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Neck
The neck facilitates a significant amount of support and motion, however its position often leaves it vulnerable to injury. Our specialists are specifically trained to diagnose, treat, and prevent problems involving the neck region.
1 - Cervical Radiculopathy
overview
Cervical radiculopathy is a dysfunction of a nerve root of the cervical spine. When any nerve root in the cervical spine is irritated through compression or inflammation, symptoms of pain, tingling, numbness, and/or weakness can radiate anywhere along that nerve’s pathway into the shoulder, arm, and/or hand. Cervical disc herniation is the most common cause of cervical radiculopathy.
Symptoms
Cervical radiculopathy symptoms typically include pain, weakness, or numbness in the areas served by the affected nerve. Pain can be felt in one area only, like the shoulder, or progress along the entire arm and into the hand and fingers. The type of pain also can vary. Some patients describe a dull, general pain. However, others describe the pain as severe burning, sharp, or knife-like.
Patients may feel pins-and-needles tingling, which can also be accompanied by numbness. Experiencing numbness or weakness in the hand can also affect the ability to grip or lift objects, as well as to perform other daily tasks such as writing, typing, or getting dressed.
treatment
Cervical radiculopathy may be treated with a combination of pain medications such as corticosteroids (powerful anti-inflammatory drugs) or non-steroidal pain medication like ibuprofen or naproxen and physical therapy. Steroids may be prescribed either orally or injected.
Physical therapy might include gentle cervical traction and mobilization, exercises, and other modalities to reduce pain. If significant compression on the nerve exists to the extent that motor weakness results, surgery may be necessary to relieve the pressure.
2 - Cervicalgia or Neck Pain
overview
Cervicalgia is a general term used to describe pain in the neck. Neck pain is not a condition, but a symptom that can result from many different causes. Treating neck pain is highly dependent on having an accurate diagnosis. Examples of common conditions causing neck pain are neck strain, degenerative disc disease, neck injury such as whiplash, a herniated disc, or a pinched nerve. Even a brief viral illness can cause temporary neck pain or stiffness.
Symptoms
Cervicalgia causes localized pain, so it rarely radiates outward. You may experience something as light as a “stiff neck” or as severe as the inability to turn your head due to severe pain or tight muscles. You may refer to your cervicalgia as “a crick in the neck.”
Another symptom of cervicalgia is a sharp pain in your neck whenever you move your head suddenly. The pain often goes away when you relax. Sometimes, it doesn’t return on a regular basis. Other times, you may feel it every time you turn your head or bend your neck.
The discomfort may be merely a sense of tightness in your neck that can extend into your upper back. Your neck and back may be tender to the touch.
These symptoms are characteristic of classic cervicalgia. Other symptoms include headaches and general neck stiffness, as well as a burning and aching sensation in your upper back and neck. These symptoms sometimes can point to a more serious illness than cervicalgia. When in doubt, seek a medical exam
treatment
Treatment for cervicalgia varies according to the symptoms and suspected cause. If you’ve been injured, apply ice to your neck and see a doctor immediately. Initial treatment could involve prescription-strength anti-inflammatory or pain medication. You also may be advised to wear a temporary cervical collar to support your head. Wearing the collar gives your neck muscles a chance to rest and heal.
If an injury didn’t cause your neck pain, it may be due to stress. In such a case, you can take measures at home to ease your pain. First, take an over-the-counter anti-inflammatory drug, such as ibuprofen, to reduce swelling. These medications also help your muscles to relax, which also reduces your pain. Applying a heating pad may also help.
Regardless of the cause, your cervicalgia can be ongoing and persistent. If your discomfort does not disappear with rest, anti-inflammatory medication, and alternating hot and cold packs, you need to see a doctor. This is especially true if you suspect you’ve had an injury within a few weeks of the onset of your symptoms.
X-Rays are often performed, and an MRI may be ordered to assess for spinal cord or nerve compression from a disc herniation or bone spur.
3 - Herniated Disc (Cervical)
overview
A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior.
Symptoms
- Arm or leg pain. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
- Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.
- Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
You also can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem.
treatment
Self Care: In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks. Restricting your activity, ice/heat therapy, and taking over the counter medications will help your recovery
Medication
Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs), and steroids. Sometimes muscle relaxers are prescribed for muscle spasms. Steroid injections into the area of your herniated disc may be prescribed if your pain is severe.
Surgical treatments
When symptoms progress or do not resolve with conservative treatment, surgery may be required. Factors such as patient age, how long the problem has persisted, other medical problems, previous neck operations, and expected outcome are considered in planning surgery. The most common surgeries performed include:
- Anterior cervical discectomy & fusion (ACDF)
- Artificial disc replacement.
- Minimally invasive microendoscopic discectomy
- Posterior cervical foraminotomy
4 - Spinal Stenosis (Cervical)
overview
Cervical spinal stenosis is the narrowing of the spinal canal in the neck. The spinal canal is the open area in the bones (vertebrae) that make up the spinal column. The spinal cord is a collection of nerves that runs through the spinal canal from the base of the brain to the lower back. These nerves allow us to feel, to move, and to control the bowel and bladder and other body functions.
In cervical spinal stenosis, the spinal canal narrows and can squeeze and compress the nerve roots where they leave the spinal cord, or it may compress or damage the spinal cord itself. The seven vertebrae between the head and the chest make up the cervical spine. Squeezing the nerves and cord in the cervical spine can change how the spinal cord functions and cause pain, stiffness, numbness, or weakness in the neck, arms, and legs. It can also affect your control of your bowels and bladder. Curiously, the spinal cord does not have the ability to sense when it is being compressed so symptoms can be subtle and develop gradually over months or years.
Symptoms
Many people older than age 50 have some narrowing of the spinal canal but do not have symptoms. Cervical spinal stenosis does not cause symptoms unless the spinal cord or nerves becomes squeezed significantly.
Symptoms usually develop gradually over a long period of time and may include:
- Stiffness, pain, numbness, or weakness in the neck, shoulders, arms, hands, or legs.
- Balance and coordination problems, such as shuffling or tripping while walking. Cervical spinal stenosis can be crippling if the spinal cord is damaged.
- Loss of bowel or bladder control
- Unsteadiness on your feet
- Headaches
treatment
There are two treatment options available to help treat cervical spinal stenosis: conservative treatment and surgical treatment. Before you consider surgical treatment, you should exhaust all conservative treatment options. Some people with cervical spinal stenosis find relief through conservative treatments and never have to undergo surgery.
Your physician might recommend a routine including some of the following conservative treatments:
- The application of heating pads or ice packs
- Exercise or physical therapy to strengthen the neck muscles
- Over-the-counter or prescription pain medication
- Therapeutic massage
- Epidural injections
- Chiropractic treatment or acupuncture
Typically, surgeons use 2 surgical techniques for spinal stenosis surgery:
- Decompression: The surgeon will remove tissue pressing against a nerve structure, which makes more room in the spinal canal (for the spinal cord) or in the foramen (for the nerve roots).
- Stabilization: The surgeon works to limit motion between vertebrae.
Shoulder
Shoulder injuries are often caused by activities that involve excessive, repetitive, overhead motions. Although discomfort may seem minor, do not underestimate the severity of injuries within the shoulder. Early detection and treatment is key to full recovery, and our facility offers attentive and knowledgeable physicians and staff.
1 - Arthritis of the Shoulder
overview
Arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.
Arthritis may be caused by disease (osteoarthritis or rheumatoid arthritis) or by trauma
Symptoms
- Pain: joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping.
- Swelling
- Changes in Surrounding Joints
- Warmth
- Crepitation and Looseness
- Cysts
- Deformity (especially from Rheumatoid arthritis)
treatment
Non-surgical treatment includes medication (anti-inflammatories), injections (a long-lasting anesthetic and a steroid) and splinting worn during periods when the joint hurts.
If nonsurgical treatment fails to give relief, surgery is usually discussed. There are many surgical options. The chosen course of surgical treatment should be one that has a reasonable chance of providing long-term pain relief and return to function. It should be tailored to your individual needs. If there is any way the joint can be preserved or reconstructed, this option is usually chosen.
2 - Labral Tear (Shoulder)
overview
The labrum is a piece of fibrocartilage (rubbery tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place. When this cartilage is torn, it is called a labral tear. Labral tears may result from injury, or sometimes as part of the aging process. Symptoms and treatment vary depending on the type and severity of the tear.
Symptoms
The main symptom caused by a labral tear is a sharp pop or catching sensation in the shoulder during certain shoulder movements. This may be followed by a vague aching for several hours. At other times, the tear may not cause any pain. Shoulder instability from a damaged labrum may cause the shoulder to feel loose, as though it slips with certain movements. If untreated, a labral tear can lead to the development of shoulder arthritis.
treatment
- Anti-inflammatory medication
- Cortisone Injection (stronger anti-inflammatory medication)
- Physical / Occupational Therapy
- Surgery including Labral Debridement or Repair
3 - Rotator Cuff Injury
overview
A Rotator Cuff injury occurs when the tissue that connects your muscles around the shoulder joint tear.
Symptoms
Most patients with Rotator Cuff injuries typically experience the following symptoms:
- Pain, especially when lifting your arm
- Hearing a grinding or popping sound when you move your arm
- Weakness in the arm
- Inability to lift arm
treatment
Treatment plan for your Rotator Cuff injury depends on the severity of your injury.
Non-surgical
- Rest and anti-inflammatories
- Physical Therapy
Surgery:
Surgery is done to help you regain motion and strength of the shoulder. Typically surgery includes the arthroscopically and repairs the torn tendons.
Our orthopedic surgeons, Dr. Kime and Dr. LoveLace, will determine which treatment option is best for you after they evaluate your injury.
4 - Frozen Shoulder (Adhesive Capsulitis)
overview
Frozen Shoulder, is a condition that results in stiffness and pain in the shoulder joint.
Symptoms
Symptoms of Frozen Shoulder include:
- Pain
- Stiffness
- Limited motion of the shoulder
treatment
Treatment involves stretching and sometimes injecting corticosteroids and numbing medications into the joint capsule. In some cases, surgery is used to loosen the joint capsule.
The Hess Orthopaedic Center surgeons, Dr. Kime and Dr. LoveLace, will walk you through the best treatment options for your Frozen Shoulder.
5 - Subacromial Bursitis
overview
A condition caused by the inflammation of the bursa that separates the acromion from the rotator cuff.
Symptoms
The most common symptoms of Subacromial Bursitis are:
- Pain on the outside of the shoulder
- Pain may spread down your arm towards the elbow or wrist
- Pain made worse when lying on the affected shoulder
treatment
To treat your Subacromial Bursitis Dr. Kime and Dr. LoveLace will develop a rehabilitation plan and provide the following treatment options:
Non-surgical
- Cold therapy
- Rest
- Anti-inflammatories
Should your Subacromial Bursitis continue after conventional treatment, our orthopedic surgeons may aspirate the bursa (remove the fluid via a needle).
Elbow
Our hands, wrists, and elbows serve many purposes, and are frequently utilized in a variety of daily activities. Whether you need carpal tunnel surgery, or a simple consultation, our facility offers a breadth of services to meet your needs.
1 - Golfer’s Elbow (Medial Epicondylitis)
overview
Golfer’s elbow (medial epicondylitis) causes pain and inflammation in the tendons that connect the forearm to the elbow. The pain centers on the bony bump on the inside of your elbow and may radiate into the forearm.
Golfer’s elbow is usually caused by overusing the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist. Repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons.
Symptoms
The main symptoms are pain and tenderness on the bony bit on the inside of the elbow called the medial epicondyle, particularly when gripping hard with the hand. There will be general weakness in the wrist and pain will be reproduced by bending the wrist palm downwards against resistance and resisting pronation or rotating the wrist inwards.
treatment
Apply the PRICE principles of protection, rest, ice, compression and elevation when the injury is acutely painful. Rest is very important. Golfers elbow will not heal if it is not allowed to rest.
A tennis elbow brace, ultrasound or ibuprofen may be prescribed by a physician to reduce pain and inflammation.
A steroid injection may be considered if more conservative treatment is not effective.
2 - Cubital Tunnel Syndrome
overview
Cubital Tunnel Syndrome is caused when your ulnar nerve, commonly known as the “funny bone,” experiences pressure or compression.
Symptoms
The most common symptoms of Cubital Tunnel Syndrome are:
- Numbness, weakness or pain in the hand or inner side of the elbow
- “Falling asleep” sensation in the hand
- “Pins and needle” feeling in the ring and small fingers
treatment
To treat Cubital Tunnel Syndrome you should avoid activities that cause symptoms, and consult with our orthopedic specialists Dr. Kime and Dr. LoveLace to develop the best treatment plan for you. The most common treatment options are:
Non-surgical
- Rest
- Immobilization with a splint
- Cushioning the ulnar nerve with an elbow pad
- Anti-inflammatory medications
Sometimes surgery may be needed to relieve pressure on the nerve.
3 - Tennis Elbow (Lateral Epicondylitis)
overview
Tennis Elbow (Lateral Epicondylitis) occurs when the elbow has been overused — repeating the same motion over and over. The tendons that join the forearm muscles on the outside of the elbow become inflamed/damaged, causing pain and tenderness on the outside of the elbow.
