Friday, December 27, 2013

TOCA is pleased to announce that David S Bailie MD has been selected as a principal investigator of a new stemless total shoulder replacement device.

TOCA is pleased to announce that David S Bailie MD has been selected as a principal investigator of a new stemless total shoulder replacement device. This is a randomized study being conducted at 12 FDA approved medical facilities in the US. Dr. Bailie is the only orthopedic surgeon approved to use this device in the western US (west of  Memphis, TN). 

This FDA approved study is being sponsored by Biomet Orthopedics ( a worldwide manufacturer/distributor of Orthopedic devices, 

Dr. Bailie has been selected by the FDA and the Western Institutional Review Board to participate and enroll qualified patients. The device has already been released and is currently being used in several European countries and the UK. Because the device is uniquely different than any current shoulder replacement on the market, in the US it requires a specifically designed FDA approved study, to be conducted by select surgeons, prior to general release to the remainder of the medical community. Until the study is complete (approximately 5-7 years), it will only be available as part of this study. Dr. Bailie is very excited to have been asked to participate in this "cutting-edge" research and be able to offer his patients a unique opportunity to participate. Participating orthopedic surgeons is by invitation only.

As criteria for patients to be included in this study is very specific and narrow, only those potential patients who are seen and examined personally by Dr. Bailie can be considered. This study will be performed under strict FDA and IRB monitoring until it is completed.


Tuesday, December 3, 2013

Congratulations Dr. Chhabra!

Congratulations to Dr. Chhabra who was was named the Medical Director for the Fiesta Bowl and Buffalo Wild Wings Bowl! His role will be to help coordinate care for all visiting teams during the Bowl week and coordinate game day medical care.


Wednesday, November 27, 2013

Liga International, The Flying Doctors of Mercy (Dr. Burgess)

(click above to view the video)

In the Spirit of Thanksgiving; a big thank you to Dr. Burgess, PA-C Lisa Babel and all the volunteers who contribute their time and talents to Liga International, The Flying Doctors of Mercy.

Below is a link from MudoFox, the Spanish version of FOX News. This second part of the special series "I Want to be a Better Person.", is the story of Dr. Burgess Phoenix Arizona, who makes magic with his hands. He is one of the league volunteers flying doctors who volunteer on medical missions down to El Fuerte, Mexico

The LIGA is still in great need help getting supplies and those supplies into Mexico. There will be 12 segments airing every night for the next several days. This broadcast is out of LA and will be converted to English for the sister networks sometime in the future. Click the link to learn more about Liga International, The Flying Doctors of Mercy.

Serie especial: I Want To Be a Better Person [Parte II]


Tuesday, November 19, 2013

Dr. Chhabra presented on “Identifying and preventing concussion in sports”.

Congratulations to Dr. Chhabra! He was invited by Edurance Scottsdale to present on “Identifying and preventing concussion in sports”. It is estimated that as many as 3.8 million concussions occur in the USA per year during competitive sports and recreation activities; however, as many as 50% of the concussions may go unreported. Dr. Chhabra discussed the latest advancements in diagnosing and treating head injury in sports. In team sports like football and hockey, concussion testing has become the norm in order to determine level of severity of the injury and to safely manage an athlete’s return to sports.

The event on November 14th, 2013 was for athletes at risk (football, soccer, hockey, cycling, basketball, etc.), coaches and parents.

Dr. Chhabra was the first orthopedic surgeon in Arizona to be certified as an ImPACT Specialist (Immediate Post-Concussion Assessment and Cognitive Testing).

Thursday, November 14, 2013

LIGA trip November 2013 (Dr. Burgess & PA-C Lisa Babel)

LIGA trip Nov 2013

This November Dr. Burgess and his Physician Assistant Lisa Babel returned to the state of Sinaloa Mexico to continue their work with LIGA International.  They, along with 107 volunteers from around the United States, were able to touch the lives of hundreds of patients in the cities of El Fuerte and San Blas. Traveling with them and helping to provide much needed equipment to treat the patients was a local orthopedic representative, Jarred Martincic.  This November clinic was a busy one, treating 640 patients including adults and children.  Several specialty areas were represented including podiatry, neurology, ophthalmology, ENT, dentistry and orthopedic hand surgery.

Traveling back to El Fuerte was something Dr. Burgess and Lisa had been looking forward to since their last visit back in April.  They were able to connect with some of the patients they had surgically treated and follow-up on their progress. Going back also meant familiarity; having their prior experience allowed them to dive back in and get right to work.  “Knowing what you have, but also knowing what you need makes a big difference in how affective you can be in the time you are there.  I was able to prioritize patients and provide surgery to all we could, but also plan for future trips where I hope to secure much needed orthopedic implants,” said Dr. Burgess. 

