Author Archives: James Hundley, MD

About James Hundley, MD

Dr. Hundley is a retired orthopaedic surgeon and the originator and co-founder of, a resource website for orthopaedic surgeons and related professionals.

Musculoskeletal Ultrasonography, The Perspective of a Medical Ultrasonography Instructor

by Laura Currie, B.S., RT(R), RDMS, RVT, RMSKS

As a sonography student in 1986, the subject of my graduation project was “Ultrasound Evaluation of the Rotator Cuff”.  The procedure was in its infancy on the West Coast but beginning to see increased use in some regions of the country.  The scans were performed by Radiologists with a particular interest in sonography and a willingness to accept the challenge.

I was fortunate to have worked with one of those Radiologist, Dr. Charles Pope, in Raleigh, NC from 1988 – 2005.  Dr. Pope had a great working relationship with many of the Orthopedic Physicians in the capital city and they referred patients for shoulder ultrasounds first to rule out rotator cuff tears.   Two days per week were reserved for shoulder patients and we averaged 16-20 rotator cuff scans per week.  As ultrasound technology advanced, we were increasingly confident in diagnosing partial thickness tears, avulsion fractures and tendon calcifications in addition to complete tears.  MRI procedures were seldom required for these patients.

In 2005 I relocated to Wilmington and began teaching in the CFCC Medical sonography program.  I was surprised to find that ultrasound was not being used to diagnose rotator cuff tears in my new community.  For the past 15 years, I have followed the growing MSK Sonography modality and watched from afar as it expanded to include scans of all upper and lower extremity joints.  Yet after 15 years of continued growth in the MSK sonography field, my community remains underserved in this modality.  While it is being used for guided therapeutics and surveillance of rheumatoid arthritis treatments, the use of ultrasound to diagnose joint/tendon injuries and pathologies has been quite slow to catch on here.

One reason for this delay is that MSK sonography is very operator dependent and our community lacks experienced MSK sonography practitioners.  As with any new medical technique or procedure, appropriate training and practice is necessary.  Some Radiologists have ultrasound scanning experience, but may not be comfortable in their ability to acquire MSK images. Orthopedic Physicians may also have been exposed to ultrasound use in their residencies and fellowships but the learning curve is steep and requires consistent exposure and practice.

Diagnostic Medical Sonographers already possess the foundation needed to learn MSK sonography and thus are able to hone the required skills at a faster pace.  CFCC sought the opinion of the sonographers in our community and found sufficient levels of interest and desire to learn MSK sonography.  In response to this interest, CFCC offered our first MSK Sonography Program in the spring of 2020.   Our curriculum includes instruction in anatomy, scan techniques, protocols and pathologies of all upper and lower extremity joints.  Students also learn the dynamic techniques that can be performed while scanning, which gives ultrasound an advantage over MRI scans.

Our first class of students included sonographers, Physical Therapists and Physicians Assistants from North Carolina, Virginia and California.  Two sonographers in Wilmington completed the first MSK course and are ready to scan shoulders, elbows, wrists, hands, hips, knees, ankles and feet.  Our Medical Sonography program plans to continue training additional sonographers and Physicians each year with the next MSK sonography course starting on January 7, 2021.

Education and training are essential to the availability of these cost-effective and convenient MSK sonography procedures in our community.  Now that this training is available, what else needs to be done before MSK sonography can move forward in Wilmington?  Is there an established dialogue between local Orthopedic Physicians and Radiologists to discuss interest in referring patients for MSK Sonography procedures and the procedures that are available?  I look forward to hearing about MSK Sonography progress in the near future.


Laura Currie is a North Carolina native and a graduate of Greensboro College, Moses Cone Radiologic Technology Program and the UNC-CH Medical Sonography Program.   She has worked as a staff sonographer at Duke University Medical Center and as a Supervisor and sonographer at Wake Radiology Diagnostic Imaging in Raleigh, NC.  

Laura is registered through the American Registry of Diagnostic Medical Sonographers holding RDMS credentials in Abdomen, OB-GYN and Neonatal Neurosonography specialties.  She also holds the RVT credentials for vascular technology and most recently earned the new RMSKS credential for musculoskeletal sonography.  In addition, Laura is a registered Radiologic Technologist. 

Laura is the Clinical Coordinator for the Medical Sonography Program at Cape Fear Community College and teaches sonographic physics, vascular sonography, obstetrical sonography and musculoskeletal sonography.  She is a past president of the North Carolina Ultrasound Society and has worked with the Society as a member of the Board of Directors and an Administrator to bring quality continuing education to sonographers throughout the Carolinas.

Ultrasonography in Evaluating Rotator Cuff Tears

by Richard J. Nasca M.D., FAAOS

Nearly half a million people are affected with rotator cuff tears each year. Most, but not all, patients with rotator cuff tears give a history of injury to the shoulder at the onset of their pain, decreased range of motion with altered function and persistent night pain that interferes with their sleep.

