Foster Kim

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AKA: Foster, Kim, MD
Categories: Physicians & Surgeons, Physical Therapists, Physicians & Surgeons, Emergency Medicine, Physicians & Surgeons, Endocrinology, Diabetes & Metabolism, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gastroenterology (Stomach & Intestines), Physicians & Surgeons, Nephrology (Kidneys), Physicians & Surgeons, Obstetrics And Gynecology, Physicians & Surgeons, Orthopedics, Physicians & Surgeons, Osteopathic Manipulative Treatment, Physicians & Surgeons, Podiatrists, Physicians & Surgeons, Radiology, Physicians & Surgeons, Rheumatology (Arthritis), Physicians & Surgeons, Sports Medicine, Physicians & Surgeons, Surgery-General, Physicians & Surgeons, Urology, Physicians & Surgeons, Weight Loss Management, Sports Medicine & Injuries Treatment, Surgery Centers

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Phone: (401) 919-5222

Address: 400 Massasoit Ave Ste 201, East Providence, RI 02914

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Foster Kim

General Practitioners

Osteoporosis
Arthritis
Shoulder Arthritis may be very disabling. Osteoarthritis (arthritis from wear of the shoulder joint), may be caused or aggravated by prior dislocation of the shoulder, fracture, prior surgical intervention or other trauma to the shoulder. Rheumatoid arthritis may also cause similar wear and disability. This may lead to pain, limited range of motion, grinding of the shoulder, and poor functional capacity of the upper extremity.
Medical Weight Loss
When conservative treatment including medial quadriceps strengthening, anti-inflammatory medication, weight reduction (if necessary), and patellar bracing have failed to decrease symptoms adequately, realignment of the extensor mechanism may be considered. This is generally performed in younger patients less than 40 years of age. This is primarily because, with arthritis present, there is less reliable improvement with extensor realignment. Multiple factors need to be considered which include: Patient age, weight, underlying arthritic changes, ligament or meniscal injuries, activity level and return to sports. Conservative measures prior to surgical intervention include medial quadriceps strengthening as outlined in my chondromalacia article.
Family Practice
In addition, Hawaii presented an unusual breadth of problems and experience, including the treatment of polio patients, and severe limb deformities sent from the Far East for treatment. He is dedicated to patient education, and high-quality Orthopaedic Care, and treats patients of all ages. Dr. Goldstein has been actively involved in Family Practice education and Medical Student Education at Brown. He was the team physician for East Providence High School for over 20 years and has interests in surgical instrument design and fabrication, collagen biological implants, and bioengineering topics related to Sports Medicine, and extensive experience in Outcomes Data tracking and Health Information Technology.
Emergency Care
In general, immediate treatment of fractures requires immobilization whether or not surgical treatment is required. The severity of the trauma, displacement, and instability will dictate the need for surgical or cast treatment. If the fracture is simple, or if severe swelling is expected, then splint immobilization is most appropriate. In general, immediate casting is dangerous and unnecessary. If this is needed, hospital admission is indicated for observation for swelling. The risk of swelling and resultant compartment syndrome, which may permanently damage muscles and nerves especially in the forearm and lower leg, are significant especially with fractures here. When splint immobilization is only needed, a week of elevation and ice treatment will help the swelling to reduce and thereby minimize the risk of cast placement thereafter.
Colonoscopy
As with any surgery, there are risks. The shoulder is a complex joint to replace. It relies on soft tissue balance and prosthetic orientation to maintain stability. Dislocation may occur if therapy is improper, soft tissue balance or prosthetic orientation is not correct, or injury occurs. As with any prosthetic joint, infection is the most worrisome risk. This may necessitate prosthetic removal, clearance of the infection and reimplantation. After surgery, antibiotics should be taken before dental cleaning, oral surgery or colonoscopy to minimize the risk of late infection.
Constipation

