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About Orthopedic Specialists

Orthopedic Specialists of Seattle provides new and advanced procedures including endoscopic carpel tunnel release surgery for carpal tunnel syrome, complex joint restoration procedures, anterior approach hip replacement surgery, and more.

Are you suffering from Hip Impingement?

Patients may have hip impingement for years before diagnosis because it’s rarely painful in its early stages. Early diagnosis is important; however, hip impingement if left untreated, can cause cartilage damage and osteoarthritis.

Once hip impingement becomes more advanced, symptoms include:

  • General stiffness in the groin or front of the thigh.
  • Running, jumping or sitting after flexing will also cause pain the groin region

What is hip impingement?

Hip impingement (femoro acetabular acetabular impingement) is a more recently recognized cause of hip pain in the active adult.

Hip impingement is caused by a lack of room or clearance between the neck of the femur and the rim of the socket (acetabulum). In a normal hip, there is a gliding motion of the round femoral head within the socket, but with an impinged hip, the gliding motion is disturbed. Dr. Downer states, “Mechanical problems do not always require surgical treatment; when symptoms affect function and lifestyle then surgery is justified.”

Dr. Downer, provides specialized care in hip restoration and replacement, and has a special interest in hip impingement conditions. Treatment options may include:

  • First approach – Trying to control the pain with anti-inflammatory medications – If pain persists, surgical treatment may be necessary.
  • Surgical treatment of hip impingement involves removing or correcting the cause of the reduced clearance between the neck of the femur and the rim of the socket (acetabulum). This may require arthroscopic surgery of the hip to remove diseased portions of the acetabulem (labrum) as well as femoral neck.
  • In severe cases, it may be necessary to correct the deformity and reshape the femoral neck and/or rim of the socket through a larger incision. In cases of malposition of the socket, a redirecting procedure, called a periacetabular osteotomy (PAO) may be required.

Don’t let a hip impingement slow down your healthy, active lifestyle. Find out treatment options so that you can continue doing the things you love. Call Orthopedic Specialists of Seattle and schedule a consultation with Dr. Downer at (206) 633-8100.

Meet Our Hip Preservation Specialist

Learn More about Dr. Phil Downer, MD

Hip Impingement

Hip impingement (femoral acetabular impingement) is a disorder of the hip that is becoming more recognized as a cause of hip pain in the active adult. It is also thought to be a previously unrecognized cause of arthritis in the young adult.

Causes of Hip Impingement

Hip impingement is caused by lack of room or clearance between the neck of the femur at the top of the thigh bone, and the rim of the socket (acetabulum). This lack of room may originate on the femoral neck, acetabulum, or both. The head of the femur may not be sufficiently offset from the neck of the femur to allow room when the hip is flexed.

This can be caused by childhood disorders or from wear over time stimulating new bone to be laid down on the front of the femoral neck. The acetabulum may be the cause of the impingement by covering too much of the femoral head in the front of the hip joint. There may also be multiple causes in the same hip.

This lack of clearance causes the neck and rim of the socket to jam together as the hip is flexed (as in sitting or running). This contact between the femoral neck and socket leads to damage of the contacting structures. This damage may be a tear of the cartilage around the socket (acetabular labrum) to more advanced cartilage damage and degenerative arthritis of the hip.

Symptoms of Hip Impingement

Typically the person with hip impingement complains of pain in the groin region during hip flexion activities such as running or jumping. There may also be symptoms after prolonged sitting. During most of these activities, the hip is placed in a flexed position, although pain may also occur with standing and walking when irritation of the hip is more generalized.

Meet Our Hip Preservation Specialist

Learn More about Dr. Phil Downer, MD

Hip Labral Tear

The acetabular labrum is a structure attached to the outside rim of the hip socket. This labrum is made of fibrous cartilage, a flexible material present in multiple joints of the body. In the hip, the labrum is thought to act as a gasket, keeping fluid in the joint during the normal loading of the joint that occurs with movement. It also acts as a stabilizer of the joint keeping the head seated in the socket.

Causes of Labral Tears

Various conditions can lead to damage of this labrum. These include traumatic events, degenerative conditions over time, as well as situations where the shape of the hip bones is incorrect. Traumatic events leading to labral tears can occur with multiple activities including motor vehicle accidents as well as common trips and falls. Degenerative labral tears are a component of generalized hip degeneration where the cartilage throughout the hip joint becomes rough and torn.

Conditions where the shape of the hip bones is incorrect are currently falling under the term hip impingement. These conditions involve improper shape of the hip socket, junction of the thigh bone head and neck, and more commonly a combination of both. This improper shape causes the labrum to be pinched or rubbed during normal movement leading to tearing and degeneration.

Treatment of Labral Tears

Treatment of labral tears involves repairing tissue if possible and removing the tissue that is too severely torn. Attention is then directed at correcting any bony abnormalities that have caused the labral tear in the first place. This is usually possible with hip arthroscopy, but may require more invasive procedures to correctly address the underlying bony problem.

More Information

Read our answers to Frequently Asked Questions about hip impingement and labral tears.

Meet Our Hip Preservation Specialist

Learn More about Dr. Phil Downer, MD

Carpal Tunnel Syndrome Wrist

Description
Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men and affects up to 10 percent of the population. It is caused by increased pressure on a nerve entering the hand through the confined space of the carpal tunnel.

The median nerve travels from the forearm into your hand through a tunnel in your wrist. The bottom and sides of this tunnel are formed by wrist bones and the top of the tunnel is covered by a strong band of connective tissue called a ligament.

Your doctor may make the diagnosis by discussing your symptoms and examining you. If symptoms continue to bother you, electrical testing of the nerve function is often performed to help confirm the diagnosis and clarify the best treatment option in your case.

Symptoms
Symptoms usually begin gradually without a specific injury. Numbness, tingling and pain in the hand are common. You may experience an electric-like shocking feeling. The thumb side of the hand is usually most involved. Symptoms at night are common and may awaken you from sleep.

During the day symptoms frequently occur with holding a phone, reading or driving. Symptoms may occur at any time. Moving or shaking the hands often helps decrease symptoms. Sometimes strange feelings and pain will travel up the arm.

Initially symptoms come and go, but over time they may become constant. A feeling of clumsiness or weakness can make delicate motions like buttoning buttons difficult and may cause you to drop things. If the condition is very severe, muscles in the palm may become visibly wasted.

Risk Factors
The actual cause is unknown in most people. Carpal tunnel syndrome is more common in women. In women, the swelling that occurs during pregnancy may cause symptoms, but those will frequently go away after delivery. Carpal tunnel syndrome becomes more common as we grow older and seems to affect people with certain medical conditions such as diabetes, thyroid conditions and rheumatoid arthritis more frequently.

Treatment Options
Symptoms can often be relieved without surgery. Treatment often begins with a brace or splint worn at night to keep the wrist in a natural position. Splints can also be worn during activities that aggravate symptoms. Simple medications such as Tylenol® or Advil® can help decrease pain. Changing patterns of hand use to avoid aggravating positions and activities may be helpful. A corticosteroid injection will often provide temporary relief, but symptoms may come back.

If your carpal tunnel syndrome continues to bother you and you do not gain relief from non-surgical treatments, surgery can be effective in diminishing symptoms. Because carpal tunnel syndrome is not a dangerous problem, the decision whether to have surgery is based mostly on the severity of your symptoms.

  • If your symptoms are severe and won’t go away you may want to consider surgery.
  • In more severe cases, surgery is considered sooner because other treatment options are less helpful.
  • In very severe cases, surgery may be recommended to prevent irreversible damage.

cons1_90_5Treatment Options: Surgical
The strong roof of the carpal tunnel is cut during carpal tunnel surgery to increase the size of the tunnel and decrease pressure on the nerve. This is done through an incision in the palm or wrist. A small camera may be used to allow the surgery to be performed through a smaller incision.

Risks of the surgery include bleeding, infection and nerve injury. Some pain, swelling and stiffness are expected, but severe problems are rare.

After surgery, elevating the hand and moving the fingers helps minimize swelling and stiffness. Minor soreness in the palm is common for several months after surgery. Most patients have improvement following surgery, but recovery may be gradual.

When carpal tunnel syndrome has been present longer and the nerve is more severely affected, recovery is slower and less complete.

Meet Our Hand & Wrist Surgery Specialists

Learn More about Dr. Scott D. Ruhlman, MD

Learn More about Dr. Wayne Weil, MD

Carpal Tunnel Syndrome, Prevention, and Treatment

Carpal Tunnel Syndrome is a common condition that occurs when the median nerve is compressed at the wrist, resulting in pain, numbness, and tingling of the hand and fingers. The carpal tunnel is a tight area of the wrist that many important tendons and nerves pass through. It has a floor, walls, a ceiling, an entrance, and an exit. The floor and walls of the tunnel are made up of the bones.

Carpal Tunnel Syndrome, Prevention, Treatment The ceiling is the transverse carpal ligament. The median nerve runs from the forearm to the hand and directly through the carpal tunnel. This nerve controls some of your hand muscles and also allows sensation of your thumb, index, middle, and half of your ring finger. When this nerve is pressed and squeezed, carpal tunnel syndrome develops.

What are the symptoms of Carpal Tunnel Syndrome?

There are nine tendons that pass through the carpal tunnel and these attach muscles of this area to bones to allow your your thumb and fingers to flex. Each of these tendons has a slippery covering called the synovium. This covering allows the tendons to slide easily as the fingers are moved.

When the synovium becomes inflamed or thickened, pressure develops on the median nerve, adversely affecting its function. With a compromised median nerve, there is less blood and nutrients available, leading to numbness, weakness, and pain of the fingers and thumb. These symptoms are considerably worse at night or while driving. … read more