ACL Injury


An ACL injury affects one of the four main ligaments that connect the femur (thighbone) to the tibia (shinbone).  The ACL (anterior cruciate ligament) is fibrous, like a rope and along with the other ligaments, holds the knee together, and provides rotational stability. 

An ACL injury usually happens during some kind of physical activity, sports or exercise. It results from a quick change of direction in forward motion, a twisting or pivoting motion, or sudden stops where the foot and lower leg are planted and the top part of the knee keeps moving forward, following the law of inertia, causing the ligament to tear either partially or completely. It is a very common sports injury both for competitive athletes and those involved in exercise or recreation sports.

Symptoms of an ACL injury include intense pain and swelling of the knee, loss of range of motion and weakness with weight-bearing on the leg. Sometimes a “pop” sound is heard when the ligament tears.

For a competitive athlete, a tear in the anterior cruciate ligament requires surgery to repair the tear, if they wish to return to their sport.  Non-competitive, yet active people may also choose to have the tear surgically repaired, so they can continue to be as active as they were before the tear. It is possible to rehabilitate the knee and not have surgery, but activity may be somewhat limited.

To repair of an ACL injury that involves a tear, the surgeon removes the damaged ACL and replaces it with a tissue graft, usually from either the patellar (knee) tendon or a hamstring tendon. 

Learn more about ACL surgery and repair.

For more information or to schedule an appointment with an knee specialist, please call our scheduling line:

877-34ORTHO (67846)

Meet the Team

Our Locations

MedStar Franklin Square Medical Center
9000 Franklin Square Drive
Baltimore, MD 21237

MedStar Good Samaritan Hospital
5601 Loch Raven Boulevard
Baltimore, MD 21239

MedStar Harbor Hospital
2900 S. Hanover Street
Baltimore, MD 21225

MedStar Union Memorial Hospital
3333 N. Calvert Street, Suite 400
Baltimore, MD 21218

Neck Pain

The spine program at MedStar Orthopaedic Institute is well-respected in the central Maryland and Washington regions for the diagnosis, treatment, and rehabilitation of neck pain and spine disorders. Our program brings together a variety of skilled specialists with experience in a wide range of spinal conditions, including some of the most complex conditions seen in orthopedic medicine. Our multidisciplinary team includes orthopedic spine surgeons, neurosurgeons, physiatrists (rehabilitative medicine physicians), nursing staff, physical and occupational therapists, radiologists, and an interventional pain management team—and we put all our expertise to work for you, to relieve your neck pain and get you back to your active life. 

What is Neck Pain?

The spine consists of bones (vertebrae) separated by soft cushions (discs). Nerves that travel from the brain to the rest of the body all pass through the spine. When pressure from spinal vertebrae is applied to nerves, pain, numbness, tingling, or weakness can occur. These sensations are not always relegated to the back or spine as back pain; rather, they can occur in many areas of the body, depending on what nerves are pressed, where they originate in the spine, and where they travel to.

No matter how sharp, or how long it lasts, neck pain often limits our ability to feel active and productive. The top priority for anyone suffering from back pain is simply to eliminate the pain. Common causes of back pain include

  • Poor posture, especially while using a computer or watching television
  • Quickly twisting or moving your head
  • Sleeping in a bad position

Arm and leg pain can arise from neck issues or injuries. Experiencing serious pain in our arms and legs can make even the simplest tasks feel very difficult.

Pain is identified two different ways: acute and chronic. Most people with back or neck injuries suffer from acute pain, which lasts four to six weeks and can stop without medical treatment. Chronic pain lasts for more than three months and requires medical treatment. 

Neck Pain Diagnosis

When you arrive at a MedStar Orthopaedic Institute's facility with neck pain, our orthopedic teams will thoroughly review your medical history and symptoms and may perform a range of physical and laboratory examinations—all with the goal of making the most accurate diagnosis so we can give you the best treatment. The most common screenings to pinpoint the source of your neck pain or associated pain includes the following:

  • X-rays show the alignment of your bones and whether you have a degenerative joint disease or possible tumors.
  • Magnetic resonance imaging (MRI) or computerized tomography (CT) scans can reveal herniated discs or problems with muscles, cartilage, ligaments, tendons, or blood vessels.
  • Myelography uses dye to show areas where your spinal cord may be getting pinched by the vertebrae in your back.
  • Bone scans detect bone tumors or compression fractures caused by osteoporosis.
  • Electrodiagnostic studies can confirm nerve compression caused by herniated discs or spinal stenosis.
  • Discograms determine any damage to discs.
  • Electromyography (EMG) assesses nerve or muscle damage

Understanding your neck pain is the first step in relieving it. Once an accurate diagnosis is reached, your MedStar orthopedic physician can discuss with you the specifics of your condition and determine a treatment plan that will meet your individual needs.

