Rotator Cuff Tear

Your shoulder is a ball and socket joint. The rotator cuff is a group of muscles that come together as a tendon at the top of the head of the humerus (ball). The rotator cuff functions to lift and rotate the arm.

In the case of a rotator cuff tear the tendon is no longer attached to the head of the humerus. The suprasinatus tendon is the tendon that is most commonly torn. Tears can be full thickness or partial thickness.

Causes & Symptoms

Rotator cuff tears occur in two common ways- wear and tear (degeneration) and injury (trauma).

Rotator cuff tears can happen at any age. Those over the age of 40 are at a greater risk due to normal wear and tear. Athletes, those of do overhead activities, and those who work with heavy objects also at greater risk with traumatic injuries.

Symptoms of a rotator cuff tear include:

• Pain in the shoulder especially when sleeping on it at night.
• Pain or weakness with lifting motions especially away from the body.
• Crunching sounds with motion.

Evaluation & Treatment

Evaluation begins with discussing symptoms, medical history, a physical evaluation, and x-rays. Examination includes range of motion, strength testing, and specialized maneuvers to evaluate the shoulder. Occasionally the neck can be a cause of shoulder pain, such as with a pinched nerve, and this should be evaluated as well. Additionally, other conditions including arthritis should be evaluated. An MRI may be ordered to help evaluate the tear further for size and age.

If it is determined that there is a rotator cuff tear, treatment options may include the use of medication, injections, physical therapy, and arthroscopic surgery. Surgery is indicated for those whose pain does not improve with nonsurgical treatment and those who are active with sports, work, or overhead activity. Using a painful shoulder with a rotator cuff tear may lead to further damage and an increase in tear size.

Treatment is aimed at reducing pain and increasing strength and motion. About fifty percent of people find pain relief and increased function with nonsurgical treatments; however, in a traumatic tear strength likely will not return.

Rotator Cuff Tendonitis & Bursitis

Rotator Cuff Tear

Your shoulder is a ball and socket joint. The rotator cuff is a group of muscles that come together as a tendon at the top of the head of the humerus (ball). The rotator cuff functions to lift and rotate the arm.

In the case of a rotator cuff tear the tendon is no longer attached to the head of the humerus. The suprasinatus tendon is the tendon that is most commonly torn. Tears can be full thickness or partial thickness.

Causes & Symptoms

Rotator cuff tears occur in two common ways- wear and tear (degeneration) and injury (trauma).

Rotator cuff tears can happen at any age. Those over the age of 40 are at a greater risk due to normal wear and tear. Athletes, those of do overhead activities, and those who work with heavy objects also at greater risk with traumatic injuries.

Symptoms of a rotator cuff tear include:

• Pain in the shoulder especially when sleeping on it at night.
• Pain or weakness with lifting motions especially away from the body.
• Crunching sounds with motion.

Evaluation & Treatment

Evaluation begins with discussing symptoms, medical history, a physical evaluation, and x-rays. Examination includes range of motion, strength testing, and specialized maneuvers to evaluate the shoulder. Occasionally the neck can be a cause of shoulder pain, such as with a pinched nerve, and this should be evaluated as well. Additionally, other conditions including arthritis should be evaluated. An MRI may be ordered to help evaluate the tear further for size and age.

If it is determined that there is a rotator cuff tear, treatment options may include the use of medication, injections, physical therapy, and arthroscopic surgery. Surgery is indicated for those whose pain does not improve with nonsurgical treatment and those who are active with sports, work, or overhead activity. Using a painful shoulder with a rotator cuff tear may lead to further damage and an increase in tear size.

Treatment is aimed at reducing pain and increasing strength and motion. About fifty percent of people find pain relief and increased function with nonsurgical treatments; however, in a traumatic tear strength likely will not return.

Shoulder Instability

Shoulder Instability (Dislocating Shoulder)

The shoulder is a complex ball and socket joint. It is made up of the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone). Shoulder instability occurs when the humeral head no longer lines up with the glenoid (socket).

Causes & Symptoms

Shoulder instability occurs most commonly from severe injury or trauma. This can result in injury to the labrum, known as a Bankart lesion. Some patients without trauma may never have a dislocation have looser joints resulting in shoulder instability. This is called multidirectional instability.

Evaluation & Treatment

Evaluation includes a history of symptoms, a physical examination, x-rays for bone injury, and specialized physical exam maneuvers. Specialized maneuvers are used to help determine the extent of instability. An MRI may be done to evaluate the labrum, capsule, and cartilage surfaces for damage.

Treatment is based on examination, imaging, and pain. Initial treatment is aimed at strengthening shoulder-stabilizing muscles. Arthroscopic surgical treatment to repair a torn labrum or tighten the shoulder capsule is indicated based on the extent in instability, nature of injury, age, and activity level. Occasionally, in those with a large bone defect or recurrent instability despite previous surgical treatment, an open surgery may be recommended to reconstruct the bone loss, known as a Laterjet procedure. Surgery is done as an outpatient and return to activities generally occurs around 3 months.

Shoulder Arthritis

The shoulder is a complex ball and socket joint. It is made up of the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone). The humeral head rotates on a portion of the scapula (glenoid) with a curved surface through range of motion. The rotator cuff tendons and a variety of ligament and cartilage structures aid in shoulder stability.

Causes & Symptoms

Arthritis is a loss of cartilage in a joint resulting in pain and inflammation. It may occur due to aging, trauma, or a variety of medical conditions. Arthritis in the shoulder most commonly results from osteoarthritis, rheumatoid arthritis (RA), posttraumatic arthritis, cuff tear arthropathy (arthritis after a long-standing rotator cuff tendon tear), and avascular necrosis (AVN).

Shoulder arthritis symptoms most commonly include pain with use, difficulty or limited motion, and a grinding sensation.

Evaluation & Treatment

Evaluation of shoulder arthritis begins with a history of symptoms and treatment, physical examination, and x-rays. An MRI may be done to evaluate the quality of the rotator cuff or a CT scan may be done to evaluate the quality of the bone in the glenoid.

The goals of treatment are to reduce pain and increase use. Initial treatment begins with the use of anti-inflammatory medications and physical therapy. Activity modification, moist heat and/or ice may also be used. Corticosteroid injections may also be used in those with continued symptoms.

Surgical treatment reserved for those to continue to have symptoms despite the above treatment. Surgical treatment is dependent on the extent of arthritis. Arthroscopic surgery to debride the damaged cartilage or labrum is an option for patients with mild arthritis. Shoulder replacement is recommended in those with moderate to advanced arthritis. This is done by replacing the surfaces with artificial components. There are a variety of replacement options and much of it is dependent on age, activity, type and extent of arthritis, and the quality of the rotator cuff. Options include resurfacing, hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty.

Shoulder Trauma

Trauma to the shoulder can result in a broken bone, dislocation, or both. Shoulder trauma can be a result of sports injuries in younger patients or from a simple fall in older patients. Shoulder injuries can include fractures of the clavicle (collar bone) and humerus (arm). They can also include dislocations of the glenohumeral (shoulder) or acromioclavicular joint (AC joint).

Causes & Symptoms

Symptoms include pain, deformity, bruising, and inability to lift the arm.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination, and X-rays. Attention is paid to ensure the integrity of the skin over the break.

In cases of glenohumeral dislocations an MRI can distinguish cartilage (labrum and articular cartilage) injury. In cases of a complex fracture a CT scan may help show the fracture fragments and extent of the injury.

Treatment is determined based on the injury. Most clavicle, proximal humerus, and scapula fractures can be treated without surgery. Additionally, most acromioclavicular joint and glenohumeral joint dislocations can be treated without surgery.

Surgery is considered for those with multiple parts, significant deformity, or associated injuries. Surgical fixation is done through a small incision as an outpatient procedure. The rehabilitation course is dependent on the nature of the injury and treatment method but typically requires a period of immobilization followed by rehabilitation often for 1-3 months depending on the injury.

Acromioclavicular Joint Separation

The acromioclavicular joint (AC) is at the top of the shoulder and is the connection of the shoulder blade (scapula) at the acromion and the collar bone (clavicle). This joint allows for some small motion to assist in arm motion.

Injuries to the AC joint occur in two ways-a direct blow while the arm is away from the body such as in a fall or tackle or from a fall on an outstretched arm. This can result in a sprain or tear of the ligaments in this location.

Causes & Symptoms

Those with an AC joint separation will notice a bump at the tip of the shoulder and pain at this site with arm motion especially across the body. X-rays will show a separation of the bones at this location.

Evaluation & Treatment

Evaluation of the AC joint begins with a history of the injury, physical examination and X-rays to evaluate the extent and any associated injuries. MRI or CT scans are not routinely needed.

AC joint injuries are classified based on degree of separation and direction. Treatment is dependent on activity level and grade of separation. A majority of sprains and separations can be treated with activity modification, sling, rest, and ice. Large separations, those who perform overhead or repetitive activities, or have continued pain despite treatment with small sprains may be best treated surgically.

Surgery is done as an outpatient and is done to realign the joint. In the acute setting this can be done with suture, while in the chronic setting this requires biologic augmentation.

Recovery time typically takes one to eight weeks depending on the severity of the injury and if surgical intervention is needed.

Clavicle Fracture

The collarbone is known as the clavicle. It connects the ribcage (sternum) and the shoulder blade (scapula). Injuries are most commonly caused by a direct blow and are common in all age groups.

Causes & Symptoms

Symptoms of a clavicle fracture include pain, deformity, bruising, and inability to lift the arm.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination, and X-rays. Attention is paid to ensure the integrity of the skin over the break.

Treatment of a clavicle fracture depends on location, patient age, and amount of displacement. Most clavicle fractures can be treated without surgery. An arm sling is used in this case for immobilization for 6 weeks. In cases with significant displacement surgical fixation is considered. In these cases a plate and screws are used to align the bones in the correct position. After surgery a sling is worn for 6 weeks with regular x-ray follow up and most people return to regular activities within 3 months of their injury.

Adhesive Capsulitis

Adhesive capsulitis is an inflammatory condition resulting in shoulder stiffness. This can occur due to a variety of reasons including injury, immobilization, disuse, diabetes and thyroid conditions.

Causes & Symptoms

Symptoms include a lack of shoulder mobility due to pain especially overhead and rotation.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination, and X-rays. MRI or CT scans are not routinely needed but may be done if there is suspicion of a rotator cuff tear.

The goal of treatment is to increase motion and decrease pain. Anti-inflammatory medication and corticosteroid injection are often initial treatments to reduce inflammation. Physical therapy is critical for range of motion. Therapy often takes several months for motion to improve and pain to resolve.

Surgery is indicated in those who have continued pain and stiffness despite the prior described treatments. Arthroscopic capsular release of the tight tissue followed by early physical therapy and range of motion will allow for improvements in range of motion. The arthroscopic release is done through small poke holes.

SLAP Tear

The labrum is a cartilage bumper that surrounds the shoulder socket (glenoid). A SLAP (Superior Labrum Anteroposterior) tear is a tear of the labrum at its upper edge. This often occurs from falling on a straight arm or from forceful contraction of the biceps muscle.

Causes & Symptoms

Symptoms include pain, deformity, bruising, and inability to lift the arm.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination including special maneuvers, and X-rays to rule out other injuries. An MRI is helpful to distinguish a tear of the labrum and its extent.

Activity level and tear size dictate treatment. Labral tissue does not heal without surgical treatment, though conservative management including rest, ice, anti-inflammatory medications, and physical therapy can reduce symptoms. Surgical treatment is considered in athletes, laborers, and those who perform overhead activities. Surgery is done as an outpatient arthroscopic procedure and aims to repair the labrum. After surgery a sling is worn for 4-6 weeks and physical therapy is begun. Generally return to full activity occurs around 4-6 months.

Biceps Tendonitis

The biceps muscle is in the upper arm and has multiple functions including bending and rotating the elbow and keeping the shoulder stable. There are two shoulder attachments of the biceps, one at the coracoid and one at the glenoid. Injury most commonly occurs to the head that attaches at the glenoid (long head). It is found most easily in its groove below the pectoralis muscle as it attaches to the upper arm (humerus). Long head of biceps tendonitis is an inflammation or irritation of the long head of the biceps tendon.

Causes & Symptoms

Injuries to the biceps tendon at the shoulder usually occur from chronic wear Symptoms of a biceps tendonitis include pain and weakness or snapping in the front of the shoulder. This can result from repetitive use, degeneration, or injury.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination including special maneuvers, and X-rays to rule out other injuries. An MRI is helpful to distinguish the extent of tendonitis or other causes of pain.

Initial treatment is with rest, ice, anti-inflammatory medications and physical therapy. A corticosteroid injection may reduce pain as well as confirm the diagnosis. Surgical treatment is considered for those that do not improve. Surgical treatment may be done as an arthroscopic or mini-open surgery. There are a variety of surgical options including repair, tenodesis, or tenotomy. Repair can be done in conjunction with a SLAP repair. Tenodesis, or anchoring of the biceps, is done in those who perform repetitive activities or for those with cosmetic concerns and involves the removal of the damaged section and reattachment of the biceps tendon to a different location. Tenotomy is considered in those who want the most minimally invasive surgery or are low demand. It involves releasing the long head of the biceps from its origin on the glenoid (socket).

Rehabilitation is dependent on the technique utilized. Repair and tenodesis requires a sling and gentle passive range of motion for 4-6 weeks. Tenotomy allows for immediate range of motion.

Biceps Tendon Tear

The biceps muscle is in the upper arm and has multiple functions including bending and rotating the elbow and keeping the shoulder stable. There are two shoulder attachments of the biceps, one at the coracoid and one at the glenoid. Injury most commonly occurs to the head that attaches at the glenoid. It is found most easily in its groove below the pectoralis muscle as it attaches to the upper arm (humerus).

Causes & Symptoms

Injuries to the biceps tendon at the shoulder usually occur from chronic wear, while injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance.

Symptoms of a biceps tendon tear at the shoulder include a “pop”, bruising, pain, an swelling. The pain and swelling often reduces over a week or two though in some people a small bulge may be noticed in the arm after a biceps tendon tear. In those who perform a lot of forearm rotational activities some weakness may be noted.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination including special maneuvers, and X-rays to rule out other injuries. An MRI is helpful to distinguish a partial from a complete tear.

Tears of the biceps at the shoulder are most often treated nonsurgically with pain and arm bulging resolving over time. Surgical treatment is considered in those who have painful cramping, are athletes or laborers, or for those who the cosmetic deformity is unacceptable.

Initial treatment includes ice, rest, and anti-inflammatory medications. Surgical fixation is done as an outpatient procedure. Physical therapy is begun post operatively with an anticipated return to full activity at 2-3 months.

Tennis & Golfers Elbow

Tendonitis is an inflammation of the tendon tissue, most typically at the inside or outside of the elbow. Irritation of the tendon at the inside of the elbow is known as golfers elbow, while inflammation of the tendon on the outside of the elbow is known as tennis elbow.

Causes & Symptoms

Most commonly tendonitis is due to no known cause and can be due to repetitive microtrauma, developing over time. In some cases an acute injury may cause symptoms to arise.

Symptoms include pain with use affecting the ability to write, work, grip objects, perform power activities or even shake hands.

Evaluation & Treatment

Initial examination should include a medical history, physical examination, and x-rays to rule out associated conditions. Specialized physical examination maneuvers can further determine the source of pain. An MRI may be indicated in only select cases.

Most commonly treatment is nonsurgical and includes friction massage, stretching, strengthening, ice massage, bracing, anti-inflammatory medication and/or injection of cortisone, and activity modification.

In cases that do not resolve with the above treatment surgery may be indicated. Surgical debridement is an outpatient procedure where the damaged part of the tendon is cleaned. Recovery usually takes about 6 weeks.

Biceps Tendon Tear (Elbow)

The biceps is a muscle in the front of the arm that allows for elbow bending, forearm rotation, and shoulder stability.

Causes & Symptoms

Injury to the biceps tendon at the elbow often occurs due to an acute injury resulting from a forced straightening of the elbow against resistance. This is different than injuries of the biceps at the shoulder which are usually from chronic wear.

Typical symptoms of a biceps tear at the elbow include a “pop” sound with initial pain, swelling, and bruising at the elbow. This often resolves over a few weeks. After swelling starts to reduce a bump or gap may be noticed at the front of the elbow. Forearm rotation may be weak.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to rule out associated injuries. Specialized physical examination testing may be done to evaluate for a gap in the tendon or decreased rotational strength. MRI’s are often done to distinguish a partial and complete tear and the level of tendon retraction.

Treatment of bicep tear at the elbow is based on the activity level of the individual and degree of tear. Most often full thickness tears in active individuals are treated surgically while those with lower activity levels may be treated nonsurgically. Nonsurgical treatment includes ice, rest, and anti-inflammatory medications. Nonsurgical treatment may lead to a 30-40% decrease in strength with arm rotation. Surgical treatment is done through small incision as an outpatient procedure. After repair biceps tendon takes 2-3 months to fully heal.