Symptoms
Typically symptoms develop gradually, and pain that begins as mild slowly worsens over time. If you have Tennis Elbow (Lateral Epicondylitis), you will most likely experience:
- Pain or burning on the outer part of your elbow
- Weak grip
treatment
Dr. Kime and Dr. LoveLace at Hess Orthopaedic Center know how important it is for you to return to your normal activities free of the pain/discomfort caused by Tennis Elbow (Lateral Epicondylitis. Typical treatment options include:
Non-surgical
- Rest
- Anti-inflammatory medications
- Arm Brace or wrist splint
- Physical/Massage Therapy
- Steroid injections or PRP injections
- Extracorporeal shock wave therapy
Surgical
If your symptoms do not lessen after 6 to 12 months of nonsurgical treatments, your orthopedic surgeon may recommend surgery. Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.
provider
4 - Elbow Bursitis
overview
This condition occurs when the bursae, a fluid-filled sac between the skin and bones on the back of the elbow, become inflamed or irritated.
Symptoms
The most noticeable symptom is swelling, but you may also experience the following:
- Pain when the elbow is touched or moved
- Restricted motion due to excessive swelling
- Redness/warmth of the skin around the elbow. Please consult our team of orthopedic doctors immediately if you have this symptom, as you may have an infection.
treatment
Our team of orthopedic surgeons Dr. Kime and Dr. LoveLace at Hess Orthopaedic Center, will provide the following treatment options for your Elbow Bursitis:
Infected Bursitis
If our team of orthopedic surgeons suspects that your Elbow Bursitis is due to an infection, we may remove the fluid from the bursa with a needle and prescribe antibiotics to ensure the infection is treated. This is commonly performed as an office procedure.
Non-infected Bursitis
- Elbow pads
- Activity changes
- Anti-inflammatories
provider
HAND and WRISTS
Our hands, wrists, and elbows serve many purposes, and are frequently utilized in a variety of daily activities. Whether you need carpal tunnel surgery, or a simple consultation, our facility offers a breadth of services to meet your needs.
1 - Arthritis of the Hand
overview
Arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.
Arthritis may be caused by disease (osteoarthritis or rheumatoid arthritis) or by trauma (fractures).
Symptoms
- Pain: joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping.
- Swelling
- Changes in Surrounding Joints
- Warmth
- Crepitation and Looseness
- Cysts
- Deformity (especially from Rheumatoid arthritis)
treatment
Non-surgical treatment includes medication (anti-inflammatories), injections (a long-lasting anesthetic and a steroid) and splinting worn during periods when the joint hurts.
If nonsurgical treatment fails to give relief, surgery is usually discussed. There are many surgical options. The chosen course of surgical treatment should be one that has a reasonable chance of providing long-term pain relief and return to function. It should be tailored to your individual needs. If there is any way the joint can be preserved or reconstructed, this option is usually chosen.
2 - Bicep Tendon Tear
overview
A Bicep Tendon Tear occurs when the tendons in your biceps that attach the muscle to your shoulder and elbow tear.
Symptoms
Common symptoms of a Bicep Tendon Tear include:
- Sudden, sharp pain in the upper arm
- You may hear an audible pop or snap when the injury occurs
- Cramping of the biceps muscle with strenuous use of the arm
- Bruising from the middle of the upper arm down toward the elbow
- Pain or tenderness at the shoulder and the elbow
- Weakness in the shoulder and the elbow
treatment
Treatment options vary depending on whether the tear is partial or complete. The Hess Orthopaedic Center surgeons, Dr. Kime, Dr. LoveLace and Dr. Schwartz, will determine if nonsurgical or surgical treatment is the best for your injury.
Non-surgical
- Rest
- Ice
- Anti-inflammatories
- Physical Therapy
Surgery
If you have a severe tear of the bicep tendon, surgery may be required.
3 - Carpal Tunnel Syndrome
overview
Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand the median nerve — is squeezed or compressed as it travels through the wrist.
Symptoms
Symptoms of carpal tunnel syndrome may include:
- Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
- Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
- Pain or tingling that may travel up the forearm toward the shoulder
- Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
- Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
treatment
Nonsurgical Treatments
- Bracing or splinting
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen and naproxen can help relieve pain and inflammation.
- Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long—particularly when your wrist is flexed or extended.
Diagnosis: your physician will examine your hand and perform specific tests to determine if you have carpal tunnel syndrome. A contributory test is an EMG/NCV, or electromyogram and nerve conduction velocity test completed by a neurologist.
Surgical Treatments
- Open carpal tunnel release. In open surgery, your doctor makes a small incision in the palm of your hand and views the inside of your hand and wrist through this incision. During the procedure, your doctor will divide the transverse carpal ligament (the roof of the carpal tunnel). This increases the size of the tunnel and decreases pressure on the median nerve.
- Endoscopic carpal tunnel release. In endoscopic surgery, your doctor makes one or two smaller skin incisions—called portals—and uses a miniature camera—an endoscope—to see inside your hand and wrist. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.
4 - De Quervain's Tendinosis / Tenosynovitis
overview
De Quervain’s tendinosis occurs when the tendons around the base of the thumb are irritated or constricted. The word “tendinosis” refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath (tenosynovitis) , can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist. Repetitive activities with the hand can cause or aggravate this condition.
Symptoms
Signs of De Quervain’s tendinosis:
- Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
- Swelling may be seen over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.
- A “catching” or “snapping” sensation may be felt when moving the thumb.
- Pain and swelling may make it difficult to move the thumb and wrist.
treatment
- Medications to reduce pain and swelling, your doctor may recommend using over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.
- You may also see a physical or occupational therapist. These therapists may review how you use your wrist and give suggestions on how to make adjustments to relieve stress on your wrists. Your therapist can also teach you exercises for your wrist, hand and arm to strengthen your muscles, reduce pain and limit tendon irritation. A thumb brace is commonly employed.
- Surgery: If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure so your tendons can glide freely.
5 - Ganglion Cyst
overview
Symptoms
The lumps associated with ganglion cysts can be characterized by:
- Location. Ganglion cysts most commonly develop along the tendons or joints of your wrists or hands. The next most common locations are the ankles and feet. These cysts can occur near other joints as well.
- Shape and size. Ganglion cysts are round or oval and usually measure less than an inch (2.5 centimeters) in diameter. Some are so small that they can’t be felt. The size of a cyst can fluctuate, often getting larger when you use that joint for repetitive motions.
- Pain. Ganglion cysts usually are painless. But if a cyst presses on a nerve — even if the cyst is too small to form a noticeable lump — it can cause pain, tingling, numbness or muscle weakness.
treatment
If the cyst is causing pain or interfering with joint movement, your doctor may recommend:
- Immobilization. Because activity can cause the ganglion cyst to get larger, it may help to temporarily immobilize the area with a brace or splint. As the cyst shrinks, it may release the pressure on your nerves, relieving pain. Avoid long-term use of a brace or splint, which can cause the nearby muscles to weaken.
- Aspiration. In this procedure, your doctor uses a needle to drain the fluid from the cyst. The cyst may recur.