Conditions That Cause Neck Pain

Brachial Plexus Injury

The brachial plexus is a group of nerves that transmit messages from the spine to the hand, shoulder and arm. Inflammation, a tumor, or a serious shoulder injury can damage the brachial plexus and cause arm and shoulder and neck pain as well as numbness, weakness, or paralysis in the arm

Cervical Stenosis

Cervical stenosis is a condition in which the bones that make up the cervical spine tighten around the spinal cord, narrowing the cushioning space between them and putting too much pressure on the spinal cord. It can be caused by:

  • The natural wear and tear of aging
  • Narrowing since birth
  • Arthritis

Cervical stenosis causes a variety of uncomfortable symptoms, including:

  • Pain in the back, neck, legs, or bottom
  • Weakness, tingling or numbness in the shoulders, arm, and legs


Treatment for cervical stenosis generally depends on the severity of the neck pain. If non-surgical treatments, including anti-inflammatory or pain medications, steroid injections, or physical therapy, do not relieve the pain, surgery may be an option. The orthopedic surgeons at MedStar Orthopaedic Institute are extensively trained in the most advanced and innovative surgical procedures to treat cervical stenosis.

  • Laminectomy, or decompression, removes the bones or ligaments that press on the nerves or spinal cord.
  • Cervical fusion - unites vertebrae together to help stabilize the spine.

Learn more about treatment for cervical stenosis.

Degenerative Disc Disease

Flattening of the discs in between the vertebrae as a natural part of the aging process, causing the spaces separating the vertebrae to become smaller, which can affect the stability of the spine.

Facet Syndrome

Facet Syndrome is inflammation of  one or more of the facet joints. Facet joints are pairs joints running on either side and in between each of the vertebrae along the entire length of the spine. These structures allow for movement of the spine and provide stability. These joints can become inflamed and cause pain in that area. Physical therapy and other non-surgical treatments such as spinal injections are often used to rehabilitate the spine.

Herniated Disc

Between your spinal bones (vertebrae) are pads of cartilage called discs. Natural use or strain can cause a disc to rupture (leak) or slip out of place (herniate). When a disc weakens, parts of it can shift and put pressure on a nerve or even the spinal cord. It may result in neck pain, numbness, tingling, or weakness. A variety of factors reduces the amount of water in the discs, making them weaker and more likely to get injured. These include:

  • Natural aging process
  • Being overweight
  • Picking up heavy objects
  • Smoking


  • Pain in the back or neck
  • Burning sensation
  • Arm and/or leg weakness
  • Numbness
  • Tingling, like your arm or leg "fell asleep"
  • Bladder control problems


Most people suffering from neck pain from a herniated disc respond well to non-surgical treatment, which includes:

  • Rest
  • Taking prescription or over-the-counter anti-inflammatory or pain medications
  • Doing physical therapy, including applying heat or ice, massage, and exercises to strengthen the neck

If non-surgical treatment does not relieve your pain, you may need surgery. MedStar Health orthopedic surgeons will work with you to determine the least invasive and most effective surgical option, which include traditional open, minimally invasive, and endoscopic discectomy.

Learn more about treatment for herniated discs.

Muscle Strain or Spasm

Pulled muscle or overworked muscle.


Cartilage surrounding the spinal vertebrae gradually erodes, causing the bone to contact with the nerve.


Bone density is lost, causing vertebrae to weaken, fracture, or collapse, putting pressure on spinal nerves causing pain.

Spinal Tumors

Tumors that grow on or near the bones of the spine or around the spinal cord can disrupt the line of communication between the spinal cord and the brain. Spinal tumors can originate in the spine, or spread to the spine from another part of the body. A spinal tumor can cause different kinds of symptoms, depending on where it is located and what type of tumor it is. Generally, spinal tumor symptoms can include:

  • Back pain
  • Strange feeling, either of coldness or numbness, in the legs or hands
  • Incontinence
  • Muscle discomfort, including weakness and cramping


Treatment for a spinal tumor aims to remove or shrink the tumor and prevent it from damaging the spinal cord. The spinal surgeons at MedStar Health will work with you and your family to determine the most effective treatment options for you. In many cases, we recommend surgery to remove the as much of the tumor as possible. Our orthopedic surgeons have training and expertise in the most advanced microscopic and minimally invasive spinal surgeries. In other cases, we may recommend non-surgical treatment options, including:

  • Monitoring tumor growth
  • Medication, such as corticosteroids, to ease any swelling and inflammation
  • Radiation
  • Chemotherapy

Learn more about spinal tumor treatment.

Treatment of Neck Pain

Neck pain treatment generally depends on how severe your pain is and the underlying cause. Common non-surgical treatment options may include:

  • Prescription and over-the-counter anti-inflammatory or pain medications
  • Injections of steroids or anti-inflammatory medications
  • Physical therapy, including applying heat or ice, massage, and strengthening exercises
  • Braces

If non-surgical treatment does not relieve your neck pain, you may need surgery. The orthopedic surgeons at MedStar Orthopaedic Institute have extensive training in the most advanced and innovative surgical procedures to treat neck pain, including minimally invasive neck surgery and motion sparing surgery.

Call Us Today

For more information or to schedule an appointment with a back, neck and spine specialist, please call our scheduling line:



Meet the Team

Our Locations

MedStar Franklin Square Medical Center
9000 Franklin Square Drive
Baltimore, MD 21237

MedStar Good Samaritan Hospital
5601 Loch Raven Boulevard
Baltimore, MD 21239

MedStar Harbor Hospital
2900 S. Hanover Street
Baltimore, MD 21225

MedStar Union Memorial Hospital
3333 N. Calvert Street, Suite 400
Baltimore, MD 21218


Knee Injury


Knee injuries can happen for many reasons. They can be related to a fall, sports or exercise activity or due to some other type of accident.  Many knee injuries can be treated non-surgically with rest, ice, bracing, physical therapy and anti-inflammatory medications. Typically, knee injuries include bone fractures, dislocated joints, a soft tissue tear in one of  the ligaments that hold the knee joint together, or a tear in the cartilage that cushions in between the bones of the knee or a tear in one of the tendons that make up the knee joint.  

Symptoms of knee injuries include pain, swelling, the knee "giving out", not being able to move the knee or a "popping" sound at the time of injury.

In some cases, ligament tears can be treated non-surgically depending on the activity level of the patient.  For athletes, who suffer a knee injury involving tears to knee ligaments, most often surgery is needed in order for the athlete to return to their sport. 


For more information or to schedule an appointment with an knee specialist, please call our scheduling line:

877-34ORTHO (67846)

Meet the Team

Our Locations

MedStar Franklin Square Medical Center
9000 Franklin Square Drive
Baltimore, MD 21237

MedStar Good Samaritan Hospital
5601 Loch Raven Boulevard
Baltimore, MD 21239

MedStar Harbor Hospital
2900 S. Hanover Street
Baltimore, MD 21225

MedStar Union Memorial Hospital
3333 N. Calvert Street, Suite 400
Baltimore, MD 21218

Learn More:

  • Learn more about knee conditons at the American Academy of Orthopaedic Surgeons

Knee Pain

Female patient at the doctor for a consultation on her ankle

The knee is a very complex structure of the body, responsible for bearing the full weight of the body when standing or moving.  Knee pain is a common problem which can be a result of issues with bone structure, knee ligaments, or cartilage. Some knee pain is the result of arthritis, injury, or chronic conditions such as gout or infection. Minor knee pain can usually be resolved with non-surgical treatments.  However, in cases of severe injury or severe arthritis, surgery to repair or replace the knee joint may be the best solution. 

Learn more about the common causes of knee pain:

For more information or to schedule an appointment with an knee specialist, please call our scheduling line:

877-34ORTHO (67846)

Meet the Team

Our Locations

MedStar Franklin Square Medical Center
9000 Franklin Square Drive
Baltimore, MD 21237

MedStar Good Samaritan Hospital
5601 Loch Raven Boulevard
Baltimore, MD 21239

MedStar Harbor Hospital
2900 S. Hanover Street
Baltimore, MD 21225

MedStar Union Memorial Hospital
3333 N. Calvert Street, Suite 400
Baltimore, MD 21218

Learn More:

  • Learn more about knee conditons at the American Academy of Orthopaedic Surgeons

Tennis Elbow

tennis elbow

Tennis Elbow and Tendonitis

The tissues that attach your bones to your muscles are called tendons. When your muscles flex, tendons spring into action, helping to move your bones. It is easy to injure the tendons in the arms and hands, since we use them so often. Tendinitis is an inflammation of a tendon that causes pain near a joint. It generally develops when an accident or injury cuts or damages the tendon.

Tennis elbow is the common term for one of the most common types of tendinitis. It is also called lateral epicondylitis and is an overuse injury caused by repeated movements of the wrist or arm. It causes an inflammation of the tendon fibers that attach the forearm muscles to the outside of the elbow. Pain occurs on the outside of the elbow and may radiate into your forearm and wrist. Your elbow may be stiff, swollen and tender. As the name suggests, tennis players, as well as golfers and other athletes, often suffer from this type of tendinitis. But tennis elbow can also affect you if you twist your wrist repeatedly on a regular basis, or if you type on a computer keyboard without proper support.

