Distal Radius Fracture

The radius is the larger of the two forearm bones. The end near the wrist is referred to the distal end, and the end close to the elbow is called the proximal end. Distal radius fractures are breaks in the radius bone close to the wrist. Most distal radius fractures occur when you fall onto an outstretched hand or from a car accident or other trauma. When the distal radius fractures, there will be instant pain, bruising, swelling, and limited range of wrist motion. Sometimes, the wrist will appear deformed or out of alignment.

To diagnose a distal radius fracture, I will need to take an X-ray of the wrist. An open fracture is where the bone breaks through the skin. If the fracture extends into the joint, it is called an intra-articular fracture. Fractures that do not go into the joint are extra-articular fractures.

Treatment of a distal radius fracture involves the immediate measure of stabilizing the arm and applying an ice pack. You do this to protect the injury from further insult and to decrease swelling and control pain. One nonsurgical option is casting done if the bone is in good position. I may find it necessary to straighten (or reduce) the bone to align it correctly. Surgery is necessary when the bone must be reduced through an incision. This is called an open reduction, and these procedures often require pins, plates, and/or screws to hold the bone pieces in place.

Scaphoid Fracture of the Wrist

The scaphoid bone is one of the many small bones of the wrist. It is located on the thumb side of the wrist where the bending occurs, just above the radius bone. When the scaphoid bone fractures, you will have pain, decreased wrist movement, bruising, swelling, and tenderness.

Most scaphoid fractures occur when you fall onto an outstretched hand. To diagnose a scaphoid fracture of the wrist, I will need to do X-rays to evaluate for displacement. Many times, however, a break in this area does not show up right away. If I suspect the scaphoid is fractured, I usually apply a wrist splint for a couple of weeks and have you come back for a repeat evaluation and possibly an MRI.

Treatment of a scaphoid fracture depends on the exact location of the break. Those that are near the thumb typically heal in a few weeks with protection. If the fracture is more complicated, I may apply a cast to the wrist and monitor the healing. Breaks of the middle area of the scaphoid are more difficult to heal due to limited blood supply.

I often recommend surgery for these types of scaphoid fractures. I make a small incision and insert metal implants to hold the bone in place while it heals. In rare incidences, a bone graft is necessary. Whether or not surgery is necessary, you may need to wear the cast or splint for as long as six months.

Elbow Fractures

The bony aspect of the elbow that extends from the ulna arm bone is called the olecranon. This prominence is located under the skin with little protection from the soft tissues or muscles. The elbow joint consists of three bones, and these allow it to bend and straighten like a hinge. The humerus is the upper arm bone, the radius is the thumb side lower arm bone, and the ulna is the pinky side lower arm bone. When the elbow is injured, either by breaking one of these bones or by tearing a ligament that connects one bone to another, it can be stiff, painful, and unstable.

Elbow fractures occur from a direct blow, such as being hit with a baseball bat, or indirectly from landing on an outstretched arm with the elbow locked out straight. Symptoms of a fracture of the elbow include sudden intense pain, swelling, bruising, inability to straighten the elbow, numbness in one or more fingers, pain with joint movement, and tenderness. In order to diagnose an elbow fracture, I must examine the injury and take an X-ray of the joint.

Treatment depends on the extent of the injury. Some fractures of the elbow only require a splint, sling, or cast and conservative measures, while others require surgical intervention. If the bones are out of place, or if there are pieces of bone cutting through the skin, surgery will be needed.

Generally, I make an incision over the back of the elbow and hold the bone pieces and other structures together with pins, wires, plates, screws, and/or sutures. Once the surgery is over, I apply a cast for a short period of time and restrict activity to allow for healing.

Shoulder injuries occur from athletic activities that involve repetitive, excessive, overhead motion, such as pitching baseball, tennis, swimming, and weightlifting. Injuries to the shoulder also happen from doing everyday activities, such as hanging curtains, washing walls, or lifting the laundry basket. The shoulder is a complex joint that connects with muscles and tendons to allow full range of motion of the arm.