Olecranon Bursitis

Bursa is a fluid sac around an area of a joint. Bursitis is an inflammation of the bursa. Olecranon Bursitis, is an inflammation of the bursal sac around the area of the tip of the elbow.

Evaluation & Treatment

Initial evaluation begins with a medical history, physical examination, and possibly x-rays if other causes are suspected. Evaluation should include a discussion of history of infection and gout.

Treatment includes rest, avoidance of direct pressure on the elbow, ice and anti-inflammatory medication. If there are any signs of infection this may be drained and antibiotics may be started.

If the bump remains despite above treatment a surgery as an outpatient can be done to remove the bursal tissue. After surgery will be wrapped but allowed to move. Recovery typically takes a few weeks.

Overuse & Chronic Elbow Injuries

Overuse injuries are those that occur due to microtrauma over time. This typically occurs in those who perform repetitive activities without adequate time to rest and recover.

Causes & Symptoms

Symptoms of over use injuries include pain during or immediately after activities. Occastionally people may feel numbness and tingling of the elbow, forearm, or hand.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to rule out associated conditions. Specialized elbow and shoulder examination maneuvers are done to further distinguish areas of pain. In some cases an MRI may be ordered to evaluate for ligament, tendon, cartilage damage, or stress fracture.

Typical treatment is aimed at reducing the stress of the overused body part. A short period of rest, activity modification, physical therapy, anti-inflammatory medications, and evaluation of technique are indicated. If symptoms do not improve despite the above treatment, surgical treatment is recommended depending on the condition. This may be done arthroscopically or through small incision as an outpatient. Typical recover occurs over 6 to 9 weeks.

Distal Humerus/Radial Head/Coronoid
Fracture (Elbow Fractures)

Fractures of the elbow are common at the end of the upper arm that makes up the top portion of the elbow joint. This area is called the distal humerus.

Causes & Symptoms

Injury to this area results commonly from a direct or indirect impact with symptoms of a fracture including swelling, bruising, pain or tenderness, inability to move the elbow, and instability.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, x-rays and specialized testing. Testing should include evaluation of pulse, nerve function, swelling and skin integrity. Care should be taken to ensure that there are no fragments that puncture the skin as this can lead to increased risk of infection. In case of complex fractures a CT scan is needed.

Initial treatment after evaluation includes the placement of a splint to the elbow, a sling to keep the elbow in position, ice and pain medication. Often distal humerus fractures require surgical fixation if there is displacement of the fragments. Surgical fixation is done with realignment of the bones and a placement of plates and screws to hold the alignment. This may be done either as an outpatient or as an overnight stay surgery. Typically physical therapy is started a few days to weeks after the injury depending on the extent of injury. Restrictions from lifting objects typically last 6 to 12 weeks.

Meniscal Injuries

The meniscus is a shock absorbing cartilage in the knee. Each knee has a medial and lateral meniscus and they are generally “C” shaped.

Causes & Symptoms

Meniscus injuries commonly occur with twisting motions, though they can occur with out a significant even especially in those over 40 years old.

Typical symptoms of a meniscus tear include clicking, popping, swelling, and stiffness of the knee. There can also be tenderness over the joint.

Evaluation & Treatment

Initial evaluation includes medical history, physical examination, and x-rays to rule out underlying conditions such as arthritis. Specialized physical examination maneuvers may be used to further determine the location of pain. An MRI may be ordered if there is suspicion of a meniscus tear to evaluate its size and type further.

Typical treatment of meniscus tears depends on age, type of tear, and activity level. Conservative treatment includes rest, ice, elevation, and some non-steroidal anti-inflammatory medication. Meniscus tears do not heal so surgical treatment is often required to reduce symptoms. Arthroscopic surgery is performed through small poke holes with specialized cameras and instrumentation as an outpatient to trim or repair flaps of cartilage. After surgery, rehabilitation is dependent on the type of tear and treatment.

Anterior Cruciate Ligament Tear

The ACL is a ligament that runs in the center of the knee at a diagonal that aids in knee stability with rotational motion. It prevents the tibia from sliding forward on the femur. Injury is most common in those who play sports such as soccer, football, and basketball.

Causes & Symptoms

Cause of an ACL injury include rapid change in direction, sudden stopping, landing incorrectly, and direct collision. Typical symptoms include a “pop” sound at time of injury with immediate knee swelling. Over a few hours the knee may feel unstable and range of motion with be decreased.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to rule out other associated conditions. Specialized examination maneuvers to test the integrity of the ACL and other structures in the knee may be done. An MRI is indicated in those where there is a suspicion for an ACL tear.

Treatment of ACL tears is dependent on age, activity level, and desire to return to activity. ACL tears do not heal though nonsurgical treatment may be indicated in those without knee instability or who are interested in activity modification and possibly bracing. For those who desire return to previous activity level, surgical treatment is recommended. This is done arthroscopically as an outpatient and several options exist in regards to graft. Regardless of treatment, rehabilitation plays a critical role. A physical therapy program will help regain knee strength and motion and typically lasts until the knee is equal to the other side.

Medial Collateral Ligament Injury

The medial collateral ligament (MCL) is a ligament on the inside of the knee which provides stability for the knee with lateral motions. It connects the femur (thigh bone) to the tibia (larger bone in your shin).

Causes & Symptoms

Injuries to the MCL occur most commonly from a direct blow to the outside of the knee resulting in a stretching of the inside of the knee. Symptoms of an MCL tear include swelling on the inside of the knee, pain, bruising, and difficulty with walking.

Evaluation & Treatment

Initial evaluation begins with a medical history, physical examination, and x-rays to rule out other associated injuries. Specialieed physical examination maneuvers may be done to determine the extent of the injury.

Initial treatment of an MCL injury is nonsurgical treatment including pain and swelling control. Crutches, a knee brace, and physical therapy may be recommended. If there is clinical suspicion of a complete tear or additional injury to the knee an MRI will be ordered. Occasionally the MCL may be torn in a way that will not heal and surgical treatment may be considered.

Surgical treatment of an MCL tear is done as an outpatient where the ligament is repaired. In a chronic injury, graft may be used to supplement the repair. Recovery typically takes 6-12 weeks with physical therapy.

Posterior Cruciate Ligament Injury

The posterior cruciate ligament is located in the back of the knee. Much like the ACL it connects the tibia (shinbone) and femur (thigh). The PCL prevents the tibia from moving backwards on the femur with motion.

Causes & Symptoms

PCL injuries require a powerful force backwards force on the knee most commonly from impact on a bent knee hitting a dashboard or a fall on a bent knee.

Typical symptoms include pain, swelling, difficulty walking, and knee instability.

Evaluation & Treatment

IInitial evaluation includes a medical history, physical examination, and x-rays to rule out other injuries. Specialized examination maneuvers may be done to test the PCL further. An MRI may be considered with suspicion for a PCL injury.

Typical treatment is based on the extent of the injury. A majority of isolated PCL injuries will heal with bracing, rest, and physical therapy. Continued symptomatic injuries of the PCL or injuries of multiple structures may require surgical treatment.

Surgical treatment is an arthroscopic outpatient surgical procedure. With surgical treatment full recovery takes up to 12 months.

Patellar Tendon & Quadriceps Tendon Tear

The quadriceps tendon is the attachment of the quadriceps muscles to the patella (kneecap). The patellar tendon attaches the tibia (shinbone) to the patella (kneecap). Together quadriceps muscles, quadriceps tendon and patellar tendon straighten the knee.

Causes & Symptoms

Patellar and quadriceps tendon tears often occur from a resistive load with the foot planted or the knee partially bent. A tear can also occur due to a fall, direct trauma, or a direct cut of the tendon. Injuries are most common in middle-aged people during sports. Occasionally tears can occur in older people due to inflammation, chronic disease, and steroid use that may affect the tendon blood flow.

Symptoms of a tendon tear include bruising, swelling, gap formation about the patella (knee cap), cramping, and inability to walk or straighten the leg.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to evaluate for associated injuries. Specialized examination maneuvers are done to determine the extent and location of the tear. MRI may be ordered to evaluate the tendon quality and to distinguish a partial from a full tear.

Treatment is based on the size and type of tear, age, and activity level. Partial tears and those in older patients may be treated with nonsurgical treatment including immobilization in a knee brace for 3-6 weeks followed by physical therapy.

More commonly, those with high-grade partial tears, an inability to raise their leg, instability with walking, or complete tears surgical treatment is considered. Surgical treatment is an outpatient procedure and involves reattachment of the torn tendon with suture. The knee will be immobilized with limited weight bearing for the first 4-6 weeks followed by strengthening and range of motion. Recovery typically takes 3-6 months.