Urology
The Total Hip Replacement Candidate is ideally greater than 60 years of age and in generally good health. There should be no history of prior hip infection. In addition, any chronic or recurrent infection elsewhere may lead to late prosthetic infection. Because of this, dental abscesses should be thoroughly treated. A patient with recurrent urinary tract infection secondary to retained kidney stones, urethral strictures, or other genitourinary problems should have urology evaluation prior to total joint replacement. Antibiotics are used after surgery, during dental work, or during colonoscopy to minimize the risk of late infection.
Kidney Stones
Orthopedic Surgeons are often keyed into Osteoporosis because this affects the risk of fractures which we treat. The most simple and effective treatments for Osteoporosis have already been discussed. Adequate calcium intake is simple and inexpensive with the use of calcium carbonate antacid taken daily. This is easily broken down in stomach acid and easily absorbed. Oyster shell calcium may be “natural,” but little may be absorbed. Aluminium-containing antacids should be avoided in excess, because they may actually have an adverse effect on bone mass. Normal dietary sources of calcium occur in leafy green vegetables, whole grains, and milk products. Excess calcium in the diet may cause constipation and in unusual circumstances may cause kidney stones. If you have a history of kidney stones, it is important to find out what they were made of. You should consult your urologist or general medical doctor for this information. Estrogen in normal doses has been found in women to be highly protective against Osteoporosis after menopause. This occurs because the sudden decline in estrogen results in an accelerated drop in bone density which may be halted. With estrogen, bone density is maintained in a similar course to that of a man. Estrogen has side effects and dangers. In normal doses, it is felt to have a very low risk of encouraging blood clot formation in the legs. A severe family history of breast cancer (mother and/or sister) is a contraindication to its use even with normal low doses in combination with progesterone. You should discuss the risks and benefits of estrogen treatment with your Gynecologist and plan on regular yearly visits prior to starting on estrogen therapy. Monthly self-breast exams should be performed as a routine screening even if estrogen is not used. Exercise is also very protective of Osteoporosis. Although swimming and bicycling are an excellent exercise for cardiovascular fitness, loading the body against the force of gravity is more effective in maintaining bone mass. Walking or jogging is, therefore, excellent exercise to maintain the bone mass. With more severe forms of osteoporosis, other treatments are sometimes utilized. This occurs when severe bone loss is noted with testing, or multiple risk factors are present and traditional methods of maintaining bone mass have been ineffective, or there is a history of prior fracture with known osteoporosis. Nasal calcitonin spray has been approved by the FDA for use with recalcitrant Osteoporosis. This is a hormone which tells the body to lay down bone. Its human form normally provides minor influence on the control of bone deposition. Diphosphonates are also available which help encourage bone deposition over breakdown. Newer forms of these have become simple to use and more predictable than their predecessors in the outcome. These have been shown to be capable of increasing bone mass instead of only slowing the progressive loss Osteoporosis. These too should be used p
Urinary Tract Infection
Hip fractures are a significant cause of debilitating injury which occur especially in older people. These may occur from minor trauma such as a simple fall or twisting injury. Hip fractures may also occur in higher energy injuries such as motor vehicle accidents or falls from bicycles or result from sports or traumatic injury. In the older individual, hip fracture is often associated with poor nutritional intake, osteoporosis, limited strength, and poor balance. Associated urinary tract infection or other general medical condition can result in dizziness and a fall which results in hip fracture.

Endocrinologist

Thyroid

Ultrasound
Typical diagnosis is made beginning with a physical exam, however, this is relatively inaccurate and reliance on ultrasound to visualize deep venous clots is the normal standard for diagnosis. Prior to this, clot visualization was performed using x-ray dense contrast and simple repetitive x-rays or fluoroscopic x-ray. Ultrasound is noninvasive quick and very accurate.
MRI
Symptoms generally include limited range of motion, crepitation or a grinding sensation within the joint on movement. Pain is often exacerbated by activity, and night-time awakening is common. The base of the neck may be “tight” with recurrent spasm, but sensation in the arm is generally normal. Patients do not complain of numbness or tingling, only pain. As in arthritis in other joints, as the surfaces wear, and bone against bone contact ensues, motion becomes increasingly limited. It is common for a patient with shoulder arthritis to present with complaints which are little different than those of a rotator cuff tear. The patients have the same limited active range of motion with pain at the extremes, and night-time awakening, but with rotator cuff tear there is also the weakness of rotation. In this situation, the plain X-Ray exam is very helpful in diagnosis. Generally, there is no need for MRI or other studies unless there is a question of a coexistent rotator cuff tear when this will substantially alter treatment.
X-Rays
Computed Tomography
Diagnosis is generally easily made with history and physical examination. Plain x-ray examination is very helpful especially using a skyline or merchant view which visualizes the patellar tracking viewed from the head towards the foot. When done properly, this sees the tilt and subluxation of the patella as well as significant patellar wear. CT scan or MRI may be indicated especially when meniscal or ligament pathology is suspected. These studies may help to visualize the patellar tracking in full extension because x-ray cannot see the patellar tracking with the knee completely straight. This can also be used to measure the Quadriceps Angle. Chondromalacia and maltracking of the patella eventually lead to increased patellar arthritis. Typically, the patient experiences ups and downs in symptoms related to activity and worsen over time.