“Without question, the hardest part of the trip is the look of disappointment in the eyes of a patient when I have to tell them there is nothing I can do, or at least until I get the proper equipment.  These people come to you with hope.  Many of them are suffering from chronic conditions from injuries sustained years ago.  That painful look of disappointment is contrary to the look of joy and appreciation when they feel their hope turn to reality.  It’s contagious and it keeps me going back.  Even my wife is planning to help on the next trip.  There is no question, it can be an emotional experience with many ups and downs,” reflected Dr. Burgess. 

Unique to this trip was a news team capturing the story of LIGA.  Rolando Nichols, lead news anchor and reporter for MundoFox, the Spanish-language broadcast network and sister station to Fox News, along with his cameraman and pilot traveled from California down to El Fuerte.  They highlighted both El Fuerte and San Blas clinics, and hope to help spread the news about what the volunteers are accomplishing, along with the tremendous need for more help and equipment that still exists.  Dr. Burgess notes, “One of the more frustrating roadblocks to our success can be the very Government of the people we are trying to serve.  We have philanthropic companies and organizations here in the States willing to donate equipment but when it gets confiscated at the border or fined so heavily you have no choice but to turn back, it’s deflating.”  Dr. Burgess is hopeful the awareness MundoFox brings, may help pry some of these “closed political doors” open and allow LIGA to fulfill its mission.

Dr. Burgess says he is commonly asked how safe it is in this region of Mexico.  “I can say so far, I have felt completely safe.  You can’t be na├»ve and you have to take precautions.  The people of Mexico have opened their hearts with thanks and many local women will cook for hours on end to keep us fed while we work.  Admittedly, it was strange to see DEA agents in small squads loaded into the back of pick-up trucks carrying automatic weapons, all dressed in black and wearing ski masks to protect their identity from drug cartel soldiers.  It was another sobering reminder how lucky we are to live in the United States of America.”   

For more information on how you can become involved, please go to
For more photos go to:

Friday, November 1, 2013

TOCA is proud to support SIGN!

TOCA is proud to support SIGN! 

SIGN ( provides orthopedic care in the developing world through education, mentorship and most importantly by providing free implants. These impacts have been designed to be placed without the need for electricity or X-ray, making them the only intramedullary implant currently designed for austere conditions. They actually manufacture and ship these implants to over 250 hospitals in 50+ countries.

Most people don't realize that 2/3 of the world has no access to orthopedic care and in the developing world road traffic accidents are a bigger problem than TB, AIDS and Malaria combined.

This is a tremendous organization and a brief history is told by the founder:


Monday, October 7, 2013

Hand Surgeon Provides Simple Tips to Avoid Spoiling Your Family’s Halloween - Dr. Burgess

Hand Surgeon Provides Simple Tips to Avoid Spoiling Your Family’s Halloween

Excitement looms around the corner for many families as we begin to pick and choose our favorite Halloween costumes, dig up the ghoulish decorations, and of course, carve our pumpkins. As a Board Certified Fellowship Trained Hand Surgeon at TOCA, I can tell you this holiday brings with it some degree of trepidation.  I have seen year after year devastating injuries as a result of improper safety precautions when it comes to carving pumpkins.  A hand slipping down the blade of a knife too many times results in more than just a cut in the skin. 

These injuries are even more common in kids and adolescents.  As much as a family affair as this may be, the carving should be left up to the adults or at most, adolescents under supervision.  Pumpkin carving parties can have a number of distractions and someone should always be designated to oversee the safety of these young adults to make sure safe and proper technique is being utilized.  For young children, I would recommend you engage them more in cleaning out the pumpkin seeds and the actual design work for your unique pumpkin ideas.  Drawing your ideas onto the pumpkin or tracing them from paper drawings still allows them to be a part of the process.

Many of these accidents can be avoidable by taking simple precautions and using the right tools.  There are many commercially available pumpkin carving kits with specific tools which lessen the risk of injury and if injury does occur, it is often less severe.  The use of typical kitchen knives for pumpkin carving typically leads to the most common and most devastating injuries.  Here is a list of probably the most common causes of injury I see as a hand surgeon:

1.       Sharp knives get easily lodged into the tough pulp of the pumpkin.  When someone tries to push or pull the knife further, the hand can slide down the very slippery blade resulting in injury. 
2.       While trying to pull the knife out, I see injuries to the non-dominant hand which is used for counter force to dislodge the knife.

3.       The non-dominant hand is also frequently injured along the web space of the hand between the thumb and pointer finger when the knife is being used to make a cross cut through the pumpkin.
4.       Stabbing injuries are also encountered when one hand is used to support the back of the pumpkin and the knife penetrates through the back side or the pumpkin slips and rolls from being poorly stabilized. 
The more severe injuries most commonly result in damage to the tendons of the hand, the small sensation or movement (motor) nerves and also the arteries that supply the critical blood supply to the fingers.  Injury to the nerves will always result in some degree of lost, altered sensation, or even increased painful sensitivity.  Repair of these complex injuries can require months of healing and rehabilitation.
Although it is impossible to completely avoid injury, following these simple tips can help avoid or lessen the severity of these injuries.  Here is a list of recommendations you can follow to keep this holiday safe and fun for everyone in your family. 

