Arash A. Dini MD

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• Shoulder Arthroscopy | Los Angeles

  Arthroscopy is a minimally invasive surgical technique that involves making several small incisions and inserting a fiber-optic device (arthroscope) and tiny surgical instruments to diagnose or treat certain conditions. Connected to a camera that displays images of the internal structure of the shoulder on a computer screen, the arthroscope allows the surgeon to precisely identify and target joint abnormalities. Orthopedic surgeons may perform a shoulder arthroscopy to diagnose and treat several different conditions of the shoulder. With this type of procedure, patients benefit from less tissue damage, shorter recovery times, less scarring and less post-operative pain than traditional open procedures. The use of this technique also avoids cutting any muscles or tendons in order to gain access to the affected area. Arthroscopy is an ideal treatment option for many patients suffering from shoulder conditions. ANATOMY OF THE SHOULDER The shoulder is made up of three bones: the humerus (upper arm bone), the scapula (shoulder bone) and the clavicle (collar bone). There are two joints where these bones connect: the acromioclavicular (AC) joint, where the collarbone attaches to the tip of the shoulder blade, and the glenohumeral joint, where the top of the arm bone connects to the shoulder blade. Osteoarthritis most commonly occurs in the AC joint. WHEN IS SHOULDER ARTHROSCOPY USED? Dr. Dini may recommend shoulder arthroscopy if you have a painful condition that isn’t responding to more conservative treatments such as physical therapy. Since most shoulder problems are the result of injury, overuse, or age-related wear and tear, arthroscopy can be an effective way to address the problems with far easier recovery than full open surgery. Beyond diagnosing the problem in the shoulder, Dr. Dini uses arthroscopy for these common procedures: Rotator cuff repair Removal or repair of the labrum Bone spur removal Repair of ligaments Removal of inflamed tissue or loose cartilage Repair for recurring shoulder dislocations Shoulder osteoarthritis, also known as degenerative bone disease and commonly called arthritis, is a disorder in which cartilage, which acts as a protective cover for the bones, degenerates. Without cartilage to act as a buffer, the affected bones rub together and wear each other down, resulting in pain and swelling. Sometimes bone spurs, which are also painful and interfere with movement, develop from the friction created by the bones’ rubbing together. Other medical conditions, such as bursitis, an inflammation of fluid-filled sacs called bursae, or rheumatoid arthritis (RA), an autoimmune disorder, may present with symptoms similar to those of osteoarthritis. CAUSES OF SHOULDER OSTEOARTHRITIS There are two types of osteoarthritis of the shoulder: primary and secondary. They are differentiated by their causes. PRIMARY SHOULDER OSTEOARTHRITIS Primary osteoarthritis is the result of normal aging. Over the years, as stress is put on the joints, cartilage wears thin and sometimes even erodes completely, resulting in stiffness and pain. Primary osteoarthritis is much more common in certain families, and clearly has a genetic component. SECONDARY SHOULDER OSTEOARTHRITIS Secondary osteoarthritis is the result of another issue or medical condition. Osteoarthritis of the shoulder can be caused or exacerbated by the following: Congenital abnormalities Obesity Gout Traumatic injury Repeated stress or trauma (as from playing sports) Autoimmune disease Alcoholism High-dose corticosteroid usage Repeated surgery to joints Endocrinological diseases A serious type of secondary osteoarthritis of the shoulder, known as avascular necrosis, occurs when the blood supply to the humerus is interrupted. Avascular necrosis can cause the death (necrosis) of bone cells in the shoulder, which eventually results in osteoarthritis. In addition to occurring post-injury, avascular necrosis can be caused by alcoholism or heavy use of steroids. SYMPTOMS OF SHOULDER OSTEOARTHRITIS There are three major symptoms of osteoarthritis of the shoulder. They are the same symptoms common to osteoarthritis affecting other parts of the body. Pain – The predominant symptom of osteoarthritis is pain that is aggravated by active or passive movement, and which becomes increasingly severe. As the osteoarthritis progresses, patients may experience pain intense enough that it interferes with sleep. Limited Range Of Motion – When attempting to move the arm, whether during normal activity or a physical examination, a patient may be unable to reach, turn or stretch the arm to the usual extent. Abnormal Joint Sound – The patient’s shoulder may produce a clicking, snapping or grinding sound called crepitus, which results from the bones at the affected joint making contact with one another.

  Link: Shoulder Arthroscopy | Los Angeles

• Adhesive Capsulitis

  FROZEN SHOULDER Adhesive capsulitis, commonly referred to as frozen shoulder, is a common condition that causes pain and stiffness in the shoulder. This condition is the result of a tightening or thickening of the capsule of connective tissue that protects the structures of the shoulder. Although the exact cause of frozen shoulder is unknown, it often occurs after a shoulder injury or shoulder surgery, or as a complication of diabetes. Symptoms of frozen shoulder tend to worsen over time, however, even without treatment, symptoms may resolve on their own in about two years time. SYMPTOMS OF ADHESIVE CAPSULITIS Patients with frozen shoulder often initially experience pain in the shoulder.Some individuals may experience pain that may worsen at night. Pain may subside and stiffness then occurs, causing limited range of motion that gradually worsens as the joint stiffness increases. Eventually, the shoulder may shift into a thawing phase, during which pain and stiffness subside and range of motion is slowly restored. DIAGNOSIS OF ADHESIVE CAPSULITIS Adhesive capsulitis may be diagnosed after a review of symptoms and a physical examination of the shoulder. Additional tests may include X-rays or an MRI scan to rule out any other conditions that may be causing symptoms. A doctor may also test the individual’s range of motion by having the patient perform different actions with the arm and shoulder. TREATMENT OF ADHESIVE CAPSULITIS Treatment for frozen shoulder usually focuses on managing pain and retaining range of motion as the condition progresses. Treatment may include: Anti-inflammatory medication Corticosteroid injections Joint distension Physical therapy A doctor may also perform a shoulder manipulation procedure by moving the shoulder joint in different directions to help loosen the tightened tissue. If other treatment is unsuccessful, arthroscopic surgery may be performed to stretch or release the contracted joint capsule.

  Link: Adhesive Capsulitis

• Arthroscopic Rotator Cuff Repair

  ARTHROSCOPIC ROTATOR CUFF REPAIR The rotator cuff is the thick band of muscles and associated tendons that cover the top of the upper arm and hold in it place, providing support and stability to the shoulder joint. The rotator cuff also allows for a full range of motion while keeping the ball of the arm bone in the shoulder socket. These tendons can become partially or completely torn as a result of a rotator cuff tear or injury. A rotator cuff tear often occurs as a result of injury or overuse of the muscles over a long period of time. Rotator cuff tears typically involve pain when lifting or lowering the arm, muscle weakness and atrophy, and discomfort at rest, particularly if pressure is placed on the affected shoulder. In most cases, surgery is recommended for tears that cause severe pain or that do not respond to more conservative treatments. Most rotator cuff repair procedures are performed through arthroscopy, which uses a few tiny incisions rather than one large incision. This technique offers patients minimal trauma, less scarring and less damage to the surrounding muscles and tissue. The smaller incisions also result in less pain in the shoulder joint after the surgery. ARTHROSCOPIC ROTATOR CUFF REPAIR PROCEDURE The purpose of arthroscopic rotator cuff repair is to attach the tendon back to the arm, along with removing any loose fragments from the shoulder area. Arthroscopy is a minimally invasive surgical technique that involves making several small incisions and inserting a fiber-optic device (arthroscope) and tiny surgical instruments to diagnose or treat certain conditions. Connected to a camera that displays images of the internal structure of the shoulder on a computer screen, the arthroscope allows the surgeon to precisely identify, target and treat joint abnormalities. During arthroscopic rotator cuff repair, the patient is sedated under general anesthesia, and several small incisions are made in the shoulder, into which a thin tube and tiny instruments are inserted. The surgeon repairs the tendon through visualization on a television monitor. During the surgery, rotator cuff tears are repaired and any bone spurs are removed. The rotator cuff muscle is stitched back to the bone, which helps the rotator cuff to heal in its proper location. Once the repair is complete, any incisions will be stitched closed and patients will be moved to a recovery room where they will be monitored post-operatively for a few hours. RISKS OF ARTHROSCOPIC ROTATOR CUFF REPAIR As with any surgery, there are certain risks involved with arthroscopic rotator cuff repair, which may include: Infection Pain Stiffness Nerve damage Need for repeated surgery These complications are rare and most people experience symptom relief with little to no complications after arthroscopic rotator cuff repair RECOVERY FROM ARTHROSCOPIC ROTATOR CUFF REPAIR After surgery, the arm is immobilized to promote proper healing. A sling may be recommended to keep the arm from moving for the first several weeks post-surgery. Physical therapy often begins shortly after surgery to help restore strength and movement and allow patients to gradually resume their regular activities. It is important for patients to commit to their physical therapy program in order to achieve the most effective surgical results. Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. It is important for patients to commit to their physical therapy program in order to achieve the most effective surgical results. After surgery, physical therapy may be necessary for up to 4 months and full recovery may take up to 6 months. Most patients experience effective pain relief, restoration of function and improved range of motion after their procedure. ARTHROSCOPIC BANKART REPAIR The socket of the shoulder, or glenoid, is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilize the joint. Traumatic injuries and repetitive overhead shoulder movements can tear the labrum, leading to pain, limited motion, instability and weakness in the joint. Symptoms of a labral injury may include shoulder pain and a popping or clicking sensation when the shoulder is moved, as well as rotator cuff weakness. One of the most common labral injuries is known as a Bankart lesion. This condition occurs when the labrum pulls off the front of the socket. This occurs most often when the shoulder dislocates. If a Bankart tear doesn’t heal properly, it can cause future dislocations, instability, weakness and pain. Bankart lesions may be treated through conservative methods such as rest, immobilization and physical therapy, particularly in older patients. However, many cases require surgery to reattach the torn labrum to the socket of the shoulder.

