Congratulations to Dr. Samuel Harmsen for his recent publication!

Congratulations to Dr. Samuel Harmsen for his recent publication!
Title: Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up
Authors: Danielle Casagrande, Di Parks, Travis Torngren, Mark Schrumpf, Samuel Harmsen, Tom R. Norris, James D. Kelly
DOI: 10.1016/j.jse.2015.11.067. Published in July 2016

This publication evaluated the results of a short stem device for total shoulder arthroplasty which helps us to better understand the optimal implants styles to use in patients in order to get the most predictable result.


Humeral loosening is an uncommon etiology for revision shoulder arthroplasty. We aimed to evaluate the radiographic and clinical outcomes of a short-stem press-fit humeral component after primary total shoulder arthroplasty.


We reviewed our patient database, from January 2008 to December 2011, for primary total shoulder arthroplasties performed with a short-stem press-fit humeral component. Radiographs and clinical outcomes were evaluated in the immediate postoperative period and at the most recent follow-up, with at least 24 months of data for all patients.


There were 73 shoulders that met our inclusion criteria, but 4 underwent revision before 2 years’ follow-up. Only 1 of these 4 was revised for aseptic humeral loosening. Sixty-nine shoulders had at least 24 months of radiographic follow-up, and 62 had radiographic and clinical follow-up. Of the 69 shoulders, 5 underwent revision for humeral loosening: 1 for aseptic loosening and 4 for infection. Two other shoulders with humeral loosening were asymptomatic, and the patients refused revision surgery. The overall revision rate for humeral loosening was 8.2% (6 of 73 shoulders). Radiolucent zones of any size were seen in 71.0%, with 8.7% of these shoulders identified as having humeral stems at risk of future loosening. Significant improvements were made in most of the measured clinical outcomes.


A high percentage of radiolucency was seen around the short-stem press-fit humeral components evaluated in this study at short-term follow-up. The overall rates of loosening and revision for the humeral implant examined in this study are higher than those noted in other recent studies evaluating press-fit stems. The cause of radiolucency and humeral loosening for this implant is not fully understood.

To read the full publication click the provided link:

To learn more about Dr. Harmsen call 602-277-6211 or visit

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ACL GRAFTS: Gerald Yacobucci, M.D.

ACL GRAFTS: Gerald Yacobucci, M.D.

Surgery for the torn Anterior Cruciate Ligament (ACL) has a long history in the orthopedic sports medicine spotlight. We have gone through many phases in our understanding of the importance of the ACL in the active patient’s knee.

We learned early on that the torn ACL did not have the capacity to heal due to its poor blood supply and the hostile healing environment in the knee joint. Initially, we thought it was expendable and therefore could be left alone when torn. Those patients didn’t do well.

We then decided the torn ACL could be repaired…stitched together…most of them failed. Next we tried replacing it with artificial substitutes…gortex and carbon fiber grafts…those lasted a very short time before rupturing and were difficult to remove.

Finally, the biological graft (human tendon) was found to have all the necessary traits to replace the torn ACL and, if properly placed in the knee, could provide the function necessary to restore stability to the active patient’s knee.

Graft choices today involve either an autograft (the patient’s tendon, typically from the surgical leg) or an allograft (from a deceased human donor, cadaver tissue).

The most popular autograft is the Patellar Tendon (Middle One-third Bone-Tendon-Bone). This is the Gold Standard of grafts as it was the first to become popular and the only one to provide bone-to-bone healing at each end of the graft. One negative is patients often get patellar pain for a period of time after the surgery. The midline incision (scar) is sensitive to kneel on and the donor site weakens the patella (making a patella fracture very challenging to treat). This is the graft of choice for the large contact athlete (ie. football lineman) due to its predictable strength and stability characteristics.

Another good autograft is the Semitendinosis-Gracilis graft. Both are medial hamstrings which can be harvested through a small incision which is well away from the midline (better cosmesis and easy to kneel on). The hamstring muscles adapt very well and fill in the donor defect with strong collagen tissue…avoiding permanent muscle deficits. At one year follow-up, most studies show this graft achieves comparable strength to the Patellar Tendon Graft. This graft makes the most sense for an athlete under age 25 whose emphasis is on speed and agility (less patellar pain and patellar tendon pain).

Lastly, the Allograft…..tibialis anterior and middle third bone-patellar-bone being the most popular. These two are grouped together are far as strength and healing traits. Their main advantage is eliminating the pain, scarring and weakness that goes with autografts….making the recovery from ACL surgery easier. Two concerns arise with these grafts. Disease transmission is a theoretical concern and has been thoroughly addressed by the human tissue bank industry. Meticulous detail goes into the harvesting, testing and preservation of this tissue which currently is felt to carry with it a risk for disease transmission of less than one in one million. The second issue (borne out in several recent studies) is one of graft rupture (failure). This has been shown in several studies to be significantly higher in male patients under the age of 25.

I hope this brief overview of a very complex topic improves understanding for the patient and serves as a starting point for discussion between the patient and their surgeon regarding ACL graft choice.

If you are experiencing knee pain call one of our experts at TOCA by calling 602-277-6211 or visiting our website to learn more!

#Recovery #Results #Relief #DrYaco

TOCA Employee Sandra Vega

“One of our long time and beloved employees, Sandra Vega has passed away from a long term battle with Cancer. She was a fighter, a mother, a grandmother, a gracious friend and a dedicated TOCA employee.

Many of us had the pleasure of working with Sandra at TOCA for over 17 years. She started out as an operator and worked her way into the scheduling department and ultimately ended up heading the Industrial department. She worked tirelessly over the years and never let her sickness slow her down. It was rare that Sandra would miss a day of work even while going through treatment. Sandra helped to develop and maintain the high quality of the industrial department and her dedication and kindness will not be forgotten.

She was a joy to be around always laughing and being positive even in the face of her struggle. Sandra has left her imprint on the face of this company and within the hearts of the employees and peers she worked with.”

– Kyle Nelson TOCA CEO

National PA Week: October 6th – 12th, 2016

Happy National #PAweek! TOCA would like to thank our talented and dedicated team of Physician Assistants’ who work hard everyday to provide the most innovative and comprehensive orthopedic care to all of TOCA’s patients.
What is PA Week?
National PA Week takes place each year from Oct. 6–12 to celebrate the profession and its contributions to the nation’s health. Before it was a week-long event, National PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program. October 6 is also the birthday of the profession’s founder, Eugene A. Stead, Jr., MD.
America’s more than 108,500 certified PAs are a powerful force for better health for millions of patients across the country. Because of PAs, the healthcare system is stronger and more patients get access to high-quality, cost-effective care.
What is a PA?
A Physician Assistant (PA-C), is a healthcare professional who is trained to practice medicine as part of a team with physicians. Physician assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, prescribe medications, counsel on preventive health care and may assist in surgery.
The physician assistants at TOCA are concerned with preventing and treating human illness and injury by providing a broad range of health care services under the direction of the TOCA physicians.

The specialized Orthopedic Physicians at TOCA and our PAs are always here to help. To learn more call 602-277-6211 or visit our website at:

#Recovery #Results #Relief

Hand Fractures

Hand Fractures: Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.

Symptoms: (Signs and symptoms of a broken bone in the hand include) 
* Swelling
* Tenderness
* Deformity
* Inability to move the finger
* Shortened finger
* Finger crosses over its neighbor when making a partial fist
* Depressed knuckle (A depressed knuckle is often seen in a “boxer’s fracture.” This is a fracture of the fifth metacarpal, the long bone below the little finger.)

Diagnosis: A physical examination is done to check the position of the fingers and the condition of the skin. The examination may include some range of motion tests and an assessment of feeling in the fingers. This will ensure that there is no damage to the nerves. X-rays identify the location and extent of the fracture.

