• Photo: Minimally Invasive Spine Surgery

    With recent advances in technology, it is now possible to perform spine surgery through minimally invasive techniques. Minimally invasive spine surgery (MISS) allows for surgery to be done with much smaller incisions than the traditional “open surgery” which typically requires a long incision to access and view the anatomy. By avoiding these long incisions and damage to the muscles of the back and neck, there is less pain and faster recovery for the patient.

    A recommendation for spine surgery usually occurs after a period of conservative treatment involving medications, physical therapy, and injections have failed to provide the patient with adequate relief of symptoms. Once surgery is decided upon, there is a process to determine if a patient is a candidate for minimal spine surgery. Not every patient meets the criteria for these techniques; however, some procedures that can be performed with a minimal approach include the removal of herniated disks, spinal fusions, and the treatment of deformities, fractures, and infection.

    Traditional spine surgery usually requires a 5-6 inch incision with extensive dissection and retraction of muscle tissue. This is a common source of postoperative pain and can also lead to significant blood loss. Hospital stays following this type of surgery can last up to 5 days or longer with an overall recovery period of several months.

    Minimally invasive spine surgery was developed to treat certain spine problems and delivers the advantage of smaller incisions, less bleeding, less injury to the muscles and other structures of the spine, and shorter hospital stays.  Some of these procedures can even be performed as same-day surgery with the patient going home after a short recovery period.

    These procedures are performed through tubular style retractors and special tools that are designed to fit through these retractors. These retractors are placed in the body with the assistance of real-time X-ray. They are passed through the skin and soft tissues down to the spinal column and then held in place during the procedure. The retractor holds the muscles open to allow the surgeon to see the small area in the spine where the problem exists. Sometimes more than one retractor is required to perform the procedure. The surgeon then uses the appropriate instruments to remove bone or disk material through the retractor and is able to place any device, such as screws or rods, if a fusion of the spine is necessary. In order to assist in visualization, a surgeon may choose to use a microscope to magnify the view through the retractor during the surgery. After the surgery is completed, the retractor is removed, minimizing the damage to the muscles.

    Back pain and spine problems are very common. Patients should always undergo appropriate nonsurgical treatment before considering surgery. However, if surgery is indicated, the option for minimally invasive spine surgery can make the recovery much easier. The technique is now available at the North Louisiana Orthopaedic & Sports Medicine Clinic.

  • Photo: Knee Injury

    David M. Trettin, M.D.
    Board-Certified Orthopaedic Surgeon
    North Louisiana Orthopaedic & Sports Medicine Clinic
    Subspecialty: Certified in Orthopaedic Sports Medicine

    Subject:  ACL Tears – Getting Back in the Game

    An anterior cruciate ligament (ACL) injury is usually caused by a sudden twisting motion in the knee when an athlete lands or stops. Oftentimes, the athlete will hear a “pop” sound in addition to experiencing instantaneous pain once the injury is sustained. Common reasons athletes suffer ACL injuries include sudden deceleration and landings with the leg in a vulnerable position. In fact, oftentimes athletes suffer this injury without any contact from another athlete, but instead by merely reacting to another player/athlete. Interestingly, female athletes sustain more ACL injuries than male athletes. Theories as to why this occurs is how the female knee is typically aligned (women have more of a “knock-knee alignment) and also the fact that women tend to be more “ligament dominant” than “muscle dominant.” Athletes can prevent ACL injuries by training themselves to land on the balls of their feet as opposed to landing flat-footed. Also, strengthening their quadriceps muscles and working on balance (proprioceptive exercise) can be helpful. Warming up thoroughly before participating in sports and strength training to make muscles firmer are two other means of preventing ACL injury. In addition to the “popping” sound that occurs with ACL injuries, other symptoms may include a buckling leg/knee, and swelling (within 24 hours). Once the swelling subsides, athletes may be able to return to daily life activities but oftentimes the injury recurs once the athlete returns to competition. Proper diagnosis of an ACL injury always begins with a thorough examination by a competent physician. As part of the exam, the doctor may perform tests to determine whether the component parts of the knee stay in their proper position after applying pressure in all directions. While an MRI is often used to detect an ACL tear, the most reliable means to detect an ACL is via arthroscopy. The arthroscopy procedure (or knee scope) requires only a small surgical incision sufficient to allow a tiny camera to detect the ACL tear. Should the athlete’s ACL injury require surgical intervention, six to nine months is a good estimate of time before the athlete can return to their preoperative sport. Physical therapy is highly recommended during this postoperative period. North Louisiana Orthopaedic & Sports Medicine Clinic is uniquely qualified to diagnose and treat athlete ACL injuries. Please contact our office if you’ve been sidelined by an ACL injury, and let us help you get back in the game. To ask questions about this or orthopaedic-related topics, please visit me at www.healthtap.com.

