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.

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.

The 21st Century Thumb – Texting Can Lead to Thumb Arthritis

534030-52122-30Let’s face it we’re all guilty of overusing the text feature of our cell phones! The 21st century thumb has been introduced to ranges of motion that are now being overused. Irregular motion of the thumb due to texting has presented new aches and pains that our bodies are not accustomed to performing. Texting involves that our thumbs move at a higher frequency than normal and a higher frequency at which you may be texting with your thumbs causes an unnatural motion that may potentially lead to tendonitis or arthritis.

 

The texting thumb usually refers to the “trigger thumb” – The constriction of a flexor tendon in the thumb, which may result from repetitive gripping motions such as texting or holding a smartphone. Its symptoms include painful popping or snapping when the thumb bends and straightens; sometimes the thumb even becomes locked in a curled position. Cortisone injections to treat the thumb eliminates the pain and restore mobility 80 to 85 percent of the time; in more severe cases, a brief surgical procedure may be required to release the pulley at the base of the thumb so that the tendon can move more easily. If you have thumb pain or stiffness that seems to worsen with use of a smartphone, change the way you use your phone and hold your phone with the hand you use less frequently or type messages with your index finger to give your thumbs a rest.

 

Dr. Wayne Weil at OSS frequently diagnoses and treats trigger finger. In mild cases, splints to rest the finger, or over-the-counter pain medications and/or corticosteroid injections may be recommended. Injections are less likely to provide permanent relief when a person has experienced trigger finger for a long time, or if there is an associated medical problem such as diabetes. Surgical treatment may be recommended for more severe cases. If the finger is stuck in a bent position, or if the symptoms are severe, surgery may be the best course of treatment. Surgery’s goal is to widen the opening of the tunnel so that the tendon can slide through it more easily. It’s usually an outpatient surgery performed through a small incision. Dr. Weil frequently performs surgery for patients with trigger finger at OSS’ on-site surgery center.

 

According to Dr. Weil, “The modern day thumb is required to perform an incredible amount of repetitive activities with use of computers, cell phones and gaming systems. This can lead to significant tendonitis and inflammation of the thumb flexor and extensor tendons. If not adequately treated conditions such as trigger finger and de Quervain’s tendonitis can compromise the ability to perform activities of daily living. I often see patients with these conditions and if caught early can treat them with hand therapy, activity modifications, cortisone injections and sometimes surgery.”

 

Thumb arthritis – Arthritis of the carpometacarpal joint, where the thumb connects to the wrist is also sometimes called “texting thumb” where forceful pinching motions occur when gripping your phone or texting with your thumbs may lead to more severe symptoms. This condition requires rest and treatment to alleviate the pain and restore mobility. Treatments may include splints and cortisone injections. Patients with persistent symptoms may need a procedure called carpometacarpal arthroplasty, in which a surgeon removes part or all of the arthritic trapezium bone to relieve pain and improve function.

 

If you believe you are suffering from a hand-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

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.

Is it a Lump or Bump? Find out What You Should Do About Ganglion Cysts of the Wrist and Hand

Perhaps it starts as a very low grade aching in the wrist, barely enough to get your attention. Then the pain becomes more frequent and persistent. As you roll your wrist around in circles trying to figure out the cause, you notice a small bump on the back of the wrist. Of course, your next move is to do the same with the opposite wrist to see if it’s present on both sides. Nothing. No bump. Time to see the doctor.

Finding a lump on your body that you know was not there previously is generally concerning. Most bumps on the hand are not cancerous, but are important to have checked out promptly by a hand surgeon. In this case, a common cause is a ganglion cyst, a small mass that can develop around the joints of the wrist and hand. Ganglion cysts are benign, fluid filled sacs that may or may not cause pain in the affected area. They are the most common form of mass found in the hand and are generally found in younger individuals between the ages of 15-40.

The most common location is on the back of the wrist, but they may also be found on the palm side of the wrist or at the base of the fingers. The cause is not known, but often times there is a correlation between their development and chronic, mechanical stress in the wrist or hand. Athletes that have repetitive stress on the wrist and hand such as gymnasts have been found to have a higher incidence of these cysts developing.

These cysts may also develop at the most distal joint of the finger. This type of cyst, called a mucous cyst, is associated with wear and tear in the finger joints and is more common with age.

In my practice, ganglion cysts are a relatively common occurrence. The diagnosis is generally straightforward, usually requiring only a physical exam and occasionally an X-ray. The size and shape of the lump, along with its location, are generally sufficient to make an accurate diagnosis, but I sometimes will order an MRI if there is any uncertainty.

In most cases, these cysts are harmless and the treatment can be as simple as periodic observation for any changes that impact movement or function of the wrist or hand. Sometimes, the ganglion can disappear by itself. In cases where the cyst causes pain or becomes an impediment to movement and function, there are more aggressive treatments available. Often, the cysts are simply persistent and unsightly, requiring removal.

First of all, if you have been surfing the internet you may have read that ganglion cysts used to be called “Bible cysts” because in times past, a treatment was to slam a bible or other heavy book over the cyst, causing it to burst. DON’T DO IT. It is not effective and you could end up with a broken bone in your hand. It is just not worth trying.

Aspiration is usually the first treatment method used to reduce a ganglion. A small needle is inserted into the cyst and the fluid is drained. This produces an immediate reduction in the size of the lump. This is performed in the office setting, and there are no significant restrictions following the procedure. The downside is that the ganglion cyst may return in at least 50% of patients. This is because the root and capsule of the cyst is left intact. An analogy would be to think of deflating a balloon. With fluid production, the balloon can simply re-inflate. Even though the permanent success of aspiration is relatively low, given the ease and simplicity of the aspiration procedure, it is still often worth a try.

Should the cyst return following needle aspiration, surgery may be required that removes the capsule and root completely. This is an outpatient surgical procedure performed under a light anesthesia – usually a combination of a local anesthetic and a sedating medicine administered by the anesthesiologist. The ganglion plus a small amount of the joint capsule or tendon sheath from which the cyst stems is removed. Following surgery, the hand will be splinted for a short duration, and the patient will be able to return to normal activities within 2-4 weeks. Physical or occupational therapy is usually not needed, but a referral may be made in instances where a patient has significant stiffness in the hand or wrist joints. Although there is a small risk of the cyst returning, my patients enjoy a high success rate, with over 90% of all excisions being permanent.

It is important to have any persistent mass checked out by a physician. He or she can perform the appropriate physical exam and testing to confirm the diagnosis and refer you to the appropriate specialist if necessary. If you should have any questions regarding this or any other conditions of the hand, wrist or elbow, please feel free to contact our office at (206) 633-8100, ext. 18133 to schedule a consultation.