Tendon Injuries

1. What is a tendon?
A tendon is a type of tissue that connects muscles to bones.

2. What does a tendon do?
Tendons are responsible for creating movement of joints by distributing the force of muscles.

3. Are there different types of tendon injuries?
Tendons can be injured acutely by a tear, or they may develop inflammation through overuse or the natural process of aging called tendinitis.

4. How are tendon injuries treated?
Depending on the type of injury, rest, anti-inflammatory medications, and therapy may be recommended or in certain cases, surgery is recommended.

Labral Tears

1. What is the labrum?
The labrum is a band of connective tissue that creates stability in the shoulder joint by preventing the ball from moving too far in the front or back of the socket.

2. How do you treat labral tears?
Some labral tears occur as natural aging process, while others are the result of trauma (a shoulder dislocation). Traumatic labral tears are usually treated with surgery while degenerative(age-related) tears are treated without surgery.

ACL Tears

1. What is the ACL?
The anterior cruciate ligament connects the thigh bone (femur) to the shin bone (tibia) and is one of the four main stabilizers of the knee joint.

2. How is the ACL injured?
The ACL can be sprained (partially stretched or completely torn) by non-contact injuries (such as landing from a jump or pivoting) or by contact injuries (such as a blow to the outside aspect of the knee.

3. How are ACL tears diagnosed?
Usually ACL tears are diagnosed with specific physical exam maneuvers. However, it is sometimes difficult to get accurate examinations in the setting of an acute injury. X-rays show f there are any associated bony injuries. MRIs are used to confirm a torn ACL as well as determine if there are any other associated injuries such as a meniscus tear or cartilage injury.

4. How are ACL tears treated?
If the ACL is completely torn, surgical reconstruction is usually recommended. Some people can be very active without their ACL, but the majority of people will not feel stable with high-level athletic activities and will either give them up or place their knee at risk for further injury by competing with an unstable knee.

5. How is the ACL reconstructed?
We perform arthroscopically assisted ACL reconstructions. This involves recreating the ACL by placing a graft to act like the old ACL.

6. What type of grafts are there?
We offer several graft options. Autograft is your own tissue such as your a portion of your patella tendon or hamstring tendons. Allograft is tissue donated from a cadaver.

Muscle Strains

What is a muscle?
A muscle is a connective tissue that can contract.

2. What do muscles do?
Muscles can move joints to create motion and can absorb energy from loading of joints (as in walking, running, or landing from a jump)

3. What is a muscle strain?
A muscle strain is a tear of the fibers of a muscle. (As opposed to a sprain which is a tear of a ligament)

4. How are muscle strains treated?
Most muscle strains are treated without surgery with a combination of rest, medication, and exercises.

Rotator Cuff Tears

1. What is the Rotator Cuff?
The rotator cuff is made up of four muscles that provide stability and motion to the shoulder joint.

2. What is a rotator cuff tear?
From attrition (wear and tear) or trauma, the rotator cuff tendons can tear. If they tear, you can still have fairly normal function, but you may have pain with using your shoulder or sleeping at night.

3. How is a rotator cuff tear diagnosed?
The diagnosis of a rotator cuff tear is based on examination, x-rays, and if recommended an MRI.

4. What is the treatment of Rotator cuff tears?
Depending on the type of tear and your activity, some rotator cuff tears may be treated with medication, therapy, injections, or surgery.

Cartilage Repair

1. What is articular cartilage?
Articular cartilage is the cushion tissue on the end of the bones of the large joints in our body.

2. How does articular cartilage get injured?
Injuries to articular cartilage may result from trauma or from degeneration (arthritis).

3. How are these injuries diagnosed?
Pain is a common complaint. Sometimes mechanical symptoms (clicking, locking, popping) are also present. X-rays may be helpful in cases of severe cartilage loss (arthritis). MRIs are helpful to assess the integrity of cartilage.

4. How are these injuries treated?
Isolated defects may be treated with a variety of techniques to restore a smooth cap to the crater such as microfracture, osteochondral autograft/allograft transplants (OATS) or autologous chondrocyte transplantation (ACI). Diffuse degeneration of cartilage, or arthritis, is usually treated with resurfacing or replacement procedures.