- Surgery. This may be an option if other approaches haven’t worked. During this procedure, the doctor removes the cyst and the stalk that attaches it to the joint or tendon. Rarely, the surgery can injure the surrounding nerves, blood vessels or tendons. And the cyst can recur, even after surgery, but this is less likely than just aspiration alone.
6 - Hand Fracture
overview
Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.
Symptoms
Signs and symptoms of a broken bone in the hand include:
- Swelling
- Tenderness
- Deformity
- Inability to move the finger
- Shortened finger
- Finger crosses over its neighbor when making a partial fist
- Depressed knuckle
A depressed knuckle is often seen in a “boxer’s fracture.” This is a fracture of the fourth or fifth metacarpal, the long bone below the ring or little finger.
treatment
Most of the time, the bones can be realigned by manipulating them without surgery. A cast, splint or fracture-brace is applied to immobilize the bones and hold them in place. The cast will probably extend from the fingertips down past the wrist almost to the elbow. This ensures that the bones remain fixed in place. The cast will be worn for three to six weeks. Gentle hand exercises can probably be started after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability to use the hand and fingers. “Buddy taping” of an injured finger to its neighbor is commonly employed.
Some hand fractures require surgery to stabilize and align the bones. These fractures usually break through the skin or result from a crushing accident. An orthopaedic surgeon can implant wires, screws, or plates in the broken bone to hold the pieces of the fractured bone in place.
7 - Tendonitis
overview
Tendonitis is an inflammation or irritation of a tendon, a thick cord that attaches bone to muscle. Tendonitis is most often caused by repetitive, minor impact on the affected area, or from a sudden more serious injury.
Tendinitis can occur in almost any area of the body where a tendon connects a bone to a muscle. The most common places are:
- Base of the thumb
- Elbow
- Shoulder
- Hip
- Knee
- Achilles tendon
Symptoms
- Pain often described as a dull ache, especially when moving the affected limb or joint
- Tenderness
- Mild swelling
treatment
Most cases of tendonitis can respond to self-care measures. See your doctor if your signs and symptoms persist and interfere with your day-to-day activities for more than a few days.
Initial treatment of tendinitis includes:
- Avoiding activities that aggravate the problem
- Resting the injured area
- Icing the area the day of the injury
- Taking over-the-counter anti-inflammatory drugs or using topical anti-inflammatory gels
If the condition does not improve in a week, see your doctor. You may need more advanced treatments, including:
- Corticosteroid injections. Corticosteroids (often called simply “steroids“) are often used because they work quickly to decrease the inflammation and pain.
- Physical therapy. This can be very beneficial, especially for a “frozen shoulder.” Physical therapy includes range-of-motion exercises and splinting (thumb, forearm, bands).
- MRI: An advanced imaging study that allows assessment of soft tissues, including tendons and muscle, enabling diagnosis of tendonitis versus rupture versus partial splitting of the tendon.
- Surgery. This is only rarely needed for severe problems not responding to other treatments
8 - Trigger Finger
overview
Stenosing tenosynovitis is a condition commonly known as “trigger finger.” It is sometimes also called “trigger thumb.” The tendons that bend the fingers glide easily with the help of pulleys. These pulleys hold the tendons close to the bone. This is similar to how a line is held on a fishing rod. Trigger finger occurs when the pulley becomes too thick, so the tendon cannot glide easily through it.
Trigger finger can involve any finger. Repetitive gripping activity may contribute to the cause.
Symptoms
Trigger finger may start with discomfort felt at the base of the finger or thumb, where the finger joins the palm. This area is often sensitive to pressure. You might feel a lump there. Other symptoms may include:
- Pain
- Popping
- Catching feeling
- Limited finger movement
treatment
The first step is to rest the finger or thumb. Your doctor may put a splint on the hand to keep the joint from moving. If symptoms continue, your doctor may prescribe drugs that fight inflammation, such as ibuprofen or naproxen. Your doctor may also recommend an injection of a steroid into the tendon sheath. If the trigger finger does not get better, your doctor may recommend surgery.
BACK/SPINE
Problems involving the spine are a common source of pain, and can affect mobility. Effective treatment is imperative to restore quality of life. Trust our experienced orthopaedic specialists to treat your injuries with the highest level of care and compassion.
1 - Degenerative Disc Disease
overview
Your spine is made up of small interlocking bones, called vertebrae, which are stacked on top of one another. In between the vertebrae, are spinal discs which act as shock absorbers for the spine. These spinal discs can degenerate due to aging or injury resulting in the condition called degenerative disc disease.
Symptoms
Typical symptoms for Degenerative Disc Disease are:
- Pain that comes and goes when bending, twisting, sitting, walking or standing
- Pain may extend from the back into the buttock or outer hip area, but not down the leg
- Numbness or tingling in the legs
treatment
Generally Degenerative Disc disease is treated via medications, physical medicine or surgery. The Hess Orthopaedic Center surgeons Dr. Kime, Dr. Love and Dr. Schwartz will determine the best nonsurgical or surgical treatment for you.
Nonsurgical Treatment
Medications
- Aspirin or Acetaminophen
- Non-steroidal anti-inflammatory medicines (Ibuprofen and Naproxen)
- Steroids, taken either orally or injected into your spine, to deliver a high dose of anti-inflammatory medicine
Physical Medicine
- Physical therapy
- Braces
- Chiropractic or manipulation therapy
- Other exercise-based programs
Surgical Treatment
- Spinal Fusion – Fuses together the painful vertebrae via a bone graft so that they heal into a single, solid bone. Screws, rods, or a “cage” are used to keep the spine stable while the bone graft heals. Full recovery can take more than a year.
- Disc Replacement – This procedure removes the disc and replaces it with artificial parts.
provider
2 - Herniated Disc (Cervical)/Herniated Discs
overview
A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior.
Symptoms
- Arm or leg pain. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions.
- Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves.
- Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
You also can have a herniated disk without knowing it — herniated disks sometimes show up on spinal images of people who have no symptoms of a disk problem.
treatment
Self Care: In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks. Restricting your activity, ice/heat therapy, and taking over the counter medications will help your recovery
Medication
Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs), and steroids. Sometimes muscle relaxers are prescribed for muscle spasms. Steroid injections into the area of your herniated disc may be prescribed if your pain is severe.
Surgical treatments
When symptoms progress or do not resolve with conservative treatment, surgery may be required. Factors such as patient age, how long the problem has persisted, other medical problems, previous neck operations, and expected outcome are considered in planning surgery. The most common surgeries performed include:
- Anterior cervical discectomy & fusion (ACDF)
- Artificial disc replacement.
- Minimally invasive microendoscopic discectomy
- Posterior cervical foraminotomy
3 - Sacroiliac Joint Pain (SI Joint)
overview
The sacroiliac joint connects the last segment of the spine, the sacrum, to the pelvis. The integrity of the sacroiliac joint depends on strong ligaments that encase and cover the joint. These ligaments compress and stabilize the joint.
The ligaments that encase the sacroiliac joint may be disrupted due to injury or degenerate due to age, allowing the joint to have excessive motion. This excessive motion may inflame and disrupt the joint and surrounding nerves.
Your physician may also refer to sacroiliac joint pain by other terms like sacroiliitis, SI joint degeneration, SI joint inflammation, SI joint syndrome, SI joint disruption and SI joint strain.
Symptoms
The most common symptom of sacroiliac joint disorders is pain in the lower back, buttock and legs. This can present as sciatica like symptoms (leg pain, burning, numbness, and tingling) that mimic lumbar disc or radicular low back pain, pain that radiates down into the legs.
treatment
The physician may request sacroiliac joint injections as a diagnostic test. Sacroiliac joint injections involve injecting a numbing medication into the sacroiliac joint. If the injection alleviates your symptoms, then your sacroiliac joint may be the likely source of your pain and your physician may elect to discuss surgical options with you, such as a sacroiliac joint fusion.
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4 - Sciatica
overview
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.
Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg. Most commonly, the L4-5 and/or L5-S1 disc(s) are the culprit for sciatica.
Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that’s associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.
Symptoms
Common symptoms of sciatica include:
- Lower back pain
- Pain in the rear or leg that is worse when sitting
- Hip pain
- Burning or tingling down the leg
- Weakness, numbness, or difficulty moving the leg or foot
- A constant pain on one side of the rear
- A shooting pain that makes it difficult to stand up
treatment
If your pain doesn’t improve with self-care measures, your doctor might suggest some of the following treatments.
Medications
- The types of drugs that might be prescribed for sciatica pain include:
- Anti-inflammatories
- Muscle relaxants
- Narcotics
- Tricyclic antidepressants
- Anti-seizure medications
Physical therapy
Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility.
Steroid injections
In some cases, your doctor might recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently.
Surgery
This option is usually reserved for when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.
Minimally invasive surgical options are available for this condition, as well as standard open discectomy surgery.
5 - Scoliosis
overview
Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Heredity may be a contributing factor
Symptoms
Signs and symptoms of scoliosis may include:
- Uneven shoulders
- One shoulder blade that appears more prominent than the other
- Uneven waist
- One hip higher than the other
If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side
treatment
Most with scoliosis have mild curves and probably won’t need treatment with a brace or surgery. Children who have mild scoliosis may need checkups every four to six months to see if there have been changes in the curvature of their spines.
While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an individual basis.
6 - Vertebral Compression Fracture
overview
Vertebral Compression Fractures occur when the bony block or vertebral body in the spine collapses, which can lead to severe pain, deformity and loss of height. These fractures more commonly occur in the thoracic spine (the middle portion of the spine), especially in the lower part. While osteoporosis is the most common cause, these fractures may also be caused by trauma or metastatic tumors.
Vertebral compression fractures (VCFs) are the most common fracture in patients with osteoporosis, affecting about 750,000 people annually. VCFs affect an estimated 25 percent of all postmenopausal women in the U.S. In people with severe osteoporosis, a VCF may be caused by simple daily activities, such as bending over.
Symptoms
The main clinical symptoms of VCFs may include any of the following, alone or in combination:
- Sudden onset of back pain
- An increase of pain intensity while standing or walking
- A decrease in pain intensity while lying on the back
- Limited spinal mobility
- Eventual height loss
- Eventual deformity and disability, including kyphosis or forward bending deformity of the spine.
treatment
Traditionally, people with severe pain from VCFs have been treated with bed rest, medications, bracing or invasive spinal surgery. Over-the-counter pain medications are often effective in relieving pain.
Back bracing can provide external support to limit the motion of fractured vertebrae, similar to the support a cast provides on a leg fracture. The rigid style of back brace limits spine-related motion greatly, which may help reduce pain.
Surgery may be recommended by the physician, depending upon the severity of pain, deformity and neurologic symptoms (and the patient’s medical history).
Hip
Overuse and injury can often lead to pain and discomfort during daily activities. Our providers offer a variety of services – from minimally invasive surgery to total joint replacements.
1 - Arthritis of the Hip
overview
Arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.
Arthritis may be caused by disease (osteoarthritis or rheumatoid arthritis) or by trauma (fractures).
Symptoms
- Pain: joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping.
- Swelling
- Changes in Surrounding Joints
- Warmth
- Crepitation and Looseness
- Cysts
- Deformity (especially from Rheumatoid arthritis)
treatment
Non-surgical treatment includes medication (anti-inflammatories), injections (a long-lasting anesthetic and a steroid) and splinting worn during periods when the joint hurts.
If nonsurgical treatment fails to give relief, surgery is usually discussed. There are many surgical options. The chosen course of surgical treatment should be one that has a reasonable chance of providing long-term pain relief and return to function. It should be tailored to your individual needs. If there is any way the joint can be preserved or reconstructed, this option is usually chosen.
2 - Hip Bursitis (Torchanteric Bursitis)
overview
Bursitis is the painful swelling of bursae. Bursae are fluid-filled sacs that cushion your tendons, ligaments and muscles. When they work normally, bursae help the tendons, ligaments and muscles glide smoothly over bone. But when the bursae are swollen, the area around them becomes very tender and painful. Trochanteric bursitis is swelling affecting the bursa of the hip.
Symptoms
The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.
Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting.
treatment
Home treatment for bursitis includes:
- Rest.
- Ice packs to the affected area.
- Medicines to relieve pain and swelling.
- Weight loss, to reduce pressure on the hip.
- Exercises to strengthen the hip muscles.
- Stretching exercises for the hip and lower back.
- Avoiding prolonged standing and the activity that causes pain.
- Using a cane or crutches to reduce pressure on the hip.
- Using a lift in your shoe, to reduce pressure on the hip if one leg is shorter than the other.
If home treatment does not relieve pain from bursitis, medical treatment such as lidocaine or steroid injections into the trochanteric bursa may help. Surgery is rarely needed.
3 - Hip Fracture
overview
Hip fractures are breaks in the thighbone (femur) just below the hip joint. They often occur in people aged 65 and older, and will most likely require surgery.
Symptoms
If you have a hip fracture, you will most likely experience:
- Severe pain in your hip or lower groin area
- Not be able to walk or put weight on your leg
treatment
Surgery is done as soon as possible after a hip fracture is diagnosed. Depending on where the break occurs and how severe it is, the Hess Orthopaedic Center surgeons Dr. Kime and Dr. LoveLace will perform two types of surgery:
- Hip Repair Surgery – Known as fixation or “hip pinning”, our surgeons will use metal screws, rods or plates to hold the bone together while it heals.
- Hip Replacement Surgery – We will replace part of all of the hip joint with artificial parts.
Following surgery our team will set you up with best rehab program to help you get back to your normal activities as soon as possible.
4 - Hip Dislocation
overview
Hip Dislocation is an injury in which the hip bone is displaced from its normal position.
