About

Hip pain is one of the most common complaints we as orthopedic surgeons see in our office. Hip pain and stiffness can severely limit function and activity. There are multiple causes of hip pain including degenerative (or osteo) arthritis, rheumatoid arthritis, labral tears, stress fractures, tendinitis, bursitis, pain referred from the low back, and pelvic problems. Frequently the cause of the pain can be determined with an examination and x-rays. If further imaging is needed an MRI would be considered although is frequently unnecessary. As with any medical problem, the first step is to determine what is causing the pain and then begin treatment to resolve pain and recover function. Commonly, the problem can be treated conservatively without surgery but at times, surgery is required to cure the hip.

Conditions

Causes of hip pain:

• Arthritis
• Labral (cartilage) tears
• Tendinitis
• Bursitis
• Muscle strains
• Stress fractures
• Referred (nerve) pain from the back
• Intrapelvic problems
• Fractures

Treatment

Treatment options vary for different underlying problems of the hip. Many problems can be managed with conservative measures including:

• Physical therapy
• Anti-inflammatory medications such as Ibuprofen and Aleve
• Injections including steroid shots and viscosupplementation (gel) injections for knee arthritis
• Alternative treatments

If conservative care is unsuccessful or in certain cases of severe disease or deformity, surgery may be indicated to cure the problem.

About

Knee and leg pain are common complaints in people of all ages. The source of pain may be from a sudden injury, an overuse injury or an underlying condition, such as arthritis. Knee pain, swelling and stiffness can severely limit function and activity. There are multiple causes of knee pain including ligament injuries, meniscus tears, cartilage injury, tendinitis, bursitis, and arthritis. Frequently the cause of the pain can be determined with an examination and x-rays. If further imaging is needed an MRI may be considered. As with any medical problem, the first step is to determine what is causing the pain. From there a treatment plan can be formulated to address the problem. Commonly, the problem can be treated with conservative measures such as physical therapy, bracing or injection. Occasionally surgery may be required to adequately address the problem.

Conditions

Causes of knee pain:

• Arthritis
• Ligament injuries
• Meniscus tears
• Cartilage injury
• Tendinitis
• Bursitis
• Muscle strains
• Gout
• Referred pain from the hip or back
• Fractures

Treatment

Treatment options vary for different underlying problems of the knee. Many problems can be managed with conservative measures including:

• Physical therapy
• Anti-inflammatory medications or Tylenol
• Injections including cortisone and viscosupplementation (gel)
• Bracing
• Alternative treatments

If conservative care is unsuccessful or in certain cases of severe disease or deformity, surgery may be indicated to cure the problem.

About

Orthopedic injuries are common in persons of all ages participating in sports, exercise and leading active lifestyles. These may include sudden injury from a traumatic event or injuries from overuse. Sports injuries may involve any bone or joint in the body but commonly involve the knee, shoulder, hip and elbow. The injury may cause a torn ligament (often referred to as a sprain), tendon or muscle (strain), meniscus, labrum, cartilage injury, broken bone, or dislocation. Frequently the injury can be evaluated with an examination by your doctor and x-rays. Sometimes more advanced imaging such as a MRI or CT scan may be necessary. As with any medical problem, the first step is to determine what anatomic structures are involved. From there a treatment plan can be formulated to address the problem. Commonly, the problem can be treated with conservative measures such as physical therapy, bracing or injection. Occasionally surgery may be required to adequately address the problem.

Treatment

Treatment options vary depending on the injury. Many problems can be managed with conservative measures including:

• Rest, ice, compression and elevation to improve swelling
• Physical therapy
• Anti-inflammatory medications or Tylenol
• Injections including cortisone or platelet rich plasma
• Bracing
• ​Activity modifications

If conservative care is unsuccessful or in certain cases of severe injury, surgery may be indicated to cure the problem. Surgery can often be performed using arthroscopic or minimally invasive techniques. Arthroscopic surgery utilizes a small camera placed inside the joint, and small instruments to address the underlying problem while minimizing injury to other structures.

