Blog - OSC

Treatment of Knee Pain by Dr Robert Snyder MD

Orthopaedic & Spine Center’s Dr Robert Snyder Shares His Insights into Treating Knee Pain

In my last post, I provided some background about Knee Arthroscopy and the injury and illness that may cause someone to need this type of surgery. In this post, I am going to outline the examination and non-surgical treatment process for knee pain from acute or chronic conditions.

Treatment of Knee Pain

Every knee problem will not require interventional treatment by an orthopaedic specialist. Perhaps after a visit to the ER or Family Physician, pain and swelling from an acute incident can be managed using the old standby for injury treatment, RICE (Rest, Ice, Compression and Elevation). Adding an over-the-counter anti-inflammatory medication, such as Ibuprofen or Aleve, can help most problems resolve without clinical intervention.

Knee Pain is Very Common

Many people, who have chronic knee pain from conditions like arthritis, are well-versed at managing the “ups-and-downs” of their pain and stiffness. They take over the counter anti-inflammatory medications, like Aleve, use heating pads, warm baths, muscle rubs – like Icy Hot or BioFreeze, and find other ways to manage their discomfort, through exercise and paying attention to their bodies.

However, some patients will not respond to conservative home treatment or have a condition that has progressed to the point where more intensive therapy is needed. That is when they come to see me and ask for my help with the problem.

Dr Robert J Snyder MD - Knee Care Specialist

What is Involved in a Knee Examination

When visiting my office, patients will complete a history form that will tell me about any knee problems they have had and any other medical conditions about which I need to know. I will order x-ray studies of the patient’s knee to show whether or not any bone damage or fracture exists. I will review those images with the patient while we are together in the examination room.

When I conduct an examination of the patient’s knee, I am going to do the following:

  1. Check the knee for swelling, discoloration, tenderness and pain
  2. Assess the patient’s range of motion in the knee joint and if movement causes pain
  3. Ask the patient to point to the area of the knee that hurts
  4. Ask questions about the pain, when it started, how did it start, when is it better or worse
  5. Ask them what kind of home treatment they have tried
  6. Evaluate whether physical therapy has been ordered and how successful it was

Once I conduct a thorough check of the patient, I will review their x-ray images with them and explain what I see. I will point out any fractures or bone damage that may show up on the x-ray. I will tell them my diagnosis and what treatment that I recommend for them. If I do not see a serious problem that needs immediate surgical intervention, I can provide a prescription for strong anti-inflammatory drugs, pain medications, or physical therapy in order to help with the pain, swelling and lack of strength and range of motion in the knee. Sometimes, I will provide a brace to support and keep the knee immobile while it heals.

In my next post, I will detail why a patient would consider knee arthroscopy and how I do the procedure.

Robert J. Snyder is an Orthopaedic Surgeon who specializes in the treatment of knees, hips and shoulders. A graduate of and former Chief-of-Surgery at the United States Military Academy at West Point, Dr. Snyder’s specialty focus is Total Joint Replacement and the treatment of Sport Injuries.

Dr. Snyder currently practices at Orthopaedic & Spine Center in Newport News, Virginia.

For more information about Dr. Snyder or OSC, please call 757-596-1900 or go to www.osc-ortho.com.

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Introduction to Knee Arthroscopy by Dr Robert J Snyder MD

OSC’s Dr Robert J Snyder on Knee Arthroscopy and Minimally Invasive Surgery

Background

Up until about 1975, the majority of knee operations were done through large, open incisions. Patients usually stayed in the hospital for a few days and the recovery period was long and painful. In the late 1970’s, arthroscopic knee surgery started to become the new standard.

The invention of and improvement upon Arthroscopic surgery techniques has revolutionized the way that I do most knee surgeries. Knee Arthroscopy uses a scope (a tiny fiber optic camera), inserted into the knee joint, to help the surgeon visualize mechanical problems that can be fixed surgically or other problems that may be causing pain or loss of function.

The scope provides an amazing level of acuity and great magnification of the area being examined. This scope, as well as the other surgical instruments, has been specially designed to be inserted through small incisions in the skin and to work in the small compartments of the knee joint. In this article, I will discuss why people have problems with their knees, how they can be treated surgically by using the Arthroscope and what to expect when having this type of surgery on the knee, including the benefits and risks.

