Achilles Tendinits

Achilles tendinitis is a commonly occurring foot condition that leads to pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body, and it connects the calf muscles to the heel bone. This tendon is used for jumping and running.

There are two types of Achilles tendinitis: noninsertional and insertional types. With noninsertional Achilles tendinitis, the fibers in the middle portion of the tendon have started to break down and the tiny tears swell and thicken the tendon. This more commonly affects young, active individuals.

With insertional Achilles tendinitis, the lower portion of the heel where the tendon attaches to the heel bone is affected. This particular type can occur for any type of patient, active or inactive.

What are the symptoms of Achilles tendinitis?

Like most foot problems, the symptoms vary from person to person. These include:

• Pain along the tendon or the back of the heel that worsens with activity
• Pain and stiffness which is worse in the morning
• Severe pain the day after exercising
• Thickening of the tendon
• Swelling that is present all the time or worsens after activity
• Bone spurring

What causes Achilles tendinitis?

Achilles tendinitis is not the result of a specific injury; the problem results from repetitive stress on the tendon. Other factors that cause this syndrome include tight calf muscles and bone spurring.

How is Achilles tendinitis treated?

Nonsurgical treatment for Achilles tendinitis involves rest, ice therapy, NSAIDS, special exercises, physical therapy, and supportive shoes and orthotics. Surgical treatment may be necessary if conservative measures fail. Occasionally a gastrocnemius recession is performed, where the calf muscles are lengthened. Surgery typically involves debridement and repair of the affected tendon.

The aim of this procedure is to remove the damaged portion of the Achilles tendon. Occasionally a tendon transfer is required when a significant amount of damaged tendon is present. The unhealthy portion of the tendon is removed and reinforced with a graft to prevent the remaining tendon from rupturing with activity.

Adult Acquired Flatfoot Deformity (AAFD)

There are many different conditions that can lead to adult acquired flatfoot deformity. This syndrome results in a fallen arch with the foot pointed outward. For this condition, most people require orthotics and braces. For those who have no relief with these measures, surgery may be an option. Your orthopedic specialist will plan a treatment regimen for you based on what is causing your AAFD.

What are the symptoms of AAFD?

The symptoms of AAFD vary from patient to patient. They include:

• Pain that is worse with activity
• Pain along the course of the posterior tibial tendon which is on the inside of the foot and ankle
• Pressure or discomfort on the outside of the ankle bone
• Bony bumps on the top and inside of the foot that make wearing shoes difficult

What causes AAFD?

The most common cause of AAFD is damage to the posterior tibial tendon. This structure is one of the most important tendons of the leg. It extends from a muscle in the calf and travels down the inside of the lower leg to attach to the bones on the inside of the foot. This tendon functions to hold up the arch and support the foot with walking. Other things that can cause AAFD include arthritis, injury, and diabetes collapse (Charcot foot).

Who develops AAFD?

Women and people over age 40 are most likely to develop AAFD. Other risk factors are hypertension, obesity, and diabetes.

How is AAFD treated?

When orthotics and braces do not work, surgical treatment for AAFD may be necessary. The type of surgery will depend on the degree of dysfunction. With stage 1 dysfunction (pain along the posterior tibial tendon with no loss of arch), surgery involves debridement of the tendon and repair of longitudinal tears.

The operation for stage 2 dysfunction (pain along the posterior tibial tendon with associated fallen arch deformity) is more complex and involves realignment of the heel bone, a tendon transfer to support the arch, and often a spring ligament repair. When the deformity is due to arthritis, surgery to fuse the bones of the hindfoot (triple arthrodesis) is often required.

Plantar Fasciitis

If you are experiencing pain on the bottom of your heel, you may have plantar fasciitis. This condition occurs when the strong band of tissue that supports the foot arch becomes inflamed and irritated. The plantar fascia is a thin, long ligament that lies just beneath the skin on the bottom of the foot. This ligament connects to the heel in the front aspect of the foot to support the arch.

What are the symptoms of plantar fasciitis?

Common symptoms of plantar fasciitis include:

• Pain after the first few steps when arising in the morning or after a long rest period
• Pain on the bottom of the foot or heel area
• More intense pain after (not during) activity or exercise

What causes plantar fasciitis?

The plantar fascia absorbs the high strains and stresses placed on the feet. Sometimes, however, there is too much pressure and damage or tears to the tissues of the foot occurs. When this happens, the body’s natural response to injury is inflammation resulting in heel pain and stiffness of the plantar fascia.

How is plantar fasciitis treated?

Nonsurgical treatment of plantar fasciitis involves rest, ice therapy, NSAIDS, exercise (calf stretch and plantar fascia stretch), cortisone injections, supportive shoes and orthotics, night splints, and physical therapy. Your orthopedic specialist will recommend what is best for you. If all these measures fail, occasionally shockwave therapy is an option. Surgery is rarely

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

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.

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.

Description
With the start of the baseball season each spring, doctors frequently see an increase in elbow problems in young baseball players. A common elbow problem is Little Leaguer’s Elbow.

The elbow is the joint where the upper arm bone (humerus) meets the two bones of the lower arm (ulna and radius). The elbow is a combination hinge and pivot joint. The hinge part of the joint lets the arm bend like the hinge of a door; the pivot part lets the lower arm twist and rotate. The rounded ends of the upper arm bone give the elbow its two “knobs” or bumps (epicondyle). Several muscles, nerves and tendons (connective tissues between muscles and bones) cross at the elbow.

Injury occurs when the repetitive throwing creates an excessively strong pull on elbow tendons and ligaments. The young player feels pain at the knobby bump on the inside of the elbow.

Little Leaguer’s Elbow can be serious if it becomes aggravated. Repeated pulling can tear the ligament and tendon away from the bone. The tearing may pull tiny bone fragments with it in the same way a plant takes soil with it when it is uprooted. This can disrupt normal bone growth, resulting in deformity.

Osteochondrosis dissecans is a less common condition that is also caused by excessive throwing and may be the source of the pain on the outside of the elbow.
Muscles work in pairs. In the elbow, if there is pulling on one side, there is pushing on the other side. As the elbow is compressed, the joint smashes immature bones together. This can loosen or fragment the bone and cartilage. The resulting condition is called osteochondrosis dissecans.

Risk Factors / Prevention
Little Leaguer’s Elbow affects pitchers and other players who throw repetitively. Continuing to throw may lead to major complications and jeopardize a youngster’s ability to remain active in a sport that requires throwing.

Symptoms
Little Leaguer’s Elbow may cause pain on the inside of the elbow. A child should stop throwing if any of the following symptoms appear:

• Elbow pain
• Restricted range of motion
• Locking of the elbow joint

Treatment Options
If left untreated, osteochondrosis dissecans can become a complicated condition. Younger children tend to respond better to nonsurgical treatments.

• Rest the affected area.
• Apply ice packs to bring down any swelling.
• If pain persists after a few days of complete rest of the affected area or if pain recurs when throwing is resumed, stop the activity again until the youngster gets treatment.
• Return to throwing.

Treatment Options: Surgical
Surgery may be necessary, especially in girls more than 12 years old and boys more than 14 years old.