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Patrick Michael Birmingham, M.D.

Patrick Michael Birmingham, M.D.

Patrick Michael Birmingham, M.D.

ACL Tears/Meniscus Tears, Rotator Cuff Tears, Hip Labral Tears
  • Locations

    NOI NorthShore Orthopedics Chicago

    680 N Lake Shore Dr
    Ste 924
    Chicago, IL 60611
    847.866.7846 866.954.5787 fax
    View Map: Google
    This location is wheelchair accessible.

    Endeavor Health Medical Group

    9650 Gross Point Rd.
    Suite 2900
    Skokie, IL 60076
    847.866.7846 866.954.5787 fax
    View Map: Google
    This location is wheelchair accessible.

    Endeavor Health Medical Group

    1942 W. Fullerton Ave.
    Chicago, IL 60647
    847.866.7846 866.954.5811 fax
    View Map: Google
    This location is wheelchair accessible.

    Endeavor Health Medical Group

    2180 Pfingsten Rd.
    Suite 3100
    Glenview, IL 60026
    847.866.7846 866.954.5787 fax
    View Map: Google
    This location is wheelchair accessible.
  • Publications
    • Corticosteroid and Anesthetic Injections for Muscle Strains and Ligament Sprains in the NFL.

      HSS journal : the musculoskeletal journal of Hospital for Special Surgery 2014 Jul

      Authors: Drakos M, Birmingham P, Delos D, Barnes R, Murphy C, Weiss L, Warren R
      Administering local anesthetic or corticosteroid injections in professional athletes to allow return to play is common but has traditionally been viewed as suspect and taboo. The skepticism surrounding therapeutic injections stems predominantly from anecdotal experience as opposed to scientific data.
      The purpose of this paper is to evaluate the current use of corticosteroid injections for muscle strains and ligaments sprains in the National Football League to document player's ability to return to play and possible adverse effects.
      Athletes from a single National Football League team who received at least one corticosteroid or anesthetic injection for either a muscle strain or ligament sprain during three consecutive seasons were retrospectively reviewed. Thirty-seven injections were given over the three seasons. Injections were either performed blindly or by using ultrasound guidance.
      Twice as many defensive players were injected than offensive players. The average number of days of conservative treatment before injection was 6.5 days. All players returned to play after injection. There were no complications from any of the injections. Seventeen (55%) players did not miss a single game, and nine (30%) did not miss a single day. Quadriceps strains were associated with the most missed games (four) and the most missed days (36.5). Proximal hamstring strains were second with an average of three missed games and 28 missed days.
      Corticosteroid injections are a safe and effective therapeutic intervention for treating muscle strains and ligament sprains in order to enable athletes to return to competition earlier.
      PMID: 25050097 [PubMed - as supplied by publisher]
    • The effect of mechanical load on tendon-to-bone healing in a rat model.

      The American journal of sports medicine 2014 May

      Authors: Hettrich CM, Gasinu S, Beamer BS, Stasiak M, Fox A, Birmingham P, Ying O, Deng XH, Rodeo SA
      Joint motion is commonly prescribed after tendon repair surgeries such as rotator cuff repairs; however, the ideal rehabilitation program to optimize tendon-to-bone healing is unknown.
      (1) Delayed loading would result in a mechanically stronger and better organized tendon-to-bone interface compared with prolonged immobilization or immediate loading. (2) Low-magnitude load would lead to superior healing compared with high-magnitude load.
      Controlled laboratory study.
      A total of 192 rats underwent unilateral patellar tendon detachment and repair followed by placement of a custom external fixator. Rats were assigned to immobilization, immediate postoperative loading, or delayed-onset loading (4- or 10-day delay). Loading was controlled using a specially designed motorized device to apply constant strain until 3 N (low load) or 6 N (high load) of axial tensile force was reached through the healing bone-tendon complex for 50 cycles per day. Rats were sacrificed at 4, 10, 21, or 28 days postoperatively for histomorphometric, immunohistochemical, radiographic, molecular, and biomechanical analyses.
      The load to failure was significantly higher in the immobilized group compared with the immediate and delayed loading groups (P < .05). Compared with loaded specimens, the immobilized specimens had significantly less fibrocartilage (at 4, 10, and 28 days), significantly better collagen fiber organization (at 4, 10, and 21 days), decreased expression of matrix metalloproteinase-13 (at 10, 21, and 28 days), and significantly fewer apoptotic cells (at 21 and 28 days). Micro-computed tomographic analyses showed that the 3-N immediate load group had significantly less total volume (P = .012), bone volume (P = .012), and bone mineral density (P = .023) for cortical bone, and the immobilized group had significantly more specimens with new bone formation at the enthesis (100%; P = .001).
      Immobilization results in a stronger tendon-bone complex, with less scar tissue and a more organized tendon-bone interface compared with all loading regimens in this study.
      Given the relatively high rate of failure after rotator cuff and other tendon-to-bone repairs, identification of optimal rehabilitation programs postoperatively is an important research goal.
      PMID: 24692434 [PubMed - as supplied by publisher]
    • The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study.

