ANKLE PAIN

For more detailed information follow this link to Ankle Pain & Instability

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ADHESIVE CAPSULITIS (FROZEN SHOULDER)

Shoulder stiffness may be caused by several disease processes. Adhesive capsulitis, or “frozen shoulder” is most commonly seen in women in their 40’s and 50’s. The cause is not fully understood, but may be related to stress, and is certainly more aggressive in patients with diabetes. The joint lining, deep to the rotator cuff, becomes inflamed and results in loss of range of motion. Treatment involves anti inflammatories, either by pill or injection, and physical therapy. Rarely, surgical release of the capsule and manipulation of the joint many be recommended.

Arthritis, or loss of the cartilage covering the ball and socket, may as well be the cause of a stiff shoulder. Some patients may experience a loss of range of motion secondary to rotator cuff issues, including calcific tendonitis.

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BACK PAIN IN ATHLETES

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HIP PAIN / INJURY

Hip pain is a common complaint among athletes and can have many causes. The pain can emanate from the hip joint itself (groin pain) or can come from injury or strain to structures around the hip, i.e.. bursa, tendons or muscles.

There are some questions that can help the doctor assist in making the correct diagnosis which can aid in effective treatment.

WAS THERE AN INJURY TO THE HIP?

Acute injuries to the hip may occur with running or jumping sports and most often involve muscle or tendon strains. These injuries usually include the hip flexors (front of thigh) or hip adductors (muscles on inside of thigh). Symptoms include tenderness, swelling and muscle spasms. The doctor may order X-rays of the hip and pelvis or on occasion order a MRI to further assess the injury. Treatment of these injuries is dependent on the nature of the injury but most often can be treated with rest, ice, anti-inflammatory medication, strengthening and stretching exercises. The assistance of a physical therapists or athletic trainer may be necessary to allow the athlete to return to sports.

These injuries cannot be completely prevented but some factors that may decrease the prevalence of injuries include:

  • Hip adductors stretches
  • Hip adductor and abductor strengthening
  • Pelvic stabilization exercises
  • Core stability including strengthening of lumbar spine (low back) and abdominal muscles

WHAT ACTIVITY MAKES YOUR PAIN BETTER OR WORSE?

Often a patient with hip labral tears will have pain with twisting maneuvers. They may also complain of pain in the groin going up or down stairs or getting in and out of a car. Areas around the hip where you can press on to cause pain usually indicate a source of pain outside the joint, i.e., muscle, tendon or bursa.

WHAT IS THE LOCATION AND CHARACTERISTICS OF YOUR PAIN?

Deep pain in the groin area is a more indicative of an injury or condition effecting the joint injury and include hip labral tear and or femoral acetabular impingement (FAI). Pain on the outside of the thigh may represent a bursitis (trochanteric bursitis). Pain in the front of the hip may represent a tendonitis or hip flexor condition. Your doctor will evaluate these areas and may obtain various studies including X-ray or MRI or even a MR arthrogram. This is a special type of MRI which includes an injection of dye into the hip joint to enhance the ability to pick up injury or tears including labral tears or impingement. In cases of FAI a CT scan may sometimes be ordered to better assess the bone around the hip joint.

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KNEE INSTABILITY

There are many causes of knee instability. The knee has four main ligaments that connect the bones together. These are the Anterior Cruciate Ligament (ACL), the Posterior Cruciate Ligament (PCL), the Medial Collateral Ligament (MCL) and the Lateral Collateral Ligament (LCL). An Injury to one or more of these ligaments can make the knee feel unstable. Sprains or tears of the knee ligaments usually follow an injury and may be associated with swelling. Twisting, hyperextending and hyper flexing the knee can all cause knee ligament injuries. In addition to swelling and pain, many patients complain of a sense of looseness, sloppiness or giving way of the knee following a knee ligament injury. MCL, LCL and PCL tears are often treated without surgery. Non-surgical treatments include use of a brace, ice, anti-inflammatory medications (NSAIDs) and physical therapy. Some ligament injuries, including ACL tears can require surgery.

Knee swelling, also called a knee effusion or “water on the knee” can also make the knee feel unstable by increasing the space between the femur, tibia and patella. There are many causes of knee swelling including injuries such as ligament tears, meniscus tears, patella dislocations and fractures. Infections of the knee can cause significant swelling. Inflammation of the knee can also cause swelling.

Tears of the meniscus are another cause of giving-way of the knee. In addition to a sense of knee instability, meniscus tears are often associated with clicking, popping and sharp pain. Meniscus tears can occur following an injury but can also be caused by minor trauma or even squatting deeply.

Patellar instability, or an unstable kneecap, can cause knee instability. There are many causes of patellar instability such as an abnormally shaped femur or an abnormally aligned knee (valgus or knock-knee deformity) and ligamentous laxity (loose or double joints).Patella dislocations can occur in an otherwise normal knee following a twisting injury. Patellar dislocations are common in young athletes and can lead to recurrent episodes of knee instability. Initial treatment of patella dislocation is often non-surgical with ice, bracing, medication (NSAIDs) and physical therapy. Surgery can be required in some cases.

WHAT CAUSES KNEE INSTABILITY?

An Injury to one or more of these ligaments can make the knee feel unstable. Sprains or tears of the knee ligaments usually follow an injury and may be associated with swelling. Twisting, hyperextending and hyper flexing the knee can all cause knee ligament injuries. In addition to swelling and pain, many patients complain of a sense of looseness, sloppiness or giving way of the knee following a knee ligament injury. MCL, LCL and PCL tears are often treated without surgery. Non-surgical treatments include use of a brace, ice, anti-inflammatory medications (NSAIDs) and physical therapy. Some ligament injuries, including ACL TEARS can require surgery.

Knee swelling, also called a knee effusion or “water on the knee” can also make the knee feel unstable by increasing the space between the femur, tibia and patella. There are many causes of knee swelling including injuries such as ligament tears, meniscus tears, patella dislocations and fractures. Infections of the knee can cause significant swelling. Inflammation of the knee can also cause swelling.

TEARS OF THE MENISCUS are another cause of giving-way of the knee. In addition to a sense of knee instability, meniscus tears are often associated with clicking, popping and sharp pain. Meniscus tears can occur following an injury but can also be caused by minor trauma or even squatting deeply.

PATELLAR INSTABILITY, or an unstable kneecap, can cause knee instability. There are many causes of patellar instability such as an abnormally shaped femur or an abnormally aligned knee (valgus or knock-knee deformity) and ligamentous laxity (loose or double joints).Patella dislocations can occur in an otherwise normal knee following a twisting injury. Patellar dislocations are common in young athletes and can lead to recurrent episodes of knee instability. Initial treatment of patella dislocation is often non-surgical with ice, bracing, medication (NSAIDs) and physical therapy. Surgery can be required in some cases.

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KNEE PAIN

Although knee pain can have many sources, there are some questions that may help your doctor make the correct diagnosis and select appropriate treatment.

DID YOUR KNEE PAIN BEGIN FOLLOWING AN INJURY?

If you had a recent injury, your knee may be painful due to a sprain of a ligament or a TEAR OF THE MENISCUS, which is a shock-absorbing pad of cartilage between the bones. Either of these problems may cause your knee to have sudden pain with twisting or turning motions. They may also make your knee feel unstable, loose, wobbly, or want to give out. Direct blows to the knee (for instance, hitting your knee on the ground or another player) can also cause contusions, which are deep bruises of the bone or soft tissue structures around your knee. Fractures of the bones at your knee (the femur, tibia or patella) can be painful and limit your ability to put weight on your injured leg.

If you have not had any recent injuries, your knee may be painful from tendinitis or arthritis. TENDINITIS is an inflammation of the tendons around the knee. ARTHRITIS is a wearing of the cartilage that covers the bony surfaces of your knee. In addition to asking you questions about your knee pain, your doctor will examine your knee to determine which structures are injured. They may order X-rays or an MRI to determine what is injured and to guide treatment.

IS YOUR KNEE PAIN MORE SHARP, OR STABBING WITH CERTAIN MOTIONS (FOR EXAMPLE, TWISTING OR SQUATTING)?

Sharp, stabbing pain is more characteristic of MENISCUS TEARS or loose bodies. A loose body is a piece of bone or cartilage which has come loose and is floating within the knee. Ligament sprains tend to be worse with twisting as well. Knee pain due to arthritis is more often aching or sore. It is worse with walking and may occur even at rest.

IS YOUR KNEE SWOLLEN?

Knee swelling which follows an injury often means there has been significant structural damage to your knee MENISCUS TEARS, ACL (ANTERIOR CRUCIATE LIGAMENT) TEARS, fractures and PATELLA (knee cap) dislocations can all cause significant swelling.

In the absence of an injury, knee swelling can be due to a flare-up of ARTHRITIS. This can be caused by doing more physical activity than your knee is accustomed to.

WHERE IS MOST OF THE PAIN?

Pain on the front of the knee can be due to irritation of your patella.  This is sometimes called CHONDROMALACIA and is often worse with stairs. Anterior knee pain can also be caused by TENDINITIS of the patella tendon or quadriceps tendon. These are tendons that attach to the top and bottom of your knee cap. These problems all tend to give more of an aching pain or soreness.

Pain on the medial, or inside, part of your knee may be caused by a sprain of the medial collateral ligament (MCL) or a TEAR OF THE MENISCUS. These tend to follow an injury and are often associated with pain with bending the knee, twisting or squatting. ARTHRITIS of the knee can cause medial knee pain, as well.

Lateral knee pain (pain on the outer aspect of your knee) can be caused by a sprain of the lateral collateral ligament (LCL) or a tear of the lateral meniscus. Like MCL sprains and medial MENISCUS TEARS, these problems usually follow an injury. Similarly, lateral knee pain can be due to arthritis as well.

IS YOUR KNEE LOCKING, CATCHING OR GIVING OUT?

MENISCUS TEARS can cause locking or catching of your knee and may even make it feel as if it wants to give out. Loose bodies can do the same. Giving out is commonly caused by an injury to one of the ligaments which support the knee. MCL and ACL ligaments are common following an athletic injury or fall. Dislocations of the patella usually follow a twisting injury and cause the kneecap to feel painfully out of place with a locked knee.

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SHOULDER INSTABILITY

Shoulder instability can be due to a traumatic dislocation or can be due to looseness of the joint. The shoulder is a ball and socket joint. A dislocation occurs when the ball (the proximal humerus) comes out of the socket. This usually follows an injury and is painful. Treatment involves putting the ball back into the socket. In an athlete this can sometimes be done on the field by an athletic trainer or physician. Most dislocations are reduced, or put in, in an emergency room. Dislocations of the shoulder can cause structural damage to the shoulder including tears of the labrum, fractures and rotator cuff tears.

Once the shoulder is put in, most patients are treated for a period of weeks in a sling for comfort, followed by physical therapy to regain strength and range of motion in the shoulder.

Some patients who dislocate their shoulder develop instability. The shoulder can start to 'come out' on a regular basis. This sometimes responds to physical therapy but can require surgery.

Some patients develop shoulder instability without any injury. This is also called multidirectional instability and can be caused by structural looseness or muscle weakness. Multidirectional instability usually responds to physical therapy and rarely requires surgery.

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SHOULDER PAIN

There are many causes of shoulder pain. Common causes of shoulder pain include arthritis, rotator cuff pathology (tears, tendinitis, and bursitis), biceps tendon pathology and traumatic injuries such as dislocations, separations and fractures.

Shoulder arthritis commonly involves the glenohumeral joint. This is the main ball and socket joint of the shoulder and is made up of the humeral head and the glenoid (the socket). Patients with glenohumeral arthritis tend to be older and both males and females can be affected. Patients with glenohumeral arthritis complain of a deep ache within the shoulder and stiffness. The pain can be present both with activity and at rest. The stiffness may make it hard to reach into a back pocket or reach overhead. Shoulder arthritis can be treated with oral anti-inflammatory medications (NSAIDs). Physical therapy or steroid injections are sometimes helpful. For patients whose arthritis cannot be treated adequately with these methods, Shoulder Replacement is a safe and effective option.

Rotator cuff pathology is probably the most common cause of shoulder pain in patients who are middle-aged and older. The rotator cuff is a series of 3 muscles (the supraspinatus, infraspinatus and subscapularis) which surround the glenohumeral joint and allow it to move normally. The rotator cuff can cause pain due to tendinitis (inflammation of the rotator cuff tendons) or bursitis (inflammation of the bursa, a filmy layer or fluid-filled sack which allows the rotator cuff tendons to glide). Some people can develop bone spurs in the shoulder as they age. These prominences on the bone can rub on the rotator cuff. This is sometimes referred to impingement syndrome. The rotator cuff can also tear away from the bone. This is called a rotator cuff tear. Patients with rotator cuff pathology usually complain of pain in the deltoid area (the area on the lateral part of the shoulder where a sergeant’s patch would sit). Night pain is common and may be indicative of a rotator cuff tear. Rotator cuff tears usually require surgery but tendinitis and bursitis can usually be successfully treated without surgery. NSAIDs, steroid injections and physical therapy are usually helpful. In addition to a history and physical exam, X-rays and MRI may be needed to help diagnose a rotator cuff tear.

The biceps tendon is another common source of shoulder pain. Pain due to biceps pathology is usually located on the front of the shoulder and may be made worse with rotational movements (such as reaching around into a back pocket or putting on a jacket or seatbelt). Biceps pain can be due to inflammation, instability of the tendon, or partial tears of the tendon. Biceps pathology is often associated with tears of the rotator cuff, specifically the subscapularis tendon. Treatment of biceps tendon pain can be non-surgical with oral medication (NSAIDs), steroid injections and physical therapy. Surgery is sometimes required, often done arthroscopically (using a camera through small incisions rather than making a larger open incision).

Shoulder pain which starts following an injury can be simply a bruise or strain. Fractures of the clavicle and humerus, shoulder dislocations and acromioclavicular joint separations are all common following an injury. Shoulder pain which begins following an injury should be evaluated by your physician or an orthopedic surgeon.

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SHOULDER STIFFNESS

Shoulder stiffness may be caused by several disease processes. Adhesive capsulitis, or “frozen shoulder,” is most commonly seen in women in their 40’s and 50’s. The cause is not fully understood, but may be related to stress, and is certainly more aggressive in patients with diabetes. The joint lining, deep to the rotator cuff, becomes inflamed and results in loss of range of motion. Treatment involves anti inflammatories, either by pill or injection, and physical therapy. Rarely, surgical release of the capsule and manipulation of the joint many be recommended.

Arthritis, or loss of the cartilage covering the ball and socket, may as well be the cause of a stiff shoulder. Some patients may experience a loss of range of motion secondary to rotator cuff issues, including calcific tendonitis.

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