The examiner will find weakness of the torn rotator cuff muscles during manual muscle testing, a disconnect in scapulohumeral rhythm and poor control of the unsupported, abducted upper extremity.

A reliable, non-radiographic method for confirming the diagnosis would be welcomed by patients and providers. Several studies comparing, Ultrasonography and magnetic resonance imaging (MRI) have demonstrated ultrasound to be as reliable and accurate in confirming full thickness rotator cuff tears as MRI. (1,2,3,4)

Ultrasound is readily available during an office visit, more cost effective than MRI and can be used when metal artifact would be an issue with MRI. Unlike MRI, ultrasound can be done without delay bypassing the difficulty in getting insurance approval and scheduling MRI, all of which can sidetrack definitive treatment.

Considering that ultrasound has been found to be reliable and accurate in confirming full thickness rotator cuff tears when performed by experienced operators using high-quality units, why is there still the need to order MRI which may not be readily available, very expensive and sometimes an uncomfortable experience for a claustrophobic patient to undergo?

Other than concerns about the quality of the unit and experience of the operator, I can see no reason that if a tear is seen on ultrasound and the history and physical examination also support the diagnosis, the surgeon should feel compelled to order an MRI. Rather it would seem prudent and reasonable for him or her to perform surgical repair with confidence.


  1. Diagnostic Accuracy of Ultrasound in Rotator Cuff Tears, Okoroba KR, Fidal MS, Tramer JS, Davis KD. Ultrasonography; Nov 2018, 38(3),1-15.
  2. Effect of surgeon -sonographer interaction on ultrasound diagnosis of rotator cuff tears: a five -year cohort study in 775 shoulders. Kurz AZ, Kelly MJ Hackett L, Murrell GA. J Shoulder Elbow Surg 2016;25:1385-1394.
  3. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: A systemic review and meta-analysis. Smith TO, Back T, Toms AP, Hing CB. Clinical Radiology 2011; 66: 1036-1048
  4. Accuracy of MRI, MR arthrography and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. De Jesus JO, Parker L, Frangos AJ, Nazarian LN. AJR Am J Roentgenol 2009,192:1701-1707
  5. Detection and measurements of rotator cuff tears with sonography: analysis of diagnostic errors. Teefey SA, Middelton WD, Payne WT, Yamaguchi K. AMJ Am JRotengen 2005;184:1768-1773.

Dr. Nasca was born in Elmira NY and is a graduate of Georgetown College and Georgetown Medical School. He completed his internship at the Hospital of the University of Pennsylvania and post graduate training in Surgery and Orthopaedics at Duke University Medical Center and Affiliated Hospitals. Dr. Nasca served as Chief of the Amputee and Hand Services at the Philadelphia Naval Hospital caring for Vietnam casualties.

Dr. Nasca held teaching appointments in orthopaedic surgery at the University of Arkansas School of Medicine and the University of Alabama School of Medicine.  During his time in practice he specialized in caring for patients with spine deformities, injuries and disorders. 










It’s Time for Fix the Oppressive U.S. Healthcare System

by Alejandro Badia, MD, FACS  

Respected Surgeon Offers Seven Solutions to Save U.S. Healthcare

 Miami, Florida – Dr. Alejandro Badia is no stranger to the flaws and frustrations of the U.S. healthcare system. A leading hand surgeon with a medical degree from NYU, multiple accolades, and decades of experience, Dr. Badia has spent more than a quarter-century in the trenches of U.S. healthcare. His new book Healthcare from the Trenches is an open discussion of the failure of the U.S. healthcare system from the perspectives of its “providers” and patients—perspectives today’s healthcare debate sorely lacks.

Dr. Badia shares the input from 27 contributors including physicians, therapists, nurses, hospital administrators, offering these seven solutions:

  1. Involve healthcare providers in the healthcare conversation—not just politicians, lobbyists, and insurance administrators who have no medical training or experience in patient care.
  2. Get rid of the middle-man—administrators and insurance companies—in the healthcare system to create a more efficient and less bloated system. Additional administrators only add to the cost of healthcare while doing nothing to contribute to actual care.
  3. Require Hospitals and Health Insurance companies become Non-Profit. Eliminate multi-million dollar salaries to executives for ‘withholding’ care to keep costs down and their paychecks UP!
  4. Encourage more all-in-one facilities so patients do not need to wait weeks for results they should be able to see in a few hours. Not only does this streamline care, but it significantly reduces costs as well.
  5. Require increased transparency in healthcare pricing.
  6. Teach Doctors to collaborate rather than compete. They must stand together in the healthcare debate, offering solutions rather than capitulating to lobbyists and insurance companies.
  7. Educate the public on the issues doctors and patients face from today’s inefficient healthcare system. Change can only come from a public that demands it.

“Instead of simply squatting under the dark cloud of our current healthcare system, Dr. Badia stands tall and offers the opinions and perspectives of healthcare providers and patients.”

