Shoulder Injuries in the Throwing Athlete

Shoulder Injuries in the Throwing Athlete

Article Featured on AAOS

Overhand throwing places extremely high stresses on the shoulder, specifically to the anatomy that keeps the shoulder stable. In throwing athletes, these high stresses are repeated many times and can lead to a wide range of overuse injuries.

Although throwing injuries in the shoulder most commonly occur in baseball pitchers, they can be seen in any athlete who participates in sports that require repetitive overhand motions, such as volleyball, tennis, and some track and field events.

Anatomy of the Shoulder

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum. The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.

Strong connective tissue, called the shoulder capsule, is the ligament system of the shoulder and keeps the head of the upper arm bone centered in the glenoid socket. This tissue covers the shoulder joint and attaches the upper end of the arm bone to the shoulder blade.

The bones of the shoulder

The bones of the shoulder. Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

The ligaments of the shoulder

The ligaments of the shoulder. Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Your shoulder also relies on strong tendons and muscles to keep your shoulder stable. Some of these muscles are called the rotator cuff. The rotator cuff is made up of four muscles that come together as tendons to form a covering or cuff of tissue around the head of the humerus.

The biceps muscle in the upper arm has two tendons that attach it to the shoulder blade. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process. These attachments help to center the humeral head in the glenoid socket.

rotator cuff anatomy

This illustration shows the biceps tendons and the four muscles and their tendons that form the rotator cuff and stabilize the shoulder joint. Reproduced and adapted with permission from The Body Almanac. (c) American Academy of Orthopaedic Surgeons, 2003.

In addition to the ligaments and rotator cuff, muscles in the upper back play an important role in keeping the shoulder stable. These muscles include the trapezius, levator scapulae, rhomboids, and serratus anterior, and they are referred to as the scapular stabilizers. They control the scapula and clavicle bones — called the shoulder girdle — which functions as the foundation for the shoulder joint.

Muscles in the upper back

Muscles in the upper back help to keep the shoulder stable, particularly during overhead motions, like throwing. (Note: this illustration has been drawn in such a way to show the many layers of muscle in the back.) Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Cause

When athletes throw repeatedly at high speed, significant stresses are placed on the anatomical structures that keep the humeral head centered in the glenoid socket.

baseball pitching phases

The phases of pitching a baseball. Reproduced and adapted with permission from Poss R (ed): Orthopaedic Knowledge Update 3. Rosemont, IL. American Academy of Orthopaedic Surgeons, 1990, pp 293-302.

Of the five phases that make up the pitching motion, the late cocking and follow-through phases place the greatest forces on the shoulder.

  • Late-cocking phase. In order to generate maximum pitch speed, the thrower must bring the arm and hand up and behind the body during the late cocking phase. This arm position of extreme external rotation helps the thrower put speed on the ball, however, it also forces the head of the humerus forward which places significant stress on the ligaments in the front of the shoulder. Over time, the ligaments loosen, resulting in greater external rotation and greater pitching speed, but less shoulder stability.
  • Follow-through phase. During acceleration, the arm rapidly rotates internally. Once the ball is released, follow-through begins and the ligaments and rotator cuff tendons at the back of the shoulder must handle significant stresses to decelerate the arm and control the humeral head.

When one structure — such as the ligament system — becomes weakened due to repetitive stresses, other structures must handle the overload. As a result, a wide range of shoulder injuries can occur in the throwing athlete.

The rotator cuff and labrum are the shoulder structures most vulnerable to throwing injuries.

Common Throwing Injuries In the Shoulder

SLAP Tears (Superior Labrum Anterior to Posterior)

In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the long head of the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and in back (posterior) of this attachment point.

Typical symptoms are a catching or locking sensation, and pain with certain shoulder movements. Pain deep within the shoulder or with certain arm positions is also common.

shoulder labrum and SLAP tear

(Left) The labrum helps to deepen the shoulder socket.

(Right) This cross-section view of the shoulder socket shows a typical SLAP tear.

Bicep Tendinitis and Tendon Tears

Repetitive throwing can inflame and irritate the upper biceps tendon. This is called biceps tendinitis. Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis.

Occasionally, the damage to the tendon caused by tendinitis can result in a tear. A torn biceps tendon may cause a sudden, sharp pain in the upper arm. Some people will hear a popping or snapping noise when the tendon tears.

biceps tendinitis

(Left) The biceps tendon helps to keep the head of the humerus centered in the glenoid socket. (Right) Tendinitis causes the tendon to become red and swollen.

Rotator Cuff Tendinitis and Tears

When a muscle or tendon is overworked, it can become inflamed. The rotator cuff is frequently irritated in throwers, resulting in tendinitis.

Early symptoms include pain that radiates from the front of the shoulder to the side of the arm. Pain may be present during throwing, other activities, and at rest. As the problem progresses, pain may occur at night, and the athlete may experience a loss of strength and motion.

Rotator cuff tears often begin by fraying. As the damage worsens, the tendon can tear. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears in throwing athletes occur in the supraspinatus tendon.

rotator cuff tear

Rotator cuff tendon tears in throwers most often occur within the tendon. In some cases, the tendon can tear away from where it attaches to the humerus.

Problems with the rotator cuff often lead to shoulder bursitis. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

Internal Impingement

During the cocking phase of an overhand throw, the rotator cuff tendons at the back of the shoulder can get pinched between the humeral head and the glenoid. This is called internal impingement and may result in a partial tearing of the rotator cuff tendon. Internal impingement may also damage the labrum, causing part of it to peel off from the glenoid.

Internal impingement may be due to some looseness in the structures at the front of the joint, as well as tightness in the back of the shoulder.

The muscles and tendons of the rotator cuff

The muscles and tendons of the rotator cuff. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

shoulder impingement

This illustration shows the infraspinatus tendon caught between the humeral head and the glenoid. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Instability

Shoulder instability occurs when the head of the humerus slips out of the shoulder socket (dislocation). When the shoulder is loose and moves out of place repeatedly, it is called chronic shoulder instability.

In throwers, instability develops gradually over years from repetitive throwing that stretches the ligaments and creates increased laxity (looseness). If the rotator cuff structures are not able to control the laxity, then the shoulder will slip slightly off-center (subluxation) during the throwing motion.

