Consultant Orthopaedic Surgeon, Dr. Alf Neuhaus, is experienced in the treatment of the ‘usual’ bone and joint pathologies, from neck and back pain, to joint problems and soft tissue (muscles, tendons, ligaments) diseases.
Treatment can be performed conservatively in our clinic, or surgically either under local anaesthetic in the clinic or under general / epidural anesthetic in a nearby private hospital. In particular the treatment of arthritis – osteoarthritis, rheumatoid arthritis, Gout - and hand surgery problems are one of his main specialties.
Neck- Back Pain
Twisting your back, pinching a nerve, back ache due to over use or bad posture, neck stiffness and headaches are only some of the problems treated by Dr. Alf Neuhaus. Taking all the time needed to get through the relevant medical history and performing a thorough clinical exploration are the key factors to establish a possible diagnosis. Radiographic and ultrasound images are often used to confirm this diagnosis and/ or to exclude other possible reasons for the pains. In most cases the appropriate treatment cold be initiated immediately, which could be anti- inflammatory medication in form of tablets or direct infiltration of the inflamed nerve with Cortisone, in some occasions even using epidural injections. Physiotherapy, osteopathic mobilisations, massage techniques and acupuncture are frequently added.
Surgical procedures like nerve decompression or removal of a herniated disc are rarely needed, but would be performed by Dr. Alf Neuhaus in a nearby private hospital.
The degeneration of a joint – arthritis – is part of the aging process and can, if left unattended, result in a completely worn out joint, leaving surgical replacement or fusion of the effected joint as the only treatment option. But if treated in the beginning or only moderate stage of arthritic changes, several approaches can help to reduce the pain and increase mobility. Special exercise program, developed and supervised by a physiotherapist, lymph drainage to reduce swelling, homeopathic medication either as tablets to help against the ache, or as injection into the joint – Hyaluronic Acid; comparable with ‘WD40’ for the joints – are often and very successfully used. In some cases it might be necessary to support the treatment with so called none- steroidal anti- inflammatory medication or even direct injections into the joint with Cortisone. Whenever needed these injections would be done guided by either radiological or ultrasound images.
If the conservative treatment seems un-effectual a surgical procedure might be indicated, which could be arthroscopic clean out, partial or even total joint replacement of the joint. The appropriate procedure would be discussed with the patient and performed in a nearby private hospital.
Read a recent article about Arthritis by Dr. Alf Neuhaus in our Health News section
One in two women over 60 will, statistically, suffer from osteoporosis, and 1 in 5 will sustain a bone fracture due to this disease. It silently makes the bone structure thinner, become fragile and eventually give way without any adequate trauma (sneezing, coughing, etc.). The only way to detect osteoporosis is performing a bone density measurement – available at Clinica SANDALF – and start treatment accordingly. If treated in time the disasters outcome of osteoporosis can be prevented. The bone most often effected are the spinal vertebras, and the result could be the unpredictable and complete collapse of one or even more of them. In most cases proper pain killing medication and very gentle exercises and mobilisation can keep those patients going. But in some cases it might be necessary to perform a special type of surgery (Cyphoplastic), in which the collapsed vertebra would be filled up with and stabilized with a special bone cement.
Rheuma – Gout
Rheumatoid Arthritis (‘Rheuma’) and Gout are two of the most common diseases that affect joints in general and can, if untreated, lead to their complete destruction. Both diseases are hereditary, ‘rheuma’ effecting both men and women almost equally, meanwhile gout statically is found 5 times more often in men than in women over the age of 50. Many external factors like smoking, alcohol consume, diet, life style and lag of exercises play an important role in how severe the disease might turn out and unfortunately being a genetic problem they cannot be cured. But modern medicine has found ways to control them and make life with them much more enjoyable. The different treatment options would be discussed with you, a long term treatment schedule will be developed and frequent check- ups and tests would confirm the success of the treatment or indicate the need to readjust it. Special physiotherapeutic exercises, massage and osteopathic mobilization techniques might be used to mobilise those joints, and other cooperating medical specialist would be consulted to elaborate the best treatment options.
Key Hole Surgery / Arthroscopy
Arthroscopy – key hole surgery – is a surgical procedure that has developed rapidly in the last 20 years or so, allowing the surgeon to look inside a joint (usually knee, hip, ankle, shoulder, elbow) using a probe attached to a camera/ screen. Most of the arthroscopies can be done as day case surgery, meaning that you would be admitted to the hospital in the morning and be ‘back on your sofa’ in the evening. The most often performed arthroscopic procedure is done on the knee to repair meniscal defects, remove cartilage damage or wash the joint out. Similar procedures are performed at other major joints like the hip, ankle or shoulder. The obvious advantage is that the joint is cleaned from any damaged parts, the patient would go home the same day and be able to use the operated joint fully weight bearing. The results of the surgery, usually recorded on a DvD, will be discussed with the patient during the post- operative consultations in our out- patient clinic and further treatment consequences planed and initiated.