In my role as an Orthopaedic Surgeon, I see patients of all ages who complain of a painful knee. As the knees are arguably some of the most actively used and abused joints in the body, it makes sense that they might give us trouble from time to time.

Knee Pain

Knee pain can be caused by a variety of different problems, and are usually in one of two categories, Acute or Chronic. Acute Knee problems are those that usually have a sudden onset, and that resolve and heal after some time, such as sports or work related injuries or an infection. Some of these types of injury will require surgery for the best outcome. Examples of Acute types of knee problems include:

  • Tears to the ACL (Anterior Cruciate Ligament) or any of the other knee ligaments
  • Meniscal Tears
  • General Sprains and Strains of the Knee Ligaments and Tendons
  • Knee Cap Dislocations or Fractures
  • Knee Joint Dislocations
  • Knee joint infections

    Knee Replacement Prosthesis

 

Chronic Knee Problems

Chronic knee problems can be defined as those which occur gradually and may worsen over a period of time. These are typically problems that do not resolve non-surgically and must be dealt with over a long-period of time, such as in arthritis of the knee. Examples of Chronic types of knee problems include:

  • Osteoporosis
  • Osteo-Arthritis
  • Baker’s Cyst
  • Inflammatory Disease, such as Lupus, Rheumatoid Arthritis or Gout

Some types of knee pain can be caused by overuse or repeated activities over time. Some examples of overuse injuries are:

  • ITB (Iliotibial Band Syndrome)
  • Tendinitis
  • Bursitis
  • Patellofemoral Pain Syndrome (this is pain of the knee cap - the patella is the medical term for the knee cap)

Although this is not a complete list of every possible knee disorder, you can see from the above discourse that the knee can be affected in many ways, causing pain and discomfort to the human who owns and uses it. In my next post, I will discuss diagnosis and treatment of common issues.

Robert J. Snyder is an Orthopaedic Surgeon who specializes in the treatment of knees, hips and shoulders. A graduate of and former Chief-of-Surgery at the United States Military Academy at West Point, Dr. Snyder’s specialty focus is Total Joint Replacement and the treatment of Sport Injuries.

Dr. Snyder currently practices at Orthopaedic & Spine Center in Newport News, VA.

For more information about Dr. Snyder or OSC, please call 757-596-1900 or go to www.osc-ortho.com.

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Treating Peripheral Neuropathy

Dr Jenny L. Andrus, MD shares her thoughts on treating Peripheral Neuropathy

In my last blog entry, I examined the different ways that Peripheral Nueropathy (PN) can be diagnosed. In this entry, I will list the different treatment options available for PN and the benefits of each.

How is peripheral neuropathy treated?

The goal of treatment for peripheral neuropathy is to treat the condition or disease that is causing the neuropathy. Once the underlying cause is improved, the neuropathy may improve. Many types of neuropathy cannot be cured and in those cases the main goal is to reduce pain and improve function. In general, adopting healthy habits can reduce the physical and emotional effects of peripheral neuropathy. I recommend that you maintain optimal body weight, avoid exposure to toxins, follow a physician-supervised exercise program, eat a balanced diet, correct vitamin deficiencies, limit or avoid alcohol consumption, and control diabetes (if applicable).

Dr Jenny Andrus MD with Dr Raj Sureja - Interventional Pain Management specialists

Neuropathic pain is often difficult to control. Mild pain may sometimes be alleviated by analgesics or pain relievers sold over the counter. Several types of medications have recently proven helpful to many patients suffering from severe chronic peripheral neuropathy pain. These include several anti-epileptic drugs such as gabapentin and some classes of antidepressants. There are medications in both the antidepressant and anti-epileptic classes which have an FDA indication for painful diabetic peripheral neuropathy. Drugs containing opiates have many potential side effects and risks. They may be helpful in some cases but are not used as first line treatment for neuropathy pain.

In addition to medication, we can also utilize physical therapy as well as physical modalities such as Transcutaneous Electrical Nerve Stimulation (TENS) to help to relieve symptoms. For some patients with refractory pain spinal cord stimulation may be effective for pain control. In spinal cord stimulation the spinal cord is stimulated to produce a pleasant sensation to override the pain sensation.

As with any other health concern, it is important to consult with a qualified physician who can treat the condition properly. If you are experiencing symptoms that you think might be neuropathy, please make an appointment with an Interventional Pain Management Specialist at the Orthopaedic & Spine Center. We will work with you to determine the best treatment to help you feel better again.

Jenny L. Andrus, MD, is a Fellowship-trained, Board-certified, Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. For more information about Dr. Andrus and her practice, go to www.osc-ortho.com . For an appointment, call 757-596-1900.

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Diagnosing Peripheral Neuropathy by Dr Jenny Andrus M.D.

Dr Jenny L. Andrus, MD an Interventional Pain Management specialist with Orthopaedic & Spine Center, shares her insight into the diagnosis of Peripheral Neuropathy

In my last blog post, I explained the causes for and the symptoms of Peripheral Neuropathy (PN). In my post today, I will outline how PN is diagnosed and discuss some of the more common tests that are used to correctly diagnose and differentiate this condition.

How is peripheral neuropathy diagnosed?

When I see a patient in the office for pain from peripheral neuropathy, I usually complete the following:

  • A Patient history, including your symptoms, work environment, social habits, exposure to any toxins, potential infections, and family history of neurological disease
  • A neurological examination to check your tendon reflexes, muscle strength and tone, ability to feel certain sensations, posture, and coordination.
  • Related tests may reveal the presence of a systemic disease causing nerve damage. Blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, and signs of abnormal immune system activity.

Based on the results of the neurological exam, physical exam, patient history, and any previous screening or testing, additional testing may be ordered to help determine the nature and extent of the neuropathy. Additional tests may include:

  • Nerve Function Tests – This test gives your doctor information about the cause and severity of your peripheral neuropathy. Electromyography (EMG) involves inserting a fine needle into a muscle to evaluate for certain types of nerve damage. Nerve conduction velocity (NCV) tests assess how our nerves and muscles respond to small electrical stimuli, generated by a probe and measured by an electrode along the nerve’s pathway.
  • Imaging Tests – CT scans and MRIs may be ordered if there is concern that a nerve may be pinched causing the neuropathy symptoms. These tests are not always necessary but can help rule out other causes of your symptoms.
  • Nerve or skin biopsy – These tests involve removing and examining a sample of tissue for abnormalities. These are not typically necessary.

In my next blog entry, I will discuss the different treatment options that exist for people who suffer with Peripheral Neuropathy and how they can find the best treatment working in partnership with their Pain Management Physician.

Jenny L. Andrus, MD, is a Fellowship-trained, Board-certified, Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. For more information about Dr. Andrus and her practice, go to www.osc-ortho.com . For an appointment, call 757-596-1900.
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The Causes of Peripheral Neuropathy by Dr Jenny Andrus

OSC’s Dr Jenny Andrus, an Interventional Pain Management specialist covers the causes of Peripheral Neuropathy

In my last blog post, I gave a brief anatomy lesson regarding the nervous system and defined Peripheral Neuropathy. In this post, I will detail the causes and symptoms of PN.

What causes peripheral neuropathy?

We know that damage to the peripheral nerves causes peripheral neuropathy. However, it is not always easy to pinpoint the exact cause of peripheral neuropathy, because a number of factors can cause neuropathies. These include:

  • Diabetes
    • The most common cause of peripheral neuropathy. Prolonged exposure to high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin all cause nerve damage. At least half of all people with diabetes develop some type of neuropathy.
  • Autoimmune disorders
    • such as rheumatoid arthritis or lupus
  • Chronic kidney disease
  • Infections
    • such as HIV
  • Low levels of vitamin B12 or other vitamin deficiencies
  • Underactive thyroid gland
  • Heavy exposure to toxins
    • such as lead, mercury and solvents
  • Alcoholism – prolonged heavy use of alcohol can cause nerve damage
  • Some medications that treat infections, cancer, seizures, and high blood pressure may cause nerve damage
  • Exposure to cold temperatures for an extended period of time
  • Pressure from bad-fitting casts, splints, a brace, or crutches can damage a nerve


What are the symptoms of peripheral neuropathy?

Symptoms of peripheral neuropathy include:

  • Numbness, tingling
  • Burning, pins and needles sensation
  • Loss of sensation to touch
  • Loss of positional sense (knowing where a body part is without looking)
  • Weakness

These symptoms can increase risk of injury to the affected limb. You may lose feeling in your legs and arms, so you may not notice when you touch something that is too hot or cold, making you more susceptible to burns. The reduced feeling may also cause you to not know when you have a small blister or sore on your feet or when you step on something sharp. These can raise your risk of serious infection.

Damage to the nerves can make it harder to control your muscles and can cause weakness. You may fall, because your legs buckle or you may trip over your own toes. A fall can cause much larger problems, including broken bones or a concussion.

In my next post, I will outline how I diagnose Peripheral Neuropathy in the patients who come to see me with chronic pain.

Jenny L. Andrus, MD, is a Fellowship-trained, Board-certified, Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. For more information about Dr. Andrus and her practice, go to www.osc-ortho.com . For an appointment, call 757-596-1900.

 

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OSCs Dr Jenny Andrus on Pain and Peripheral Neuropathy

Chronic Pain and Interventional Pain Management by Jenny L. Andrus, MD

As an Interventional Pain Management Specialist at the Orthopaedic & Spine Center, I treat many patients who are suffering with chronic pain caused by peripheral neuropathy. Often, a patient will come to me frustrated by the symptoms and functional limitations caused by peripheral neuropathy.

Jenny Andrus MD and Raj Sureja MD of OSC pain management team

Dr Jenny Andrus with Dr Raj Sureja - Interventional Pain Management Specialists

Peripheral neuropathy isn’t a single disease, but rather has many potential causes. For that reason, it can be difficult to diagnose and more difficult to treat. Early diagnosis and treatment is key – it offers a better chance to control symptoms and prevent further damage. The best outcome is achieved by working together with your Interventional Pain Management specialist to determine where the nerve damage is, what is causing it and how the pain can be relieved.

Our nervous system

To better understand peripheral neuropathy, let’s start with an anatomy lesson about our nervous system. The nervous system is very complex – it has several parts, and is the “command center” for the body. It sends and receives messages using electrical impulses. It has two primary functions. Orders are sent from the brain to body organs and muscles that cause each movement in our bodies. Its other function is to send information about the body’s condition or environment to the brain along sensory nerves. The nervous system clearly carries a heavy load; therefore, when something goes wrong with our nerves, the result can be very debilitating.

The nervous system is divided into the central nervous system and the peripheral nervous system. The central nervous system is comprised of the spinal cord and brain. The peripheral nervous system consists of the nerves outside of the spinal cord and brain. Unlike the central nervous system, the peripheral nervous system is not protected by the bones of the spine and skull, leaving it exposed to toxins and mechanical injuries. This exposure can allow damage to the peripheral nerves.

What is peripheral neuropathy?

Peripheral neuropathy results from some type of damage to the nerves. It often causes numbness and pain. People typically describe the pain of peripheral neuropathy as tingling or burning. You may also lose feeling in your hands, feet, arms and legs.

In my next blog, I will discuss the causes and symptoms of Peripheral Neuropathy.

Jenny L. Andrus, MD, is a Fellowship-trained, Board-certified, Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. For more information about Dr. Andrus and her practice, go to www.osc-ortho.com . For an appointment, call 757-596-1900.

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Carpal Tunnel Release Surgery – Endoscopic or Open Approach?

Patients and Physician Referrals May Call (797) 596-1900 for a Consultation

In my previous post, I detailed information on all of the ways you can be treated for CTS non-surgically. In this post, I will look at both surgical approaches for Carpal Tunnel Release and, with the input from Dr. Boyd Haynes, provide the information you need to determine which is best for you.

So you have decided to have surgery to address the uncomfortable symptoms of CTS…now you need to know the facts about the two surgical approaches that are used for CT release.