Symptoms
Most patients with a Hip Dislocation injury will experience swelling, pain and visibly see the joint is out of place. The leg may feel numb or tingle, and be hard to move.
treatment
Immediate medical treatment is needed with this Hip Dislocation injury. The orthopedic Dr. Kime and Dr. LoveLace at Hess Orthopaedic Center will either push the joint back into place via hand, surgery or rehabilitation.
5 - Osteoarthritis of the Hip
overview
Osteoarthritis of the Hip, is a type of arthritis that occurs when the flexible connective tissue that protects the ends of the bones wears down in the hip.
Symptoms
The most common symptoms of Osteoarthritis of the Hip include:
- Pain in the hip, inner thigh, buttocks and knees
- Tenderness in the hip when pressure is applied
- Feeling a “grating” sensation when walking
- Stiffness limiting range of motion in the leg/legs
treatment
Our orthopedic specialist, Dr. Schwartz and Pamela Thomas, PA-C, will treat your Osteoarthritis in your hip by using non-surgical options to reduce pain and maintain joint movement. Should your symptoms persist, Dr. Kime or Dr. Lovelace will determine if surgery (arthroscopy or hip joint replacement) is needed.
Non-surgical
- Anti-inflammatories
- Physical therapy
- Physical exercise plan to maintain joint movement
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6 - Total Hip Replacement
overview
In a Total Hip Replacement, the damaged bone and cartilage within the hip joint is replaced with prosthetics/implants to replicate the ball and socket of a healthy hip.
Preparation: In preparation for the procedure, you are anesthetized. The surgeon creates an incision to expose your hip joint. The damaged head of your femur is removed.
Symptoms
Most candidates for total hip replacement surgery experience the following symptoms:
- Severe pain in the hip joint that limits daily activity
- Limited hip motion
treatment
Developing the right treatment plan for your hip pain is of the utmost importance to Dr. Kime and Dr. LoveLace at Hess Orthopaedic Center. Our orthopedic specialist will consult with you to determine if non-surgical or surgery are the best options for you.
Knee
Knees bear the body’s weight, and are often the first joints to signal changes and pain associated with progressing age. Our surgeons have extensive knowledge and experience addressing knee pain, and offer appropriate and effective treatments based on the nature and severity of injuries.
1 - Anterior Cruciate Ligament Tear (ACL Tear)
overview
The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.
One of the most common knee injuries is an anterior cruciate ligament sprain or tear.Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.
If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.
Symptoms
When you injure your anterior cruciate ligament, you might hear a “popping” noise and you may feel your knee give out from under you. Other typical symptoms include:
- Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
- Loss of full range of motion
- Tenderness along the joint line
- Discomfort while walking
treatment
Nonsurgical Treatment
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.
- Bracing. Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
- Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
Surgical Treatment
Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as scaffolding for a new ligament to grow on.
Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.
provider
2 - Arthritis of the Knee
overview
Arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.
Arthritis may be caused by disease (osteoarthritis or rheumatoid arthritis) or by trauma (fractures).
Symptoms
- Pain: joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping.
- Swelling
- Changes in Surrounding Joints
- Warmth
- Crepitation and Looseness
- Cysts
- Deformity (especially from Rheumatoid arthritis)
treatment
Non-surgical treatment includes medication (anti-inflammatories), injections (a long-lasting anesthetic and a steroid) and splinting worn during periods when the joint hurts.
If nonsurgical treatment fails to give relief, surgery is usually discussed. There are many surgical options. The chosen course of surgical treatment should be one that has a reasonable chance of providing long-term pain relief and return to function. It should be tailored to your individual needs. If there is any way the joint can be preserved or reconstructed, this option is usually chosen.
3 - Meniscus Tear
overview
This common injury of the knee occurs when one of the rubbery, C-shaped disc that cushions your knee (meniscus) tears. This tear is usually caused by twisting or rotating your knee suddenly.
Symptoms
Symptoms of a Meniscus tear may include:
- A popping sensation and pain in your knee
- Trouble straightening your leg
- Swelling and stiffness
- Catching or locking of your knee
treatment
Treatment will vary depending on the type of tear, its size and location. The Hess Orthopaedic Center surgeons Dr. Kime and Dr. LoveLace will determine if nonsurgical or surgical treatment is the best for your injury.
Non-Surgical Treatment - Most common if your tear is small and on the outer edge of the meniscus
- Rest
- Ice
- Compression
- Elevation
- Non-steroidal anti-inflammatory medicines
Surgical Treatment
- Our surgeon will repair the Meniscus tear via arthroscopic surgery, which is a miniature camera inserted through a small incision. They will then insert miniature surgical instruments to trim and repair the Meniscus.
4 - Osteoarthritis of the Knee
overview
The knee is made up of cartilage, which is a tough, flexible connective tissue that acts as a shock absorber. In Osteoarthritis of the Knee, the cartilage is gradually broken down.
Symptoms
Most patients with Osteoarthritis of the Knee experience the following symptoms:
- Pain
- Swelling
- Stiffness of the knee
- Decreased mobility
- Bone spurs (may occur)
treatment
Depending on the severity of the Osteoarthritis of the Knee, The Hess Orthopaedic Center surgeons, Dr. Schwartz and Pamela Thomas, PA-C, will determine if nonsurgical or surgical treatment is the best for you.
Non-surgical
- Anti-inflammatories
- Steroid injections
- Physical therapy
Surgery
If your cartilage is severely damaged, you may have to have knee replacement surgery. Should you need this treatment option, our surgeons will walk you through the steps of the surgery and your recovery.
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5 - Total Knee Replacement
overview
If your knee is severely damaged, you may have to have a Total Knee Replacement procedure, which replaces the damaged portions of your knee with artificial parts. This procedure aims to restore function and motion of the knee joint.
Symptoms
Candidates for a Total Knee Replacement procedure may experience the following symptoms:
- Severe knee pain limiting everyday activities
- Long-lasting knee inflammation and swelling that doesn’t get better with rest or medications
- A bowing in or out of your leg
- Knee stiffness
treatment
The Hess Orthopaedic Center surgeons will walk you through the steps and recovery of Total Knee Replacement procedure. Our surgeons, Dr. Kime and Dr. LoveLace, will most likely replace the damaged portions of your knee with artificial parts.
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Ankle
The ankle is a complex joint formed by the connection of three bones and including several important ligaments. When the ankle is injured you may experience the following symptoms:
- Swelling
- Tenderness in your ankle
- Difficulty putting weight on your ankle
Common conditions causing ankle pain are:
1 - Achilles Tendon Injuries
overview
The Achilles Tendon is the largest tendon in the body. It stretches from the heel bone to your calf muscles, and you use it to walk, run and jump. The most common injuries to the Achilles tendon include tendonitis (inflammation), tendinosis (degeneration) and rupture.
Symptoms
Pain and tenderness are the most typical Achilles Tendon injury symptoms. However, you may experience tenderness and stiffness of the ankle.
treatment
Depending on your Achilles Tendon injury, our podiatric surgeon, Dr. Moorman, will provide the following treatment options:
Tendinitis and Tendinosis
- Rest
- Ice
- Over-the-counter pain relievers
- Physical therapy
Achilles Rupture
Ruptures are treated either with surgery, a cast or both.
2 - Ankle Fractures (Broken Ankle)
overview
A fractured ankle could involve all (or one) of the bones that make up the ankle joint:
- Tibia – shinbone
- Fibula – smaller bone of the lower leg
- Talus – a small bone that sits between the heel bone (calcaneus) and the tibia and fibula
Symptoms
Symptoms of a broken ankle include:
- Immediate and severe pain
- Swelling
- Bruising
- Tender to touch
- Cannot put any weight on the injured foot
- Deformity (“out of place”)
treatment
After a thorough exam of your ankle and x-ray images, your physician may recommend non-operative treatment or surgery to assist with healing. The treatment plan depends on the severity and placement of the fracture
Non-operative treatment
- Casting / Immobilization: protecting and restricting the ankle and foot in a cast or splint
- Rest, Ice, Elevation, restricted weight-bearing
- Pain medication (if medically necessary)
Surgical treatment
If the fracture is out of place or the ankle is unstable, surgery may be recommended.
In some cases, surgery may be considered even if the fracture is not out of place. This is done to reduce the risk of the fracture not healing (called a nonunion), and to allow you to start moving the ankle earlier
Depending on the fracture, the bone fragments may be fixed using screws, a plate and screws, or different wiring techniques
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3 - Ankle Instability
overview
Ankle instability is a condition involving repeated sprains, ongoing pain and repeated instances of the ankle “giving away”. The condition is caused by several different factors, including static alignment, muscle weakness, poor body movement, and ligament injury. The condition may lead to arthritis and long term chronic pain if left untreated.
Symptoms
Symptoms may include:
- A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
- Persistent (chronic) discomfort and swelling
- Pain or tenderness
- The ankle feeling wobbly or unstable
treatment
The physician may recommend a conservative treatment plan that includes:
- Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport.
- Bracing. Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation.
In some cases, the foot and ankle surgeon will recommend surgery based on the level of
instability or how well non-surgical treatment has helped the condition.
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4 - Ankle Sprains
overview
Ankles sprains are common injuries that results when the strong ligaments that support the ankle is stretched beyond its normal range of motion. They range from mild to severe, depending on how much damage is done to the ligament. There are three types of common sprains:
- Lateral Inversion Sprains – Caused by your foot rolling inward
- Medial Eversion Sprains – Caused when your foot rolls outward
- Syndesmosis (High Ankle) Sprains – Occurs when the foot rolls outward and the leg turns inward
Symptoms
A sprained ankle is painful. Common symptoms include:
- Swelling
- Bruising
- Tenderness to touch
- Instability of the ankle—this may occur when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.
If there is severe tearing of the ligaments, you might also hear or feel a “pop” when the sprain occurs.
treatment
Treatment for an ankle sprain depends on the severity of the injury. Dr. Moorman, at Hess Orthopaedic Center will examine your ankle and provide the following treatment options:
- Rest, ice, compression and elevation
- Wrap, brace or walking boot to stabilize the ankle
- Rehabilitation exercises
5 - Tarsal Tunnel Syndrome
overview
Tarsal Tunnel Syndrome is a condition involving pressure on the tibial nerve in the ankle region. The nerve passes into the foot from around the inside of the ankle just below the ankle bone. Just beyond this point, the nerve enters the foot by passing between a muscle and a bone in the foot. This area is called the Tarsal Tunnel. The Posterior Tibial Nerve is the largest nerve that enters the foot.
The most common causes of the compression/pressure include: tenosynovitis (swelling of the synovial membrane lining the tendons), tumors such as lipoma or ganglion, rheumatoid arthritis, osteoarthritis, fractures of the talus, tibia or calcaneum bones, fibrosis around the tibial nerve, pregnancy, varicose veins, or presence of extra muscle tissue in the tarsal canal.
Symptoms
Pain
- pain with prolonged standing or walking (or wearing a particular type of shoe)
- sharp, burning pains in the foot
- Pain located around the ankle (usually on the inner side) and extending to the toes usually worsens during walking and is relieved by rest
Numbness
- intermittent numbness in the plantar foot
Sensation
- Foot may feel dry in one half or the other
- Foot may feel cold in one half or the other
treatment
Treatment may include the following:
- Nerve Conduction Studies / MRI
- Corticosteroid injections: Injections of a corticosteroid/anesthetic mixture into the area may relieve pain
- Orthoses / Orthotics / splint
- Anti-inflammatory medications
- When other treatments do not relieve the pain, surgery to relieve pressure on the nerve may be necessary.
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Foot
The foot and ankle are complex structures interwoven with ligaments, vessels, muscles, and bones. A tiny misalignment can equal major repercussions. Our Podiatrist provides a full spectrum of services related to your foot and ankle problems.
1 - Arthritis of the Foot
overview
Arthritis is a disease characterized by the inflammation of the cartilage and lining of the body’s joints. Inflammation causes redness, warmth, pain and swelling. Arthritis is a major cause of foot pain because each foot has 33 joints that can become affected by the disease.
There are many different types of arthritis. The most common in the foot are osteoarthritis, rheumatoid arthritis and posttraumatic arthritis.
- Osteoarthritis causes excessive strain and the wearing away of cartilage in the joints of the foot. Movement becomes very difficult and painful. The pain and swelling worsens while standing or walking, and stiffness usually occurs after periods of rest.
- Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body, and often starts in the foot and ankle. It is symmetrical, meaning that it usually affects the same joint on both sides of the body
- Posttraumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury.
Symptoms
The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There can be other symptoms, as well, including:
- Pain with motion
- Pain that flares up with vigorous activity
- Tenderness when pressure is applied to the joint
- Joint swelling, warmth, and redness
- Increased pain and swelling in the morning, or after sitting or resting
- Difficulty in walking due to any of the above symptoms
treatment
Conservative treatment (non-surgical treatment) of the arthritic foot includes proper footwear, orthotics, and/or forefoot supports. Treatment may also include Physical Therapy and Anti-Inflammatory medications.
Your physician may recommend surgery in some cases, including arthroscopic debridement to remove loose cartilage or a total ankle replacement.
provider
2 - Bunion
overview
A bunion is a bony, often painful bump, on the inside of the foot at the big toe joint. It typically starts small, but over time as the big toe pushes outward against the first metatarsal bone it can become very large.
Symptoms
In addition to the visible bump at the base of your big toe, symptoms of a bunion may include:
- Pain, swelling and redness around the affected joint
- Hardened skin on the bottom of the foot
- A callus or corn on the bump
- Stiffness and restricted motion in the big toe, which may lead to difficulty in walking
treatment
Bunions are most commonly treated without surgery. The podiatric surgeon, Dr. Moorman, at Hess Orthopaedic Center will create a treatment plan that is right for your needs depending on the severity of your bunion.
Most common non-surgical treatments
- Changes in footwear
- Padding
- Orthotics and Other Devices
- Icing
- Medications (anti-inflammatories)
Bunion Surgery
- Realings bone, ligaments, tendons and nerves so that the big toe can be brought
back to its correct position
3 - Foot Fracture
overview
Fractures of the bones in the foot are quite common. About 1 in every 10 broken bones occurs in the foot.
Fractures can result from a direct blow to the foot, such as accidentally kicking something hard or dropping a heavy object on your toes. They can also result from the overuse and repetitive stress that comes with participating in high-impact sports like running; this is called a stress fracture.
Some of the more common fractures involve the metatarsal bones (the long bones between your toes and the middle of your foot), calcaneous (heel bone), and phalanges (toes)
Symptoms
The most common symptoms of a fracture are pain and swelling. Other symptoms may include:
- Bruising or discoloration that extends to nearby parts of the foot
- Pain with walking and weight bearing
- Tenderness
- Limping
treatment
Most foot fractures can be treated with an initial period of elevation and limited weight bearing. This is followed by gradual weight bearing in a cast or walking boot. Surgery is not often required.
If you have fractured several metatarsals at the same time and your foot is deformed or unstable, surgery is necessary. During the procedure, your doctor will make an incision in your foot, and then insert pins or plates and screws to hold the bones in place while they heal.
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4 - Flat Foot (Pes Planus)
overview
Flat foot is a condition that causes the arches of the foot to collapse, forcing the entire sole of the foot to come in contact with the ground when standing.
Flat foot occurs regularly in children, but most children outgrow it eventually as their feet get larger, their baby fat disappears and their foot muscles strengthen with weight bearing activity such as walking.
Acquired adult flatfoot deformity (AAFD) is a progressive flattening of the arch of the foot that occurs as the posterior tibial tendon becomes insufficient.
A foot and ankle specialist should be consulted for patients with flat foot if they also have foot pain, if the ankle is red, the feet or ankles feel tired, or calluses are forming under the arches.
Symptoms
Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms below:
- Pain along the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle.
- Pain that is worse with activity. High intensity or impact activities, such as running, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time.
- When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain on the outside of the ankle.
treatment
Treatment may include stretching exercises to lengthen the heel cord. Your doctor may also recommend shoe inserts called orthotics. These custom-molded arches made of composite materials provide support and relieve pain. Shoe inserts not only help people with flat foot to walk comfortably, they also extend the life of their shoes, which otherwise would wear unevenly. In certain cases, physical therapy is recommended.
In rare cases where conservative treatments don’t relieve pain, surgery is recommended.
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5 - Hammer Toe
overview
A Hammer Toe occurs when the middle joint in the second, third or fourth toes bends downward.
Symptoms
A downward, claw-like bend in the toe at the middle joint is the most visible symptom of a Hammer Toe. Other symptoms include:
- Pain/difficulty moving the toe
- Corns or calluses forming on top of the middle joint or tip of the toe
treatment
The podiatric surgeon, Dr. Moorman, at Hess Orthopaedic Center will develop an individualized treatment plan depending of the stage of your condition.
Most common Non-surgical Treatments
- Being fitted with new shoes that have soft, roomy toe boxes
- Toe exercises
Surgery
If these options are not successful, outpatient surgery may be needed to straighten the toe.
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6 - Heel Spurs
overview
A bone spur (or osteophyte) is a small bony growth or collection of bony growths on or near the joints. When a bone spur occurs on heel, it is called a heel spur. Heel spurs occur when calcium deposits build up on the underside of the heel bone; this usually occurs over a period of many months.
Symptoms
Although heel spurs are often painless, they can cause pain. Often, the heel spur will show up on an x-ray taken for some other problem. Pain may be more severe after long periods of rest (sleep) or after running, walking or lifting heavy weight.
treatment
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7 - High Arch (Cavus Foot)
overview
A high arch, which is also called a cavus foot, is sometimes seen in children but may not be noticed until adulthood. High arches are hereditary or caused by a bone (orthopedic) or nerve (neurological) condition.
People with high arches are vulnerable to overuse injuries during sports and exercise because their feet aren’t good shock absorbers. Not as much of the foot touches the ground to provide support for walking.
Symptoms
- Shortened foot length
- Difficulty fitting shoes
- Foot pain with walking, standing, and running (not everyone has this symptom)
treatment
High arches, particularly ones that are flexible or well cared for, may not need any treatment.
Corrective shoes may help relieve pain and improve walking. This includes changes to the shoes, such as an arch insert and a support insole.
Surgery to flatten the foot is sometimes needed in severe cases. Any nerve problems that exist must be treated by specialists.
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8 - Plantar Fasciitis
overview
Plantar fasciitis is the most common cause of pain in the heel of the foot. It occurs when the strong band of connective tissue that supports the arch of your foot becomes inflamed or irritated.
Symptoms
Most patients with Plantar Fasciitis will feel a stabbing sensation in the heel of the foot. The pain is typically worst in the morning when you take a few steps out of bed, or following exercise.
treatment
Plantar Fasciitis is typically treated with:
- Rest
- Ice
- Anti-inflammatories/Corticosteroid Medications
- Orthotics/Splints
- Physical Therapy
If these techniques are not effective, surgery may be needed.
Dr. Moorman, at Hess Orthopaedic Center will examine your foot and create the best treatment plan for you.
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9 - Soft Tissue Masses (Foot)
overview
Soft tissue tumors are cell growths that emerge nearly anywhere in the body: in tendons, muscles, ligaments, cartilage, nerves, blood vessels, fat, and other tissues. Patients commonly refer to these masses as lumps or bumps.
There are a large number of lumps and bumps that may occur in the foot; the most common are bursas, ganglion cysts, inclusion cysts, fibromas or lipomas.. Soft tissue tumors can be cancerous or benign. The vast majority of soft tissue masses of the foot are benign (non-cancerous).
Symptoms
The mass usually presents as a localized lump or bump on the forefoot, rearfoot or ankle area. It may or may not be painful. The average soft tissue mass is usually 3-4 cm.
treatment
If you have a mass, have it examined by a physician.
Your physician may offer the following treatment:
- Aspirate or drain the mass if it appears to be fluid-filled.
- Inject the mass with a steroid, which may shrink it.
- Order an MRI.
- Recommend and perform excision.
- The mass can then be examined by a pathologist and diagnosis can be made.
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PAIN MANAGEMENT
Pain Management specialists focus on the use of medications, injections and other interventional procedures to assist in the diagnosis and treatment of pain-related conditions.
Please check our Pain Management website here hesspain.com for more information on services Hess Orthopaedic provides.