      The American journal of sports medicine 2012 May

      Authors: Birmingham PM, Kelly BT, Jacobs R, McGrady L, Wang M
      A link between femoroacetabular impingement and athletic pubalgia has been reported clinically. One proposed origin of athletic pubalgia is secondary to repetitive loading of the pubic symphysis, leading to instability and parasymphyseal tendon and ligament injury. Hypothesis/
      The purpose of this study was to investigate the effect of simulated femoral-based femoroacetabular impingement on rotational motion at the pubic symphysis. The authors hypothesize that the presence of a cam lesion leads to increased relative symphyseal motion.
      Controlled laboratory study.
      Twelve hips from 6 fresh-frozen human cadaveric pelvises were used to simulate cam-type femoroacetabular impingement. The hips were held in a custom jig and maximally internally rotated at 90° of flexion and neutral adduction. Three-dimensional motion of the pubic symphysis was measured by a motion-tracking system for 2 states: native and simulated cam. Load-displacement plots were generated between the internal rotational torque applied to the hip and the responding motion in 3 anatomic planes of the pubic symphysis.
      As the hip was internally rotated, the motion at the pubic symphysis increased proportionally with the degrees of the rotation as well as the applied torque measured at the distal femur for both states. The primary rotation of the symphysis was in the transverse plane and on average accounted for more than 60% of the total rotation. This primary motion caused the anterior aspect of the symphyseal joint to open or widen, whereas the posterior aspect narrowed. At the torque level of 18.0 N·m, the mean transverse rotation in degrees was 0.89° ± 0.35° for the native state and 1.20° ± 0.41° for cam state. The difference between cam and the native groups was statistically significant (P < .03).
      Dynamic femoroacetabular impingement as caused by the presence of a cam lesion causes increased rotational motion at the pubic symphysis.
      Repetitive loading of the symphysis by cam impingement is thought to lead to increased symphyseal motion, which is one possible precursor to athletic pubalgia.
      PMID: 22392561 [PubMed - as supplied by publisher]
    • Functional outcome after repair of proximal hamstring avulsions.

      The Journal of bone and joint surgery. American volume 2011 Oct 05

      Authors: Birmingham P, Muller M, Wickiewicz T, Cavanaugh J, Rodeo S, Warren R
      Rupture of the proximal origin of the hamstrings leads to pain, weakness, and a debilitating decrease in physical activity. Repair of these injuries should be based on the expectation that these deficits can be addressed. The goal of this study was to objectively evaluate the efficacy of repair of proximal hamstring avulsions.
      Thirty-four patients were identified retrospectively to have a complete rupture of the proximal origin of the hamstrings based on the presence of a bowstring sign and the results of magnetic resonance imaging (MRI).Patients were contacted for follow-up evaluation to fill out a subjective questionnaire, to undergo functional testing, and to undergo isokinetic testing on a Cybex dynamometer. Twenty-three patients were evaluated.
      There were nine acute and fourteen chronic repairs, and the average period of follow-up was 43.3 months. Twenty-one of twenty-three patients reported returning to activity at an average of 95% of their pre-injury activity level at an average of 9.8 months. Eighteen patients reported excellent results; four, good results; and one, fair results. Hamstring strength was an average of 93% and 90% of that in the uninvolved limb at 240° per second and 180° per second, respectively. The hamstrings-to-quadriceps ratio was 56% for 240° per second and 48% at 180° per second. Hamstring endurance was an average of 81% and 91% of the nonoperative limb at 240° per second and 180° per second, respectively. Postoperative quadriceps strength and endurance were positively correlated with return to pre-injury level of activity (r = 0.6, p < 0.05; and r = 0.6, p < 0.05) and negatively correlated with time to return to sport (r = -0.5, p < 0.05; and r = -0.5, p < 0.05). There was no significant effect associated with age or time from injury.
      Repair of a symptomatic and displaced ruptured proximal hamstring tendon yields good subjective and objective functional results with minimal complications. Overall, patients are satisfied with surgical repair and experience return of functional activity with minimal postoperative weakness.
      PMID: 22005868 [PubMed - as supplied by publisher]
    • Recurrent posterior dislocation of the hip with a bankart-type lesion: a case report.