1.       Get the right equipment.  Sharp ordinary kitchen knives are dangerous.  There are many commercially available pumpkin carving kits on the market.  Make them an investment in your family’s safety.  The Journal of Preventative Medicine has shown these kits to be effective in lowering the number and severity of carving related injuries. 

2.       Make smaller and more controlled cuts with the right instrument.  Avoid using a tool which has the capability of passing through the entire pumpkin which can injure the hand in back providing support.
3.       Prepare your workstation.  The work surface you choose to use can decrease your risk of injury.  Choose a surface which will decrease the risk of the pumpkin sliding around as you apply pressure with carving tools.  This also lessens the risk to your non-dominant hand by allowing the work station to steady the pumpkin while keeping your hand out of the path of the blade.  Commercially available bases are also available.
4.       Dry your hands, your tools and your pumpkin thoroughly and frequently.  The pulp of a pumpkin is extremely slippery so anytime you handle sharp instruments with a compromised grip, you are asking for injury.

5.       Control your distractions.  This is especially true for those pumpkin carving parties with multiple people, multiple age ranges and levels of experience.  Use the chaperone method where one person watches for sharp tools lying dangerously around, corrects dangerous technique, and assists in drying the carver’s hands and tools frequently.

6.       Avoid alcohol.  This may seem obvious but I can’t tell you how many times I see avoidable injuries caused by poor judgment, diminished coordination, and a lack of focus.  Leave the libations for afterwards when everyone can enjoy each other’s creations without someone sitting in the Emergency Department.
Should you or your family happen to be injured from a cut or stabbing wound, apply direct pressure to the injury.  This is usually the most affective and quickest way to control bleeding.  Wash the wound thoroughly with soap and water or other equivalent disinfectant.  Apply a topical antibiotic and appropriate sized bandage.  More severe injuries will require medical attention.  If 15 minutes of pressure to the injury does not stop the bleeding, if you notice discoloration to the hand, if you notice an immediate or later change in the sensation to your hand or finger, or if you find you cannot move any of the joints of your hand normally, you should seek medical attention immediately.  Urgent Care facilities and Emergency Departments are a good place to start.  They can often evaluate the wound for more significant injuries and provide stich closure to wounds.  I can’t emphasize enough; however, how important it is to make sure you receive appropriate follow up with one of the board certified hand surgeons here at TOCA if there is any question at all regarding the possibility of further injury.  Although these injuries almost never require hospital admission and emergency surgery, timely follow up as an outpatient in our office can make a world of difference if surgery is found to be necessary.

I do hope you find this information helpful in avoiding potential injury to you and your family during this and future Halloween seasons.  

 - Dr. Burgess


Wednesday, September 25, 2013

Sympathy to the Flora Family as well as the Fry's family.

Jon Flora

On behalf of TOCA, we would like to extend our sympathy to the Flora family as well as the Fry’s family. Jon Flora an exemplementry leader in the company and in the community through dedication, service and giving back to several non-profit organizations and charities. He will be greatly missed.

Tuesday, September 17, 2013

Meet Dr. Burgess!

Meet Dr. Kraig Burgess


 TOCA would like to introduce you to Dr. Kraig M. Burgess. Dr. Burgess has distinguished himself as an expert in the field of Orthopedic Hand and Upper Extremity Surgery. Dr. Burgess received his Bachelor’s degree from The Ohio State University. His medical school training was completed at the Ohio University College of Osteopathic Medicine in Athens, Ohio. 

Upon completion of his Internship and Residency in General Orthopedics, Dr. Burgess performed an additional year of Fellowship Training. This fellowship specific training in hand and upper extremity surgery included an enormous variety of reconstructive procedures and extensive trauma training at the Cleveland Clinic Foundation. U.S. News and World Report consistently rank The Cleveland Clinic as one of the nation’s best overall hospitals and the Orthopedic Surgery Department is among the top 5 year after year. Dr. Burgess has also successfully completed a Certificate of Added Qualification in Hand Surgery.


Monday, September 16, 2013

Meet Dr.Haber

Dr. Haber is an expert in the treatment of all hand and wrist conditions. He has Certificate of Added Qualification in Hand Surgery and is Board Certified in Plastic and Reconstructive Surgery. He serves as a hand surgery consultant for Arizona State University athletes, Phoenix Suns and Phoenix Mercury. Dr. Haber has special interest in golf related hand and wrist conditions. He has been an investigator for an international study for collagenase injection for Dupuytren’s Disease. He treats all severities of arthritis, nerve compressions and repetitive hand disorders. Dr. Haber has presented his research and has been published in leading medical journals. 


