- ACL Tear
- Adhesive Capsulitis
- Ankle Sprain
- Anterior Knee Pain
- Articular Cartilage Injury
- Back Pain in Athletes
- Frozen Shoulder
- Femoral Acetabular Impingement (FAI)
- Gluteus Medius / Minimus Tears
- Knee Sprain
- Hip Conditions
- Labral Tear
- Loose Bodies
- Meniscus Tear
- Patella Instability
The anterior cruciate ligament (ACL) is one of the four main ligaments providing stability to the knee. The ACL provides stability to anterior stress and rotation. Tears of the ACL are common in athletes, especially females. Over 100,000 ACL surgeries are performed in the United States each year. ACL tears can occur from contact (a football player hit on the knee) and non-contact (twisting) injuries. Athletes who tear their ACL often report feeling a tear, pop or a sense of having the knee "shift." ACL tears are usually associated with significant swelling and a sense if instability. Athletes may feel their knee is "sloppy," "loose," or "wobbly." Female athletes are at 3-5 times increased risk of ACL tear versus males in the same sport. This is felt to be due to different bony and ligament anatomy in a female’s knee, different muscle activity patterns (females jumping, landing, and running differently than males) and looseness of the knee associated with hormonal changes during a female’s menstrual cycle.
ACL tears can usually be diagnosed based on history and physical examination. X-rays are usually taken to ensure there are no fractures. An MRI may be used to confirm the diagnosis.
Surgery is usually recommended to reconstruct the ACL in young patients and athletically active patients of any age. Without surgery, many patients are unable to return to sports that involve cutting and pivoting, even with physical therapy and use of a brace. Lower demand, older patients can be managed successfully without surgery with very little risk of later arthritis. In younger, more active patients, non-surgical treatment is associated with an increased risk of tearing the meniscus which can lead to premature arthritis.
Initial management of an acute ACL tear usually involves ice, non-steroidal anti-inflammatory medications (NSAIDs, such as Ibuprofen, Naprosyn and others) and physical therapy to allow swelling, inflammation and stiffness to subside.
ACL surgery involves reconstructing the injured ligament with the patient’s own tendons or allograft (cadaver) tissue.
ADHESIVE CAPSULITIS (FROZEN SHOULDER)
The exact cause of adhesive capsulitis or frozen shoulder, is not completely understood. Patients frequently present with a sudden painful loss of range of motion. At times a small injury is reported, but usually there is no inciting injury. Adhesive capsulitis is much more common in women, and is much more aggressive in patients with diabetes. The typical age of onset is in the 40’s and 50’s. Social stressors may play a role in its onset. The capsule, or joint lining, becomes inflamed, and causes true stiffness.
Management usually starts with anti inflammatory medication, either in the form of pills or injection of steroid into the shoulder. Physical therapy is frequently helpful as well. In patients who have persistent loss of motion despite these measures, surgical release of the capsule and manipulation of the joint may be recommended.
Ankle sprains are one of the most common sporting injuries that bring a player to an orthopaedic surgeon’s office. They do, however, occur in athletes and non-athletes alike. A typical ankle sprain occurs with inversion of the ankle (rolling the ankle) which causes a stretch of the lateral ligaments that stabilize the joint. There are 3 ligaments that span the ankle from the lateral fibula (the smaller of the 2 leg bones that make up the ankle joint) to the foot. The anterior talofibular ligament runs on the front of the fibula and is the most commonly injured. The ligaments may be stretched or even completely torn but most always heal without surgery. A "high ankle sprain" refers to an injury to the ligaments that hold the larger tibia to the smaller fibula in the leg. These are more severe injuries and can be associated with medial ankle pain and swelling and may more often make the athlete unable to bear weight.
An ankle sprain can cause swelling, pain, stiffness and make the patient unable to bear weight on the leg. After the first couple of days, the swelling and bruising can start to go down into the foot or toes as the fluid drains to the lowest spot.
When I evaluate a patient with an ankle sprain, I carefully palpate (push on) the different structures of the ankle and foot to determine which is damaged. I also examine the foot and leg for swelling and numbness, specifically on the top of the foot. When the bones are more tender than the ligaments I am more concerned about the person having an ankle fracture. I routinely do X-rays of the ankle and sometimes of the tibia and foot as well if I am concerned about a fracture or injury to those areas based on my exam of the patient.
If you have had an ankle sprain, especially if you are unable to bear weight on the leg, you should seek evaluation with your physician or an orthopedic surgeon.
ANTERIOR KNEE PAIN
Anterior knee pain is a common condition that results in pain in the front part of the knee. Pain may come from the patella (kneecap), the patellar tendon (under the kneecap), the quadriceps tendon (over the kneecap), or the top of the tibia (shin bone). These conditions are called patellofemoral syndrome, patellar tendinitis, quadriceps tendonitis, and Osgood-Schlatter Syndrome, respectively.
Patellofemoral syndrome or "runner's knee" is a condition when the underside of the kneecap tracks incorrectly in the groove of the femur and results in anterior knee pain. It can result in pain when climbing or descending stairs or sitting for long periods of time. This irregular rubbing can result in irregularity of cartilage (chondromalacia) under the kneecap which can cause clicking, grinding or creaking when bending the knee. Initial treatment should include rest, ice, and anti-inflammatory medicines (NSAIDS). Sometimes a brace can be used initially to help relieve symptoms and allow limited activity and exercise to continue. Treatment usually focuses on the leg muscles using home exercises and physical therapy. The condition is usually improved with quadriceps strengthening such as with bicycling. Hamstring flexibility as well has hip muscle strength helps improve the kneecap position when exercising, thus causing less pain.
Patellar tendinitis or "jumper's knee" is when the tendon underneath the kneecap becomes inflamed or irritated with overuse from running or jumping. If left untreated and if the pain continues, the tendon can become chronically injured and then much more difficult to treat. Initial treatment should include rest, ice, and anti-inflammatory medicines. Sometimes a brace can be used initially to help with symptoms to allow exercise and activity before complete recovery. Treatment should then focus on flexibility of the quadriceps, hamstrings, and calf muscles.
Quadriceps tendinitis is when the tendon above the kneecap becomes inflamed. It is much less common than the other causes of anterior knee pain but still can be quite challenging to treat. Initial treatment should also consist of rest, ice, and NSAIDS. Physical therapy and rehabilitation may be required as this condition can place a person at higher risk for quadriceps tendon rupture.
Osgood-Schlatter syndrome is when the growth plate at the top front of the shin bone (tibia) becomes irritated and inflamed. It occurs in young people who have open growth plates and are still getting taller. It is more common in young people who do sports year round, especially those that have a lot of running and jumping. If left untreated, it can permanently damage the growth plate. Rest, ice and occasionally, NSAIDS can be used to help relieve the pain. The bad news is that usually needs a period of rest and limited activity to subside. The good news is that it almost always goes away on its own when growth slows or stops!
As you can see, most of the conditions causing anterior knee pain can be treated with rest, ice, and NSAIDS. They rarely require surgery, but if they don't seem to be getting better after following this advice, you should seek medical advice from your doctor or a sports medicine specialist!
ARTICULAR CARTILAGE INJURY
The term "articular cartilage" refers to the slippery surface that is present on the ends of bones as they form joints. It is comprised of a very specialized type of tissue known as hyaline cartilage. It is designed to be able to withstand impact stresses and constant weight bearing and is also very smooth to allow the bones, which comprise the joints, to slide in relation to one another.
Articular cartilage injury can be either chronic or acute. With aging and with arthritis conditions, a loss of the articular cartilage results in exposure of the underlying bone, which can be quite painful. Acute injuries to the articular cartilage can occur as fractures of the underlying bone and can also occur with acute ligamentous injuries of the joint. Injuries of the articular cartilage are very common following patellar dislocations, and can arise from the undersurface either of the patella or the end of the femur. Another common cause for articular cartilage defects is a condition known as osteochondritis dissecans. This frequently occurs in adolescence and involves an interruption of the blood supply to the underlying bone. This area of diseased bone can become brittle, fracture and thus create a defect in the overlying articular cartilage.
Because acute articular cartilage injuries often arise as a result of a traumatic injury such as a patella dislocation or a tear of the anterior cruciate ligament, the symptoms are usually that of the acute injury. This usually includes pain and swelling. MRI is the best study to evaluate for an acute injury of the articular cartilage. X-rays are often obtained initially to rule out a fracture.
The treatment of acute articular injuries depends on many factors and can range from simple things like ice and rest, but can also include arthroscopic surgery and major joint reconstruction.
BACK PAIN IN ATHLETES
FEMORAL ACETABULAR IMPINGEMENT (FAI)
This is a condition where there is abnormal contact between the ball and socket components of the hip. This abnormal contact can result in damage to the hip lining (labrum) or the articular cartilage (covering the ball or socket). This occurs in predominantly in young active adults.
Symptoms of FAI often include hip pain and loss of motion. FAI is diagnosed with a medical history, physical examination and X-rays. Often an MRI or MR arthrogram is obtained to evaluate the degree of articular degree of arthritis and for assessing labral tears and bone configuration. CT scan may also be obtained to further assess the bone on both the ball and socket side of the hip.
In cases of FAI with associated labral tears, hiparthroscopy can be used to repair or trim (debride) the labrum in addition to trimming the bone causing impingement either on the ball or socket side of the joint or both.
GLUTEUS MEDIUS / MINIMUS TEARS
In patients who have failed non operative management/treatment of gluteus medius or minimus tears and have ongoing pain and or weakness, surgical repair of these tendons through arthroscopic or mini open approach can be performed.
A knee sprain is usually caused by a twisting injury to the knee but can also occur as a result of a fall, a direct blow, or a sudden deceleration. A sprain is a broad term that generally implies an injury to one of the ligaments which make the knee stable. These ligament injuries can range in severity from a minor stretching injury, where the ligament is swollen and inflamed, to a complete tear of one or more of the ligaments. Most knee sprains involve minor stretching injuries to the medial collateral ligament (MCL). Knee sprains can also result in complete tears of the anterior cruciate ligament (ACL) which can require surgery.
Most knee sprains cause pain. When pain is severe, it may become difficult to walk or even support your weight with the injured leg. Knee sprains can also cause stiffness and a sense of instability.
Some symptoms which can occur following a knee sprain can suggest a more severe injury and should be seen by a doctor. These include swelling, the inability to put weight on the leg, catching, locking and giving-way episodes. In addition to performing a physical examination, your doctor will typically perform X-rays to ensure that there is no fracture. MRI imaging may be required for some knee sprains as well.
Many knee sprains are successfully treated without surgery. Your doctor may recommend the use of ice, a supportive brace, crutches and anti-inflammatory medications (NSAIDs) which can help relieve pain and swelling.
- Labral Tears
- Femoral Acetabular Impingement
- Loose Bodies
- Recalcitrant Trochanteric Bursitis
- Gluteus Medius / Minimus Tears
The labrum is a piece of cartilage that surrounds the socket of the shoulder in a ring-like fashion. The shoulder is a ball and socket joint. The socket is called the glenoid and is much more shallow than the socket of the hip joint. As such, the bony socket of the shoulder has little inherent stability. The labrum acts as a rim, deepening the socket by approximately 200% and making the shoulder more stable. The top of the labrum (the 12 o clock position on a clock face) is also the place where the biceps tendon anchors into the shoulder.
Tears of the inferior half of the labrum, both anteriorly and posteriorly, are usually caused by instability of the shoulder, either a full or partial dislocation. A partial dislocation, where the shoulder starts to slip out but then goes back in, is also called a subluxation. In young patients, almost all shoulder dislocations and subluxations cause labral tears. A tear of the anterior labrum is also referred to as a Bankart lesion.
Tears of the superior labrum are also called SLAP tears and are problematic because they disrupt the anchoring point of the biceps tendon. SLAP tears can occur in a number of ways including falls on an outstretched arm, forceful extension of the elbow or with overuse and throwing.
Inferior labral tears usually cause recurrent episodes of instability or recurrent shoulder dislocations. If the shoulder is subluxing, this may cause the arm to "go dead" temporarily. In young patients this often requires surgical repair, as physical therapy and bracing may not be effective. In addition to a history and physical examination, your surgeon will likely order X-rays and often an MRI. When surgery is needed it can usually be done arthroscopically (without a formal incision) on an outpatient basis. A sling is worn following surgery and physical therapy is required before returning to sports.
SLAP tears don’t typically cause instability, although they can cause dead-arm symptoms in throwing athletes. More often, they are associated with sharp pain which is worse with certain activities (driving, throwing, overhead activities) or positions of the shoulder. Pain is typically deep within the anterior-superior shoulder. SLAP tears may cause clicking, popping or locking of the shoulder. Despite this, SLAP tears may respond to physical therapy and often do not require surgery. When rehabilitation fails, the surgical treatment of SLAP tears is very similar to the repair done for instability. Recovery is similar as well.
Loose cartilage or bone fragments can occur within the hip joint in certain medical conditions (synovial chondromatosis) or can be a result of a trauma (hip dislocations/subluxation). Hip arthroscopy can be used to remove these loose bodies.
The meniscus is a piece of cartilage that sits in the knee between the femur and tibia. There is both a medial and lateral meniscus and they have several important roles in the normal function of the knee. The primary function of the meniscus is to increase the contact area between the femoral condyle (the rounded medial and lateral ends of femur) and the tibial plateau (the flat surface of the top of the tibia). By increasing conformity and contact between the femur and tibia, the meniscus acts as a pad or shock absorber within the knee. The meniscus (particularly the medial meniscus) also helps maintain stability in the knee in the case of ligament injury. Loss of the meniscus can lead to an increase in the amount of force placed on a given area of the articular cartilage in the knee. This can lead to wear of the cartilage and arthritis of the knee in some cases.
Meniscus tears are one of the most common causes of knee pain presenting to an orthopedic surgeon. Meniscus tears can occur in a number of ways. In young patients, meniscus tears usually occur with a significant injury, such as hyper flexing the knee or twisting the knee during sports. As people age, the meniscus loses some of its toughness and can tear following minor activities. Older patients may feel a pop in the knee just from squatting down to get something off the floor.
Patients with meniscus tears usually report a sharp pain in the knee, medially or laterally, that is often made worse with squatting or twisting activities. In addition to sharp pain, meniscus tears can cause mechanical symptoms such as locking or giving-way of the knee. Some patients also report painful clicking or a sense of something moving around in the knee.
Diagnosis of a meniscus tear can usually be made by taking a history from the patient and examining the patient’s knee. Although the meniscus cannot be seen on X-rays, X-rays are typically taken to make sure there are no fractures and to look for arthritis in the knee. Once a meniscus tear is suspected, an MRI can confirm the tear and rule out other injuries. Treatment of a meniscus tear does not always require surgery. Ice, Non-steroidal anti-inflammatory medications (NSAIDs, such as Ibuprofen, Naprosyn and others) and steroid injections can all be helpful. Temporary use of a brace or physical therapy to decrease swelling and restore range of motion can also help. With use of these treatments, some patients may become symptom free.
When symptoms do not respond to non-surgical treatment, surgery for meniscus tears is generally very effective and involves limited recovery time. Surgery for meniscus tears is accomplished using a knee arthroscopy or scope. A knee arthroscopy involves using a camera and small instruments through two small incisions to remove the torn part of the meniscus. The majority of meniscus tears are treated by removing the torn piece as only approximately of 15% of all meniscus tears are potentially repairable. When the meniscus tears in such a way that it can be repaired, this is often done arthroscopically but typically has a longer recovery time. Nevertheless, if the meniscus is repairable, preserving the meniscus leads to the lowest risk of developing arthritis in the future.
The patella or "kneecap" is located within the extensor mechanism of the knee between the quadriceps tendon above and the patellar tendon below. The undersurface of the patella is somewhat triangular in shape and allows it to slide within a groove on the end of the femur known as the trochlea. Patellar instability refers to an alteration in the normal tracking of the patella.
Patellar instability may be caused by a traumatic event or may arise atraumatically from underlying anatomic causes. In a traumatic dislocation, the cause is usually a twisting injury with the foot planted. It may also be caused by a direct blow to the side of the patella. Almost universally, the patella dislocates laterally. In a true dislocation the patella pops out of its usual groove along the trochlea and remains out until manually reduced. A subluxation, or transient dislocation, occurs when the patella pops either part way or fully out of its groove, but then immediately pops back into place. Both a subluxation and dislocation usually result in significant bleeding into the joint with visible swelling appreciated. At times the acute instability event may cause fractures from either the patella or the femur.
Atraumatic instability of the patella is usually caused by anatomic variations that significantly increase the potential for the patella to slide out of its usual tracking position. For example, with trochlea dysplasia, the usual concave surface on the end of the femur is too shallow and it is associated with an increased risk for patellar instability. Likewise, there is great variability in the alignment of the actual extensor mechanism. In patients whose patellar tendon attaches to far laterally, there is alteration in the soft tissue balance and patellar instability or subluxations may be the result. Patients that are congenitally are "loose jointed" have as well been observed to have an increased risk of developing patellar instability.
ROTATOR CUFF TEAR
Rotator cuff disorders are the leading cause of shoulder pain in patients middle-aged and older. While problems with the rotator cuff tendons can be painful and debilitating, with proper treatment, most patients are able to return to all of the activities they enjoy without pain.
WHAT IS THE ROTATOR CUFF?
The rotator cuff is a series of 3 muscles which surround the shoulder joint. The shoulder joint is a ball and socket made up of the head of the humerus (the ball) and the glenoid, which is the part of the scapula that acts as the socket. The socket of the shoulder is very shallow, unlike the hip joint which is much deeper. As such, it is inherently unstable. The rotator cuff muscles act by compressing the ball into the socket, which keeps the ball centered. When the rotator cuff is not functioning, either because it is torn or weakened, the ball moves abnormally on the socket. In the short term, this can cause pain and weakness. With time this abnormal motion can cause degenerative arthritis of the shoulder joint. In addition to rotator cuff tendon tears, the rotator cuff can become painful because of tendinitis (inflammation of the rotator cuff tendons) or bursitis (inflammation of the filmy tissue that covers the rotator cuff and allows it to glide past the bones of the shoulder).
ROTATOR CUFF SIGNS AND SYMPTOMS
Most patients with rotator cuff problems are middle-aged or older. Patients typically complain of pain in the deltoid area, or the place a sergeant’s patch would lie on your arm. The pain is usually aching and may be present both during activities and at rest. Reaching over your head may become painful. Some patients wake up at night with pain. While your rotator cuff may become painful due to an injury or overusing it, pain can come on gradually with no apparent cause.
When I evaluate a patient with rotator cuff pain, I ask about their general health including whether or not they smoke. I ask if it is the dominant hand that is affected and what they do for work. I also ask about things they enjoy out of work, such as sports or hobbies. I always do a complete examination of the shoulder, looking for focal areas of tenderness, stiffness and checking the rotator cuff for weakness. I always take X-rays of the shoulder to look for evidence of arthritis or large rotator cuff tears. While rotator cuff tears are best seen on MRI, X-rays are helpful in determining if a rotator cuff tear can be repaired. Based on my history and examination, I determine whether I think a rotator cuff tear is likely. If that is the case, an MRI is ordered.
ROTATOR CUFF TREATMENT
Many times the rotator cuff is inflamed but not torn. When that is the case, most patients can be treated without surgery. If I see a patient with rotator cuff-type pain and they have no weakness, I usually treat them without surgery initially. The first step is to decrease inflammation which helps relieve pain. Anti-inflammatory medications (Non-steroidal anti-inflammatory drugs or NSAIDs) can be helpful. These include medications like Ibuprofen or Naproxen. There are many such drugs most differ in how often and how much you need to take. I often inject cortisone, a steroid, into the area around the rotator cuff. This works much like NSAIDs but is more potent and without some of the side-effects of the oral medications.
Once the inflammation subsides, I recommend that patients see a physical therapist. This can be very helpful to restore strength and range of motion. By strengthening the rotator cuff muscles, the normal motion of the ball and socket joint can be restored. Non-surgical treatment of rotator cuff tendinitis or bursitis is usually successful. Surgery can sometimes be necessary if non-surgical treatment fails.
When a rotator cuff tear is diagnosed based on history, examination or MRI, I often recommend surgery. While the symptoms of a torn rotator cuff tendon may improve with time, the tendon seldom heals and pain usually returns. Unfortunately, when a torn rotator cuff is neglected, it can become much larger with time. Surgery becomes more difficult and sometimes the tear may become large enough that it cannot be repaired. This can lead to the painful stiffness of arthritis.
Rotator cuff surgery has evolved over time. Most rotator cuff repairs are performed as an outpatient procedure, with patients going home after surgery. Most rotator cuff repairs can be done arthroscopically at this point. The surgeon makes several small (5mm) incisions around the shoulder and introduces an arthroscope, or camera, into the shoulder joint. The rotator cuff tendon is repaired by sewing it to the bone.
Following surgery, I typically have patients wear a sling for several weeks to allow the tendon to heal down to the bone. Early home exercises are recommended to avoid getting a stiff shoulder. This is followed by several weeks of physical therapy to regain all of your strength and range of motion. Rotator cuff repair surgery has, overall, a very high success and low rate of potential complications. Most patients can return to all activities with excellent relief of pain.
RECALCITRANT TROCHANTERIC BURSITIS
In patients with trochanteric bursitis who have failed extensive non-operative management including activity modification, icing, stretching, cortisone injection and physical therapy occasionally surgical hip arthroscopy can aid in more definitive treatment. This procedure involves arthroscopic release of the ITB (iliotibial band) and removal of the inflamed trochanteric bursitis.
SHOULDER DISLOCATION & INSTABILITY
A shoulder separation refers to an injury to the acromio-clavicular (AC) joint. This is the joint on top of your shoulder where the collarbone (clavicle) is linked to the acromion, which is a part of the scapula. The injury usually is caused by a blow to the side or the top of the shoulder. The ligaments which join the bones together are torn to varying degrees, and pain and a prominence on the top of the shoulder result. Management of the injury is usually ice, rest, sling, and graduated return to activities. The "bump" on top of the shoulder will be permanent, though usually patients have minimal long term problems. Occasionally, surgery to realign the joint will be recommended for severe separation.
Many patients present with a painful bump over the AC joint with no history of trauma. Osteoarthritis frequently effects this joint and causes pain with overhead and cross body maneuvers. Weight lifters may also cause a chronic injury, termed "osteolysis" which causes the end of the clavicle to absorb and results in pain. Injection of the AC joint may be recommended for both of these conditions, and surgical treatment where the end of the clavicle is removed to recreate a space is an option for patients with persistent pain.
SHOULDER TENDINITIS & BURSITIS
Tendinitis refers to an inflammation of a tendon. In the shoulder, inflammation and tearing of the rotator cuff tendons is probably the single most common cause of shoulder pain among middle-aged and older patients who present to an orthopedic surgeon. The rotator cuff is a continuous sleeve, or cuff, of tissue that surrounds the glenohumeral joint (the ball and socket joint of the shoulder). The socket of the shoulder is very shallow and the rotator cuff functions to center the ball on the socket. The clavicle (collarbone) and acromion are bones which sit on top of the rotator cuff. As people age, some may develop a prominence or spur on the underside of these bones which can narrow the space available for the rotator cuff and cause pain. This is referred to as rotator cuff impingement. The subacromial bursa as a filmy layer of tissue that allows the rotator cuff tendons to glide under the bony structures. Bursitis refers to an inflammation of this tissue and is indistinguishable from tendinitis.
Pain due to a rotator cuff problem (either tendinitis, bursitis or even a rotator cuff tear) usually is aching in character and located over the lateral shoulder, the area where a sergeant’s patch would sit. It may be worse with overhead activity. Rotator cuff tears can also cause weakness and night pain.
As long as the rotator cuff tendons are not torn, treatment of shoulder tendinitis and bursitis typically does not require surgery. In addition to physical therapy and oral anti-inflammatory medications (NSAIDs such as Ibuprofen and Naproxyn), injection of a steroid (commonly called cortisone) into the inflamed bursa can give significant relief. When I evaluate a patient with shoulder tendinitis, I usually perform X-rays to evaluate for boney impingement. I also carefully examine the patient’s rotator cuff for any weakness. If the patient is weak, I am concerned about a rotator cuff tear and usually order an MRI. In addition, if the patient isn’t made better by the treatments discussed above, I order an MRI to rule out a rotator cuff tear.
Surgery is sometimes needed for shoulder impingement and can be done arthroscopically.
A stress fracture is a crack in a bone that occurs because of repetitive stress that progressively weakens an area and can result in a fracture. Each of these individual stresses will not result in a fracture, however, when they occur repetitively, they result in progressive weakening of the bone. Most common in the leg and foot, they usually occur in running and jumping athletes. The most common site is the shin (tibia) but also can occur in the foot and upper leg (femur). They may result from a change in training, such as running more miles, running and jumping on hard surfaces, adding new, more intense workouts, or even changing shoes. Occasionally, it can indicate that there is a problem with bone density. Pain that occurs in the leg or foot with weight bearing and gets worse with running or walking should always be evaluated by a doctor. Pain from tendinitis, muscle strains, and shin splints can be mistaken for a stress fracture but should still be evaluated. If left untreated, a stress fracture can go on to a full fracture which can require surgery. Most stress fractures will heal on their own but usually require several weeks of rest from activity and exercise. If you suspect that you have a stress fracture, stop the activity that causes the most pain and seek medical advice.
TENDINITIS & BURSITIS
Tendinitis is when a tendon, which attaches a muscle to a bone, becomes inflamed or irritated. Bursitis is when a bursa becomes inflamed or irritated. A bursa is a small, fluid-filled sack that usually sits in areas of friction in the body, such as where a tendon or skin may rub over a bone. Tendinitis and bursitis may exist together or separately and may cause pain deep in a joint or may cause swelling, pain, redness, and warmth. Tendons and bursa exist in every joint in the body so can result in pain almost anywhere! The most common sites for tendinitis and bursitis are the shoulder, elbow, hip, and knee.
The rotator cuff is a series of four muscles in the shoulder that work to hold the "ball in the socket." The muscles start on the shoulder blade and their tendons insert on the humerus at the shoulder. The tendons each have bursae that keep them from catching and rubbing. Their tendons and bursae can become inflamed with overuse, especially with overhead activities. Pain is often worse at night and sometimes can result in loss of range of motion. Rest, ice, and anti-inflammatory medicines (NSAIDS) should be used initially to calm the pain and swelling. If these are not effective after a period of time, stronger medicines or even a corticosteroid injection may be needed to reduce pain and inflammation. Often, physical therapy or home exercises may be necessary to help reduce the chances of the pain coming back.
In the elbow, tendinitis usually occurs in the outside (“tennis elbow”) or the inside (“golfer’s elbow”). Both are usually from overuse and can become chronic. Treatment includes stretches, ice, and NSAIDS. If this is ineffective, sometimes an injection of corticosteroid can be given to reduce pain and aid in healing. When bursitis occurs in the elbow, it is usually over the olecranon, or point of the elbow. It results in swelling, sometimes as big as a golf ball over the end of the elbow. It usually results from minor trauma to the elbow. It can usually be treated with compression, ice and NSAIDS. Usually it is not terribly painful and resolves on its own. If it is red, hot and swollen, it should be evaluated by a medical professional as it may be infected.
In the knee, the most common site of tendinitis is at the iliotibial band, or ITB, on the outside of the knee. This is a very common condition in runners and causes pain on the outside of the knee but rarely any visible swelling. Sometimes it can even cause the knee to feel "locked." Treatment usually included rest from running, ice, and NSAIDS. To help prevent it from reoccurring, stretches for the ITB, as well as strengthening exercises for the hip are helpful. Bursitis in the knee usually is prepatellar or "in front of the kneecap." It results in swelling, warmth, and redness over and in front of the knee. It usually results from kneeling or minor trauma. It usually goes away on its own with compression, ice, NSAIDS, and avoiding kneeling.
When pain occurs in the outside of the hip, it is usually caused by bursitis or tendinitis. Several muscles insert on the greater trochanter (the bump on the outside of the hip). They can become inflamed from overuse and also from inflexible muscles. Treatment includes rest, and NSAIDS. If this is ineffective, physical therapy and sometimes a corticosteroid injection can be helpful.
Tendinitis and bursitis are the most common causes of pain in a joint that did not suffer an injury. If they came on suddenly, you should seek medical advice as this could indicate a tendon tear that could need surgery. Pain that does not respond to a period of rest and anti-inflammatory treatments should also be evaluated by your doctor or a sports medicine specialist.