bones may become brittle and fragile. Called osteoporosis, this condition leads to joint degeneration and increased susceptibility to fractures and trauma. The Kayal Orthopaedic team will address not only your acute, osteoporosis-related knee injury, but will also assist you with long-term disease prevention and management. 
The most common symptom, of course, is pain. You may experience throbbing, aching, shooting or nerve-related pain, depending upon the location and extent of your injury. Other common knee injury symptoms include:
    • Joint swelling and stiffness
    • Redness and “hotness”
    • Weakness and immobility
    • Locking, popping or crunching
    • Obvious joint deformity
Often, my team of NJ orthopedic surgeons can establish a diagnosis with just a physical exam and medical history. However, your injury may also require diagnostic imaging, such as MRIs, CT scans and x-rays. Our office staff deals with your insurance company and obtains necessary authorizations for further testing—so you’ll have a diagnosis promptly and efficiently. 
While treatment for knee injuries is as varied as the conditions, themselves, there are a few customary treatment options. First, your NJ orthopedic surgeon may prescribe icing, elevation and acute anti-inflammatory medications to reduce swelling and relieve pressure. If your injury does not require surgery, knee surgeons may recommend physical therapy and home exercises to strengthen and re-stabilize the joint. Physical therapy will focus on strengthening the quadriceps (front thigh) muscles, as well as the hamstrings (back thigh) muscles. Balance and flexibility exercises may also prove helpful.
If these conservative treatments are not indicated—or are not helpful after a period of time—knee surgery may be required. 
If nonsurgical rehabilitation is not effective or recommended, there are several types of surgery that may be performed for knee injuries. These include knee arthroscopy, minimally invasive knee joint replacement, unicompartmental arthroplasty and total knee replacement. To get the details about each of these cutting-edge surgical options, visit our Patient Information Center or make an appointment today.

As the regional pioneer of the partial knee and patellofemoral knee replacement technology, I’ve performed more of these surgeries than any other orthopaedic surgeon in the area. My team and I are experts in diagnosing and treating all types of knee injuries and bone conditions, so there’s no better place to seek NJ knee injury care. We specialize in attentive, customized treatment, and boast a staff of compassionate, qualified experts. Call 201-447-3880 to schedule your appointment today!   

Tuesday, April 26, 2011

Hip Problems? Ask the Kayal Orthopaedic Center Expert!

By Robert A. Kayal, MD, FAAOS

As an experienced NJ orthopedic surgeon, I am thrilled to have the opportunity to eliminate pain and suffering—while restoring patients to a life of activity and health. If you’re experiencing regular hip pain, clicking or reduced range of motion, you don’t have to live in misery. Our team of premier surgeons can help. Below, you’ll find answers to the common questions my patients have about hip problems. Don’t see the answer to your hip question below? Call our office at 201-447-3880 to learn more!


Hip arthroscopy is a relatively new technology, and Dr. Pope and I are two of only a few surgeons in the NY-Metropolitan area to regularly perform this cutting-edge surgery. During the orthopedic procedure, small instruments are placed through puncture sites around the hip joint to address pathology in the hip joint, itself. Such conditions include, but are not limited to: loose bodies, osteoarthritis of the hip, labral tears of the hip and a condition called femoroacetabular impingement (FAI). Hip arthroscopy is typically performed as an outpatient surgery, and is used to treat hip joint pain, loss of motion, snapping, clicking and mechanical complaints of catching, buckling or giving way. Many times, a hip MRI arthrogram is performed prior to the procedure to better assess your hip joint pathology. The procedure often leads to significant and rapid improvement of your hip joint symptoms. Total hip replacement is a common orthopedic procedure. As the population ages, it is expected to become even more common. Hip replacement surgery involves removing the head of the thighbone (femur) and replacing the ball-and-socket mechanism of the hip with artificial implants. This relieves pain and improves mobility. 

Minimally invasive hip replacement allows our surgeons to perform the hip replacement through one or two small incisions. Patients usually have less pain compared with traditional hip replacement surgery, and rehabilitation is faster.


Osteoarthritis, caused by the wear and tear of aging, is the most common reason for hip replacement. Osteoarthritis causes the cartilage covering the joint surfaces to wear out, resulting in pain and stiffness.

Other conditions that cause destruction of the hip joint include: 
  • Loss of the blood supply to the head of the thighbone (osteonecrosis)
  • Rheumatoid arthritis
  • Injury & infection
  • Developmental abnormalities of the hip. 
Patients with arthritis may also have brittle bones (osteoporosis), but there is no direct relationship between bone density and the development of arthritis of the hip.


Hip arthritis typically causes pain that is dull and aching. The pain may be constant, or it may come and go. Pain may be felt in the groin, thigh, and buttock, or there may be referred pain to the knee. Walking, especially for longer distances, may cause a limp. Some patients may need a cane, crutch, or walker to help them get around. Pain usually starts slowly and worsens with time and higher activity levels. Patients with hip arthritis may also have difficulty climbing stairs. Dressing, tying shoes, and clipping toenails can be difficult or impossible, and pain commonly interferes with sleep.

