Our Specialties.

Rapid Recovery for Joint Replacment

With MCO’s Rapid Recovery protocol, two thirds of patients are able to go home one
 day after joint replacement surgery. However, each patient recovers differently, and discharge planning is tailored to each patient’s specific health care needs. 

Rapid Recovery Goal
When it comes to treating pain, it is important to get ahead of the pain and stay ahead of the pain. Doing so gives the patient better, consistent pain control while reducing the amount of medication needed to control the pain.

Before Surgery
Before surgery, medications are given in the preoperative area to help reduce pain while the patient is in surgery. These medications allow for less intravenous therapy pain medications while under anesthesia.

During Surgery
In surgery, the surgeon and anesthesiologists use a combination of anesthetics and pain medication to keep you comfortable throughout the operation. The goal of these medications is to keep your pain manageable, yet allow you to wake up in the recovery room with less nausea and drowsiness.

After Surgery
In the recovery room, a nurse consistently assesses a patient’s pain. If pain is present, the nurse is able to use a variety of interventions to ease the pain. Our recovery team has also developed a protocol to expedite patients through this phase and get them to their hospital room faster. This allows the patient to be reunited with family and begin therapy. This recovery stay now averages about 40 minutes as compared to two to three hours in the past.

Rehabilitation
Physical therapy and occupational therapy is available to help patients get up and walking on the afternoon or evening of surgery and set a schedule for ongoing therapy the next day. The next day patients receive therapy in the morning and afternoon.

Discharge from Hospital
If the patient is safe, comfortable, confident, and medically stable, he or she could discharge home. Upon discharge, the patient will receive a visit from a community paramedic who comes to the patient home to ensure the patient is safe and has effectively transitioned back into their home setting.



Knee and Shoulder Arthroscopy

Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint. The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint."

 In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint. By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the knee. This lets the surgeon see the cartilage, ligaments, and the undersurface of the kneecap. The surgeon can determine the amount or type of injury and then repair or correct the problem, if it is necessary.



Hip and Knee Replacement

Total hip replacements are most often done to provide relief for severe arthritis, fractures, and some bone abnormalities. Patients who are candidates for total hip replacement surgery generally have:  severe pain that impedes work and everyday activities; pain that cannot be managed by anti-inflammatory medications, canes or walkers; or significant stiffness of the hip.

Total hip replacement surgery is a major surgery and there are some potential risks that should be discussed with your doctor. Some patients recover sooner than others depending on age, health status, and response to rehabilitation. The average time for full recovery is about six to 12 weeks and varies with each patient. Physical therapy begins while the patient is still in the hospital and continues either at home or in a specifically designated rehabilitation unit. For a hip replacement, the patient has some therapy in the hospital but none for six weeks at home. However, at the six-week clinic visit, if the patient requires therapy, it is initiated then.

Total Hip Replacement
Hip replacement consists of the replacement of the femoral (thigh bone) head and the acetabulum, or socket of the pelvis.  In order for the surgeon to do this, five components are implanted where the arthritic bone once was.

Acetabulum (hip socket): 

  • After removal of the arthritic femoral head, the surgeon shaves away arthritis present in the socket. They then press-fit a cup into the pelvis.  A screw may be placed based on stability of the cup.
  • A high-grade polyethylene liner is then placed into the cup to allow for smooth movement between the cup and the femoral head.

Femur (thigh bone):

  • The femur is then prepared to receive a stem. This stem will hold the femoral head in place and is placed in the bone space down the femur.
  • A neck is placed on the end of this stem to accept the new femoral head.


Knee Replacement
Knee replacement surgery works best for patients with severe arthritis throughout the knee. This is seen most often in older adults, but can also occur in younger patients due to a significant injury or infection. When arthritis knee pain severely limits the ability to walk, work or perform the simplest of tasks, knee replacement should be considered.

Keeping your weight down is good for your knee and your overall health. Patients should make an effort to begin a preoperative program of exercise. Simple isometrics (muscle tensing exercises) help strengthen your leg muscles in preparation for postoperative walking.

Knee replacement can correct the knee problem, but muscles remain weak and will only be strengthened through regular exercises. Knee replacement surgery patients require physical therapy to regain range of motion and strengthen muscles. This therapy begins in the hospital with a physical therapist and continues thereafter.

Due to advancements in pain management, the surgical team is able to keep patients very comfortable after surgery. While there is pain associated with this procedure, it can be controlled and is only temporary.

Total Knee Replacement
For a total knee replacement, there are three components that will likely be replaced.  These include the head of the femur (thigh bone), surface of the tibia (shin bone), and the underside of the patella (knee cap).

Femur (thigh bone):

  • The osteoarthritis that was present on the surface of the bone is removed and the bone is shaped to accept a new component. This component is cemented to the existing bone at the end of the thigh bone.

Tibia (shin bone): 

  • Like the femur, the tibia is cut, removing any arthritis present on the surface or sides. A component is then cemented down onto this bone.

Patella (knee cap):

  • On the undersurface of the knee cap arthritis may be present. If so, this arthritis is shaved off and a new surface is cemented in allowing for movement along the surface of the femoral component.

Liner:

  • A high-grade polyethylene liner is placed between the femoral and tibial components to provide articulation and stability of the new joint.


Shoulder Replacement

Physical therapy is very important in the months following surgery. Physical therapy improves the motion of the shoulder as it heals. Many surgeons do not start therapy for six to eight weeks depending on soft tissue repairs during the joint replacement surgery.

Total Shoulder Replacement (Traditional or Reverse)

A total shoulder consists of the replacement of the head of the humerus (upper-arm bone) and the surface that it moves with, known as the glenoid process.    