TOCA Welcomes Dr. Daniel Nemeth!

TOCA Welcomes Dr. Daniel Nemeth a fellow in Interventional Spine, Physical Medicine & Rehabilitation with Dr. Huston. 

What is a Fellow?

A Fellowship is the period of medical training that a physician may undertake after completing a specialty training program. During this time, the physician is known as a fellow. Fellows are capable of acting as attending physician or consultant physician in the generalist field in which they were trained, such as Orthopedic Surgery, Physical Medicine and Rehabilitation. After completing a fellowship in the relevant sub-specialty, the physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as Interventional Spine or Orthopedic Sports Medicine.


Tuesday, August 27, 2013

Congratulations Dr. Carter!

Congratulations to Dr. Carter for his chapter publication titled "Allograft Meniscus Transplantation: Dovetail Technique", in the book: "Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine (edition 2)" by Brian Cole and Jon Sekiya.


Wednesday, August 7, 2013

Dr's Carter, Lederman and Chhabra will host our first fellow in Orthopedic Sports Medicine, Chris Stevens, MD.

Dr's Carter, Lederman and Chhabra will host our first fellow in Orthopedic Sports Medicine, Chris Stevens, MD. Please welcome Dr. Stevens to TOCA for the 2013-2014 academic year!

TOCA is partnered with Banner Good Samaritan Orthopedic Surgery Residency program to host the only ACGME Accredited Sports Medicine Fellowship program in Arizona. Dr. Chhabra is the fellowship director. Dr's Carter, Lederman and Chhabra are the Sports Medicine Department for the Orthopedic Surgery residency program.


Monday, August 5, 2013

Perry Edinger (PA-C to Dr. Bailie); "Brutal Badwater marathon leaves mark on runner" - azcentral sports

Perry Edinger (PA-C to Dr. Bailie) was interviewed on Sunday by the Arizona Republic concerning the brutal Badwater Marathon and his journey and battle with the resulting heat related health effects. 

"Brutal Badwater marathon leaves mark on runner"

By Bob Young
azcentral sports
Sun Aug 4, 2013 1:49 AM
Perry Edinger felt the lure of “The World’s Toughest Footrace” for most of his adult life.

In July 2009 — partly to complete that quest and partly to find purpose in his life after losing his wife, Samantha, to ovarian cancer in 2007 — Edinger took up this ultimate challenge.

He covered the 135 miles in 29 hours, 19 minutes, 4 seconds to finish ninth among the 86 runners.

Edinger, 52, a Valley physician’s assistant who specializes in treating running injuries, knows this because it’s in the Badwater record book. And his trek was chronicled in photos, video and words by azcentral sports four years ago.

The documentation is fortunate, because Edinger left a piece of himself in Death Valley — including virtually every memory of that brutal run through temperatures that soared above 120 degrees in the lowlands and dipped into the low 50s going across two mountain passes on the way to Whitney.

“I remember, at about 23 miles, getting sick, vomiting,” he said. “Everything else, I really only remember if I see pictures, and then it’s vague. I’ll look at the pictures, and I’ll study it, and it will almost be there, but not really. It’s just not there.”

Signs of trouble

Edinger is an experienced ultradistance runner, who had recorded the best combined total time in four of the oldest races of 100 miles or more, the so-called “Grand Slam” of ultrarunning, before entering Badwater.

He had run in subfreezing conditions and in hellish heat. But he had never found himself at a loss to remember it. He recalls attending a Badwater pre-race meeting and getting sick in those early miles, but his next real memory is sitting in his car at a video store after returning to Arizona and asking himself why he had gone there.

“I remember sitting there wondering, ‘What the hell am I doing here? Oh yeah, I was supposed to get videos,’ ” he said. “I got the videos, and when I got home, I put my keys down for a week. I just didn’t feel good about driving.”

There were other curious signs of trouble. He was experiencing severe headaches. He had not needed reading glasses before Badwater, but now, he was having trouble reading, and the headaches became worse when he tried.

“I needed reading glasses,” he said. “I thought, ‘Yeah, I’m just getting to be that age.’ But I did not need them the day before Badwater.”

There also were intestinal issues, night sweats and trouble sleeping. He finally decided to seek help and underwent a battery of tests at Barrow Neurological Institute under the direction of Dr. Marwan Maalouf (who was killed about a year ago when he was struck by a car while riding his bicycle not far from Barrow).

A standardized concussion test that measures cognitive function based on age determined that Edinger was in the lower 10 percent of his age group nationally.

Only he hadn’t hit his head.

‘There was risk involved’

There is no way to know for certain now exactly what happened.