Nonsurgical Treatment: Most of the time, the bones can be realigned by manipulating them without surgery. A cast, splint or fracture-brace is applied to immobilize the bones and hold them in place. The cast will probably extend from the fingertips down past the wrist almost to the elbow. This ensures that the bones remain fixed in place.

A second set of X-rays will probably be needed about a week later. These X-rays are used to ensure that the bones have remained in the proper position.

The cast will be worn for three to six weeks. Gentle hand exercises can probably be started after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability to use the hand and fingers.

Surgical Treatment: Some hand fractures require surgery to stabilize and align the bones. These fractures usually break through the skin or result from a crushing accident. An Orthopedic Surgeon can implant wires, screws, or plates in the broken bone to hold the pieces of the fractured bone in place.

If the bone changes position while healing, the finger may lose some function. After the bone has healed, the surgeon may remove the implants or may leave them in place. The physician may want to examine the hand periodically to ensure that the joint doesn’t tighten (contract) during healing.

Joint stiffness may be experienced because of the long immobilization period. Exercises can help restore strength and range of motion. A physical therapist may be able to help with this.

If you are experiencing hand or wrist pain, the specialized Orthopedic Physicians at TOCA are here to help. To learn more call 602-277-6211 or visit our website at:

#Recovery #Results #Relief

Workers’ Compensation Injury

Workers’ Compensation Injury: Workers’ compensation is a form of employer insurance that’s meant to provide injured employees with an efficient and quick way to receive medical care for work-related injuries.

TOCA takes your comfort and time seriously. Whether your daily routine involves manual labor or you spend most of your time sitting a desk, we understand that pain is a very real issue in the working world, and we go out of our way to keep it from interfering with the job you love.

As such, TOCA would like to express our sincerest appreciation for the industrial communities that support our services. We understand that time is valuable and schedules are tight, so we’ve implemented a new system that helps you make appointments for industrial patients with the utmost ease. Our dedicated team of Industrial Support Specialists will be your primary contact for setting up industrial appointments with all of our physicians….this means you won’t have to juggle your calendar simply to book a consultation.

Just make one call to 602-512-8409, and our dedicated team of Industrial Support Specialists will help you with all the details of your care.

You can also read more at:

Heel Pain: Exercises to Help with Plantar Fasciitis!