      The American journal of sports medicine 2010 Feb

      Authors: Birmingham P, Cluett J, Shaffer B
      PMID: 19684290 [PubMed - as supplied by publisher]
    • Outcome of latissimus dorsi transfer as a salvage procedure for failed rotator cuff repair with loss of elevation.

      Journal of shoulder and elbow surgery 2008

      Authors: Birmingham PM, Neviaser RJ
      Eighteen patients, referred from an outside institution with massive, irreparable rotator cuff tears and loss of elevation, were treated with a latissimus dorsi tendon transfer as a salvage procedure for failed, prior, attempted rotator cuff repair. Clinical outcomes were measured by the American Shoulder and Elbow Surgeon's (ASES) score, pain level, and active range of motion. The average postoperative ASES score was 61, an increase from 43 pre-operatively (P = .05). Active elevation improved to an average of 137 degrees compared to 56 degrees pre-operatively (P < .001). The average post-operative pain level was 22 mm, down from 59 (P = .001), and the average post-operative active external rotation at the side was 45 degrees, improved from 31 degrees (P < .001). We conclude that latissimus transfer, as a salvage procedure for failed rotator cuff repair with loss of elevation, allows for significant return of active elevation and function with minimal post-operative pain.
      PMID: 18760633 [PubMed - as supplied by publisher]
    • Case reports: treatment of subtrochanteric and ipsilateral femoral neck fractures in an adult with osteopetrosis.

      Clinical orthopaedics and related research 2008 Aug

      Authors: Birmingham P, McHale KA
      We describe a patient with autosomal-dominant osteopetrosis, a subtrochanteric fracture, and an ipsilateral femoral neck fracture treated with a hip spica cast Although the fracture united with coxa vara and external rotation deformities, the patient successfully returned to his normal activities of daily living. Operative fracture treatment in patients with osteopetrosis is difficult, and our patient provides evidence that with nonoperative treatment these patients can return to a functional level when operative treatment is not an option.
      PMID: 18431613 [PubMed - as supplied by publisher]
    • Simulated joint infection assessment by rapid detection of live bacteria with real-time reverse transcription polymerase chain reaction.

      The Journal of bone and joint surgery. American volume 2008 Mar

      Authors: Birmingham P, Helm JM, Manner PA, Tuan RS
      Although microbiological bacterial culture is currently considered the gold standard for diagnosis of septic arthritis, many studies have documented substantial false-negative and false-positive rates. The objective of this study was to determine whether real-time quantitative reverse transcription polymerase chain reaction can be used to detect bacterial messenger RNA (mRNA) in synovial fluid as a way to distinguish live and dead bacteria as an indicator of active infection.
      Synovial fluid samples were obtained from twelve consecutive patients who presented with knee pain and effusion but no evidence of infection. Following assurance of sterility with plate cultures, each sample was inoculated with clinically relevant bacteria and incubated for twenty-four hours to simulate septic arthritis. Bacterial viability and load were assessed with cultures. Selected samples were also treated with a single dose of a combination of two antibiotics, vancomycin and gentamicin, and sampled at several time points. Total RNA isolated from each sample was analyzed in triplicate with one-step real-time quantitative reverse transcription polymerase chain reaction to detect mRNA encoding for the genes groEL or femC. Controls included sterile, uninoculated samples and inoculated samples analyzed with quantitative polymerase chain reaction without reverse transcription. mRNA content was estimated on the basis of detection limits as a function of serial dilutions and was expressed as a function of colony number in bacterial cultures and RNA content as determined spectrophotometrically.
      All synovial fluid samples that had been inoculated with one of the four bacterial species, and analyzed in triplicate, were identified (distinguished from aseptic synovial fluid) with real-time quantitative reverse transcription polymerase chain reaction; there were no false-negative results. All inoculated samples produced bacterial colonies on culture plates, while cultures of the aseptic samples were negative for growth. The detection limit of the one-step bacterial mRNA-based real-time quantitative reverse transcription polymerase chain reaction varied depending on the bacterial species. A time-dependent decrease in the concentration of detectable bacterial mRNA was seen after incubation of bacteria with antibiotics.
      The direct quantification of the concentration of viable bacterial mRNA with real-time quantitative reverse transcription polymerase chain reaction allows identification of both culture-positive bacterial infection and so-called unculturable bacterial infection in a simulated septic arthritis model. In contrast to conventional polymerase chain reaction, real-time quantitative reverse transcription polymerase chain reaction minimizes false-positive detection of nonviable bacteria and thus provides relevant information on the success or failure of antibiotic therapy.
      PMID: 18310711 [PubMed - as supplied by publisher]
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