Pain and loss of throwing velocity will be the initial symptoms, rather than a sensation of the shoulder “slipping out of place.” Occasionally, the thrower may feel the arm “go dead.” A common term for instability many years ago was “dead arm syndrome.”

Glenohumeral Internal Rotation Deficit (GIRD)

As mentioned above, the extreme external rotation required to throw at high speeds typically causes the ligaments at the front of the shoulder to stretch and loosen. A natural and common result is that the soft tissues in the back of the shoulder tighten, leading to loss of internal rotation.

This loss of internal rotation puts throwers at greater risk for labral and rotator cuff tears.

Scapular Rotation Dysfunction (SICK Scapula)

abnormal positioning of the scapula

This photograph shows abnormal positioning of the scapula on the right side. Reproduced with permission from Kibler B, Sciascia A, Wilkes T: Scapular Dyskinesis and Its Relation to Shoulder Injury. J Am Acad Orthop Surg 2012; 20:364-372.

Proper movement and rotation of the scapula over the chest wall is important during the throwing motion. The scapula (shoulder blade) connects to only one other bone: the clavicle. As a result, the scapula relies on several muscles in the upper back to keep it in position to support healthy shoulder movement.

During throwing, repetitive use of scapular muscles creates changes in the muscles that affect the position of the scapula and increase the risk of shoulder injury.

Scapular rotation dysfunction is characterized by drooping of the affected shoulder. The most common symptom is pain at the front of the shoulder, near the collarbone.

In many throwing athletes with SICK scapula, the chest muscles tighten in response to changes in the upper back muscles. Lifting weights and chest strengthening exercises can aggravate this condition.

Doctor Examination

Medical History and Physical Examination

The medical history portion of the initial doctor visit includes discussion about your general medical health, symptoms and when they first began, and the nature and frequency of athletic participation

During the physicial examination, your doctor will check the range of motion, strength, and stability of your shoulder. He or she may perform specific tests by placing your arm in different positions to reproduce your symptoms.

The results of these tests help the doctor decide if additional testing or imaging of the shoulder is necessary.

Imaging Tests

Your doctor may order tests to confirm your diagnosis and identify any associated problems.

X-rays. This imaging test creates clear pictures of dense structures, like bone. X-rays will show any problems within the bones of your shoulder, such as arthritis or fractures.

Magnetic resonance imaging (MRI). This imaging study shows better images of soft tissues. It may help your doctor identify injuries to the labrum, ligaments, and tendons surrounding your shoulder joint.

Computed tomography (CT) scan. This test combines x-rays with computer technology to produce a very detailed view of the bones in the shoulder area.

Ultrasound. Real time images of muscles, tendons, ligaments, joints, and soft tissues can be produced using ultrasound. This test is typically used to diagnose rotator cuff tears in individuals who are not able to have MRI scans.

Treatment

Left untreated, throwing injuries in the shoulder can become complicated conditions.

Nonsurgical Treatment

In many cases, the initial treatment for a throwing injury in the shoulder is nonsurgical. Treatment options may include:

  • Activity modification. Your doctor may first recommend simply changing your daily routine and avoiding activities that cause symptoms.
  • Ice. Applying icepacks to the shoulder can reduce any swelling.
  • Anti-inflammatory medication. Drugs like ibuprofen and naproxen can relieve pain and inflammation. They can also be provided in prescription-strength form.
  • Physical therapy. In order to improve the range of motion in your shoulder and strengthen the muscles that support the joint, your doctor may recommend specific exercises. Physical therapy can focus on muscles and ligament tightness in the back of the shoulder and help to strengthen the structures in the front of the shoulder. This can relieve some stress on any injured structures, such as the labrum or rotator cuff tendon.
  • Change of position. Throwing mechanics can be evaluated in order to correct body positioning that puts excessive stress on injured shoulder structures. Although a change of position or even a change in sport can eliminate repetitive stresses on the shoulder and provide lasting relief, this is often undesirable, especially in high level athletes.
  • Cortisone injection— If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can provide long-term pain relief for tears or other structural damage.

cortisone injection in shoulder

A cortisone injection may relieve painful symptoms. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
Your doctor may recommend surgery based on your history, physical examination, and imaging studies, or if your symptoms are not relieved by nonsurgical treatment.The type of surgery performed will depend on several factors, such as your injury, age, and anatomy. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.

Arthroscopy. Most throwing injuries can be treated with arthroscopic surgery. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.

During arthroscopy, your doctor can repair damage to soft tissues, such as the labrum, ligaments, or rotator cuff.

shoulder arthroscopy

During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint.

Open surgery. A traditional open surgical incision (several centimeters long) is often required if the injury is large or complex.

Rehabilitation. After surgery, the repair needs to be protected while the injury heals. To keep your arm from moving, you will most likely use a sling for for a short period of time. How long you require a sling depends upon the severity of your injury.

As soon as your comfort allows, your doctor may remove the sling to begin a physical therapy program.

In general, a therapy program focuses first on flexibility. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. This typically occurs 4 to 6 weeks after surgery.

Your doctor will discuss with you when it is safe to return to sports activity. If your goal is to return to overhead sports activities, your doctor or physical therapist will direct a therapy program that includes a gradual return to throwing.

It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year to return to your sports activities.

Prevention

In recent years, there has been a great deal of attention on preventing throwing injuries of the shoulder.

Proper conditioning, technique, and recovery time can help to prevent throwing injuries. Throwers should strive to maintain good shoulder girdle function with proper stretches and upper back and torso strengthening.

In the case of younger athletes, pitching guidelines regarding number of pitches per game and week, as well as type of pitches thrown, have been developed to protect children from injury.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Frequently Asked Questions About Ganglion Cysts

Frequently Asked Questions About Ganglion Cysts

Article Featured on Michigan Hand & Wrist

Ganglion cysts are noncancerous lumps that most commonly develop along the tendons or joints of your wrists or hands. They also may occur in the ankles and feet. Ganglion cysts are typically round or oval and are filled with a jellylike fluid.

Small ganglion cysts can be pea-sized, while larger ones can be around an inch (2.5 centimeters) in diameter. Ganglion cysts can be painful if they press on a nearby nerve. Their location can sometimes interfere with joint movement.

If your ganglion cyst is causing you problems, your doctor may suggest trying to drain the cyst with a needle. Removing the cyst surgically also is an option. But if you have no symptoms, no treatment is necessary. In many cases, the cysts go away on their own.

