Knee Arthroscopy

What is knee arthroscopy?

During the last two decades, the diagnosis and treatment of knee joint problems have improved thanks to a minimally invasive procedure called knee arthroscopy. This surgical technique allows orthopedic specialists to see inside the knee and to carry out diagnostic and treatment measures through tiny incisions. This approach to surgery reduces pain, minimizes scarring, and helps speed up the recovery period when compared to traditional “open” knee surgery.

How does arthroscopy of the knee work?

Arthroscopy involves the orthopedic surgeon to using a device known as an arthroscope. This instrument is a tiny, pen-shaped device that has a small video camera attached to the end. The arthroscope is inserted into the knee through small incisions and the camera relays images to a computer screen. Our orthopedic specialists can use these images to diagnose knee problems. Once that is done, the doctor can carry out the appropriate procedure in the same surgical setting.

What does knee arthroscopic surgery treat?

Orthopedic specialists can use arthroscopic surgery to perform a variety of procedures. These include the repair or reconstruction of torn ligaments, the removal of small loose bits of bone. The hard tissue that provides structural support to the body. It is primarily composed of hydroxyapatite cryst… or cartilagecartilageThe hard, thin layer of white glossy tissue that covers the end of bone at a joint. This tissue allows motion, and repair or resection of torn meniscus tissue. Many of these conditions arise due to a knee injury or degeneration.

What are the benefits of arthroscopic surgery of the knee?

There are many benefits of knee arthroscopy when compared to traditional “open” surgery. With this procedure, you likely to experience less pain after the surgery and you have a lower risk of developing certain complications like infections or scarring. In addition, the hospital stay is shorter as most knee arthroscopic surgeries are performed on an outpatient basis in a freestanding surgery center. The greatest benefit is usually a quicker overall recovery.

What are the risks of knee arthroscopy?

All medical and surgical procedures have some risk. With knee arthroscopy, the risks are minimal and our orthopedic specialist will discuss these with you prior to your surgery. These risks depend on your current state of health, the type of surgery performed, and the extent of your injury or knee problem.

What should I expect before surgery?

Prior to an arthroscopic procedure, depending on your overall health you might have to see a primary care health professional for a general physical examination. In addition, you will need to tell the doctor about any medications you are taking and he may advise you to stop some of these before the procedure.

What should I expect after surgery?

You will need to start exercising the knee immediately after your procedure to restore range of motion and strength to the joint. While many patients get back to normal activities without much difficulty, plan to discuss this issue with your orthopedic specialist, as he may have a specific rehabilitation program for you to follow.

Immediately after your knee arthroscopy you will experience some swelling and discomfort of the knee. This will usually only last for a few days, however. Your doctor will prescribe specific medications that work to alleviate these symptoms and help you get back on your feet.

Also, you should expect to feel a little stiff when performing exercises early after surgery. Any activity that leads to significant discomfort should be stopped immediately and your orthopedic specialist should be notified. Our orthopedic surgeons request that you elevate your leg frequently and use ice to reduce swelling.

Common Wrist Fractures and Repair

I see many wrist fractures, these are among the most common along with symptoms and treatment.

Distal Radius Fracture

The most commonly broken wrist bone with a fall on an outstretched hand is a break of the distal radius. The radius is the larger of the two forearm bones and the end toward the wrist is called the distal end. When the area of the radius near the wrist breaks it is considered to be a fracture of the distal radius. Distal radius fractures are very common.

Symptoms of a distal radius fracture are immediate pain, bruising, swelling, and tenderness. Often times the wrist hangs in an odd or bent way, otherwise known as a deformity.

What are the risk factors for a distal radius fracture?
Osteoporosis is a risk factor for all types of fractures, especially a distal radius fracture. A broken wrist can happen in healthy bones as well. The majority of these types of fractures occur in people older than 60 years of age who fall from a standing position. The other subset of people who injure their wrist are young patients with a high impact fall, causing a break in an otherwise normal wrist.

How is a distal radius fracture treated without surgery?
Treatment for a distal radius fracture involves the nature of the fracture, the age and activity level of the person injured, and the orthopedic specialist’s personal preferences. The doctor can cast the broken bone if it is in good position and is stable. Sometimes the orthopedic specialist must straighten the bone (reduce it) before a cast is applied. This is what doctor’s call a closed reduction. The cast is usually worn for about 6 weeks and at that time the doctor could order physical therapy to help with rehabilitation.

What is involved in surgical treatment?
There are times when distal radius fractures result in the bone being so much out of place that it cannot be corrected without surgery. The orthopedic surgeon will make an incision to directly access the broken bones to improve alignment. The bone can be held in correct position with the use of a plate and screws, metal pins, an external fixator or any combination of techniques.

