Below are links to articles posted in May, 2019
Do You Have Femoroacetabular Impingement?
Are you suffering from pain in the groin or hip area? Hip pain can result from a variety of injuries or conditions. Understanding what causes your discomfort is often the first step in treating symptoms and preventing future injuries.
Femoroacetabular Impingement (FAI) occurs when extra bone develops on or near the hip joint. Sometimes referred to osteophytes or bone spurs, these growths can disrupt the movements of the hip bones. Over time, the friction generated by these bone spurs can damage the joint and limit your activity.
How do you know if you have FAI? Let’s take a closer look at the hip joint and how this condition affects your hips. Then, we’ll look at the best treatment options to reduce pain and restore function to the area.
Understanding the Hip Joint
The hip joint is one of the largest joints in the body. It also plays a key role in weight-bearing activities. Walking, running, and other vigorous activities can apply a lot of stress to the joints. Luckily, a healthy hip can support your weight, easily withstanding these stressors. Disease and injury, however, can alter the hip structure which, in turn, affects its function.
The ball-and-socket joint of the hip connects two bones—the thigh bone (femur) and the pelvis. The round femoral head fits snugly into a “socket” known as the acetabulum. Think of the acetabulum as a cup-shaped structure and the femoral head as slightly more than half a sphere. A smooth layer of articular cartilage covers the bones in the joint. The body produces synovial fluid to keep the cartilage slippery so the bones can move past each other without damage. Another ring of strong cartilage—known as the labrum—lines the outer edge of the acetabulum. The labrum deepens the joint, allowing for enhanced range of motion and joint alignment.
In addition, a series of ligaments and muscles hold the hip joint in place, delivering stability. Some of the strongest ligaments in the body are located at or near the hip joint. Muscles allow the bones associated with the hip to bend, straighten, rotate, and move the leg to and away from the midline.
What is Femoroacetabular Impingement?
FAI occurs when abnormal bone growths form around the femoral head or acetabulum. However, the exact cause of FAI is unknown. It’s believed that genetics and pediatric hip diseases, like coxa vara or Legg-Calve-Perthes disease, increase the likelihood of developing FAI. Additionally, participating in high-impact sports such as hockey or basketball during adolescence may play a role. Sports, however, do not seem to cause FAI. They simple hasten the onset and severity of the symptoms.
Furthermore, hip impingement can occur in three different ways:
- Pincer Impingement: Occurs when the bone growth extends over the rim of the acetabulum. As a result, the labrum may become damaged.
- Cam Impingement: Occurs when a bump forms on the femoral head. When the head loses its typical round shape, it cannot move smoothly around the inside of the acetabulum.
- Combined Impingement: As the name suggests, this is when growths are found on both the femoral head and acetabulum.
Symptoms of Femoroacetabular Impingement (FAI)
In minor cases, some individuals may not even realize that they have FAI. In fact, people with FAI can live normal, active lives without experiencing much discomfort. However, others can gradually develop symptoms when damage to the surrounding soft tissues occurs. Symptoms of FAI include:
- Stiffness in the groin, hip, or thigh
- Groin or hip pain—especially after running, exercise, or sitting for extended periods of time
- Difficulty flexing the hip beyond a right angle
- Reduced range of motion including difficulty flexing, rotating, and adducting the hip
- Painful locking, clicking, or instability related to labral tearing
In addition, the damage caused by FAI may also lead to hip osteoarthritis. This occurs when the impingement causes the cartilage to wear off the bones in the hip socket. Likewise, the rubbing together of bones causes swelling, pain, and loss of motion in the joint.
Diagnosing Femoroacetabular Impingement (FAI)
If you’re experiencing symptoms like those discussed above, you may want to get checked out by a doctor. Several other conditions cause similar symptoms, including hip pain. Pinpointing the exact cause of your hip pain makes treating it much more effective.
A doctor’s visit usually begins with a full review of your medical history and overall health. This includes discussing current and previous occupational or recreational activities that may have contributed to your hip condition.
If FAI is suspected, the doctor generally performs an impingement test. The doctor conducts this test while you lie on your back. Your knee is brought to your chest and gently rotated toward your opposite shoulder. If you feel pain or it recreates your symptoms, you may have FAI.
In addition to a general exam and impingement testing, the doctor may order diagnostic imaging to obtain a better view of the area. These tests can include:
- X-rays and computed tomography (CT) scans: Images that allow the doctor to see any abnormalities in your hip joint. CT scans also help doctors to obtain a detailed view of the joint structure.
- Magnetic resonance imaging (MRI) scans: By using a magnetic field and radio waves, this test allows the doctor to observe any damage to the articular cartilage and labrum.
Getting Help for Your Femoroacetabular Impingement (FAI)
Once diagnosed with FAI, both conservative and surgical options are available to relieve symptoms and restore joint function.
