The POA Surgery Center

The new POA Surgery Center is a standalone surgical facility that provides patients with an exceptional surgical experience. Surgery can feel like a big deal. Because of that, our team designed a surgical fascility to help patients recover safely and comfortably, often going home the same day, with a hand-selected orthopedic team. It's the same equipment, treatments and care our surgeons would choose for their own families.

Our team made every decision about the Surgery Center with one question in mind: what is best for the patient?

Ultimately, it matters because our patients matter. With a surgery center, our team maintains control over your care. In a large hospital, orthopaedic patients share operating rooms, staff and schedules with every other specialty. At our center, every room, every team member and every piece of equipment exists for the types of surgery we perform daily.

"What we built with our new surgical center is a facility where we can provide optimal care under our control to our patients."

Why It Matters.

It was designed by our team to help patients avoid the common stress and hassle of surgery. They ge to recover where they are most comfortable: at home, cared for by people they know. Every decision about the center was made by your surgeons with care, convenience and recovery in mind.

Are you suffering from pain?

Please contact us! We'd love to help.

If you have pain, please contact us and schedule an appointment. We have urgent care facilities all over New Jersey for your convenience.

Schedule Exam

Urgent Care

This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.

Shoulder and upper arm pain: Why?

Pain that sits deep in the shoulder and runs down the outside of the upper arm is an incredibly common complaint at Princeton Orthopaedic Associates. That question leads to others: Is the neck the real source of the pain? What does a torn rotator cuff actually mean? Why does a stiff shoulder take so long to settle? Where does treatment start? How likely is a dislocated shoulder to come out again? And which warning signs need care right away?

You're in good company. Shoulder pain is one of the most common reasons people see a doctor for aches and pains. Not rare. And not something you have to live with.

Quick answers before the details

Start here: what your shoulder may be telling you

Could my shoulder pain actually be coming from my neck?

Yes, and it gets missed a lot. Nerves leave the neck and run through the shoulder into the hand, so a pinched nerve in the neck can make the outer shoulder and upper arm ache while the shoulder itself is healthy.

Pain that comes from the neck often changes when you move your neck, and it can bring tingling, numbness or weakness down the arm. Neck and shoulder problems also show up together, so we check both at the same visit.

My shoulder is getting stiff, not just sore. What is frozen shoulder?

Frozen shoulder is when the lining around the ball-and-socket joint becomes inflamed and tight. Reaching behind your back or turning the arm outward gets hard, and the stiffness shows up in every direction. It most often shows up in middle age.

It also tends to move through phases, which can help you know what to expect when progress feels slow. Most people get much better, but it can take a year or more, and some stiffness can linger, so we don't simply wait it out.

Every shoulder moves through these at its own pace. We'll help you with the pain and keep the shoulder moving along the way.

What does treatment usually start with?

Almost always with movement. For most tendon pain at the top of the shoulder, guided exercise is the first treatment, because it helps pain, motion and strength.

• If we need a closer look at a tendon, an ultrasound or MRI can help.
• If pain is too strong to do your exercises, an injection may calm it down enough to get started.
• For a rotator cuff tear that didn't come from an injury, we usually start with exercise too, and talk about surgery only if you aren't improving after a few months.
• If you do have surgery, we get the shoulder moving again early rather than keeping it still for long.

Here's what that means for you. Starting with rehab isn't a delay tactic, and we're not hoping the problem quietly goes away. Rehab is the treatment.

I dislocated my shoulder once. Will it happen again?

Age at the first dislocation is one of the strongest clues we have. Younger people are more likely to have it happen again, usually within the first couple of years. That's why we don't treat a teenage wrestler and a 55-year-old gardener the same way.

Older shoulders behave differently. After 40, it's less likely to come out again, but we look more carefully for damage that came with the dislocation, like a rotator cuff tear or a nerve injury. A first dislocation after 40 is worth checking for both.

Which symptoms shouldn't wait?