– Grady Harp, Amazon Top 50 Hall of Fame Reviewer, 5-stars

Dr. Badia explains, “Despite the political debates and media coverage on healthcare policy and reform, there remains little or no feedback from the people in the trenches—the physicians and other health care professionals who provide care to the patients. That’s why I wrote Healthcare from the Trenches. My hope is that a broader discussion of the issues can be a catalyst to positive change.

Dr. Badia is the founder and chief medical officer of the Florida-based OrthoNOW®, a pioneering network of single-specialty, immediate orthopedic care centers in South Florida.

“Dr. Badia passionately believes that the key participants in every healthcare transaction deserve a voice, and this is just what Healthcare from the Trenches does.”

– Susan Keefe, Midwest Book Review and Columbia Book Review, 5-stars

 “The goal is to provide the patient with the care they need, at the time they need it, minimizing any interference to that process,” says Dr. Badia. “This is a life and death matter and people are dying because of a flawed system. It’s time for every American to be educated about the root causes of our healthcare crisis and demand meaningful reform.”

Healthcare in the Trenches: An Insider Account of the Complex Barriers of U.S. Healthcare from the Providers and Patients’ Perspective, ISBN 978-0-57868-099-6 (Paperback) $19.97, AISN B088PSH2RL (eBook) $2.99, 2020, Badia Hand to Shoulder, 465 pages, available at Amazon or

Alejandro Badia, M.D., F.A.C.S. has been in the trenches with our broken healthcare system since 1989

A hand and upper extremity orthopedic surgeon at Badia Hand to Shoulder Center in Miami, Florida, Dr. Badia previously served as Chief of Hand Surgery at Baptist Hospital of Miami. He studied physiology at Cornell University and obtained his medical degree at New York University, where he also trained in orthopedics. A hand fellowship at Alleghany General Hospital in Pittsburgh was followed by an AO Trauma fellowship in Freiburg, Germany. He runs an active international hand fellowship and previously organized a yearly Miami meeting for surgeons and therapists that was devoted to upper limb arthroscopy and arthroplasty. In 2005, Dr. Badia cofounded the Miami Anatomical Research Center (M.A.R.C.), one of the world’s largest surgical cadaveric training labs.

In 2008, he completed the Badia Hand to Shoulder Center, a fully integrated clinical facility for the upper limb also encompassing the Surgery Center at Doral, rehabilitation and an MRI imaging facility. More recently, Dr. Badia inaugurated OrthoNOW®, the first intermediate orthopedic urgent care center in South Florida. OrthoNOW® was officially franchised in early 2013 and is actively engaging healthcare entrepreneurs and surgeons, in North America and abroad, to open immediate orthopedic care facilities.

For more information on Dr. Badia, visit, and

Media Contact: For a review copy of Healthcare from the Trenches or to arrange an interview with Dr. Alejandro Badia, contact Scott Lorenz of Westwind Communications Book Marketing at or by phone at 248-705-2214. Follow Lorenz on twitter @abookpublicist

For more information about Dr. Badia’s book, click on Healthcare from the Trenches.



Bone, Inside and Out, A Synopsis

by Roy A. Meals, MD


Human bone is versatile and entirely unique: it repairs itself without scarring, it’s lightweight but responds to stresses, and it’s durable enough to survive for millennia. In Bones, orthopedic surgeon Roy A. Meals explores and extols this amazing material that both supports and records vertebrate life.

Inside the body, bone proves itself the world’s best building material. Meals examines the biological makeup of bones; demystifies how they grow, break, and heal; and compares the particulars of human bone to variations throughout the animal kingdom. In engaging and clear prose, he debunks familiar myths―humans don’t have exactly 206 bones―and illustrates common bone diseases, like osteoporosis and arthritis, and their treatments. Along the way, he highlights the medical innovations―from the first X-rays to advanced operative techniques―that enhance our lives and introduces the giants of orthopedic surgery who developed them.

After it has supported vertebrate life, bone reveals itself in surprising ways―sometimes hundreds of millions of years later. With enthusiasm and humor, Meals investigates the diverse roles bone has played in human culture throughout history. He highlights allusions to bone in religion and literature, from Adam’s rib to Hamlet’s skull, and uncovers its enduring presence as fossils, technological tools, and musical instruments ranging from the Tibetan thighbone kangling horn to everyday drumsticks. From the dawn of civilization through to the present day, humankind has repurposed bone to serve and protect, and even to teach, amuse, and inspire.

Approachable and entertaining, Bones richly illuminates our bodies’ essential framework.

150 illustrations

See more on by clicking on BONE, INSIDE AND OUT.

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The STIC Intra-Compartmental Pressure Monitor System by C2Dx

by Rob Salter, Internal Product Specialist, C2Dx, Inc.

C2Dx is the exclusive manufacturer of the STIC Intra-Compartmental Pressure Monitor System previously supplied by Stryker. The company is led by a team of medical device industry veterans with years of experience providing superior products and service to customers around the globe. Our company is privately held and dedicated to providing world class products and service to healthcare professionals, while driving costs out of the healthcare continuum.