The shoulder consists of the head of your upper arm bone (the humerus), your shoulder blade (the scapula), and your collarbone (the clavicle). The humerus fits into a round socket called the glenoid. The rotator cuff is a combination of tendons and muscles that keep your humerus in alignment.

The shoulder’s unique mobility leads to problems of impingement of the bony structures or the soft tissues as well as instability. With some shoulder injuries, you may only feel pain with movement of the joint. Others, however, result in pain at rest.

What are the types of shoulder injuries?

Most shoulder injuries fall into one of the four major categories: (1) tendon inflammation or tear; (2) instability; (3) arthritis; and (4) fracture.

Rotator Cuff Tears – The rotator cuff is one of the most significant structures of the shoulder. This component allows you to lift your arm and reach overhead. When your rotator cuff is injured, you will have loss of function of the shoulder.

Bursitis – A bursae is a small, fluid-filled sac that is located in the shoulder joint and other joints of the body. When the bursae is inflamed and swollen, there is loss of cushion between the bones and the overlying soft tissues that reduce the friction of the gliding motion. This condition is called bursitis, and it can cause the shoulder to have pain and loss of function.

Tendinitis – A tendon is a cordlike structure that connects muscle to bone. Tendinitis of the shoulder is the result of wearing down of the tendon from overuse. The acute form of tendinitis results from excessive throwing or other overhead activities during sporting activities or work. Chronic tendinitis is due to age, and there is degeneration of the tendon with this condition.

Tendon Tears – The tendon can split and tear from an acute injury or degenerative changes related to the aging process, long-term overuse and wear and tear, or from sudden trauma. Tendon tears can be partial or complete.

Impingement – Shoulder impingement is the result of the top of the shoulder blade putting pressure on the underlying soft tissues during arm lifting. The blade rubs on the bursa and rotator cuff causing limited movement and pain. If left untreated, severe impingement can result in rotator cuff tearing.

Instability – The shoulder is considered unstable when the head of the humerus is forced out of the socket. Instability occurs from sudden trauma or due to overuse of the joint. Dislocations can be partial (called subluxation), where the ball of the upper arm just partially comes out of socket. A complete dislocation is where the ball comes all of the way out of position. If the surrounding support structures are torn or loose, dislocations can occur repeatedly. Shoulder instability leads to increased risk of arthritis.

Arthritis – When there is wear and tear on a joint with inflammation, the joint is considered to have arthritis. Shoulder joint arthritis causes stiffness, decreased range of motion, crepitus, and pain. This type of injury is more common among older people.

Fracture – A fracture is a broken bone. Shoulder trauma can result in a fracture of the humerus, the clavicle, or the scapula, and this causes severe pain, bruising, and swelling of the shoulder.

What can I expect at the doctor’s examination?

If you have a shoulder injury, you should seek medical attention immediately. I will conduct a thorough evaluation in order to determine the cause of your shoulder pain and offer prompt treatment. During the physical examination, I inspect your shoulder for physical abnormalities, deformity, muscle weakness, tender areas, and swelling.

It is also necessary for me to assess your joint range of motion and strength. To properly evaluate your injury, I will take X-rays and possibly order a MRI, CT scan, and/or ultrasound. An arthroscopy is a surgical procedure where I look inside the joint with a tiny camera to evaluate the extent of the injury. This may be necessary for repair and diagnosis of certain shoulder injuries that are complex.

What is the treatment for shoulder injury?

The treatment of your shoulder injury depends on the type of injury. Some of the various options that I utilize include:

Activity Changes – Treatment typically involves alteration of your activities and rest so your shoulder can regain strength and flexibility.

Physical Therapy – Certain types of shoulder injuries require physical therapy. This treatment involves exercises and range of motion techniques that help you regain strength and motion of the shoulder joint.

Medications – I often prescribe certain medications to reduce inflammation and pain. Also, specific shoulder injuries require injections of anesthetics or steroids.