Most shoulder pain can be watched for a couple of weeks while it settles down. Some signs shouldn't wait, though. If any of these apply to you, get seen promptly rather than giving it more time:

• Shoulder or arm pain along with chest pain or pressure, sweating, nausea, jaw pain, or shortness of breath. Call 911. This can be a heart attack, not a shoulder problem. Be especially careful with sudden left-sided shoulder or arm pain, and in women and people with diabetes, whose warning signs can look unusual.
• An injury that leaves the shoulder looking out of place or unable to move. Go to the emergency room, since a dislocated shoulder needs to be put back in right away.
• An injury followed by pain and weakness, or suddenly not being able to raise your arm, which can mean a torn rotator cuff.
• Signs of infection such as red skin, a very painful joint, fever, or feeling generally unwell. Get checked the same day.
• New numbness, tingling, or weakness anywhere in the arm or hand.
• Any new lump or swelling around the shoulder.
• Weight loss you can't explain, or a past history of cancer.
• Constant pain at rest that never lets up, or night pain that doesn't change when you shift position.
• New swelling in several joints at once.

Watch for a slower timeline as well. If your pain isn't getting better after about three months of treatment, it's time to see a specialist, and sooner if the shoulder feels loose or the pain after an injury is severe.

What happens when you come see us?

We listen first. How the pain started, which positions set it off, whether it wakes you, whether anything travels into the hand, and what you can't do right now. Then we examine the shoulder and the neck together, test your strength, and watch how your shoulder blade moves when you lift.

Imaging comes after the exam, not before it, and only when it will change the plan. X-rays show bone. Ultrasound and MRI show tendons and soft tissue. Plenty of patients leave with a diagnosis and a rehab plan, no scan needed.

Let's figure out what's going on with your shoulder

Our shoulder and sports medicine team at Princeton Orthopaedic Associates sees this every day, from the weekend pickleball ache to the arm you can no longer lift. We'd invite you to come in for a clear answer and a plan built around what you need to get back to.

Schedule Exam with our team and let's start with the cause, not just the pain.

Are you suffering from pain?

Please contact us! We'd love to help.

If you have pain, please contact us and schedule an appointment. We have urgent care facilities all over New Jersey for your convenience.

Schedule Exam

Urgent Care

This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.

Pain under your shoulder blade?

Shoulder blade pain is confusing. The blade itself is rarely the part that is actually hurt. Scapular fractures do happen, usually after a car crash or another high-energy hit, and stress fractures in the scapula turn up now and then in throwers and overhead athletes. More often the ache comes from the muscles and cushions that let the blade glide. It can also come from an irritated nerve in the neck, a nearby rib or joint, or a bone in the spine.

What sits under your shoulder blade

Your shoulder blade doesn't lock into a socket against your rib cage. It rests there, held in place by muscles, with small fluid-filled cushions (bursae) between it and the ribs to cut friction. When those muscles tire or weaken, the blade can rub instead of glide, and it starts to ache.

Match your symptoms before you guess at a cause

How the pain behaves tells us more than where you point. Use this table as a rough guide, not a diagnosis. If sharp pain with breathing comes with shortness of breath, see the emergency list below. If no row fits, come in for an exam and we'll sort it out together.

Get emergency care right away for these

• Shoulder blade or upper back pain that comes with chest pain or pressure, shortness of breath, sweating, nausea, or pain spreading to your jaw or arm. This can be a heart problem. Call 911.
• Sharp pain when you breathe that comes with shortness of breath, coughing up blood, a racing heart, or a swollen, painful calf. This can be a blood clot or a lung problem. Call 911.
• New weakness in your legs, unsteady walking, numbness in the groin or inner thighs, or changes in bladder or bowel control. Go to the emergency room right away.

See a doctor soon for these

These aren't usually emergencies, but don't wait a few weeks to see if they settle.

• Pain that started right after a crash, a fall, a heavy lift or a direct blow to the upper back
• New weakness in the arm or hand, or numbness that stays instead of coming and going
• Shoulder blade or upper back pain in anyone with a history of cancer, a weakened immune system, or a history of injecting drugs
• Pain that is worse at night, doesn't ease when you change position, or wakes you from sleep
• Fever, chills, night sweats, or weight loss you can't explain
• Pain on the right side with nausea or belly symptoms, often after meals, but no chest pain or shortness of breath. It can come from an organ like the gallbladder and needs a medical check. When in doubt, call 911.
• Pain that doesn't change no matter how you move your arm

Fever or chills with new back pain should be checked the same day, especially if your immune system is weak or you have injected drugs.