Compartment syndrome is one of the few true orthopedic emergencies and the consequences can be dire. A delay in diagnosis often leads to delayed treatment, causing irreversible muscle damage after 8 hours and irreversible nerve damage after 6 hours. The leading causes of malpractice claims filed against orthopaedic surgeons is missed compartment syndrome. These suits involve 87% delays in diagnosis and 37% delays in treatment, with 65% of total suits won by the plaintiff.

As described, time to diagnosis is one of the most prognostic factors, yet the ambiguity of the clinical signs may lead to delay. Many clinical exam findings are lagging indicators while pain out of proportion is the only leading indicator. Pain has low sensitivity, is considered subjective and on its own, inconclusive. Individual signs have only 13 – 54% sensitivity and 3+ signs are required for 98% sensitivity.

Recognized as the Gold Standard for over 30 years, the STIC Intra-Compartmental Pressure Monitor provides quick and continuous measurements, which adds valuable data to your clinical assessment for a prompt and more informed decision. Results show 94% sensitivity, 98% specificity, and 99% negative predictive value (Duckworth and McQueen, 2019).

Additional benefits of the STIC Monitor System include:

  • Sterile disposables for a simple, rapid set-up
  • Proven accuracy and reliability with strong clinical evidence
  • Hand-held with convenient pre-filled syringe for easy transport
  • Cost effective with a dedicated CPT reimbursement code

Click here to learn more about the STIC Intracompartmental Pressure Monitor System.

Examples of Who and Why Healthcare Institutions are Transitioning to Reusable Isolation Gowns

by Michael Benko

This year has been tough one for everyone including the professionals in charge of safety supplies, PPE and materials management. The struggle to keep healthcare employees safe during a pandemic is harder than it sounds. Covid-19 hit the world like a runaway train and unfortunately, it still hasn’t found its brake lever. The need for quality PPE, including isolation gowns is at an all-time high, but the supply remains elusive at best.

Prior to Covid-19, disposable isolation gowns were considered the typical answer to most Purchasing Directors’ question of “What type of isolation gown does my facility need?”. The disposable isolation gown was readily available from many overseas manufacturers, at a price that satisfied the bottom line. The number of gowns needed on any given day was low enough that any facility could order what they needed in advance and keep an ample supply level. My goodness, how things have changed.

Due to the increase in the need, and the decrease in availability, many hospitals and healthcare facilities have transitioned to reusable isolation gowns. This is not a new, or novel, idea. In fact, prior to the access to cheap plastic and polymer type materials over the last few decades, reusable items, including isolation gowns, were utilized at much higher rate than they are today. It wasn’t until the healthcare community was slapped in the face with a pandemic, and a need to change antiquated habits, that the idea and popularity of reusable isolation gowns came back into vogue. But the question that continues to come up is “Who has transitioned to, or who is already using reusable isolation gowns, and how have they done it?” The purpose of this article is to shed light on these questions.

Some proactive institutions that have led the way on this front. In some cases, due to the need that the H1N1 pandemic a few years ago revealed the lack of preparedness that the overall healthcare community was facing. In some cases, it was due to the massive amounts of waste and overuse of single use items. In other cases, it was due to the huge costs involved with having to purchase so many disposable items. Regardless of the reasons, the outcomes have been documented, and the benefits should be plastered everywhere.

Following is an excerpt from that was published back in December, 2015, following the impact of H1N1. The link to the article is here:

“Ronald Reagan UCLA Medical Center, located in West Los Angeles, began a reusable isolation gown pilot project in May 2012, starting with a liver transplant unit that was using 1,000 disposable isolation gowns per day. During a collaborative six-month trial period, the reusable isolation gown design was finalized and rolled out. The reusable gowns offer more comfort and better protection than their disposable counterparts, and can be laundered and reused 75-100 times. More than 3.3 million reusable gowns have been used at both hospitals since the implementation, representing a financial savings of over $1.1 million, on purchase alone. Since 2012, a total of 297 tons of waste has been diverted from landfills as a direct result of the reusable gown program.”

The savings in cost, and reduction in waste, were realized after only three years. We can only speculate the cost savings and waste reductions, since then, and since the current, arguably the worst, pandemic in modern history, Covid-19, wreaked havoc on the medical world. It goes on to say,

“Isolation gowns are used by practitioners, housekeepers, and visitors when entering the room of a patient on precaution. These gowns are single-use disposables. At Ronald Reagan UCLA Medical Center, on average approximately 6,000 gowns were being used per day (2.2 million gowns per year). In order to reduce the waste associated with isolation gowns, the academic and healthcare sides of UCLA came together in 2012 to pilot the use of reusable isolation gowns.”

It is easy to see that the benefits were plenty, and on many fronts. Although not all healthcare facilities were as forward thinking as UCLA prior to Covid-19, many have since made the transition to reusable isolation gowns since, due to the caring need that they were confronted with.

