If you are trying to lose weight, this most often means eating fewer calories and avoiding some foods. A weight-loss diet needs to provide adequate nutrition and a good variety of satisfying foods as well as a reduction in calories.
Primary Care
There are a couple of reasons you may have a higher out of pocket cost. We are a Specialist Office, which means some insurance policies charge a higher co-pay for a Specialist than they charge for your Primary Care Physician. Another reason could be that we are out of network with your insurance. There is a difference between accepting your insurance and being a contracted provider on your insurance. You can check with your Insurance Company to see if we are a contracted provider. If you have out-of-network benefits you may be able to see us, but your out-of-pocket costs may be higher. If you do not have out-of-network benefits your insurance may deny payment and you will be responsible for the costs. It is important that you understand your insurance benefits.
Smoking Cessation
Emergency Care
Follow-up appointments usually require much less time than first appointments. Their purpose is to evaluate results of treatment or occasionally, to review results of tests or studies obtained. The patient should try to return at the interval previously specified by the physician unless there is a significant change or problem that warrants an earlier review. If there is an emergency or a rapidly worsening problem do not wait for an appointment. Go to an emergency room for evaluation.
As an important joint in many sports requiring the upper extremity, like gymnastics, throwing sports and basketball, the elbow is occasionally injured to the point of damage to its ligaments or cartilage. Ligaments can be injured either from a one time strain or twisting injury or from repetitive activities that cause cumulative injury. Instability can then lead to abnormal function of the elbow and resultant pain with use. Secondary cartilage injury from instability or primary injury from a direct blow or twisting injury can result in loose cartilage or combination cartilage and bone pieces that make the joint motion painful or untrustworthy. Patients often describe minimal pain when the joint is not moving or at rest but problems when they are participating in sports or activities that require use of the elbow such as throwing, lifting or pushing. The discomfort can be intermittent and can result in performance decrease and difficulty with certain aspects of the required elbow us in sports and other daily activities. Treatment revolves around first making a correct diagnosis as the cause or etiology of the problem. This requires a physical exam, x-ray and or MRI studies, and occasionally arthroscopic exam. Once the correct diagnosis is affirmed, treatment can be as simple as muscle strengthening and balancing exercises or if warranted, arthroscopic debridement and/or ligament repair.
Radiology
Welcome to the Knee and Shoulder Institute, the practice of Steven C. Thomas, MD, Gregory T. Bigler, MD, Donald W. Pennigton, DO and Justin B. Limtong, DO. Our board certified surgeons, Dr. Thomas, Dr. Bigler, Dr. Pennington, Dr. Limtong and their staff look forward to providing you with state of the art orthopaedic care. At the Thomas and Mack Medical Plaza you will find an integration of clinical orthopaedics, physical therapy, outpatient arthroscopy and surgery center, and radiology/lab services all organized to provide you with the pinnacle of diagnosis and treatment facilities.
Away from the operating room he really enjoys his family, mountain biking, off-roading and both restoring, modifying, and customizing cars. He also dabbles in bee-keeping. His desired super-power is time-travel. He and his wife, DeeAnna, have three sons and are enjoying their first grandson. After practicing for more than eighteen years in Corvallis Oregon, founding Samaritan Orthopedics and Sports Medicine, and serving for more than 15 years as the Chief of Orthopedic for Oregon State University (Go Beavs!), the Penningtons are making Las Vegas their new home. The move to Las Vegas puts them closer to aging parents, their kids and grandson. They are looking forward to new friendships, new adventures, and finding the beauty of the Las Vegas desert.
Arthroscopy
Arthroscopy is a surgical procedure used to diagnose and treat various problems inside joints. Through a small incision, the pencil-sized arthroscope is placed into the joint. Via a fiberoptic light source and small lens, a micro TV camera transmits the image to a monitor where it can be observed as well as recorded. Other instruments can be placed through another small incision to allow the performance of various surgical procedures. The arthroscope magnifies the structures within the joint giving an in-depth and detailed view of the joint and the pathology.
Joint Replacement
We are excited to announce that Thomas and Bigler Knee and Shoulder Institute has expanded our Institute with the addition of 2 additional fellowship trained Orthopedic Surgeons. Dr. Pennington specializes in general orthopedic surgery with special emphasis on sports related injuries of the knee and shoulder and Shoulder Joint Replacement surgery. Dr. Limtong treats all general orthopedic conditions and specifically specializes in Joint Replacement & Revision surgery of the Hip and Knee. This will increase our Doctors to 3 of the most highly trained and qualified orthopedic surgeons in our community. Call now for an appointment and be seen within 10 days.
