Fractures
Diagnosis and treatment of fractures
Bones are complex semi-rigid structures designed to weight-bear. When subjected to great forces bones may shatter or fracture. Fracture severity will vary depending on the force used to cause the fracture itself. In general, bones in the younger population require greater energy to fracture while much less energy is needed to fracture an older bone.
Causes
The more frequent being:
Acute trauma. Falls, motor vehicle accidents and sports related trauma are a few examples that can end in fractures.
Overuse. Stress fractures, due to a repetitive activity on a particular bone.
Osteoporosis, osteopenia. In this condition there is a predisposition for fractures since the normal bone mineralization and architecture is altered.
Symptoms
In general, fractures are quite painful and the deformity may be very apparent.
Pain and swelling
Deformity
Bruise in the skin
It is of upmost importance to have a consultation by your orthopedic surgeon if you suspect to have a fracture for its proper treatment.
Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int. 2020;31(2):251-257. doi:10.1007/s00198-019-05226-w
Shoulder
Rotator cuff tears, shoulder instability and osteoarthritis of the shoulder
Rotator cuff tears
Description
Tears of the rotator cuff are a common cause of shoulder pain in the adult population. A tear in the rotator cuff will cause weakness and pain with movements of your arm over your head.
When a tear is present, the function of the muscle is directly affected. Most of the times the affected tendon is the supraspinatus tendon, but this does not mean the rest of the cuff is no injured.
In some cases the tendons have their normal “wear and tear” with aging and a fall of sudden movement may rupture the remaining tendon.
In general two types of tear of the rotator cuff exist:
Partial tear. Also known as incomplete tears, in which the tendon although damaged is not completely ruptured.
Complete tears. Also known as complete thickness tears, in these injuries the tendon is no longer attached to bone and marked weakness and pain follow.
Causes
Two main causes produce tendon tears of the rotator cuff: the normal “wear and tear” that comes with aging and trauma.
In the first case, the tendon progressively becomes thinner with age and use and bone spurs may develop causing it to impinge and continua tearing.
In the latter case, a recent history of trauma exists in which the tendon following a fall or lifting of a heavy object tears.
Symptoms
The following symptoms are commonly described by patients with tears of the rotator cuff:
Night pain, increases laying on the affected shoulder, may ever interrupt sleep.
Pain while lifting the arm over the head, eating, combing their hair.
Weakness, loss of strength as compared to the other shoulder.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have shoulder pain for its proper treatment.
Dickinson RN, Ayers GD, Archer KR, et al. Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study. J Shoulder Elbow Surg. 2019;28(5):833-838. doi:10.1016/j.jse.2018.10.001
Shoulder instability
The shoulder joint is the most mobile of the whole body, with such ease of movement there is also an increased risk for instability to occur.
Causes
Shoulder instability occurs when the shoulder dislodged from its socket, producing pain. Most of the times trauma produces the instability.
Following the first shoulder dislocation, there is extensive damage to ligaments, capsule and other soft tissue structures of the shoulder. As more damage is present, dislocations become recurrent even with simple movements.
Symptoms
Most patients refer pain and deformity as the predominant symptoms.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have shoulder pain for its proper treatment.
Friedman LGM, Lafosse L, Garrigues GE. Global Perspectives on Management of Shoulder Instability: Decision Making and Treatment. Orthop Clin North Am. 2020;51(2):241-258. doi:10.1016/j.ocl.2019.11.008
Osteoarthritis of the shoulder
Description
Pain and rigidity is the hallmark of shoulder osteoarthritis. In this pathology there is a progressive damage and destruction of the cartilage lining of the bones that make up the shoulder. Once this lining of protective cartilage is gone, bone rubs against bone and pains ensues.
Causes
Cartilage cover areas of contact between bones, favoring the friction between them. When cartilage wears out bones come in contact with one another and friction is altered between them. Sometimes cartilage damage occurs following trauma, for example a fracture or due to progressive wear.