Knee Osteoarthritis

Osteoarthritis is a thinning of the cartilage around a joint.

Evaluation & Treatment

Initial evaluation of knee osteoarthritis includes a medical history, physical examination, and x-rays. X-rays will show joint space narrowing and possibly bone spurs.

Treatment for knee osteoarthritis is symptom based. Initial treatment of knee osteoarthritis includes weight loss, stretching, low-impact activity, anti- inflammatory creams or medications, and glucosamine and chondroitin. Joint injections may also be considered which include corticosteroids or viscosupplements.

If symptoms are more severe partial or total knee replacement may be considered. The majority of knee replacements are done as an inpatient surgery and expected recovery is several months to pain free walking.

Iliotibial Band Syndrome

The iliotibial band (ITB) is a thick band of tissue along the outside of the thigh that assists in kicking the leg out to the side. In addition the ITB stabilizes the pelvis and acts as an additional support for the knee. It is a continuation of the tensor fascia lata muscle and is often painful in runners.

Causes & Symptoms

The ITB may become inflamed from over use and friction resulting in pain with activity. Causes of ITBS include leg length differences, running on an uneven surface, foot anatomy, or training errors such as increasing speed or distance too quickly.

Typical symptoms include feeling “tight” over the knee or hip, a hip snapping sensation, swelling, or a sharp burning pain.

Evaluation & Treatment

Initial evaluation includes a medical history and physical examination. X-rays are not often indicated. Examination includes provocative maneuver testing.

Typical treatment mainly consists of rest from activity, ice and anti-inflammatory medication. As symptoms reduce a complete stretching and strengthening program should be initiated. Frictional massage is also beneficial in later stages.

Pes Anserine Bursitis

A bursa is a sac of fluid that helps tendons slide. The pes anserine is an area of the knee where three hamstring tendons attach. Bursitis is inflammation of the bursa tissue.

Causes & Symptoms

Bursitis often develops as the result of overuse or constant friction. Causes of pes anserine burisits include hamstring tightness, excessive hill running, obesity, osteoarthritis, and meniscal tears. Typical symptoms include pain and tenderness on the inside of the knee 2 to 3 inches below the joint. Pain may also be felt at this location with exercise or climbing stairs.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to rule out associated conditions including stress fracture. Treatment includes rest, cross-training, ice, anti-inflammatory medications, and occasionally corticosteroid injection.

Patellofemoral Pain

The patellofemoral joint in the joint between the kneecap and the groove on the femur.

Causes & Symptoms

Patellofemoral pain can affect all ages. In younger patients it can occur without signs of arthritis while in older patients it is commonly due to arthritis.

Typical symptoms include pain with impact activity, kneeling, prolonged sitting, and stiffness when rising from a seated position.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to evaluate the groove and patellar surfaces. Specialized examination maneuvers also help other associated conditions. Occasionally an MRI may be considered to evaluate the ligaments of the kneecap in the setting of an injury.

Initial treatment includes activity modification, footwear modification, specific stretching, anti-inflammatory medication. In those with patellar instability or patellar arthritis surgical treatment may be considered.

Patellar Instability (Dislocating Kneecap)

The kneecap, patella, is a bone that connects the thigh and shinbone through tendon connections. The patella allows for the leg to straighten and bend.

Causes & Symptoms

Typically, the kneecap fits and slides smoothly in its groove. In some cases the groove is uneven or too shallow and the kneecap may partially or completely dislocate with motion. In the setting of a traumatic injury, a sharp blow to the kneecap may tear the ligaments that stabilize the kneecap and may cause the kneecap to dislocate.

Symptoms of a knee cap dislocation or patellar instability include buckling, repeat sensation of dislocation, catching with bending, stiffness, and swelling.

Evaluation & Treatment

Evaluation includes a detailed history and physical examination maneuvers.

Initial evaluation includes a detailed history, physical examination, and x-rays to evaluate the groove. Specialized examination maneuvers may be done to determine the extent of laxity. An MRI may be ordered to evaluate for ligament damage.

Initial treatment is based on the number of previous dislocation events. In those who are first time dislocators, nonsurgical treatment is indicated. Nonsurgical treatment focuses on utilizing a stabilizing brace, swelling reduction and strengthening of the hip and quadriceps muscles.

Surgical treatment is considered for those who have had multiple dislocations not improved with physical therapy and those with associated injuries such as cartilage damage. Surgical treatment is done through a small incision as an outpatient. Return to normal activities occurs between 1 to 3 months.

Carpal Tunnel Syndrome

The carpal tunnel is an area at the wrist where tendons and other structures of the hand pass from the forearm to the hand. Within the carpal tunnel is the median nerve that is a nerve that control sensation palm side of the thumb, index finger, and long fingers. Carpal tunnel syndrome is a source of numbness or pain in these fingers.

Causes & Symptoms

Carpal tunnel syndrome may occur when tissues/tendons within the carpal tunnel swell resulting on pressure on the median nerve. This often does not have a definitive cause. Risk factors include heredity, hormonal changes, older age, and medical conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance.

Typical symptoms include hand numbness, tingling, and pain while sleeping at night or while holding objects, difficult with fine movements, and even wasting of the muscles around the thumb.

Evaluation & Treatment

Initial evaluation includes a medical history and physical examination. X-rays are often not needed. Specialized examination manuvers may be used to determine the extent of compression. Nerve conduction studies may be done to confirm the diagnosis and determine the best treatment option.

Initial treatment is typically nonsurgical. Often pain can be relieved with bracing, anti-inflammatory medications, and activity modifications. A night brace or splint worn keeping the wrist in a neutral position may decrease symptoms. Corticosteroid injection will often provide temporary relief.

For those with continued pain despite nonsurgical treatment outpatient carpal tunnel release may be considered. Use of the hand is allowed a few days after surgery and sensation recovery is gradual. Typically grip and pinch strength return by about 2 months after surgery.

Trigger Finger

The tendons of the fingers slide through the hand to the digits through a series of coverings known as pulleys. Trigger finger is a condition where the tendons are inflamed and catch with motion underneath these coverings.

Causes & Symptoms

Trigger finger may be caused by a variety of conditions but people with diabetes and rheumatoid arthritis as well as older patients and women are at greater risk.

Typical symptoms include pain, catching, and popping with straightening of the finger. Occasionally a painful lump in the palm may be noticed. Catching may be worse at the beginning of the day.

Evaluation & Treatment

Initial evaluation includes a medical history and physical examination. Typically x-rays are not needed for the diagnosis.

Typical treatment is nonsurgical and includes rest, anti-inflammatory medications, and corticosteroid injections.

In those who do not improve with the above treatment, outpatient surgical release of the covering may be indicated. Recovery is usually complete within a few weeks.

Distal Radius Fracture (Wrist fracture)

The radius is one of two bones in the forearm. A fracture of the distal radius is a break of this bone at the level of the wrist. The radius is the most commonly broken bone in the arm.

Causes & Symptoms

Distal radius fractures most commonly occur from a fall onto an outstretched arm. Fractures of the distal radius may occur in young patients from a high energy injury or in older patients from a fall from a standing height.

Typical symptoms include pain, deformity, tenderness, bruising, and swelling.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to evaluate the fracture for displacement. Physical evaluation should also include an examination of pulse, nerve function, swelling and skin integrity. Fragments may puncture the skin which could lead to an increased risk of infection. In some cases a CT scan is needed to evaluate complex fractures.

Initial treatment includes the placement of a splint to the wrist, ice, and pain medication. Further treatment is dictated by fracture pattern, age, and activity level. Typically, nonsurgical treatment is recommended in those cases where the fracture is stable and there is good alignment of the bones in a splint is cast. This will then be followed with weekly X-rays to monitor for any movement. Surgical treatment is indicated in unstable fractures or those with displacement that cannot be reduced. If surgical treatment is indicated it is done with a plate and screws to hold the bone in place as an outpatient procedure through a small incision. After surgery immobilization in a splint or cast is needed for some time. Typically light activities, such as swimming or exercising the lower body in the gym can begin within 1 to 2 months after the cast removal. More strenuous activities such as skiing or football may be resumed after 3 to 6 months.

Ganglion Cyst of the Wrist & Hand

A cyst is a fluid out pouching. A ganglion is a cyst that arises from a joint. Typically the cyst has a balloon cyst with a stalk that begins at the joint.

Causes & Symptoms

The cause of ganglion cysts is unclear though some thought is that repetitive wrist trauma may increase the risk.