Conservative Treatments for FAI
Physical therapy (PT) offers several benefits for individuals who suffer from FAI. Exercise-based physical therapy programs can reduce disability by focusing on muscle strength and flexibility. PT also assists with restoring your range of motion. In addition, a physical therapist can provide education about activity modification, movement pattern retraining, and pain management.
A non-steroidal anti-inflammatory medication, like ibuprofen, can also alleviate pain and inflammation. Depending on your discomfort, the doctor may prescribe pain medications. Always take these as directed as they can become addicting.
Surgical Options for FAI
The goal of FAI surgery is to correct the abnormalities caused by FAI and repair any damaged soft tissues. Surgical options can include:
- Hip Arthroscopy: This minimally invasive surgery uses a tiny camera and surgical tools. These tools allow the surgeon to remove the bone spurs caused by FAI. The surgeon will also repair damage to the articular cartilage and labrum. Hip arthroscopy is the most common surgery for those who suffer from FAI.
- Hip Replacement: If your FAI has caused severe hip osteoarthritis, a total hip replacement may be necessary. Those who are not good candidates for hip arthroscopy may benefit from a hip replacement. While this surgery is more complicated, the outcomes generally eliminate or decrease symptoms and restore function.
As surgical techniques and technologies improve, the reliance on minimally invasive surgery will only increase. Since minimally invasive surgery only requires small incisions, this means less scarring, damage to soft tissues, and blood loss. As a result, you can also recover faster from hip surgery with less preoperative pain.
Ready for an Experienced Team to Help You?
Dealing with hip pain can keep you from doing the things you love. Instead of being sidelined with FAI, maybe it’s time you consulted with a team of doctors who are ready to pinpoint the source of your pain and empower you with the best treatment options.
Our experts at Orthopedic & Laser Spine Surgery will take the time to get to know you, your symptoms, and goals for treatment. We work with you to create a treatment plan geared toward your individual needs and preferences.
Using the latest technology and medical advances, we treat your conditions to ensure accuracy and successful outcomes. Are you ready to take care of your hip pain and return to the things you love? Schedule a consultation with Orthopedic & Laser Spine Surgery today to see how we can help.
Common Symptoms of Degenerative Disc Disease
Your spine is composed of a series of spongy discs, which are sandwiched in-between a tower of vertebrae. In a normal, healthy spine, these structures act as shock absorbers between these bones. This alignment not only gives the spine its much-needed flexibility but also its innate force of resistance. Unfortunately, as is the case with most mechanical systems, our discs wear down with time. Some people experience this degeneration with little to no issues. Others, however, develop a variety of health issues and adverse symptoms. Every individual has their own unique anatomy, which in turn affects the severity of symptoms.
Spinal disc degeneration may occur in a variety of different ways. Most commonly, the discs simply dry out, which flattens them, inhibiting their function. Naturally, a flatter disc also means less shock absorption. In addition, this translates into less padding between the vertebrae, as well as pain.
In some cases, the hard outer shell of the disc may crack, causing the soft inner material to leak out. When this happens, it often applies pain-generating pressure to nearby nerves. Sometimes, the disc may also bulge or slip out of place, likewise inflaming nerve tissue.
Luckily, these are treatable problems that medication, physical therapy, steroid injections, and sometimes surgery can alleviate. Just know that if you have back pain, there are options for you. Always seek out medical assistance if your symptoms affect the quality of your everyday life.
Degenerative Disc Disease & Related Issues
Again, the discs of the spine act as impact cushions between the vertebral bones. In addition, our discs consist of a rubber-like structure that is made up of fibrocartilaginous tissues. The medical community calls the outer layer of an intervertebral disc the annulus fibrosus. Alternatively, doctors refer to the inner core of the disc as the nucleus pulposus. The latter is the portion of the disc that doctors describe as soft and jellylike.
Knowledge of this structure is paramount to understanding just how the discs of the spine degenerate, as well as what affects this process. We already know that discs may dry out over time, leading to less distance between the vertebrae of the spine. Additionally, we also know that changes in the disc’s structure may occur via cracks, tears, bulging, and so on. In some cases, the disc may even fracture into smaller pieces.
But, deterioration doesn’t just end there. When our body undergoes negative changes such as these, it tends to overcompensate in response. As a result of less padding between the vertebrae, the body produces osteophytes, otherwise known as bone spurs. These are bony projections that form on the perimeter of our bones. Unfortunately, this process may result in pressure against the spinal cord or adjacent nerves. This can inhibit the function of these nerves, leading to painful symptoms.
Degenerative disc disease may also cause cartilage breakdown. This poses a significant problem, as cartilage helps to reduce friction in the joints. Likewise, degenerated discs may also lead to herniated or bulging discs, as well as spinal stenosis. The latter here describes an instance in which the space surrounding the spinal canal narrows, potentially causing pain, weakness, and numbness.