Although tendinitis and tennis elbow can be painful, the good news is that it rarely becomes chronic if caught early and treated properly. Treatment often involves a team of experts including primary care doctors, physical therapists, and in some cases surgeons. They all work together to provide you with customized, effective care. Learn about tennis elbow treatment options.

For pain relief, treatment options include:

  • Rest
  • Ice
  • Physical Therapy
  • Cortisone injections
  • Ceasing or changing your activity
  • Elbow supports
  • Anti-inflammatory medicines

If surgery becomes necessary, arthroscopic procedures are minimally invasive, provide tennis elbow sufferers with a relatively short recovery period, and can produce long-lasting results. Learn more about our team of Tennis Elbow specialists.

Call Us Today

For more information or to schedule an appointment:

877-34ORTHO (67846)

Meet the Team

Our Locations

MedStar Franklin Square Medical Center
for tennis elbow and other elbow conditions
9000 Franklin Square Drive
Baltimore, MD 21237

MedStar Good Samaritan Hospital 
for tennis elbow and other elbow conditions
5601 Loch Raven Boulevard
Baltimore, MD 21239

MedStar Harbor Hospital
for tennis elbow and other elbow conditions
2900 S. Hanover Street
Baltimore, MD 21225

MedStar Union Memorial Hospital 
for tennis elbow and other elbow conditions
3333 N. Calvert Street, Suite 400
Baltimore, MD 21218

Hip Impingement

Hip Pain

Hip pain is common in active individuals and athletes. The hip joint is prone to injury in both repetitive motion and high impact activities.

The surgeons of MedStar Orthopaedic Institute, who specialize in the treatment of hip pain, have a comprehensive and precise understanding of the causes of hip pain. While there are many causes, hip impingement is becoming an increasingly recognized problem in the athletic and highly active populations. The good news is that there are new and improved methods of treatment.

Hip Impingement

 MedStar Orthopaedic Institute’s surgeons commonly diagnose hip impingement, also known as femoral acetabular impingement or FAI, in young, active individuals who are performing repetitive hip movements. However, it is an overuse injury and can be present at all ages and activity levels. 

This condition is caused by abnormal contact between the ball of the femur and the socket. The abnormal contact can be a result of excessive bone around the socket, the femur, or a combination of both.

The excess bone creates a joint that is no longer spherical. This abnormal shape can cause injury to the cartilage as well as the labral soft tissue (cartilage). The damage caused may lead to increased pain and arthritis in the hip joint or hip labrum if left untreated.

Common Symptoms:

  • Pain in the groin with activity
  • Discomfort in the hip with sitting or standing
  • Catching or locking with hip motion
  • Decreased range of motion and discomfort with hip flexion and rotation


A diagnosis of hip impingement is based on a person’s symptoms and a thorough examination of his or her hips, spine, and lower extremities. An X-ray will be taken, and possibly a CAT or MRI scan.


Your doctor will probably want to begin your treatment conservatively before considering surgery.

  • Nonsurgical: If we determine that you have impingement that is due to an overuse injury, we will recommend rest and a modified exercise routine to reduce your pain.

Our specialists may recommend physical therapy to correct alignment abnormalities and strengthen the muscles around the hip. Steroid injections directly into the hip joint may decrease the inflammation and provide temporary, symptomatic relief.

  • Surgical: Surgery is recommended when impingement symptoms do not improve. In the past, hip impingement treatment required a large incision around the hip, dislocation of the hip joint, and contouring and repairing of the bone and labrum. This required hospital admission and a lengthy recovery. With recent advances in surgical technique, surgeons from MedStar Orthopaedic Institute can now treat it arthroscopically. 

Minimally invasive hip arthroscopy is performed through several very small incisions, rather than a large incision. The hip scope procedure is performed under general anesthesia, and a patient typically goes home the same day.

Meet Our Hip Impingement Specialist

kenneth tepper

 Kenneth Tepper, MD


Learn More about:

Orthopaedic Oncology

Bone and Soft Tissue Cancer


Orthopaedic cancers start in or travel to bone, muscle, or soft tissue. MedStar Health orthopaedic oncologists are leaders in the surgical advances and innovations to treat this type of cancer, including limb-sparing surgery, a modern technique that can save an affected arm or leg and avoid amputation. Because of our experience, we frequently perform complex and revision surgeries referred from other medical centers in the country.

In addition to our advanced and compassionate clinical care, we have a highly successful, accredited fellowship training program and educate students and residents with an emphasis on our surgical services and research.

Types of Orthopaedic Cancer

Benign Orthopaedic Tumors

Benign orthopaedic tumors put pressure on healthy tissue but do not spread. They pose minimal risks and are considered non-cancerous. Some childhood benign tumors, such as bone cysts, may fully resolve over time as the bone matures with age.