  Link: Arthroscopic Rotator Cuff Repair

• Triceps Injuries

  TRICEPS INJURIES The triceps muscle, which allows the arm to straighten, runs from the shoulder to the elbow. It is attached to the adjacent bones by a large tendon. Damage to this muscle or tendon are know as triceps injuries. Complications from triceps injuries are uncommon, with most injuries healing on their own, as long as the triceps is rested for a sufficient period of time. Types of triceps injury or trauma may include: Muscle strain or pull Tendonitis, inflammation of the tendon Tendinosis, chronic degeneration caused by repeated injuries Triceps rupture, a tearing of the tendon Tendinopathy is an inclusive term referring to any disorder of the tendon. CAUSES OF TRICEPS INJURY Triceps injury or trauma may be caused in a number of ways, including: Overstretching the arm Receiving a sudden blow Forcibly straightening the arm Repeatedly overusing the upper arm Triceps injuries are common in athletes and sports enthusiasts and may result from repetitive injury, such as hitting too many squash or tennis balls, lifting too much weight, pitching too many baseball games or playing lacrosse, volleyball or football too intensely. Risk of triceps injury increases if individuals are obese, have overdeveloped biceps, or fail to warm up sufficiently before exercising. SYMPTOMS OF TRICEPS INJURY The primary symptom of a triceps injury is pain, which may be severe. This pain is intensified by full straightening or completely bending the arm. Other symptoms of triceps injuries may include: Tenderness Inflammation Redness or bruising Arm stiffness Inability to straighten or bend the arm Any or all of these symptoms may be apparent. Swelling, soreness or discoloration normally occur on the upper arm near the elbow. TREATMENT OF TRICEPS INJURY Common treatments for triceps injuries include: Applying ice Taking an anti-inflammatory medicine Wearing a strap around the lower-triceps area The compression of the strap is especially useful when performing activities that cause discomfort. As soon as the pain subsides, the patient with a triceps injury should begin doing gentle exercises to prevent stiffness. Stretching with resistance bands is particularly helpful. A physician should be consulted for triceps injuries that cause significant pain or do not improve with home treatments.

  Link: Triceps Injuries

• Subacromial Decompression

  SUBACROMIAL DECOMPRESSION Impingement is a common shoulder condition that causes pain as a result of pressure on the rotator cuff from the shoulder blade. The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. When impingement occurs and the arm is lifted, a bone or ligament can rub against the rotator cuff, producing pain and limiting movement. Shoulder impingement typically worsens over time. Initially, individuals with a shoulder impingement may feel mild pain in the shoulder, which often radiates from the front of the shoulder to the side of the arm. The pain may worsen upon lifting the arm, reaching for something or throwing, and there may be some swelling and tenderness at the front of the shoulder as well. As impingement progresses, pain and stiffness worsen until the patient may not be able to lift or lower the affected arm. Eventually, if left untreated, the condition may severely limit arm motion to the point that the arm becomes difficult to move at all. Initial treatment of shoulder impingement includes conservative measures such as resting the arm, non-steroidal anti-inflammatory medications, corticosteroid injections and a regimen of physical therapy. However, if these techniques do not provide adequate pain relief, surgery will most likely be recommended. THE SUBACROMIAL DECOMPRESSION PROCEDURE Severe cases of impingement may require surgery to remove the pressure and create more space for the rotator cuff. The most common procedure for treating impingement is subacromial decompression. This surgery involves the removal of some of the affected tissue and part of the bursa, which is the small sac that has become inflamed due to the impingement. In some cases, the front edge of the shoulder blade must be removed as well. Either general or local anesthetic will be administered prior to the start of the procedure. A subacromial decompression can be performed through arthroscopy or an open technique, depending on the severity of the condition. When arthroscopy is used, two to three tiny incisions are made in the shoulder area. The arthroscope and specialized surgical tools are inserted into the incisions and the surgeon uses a video monitor to view the damaged area and excise the tissue and bone as needed. Once sufficient space has been created to allow for free movement of the tendons of the rotator cuff, the surgeon will withdraw the instruments and suture the incisions closed. If the surgery is performed using an open technique, one incision is made in the shoulder, and muscles and tissues are separated to provide access to the joint and subacromial space. RECOVERY FROM SUBACROMIAL DECOMPRESSION The length of recovery from a subacromial decompression procedure will depend on a number of factors, including whether the surgery was performed arthroscopically or through an open method. A sling may be needed after surgery to immobilize the arm and encourage initial healing. Once the sling is no longer necessary, a rehabilitation program will begin that focuses on increasing strength and range of motion in the affected shoulder. Improvements to the shoulder in comfort and function are typically apparent within a few months after the subacromial decompression procedure, but full recovery may take as long as a year. SHOULDER INSTABILITY Shoulder instability is a condition characterized by a loose shoulder joint, caused by weakened and stretched surrounding muscles and ligaments. This may become a chronic condition after a dislocation, which occurs when the ball of the upper arm bone comes out of the socket. Chronic instability may produce frequent slipping, or partial dislocation, known as subluxation. Shoulder instability may occur after an acute injury that stretches or tears the ligaments in the shoulder, or it may be a result of overuse. In other cases, a naturally loose joint capsule simply does not hold the ball of the humerus tightly in its socket. Athletes whose sports involve repetitive overhead motions, such as tennis and volleyball players and swimmers, have a higher instance of developing instability. The shoulder is more susceptible to this type of condition than other joints because it provides the arm with a tremendous range of motion. If a dislocation takes place, the muscles, tendons and ligaments of the shoulder may tear or loosen, resulting in the persistent slippage associated with instability. SYMPTOMS OF SHOULDER INSTABILITY People with unstable shoulders may experience pain and limited motion in the joint and additional symptoms may include: Soreness Weakness Numbness in the arm Symptoms of shoulder instability may discourage participation in sports that require stretching the arm overhead. DIAGNOSIS OF SHOULDER INSTABILITY Shoulder instability can be diagnosed after a medical history has been taken and a physical examination performed.

  Link: Subacromial Decompression

• Shoulder Labral Repair

  LABRAL TEAR SHOULDER The socket of the shoulder, or glenoid, is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilize the joint. Traumatic injuries and repetitive overhead shoulder movements may cause a tear in the labrum, leading to pain, limited motion, instability and weakness in the joint. Symptoms of a labral injury may include shoulder pain and a popping or clicking sensation when the shoulder is moved. Some people experience weakness and a restricted range of motion as well. A labral tear is typically diagnosed through imaging tests, a physical examination and a review of symptoms. While many labral tears can be treated by managing pain symptoms through medication and undergoing physical therapy, some cases require surgical treatment. THE SHOULDER LABRAL REPAIR PROCEDURE Labral repair surgery trims the damaged portion of the labrum in the shoulder and if necessary, secures it with staples, anchors or sutures. This outpatient procedure is usually performed through arthroscopy, which allows the doctor to view the tear through a small camera and insert the specialized tools through tiny incisions. Patients can benefit from less tissue damage, shorter recovery times and less scarring with arthroscopic techniques. However, larger tears may require an open procedure. Once anesthesia has been administered, the surgeon will make the incisions in the shoulder area. Upon obtaining a visualization of the labrum, the injury can be better evaluated. The torn area will be removed and all necessary repairs are made. If a separation from the tendon has occurred as well, it may require the use of sutures and anchors to achieve fixation by drilling tiny holes in the glenoid bone in which the anchors are then embedded. Sutures are used to connect the labrum to the anchors, maintaining the correct positioning of the labrum and preventing the labrum from detaching again. RISKS OF A LABRAL REPAIR PROCEDURE Labral repair procedures are considered safe, but all forms of surgery carry some risk. The risks generally associated with a labral repair may include infection, bleeding, formation of a blood clot, shoulder stiffness, shoulder weakness and nerve damage. RECOVERY FROM A LABRAL REPAIR PROCEDURE It is important to properly support and protect the arm immediately following a labral repair surgery, so most patients typically wear a sling for three to four weeks after the procedure. Physical therapy begins soon after the surgery and can be very helpful in restoring the flexibility, strength, and full range of motion to the shoulder. Most patients can typically return to jobs and other activities that are mainly sedentary after a few weeks. As healing progresses, athletes will be able to gradually participate in sports again. Complete recovery time may vary and depends on a number of factors, including whether the procedure was performed using an arthroscopic or open approach, but usually takes several months. Labral repair surgery is usually effective in treating labral tears, eradicating pain and regaining complete mobility in the arm.

  Link: Shoulder Labral Repair

• Shoulder Arthroplasty

  SHOULDER REPLACEMENT Severe shoulder conditions with persistent symptoms that have not responded to conservative treatments may benefit from shoulder arthroplasty, or shoulder joint replacement surgery. Shoulder arthroplasty is a procedure in which the damaged joint is replaced with an artificial joint that allows patients to enjoy painless motion and resume their regular activities. Joint replacement of the shoulder is not performed as frequently as that of the hip or knee, but it is equally effective in improving a patient’s comfort and use of the affected arm. REASONS FOR SHOULDER ARTHROPLASTY Prolonged pain in the shoulder and other symptoms can be effectively relieved by replacing the damaged bone and cartilage with a metal and plastic implant. Similar to the hip, the shoulder is a ball-and-socket joint that can be significantly improved with joint replacement surgery. Shoulder arthroplasty is often performed to treat conditions such as: Osteoarthritis Rheumatoid arthritis Rotator cuff tears Osteonecrosis Patients with severe cases of these conditions typically experience pain, limited range of motion, stiffness, swelling and other uncomfortable symptoms. A doctor will take a medical history and perform a physical examination in order to evaluate the nature and extent of the problem. In many cases imaging tests such as X-rays or an MRI or bone scan may be necessary to determine the best possible course of treatment. THE SHOULDER ARTHROPLASTY PROCEDURE Shoulder arthroplasty takes about two hours to perform and is usually performed with the patient under general anesthesia. It may be performed arthroscopically using very small incisions and a tiny camera and surgical tools or through a traditional open procedure that requires an incision four to six inches in length. In either method, after the incisions are made the surgeon will remove the damaged portions of the bone and cartilage within the shoulder. This generally includes the head of the humerus, or upper arm, bone and the glenoid, which forms the socket. The surfaces of the remaining bone are then smoothed and prosthetic devices are positioned in the space and attached with surgical cement. In some cases, the metal ball with a stem that is used to replace the ball of the humerus may be able to be fitted to the bone and not require cementing if the existing bone is strong enough. Once the artificial joint is securely in place in the shoulder, the surgeon can suture the incisions closed. The patient will then spend several hours in a recovery unit before being transferred to a hospital room. RECOVERY FROM SHOULDER ARTHROPLASTY Patients are typically required to stay in the hospital for one to three days following the procedure. Prescription medications may be provided to alleviate any pain and prevent post-surgery infection. Patients need to wear a sling for the first several weeks to provide adequate protection and support to the healing shoulder. Physical therapy is also an important part of the recovery process as it is an effective way to restore flexibility and function to the joint after surgery. Most patients are able to return to all of their regular activities after two to three months. RISKS OF SHOULDER ARTHROPLASTY While shoulder arthroplasty is considered a safe and effective procedure, there are certain risks involved with any surgical procedure. These risks may include infection, blood clots, nerve injury, instability and loosening of the implant. These risks are considered rare, and most patients experience symptom relief and improved range of motion after this procedure.

  Link: Shoulder Arthroplasty

• SLAP Lesion & Repair

  SLAP LESION A superior labral anterior and posterior lesion, commonly known as a SLAP lesion, is an injury to the labrum, the rim of cartilage that surrounds shoulder joint. The labrum forms a cup for the arm bone to move within, increasing shoulder stability. Injury to the labrum is often caused by a repetitive motion that pulls on the biceps tendon, or an acute type of trauma such as a shoulder dislocation or a fall with the arm stretched out. In individuals over the age of 40, a SLAP lesion may be caused by the wear and tear in the superior labrum that occurs over time, as a result of the aging process. SYMPTOMS OF A SLAP LESION Patients with a SLAP lesion may experience shoulder pain with movement as well as the following symptoms: Limited range of motion Frequent shoulder dislocation A catching or clicking sensation in the shoulder Individuals may also experience decreased strength in the shoulder when they have a SLAP lesion. DIAGNOSIS OF A SLAP LESION SLAP lesions are typically diagnosed after a medical history is taken and a physical examination is performed. A doctor may test the strength and range of motion of the shoulder by moving the arm in different directions. Imaging tests such as X-rays and MRI scans may also be necessary to view any damage to the shoulder and the surrounding areas. TREATMENT OF A SLAP LESION Treatment for a SLAP lesion may vary depending on the severity of the condition. SLAP lesions that cause only mild pain and discomfort may be treated with conservative measures such as non-steroidal anti-inflammatory medication or physical therapy. For those SLAP lesions that cause more severe pain, surgery is usually the most effective course of treatment. Surgery to repair a SLAP lesion is usually performed arthroscopically. Depending on the injury, there are a number of ways to repair the damage to the labrum. The technique used may not be determined until the tear is visible to the surgeon and the repair procedure may include: Debridement of fraying tissue to prevent a tear Securing the loose labrum to the cup of the joint Repair or removing the torn labrum tissue Removing the labral tear and repairing the biceps tendon After surgery, a sling may be used to keep the arm stable while the labrum heals. A physical therapy program begins after healing, and full recovery after SLAP lesion repair may take several months. SLAP LESION REPAIR A superior labral anterior and posterior lesion, commonly known as a SLAP lesion, is an injury to the labrum, the rim of cartilage that surrounds shoulder joint. The labrum forms a cup for the arm bone to move within, increasing shoulder stability. Injury to the labrum is often caused by a repetitive motion that pulls on the biceps tendon, or an acute type of trauma such as a shoulder dislocation or a fall with the arm stretched out. A SLAP lesion may also be caused by wear and tear in the superior labrum that occurs over time and generally appears in individuals over the age of 40. Patients with a SLAP lesion may experience pain with movement,limited range of motion, frequent dislocation and a catching sensation in the shoulder. Treatment for a SLAP lesion may vary depending on the severity of the condition. SLAP lesions that cause only mild pain and discomfort may be treated with conservative measures such as non-steroidal anti-inflammatory medication or physical therapy. For those SLAP lesions that cause more severe pain, surgery is usually the most effective course of treatment. THE SLAP REPAIR PROCEDURE Surgery to repair a SLAP lesion is performed on an outpatient basis. General anesthesia is administered to the patient and in some cases a nerve block is used as well. These procedures can usually be performed arthroscopically through several small incisions into which a camera and tiny surgical instruments are inserted. Whether the surgical approach is arthroscopic or open, there are a number of ways to repair the damage to the labrum. The technique used may not be determined until the tear is visible to the surgeon and the procedure may include: Debridement of fraying tissue to prevent a tear Securing the loose labrum to the cup of the joint Repair or removing the torn labrum tissue Removing the labral tear and repairing the biceps tendon The SLAP repair procedure generally takes approximately 90 minutes to complete. RISKS OF THE SLAP REPAIR PROCEDURE While SLAP repair is considered a safe procedure with a very low incidence of complications, there are possible risks that may include: Infection Blood clots Bleeding Stiffness in the shoulder Nerve or blood vessel injury There is also a risk that the patient may have a reaction to the anesthesia. RECOVERY FROM THE SLAP REPAIR PROCEDURE Patients may experience pain and mild swelling following the surgery. Medication is prescribed for pain and ice is applied to the site of repair to manage swelling.

  Link: SLAP Lesion & Repair

• Shoulder Dislocation & Impingement

  DISLOCATED SHOULDER A dislocation is an injury to a joint in which the ends of the bones are forced from their normal positions. The shoulder is a “ball-and-socket” joint where the “ball” is the rounded top of the arm bone (humerus) and the “socket” is the cup (glenoid) of the shoulder blade. A layer of cartilage called the labrum cushions and deepens the socket. A shoulder dislocation occurs when the humerus pops out of its socket, either partially or completely. As the body’s most mobile joint, able to move in many directions, the shoulder is most vulnerable to dislocation. A shoulder dislocation may be caused by a sports injury, trauma from a motor vehicle accident or a fall. SYMPTOMS OF SHOULDER DISLOCATION Dislocation causes pain and unsteadiness in the shoulder. The shoulder may be visibly deformed or look out of normal placement. Other symptoms of a dislocated shoulder may include: Swelling Numbness Weakness Bruising The muscles in the shoulder may spasm and cause tingling sensations in the neck and down the arm. Complications of a shoulder dislocation may also include muscle tears, tendon or ligament injuries, and blood vessel or nerve damage. DIAGNOSIS OF SHOULDER DISLOCATION A shoulder dislocation is diagnosed through a physical examination and a review of symptoms. Additional diagnostic tests may include: X-ray MRI scan Electromyography The electromyography test is used to determine whether there is any nerve damage as a result of the shoulder dislocation. TREATMENT OF SHOULDER DISLOCATION In most cases, the dislocated shoulder can be manipulated back into place by a doctor in a process known as closed reduction. When the shoulder bone is back in place, severe pain normally subsides. The arm and shoulder are then immobilized in a special splint or sling for several weeks as the shoulder heals. Medication may also be prescribed for pain. A shoulder that is severely dislocated or in cases where surrounding ligaments or nerves have been damaged, surgery may be necessary to tighten stretched ligaments or reattach torn ones. After treatment for a shoulder dislocation, when pain and swelling have subsided, physical therapy is recommended to restore the range of motion of the shoulder, strengthen the muscles, and prevent future dislocations. After treatment and recovery, a previously dislocated shoulder may remain more susceptible to reinjury, potentially resulting in chronic shoulder instability and weakness. SHOULDER IMPINGEMENT Shoulder impingement occurs when the front of the shoulder blade rubs against the rotator cuff causing irritation and pain. The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. If the rotator cuff weakens or is injured, the bone of the upper arm (humerus) can lift up, pinching the rotator cuff against the shoulder blade. The muscles can then swell further, creating a cycle of pain and weakness that worsens over time. Shoulder impingement is one of the most common causes of shoulder pain and occurs more frequently in athletes who lift their arms overhead, such as swimmers, baseball players and tennis players. CAUSES OF SHOULDER IMPINGEMENT Shoulder impingement is often caused by the weakening of, or injury to, the shoulder tendons which may be due to: Aging Rotator cuff injuries Tendonitis Bursitis Shoulder impingement may also be caused by overuse of the rotator cuff, and may be more common in people who do repetitive lifting or activities that include frequent raising of the arm, such as construction workers, painters or athletes. In some cases, impingement may occur without a discernible cause. SYMPTOMS OF SHOULDER IMPINGEMENT The symptoms of shoulder impingement often worsen over time. Initial symptoms may include mild pain in the shoulder, and may progress to Pain radiating from the front of the shoulder to the side of the arm Sudden pain when lifting and reaching the arm Swelling and tenderness in the shoulder Loss of strength and motion As impingement progresses, pain and stiffness may worsen until it becomes difficult to lift or lower the arm. Left untreated, shoulder impingement may severely limit arm motion to the point that the shoulder becomes “frozen.” DIAGNOSIS OF SHOULDER IMPINGEMENT Shoulder impingement may be diagnosed after a review of symptoms and a physical examination of the shoulder. Additional tests may include X-rays or an MRI scan to rule out any other conditions that may be causing symptoms. A doctor may also test the individual’s range of motion and arm strength by asking the patient to perform different actions with the arm and shoulder. TREATMENT OF SHOULDER IMPINGEMENT Treatment for shoulder impingement focuses on managing pain and restoring function of the shoulder.

  Link: Shoulder Dislocation & Impingement

• Hip Conditions

  The hip is a ball-and-socket joint that joins the ball of the thigh bone (femur) to the socket of the pelvis (acetabulum). This joint is lined by cartilage known as the acetabular labrum that cushions the socket. Because the hip is a weight-bearing joint, it is subject to a number of ailments, such as strains and fractures, resulting from overuse, accidents and arthritic changes. Q: What Is Bursitis Of The Hip? Q: What Is Arthritis Of The Hip? Q: What Is Osteoporosis Of The Hip? Q: What Is Avascular Necrosis Of The Hip? Q: What Is A Hip Pointer? Q: What Is Hip Dysplasia? Q: What Is Snapping Hip Syndrome? HIP ULTRASOUND An ultrasound of the hip provides detailed images of the inner structures of the hip in a minimally-invasive manner. It enables physicians to accurately diagnose a wide range of conditions affecting the hip, ensuring you receive the treatment you need to live a pain-free life. No special preparations are necessary before undergoing a hip ultrasound. THE HIP ULTRASOUND PROCEDURE Both hips are usually examined during a hip ultrasound, which takes about half an hour to perform. During the examination, the patient lies down on an examination table. The technician will apply warm gel to a transducer and place it onto the hip; the transducer is a small handpiece that captures images of the areas being studied. After the hip ultrasound, the patient can resume day-to-day activities immediately. A radiologist will analyze the images obtained and create a detailed report of the findings. The doctor will receive these results and discuss them with the patient. In the event of abnormal results, the doctor will discuss the next steps towards treatment. Hip ultrasound is a safe examination and does not expose patients to radiation.

  Link: Hip Conditions

• Hip Arthroscopy

  HIP ARTHROSCOPY Hip arthroscopy is a minimally invasive procedure used to diagnose and treat a wide range of conditions affecting the hip joint. This procedure can be used to confirm the diagnosis of various imaging procedures, such as X-rays and MRIs, as it provides a three-dimensional, real-time image of the affected area. If damage or abnormalities are detected during the arthroscopy, repairs can often be made during the same procedure. REASONS FOR HIP ARTHROSCOPY Hip arthroscopies can be performed for a number of reasons, to definitively diagnose or repair of the following conditions: Osteoarthritis Joint cartilage (labral) tears Loose pieces of bone or cartilage, or bone spurs Snapping hip syndrome CANDIDATES FOR HIP ARTHROSCOPY Arthroscopy is considered an ideal treatment option for many conditions affecting the hip, since it offers smaller incisions, shorter recovery times and less scarring. Patients can often return home the same day as their procedure and resume their regular activities in just a few weeks, while enjoying less pain, greater range of motion and restored joint function. While arthroscopy offers many advantages over conventional hip surgery, it is not right for all patients, especially those with conditions affecting hard-to-visualize areas. In such cases, traditional surgery may be more appropriate. HIP ARTHROSCOPY PROCEDURE During the hip arthroscopy procedure, the surgeon makes a small incision near the affected area of the hip and inserts an arthroscope, a long flexible tube with a camera and a tiny light on the end. This device displays magnified images of the inside of the hip joint on a video monitor for the surgeon to view in real time. During this diagnostic part of the procedure, the hip is examined for any signs of tearing, damage or degeneration to the ligaments, cartilage and other internal structures. If damage is detected, it can often be repaired during the same procedure by creating a few more small incisions through which tiny surgical instruments are inserted. These instruments allow the surgeon to replace damaged cartilage, join together torn ends, remove loose bodies or realign the joint to minimize pain and inflammation. Once the repair has been performed, the tools and arthroscope are removed and the incisions are sutured closed. A dressing will be applied to the area, which will later be replaced with smaller bandages as the incisions heal. RECOVERY FROM HIP ARTHROSCOPY After the hip arthroscopy procedure, patients may experience pain, swelling and bruising at the incision sites for several days. Pain medication and the application of ice are advised in order to manage this pain and reduce inflammation. Most patients will be encouraged to get up and walk around as soon as possible, but will need to use crutches or a walker for 7 to 10 days as healing takes place. In order to restore function and strength to the hip joint, patients will need to undergo a customized physical rehabilitation program after surgery, designed to meet their individual goals. Physical rehabilitation may include weight-bearing exercises, hip mobilization techniques, flexibility exercises and other activities that target the various muscles of the region: the quadriceps, the hamstrings, the gluteals, the abductors and adductors. The length of the rehabilitation regimen varies according the patient’s specific condition and rate of healing. Most patients are able to return to full physical activity after several weeks, but other may require up to 12 weeks to fully recover. RISKS OF HIP ARTHROSCOPY While hip arthroscopy is considered safer and more efficient than conventional hip procedures, there are still certain risks associated with any type of surgery. Some of these risks may include: Infection Nerve or blood vessel damage Tissue damage Prolonged pain Blood clots Patients should discuss these and other risks with the doctor before undergoing hip arthroscopy. SNAPPING HIP SYNDROME Snapping hip syndrome, or “dancer’s hip” is a condition commonly affecting athletes and dancers. It involves a snapping sensation, often accompanied by a popping sound during movement. The snapping sensation occurs as a muscle or tendon in the area moves over a bony structure. While the syndrome, for many, is only an annoyance, for individuals with a very active lifestyle or occupation it may lead to pain, weakness and disability. Most commonly, the problem occurs in a band of connective tissue that passes over large jutting bone of the thigh, the trochanter. This band is known as the iliotibial band. Two other bands can cause snapping hip syndrome: the iliopsoas, which connects to the inner upper thigh and the rectus femoris, which stretches from the inner thigh through the pelvis. Less frequently, snapping hip syndrome can be the result of torn cartilage or bone in the hip joint, known as a labral tear.

  Link: Hip Arthroscopy

• Cam Impingement & Labral Debridement

  HIP IMPINGEMENT A femoracetabular impingement (FAI) is a condition where the bones of the hip are abnormally shaped and there is an abnormality in the way the ball of the femur (thighbone) and the acetabulum (hip socket) fit together. A cam impingement is a type of FAI where the ball of the femur is misshapen and does not move smoothly within the hip socket. The friction creates a protrusion on the ball of the femur that places pressure on the cartilage in the joint and damages it. As a result, bone spurs may develop, causing joint damage and pain. This condition is caused by hip bones that do not form normally during the years of growing and development in childhood. SYMPTOMS OF CAM IMPINGEMENT Patients with a cam impingement typically experience pain around the hip area that may be dull and persistent. In some cases, sharp, stabbing pain sometimes occurs with sudden movement such as twisting or turning. Pain may occur in the groin area or toward the outside part of the hip. DIAGNOSIS OF CAM IMPINGEMENT A cam impingement is diagnosed through a review of the patient’s medical history as well as a a physical examination of the hip and surrounding joints. Additional tests may include: X-ray CT scan MRI scan The doctor may also perform an impingement test by moving and rotating the knee towards the chest and opposite shoulder, to see if these movements recreate any pain. If symptomatic pain is recreated with these movements, the patient will test positive for an impingement. TREATMENT OF CAM IMPINGEMENT Cam impingement may respond to conservative treatments such as limiting certain physical activities and taking non-steroidal anti-inflammatory medication. Physical therapy may be helpful in restoring range of motion and strength to the muscles around the hip joint. In severe cases, if the symptoms do not improve, arthroscopic surgery may be recommended to remove any damaged cartilage and trim the bony protrusion of the hip socket and femur. The goal of the procedure is to trim the bones enough to prevent the impingement from occurring. LABRAL DEBRIDEMENT The labrum is a protective layer of cartilage in the hip joint. It provides this relatively shallow ball-and-socket joint with more stability and cushioning, allowing for a full range of motion. Tears in this cartilage, known as labral tears, are often caused by either trauma to the hip or chronic overuse. Such injuries are more common in individuals who play sports which require repetitive twisting or pivoting motions, such as golf or hockey. Tears of this type may also be the result of excessive wear on the labrum due to anatomical abnormalities. Labral tears can lead to pain, stiffness and a catch or click within the joint during movement. DIAGNOSIS OF A LABRAL TEAR To diagnose a labral tear, the physician will perform a physical examination and take a thorough medical history. Labral tears are frequently misdiagnosed because their symptoms are similar to those of a number of other ailments or conditions. To confirm a suspected diagnosis, an injection of anesthesia may be administered to help pinpoint the area in which the pain originates. Testing may include X-rays or an MRI scan to provide a precise view of the internal structures of the hip joint. THE LABRAL DEBRIDEMENT PROCEDURE While some labral tears can be treated by managing pain symptoms with a combination of medication and physical therapy, many cases require surgical treatment. The goal of a labral debridement procedure is to trim back the torn area of the labrum in order to lower the risk of further tearing. The procedure is often performed arthroscopically, using very small incisions and special surgical tools. This minimally invasive approach reduces trauma to the area and generally takes about one hour to complete. After anesthesia is administered, the leg is placed in traction to maximize access to the hip joint. The surgeon makes tiny incisions near the hip and inserts the arthroscope and surgical tools. The arthroscope provides a clear view of the joint so the surgeon can precisely evaluate which portion of the labrum to trim back. Once the debridement is complete, the incisions are closed with sutures. Labral debridement is a less extensive surgery than a labral repair procedure. Labral repair involves the implantation of anchors that must be drilled into the bone. In contrast, labral debridement focuses only on the shaving down of an area of the labrum and requires the use of no fixation devices. Both procedures have high success rates, reduce pain in the hip and improve the range of motion in the joint. The determination as to which procedure is better for each individual patient’s condition is dependent on several factors, primarily the extent of the damage. RISKS OF A LABRAL DEBRIDEMENT Labral debridement is considered a safe procedure, but, as with all forms of surgery, it does carry some risks.

  Link: Cam Impingement & Labral Debridement

• Piriformis Syndrome

  SCIATICA FROM PIRIFORMIS SYNDROME Piriformis syndrome occurs when the piriformis muscle, which runs from the lower spine to the top of the thigh bone, presses on the sciatic nerve. As a result, it causes pain, tingling and numbness in the buttocks and, often, down the back of the leg. The pain often worsens as a result of sitting for a long period of time, walking, running, or climbing stairs. While piriformis syndrome may occur for no apparent reason or develop after regular physical activity, it is sometimes caused by a a traumatic injury, such as a car accident or a fall. People with piriformis syndrome often experience tenderness in the buttocks and pain down the back of the thigh, calf and foot. It may start as intense, burning pain in the buttocks and get worse during activities, such as walking or running, that cause the piriformis muscle to press against the sciatic nerve. Symptoms of piriformis syndrome may be long-lasting, often troubling patients for years. Piriformis syndrome is diagnosed through a physical examination and a review of symptoms. The affected leg may be moved in several different positions to measure pain levels. Additional tests may include MRI or CT scans. Treatment for piriformis syndrome may initially focus on exercises to stretch the piriformis muscle, and conservative treatments such as hot and cold therapy, massage, and taking a break from activities that may cause pain. Nonsteroidal anti-inflammatory medication may be used for pain relief. If discomfort persists, steroid injections into the piriformis muscle and the sciatic nerve may help to relieve pain. In severe cases, surgery may be necessary to relieve pressure on the sciatic nerve.

  Link: Piriformis Syndrome

• Meniscus Tear

  MENISCUS TEAR The meniscus is a C-shaped piece of tough cartilage located in the knee, that acts as a shock absorber between the shinbone and the thighbone. There are two minisci within each knee. The meniscus on the inside part of the knee is known as the medial meniscus and the meniscus located on the outside of the knee is referred to as the lateral meniscus. A meniscus tear may be the result of an activity that forcefully twists or rotates the knee. A torn meniscus is a common knee injury that may be caused by playing sports, or a traumatic injury, and most frequently occurs when the knee joint is bent and the knee is then twisted. Torn menisci are common in athletes, but in some cases this condition may occur in older adults whose cartilage has worn away, as a result of many years of wear and tear of the joint. SYMPTOMS OF A MENISCUS TEAR Meniscus tears are usually defined by a distinctive popping or clicking sensation when the injury occurs. Most people will still be able to walk or play a sport using their injured knee, but the knee typically becomes swollen and stiff within a few days. The most common symptoms of meniscus tears include: Stiffness Swelling Persistent pain whenever the knee is moved or twisted Inability to fully straighten the knee A torn meniscus may also be accompanied by joint that frequently locks in place and the inability to completely straighten the knee. DIAGNOSIS OF A MENISCUS TEAR A meniscus tear is typically diagnosed after a complete evaluation of the patient’s symptoms is conducted and a medical history obtained. The knee will be examined for tenderness along the joint line, which usually signifies the presence of a meniscus tear. Several diagnostic tests will generally follow to confirm the tear. One commonly used evaluation tool is the McMurray test, in which the knee is bent, straightened and moved around in a circular fashion by the doctor. The circular motion places added tension on the meniscus and causes an audible clicking sound, enabling the doctor to diagnose the tear. Imaging tests, such as X-rays or an MRI or CT scan, may also be needed to obtain a view of the torn meniscus. TREATMENT FOR A MENISCUS TEAR If left untreated, a meniscus tear may result in a portion of the cartilage becoming loose and moving into the joint, causing the knee to slip out of place. Treatment usually depends on the severity of the tear and its exact location. Initial treatment methods for meniscus tears are generally conservative, such as placing ice on the knee, taking anti-inflammatory medications and elevating the knee to reduce swelling. If symptoms continue despite these conservative measures, surgery may be necessary. Minimally invasive knee arthroscopy is one of the most commonly performed procedures to treat the condition. During this procedure, a flexible tube with a camera known as an arthroscope is inserted into the knee through a small incision. Small surgical instruments will be used to perform either a meniscus repair, which focuses on suturing the torn edges of the meniscus together to promote healing, or a meniscectomy, during which damaged meniscal tissue is trimmed away. Physical therapy may also be effective at strengthening the muscles that support the knee joint. If these treatments are not effective and symptoms continue, meniscus repair surgery may be recommended. Meniscus repair is an arthroscopic surgery performed by orthopedic surgeons to remove the torn segment of the meniscus. The torn edges are then sutured together, which allows them to heal properly. Recovery from meniscus repair surgery can take several months of immobilization and the use of crutches. A physical therapy program is also effective after surgery to strengthen muscles and help the patient regain full mobility.

  Link: Meniscus Tear

• Knee Arthroscopy | Los Angeles

  Arthroscopy is a minimally invasive procedure that allows doctors to examine tissues inside the knee. During an arthroscopic procedure, a device known as an arthroscope is inserted into a small incision in the knee. Through this tube, a thin fiberoptic light, magnifying lens and tiny video camera are inserted, allowing the doctor to examine the joint in great detail. Arthroscopy may be a diagnostic procedure following a physical examination and imaging tests such as MRI or CT scans or X-rays. It may also be used as a method of treatment to repair small injuries in the knee. KNEE ARTHROSCOPY AS TREATMENT Relatively minor knee damage is frequently treated using arthroscopic techniques. Most knee damage results from sports injuries or osteoarthritis. During an arthroscopic procedure, the surgeon may be able to treat: Loose bone or cartilage Meniscal tears Torn ligaments Synovitis (swelling of the joint lining) Misalignment of the patella (knee cap) Inflamed tissue In patients with osteoarthritis of the knee, arthroscopy is also used in the removal of dead tissue, a process known as debridement. BENEFITS OF KNEE ARTHROSCOPY Because it is minimally invasive, arthroscopy offers the patient many advantages over traditional, more invasive, surgery. These include: No cutting of muscles or tendons Smaller incisions Less bleeding during surgery Less scarring Shorter recovery time Shorter and more comfortable rehabilitation CANDIDATES FOR KNEE ARTHROSCOPY Knee arthroscopy is quickly becoming the ideal procedure for many conditions affecting the knee. Its minimally invasive advantages allow patients to receive fast and simple pain relief, increased range of motion and restored function, while avoiding or delaying the need for joint replacement surgery. Despite its many advantages, arthroscopy is not appropriate for every patient. Some patients, especially those with knee problems that are in difficult-to-see areas, may benefit more from conventional surgery. THE KNEE ARTHROSCOPY PROCEDURE knee arthroscopy is performed on an outpatient basis under local or general anesthesia, depending on the type and severity of the condition, as well as the patient’s personal preference. During the procedure, the surgeon inserts the arthroscope into the knee through a tiny incision. This instrument is used to identify any damage or abnormalities within the knee, or to confirm the diagnosis of a previous imaging exam. RECOVERY FROM KNEE ARTHROSCOPY After a knee arthroscopy , patients often experience swelling and pain for several days. These symptoms can be controlled by the usual home remedies: resting and elevating the leg, applying ice and taking over-the-counter painkillers. Patients are encouraged to get up and walk around as soon as possible after the procedure, although crutches or a cane may be needed for some period of time. Most patients can usually return to work within a week, but will need to undergo physical therapy in order to restore full range of motion to the joint. Most patients can resume light physical activities after a few weeks, although full recovery from knee arthroscopy may take 12 weeks or longer. RISKS OF KNEE ARTHROSCOPY While knee arthroscopy is considered safe for most patients, there are certain risks associated with any surgical procedure. These risks include: infection, blood clots, accumulation of blood in the knee, nerve damage or adverse reactions to medications or anesthesia. In the great majority of cases, the knee arthroscopy goes smoothly. The posterior cruciate ligament (PCL) is one of four ligaments that helps support the knee and protects the shin bone (tibia) from sliding too far backwards. The cruciate ligaments are located inside the knee joint and cross over each other, forming an “X”. The anterior cruciate ligament is in the front and the posterior cruciate ligament is located behind it in the back of the knee. These ligaments control the back and forth motion of the knee. Injury to the PCL most commonly occurs when the knee is bent and an object strikes the shin, pushing it backwards. This is commonly referred to as a “dashboard injury” because it often happens during a car accident when the shin is forcefully pushed into the dashboard. A PCL tear may also be caused by a sports injury or a fall. In many cases, a posterior cruciate ligament tear occurs along with injuries to other parts of the knee, including other ligaments, cartilage and and bone. SYMPTOMS OF A PCL TEAR Individuals with PCL tears may experience pain,swelling and limited range of motion within the knee. Some people may also experience a feeling that the knee has popped or given out, as it causes instability within the joint. In most cases, a PCL tear will make it difficult to walk. DIAGNOSIS OF A PCL TEAR A PCL tear is diagnosed through a physical examination of the knee.

  Link: Knee Arthroscopy | Los Angeles

• Arthritis in Knee

  ARTHRITIS IN KNEE Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis is the most common form of arthritis and it commonly affects the knees. Arthritis of the knee may develop as the cartilage protecting the bones of the knee joint wears down over time. Over the years, as stress is put on the joints, cartilage wears thin and sometimes even erodes completely, resulting in stiffness and pain. Arthritis of the knee occurs more frequently in older individuals, however it sometimes develops in athletes from overuse of the knee joint or after an injury. Symptoms of arthritis of the knee may include pain, swelling and stiffness within the joint. Some individuals also experience a feeling of weakness in the knee that results in the knee locking or buckling. These symptoms tend to worsen after increased physical activity and as the condition progresses. Over time, as arthritis of the knee progresses, the knee joint becomes increasingly stiff and inflamed, difficult to move, and very painful, even when at rest. To diagnose arthritis of the knee, a doctor will review all symptoms and perform a physical examination. X-rays and other imaging tests are often used to assess the amount of damage to the joint. Treatment for arthritis of the knee initially focuses on relieving pain and addressing symptoms and is commonly treated with a combination of methods. Avoiding certain physical activities that place stress on the knee may be helpful. Medication may also be used to treat pain and may include: Anti-inflammatory medication such as aspirin, ibuprofen or acetaminophen Prescription pain relievers Corticosteroid injections Physical therapy may be a successful form of treatment for some patients. Severe cases of osteoarthritis of the knee may require surgery to reposition the bones or replace the joint. Most procedures can be performed through arthroscopy, which significantly reduces bleeding, scarring and recovery times.

  Link: Arthritis in Knee

• Anterior Cruciate Ligament Injury & Reconstruction

  ACL INJURY The anterior cruciate ligament, commonly known as the ACL, is one of the most commonly injured ligaments in the knee. Running diagonally through the middle of the joint, the ACL works together with three other ligaments to connect the femur (thigh bone) to the tibia (the larger of the two lower leg bones). A tearing of this ligament causes the knee to become unstable and the joint to slide forward. ACL injuries occur most often in athletes as a result of direct contact or an awkward fall. About half of all ACL injuries are also accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee. CAUSES OF AN ACL INJURY The ACL ligament most frequently tears as a result of a sudden turn or change of direction that causes the knee to twist or hyperextend. Such an injury most often occurs in sports that involve abrupt stops and changes in direction, such as tennis, football, soccer and basketball. It may also occur as a result of an automobile or skiing accident. Many ACL ligament tears also result from commonplace accidents like falling off a ladder or missing a step on a staircase. RISK FACTORS FOR AN ACL INJURY Women are more likely to experience an ACL tear than men, even when they are engaging in the same activities. This is because women have a strength imbalance in their thighs, with the quadriceps, the muscles at the front of the thigh, being more powerful than the hamstrings, the muscles at the back. SYMPTOMS OF AN ACL INJURY Signs of an ACL injury are difficult to ignore. These signs include: Popping sound as the ligament tears Immediate pain, swelling and instability Increasing swelling and pain following the injury Limited range of motion of the knee Tenderness at the site Inability to walk Patients who are suspected of having ACL injuries should obtain medical attention immediately to avoid further joint damage. DIAGNOSIS OF AN ACL INJURY A physical examination for an ACL injury includes evaluation of swelling and tenderness, especially in comparison to the unaffected knee. It also involves moving the knee into different positions to assess possible ACL damage. For a definitive diagnosis of an ACL tear, imaging tests, including X-rays, ultrasound, MRI and CT scans, are administered so that the internal structure of the knee can be visualized. TREATMENT FOR AN ACL INJURY Patients who suffer ACL injuries must use crutches and possibly knee braces during the early stages of recovery. Depending on the severity of the injury, surgery may or may not be necessary. While not all ACL injuries require surgery, leaving the ligament torn or damaged puts the patient at risk for recurring episodes of knee instability. It may also increase the likelihood of developing tissue damage or arthritis over time. For athletes who want to return to high-risk sports, surgical reconstruction is always necessary. Ligament tears cannot be repaired by simple reattachment. Normally grafting of part of another ligament, usually taken from the patient’s knee or hamstring muscle, will be used in the procedure. At times, the graft may be taken from a deceased donor. Physical rehabilitation is always necessary to restore strength, function and stability to the knee, whether or not the patient undergoes surgery. ACL REPAIR The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments in the knee. Running diagonally through the middle of the joint, the ACL works in conjunction with three other ligaments to connect the femur (upper leg bone) to the tibia (the larger of the two lower leg bones). ACL injuries occur most commonly in athletes as a result of direct contact or an awkward fall. About half of ACL injuries are also accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee, any of which may complicate the repair process. THE ACL RECONSTRUCTION PROCEDURE ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. In most cases, an ACL repair is necessary because there has been an avulsion of the ligament, which means that not only the ligament, but a piece of bone, has been fractured. Simply reconnecting the torn ends of the ACL will not repair it. The torn ligament has to be completely removed and replaced. Part of another ligament, usually in the knee or hamstring, is used to create a graft for the new ACL. Most commonly, the graft used is an autograft, harvested from patient’s own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. In other procedures, allograft tissue, taken from another (usually deceased) donor, is used. The graft may be attached with screws or staples before incisions are closed. This procedure is performed under general anesthesia on an outpatient basis.

  Link: Anterior Cruciate Ligament Injury & Reconstruction

• Patellofemoral Syndrome

  PATELLOFEMORAL SYNDROME Patellofemoral syndrome, also known as chondromalacia patella, is a painful knee condition caused by a degeneration of the cartilage in the kneecap, which may be caused by overuse, injury, obesity or malalignment of the kneecap. While this condition can affect anyone, it is most common in athletes and people who put heavy stress on their knees. SYMPTOMS OF PATELLOFEMORAL SYNDROME Individuals with patellofemoral syndrome experience knee pain that gets worse when the knee is bent, during activities that may include: Kneeling Walking up or down stairs Squatting Sitting Jumping Some individuals also experience a buckling or popping sensation within the knee, as well as feelings of tightness or fullness. DIAGNOSIS OF PATELLOFEMORAL SYNDROME Patellofemoral syndrome is diagnosed through a physical examination of the knee and leg. Imaging tests may include X-rays, MRI scans or CT scans to visualize the tissue within the knee and rule out structural damage as the cause of pain. TREATMENT OF PATELLOFEMORAL SYNDROME While patellofemoral syndrome may be a chronic condition, there are several basic treatment options available to relieve symptoms, most of which focus on avoiding activities that may cause pain. Additional treatment may include: Anti-inflammatory pain medications Rest Icing the affecting area Supportive braces Customized physical therapy exercises, including stretching to improve flexibility and relieve tightness, may also be effective for treating patellofemoral syndrome. Severe cases may require arthroscopic surgery to remove fragments of damaged cartilage or surgery to realign the kneecap and relieve pressure.

  Link: Patellofemoral Syndrome

• Medial & Lateral Collateral Ligament Sprain

  MCL SPRAIN (MEDIAL COLLATERAL LIGAMENT) The collateral ligaments are located on the sides of the knees. The medial collateral ligament (MCL) is located in the knee, connecting the inner side of the thigh bone to the shin (tibia) bone. The MCL helps the knee to resist force and keeps it stable against unusual movement. The collateral ligaments also control the sideways motion of the knee. This ligament may become torn or damaged as a result of direct impact to the outside of the knee. An injury may cause the MCL to loosen, stretch and possibly tear, resulting in pain and inflammation. SYMPTOMS OF AN MCL SPRAIN Patients with an MCL sprain may experience the following symptoms on the inside of the knee: Pain Tenderness Swelling After an MCL sprain, individuals may also experience, instability, or the feeling that the knee is going to give way. TYPES OF MCL SPRAINS An MCL sprain is diagnosed through a physical examination of the knee. Additional imaging tests may include an X-ray or MRI scan. The doctor determines the grade of the MCL sprain based on the extent of damage, which may range from a mild tear to a complete rupture. MCL sprains may be classified as: Grade 1 sprains occur when the ligament is mildly damaged Grade 2 sprains occur when the ligament has been stretched and loosened Grade 3 sprains occur when the ligament is completely torn Grade 2 sprains are commonly referred to as a partial tear of the ligament. TREATMENT OF AN MCL SPRAIN Treatment for an MCL sprain varies based on the severity of the injury, but it can normally be treated with conservative methods that include: Rest Ice Compression Elevation Knee brace A physical therapy program may help to strengthen and restore function to the knee. In severe cases, when the ligament has torn completely and not healed properly, surgery may be necessary for repair. LCL SPRAIN (LATERAL COLLATERAL LIGAMENT) The collateral ligaments are located on the sides of the knees. The lateral collateral ligament (LCL) is located within the knee joint, connecting the outer side of the thigh bone (femur) to the fibula, the smaller bone in the lower leg. The LCL provides strength and stability to the joint and helps the knee to resist force and stay stable during unusual movement. The collateral ligaments also control the sideways motion of the knee. This ligament may become torn or damaged as a result of direct impact or force that may push the knee sideways. An injury may cause the LCL to loosen, stretch, and possibly tear, resulting in pain and inflammation on the outer part of the knee. An LCL sprain commonly occurs in athletes who participate in collision sports such as rugby and football. SYMPTOMS OF AN LCL SPRAIN Patients with an LCL sprain may experience the following symptoms on the outside of the knee: Pain Tenderness Swelling After an LCL sprain, individuals may also experience, instability, or the feeling that the knee is going to give way. DIAGNOSIS OF AN LCL SPRAIN An LCL sprain is diagnosed through a physical examination of the knee. Additional imaging tests may include an X-ray or MRI scan. Imaging tests allow the doctor to see whether the injury is associated with a broken bone as well as get a more accurate view of the injury to determine treatment. TYPES OF LCL SPRAINS The doctor determines the grade of the sprain based on the extent of damage, which may range from a mild tear to a complete rupture. LCL sprains may be classified as: Grade 1 sprains occur when the ligament is mildly damaged Grade 2 sprains occur when the ligament has been stretched and loosened Grade 3 sprains occur when the ligament is completely torn When the lateral collateral ligament is injured, other structures within the joint are commonly injured as well. TREATMENT OF AN LCL SPRAIN Treatment for an LCL sprain varies based on the severity of the injury, but it can normally be treated with conservative methods that may include: Rest Ice Compression Elevation Knee brace Individuals are advised to avoid any exercise or physical activity for several weeks after the injury to ensure complete healing. As the ligament heals, a physical therapy program may help to strengthen and restore function to the knee. In severe cases, when the ligament has torn completely and not healed properly, surgery may be necessary for repair.

  Link: Medial & Lateral Collateral Ligament Sprain

• Iliotibial Band Syndrome

  ILIOTIBIAL BAND SYNDROME The iliotibial band is a band of tissue that runs along the outside of the leg from the hip to just below the knee, providing functionality and stability to the knee joint and surrounding area. Iliotibial band syndrome occurs when this band becomes so tight and inflamed that it rubs against the outer portion of the femur, causing irritation and instability to the knee joint. Also known as IT band syndrome, this condition often occurs in people who are physically active, such as runners or cyclists. SYMPTOMS OF ILIOTIBIAL BAND SYNDROME Frequent bending of the knee during physical activity may result in the symptoms of IT band syndrome, which may include: Pain on the outside of the knee Hip pain that comes and goes Swelling of the knee Pain may worsen with movement and improve with rest. DIAGNOSIS OF ILIOTIBIAL BAND SYNDROME IT band syndrome is diagnosed after a physical examination and review of symptoms. An MRI scan may be performed to confirm a diagnosis of this condition, as MRI images may show a thickening of the band, which is often the cause of irritation. TREATMENT OF ILIOTIBIAL BAND SYNDROME IT band syndrome is often treated with conservative methods to reduce pain and swelling and may include: Applying ice to the affected area Anti-inflammatory medications Rest Stretching exercises are also recommended and physical therapy can help individuals to strengthen muscles and develop methods for exercises to prevent further injury. Cortisone injections may be beneficial if pain does not subside, and in severe cases, surgery may be recommended.

  Link: Iliotibial Band Syndrome

• Hamstring Injury

  HAMSTRING INJURY An injury to the hamstring muscle is a painful problem, frequent among athletes, especially those who sprint, or run and stop suddenly. The hamstring is not a single muscle, but three muscles located at the back of the thigh. A hamstring injury may involve a strain, which is a stretching or partial tearing of the muscle, or an avulsion injury, which is a complete tear of the muscle, pulling it away from the bone. Because hamstring injuries are usually the result of one of the muscles being stretched beyond capacity, such injuries are commonly referred to as “pulled hamstrings.” RISK FACTORS FOR A HAMSTRING INJURY While a hamstring injury can happen to anyone, individuals are at greater risk of suffering such an injury if they: Participate in running, soccer, tennis, football, basketball or dance Have had a previous hamstring injury Are not flexible or have not stretched prior to exercise Have a muscle imbalance between the quadriceps and hamstrings Are adolescents in the midst of a growth spurt SYMPTOMS OF A HAMSTRING INJURY Patients with a hamstring injury may experience any of all of the following symptoms, depending on the severity of the tear: Sudden pain during exercise Snapping or popping sensation Pain in back of thigh or lower buttock Tenderness and bruising at the site Weakness in the hip or knee Tingling sensation at the back of the thigh Since the hamstring muscles make it possible to extend the leg straight behind the body and to bend the knee, pain during these movements may be a sign of a hamstring injury. DIAGNOSIS OF A HAMSTRING INJURY To determine whether the hamstring has been injured and to what extent, the doctor will take a medical history and perform a physical examination of the area. With the patient lying face down, the doctor will look for any sign of tenderness, bruising or muscle spasm on the back of the thigh and will move the leg into different positions to try to pinpoint the region of the damage. If the patient has difficulty putting weight on the affected limb, further diagnostic testing will likely be required, first X-rays to rule out any possible fracture, and then an MRI scan or ultrasound to view the hamstring tear itself. HAMSTRING INJURY TREATMENT Treatment for a hamstring injury depends on the severity of the damage, but many cases will heal with minimal care. Patients can relieve symptoms and facilitate the healing process through home remedies such as resting, applying ice and taking anti-inflammatory medications to diminish pain and swelling. Physical therapy is also typically very beneficial, as it works to gently stretch and strengthen the hamstring muscle. As the symptoms improve, gradually increasing exercise may prevent a recurrence of the injury. Generally, most patients can resume normal activities and sports participation in 4 to 6 weeks when the symptoms are gone. If these conservative measures are not effective for a partial tear, an injection of either corticosteroids or platelet rich plasma may be recommended. These treatments can provide significant relief from pain and assist in the healing of damaged tissue. Severe hamstring injuries may require surgery to repair the torn muscle, especially in athletic patients, who may otherwise experience weakened muscles or other limitations in their ability to fully engage in the sports of their choice. ARTHROSCOPIC HAMSTRING REPAIR The three hamstring muscles, located behind the thigh, attach to leg bones, allowing the knee to bend. Strains to the hamstrings are common, especially during vigorous sports activities involving running and jumping. Such injuries, whether they involve just over-stretching or an actual tear, can be painful and debilitating. Partial tears sometimes respond well to conservative methods of treatment, including rest and splinting because, as scar tissue forms during healing, it forms a kind of bridge, reconnecting muscle to bone. More severe or complete (avulsion) tears occur more rarely. However, when they do occur, the distance between muscle and bone is too great to be bridged by scarring, and surgical repair is required. Traditionally, hamstring repair surgery has been performed through open techniques that require large incisions and expose the surrounding region to potential complications. In recent times, hamstring repair can be successfully managed arthroscopically. ADVANTAGES OF ARTHROSCOPIC HAMSTRING REPAIR Arthroscopy is a minimally invasive procedure that offers many benefits to the patient over traditional surgery. During an arthroscopic hamstring repair, the necessary equipment, all of which is miniaturized, is inserted through a small incision into the problem area. A thin fiberoptic light, a magnifying lens, a tiny camera, and small surgical tools allow the surgeon to examine the injury in detail and make repairs with precision.

  Link: Hamstring Injury

• Cartilage Defects

  CARTILAGE DEFECTS Cartilage defects of the knee involve damage to the articular cartilage, the smooth substance that covers the ends of the bones, keeping them from rubbing together. Cartilage defects may be degenerative, resulting from wear and tear, or traumatic, caused by an injury such as falling on the knee, jumping down, or rapidly changing directions while playing a sport. Such injuries do not always produce immediate symptoms because there are no nerves in cartilage. Over time, however, cartilage defects can disrupt normal joint function, leading to pain, inflammation, a grinding sensation in the knee and limited mobility. Cartilage damage can range from a soft spot on the cartilage to a small tear in its top layer, to an extensive cartilage tear all the way to the bone. Such damage may gradually worsen or cause other problems in the joint. Since cartilage lacks a blood supply, the body cannot usually repair such defects on its own. Some severe tears that injure the bone, however, promote the growth of scar tissue known as fibrocartilage. This material while it replaces the missing articular cartilage, does not provide as smooth a gliding surface as the healthy cartilage, and so does not facilitate fluid motion. DIAGNOSIS OF CARTILAGE DEFECTS In order to diagnose a defect in the cartilage of the knee, the doctor will take a medical history and perform a physical examination. Imaging tests provide views of the tissue and bone within the knee to help the doctor evaluate the cause of the pain. The imaging tests performed may include X-rays, MRI and CT scans. TREATMENT OF CARTILAGE DEFECTS Cartilage defects vary widely in size and degree. They need to be thoroughly assessed relative to location, severity, and the age and activity level of the patient, before a treatment plan can be determined. In most cases, surgery is necessary to provide relief from pain and increase mobility. DEBRIDEMENT Older patients who have smaller cartilage defects with mild symptoms may be suitable candidates for debridement. This arthroscopic procedure involves several small incisions into which a tiny camera and instruments are inserted. Loose or damaged tissue is removed, providing some relief, although typically the defects are not actually repaired during this procedure. MICROFRACTURE Microfracture is an arthroscopic procedure performed to repair damaged knee cartilage. During the microfracture procedure, a small surgical tool called an awl is inserted into the knee to create small holes, known as microfractures, in the bone near the defects. This process stimulates the release of cartilage-producing cells that will help to rebuild the damaged area. OSTEOCHONDRAL AUTOGRAFT TRANSPLANTATION (OATS) This procedure takes healthy cartilage from a non-weight-bearing area of the patient and transplants it to the site of the damage. This process is used for smaller defects, and involves filling the holes in the cartilage with small quantities of healthy transplanted tissue. AUTOLOGOUS CHONDROCYTE IMPLANTATION During this procedure, a sample of healthy cartilage is harvested, reproduced in large quantities outside the body, and then re-implanted onto the adjacent bone. This newly grown cartilage coats the bone, providing protection and support. While surgery may be necessary, where there is only mild cartilage damage, conservative treatments, including resting the knee, wearing a brace, taking non-steroidal anti-inflammatory medications (NSAIDS), and getting injections of corticosteroids, may be sufficient to relieve symptoms.

  Link: Cartilage Defects

• Viscosupplementation

  VISCOSUPPLEMENTATION Osteoarthritis is a degenerative joint disease that can affect the knee. It causes the surface layer of cartilage to break down and wear away, and the joint’s synovial fluid to lose its ability to lubricate. This combination causes pain, stiffness, limited joint motion, and inflammation in the knee. Osteoarthritis of the knee is often initially treated with pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs and corticosteroid injections. However, these methods are not always effective, and can have adverse effects such as gastrointestinal problems, allergic reactions or kidney damage. Viscosupplementation, in which injections of hyaluronic acid are used to improve knee function, is an alternative to pain medication for treatment of osteoarthritis of the knee. Those with osteoarthritis often have a low level of hyaluronic acid in their joints. Hyaluronic acid, which is a naturally occurring substanc found in joint fluid, acts as a lubricant so that bones move smoothly, and as a shock absorber so that joints can bear weight. During viscosupplementation, hyaluronic acid is injected directly into the knee joint; it is typically administered in a series of 1 to 5 injections over several weeks’ time. Benefits of viscosupplementation include the following: Reduction in pain Improved mobility Reduction in swelling and inflammation Effects that last for several months It can take several weeks for patients to experience full symptom relief after hyaluronic-acid injections. Side effects associated with viscosupplementation are temporary, and include injection-site pain, swelling, redness and rash; bruising around the joint, or fluid accumulation in the knee. If these reactions occur, they are usually mild and do not last long. Viscosupplementation is most effective for mild-to-moderate cases of osteoarthritis, and may be a good option when osteoarthritis has not responded to conservative treatment with pain medication.

  Link: Viscosupplementation

• Osteoarthritis of the Ankle

  ANKLE OSTEOARTHRITIS Osteoarthritis, a condition that causes pain, stiffness and swelling in the joints, develops over time as the cartilage protecting the bones in the joints wears down. It is the most common form of arthritis, and can affect any joint, including the ankle joint, which connects the shinbone (tibia) to the upper bone of the foot (talus). When osteoarthritis develops in the ankle joint, stiffness and pain can result, and balance and walking may be compromised. As people age, they are more likely to develop osteoarthritis, not only because of cartilage wear and tear, but because cartilage loses its ability to self-heal. SYMPTOMS OF OSTEOARTHRITIS OF THE ANKLE Osteoarthritis of the ankle may not initially cause symptoms. As the condition progresses, however, symptoms develop and usually worsen over time. Symptoms may include the following: Pain Tenderness Stiffness Swelling Bone spurs Joint deformity Difficulty walking If the nerves surrounding the joint become irritated, patients may also experience numbness and tingling in the ankle. TREATMENT OF OSTEOARTHRITIS OF THE ANKLE Although treatment for ankle osteoarthritis depends on its severity, conservative methods of treatment, such as losing weight to relieve pressure on the affected ankle, are usually tried first. Additional conservative methods that may provide relief include the following: Wearing more comfortable shoes Using cushioned shoe inserts Limiting high-impact activities Wearing a brace Using a cane for support Anti-inflammatory medication and steroid injections can also be helpful in relieving pain. In severe cases of osteoarthritis, advanced but invasive treatments such as ankle arthroscopy, ankle-fusion surgery or ankle-replacement surgery may be recommended. CHRONIC ANKLE INSTABILITY Chronic ankle instability is a condition in which the outer portion of the ankle has a chronic sensation of weakness and constantly “gives way” during walking and other activities. While this condition commonly occurs during physical activity, it may even occur while an individual is standing still. Chronic ankle instability commonly affects athletes and is often caused by an ankle sprain that has not healed properly or by repeated ankle sprains. A sprained ankle tears or stretches connective tissues, affecting balance, and if not treated properly, chronic ankle instability and other ankle problems may occur. SYMPTOMS OF CHRONIC ANKLE INSTABILITY The most common symptom of chronic ankle instability is a wobbly, unstable feeling within the ankle. Additional symptoms that may affect the ankle may include: Pain Tenderness Swelling and discomfort Some individuals with chronic ankle instability may experience a repeated turning of the ankle when walking or running on uneven surfaces. DIAGNOSING CHRONIC ANKLE INSTABILITY Chronic ankle instability may be diagnosed through a physical examination, and a medical history review. Patients may be asked about past ankle injuries and recovery. Imaging tests, such as x-rays are often performed to detect any damage to the ankle bone and provide an accurate diagnosis. TREATMENT FOR CHRONIC ANKLE INSTABILITY Most cases of chronic ankle instability are treated through conservative measures that may include: Physical therapy Anti-inflammatory medication Ankle bracing Severe cases of chronic ankle instability that do not respond to conservative treatment methods may require surgical correction. Surgery for chronic ankle instability involves repairing or reconstructing the damaged ligaments that cause symptoms. Recovery from surgery varies depending on the specific procedure that is performed.

  Link: Osteoarthritis of the Ankle

• Jones Fracture

  JONES FRACTURE A Jones fracture, named for the doctor who first described it, is an injury to the fifth metatarsal bone of the foot, the bone at the base of the small toe. This fracture most often occurs as the result of an ankle sprain or other foot injury where the foot turns inward (inversion injury), and not as a result of direct impact to the area. Repetitive stress may also cause a Jones fracture. Because there is a limited blood supply in the area, and because a Jones fracture further interrupts blood flow, such a fracture may take longer to heal than other injuries. There is a possibility that there may be a non-union, or failure of the bone to heal, requiring surgical intervention. SYMPTOMS OF A JONES FRACTURE Patients with a Jones fracture typically experience pain on the middle and outside of their foot, along with swelling, bruising and difficulty walking. Because a Jones fracture frequently occurs in conjunction with another injury, it may go undetected. Because it may have difficulty healing, it is important that a correct diagnosis be made promptly. SYMPTOMS OF A JONES FRACTURE Mild Jones fractures are normally immobilized with a cast, splint or walking boot for 6 to 8 weeks. Usually, patients use crutches to keep the injured foot from bearing any weight. Patients are given non-steroidal anti-inflammatory drugs (NSAIDS) to reduce pain and swelling. Once the cast is removed, patients require an additional 2 to 3 weeks of rehabilitation. As with other fractures, older patients usually take longer to heal than younger patients. In more severe cases, where the bone is displaced by the fracture or does not heal properly, surgery is necessary to treat the fracture. Surgery is also frequently performed on professional athletes to shorten the healing process. Metal devices, such as plates or screws,are used in such operations to fixate the bone. Sometimes a bone graft or a substance that will stimulate bone growth is also used. After surgery, the foot is put in a cast to immobilize it and protect it during the healing process.

  Link: Jones Fracture

• Achilles Tendon Rupture

  ACHILLES TENDON RUPTURE The Achilles tendon is the strong band of tissue that connects the calf muscle to the heel. If stretched too far, the tendon can tear, or rupture, causing severe pain in the ankle and lower leg that can make it difficult or even impossible to walk. An Achilles tendon rupture, which may be partial or complete, often occurs as a result of repeated stress on the tendon while playing sports such as soccer or basketball. Although frequently resulting from the same stresses that cause Achilles tendonitis, a rupture of the Achilles tendon is a far more serious injury, usually requiring surgical repair. RISK FACTORS FOR ACHILLES TENDON RUPTURE An Achilles tendon may rupture if it has been previously over-stretched or weakened by: Poor stretching habits prior to exercise Tight or weak calf muscles Wearing shoes that do not fit properly Engaging in physical activity after a long break Taking certain types of antibiotics, such as Cipro or Levaquin Having steroid injections into the ankle joint Running on difficult terrain or in extremely cold weather Being a man, being obese, having flat feet or having diabetes or hypertension increase the risk for an Achilles tendon rupture. SYMPTOMS OF ACHILLES TENDON RUPTURE Achilles tendon ruptures are usually caused by traumatic injury, frequently accompanied by a popping or snapping sound as the tendon tears. Patients usually experience severe pain and swelling near the heel of the foot and are unable to walk normally or bend their foot. Because these symptoms are similar to those of other conditions, such as bursitis and tendonitis, it is important to seek prompt medical attention in order to determine the correct diagnosis. TREATMENT OF ACHILLES TENDON RUPTURE Treatment for an Achilles tendon rupture depends on the severity of the condition, but most often requires surgery to repair the tendon and restore function to the foot. Less severe cases may only require a cast or walking boot for several weeks, although the risk of a recurring rupture is higher with this treatment than with surgical repair. When surgery is necessary, the tendon is reattached and sometimes reinforced with other tendon tissue. Physical rehabilitation for several months is usually necessary after an Achilles tendon rupture, whether or not an operation is performed. ANKLE LIGAMENT RECONSTRUCTION An ankle sprain is a common injury that occurs when the ankle is twisted or turned, and results in torn ligaments within the joint. This injury often causes pain, swelling and bruising, and if it does not heal properly, it may lead to chronic ankle instability or repeated ankle sprains. Ankle ligament reconstruction is a procedure commonly performed on patients experiencing chronic ankle instability and repeated ankles sprains. It is effective in repairing torn ligaments, tightening loosened ligaments and improving the overall stability of the joint. THE ANKLE LIGAMENT RECONSTRUCTION PROCEDURE The ankle ligament reconstruction procedure is performed on an outpatient basis while the patient is sedated under general anesthesia. Different techniques may be used by the surgeon, depending on the condition of the ankle. During the procedure, torn ligaments may be repaired with stitches or sutures, two ligaments may be reattached, or part of a lateral tendon around the ankle may be used to repair the torn ligament. After the procedure is complete, a splint or cast is applied to the ankle. This procedure may take up to 2 hours to perform. RISKS OF ANKLE LIGAMENT RECONSTRUCTION As with any surgery, there are possible complications associated with ankle ligament reconstruction which may include: Reaction to anesthesia Nerve damage Infection Bleeding After surgery, blood clots within the veins of the legs may also occur. RECOVERY FROM ANKLE LIGAMENT RECONSTRUCTION After surgery, patients will use crutches for up to two weeks. After this time, they may begin walking in a removable walking boot. Physical therapy is a crucial part of the healing process, and usually begins after about six weeks. Physical therapy treatments focus on improving range of motion without putting excessive strain on the healing tendons. Muscle-stengthening exercises and range of motion exercises may all be used to increase movement and mobility. Most patients fully recover from ankle ligament reconstruction after three to four months, and at that time they can resume all regular activities including running and exercise.

  Link: Achilles Tendon Rupture

• Open Reduction Internal Fixation of the Ankle

  OPEN REDUCTION INTERNAL FIXATION (ORIF ANKLE) An ankle fracture is a common injury that involves a break in one or more of the bones that make up the ankle joint. This may include a crack or break in the the tibia, fibula, or talus. The more bones that are broken, the more complicated and severe the fracture is. Common causes of an ankle fracture may include a sports injury, a motor vehicle accident or a fall. Treatment for an ankle fracture can vary depending on the severity of the condition. While mild fractures may be treated through nonsurgical methods, more severe fractures may require surgery to realign the bones and ensure that they heal correctly. Severe ankle fractures that will not heal properly with splinting or casting alone, may benefit from a procedure known as open reduction internal fixation. Open reduction internal fixation is a surgical technique that secures the bones in place with the help of screws, plates, wires, rods and pins. These tools allow the bones to heal properly, restoring function to the joint with no damage or discomfort to the patient. Depending on the severity of the fracture, these devices are sometimes removed from the ankle after it has healed from the surgery. THE OPEN REDUCTION INTERNAL FIXATION PROCEDURE Open reduction internal fixation takes place in two phases. First, an incision is made in the ankle and the broken bone is realigned and put back into place. Next, a plate with screws, a pin, or a rod that goes through the bone will be attached to the bone to hold the broken parts together. The steel rods, screws, or plates can be permanent, or temporary and may be removed when healing takes place. The incision is then closed with staples or stitches. A cast or brace is usually applied after this procedure RISKS OF OPEN REDUCTION INTERNAL FIXATION While it is considered a safe procedure, risks of open reduction internal fixation may include: Infection Bleeding Swelling After the surgery, some patients may experience joint pain or movement from the inserted devices. RECOVERY AND RESULTS After the open reduction internal fixation procedure, the ankle fracture may take several months to heal depending on the severity of the initial injury. Initial recovery treatments focus on controlling pain and swelling with the use of ice and anti-inflammatory medication. After the cast is removed, movement may still be restricted until the bone is strong enough for regular activity. Physical therapy can help patients to gradually restore full movement of the ankle and treatments focus on improving range of motion without putting excessive strain on the healing bone or ligaments. As the ankle heals, muscle-stengthening exercises as well as range of motion exercises and balance training are may all be used to increase movement and mobility. Full recovery after open reduction internal fixation may take up to 6 months.

  Link: Open Reduction Internal Fixation of the Ankle

• Posterior Tibial Tendon Dysfunction

  FLAT FOOT Posterior tibial tendon dysfunction occurs when the posterior tibial tendon of the foot becomes torn or inflamed. Commonly referred to as flat foot, this condition often results in the inability to provide support for the arch of the foot. The posterior tibial tendon is the tendon that attaches the calf muscle to the bones on the inside of the foot and ankle, and is responsible for creating the arch in the feet. This tendon provides the support that normally holds up the arch of the foot while walking. As the tibial tendon tears, individuals often experience pain as the foot gradually rolls inward and flattens. Over time, the supporting ligaments in the foot begin to stretch and tear as well. CAUSES OF POSTERIOR TIBIAL TENDON DYSFUNCTION Posterior tibial tendon dysfunction may be a condition that some people are born with. Other causes may include: Stretched or torn tendons Nerve problems Fractured or dislocated bones in the leg or foot Posterior tibial tendon dysfunction often occurs in athletes such as basketball and tennis players who may have tears in this tendon from repetitive use. This condition is also more common in women, people who are obese and people with diabetes. SYMPTOMS OF POSTERIOR TIBIAL TENDON DYSFUNCTION Some people with this condition may not experience any symptoms at all, however, others may experience: Pain along the inside of the foot and ankle Swelling Limited flexibility Pain that intensifies with activity Pain on the outside of the ankle The shape of the foot may also change in individuals with posterior tibial tendon dysfunction, as the heel may tilt outwards and the ankle may roll inwards,as the arch of the foot collapses. DIAGNOSIS OF POSTERIOR TIBIAL TENDON DYSFUNCTION Tibial tendon dysfunction is diagnosed through a physical examination and a review of symptoms as well as diagnostic tests that may include X-rays, CT scans or MRI scans. TREATMENT OF POSTERIOR TIBIAL TENDON DYSFUNCTION Initial treatment for posterior tibial tendon dysfunction may include conservative methods that may include: Rest Applying ice to the affected area Anti-inflammatory medication Immobilization through a short cast or walking boot Physical therapy Additional treatment for this condition may also include orthotic devices or braces to support the joints of the foot. In severe cases that do not respond to conservative methods,surgery may be required to cut or realign the bones and correct the deformity. Surgery often involves an osteotomy, which cuts and shifts the heel bone in order to transfer another tendon to be used in place of the torn tibial tendon. Other surgical methods may also include lengthening of the achilles tendon or a fusion of the joints in the back of the foot. Most patients have successful results from surgery.

  Link: Posterior Tibial Tendon Dysfunction

• Osteochondral Lesion of the Talus

  OSTEOCHONDRAL LESION OF THE TALUS The talus is the uppermost bone in the foot that, together with the tibia, makes up the ankle joint. The top of the talus is a dome-shaped area that is completely covered with cartilage to allow for smooth, painless movement of the joint. When the ankle joint is injured, the cartilage may become torn or fractured leading to a condition called an osteochondral lesion of the talus. In severe cases, as piece of cartilage may even break off but stay wedged in place. Also known as a talar dome lesion, this condition causes pain and swelling within the ankle, and left untreated, may lead to long-term damage to the bone. SYMPTOMS OF OSTEOCHONDRAL LESION OF THE TALUS Symptoms of osteochondral lesions of the talus tend to develop gradually, and may not be immediately noticeable. An osteochondral lesion often causes: Chronic pain in the ankle Clicking or catching feeling when walking Feeling that the ankle will give out Swelling Symptoms are usually worse when weight is put on the foot and are not as severe when the foot is at rest. As this condition progresses, symptoms may worsen, especially if there is loose pieces of cartilage or bone within the ankle. Left untreated, osteochondral lesions may cause chronic pain and swelling, and may eventually limit the motion of the joint. CAUSES OF OSTEOCHONDRAL LESION OF THE TALUS Osteochondral lesions are usually caused by an injury, such as an ankle sprain, which damages the cartilage and forces it to soften and slowly break off. A broken piece of cartilage may remain in the ankle, causing an osteochondral lesion to occur. A lesion may not develop until months or even years after an injury occurs, unless the injury is severe. This condition may also be caused by abnormal bone development, which is most commonly seen in children. Repeated trauma to the ankle over time can also cause osteochondral lesions to gradually develop. DIAGNOSIS OF OSTEOCHONDRAL LESION OF THE TALUS An osteochondral lesion of the talus is often missed during the early diagnosis of ankle injuries, since an injury such as a sprain is usually considered minor and does not require treatment. However, if pain and swelling persist, an osteochondral lesion may be suspected. In addition to a physical examination of the ankle and foot, imaging tests such as X-rays and MRI scans may be performed to diagnose an osteochondral lesion of the talus. TREATMENT FOR OSTEOCHONDRAL LESION OF THE TALUS Treatment for osteochondral lesions of the talus usually begins with conservative methods to help relieve pain caused by stable lesions with no loose cartilage or bone. Conservative treatment methods may include: Nonsteroidal anti-inflammatory drugs Immobilization Physical therapy Ankle brace If these methods fail to relieve the symptoms of the lesion, surgery may be needed. Surgery for this condition may involve removing the loose cartilage or bone within the joint and promote healing of the talus. There are several different surgical techniques available to treat this condition. These techniques vary depending on the size, location and severity of the lesion. After surgery, most patients experience permanent relief from ankle pain and swelling caused by the lesion.

  Link: Osteochondral Lesion of the Talus