Hand Surgery
Orthopedic Surgery
Dr. Justin Limtong is a fellowship trained Orthopedic Surgeon with a specialized focus on adult hip and knee reconstruction. His journey began with a Bachelor of Science in Biology from the University of Nevada, Las Vegas. He then earned his medical degree from Nova Southeastern University in Florida and went on to complete his residency from Broward Health Medical Center, a preeminent Level 1 trauma center located in the heart of Ft. Lauderdale, Florida. During his tenure here, he embraced the role of chief resident in Orthopedic Surgery, a responsibility that saw him fine-tune his surgical skills and amass comprehensive expertise spanning the spectrum of Orthopedic Surgery.
Arthroscopy
What are the possible complications and risks? Complications from arthroscopy are rare, and even the minor ones occur less than 5% of the time. The major ones are very rare. They include but are not limited to death, infection, bleeding, phlebitis, blood clots, damage to nerves or blood vessels, pain, failure of a tendon or ligament repair, failure to alleviate pain, and instrument breakage. In addition, there are risks posed by anesthesia. It is important to understand both the potential benefits as well as the potential risks of arthroscopy before making a decision for or against it. There are many precautions taken to avoid any complications, but despite this, arthroscopy, like any other surgical procedure, does have risks.
Knee Replacement
The bones of the knee joint like all other joints in the body are covered by hyaline cartilage. This is a remarkable substance which provides for a nearly frictionless surface for many decades. When the cartilage gets damaged, either by trauma, infection, or just long-term wear and tear, it results in osteoarthritis. There are other types of arthritis, but osteoarthritis is simply the result of the cartilage surface wearing out. Treatment for cartilage problems can include smoothing the cartilage surgically, creating new cartilage with stem cell techniques, or replacing the cartilage with metal and plastic (knee replacement procedures).
Dr. Thomas was born in 1955 in Salt Lake City, Utah. He was brought up in Las Vegas and graduated from Ed. W. Clark High School in 1973. He attended The University of Utah and completed his premedical studies Magna Cum Laude and as Valedictorian of the College in 1979. He completed medical school and research at Johns Hopkins in 1984. Five years of orthopaedic residency training were completed in Seattle, Washington at the University of Washington and affiliated hospitals. After completion of residency, he stayed on with Dr. Frederick Matsen to continue fellowship training in surgery of the shoulder and elbow and to complete his research in cruciate ligament reconstruction and sports injuries of the knee. After completing his additional training, a traveling fellowship in arthroscopic treatment of knee and shoulder injuries was completed. Training was received from Dr. Russell Warren, team physician for the New York Giants professional football team among other teams, at the Hospital for Special Surgery in New York City. Dr. Thomas then trained in southern California with Dr. Stephen Snyder who is considered one of the most advanced and innovative shoulder arthroscopists of our time. Dr. Thomas has numerous publications in the orthopaedic literature including co-authorship of several chapters in the major orthopaedic text books.
Physical Therapy
Elevation and ice packs will help decrease the pain and swelling for the first 24 hours after surgery. Physical therapy is usually started on the day after surgery and certainly within the first few days. A follow-up appointment with your physician will be made for approximately three weeks from the time of surgery. If there is a problem or a special concern prior to this that the therapist cannot resolve, the physician’s assistant should be contacted for an earlier appointment.
Tennis Elbow
The elbow is a relatively complex joint, comprised of the articulation of the distal humerus with the round radial head and the saddle shaped ulna bone. The most common complaint heard concerning the elbow is pain along the lateral or outer border of the elbow. It usually starts insidiously and is described as an aching or soreness, sometimes radiating down into the forearm a bit. Gripping things often makes it worse and it is usually not associated with any feelings of instability or abnormal motion. It can be tender or sensitive to the touch along the outer or lateral border of the distal humerus bone and occasionally responds somewhat to anti-inflammatory medicines like aspirin or ibuprofen. In some people it can be present for months and months and in others it seems so chronic that it will never go away. Though the common name for it is “tennis elbow”, most patients who get it are not tennis players. Treatment for it is first to understand the mechanics of the problem so that it can be protected in such a way to let the body try to heal itself. Physical therapy and certain medication routines can assist in this. In refractory or hard to heal cases injections are sometimes tried, however, these often help more with the symptoms than actually healing the problem. Surgery is always a last resort and fortunately is only necessary in a minority of cases.
Treatment for the more minor or moderate problems usually entails physical therapy exercises for motion and strength improvement as well as training to balance the muscle forces about the ankle. Medication can help reduce inflammation but will not correct the underlying problem. In refractory or more severe cases, arthroscopic surgery can treat damaged joint surfaces as well as assist or allow treatment of ligament laxity or insufficiency. In some cases, post-traumatic arthritis resulting from past ankle injuries can also be treated with arthroscopic techniques, though when severe, these types of injuries may require joint altering surgeries like fusions or joint replacement.