Sprains, strains and soft-tissue injuries

  • A sprain is a stretch or tear injury of a ligament. Ligaments stabilize and support the spine and joints. An injury will often cause pain, swelling, bruising, and a sense of instability.
  • A strain is a stretch or tear injury of a muscle or tendon. Tendons are the tapered end of muscles, which act to move or stabilize a joint. An injury will often cause pain, swelling, muscle spasm, and localized weakness.
  • A contusion is another name for a bruise. It is caused by a direct blow to tissue. It may cause skin discoloration if bleeding occurs near the skin.

Tendonopathy

Tendonopathy is the medical term used to describe a disorder of a tendon. Tendons are the tapered end of muscles, which act to move or stabilize a joint.

"Tendonitis” is the term used to describe inflammation of a tendon. After an acute injury, some degree of inflammation is beneficial as your body attempts to heal itself.

Common names for tendonitis conditions include:

  • Tennis elbow
  • Golfer's elbow
  • Pitcher's shoulder
  • Swimmer's shoulder
  • Jumper's knee

Most cases of tendonitis can be successfully treated with rest, bracing, physical therapy, oral or topical medications, or corticosteroid injections.

Many cases of chronic tendon pain are no longer due to inflammation, which is best termed “tendonosis” rather than tendonitis, and anti-inflammatory treatments may not be the best option.

Another treatment for tendonosis includes percutaneous tenotomy, in which ultrasound is used to precisely guide a needle into a specific region of abnormal tendon tissue. This technique can initiate a natural healing response, which combined with rest then therapeutic exercise, allows the tendon to heal.

If a tendon remains resistant to treatment, another option may be injection of platelet rich plasma (PRP).

Calcific tendonopathy is a condition in which calcium crystals deposit within abnormal tendon tissue, and often results in further pain, prolonged healing times, and resistance to typical conservative care.

A technique called percutaneous barbotage involves flushing and aspirating the calcium using a needle through the skin, with precision ultrasound-guidance.

Trigger finger is a condition in which the tendon and/or the sheath that holds it close to the bone becomes enlarged. This prevents gliding of the tendon and thus immobility of the finger. Bracing, corticosteroid injection, and surgical “release” techniques are treatment options.


Cartilage injury

Cartilage caps the ends of bones that form most joints. It is a smooth surface that allows joint gliding and shock absorption.

Cartilage abnormalities range from softening and swelling, fissuring (fine cracks), partial and complete tears, flap defects, and widespread exposure of the bone below (bone-on-bone arthritis).

Cartilage can have limited healing potential because it does not have its own blood supply, rather relies on nutrients diffusing from the bone below.

Cartilage abnormality due to arthritis has minimal healing potential, and there is currently no cure to arthritis.

Traumatic cartilage injury may require surgery to optimize healing potential.

  • Microfracture involves creating small perforations in the bone below the absent cartilage, which leads to an exaggerated and prolonged natural healing response.
  • Mosaicplasty involves taking a piece of healthy cartilage from an area of the joint that does not contribute to weight-bearing and patching it into the defect.
  • Cartilage transplant involves placing cartilage from a donor into the defect.

Dislocations

A dislocation occurs when the two bone ends that form a joint are forcibly moved out of position. It most commonly occurs in the shoulder and fingers, but can occur in the hip, knee, elbow or most other joints.

The quicker the joint can be put back into place by a trained health care provider, there typically is less residual injury and stiffness.

Most joints heal near completely, but the shoulder joint may have increased risk of repeat dislocation.


Stress fractures

Stress fractures are tiny cracks in a bone. They are caused by the repetitive application of force, often by overuse — such as long-distance running or track and field events.

Stress fractures can also arise from relatively minor injuries if the bone is weakened by low bone density (e.g. osteoporosis).

Stress fractures are most common in the leg and foot.


Fractures

Fractures involve a break in the bone. Fractures are described based on their location and characteristics.

Complete and incomplete fractures describe if it involves the entire thickness of the bone.

Closed fractures do not pierce through skin, but open fractures do.

Compound fractures have multiple fragments.

Displaced fractures are out of alignment (e.g. angulated, rotated) and require re-alignment. This is performed by the surgeon’s hands using x-ray guidance (closed reduction) or with surgery (open reduction).

Fractures in children at the ends of growing bones are called Salter-Harris fractures, and require urgent evaluation by an orthopedic specialist familiar with pediatric conditions.


Arthritis

Arthritis is inflammation of one or more of your joint’s cartilage plate, and causes joint pain and stiffness.

It is very common, effecting over 50 million American adults and 300,000 children. Half of effected adults are significantly limited in their activities, and arthritis is the leading cause of disability.

The most common types of arthritis are osteoarthritis (OA), rheumatoid arthritis (RA), and gout, but there are over 100 causes of arthritis.

Osteoarthritis is caused by genetic influences, major cartilage injuries that do not heal completely, and minor repetitive injuries. There is no sure way to prevent or slow down OA, but there are strategies to lower one’s risk, such as maintaining a healthy weight and frequent exercise that is not overly impacting on the joint.

Rheumatoid arthritis is an autoimmune disorder that targets the lining of joints (synovium). It can be differentiated from OA based on an examination, x-ray and/or ultrasound findings, and lab testing. When RA is diagnosed, it is important to see a Rheumatology specialist for treatment, as use of medications very early in the disease is more effective than later on.

Gout involves uric acid crystals depositing in the joints, typically in toes but also in knees and ankles. Medications are not always required, as a healthy lifestyle may be adequate. Reducing stress and exercising more are helpful. Eating less purines (e.g. red meat, shellfish), fewer processed foods, and reducing alcohol and sugary drinks will also reduce one’s risk. A condition similar to gout is pseudogout, which involves joint deposits of calcium rather than uric acid.

The treatments vary depending on the type of arthritis, but similar goals include reduction of symptoms and improving quality of life. Your doctor may recommend a specific aerobic and strength-training exercise program, stretching, physical therapy, weight management, anti-inflammatory medications (e.g. NSAIDs) such as ibuprofen, naproxen, or Voltaren gel), analgesics (e.g. Tylenol), or supplements (e.g. glucosamine-chondroitin). Injection options may include corticosteroid, hyaluronic acid (e.g. Euflexxa, Synvisc), or alternative injectates such as platelet rich plasma (PRP). Assistive devices may be helpful, such as braces, shoe inserts, cane, walker, and special tools for hand arthritis.

Surgery is reserved for severe cases that limit everyday activities and is resistant to other care. Your surgeon will talk to you about whether you are a candidate for various types of joint replacements, such as total versus partial joint replacement, traditional versus minimally-invasive surgical approaches, and standard versus customized prosthetics (e.g. MAKOplasty).


Joint Contractures (e.g. Frozen shoulder)

A joint contracture is due to tightened tissues around a joint that restrict motion and often cause pain. This can occur after joint surgery with prolonged joint immobilization, and your surgeon will discuss with you how to limit this risk.

A very common type of joint contracture is a frozen shoulder. Also called adhesive capsulitis, it causes pain and stiffness in the shoulder. It occurs in about 2% of the general population, and most commonly affects women between the ages of 40 and 60.

Conditions that increase one’s risk of having a frozen shoulder include thyroid disorders, diabetes, a history of frozen shoulder, and joint immobilization from any cause.

The symptoms often follow a progression through 3 distinct stages:

  • In Stage 1, or the “freezing stage”, there is an increasing degree of pain and stiffness.
  • In stage 2, or the “frozen stage”, there is no further progression in the degree of stiffness, and the degree of pain may slowly subside.
  • In stage 3, or the “thawing stage”, the shoulder stiffness slowly improves and there often is pain only briefly after certain movements.

Stage 1 can take 6 weeks to 9 months, stage 2 may take 4-6 months, and stage 3 can take 6 months to 2 years. Over ninety percent of people will improve and heal with conservative treatments.

Your doctor will recommend stretching and exercises specific to you and the stage of the disease, and may prescribe anti-inflammatory medication or perform a corticosteroid joint injection.

If the shoulder remains overly stiff during or after stage 3, there are several options. An ultrasound-guided hydrodilation procedure can stretch the joint capsule enough to restore motion in some people.

Surgeons can manipulate (stretch) the joint while one is under anesthesia, and rarely arthroscopic surgery is needed.