Tag Archives: Dr Paul H Lento

MRI’s Have All The Answers … OR DO THEY???

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“Doctor, haven’t you looked at my MRI?”

This is a question that frequently comes up while visiting a doctor’s office. Most patients who have experienced an orthopedic issue at one time or another will probably undergo an MRI to better clarify the cause of the problem.

However, diagnostic studies such as MRI’s are not always the answer and in many ways can lead to more tests, anxiety, and potentially unnecessary and ineffective treatment. For example, numerous medical studies have been published detailing how MRI’s reveal many “abnormalities” which most likely are considered typical age-appropriate changes and most likely don’t need aggressive treatment.

In a landmark study published in the New England Journal of Medicine in 1994, Jensen and his colleagues performed MRI’s of the lumbar spine in close to 100 people who had NEVER had any complaints of back pain. Remarkably over 50% had disc bulges, 30% had disc protrusions, and even 1% had massive disc extrusions, all without having any pain.  Similarly another classic MRI study revealed that the majority of patients will have an “abnormality” seen on MRI of the knee such as a meniscus tear or arthritis but have no pain.  As expected, many of these “findings” become more common with advancing age.

So what are we to conclude with this quagmire of MRI information? The most important factor is considering what every good physician learns in medical school. A good physician should obtain an accurate history and physical and correlate that to the imaging study like the MRI.

“The mystery is in the history” is a good rule of thumb to live by when talking to patients and helping them to sort out what the actual problem is. It is vitally important to correlate the patient’s history and physical examination to imaging tests like MRI and CT scans. In this way, the normal age-related changes seen on these imaging tests can be addressed appropriately and patients will ultimately have better outcomes.

So remember the important question is not “has the doctor seen my MRI?” but more importantly “has the doctor listened and examined me? “

Paul Lento, MD is a triple board certified Physical Medicine and Rehabilitation physician at SOA. He has earned the national honor as a Castle Connelly “Top Doc” four years in a row. Sarasota Orthopedic Associates offers same/next day appointments at our three locations in Sarasota, Lakewood Ranch, and Venice. For more information visit our website at www.SOA.md or call us at 941-951-BONE.

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Driving … A Pain In The Neck? AND IN MY BACK!

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We’ve heard many times about how important it is to maintain good posture at our workplace desks to protect our neck and spine, however most of us don’t give it a second thought when driving. Unlike sitting in a chair, the spine experiences variations of force when in a car. Vibrations from car movement may push on the discs, our internal “shock absorbers”, acting as cushions.

Proper driving posture and seat positioning may avoid a myriad of chronic problems. Here are some helpful tips to avoid discomfort:

Position your car seat to the proper height and distance across from the wheel so that your hands can comfortably reach the recommended “10 and 2” or “9 and 3″ location.

  • Your thighs should rest as much as possible on the seat in order to align your knees on the same level plane as your hips.
  • Elbows should be slightly bent.
  • Consider using a neck support, one similar to that used on a plane. This keeps your neck straight. Even a 20 degree downward curve in the neck will cause stress over time.
  • If you have lumbar support in your car, use it. If not, use a portable back support or a rolled up sweater to place at the small of your back.
  • A seat cushion used for extra padding will help protect your spine from a bumpy ride.
  • For long rides, take regular breaks; get out and s-t-r-e-t-c-h.
  • If you have cruise control, use it to give your back a rest. Place both feet firmly on the car floor. Bend your ankles a few times to stimulate blood flow.

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Whatever the cause of your neck or back pain, don’t delay having it checked. Chronic pain needs assessment, particularly if it’s worse at night and wakes you up from your sleep.

The physicians at Sarasota Orthopedic Associates are experts in diagnosing, evaluating, and treating neck and back pain. Call us at 941-951-2663 for an appointment at one of our four locations in Sarasota, Lakewood Ranch, Venice, or Bradenton. For more information about us, visit our Facebook page at www.facebook.com/srqsoa or our web page at www.SOA.md

GETTING TO KNOW YOU – Paul Lento, MD

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Last week we featured Dr Michael Gordon. This week, we asked the same questions of Paul Lento, MD, a triple board certified Physical Medicine & Rehabilitation physician here at SOA.

What inspired you to become a physician?

Not so much “what” but “who”.  My father had a pretty strong influence on my decision. He often talked that I should choose a career to help improve people’s lives but was also challenging. I thought medicine would be the best avenue to achieve both of these goals.

Why Physical Medicine and Rehabilitation (PM&R)?

While I was a General Medical Officer in the Navy taking care of Marines, I realized most of the personnel I saw had non-surgical orthopedic injuries, which often improved with a good rehabilitation program. PM&R focuses on several non-surgical options while treating the entire person, not just one body part.

What do you love most about your job?

Probably learning about the interesting things my patients have done in life. I have seen patients who have played professional tennis to those who taught Vivien Leigh how to talk with a southern drawl. One patient of mine was a bomber pilot in WWII.  Truly amazing people.

