Dr. Rubin’s Blog Posts
Partial Rotator Cuff Repair in Large Tears: What You Should Know
Large rotator cuff tears can be challenging to repair fully—especially when tissue quality or tendon retraction limits a complete repair. In these cases, a partial repair may offer meaningful pain relief and improved function without the risks of overtension or poor healing associated with aggressive repairs.
Recent evidence shows that partial repairs can:
Reduce pain and improve range of motion
Preserve shoulder mechanics
Delay or even prevent the need for reverse shoulder arthroplasty in older adults
At Rubin Sports Medicine, we often evaluate whether a biologically friendly, non-operative pathway (like PRP or physical therapy) or a surgical strategy (like partial repair) makes the most sense—tailored to your goals and activity level.
What Is the Stromal Vascular Fraction (SVF)?
The stromal vascular fraction (SVF) is a regenerative cell-rich portion of fat tissue that contains mesenchymal stem cells, pericytes, endothelial cells, and various immune cells. It’s gaining interest in the field of orthobiologics for its potential to support healing in musculoskeletal injuries.
Unlike platelet-rich plasma (PRP), which comes from blood, SVF is harvested from a small amount of fat—usually via liposuction—and processed either enzymatically or mechanically. Early studies suggest that SVF may help reduce inflammation, modulate pain, and enhance tissue repair, particularly in conditions like knee osteoarthritis, tendon injuries, and joint degeneration.
At Rubin Sports Medicine, we stay at the forefront of regenerative options like SVF to support non-surgical orthopedic recovery personalized to your lifestyle and goals.
Medial Malleolus Stress Fractures: A Rare but Serious Injury
Medial malleolus stress fractures are an uncommon but significant source of ankle pain, often seen in athletes and runners with repetitive impact or loading. Unlike lateral ankle injuries, these fractures can be easily missed early on and may require high clinical suspicion for diagnosis.
Key points:
Typically presents with vague medial ankle pain that worsens with activity.
Diagnosis often confirmed with MRI, since early X-rays may appear normal.
Associated with high risk of nonunion or displacement if left untreated.
Treatment ranges from non-weight bearing immobilization to surgical fixation, especially in elite athletes or high-risk cases.
At Rubin Sports Medicine, we carefully evaluate atypical ankle pain and use advanced imaging and biomechanical analysis when needed to ensure accurate diagnosis and personalized treatment planning.
Exosomes and Osteoarthritis: A New Frontier in Joint Health
Exosomes are small, extracellular vesicles released by cells that play a key role in cell signaling and tissue repair. In the world of orthobiologics, exosomes are emerging as a promising option for treating osteoarthritis (OA) by potentially reducing inflammation and promoting cartilage regeneration.
Highlights:
Derived from sources like stem cells or platelets, exosomes carry growth factors, proteins, and genetic material that influence joint healing.
Early studies suggest they may improve pain and function in knee OA with fewer inflammatory reactions than traditional cell-based therapies.
Still investigational in the U.S., with evolving FDA guidance on their clinical use.
Safety, dosing, and sourcing vary—careful patient selection and regulatory compliance are key.
At Rubin Sports Medicine, we stay at the cutting edge of regenerative medicine—including exosomes—as we explore the safest, most effective ways to support joint preservation and non-surgical recovery.
Piriformis Syndrome: When the Muscle Mimics Sciatica
Piriformis syndrome is a condition where the piriformis muscle, located deep in the buttock, irritates or compresses the sciatic nerve, leading to symptoms that often mimic sciatica.
Key features:
Pain typically presents as deep gluteal discomfort that may radiate down the leg.
Aggravated by sitting, climbing stairs, or prolonged activity.
Often confused with lumbar radiculopathy, making accurate diagnosis essential.
Treatment includes targeted physical therapy, stretching, and sometimes image-guided injections to reduce inflammation and nerve irritation.
At Rubin Sports Medicine, we use detailed biomechanical exams and ultrasound guidance to differentiate piriformis syndrome from other causes of leg pain and tailor non-surgical treatment plans to restore mobility and function.
Platelet-Poor Plasma (PPP) Injections for Hamstring Injuries
While platelet-rich plasma (PRP) often gets the spotlight, platelet-poor plasma (PPP) is gaining attention as a regenerative option for treating hamstring strains—especially in athletes with recurrent injuries.
Highlights:
PPP contains fewer inflammatory cytokines and may reduce muscle scarring during healing.
Studies suggest PPP may support faster return to sport in certain hamstring injuries by promoting a more balanced healing response.
Unlike PRP, PPP doesn’t rely on high platelet concentrations—making it potentially more useful in muscle injuries, where excess inflammation can be counterproductive.
The technique is still evolving, and patient selection is key.
At Rubin Sports Medicine, we use both PRP and PPP selectively based on injury type, phase of healing, and your athletic goals—offering precision in non-operative muscle recovery.