Joint replacement is a major orthopaedic surgical procedure and therefor usually ‘the end of the line’ of treatment. Sometimes, when all other treatment options like standard medication, physiotherapy, special massage techniques and alternative approaches like Yoga don’t deal with the pain caused by the worn out joint, or the pain simply gets unbearable, the only solution might be the replacement of the arthritic joint with an artificial one. The by far most often replaced joints are the knee and hip, followed by shoulder and ankle.
Back – Spine – Surgery
The outcome of spinal surgery, at the neck or the back, has improved significantly in the last 20 years or so, due to more sophisticated imaging devices (MRI scans), new surgical techniques and better surgical equipment. The pre- operative planning has also improved, allowing to identify those patients that really would benefit from a surgical procedure. The most often performed surgical procedure at the spine is a so called decompression, meaning taking away structures that might ‘press’ on the nerve responsible for the pain. In rare occasions it might be necessary to even fuse a small part of the spine.
Spinal surgery should only performed if all other treatment options – physiotherapy, medication, infiltrations including epidural, massage techniques, osteopathic treatments - have failed to improve the symptoms. The exception could be fractures of a vertebra, due to osteoporosis or trauma, in which case an immediate surgical procedure might be indicated to stabilise the broken vertebra. The surgery would be performed under general anaesthetics, and hospital stay would be 2-3 days. You might have to wear a protective lumbar corset for 3-4 weeks, but would be allowed to mobilise full weight bearing from day one on. The post- operative rehabilitation and wound care would be done in the facilities of Clinica SANDALF following discharge from the hospital. Total recovery, including initiation of gentle sports like swimming, stationary bike or golf, would be achieved by 10-12 weeks after the surgery.
Carpal tunnel syndrome and ‘trigger finger/ thumb’ are two very well-known and frequent medical conditions of the hand. The first one causing numbness and pain in some of the fingers, the later one making a finger get stuck in flexion when trying to open the fist. In the early stages of a carpal tunnel, when there is no pain yet and the numbness only appears in certain positions of the hand or at night, treatment could be initiated with a night splint for the wrist and an injection with local anaesthetics and Cortisone into the effected carpal tunnel. In case of a ‘trigger finger’ injections are not recommended as they are not only very uncomfortable but also baring the risk of damaging the tendon. ‘Trigger finger’ and the advanced stage of carpal tunnel are treated surgically under local anaesthetics. Dr. Alf Neuhaus is performing these procedures in the small operating room available in Clinica SANDALF, no hospital stay is needed and the patient would be back home within a couple of hours. The symptoms are usually gone immediately after the surgery, the hand can be used almost normal and stitches would be removed after 10-12 days.
More complicate conditions like Dupuytren’s disease or severe arthritis of finger joints, would be operated by Dr. Alf Neuhaus, who had been trained in hand surgery, in a nearby private hospital, and would include a 1-2 days hospital stay. All the follow up consultations for wound care, suture removal and hand therapy would be done in the facilities of Clinica SANDALF.
Some ‘minor’ conditions like ingrown toe nail or hammer/ claw toe can be very uncomfortable, but can be dealt with by a small surgical procedure done under local anaesthetics. Dr. Alf Neuhaus would use the small operating room available in CLinica SANDALF and the patient would walk out within a couple of hours, although obviously not able to drive a car. All follow up consultations regarding wound care and suture removal would be done in Clinica SANDALF, and the patient would be ‘back to normal’, including sport activities, within 2-3 weeks. Other medical conditions like the tarsal tunnel syndrome or Morton’s neuroma, both involving nerve inflammations, can often be treated conservatively with anti- inflammatory medications, or direct infiltration with Cortisone, temporary splinting or insoles, special massage techniques and physiotherapeutic gait education. Should these pathologies need surgical attentions, the procedure would be performed by Dr. Alf Neuhaus in a nearby private hospital, as a day case or including 1-2 days hospital stay.
Hallux valgus is another very common problem of the foot, with the big toe ‘moving’ towards the other toes, sometimes even crossing over the next one. A surgical re- alignment, involving a bone procedure for re- positioning and re- alignment, is usually needed. The foot will be immobilised in a special boot for 6 weeks, allowing partial weight bearing for the first three weeks, and fully weight bearing for the following three weeks. Total hospital stay should not be longer then 2 days. Returning to normal gait immediately following removal of the Aircast boot, including none- running sports like walking or playing golf.