Other benign bone tumors are considered more aggressive and require additional care. These include:

  • Giant cell tumors occur around the knee or the ends of long bones and can quickly damage the bone. These tumors tend to affect young adults.
  • Chondroblastomas occur at the very ends of the long bones in the arms or legs and can damage the growth plate or joint surfaces. These tend to occur in children.
  • Aneurysmal bone cysts cause the bones in the arms, legs, trunk, or skull to expand dramatically. These tumors tend to affect children and younger adults and can damage bone and often grow back.
  • Osteoid osteomas may occur anywhere in any bone and are typically extremely painful, due to chemicals released by the tumor into the the surrounding nerves.


Giant cell tumors, chondroblastomas and aneurismal bone cysts are often treated with the same therapy, including a combination of:

  • Curettage, where the tumor or cyst is scraped out during a surgical procedure
  • Cryosurgery, where the tumor or cyst is frozen with liquid nitrogen and destroyed
  • Reconstruction, where the remaining bone is repaired with metal rods, cement and bone graft

Osteoid osteoma is often treated with:

  • Surgery
  • Radiofrequency ablation


Sarcomas are tumors that occur in bones or soft tissue such as muscles, fat, and nervous tissue, and are distinguished by the type of tissue from which they originate.

Bone Sarcomas

  • Primary tumors originate in the bones (less common than many other cancers that spread, or metastasize, to bone)
  • Secondary tumors begin in a different part of the body and spread to the bones. 

Common bone sarcomas include:

  • Osteosarcoma, which forms osteoid or hard bone tissue, is the most common form of bone sarcoma, found in about 35 percent of cases. While it may occur at any age, it tends to affect children in late adolescence and appears most commonly around the knee.
  • Chondrosarcoma​, which forms cartilage tissue, is found in about 30 percent of cases. It tends to affect adults older than 40, and appears in the hip, pelvic, and shoulder areas.
  • Ewing's Sarcoma, which develops in the lungs, bone or the pelvis, arises from cells of unknown origin. It tends to affect children younger than age 19, and appears in the legs and arms. It is more common in boys than girls.

Risk Factors

Certain conditions, as well as exposure to certain chemicals, put people at higher risk for developing bone sarcomas, particularly osteosarcoma. These include:

  • Hereditary conditions, including a rare childhood eye cancer called hereditary retinoblastoma, and hereditary bone diseases, such as enchondromatosis and osteochondromatosis
  • Prior radiation exposure
  • Treatment with anti-cancer medications


As a sarcoma begins to develop, there may be no noticeable symptoms. However, over time, patients may feel:

  • Persistent pain
  • Swelling
  • A bump or mass where the tumor is located

Diagnosis and Treatment

Your doctor can detect the presence of a bone sarcoma in the following ways:

  • History and physical examination: This includes feeling and looking at the area of pain, as well as gathering information about family medical history.
  • Imaging tests help to determine a tumor's size, shape, location and whether a tumor is benign or malignant. Imaging tests include:
    • X-rays, CT and PET scans, and MRI
    • Angiogram: creates a picture of the interior of the blood vessels
    • Bone scan: a doctor injects and then tracks a radioactive substance through the blood. A scanner can detect the substance's route once it settles in the bones.
  • Blood work: tests for levels of alkaline phosphatase. This chemical in the blood may be higher than normal because of tumor growth in the bone tissue.
  • Biopsy: your doctor collects a tissue sample from the affected area to identify the exact type of tumor

After examining the results of one or more of these tests, your doctor will tell you if you have a bone sarcoma and will always answer any questions you have. MedStar Health also has compassionate patient support services for newly diagnosed patients.

Many patients will have success from a combination of treatment types. Each patient undergoes a thorough evaluation to determine the most effective course of treatment, which include

Soft Tissue Sarcomas

Soft tissue sarcomas are rare cancerous tumors that can grow in muscle, fat, nerves, and blood vessels, and they are distinguished by where in the body they originate. About half of all soft tissue sarcomas affect the arms and legs, while the rest appear in the head, neck, or trunk. Regardless of where they begin to grow, soft tissue sarcomas tend to present with similar characteristics and symptoms, and are treated the same way.


  • Fibrosarcoma: Develops from the tissues keeping bones, organs, and muscles secure and appears most often in the legs, arms, and trunk.
  • Hemangiosarcoma: Develops from the blood vessels in the arms, legs, head and trunk.
  • Leiomyosarcoma: Develops from smooth muscles used to control the movement of internal organs and blood vessels. These tumors tend to affect adults.
  • Liposarcoma: Develops from fatty tissues, and appears most often in the legs and trunk.
  • Lymphangiosarcoma: Develops from the lymph vessels, and appears in the arms. It tends to affect tissues that may have been exposed to radiation.
  • Malignant fibrous histiocytoma: Develops within muscle or fat, most often in the thighs and trunk. It tends to affect older adults.
  • Neurofibrosarcoma: Develops from nerves, and appears most often in the legs, arms and trunk.
  • Rhabdomyosarcoma: Develops from skeletal muscles used to move bones. It tends to affect young children, and appears most often in the arms and legs.
  • Synovial sarcoma: Develops from tissues that cushion the joints, such as knees and elbows. It tends to affect children and adolescents.