(Editorial Note: For the “younger” folks, Vivien Leigh was best known for her two Academy Award winning roles from classic movies as Scarlet O’Hara in “Gone With The Wind” and Blanche DuBois in “Streetcar Named Desire”.)

What is your biggest challenge?

Explaining to patients that I’m not an orthopedic physician. People look at me like I must be from another planet. The specialty of PM&R is very small and not well-known but I chose it as I think it has a lot to offer patients.

If I weren’t an orthopedic physician I’d be a _____________.

Fishing boat captain or a bartender on a beach in St. Barths.  Who knows, maybe combine the two when I retire?

Your proudest moment?

The times when I see my kids being kind to other people.

Where is the most interesting place you’ve travelled?  Why?

While I’ve been to different countries, I would have to say Salt Lake City during the 2002 Winter Olympics. I saw and met people from all over the world. It was like circling the globe in two weeks without having to leave the U.S.

Any hobbies?  Activities?

I love to fish. I would try to fish in any body of water if given the chance. It’s one of the reasons I moved to Florida.

What’s your next adventure?

I may explore Italy in the next year or two if I can get away.

Your guilty pleasure food?

Having lived in both Chicago and Philadelphia, I would have to say deep dish pizza and soft pretzels.

Paul Lento, MD is triple board certified and a Castle Connelly “Top Doc”.  You may read his medical biography by visiting our website here. To make an appointment with Dr Lento, call 941-951-2663. Sarasota Orthopedic Associates has 13 physicians across 4 locations (Sarasota, Lakewood Ranch, Venice, and Bradenton) and we offer same day appointments when needed. Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

SHOULD MY CHILD PLAY THE SAME SPORT ALL YEAR LONG?

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Ahhh!!! Florida, with its beautiful warm sunny days and virtually endless opportunities for sporting events, is a hotbed for the development of youth sports.  Here in the Sarasota/Bradenton area, there are numerous opportunities for the young athlete to participate in sports year round.  Too often, however, young athletes are playing only one sport all year long without the potential for rest or recovery.

Unfortunately, sports medicine specialists now understand that this is not a healthy strategy. In fact, young athletes who play or perform a single sport greater than eight months out of the year are at a significantly increased risk of experiencing an injury compared to the other youths who participate in different sports.  In a recent sports medicine article, youth athletes who focus on a specific specialization of sport program are twice as likely to get injured compared to their friends who participated in self-directed unstructured free play.

There are a few theories as to why this may occur. Playing only one sport may overload developing structures causing overuse injuries.  Additionally, proper development of other diverse muscle skills which occur during regular free play or from participating in array of different sports may not occur when a child only plays one sport.

Based on these theories, it is recommended that young athletes be given time away from their specific sport so that they can participate in free unstructured play with their peers.  Parents and educators should provide opportunities for free play as well so that our young athletes can improve their motor development in general during the growing years which can reduce injury rates and encourage life-long activity free of injury.

Paul H. Lento, MDDr Lento is Fellowship Trained and Triple Board Certified in Physical Medicine.  He is a nationally recognized Sports Physician having served as team physician for major sporting events such as Winter Olympics and major city marathons. Locally he is team physician for Lakewood Ranch High and Booker High Schools. He holds the distinction being named a Castle Connelly Top Doc and sees patients at Sarasota Orthopedic Associates.  Learn more HERE.

USING ULTRASOUND TECHNOLOGY TO DETECT CAUSES OF PAIN

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Musculoskeletal Ultrasound (US) is a non-invasive office-based diagnostic test that uses non-painful ultrasound waves that creates images of various structures in the body. These images help elucidate the various causes of orthopedic pain such as tendon tears, muscle contusions, and even early stress fractures of bone.

Unlike x-rays, which use harmful ionizing radiation, US is completely safe even in patients with pacemakers and other types of surgical hardware who may not be able to receive an MRI. Patients also do not need to worry about getting into a narrow tube, which can cause some patients to become extremely claustrophobic.  In fact, in a comparative study, patients preferred getting a diagnostic US compared to undergoing MRI scans.

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Since US can be used while a patient is moving, it is a great diagnostic test to determine causes of pops, snaps, or clicks occurring about joints, muscles or tendons. Additionally, it can not only help identify the underlying problem causing the pain, but it can also help guide a therapeutic injections.  When performed under US-guidance these procedures have been shown to be less painful and more effective in treating various orthopedic conditions compared to more traditional procedures.

 Dr Paul Lento, a non-operative board certified sports medicine specialist at Sarasota Orthopedic Associates, has been performing Musculoskeletal US since 2003 and has published book chapters and journal articles on the topic.  Additionally, while lecturing nationally and internationally, he has trained several hundred physicians on Musculoskeletal US.  He is fellowship trained and certified as a Registered Musculoskeletal Sonographer (RMSK) and has been using non-surgical treatments for various musculoskeletal conditions since 2000.   Here at SOA, our doctors strive to provide the latest strategies, which help get our patients back on their feet, back to work, back in the game, and back to life.

