Osteonecrosis

Osteonecrosis

Osteonecrosis literally means "death of bone" (osteo = bone, necrosis = death). This condition is often called avascular necrosis. It leads to tiny breaks, and often eventual collapse from within the bone. Osteonecrosis frequently appears in relation to another disease or conditions such as rheumatoid arthritis or alcoholism. The underlying problem of osteonecrosis is a decrease in the blood supply to the affected area. The most common areas affected are the hips, knees, and shoulders, but the elbows, hands and feet also may become involved.

The following groups of people are most at risk for developing this condition:

  • People who have a rheumatic disease such as rheumatoid arthritis or systemic lupus erythematosis
  • People who are taking high doses of steroids (cortisone-like drugs)
  • Alcoholics
  • Professional scuba divers who have the bends (a condition brought on by the rapid reduction of air pressure)
  • People who have connective tissue disorders, such as Gaucher's disease.

Osteonecrosis of the hip occurs most often between the ages of 30 and 50, and is slightly more frequent in men than in women. Osteonecrosis of the knee occurs most often between the ages of 50 and 60, or much earlier if other risk factors are present. Osteonecrosis of the knee occurs three to four times more often in women than in men. Osteonecrosis often involves more than one joint at a time.

The primary symptom of osteonecrosis is pain. Other symptoms of osteonecrosis include limitation of motion, joint stiffness and muscle spasms.

Symptoms usually begin slowly. In fact, in the earliest stage, there are usually no symptoms at all. Other people may notice that you are limping before you feel any pain. Once symptoms begin, they come and go. If the condition is left untreated, progressive bone damage will often occur. Surgery is usually required to correct the bone damage.

Early diagnosis of osteonecrosis is important in order to lessen the damage to bone. As the condition progresses, the death of bone often leads to changes within the bone and nearby joints so that a routine x-ray shows these changes. All too often, permanent damage has already developed by this point.

Aspirin and the newer nonsteroidal anti-inflammatory medications can help relieve the pain of osteonecrosis. Heating pads, warm baths, and an electric blanket can relieve muscle spasms and pain. Activity modifications and the use of crutches or canes can unload painful joints, and physical therapy can help maintain flexibility. These measures may provide some relief, but do not change the underlying process.

Keep in mind that it is up to you to keep your doctor informed of any increase in pain or decrease in mobility. This way, he or she can work with you to keep you as comfortable and functional as possible.

In later stages, if the area of bone has been severely damaged, joint replacement surgery called arthroplasty is needed to replace the damaged bone.

Rheumatoid arthritis

Rheumatoid arthritis

Rheumatoid arthritis (RA) primarily affects the synovium, the membrane that lines and lubricates a joint. It is the most common form of inflammatory arthritis.

There is no cure for rheumatoid arthritis at present. Until the cause of RA is known, it will not be possible to eliminate the disease entirely. The goals of current treatment methods, therefore, are to relieve pain, reduce inflammation, stop or slow down joint damage, and improve function and patient well-being.

Rheumatoid Arthritis Symptoms

Initial symptoms of rheumatoid arthritis are generally pain and stiffness in the morning and few symptoms with activity. The pain and swelling will usually progress on to obvious joint swelling and the level of stiffness in the morning increases. Other symptoms include fatigue and difficulty sleeping due to joint stiffness.

Rheumatoid arthritis can be distinguished from other forms of arthritis by the location and number of joints involved. The areas affected include the neck, shoulders, elbows, wrists, and hands, especially the joints at the base and middle of the fingers but not the joints at the end of the fingers. In the lower extremities, RA can affect the hips, knees, ankles, and the joints at the base of the toes. RA tends to spare the low back. The joints affected tend to be involved in a symmetrical pattern. That is, if knuckles on the right hand are inflamed, it is likely that knuckles on the left hand will be inflamed as well. This symmetry is not found as often in most other types of arthritis.

Inflamed joints will be warm, swollen, tender, often red, and painful or difficult to move. These physical signs of arthritis are due to inflammation of the lining of joints and tendons in a layer of tissue that is called synovium. The cells of the immune system within the synovium appear active and capable of causing tissue damage. If this inflammation persists or does not respond well to treatment, destruction of nearby cartilage, bone, tendons, and ligaments can follow. This leads to deformity and disability that can be permanent.

Anyone can get rheumatoid arthritis, including children and the elderly. However, the disease usually begins in the young to middle adult years. Among people with RA, women outnumber men by 3 to 1. In the United States, approximately one percent of the population, or 2.5 million people, have rheumatoid arthritis. It occurs in all ethnic groups and in all parts of the world.

Rheumatoid Arthritis Treatments

The goals of current RA treatment methods are to relieve pain, reduce inflammation, stop or slow down joint damage, and improve function and patient well-being. There is no single standard treatment that applies to all people with RA. The disease may be very different from person to person. Instead, a treatment program should be designed to best meet each person's needs, taking into account how severe the arthritis is, other medical problems, and individual lifestyle and preferences. Often the use of two or more medications at a time, each serving a distinct purpose, is necessary. Some of these medications affect the immune system, making careful monitoring a requirement for treatment.

Treating rheumatoid arthritis usually involves a teamwork approach, using health professionals from different disciplines to help an individual deal with the disease. Treatment most often is directed and coordinated by an arthritis specialist, who is a physician with special training in arthritis and other diseases of the bones, muscles, and joints. Other health professionals, such as physical therapists, occupational therapists, nurses, psychologists, orthopaedic surgeons, and social workers, often play other roles in implementing the treatment plan.

It often is difficult to be patient when suffering from rheumatoid arthritis. People with rheumatoid arthritis might be tempted to try unproven treatments. A treatment that promises "a quick cure" or "miraculous relief" can sound wonderful. But remember, these unproven treatments usually are expensive and will do nothing. The sensational successes advertised are usually illusions. They even may be harmful and often keep people from getting the medical care they really need. For example, magnet therapy has not been proven to work for rheumatoid arthritis. New or alternative treatments should be discussed with your doctor.

Medical management may include the use of non-steroidal antiinflammatory medication, corticosteroids, injectable gold salts (Myochrysine, Solganal), methotrexate (Rheumatrex), hydroxychloroquine (Plaquinil) and antimalarial drugs, Sulfasalazine (Azulfidine), D-Penicillamine (Depend, Cuprimine), and various other immunosuppressive agents.

Physical therapy treatments are helpful for most individuals with rheumatoid arthritis. Physical therapists can teach you how to exercise appropriately for your physical capabilities. They will give you valuable instruction on how best to use heat and cold treatments to reduce joint stiffness and swelling and make movement easier. At times, therapists may use special machines to apply deep heat or electrical stimulation to reduce pain or improve joint mobility.

Therapists construct splints for the hand and wrist and teach people how to best protect and use their joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations that may be caused by RA. Sometimes this includes the use of practical tools and items that help individuals perform their day-to-day activities. It is important to remember that people with RA can and should be able to do most of the normal or usual things everyone else can, except that it takes them a little bit longer to do it.

For individuals with severe joint damage, surgery such as total joint replacement can mean the difference between being dependent on others and independent life at home or in the community. Such procedures are performed by orthopaedic surgeons with special training in joint replacement. The damaged parts of the joints are replaced with metal or plastic components. Some people with RA will benefit from replacement of other joints and from other types of surgery for hand and foot problems caused by the disease. Patients with early rheumatoid arthritis, however, should be placed on a program of medications and therapy before surgery is considered.

Osteoarthritis

Osteoarthritis

Osteoarthritis (OA), or degenerative joint disease (DJD), is a form of arthritis characterized by the loss of joint smoothness and range of motion without major joint inflammation. Post-traumatic arthritis is similar to osteoarthritis, but the cause is clearly evident (usually the result of a trauma to the joint sometime in the past).

Osteoarthritis is the most common type of arthritis, affecting over 20 million people in the United States. It probably affects almost every person over age 60 to some degree, but symptoms are often mild.

Osteoarthritis Symptoms

  • Joint pain and aching
  • Limited range of motion and instability
  • Erosion of the joint's cartilage and formation of bone spurs
  • Stiffness and roughness on motion

If degenerative joint disease is related to abnormalities of cartilage surrounding joints (articular cartilage), it may involve many of the joints of the body. On the other hand, if the degenerative joint disease is caused by an injury, only one joint may be involved. The hips, knees, spine, and shoulders are most commonly involved. This condition may also affect some finger joints, the joint at the base of the thumb, and the joint at the base of the big toe.

In osteoarthritis, the normally smooth cartilage surface softens and becomes pitted and frayed. As the cartilage breaks down, the joint may lose its normal shape. The bone ends thicken and form bony growths, or spurs, where the ligaments and capsule attach to the bone.

Stiffness and joint deformity usually progress slowly without general body symptoms. By contrast, rheumatoid arthritis (RA) usually begins earlier, often developing more suddenly. RA usually affects the same joint on both sides of body (e.g. both knees), causing redness, warmth, and swelling of many joints. RA is often accompanied by a general feeling of sickness, fatigue, weight loss, and fever.

In the hip, OA may produce pain around the groin or in the inner thigh. Some people feel referred pain to the buttocks, the knee or along the side of the thigh. Degenerative joint disease of the hip may cause a limp and may limit range of motion, for example making it difficult to spread the legs.

Degenerative joint disease of the knees may produce pain and stiffness of the knee associated with a grating or catching sensation in the joint when it is moved. It may make it difficult to walk up and down stairs and lumps may be noted particularly along the medial (inner) side of the knee. If the pain prevents you from moving or exercising your knee, the large muscles around the knee area will become weaker.

Degenerative joint disease of the fingers may produce bony lumpiness around the joints of the finger and perhaps pain and stiffness of these joints as well. In the fingers, the breakdown of joint tissue in the fingers causes bony growths (spurs) to form in these joints. If spurs occur in the end joints of the fingers, they are called Heberden's nodes. If they occur in the joints in the middle of the fingers they are called Bouchard's nodes.

Degenerative joint disease of the feet most commonly affects the large joint at the base of the big toe. Stiffness, lumpiness and pain may be associated. Wearing tight shoes and high heels can make this pain worse.

Degenerative joint disease of the spine may produce stiffness of the back and at times, symptoms of pressure on the spinal cord and nerves running through the spine. The latter are particularly important to notice and may include numbness or weakness of the arms or legs, difficulty with controlling the bowel or bladder, loss of balance and pain radiating out the arms or down the legs.

"Wear and tear" is a widely accepted explanation of the cause of OA. It should be noted that OA is the result of an interlocking pathophysiologic malfunction of cartilage and bone metabolism. Interpreting "wear and tear" of the joints in OA from a biomechanic perspective allows patients to understand how OA differs from age-associated degeneration and overuse of the joints. There are ways to reduce the OA "wear and tear" effects which include weight control, muscle strengthening exercises, and increased proprioception accuracy (the ability to feel your joint's position in space).

The effects of degenerative joint disease can often be controlled by a few basic measures, such as diet, exercise, medication, and surgery.

If you have OA, your diet should optimize your body weight so that the joints do not bear large loads which would cause them to wear more quickly. Joints in a person with OA should be protected from rough use, particularly those involving sudden impacts. Canes or walkers may help protect the hip and knee and prevent limping. Physical therapy can help maintain joint ranges of motion, strength and stability. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) which are also effective in relieving pain.

Osteoarthritis Treatments

  • Removing joint spurs
  • Realigning the joint
  • Fusion of the joint
  • Joint replacement

In the past several years, these operations have become very effective, and many people have benefited from joint reconstruction or replacement.

Osteoporosis

Osteoporosis

Twenty-five million Americans have osteoporosis. Fifty thousand people die each year because of complications related to osteoporosis. Yet, most of us know little about protecting ourselves from this disease.

What is Osteoporosis?

Osteoporosis is a disorder of the bones characterized by decreased bone mass (generalized thinning of the bones), which also decreases bone strength. Because weakened bones are more fragile and more likely to break, people with osteoporosis are at increased risk of fractures, especially fragility fractures (broken bones that happen with little or no trauma). It is not a form of arthritis, although it may cause fractures that, in turn, lead to arthritis.

In the United States, osteoporosis causes more than 1.3 million fractures annually and is much more common in women than in men. The most common first fracture is a wrist fracture, which typically occurs at age 50 to 70 in women. Hip fractures and fractures of the spine (compression fractures) may also occur and are most common in patients who are in their 70s. Particularly when it leads to hip fracture, osteoporosis can cause a great deal of suffering, including an increased risk of institutionalization or death.

Most people with osteoporosis have no symptoms and are totally unaware that they have the problem. One early sign can be a loss of height caused by curvature of the spine (Dowager's hump), which is caused by weakened vertebrae (spine bones). The weakened vertebrae undergo compression fractures — tiny breaks that cause the spine bones to collapse vertically. When this happens, the height of the vertebrae is decreased, and the shape of each single vertebra goes from a normal rectangle to a more triangular form. Although the loss of height caused by compression fractures can sometimes be associated with back pain or aching, more typically it is asymptomatic (causes no symptoms).

When taking your history, your doctor will look for factors that increase your risk of osteoporosis. 

Osteoporosis Risk Factors

  • Being female
  • Being age 40 or older
  • Being a postmenopausal woman who does not take estrogen replacement medication
  • Having a diet low in calcium or an intestinal problem that impairs absorption
  • Having an overactive thyroid
  • Leading a sedentary lifestyle, with little or no routine exercise
  • Being thin
  • Taking certain medications, such as prednisone
  • Having a certain ethnic background (white people and those of Asian descent are more at risk of osteoporosis than are African-Americans)
  • Smoking
  • Using alcohol to excess
  • Having a family history of osteoporosis
  • Having a history of at least one fragility fracture

The diagnosis of osteoporosis should be strongly suspected in any person who has a fragility fracture. It can also be established by a bone density test, or bone densitometry. There are several techniques available to measure bone density. The most complete and accurate method is DEXA (dual- energy X-ray absorptiometry), which is the best for both diagnosing osteoporosis and assessing response to treatment. DEXA is a quick (10 to 15 minutes) and painless test that uses minute amounts of radiation (less than dental X-rays) and is generally done on the spine and hip. DEXA is available at MedStar Orthopaedic Institute.

Bone densitometry can diagnose osteoporosis when the condition is asymptomatic and mild and can help lead to treatment that will prevent the condition from getting worse. In people with loss of height or suspicious fractures, bone density tests not only confirm the diagnosis of osteoporosis, they also serve as a baseline for treatment and can be used to follow the response to therapy.

Ask your physician or therapist atMedStar Orthopaedic Institute if you are at risk for osteoporosis and if bone densitometry may be indicated.

Knee Conditions

MedStar Health knee specialists offer sophisticated pain management to limit pain caused by surgery, as well as the most advanced physical therapy treatment to build back your strength and range of motion. No matter how simple or complex your knee condition, the experienced orthopaedic knee surgeons at MedStar Health will offer you a successful solution.

Arthritis of the Knee

Arthritis is an inflammation of the tissues that cushion the joints where your bones meet. This inflammation can cause pain, swelling, and joint damage. Your knee joints are especially vulnerable to arthritis, which includes

  • Osteoarthritis: The natural aging process can wear away at the cartilage between the bones at joints, causing inflammation and pain. It commonly affects knees.
    • Post-traumatic arthritis: This form of osteoarthritis develops after you experience an injury to the knee. It can develop years after your injury occurs.
  • Rheumatoid arthritis: This immune system dysfunction attacks and wears away at the cartilage lining between the bones in your joints. You generally experience rheumatoid arthritis on both sides of your body, so it would affect both knees.

Advanced arthritis in the knee can make it difficult to walk and perform many other basic daily activities. Knee replacement surgery can provide relief from arthritis symptoms, and the expert orthopaedic knee replacement surgeons at MedStar Health offer a wide range of advanced treatment and surgical options for all types of advanced knee arthritis.

Knee arthritis symptoms generally include:

  • Stiffness and swelling in knee area
  • Difficulty moving the knee
  • Knee feels weak and painful
  • Knee feels unstable, as if it might give way
  • Difficulty walking

Sports Medicine

Sports Medicine

Sports Medicine

Whether you are a beginner, recreational athlete or an elite professional, you can be sure to benefit from the fully integrated approach to recovery and maintenance of health and wellbeing offered by the MedStar Health sports medicine orthopaedic specialists. Our teams of medical specialists—including physicians, sports physical therapists, occupational therapists, and athletic trainers—are dedicated to helping you reach or return to your desired level of activity, as quickly and safely as possible.

What separates MedStar Health from other medical facilities is our unique understanding of athletes and other physically active individuals and the injuries they suffer. We appreciate the sense of urgency and the high level of expectations our patients bring to treatment.

Focus on Total Performance

We know that to manage injuries appropriately, we need to look at why they occurred. So, in addition to traditional evaluation measures, our assessment includes careful review of training techniques, inspection of equipment, and/or biomechanical activity analysis.

At MedStar Health, our goal is not simply to treat your injury, but also to integrate the injured joint or muscle into the total performance of the body. We emphasize early intervention, learning techniques to avoid complications, and maintaining good physical conditioning even during injury convalescence.

Common Injuries

A number of injuries are common in the sports arena, and, depending on the sport you play and how often you participate, often require specific treatments. The list of possible injuries is almost as long as the list of activities in which you can participate, but a number of injuries occur fairly frequently in all sports.
Sprains and Strains

A sprain occurs when a ligament is stretched or torn, while a strain occurs when a muscle or tendon is injured. Most sprains and strains respond well to conservative therapy, which includes R.I.C.E. and rehabilitation.

  • R.I.C.E. therapy is best applied in the 48 hours after an injury and includes:
    • Rest and reduction in activities
    • Ice applied for 20 minutes at a time, four to eight times a day
    • Compression, such as with elastic bandages
    • Elevation above the level of the heart to decrease swelling. (Over-the-counter drugs, such as acetaminophen or ibuprofen, can help decrease pain and inflammation.)
  • Rehabilitation varies according to the injury, but may include special exercises and a gradual increase of activity until healing is complete. Some sprains or strains may be severe enough to require surgery to repair them.

Ligament Injuries

Ligaments are the tough, flexible tissues that connect two bones or cartilages or hold together a joint. The knee has four main ligaments: the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments. When the knee is suddenly twisted or directly impact, these ligaments can be injured.

  • Cruciate ligament injuries may respond to conservative treatment; however, most require surgery. The sports medicine surgeons at MedStar Health have significant experience and expertise in a number of surgical options and will discuss the best treatment choices with you.
  • Collateral ligament injuries are more likely to respond to nonsurgical treatments; however, severe injuries or ones that also involve the cruciate ligaments usually require surgery.

Anterior Cruciate Ligament (ACL) Injuries

The most commonly injured of the ligaments is the ACL, and not just by athletes—over 250,000 ACL injuries occur annually within the general population. Tears in the ACL generally result in ACL surgery, extensive physical therapy, significant time away from recreational activities, and a likelihood of arthritis within 10 years.

ACL Injury Prevention

MedStar Health has developed a comprehensive program to reduce injury risk that involves proper dynamic warm ups, a targeted strengthening program, and a progressive plyometric program. Our mission is to help educate and train as many teams, coaches and parents as possible to help minimize the risk of an athlete suffering this common injury.

ACL Treatment

To initially manage ACL injuries, MedStar Health specialists focus on obtaining a full range of motion of the knee and allowing the swelling to subside. Once these have been achieved, both conservative and ACL surgery treatment options can be exercised.

  • Conservative treatment involves muscular strengthening and often bracing to help stabilize the knee. It is optimal for those who are older or less active, and those who do not plan to return to athletic or vigorous activity.
  • Surgical reconstruction offers a better alternative in preventing recurrent instability and allowing for return to function.

Meniscus Injuries

The knee meniscus is a piece of cartilage that serves as a shock absorber between the ends of the leg bones, helps lubricate the joint, and distributes body weight across the joint. Meniscal tears are typically caused by twisting or hyperflexing the joint. These tears can also occur due to degenerative processes caused by aging. Occasionally, these tears may occur simultaneously with injury to the ACL. When the ACL is injured, these tears can result in pain, swelling, and often clicking or catching within the knee.
Minor tears may be treated with therapy and strengthening exercises. More extensive tears often require surgery to reattach the meniscus, replace it with donor cartilage or remove it. Most procedures can be performed using the minimally invasive arthroscopy techniques that allow shorter hospital stays and decreased recovery times. More information about meniscal surgery is available here.

Achilles Tendon Rupture

The Achilles tendon, which joins the muscles of the lower leg, is the largest tendon in the body. A ruptured Achilles is a serious injury that typically requires surgery. MedStar Health surgeons now expertly perform this surgery with minimal incisions, ensuring less pain, faster healing, and excellent long-term results.

Torn Rotator Cuffs

The rotator cuff comprises the muscles and tendons that hold the upper arm bone it its joint. A torn rotator cuff may respond to non-surgical therapies, but often will require surgery. Arthroscopy often is used to repair small injuries, and minimal incision surgery is now an option to repair complete tears. 

Concussion

A concussion is a type of brain injury caused by a bump, blow, or jolt to the head that can change the way the brain normally functions. Concussions can occur in any athletic activity, as well as from motor vehicle crashes or falls. MedStar Health orthopaedic and sports medicine specialists with expertise in concussion management urge you to have all suspected concussions evaluated—the primary risks of not receiving a medical evaluation may include:

  • Increased risk for severe brain injury or even death
  • Prolonged symptoms
  • Difficulties with schoolwork and other activities

Signs and symptoms of a concussion include

  • Appears dazed or stunned
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Exhibits moody behavior or personality changes
  • Can't recall events prior to hit or fall
  • Headache or pressure in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light or noise
  • Feeling sluggish or foggy
  • Concentration or memory problems
  • Does not feel “right” or is feeling “down”

Consistent with the Maryland and Washington, D.C., athletic concussion prevention laws, athletes suspected of suffering a concussion should remove themselves or be removed from the game or practice immediately, regardless of how mild it seems or how quickly symptoms clear. Continuing to play without medical clearance leaves athletes vulnerable to a more severe brain injury or, rarely, death.

Be aware that symptoms and signs of concussion may not appear immediately after the injury and can take hours or days to fully appear. Because athletes may not report their concussion symptoms, coaches, teammates, and parents need to be educated to recognize them and seek appropriate assistance.

If a concussion is suspected, seek medical attention right away and call a MedStar Sports Medicine athletic trainer at 888.44SPORT (888.447.7678). Athletic trainers are available for free phone consultations 24 hours a day, seven days a week. 

Shoulder Conditions

shoulder conditions

MedStar Health has a team of orthopaedic specialists dedicated to helping you regain the functionality of your shoulder and perform a full range of motion. Whether acute (from an injury) or chronic (due to long-term overuse), shoulder pain can be very debilitating. Many conditions affecting the shoulder can be treated non-surgically; however, shoulder surgery is an excellent option for those who have experienced a serious problem and need to regain mobility. MedStar Health shoulder specialists use a variety of treatment methods for shoulder pain, including surgical and nonsurgical options, and are available across the central Maryland and Washington D.C. regions. If you are experiencing shoulder pain that lasts longer than a few weeks or is severe, contact MedStar Health to meet with orthopaedic specialist. 

Conditions Related to Shoulder Pain

The shoulder is a complex joint built to allow movement in many directions: forward, backward, around in a circle, and away from the body. Muscles and ligaments help keep the shoulder stable and secure in your shoulder socket. We depend on our shoulders to support many of our most basic motions, including pushing, pulling, lifting, and throwing. Because the shoulder is a very flexible joint, it is highly vulnerable to injury. Whether you’re a competitive athlete or an active elder suffering from years of repetitive motion, our shoulder specialists are here to treat a wide variety of shoulder conditions.

Arthritis

Arthritis, which is loss of the normal cartilage, or smooth surfaces that line your shoulder joint, makes moving your shoulder and arm painful. In addition to pain, arthritis inflammation can cause swelling and joint damage. Types of shoulder arthritis include:

  • Osteoarthritis: The natural aging process can wear away at the cartilage between the bones at your shoulder joints, causing inflammation and shoulder pain.
  • Rheumatoid arthritis: This immune system dysfunction attacks and wears away the cartilage lining between the bones in your shoulder joint. The disease often affects multiple joints in your body.
  • Post-traumatic arthritis: This form of arthritis results from an injury or fracture to the shoulder.

Shoulder arthritis symptoms generally include:

  • Shoulder pain
  • Swelling
  • Redness or heat in the area
  • Trouble raising your arm
  • Clicking sound when you raise your arm

Treatment

Treatment for shoulder arthritis usually depends on what specific type of arthritis you have, and how severe the shoulder pain is. Nonsurgical options may include:

  • Resting your arm and avoiding painful activities
  • Over-the-counter or prescription anti-inflammatory medications
  • Applying heat or ice to the shoulder
  • Steroid injections
  • Physical therapy, including exercises designed to restore strength and range of motion in your arm and shoulder

Surgery

The orthopaedic surgeons at MedStar are experienced in the most advanced and innovative surgical procedures for shoulder arthritis treatment, including:

  • Total shoulder replacement surgery:
  • Reverse total shoulder replacement surgery

 

Frozen Shoulder

Frozen shoulder occurs when the capsule of connective tissue that surrounds the shoulder thickens and contracts, leading to stiffness and shoulder pain from restricted movement.

Causes

The condition generally affects adults ages 40 to 60 and can be caused by diseases such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s, or cardiac disease. It can also result from immobilizing the shoulder too long after an injury, which is why a vital part of any shoulder recovery is physical therapy.

Treatment

Physicians typically treat this condition with anti-inflammatory medication and physical therapy, which is successful in 90 percent of cases. For those who don't experience relief for two to three years, surgical options will be explored.

 

Rotator Cuff Conditions

Three bones form the shoulder joint: the collarbone, the upper arm bone, and the shoulder blade. Together, these bones give the shoulder its wide range of motion.  Attached to the shoulder is a group of muscles known collectively as the rotator cuff. These keep your arm in place while allowing it to move up and around. Rotator cuff disorders include:

Tendonitis and bursitis

Tendonitis and bursitis, both inflammatory conditions, are the most common causes of shoulder pain and stiffness. They can result from repetitive motion, such as in sports, or from a serious, sudden injury. The conditions are most common in adults older than 40, as the tendons have aged and are more susceptible to injury.

  • Tendonitis occurs when tendons in the rotator cuff become inflamed or irritated, causing shoulder pain.
  • Bursitis occurs when the fluid-filled sac that protects the space between tendons and bones becomes inflamed or irritated.

Treatment

Treatment goals include reducing pain and inflammation. Rest, hot/cold compression and splinting usually are recommended. If those treatments are not successful, a physician may provide corticosteroid injections, recommend physical therapy, and in the most severe cases, perform surgery.

Rotator Cuff Tear

Rotator cuff tears are a common cause of shoulder pain and disability in adults and can seriously inhibit many daily activities, like combing your hair or getting dressed. This type of injury typically results from a wearing down of the tendon, which occurs slowly over time, but it can also be caused by a sudden trauma.

Symptoms

Some common symptoms of rotator cuff tears include:

  • Arm and shoulder pain
  • Weakness and tenderness in the shoulder
  • Limited range of motion and pain, especially when raising and lowering your arm
  • Snapping or cracking sensation when moving the shoulder
  • Inability to rest or sleep on the affected shoulder due to pain

Treatment

Treatment for rotator cuff tears is usually very conservative: rest, sometimes in a sling, hot/cold application, and anti-inflammatory medications are recommended. In the most severe cases, surgery is necessary. Surgeons may perform an arthroscopic surgery or an open surgical repair.

 

Dislocations

Because the shoulder joint is so mobile, it can be very easy to dislocate the bone from the socket. The top of the upper arm bone (humerus) can partially or completely come out of the socket (glenoid).

  • Partial: The bone moved partially out of the shoulder joint socket and returned on its own.
  • Total: The bone moved completely out of the shoulder joint socket and had to be returned to its proper position by and outside force.

Causes and Symptoms

Shoulder dislocations can occur from falls, car accidents, or strong contact during sports. Those with a dislocated shoulder can experience swelling, numbness, weakness, bruising, pain, instability, and even muscle spasms.

Treatment 

To treat a dislocated shoulder, a physician uses a process called closed reduction that places the upper arm back into the socket. Pain relief is almost immediate. Physicians typically recommend that, after treatment, the shoulder be immobilized in a sling or other device for a few weeks. 

 

Fractures

Fractures are broken bones and those that affect the shoulder typically involve the

  • Clavicle (collar bone)
  • Proximal humerus (upper arm bone)
    • Fractures of the clavicle or the proximal humerus often result from the force of a hard fall, collision, or motor vehicle accident.
  • Scapula (shoulder blade)
    • The scapula is not as easily fractured because of the protection afforded by the chest and surrounding muscles. Therefore, scapula fractures are commonly the result of more severe traumas and are associated with injuries to the chest.

Shoulder fractures may affect anyone but can be common in older adults when linked to osteoporosis. Children are more likely to fracture the clavicle, while adults fracture the proximal humerus more frequently. Some common symptoms of shoulder fractures include:

  • Shoulder pain
  • Swelling and bruising of the shoulder area
  • Inability to move the shoulder without pain
  • A bump or disfigurement at the site of the fracture
  • Snapping or cracking sensation when moving the shoulder

Treatment

Most shoulder fractures can be treated by setting the joint into place and using a sling or strap to immobilize it. After a period of healing, rehabilitation exercises are recommended to promote shoulder strength and motion. More severe cases, in which fracture fragments have been displaced from their normal position, surgery may be necessary to realign the shoulder.

 

Shoulder Instability

Shoulder instability develops when your muscles and ligaments are not strong enough to hold the shoulder bones securely in the socket. This can lead to multiple painful shoulder dislocations or prevent you from using the shoulder or lifting your arm. Shoulder instability can develop as a result of:

  • Previous shoulder dislocations: The more often you experience shoulder dislocations, the less stable your shoulder becomes.
  • Loose ligaments: Ligaments are the tissues that bind bones together. Shoulder ligaments can either be naturally loose or become loose over time, especially if you repeatedly bring your arm up over your head, as in swimming or tennis.

Treatment

Most cases of shoulder instability respond well to conservative treatment involving intensive rehabilitation exercises and physical therapy to strengthen the muscles and help hold the shoulder in place. In cases where nonsurgical methods are unsuccessful, surgical options—such as coracoids transfer for shoulder instability—will be explored.

 

Shoulder Separation

Shoulder separation often is confused with shoulder dislocation, but the two are very different injuries. Shoulder separation occurs when the connection between the shoulder blade and collarbone is disrupted. Typically, this injury occurs after a fall onto the shoulder (common in sports).

Symptoms

Symptoms depend on the severity of the separation, but most always include severe shoulder pain, swelling, bruising, and, sometimes, deformity.

Treatment

Treatment also depends upon the severity of the injury. Physicians categorize shoulder separation into six levels. Depending upon the severity level of the separation, treatment can range from rest, ice, and a sling to surgical procedures.

Hip Conditions

hip conditions

At MedStar Orthopaedic Institute, we offer the most advanced care and treatment for all hip conditions, including osteoarthritis and rheumatoid arthritis. One of our top priorities is to educate you on the details of your hip condition, addressing all questions and concerns you have. We promise to advise you and your family on a treatment plan that includes the most effective approaches and a variety of procedures that benefit you with faster recovery times, better pain management, and more precise surgery, if necessary.

Arthritis of the Hip

Arthritis is an inflammation of the tissues that cushion the joints where your bones meet. This inflammation can cause pain, swelling, and joint damage. Your hip joints are especially vulnerable to arthritis, which includes

Osteoarthritis

  • The natural aging process can wear away at the cartilage between the bones at joints, causing inflammation and pain. It commonly affects hips.
    • Post-traumatic arthritis: This form of osteoarthritis develops after you experience an injury to the hip. It can develop years after your injury occurs.

Rheumatoid arthritis

  • This immune system dysfunction attacks and wears away at the cartilage lining between the bones in your joints. You generally experience rheumatoid arthritis on both sides of your body, so it would affect both hips.

Advanced osteoarthritis or rheumatoid arthritis in the hip can make it difficult to walk and perform many other basic daily activities. Hip replacement surgery can provide relief from arthritis symptoms, and the expert orthopaedic hip replacement surgeons at MedStar Health offer a wide range of advanced treatment and surgical options for all types of advanced hip arthritis.

Hip arthritis symptoms generally include:

  • Stiffness in the hip area, including the thighs and groin
  • Pain in the hip area
  • Difficulty moving the hip in different directions
  • Difficulty walking

Hip Pain

Hip pain is common in active individuals and athletes.   The hip joint is prone to injury in both repetitive motion and high impact activities.  

The surgeons of MedStar Orthopaedic Institute,who specialize in the treatment of hip pain, have a comprehensive and precise understanding of the causes of hip pain.  While there are many causes, hip impingement is becoming an increasingly recognized problem in the athletic and highly active populations.  The good news is that there are new and improved methods of treatment.

Hip Impingement

 MedStar Orthopaedic Institute’s surgeons commonly diagnose hip impingement, also known as femoral acetabular impingement or FAI,  in young, active individuals who are performing repetitive hip movements. However, it is an overuse injury and can be present at all ages and activity levels. 

 This condition is caused by abnormal contact between the ball of the femur and the socket.   The abnormal contact can be a result of excessive bone around the socket, the femur, or a combination of both.

The excess bone creates a joint that is no longer spherical. This abnormal shape can cause injury to the cartilage as well as the labral soft tissue (cartilage).   The damage caused may lead to increased pain and arthritis in the hip joint or hip labrum if left untreated.

Common Symptoms:  

  • Pain in the groin with activity
  • Discomfort in the hip with sitting or standing
  • Catching or locking with hip motion
  • Decreased range of motion and discomfort with hip flexion and rotation

Diagnosis 

A diagnosis of hip impingement is based on a person’s symptoms and a thorough examination of his or her hips, spine, and lower extremities.  An X-ray will be taken, and possibly a CAT or MRI scan.

Treatment 

Your doctor will probably want to begin your treatment conservatively before considering surgery.

  1. Nonsurgical: If we determine that you have impingement that is due to an overuse injury, we will recommend rest and a modified exercise routine to reduce your pain.

Our specialists may recommend physical therapy to correct alignment abnormalities and strengthen the muscles around the hip.  Steroid injections directly into the hip joint may decrease the inflammation and provide temporary, symptomatic relief.

  1. Surgical: Surgery is recommended when impingement symptoms do not improve. In the past, hip impingement treatment required a large incision around the hip, dislocation of the hip joint, and contouring and repairing of the bone and labrum.  This required hospital admission and a lengthy recovery.   With recent advances in surgical technique, surgeons from MedStar Orthopaedic Institute can now treat it arthroscopically. 

Minimally invasive hip arthroscopy is performed through several very small incisions, rather than a large incision.  The hip scope procedure is performed under general anesthesia, and a patient typically goes home the same day.

Elbow Conditions

At MedStar Health, we understand how vital it is for you to have healthy elbows—they serve a wide variety of functions and are necessary for achieving our most basic needs and performing our most complex movements. Any elbow injury has the potential to significantly affect your quality of life.

From repairing traumatic injuries to treating repetitive motion injuries like tennis elbow, arthritis, or congenital conditions, MedStar Health orthopaedic specialists have the training and the experience necessary to restore your elbow function and minimize your pain. Our goal is to help you return to your regular activities healthy and pain-free.

Rehabilitation Therapies

At MedStar Health, our specialists work with each patient to establish a treatment plan—including the techniques used in supervised and independent therapy sessions—based on their individual situation and needs.

Additionally, our therapists teach and guide each patient to maximize the use of the dysfunctional extremity while preventing re-injury or worsening of condition. Therapists may educate the patient on the disease process, the healing process, and rationale for the prescribed therapy techniques.

An assortment of services are offered, including

  • Management of acute or chronic pain
  • Protective splinting for immobilization and controlled motion post-operatively or post-injury
  • Exercise programs to restore motion, strength, and fine and gross motor coordination
  • Home exercise programs
  • Sensory re-education programs after nerve injury
  • Thermal and electrical modalities to minimize pain and swelling, facilitate restoration of joint motion and tendon gliding, and decrease hypersensitivity
  • Whirlpools to assist with wound healing
  • Social work consultations

We treat the following elbow conditions:

  • Cubital Tunnel Syndrome
  • Ulnar Nerve Compression
  • Arthritis
  • Dislocations
  • Reflex Sympathetic Dystrophy
  • Tendinitis and Tennis Elbow

We also offer

  • Rehabilitation Therapies

Cubital Tunnel Syndrome

The cubital tunnel is a narrow tube of tissue at your elbow that contains the ulnar nerve. The ulnar nerve runs from your shoulder down to your wrist and controls movement in your ring and pinky fingers. Cubital Tunnel Syndrome is a type of nerve entrapment that forms when this tunnel swells, putting pressure on the ulnar nerve, causing pain and numbness in the hand and fingers.

Cubital tunnel syndrome can cause the following symptoms:

  • Tingling in the ring and pinky fingers, making it more difficult to use them
  • Numbness in the ring and pinky fingers
  • Weakness in the hands


The cubital tunnel is more likely to swell if

  • You sleep or lean on your elbow for too long
  • You bend the elbow back and forth repeatedly
  • Fluid builds up in the elbow
  • You hit or fall on the elbow with force


Other conditions that can contribute to the development of cubital tunnel syndrome include elbow arthritis, fractures, cysts, and bone spurs.

Treatment

Treatment for cubital tunnel syndrome depends on how severely your nerve is compressed and whether you are beginning to develop muscle weakness. Nonsurgical treatment options may include

  • Braces
  • Splints
  • Injections of steroids or anti-inflammatory medications
  • Physical therapy

If nonsurgical treatment does not relieve your symptoms, or your muscles are weakening too much, you may need surgery. Surgical options can relieve symptoms by:

  • Widening the cubital tunnel to release the pressure on your nerve
  • Moving the nerve so it is more protected from injury


 Learn more about MedStar Health’s approach to minimally invasive nerve surgery.

Ulnar Nerve Compression

The ulnar nerve is what people commonly call the funny bone. It fits in a groove in the bottom of the elbow and is very vulnerable to stress, trauma, or overuse. Ulnar nerve compression can cause a lack of sensation, muscular weakness, and shooting pain from the elbow down to the pinkie and ring finger. Numbness and tingling in ring and pinkie fingers are the most common symptoms.

Treatment

Nonsurgical treatments such as splints, oral anti-inflammatory medications, and adjustments in daily activities are typically pursued as the initial course of action. If the swelling around the nerve does not respond to nonsurgical treatments, surgery may be recommended.

Arthritis

Arthritis is an inflammation of the tissues that line your joints. This inflammation can cause pain, swelling, and joint damage. Types of arthritis that most often affect your elbow include:

  • Osteoarthritis: The natural aging process can wear away at the protective cartilage that allows the many bones in your elbow to move smoothly, causing inflammation, swelling, and pain.
  • Rheumatoid arthritis: This immune system dysfunction attacks and wears away at the cartilage lining between the bones in your elbow. Rheumatoid arthritis generally affects the joints on both hands and is less likely to affect your elbow.

Elbow arthritis symptoms generally include:

  • Pain
  • Limited ability to move elbow
  • Swelling
  • Numbness or tingling in ring and pinky fingers

Along with the symptoms above, rheumatoid arthritis can also cause:

  • A weak grip
  • Difficulty using the hand
  • Pain in the knuckles
  • Fatigue
  • Weight loss
  • Fever

The surgeons at MedStar Health have the expertise to help you overcome any challenge your arthritis presents. We treat the entire spectrum of arthritis disorders—from early-stage management to end-stage joint replacement—and offer advanced arthritis treatment options, including the latest arthroscopic and minimally invasive surgical techniques.  We will work with you to develop a treatment plan tailored to your individual needs and the demands of your daily life.

Dislocations

An elbow dislocation occurs when any of the elbow bones are moved out of place. Falling with force onto your hand can push elbow bones out of place; this is the most common cause of cause an elbow dislocation. In some cases, elbow bones may fall back into place on their own, but still cause some pain or bruising.

Dislocating any of the bones of the elbow can cause the following symptoms:

  • Pain and swelling
  • Bruises
  • Inability to bend or move the elbow
  • Lack of feeling in the fingers
  • Arm looks obviously bent out of shape

To treat an elbow dislocation, our specialists will immediately perform a reduction maneuver.

In some cases, elbow dislocations require surgery. If your injury caused your bones to shift out of place or break through the skin, you may need surgery to restore the proper alignment and avoid infection. If your injury crushed portions of your bone, your surgeon may need to replace the lost bone with bone filler, which is human or artificial bone replacement material.

Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD) is a condition of chronic, burning pain; stiffness; swelling; sweating; and discoloration of the hand or arm that may become disabling. It occurs from over-activity in the sympathetic (unconscious) nervous system that controls the blood flow, sweat glands, and other involuntary bodily functions. Additionally, a patient with RSD who sustains an injury usually feels a greater amount of pain than a person without RSD who has sustained the same injury.

RSD has three stages:

  • Acute: May last up to three months. Symptoms include pain and swelling, increased warmth and redness in the affected part/limb, and excessive sweating.
  • Dystrophic: Can last three to 12 months. Swelling is more constant, skin wrinkles disappear, skin temperature becomes cooler, and fingernails become brittle. Pain is more widespread, stiffness increases, and the affected area becomes sensitive to touch.
  • Atrophic: Lasts one year or more. The skin of the affected area is now pale, dry, tightly stretched and shiny. The area is stiff, pain may decrease, and the chance of getting motion back is decreased.

Causes

In some cases, the cause of RSD is unknown. RSD may follow a sprain, fracture, injury to nerves or blood vessels, or the symptoms may appear after a surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack.

Treatment

The pain of RSD may be severe, resulting in physical and psychological alterations. A coordinated multidisciplinary approach to treatment is best, which may include medication (oral and injections), physical or occupational therapy, and/or surgery.

Tendinitis and Tennis Elbow

The tissues that attach your bones to your muscles are called tendons. When your muscles flex, tendons spring into action, helping to move your bones. It is easy to injure the tendons in the arms and hands, since we use them so often. Tendinitis is an inflammation of a tendon that causes pain near a joint. It generally develops when an accident or injury cuts or damages the tendon.

Tennis elbow is the common term for one of the most common types of tendinitis. It is an overuse injury that causes an inflammation of the tendon fibers that attach the forearm muscles to the outside of the elbow. As the name suggests, tennis players, as well as golfers and other athletes, often suffer from this type of tendinitis. But tennis elbow can also affect you if you twist your wrist repeatedly on a regular basis, or if you type on a computer keyboard without proper support.

Although tendinitis and tennis elbow can be painful, the good news is that it rarely becomes chronic if caught early and treated properly with the following

  • Rest
  • Ice
  • Cortisone injections
  • Ceasing or changing your activity
  • Elbow supports
  • Anti-inflammatory medicines

If surgery becomes necessary, arthroscopic procedures are minimally invasive, provide a relatively short recovery period, and can produce long-lasting results.

Hand Conditions

At MedStar Health, we understand how vital it is for you to have healthy hands—both serve a wide variety of functions and are necessary for achieving our most basic needs and performing our most complex movements. Any hand injury has the potential to significantly affect your quality of life.

From repairing traumatic injuries to treating repetitive motion injuries, arthritis, and congenital conditions, MedStar Health orthopaedic specialists have the training and the experience necessary to restore your hand and wrist function and minimize your pain. 

Hand Conditions

Whether your condition is simple or complex, the expert orthopaedic hand and elbow specialists at MedStar Health offer you effective and advanced options for diagnosis, treatment, and rehabilitation. Our goal is to help you return to your regular activities healthy and pain-free.

Hand conditions we treat include:

  • Hand Nerve Entrapment
    • Carpal Tunnel Syndrome
    • Cubital Tunnel Syndrome
  • Dupuytren's Contracture
  • DeQuervain’s Disease
  • Finger Conditions
  • Hand Cysts and Tumors
  • Arthritis
  • Thumb Arthritis
  • Fractures and Dislocations
  • Reflex Sympathetic Dystrophy
  • Tendon Conditions
  • Ulnar Nerve Compression

 

Hand Nerve Entrapment

When the protective covering surrounding the nerves in your hand, arm, or elbow tightens, and squeezes the nerve itself, a condition called hand nerve entrapment can result.

 

Carpal Tunnel Syndrome

The carpal tunnel is a space in the wrist where a nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome is a type of hand nerve entrapment that occurs when swelling in the tunnel compresses the median nerve. As a result of the pressure on the median nerve, patients with carpal tunnel syndrome may experience symptoms including:

  • Pain in the hand and fingers, including burning, tingling, and numbness
  • Pain in the wrist or hand, extending to the elbow
  • Sensation that the hand is swollen, even if it is not
  • Weakened grip and difficulty picking up small items
  • Problems with fine finger movements in one or both hands
  • Numbness in hands

This condition is common in people who perform repetitive wrist and hand motions, such as typing on a computer keyboard. It also affects those who grip tightly or uses their wrists consistently, such as cashiers, cyclists, meat cutters, and musicians.

Treatment

Many nonsurgical courses of treatment for carpal tunnel syndrome are available, such as

  • Splints or braces to immobilize and rest the wrist
  • Adjustments to how you perform daily activities
  • Oral anti-inflammatory medications
  • Steroid injections

If nonsurgical treatment is not successful or treatment is sought too late, surgery may be required. This surgery involves enlarging the carpal tunnel, which will relieve the swelling and pressure on the nerve.

 

Cubital Tunnel Syndrome

The cubital tunnel is a narrow tube of tissue at your elbow that contains the ulnar nerve. The ulnar nerve runs from your shoulder down to your wrist and controls movement in your ring and pinky fingers. Cubital Tunnel Syndrome is a type of hand nerve entrapment that forms when this tunnel swells, putting pressure on the ulnar nerve, causing pain and numbness in the hand and fingers.

Cubital tunnel syndrome can cause the following symptoms:

  • Tingling in the ring and pinky fingers, making it more difficult to use them
  • Numbness in the ring and pinky fingers
  • Weakness in the hands

The cubital tunnel is more likely to swell if

  • You sleep or lean on your elbow for too long
  • You bend the elbow back and forth repeatedly
  • Fluid builds up in the elbow
  • You hit or fall on the elbow with force

Other conditions that can contribute to the development of cubital tunnel syndrome include elbow arthritis, fractures, cysts, and bone spurs.

Treatment

Treatment for cubital tunnel syndrome depends on how severely your nerve is compressed and whether you are beginning to develop muscle weakness. Nonsurgical treatment options may include

  • Braces
  • Splints
  • Injections of steroids or anti-inflammatory medications
  • Physical therapy

If nonsurgical treatment does not relieve your symptoms, or your muscles are weakening too much, you may need surgery. Surgical options can relieve symptoms by:

  • Widening the cubital tunnel to release the pressure on your nerve
  • Moving the nerve so it is more protected from injury

Learn more about MedStar Health’s approach to minimally invasive nerve surgery.

 

Dupuytren’s Contracture

Dupuytren's contracture is an abnormal thickening of the tissue between the skin and the tendons in the palm, which may limit the use of one or more fingers or may eventually cause the fingers to be pulled in toward the palm in a bent position.

The first sign of the condition is usually a small lump or nodule in the palm, often occurring in the crease of the hand that is closest to the base of the ring and little fingers. Further indication is that at a certain point, the palm cannot be placed flush with a flat surface such as a table. As the disease progresses, the involved finger is drawn toward the palm by the band of fibrous tissue that forms there.

Dupuytren's contracture is a hereditary condition and the cause is not known.  It is more common in men over the age of 50. The disease appears later in women.

Treatment

Treatment is most effective when sought at the nodule (small lump) stage. Collagenase injections are available as a nonsurgical option. Surgery will only temporarily restore use to the fingers. With time, the condition will return. You doctor will discuss with you your individual case and whether surgery is a viable option for you.

 

DeQuervain's Disease

DeQuervain's disease is an irritation and swelling of the sheath or tunnel that surrounds the thumb tendons as they pass from the wrist to the thumb. The source of DeQuervain's disease is often unknown, but it may be caused by overuse and repetitive motions and has been associated with pregnancy and certain inflammatory conditions such as rheumatoid arthritis. Although anyone can get DeQuervain's, it affects women considerably more often than men.

Symptoms may include

  • Twinges of pain at the base of the thumb or the thumb side of the wrist.
  • Pain that appears gradually or suddenly, and it is felt in the wrist and can travel up the forearm.
  • Pain that is usually worse with use of the hand and thumb, especially when forcefully grasping things or lifting items such as a gallon of milk.

Treatment

In almost all cases, nonsurgical treatments are explored first. Splints, oral anti-inflammatory medications or injections may help reduce the irritation and swelling. Temporary avoidance of activities that cause pain may also ward off symptoms.

For those cases that do not respond to nonsurgical treatments, surgery may be recommended. The procedure enlarges the tendon compartment to make more room for the irritated tendon. Normal use of the hand can be resumed once comfort and strength return.

 

Finger Conditions

Mallet finger is a rupture of the tendon at the tip of the finger, which causes the tip of the finger to drop or bend downward, creating a mallet shape. It is usually not painful unless a piece of bone is broken as well. Mallet finger can be caused by a direct blow to the finger and commonly affects athletes.

Nail bed injuries often occur when fingers are crushed, causing the bone beneath the nail to fracture, a cut to the nail bed itself, or, simply, a tremendous bruise. These injuries tend to cause hematomas, blood pooled under the nail that appears black or blue.  The pressure of the blood can be very painful and, in some cases, permanent deformity can result. The pain can be reduced by having the blood drained by a physician.

Skier's and goalkeeper's thumb, the most common of all ligament tears, is a tear of the ligament at the base of the thumb where it meets the palm. Skier's/goal keeper's thumb is usually caused by falling on an outstretched hand and thumb. Nonsurgical treatment involves splinting and casting, but surgery may be required to repair the tear.

Trigger finger is the common name for a condition that leads to swelling in the tendons that control finger bending. Such swelling prevents the tendons from gliding smoothly, which causes pain, popping, or a catching feeling. Whenever possible, nonsurgical treatment are attempted first. Splints, oral anti-inflammatory medications, steroid injections, and adjustments in daily activities may be successful in reducing the swelling around the tendon. If the finger does not respond to nonsurgical treatments, surgery may be recommended.

 

Hand Cysts and Tumors

A tumor is any kind of unusual group of cells that grows in your body. We often associate tumors with cancer, but most hand tumors are not cancerous.

A ganglion cyst is the most common hand tumor and generally grows either on the top or inner side of your wrist. These fluid-filled pouches can put pressure on your nerves, causing pain.

Symptoms

  • The earliest indicator you will see is the lump (ganglion cyst) itself. The lumps are typically very painful but they can sometimes be painless.
  • Pain and tenderness will increase with extended use of the hand, and range of motion may be restricted.
  • Ganglions often change in size and may disappear spontaneously and completely.

A giant cell tumor of tendon sheath is another common hand tumor, but it is solid, rather than filled with fluid. It grows on the protective covering that surrounds the tendons in the fingers.

Treatment

Physicians generally seek to heal ganglion cysts without surgery. In some cases, ganglion cysts disappear on their own without any treatment. For cysts that do not resolve themselves, treatment options include:

  • Brace or splint: Wearing a brace or splint keeps the affected wrist from moving. Resting the wrist keeps the cyst from growing, and helps to relieve pain.
  • Aspiration: Your physician may drain the fluid within the cyst, helping it to heal and disappear.
  • Surgery: Surgery is recommended for giant cell tumors of tendon sheath and ganglion cysts that return even after aspiration. Minimally invasive hand surgery is employed to remove the cyst or tumor, as well as any affected surrounding joint tissue.

 

Arthritis

Arthritis is an inflammation of the tissues that line your joints. This inflammation can cause pain, swelling, and joint damage.

Hand and Wrist Arthritis

Types of arthritis that most often affect your hand and wrist include:

  • Osteoarthritis: The natural aging process can wear away at the protective cartilage that allows the many bones in your hand, wrist, and elbow to move smoothly, causing inflammation, swelling, and pain.
  • Rheumatoid arthritis: This immune system dysfunction attacks and wears away at the cartilage lining between the small delicate bones in your hand and wrist. Rheumatoid arthritis generally affects the joints on both hands.


Hand arthritis symptoms can include:

  • Pain or burning in the hand joints, especially in the morning and with heavy use
  • Swelling
  • Warmth due to inflammation
  • Nearby joints become unusually flexible to compensate for the affected joint
  • Feeling or hearing grinding of the joint inside the hand
  • Appearance of cysts on the fingers

Arthritis of the wrist generally causes symptoms including:

  • Pain
  • Swelling
  • Lack of strength
  • Difficulty moving the wrist


Along with the symptoms above, rheumatoid arthritis can also cause:

  • A weak grip
  • Difficulty using the hand
  • Pain in the knuckles
  • Fatigue
  • Weight loss
  • Fever


The surgeons at MedStar Health have the expertise to help you overcome any challenge your arthritis presents. We treat the entire spectrum of arthritis disorders—from early-stage management to end-stage joint replacement—and offer advanced arthritis treatment options, including the latest arthroscopic and minimally invasive surgical techniques.  We will work with you to develop a treatment plan tailored to your individual needs and the demands of your daily life.

Thumb Arthritis

Thumb arthritis, also called basal joint arthritis, is a type of osteoarthritis caused when cartilage wears away in the joint at the base of the thumb.  

People who work with their hands and perform repetitive gripping movements are more likely to develop the condition. Massage therapists, hairdressers, or others who work with tools or instruments have the greatest risk of developing the disease. Basal joint fractures or ligament injuries can also increase the likelihood of developing thumb arthritis.

Left untreated, thumb arthritis can cause severe pain and make it difficult to perform even simple tasks. The best way to minimize the damage of thumb arthritis and treat it successfully is to see your doctor when symptoms begin. The sooner you begin treatment, the more options you’ll have to manage the condition.

Symptoms often include

  • Pain felt at the base of your thumb when you grip or pinch something.
  • Pain when you apply pressure to the heel of your hand.
  • Stiffness in the morning that gets better during the day, but begins to ache in the evening.
  • Swelling and tenderness at the base of the thumb.
  • Aching in the joint after prolonged use.
  • A limited range of motion in the thumb, or loss of strength while gripping or pinching items
  • A bump on the joint or an enlarged, out-of-joint appearance

Treatment

In the early stages of thumb arthritis, a number of treatments can alleviate symptoms, including:

  • Oral or topical medications, such as acetaminophen, ibuprofen, prescription pain relievers, or pain-relieving gels
  • Icing the area for five to 15 minutes as needed throughout the day to relieve pain and swelling
  • Working with a hand therapist to strengthen supporting muscles and tendons and learning adaptive techniques to lessen the strain on the joint
  • Wearing a supportive splint or brace to limit thumb movement and allow the joint to heal


In many cases, your doctor will suggest a combination of treatments to control symptoms. When medications, self-care, and physical therapy aren’t successful, steroid injections can relieve pain and swelling for several months. Because steroid injections can’t be used indefinitely, they only offer a temporary solution.

When nonsurgical treatments are no longer effective, surgery can offer relief. Most often, surgeons use the ligament reconstruction and tendon interposition (LRTI) technique, which can restore thumb movement and eliminate pain. During this outpatient procedure, surgeons remove the arthritic joint and replace it with a graft from one of your tendons to stabilize the thumb. Because tendons are used, rather than a metal or plastic implant that can wear out, the surgery can provide a long-term solution.

 

Fractures

Generally, fractured hands, fingers, and wrists will heal without surgery and nonsurgical treatment often includes splints or casts and physical therapy.

If your injury caused your bones to shift out of place or break through the skin, you may need surgery to restore the proper alignment. During surgery, your orthopaedic surgeon may use wires, screws, or plates to secure your bones back to the correct position.

MedStar also offers advanced surgical options, including:

  • Advanced wrist arthroscopy
  • Complex fracture repair of the hand and wrist

 

Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD) is a condition of chronic, burning pain; stiffness; swelling; sweating; and discoloration of the hand or arm that may become disabling. It occurs from over-activity in the sympathetic (unconscious) nervous system that controls the blood flow, sweat glands, and other involuntary bodily functions. Additionally, a patient with RSD who sustains an injury usually feels a greater amount of pain than a person without RSD who has sustained the same injury.

RSD has three stages:

  • Acute: May last up to three months. Symptoms include pain and swelling, increased warmth and redness in the affected part/limb, and excessive sweating.
  • Dystrophic: Can last three to 12 months. Swelling is more constant, skin wrinkles disappear, skin temperature becomes cooler, and fingernails become brittle. Pain is more widespread, stiffness increases, and the affected area becomes sensitive to touch.
  • Atrophic: Lasts one year or more. The skin of the affected area is now pale, dry, tightly stretched and shiny. The area is stiff, pain may decrease, and the chance of getting motion back is decreased.

Causes

In some cases, the cause of RSD is unknown. RSD may follow a sprain, fracture, injury to nerves or blood vessels, or the symptoms may appear after a surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack.

Treatment

The pain of RSD may be severe, resulting in physical and psychological alterations. A coordinated multidisciplinary approach to treatment is best, which may include medication (oral and injections), physical or occupational therapy, and/or surgery.

 

Tendon Conditions

The tissues that attach your bones to your muscles are called tendons. When your muscles flex, tendons spring into action, helping to move your bones. It is easy to injure the tendons in the arms and hands, since we use them so often.

Tendinitis

Tendinitis is an inflammation of a tendon that causes pain near a joint. It generally develops when an accident or injury cuts or damages the tendon.

  • Tennis elbow is the common term for one of the most common types of tendinitis. It is an overuse injury that causes an inflammation of the tendon fibers that attach the forearm muscles to the outside of the elbow. As the name suggests, tennis players, as well as golf players and other athletes, often suffer from this type of tendinitis. But it can also affect you if you twist your wrist repeatedly on a regular basis, or if you type on a computer keyboard without proper support.

Although tendinitis can be painful, the good news is that it rarely becomes chronic if caught early and treated properly with the following

  • Rest
  • Ice
  • Cortisone injections
  • Ceasing or changing your activity
  • Wrist splints

If surgery becomes necessary, arthroscopic procedures are minimally invasive, provide a relatively short recovery period, and can produce long-lasting results.

Tendon Flexor Injuries

The muscles located in the hand and forearm that control the bending or flexing of the fingers are called flexor muscles. The tendons of the flexor muscles that lead to the fingers and the thumb begin just beyond the middle of the forearm.

Deep cuts on the palm side of the wrist, hand, or fingers can cause tendon flexor injuries. With partial cuts, fingers may still bend, but the motion will be painful and the tendon may eventually rupture. When both tendons are cut completely through, the finger joints cannot bend on their own at all.

It is more than likely that your doctor will recommend surgery to repair your cut tendon. Following surgery, and depending on the type of cut, the injured area will either be protected from movement or started on a very specific limited motion program for several weeks.

Trigger Finger

Trigger finger is the common name for a condition that leads to swelling in the tendons that control finger bending. Such swelling prevents the tendons from gliding smoothly, which causes pain, popping, or a catching feeling.

Whenever possible, nonsurgical treatment are attempted first. Splints, oral anti-inflammatory medications, steroid injections, and adjustments in daily activities may be successful in reducing the swelling around the tendon. If the finger does not respond to nonsurgical treatments, surgery may be recommended.

 

Ulnar Nerve Compression

The ulnar nerve is what people commonly call the funny bone. It fits in a groove in the bottom of the elbow and is very vulnerable to stress, trauma, or overuse. Ulnar nerve compression can cause a lack of sensation, muscular weakness, and shooting pain from the elbow down to the pinkie and ring finger. Numbness and tingling in ring and pinkie fingers are the most common symptoms.

Treatment

Nonsurgical treatments such as splints, oral anti-inflammatory medications, and adjustments in daily activities are typically pursued as the initial course of action. If the swelling around the nerve does not respond to nonsurgical treatments, surgery may be recommended.