Degenerative Disc Disease (DDD) Symptoms
It is vital to note that DDD will happen to some extent in almost everyone. However, not all patients will experience negative symptoms as a result. Yet, others will experience extreme pain which affects their ability to carry out daily tasks. Usually, degenerative disc disease begins with damage to spinal structures. However, over time, this may evolve into problems elsewhere in the body.
Symptoms of degenerative disc disease vary from quite mild to utterly incapacitating. Usually, the symptom with the earliest onset is pain and weakness. You may notice that the pain tends to travel to other parts of the body. Over time, these symptoms may evolve into other conditions, such as osteoarthritis, which leads to even more pain and stiffness in the spine.
The location of the damage in the spine has a natural effect on the nature of the condition’s symptoms. For example, when DDD affects the lumbar spine, painful nerve symptoms and tingling may also arise in the buttocks, upper thighs, legs, and/or feet. Conversely, when the condition affects the cervical spine, symptoms may extend to the shoulder, arm, and/or hand.
Lastly, the body may try to overcompensate for structural instability through muscles spasms. Any of the pain that the condition causes may also be exacerbated during certain activities such as bending, lifting, twisting, or prolonged periods of sitting. Patients may be able to temporarily combat this by walking or laying down.
Degenerative Disc Disease (DDD) Diagnosis
Doctors often begin their diagnostic process with a series of questions that probe the patient’s medical history, prior injuries, and familial trends. Your doctor will also ask questions about the location of symptoms, as well as which activities result in pain. During a physical examination, your doctor may look for the following:
- Muscular Symptoms: The doctor will look for any signs of muscle weakness, atrophy, or abnormalities in movement.
- Pain Triggers: The doctor will ask the patient to perform specific motions in order to figure out which areas the condition is affecting. He or she may also apply pressure to certain areas to determine the existence of degenerated discs.
- Reflexes: Utilizing a reflex hammer, the doctor will test your nerve function to see if there are any compressed nerve roots. In some instances, your doctor may apply heating and cooling techniques to see if the nerves react properly to adjustments in temperature.
Your doctor may also deem it necessary to order diagnostic imaging tests, such as a CT or MRI scan. He or she may also use a discogram, which utilizes dye injections to locate the disc that causes pain.
Degenerative Disc Disease (DDD) Treatment
Treatment for any medical condition typically involves either conservative methods or surgery. Most of the time, doctors prefer to use nonsurgical methods, as these typically end up being sufficient. That being said, there are certainly more severe cases of DDD in which surgery becomes absolutely necessary.
Conservative treatments for DDD include physical therapy, occupational therapy, medications, and weight loss regimens. Doctors may also opt to use steroidal facet joint injections to provide their patients with temporary yet effective pain relief. Sometimes, doctors recommend back braces for patients who struggle with spinal instability. There are also minimally invasive procedures available, including radiofrequency ablation as well as heated catheter insertion.
If the patient does not respond to conservative treatments within 12 weeks, then the doctor will begin to consider surgery. Generally speaking, there are two options that surgeons commonly employ to treat degenerative disc disease. Most commonly, surgeons use spinal fusion to weld two vertebrae together, permanently increasing spinal stability. In other instances, a surgeon may use decompression surgery to remove a portion of the offending joint, relieving adjacent nerve pressure.
Are you experiencing back pain that doesn’t seem to go away on its own? If so, contact Orthopedic & Laser Spine Surgery today at (855) 853-6542. Our facility is staffed with only the most passionate experts who put the patient’s needs above all else. It is our goal to ensure that every patient is given an individual care plan that best suits the specifics of his or her case. You don’t have to live in constant discomfort. Contact us today and begin your journey toward pain-free living!
Choosing Between Shoulder Resurfacing vs. Shoulder Replacement
Shoulder arthritis is a serious condition that compromises our ability to perform day-to-day activities. As you might imagine, shoulder arthritis targets the typically smooth ball-and-socket joint of the shoulder. Under normal circumstances, the surface of this joint is smooth and allows for less friction in between the moving parts of our shoulder. Arthritis changes this fact, eliminating the cartilage in the joint that allows for the free range of motion to which we are accustomed.
Generally speaking, patients with this condition have a couple of options, but this article will focus on the two main ones: shoulder replacement and shoulder resurfacing. Shoulder joint replacement is a bit more well known, and doctors originally used it to treat catastrophic shoulder injuries. Over the years, the procedure has seen a resurgence, with doctors using shoulder replacement to treat more than just that. In fact, shoulder replacement surgery now has important uses in treating other painful shoulder conditions, such as arthritis.
Shoulder resurfacing is viewed more as an alternative to shoulder replacement and doctors typically use it on patients who are younger. Instead of replacing the humerus and scapula, shoulder replacement involves switching out the affected area with a specialized metallic head. Essentially, this replaces the surface of the joint and allows for the majority of the existing bone to remain as is.
The best treatment for you will depend on the severity of your condition. For more information, be sure to communicate regularly with your medical provider.
The Anatomy of the Shoulder
Three bones compose the shoulder joint: the humerus, scapula, and collarbone. Medical experts refer to the shoulder joint as a ball-and-socket joint. The reason for this is because the ball of the humerus fits neatly into the small socket (glenoid) of the scapula.
At the surface of where the bones touch exists a covering of articular cartilage. This is a smooth material that keeps the bones safe and enables them to have a full range of motion. Additionally, there exists a fine, smooth tissue that doctors call the synovial membrane. This membrane envelopes all of the other surfaces inside the joint of the shoulder. In a normal shoulder, the synovial membrane secretes a tiny amount of fluid that helps to eliminate the friction in between the bones of the shoulder.
Lastly, but certainly not least, there are the muscles and tendons that exist around the shoulder to provide structural support. All of these parts work together to form a joint with the greatest range of motion throughout the entire body.
Diagnosis & Evaluation
Your doctor will likely send you in the direction of an orthopedic surgeon for a more in-depth medical evaluation to determine which surgery will benefit you the greatest. Usually, such an evaluation consists of the following elements:
- Medical History: Your surgeon will need information about pre-existing medical conditions as well as the specifics of your case. This includes facts about the extent of your pain and the current functionality of your shoulder.
- Physical Examination: A physical assessment will test a multitude of things. Usually, this involves examining your shoulder’s motion, strength, and stability.
- X-Ray Imaging: As with any imaging test, x-rays will show the doctor the severity of your condition. These images will reveal things such as the loss of joint space, bone deformities, bone spurs, and any other loose articles (such as cartilage or bone) that may be floating around in places they shouldn’t be.
- Other tests: Your surgeon may deem it necessary to order other tests, such as MRIs, blood tests, or bone scans. These tests will help your surgeon determine the important factors of your condition, such as the current state of your soft tissues and bones.
Is Shoulder Resurfacing Right For Me?
You can think of shoulder resurfacing as kind of a “middle ground” treatment. It is most viable for patients who need pain alleviation, but are not quite to the point where they need a total replacement. In patients where the arthritis is mild and limited to the humeral head, it may be more ideal than a total replacement. Usually, doctors use the procedure to treat conditions such as different types of arthritis, rotator cuff injuries, and avascular necrosis.
The procedure is certainly more conservative than total shoulder replacements. That being said, only a highly skilled professional will be able to determine whether or not it is a viable alternative for the patient. In the event that the doctor does see this as a viable alternative, the possible benefits are:
- Anatomical restoration
- Less invasive surgery
- Minimal scarring/less chance of surgical trauma
- Faster recovery time
- Less painful
- The procedure is still possible in lieu of bone deformity
- No risk of fracture
- It is easy to revisit the procedure if necessary
Patients who have a shoulder resurfacing procedure can usually expect to stay in the hospital for a day or two. After a day has passed, the doctor or nurse will remove the wound dressings. Next begins the first phase of recovery, which involves a series of limited exercises. Usually, the patient will have to wear a sling for up to six weeks. After the patient leaves the hospital, they should perform exercises at home for a few weeks to restore the range of motion to the joint. Generally speaking, total recovery tends to wrap up at around three months time.
Am I a Candidate for Shoulder Replacement Surgery?
First of all, there are several different types of shoulder replacement surgeries. In fact, shoulder resurfacing is actually a subtype of shoulder replacement surgery, albeit a less invasive one. So, for the sake of brevity, this article will refer to the most common form of shoulder replacement surgery: total shoulder replacement. Whereas shoulder resurfacing involves simply replacing the surface of the humeral head with a stemless prosthesis, total shoulder replacement involves a metal ball attached to a stem with a synthetic socket.
Perhaps the biggest indicator for the necessity of this procedure is pain that is not alleviated through more conservative methods or less invasive procedures. Additionally, the pain must exhibit a progressive stiffness with accompanying loss of motion range. Typically, patients report an almost grating sensation within their ball-and-socket joint that is quite uncomfortable.
Basically, doctors only consider more traditional open surgeries like these over minimally invasive procedures when there are no other viable options. Minimally invasive procedures and conservative options are always the preferred route to take. However, the nature of how they work sometimes does not allow for proper recovery. For more information, please consult your doctor to see if this procedure is right for you.
If you have shoulder pain that has not abated with more conservative treatments, please contact Orthopedic & Laser Spine Surgery at (855) 853-6542. Our team of spine doctors are leading experts in the field of minimally invasive treatment and surgical care. We will work tirelessly to ensure that you are put on a treatment plan that suits your specific needs. Don’t hesitate, contact our practice today!