In a more recent article written by Will Maddox, published in Healthcare Business in May, 2020, and posted on (, the following statements were made:

“Alan Bonds is the general manager of the North Texas Health Care Laundry, which is a nonprofit cooperative owned by Baylor Scott & White Health, Texas Health Resources, and Methodist Health that launders linens, scrubs, and gowns for 50 hospitals and 500 clinics in North Texas. The nonprofit employs 300 people and processes about 1 million pounds of hospital laundry a week. When the pandemic began to grow, he placed orders for more reusable gowns and scrubs to be ready for what he thought was coming. 

 As more hospitals move to reusable PPE to avoid shortages, there may be economic and environmental benefits, but making sure hospitals are prepared for a second wave is reason enough to plan ahead. “The supply chains worldwide were caught off guard, who knew this was going to happen?” Bonds says. “Everyone is trying to be prepared so that next time this happens we are not caught off guard.” “

The article goes on to state the following with multiple quotes from Dr. Cohen:

“As the pandemic took hold, PPE was suddenly in high demand and price gouging became an issue. Manufacturers of disposable equipment are based largely in China and India, which were dealing with their own economic and health issues. By early spring, supply lines were cut off. Suddenly, reusable PPE became the alternative protection gear. “Studies show that reusable items are better for the environment, reduce solid waste generation, energy, water use and cut greenhouse gas emissions,” writes Dr. Murray Cohen, a now retired infectious disease epidemiologist.”

 “Reusable personal protective equipment, scrubs, patient gowns and other reusable healthcare garments have already proven safe and effective and more sustainable than disposable products,” writes Cohen, who notes that this equipment can be used 80 to 100 times rather than just once. “The utilization of reusable PPEs, once the industry standard, needs to be greatly expanded to prevent the types of shortages being experienced now at hospitals nationwide.”

The demand for reusable isolation gowns has grown exponentially and will continue to transform the norm, from disposable to reusable, for years to come. In a recent publication, even household names in the garment industry have begun to produce reusable isolation gowns. The following is an article regarding Hanes Brands, which is now producing reusable isolation gowns to be used by FEMA:

“The long-sleeve medical gowns are made from fabric designed to be splash resistant and can be washed and reused. They will be distributed by FEMA to hospitals nationwide and temporary treatment facilities.”

Green Leaf Medical Solutions, LLC was created to deliver the best-in-class, most comfortable, reusable, Level 2 Isolation gown to whoever needs it. To deliver it to them in the shortest time frame possible by utilizing a 100% American workforce and proudly claiming Made in the USA. But even reusable isolation gowns will eventually have to be discarded, and the idea of just reducing waste was not enough for Green Leaf Medical Solutions.

Thus, we created a closed loop system, that allows for the retired gowns to be returned to a repurposing facility, that will break down the used 100% polyester fabric and create new, usable polyester fabric. This is the closest thing the industry has to a zero-waste system, period.

EZ-USE Reusable Isolation Gowns allow for up to 50 washes before having to be retired. Once you have an order of them in rotation at your facility, you will always be only one laundry day away from a fresh, clean batch of isolation gowns. Compare that to the number of disposable gowns that you have to go through on a weekly, monthly, or annual basis. EZ-USE, Level 2 reusable isolation gowns give you the confidence that you will never run out of critical isolation gowns again.

Nevertheless, many facilities and healthcare organizations have NOT made the change to reusable isolation gowns. Many times, it is simply because of uncertainties, namely the cost and process of laundering.

First, what about the cost? We would be foolish to create a product that no one can afford. Yes, the cost to produce in the USA is more expensive than overseas production. Yes, the usage of premium materials has its price as well. That’s where the beauty of mathematics comes in.  You can reuse the EZ-USE reusable isolation gown up to 50 times vs. a disposable isolation gown only being able to lawfully be used once. When you divide the cost per gown, by the number of uses, and add in the cost to launder, the cost per use is around $0.83 cents. The current cost of disposable isolation gowns is still elevated from pre-COVID pricing and can be as high a $4.00 per gown. Even at pre- COVID pricing for disposable isolation gowns, the EZ-USE Reusable Isolation Gown is a BARGAIN!

Second, the process to launder reusable isolation gowns was clearly laid out by both the CDC and Joint Commission. The process is simple, fast and the laundering process is no more arduous than washing other materials. Highlights of the procedure to launder reusable isolation gowns is as follows:

– Do not shake dirty laundry; wear PPE when handling.

– Follow manufacturer’s instructions- warmest water setting for the item and dry completely.

-Dirty laundry that has been in contact with COVID-19 patient can be washed with general laundry.

– Clean and disinfect laundry room surfaces, washers, hampers or other carts for transporting laundry according to guidance for hard or soft surfaces.

− If using reusable gowns, notify laundry services.

This is why so many healthcare organizations, hospitals, clinics, and even the US government have started making the transition to reusable isolation gowns. If you are on the fence about how to protect your healthcare employees, doctors, nurses, and staff, and would like to discuss how Green Leaf Medical Solutions, LLC may be able to show you that our gowns are GREENER on the other side, feel free to reach out to me anytime.

