Femoroacetabular Impingement (FAI): Cause & Treatments

Femoroacetabular impingement (FAI) is a medical condition in which the bones of the hip are shaped abnormally. It usually occurs in the hip joint and since they do not fit perfectly, the hip bones tend to rub against each other, resulting in damage to the joint. Impingement refers to a certain portion of the soft tissues located in the hip joint getting pinched. Femoroacetabular refers to the impingement happening where the femur is in contact with the acetabulum or hip socket.

Causes

The exact cause of Femoroacetabular Impingement is still under considerable debate up till today. With advances in medical imaging techniques such as MRI, subtle changes in the shape of the femoral head might be the main cause of this injury. The problem occurs when the head of the femur knocks against the cartilage rim surrounding the acetabulum, pinching it in the progress.

In normal circumstances, the femoral head glides smoothly inside the hip socket as it is the perfect size. However, if the acetabulum cup is too shallow or small, the head is unable to obtain a perfect fit. In the case of FAI, the socket s too deep for the head to get a proper grip. When the femur bends and rotates, the cartilage gets pinched as a result. As time passes, this impingement can cause the edges surrounding the impingement site to get torn. With the combined effect of changes in the hip joint, the result repetitive motions can cause traumas to the hip joint, resulting in a partial or complete labral tear.

Nonsurgical treatment

The first step of treatment is nonsurgical and will involve modification to daily activities. Appropriate muscles will need to be strengthened in a bid to restore normal neuromuscular control. Tight and tense muscles surrounding the hip can contribute to pinching and strengthening it may lengthen the muscle and reduce impingement. Patients may also be administered intra-articular injection with a steroid medication to reduce inflammation.

Surgical treatment

Surgery is recommended when pain is persistent despite significant nonsurgical care. This usually indicates an obvious structural abnormality at the hip. Once surgery is decided, three options will be given to the patient: full open incision, arthroscopic surgery or osteotomy. Open incision involves dislocating the femur head from the socket to reshape it. In arthroscopic surgery, dislocation is not required. Instead, multiple small incisions are made to insert a robotic arm to do the necessary corrections. Osteotomy involves reshaping the socket for pincer-type impingement.

Coronoid Fracture: Cause & Symptoms

Coronoid fractures often happen in the ulna although they are relatively uncommon. However, coronoid fractures can be critical injuries. They usually occur in conjunction with elbow dislocations and will lead to elbow instability. The coronoid is designed to strengthen the elbow, increasing the stability. Therefore, a fracture will lead to unstable elbows and a possible loss of motion.

Traumatic elbow injuries such as a coronoid fracture will usually result in a dislocation of not only the bony structures but also injuries to the soft tissues. Very often, the posterior elbow is dislocated and managing it is extremely difficult. Unlike other fractures, coronoid fractures do not respond well to close reduction or splinting.

Causes

Coronoid fracture usually comes hand in hand with an elbow dislocation as dislocation itself involves a large energy impact onto the surrounding bones and soft tissues, leading to several severe soft tissue injuries. This usually happens during high impact sports such as rugby or accidents. One of the most common cause is a fall from a certain height, landing on an outstretched arm when trying to break the fall. The main mechanism involves a combination of twisting and flexing. When the elbow is loaded axially, it is in its weakest state and will lead to the weakening of the coronoid.

Symptoms

Patients suffering from coronoid fractures often have the following symptoms. Patients will be in tremendous pain with diffuse swelling and tenderness. The level of tenderness can be multifocal and depends of the area of injury. Range of motion including flexing, extension and rotation will be severely limited or totally impossible.

Complications

Coronoid fractures may lead to complications if it is not treated properly. The ends of broken bones are sharp and they can cut and tear surrounding blood vessels, nerves and tendons. Fractures may also lead to excessive bleeding and swelling in the elbow region, causing blood clot formation and the disruption of normal blood flow to the rest of the arm. This will lead to a loss of sensation and even function of the arm, requiring emergency attention.

Management

Patients suffering from coronoid fractures will have unstable elbows and it can be fixed by suturing the bone and anterior capsule to the anterior ulna. Surgery will involve either internal fixation or replacement of the fractured radial heads. The injured ligaments need to be surgically reconstructed and if the elbow is still unstable, hinged external fixation will be required.

Spinal Stenosis: Cause & Symptoms

Spinal stenosis is the result of the narrowing of free spaces in the spine. This will cause extra pressure to act onto the spinal cord and the nerves running through it. In majority of the cases, spinal stenosis affects the lumbar spine. This will eventually cause pain along the legs and make walking a difficult task to accomplish.

Causes

There are many different possible causes for spinal stenosis:

  • As we grow older, our soft connective tissues such as the tendons and ligaments will start to harden and thicken. When this happens, spurs will start to develop and some may make their way into the spinal canal. This will result in the damaging of the vertebrae and cause the facet joints to wear and tear. Eventually, this will cause the narrowing of the lower spine.
  • When one of the many vertebrae slips over another, this will cause congestion and narrow the spinal canal.
  • Spinal tumour. Spinal tumours are abnormal growth of soft tissues that will cause inflammation of the spinal canal. White blood cells will rush to the site and cause an overgrowth of new tissues. This will eventually result in the narrowing of the spinal canal.
  • Accidents especially high impact ones may shatter or dislocate the spine, causing small bones to impinge onto the canal.

Symptoms

Patients suffering from early stages of spinal stenosis often have no symptoms. Symptoms will develop slowly over time and may include:

  • Pain in the back
  • Burning pain at the buttocks
  • Numbness in the legs
  • Loss of feeling in the feet
  • Loss of sexual abilities
  • Loss of bowel or bladder control
  • Pain and weakness of legs

The pain in the legs are usually due to inefficient circulation of the blood. Leg pain will usually go away with rest but patients with spinal stenosis will get persistent leg pain despite resting. Narrowing of the spine will also cause nerve impingement, resulting in important nerves to be deprived of the abilities, leading to incontinence.

Spinal stenosis have no unique signs nor symptoms and will worsen over time. Although x-ray results look promising, there is still uncertainties. The best method to manage lumbar spinal stenosis is to understand the disease better and to strengthen the back by engaging in strengthening activities daily.

Bunions: Cause & Treatments

Bunions are bony humps that form at the base of the big toe. When this happens, the big toe will curve towards the other toes and cause the base of the toe to push towards the first metatarsal bone. It usually occurs at a joint and the entire body weight will be acting on it. This will result in tremendous pain and discomfort.

Causes

As we grow and develop, more pressure is acting on the foot due to the need to support the body’s entire weight. Therefore, it gets worse as age increases. Bunions is hereditary and will run in the family due to the fact that foot type and shape is hereditary. In some cases, bunions will develop with existing medical conditions such as arthritis. Women are also at a higher risk of suffering from bunions due to the fact that most women wear tight and ill-fitting high heeled shoes, pushing the foot bone into awkward positions for long periods of time.

Non-surgical treatment

Non-surgical is targeted to reduce pressure on the big toe and provide pain relief.

  • Wearing wide and comfortable shoes with sufficient space for toes to wriggle. The insoles should also provide good arch support.
  • Custom made orthotics will help to distribute the body’s weight equally throughout the foot and reduce any unnecessary pressure acting on the big toe.
  • Pain relief medication will provide instant pain relief for patients and bring down the swelling.
  • Ice is a cheap and effective method to reduce swelling and provide pain relief.

Surgical treatment

If non-surgical treatment does not provide adequate pain relief, daily activities such as walking can be severely hindered. In such cases, surgery may be the only option left. The main aim of bunion surgery is to straighten the curved toe bone and provide pain relief.

  • Bunionectomy is a bunion specific surgery and involves removal of part of the affected metatarsal head.
  • Osteotomy involves the cutting of bones located in the toe to prevent bone spurs from sticking out and re-alignment the soft tissues around the toe joint.
  • Resection arthroplasty is reserved for more serious cases and involve the removal of bone located at the end of the first metatarsal joining the metatarsophalangeal joint.

As the saying goes, prevention is better than cure. A good pair of footwear is often all that is needed to prevent one from getting bunions. Selecting a pair of functional shoes over one that is aesthetically pleasing is a much sensible choice.

All about Electrodiagnostic Testing

Our body possess a huge ability to generate electricity and it is through this ability that allows us to achieve good health. The electricity that is generated will send important signals from all parts of the body to the brain and provides a source of instantaneous communication. These electrical signals are created by the nerves and instructions are sent to the muscles to carry them out. However, signals can easily be affected due to diseases or injuries. The presence of pain and numbness in different parts of the body can help doctors to diagnose the exact cause of injury and this is what electrodiagnostic testing is all about.

Electrodiagnosis employs the science of electrophysiology, using electrical pulses to study neurophysiology. There are two separate parts in this test: testing the nerves and testing the muscles. Both tests will evaluate the ability of both nerves and muscles to function as a single entity unit. This test will allow narrow down the list of possible causes of pain and weakness.

Nerve conduction studies (NCS)

NCS is done in conjunction with its muscle counterpart. The main purpose is to determine if a particular nerve is functioning properly. It is done by placing sensors over nerves in both the hands and legs and stimulating it with electrical pulses. Patients will experience a warm and itchy sensation similar to suffering from an ant’s bite. Through this test, doctors will be able to evaluate the performance of the nerves and to identify which nerves are not performing well. A healthy nerve will conduct electricity at an extremely fast rate up to 200km/h whereas a damaged nerve will have a much lower conduction rate.

Electromyography (EMG)

EMG on the other hand analyses the electrical activity in muscles. When a muscle is in use, it will be buzzing with electrical signals as the muscle attempts to communicate with different parts of the body. Likewise when it is not in use, it will be electrically quiet. Unlike NCS, EMG will cause slight discomfort to patients as small needles are inserted to monitor and record electrical activities. The wires will be connected to a small TV that will broadcast these electrical signals. After the test, the needles will be removed and this will cause further trauma to the area, resulting in bruises in the following days.

Electrodiagnostic tests are pretty accurate due to the advancement of medical technology and devices. However, it is only able to identify whether the nerves are functioning properly and it is unable to identify the cause of pain.

Lisfranc (Midfoot) Injury: Cause & Treatments

Lisfranc or midfoot injuries are often the results of broken bones in the midfoot or torn ligaments. Lisfranc injuries can vary from complex to simple depending on the number of joints and bones that are involved. Many patients often mistaken their midfoot injury to that of a simple sprain. As a result, many choose to self-medicate with pain relief cream. However, Lisfranc injury is not as simple as it seems and may even require surgery in some cases.

Located in the midfoot are clusters of small bones forming an arch at the top of the foot. There are five long metatarsal bones extending to the tones and ligaments and tendons hold the bones in place. However, there are no connective tissues holding the first metatarsal to the second metatarsal.

Lisfranc injuries can occur due to either direct or indirect trauma. Direct trauma is often result of an external force striking the foot while an indirect trauma occurs due to a force transferring to the stationary foot that deforms the foot. The foot is a smart system that is divided into three different sections namely the hindfoot, midfoot and forefoot. The role of the midfoot is to translate force and provide rotational stability and it is the keystone for plantar flexion and dorsiflexion. Therefore with a lack of dorsal support, the load acting on the foot is sufficient to cause dorsal displacement, leading to broken bones and/or ligaments.

The earlier a Lisfranc joint injury is diagnosed, the better it is for both patient and doctor. An initial clinical evaluation involving radiographs such as x-rays and MRI will be performed to indicate the probability of a mild, moderate or complex sprain. If diastasis is not present, immobilisation will be needed. This will include the usage of an immobilisation cast for a period of four to six weeks followed by limited movements. After six weeks, rehabilitation exercises need to start immediately. This is due to the bone being a piezoelectric material and will resorb after periods of inactivity.

If surgery is needed, it will be performed within 24 hours of the injury or after 10 days to allow for the drainage of bodily fluid due to swelling. Kirshner wires will be used to fix the bones together and bone fragments will be removed. After surgery, patients need to be immobilised in a cast for up to 12 weeks with minimal movements.

Some people will no longer be able to return to pre-injury levels of activity after a midfoot injury despite advancement in medical technology.

 

Shoulder Joint Tear (Glenoid Labrum Tear): Symptoms & Prevention

The shoulder joint is composed of three different types of bones: the shoulder blade, upper arm bone and collarbone. This type of joint is a ball and socket joint, allowing for extreme flexibility and wide range of motion. The upper arm bone acts like a ball and is securely inside the shoulder blade socket. For stabilization purposes, the upper arm bone is slightly larger than the socket, ensuring that the fit is tight. To further enhance the stability, there is a layer of soft tissue called the labrum. Injuries to the labrum is the cause of a shoulder joint tear. In this article, we will look at some of the symptoms and preventive measures.

Symptoms of Glenoid Labrum tears are difficult to be diagnosed. The pain is unable to be localized to the exact location and pain is severely increased when actions involving the injured shoulder is attempted. Such actions can include stretching the arm or raising a hand. As time passes, the shoulder will be weaker and instability will start to set in.

Shoulder joint tears are often caused by a sudden trauma to the shoulder blade. These can include falling on an outstretched arm or a direct blow to the shoulder. In order to prevent this, protective measures should be taken:

Warm-ups and stretching

Have you ever taken a rubber band and pulled it suddenly? The rubber band will end up breaking immediately. This is the same for our muscles and it is the reason why warm ups and stretching are extremely important. Warming up will loosen the muscles and enable the tendons and ligaments to stretch. This will allow them to function properly and hold the shoulder joint together.

Protective gears

Shoulder joint tears are also much more common in players engaging in high impact sports such as rugby and baseball. Players often wear protective paddings designed for the shoulder. These cushioning pads are able to cushion and absorb shocks to a certain extent. Some are even able to prevent fractures and dislocations.

Build strong muscles

Building up strength in the shoulders will increase the ability of tendons, ligaments and muscles to withstand the impact experienced by the shoulder. Strong muscles will hold the shoulder together and prevent any muscular tears during an impact.

Shoulder joint tears are extremely painful and affects our daily lifestyle. Players who participate in high impact or repetitive sports shoulder consider investing in good protective gears and ensure that proper warm ups are performed prior to the start of their activity.

Olecranon Fractures: Treatment & Management

Our elbow is a complex hinge joint made up of three different bones. It can also perform various functions. The elbow is able to bend and straighten up, rotate and turning up and down. When you try to bend your elbow, the sharp tip protruding out is called the olecranon. Olecranon fractures are injuries that affect the particular bone.

Treatment

After a patient suffers from an Olecranon fracture, the first thing a doctor will administer is ice and pain relief medication followed by elbow immobilization. The doctor will then determine if surgery is required depending on the extent of the fracture.

Nonsurgical treatment

Patients who do not have a severe fracture will not be required to undergo surgery. Nonsurgical treatment is fairly straightforward. The patient will need to immobilize the fractured elbow using a splint or sling during the healing process. The patient will also need to visit the hospital once a week for X-ray imaging to monitor the healing process. If there are no protruding bone fragments, movement will resume after a month. During the healing process, a physiotherapist will be assigned to teach basic strengthening exercises. If the fracture shifts during this process, the patient will eventually surgery to piece the bones together.

Surgical treatment

Surgery will be needed for patients who have serious fractures such as an open fracture or displaced fracture. In a displaced fracture, the fracture is out of place. This is due to the strong attachment of the bicep muscles to the olecranon. Once the fracture is out of place, the elbow will be unable to straighten at all. An open fracture on the other hand means that the bone fragments have cut the skin, leading to an increased risk of infection. This is a much more serious condition and patients will be administered with antibiotics and tetanus shot. An incision will be made at the back of the elbow where the surgeon will piece the bone fragments together again. Large pieces of bones may be joined together using pins, wires, screws or plates and these metal implants can be permanent or biodegradable.

Management

Following surgery, rehabilitation will be required in order to regain the elbow to its previous condition. As the healing process is lengthy, bone resorption could have taken place. As such, the region is much weaker. A physiotherapist will thus concentrate on regaining bone mass and muscular strength in the elbow.

Impingement Syndrome: Symptoms & Treatments

Impingement of the shoulder is an extremely common problem associated with shoulder pain. It occurs due to the impingement of tendons in the shoulder. Repeated usage of the shoulder joint will increase the chances of one suffering from shoulder impingement. This is especially so for athletes involved in sports such as tennis, swimming and badminton. Unlike other injuries, pain is extremely persistent in shoulder impingement and will affect all of the daily activities.

The structure giving our body its shape are the bones and surrounding it are the muscles. When an injury is suffered, blood will rush to the site in order to combat against infection. When this happens, the area will swell up and lead to a chain event. The swelling up of muscles will create tremendous pressure and impinge onto soft tissues such as the ligaments and tendons.

The usual symptoms associated with shoulder impingement include tenderness and soreness. There will be persistent pain throughout that does not go away with treatments such as using hot pack or massages. Over time, the shoulder muscles will weaken and it is nearly impossible to place the arm over your head. Prolonged impingement will lead to the tearing of the shoulder muscles, leading to a rotator cuff injury.

Symptoms of a shoulder impingement is classified into 3 different stages from 1 to 3. Stage 1 involves young patients who are below 25 years. In this stage, the only type of symptom observed is swelling and imflammation. This is due to the ability of the body to repair itself. In stage 2 which involves people from 25 years to 40 years, there will be a significant loss of ability to use the shoulder joint due to it weakening. In stage 3 which happens to people above 40 years old, the symptoms will be much more serious as it often involves the tendons, muscles and bones.

The initial stages of treatment is non-surgical. Oral medications such as aspirin and ibuprofen will be prescribed in an attempt to reduce inflammation. Physical therapy will also be conducted to strengthen the shoulder muscles and improve the range of motion and rotation. If these do not seem to have an effect, a cortisone injection will be injected directly to combat infection. If no improvement is seen after 2 months, the patient will have to undergo a MRI scan and a surgery will need to be performed if it is diagnosed to be a rotator cuff tear.