The first surgical approach is the open approach. This approach has been used for many years and the outcome of the surgery is usually quite good and their symptoms are relieved. This approach involves the following:

  • Outpatient Surgery
  • A 2-inch incision in the palm
  • Longer time under anesthesia
  • Longer surgery time
  • A longer scar
  • Longer recovery time
  • Activity restrictions

The endoscopic approach involves using a scope to visualize the ligament which needs to be released and performing the surgery through a surgical cannula. This approach has also been used for many years and the results are excellent for most patients, relieving their symptoms. This approach involves the following:

  • Outpatient Surgery
  • A 1/2-inch incision in the wrist
  • Shorter time under anesthesia (approximately 7 minutes )
  • Shorter surgery time
  • A shorter scar
  • Shorter recovery time
  • Quicker return to work
  • Any activity is okay, as tolerated

Dr. Boyd Haynes of Orthopaedic & Spine Center tells me the following, “The long term results of both the open and endoscopic surgeries are the same at 3 months, but the Endoscopic (ECTR) technique will get the patient back to work 2-3 times faster than the open surgery. The way I practice medicine is to only do the type of surgery that I would want to have or for my family to have. If I was having a Carpal Tunnel Release, the Endoscopic Release would be the approach I would choose.”

So, there you have it. If you have Carpal Tunnel Syndrome, consult with a Fellowship-trained, Board-Certified Orthopaedic Specialist about your treatment. That way you can ensure you have the best outcome, whatever surgical option you choose.

Patients and Physician Referrals May Call (797) 596-1900 for a Consultation

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How is Carpal Tunnel Syndrome Treated?

OSC’s Dr Boyd Haynes Shares His Views on Treatment of Carpal Tunnel Syndrome

Call (757) 596-1900 for a Private Consult or Physician Referral with Dr Boyd Haynes

In my last post, I discussed how orthopaedic surgeons diagnose Carpal Tunnel Syndrome or CTS. Dr. Boyd Haynes of the Orthopaedic & Spine Center has also given me his insights into his practice and his treatment of patients with CTS. In this blog, we will look into the various treatment options for CTS.

Dr Boyd Haynes Discusses Carpal Tunnel Syndrome - Video

So, you have been diagnosed with Carpal Tunnel Syndrome…what next?

All studies show that once you get carpal tunnel syndrome, the symptoms may be managed, but nothing will reverse the condition or cure it, except for surgical intervention. Most people choose to try and manage the symptoms and your Orthopaedic Specialist has a variety of options for doing so. Dr. Boyd Haynes of OSC usually recommends the following course of conservative treatment for his patients:

Anti-inflammatory medications, splints or bracing for the wrist and hand, cortisone injections can all be used to manage the symptoms. The cortisone injections are useful to help in diagnosing confusing questionable symptoms (like someone with Diabetes). It is also helpful in pregnant ladies with reversible carpal tunnel syndrome. After the cortisone injection patients usually exhibit some worsening discomfort for the first 2-4 days and then they get some relief.

Some people may manage their symptoms effectively and despite knowing they may have permanent nerve damage, may choose not to have surgery. The majority of patients will find, however, that their symptoms continue to worsen and they decide that they want to do something to permanently address the problem. That is when surgery is the next step.

In my next entry, I will compare and contrast the different surgical approaches for completing a Carpal Tunnel Release. Each approach has pros and cons and it is important to understand the benefits and risks of each type of surgery before you decide which approach best meets your needs.

Patients and Physician Referrals May Call (797) 596-1900 for a Consultation

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How is Carpal Tunnel Syndrome Diagnosed?

Orthopaedic & Spine Center on the Diagnosis of Carpal Tunnel Syndrome (CTS)

Call (797) 596-1900 for a consultation with Dr Boyd Haynes at OSC

A couple of days ago, I discussed what Carpal Tunnel Syndrome is (see the post here), who is the most likely to develop this condition and what puts others at risk for this syndrome. Today, I will be discussing how CTS is diagnosed by a specialist and the variety of ways they confirm their diagnosis.

