MUSCULOSKELETAL INJURIES
A musculoskeletal injury (MSI) refers to damage of muscular or skeletal systems, which is usually due to a strenuous activity and includes damage to skeletal muscles, bones, tendons, joints, ligaments, and other affected soft tissues. Symptoms include:
• Mild, to severe aches
• Low back pain
• Numbness
• Tingling
• Atrophy
• Weakness
There are two types of MSIs — acute and chronic. An acute injury can be traced back to a specific incident, causing immediate pain and often swelling. On the other hand, a chronic injury can be caused by repetitive actions/use through work, exercise or daily use. The most common areas of MSIs are:
• Neck and shoulder injuries
• Wrist and hand injuries
• Leg and foot injuries
• Spinal and neck injuries
• Elbow injuries
MSIs can be treated with a variety of protocols — each personalized for your specific injury and needs. Treatments can include:
• Rest and immobilization
• Physical Therapy
• Medication
• Surgery
• IV Therapies
• Peptide Therapies
• Prolotherapies
• Dietary and lifestyle changes
The hip joint is the connection of the “ball” (head of the femur bone) with the “socket” (acetabulum of the pelvis). It supports the weight of the body in static and dynamic postures, and allows for a wide range of movements. The hip is composed of several bones, as well as three key ligaments which reinforce the joint. The hip joint also includes the labrum, which is a ring of cartilage that surrounds the “socket” and holds the “ball” in place, making the joint harder to dislocate.
The hip joint is susceptible to many musculoskeletal injuries, which include arthritis, dislocation, impingement, labral tears and damage to the surrounding muscles, tendons and ligaments.
Symptoms of a hip injury may include:
• Pain while walking or pivoting
• Pain at night
• Decreased mobility or flexibility
• Catching, popping or grinding of the joint
Injuries to the hip may result from acute trauma, such as a fall or motor vehicle accident, or chronic wear and tear. Diagnosis will include a comprehensive physical examination to determine range of motion, stability and pain, as well as an X-ray, MR arthrogram to determine the nature of the injury and an intra-articular injection.
Some other hip conditions include:
• Hip impingement or femoroacetabular impingement (FAI): Encompasses conditions of the hip in which the shape of your hip bones do not permit normal movement of the hip and may cause pain. Abnormal bone shape can be on the femur (CAM impingement), on the rim of the acetabulum (Pincer impingement), or both. The rubbing of the bones in an abnormal fashion can cause pain and lead to damage of other structures in the hip, including the cartilage and acetabular labrum.
• Labral tear: The fibrous cartilage lining of the acetabulum (socket), the labrum, may be torn through various mechanisms including impingement and trauma. Many individuals have labral tears, and labral tears may or may not cause an individual to experience symptoms in their groin and hip. The injection you have or may get into your hip helps determine if the labral tear is contributing to your hip pain. Some symptoms of labral tears are locking, catching, and/or pain in the groin.
• Loose bodies: A loose body is one or multiple pieces of tissue or bone that have fragmented from their normal position in the joint and are no longer attached properly. These fragments become free to move about the joint and may damage normal tissue and cause pain and/or a catching sensation. These fragments can result from trauma, such as a fall, motor vehicle accident, or sport injury.
• Hip cartilage injuries: The surface of the head of the femur and corresponding surface on the acetabulum are lined by a surface known as articular cartilage. This surface allows smooth motion within the hip joint and can be found in various other joints including the shoulder, knee, and ankle. The concern about articular cartilage injury lies in the lack of potential for this type of cartilage to regenerate and heal when significantly damaged.
Patients that sustain trauma to the hip joint and/or have chronic impingement may damage this cartilage. Usually, the cartilage begins degeneration by undergoing softening. When associated with impingement, the second stage of cartilage injury usually involves the detachment of the cartilage from the underlying bone. This can be thought of as a bubble of cartilage. The next stage of cartilage injury is generally detachment of the bubble to the point where it becomes a cartilage flap. This cartilage flap will not heal back to the bone on its own. Untreated flaps encourage further cartilage degeneration and the progression of osteoarthritis within the hip joint.
For some patients, hip arthroscopy surgery will be necessary to treat their condition, find long-term pain relief, and achieve their full recovery goals. Arthroscopic hip surgery involves making 2 or 3 small incisions around your hip and looking inside the joint with a camera that is around the same diameter as a pencil. While the camera is inserted in one small incision, the other incision(s) will be used to place various instruments in the joint in order to treat the cause of your hip discomfort.
Frequently Asked Questions
Q: Will surgery always be necessary to treat hip pain?
A: No, some hip injuries can be treated without the need for surgery. Nonsurgical treatments for a hip injury typically include a modification of activities, physical therapy exercises to stretch and strengthen the joint, and non-steroidal anti-inflammatory medications to relieve pain. Nonsurgical means are often prescribed before any surgical options are recommended.