Risk Factors

Certain conditions, as well as exposure to certain chemicals, put people at higher risk for developing soft tissue sarcomas. These include:

  • Hereditary conditions, including a rare childhood eye cancer called inherited retinoblastoma, Li-Fraumeni syndrome, Gardner's syndrome, and a nerve tissue disorder called neurofibromatosis.
  • Radiation exposure, specifically when used to treat other cancer types.
  • High dose chemical exposure to
    • Vinyl chloride, an ingredient in plastic
    • Phenoxyacetic acid, an ingredient in certain herbicides
    • Chlorophenols, an ingredient in wood preservatives
    • Arsenic


As the soft tissue sarcoma develops, patients may feel a lump. These sarcomas often do not cause pain or swelling, so it is important to have a doctor examine any lump that lasts a long time.

Diagnosis and Treatment

Your doctor can detect the presence of a soft tissue sarcoma in the following ways:

  • History and physical examination: This includes palpating (feeling) the tumor mass. as well as gathering information about family medical history.
  • Imaging tests help to determine a tumor's size, shape, location and whether a tumor is benign or malignant. Imaging tests include X-rays, CT and PET scans, and MRI

After examining the results of one or more of these tests, your doctor will tell you if you have a bone sarcoma and will always answer any questions you have. MedStar Health also has compassionate patient support services for newly diagnosed patients.

Our Location

Orthopaedic Cancer at MedStar Franklin Square Medical Center
The Harry and Jeanette Weinberg Cancer Institute
The National Center for Bone and Soft Tissue Tumors
9103 Franklin Square Drive
Suite 2200
Baltimore, MD 21237



Throughout our lives, bone is continually absorbed and removed while new bone is rebuilt. Before age 30, bone strength remains stable as bone loss is equivalent to bone growth.

After age 30, especially in women during and after menopause, bones change dramatically—the pace of bone absorption and removal becomes faster than the rate at which bone is restored. This pattern of rapid bone loss is known as osteoporosis. If bone loss continues, bones become weak and can easily fracture. Significant bone deficiency also can lead to loss of height.

Taking steps to preserve stable bones is important, particularly as we age and begin to lose strength. It is important to be aware of any risk factors for osteoporosis that apply to you, including

  • Sex: females are at greater risk for the disease than males
  • Family history: if you have relatives with the disease, your risk increases
  • Race: Caucasian and Asian women have a greater chance of developing the condition than other ethnicities
  • A low-calcium diet
  • A small, thin frame/body weight less than 127 lbs.
  • Advanced age
  • Alcohol and tobacco use
  • Certain medications, such as steroids or anticonvulsants
  • Early menopause
  • Eating disorders
  • History of bone fracture/recurrent falls
  • Lack of exercise
  • Poor health/fragility
  • Loss of height
  • Women who have had ovaries removed

Though you may not be able to change such risk factors, you can many steps to lower your chances of developing osteoporosis, including

  • Eat a balanced diet rich in calcium and vitamin D. (Try yogurt with a glass of calcium-fortified orange juice for breakfast. Choose dark green, leafy vegetables to have with dinner.) The recommended daily intake of vitamin D is between 400 and 800 international units. How much calcium you need depends on your age:
    • For girls ages 9 to 18: 1,300 mg a day
    • For women ages 19 to 50: 1,000 mg a day
    • For women 51 and older: 1,200 to 1,500 mg a day
  • Get regular exercise
  • Eliminate smoking
  • Limit alcohol consumption
  • Get regular check-ups and have a bone density test if you are at risk.

Diagnosis with DEXAscan Technology

Although bone loss is a natural part of aging, you can take steps to ensure that bones remain healthy and strong. Unlike the past, you don't have to wait until you suffer a debilitating fracture before identifying and treating the problem. Now, there's a quick, noninvasive procedure to measure bone density and detect bone loss early.

To evaluate the bone health of patients, our rheumatologists perform bone densitometry with an advanced technology called DEXA (Dual Energy X-Ray Absorptiometry). This painless machine safely, accurately and painlessly measures bone density and the mineral content of bone, while the patient lies still on a padded table for about 20 minutes. The results of the test are used to determine if you need medication to maintain bone mass and reduce bone loss and fracture risk. With this technology, our doctors can recognize even the earliest signs of bone loss or osteoporosis.