Dr. Thomas Carter, the Phoenix Suns’ orthopedic surgeon and a longtime friend of Edinger’s, believes that he may have suffered hyponatremia, a condition in which the body loses too much sodium, resulting in an electrolyte imbalance. It can be worse than dehydration.

Carter had warned Edinger that such a run was dangerous to his long-term well-being.

“Your whole chemical balance is out of whack,” Carter said, who added that a run of such a distance also causes muscle breakdown that can affect liver and kidney function.

“People like Perry always try to push the envelope to try to achieve things,” he said. “The thing about him, he pushes his body to the limit, but he’s not 20 years old anymore. Sometimes, the damage can be irreparable.

“Fortunately for him, he’s done pretty well compared to some people who have concussions or brain trauma.”

In the years since the event became an official footrace in 1987, no runner has died at Badwater despite the horrific conditions. Runners must apply for admission and have proven ultramarathon experience at a high level.

“I knew there was risk involved,” Edinger said. “I thought I might end up with a stress fracture, something like that. You can easily deal with that.”

He has studied the work of exercise scientist Timothy Noakes, who is credited with helping to identify hyponatremia. Edinger believes that he put too much emphasis on keeping his spinal cord cool, putting cold water on his neck and back as often as possible during the hottest portion of the run to fend off muscle fatigue. However, he neglected to keep his head properly cooled.

And when he repeatedly tried to ingest electrolyte capsules, he couldn’t keep them down.

“I couldn’t get salt down. I did lose 17 pounds that day. I don’t know,” he said. “There are certain things you can’t go back and test. I listen to the video, and there’s a part where I’m climbing a hill and I’m talking about doughnuts and slurring my speech. I was like, where did that come from? Doughnuts? That’s not me.”

What was clear is that he suffered some sort of brain injury during the run, most likely a cerebral edema or increase in fluid around the brain. Hyponatremia is one condition that can lead to cerebral edema.

“When I first saw the neurologist, I already had done a (magnetic resonance imaging test), and the two questions I had for him were: Do you think this will last forever, and is this going to cause the early onset of something, like dementia or something?” Edinger said.

“His two answers were: no and no. I said, OK, I’m good then. I really don’t need anything else. I would like to find out exactly what’s going on, though.”

Edinger had been working as a physical therapist at the Orthopedic Clinic Associates in the Valley, but he decided to enter a physician’s-assistant program not long after Badwater. He said he struggled to absorb the material at first.

“Man, it was horrible,” he said. “I’d have to read things five or six times.”

Lasting effects

Edinger completed the program, and he has continued to improve. Since Badwater, he has married, and he and his wife, Amy Norton, have a son, Miles, who is almost 3.

He didn’t want Amy, whom he was dating at the time of Badwater, or his mother, Jan, present during that race across the desert. He figured that he had the talent to finish in the top 30. He planned, as Carter predicted, to push the envelope and finish in the top 10.

“I didn’t want people there who might pull me out because I overstepped my bounds,” he said. “The people who were there knew what they were there to help me with and let me make my own decisions. I was willing to overstep my bounds. I think I overstepped my bounds.”

And there are other lasting effects. Since Badwater, his system can’t handle dairy products or soy. Neither was an issue before. He does not tolerate extreme heat or extreme cold well. And, for a lifelong runner, maybe the worst effect is that he has struggled to regain his running fitness.

“I went to get an MRI and went to see the neurologist because I was afraid, not only did I screw this up and I may not be able to run, but I may have screwed up because I don’t have very good neurological function and I’m not going to be the same person,” he said.

“The question is: Will it arise again when I’m 65? Or will I continue to get better every day like I have been, and five years from now, I’ll remember the race. I won’t know until I’m 65. And I’m good with that.”

Mark Zimmer, a friend who worked alongside Edinger when Edinger was the head athletic trainer at Arizona State University, said he knew something was wrong when he found out Edinger wasn’t running much.

Zimmer was on Edinger’s crew at Badwater as well as at the Zane Grey 50-mile Endurance Run along the Mogollon Rim and the Western State’s 100. Nobody knew at Badwater that Edinger was having problems, and, Zimmer pointed out, how would they?

“When somebody runs that far, you expect them to be fatigued, not to be as vocal or as conversational; no, I didn’t realize anything was wrong with him,” he said. “Running all day and night for 29 hours through the heat of Death Valley, my expectation was that it is going take a toll on body and mind a little bit.

“But I recall right before we got to the last town before the final climb (Lone Pine), there is a T in the road, and he stopped there and changed shorts. He was having some bad chafing, and he changed into these two-and-one shorts (with a Spandex liner). That was 120 to 125 miles in, and a person who wasn’t thinking straight would not have thought of that.

“It wasn’t like he was talking about pink ghosts and hallucinating. I would have noticed that. Afterward, when I realized he wasn’t running, that’s when I knew it had really taken a toll on him.”