The everyday causes: too much load, too little support

The cause we see most is simple: the muscles that hold your shoulder blade steady get overworked from desk work, a heavy bag, or lots of reaching, and they turn sore and tight.

A pinched nerve in the neck feels different: burning pain, often with tingling down the arm into the hand. Irritated joints or ribs in the upper back tend to cause a sharp, catching pain with a deep breath, a cough or a twist.

When it grinds, clicks or snaps

Some people hear their shoulder blade and feel it. It can grind, click or snap against the ribs as you raise your arm, often after lots of overhead work. A hands-on exam usually tells us what's going on.

When the blade sticks out like a wing

Sometimes the inner edge of your shoulder blade lifts away from your ribs. Weak muscles can cause this, and a nerve problem can also make the shoulder blade stick out like a wing. Come in for an exam so we can tell which it is.

The cause that hides: a spine fracture

If you're over 50 or have thin bones, sudden pain in your upper back or around your shoulder blade should be checked within a day or two, not weeks. A minor fall or lift can be enough to crack a bone in the spine so it squashes down (a compression fracture). If we find one, we treat it and help you start a bone-health plan.

Your desk is part of the treatment plan

Sitting at a computer all day long can be the culprit. Moving often, getting up, stretching and paying attention to your posture are helpful. No single posture protects you on its own, so take short breaks. Set up your desk in this order, since each step affects the next.

1. Set the chair first, with your feet flat and your lower back supported.
2. Adjust the armrests next. Armrests set too high keep your shoulders shrugged.
3. Bring the mouse in close, so your shoulder isn't holding your arm out all day.
4. Then set the screen height. A screen that's too high makes you tip your head back.
5. Last, check how high your arms sit while you type. Arms held too high or too low both strain your shoulders.

On a laptop, a separate keyboard and a stand that raises the screen often help your neck.

How we pin down the cause

We start with your story and a hands-on exam, watching how your shoulder blade moves and checking your neck, ribs, spine and strength. We add imaging, such as an X-ray or MRI, only when it will change the plan. Many people never need an MRI or CT scan.

Treatment, simplest first

Almost every plan starts without surgery. Rest, medicine, physical therapy and home exercises help many people, and injections or surgery come up only if the pain stays strong. Worsening arm weakness needs to be seen quickly.

What you can do this week

You don't have to wait for your visit to start. Try these and write down what happens.

• Hold anything heavy close to your body, not out at arm's length.
• Break up overhead work into shorter blocks, with rests in between.
• Notice whether turning your head toward the sore side brings back the pain or tingling in your fingers.
• Notice whether a deep breath or a twist makes the pain sharp.
• Work through the desk steps above, in order.

Let's find out what's actually causing it

If your shoulder blade pain has lasted more than a couple of weeks, keeps coming back, or comes with weakness, numbness or grinding, we'd like to take a look. Our orthopaedic physicians, physiatrists (rehabilitation doctors) and physical therapists work side by side on a plan built around your goals.

Schedule Exam with Princeton Orthopaedic Associates and let's get you moving comfortably again.

The information here is educational and is not a substitute for individual evaluation, diagnosis or treatment by a qualified clinician.

Are you suffering from pain?

Please contact us! We'd love to help.

If you have pain, please contact us and schedule an appointment. We have urgent care facilities all over New Jersey for your convenience.

Schedule Exam

Urgent Care

This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.

Pain behind the knee and calf: what it usually means

Pain behind the knee or in the calf is usually something simple, like a pulled calf muscle or an irritated knee. Most of the time it settles with some rest and a little patience. Once in a while it's a blood clot, and that needs care the same day. Here's how to tell the difference, what you can do at home, and when to come see us.