Surgery – While some shoulder injuries respond to conventional treatment modalities, others require surgical correction and intervention. Rotator cuff tears and recurring dislocations often require surgery. I also perform arthroscopic procedures to remove scar tissue and repair torn tissues for some shoulder injuries.

Plica syndrome of the knee occurs when synovial tissue bands become irritated from injury or overuse. Pieces of synovial plica are remnants from early fetal development. These plica are membranes that should normally diminish during the second trimester of fetal development. When the pouches do not combine to form a synovial cavity, the plica remain in the knee as bands of synovial tissue.

Plica syndrome of the knee is associated with chronic overuse, inflammatory conditions, and knee injury. The medial plica is one of the four plica that are found in the knee. This piece of the lower end of the kneecap runs sideways and attaches to the lower aspect of the thighbone.

How does a plica cause problems in the knee?

A plica that becomes irritated causes knee pain. This occurs as a result of repetitive motions, certain exercises, or from kneeling. Any activity that causes repetitive bending and straightening of the knee can cause knee plica syndrome, such as stair-climbing, running, or biking. When the knee is struck near the medial plica from a fall or car accident, knee plica syndrome can develop. These types of injuries cause the plica and the tissue around it to swell and become painful.

What are the signs and symptoms of plica syndrome?

The main symptom of plica syndrome is pain. There is frequently a snapping sensation along the inside aspect of the knee when it is bent. This is caused by the rubbing of the thickened plica over the edge of the thighbone where it enters the joint. The knee may also be tender to touch and swollen.

How is plica syndrome diagnosed?

The orthopedic specialist diagnoses plica syndrome during a physical examination or at an arthroscopic surgery procedure. X-rays, a CT scan, and/or a MRI may be done to rule out other problems. X-rays rule out fractures, and the MRI shows soft tissue injuries. The CT scan can detect a thickened plica in some cases. To confirm the diagnoses and treat the problem at the same time, the orthopedic specialist may perform an arthroscopy.

What is the treatment for plica syndrome?

Our orthopedic specialists treat plica syndrome by resting the knee joint and with anti-inflammatory medications. If these conventional measures do not ease the pain of the knee, the doctor may inject cortisone into the joint.

Cortisone is a powerful anti-inflammatory agent. For serious cases of plica syndrome, surgical removal of the plica may be necessary. This procedure is done with an arthroscope, using a small camera and tiny instruments to remove the inflamed tissue.

The area left once the plica is removed heals with minimal scarring. Plica resection is often needed. The goal of treatment is to reduce the inflammation and restore function.

What is involved with the rehabilitation process?

If your doctor treats you non-surgically, you should return to normal activity within 4 to 6 weeks. It may be necessary for you to see a physical therapist during this time to learn stretching and strengthening exercises.

Other therapies include friction massage, ultrasound, and ice applications, all done to decrease the inflammation associated with plica syndrome. If you have surgery, you will need physical therapy to help you regain strength and function.

A fracture is a broken bone. These types of injuries occur when there is physical force exerted on the bone. Broken bones are common during childhood. Also, as you age, your bones become more stiff and delicate and you are more susceptible to fractures. There are several types of fractures, but the main categories are displaced, non-displaced, open, and closed.

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The knee is a complex joint that is vulnerable to a variety of injuries. The knee is made up of the femur (the thigh bone), the tibia (the shin bone), and the patella (the knee cap). The femur rotates on the upper end of the tibia and the patella fits on the end of the femur.

There are also many large ligaments that connect the bones of the knee and help control knee motion. The meniscus is a wedge of cartilage that serves as a cushion between the femur and tibia and also absorbs shock. Many football athletes experience injuries to these knee structures.

Ligament Injuries

Football players frequently injure one or more of the knee ligaments. These ligaments include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL).