Thanks for taking the time to read.  I look forward to helping you find a SOLUTION!

Michael Benko, Green Leaf Medical Solutions, LLC


To learn more about EZ-USE, Reusable, Isolation Gowns, please click here.

Why Recreate the Isolation Gown?

by Michael Benko, Owner, Green Leaf Medical Solutions, LLC

Green Leaf Medical Solutions, LLC was created to solve the problems that we saw in the Healthcare community when the world was introduced to the pandemic know as Covid-19. Prior to Covid-19 disposable isolation gowns were the norm. They were cheap, readily available, and the demand was low enough, that no one thought about the use of disposable isolation gowns as a primary focus point. Materials management, Supplies Directors, Purchasing Executives and the like, went about their daily tasks of ordering what they needed, when they needed it. Status quo worked. Why rock the boat if there isn’t a need?

Then Covid came along and shocked the healthcare community to the core. Hospitals were overrun. Demand skyrocketed for all PPE, including disposable isolation gowns, and so did the prices. The entire world was in a battle to source effective, compliant PPE. In addition to the need for more supply, political tensions heated up and international sourcing became even more difficult, time consuming, and expensive. The available supply of all PPE equipment dried up almost overnight, as the need continued to climb along with the positive cases of Covid-19. This is when, what we call, ’Crisis-Mode” occurred.

Nurses, doctors, hospital staff members, and HCPs were using whatever they could find to act as PPE. HCPs tried desperately to find new ways to protect themselves and their patients with limited supplies of isolation gowns, face masks, head covers and almost all other types of disposable PPE equipment. The FDA and Joint Commission even started to allow healthcare workers to reuse disposable PPE equipment and coined it “Conservation Methods”. Something that has never been done in the past, due to the risk involved. On August 14, 2020, that statement has since been retracted and facilities must now use 1 gown/patient/visit. Increasing, once again, the number of disposable isolation gowns that will be needed. Something had to be done. This is why Green Leaf Medical Solutions, LLC was created.

Green Leaf Medical Solutions, LLC didn’t invent the reusable isolation gown, but we did RE-INVENT the reusable isolation gown. In fact, we like to think that Green Leaf Medical Solutions, LLC PERFECTED the reusable isolation gown.

Most isolation gown users do not like utilizing a reusable isolation gown for multiple reasons. One being due to the inefficiency of donning and doffing, having to untie the gown in 2 separate places in hard to reach locations, often times after being ‘contaminated’. Another reason is comfort. Most reusable isolation gowns are created with the least expensive material the manufacturer can find. They are heavy, hot and stiff. Many times the fit is less than optimal as well. Leading to an increase in non-compliance and possible accidental contamination.

The patent pending EZ-USE design of the Green Leaf Medical Solutions Level 2 (ANSI/AAMI PB70), reusable isolation gown solves these issues, and more. The design of the EZ-USE Isolation Gown allows for SAFE, single person donning and doffing, and is as easy as tearing off a cheap, less effective disposable isolation gown. The 100% polyester material is the best in the business and has a tight weave, that gives the EZ-USE Isolation Gown, a soft, cool, comfortable feel. It’s presentation is professional and end users love to wear it. Green Leaf Medical Solutions designed a novel and unique thumb hole that is unparalleled in the isolation gown market. This unique thumb hole design allows for easy access to insert the thumb while donning the gown. As an added level of professionalism, any healthcare facility, hospital, workforce, or company can add their logo to the EZ-USE Level 2 Reusable Isolation Gowns at no extra charge. This adds a level of professionalism and uniformity to all who see it.

While attempting to solve the availability issues that Covid-19 brought to the healthcare community, Green Leaf Medical Solutions had to do something that very few companies are willing to do, MADE IN THE USA. We decided that every single part and piece, from the fabric weaving, to the cut and sew operations, had to be done in our own backyard. The fabric is produced in the state of North Carolina, and the manufacturing of the EZ-USE isolation gown is done in Georgia. Both within a stone’s throw from our headquarters in the great state of South Carolina. We are truly MADE IN THE USA, and we are very proud of that fact. This allows the ‘lead time’ to be very short. In most situations we can deliver up to

10,000 brand new, premium, EZ-USE level 2 reusable isolation gowns per week, with a lead time of only 2 weeks.

EZ-USE Reusable isolation gowns allow for up to 50 washes before having to be retired. Once you have an order of them in rotation at your facility, you will always be only one laundry day away from a fresh, clean batch of isolation gowns. Compare that to the number of disposable gowns that you have to go through on a weekly, monthly, or annual basis. EZ-USE level 2 reusable isolation gowns give you the confidence that you will never run out of critical isolation gowns again.

But what about the cost? We would be foolish to create a product that no one can afford. Yes, the cost to produce in the USA is more expensive than overseas production. Yes, the usage of premium materials has its price as well. That’s where the beauty of mathematics comes in…

With the EZ-USE reusable isolation gown, you are able to reuse it up to 50 times vs. a disposable isolation gown only being able to lawfully be used once. When you divide the cost per gown, by the number of uses, and add in the cost to launder, the cost per use is around $0.83 cents. The current cost of disposable isolation gowns is still elevated from pre-Covid pricing and can be as high a $4.00 per gown. Even at pre-Covid pricing for disposable isolation gowns, the EZ-USE Reusable Isolation Gown is a BARGAIN!