Edinger recently served as a consultant for the “Scottsdale Beat the Heat” race, a 7-mile run celebrating the hottest day in Valley history. He said he didn’t have any qualms about the event because of the distance and because there were a lot of aid stations on the course.

He pre-ran the course a few hours before the event with no problems and then ran it again during the event. But he had to pull up and walk the final few miles when he started feeling ill.

Prior to Badwater, he wouldn’t have considered slowing down.

“I think I’m more sensitive to what’s happening now. I have more valuable things in my life,” he said, noting the birth of his son. “So, I’ll listen a little more (to my body), and if things are going bad, I’ll shut it off.”

No regrets

Despite the post-race problems, Edinger said he has no regrets, other than having no memory of the final miles up to the Portal.

“I had the second-fastest time going up the hill,” he said, smiling, “but I only know that from the stats.

“What I drew from that race makes me understand that everyone is so much better than they believe they are. You can do so much more than you think you can. That was an extreme. Everybody has things in their life they’re hesitant to do. You can do it. I proved that to myself.

“I hit every goal I had in that race. I will not repeat the run. But would I do it again if I had to go through these last couple of years after the race? I’d do it again.”

Edinger now works with Dr. David Bailie at the Orthopedic Clinic Associates, where he plans to build a practice for treating running-related injuries. He conducts clinics on running health each month at Sole Sports locations in Scottsdale, Tempe and Glendale as well as at iRun and Runner’s Den, running stores in Phoenix.

He hopes to run ultramarathons again, but only as a pacer to help other runners achieve their goals. And Edinger looks back at Badwater much as a climber might look back at a summit of Mount Everest.

“Those who have climbed it and come down maybe two or three toes short ask them the same question: Was it worth it to them?” he said. “I bet most all of them would say that it was worth it.

“Great things are not accomplished without a price. And for me, that’s about as great as I’m going to get.”

Bob Young was a member of Edinger’s crew at Badwater and has completed five ultramarathons. He will not be adding Badwater to his bucket list. Reach him at 602-444-8271 or

To View the interview video, click the link below:

To read the artical on, click the link below:


Wednesday, July 31, 2013

Congratulations to Dr. Lederman!

Congratulations to Dr. Lederman! Dr. Lederman's research paper titled "Reverse Total Shoulder Arthroplasty is Associated with Good Clinical Outcomes that are Sustained Through Mid-Term Follow-Up: Prospective Cohort Study" has been accepted for presentation at the 2013 American Shoulder and Elbow Surgeons closed meeting.  Dr. Lederman is the lead author along with Sam Harmsen, MD (Resident-Banner Good Samaritan Orthopedic Surgery Residency program), James Kelly, MD (San Francisco) and Brad Edwards (Houston).


Tuesday, July 30, 2013

TOCA Tips: Ankle Sprains

Ankle sprains are very common in athletes and occur when there is a traumatic injury to the ligaments surrounding the ankle joint. Ankle sprains occur when an abnormal force is applied to the foot. Commonly, this happens while running or jumping on an uneven surface. The foot rolls in (inversion) or out (eversion) and the ligaments are stretched or torn, depending on the severity. Occasionally a pop is heard at the time of the sprain, followed by pain and swelling of the ankle.

Initial treatment for ankle sprains consists of the R.I.C.E. treatment plan (Rest, Ice, Compression and Elevation).  Limit weight bearing with severe sprains early in treatment. Ice should be used for 20 minutes each hour, being careful not to put it directly on your skin as to avoid frostbite. Wrap the ankle in an ACE bandage or compression stocking to minimize swelling. Lace up ankle braces can give added support. Raise the ankle above the heart to minimize swelling. A NSAID can be helpful to reduce pain and inflammation. Early mobilization and physical therapy have been proven to decrease the time to return to sporting activities.

If you are unable to bear weight or have direct tenderness over the bone, seek medical treatment immediately to rule out a fracture.

- Dr. Anikar Chhabra, M.D., M.S.


Friday, July 26, 2013

Monitor young pitchers count, types thrown: - Dr. Padley

Monitor young pitchers count, types thrown:
-        Dr. Padley

     As durable as children are, injuries in young athletes are on the rise.  Thousands of children are seen each year by health-care providers for elbow or shoulder pain.  It’s critical that parents and coaches monitor their sports-related activities.

     For young pitchers, proper form and technique need to be monitored, as well as the number of pitches thrown.  If a young pitcher is throwing improperly, too much, too early and without proper rest, serious elbow or shoulder injuries may occur.  To protect kids from overuse injuries, guidelines have been recommended for the number of pitches baseball players should throw, based on age.  This also needs to be monitored closely by the parents and totaled together if a child plays on more than one team at a time.