Q: What can be treated using hip arthroscopy?
A: Arthroscopic hip surgery is a treatment option for various hip conditions, including:
• Labral tears
• Impingement
• Cartilage injuries
• Removal of loose bodies
Arthroscopic surgery will be recommended for injuries that do not respond to non-surgical methods and involve weakness, loss of function, and/or pain.
Q: Why is arthroscopy a superior method of hip surgery?
A: The advantage of arthroscopy to traditional open surgery is that the joint does not need to be completely opened up, and no muscles are cut or displaced. This reduces the recovery time and may increase the success rate due to reduced trauma to the joint.
Dislocations, sprains/strains and tears make up to 20% of all sports injuries. Most shoulder injuries are caused by overuse — particularly with sports that require overhead movement, such as tennis, swimming, basketball and volleyball. Ask us about our preventative exercise programs for the off-season. Shoulder injuries can be treated with non-surgical, orthobiological, or minimally-invasive arthroscopic surgery.
Frequently Asked Questions
Q: Will I need physical therapy following shoulder instability treatment?
A: PT is an important part of your recovery from shoulder instability, especially if you received shoulder instability surgery. You must see a physical therapist 3 times a week, beginning after your first postoperative visit for suture removal. In addition, you will perform your exercises at home 3 times a day. These exercises will consist of hand, wrist and elbow range of motion as well as specific exercises to prevent your shoulder from becoming stiff. We will write a prescription for you to take to your therapist. If you need help finding a therapist, please let our office know.
Q: How long will it take to recover from an orthopedic shoulder injury?
A: Every patient is unique, and your recovery period will depend on a wide range of personalized factors. We will advise you on your length of recovery during your consultations, and our team will be with you at each step of your rehabilitative process.
Q: How does an arthroscopic rotator cuff surgery work?
A: When an orthopedic shoulder surgeon performs arthroscopic shoulder surgery, we make two tiny, minimally-invasive incisions in your affected shoulder. We then insert a tiny tool with a camera attached called an arthroscope, which allows us to view the inside of your joint without opening the entire shoulder. Partial tears will involve a trimming or smoothing procedure called “debridement,” while full tears will involve suturing the two sides of the tendon back together. Tendons torn away from their insertion onto the upper arm bone (humerus) will need to be reattached.
The knee is an extraordinarily hardworking element of the body, whether you’ve damaged this weight-bearing joint through strenuous activity, work or an accident our team is highly experienced in treating injuries of the knee, both surgically and non-surgically.
Our comprehensive approach to musculoskeletal wellness harnesses innovative surgical and orthobiologic and rehabilitation techniques to ensure you return to peak performance.
Types of knee injury include ACL & Meniscus Tears and Medial Patellofemoral Injuries & Instability.
Cartilage is your body’s primary connective tissue, and one of its most vital. One of the main roles it plays is as a connector in all of your joints, from the wrists and elbows to the ankles and knees. Cartilage is flexible and strong, but any number of traumas or conditions can cause it to tear. In some cases, that tear shows multiple patterns, and will be considered “complex.” Complex cartilage tears are notoriously difficult to treat, but new techniques have opened the doors for us to repair damaged cartilage and help patients recover their full functionality.
Osteochondral defects, or osteochondral lesions, occur when cartilage that is attached to the bones of a joint becomes torn or otherwise damaged. In a case of osteochondral defect, ankles and knees are the most commonly affected joint, though the cartilage of any joint can be damaged in this way. When they affect the knee, osteochondral defects often happen between the thigh bone and the shin bone, whereas in the ankle, these defects often happen on the talus bone where your foot meets your leg.
Many osteochondral defects begin with a smaller injury, such as a strain or sprain. Symptoms of a serious osteochondral defect include:
• Pain in the joint during regular activity
• Swelling in the joint during regular activity
• Consistent aching
• A “loose” or unstable feeling in the joint
• A “clicking” feeling in the affected joint
Osteochondral defect treatment generally involves a surgical procedure that is designed to repair, restore, or even replace the damaged cartilage. As part of our practice, our goal is to offer patients the least invasive, most technologically forward techniques available, several of which involve the use of orthobiologics.
Frequently Asked Questions
Q: Can orthobiologic treatment be used to assist in cartilage restoration?
A: Orthobiologics is an approach that may offer patients less invasive procedures and better outcomes than traditional surgical solutions. We incorporate orthobiologic techniques such as platelet-rich plasma to help patients recover from complex cartilage injuries.
Q: Why is it important to treat a complex cartilage injury as soon as possible?
A: One of the most dangerous aspects of a complex cartilage injury is the fact that without treatment, it can become progressively worse. The longer a complex cartilage tear or osteochondral defect goes untreated, the more difficult it will become to repair.