Symptoms
Pains is the predominant symptom in patients with shoulder osteoarthritis, increasing with daily activities and even precluding a normal gait.
Other symptoms include:
Rigidity
Limited range of motion
Night pain
It is of upmost importance to have a consultation by your orthopedic surgeon if you have shoulder pain for its proper treatment.
Harrison AK, Knudsen ML, Braman JP. Hemiarthroplasty and Total Shoulder Arthroplasty Conversion to Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med. 2020;13(4):501-508. doi:10.1007/s12178-020-09649-5
Elbow
Elbow dislocation and tennis elbow (lateral epicondylitis)
Elbow dislocation
Description
The elbow joint is composed of three bones, when there is a separation between those bone a dislocation is occurring.
Causes
Generally following trauma after a fall onto an outstretched hand or a motor vehicle accident. The force that is generated as the hand hit the ground is transmitted to the elbow where structures rupture and a dislocation ensues.
Symptoms
Elbow dislocations are very painful and the deformity es evident. Partial dislocations are complex elbow lesions that may elicit mild pain.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have elbow pain for its proper treatment.
Duparc F, Merlet MC. Prevention and management of early treatment failures in elbow injuries. Orthop Traumatol Surg Res. 2019;105(1S):S75-S87. doi:10.1016/j.otsr.2018.05.016
Tennis elbow (lateral epicondylitis)
Lateral epicondylitis also known as tennis elbow, is a painful condition of the external part of the elbow. Patients who perform sports where a repetitive strain is placed on the wrist and elbow develop this condition.
Causes
Tennis elbow results from the inflammation of the tendons that arise from the lateral side of the elbow and which in turn run through the forearm to reach the wrist.
In general, overuse causes the main symptoms. The tendon of the extensor carpi radialis brevis (ECRB) is commonly affected since it is the main stabilizer of the wrist when the elbow is extended.
Symptoms
They occur gradually:
Pain that worsens with activity in the lateral side of the elbow
Loss of grip strength
Loss of strength in the forearm
It is of upmost importance to have a consultation by your orthopedic surgeon if you have elbow pain for its proper treatment.
Bateman M, Littlewood C, Rawson B, Tambe AA. Surgery for tennis elbow: a systematic review. Shoulder Elbow. 2019;11(1):35-44. doi:10.1177/1758573217745041/
Elbow arthritis
Description
The cartilage wear that occurs in the elbow produces pain and rigidity. The wear reaches a stage in which bones are rubbing against one another causing movement to be very painful.
Causes
Aging causes a normal wear of the cartilage in the joint of the elbow, certain conditions can increase the rate of wear in a joint for example inflammatory disease, and previous fractures or dislocations.
Symptoms
The most frequently reported symptom is pain and rigidity with loss of the normal range of motion.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have elbow pain for its proper treatment.
Pooley J. Total elbow replacement - patient selection and perspectives. Orthop Res Rev. 2019;11:23-40. Published 2019 Jan 25. doi:10.2147/ORR.S134719/
Hand
Carpal tunnel syndrome and trigger finger
Carpal tunnel syndrome
Description
This is a very frequent condition, causing pain, numbness and tingling in the hand and forearm of many patients. The affected structure is the median nerve which provides sensory feedback to the palm and most of the fingers in the hand.
In most cases, symptoms worsen over time highlighting the importance of an early diagnosis and treatment. Treatment varies depending on the degree of compression of the nerve hence a timely treatment will provide the best possible results.
Causes
Many factors come into play in this syndrome. In general, women are affected more than men and patients usually are over the age of 40.
Some risk factors to develop carpal tunnel are: pregnancy, changes in hormones, diabetes, rheumatoid arthritis, thyroid disorders, repetitive hand use, to name a few.
Symptoms
Usually symptoms come and go during the day in the early stages of nerve compression. As damage to the nerve occurs symptoms become continuous with a specially spike during the night.
Numbness, tingling, pain – in the thumb, index, middle and ring finger.