See a qualified orthopedic physician to diagnose hip arthritis. First, we’ll inquire about your symptoms and perform a physical examination. X-rays may show loss of the cartilage space in the hip socket and a "bone-on-bone" appearance. Bone spurs and bone cysts are also common. We may recommend additional tests to confirm the diagnosis, including magnetic resonance imaging (MRI) or computed tomography (CT) scans.


Nonsurgical Treatment
For hip arthritis, the first recommended treatment is usually over-the-counter, anti-inflammatory medications, such as ibuprofen. Some nutritional supplements, including glucosamine, may also provide some relief. Short-term physical therapy may help improve strength and reduce stiffness.

For patients with more advanced arthritis, use of a cane opposite the affected hip can transfer weight away from the painful hip and improve walking ability. A walker can also be used. Arthritis, however, is progressive. Even with treatment, it will worsen over time. Weight loss can help decrease joint stress. 

Surgical Treatment
Pain and mobility may worsen with hip osteoarthritis, even when all of the recommended nonsurgical treatments have been tried. If this happens, our NJ orthopedic team may recommend surgery. Surgical options include:
  • Arthroscopy: Arthroscopy of the hip is a minimally invasive, outpatient procedure that is relatively uncommon. Your doctor may recommend it if the hip joint shows evidence of torn cartilage or loose fragments of bone or cartilage. 
  • Osteotomy: Candidates for osteotomy include younger patients with early arthritis, particularly those with an abnormally shallow hip socket (dysplasia). The procedure involves cutting and realigning the bones of the hip socket and/or thighbone to decrease pressure within the joint. In some people, this may delay the need for replacement surgery by 10 to 20 years.


Traditional Hip Replacement
Traditional hip replacement surgery involves making a 10- to 12-inch incision on the side of the hip. The muscles are split or detached from the hip, allowing the hip to be dislocated.

Once the joint has been opened up and the joint surfaces exposed, your surgeon removes the ball at the top of the thighbone, or femur. The hip socket is prepared by removing any remaining cartilage and some of the surrounding bone. A cup-shaped implant is then pressed into the bone of the hip socket. It may be secured with screws. A smooth plastic bearing surface is then inserted into the implant so the joint can move freely.

Next, the femur is prepared. A metal stem is placed into the femur to a depth of about 6 inches. The stem implant is either fixed with bone cement or is implanted without cement. Cementless implants have a rough, porous surface. It allows bone to adhere to the implant to hold it in place. A metallic ball is then placed on the top of the stem. The ball-and-socket joint is essentially “recreated.”

Minimally Invasive Hip Replacement
Minimally invasive hip replacement surgery allows Kayal Orthopaedic Center surgeons to perform your hip replacement through one or two smaller incisions. Candidates for minimal incision procedures are typically thinner, younger, healthier, and more motivated to have a quick recovery, compared with patients who undergo the traditional surgery.

Before you decide to have a minimally invasive hip replacement, get a thorough evaluation from myself or Dr. Pope to discuss the risks and benefits. Both traditional and minimally invasive hip replacement procedures are technically demanding, and they require that your surgeon and operating team have considerable experience. 

SURGICAL TECHNIQUE: The artificial implants used for the minimally invasive hip replacement procedures are the same as those used for traditional hip replacement. Specially designed instruments are needed to prepare the socket and femur and to place the implants properly.

The surgical procedure is similar, but there is less soft-tissue dissection. A single, minimally invasive hip incision may measure only 3 to 6 inches. It depends on the size of the patient and the difficulty of the procedure. The incision is usually placed over the outside of the hip. The muscles and tendons are split or detached, but to a lesser extent than in the traditional hip replacement operation. They are routinely repaired after implants are placed. This encourages healing and helps prevent hip dislocation.

Two-incision hip replacement involves making a 2- to 3-inch incision over the groin for placement of the socket. A 1- to 2-inch incision is made over the buttock for placement of the stem. To perform the two-incision procedure, our team may require X-ray guidance. It may also take longer to perform this surgery than it does to perform traditional hip replacement surgery. 

BENEFITS: Reported benefits of less invasive hip replacement include:
  • Reduced pain
  • More "cosmetic" incisions
  • Less muscle damage
  • Faster rehabilitation 
  • Shorter hospital stays
For traditional hip replacement, hospital stays average 4 to 5 days. Many patients need extensive rehabilitation afterward. With less-invasive procedures, the hospital stay may be as short as 1 or 2 days. Some of our patients even return home the day of surgery.

While early studies suggest that minimally invasive hip replacement surgery streamlines the recovery process, the risks and long-term benefits of less-invasive techniques have not yet been documented.

Tired of living in pain? Our premier orthopedic surgeons can help! Contact our caring staff to schedule a comprehensive hip assessment with Dr. Pope or myself—and discover how we can eliminate your pain and return you to vitality!