Heel Pain: Exercises to Help with Plantar Fasciitis!
Walking, running, and jumping put a lot of pressure on the feet. Although the feet can take a lot of force, the pressure can take its toll and heel pain can develop. Heel pain can occur due to a few different reasons, but one of the most common causes is plantar fasciitis.
Causes of plantar fasciitis:
The plantar fascia is a ligament that runs under the soles of the feet. It connects the heel bones to the front of the feet. The plantar fascia also supports the arch. There are a few different causes of plantar fasciitis. The ligament can become inflamed due to repeated force from high-impact activities and sports that involve a lot of jumping. Wearing high heels may also place added stress on the fascia.
Having a job that requires a lot of standing or walking increases a person’s chances of developing the condition. People who are flat-footed may also be more likely to develop plantar fasciitis. Flat feet can cause an uneven distribution of weight when someone walks, which puts added stress and pressure on the fascia.
Exercises and plantar fasciitis:
Plantar fasciitis can disrupt workout routines. Continuing to do certain activities can make heel pain worse. But sitting idly by and not exercising is unhealthy.
It is possible to still work out when dealing with plantar fasciitis. The key is to avoid activities that place a lot of force on the heel.
People should consider doing activities that don’t usually involve impact to the heel, such as rowing, swimming, and lifting weights.
Stretches for plantar fasciitis:
According to the American Academy of Orthopaedic Surgeons, certain stretches may help reduce heel pain and prevent plantar fasciitis from reoccurring.
People who have plantar fasciitis pain in the morning may want to do the stretches as soon as they wake up.
* Sit in a cross-legged position at the end of the bed or a chair. Place the affected foot over the knee of the other leg. Grab the heel of the painful foot with one hand and the toes with the other hand. Gently pull up on the toes while at the same time pulling up on the heel. Bending the toes up stretches the fascia. Bending the ankle up stretches the Achilles tendon, which may help decrease pain. Hold the stretch for about 10 seconds. Relax the foot and repeat 10 to 20 times. If both feet are affected, repeat on the other foot.
* Sitting in a chair, hold the leg out straight and flex and extend at the ankle joint. This exercise stretches both the fascia and the calf muscle. Repeat 10 times on each foot.
* Place the hands on a wall, keep the back leg straight and the heel down. Pull the hips forward towards the wall until the stretch is felt in the back of the lower leg. Hold for 10 seconds and repeat several times. If the heel on the opposite leg hurts, repeat the stretch on that leg too.
Symptoms of plantar fasciitis:
The most common symptom of plantar fasciitis is pain in the heel. Some people also feel pain in the arch of the foot.
Usually, the pain starts off mild and is often felt first thing in the morning when stepping out of bed. Pain also tends to be felt after sitting for a long period. Although it can vary, discomfort often decreases after walking around for a while.
Some people also experience pain when climbing stairs. Participating in intense activity, such as running, may also cause pain.
The pain from plantar fasciitis can last a long time, and complications can develop. Scar tissue can form due to continued inflammation of the fascia. Once scar tissue forms, it’s harder to treat the condition and pain can persist.
Plantar fasciitis can also lead to pain elsewhere in the body. For example, when someone has heel pain, they may change the way they walk without realizing it. Knee, hip, and back problems can develop due to changing body movements.
Treatment options:
* Ice
* NSAIDs: Over-the-counter nonsteroidal anti-inflammatory drugs may also help reduce discomfort and inflammation.
* Orthotics: Foot orthotics are custom foot supports to place in the shoes.
* Splint: A splint worn at night may also be recommended.
* Switching activities
* Steroid injections: In cases where heel pain continues, anabolic steroids injections may be an option.
* Surgery: When all other treatments fail, surgery may be an option.
If you are experiencing foot, heel and/or ankle pain, the Physicians at TOCA are here to help! To learn more visit: or call 602-277-6211.
#Recovery #Results #Relief #heal

Which Helmet for Which Activity? It takes brains to be safe — Be smart and wear a helmet!