Lastly, and in our mind, the most important part, is the environment. The healthcare system in North America alone disposed of an estimated 5 million tons of single use plastic/polymer items into our landfills last year. That’s 10 BILLION pounds. That’s right, Billion… with a B! Green Leaf Medical Solutions, LLC is partnering with a 3rd party organization to take back all EZ-USE isolation gowns after they are retired. They will then repurpose the entire gown and reuse the created fabric. This is as close to a ZERO- WASTE closed loop cycle as possible. We may not be able to single handedly alter the course of the environment, but together, we can be part of the SOLUTION, instead of being part of the problem. As an added incentive to facilities choosing the path less traveled… the GREEN path, we offer 10% discounts on all future orders once the majority of the total EZ-USE gowns originally purchased are return to the repurposing facility.

That is the story of Green Leaf Medical Solutions, LLC. This is why we do what we do. Our goal is to help the healthcare community… Be safe, be prepared, look professional, feel good, be confident, save money, and do their part to help save this amazing planet…EARTH!

Please click here to learn more about the EZ-USE, Disposable, Isolation Gown.


Cost-per-Use Analysis and Reasons to use the EZ-USE Isolation Gowns

Why Choose EZ-USE reusable isolation gowns?

  1. The EASE-OF-USE of the patent pending “EZ-USE” design makes donning and doffing:

    a. Faster and easier, completely eliminating ties.
    b. Able to be doffed one handed, safely by a single user, without secondary assistance. c. More efficient, saving time and money.
    d. Safer, reducing the risk of cross contamination.
    e. More comfortable to the staff, potentially increasing compliance.
    f. Eliminates the need for additional staff members to don and doff for others.

  2. It is 100% Made in the USA and Berry Compliant:

    a. Green Leaf Medical Solutions, LLC is headquartered in Summerville, SC.
    b. The premium ANSI/AAMI PB70 Level 2 fabric is produced in North Carolina. c. The EZ-USE gown is manufactured in Swainsboro, GA.

    1. This allows for fast turnaround time; from P.O. to delivery in as little as 2 weeks.
    2. Decreases the risk of delayed shipments from international manufacturing.
    3. Increases availability vs. international manufacturing.
    4. Allows for constant and complete oversight of production; less risk of delays and

      receipt of faulty product.

    1. With reusable isolation gowns, you will always have a fresh supply of gowns each day.
    2. Covid-19 taught us that the availability of important PPE equipment can disappear faster than than we can reorder it, without any warning, putting you in a crisis situation.

    c. Using “Conservation Methods” was a bandaid on a bullet hole, which lead to some getting unnecessarily sick, and is no longer permissible according to Joint Commission.

    1. Reusable isolation gown utilization allows for constant availability of supply, no matter the situation.
    2. Decreases the stress and hassle of having to constantly reorder sub-par, inferior gowns, over and over again, saving your time for more important things.
  4. COST, plain and simple.
    1. With up to 50 uses per reusable isolation gown, the cost per use is about the
      same as pre-covid pricing pricing for disposable gowns, even with the cost to launder included.
    2. The average cost of the EZ-USE gown is $26.50/gown (depending on volume).

    c. Divide $26.50 by 50 uses and the cost per use is $0.53 cents per use.

    1. Due to recent shortages and price gouging in the PPE marketplace, the cost of

      disposable gowns has skyrocketed to prices in excess of $5.00+ per gown. In this

      current situation, the cost for the EZ-USE gown is significantly LESS EXPENSIVE.

    2. Regardless of the cost of single use disposable gowns, over the life of the EZ-USE

      Reusable Isolation Gown, including cost to launder (see below), it saves you money.

  5. But what about the cost to launder?

    a. The average cost to launder reusable gowns is $0.35 (cents/pound). The EZ-USE gowns weighs 13.9oz. Thats 87% of 1 pound equating to circa $0.30 per washing.

    b. Once you add the $0.53 cents/use/gown to the $0.30 cents/wash/gown, the total cost of the EZ-USE gown is approximately $0.83 cent/per use.

    c. That is only $0.83 cents per use vs. as high as $5.00 per disposable.
    d. Even pre-Covid pricing would have a hard time competing with that, plus the quality of

    product, ease of use, comfort, convenience, availability, and overall appearance, is worth so much more!