Common Sports Injuries

Elbow

• Ligament injuries
• Biceps tendon tears
• Dislocation
• Epicondylitis (tennis or golfer’s elbow)

Foot, Ankle, and Lower Leg

• Ligament injuries
• Achilles tendon injuries
• Ankle sprains

Hip

• Femoracetabular impingement
• Labral tears
• Strain injuries
• Sports Hernia

Thigh

• Strain injuries

Knee

• Ligament injuries to the ACL, PCL, MCL or LCL
• Tendon tears of the patellar, quadriceps tendons
• Meniscus tears
• Articular Cartilage injury

Shoulder

• Rotator cuff injuries
• Injuries to the acromioclavicular joint (shoulder separation)
• Shoulder dislocations or instability
• Labral tears

About

The shoulder and elbow allow the upper extremity to move in all different directions, to allow the hand to be put in the desired position of use. The shoulder has more motion than any joint in the body, because of its unique design. It’s built like a basketball resting on a dinner plate. The ligaments, muscles, tendons, and labrum keep the two attached together, and are susceptible to injury or overuse conditions. The elbow is an intricate hinged joint, also with many attached soft tissues. Shoulder and elbow conditions may occur from trauma, overuse, and wear and tear over time. The overhead throwing motion puts strain on the shoulder and elbow, causing pain and instability, commonly seen in the Weekend Warrior.

Conditions

Shoulder

• Tendon problems: rotator cuff tendinitis, also called impingement syndrome, is inflammation of the tendon and can be caused from repetitive overuse in the overhead position. Rotator cuff tears can occur from a traumatic injury or with wear and tear over time.
• ​Instability: the shoulder joint may be dislocated from a traumatic injury, which could lead to recurrent episodes in the future. The acromioclavicular joint (where the collarbone attaches to the shoulder blade) may be injured from a fall and is called a shoulder separation.
• Labral tears: the labrum is a bumper of tissue in the shoulder joint which improves stability and can be injured in a dislocation. It is also an attachment point for the biceps tendon and be damaged from an injury in the overhead position.
• Fractures: may involve the ball or the socket, or the collarbone, and if displaced may require surgery to restore it into the anatomic position.
• Degenerative arthritis: may involve the ball or socket, or both or the acromioclavicular joint. This may occur from progressive wear and tear on the joint, or from a previous fracture or dislocation. Rotator cuff arthropathy occurs when there is degenerative arthritis of the shoulder in combination with a large rotator cuff tear.

​Elbow

• Tendon problems: tendinitis around the elbow is very common and may occur on the outside (tennis elbow) or in the inside (golfer’s elbow) of the joint and is usually caused from repetitive overuse of the arm.
• Stiffness and loose bodies: degeneration of the joint from wear and tear, can cause loss of motion of the joint, either bending or extending. Loose bodies within the joint can cause the elbow to lock up or feel like something is catching when ranging the joint.
• Nerve: the ulnar nerve can become inflamed after a direct blow to the elbow or may become unstable in the groove where it normally rests.
• Instability: the elbow may be unstable after a dislocation of the joint if the ligaments fail to heal properly.
• Fractures: occur from a fall onto an outstretched hand or from a direct blow to the elbow, and if displaced may require surgery to restore anatomy.
• Bursitis: occurs from a direct blow or from resting the elbow constantly on a hard surface. It causes fluid accumulation at the point of the elbow.
• Degenerative arthritis: may occur from wear and tear on the joint or from a fracture or dislocation.

Treatment

After a thorough history and physical examination, your physician will most likely obtain X-rays of the shoulder or elbow joint. To evaluate the soft tissues or the boney structures more thoroughly, an MRI or a CT scan may be necessary. After a diagnosis is made, a treatment plan will be devised. The patient will always be informed of the plan and the natural history of the condition. A team approach will be undertaken to meet the patient’s expectations and goals to get them back to normal.

Conservative Treatment

​Most of the overuse problems of the shoulder and elbow can be treated non operatively. This would include rest, activity modification, bracing and judicial use of anti-inflammatories and an occasional cortisone injection. A self-directed exercise program or a supervised physical therapy program is usually indicated. If there is failure of improvement or if the patient’s expectations aren’t met, surgical treatment options can be discussed.

Surgical Treatment

The procedures of the shoulder and elbow can be done as an outpatient, and many can be done arthroscopically and if not, a mini-incision, which is minimally invasive will be done.​

Shoulder

• ​Rotator cuff repair
• Subacromial decompression
• Distal clavicle excision
• Biceps tenodesis
• Labral repair
• Capsular shift
• Superior capsular reconstruction
• Latarjet procedure
• ORIF of fractures​​
• Joint Replacement
• Reverse total shoulder arthroplasty

Elbow

• Debridement of the joint with spur excision
• Loose body removal
• Ligament reconstruction
• Ulnar nerve decompression
• Treatment for chronic tendinitis
• Bursectomy
• ORIF of fractures
• Joint Replacement​

Postoperative treatment

Proper aftercare following surgery is as important as the procedure itself. In a majority of cases a supervised rehab program with a physical or occupational therapist will be prescribed. There is a fine line between doing too much and not enough in therapy, and this will be carefully monitored by your physician. With a team approach from start to finish, we would anticipate a return to normal activities following your treatment!