General Surgery
After two years of General Surgery, he completed an Orthopaedic Surgery Residency at Rutgers University in 1988. His personal experience in gymnastics, running, and competitive swimming, prompted Fellowship subspecialization in Sports Medicine with Dr. Douglas Jackson in Long Beach, California. This Fellowship was completed in 1989.
Orthopedics
Sciatica
Diagnosis is usually straightforward. Arthritis is usually easily seen on plain X-ray films, and hip motion is generally limited and painful. The pain is often in the groin or radiates into the thigh or even to the knee. Sciatica or nerve-related pain from the back may coexist, or be confused with the pain of hip arthritis. In cases where the x-ray and physical exam do not match the pain complaints, MRI, bone scan, or joint injection test may be indicated to localize the source and cause of pain.
Arthroscopy
Meniscal tears are now treated arthroscopically. The Arthroscope is a small fiber-optic telescope used to look into the knee. Although general anesthesia is often used, arthroscopy may be performed with regional anesthesia (“local block”) or even local anesthesia with IV sedation with little discomfort. Total relaxation is required to fit the small instruments required into the knee and perform the necessary surgery without damage to the joint surfaces. The geometry of meniscal tear and the age of the patient dictate meniscal tear repair vs. partial resection. In general, tears in young patients at the outer edge of the meniscus may be repairable. Older patients generally have tears which are due to wear and tear and are less likely to be repairable. The healthiest knee is one with all its original parts. Meniscal preservation is therefore attempted whenever possible. M eniscal repair requires suture of the torn parts together. This can be performed arthroscopically but may require a secondary incision utilized to protect important nerves and vessels. If meniscal tear accompanies ligament injury, then ligament reconstruction is recommended. This is especially important if meniscal repair is performed.
Joint Replacement
The end of the femur and tibia form the knee joint. They are covered with a thin, smooth layer of cartilage. In the knee hyaline (surface) and meniscal cartilage cushion the joint and absorb shock. Normally this cartilage is lubricated by a few drops of synovial fluid. The lining of the joint which produces this fluid is synovium. With cartilage debris from wear, the synovium proliferates and produces excess fluid. Cartilage has poor healing capabilities; as it wears away, the bone becomes exposed. The bone surfaces rubbing against each other cause pain, while cartilage has no sensation. There are no predictable or satisfactory methods for reversing the damage of arthritis. When nonsurgical alternatives cannot bring a suitable level of relief, total joint replacement is a realistic alternative.
Orthopedic Surgery
As a Consumer, you have a choice of the Physician you see as long as you are not restricted by your “Insurance Carrier”. Please keep in mind that when you sign up for an Insurance Plan, you should be sure that your current doctors and anyone you might want to see is included on this Insurance “Panel” (Physicians allowed to see patients with that Insurance Coverage). This is as true with any Physician Provider as my Orthopedic Surgery Practice.
Arthroscopy
Rehabilitation is very dependent on the Orthopedic procedure necessary. Please see After Arthroscopy for information. Arthroscopic lateral release (dividing the lateral knee capsule) although simple and quick to perform, requires a long period of rehabilitation to regain the strength of the extensor mechanism and improve stability. This typically will not work by itself in patients with a very high Quadriceps angle. Swelling of the knee, especially after activities which load the extensor mechanism, may take 4 months to resolve even after simple lateral release. More extensive realignment procedures which move the patellar tendon site of attachment, require healing of the bone attachment site as well as surrounding soft tissue healing. Here improvements may be expected 4 to 6 months following surgery. Much of the necessary rehabilitation may be undertaken on a home program of therapy or at a gym facility, once the required exercise program is familiar and progress is made to a safe and comfortable point after surgery.
Hip Replacement
The hip may also need replacement in some cases of fracture, although the prosthesis differs depending on patient age and bone quality as well as general health. While the baseline status of the patient and the reason for replacement are variables, Hip Replacement is nearly always successful and has an excellent outcome with the restoration of mobility and walking tolerance without pain.
Knee Replacement
A relatively young person with knee arthritis, which is almost exclusively on one side of the knee, with severe pain and limited ambulatory tolerance, is a candidate for uni-condylar knee replacement. When knee pain from osteoarthritis, interferes with daily activity, walking tolerance, and independence, it is time to consider this alternative. Patients may choose a uni-condylar knee replacement when they have exhausted conservative measures and they cannot maintain normal activities of daily living.
Knee Arthroscopy
Patients with ACL tear need to avoid recurrent giving way. If these episodes cause pain and swelling, the knee may be progressively damaged. This most commonly occurs with associated meniscal (cartilage tears). Early wear and tear arthritis may eventually develop. When this occurs, surgical reconstruction or modified activities should be considered before these changes occur. Anterior cruciate ligament reconstruction is a surgical procedure performed with knee arthroscopy. Biological tissues Autograft (self) or Allograft (same species, different individual), are the most successful replacements. Artificial ligaments are available but are only licensed for use after biological graft failure. They are now rarely used because of eventual failure. Arthroscopic methods of knee ligament reconstruction have been developed which allow for small incisions, less postoperative pain, and shorter hospital stays. Rehabilitation is also sped up with this method. A strip of patellar tendon or hamstring tendon is used to replace the torn ligament. These are placed by Arthroscopic technique by drilling tunnels into both tibia and femoral attachment sites. The graft is pulled into the knee, locked in place on the femoral side with an interference screw which wedges between the graft and the surrounding bone. The graft is then tensioned on the tibial side and fixed in a similar fashion here. This allows for early protected knee motion. Ligament reconstruction should generally be delayed after acute injury for four weeks. This minimizes the risk of postoperative knee stiffness. Occasionally, surgery needs to be performed early, when a cartilage tear blocks knee motion and normal walking. Associated meniscal tears may require intervention even if the anterior cruciate is not reconstructed. Repairing or removing the torn portion of the meniscus may provide for a more functional knee. Meniscal repair should not significantly alter the course of rehabilitation. The highest level of function will most likely result if all structures are repaired before additional damage occurs.