Ganglions at the wrist are most commonly found between the ages of 15 and 40 years. Cysts that develop at the end joint of a finger, mucous cysts, are more commonly caused by arthritis in the finger joint.

Symptoms include a hard bump, pain with wrist motion, and occasionally numbness or tingling of the hand. Some smaller ganglions can remain hidden under the skin.

Evaluation & Treatment

Initial evaluation includes a medical history and physical examination. X-rays may be done to rule out other conditions including a bone tumor or arthritis. In cases of a suspicious ganglion or those who may have an occult ganglion an MRI or ultrasound may be indicated.

Initial treatment of a ganglion cyst is nonsurgical including observation, immobilization, or aspiration. A significant portions of cysts return after aspiration. Surgical treatment may be considered if nonsurgical treatment does not provide relief. Surgical cyst removal is done as an outpatient procedure through a small incision. Activities usually can be resumed 2 to 6 weeks after surgery.

De Quervain's Tendinosis

Tendinosis is a swelling of the tendons. De Quervain's tendinosis is an inflammation of the tendons that move the thumb.

Causes & Symptoms

De Quervain's tendinosis most often is caused by overuse but can also be seen with pregnancy and rheumatoid disease. It is most common in middle-aged women.

Symptoms include pain and tenderness along the thumb side of the wrist especially with forming a fist, grasping, gripping, and turning the wrist.

Evaluation & Treatment

Initial evaluation includes a medical history and physical examination. X-rays are often not needed. Specialized examination maneuvers including making a fist with the fingers closed over the thumb, and then bending the wrist toward your little finger can be done to diagnosis this further.

Most cases can be treated nonoperatively. Treatment begins with splinting, anti-inflammatories, activity modification and occasionally corticosteroid injection.

Surgical treatment is reserved for those with pain after several months of nonsurgical treatment. Outpatient surgery may be done to open the covering over the tendons. Normal use of the hand usually can be resumed once comfort and strength have returned.

Basal Joint Arthritis (Thumb Arthritis)

The basal joint is the joint at the base of the thumb that allows the thumb to rotate and pinch. Arthritis is a thinning of the cartilage of a joint. Arthritis of the basal joint is more common in women than in men, and usually occurs after 40 years of age.

Causes & Symptoms

Often basal joint arthritis can develop overtime without a known injury. Those with prior fractures or other injuries may have an increased likelihood of developing this condition.

Typical symptoms include pain, loss of strength in the thumb with gripping or pinching, swelling, tenderness at the base of the thumb, and limited motion.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays of the thumb and hand. Arthritis at the base of the thumb commonly also is associated with carpal tunnel syndrome and this may be evaluated.

Typical treatment of basal joint arthritis is initially nonsurgical including ice, anti-inflammatory medications, supportive splints, and corticosteroid injections. Surgical treatment is considered for those with discomfort despite nonsurgical measures. Surgical treatment is an outpatient procedure. After surgery a cast is placed for several weeks. Full recovery typically takes several months of physical therapy.

Hand & Finger Fractures

The hand consists of 27 bones including eight bones in the wrist (carpals), five bones in the palm (metacarpals), and 14 bones in the fingers (phalanges).

Causes & Symptoms

Symptoms of hand or finger fractures include swelling, tenderness, bruising, inability to completely move the finger, and deformity of the finger.

Hand and finger fractures often are caused by direct trauma.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to assess the fracture for displacement. Examination should also assess pulses, position and alignment of the fingers, skin condition, and sensation.

Treatment is based on the amount of stability and displacement of the fracture. Often times the bones may be realigned by manipulation and casting. In these cases x-rays should be done within a week to ensure stability and alignment. Typically the case is worn for 3-6 weeks. Finger splints are typically worn for about 3 weeks.

For those with an unstable fracture or displacement outpatient surgical treatment may be considered. Typically this involves placement pins, screws, or wire, to hold the fractured bones together. Rehabilitation can begin once the fracture appears healed.

Scaphoid Fracture

The scaphoid is a bone in the wrist found on the thumb side and is the most commonly broken.

Causes & Symptoms

A fracture of the scaphoid is usually caused by a fall on an outstretched hand, with the weight landing on the palm. Scaphoid fractures can occur in all ages and typically occur with high-energy trauma. Most commonly men 20-30 years old experience these fractures.

Typical symptoms include pain and swelling at the wrist below the thumb resulting in an inability to move the thumb or wrist. Pain also prevents full grip. Some times fractures are missed as they are thought to be strains and in this case repeat x-rays should be done to ensure that there is no fracture.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays to evaluate the extent and displacement of the injury. An MRI may be considered if clinical suspicion is high but no fracture is seen on x-ray. To evaluate displacement further a CT scan may be ordered.

Treatment of scaphoid fractures depends on the acuity, location, and displacement of the break. Fractures that are closer to the thumb have a better blood supply and may be treated with a cast. Fractures in the middle of the bone (waist) or closer to the forearm (proximal pole) have a poor blood supply often surgical treatment is indicated. Surgical treatment is an outpatient procedure and involves placement of a screw to hold the fragments in place. After surgery, a cast or splint must be worn until healing is noted. Recovery takes several months and therapy is started to ensure full hand motion and strength.

Ankle Fractures

Ankle fractures are a break in one of several bones about the ankle. They can be fractures with our without dislocation.

Causes & Symptoms

Ankle fractures can occur at any age and can result from a high-energy twist, fall, or direct blow. In older people ankle fractures can result from a simple twist or fall.

Symptoms of an ankle fracture include pain, swelling, bruising, tenderness to touch, and inability to place weight on the leg. In the case of a fracture dislocation the ankle may look out of place.

Evaluation & Treatment

Initial evaluation includes a medical history, physical examination, and x-rays. Physical examination is done to ensure pulses, nerve function, swelling and skin integrity. If there is any bleeding around the fracture site this may be concerning for a skin puncture and this has an increased urgency as this can lead to increased risk of infection. Occasionally a CT scan is needed to evaluate more complex fractures.

Initial treatment initially includes reduction if needed and immobilization in a splint. Nonsurgical treatment reserved for those fractures where the fragments are not out of place or the ankle is not unstable. Occasionally a stress x-ray may be done to ensure ankle stability.

Surgical treatment is indicated if the fragments are not aligned or the ankle appears unstable. Surgical treatment is done plates and screws to hold the fragments in the correct position. Without fixation of displacement fragments, fractures may not heal or heal in a suboptimal position resulting in pain or the early development of arthritis. Typical treatment involves no weight bearing on the ankle for 6 weeks and possibly 12 weeks with unstable injuries. Return to driving is variable but averages 9 to 12 weeks from the time of injury.

Ankle Sprain & Lateral Ankle Instability

A sprain is a stretch or partial tearing of one or several ligaments. In the ankle this most commonly happens around the lateral ankle and results from an inward twisting motion.

Causes & Symptoms

Symptoms of an ankle sprain include tenderness, swelling, and stiffness. This is different than an ankle fracture in that the ankle is stable and only causes mild to moderate pain with walking. A more serious sprain may be painful to walk on. In severe ankle sprains, the ankle may give way or be too painful to walk on.

Evaluation & Treatment

Evaluation begins with a medical history, physical examination, and x-rays. A history of prior ankle injuries should be discussed. X-rays are done to rule out broken bones in the ankle or the foot.

Initial treatment is based on the extent of the injury. A majority of ankle sprains resolve with rest, ice, and elevation. A protective ankle brace or boot can help with reducing discomfort with walking. Physical therapy to strengthen the ankle ligaments and improve post injury proprioception is helpful for those who’s symptoms last longer than a few days. Recurrent ankle instability that is not improved with therapy and bracing may benefit from ligament reconstruction. Reconstruction utilizes surrounding tissue to create stability in place of the torn ligament. After reconstruction surgery the ankle is protected in a cast or boot for 6 weeks and return to activity typically takes 3-4 months.

Plantar Fasciitis & Bone Spurs

The plantar fascia is a tissue at the bottom of the foot that connects the heel to the fore-foot and supports the arch. Plantar fasciitis is an inflammation of this tissue.

Causes & Symptoms

Plantar fasciitis typically develops without any specific cause and develops slowly over time. Risk factors include tight calf muscles, obesity, high foot arch, repetitive impact activity, and new or increased activity level.

Heel spurs are not necessarily a cause of pain. One out of 10 people has heel spurs, but only 1 out of 20 people with heel spurs has foot pain. Since the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Symptoms of plantar fasciitis include most notably pain with the first few steps in the morning, pain on the bottom of the foot near the heel, and pain after but not during exercise.

Evaluation & Treatment

Evaluation includes a detailed medical history and physical examination. X-rays may be done to rule out other conditions.