 

CONCUSSION: Causes, Symptoms, and Treatment

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What is it and what causes it? Concussion in sports involves a complex process whereby trauma induced to the body or head creates abnormalities in processing of the brain.  While most people believe that a concussion requires a direct hit to the head, many athletes can develop a concussion even from blows to the body, which involve a sudden acceleration or deceleration force.  An estimated 3.8 million concussions occur in the US during recreational and competitive play with many more going unreported.

What are the symptoms of concussion? The symptoms from a concussion are extremely variable and no one concussion is the same as another.  Many athletes will experience headache, fogginess, dizziness, sleep difficulties, irritability, and difficulty concentrating just to name a few. Unfortunately, the symptoms of dizziness and fogginess can be associated with a longer time to recover completely.

Who is at risk of a concussion? Unfortunately some athletes may be a greater risk for a experiencing a concussion.  Younger athletes, female athletes, athletes with Attention Deficit Disorder (ADD/ADHD) as well as those who have experienced a previous concussion are at greatest risk for experiencing a concussion.

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How are concussions treated? This area of sports medicine continues to evolve and clinicians are changing the way concussions are managed.  With appropriate history, physical examination, and testing, clinicians are better able to gear specific treatment strategies towards an athlete’s symptoms.  While 90% of athletes will recover from a concussion in 3-4 weeks with relative rest and modifying aggravating activities, the other 10% may need dedicated rehabilitation strategies to help them overcome symptoms.  Once an athlete is symptom free, they can begin a graded exercise program that helps return them back to the sport safely.

At SARASOTA ORTHOPEDIC ASSOCIATES we have physicians who are trained at identifying high school athletic concussions and are able to recommend appropriate treatments, which will help them get back on their feet, back to work, back in the game, and back to life.

PAUL LENTO, MD / FAAPMR (click here for more on Dr Lento) / Triple Board Certified in Physical Medicine and Sports Rehabilitation

 

HELP: I HAVE BACK PAIN- Should I Still Exercise?

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Sadly, 90% of the American population will experience some form of significant back pain at some point in their life.  While one can get much advice from the internet, magazines, healthcare providers, and even their Aunt Edna on what is the best remedy, it is often unclear whether continuing an exercise program is a good idea following the development of acute back pain.

A good rule of thumb is that for the first day or two one should try to move as tolerated, given their level of the pain.  Studies have shown that the patient who stays in bed not doing any activity will do worse in terms of returning to regular activities as opposed to those who move as best as they can and continue to try to function.

After the first few days one can start to reintroduce activities as tolerated. If, however, any pain radiates down the legs with exercise, then that should be avoided.  Oftentimes, if symptoms are recurring in the leg, they may be more notable when a person is standing or sitting.  In the case where pain radiates down the leg while in a seated position, biking would be an exercise to be avoided while walking or swimming would be a recommended activity.  The same holds true if pain is worse with standing; in that case, biking may be the recommended activity.

In general, it is safe to exercise as long as the pain in the back remains localized and does not become worse with a particular activity.  As with any condition, if these measures along with over-the-counter medication do not help over a period of a week or two, medical care should be sought. At Sarasota Orthopedic Associates, we are well equipped to handle any type of injury, including back pain, and are committed to getting you back to life.

Paul Lento, MD

PM&R, American Medical Society Sports Medicine

 

 

TENNIS ELBOW? It’s Not What You Think!

tennis-elbow Many people will come to the sports clinic with complaints of pain on either side of their elbow which has been present for months and is aggravated by gripping things or shaking hands. While often referred to as Golfer’s or Tennis elbow, this painful tendon condition usually occurs not from playing golf or tennis but from repeatedly gripping or lifting objects improperly. Unfortunately, the condition can become severe enough where the tendons on either side of the elbow will become swollen, degenerated, and possibly torn causing persistent pain. Despite being referred to as lateral or medial epicondylitis by the medical community, this condition is known not to be an inflammatory condition. Because of this, typical anti-inflammatory medications like Ibuprofen or Naprosyn often will not help. While steroid or “cortisone” injections can be tried and may give temporary relief, studies have shown that the condition often returns weeks to months later causing further delay in healing. The good news is that this condition can be treated non-surgically. Medical studies have revealed that a dedicated specific exercise program that concentrates on eccentric strengthening of the elbow and wrist tendons often will successfully cure the problem. Even when rehabilitation fails, other procedures less invasive than having surgery can often be performed which can significantly improve pain in 90% of the cases. So whether you are struggling with chronic elbow pain from playing doubles tennis or from lifting luggage at the airport, the physicians at SOA can evaluate your elbow problem, correctly diagnose the cause of the pain, and suggest a specific treatment regimen which will get you back on the road to recovery. Paul Lento, MD PM&R, American Medical Society Sports Medicine