Traditional (above):  In the traditional shoulder replacement, the prosthetic humeral head is at the end of the humeral stem.    


Reverse (above):  In the reverse method, the ball of the joint is attached to the scapula and the socket is at the end of the humerus.



Sports Medicine

Common sports injuries include sprains and strains, knee injuries, swollen muscles, Achilles tendon injuries , pain along the shin bone, rotator cuff injuries, fractures , and dislocations. Treatment can range from immobilization, pain relief medication, or physical therapy to surgery. 

With fellowship training in sports medicine and orthopaedic surgery, Dr. Jon Herseth treats a wide range of sports-related injuries and conditions. He is experienced in performing shoulder and knee arthroscopic surgery, two of the most common surgical procedures for sports injuries.



Carpal Tunnel Syndrome

Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure on the median nerve in your wrist. The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel . The median nerve controls movement and feeling  in your thumb and first three fingers (not your little finger). Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller.

Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. A different nerve gives feeling to the little finger. You may first notice symptoms at night. You may be able to get relief by shaking your hand.

Your provider will ask if you have any health problems—such as arthritis, hypothyroidism, or diabetes—or if you are pregnant. He or she will ask if you recently hurt your wrist, arm, or neck. Your provider will want to know about your daily routine and any recent activities that could have hurt your wrist. During the exam, your provider will check the feeling, strength, and appearance of your neck, shoulders, arms, wrists, and hands. Your doctor may suggest tests, such as blood tests or nerve tests.

The goal of treatment for carpal tunnel syndrome is to allow you to return to your normal function and activities and to prevent nerve damage and loss of muscle strength in your fingers and hand.

Treatment options include:



Wrist and Hand Injuries


Injury or diseases affecting the hand and wrist are delicate and sensitive to repair. Filled with tiny blood vessels and a network of carefully woven nerves, these tiny spaces require the skilled touch of a professional. Your hands are your lifeline—from threading a needle, to throwing a ball or simply holding those you love, you count on your hands. At MCO, we have the only dedicated and experienced specialist in the Brainerd Lakes Area. Our hand specialist has additional, specialized training in the treatment of hand problems beyond training in orthopaedic surgery. She is a member of the American Society for Surgery of the Hand which requires a full year of additional training along with the passage of a rigorous certifying examination. From large complex orthopedic surgeries to the intricate details of the hand and wrist, our team specializes in reconstruction and microsurgery surgical procedures that involve vessels so small we need special magnifying equipment just to see them. Don’t trust the details to just anyone. We welcome you to our practice for quality care and an outstanding patient experience.

Common problems treated include:
• Carpal tunnel syndrome
• Tennis elbow
• Hand and wrist pain
• Trauma
• Tendon and nerve lacerations
• Arthroscopy
• Reconstructive procedures
• Joint fusions
• Microsurgery
• Sports injuries of the hand and wrist
• Fractures of the hand, wrist and forearm
• Trigger finger
• Arthritis
• Nerve and tendon injuries
• Congenital limb differences

Not all problems treated by a hand specialist need surgery. The doctor often recommends non-surgical treatments such as medications, splints, therapy, or injections.

After your initial consultation with the doctor, you may be scheduled for therapy, further diagnostic testing or conservative treatment, e.g., splinting, injection, taping, casting or surgery. Therapy, diagnostic testing and conservative treatment can be schedule at either of our locations.

You may need occupational hand therapy for a variety of reasons. This could mean a one-time visit or a series of treatments over multiple weeks. Frequently, the physician will request an initial evaluation to test your strength, range of motion, dexterity and sensation. Therapy may be ordered before or after surgery for strengthening, desensitization, exercise, active and passive range of motion and other techniques used to facilitate healing.



Hand Therapy


If you have pain in your fingers, hand, wrist or arm, or if you have other upper-extremity related concerns, you may want to consult a hand specialist. At MCO, we are committed to making our patients’ visits and care a positive experience and to render care that maximizes hand function as quickly as possible.



Fracture Care

A fracture is a broken bone.  The severity of a fracture usually depends on the force that caused the break. If the bone's breaking point has been exceeded only slightly, then the bone may crack rather than break all the way through. If the force is extreme, such as in an automobile crash or a gunshot, the bone may shatter.

Many fractures are very painful and may prevent you from moving the injured area. Other common symptoms include: swelling and tenderness around the injury, bruising, or deformity — a limb may look "out of place" or a part of the bone may puncture through the skin.

Surgery is sometimes required to treat a fracture. The type of treatment required depends on the severity of the break, whether it is "open" or "closed," and the specific bone involved. Doctors use a variety of treatments to treat fractures: cast immobilization, functional cast or brace, traction, external fixation, and open reduction and internal fixation.

Fractures typically take six to eight weeks to heal, depending on the extent of the injury and how well you follow your doctor's advice. X-rays taken throughout the healing process can demonstrate the extent of bone healing. Pain usually stops long before the fracture is solid enough to handle the stresses of normal activity. Even after your cast or brace is removed, you may need to continue limiting your movement until the bone is solid enough for normal activity. Sometimes, in order to increase the strength of the limb affected, exercises might be prescribed to help you restore normal muscle strength, joint motion, and flexibility.



Total Joint Coordinator


Before surgery and after surgery, the total joint coordinator is available to answer any questions or concerns that may arise. He can be reached by cell phone at 218-546-3484 during normal business hours.  If needed, total joint patients can be seen in the clinic if there are any concerns to reassure the patient in his or her recovery.