Initial treatment includes rest, ice, anti-inflammatory medications, and stretching of the calf and plantar fascia. Occasionally soft heel pads, night splints, extracorporeal shockwave therapy, and rarely corticosteroid injections may be suggested. Greater 90% of patients with plantar fasciitis will improve within 10 months of this treatment.

Surgery should only be considered after 12 months of aggressive nonsurgical treatment. If surgical treatment is recommended it can be done through a small incision as an outpatient procedure. As surgery for plantar fasciitis can result in chronic pain and dissatisfaction, it should only be considered after exhaustive nonsurgical treatment.

Posterior Tibial Tendon Dysfunction (Flat Foot)

The posterior tibial tendon is a tendon on the inside of the ankle that provides stability and support for the arch of the foot. Pain can occur when the posterior tibial tendon becomes inflamed or torn. This may result in a flatfoot.

Causes & Symptoms

Posterior tibial tendon dysfunction occurs in those with obesity, diabetes, and hypertension. It is most commonly seen in women and in people older than 40 years of age. In the setting of an acute injury or chronic over use, the tendon can become inflamed.

Symptoms of posterior tibial tendon dysfunction include pain and swelling along the inside of the foot and ankle and pain that is worse with activity.

Evaluation & Treatment

Initial evaluation includes a detailed history, examination maneuvers, and X-rays. An MRI or ultrasound may be ordered to evaluate for a tendon tear or extent of tendonitis.

Treatment begins with rest, ice, anti-inflammatory medications, immobilization, orthotics, braces, and physical therapy. Pain resolves slowly even with treatment and may last 3-6 months with treatment and sometimes longer if symptoms have been for many months prior to treatment.

Surgery should be considered if pain does not improve despite 6 months of appropriate treatment. Surgical treatment may be done as an outpatient or overnight procedure. Reduction in pain may take 12 months or longer.

Bunion

A bunion is a painful deformity of the great toe at the metatarsophalangeal joint.

Causes & Symptoms

Bunions occur due to a variety of conditions including heredity and narrow toed shoes. Symptoms include swelling or tenderness about the great toe and pain with shoes.

Evaluation & Treatment

Initial treatment begins with a medical history, physical examination, and x-rays. Most bunions are treatable without surgery. Modifications such as wide toe box shoes with soft soles and short heels (< 2 ¼ inches) often reduce symptoms.

Surgical treatment is indicated in those who continue to have pain at the bunion despite modifications or are unable to change footwear. If surgical treatment is indicated it can be done through a small incision on the toe as an outpatient procedure. Recovery often takes several weeks in a walking boot.

Chronic Exertional Compartment Syndrome

Compartment syndrome is a painful condition that occurs when pressure builds in the muscles to a point that restricts blood flow.

Causes & Symptoms

Compartment syndrome can be divided into two catagories, acute and chronic. Acute compartment syndrome often occurs due to trauma and is a medical emergency. Chronic compartment syndrome, known as exertional compartment syndrome occurs over time and is caused by and directly correlated with exertion. This pain stops with rest.

Evaluation & Treatment

The evaluation of chronic compartment syndrome begins with a medical history, physical examination, and x-rays to rule out other conditions such as a stress fracture. Occasionally compartment testing during activity may be done. Treatment includes physical therapy, orthotics, anti-inflammatory medication, and rarely surgical release.

Hip Osteoarthritis

Osteoarthritis is a degenerative condition where the cartilage covering bones decreases over time. As the cartilage decreases, the bones rub together causing pain with movement.

Causes & Symptoms

Evaluation of hip osteoarthritis includes a medical history, physical examination, and x-ray evaluation. Initial treatment includes rest, anti-inflammatory medications, stretching, and activity modification. In cases that do not improve with the above treatment, hip replacement (hip arthroplasty) may be considered.

Evaluation & Treatment

Evaluation of hip osteoarthritis includes history, physical examination, and x-ray evaluation. Treatment includes rest, stretching, activity modification, anti-inflammatory medications, and weight-loss. Definitive pain relief for end stage arthritis is accomplished through a hip replacement (hip arthroplasty) and is dependent on age, activity level, and medical conditions.

Hip Pointer

A Hip Pointer is a bone bruise from a direct blow to the iliac crest, a portion of the pelvis on the side of the body.

Causes & Symptoms

Hip pointer symptoms include pain, swelling, bruising, muscle spasms, and tenderness at the iliac crest. This is often worse with walking and core movement.

Evaluation & Treatment

Initial evaluation of a hip pointer includes a medical history, physical examination, and X-rays to rule out fractures or bony avulsions.

Treatment consists mainly of ice and compression, rest, and anti-inflammatory medications.

Lumbar Strain (Back Strain)

A lumbar strain results from injury to the muscles or ligaments around the spinal column (vertebrae).

Causes & Symptoms

Injury can results from muscle injury due to impact, stretching, bending, or muscle imbalance from degenerative spine conditions. Symptoms include spasms and swelling.

Evaluation & Treatment

Evaluation includes a detailed history and examination. Special maneuvers including strength, sensation, and reflexes testing are done. X-rays are evaluated to check the alignment of the bones.

Initial treatment includes rest, ice, and compression, lumbar support, and physical therapy. Preventative treatment focuses on core strengthening and includes stretching and strengthening of the trunk muscles, hamstrings, and quadriceps.

Lumbar Radiculopathy
(Sciatica/Herniated Disc/Pinched Nerve)

Pain in the low back that radiates to the hip, leg, and toes often times is caused by an irritation or injury to the nerves at the level of the spinal root near the lumbar spine. As vertebral disks age, they lose height and may begin to bulge or herniate.

Causes & Symptoms

Spondylosis is arthritis of the back and occurs with age. It is important to keep in mind that all these changes are "normal" and they occur in everyone. Though they are found in all people it is not known why some people have symptoms while others do not.

Pain from lumbar radiculopathy travels down the arm in the area of the involved nerve. It can occasionally cause weakness. Pain is usually described as sleeping, cramping, numbness, sharp, or pins and needles.

Evaluation & Treatment

Evaluation includes a detailed history and examination. Special maneuvers including strength, sensation, and reflexes testing are done. X-rays are evaluated to check the alignment of the bones. An MRI may be ordered to evaluate disk bulges and nerve root or spinal cord compression. In some cases electromyography and nerve conduction studies may be ordered evaluate the nerves further.

A majority of patients with cervical radiculopathy get better with time, medication, and physical therapy. Occasionally those with MRI findings that do not improve may benefit from spinal injections.

In those who do not find relief with the above treatment and who have MRI findings, surgical treatment may be recommended. Recovery from spinal surgery depends on the procedure performed and typically takes several months.

Cervical Radiculopathy/Herniated
Disc (Pinched nerve)

Pain in the neck that radiates to the shoulder, arm, or hand often times is caused by an irritation or injury to the nerves at the level of the spinal root near the neck. . As vertebral disks age, they lose height and may begin to bulge or herniate.

Causes & Symptoms

Spondylosis is arthritis of the neck and occurs with age. It is important to keep in mind that all these changes are "normal" and they occur in everyone. Though they are found in all people it is not known why some people have symptoms while others do not.

Pain from cervical radiculopathy travels down the arm in the area of the involved nerve. It can occasionally cause weakness. Pain is usually described as sleeping, cramping, numbness, sharp, or pins and needles.

Evaluation & Treatment

Evaluation includes a detailed history and examination. Special maneuvers including strength, sensation, and reflexes testing are done. X-rays are evaluated to check the alignment of the bones. An MRI may be ordered to evaluate disk bulges and nerve root or spinal cord compression. In some cases electromyography and nerve conduction studies may be ordered evaluate the nerves further.

A majority of patients with cervical radiculopathy get better with time, medication, and physical therapy. Occasionally those with MRI findings that do not improve may benefit from spinal injections.

In those who do not find relief with the above treatment and who have MRI findings, surgical treatment may be recommended. Recovery from spinal surgery depends on the procedure performed and typically takes several months.

Tendonitis

Tendons are structures that connect muscles to bone. Tendonitis is an inflammation on tendons.

Causes & Symptoms

Tendonitis most commonly occurs from overuse. Tendonitis can occur from an incrase in activity level or due to age related changes in tendons. As people age, tendons loose their elasticity and ability to glide smoothly. The cause of these age-related changes is not entirely understood. Injury resulting in alteration of the gliding path of a tendon may also result in irritation of the tendon.

Evaluation & Treatment

Evaluation of tendonitis begins with a medical history and physical exam. Findings include tenderness or swelling over the tendon and pain with motion. X-rays and MRIs are not usually needed for the diagnosis.

Treatment of tendonitis includes rest, anti-inflammatory medication, ice, cross training, and physical therapy.

Shin Splints

The tibia is the bone along the front of the lower leg below the knee. “Shin splints” are pain in this region.

Causes & Symptoms

Shin splints can result from overuse or overload. The pain is a result of inflammation in the connective tissue and muscles of the leg. It is most commonly seen with activities such as running on a slanted surface, hill running, worn-out footwear, increased level of training, and those with flat foot.

Symptoms of shin splints include a tender, sore, and/or painful lower leg with or without swelling. This is mostly with activity but can be felt at rest as well.

Evaluation & Treatment

Evaluation of shin splints begins with a medical history and physical exam. X-rays are done to rule out other conditions such as stress fractures, which are small cracks in the bone.

Treatment of shin splints includes rest, ice, anti-inflammatory medication, and reducing activity level. Activities such as low impact exercises, such as swimming, bicycling or water running may be helpful during this time.

Ice packs wrapped in a thin towel can be applied to the affected shin for 15 to 20 minutes four times a day for several days.

In those with shoe wear problems, evaluation and orthotics may be recommended. With treatment activity can be increased gradually.

Stress Fracture

A Stress fracture is a small crack in a bone from repetitive overload. This often occurs in the setting of muscle fatigue.

Causes & Symptoms

Stress fractures are most commonly seen in those who have sudden increases in training.

Evaluation & Treatment

Evaluation of stress fractures begins with a medical history and physical exam. X-rays are done to evaluate for fracture lines. In cases where there is high suspicion but fracture lines are not seen and MRI will assist in the diagnosis.

Treatment for stress fractures includes rest and possibly limited weight bearing until the symptoms resolve.

Sports Hernia

A Sports Hernia is a tear in the lower abdominal muscles or tendons resulting in exertional pain. A sports hernia more specifically is a tear in the inguinal floor, or a tear in the oblique muscles. This differs from an inguinal hernia because the colon is not the part responsible for the protrusion, rather it is the muscle.

Causes & Symptoms

Activities with explosive or repetitive motions predispose people to sports hernias.

Pain can be from a single incident or gradual. Pain is often felt in the pubic region just below the belt line with activity and can be painless at rest.

Evaluation & Treatment

Evaluation of a sports hernia begins with a medical history and physical exam. The best way to diagnose a sports hernia is through an MRI or bone scan of the pelvis.

Initial treatment includes rest, anti-inflammatory medications, activity modificaiton, and physical therapy. Therapy includes ultrasound, trunk stabilization, lower abdominals strengthening, and adductor strengthening.

In rare cases surgery is indicated. In this case an abdominal surgeon repairs the pelvic floor, use mesh fibers to reattach partial tears, or perform an adductor release to relieve pressure off the inguinal ligament.

Shoulder Arthroscopy

Arthroscopy is the use of a camera and specialized equipment through small incisions to evaluate, diagnose, and treat problems inside a joint.

What to Expect

Arthroscopy can be used for many conditions including rotator cuff repair, labral repair, decompression, releases, and nerve releases. Through the use of smaller incision, a faster and less painful recovery can be expected.

Arthroscopic surgery is done as an outpatient. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the shoulder and arm for pain relief.

Once in the operating room, you will be positioned so that a clear view of the inside of your shoulder can be obtained. A member of the surgical team will clean the skin over the shoulder with an antiseptic solution and a sterile drape will cover your shoulder and arm and your forearm will be placed in a holding device to ensure your arm stays still.

Through small incisions about the shoulder fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing the inside of your shoulder and any damage.

Small instruments are placed through 1-3 separate incisions and can be used to shave, cut, grasp, pass suture, and tie knots. Anchor are often used to hold stitches into bone.

At the completion of surgery the incisions are closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

Recovery from shoulder arthroscopy depends on the procedure performed but takes several weeks and a few months before full recovery. You may find it comfortable sleeping in a reclining chair or propped up in bed for the first few days after surgery. Physical therapy will play a vital role after surgery in regaining strength and motion.

At the completion of surgery the incisions are closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks for your shoulder joint to completely recover.

You can expect some pain and discomfort for at least a week after surgery. You will be prescribed pain medicine to help with this discomfort. It is important to ice the shoulder during the first 48 hours.

Patients find that they are more comfortable sleeping in a reclining chair or propped up in bed during the first days after surgery.

Rehabilitation plays an important role in getting you back to your daily activities. An exercise program will help you regain shoulder strength and motion. A rehabilitation plan will be discussed at the first visit based on the intra-operative findings.

Open Shoulder Surgery

Open shoulder surgery is surgery through an incision in the area of the shoulder and is most commonly used for treatment of shoulder fractures, shoulder replacements, acromioclavicular joint reconstructions, biceps repair, clavicle fractures and many other procedures.

What to Expect

Open shoulder surgery is done either as an outpatient or as an overnight stay procedure. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the shoulder and arm for pain relief.

Once in the operating room, you will be positioned so that a clear view of the inside of your shoulder can be obtained. A member of the surgical team will clean the skin over the shoulder with an antiseptic solution and a sterile drape will cover your shoulder and arm and your forearm will be placed in a holding device to ensure your arm stays still.

Typically the incision is made over the fracture or area of reconstruction. Access to the shoulder joint itself is done through the deltopectoral interval, an interval between two muscles at the front of the shoulder. At the end of surgery the incision is closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home or to the hospital floor. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night if you go home.

Recovery from shoulder surgery depends on the procedure performed but takes several weeks and a few months before full recovery. You may find it comfortable sleeping in a reclining chair or propped up in bed for the first few days after surgery. Physical therapy will play a vital role after surgery in regaining strength and motion.

Elbow Arthroscopy

Arthroscopy is the use of a camera and specialized equipment through small incisions to evaluate, diagnose, and treat problems inside a joint.

What to Expect

Arthroscopy can be used for many conditions including release of scar tissue, debridement of arthritis, removal of loose bodies, and treatment of cartilage damage. Through the use of smaller incision, a faster and less painful recovery can be expected.

Arthroscopic surgery is done as an outpatient. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the arm for pain relief.

Once in the operating room, you will be positioned so that a clear view of the inside of your elbow can be obtained. A member of the surgical team will clean the skin over the shoulder with an antiseptic solution and a sterile drape will cover your elbow and arm and your forearm will be placed in a holding device to ensure your arm stays still.

Through small incisions about the shoulder fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing the inside of your elbow and any damage.

Small instruments are placed through 1-3 separate incisions and can be used to shave, cut, grasp, pass suture, and tie knots. Anchor are often used to hold stitches into bone.

At the completion of surgery the incisions are closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

Recovery from elbow arthroscopy depends on the procedure performed but takes several weeks and a few months before full recovery. You may find it comfortable sleeping in a reclining chair or propped.

Open Elbow Surgery

Open elbow surgery is most commonly used for treatment of all types of elbow fractures, tennis and golfers elbow, ulnar nerve decompression, biceps tendon repair, collateral ligament repair, and elbow replacements.

What to Expect

Prior to having surgery you may be asked to see a primary care doctor to obtain “medical clearance” and to insure that any medical problems are addressed and health is optimized prior to surgery. Blood tests, an electrocardiogram, or chest x-ray may be needed. In some cases, based on health risks, a more extensive evaluation may be necessary.

Open elbow surgery is performed both as an outpatient and inpatient procedure. You may be able to go home the same day or may stay in the hospital overnight depending on the extent of the surgery.

The hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Make sure to follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery a member of the anesthesia staff will talk with you about anesthesia options. Open elbow surgery is performed with sedation, light general anesthetic, or general anesthetic. Regional nerve block injections that numb just your elbow area are rarely used in open elbow surgery because the numbing effect can last for a few hours after the procedure is completed. Although the numbing effect can help with managing pain, it prevents a careful nerve examination in the recovery room to make sure that the nerves that travel down your arm are functioning well.

If necessary for pain control, a regional anesthetic may be provided in the recovery room after nerve examination.

Once in the operating room, you will be positioned to allow access to the elbow. Care is taken to ensure that your spine and other pressure points in your arms and legs are protected and padded after positioning.

Next, a tourniquet is applied to your upper arm which is then placed in an arm holder to keep it in position during the procedure. A compressive dressing may be applied to your lower arm and hand to limit swelling. The surgical team will clean your skin with antiseptic and cover your shoulder and upper body with sterile surgical drapes.

At the completion of surgery the incision is closed with stitches and covered them with a large, soft bandage.

Postoperatively you may go home the same day or stay in the hospital overnight. Postoperatively nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

You can expect some pain and discomfort for at least a week after surgery. You will be prescribed pain medicine to help with this discomfort.

It is important to ice and elevate your elbow regularly for 48 hours after surgery. This will reduce the risk of severe swelling and help to relieve pain. When elevating your arm, whether you lie flat or recline, make sure your elbow is resting higher than your heart and your hand is positioned higher than your elbow.

Movement of your fingers and wrist frequently is encouraged to help stimulate circulation and minimize swelling. Timing on when you can start these gentle exercises, as well as return to daily activities, will depend on the type of surgery performed.

Rehabilitation plays an important role in getting you back to your daily activities. An exercise program will help you regain elbow and forearm motion and strength. A rehabilitation plan will be discussed at the first visit based on the intra-operative findings.

Return to driving, basic activities of daily living, and return to work will depend on the type of surgery you required.

Knee Arthroscopy

Arthroscopy is the use of a camera and specialized equipment through small incisions to evaluate, diagnose, and treat problems inside a joint.

What to Expect

Arthroscopy can be used for many conditions including removal or repair of torn meniscal cartilage, reconstruction of torn ligaments including the anterior cruciate ligament (ACL), removal of loose fragments of bone or cartilage, and removal of inflamed synovial tissue. Through the use of smaller incision, a faster and less painful recovery can be expected.

Arthroscopic surgery is done as an outpatient. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the knee and leg for pain relief.

Once in the operating room, you will be positioned so that a clear view of the inside of your knee can be obtained. A member of the surgical team will clean the skin over the knee with an antiseptic solution and a sterile drape will cover your knee and leg.

Through small incisions about the knee fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing the inside of your knee and any damage.

Small instruments are placed through 1-3 separate incisions and can be used to shave, cut, grasp, pass suture, and tie knots. Anchor are often used to hold stitches into bone.

At the completion of surgery the incisions are closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

Recovery from knee arthroscopy depends on the procedure performed but takes several weeks and a few months before full recovery.

Physical therapy will play a vital role after surgery in regaining strength and motion.

Open Knee Surgery

Open knee surgery is surgery through an incision in the area of the knee and is most commonly used for all types of knee and patella fractures, MPFL reconstruction, and posterolateral corner (PLC) reconstruction.

What to Expect

Open knee surgery is done either as an outpatient or as an overnight stay procedure. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the knee and leg for pain relief.

Once in the operating room, you will be positioned so that a clear view of the inside of your knee can be obtained. A member of the surgical team will clean the skin over the knee with an antiseptic solution and a sterile drape will cover your knee. Typically the incision is made over the fracture or area of reconstruction. At the end of surgery the incision is closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home or to the hospital floor. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night if you go home.

Recovery from knee surgery depends on the procedure performed but takes several weeks and a few months before full recovery. Physical therapy will play a vital role after surgery in regaining strength and motion.

Wrist Arthroscopy

Arthroscopy is the use of a camera and specialized equipment through small incisions to evaluate, diagnose, and treat problems inside a joint.

What to Expect

The Arthroscopic approach is mainly is utilized for arthroscopy can be used for many conditions including carpal tunnel release, TFCC ligament debridment or repair, removal of loose bodies, treatment of cartilage damage, and diagnostic arthroscopy. Through the use of smaller incision, a faster and less painful recovery can be expected.

Arthroscopic surgery is done as an outpatient. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the wrist and arm for pain relief.

Once in the operating room, you will be positioned so that a clear view of the inside of your wrist can be obtained. A member of the surgical team will clean the skin over the wrist with an antiseptic solution and a sterile drape will cover your hand, wrist, and arm.

Through small incisions about the knee fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing the inside of your wrist and any damage.

Small instruments are placed through 1-3 separate incisions and can be used to shave, cut, grasp, pass suture, and tie knots. Anchor are often used to hold stitches into bone.

At the completion of surgery the incisions are closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

Recovery from wrist arthroscopy depends on the procedure performed but takes several weeks and a few months before full recovery.

Physical therapy will play a vital role after surgery in regaining strength and motion.

Open Hand & Wrist Surgery

Open hand and wrist surgery is surgery through an incision in the area of the hand and wrist and is most commonly used for carpal tunnel syndrome, trigger finger, arthritis, and all types of hand & wrist fractures.

What to Expect

Open hand and wrist surgery is done either as an outpatient or as an overnight stay procedure. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the hand and wrist and arm for pain relief.

Once in the operating room, you will be positioned so that a clear view of the hand and wrist can be obtained. A member of the surgical team will clean the skin over the hand and wrist with an antiseptic solution and a sterile drape will cover your hand and wrist. Typically the incision is made over the fracture or area of reconstruction. At the end of surgery the incision is closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home or to the hospital floor. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night if you go home.

Recovery from hand and wrist surgery depends on the procedure performed but takes several weeks and a few months before full recovery. Physical therapy will play a vital role after surgery in regaining strength and motion.

Open Foot & Ankle Surgery

Open foot and ankle surgery is surgery through an incision in the area of the foot most commonly used for treatment of all types of foot and ankle fractures, Achilles tendon ruptures, and bunion deformities.

What to Expect

Open foot and ankle surgery is done either as an outpatient or as an overnight stay procedure. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the foot and ankle for pain relief.

Once in the operating room, you will be positioned so that a clear view of your foot and ankle can be obtained. A member of the surgical team will clean the skin over the foot and ankle with an antiseptic solution and a sterile drape will cover your foot and ankle. Typically the incision is made over the fracture or area of reconstruction. At the end of surgery the incision is closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home or to the hospital floor. Nurses will monitor your responsiveness and provide pain medication , if needed. You will need someone to drive you home and stay with you for at least the first night if you go home.

Recovery from foot and ankle surgery depends on the procedure performed but takes several weeks and a few months before full recovery . Physical therapy will play a vital role after surgery in regaining strength and motion.

Arm/Forearm/Hand/Upper
Extremity Fracture Surgery

Open arm/forearm/hand/upper extremity fracture surgery is surgery most commonly used for treatment of fractures of the humerus (upper arm), radius/ulna (forearm), and hand.

What to Expect

Open arm/forearm/hand/upper extremity fracture surgery is done either as an outpatient or as an overnight stay procedure. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the upper extremity for pain relief.

Once in the operating room, you will be positioned so that a clear view of the fracture. A member of the surgical team will clean the skin over the fracture site with an antiseptic solution and a sterile drape will cover your upper extremity. Typically the incision is made over the fracture or area of reconstruction. Most fractures are treated with placement of plates and screws on the bone after alignment is restored. Some hand fractures are fixed with small pins underneath or through the skin. Flexible rods may be used in children once alignment is restored. At the end of surgery the incision is closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home or to the hospital floor. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night if you go home.

Recovery from upper extremity fracture surgery depends on the procedure performed but takes several weeks and a few months before full recovery. Physical therapy will play a vital role after surgery in regaining strength and motion.

Thigh/Leg/Foot/Lower
Extremity Fracture Surgery

Open thigh/leg/foot/lower extremity fracture surgery is surgery most commonly used for treatment of fractures of the femur (thigh), tibia/fibula (leg), and foot.

What to Expect

Open thigh/leg/foot/lower extremity fracture surgery is done either as an outpatient or as an overnight stay procedure. Prior to surgery you will be asked to see your primary care doctor for “medical clearance”. They may check blood tests, EKG, and a chest x-ray in addition to other tests they find indicated.

Once surgery is scheduled, the hospital or surgery center will contact you ahead of time to provide specific details about your procedure. Please make sure to ask any questions you have and follow the instructions on when to arrive and especially on when to stop eating or drinking prior to surgery.

On the day of surgery, the anesthesia staff will talk with you about anesthesia options. You will be asleep for the procedure and often a regional nerve block is recommended to numb the lower extremity for pain relief.

Once in the operating room, you will be positioned so that a clear view of the fracture. A member of the surgical team will clean the skin over the fracture site with an antiseptic solution and a sterile drape will cover your lower extremity. Typically the incision is made over the fracture or area of reconstruction. Most fractures are treated with placement of plates and screws on the bone after alignment is restored. Some hand fractures are fixed with small pins underneath or through the skin. Flexible rods may be used in children once alignment is restored. At the end of surgery the incision is closed with stitches and covered them with a large, soft bandage.

Postoperatively you will stay in the recovery room for 1 to 2 hours before being discharged home or to the hospital floor. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night if you go home.

Recovery from lower extremity fracture surgery depends on the procedure performed but takes several weeks and a few months before full recovery. Physical therapy will play a vital role after surgery in regaining strength and motion.