When to get help right away

Get seen the same day if you notice any of these:

• Swelling, warmth or redness in the calf, especially if nothing happened to explain it
• A heavy, tight leg with no injury to explain it
• Chest pain, shortness of breath or coughing up blood (call 911)
• Fever along with a hot, swollen knee
• Numbness, weakness, or a foot that drags when you walk
• Numbness in both legs, numbness around your groin, buttocks or inner thighs, or trouble controlling your bladder or bowels (call 911 or go to the emergency room)
• Knee pain right after a fall, a car accident or a twist you couldn't walk off
• You can't put weight on the leg
• A snap or pop at the back of the lower calf or ankle, or you can't stand on tiptoe (possibly a torn Achilles tendon)

Why this matters: A blood clot in the leg can feel a lot like a pulled muscle. If your calf is swollen and you can't point to something that caused it, don't wait it out. Get it checked.

Common causes of pain behind the knee and calf

Where it hurts and how it started are the two best clues. Here's a simple guide:

Takeaway: Pain that starts suddenly during activity is usually a strain. Pain that builds up slowly is more often tendon irritation or wear inside the knee. If you're not sure which it is, that's exactly what an exam is for.

A lump behind the knee

A soft bulge in the crease behind your knee is usually a Baker's cyst. The cyst itself is harmless, just a pocket of joint fluid, but any new lump needs a check. A cyst is often a sign that something inside the knee, like arthritis or a meniscus tear, is making extra fluid. Treating that problem is usually what settles the cyst.

Now and then a cyst bursts and fluid leaks down into the calf. That can look just like a blood clot, with swelling and pain in the calf, so it always needs a proper check before anyone treats it.

Takeaway: A lump behind the knee usually isn't dangerous by itself, but it's worth letting us find out what's causing it.

Other causes we check for

We also check for these:

• A hamstring strain or sore tendon. The hamstring tendons cross the back of the knee. A strain often starts suddenly during a sprint, while a sore tendon usually builds up from overuse.
• Knee arthritis. This usually builds slowly, with stiffness that's often worse in the morning or after sitting.
• A pinched nerve in the lower back. Nerve pain (sciatica) can travel from the back or buttock down into the calf, sometimes with tingling.
• Muscle cramps. Common at night or after a hard workout, and gentle stretching usually eases them.

Takeaway: Several of these feel alike, so an exam looks beyond just the spot that hurts.

What you can do at home

If you have none of the warning signs above and you know what set it off, like a sprint, a jump or a long hike, simple care usually helps:

• Rest from the activity that hurt it, but keep walking gently
• Use ice and keep the leg raised to calm the swelling
• Skip hard stretching for the first few days
• Ask your doctor before taking anti-inflammatory medicine

Ice or heat? Start with ice, in short sessions with a cloth between the ice and your skin. Hold off on heat and massage for the first few days.

Give it about two weeks. If it isn't clearly better by then, come in for an exam. Get checked the same day if the pain gets worse, you can't put weight on the leg, the swelling grows or your calf turns warm.

Protecting your calf and knee

A few simple habits can lower your chances of a strain:

• Warm up before activity and stretch your calves regularly
• Build up new or harder workouts gradually
• Keep your calves and the backs of your thighs strong, with rest days between hard workouts

Know when a clot is more likely. Most calf pain isn't a clot, but the chances go up after surgery or a leg injury, on long trips, or when you have been laid up in bed or a cast. At those times, move around as much as your care team allows, and get a swollen, warm calf checked the same day.

What happens at your visit

We'll ask how and when the pain started, then examine your knee, your calf and the way you walk. Imaging isn't always needed. When we do want a closer look, we pick the test that answers the question: an X-ray for bone, or an ultrasound or MRI for muscles, tendons and cysts. Then we'll build a plan around what you want to get back to.

How long recovery takes

It depends on the cause. A mild calf strain often feels better within a few weeks, while a bigger tear can take a couple of months or longer. Physical therapy helps you rebuild strength step by step, so you can get back to walking, running or sports and lower the chance of hurting it again. We'll give you a realistic timeline after your exam.

Who to see for pain behind the knee and calf

Our team works together, and the right place to start depends on what's going on.

Schedule Exam

If the pain behind your knee or calf has lasted more than two weeks, keeps coming back or is changing the way you walk, come see us. You don't have to figure it out on your own; that's what the exam is for.

Are you suffering from pain?

Please contact us! We'd love to help.

If you have pain, please contact us and schedule an appointment. We have urgent care facilities all over New Jersey for your convenience.

Schedule Exam

Urgent Care

This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.