Which Helmet for Which Activity? It takes brains to be safe — Be smart and wear a helmet!
Why are helmets so important?
For many recreational activities, wearing a helmet can reduce the risk of a severe head injury and even save your life.
How does a helmet protect my head?
During a typical fall or collision, much of the impact energy is absorbed by the helmet, rather than your head and brain.
Does this mean that helmets prevent concussions?
No. No helmet design has been proven to prevent concussions. The materials that are used in most of today’s helmets are engineered to absorb the high impact energies that can produce skull fractures and severe brain injuries. However, these materials have not been proven to counteract the energies believed to cause concussions. Beware of claims that a particular helmet can reduce or prevent concussions.
To protect against concussion injury, play smart. Learn the signs and symptoms of a concussion so that after a fall or collision, you can recognize the symptoms, get proper treatment, and prevent additional injury.
Are all helmets the same?
No. There are different helmets for different activities. Each type of helmet is made to protect your head from the kind of impacts that typically are associated with a particular activity or sport. Be sure to wear a helmet that is appropriate for the particular activity you’re involved in.
The protection that the appropriate helmet can provide is dependent upon achieving a proper fit and wearing it correctly; for many activities, chin straps are specified in the standard, and they are essential for the helmet to function properly. For example, the bicycle standard requires that chin straps be strong enough to keep the helmet on the head and in the proper position during a fall or collision. Helmets that meet a particular standard will contain a special label or marking that indicates compliance with that standard (usually found on the liner inside of the helmet, on the exterior surface, or attached to the chin strap). Don’t rely solely on the helmet’s name or appearance, or claims made on the packaging, to determine whether the helmet meets the appropriate requirements for your activity.
Don’t add anything to the helmet, such as stickers, coverings, or other attachments that aren’t provided with the helmet, as such items can negatively affect the helmet’s performance.
Avoid novelty and toy helmets that are made only to look like the real thing; such helmets are not made to comply with any standard and can be expected to offer little or no protection.
How can I tell if my helmet fits properly?
A helmet should be both comfortable and snug. Be sure that the helmet is worn so that it is level on your head—not tilted back on the top of your head or pulled too low over your forehead. Once on your head, the helmet should not move in any direction, back-to-front or side-to-side. For helmets with a chin strap, be sure the chin strap is securely fastened so that the helmet doesn’t move or fall off during a fall or collision.
If you buy a helmet for a child, bring the child with you so that the helmet can be tested for a good fit. Carefully examine the helmet and the accompanying instructions and safety literature.
How long are helmets supposed to last?
Follow the guidance provided by the manufacturer. In the absence of such guidance, it may be prudent to replace your helmet within 5–10 years of purchase, a decision that can be based, at least in part, on how much the helmet was used, how it was cared for, and where it was stored. Cracks in the shell or liner, a loose shell, marks on the liner, fading of the shell, evidence of crushed foam in the liner, worn straps, and missing pads or other parts, are all reasons to replace a helmet. Regular replacement may minimize any reduced effectiveness that could result from degradation of materials over time, and allow you to take advantage of recent advances in helmet protection.

For more information visit: or call 602-277-6211!

#Recovery #Results #Relief



Shoulder Injury Prevention Tips

Shoulder Injury Prevention Tips: Overhand sports such as baseball, tennis, volleyball, swimming, and softball require a significant amount of shoulder use and it is important to keep in mind the best ways to maintain healthy shoulders.

  • Prior to activity, it is important to have enough time to warm up and cool down. Make sure that you get your heart rate up then stretch the major muscle groups, including your shoulders, back, and legs. Other ways to get your heart rate going is riding on an exercise bike and for the shoulders, arm circle exercises, alternating between small and large circles.
  • As you get older, it is important to have strong rotator cuff muscles. The main function of the rotator cuff is to rotate the shoulder and lift the arm both internally and externally. Overhand athletes use the rotator cuffs when in action and strength training is one of the best ways to ensure strong rotator cuffs. Also, elastic band exercises such as the T, Y, and I formations are proven to work well.
  • Between events, allow yourself appropriate time to recover. Whether you play tennis, volleyball, or softball, you should always find time to rest in between events.
  • Most importantly, listen to your body. If an area of your body starts to hurt during a workout, avoid the mentality of no pain, no gain and stop your workout. This mentality can lead to many problems such as soreness and injury. Painless clicking in the shoulders is not necessarily a cause for concern. However, it may very well be a sign from your body to allow yourself time to rest. And, if it becomes painful, the physicians at TOCA are here to help!

For more information visit: or call 602-277-6211!

#Recovery #Results #Relief



Congratulations to Dr. Lederman!

Congratulations to Dr. Lederman! His research on Reverse Shoulder Arthroplasty Titled: Finite Element Analysis of Glenoid-sided Lateralization in Reverse Shoulder Arthroplasty. Patrick Denard MD, Evan Lederman MD, Bradford Parsons MD and Anthony Romeo MD. has been accepted by the Journal of Orthopedic Research. This paper in collaboration with Shoulder specialists from Rush University in Chicago, Mount Sinai in New York and Oregon Health Sciences helps further understand complexities of reverse shoulder arthroplasty.

If you are experiencing shoulder pain the Physicians at TOCA are hear to help. To learn more visit our website at: or call 602-277-6211.
#Recovery. #Results. #Relief. #shoulderpain #shoulderinjury#orthopedics #injuryprevention