Scaphoid Fracture of the Wrist

The scaphoid bone is one of the small bones in the wrist, and it is the wrist bone that is most likely to break. It is located on the thumb side of the wrist in the area where the wrist bends. It can be easily located when the thumb is held in a “hitch-hiking” position. The scaphoid bone is at the base of the hollow made by the thumb tendons.

Symptoms it is fractured include pain, swelling, and tenderness at the base of the thumb. The pain will worsen when the person grips something or tries to move the thumb or wrist. A scaphoid fracture is usually caused by a fall onto an outstretched hand and is not always as painful as one might think.

What are the risk factors for a scaphoid fracture?
Anyone can fracture their scaphoid bone but it is more common in athletes who participate in activities where falls are common. Men aged 20 to 30 are most likely to experience this type of injury.

How is a scaphoid fracture treated without surgery?
If the bone is in proper position and has good blood supply, the orthopedic specialist may treat it by casting. The cast is usually worn for 12 weeks. Many opt for surgical stabilization to minimize the length of immobility.

What is involved in surgical treatment?
Due to the precarious nature of the blood supply to the scaphoid, the orthopedic specialist may recommend surgery to optimize healing and prevent long term wrist arthritis. During the procedure metal implants (such as screws and wires) are used to hold the scaphoid in place until the bone is completely healed. The surgeon makes an incision over the front or the back of the wrist to align the bone, insert the metal implants, and repair the damage.

In special situations where the bone is not healing well on its own, a bone graft may be needed to aid in healing. A bone graft is new bone that is place around the broken bone to help stimulate bone healing. This allows the bone pieces to heal together into a solid bone.

Sports Injuries of the Elbow in Children and Teens

Most elbow injuries in children occur during activities like sports and play, or are the result of accidents and falls. The risk of injury is greater for those who participate in contact sports such as football, soccer, wrestling.

Also, injuries risk is higher for those who engage in snowboarding, skateboarding, hockey, skiing, biking, or in-line skating. When an injury occurs in a child or teen, it can affect the growing end of the long bones of the arm called the growth plate. These types of injuries always need to be evaluated by an orthopedic specialist. … read more

Common Shoulder Injuries Related to Sports

Clavicle Fracture (Broken Collarbone)
A broken collarbone (clavicle) is a very common fracture that occurs in people of all ages but occurs more commonly with sports related injuries. The clavicle is located between the ribcage and the shoulder blade and it connects the arm to the body. The collarbone lies above many vital structures, such as nerves and blood vessels.

What causes a clavicle fracture?
Clavicle fractures are most often caused by a direct blow to the shoulder area. These types of injuries occur during a fall on an outstretched arm, a contact hit (when a football player collides with an opponent), or any other type of direct impact to the shoulder that can occur during sporting activities.

What are the symptoms of a broken collarbone?
These types of fractures can be very painful and make it difficult to move your arm. Other symptoms include a sagging shoulder, inability to lift the arm due to pain, a grinding sensation with arm movement, a deformity or “bump” along the collarbone area, bruising, swelling, and tenderness over the broken area.

How is a clavicle fracture treated without surgery?
Broken collarbones do not always require surgery. If the bone ends are not shifted out of place and line up correctly, you may be treated with an arm sling and rest. Basically, the orthopedic specialist will have you wear this to keep your arm in proper position while the collarbone heals. Once your bone begins to heal, your doctor may order physical therapy for you to help you strengthen the muscle of your shoulder. The therapist will teach you exercises, too, to help prevent weakness and stiffness.

What is involved with surgical treatment?
If your bones are displaced (out of alignment) your orthopedic specialist may recommend surgery to align the bones. This is done to hold them in position while they heal.
During the procedure, the bone fragments are repositioned into normal alignment and held in place with special screws and metal plates that attach to the outer surface of the bone. After your surgery, you may notice a small patch of numb skin below the incision but with time this is less noticeable. You will also be able to feel the plate through your skin. These plates and screws are not removed until long after the bone heals.

Dislocation of the Shoulder
Many athletes who play tennis, baseball, or football tend to experience a dislocated shoulder. The shoulder joint is the body’s most mobile joint, turning in many directions. This advantage puts this joint at risk for dislocation. A complete dislocation means that the humerus (upper arm bone) is all the way out of the socket.

What causes dislocation of the shoulder?
Your shoulder can become dislocated by throwing, hitting, and overuse. Many people who play softball or baseball injure their shoulder this way.

What are the symptoms of a dislocated shoulder?
Symptoms include numbness, weakness, bruising, and swelling of the shoulder area. Some dislocations are severe enough to tear tendons and ligaments and to damage nerves. The shoulder joint can be dislocated forward, backward, or downward. The muscles of the shoulder area may have spasms from the disruption, as well, leading to pain and stiffness.

How is a dislocated shoulder treated?
Your orthopedic specialist will have to place the ball of the humerus back into the joint socket. This procedure is called a closed reduction and no surgery is necessary. Once the shoulder is back in place, the pain stops immediately.

Shoulder Impingement (Rotator Cuff Tendinitis)

The rotator cuff is made up of tendons and muscles that allow for a great range of motion of your arm. This is a frequent source of pain for athletes and an area that is at risk for injury during sporting activities. Shoulder impingement is often referred to as rotator cuff tendinitis and is one of the most common causes of shoulder pain.

What causes rotator cuff tendinitis?
When you raise your arm to shoulder height, the space between the bone and rotator cuff narrows. The bone can rub against (or impinge on the tendon and the bursa, causing irritation and pain when the arm is used repeatedly. Young athletes who use their arms for overhead action are particularly vulnerable. This includes those who play tennis, softball and baseball, and swimmers.

What are the symptoms of shoulder impingement?
When the rotator cuff is irritated this can lead to local swelling and tenderness in the front aspect of the shoulder. You may also have pain and stiffness when you lift your arm. There is also a sensation of tenderness when the arm is lowered from an elevated position. Other symptoms include sudden pain when reaching or lifting, pain radiating from the front of the shoulder to the side of the arm, minor pain at rest, and pain when throwing or using the arm.

How is rotator cuff tendinitis treated without surgery?
Your orthopedic specialist wants to reduce your pain and restore function of your shoulder. He will consider your activity level, your age, and your general state of health. Many times shoulder impingement can be treated with medications and rest. It is not uncommon for athletes to be ordered physical therapy to help restore normal motion of the shoulder. Your therapist will teach you specific stretching and strengthening exercises to relieve your shoulder pain and help you get back to normal activities.

What is involved with surgical treatment?
The goal of surgery is to create more space for the rotator cuff and this involves removing a portion of the inflamed bursa. Your orthopedic specialist will perform an anterior acromioplasty, where part of the bone is removed to allow for movement of the rotator cuff. Many times, the surgeon opts to perform this procedure by way of arthroscope.

The arthroscopic technique allows for use of small thin surgical instruments to be inserted around puncture wounds around the shoulder. The doctor can see inside the shoulder through a small camera inserted into the joint that displays images onto a computer TV monitor.

Shoulder Conditions and Shoulder Surgery

Your shoulder allows you to move and rotate your arm in a variety of positions. The shoulder, in fact, is the most flexible joint your body has. This type of flexibility also makes your shoulder susceptible to injury. If you do injure your shoulder, there are some nonsurgical methods of treatment that sometimes are recommended before surgery is considered.

However, in some cases, delaying surgical repair could increase the likelihood that your condition will be more difficult to treat later on.

If you have injured your shoulder, consult one of our orthopedic specialists for correct diagnosis and treatment of the problem, as this can make a big difference in the long run.

How does the shoulder work?

Your shoulder is made up of a ball-and-socket joint that has three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The top end of the humerus has a ball on the end that fits into a small socket of the shoulder blade. This is what forms the shoulder joint. The socket of the shoulder is surrounded by soft-tissue and the head of the arm bone has a smooth, durable surface. There is a thin inner lining of the joint called the synovium, and this allows for the smooth motion of the joint.

The upper portion of the scapula protects the shoulder joint. Your collarbone is attached to the shoulder blade by the acromioclavicular joint, often called the ‘AC joint’. The inner portion of the collarbone joins with the breastbone (sternum). Your rotator cuff is the group of tendons and muscles that attach your upper arm to your shoulder, and this structure covers the shoulder joint. You have many muscles that attach to the three upper arm bones and these enable you to lift your arm, throw a ball, swim, and reach over your head.

What are some common shoulder conditions?

Bursitis or Tendinitis
Bursitis or tendinitis occurs with overuse from repetitive activities like weight lifting, swimming, and throwing. These types of activities lead to a pinching and rubbing of the rotator cuff under the AC joint. The biceps tendon and rotator cuff will get irritated and inflamed with tendinitis and can lead to impingement syndrome and biceps tendon tears and/or rotator cuff tears. Sometimes, this condition can be treated by limiting the activity, but oftentimes, the pain starts after the damage has been done. If you have this condition and it is associated with isolated biceps tendon damage and pain, a procedure called ‘biceps tendoesis’ can be performed by our surgeons. This procedure relieves symptoms and prevents further damage to the joint.

Partial Rotator Cuff Tears
If the rotator cuff is partially torn, it is called a ‘partial thickness tear’. These are associated with chronic inflammation of the shoulder joint and the development of spurring under the AC joint. Sometimes, our orthopedic specialists treat these with modification of activity, light exercise, as steroid injections. If these methods fail, surgery will be necessary to repair the rotator cuff and remove the spurs that have developed.

Full-Thickness Rotator Cuff Tears
When the rotator cuff is torn completely in two pieces, it is known as a full-thickness rotator cuff tear. This can occur from heavy lifting, a fall, or a car accident. Most of the time, surgery of the shoulder is necessary for full-thickness tears. Arthroscopic techniques allow our expert surgeons to shave the spurs, evaluate the rotator cuff, and repair the tear. If the tear is larger or significantly retracted or associated with other structural problems, the surgeon may have to perform open surgery on the shoulder.

Impingement Syndrome
Impingement syndrome develops when the bursa of the joint is inflamed and the bone and tendons are irritated from rubbing on the undersurface of the acromion or AC joint. Our orthopedic surgeons can treat this with an ‘arthroscopic subacromial decompression’ procedure. With this procedure, the doctor removes some of the bony prominence or spurs and the inflamed bursa to allow for more space for the shoulder structures.

Instability
When the head of the upper portion of the arm bone is forced out of the shoulder socket, instability occurs. This usually is the result of a sudden injury, but can occur from excessive laxity of the shoulder ligaments. The two forms of instability are subluxations and dislocations. Basically, a subluxation is an incomplete dislocation. With subluxation, the shoulder is partially out of the socket. A dislocation occurs when the head of the upper arm bone slips completely out of the socket and may result in chronic instability of the joint. If you have repeated dislocations, our orthopedic specialists can operate by means of arthroscopic or open surgical repair.

Frozen Shoulder
A frozen shoulder occurs when the structures of the shoulder joint become immobile and lose flexibility. This occurs from injury or ‘wear-and-tear’ or may develop spontaneously with no specific cause. Our orthopedic specialists can treat frozen shoulder with many modalities including physical therapy, anti-inflammatories, injections and on rare occasions with manipulation under anesthesia or surgery to release the tight structures.

Fractured Collarbone and Acromioclavicular Joint Separation
Two common injuries for children and young adults who fall are a fractured collarbone and acromioclavicular separation. Most of these types of injures can be treated with splinting and arm slings, but often a serious displaced fracture or separation requires open surgical repair.

Fractures of the Upper Humerus or the Humeral Head
If you fall on an outstretched arm, you could suffer a fracture of the upper arm or humeral head. This type of fall is common in older people with osteoporosis. Open surgical repair is needed if the fracture is fragmented or displaced. Sometimes, our orthopedic specialists must put in an artificial joint called a prosthesis.

Osteoarthritis and Rheumatoid Arthritis
Arthritis can completely destroy the shoulder joint and its surrounding structures. Two forms of arthritis that do this are osteoarthritis (the most common type) and rheumatoid arthritis. These conditions may also cause deterioration and degeneration of the rotator cuff. If this happens, our orthopedic surgeons can surgically replace the shoulder joint with a metal and plastic joint to aid mobility and eliminate pain.

What are the types of shoulder surgeries?

Arthroscopy
Arthroscopy is a type of shoulder surgery that allows the surgeon to insert a small device inside the joint structure through a small incision to look inside. The images inside the shoulder joint can be viewed on a TV monitor that allows our orthopedic specialists to make a correct diagnosis. The surgeon can also insert small instruments inside the joint to make necessary repairs. Arthroscopy can usually be performed on an outpatient basis. The American Orthopedic Society for Sports Medicine reports that there are around 1.4 million shoulder arthroscopies done worldwide every year.

Open Surgery
Open shoulder surgery may be needed for some cases where there is an extensive injury or if the structures inside the joint are severely damaged. Open surgery can be done with a few small incisions. For some injuries, open surgery is associated with better results than arthroscopy. Open surgery technique uses larger incisions than arthroscopy to allow the surgeon to mobilize retracted tissues. Our orthopedic specialists will recommend the procedure that is best for you.

What are the possible complications of shoulder surgery?

After your shoulder surgery, some pain, stiffness, and tenderness are to be expected. There are some possible risks that could occur, however. These include infection, blood clots, and nerve damage.

How can I prevent future shoulder problems?

Once you have undergone a shoulder procedure, it is vital that you continue a shoulder exercise program that includes daily stretching and strengthening. Patients who follow their doctor’s therapies and instructions have the best medical outcome after shoulder surgery.

What can I expect during the recovery from shoulder surgery?

Your recovery really depends on the type of surgery that was performed. Most of the time, you will receive physical therapy for several weeks following surgery. It is critical that you only perform the activities your orthopedic specialist recommends.