Michael Benko: 843.934.8700

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Disposable Gowns








$0.86(includes laundry costs)






Example Scenario #1:

If your facility uses 1000 isolation gowns/week:

Cost per Unit:
Number Needed/week: Cost to Purchase: Number of uses per gown: Time to Reorder:
Cost to Launder:
Total cost per use:
Total cost/50 weeks:

Savings every 50 weeks:

Example Scenario #2:


If your facility uses 10,000 isolation gowns/week:

Disposable: $4.00

1000 $4,000 1 Weekly $0



EZ-USE: $28.00

500 $14,000

50 Weeks

$0.30 $0.86


Disposable: $4.00

10,000 $40,000 1

Weekly $0 $4.00


EZ-USE: $28.00 5,000 $140,000

50 Weeks

$0.30 $0.86


Cost per Unit:
Number Needed/week: Cost to Purchase: Number of uses per gown: Time to Reorder:
Cost to Launder:
Total cost per use:
Total cost/50 weeks:

Savings every 50 weeks:
Disclaimer: Prices given in example scenarios are averages. Some prices may be subject to change

$1.78 Million



Protect Your Patient’s Non-Operative Leg with The Montgomery Knee Board

by Thomas Montgomery, M.D.

Helping O.R. Staff Regain Confidence in Patient Positioning

Your surgical team is doing all that they can to keep patients safe but they simply cannot see what is going on underneath surgical drapes. Circulating nurses and patient positioning teams must be thorough and efficient but positioning the well-leg during arthroscopic knee procedures is a serious challenge. Current devices do not get the job done; foam pads slip, bulky metal positioners are heavy and get in the surgeon’s way, rolled sheets flatten. The Montgomery Knee Board secures the non-operative leg easily, quickly and safely.

The Montgomery Knee Board is light, affordable and works easily with any foam pad to help your surgical team regain their confidence in your operating room. This is achieved in three simple steps:

  1. Slip The Montgomery Knee Board in between the bed cushion and the surgical bed
  2. Place any foam pad on top of the device
  3. Rest assured that the patient’s well-leg is secured throughout the procedure

“My surgical staff used to have a difficult time properly and safely positioning a patient’s well leg during arthroscopic knee procedures. Pads and various types of “holders” were stuffed underneath the well-leg in an attempt to provide support; however current technology seemed to adjust during surgery. Slippage can lead to all sorts of unforeseen issues with the well leg, that’s why we created The Montgomery Knee Board.”

– Thomas J. Montgomery, MD – Surgeon and Inventor

Learn more by clicking on The Montgomery Knee Board.



Benefits of Cold Therapy

As the team physician for all sports at a university for over twenty years, I had the opportunity to see athletic trainers perform.  They were very good at diagnosing injuries and knowing which ones could be managed with therapy and which ones needed additional studies and sometimes surgical treatment.  When injuries could be managed with therapy and modalities alone, they were able to accelerate recovery to bring athletes back to high levels of function at a rate that seemed magical.

 Among the most frequent modalities was cold therapy and they used it in multiple ways.  Naturally ice packs were a must on the sidelines and they always had them handy.  When someone was injured icing was begun immediately to reduce blood flow with bleeding into the tissues to try to keep the swelling to a minimum.

They also used cold therapy in accelerate recovery.  One of the favorite treatments was immersion of a limb in a bucket of ice-filled water.  They would then remove it and apply gentle heat, always being careful to not use cold too long or heat too high.  The hyperemic response to removal from cold also occurred without the application of heat.

Hyperemia is an increased blood flow that causes the skin to redden and ultimately warm.  You can see it in people’s faces when they come inside from the cold.  You can definitely see it when one removes ice packs from the skin.  So, not only do you get the benefit of cooling to reduce swelling but you also get the benefit of increased blood flow after removing the cooling device.

Our trainers made a convincing case for another benefit of this so-called “contrast” therapy.  They hypothesized that the change in reduced blood flow from cold followed by increased blood flow from warming caused the tissues to shrink and expand with a resulting pumping effect to help drive out swelling (edema).

A third benefit of cold therapy is pain relief.  Cold applied to an injured or painful area can reduce the pain.  That not only makes the person more comfortable but allows better rehabilitation by making it less painful to move an ankle or tighten a muscle.

In summary, the benefits of cold therapy are

  • Temporary reduction of blood flow to
    • Reduce bleeding to an area of acute injury
    • Possibly to transiently shrink tissues to help pump out edema
    • Hyperemia (representing increased blood flow) upon warming to help accelerate the healing process
    • Pain reduction

The biggest problem with cold therapy is inconvenience and risk of cold injury.

  • It’s not practical to carry around a bucket of ice slush so this sort of immersion therapy generally needs to be provided in a training room.
  • Ice packs alone are hard to keep in place and plastic bags of ice tend to leak and “sweat” wetting one’s clothing, etc.
  • Cold injury can occur if you treat with too much cold for too long.
  • Compression (another therapeutic modality for managing edema) is difficult to apply over ice packs.
  • Electrical cooling devices require (believe it or not) electricity, limiting mobility.

A convenient and useful way to provide both cold therapy and compression is provided with the ICE20 Compression Therapy Wraps.  You may click on ICE20 to see our list of their nice cold therapy devices.


James D. Hundley, MD; Orthopaedic Surgeon, Retired; Former Athletic Team Physician