Physical Therapists

Sports Medicine
Sports Medicine and Orthopaedics of Rhode Island, requires all physicians, staff, and business associates to protect confidential information. Confidential information that identifies you and your medical treatment, is called Protected Health Information (PHI). We will use your PHI to provide you with the highest quality medical care possible. We will protect the confidentiality of you PHI to the highest degree possible.
Physical Therapy
Because Coumadin has a 24-hour half-life, (meaning that it is only half gone after a full day), a dose the day before surgery has little or no bleeding risk but is protective. To simplify treatment and cost to the patient, I have given patients Coumadin prior to surgery using a small dose and hopefully enough tablets to fill the 3 weeks following surgery. 3 tablets are given only once on the day before surgery around midday. The size of the tablet for every patient is different depending on weight, age, sex, and a guess of nutritional status. When the patient is in the hospital, they receive a smaller dose the day of surgery and monitoring begins. When the patient goes home, physical therapy and a home care nurse visits 2 or 3 times a week, and they can obtain a PT–INR to monitor the Coumadin effect. This needs to be reported to us so any alteration in the dose can be made. With small tablets given prior to surgery, patients generally take 2 or 3 tablets daily until 3 weeks have completed. Following this, there is no need for monitoring of PT–INR.
Tennis Elbow
Prevention of Tendinitis is accomplished by stretching the areas prone to injury and maintaining strength without tendon overload. “Warm-up” should occur before sports. It should include moving through the full range of the joint involved. Overuse injuries are to be avoided. This means decreased activity, away from the sport for rest. Equipment of lightweight with correct grip size is essential to avoid injury. In the case of tennis, string tension should be even and properly adjusted in the racquet. In tennis, new light materials and larger grip diameters may reduce tendon loads. Improved flexibility of racquet and club handles also reduces the risk of tendon injury. Muscle-strengthening will decrease the likelihood of tendon injury. Playing technique is important in avoiding injury. Excessive force or poor stroke mechanics in contacting the ball in golf and tennis may cause “tennis elbow” or “golfers elbow”.
Shoulder Pain
Ankle Sprain
Ankle sprain or ligament injury is a very common injury in sports, work, and normal daily activities. It accounts for a large amount of disability and time out of work and sports participation. The foot and ankle form a complex supporting structure for the body, with the ankle providing a large part of foot motion in the plane of forward motion. The ligaments about the tibiofibular joint and ankle stabilize and guide this basic hinge joint. Ankle ligament injury most commonly occurs with sudden foot inversion, when the outer border of the foot rolls toward the opposite foot. Generally, the anterior talofibular ligament is ruptured first, followed by the calcaneofibular and posterior talofibular ligaments as severity increases. Ankle sprain severity grade is based on a physical exam. The mildest grade has no physical laxity and only ligament tenderness. The second grade has anterior talofibular partial tearing of the ligaments involved, and the third grade has complete ligament disruption. The severity of ligament injury correlates well with a calcaneofibular disability, time to return to work or sports, and the ligament risk of a recurrent ankle sprain. Treatment is based upon the grade or severity of the injury.
Neck Pain