Swan Neck Deformities: Understanding the Curve in the Finger
Swan neck deformity is a condition where the finger develops a zig-zag posture: hyperextension at the PIP joint and flexion at the DIP joint. This abnormal alignment can affect hand function, grip strength, and cause discomfort.
Key points:
Often associated with rheumatoid arthritis, but may also follow trauma, tendon imbalance, or joint laxity.
Patients may notice difficulty gripping, typing, or buttoning clothes.
Diagnosis is clinical and may include X-rays to assess joint damage or ligament instability.
Treatment depends on the underlying cause and may include splinting, hand therapy, or in advanced cases, surgical intervention.
At Rubin Sports Medicine, we focus on non-surgical management whenever possible—emphasizing custom bracing, strengthening, and joint protection strategies to preserve hand function.
Ultrasound-Guided Periscapular Trigger Point Injections
Periscapular trigger points—tight, irritable muscle bands near the shoulder blade—can cause chronic upper back or scapular pain, especially in athletes, desk workers, and post-op shoulder patients.
Key insights:
These trigger points often develop in the rhomboids, levator scapulae, and serratus posterior superior muscles.
When conservative care (e.g., physical therapy, dry needling) doesn’t relieve pain, ultrasound-guided trigger point injections can help.
Using ultrasound improves precision, allowing clinicians to safely target deep or overlapping muscle layers while avoiding lung tissue (especially near the upper ribs).
Injections may include local anesthetic alone or combined with anti-inflammatory medication.
At Rubin Sports Medicine, we use ultrasound-guided techniques to safely and effectively treat hard-to-reach myofascial pain in athletes and active patients.
Creatine Use in Athletes: What the Evidence Really Shows
Creatine monohydrate is one of the most researched and effective supplements for athletic performance, with proven benefits in strength, power, and recovery. Despite outdated myths, it’s considered safe, legal, and well-tolerated when used properly.
Key takeaways:
Shown to improve explosive strength, high-intensity exercise performance, and lean mass gains.
Particularly helpful in sports requiring short bursts of power—like sprinting, weightlifting, and team sports.
No strong evidence linking creatine to muscle cramps or dehydration, despite common misconceptions.
Can be safely used by adolescents and adults under professional guidance, especially when paired with structured training and nutrition.
At Rubin Sports Medicine, we offer personalized guidance on supplements like creatine within the broader context of performance optimization and safe athletic care.
Types of Shoulder Labrum Tears: What You Need to Know
The shoulder labrum is a ring of cartilage that helps stabilize the ball-and-socket joint. When torn, it can lead to pain, instability, clicking, or weakness—especially in overhead athletes and active adults.
Common types of labral tears include:
SLAP tears (Superior Labrum Anterior to Posterior): Often seen in throwers or weightlifters.
Bankart tears: Associated with shoulder dislocations and instability.
Posterior labral tears: Less common, but can affect contact athletes and lifters.
Degenerative labrum tears: Related to wear and tear, often seen in middle-aged or older patients.
Accurate diagnosis usually involves MRI with contrast and a thorough exam. Treatment may include physical therapy, biologic injections, or, in some cases, surgical repair.
At Rubin Sports Medicine, we specialize in identifying the root cause of shoulder pain and offering evidence-based, non-surgical options tailored to your activity level and goals.
Tibia Stress Fractures: A Common Source of Shin Pain
Tibial stress fractures are one of the most frequent overuse injuries in runners, military trainees, and athletes involved in high-impact sports. They often begin as shin pain during activity and can progress if not identified early.
Key points:
Caused by repetitive stress exceeding the bone’s ability to remodel.
Pain typically starts with activity and improves with rest—but worsens over time if untreated.
Diagnosis may require MRI, as X-rays can be normal in early stages.
Treatment focuses on activity modification, bone loading progression, and correcting risk factors (e.g., footwear, biomechanics, nutrition).
At Rubin Sports Medicine, we combine diagnostic imaging, gait analysis, and a progressive return-to-sport plan to safely guide healing while minimizing downtime.
Hip Microinstability: The Hidden Cause of Hip Pain in Athletes
Hip microinstability refers to subtle abnormal motion of the hip joint—often due to capsular laxity, repetitive stress, or underlying structural issues like dysplasia. It’s a frequently overlooked source of deep hip pain, especially in young athletes, dancers, and gymnasts.
Key signs:
Vague, deep anterior hip or groin pain with activity
Clicking or catching sensation
Feelings of the hip “giving way”
Aggravated by pivoting, twisting, or hyperextension
Diagnosis involves a detailed physical exam and sometimes MRI or fluoroscopy to assess ligamentous laxity or labral involvement.
At Rubin Sports Medicine, we use a combination of dynamic ultrasound, targeted rehab, and injection-based diagnostics to help patients recover without surgery whenever possible.