So if you are experiencing symptoms of carpal tunnel syndrome, what should you do next?

It is important to get a diagnosis and confirm it truly is CTS and not other conditions that can mimic carpal tunnel syndrome. It is also important to remember that CTS can permanently damage the medial nerve of the hand, causing irreparable damage, resulting in lifelong numbness.

Your physician will conduct a complete history and physical, ask about your symptoms, do a physical examination of the fingers, palm and wrist, and will look for swelling, discoloration or other obvious signs of trauma. Your specialist will ask you to hold your wrists in a particular way or perform certain movement tests to see if your symptoms can be replicated or made worse. Your specialist may also order lab tests to rule out diabetes or hypothyroidism, which can be an underlying cause for carpal tunnel syndrome

Sometimes, your physician will order a more intensive test to confirm a suspected diagnosis of CTS. In a nerve conduction study, electrodes are placed on the hand and wrist and small electric shocks are used to see how quickly the nerves are relaying information. Electromyography involves sticking a small needle into the muscle and measuring nerve activity. While highly reliable and informative, these two tests are slightly uncomfortable for the patient. Once done, they do not need to be repeated. Dr. Boyd Haynes, of Orthopaedic & Spine Center, usually prefers doing these tests. Ultrasound can also be used to detect if the median nerve is being compromised. MRI has been found to be of little use in diagnosing CTS, but it can clearly show the anatomy of the hand and wrist to the physician, if there is a concern about a mechanical problem. Dr. Haynes had a transcriptionist he operated on with his endoscopic technique and she was able to return to an 8 hr. typing job 4 days later!!! She had her other hand done 3 weeks later as well.

In my next blog posting, I will detail for you how Carpal Tunnel Syndrome is treated.

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Controlling Pain and Interventional Pain Management

Exercise Properly and Throw No Pain, No Gain Out the Window

by Orthopaedic & Spine Center Staff - Call (797) 596-1900 for consultation

We have all heard the phrase “No pain, no gain.” Often these words are grunted by gym rats in a workout facility (insert clip “I pick things up and put things down”). In fact, Jane Fonda is credited as popularizing the motto in the early 1980s, during her “aerobic video” phase. She encouraged us to keep pushing ourselves to feel the burn as we worked our muscles to exhaustion in our living rooms. The motto encourages us to keep trying, keep pushing, keep going, even if it hurts.

Apply these words to everyday life: Is this a healthy way to live? Is it in our best interest to keep tolerating the pain? Does it do any good to ignore our own suffering?

The answers to these questions are a resounding no, no and no!

Doctors generally class pain into 2 types, nociceptive and neuropathic. Nociceptive is a result of an injury to a part of the body, such as a muscle or bone. The pain is in one place and constant, and when the damage heals, the pain usually goes away. Examples are bumps, bruises, broken bones, and burns.

Neuropathic pain is more complicated. It is the result of an injury or problem with the nerves, and is often triggered by an injury or surgery. The injured nerve stops working properly and sends the wrong signals to the brain. Nerve pain is often difficult to diagnose because the pain results from an issue inside your body, not on the outside. It can be related to a number of medical conditions such as diabetes, shingles, cancer, carpal tunnel syndrome, a failed surgery or it can be from a totally unknown cause. Symptoms can include tingling, numbness, burning, or a “pins and needles” feeling.

When not properly managed, any type of pain can affect your quality of life. Simple acts can be agonizing. You may have difficulty sleeping at night or trouble concentrating, be unable to work or feel hopeless that no relief is in sight. There are options for you to effectively manage your pain and continue to live an enriched and productive life. Make an appointment with an Interventional Pain Management Specialist to hear about medicines and procedures that may help you feel better.

OSC's Interventional Pain Management Specialists

Dr Jenny Andrus and Dr Raj Sureja

Visit www.osc-ortho.com to learn more about Dr. Raj Sureja and Dr. Jenny Andrus, the OSC Interventional Pain Management Specialists, and the procedures they do to help patients improve their quality of life. Throw the motto “no pain, no gain” out the window and start living your life to its fullest again!

Contact Orthopaedic & Spine Center for a consultation on (797) 596-1900
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