Pain in the forearm.
Loss of strength and dexterity.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have pain or discomfort in your hand for its proper treatment.
Ostergaard PJ, Meyer MA, Earp BE. Non-operative Treatment of Carpal Tunnel Syndrome. Curr Rev Musculoskelet Med. 2020;13(2):141-147. doi:10.1007/s12178-020-09616-0/
Trigger finger
Description
This condition causes pain, rigidity and a characteristic locking and catching of the involved finger upon flexion and extension of the fingers of the hand.
Generally, the thumb or the ring finger are affected. Anatomically there is a thickening of the pulley system through which the tendon normal slides when we flex a finger (pulley A1).
Causes
There are some factors that increase the risk of developing this condition:
Diabetes mellitus, rheumatoid arthritis
Manual labor, increase or repetitive finger motions.
Symptoms
Palpable mass on the base of the affected finger.
Locking and catching sensation, rigidity of the finger when it is flexed into a fist.
Pain when trying to unlock the finger.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have pain or discomfort in your hand for its proper treatment.
Urits I, Smoots D, Anantuni L, et al. Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review [published correction appears in Pain Ther. 2020 Mar 31;:]. Pain Ther. 2020;9(1):129-142. doi:10.1007/s40122-020-00158-4
Knee
Anterior cruciate ligament (ACL) tear, meniscal tears and knee osteoarthritis
Anterior Cruciate Ligament (ACL) Tear
ACL tears are quite common among athletes and people who do any physical activity or sport requiring pivoting around the knee, for example soccer players, basketball.
The cruciate ligaments of the knee are intra-articular structures that provide stability to the knee.
Causes
In general, anterior cruciate ligament tears are secondary to a traumatic injury of the knee.
A sudden change in direction while running
Sudden de-acceleration
Upon landing after a jump
·After a direct impact to the knee
Symptoms
Patients usually recall a cracking sensation or sound during the injury
Pain and swelling ensues
Instability of the knee
Loss of range of movement
Insecurity when walking on uneven surfaces.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have pain or discomfort in your knee for its proper treatment.
Cheung EC, DiLallo M, Feeley BT, Lansdown DA. Osteoarthritis and ACL Reconstruction-Myths and Risks. Curr Rev Musculoskelet Med. 2020;13(1):115-122. doi:10.1007/s12178-019-09596-w
Meniscal tears
Description
The menisci are frequently injured in sporting activities. These cartilaginous structures inside the knee have important role in weigh and energy transmission through the knee. Patients involved in contact spots have a particular risk of injuring their menisci.
Causes
The most common cause is traumatic, during a sport or upon doing a squat with a twist of the knee. Older patients have different meniscal tear patterns which require a different treatment approach.
Symptoms
Patients sometimes recall a “pop” in the knee. Generally, they are able to weight bear, walk and may notice the menisci may block knee flexion.
It is of upmost importance to have a consultation by your orthopedic surgeon if you have pain or discomfort in your knee for its proper treatment.
Kopf S, Beaufils P, Hirschmann MT, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1177-1194. doi:10.1007/s00167-020-05847-3
Knee osteoarthritis
Osteoarthritis of the knee is a very common disease. In its degenerative form, it afflicts a great proportion of our aging population. Occurring in people older than 50 years old, knee destruction may be see even in younger patients.
Knee cartilage is a thick structure that wears with use, once the cartilage is gone, bone rubs against bone producing pain a rigidity in the knee.
Symptoms
Pain, swelling that worsens over time
Rigidity
Knee block
It is of upmost importance to have a consultation by your orthopedic surgeon if you have pain or discomfort in your knee for its proper treatment.
Sousa PL, Sculco PK, Mayman DJ, Jerabek SA, Ast MP, Chalmers BP. Robots in the Operating Room During Hip and Knee Arthroplasty. Curr Rev Musculoskelet Med. 2020;13(3):309-317. doi:10.1007/s12178-020-09625-z