     David M. Trettin, M.D.

  • Photo: Hip Injury

    A hip fracture is a break in the upper one-fourth of the femur or thighbone. Currently there are over 350,000 hip fractures occurring yearly in the United States and by the year 2050 that number is expected to climb to 650,000. Women have almost 3 times the number of hip fractures as men, but the mortality rate of men with these injuries is twice as high as seen in women. 

    Functional recovery following hip fractures extends up to one year but only 40 percent of hip fracture patients can expect to walk with the same level of ease or functionality as before their injury occurred. Nonetheless, researchers have documented that three-fourths of hip fracture patients are able to perform basic activities of daily living within one year of their injury.

    Hip fractures are classified according to their severity and by their location in the upper femur. Femoral neck fractures occur between the head of the thigh bone and the trochanters of this bone.  Intertrochanteric fractures occur between the greater and lesser trochanters, and subtrochanteric fractures occur below the lesser trochanter. Each of these fracture types may be displaced (meaning the blood supply to the head of the femur is injured), non-displaced (meaning the fracture is well-aligned), or minimally-displaced.  

    Displaced femoral neck fractures usually require a replacement prosthesis while both intertrochanteric and subtrochanteric fractures are usually stabilized with a rod & screws or a plate & screws.  Non-displaced femoral neck fractures can be managed non-operatively but must be X-rayed frequently as there is a significant risk for future displacement requiring a prosthetic. Operative intervention for patients having sustained an acute hip fracture is preferable within the first 24-48 hours after which an early rehabilitation course should begin. In cases such as these where surgical intervention is delayed, there is a greater likelihood of morbidity and mortality.

    A high percentage of hip fractures are considered fragility fractures or injuries related to osteoporosis. Any individual over the age of 50 who sustains a fracture as a result of only modest trauma (i.e., fall from standing height) should be screened for osteoporosis. Calcium and vitamin D taken daily, encouraging weight-bearing exercise and/or weight training, smoking cessation, and avoiding excessive prolonged alcohol intake are preventative measures for osteoporosis. Medication such as bisphosphonates and calcitonin, along with newer medications just out or soon to be released have been shown to reverse osteoporosis and thus lessen the chance for future fractures. These pharmaceuticals should be strongly considered in individuals who have previously sustained a fragility fracture and are shown to have osteoporosis upon testing. 

    If you are living with hip pain or suspect you have a condition such as osteoporosis which makes you susceptible to a hip fracture, consider scheduling an appointment with one of our orthopaedic surgeons who can properly diagnose and treat your condition. 