Learn more about DEXAscan.


We recommend a combination of vitamin supplements and careful monitoring to manage the vitamin D deficiency that causes osteomalacia. Vitamin supplements include calcium, vitamin D, and phosphorus. We also monitor the levels of phosphorus and calcium in your blood through regular blood work.


We recommend a combination of nutritional changes and increased calcium to treat rickets—a softening and weakening of the bones—and prevent it from returning.

Rickets symptoms generally disappear once we replace the calcium, phosphorus, or vitamin D that you are missing. Our specialists will work with you and a nutritionist to make sure you eat foods rich in vitamin D.

Call Us Today

For more information or to schedule an appointment with a physician, please call our scheduling line:

877-34ORTHO (67846)


Orthopaedic Trauma


MedStar Orthopaedic Institute offers a coordinated referral service for the treatment of musculoskeletal trauma. These types of complex trauma injuries cases and their complications call for specialized, centralized care.

 MedStar Orthopaedic Institute’s multidisciplinary approach combines orthopedic surgery, plastic surgery, interventional radiology, infectious disease and wound care services into an integrated team to deliver the extensive care required for the most challenging musculoskeletal trauma cases. This type of coordinated care is proven to improve outcomes and speed recovery.

 Acute Trauma

Acute trauma is damage done to the bones, muscles, tendons and ligaments after an injury. These types of injuries may include:

  • Extremity fractures
  • Pelvic fracture
  • Traumatic amputation
  • Leg fractures 

When assessing these types of conditions, our orthopedic specialists will evaluate the patient, and make a decision for the most appropriate treatment. Depending on the severity of the trauma, surgery may be necessary to repair and stabilize the injury. In the cases of more mild injuries, your doctor may recommend splinting, rest and treating the pain.

It is important to have your injuries assessed by an orthopedic specialist with the expertise to decide on the best approach to treatment, but it is critical to have your care managed in a facility that has the full range of orthopedic services. Our orthopedic nurses routinely care for patients post-surgery, and we offer the full range of physical therapy and rehabilitative services.

Post-traumatic Reconstruction

Post-traumatic reconstruction corrects problems such as malunions (bones that have healed incorrectly) and nonunions (fractures that have not healed). Revision surgery (a second surgery to correct complications that may have occurred following the first surgery) is something that no patient wants, but is sometimes necessary.

The surgeons at MedStar Orthopaedic Institute have routine experience with these types of surgeries following referrals from other orthopedic surgeons throughout the region. As experts in post-traumatic reconstruction, your surgeons will listen to your medical history, carefully assess the injury and examine your past medical records. They will be able to recommend a reasonable approach that may treat the original injury, as well as any complications that have arisen since then.

Infected Joints

If a joint becomes infected, both the health of the joint and limb, as well as the overall health of the patient, become an immediate concern. Not all orthopedic specialists are trained to manage and treat infected total joints. At MedStar Orthopaedic Institute, our orthopedic surgeons appropriately manage and aggressively treat infections. This often times requires additional surgery and a course of antibiotics. While this is unfortunate, it is critical for removing bacteria from your system and maximizing your overall health and outcome. Learn more about bone infection, also known as osteomyelitis.


  • Fracture stabilization
  • Debridement
  • Soft-tissue reconstruction
  • Freely vascularized soft and hard tissue grafting
  • Microsurgery
  • Bone transport, autograft and allograft techniques
  • Deformity correction
  • Fusion of joints (Arthrodesis)
  • Complex arthrodesis after joint infection
  • Bone grafting
  • Removal/eradication of infection for total joint arthroplasty
  • Localized and systemic antibiotic delivery

Meet Our Surgeon

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Robert Brumback, MD

Team of multidisciplinary specialists:

  • Orthopaedic surgeons
  • Infectious disease specialists
  • Plastic surgeons
  • Interventional radiologists
  • General surgeons
  • Wound care specialists

Pediatric Orthopaedics

pediatric orthopaedic surgery

Pediatric orthopaedics is a subspecialty of orthopaedics that focuses on the musculoskeletal problems common to children and adolescents. Children are not merely, as the saying goes, small adults—many basic differences exist between the orthopaedic problems frequently seen in adults and those prevalent in children and adolescents.

The most unique characteristic of this age group is that they are actively growing; when physicians deal with pediatric musculoskeletal problems, they must consider the effect further growth will have on any treatments and on the anticipated outcomes.

In recognizing and emphasizing such differences, this subspecialty has opened the door to more careful study of both common and rare afflictions of the musculoskeletal system, which has led upgraded treatment protocols and improved prognoses for many abnormalities.