Here are the most common questions about Ganglion Cysts

Q: What is a ganglion cyst?

A: A ganglion cyst is a buildup of fluid under the skin, and although they can occur anywhere on the body, they are most commonly found on the wrist, feet, or ankles.

Q: What are the symptoms of a ganglion cyst?

A: The most common symptoms of a ganglion cyst include:

  • A firm, round lump under the skin.
  • Joint pain around the affected area.
  • Swelling, numbness, and muscle weakness surrounding the cyst.

Q: What causes a ganglion cyst?

A: The cause is not known at this time.

Q: How is a ganglion cyst diagnosed?

A: A licensed medical professional will perform a thorough examination may involve any of the following:

  • Moving the joint around the cyst while performing a visual inspection.
  • An ultrasound of the affected area.
  • An MRI of the joint where the cyst is located.

Q: How is a ganglion cyst treated.

A: While, some ganglion cysts pose no threat and will go away on their own, some require one or more of the following treatment methods:

  • Aspiration, or draining, of the cyst to decrease inflammation and reduce pain.
  • A steroid injection directly into the cyst.
  • Surgical removal of the cyst.

Q: What can I do to manage the symptoms?

A: Your medical professional will likely suggest one of the following:

  • Hand therapy designed to help improve movement and reduce pain.
  • A protective splint that will limit movement and shrink the cyst.
  • If surgery is required, proper wound care will prevent tissue damage and reduce pain and swelling.

Q: When should I seek professional care?

A: Seek the assistance of a medical professional if you experience any of the following:

  • You are experience pain, numbness, or limited motion in the affected joint.
  • The limb containing a cyst gets stiff, unstable, numb, or weak.
  • A previously treated cyst returns or grows.
  • Your pain is ongoing after treatment.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What Are The Most Common Wrist Injuries?

What Are The Most Common Wrist Injuries?

Article Featured on Michigan Hand & Wrist

Repetitive motions and everyday activities can easily lead to injuries of the wrist. It is important to understand the most common of these injuries so you know when it’s time to consult a doctor.

Sprains and Strains

If you experience pain, bruising and the inability to move your wrist, you may have a stretched or torn ligament. This is called a sprain, and it is caused by things such as falling or getting hit. A stretched or torn tendon or muscle in your wrist is a strain, which might happen over the course of time or develop suddenly. Many wrist strains and sprains can be treated at home with ice, rest and compression bands. More serious cases may require physical therapy.

Broken Bones

Broken wrists account for 10 percent of broken bones in the United States. The term “broken wrist” usually applies to a fracture of the radius in the forearm that occurs at the lower, or distal, end near where it connect to the hand bones on the thumb side. Broken wrists are usually caused by falling with outstretched arms or getting hit very hard. Symptoms of a broken wrist include severe pain, swelling, tenderness, and a deformity that makes it appear bent. People who suspect they have a broken wrist should consult a doctor immediately so treatment can begin.

Carpal Tunnel Syndrome

The eight bones of the wrist are called carpals, and the tube that runs through them is called the carpal tunnel. The carpal tunnel contains nerves and tendons, and when those tendons swell or become irritated it narrows the canal and puts pressure on the nerves that causes them to compress. This causes numbness, and as it worsens people may have trouble grasping things. Treatments include rest, splints and medications for pain and to reduce inflammation. Severe cases require surgery in order for people to regain normal wrist movement.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What are the symptoms of knee ligament injuries

What are the symptoms of knee ligament injuries?

What are knee ligament injuries?

Knee ligaments are the short bands of tough, flexible connective tissue that hold the knee together. Knee ligament injuries can be caused by trauma, such as a car accident. Or they can be caused by sports injuries. An example is a twisting knee injury in basketball or skiing.

The knee has 4 major ligaments. Ligaments connect bones to each other. They give the joint stability and strength. The 4 knee ligaments connect the thighbone (femur) to the shin bone (tibia). They are:

  • Anterior cruciate ligament (ACL). This ligament is in the center of the knee. It controls rotation and forward movement of the shin bone.
  • Posterior cruciate ligament (PCL). This ligament is in the back of the knee. It controls backward movement of the shin bone.
  • Medial collateral ligament (MCL). This ligament gives stability to the inner knee.
  • Lateral collateral ligament (LCL). This ligament gives stability to the outer knee.

What causes knee ligament injuries?

Cruciate ligaments

The ACL is one of the most common ligaments to be injured. The ACL is often stretched or torn during a sudden twisting motion. This is when the feet stay planted one way, but the knees turn the other way. Slowing down while running or landing from a jump incorrectly can cause ACL injuries.  Skiing, basketball, and football are sports that have a higher risk for ACL injuries.

The PCL is also a common ligament to become injured in the knee. But a PCL injury usually occurs with sudden, direct hit, such as in a car accident or during a football tackle.

Collateral ligaments

The MCL is injured more often than the LCL. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee. This can happen when playing hockey or football.

What are the symptoms of knee ligament injuries?

Cruciate injury

A cruciate ligament injury often causes pain. Often you may hear a popping sound when the injury happens. Then your buckles when you try to stand on it. The knee also swells. You also are not able to move your knee as you normally would. You may also pain along the joint and pain when walking.

The symptoms of a cruciate ligament injury may seem like other health conditions. Always see your healthcare provider for a diagnosis.

Collateral ligament injury

An injury to the collateral ligament also causes the knee to pop and buckle. It also causes pain and swelling. Often you will have pain at the sides of the knee and swelling over the injury site. If it is an MCL injury, the pain is on the inside of the knee. An LCL injury may cause pain on the outside of the knee. The knee will also feel unstable, like it is going to give way.

How are knee ligament injuries diagnosed?

Your healthcare provider will ask you have your health history and do a physical exam. You may also needs one or more of these tests:

  • X-ray. This imaging test can rule out an injury to bone instead of a ligament injury. It uses energy beams to make images of internal tissues, bones, and organs on film.
  • MRI. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. It can often find damage or disease in bones and a surrounding ligament, tendon, or muscle.
  • Arthroscopy. This procedure is used to diagnose and treat joint problems. The healthcare provider uses a small, lighted tube (arthroscope) put into the joint through a small cut (incision). Images of the inside of the joint can be seen a screen. The procedure can assess joint problems, find bone diseases and tumors, and find the cause of bone pain and inflammation.