Ligament Sprains

1. What is a ligament?
A ligament is a connective tissue that connects two bones together.

2. What do ligaments do?
Ligaments provide stability to joints and allow for normal motion of joints in repon=se top muscle forces.

3. What is a ligament sprain?
A sprain is a tear of a ligament. (as opposed to a strain which is a tear of a muscle)

4. How are ligament sprains treated?
This depends on the severity and location of the ligament injury. Less severe injuries in certain locations usually heal without surgery. Ligament injuries within joints often require surgery to restore normal function.

Shoulder Dislocations

1. What is a shoulder dislocation?
A shoulder dislocation is when the ball of the shoulder pops out of the socket.

2. What is the treatment of a shoulder dislocation?
Emergently, the ball needs to be replaced in the socket which might require a trip to the emergency room. The risk of repeat dislocation is based on age which may indicate a simple course of rehabilitation or possibly surgery.

3. What type of imaging studies are necessary for a dislocation?
In general, x-rays are the only imaging study needed to confirm a dislocation. However, an MRI or and MRI arthrogram (an MRI with contrast injected into the shoulder) may be recommended to see if surgery would be recommended.

Meniscus Tear

1. What is the meniscus?
The meniscus is a type of cartilage that acts as a cushion on the inside (medial) and outside (lateral) part of the knee.

2. What does a meniscus do?
The meniscus acts as a cushion between the thigh and shin bones and it adds stability to the knee joint.

3. How does a meniscus tear?
Meniscus tears may be the result of trauma or degeneration (a natural breakdown of the tissue with age).

4. How do you diagnose meniscus tears?
The patient’s complaints and physical exam usually are the most important data. X-rays are often obtained to evaluate for arthritis. MRIs are used to confirm this suspected diagnosis.

5. How are meniscus tears treated?
Depending on the type of tear and the symptoms the tear is causing, tears may be treated differently. Non-operative management includes rest, anti-inflammatory medication, therapy, or injections. Operative management includes arthroscopic surgery to cut away the torn tissue or repair it.

Stress Fractures

1. What is a stress fracture?
Stress fractures are fractures of a bone because of overuse. Athletes who change their activities or start intense training too quickly are at risk for stress fractures. Stress fractures are most common in runners and gymnasts, but are not exclusive to any athlete.

2. Are stress fractures serious?
All stress fractures can lead to problems if not allowed time to heal. However, some stress fractures are more concerning then others because of their location (hip, spine) or because of poor blood supply (foot).

3. What are the symptoms of stress fractures?
Pain is the main complaint with stress fractures. Early on, the pain may be at the beginning of an activity and then subside. More advanced injuries may have pain throughout the activity as well as pain at rest.

4. How are stress fractures diagnosed?
Examination by a physician and the patient’s complaints are the most helpful. Early in the process, x-rays may look normal. Depending on the location, additional tests may be recommended such as a bone scan or an MRI.

5. How are stress fractures treated?
Most stress fractures will heal with a combination of activity modification (rest, cross-training), immobilization, and medication. Other interventions may include orthotics, therapy, and technique training to prevent recurrent injuries.

Shoulder Instability

1. What is Shoulder Instability?
Shoulder instability is when the ball is loose in the socket of the shoulder. This may be acute or chronic (multiple occasions).

2. What is the treatment of shoulder instability?
In most cases, shoulder instability can be treated with exercises. In some cases, surgery is indicated to provide stability by tightening ligaments or providing bony support to the shoulder joint.

Patella Dislocation

1. What is a patella dislocation?
The patella or kneecap can move out of its normal position in the groove at the end of the thigh bone (femur).

2. How does it happen?
It may happen from a direct blow from a fall or from certain twisting motions.

3. How is it diagnosed?
Some patella dislocations spontaneously return to a normal position. Some may require a trip to the Emergency Room where they need to be placed back into position.

4. Who gets a patella dislocation?
In general, this is an injury of young teenagers, with a greater ratio of females to males.

5. How do you treat a dislocation?
There are both nonoperative (immobilization and therapy) and operative (surgical repair or stabilization) methods of treating this problem. Which treatment is best for each patient is based on factors such as whether there is a loose body in the knee joint or if there is malalignment of the lower extremity that has predisposed to the injury. Xrays and an MRI may be needed to determine the best course of treatment. Often, after one dislocation, nonoperative treatment is recommended and if additional dislocations occur surgery will be recommended.

Bursitis

1. What is a Bursa?
We have bursae all over our bodies. They are small fluid-filled sac-like structures that allow tendons to glide over bony prominences or under our skin. Normally, bursae are not filled with much fluid and are like a plastic grocery bag collapsed on itself. These low friction surfaces allow tendons to move without getting irritated.

2. Where are bursae located?
All over or body, but mostly around joints. The most commonly injured bursa are located in the shoulder, elbow, hip, knee and achilles.

3. What is bursitis?
Bursitis is inflammation of a bursa sac. This can be a result of trauma, overuse, infection, or systemic processes like gout, lupus, or rheumatoid arthritis.

4. How is bursitis treated?
This depends on the cause of the bursitis. Traumatic or overuse bursitis often responds with rest, antiinflammatory medication, injections, and rehab exercises. Infections require antibiotic medication and sometimes surgery.

Shoulder Separation

1. What is a shoulder separation?
A shoulder separation is a sprain of the ligaments of the acromioclavicular joint (the joint between the shoulder blade and the collar bone) of the shoulder. It is not a dislocation.

2. How are shoulder separations treated?
Most shoulder separations can be treated with a short period of activity modification, medication, and rehabilitation. Certain types of shoulder separations that are severe are treated with surgery.

Patella Malalignment/ Instability

What is Patella malalignment?
Patella malalignment is the result of abnormal orientation of the bones of the hip, knee, or foot. It results from the development of the bones from birth and can result in instability or cartilage irritation (chondromalacia) and breakdown (arthritis).

2. What is patella instability?
Patella instability is when the kneecap repeatedly dislocates or subluxes (partially dislocates) from its normal relationship in the knee.

3. How is patella malalignment/instability diagnosed?
The symptoms and history reported by the patient are key. Physical examination usually will show some structural or postural abnormalities in the hip, knee, or foot that are usually the cause of the problem.

4. How is this problem treated?
Nonoperative options include: knee braces, arch supports for the feet, core strengthening, and hamstring flexibility. Surgical options may involve soft tissue repairs or reconstructions, or in some cases, realignment of some of the bones of the knee.

Quadriceps/Patella Tendon Tear

1. What are the quadriceps and patella tendons?
Both of these tendons are part of the knee extensor mechanism. The quadriceps tendon connects the four front muscles of the thigh to the top of the kneecap (patella). The patella tendon connects the bottom of the knee cap to the shin bone (tibia). Together, they help extend the knee to a straight position.

2. How do they tear?
In most cases, there is some degeneration (aging) of the tendon that weakens it and allows it to tear. Sometimes tears occur during falls, sometimes they occur during athletic activities.

3. How are these tendon tears diagnosed?
The history of the injury, difficulty walking and the physical exam are important information. X-rays often show the kneecap in an unusual location (too high or too low). MRIs may confirm these tears in certain cases.

4. How are they treated?
Surgical repair is usually recommended. This cannot be done arthroscopically as it requires exposure of the tendon to repair it to the kneecap.

Ankle Impingement

1. What is ankle impingement?
Ankle impingement occurs when two of the ankle bones (the talus and the tibia) repetitively abut one another. This may lead to pain because of bone spurs that form or because the ankle joint lining gets irritated (synovitis).

2. How is it diagnosed?
Physical exam may reproduce symptoms with specific maneuvers. X-rays may show bone spurs. An MRI will usually show synovitis (inflammed joint lining).

3. How is it treated?
Rest, anti-inflammatories, therapeutic exercises, and sometimes a steroid injection may successfully treat it. Arthroscopic surgery is also successful in treating this problem.

Biceps Tendon Tears

1. What is the biceps tendon?
The biceps muscle is a muscle of the upper arm that crosses the shoulder and elbow joints. The biceps tendon at the elbow helps flex the elbow and rotate the hand so the the palm faces the ceiling. It is important for activities such as using a screwdriver.

2. What is a biceps tendon tear?
A tear of the biceps tendon occurs when the muscle has degeneration (weakening from a natural aging process) and the tendon is overloaded. Tears may be partial or complete.

3. How do you diagnose a biceps tendon tear?
The patient’s complaints and the physical exam are the most important information. X-rays will often be normal but are ordered to rule out any possible injuries to the bone. MRIs are sometimes ordered to confirm the diagnosis, or to clarify a complete from a full thickness tear

4. How are biceps tendon tears treated?
In some circumstances, non-operative management may be recommended. However, surgical reattachment of the tendon to the bone is usually recommended to restore power and endurance to the elbow.

Labral Tears

1. What is the labrum?
The labrum is a band of connective tissue that creates stability in the shoulder joint by preventing the ball from moving too far in the front or back of the socket.

2. How do you treat labral tears?
Some labral tears occur as natural aging process, while others are the result of trauma (a shoulder dislocation). Traumatic labral tears are usually treated with surgery while degenerative(age-related) tears are treated without surgery.

Ankle Instability

1. What is ankle instability?
Ankle instability is when the ligaments of the ankle are stretched or torn and are not functioning well enough to prevent the ankle from “rolling over.” This may occur during rigorous sports or during activities such as walking.

2. Why is it a problem?
Every time the ankle rolls, there is a chance of causing a significant injury to the cartilage of the ankle. Additionally, it may severely limit one’s ability to be active or do basic activities of life.

3. How is it diagnosed?
Physical examination will usually reveal instability of ligaments. Stress x-rays with are also commonly taken in the office. Sometimes an MRI may be recommended to evaluate for other injuries or to confirm the diagnosis.

4. How is it treated?
If bracing and physical therapy cannot restore enough stability, surgical repair or reconstruction of the ligaments is recommended.

Golfer’s Elbow

1. What is golfer’s elbow?
Golfer’s elbow or medial epicondylitis is irritation of the flexor tendons of the wrist at the elbow.

2. I don’t play golf, how did I get tennis elbow?
Golfer’s elbow is an inflammatory/degenerative condition of the flexor tendons of the elbow. It can occur from overuse of any elbow motion (including repetitive motions such as crocheting). It may also occur spontaneously based on a hormonal trigger, which is not well understood.

3. How is golfer’s elbow treated?
Golfer’s elbow often is cured by a combination of anti-inflammatory medication, therapeutic exercises, and bracing. Sometimes, an injection is recommended. In rare circumstances, when all other treatments do not work, surgery may be recommended.

Osteochondral Lesions

1. What are osteochondral lesions of the ankle?
These are bone and cartilage injuries to a bone in the ankle called the talus.

2. How do they occur?
They may be the result of a single trauma such as a bad ankle sprain, or multiple repetitive trauma like recurrent ankle sprains. In some adolescents, these injuries can occur spontaneously.

3. How are they diagnosed?
They may cause pain or swelling in the ankle. They are usually painful to touch. X-rays will often show them. MRIs are usually ordered to assess the extent of the injury as well as the quality of the cartilage.

4. How are they treated?
Treatment is very individualized based on the type of lesion and the patient. Non-operative management includes immobilization, activity modification, and protected weight bearing. Surgical management may include arthroscopic or open procedures to restore the integrity of the articular surface of the talus.

Tennis Elbow

1. What is tennis elbow?
Tennis elbow or lateral epicondylitis is irritation of the extensor tendons of the wrist at the elbow.

2. I don’t play tennis, how did I get tennis elbow?
Tennis elbow is an inflammatory/degenerative condition of the extensor tendons of the elbow. It can occur from overuse of any elbow motion (including repetitive motions such as crocheting). It may also occur spontaneously based on a hormonal trigger which is not well understood.

3. How is tennis elbow treated?
Tennis elbow often is cured by a combination of anti-inflammatory medication, therapeutic exercises, and bracing. Sometimes, an injection is recommended. In rare circumstances, when all other treatments do not work, surgery may be recommended.