Achilles Tendonitis
Sports or work-related tendon injuries often involve high repetitive loading of tendons with microscopic areas of rupture, surrounding inflammation and scar formation. In the tennis player, golfer or swimmer, this may be seen with a painful elbow or shoulder. In basketball this may be seen as patellar tendonitis of the knee, and in the runner, it may be seen as Achilles tendonitis. Causes of tendonitis include repetitive or acute tendon overload, constriction of a tendon sheath with associated tendon friction, direct blow to a tendon attachment site, or systemic diseases which cause generalized soft tissue inflammation. The site of injury may be at the anchor site of tendon to bone, the mid-substance of the tendon, or at the muscle-tendon junction. In tennis, lateral epicondylitis occurs at the bone-tendon origin of the wrist extensor muscles in the forearm. In golf, the medial epicondylitis is more commonly affected.
Ankle Instability
Orthopedic Ankle ligament reconstruction is sometimes necessary when ankle instability is recurrent and limits normal function. It may also be helpful to slow arthritic changes in an ankle with severe instability and resulting joint damage. This may require arthroscopy of the ankle joint to remove loose debris, along with ligament reconstruction. This is accomplished by advancing the ligaments originally torn free, tightening them, and sewing them in this position. In many instances, one or more ligaments are not present because of the recurrent sprain. In this case, new ligaments are created using a strip of peroneus brevis tendon. This is woven through the fibula and heel bone (calcaneus), through small drill holes, to create new ligaments which recreate normal stability. This allows a high level of function without pain or instability in 85% of cases or greater. Late cases of severe ankle arthritis may occur from chronic recurrent ankle injuries and instability. In this case, the fusion of the ankle may be indicated. With fusion, little loss of motion is generally noticed, but the pain is reduced or eliminated. Ankle Fusion may be performed arthroscopically, generally allowing rapid return to ambulation and early fusion without the disability or healing delay resulting from open surgical fusion.
Ankle Sprain
Ankle treatment is aimed at reducing pain and swelling with rest, ice and compression. In the case of significant ankle laxity, external ankle support aids ligament healing to as near normal as possible. With low grade or single ligament disruption, support may be achieved with functional ankle support or splint. With the high grade, multiple ligament injuries which are as unstable as ankle fractures, cast support or walking boots are indicated. Functional walking boots may give the same support as a cast while allowing for daily bathing and early motion. These are often much more comfortable to wear, but more expensive. As swelling and pain subside, and early healing proceeds, strengthening of the supporting muscles of the ankle is indicated. This aids in stabilizing the joint and restores weakened muscles arising from pain and immobilization after injury. Exercises to aid balance on the affected leg also aids recovery. Surgery is rarely indicated after primary ankle sprain unless fractures coexist or the ligament sprain does not heal with significant improvement in stability, and therapy is ineffective at improving stability to an acceptable level. It is more important for the ankle to be stable against sliding in the front-to-back direction than stable against rolling under into inversion. This is probably also responsible for late arthritis in the long term recurrent sprain.

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