    R. Brian Bulloch, M.D.
    Info from this article gleaned from the aaos.org website.

  • Photo: Gravelle

    Dupuytren’s disease is a fairly common disorder that I see in my practice. This disease, due to excess collagen production, can cause stiffness in the hand and the inability to straighten the fingers.  Patients with this condition first notice a nodule or bump that may gradually form a rope like cord under the skin. Dupuytren’s disease typically affects the ring and pinky finger and occasionally the area between the thumb and index finger. It is usually not painful, but if it progresses, can affect everyday life. Opening jars, shaking hands, or putting on gloves becomes difficult due to restricted motion of the hand and fingers. If the condition is mild, observation is the treatment of choice. However, if the inability to straighten one or more fingers occurs, treatment is indicated to restore function. Until recently, the only treatment option was to surgically remove the diseased tissue. In 2010, Xiaflex® was approved as a nonsurgical alternative for Dupuytren’s disease. Xiaflex® is a collagenase, an enzyme that breaks down collagen. It is a minimally invasive, nonsurgical treatment that can be dramatically effective with just one injection for appropriate candidates. The procedure involves an injection of Xiaflex® into the thickened tissue of the hand. The patient goes home and the medication begins to dissolve the excess collagen overnight. The patient returns to the office the next day. A local anesthetic is then injected into the area and the affected finger is manipulated into a straight position. The patient then meets with our Certified Hand Therapist to have a splint made, which is worn at night for 4 weeks. This alternative treatment gives patients a more conservative, nonsurgical choice. It can be extremely effective and avoids the risks commonly associated with surgery. If you have any questions about Dupuytren’s disease or this treatment, please call our office to schedule an appointment.

  • Photo: Hand Injury

    Our hands are very important to us on a daily basis. Sometimes hand pain can be debilitating and impair our ability to perform day to day activities. Hand surgeons specialize in taking care of patients with problems concerning the hand, elbow, and shoulder. Some common problems typically treated by a hand surgeon include:

    • Carpal Tunnel Syndrome
    • Injuries and fractures of the hand and arm
    • Tendonitis of the elbow (often referred to as tennis or golfer’s elbow)
    • Wrist or hand pain
    • Trigger finger
    • Dupuytren’s contracture
    • Arthritis
    • Nerve and tendon injuries

    It is important to know that not all problems need surgery. Many nonsurgical treatments may be offered as well. Examples of nonsurgical options may include medication, physical therapy, or injections. If you have a problem of the hand, elbow, or shoulder call the North Louisiana Orthopaedic & Sports Medicine Clinic today to schedule your appointment.

    Martin deGravelle Jr., M.D.

  • Photo: Dr. W. Sol Graves, MD

    By White "Sol" Graves, M.D.

    The shoulder is an extremely fascinating and complex joint. It’s shallow socket and round ball allows us to reach and use our hands in many different positions. However, this increased range of motion and activity make the shoulder joint less stable and more prone to injury.

    The rotator cuff tendons play a key role in the normal healthy function of the shoulder. The rotator cuff is formed by the tendons of 4 muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff connects the ball part of the shoulder (the humerus) to the shoulder blade and socket (the scapula).

    The rotator cuff tendons have areas of very low blood supply, and these areas make the tendons especially vulnerable to degeneration from aging. These degenerative changes help explain why the rotator cuff is more commonly injured later in life.

    Unfortunately, with degeneration rotator cuff injuries can occur even with everyday activities. However, repetitive activities (especially overhead) tend to lead to the most problems with the rotator cuff.

    Many tears to the rotator cuff occur with excessive force, such as trying to catch a heavy object or lifting a heavy object with the arm extended. In addition a fall directly on the shoulder can lead to tears of the rotator cuff.

    Rotator cuff tears typically cause pain and weakness in the shoulder. In some cases tears may be partial and cause pain but still allow good motion and strength.

    Most complete tears will result in weakness and pain, and very large tears can sometimes limit the ability to raise the arm away from your side.

    Rotator cuff injury is best diagnosed with a history, physical exam, plan X-ray and in most cases an MRI. MRI is extremely useful in determining if a tear is present, as well as where the tear is located and the size of the tear.

    A complete rotator cuff tear will not heal. Complete tears usually require surgery if your goal is to return your shoulder to optimal function. Partial tears may not require surgery. Non-operative treatment options include rest, anti-inflammatory medicine, steroid injections, and physical therapy. However, if pain and dysfunction persist, then surgery may be needed.  

    If surgery is needed to repair the rotator cuff, excellent results can usually be obtained through an arthroscopic repair. This is an outpatient procedure that only requires small stab incisions. The arthroscope allows excellent visualization of the rotator cuff and a thorough evaluation of the entire shoulder joint. The repair is done by placing small anchors in the bone (humerus). Stitches from the anchor are passed through the rotator cuff tendon and securely tied, repairing the tendon back to the bone.

    If you are living with shoulder pain or suspect you have a rotator cuff tear, consider scheduling an appointment with one of our orthopaedic surgeons who can properly diagnose and treat your condition.

  • Photo: David M. Trettin, M.D

    David M. Trettin, M.D.
    Board-Certified Orthopaedic Surgeon
    North Louisiana Orthopaedic & Sports Medicine Clinic
    Subspecialty: Certified in Orthopaedic Sports Medicine


    One of the most common musculoskeletal complaints that bring people to their doctor is knee pain. In our group practice in Monroe at the North Louisiana Orthopaedic & Sports Medicine Clinic, almost 40% of the new patients that we see complain of knee pain. In fact, the number of knee problems experienced by people of all ages has grown as a result of an increasingly active society.

    The knee joint is the largest joint in the body. The upper and lower bones of the knee are separated by two discs (menisci). The upper leg bone (femur) and lower leg bones (tibia and fibula) are connected by ligaments, tendons and muscles. The surfaces of the bones inside the knee joint are covered by articular cartilage which absorb shock and provides a smooth gliding surface for joint movement.

    While the knee joint’s main function is to act as a hinge in order to bend and straighten the body, the knee can also twist and rotate. Thus, injuries to the knee and overuse of the knee may hurt both the bone and also the ligaments, tendons and cartilages that help support the knee.

    While many jobs, sports and recreational activity, getting older or having a disease such as osteoporosis or osteoarthritis increase the chances of having knee problems, injury is the most common cause of knee problems. Sudden or acute injuries may be caused by a direct blow to the knee from abnormal twisting, bending or falling. Pain, bruising and swelling may be severe and develop within minutes of the injury. The nerves, blood vessels, bursa (fluid sacs) which allow tendons to rub over the bone may be pinched or damaged during the knee injury. The knee or lower leg may feel numb, weak, cold, tingle or look bruised or blue. Swelling can occur sometimes very quickly after knee injuries.

    Acute injuries to the knee may include:

    1. Sprain, strain or other injuries to the ligaments or tendons.
    2. Tear in the rubbery cushion to the knee joint (the meniscus), ligament tear such as an anterior cruciate ligament (ACL) or medial collateral ligament (MCL).
    3. Breaks or fractures of the kneecap, lower portion of the femur or upper part of the tibia or fibula.
    4. Severe force to bend the knee or when the knee forcefully hits an object.
    5. Kneecap dislocation. This type of dislocation occurs most frequently in 13-17-year-old girls.

    Overuse injuries occur with repetitive activities or prolonged pressure on the knee. Activities such as stair climbing, bicycle riding, jogging or jumping stress the joints and tendons that support the knee and can lead to irritation and inflammation. In children, injuries to the growth plate and overuse injuries to the growth plate (Os-Good Schlatter’s) are fairly common. Other common causes of children’s knee pain include infections, tendinitis and adult-type injuries as well.

    Most knee injuries and knee pain can be diagnosed in the office with a thorough history and physical exam. X-rays and occasionally an MRI scan can help confirm the diagnosis. Once the correct diagnosis of the knee pain is made, the treatment plan (medicine, physical therapy, surgery, etc.) can then be discussed with the patient. The orthopaedic surgeons at North Louisiana Orthopaedic & Sports Medicine Clinic are uniquely trained to diagnose and treat correctly knee pain or knee injuries. Please come and see one of our board-certified orthopaedic surgeons about your knee pain.

    David M. Trettin, M.D.