How are knee ligament injuries treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

  • Treatment may include:
  • Pain medicine such as ibuprofen
  • Muscle-strengthening exercises
  • Protective knee brace
  • Ice pack to ease swelling
  • Surgery

Key points about knee ligament injuries

  • Knee ligaments are the short bands of elastic tissue that holds the knee together. There are 4 main ligaments in each knee.
  • Knee ligament injuries can be cause by trauma, such as a car accident. Or they can by caused by sports injuries.
  • The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured.
  • Treatment may include medicine, muscle-strengthening exercises, a knee brace, or surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

How to Tell if Your Foot is Broken: Symptoms & Treatment Options

How to Tell if Your Foot is Broken: Symptoms & Treatment Options

Article Featured on Mayo Clinic

Overview

Foot and ankle bones

A broken foot is an injury to the bone. You may experience a broken foot during a car crash or from a simple misstep or fall. The seriousness of a broken foot varies. Fractures can range from tiny cracks in your bones to breaks that pierce your skin.

Treatment for a broken foot depends on the exact site and severity of the fracture. A severely broken foot may require surgery to implant plates, rods or screws into the broken bone to maintain proper position during healing.

Symptoms of a Broken Foot

If you have a broken foot, you may experience some of the following signs and symptoms:

  • Immediate, throbbing pain
  • Pain that increases with activity and decreases with rest
  • Swelling
  • Bruising
  • Tenderness
  • Deformity
  • Difficulty in walking or bearing weight

When to see a doctor if you think your foot is broken

See a doctor if there is obvious deformity, if the pain and swelling don’t get better with self-care, or if the pain and swelling gets worse over time. Also, see a doctor if the injury interferes with walking.

Common Causes of a Broken Foot

The most common causes of a broken foot include:

  • Car accidents. The crushing injuries common in car accidents may cause breaks that require surgical repair.
  • Falls. Tripping and falling can break bones in your feet, as can landing on your feet after jumping down from just a slight height.
  • Impact from a heavy weight. Dropping something heavy on your foot is a common cause of fractures.
  • Missteps. Sometimes just putting your foot down wrong can result in a broken bone. A toe can get broken from stubbing your toes on furniture.
  • Overuse. Stress fractures are common in the weight-bearing bones of your feet. These tiny cracks are usually caused over time by repetitive force or overuse, such as running long distances. But they can also occur with normal use of a bone that’s been weakened by a condition such as osteoporosis.

Risk factors

You may be at higher risk of a broken foot or ankle if you:

  • Participate in high-impact sports. The stresses, direct blows and twisting injuries that occur in sports such as basketball, football, gymnastics, tennis and soccer can causes foot fractures.
  • Use improper technique or sports equipment. Faulty equipment, such as shoes that are too worn or not properly fitted, can contribute to stress fractures and falls. Improper training techniques, such as not warming up and stretching, also can cause foot injuries.
  • Suddenly increase your activity level. Whether you’re a trained athlete or someone who’s just started exercising, suddenly boosting the frequency or duration of your exercise sessions can increase your risk of a stress fracture.
  • Work in certain occupations. Certain work environments, such as a construction site, put you at risk of falling from a height or dropping something heavy on your foot.
  • Keep your home cluttered or poorly lit. Walking around in a house with too much clutter or too little light may lead to falls and foot injuries.
  • Have certain conditions. Having decreased bone density (osteoporosis) can put you at risk of injuries to your foot bones.

Complications from a Broken Foot

Complications of a broken foot are uncommon but may include:

  • Arthritis. Fractures that extend into a joint can cause arthritis years later. If your foot starts to hurt long after a break, see your doctor for an evaluation.
  • Bone infection (osteomyelitis). If you have an open fracture, meaning one end of the bone protrudes through the skin, your bone may be exposed to bacteria that cause infection.
  • Nerve or blood vessel damage. Trauma to the foot can injure adjacent nerves and blood vessels, sometimes actually tearing them. Seek immediate attention if you notice any numbness or circulation problems. Lack of blood flow can cause a bone to die and collapse.

Prevention

These basic sports and safety tips may help prevent a broken foot:

  • Wear proper shoes. Use hiking shoes on rough terrain. Wear steel-toed boots in your work environment if necessary. Choose appropriate athletic shoes for your sport.
  • Replace athletic shoes regularly. Discard sneakers as soon as the tread or heel wears out or if the shoes are wearing unevenly. If you’re a runner, replace your sneakers every 300 to 400 miles.
  • Start slowly. That applies to a new fitness program and each individual workout.
  • Cross-train. Alternating activities can prevent stress fractures. Rotate running with swimming or biking.
  • Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, really can do your body good. Taking vitamin D supplements also can help.
  • Use night lights. Many broken toes are the result of walking in the dark.
  • Declutter your house. Keeping clutter off the floor can help you to avoid trips and falls.

Diagnosing a Broken Foot

During the physical exam, your doctor will check for points of tenderness in your foot. The precise location of your pain can help determine its cause. They may move your foot into different positions, to check your range of motion. You may be asked to walk for a short distance so that your doctor can examine your gait.

Imaging tests

If your signs and symptoms suggest a break or fracture, your doctor may suggest one or more of the following imaging tests.

  • X-rays. Most foot fractures can be visualized on X-rays. The technician may need to take X-rays from several different angles so that the bone images won’t overlap too much. Stress fractures often don’t show up on X-rays until the break actually starts healing.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into a vein. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas, including stress fractures, show up as bright spots on the resulting image.
  • Computerized tomography (CT). CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body. CT scans can reveal more detail about the bone and the soft tissues that surround it, which may help your doctor determine the best treatment.
  • Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to create very detailed images of the ligaments that help hold your foot and ankle together. This imaging helps to show ligaments and bones and can identify fractures not seen on X-rays.

Treating a Broken Foot

Treatments for a broken foot will vary, depending on which bone has been broken and the severity of the injury.

Medications

Your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others).

Therapy

After your bone has healed, you’ll probably need to loosen up stiff muscles and ligaments in your feet. A physical therapist can teach you exercises to improve your flexibility and strength.

Surgical and other procedures

  • Reduction. If you have a displaced fracture, meaning the two ends of the fracture are not aligned, your doctor may need to manipulate the pieces back into their proper positions — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.
  • Immobilization. To heal, a broken bone must be immobilized so that its ends can knit back together. In most cases, this requires a cast.

    Minor foot fractures may only need a removable brace, boot or shoe with a stiff sole. A fractured toe is usually taped to a neighboring toe, with a piece of gauze between them.

  • Surgery. In some cases, an orthopedic surgeon may need to use pins, plates or screws to maintain proper position of your bones during healing. These materials may be removed after the fracture has healed if they are prominent or painful.

Preparing for your appointment for a Broken Foot

You will likely initially seek treatment for a broken foot in an emergency room or urgent care clinic. If the pieces of broken bone aren’t lined up properly for healing, you may be referred to a doctor specializing in orthopedic surgery.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

For a broken ankle or foot, basic questions to ask your doctor include:

  • What tests are needed?
  • What treatments are available, and which do you recommend?
  • If I need a cast, how long will I need to wear it?
  • Will I need surgery?
  • What activity restrictions will need to be followed?
  • Should I see a specialist?
  • What pain medications do you recommend?

Don’t hesitate to ask any other questions you have.

What to expect from your doctor

Your doctor may ask some of the following questions:

  • Was there a specific injury that triggered your symptoms?
  • Did your symptoms come on suddenly?
  • Have you injured your feet in the past?
  • Have you recently begun or intensified an exercise program?

What to do in the meantime

If your injury isn’t severe enough to warrant a trip to the emergency room, here are some things you can do at home to care for your injury until you can see your doctor:

  • Apply ice for 15 to 20 minutes at a time, every three to four hours to bring down the swelling.
  • Keep your foot elevated.
  • Don’t put any weight on your injured foot.
  • Lightly wrap the injury in a soft bandage that provides slight compression.
When to Worry About Neck Pain … and when not to!

When to Worry About Neck Pain … and when not to!

Article by Paul Ingraham | Featured on Pain Science

We fear spine pain more than we fear other kinds of pain. Backs and necks seem vulnerable. And yet most spinal pain does not have a serious cause. The bark of neck pain is usually worse than its bite. This article explains how to tell the difference.

Please do seek care immediately if you’ve been in an accident or you have very severe or weird pain or other symptoms — obviously. This article is for non-emergency situations. But if you have neck pain that’s been starting to worry you, this is a good place to get some reassurance and decide whether or not to talk to a doctor.

Although it’s rare, once in a while neck pain may be a warning sign of cancer, infection, autoimmune disease, or some kind of structural problem like spinal cord injury or a threat to an important blood vessel. Some of these ominous situations cause hard-to-miss signs and symptoms other than pain and are likely to be diagnosed correctly and promptly — so, if it feels serious, go get checked out. Otherwise, if you are aware of the “red flags,” you can get checked out when the time is right — and avoid excessive worry until then.

The rule of thumb is that you should start a more thorough medical investigation only when all three of these conditions are met, three general red flags for neck pain:

  1. it’s been bothering you for more than about 6 weeks
  2. it’s severe and/or not improving, or actually getting worse
  3. there is at least one other “red flag” (see below)

And there is one (hopefully obvious) situation where there’s no need to wait several weeks before deciding the situation is serious: if you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves. I didn’t really have to tell you that, did I? Well, I did for legal reasons!

Several more specific red flags for neck pain: a checklist

Check all that apply. Most people will not be able to check many of these! But the more you can check, the more worthwhile it is to ask your doctor if it’s possible that there’s something more serious going on than just neck pain. Most people who check off an item or two will turn out not to have an ominous health issue. But red flags are reasons to check… not reasons to worry.

  • Light tapping on the spine is painful.
  • Weight loss without dieting is a potential sign of cancer.
  • Mystery fevers and/or chills (especially in diabetic patients).
  • A fierce headache, and/or an inability to bend the head forward (nuchal rigidity), and/or fever, and/or altered mental state are all symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects).
  • A severe headache that comes on suddenly is colourfully called a “thunderclap headache”! Most are harmless, but they should always be investigated.1
  • Severe, novel pain (throbbing or constrictive) may be caused by an artery tear234 with a high risk of a stroke. Pain is the only symptom of some tears. Most but not all cases5 are sudden, on one side, and cause both neck and head pain (in the temple or back the skull), but the pain is usually strange.6 Any hint of other symptoms?7 Go to the ER.
  • There are many possible signs of spinal cord trouble in the neck,8 with or without neck pain, mostly affecting the limbs in surprisingly vague ways that can have other causes: poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); an awkward gait. Sometimes people have both neck pain and more remote symptoms without realizing they are related.
  • Unexplained episodes of dizziness and/or nausea and vomiting may indicate a problem with stability of the upper cervical spine. (Such symptoms should never be dismissed by alternative health professionals as “detoxification” or “healing crisis.” For context, see What Happened To My Barber?)
  • Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
  • If you are feeling quite unwell in any other way, that could be an indication that neck pain isn’t the only thing going on.9
  • The main signs that neck pain might caused by autoimmune disease specifically include: a family history of autoimmune disease, gradual but progressive increase in symptoms before the age of 40, marked morning stiffness, pain in other joints as well as the low back, rashes, difficult digestion, irritated eyes, and discharge from the urethra.

Signs of arthritis are not red flags

One of the most common concerns about the neck that is not especially worrisome: signs of “wear and tear” on the cervical spine, arthritis, and degenerative disc disease, as revealed by x-ray, CT scans, and MRI. Many people who have clear signs of arthritic degeneration in their spines will never have any symptoms, or only minor, and/or not for a long time.10 For instance, about 50% of fortysomethings have clinically silent disk bulges, and even at age 20 there’s a surprising amount of spinal arthritis. The seriousness of these signs is routinely overestimated by patients and healthcare professionals alike.11

Signs of arthritis are almost never diagnostic on their own.12 Do yourself a favour: don’t assume that you have a serious problem based only on pain plus signs of arthritis. Pain is common; serious degeneration is not.

Percentages of people with various kinds of spinal degeneration but no pain. Source: Brinjikji et al
Imaging finding Age
20 30 40 50 60 70 80
Disc degeneration 37% 52% 68% 80% 88% 93% 96%
Disk height loss 24% 34% 45% 56% 67% 76% 84%
Disk bulge 30% 40% 50% 60% 69% 77% 84%
Disk protrusion 29% 31% 33% 36% 38% 40% 43%
Annular fissure 19% 20% 22% 23% 25% 27% 29%
Facet degeneration 4% 9% 18% 32% 50% 69% 83%

Sharp, stabbing, and shooting neck pains are usually false alarms

Sharp neck pain is not in itself a red flag. Believe it or not there is no common worrisome cause of neck pain that is indicated by a sharp quality. In fact, oddly, sharp pains are actually a bit reassuring, despite how they feel. In isolation — with no other obvious problem — they usually indicate that you just have a temporary, minor source of irritation in the cervical spine. Serious causes of neck pain like infections, tumours, and spinal cord problems tend grind you down with throbbing pains, not “stab” you.

Sharp, shooting pains are mostly neurological false alarms about relatively trivial musculoskeletal troubles: your brain reacting over-protectively to real-but-trivial irritations in and around the spine. The brain takes these much more seriously than it really needs to, but evolution has honed us to be oversensitive in this way. That’s not to say that the brain is always over-reacting, but it usually is. Most of the time, a sharp pain is a warning you can ignore.

The cervical spine is also surrounded by a thick, tangled web of nerves. In general, those nerves are amazingly difficult to irritate, much harder than people think, but it’s not impossible. Many sharp and shooting neck pains are probably caused by minor neuropathy (pain from nerve irritation) that will ease gradually over several days or a few weeks at the worst, like a bruise healing. It’s unpleasant, but not actually scary, like banging your funny bone (ulnar nerve): that thing can really take a licking and keep on ticking. So can the nerves in your neck.

Is a stiff neck serious?

Rarely. Nearly all neck stiffness is minor, diffuse musculoskeletal pain: several mildly irritated structures adding up to uncomfortable, reluctant movement as opposed to physically limited movement. The most common scary neck stiffness is the “nuchal rigidity” of meningitis — which makes it very difficult and uncomfortable to tilt the head forward — but that will be accompanied by other serious warning signs, of course. Like feeling gross otherwise (flu-like malaise).

If you have severe neck stiffness for a long time, plus any other warning signs, there could be a worrisome cause — but still probably not, and probably not urgent. Investigate if you have enough red flags, and even then it’s likely to amount to nothing.

Miscellaneous medical causes of neck pain that might mean you can stop worrying about something worse

This section presents a comprehensive list of somewhat common medical problems that can cause neck pain (and might, conceivably, be confused with an “ordinary” case of neck pain). I’ll give you a quick idea of what they are and what distinguishes them. If you find anything on this list that seems awfully similar to your case, please bring the idea to your doctor like a dog with an interesting bone; and get a referral to a specialist if necessary.

Important! None of these are dangerous! Although some are quite unpleasant. Reading about medical problems on the Internet can easily freak us out,13 so the goal here is to identify possible causes of neck pain that are not so scary. If you can get a positive ID on one of these conditions, then you get to stop worrying about the threat of something worse.

Some skin problems on the neck can cause neck pain, but are usually obvious — most people will identify them as “skin problems on the neck” and not “a neck problem affecting the skin.” Herpes zoster (shingles) [CDC] causes a painful rash, cellulitis [Mayo] is extremely painful but superficial, and a carbuncle[Wikipedia] … well, it’s just a super zit, basically. If you can’t diagnose that one on your own, I can’t help you!

Bornholm disease [NHS] is a crazy viral disease with several other intimidating names.14 It feels like a vice-grip on the chest and lungs, is intensely painful, and sometimes also causes neck pain. If you feel like you can’t breathe, you should look into this. The infection is temporary. It’s an extremely unlikely diagnosis.

Trichinosis [Wikipedia] (or trichinellosis, or trichiniasis) is a parasitic disease caused by eating raw or undercooked pork and wild game. It can be mild or severe or fatal, and digestive disturbance is likely. It can also cause spasming and widespread muscle pain, including the neck. There’s a laundry list of other symptoms.

 Photo of a person’s temple, with an obvious swollen and tortuous artery.

Temporal arteritis can cause neck pain as well as fierce headaches.

Temporal arteritis [healthline] is an inflammation of arteries in the temple, with a lot of symptoms: severe headache, fever, scalp tenderness, jaw pain, vision trouble, and ringing in the ears are all possible symptoms, along with neck pain. It’s almost unheard of in people younger than 50, and it usually occurs in people with other diseases or infections.

Lymphadenopathy. [Merck] The lymph nodes of the neck may bulge and swell in response to disease or infection. Once in a blue moon, someone might mistake these bulgings for muscle knots. More likely, it will be obvious that something else is going on: a variety of other symptoms.

Parsonage-Turner syndrome, [RareDiseases.org] inflammation of the brachial plexus. For no known reason, sometimes the web of nerves that exit the cervical spine, the brachial plexus, becomes rapidly inflamed. This condition may sometimes occur along with neck pain. Strong pain in the shoulder and arm develops quickly, weakens the limb, and even atrophies the muscles over several months. There is no cure, but most people make a complete recovery.

Thyroiditis, [Wikipedia] inflammation of the thyroid gland in the throat, can be difficult to diagnose, causing a bewildering array of vague symptoms. If your neck pain is accompanied by symptoms like fatigue, weight gain, feeling “fuzzy headed,” depression and constipation, consider checking with your doctor.

Eagle’s syndrome [Medscape] is a rare abnormal elongation of a bizarre little bit of bone at the back of the throat called the styloid process. Even a normal styloid process looks jarring when you first see one: it is so skinny and sharp that it makes one wonder how it can possibly not be stabbing something. Well, it turns out that in some cases it does “stab” you in the neck. This will cause a feeling of a lump in the throat and/or moderate intensity pains throughout the region, possibly including the side of the neck, although pain is more likely to dominate the jaw and throat.15

And one more important one …

Necks just hurt sometimes

The neck is one of a few areas of the body — along with the low back, jaw, and bowels — that is vulnerable to bouts of unexplained pain, sometimes quite stubborn. In most cases, the pain goes away. Pain is weird and unpredictable, and is often the result of the brain being overprotective and paranoid.

Worrying about the pain may be literally the worst thing you can do — not just a poor coping mechanism, but a genuine risk factor. Like noise pollution, the more you focus on it, the worse it gets. That’s why this article is focused on rational reassurance.

If you want more, carry on with my huge neck crick tutorial, for people with a frustrating sensation of mechanical stuckness. Or read about the weirdness of pain and learn more about how to tame your brain’s false alarm: Pain is Weird.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

12 Tips for Holiday Eating

Article Featured on Harvard Health

It’s easy to get swept up in the holiday season. This combination of religious and national celebrations can help keep the cold winter away. But the feasts and parties that mark it can tax the arteries and strain the waistline. By eating just 200 extra calories a day — a piece of pecan pie and a tumbler of eggnog here, a couple latkes and some butter cookies there — you could pack on two to three pounds over this five- to six-week period. That doesn’t sound like much, except few people shed that extra weight in the following months and years.

You don’t need to deprive yourself, eat only boring foods, or take your treats with a side order of guilt. Instead, by practicing a bit of defensive eating and cooking, you can come through the holidays without making “go on a diet” one of your New Year’s resolutions.

  1. Budget wisely. Don’t eat everything at feasts and parties. Be choosy and spend calories judiciously on the foods you love.
  2. Take 10 before taking seconds. It takes a few minutes for your stomach’s “I’m getting full” signal to get to your brain. After finishing your first helping, take a 10-minute break. Make conversation. Drink some water. Then recheck your appetite. You might realize you are full or want only a small portion of seconds.
  3. Distance helps the heart stay healthy. At a party, don’t stand next to the food table. That makes it harder to mindlessly reach for food as you talk. If you know you are prone to recreational eating, pop a mint or a stick of gum so you won’t keep reaching for the chips.
  4. Don’t go out with an empty tank. Before setting out for a party, eat something so you don’t arrive famished. Excellent pre-party snacks combine complex carbohydrates with protein and unsaturated fat, like apple slices with peanut butter or a slice of turkey and cheese on whole-wheat pita bread.
  5. Drink to your health. A glass of eggnog can set you back 500 calories; wine, beer, and mixed drinks range from 150 to 225 calories. If you drink alcohol, have a glass of water or juice-flavored seltzer in between drinks.
  6. Avoid alcohol on an empty stomach. Alcohol increases your appetite and diminishes your ability to control what you eat.
  7. Put on your dancing (or walking) shoes. Dancing is a great way to work off some holiday calories. If you are at a family gathering, suggest a walk before the feast or even between dinner and dessert.
  8. Make room for veggies. At meals and parties, don’t ignore fruits and vegetables. They make great snacks and even better side or main dishes — unless they’re slathered with creamy sauces or butter.
  9. Be buffet savvy. At a buffet, wander ’round the food table before putting anything on your plate. By checking out all of your options, you might be less inclined to pile on items one after another.
  10. Don’t shop hungry. Eat before you go shopping so the scent of Cinnabons or caramel corn doesn’t tempt you to gobble treats you don’t need.
  11. Cook from (and for) the heart. To show family and friends that you reallycare about them, be creative with recipes that use less butter, cream, lard, vegetable shortening, and other ingredients rich in saturated fats. Prepare turkey or fish instead of red meat.
  12. Pay attention to what really matters. Although food is an integral part of the holidays, put the focus on family and friends, laughter and cheer. If balance and moderation are your usual guides, it’s okay to indulge or overeat once in a while.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Do I Need Carpal Tunnel Surgery

Do I Need Carpal Tunnel Surgery?

Article Featured on WebMD

Most of us use our hands almost every minute of the day without ever giving it a second thought. But if you have carpal tunnel syndrome, the pain, numbness, and tingling in your fingers get your attention. Treatments like wrist braces and corticosteroids can help, but in more severe cases, you may need surgery.

Carpal tunnel syndrome is caused by pressure on your median nerve. This is what gives you feeling in your thumb and all your fingers except your pinky. When the nerve goes through your wrist, it passes through the carpal tunnel — a narrow path that’s made of bone and ligament. If you get any swelling in your wrist, that tunnel gets squeezed and pinches your median nerve. That, in turn, causes your symptoms.

Whether you’ve decided to have surgery or are still thinking about it, you should know what to expect.

When Would My Doctor Suggest Surgery?

Over time, carpal tunnel syndrome can weaken the muscles of your hands and wrists. If symptoms go on for too long, your condition will keep getting worse. If any of these sound like your situation, your doctor might suggest surgery:

  • Other treatments — like braces, corticosteroids, and changes to your daily routine — haven’t helped.
  • You have pain, numbness, and tingling that don’t go away or get better in 6 months.
  • You find it harder to grip, grasp, or pinch objects like you once did.

What Are My Surgery Options?

There are two main types of carpal tunnel release surgery: open and endoscopic. In both cases, your doctor cuts the ligament around the carpal tunnel to take pressure off the median nerve and relieve your symptoms. After the surgery, the ligament comes back together, but with more room for the median nerve to pass through.

  • Open surgery involves a larger cut, or incision — up to 2 inches from your wrist to your palm.
  • In endoscopic surgery, your surgeon makes one opening in your wrist. He may also make one in your arm. These cuts are smaller, about a half-inch each. He then places a tiny camera in one of the openings to guide him as he cuts the ligament.

Because the openings are smaller with endoscopic surgery, you may heal faster and have less pain. Ask your doctor which operation is best for you.

Results and Risks

Most people who have carpal tunnel surgery find that their symptoms get cured and don’t come back. If you have a very severe case, surgery can still help, but you may still feel numbness, tingling, or pain from time to time.

Risks come with any operation. For both types of carpal tunnel release surgery, they include:

  • Bleeding
  • Damage to your median nerve or nearby nerves and blood vessels
  • Infection of your wound
  • A scar that hurts to touch

What’s the Surgery Like?

First, you’ll get local anesthesia — drugs to numb your hand and wrist. You may also get medicine to help keep you calm. (General anesthesia, which means you will not be awake during surgery, is not common for carpal tunnel syndrome).

When the operation is finished, your doctor stitches the openings shut and puts a large bandage on your wrist. This protects your wound and keeps you from using your wrist.

Your doctor and nurses will keep an eye on you for a little while before letting you go home. You’ll likely leave the hospital the same day. Overnight stays are rare.

How Long Does It Take to Heal?

You may get relief from symptoms the same day as your surgery, but complete healing takes longer. Expect to have pain, swelling, and stiffness after the operation. Your doctor will let you know what medicines might help. You may have some soreness for anywhere from a few weeks to a few months after surgery.

Your bandage will stay on for 1-2 weeks. Your doctor may give you exercises to do during this time to move your fingers and keep them from getting too stiff. You can use your hand lightly in the first 2 weeks, but it helps to avoid too much strain.

Slowly, you can get back to more normal activities, like:

  • Driving (a couple of days after surgery)
  • Writing (after a week, but expect 4-6 weeks before it feels easier.)
  • Pulling, gripping, and pinching (6-8 weeks out, but only lightly. Expect 10-12 weeks before your full strength returns, or up to a year in more severe cases.)

Your doctor will talk to you about when you can go back to work and whether you’ll be limited in what you can do.

Will I Need Occupational Therapy?

If you do, your doctor will suggest it once your bandage comes off. You’ll learn exercises to improve your hand and wrist movement, which can also speed up healing.

Some people find that their wrists aren’t as strong after surgery as they were before. If this happens to you, occupational therapy can help increase your strength.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Hip Pointers in Contact Sports

Hip Pointers in Contact Sports

Article Featured on Nationwide Children’s Hospital

Hip Pointers

Bumps and falls are all a part of everyday life as an athlete, and can often result in bruising and injury. The majority of these types of injuries are seen in contact sports. The term “hip pointer” is often used as a catch all phrase for any injury resulting in pain to the front of the hip. However, this is not always the case.

What is a Hip Pointer?

A hip pointer is bruising caused by a fall or a direct blow to the iliac crest, or front and top of the pelvis. This bruising is not always visible and may actually occur deep below the skin. Bruising may also occur in the abdominal muscles which attach to the pelvis. Most often hip pointers are seen in contact sports such as football and soccer. Hip pointers are extremely painful and may be aggravated by walking, running, laughing, coughing, or deep breathing.

Treatment

Hip pointers are treated immediately with rest and ice. Resting the injured hip from extremely painful movements will help to reduce swelling and speed the healing process. It may take 1 to 2 weeks before the injured hip is pain free with movement. During this time the athlete should be allowed to stretch the hip in all directions to avoid stiffness. The rule here is to stretch in the pain free range. Any pain will only slow the healing process and delay their return to sport.

It is important to consult your physician if your pain last more than two weeks or worsens overtime. This may be a sign of a more severe injury. Ice should be applied directly to the hip for 30 minutes of every 1-2 hours for the first 72 hours. A regimen of gentle stretching for 20-30 seconds can help to loosen the muscles around the injured hip and reduce pain. For more information on strains please see the article “The Sprains and Strains of Sporting Injuries” located on the Nationwide Children’s Hospital website.

Prevention

Hip pointers can be prevented by wearing appropriate protective equipment. For example, football and hockey wear protective hip pads to help prevent this injury. In other sports where padding is not worn, such as soccer, certain skills and techniques can be taught to avoid this injury. Padding can also be worn to prevent further injury to the hip.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What Is Cervicogenic Headache?

Article Featured on Spine Health

Cervicogenic headache (CGH) occurs when pain is referred from a specific source in the neck up to the head. This pain is commonly a steady ache or dull feeling, but sometimes the pain intensity can worsen. CGH symptoms are usually side-locked, which means they occur on one side of the neck, head, and/or face.

CGH is a secondary headache that occurs because of a physical or neurologic condition that started first. CGH may be caused by trauma, such as fracture, dislocation, or whiplash injury, or an underlying medical condition such as rheumatoid arthritis, cancer, or infection. While the pain source is located in the cervical spine, CGH can be difficult to diagnose because pain is not always felt in the neck. CGH symptoms can also mimic primary headaches, such as migraine and tension-type headache.

Cervicogenic Headache Pain

CGH usually starts as an intermittent pain and may progress to become a continuous pain. The common features of CGH include:

  • Pain originating at the back of the neck and radiating along the forehead, area around the eye, temple, and ear
  • Pain along the shoulder and arm on the same side
  • Reduced flexibility of the neck
  • Eye swelling and blurriness of vision may occur on the affected side in some cases
  • Pain almost always affects the same side of the neck and head, but in uncommon cases both sides may be affected

CGH pain is mainly triggered by abnormal movements or postures of the neck, pressing the back of the neck, or sudden movements from coughing or sneezing.

The long-term outlook for CGH depends on the underlying cause of the headache. CGH is generally chronic and may continue for months or years. However, once diagnosed the condition can be well managed with treatment.

How a Neck Problem Can Cause Cervicogenic Headache

In the upper cervical spine region, the trigeminocervical nucleus is an area of convergence of sensory nerve fibers originating from both the trigeminal nerve and the upper spinal nerves. The trigeminal nerve is responsible for pain sensation in the face including the top of the head, forehead, eye, and temple area. When a pain sensation from a cause of CGH is sensed by the upper spinal nerves, it gets transferred to the trigeminal nerve fibers in the trigeminocervical nucleus. This results in pain being felt in different regions of the head.

Several factors can transmit pain from the neck to the head, such as:

  • An injury to the atlanto-occipital joint (joint between the base of the skull and the first cervical vertebra)
  • Injury to a component of the cervical spine, such as a vertebra, facet joint, or disc
  • Cervical radiculopathy resulting from pinched nerve in the upper spinal region
  • Injury to neck muscles
  • Tumors in the cervical region

A common cause for CGH is whiplash injury resulting in pain shortly after the injury. CGH originating from whiplash may resolve in a few days, or may last for years.

When Is Cervicogenic Headache Serious?

In some cases, CGH may be caused by dangerous underlying conditions such as tumor, hemorrhage, fracture, or arteriovenous malformation (abnormal connection between arteries and veins) in the head or neck region. In such cases, one or more of the following symptoms may also be present:

  • A change in the type of headache pain, such as severe headache that is intolerable
  • Nausea and vomiting
  • Confusion and disorientation
  • Headaches triggered by coughing or Valsalva maneuver (an attempt to expel air with the mouth shut and nostrils pinched tight)
  • Neck stiffness and swelling
  • Numbness in the arms

It is important to seek medical attention immediately if any of these symptoms are experienced.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.