Frozen shoulder is such a painful condition that patients in the past have equated to being tormented by a medieval torture rack. Because it tends to arise, progress, and ultimately dissipate without any particular cause or warning, many patients find themselves mystified by the condition.

This article helps to demystify the various stages and remedies associated with frozen shoulder, covering everything from the freeze to the thaw. Although restricted movement and steroid injections remain common prescriptions, some cases will require more aggressive intervention:

In certain severe case a manipulation under general anaesthesia maybe necessary though stringent exercise following this is essential for a good outcome. Resistant case[s] may need an Arthroscopic Capsular release surgery. Open releases have become obsolete with the advent of Arthroscopic Surgeries (key hole surgeries) which are definitely less morbid and have a faster recovery period.

If you are dealing with the immobility and distress of frozen shoulder, please contact a San Diego orthopedic surgeon today.


Frequent readers know that I write often about the latest advances in stretching and exercise, especially if they have shown promise in helping patients avoid orthopedic surgery. Good warm-ups, smart stretches and better athletic form can often be just as effective as more aggressive surgical procedures.

Now a new article has highlighted an age-old technique for treating curvature of the spine, and it is reviving the debate over whether “bracing” is the best treatment for an S-shaped spine. Known as the Schroth Method, the original customized approach involves stretching and breathing, and extends into everyday life:

The therapy, tailored to each patient’s curves, focuses on halting curve progression, reducing pain, and improving posture, strength and lung function. The exercises include stretching, strengthening and breathing techniques that counteract the rotation of spinal curvatures. Patients are supposed to do them at home and incorporate postural corrections into their daily lives.

Now a randomized study has been performed comparing the Schroth Method to more conventional techniques, and the results were noteworthy:

At the University of Alberta in Canada, researchers recently completed a randomized pilot study of Schroth, financed in part by the research society. The six-month study showed that adolescents with scoliosis who did these exercises fared better than teenagers who didn’t with regard to curve progression, pain and self-image.

This is just one step toward a better way to contain the progressive effects of scoliosis, but it could represent greater changes to come. If you’d like to learn more about the latest news and advances in orthopedic surgery, contact my San Diego offices today.


The world of orthopedic surgery in Southern California is full of fascinating stories. Although the Southland is widely considered America’s cosmetic surgery capital, it isn’t widely known that the surgeons of San Diego and its neighbors also tend perform a number of other elective surgeries.

This news story caught the eye of many of you: a piece in the New York Times about a trend to improve the aesthetic and structural beauty of patients’ feet. One cannot make up some of the extraordinary branding terms that lard the article from top to bottom, including such gems as “toebesity” and “Cinderella procedure.” The purpose of these procedures is to fulfill a timeless desire; one doctor calls them:

“the final frontier” for those who have had work done on their faces. “My practice has exploded because of Manolo Blahnik, Christian Louboutin and Nicholas Kirkwood,” he said in a recent phone interview. “There’s nothing like opening a shoe closet that’s been closed to somebody for years.”

Suffice it to say, your foot is a complex mechanical structure that must bear and redirect hundreds of pounds every minute. Altering the basic geometry or stability of a foot to fit into a pair of shoes is a dangerous game. Far better to find ways you can achieve the look you want without altering an essentially functional body part.

As an orthopedic surgeon, I can say with confidence: Those feet were made for walking.


There was a time not too long ago when countless pitching careers were cut short by strain on the elbow ligaments. That was before Dr. Frank Jobe came up with a legendary innovation in orthopedic elbow surgery – a procedure known officially as ulnar collateral ligament reconstruction, and unofficially in clubhouses across the nation as Tommy John surgery.

Deceptively simple in its execution, the procedure, which involves relocation of a forearm tendon to the elbow, has undergone precious few changes since it was first performed on – you guessed it – Tommy John, formerly of the Dodgers. The pitcher’s transformation was swift and decisive.  Today the same technique is prescribed for thousands of athletes, including tennis players and javelin throwers, who undergo extreme  elbow strain on a daily basis.

It’s hard to argue with this watershed in prognosis:

In 1974, Jobe estimated that John’s chance of regaining his form was 1 in 100. Current studies suggest a rate of success, generally defined as an athlete’s reaching the same plane for at least one season, of more than 80 percent.

Dr. Jobe passed away recently, but his legacy lives on in the many active people who appreciate his work every day. As a specialist in orthopedic elbow surgery here in San Diego, I am indebted to Jobe for one of the most effective tools in my arsenal.


There is a growing momentum in sports medicine to encourage athletes and their coaches to warm up in more effective ways. Born partly out of the Santa Monica Sports Medicine Foundation’s PEP program, and spurred on by success stories such as this one, these new exercises are widely touted as simple and powerful, reducing knee surgery numbers by a substantial percentage:

These programs, formally known as neuromuscular training, use a series of exercises to teach athletes how to land, cut, shift directions, plant their legs, and otherwise move during play so that they are less likely to injure themselves. Studies have found that the programs can reduce the number of A.C.L. tears per season by 50 percent or more, particularly among girls, who tear their A.C.L.s at a higher rate than boys do (although, numerically, far more boys are affected).

The good news: these are easy-to-perform and familiar exercises which resemble the calisthenics we all learned growing up. Educating yourself or your local sports team is as simple as watching a few online videos. Yet the savings in medical care costs can be staggering, especially as you diminish the likelihood of ACL tears and their attendant recovery measures.

While a warm up run to get the juices flowing and proper stretching prior to the main work out helps to prevent muscle strains, neuromuscular training is an entirely different concept.  Neuromuscular training is really nothing more than a functional core workout.  Yup, that’s it!  What you do in martial arts, or yoga, or pilates….these strengthening activities helps the young female soccer athlete avoid that infamous ACL tear.  The muscles in the torso, abdominal wall, pelvis, and proximal thigh help the athlete to properly position the knee, which minimizes risk of ACL tear.  It has been proven!!!

For some mature athletes, in addition to neuromuscular training, further measures to maximize knee longevity and function include oral supplements (glucosamine, chondroitin, MSM), platelet rich plasma (PRP) or stem cell injections, and hyluronic acid (HA) injections.

I specialize in knee surgery and orthopedic surgery in San Diego, and encourage all my patients to take every precaution they can to stay active and nimble. Please call my offices today to learn more about how you can prevent knee surgery.


A provocative article in last week’s New York Times discusses the quiet epidemic of older people living with serious pain who fail to report it to their doctors. Whether it’s due to stoicism, resignation, or something else, the net effect can be devastating:

[S]tudies have found that elderly patients are less likely than younger adults to report pain to their doctors. Instead, many suffer in silence at considerable cost to the quality of their lives. . . .

Untreated or inadequately treated pain is disabling and can hasten the death of an older adult by interfering with the ability to exercise, eat properly or maintain social contacts. Persistent pain can lead to immobility, depression, sleep problems, loss of appetite and isolation, all of which may increase the need for expensive medical care.

The article addresses cases of shoulder pain, hip pain and knee pain. Each could have been addressed earlier with proper orthopedic care, especially in cases where arthritic pain has led to a vicious cycle of immobility and declining health.

Agonizing pain is not a natural byproduct of aging, and no one should accept its arrival as a sort of grim “new normal.” If you have chronic knee, shoulder, elbow or hip pain and desire expert orthopedic care in San Diego, please contact my offices.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow