Typical Orthopaedic Diagnoses
- What is Impingement Syndrome?
This used to be called Bursitis in the shoulder. There is a bursa on top
of the rotator cuff and underneath the flat bone (acromion). When the
rotator cuff is irritated, the body's natural reaction is to try and
cushion it by filling the bursa with fluid. This in turn puts more
pressure on the rotator cuff. When the rotator cuff gets more irritated
it can scar or tear, leading to more pain, or more weakness.
- What is a Rotator Cuff Tear?
This is a tearing of one or more tendons of the rotator cuff. It usually
tears where it is attached on the arm. It can be caused by one major
trauma, or over time in patients that have Impingement Syndrome (see
- What is an Anterior Cruciate Ligament Tear?
The anterior cruciate ligament is one of four major ligaments that
connect the femur (thigh bone) and tibia (shin bone) and keeps the tibia
from moving too far forward relative to the femur. When you tear your
ACL (anterior cruciate ligament) in your knee, it has to be
reconstructed, not repaired. This is because there is not a very good
blood supply to the center of the ligament, and simply stitching the
tear is not adequate. The most common ways to tear the ACL is with
hyperextending the knee, as when you catch the tip of ski and your knee
bends the wrong way. In football, a helmet to the outside of the knee, a
so called valgus injury, may result in the terrible triad: an ACL tear,
a medial collateral ligament (MCL) tear – the ligament on the inside of
the knee, and a tear of the medial meniscus – the cartilage cushion on
the inside portion of the knee. The ACL can be tear w/ other mechanisms
but these are the more common ways. The ACL is important in pivoting or
cutting. That is why patients who tear their ACL can often perform
straight ahead type activities like running or weightlifting but are
unable to play football, basketball, or soccer.
- What is a Dislocated Shoulder?
This is where the "ball" (humeral head) part of the joint comes out of
the "socket" (glenoid) portion of the joint. The shoulder is a generally
unstable joint. It is like a big ball sitting on a small flat saucer.
This gives you the range of motion you have in your shoulder.
By comparison, in the hip, the ball sits in the socket, but most people
don't have the same range of motion in their hips as they do in their
There are two main static stabilizers in the shoulder. The labrum is a
"rubbery" substance like a meniscus that goes around the socket and acts
like a rubber stop. The capsule or joint lining is a sac that surrounds
the joint. The dynamic stabilizer (which can strengthen or relax) is the
rotator cuff. When you dislocate your shoulder, the structures that can
be injured are the labrum, the capsule, the humeral head and/or the
glenoid. In older patients, the rotator cuff may also be injured.
The shoulder usually dislocates in the front, but can also come out the
back, typically in patients with seizures.
- What is a Separated Shoulder?
This involves the AC joint, which is between the collarbone (clavicle)
and the flat part on the top of shoulder blade (acromion). When the
ligaments in this joint tear, you then have a separated shoulder. It may
first appear that the collarbone is pushing up, but actually the
shoulder blade has dropped.
- What is Carpal Tunnel Syndrome?
This is a big "tunnel" on the palm side of your wrist. There are eight
tendons inside along with the median nerve. The median nerve supplies
feeling to the thumb, the index finger, the middle finger and usually
half of the ring finger. It also supplies the "power" to most of the
muscles which move the thumb. When the tendons become irritated, they
become swollen. This can occur, for example, when you are typing on a
for a long period of time. Because the tunnel is a fixed size, when
there is swelling, there is less room for the nerve and it becomes
pinched. It is similar to your gaining five pounds and shrinking your
jeans-either the inside has to get smaller or the outside has to get
The way to make the inside smaller is to get rid of the irritation in
the tendons and shrink the tendons back to their normal size. This can
be done with rest, braces, medications and/or injections. If the nerve
is pinched for long periods of time, then in addition to the pain, there
can be tingling, numbness or even weakness. When the symptoms become
more severe, your Doctor may have you get an EMG, which tests the
function of the nerve. If there is too much pinching of the nerve or you
have not gotten better, he or she may recommend a Carpel Tunnel Release
What is "Trigger Finger"?
Tendons that bend the knuckles of the finger start in the forearm.
Because they are so long, they have arches or pulleys along the way to
help pull them close to the bone. One of the arches, the A1 Pulley, is
located where the finger connects to the palm. Because this is the area
where there is a lot of movement of the tendon, there can be irritation.
When the tendon gets irritated, it swells and rubs on the pulley. When
the pulley gets irritated, it scars or shrinks (tightens). Because of
this it "catches" and that is where term "trigger finger" comes from.
The finger can even get stuck when the swollen portion moves past the
pulley and can't pull back. Again, this is like gaining five pounds and
shrinking your jeans. You now either have to make the inside smaller or
the outside bigger.
You can sometimes make the inside smaller with rest or an injection. If
this doesn't work, you may require a trigger finger release (see below).
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