• ACL Injury – When an athlete changes direction rapidly, lands wrong from a jump, or simply slows down when running, the ACL could tear. With this injury, knee swelling immediately occurs and walking is painful. The knee may have loss of range of motion and tenderness with an ACL injury. Treatment for this type of injury depends on the degree of tear to the ligament, whether or not there are other associated injuries, and how much physical demand the patient puts on their knee. Sometimes, the orthopedic specialist needs to operate to repair a complete tear of the ACL. Recovery is measured in months, rather than weeks for this type of injury.
• MCL Injury – The MCL is generally injured from a direct blow to the outside portion of the knee. The ligament is torn or stretched when the foot is planted firmly on the ground and a sideways force hits the knee. An injured MCL causes pain, difficulty walking, and tenderness. Therapy involves the use of a knee immobilizer, rest, ice applications, compression with a support bandage, and frequent knee elevation. Surgery is only necessary for severe tears of the MCL.
• PCL Injury – The PCL is injured when a football player receives a blow to the front aspect of the knee or makes a simple misstep on the turf. Most PCL tears and injuries will heal with conservative treatment. An injured PCL leads to pain with walking, instability, and swelling of the knee. Surgery may be necessary with complete tearing and extensive damage to the PCL.
  LCL Injury – The LCL is the least likely ligament to be injured during football activities. When severe force is applied to the inside of the knee, a LCL injury could occur. Symptoms include pain, swelling, weakness, tenderness, and discomfort to the outside of the knee. Treatment involves the RICE method, anti-inflammatory medications, and immobilization. Surgery to reattach the ligament to the bone is sometimes required.

Cartilage Injuries
Torn Cartilage – Most of the time, the meniscus is the cartilage that is torn during a football game. This rubbery, tough structure serves as a shock absorber during athletic activities. The meniscus tears with cutting, decelerating, pivoting, twisting, or from being tackled. Most torn meniscus injuries cause gradual pain and swelling, worse with climbing steps or uphill.

Not all meniscus tears require surgery, but frequently the damage can only be repaired through an operation.

Fractures
The patella can break if the football player falls directly onto it or receives a direct blow in that area. If the bone is fragmented, surgery will be required for repair. If the bone is in appropriate position, the orthopedic specialist may prescribe an immobilizer and rest for the injury.

The head of the fibula on the outside area of the knee joint is easily fractured from direct blows or as part of an injury to the lower leg. If the bone is not out of alignment, immobilization and conventional therapy will treat the injury.

Sometimes, however, the fibula fracture is complex and requires surgical repair. With jumping types of injuries, the tibia bone can be damaged. If the fracture occurs in the tibial plateau, surgery is often necessary.

Bursa Inflammation
Bursa inflammation is also called ‘housemaid’s knee’ or prepatellar bursitis and is the result of repetitive kneeling or crawling on the knees. The space between the kneecap and skin is called the bursa and it becomes irritated and fills with fluid. Bursa inflammation is a common type of knee injury of football players. Treatment includes using anti-inflammatory medications and rest. Occasionally the bursa needs to be drained for resolution of the problem.

Patellar Injuries
The patella can dislocate if it receives a direct blow. The blow can force this bone toward the outside area of the knee. Most dislocations of the patella easily return to normal alignment by simply straightening out the knee. However, some patella dislocations are serious and require surgery.

Also, patella-femoral syndrome is inflammation to the underside of the patella. This condition causes localized pain, which is worse with running and walking down stairs.

Treatment involves strengthening exercises, the use of ice therapy, and anti-inflammatory medications. Severe cases of this disorder require arthroscopic surgery to remove the damaged cartilage and realign parts of the quadriceps muscle.

Muscle and Tendon Strain
Most strains of the knee are treated with rest, ice therapy, elevation, and compression. Crutches help with walking, and the doctor may order an anti-inflammatory medication. These injuries are often the result of hyper-extension involving the hamstring muscles or hyperflexion causing the quadriceps to be injured.

If the patellar or quadriceps tendon is ruptured, there is inability to extend the knee. Surgery is necessary to repair this type of injury.