     Pitch types require monitoring, as well.  When kids are still physically developing, advanced pitch types, such as screwballs and sliders, can lead to damage and injury to joints, ligaments and growth plates.  These types of injuries, if ignored, can potentially cause significant or permanent damage.  As young athletes mature physically, their elbows and shoulders can handle more.

     Common symptoms of throwing injuries include continued pain, swelling, bruising, weakness and a “dead arm” feeling.

     Other overuse signs include loss in velocity, control and endurance.  If any of these symptoms appear, make sure your child gets plenty of rest.  Ice and ibuprofen can help with soreness and inflammation.

     If symptoms persist, contact your child’s healthcare provider for a thorough examination.

Pitch count by age per game                    Pitch type by age
 Age 7-8: 50                                                        Fastball: 8
 Age 9-10: 75                                                     Change-up: 10
 Age 11-12: 85                                                   Curveball: 14
 Age 13-16: 95                                                   Knuckleball: 15
 Age 17-18: 105                                                 Slider/Forkball: 16

                                                                             Screwball: 17

Tuesday, July 23, 2013

Dr. David Bailie to speak at ICA

Dr. David Bailie has been asked to speak at the ICA (Industrial Commission of Arizona) Seminar. His lecture will be on the topic of Treatment for Shoulder Injuries: Best Practices Reduce Medical Costs, Friday August 9th at 9:15 am.


Friday, July 19, 2013


Any condition that irritates or destroys a joint is referred to as arthritis.  The most common form is osteoarthritis, or as it is sometimes known, degenerative joint disease.   In a normal joint, cartilage covers the ends of the bones and permits their smooth, painless movement against one another.  In osteoarthritis, the cartilage layer wears out, allowing bone to make contact against bone.  As the process worsens, the signs and symptoms of arthritis develop.
The basilar joint, or the first carpometacarpal joint of the thumb, is formed by a small wrist bone called the trapezium and the thumb metacarpal bone.   The unique shapes of these bones permit the thumb to move in and out of the plane of the palm, as well as bend across the palm to oppose the other fingers.  Arthritis involving the base of the thumb is far more common in women than in men, and typically occurs after the age of 40.  A prior history of fracture or other injury to the joint may increase the likelihood of developing arthritis.

The earliest symptom of basilar joint arthritis is pain with activities that involve pinching.  These include opening jars, doorknobs, car door and turning keys.  Prolonged or heavy use of the thumb may produce an aching discomfort at the base of the thumb.  Changes in the weather may produce similar symptoms.  As the disease progresses, less stress is required to produce pain.  Pinch strength diminishes.  Activity-related swelling may develop.  Later, any motion of the thumb, even without stress, may become painful.  Eventually the joint begins to appear larger and out of place.  This is usually accompanied by decreased thumb motion.  Often the most difficult maneuver is grasping objects.
A careful history by the physician will give a high index of suspicion of basilar arthritis.  Inspection of the thumb will sometimes reveal a tender prominence at the base of the thumb.  As a diagnostic test your physician may press the thumb metacarpal against the trapezium and move the joint.  This grind test will usually reproduce the symptoms of pain, and may produce a gritty sensation called crepitation.  This represents bone on bone contact, which also may show up on x-ray.
Initially, the symptoms of basilar joint arthritis will respond to limited activities and rest.  If this fails, use of an anti-inflammatory medications and a protective splint may be of benefit.  Additional relief of symptoms can sometimes be achieved by a cortisone injection into the joint.  When conservative methods of treatment no longer provide benefit, surgery may be warranted.
The goal of surgery is to decrease pain and preserve motion in the thumb. This is accomplished by removing the destroyed joint and creating a substitute joint called an arthroplasty.  Unrestricted use of the thumb is usually allowed at 12 weeks from surgery.

Tuesday, July 16, 2013

Hip Pain Causes: Dr Grant Padley

Hip Pain Causes: Dr Grant Padley

Hip pain can be the result of a number of causes not associated with arthritis.  Some common causes of non-arthritic hip pain include fracture, inflammation in the hip joint, bursitis, and femeroacetabular impingement (FAI, which is friction caused by abnormally shaped hip bones).

Arthritic hip pain is typically described as a “constant ache” pain that is felt in the groin area and increases with physical activity and prolonged use.  Non-arthritic hip pain, however, is often felt deep in the front of the hip, on the side, and in the buttocks.

How hip pain is treated depends on the cause of the pain.  Treatment should be sought after injury that limits your ability to move or perform routine activities as you normally would.

Additionally, any hip pain that doesn't go away after two to three weeks of conservative therapy, which includes anti-inflammatory medication, ice, rest and activity modification, should be evaluated by a health-care provider.  Your provider can conduct physical examination and order any tests or radiographic images that may be necessary to properly diagnose the source of your hip pain.

Conservative treatment, including physical therapy, is always the first and preferred approach to treat hip pain.  However, when attempts to address hip pain through conservative methods are not successful, hip arthroscopic surgery might be indicated.