The pediatric and orthopaedic surgeons at MedStar Health specialize in a wide range of diseases and abnormalities in children and adolescents, including:

  • Routine pediatric orthopaedic injuries and conditions
  • Hip dysplasia
  • Clubfoot
  • In-toeing and out-toeing
  • Flatfeet
  • Bowlegs
  • Knock-knees
  • Perthes disease
  • Slipped epiphysis
  • Fractures
  • Sports injuries
  • Neuromuscular conditions with spasticity
  • Cerebral palsy
  • Stroke
  • Traumatic brain injuries
  • Limb lengthening
  • Deformity
  • Scoliosis


A clubfoot is a foot that is deformed at birth, pointing downward and inward as well as rotated. There are four different types of clubfeet: positional, teratologic, syndromic, and congenital. A positional clubfoot is a normal foot that was held in an abnormal position in the uterus. The bony alignment is normal and the foot is usually corrected by stretching or a short course of casting. A teratologic clubfoot is associated with neurologic disorders such as spina bifida. A syndromic clubfoot is associated with an overall genetic syndrome such as arthrogryposis. Both teratologic and sydromic clubfeet almost always require surgery as definitive treatment, although casting does help stretch the soft tissues in preparation for surgery. A congenital clubfoot is a foot with abnormal bony deformity present at birth but not associated with any neuromuscular cause or syndrome. The remainder of this discussion will focus on congenital clubfeet.

In an infant, clubfoot itself is not painful. The bones are abnormally shaped and the tendons, muscles, and ligaments are tight. The foot and calf are usually smaller than normal, and the muscles may be weaker and the nerves may be abnormal. Often the blood supply is abnormal as well. Due to differences in clubfoot, treatments and outcomes may vary. If untreated, the deformity does not improve on its own. Rather, the deformity worsens, and if left uncorrected, will become unsightly and crippling, leading to children walking on the top rather than the bottom of their foot. This eventually creates skin breakdown, ulceration, and infection, and can ultimately lead to an amputation in the most severe untreated cases.

Treatment begins as soon as possible after birth. This usually involves manipulation of the foot into the best possible position and holding it with a long leg casting. However, different physicians may use other treatments such as physical therapy, splints, taping, and short leg casts.

No matter what the treatment, the goal is to create a foot with the sole on the ground, which is flexible and pain free. Most children with corrected clubfeet will be able to participate in most aspects of childhood with little or no difficulty and do well into their adult years. Even after growth is complete, the patient with a clubfoot will need to be followed into their adult years to ensure a well functioning foot.


Fractures in children differ significantly from fractures in adults.

For instance, covering the surface of all bones is a membrane called the periosteum; a child's periosteum is thicker than an adult periosteum and contains active, bone-making cells with a very rich blood supply. Therefore, children's fractures heal much more rapidly than adult fractures.

Children rarely need physical therapy after their fractures heal—once a child's fracture heals and any cast is removed, normal use of the extremity is all that is required to restore function. Additionally, joint stiffness in children is quite uncommon, whereas in adults it is of much greater concern.

However, pitfalls also exist in children's fractures. At the end of each long bone (for example, the bones in arms or legs), children have a soft cartilage growth plate. This growth plate is sensitive to trauma or injury. On occasion, it can close or partially close, which means it can stop growing, leaving a child with a shortened bone or, more commonly, an angular deformity of the arm or leg.

With very severe or unusual injures—such as fractures around the elbow, adjacent to joints, or in or near growth plates—surgery may be necessary to realign the fractured pieces of bone.

Leg Length Discrepancy

Leg length discrepancy, a difference between the lengths of the lower limbs, can occur in children for a number of reasons. A small leg length discrepancy (a quarter of an inch or less) is quite common in the general population and of no clinical significance. Larger leg length discrepancies, though, become more significant.

Frequently, the condition follows a fracture—broken bones in children sometimes grow faster for several years after healing (resulting in a longer leg). If the break occurs in the growth center near the end of the bone, however, it can cause slower growth (resulting in a shorter leg).

A congenital abnormality associated with a condition called hemihypertrophy (asymmetrical body growth) can also lead to leg length discrepancy. Or, it may result from neuromuscular diseases such as polio and cerebral palsy. Still, many times, no cause can be identified.

The long-term consequences of a leg length discrepancy may include knee pain, back pain, and abnormal gait or limp.

To evaluate the condition, Medstar Health specialists will take sequential x-rays to measure the exact discrepancy, while following its progression, and can establish a treatment plan once all the facts are known: the bone age (skeletal age and chronological age are not necessarily equal—frequently, a child's bone age will be significantly different), the exact amount of discrepancy, and the cause, if it can be identified.


Call Us Today

For more information or to schedule an appointment with an pediatric orthopaedic specialist, please call our scheduling line: