Orthopedic Topics


 

Pennsylvania Orthopedic Associates believes it is helpful for patients to have access to information about their injury or on the care they are receiving.  Below are some selected topics for your review.  We suggest that you also review information available on the sites referenced in the “Helpful Links” section.
If you require further information please contact us at 215-947-7550 for an appointment. 
 
Knee Arthroscopy

Knee arthroscopy is a minimally invasive procedure that allows a doctor to diagnose and sometimes treat injuries in your knee through a small incision.  An arthroscope is a small tube with a light on the end that is inserted in your knee and projects an image of the inside of your knee onto a TV monitor.
During your procedure, the doctor will begin by giving you a general, regional, or local anesthetic which will keep you from feeling pain during the operation. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep, while local and regional anesthetics numb part of the body while you remain awake. The doctor will then insert the arthroscope, a tube containing a saltwater solution, and a probe instrument into the lower part of your knee. He will then inject fluid into the knee.
Your doctor may find loose material or a tear in the cartilage or ligaments. Sometimes the doctor can repair the tears and remove loose pieces of cartilage using small instruments and the arthroscope. If the problem cannot be fixed by this procedure, the doctor may recommend open knee surgery.  After the procedure the doctor will close the small openings with one or two stitches or sticky tape.


Knee and Hip Replacement

A patient who may need a joint replacement will usually have symptoms of pain while standing on the affected knee or their hip is painful.   The degeneration of the knee and hip joints can lead to a reduction in the range of motion of the affected joint.
In order to determine your treatment plan, your doctor will begin with a complete history and physical examination.  The doctor will also order imaging studies to determine the extent of the degenerative process.  Other tests may be required if there is reason to believe that other conditions are contributing to the degenerative process. Blood tests may be required to rule out systemic arthritis (such as Rheumatoid Arthritis) or infection.
In knee and hip joint replacement surgery, the damaged bone and cartilage are replaced with metal and plastic surfaces that are shaped to restore joint movement and function forming a new artificial joint.


ACL Reconstruction


The anterior cruciate ligament (ACL) is a stabilizing ligament that connects your thighbone to the shinbone.  Ligaments are tough, non-stretchable fibers that hold your bones together.  An anterior cruciate ligament (ACL) unravels like a braided rope when it’s torn and does not heal on its own due to its poor blood supply. Reconstruction surgery can help many people recover their full function after an ACL tear.  
The treatment of a torn ACL usually involves an arthroscopic surgical reconstruction of the injured ligament.  A number of different types of tissue have been utilized to reconstruct the ACL.  Common types of ACL reconstruction involve harvesting the central third of the patellar tendon, harvesting a hamstring tendon and using allograft or donor tissue.
After harvesting the tissue, holes will be placed into the tibia (bone below the knee) and femur (bone above the knee) and the graft is secured in the same position as the original ACL.  The graft is usually held in place with bioabsorbable screws or metallic screws.


Radiculopathy

An injury to the vertebrae or disks in your neck (your cervical vertebrae) can result in pain, numbness or weakness in your shoulder, arm, wrist or hand. That's because the nerves that extend out from between the cervical vertebrae provide sensation and trigger movement in these areas, this condition is called radiculopathy. Several conditions can put pressure on nerve roots in the neck. The most common causes for radiculopathy are:
• Herniated cervical disk. In this situation, the outer layer (annulus) of the disk cracks and the gel-like center (nucleus) breaks through. This causes the disk to protrude, putting pressure on the nerve that exits the spinal column at that point.
• Spinal stenosis. Sometimes, the space in the center of the vertebrae narrows and squeezes the spinal column and nerve roots.
• Degenerative disk disease. As we age, the water content in our body cells diminishes and other chemical changes occur that can cause the disk to shrink. Without sufficient cushioning, the vertebrae may begin to press against each other thus pinching the nerve.
In determining your plan of treatment your physician will begin with a detailed history and physical, a careful examination and ask about your symptom history.   Your physician may also order, radiology studies to assist in the diagnosis and treatment of your problem.  Initially, your doctor may suggest a conservative treatment plan of rest, medication and physical therapy.  Surgery may be recommended depending upon the severity of your radiculopathy  or if the other treatments do not alleviate your symptoms.
Spinal Stenosis
In spinal stenosis, the spinal canal (which contains and protects the spinal cord and nerve roots), narrows and pinches the spinal cord and nerves. The result is low back pain as well as pain in the legs. Stenosis may pinch the nerves that control muscle power and sensation in the legs. There are many potential causes for spinal stenosis, including but not limited to; aging, heredity and changes to the lumbar spine.
Patients who suffer from spinal stenosis may have pain and difficulty in walking, numbness or tingling in their legs or clumsiness or frequent falling.  Many of these symptoms may also be caused by medical conditions.
Your physician may order imaging studies to help determine the cause of the problem. At first your physician may recommend changes in posture, medications such as nonsteroidal anti-inflammatory drugs, rest and losing weight to help address your pain.  Surgery may be recommended depending upon your severity of spinal stenosis or if other treatments do not alleviate the pain.


Herniated Disk

A herniated disk is a common source of lower back pain.  Disks are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. In the middle of the spinal column is the spinal canal, a hollow space that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the back to flex or bend and act as shock absorbers.
The outer edge of the disk is a ring of cartilage called the annulus while the center of the disk is called the nucleus. A disk herniates or ruptures when part of the center nucleus pushes the outer edge of the disk into the spinal canal, and puts pressure on the nerves. 
Since low back pain affects four out of five people, having pain alone is not enough to recognize a herniated disk. However, if the back pain is the result of a fall or a blow to your back, do not hesitate to contact a doctor. The most common symptom of a herniated disk is sciatica, a sharp, often shooting pain that extends from the buttocks down the back of one leg. This is caused by pressure on the spinal nerve. A patient may also have weakness or tingling in their leg, loss of bladder control or a pain in their back.


In diagnosing and treating your herniated disc, your physician will complete a detailed history and physical examination and may order some imaging tests to determine your plan of care. Your physician may suggest rest, medication, icing the area, gentle heat,  epidural injections  to lessen nerve irritation or surgery. Surgery may be recommended depending upon the severity of your herniated disk or if the other treatments do not address your herniated disk.


Epicondylitis (Tennis Elbow)


With tennis elbow there will be pain and tenderness over the epicondyles.  A patient’s pain will be worse when they grip or move their forearm.  Pain worsens with gripping or rotation of the forearm, including playing tennis, golfing, using a screwdriver or carrying something where you have to use a grip.  The tear may be caused by sudden stress on the ligament or overuse.


Carpal Tunnel Syndrome


Carpal tunnel syndrome is caused by pressure on the median nerve in your wrist. People who use their hands and wrists repeatedly in the same way (for example people who work on a computer) may develop carpal tunnel syndrome.  Pressure on the nerve may also be caused by a fracture or other injury, or other medical conditions such as diabetes, thyroid disease or vitamin deficiency.
A patient with carpal tunnel syndrome may experience pain or numbness in their hand or wrist, increased pain when they use their hand, a weakened grip or pain at night
Trigger Finger

Trigger finger is a common disorder of the hand which causes a painful snapping or locking of the fingers or thumb. The medical name for this condition is stenosing tenosynovitis. Stenosing refers to the narrowing of an opening or passageway in the body. Tenosynovitis refers to inflammation of the outer covering of the tendons that bend and extend the fingers and thumb. The tendons are tough, fibrous cords that connect the muscles of the forearm to the bones of the fingers and thumb. This muscle and tendon system enables one to bend the fingers inward when making a fist, and extend them out straight.


The exact cause of trigger finger or thumb is not always evident.  In some cases it may be caused by repeated strain to the area, including repetitive grasping, such as when someone works with tools. But it can also result from certain medical conditions, such as diabetes.
Shoulder Arthroscopy
Trauma or overuse can cause the soft tissues in the shoulder to stretch or tear.  When this happens, a feeling of looseness may develop and the shoulder may “pop out” of position when a patient does certain activities.  Pain and weaknesses may begin to interfere with a patient’s quality of life. 


Rotator Cuff Injury


A rotator cuff injury is a strain or tear to the group of tendons and muscles that hold your shoulder joint together.  This injury may result from a fall, lifting a heavy object, repetitive overuse of your shoulder in certain sports, such as swimming or pitching, or manual labor.
Shoulder Separation

A shoulder separation occurs when you tear the ligaments that hold your clavicle (collarbone) to the joint where it meets your shoulder blade.   A shoulder separation may occur as a result of a blow to your shoulder, a fall or from contact sports, such as football or hockey.  The symptoms include severe pain, especially when the injury occurs, limited shoulder movement and tenderness, bruising and swelling to the shoulder area, as well as an unusual shape to the shoulder area.

Ankle Sprain


An ankle sprain is caused by twisting of the ankle.  A sprain is an injury that causes a stretch or tear to one of the ligaments in the ankle joint.  Most sprains occur on the outside of the ankle but they can occur on the inside of the ankle as well.  A patient with a sprained ankle may have mild aching or sudden pain in the ankle, swelling or discoloration or restricted use of the ankle.


Achilles Tendon Injuries


Achilles tendonitis can be caused by overuse of the tendon, tight calf muscles or Achilles tendon, strain from increased training or over-pronation when walking. The Achilles tendon can even rupture if there is a violet stretch to the tendon.   Achilles tendonitis may cause pain and swelling over the tendon.  If the Achilles tendon tears or ruptures, a patient may feel a “pop”.

Location
Pennsylvania Orthopedic Associates
727 Welsh Rd. , Suite 103
Huntingdon Valley, PA 19006
Phone: 215-947-7550
Fax: 215-947-0590
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