Tuesday, July 9, 2013

Benefits of Sports far outweigh risks of potential injury: Dr Grant Padley

Benefits of Sports far outweigh risks of potential injury: 
Dr Grant Padley

     Sports-related injuries are a regular part of being an athlete.  Most athletes will suffer some type of injury, such as sprains and strains, knee and shoulder injuries, fractures, dislocations, and bumps and bruises.  Sometime, ice, rest or physical therapy are all that’s needed.  However, occasionally as with a majority of ACL injuries surgery is needed.

     Knee injuries are common and, as a result, surgical and rehabilitative techniques have been developed to repair the knee and help prevent future problems, such as reinjury, structural weakness, or arthritis.  In fact, sometimes surgery and focused exercise can make the injured part even stronger than before.

     In a recent study of professional football players who underwent surgery and rehabilitation to reconstruct isolated ACL tears, the results revealed that there were little, if any, long-term limitations on their athletic performance as a result of the injury.

     Of course, there are certain injuries that are more severe and that can have long-lasting effects.  We hear regularly about amateur and professional athletes who have suffered catastrophic or career-ending injuries to the neck, spine, hip and knee, for example.  Still, considering the number of people playing sports, such instances are the exception rather than the rule.

     Sports provide young people with an opportunity to develop social skills and camaraderie while maintaining an active lifestyle.  By and large the benefits of participating in sports and team competition greatly outweigh the fear of or potential for injury.  Always consult your doctor when injuries occur or if you have additional concerns or complications.

Monday, July 8, 2013

Dr. Yacobucci to instruct Orthopedic Surgeons on new techniques

Dr. Yacobucci has been asked to instruct a group of Orthopedic Surgeons on new techniques for resurfacing cartilage defects in the knee on July 20th in Las Vegas, NV. 

Dr. Yacobbuci is specialist in Sports Medicine, Arthroscopic & Reconstructive Surgery of the Knee & Shoulder.


Wednesday, July 3, 2013

TOCA pledge to 100 Club of Arizona

In light of the tragic events at the Yarnell fire in which 19 firefighters lost their lives, TOCA has pledged $1,900 to the 100 Club of Arizona to honor the memory of these fallen Heroes and to provide support for their families. This tragedy has touched many.

If you would like to donate you can find the 100 Club of Arizona on facebook:

as well as online at:


Tuesday, July 2, 2013

Dr. Padley speaks at A.T. Still University

For the 3rd Year Dr. Padley has been asked to speak at A.T. Still University for their Physician Assistant program. He gave a lecture on Hip Disorders. Dr. Padley specializes in Arthroscopic Surgery, Sports Medicine, Knee, Hip, Shoulder & Elbow. TOCA is proud of his commitment to continuing to support higher education in the community.  


Thursday, June 27, 2013

TOCA is proud to announce that Dr. Carter performed the first meniscal allograft in South Africa.

(View of Cape Town from the the top of the famous Table Mountain)

Dr. Tom Carter was the visiting professor at Sports Science Institute of South Africa this month in Cape Town. TOCA is proud to announce that Dr. Carter performed the first meniscal allograft in South Africa.


Wednesday, June 26, 2013

Congratulations Dr. Anikar Chhabra for this outstanding recognition!

Congratulations Dr. Anikar Chhabra 
for this outstanding recognition!

TOCA is proud to announce that Dr. Anikar Chhabra was awarded faculty of the year from the Banner Good Sam Orthopaedic Residency program. This award is voted on by the residents in the program for outstanding contribution to their education. 


Monday, June 24, 2013

Dr. Kostas Economopoulos: Final Thoughts on Australia

“I have spent the last 6 months learning about hip arthroscopy and hip injuries in athletes.  It has been an amazing experience in many ways.  I have had the honor of working with one of the true pioneers in hip arthroscopy, Dr. John O’Donnell in Melbourne, Australia.  In addition to performing over 250 hip arthroscopies during my time here, I have learned how to deal with many complicated hip issues including femoroacetabular impingement (FAI).  In addition, my family and I have had a wonderful experience learning about Australian culture.  We have been fortunate enough to travel to many wonderful places in Australia including the Great Barrier Reef and Sydney.  Although I have loved my time in Australia, I look forward to returning to my family and friends and using the skills and knowledge I have gained when I start with TOCA in Phoenix.”

Dr. Economopoulos will begin seeing patients in Mesa, Phoenix & Scottsdale August 1st, 2013.


Wednesday, June 19, 2013

Dr. Carter invited to speak in South Africa

(Cape Town, South Africa)

Dr. Carter was invited to be a guest speaker and surgeon for South Africa Orthopedic/ Sports Medicine Society in Cape Town, South Africa. Great Job Dr. Carter!