Sports, hobbies or work that require frequent pivoting and turning often cause anterior cruciate ligament (ACL) sprains or tears. ACL injuries are the most common knee injuries, many of which require surgery. About half of all injuries to the ACL also occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.
Injured ligaments are considered “sprains” and are graded on a severity scale of one to three. Most ACL injuries are complete or near complete tears, or grade three sprains. Symptoms may include hearing or feeling a “pop,” intense knee weakness, pain with swelling, loss of range of motion, tenderness along the joint, and discomfort when walking.
Diagnosing an ACL injury usually involves a doctor’s examination and X-rays or an MRI or CT scan.
If the overall stability of the knee is intact, your doctor may recommend nonsurgical options. Rest, ice, bracing, and physical therapy may help those who have slight injuries or do not have an active lifestyle. Surgery is needed for active patients and those with serious tears. Rebuilding the ligament with a tendon from the patient or a cadaver, followed by physical therapy and rehabilitation, will help get the patient back to normal.
The Achilles tendon – the largest tendon in the body – connects the calf muscles to the heel bone and is used for walking, running and jumping. Achilles tendinitis is inflammation of the Achilles tendon.
Achilles tendinitis is typically not related to a specific injury, but instead results from repetitive stress to the tendon. Other factors may affect the tendon like a sudden increase in the amount or intensity of exercise activity, tight calf muscles, or a bone spur.
Common symptoms of Achilles tendinitis include pain and stiffness along the Achilles tendon, especially in the morning; pain along the tendon or back of the heel that worsens with activity; severe pain the day after exercising; thickening of the tendon; bone spur; and swelling that gets worse throughout the day with activity.
A doctor will examine the area and order imaging tests like x-ray or magnetic resonance imaging (MRI) for diagnosis. Nonsurgical treatments include rest, ice, and physical therapy. Anti-inflammatory medication and cortisone shots may also help. Braces or boots can ease pain. Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure that may stimulate healing.
Surgical options are usually considered after at least six months of pain and other symptoms. There are several different types of surgery that can lengthen the calf, repair the tendon, or transfer a tendon from another part of the body.
Most sports injuries can be treated at home with the RICE approach. RICE stands for rest, ice, compression, and elevation.
Rest – Stop or greatly reduce activity that might affect the injured area. Weight-bearing activity on joints in the leg may need to be assisted with crutches.
Ice – Put a cold pack of a bag of ice wrapped in a towel or a bag of frozen vegetables on the injury for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
Compression – An elastic compression from a pharmacy will help reduce swelling and provide mild support.
Elevation – Recline as you rest and elevate the injury above your heart.
Non-steroidal anti-inflammatory medicines like aspirin and ibuprofen will help reduce inflammation and ease pain. Symptoms like pain and swelling that persist should be examined by a doctor. Untreated injuries could lead to permanent damage or disability. Doctors may prescribe a more specific brace or cast for minor injuries and may order advanced testing if they suspect a more serious problem.
A sprained ankle is a very common injury that affects people of all ages and abilities. When the ligaments of the ankle are forced to stretch beyond the normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers. This usually happens when the foot rolls, twists or moves in an abnormal angle in relation to the foot. Symptoms include pain and swelling or even hearing or feeling a “pop” in the ankle area.
To diagnose a sprained ankle, doctors will complete a physical exam and order x-rays or MRI or CT studies. The sprain is graded on a scale of one to three. Most ankle sprains can be treated with ice, rest, bracing, elevation, anti-inflammatory medications, and physical therapy. Grade two sprains may need more time to heal than grade one sprains. If the sprain is a grade three, involving a full tear, surgery may be needed, although this is quite rare.
The knee is the largest joint in the body, and one of the most easily injured. Because many sports like football, skiing, soccer, running, and basketball require intense use and manipulation of the knee area, it is a common area for athletes of all abilities to injure.
The knee is made up of four main parts: bones, cartilage, ligaments, and tendons. Common knee injuries include fractures, dislocations, sprains, and ligament tears. In many cases, the injury will affect more than one structure in the knee. Pain and swelling are the most common signs of knee injury. The knee may also “catch” or lock up. Instability in the knee makes it feel like it is weak or giving way.
To diagnose knee injuries, a doctor will complete a physical exam and order x-rays or other imaging studies. Arthroscopy, a minimally invasive surgical procedure, can also be used to view the joint and make more specific diagnoses.
Many knee injuries can be successfully treated with simple measures, such as rest, icing, compression or bracing, and elevation. When pain and swelling subside, physical therapy and rehabilitation can help strengthen the area. Other injuries may require surgery. Arthroscopy allows a doctor to make some repairs while viewing the area. If there is a complicated injury affecting a number of knee structures, open surgery may be needed.
When an abnormal condition appears at birth, it’s called a congenital condition. There are a number of congenital problems that affect the bones, muscles and tendons. Many can be addressed in early childhood to give the patient an opportunity for more traditional growth and development.
Some congenital orthopaedic conditions include: metatarsus adductus, also known as metatarsus varus, a common foot deformity that causes the front half of the foot to turn in; clubfoot, also known as talipes equinovarus, a foot deformity; developmental dysplasia of the hip joint; congenital limb defects; osteogenesis imperfecta (OI), also known as brittle-bone disease; and muscular dystrophy (MD), a disorder of the muscles.
Through examination and imaging, doctors can analyze the extent of the congenital problem and how it affects surrounding bones and tissues. Your Palm Beach Health Network Physician Groups team is experienced with every treatment from splints and bracing to complex surgeries like limb lengthening. Treating orthopaedic congenital deformities often includes physical therapy and rehabilitation as part of a comprehensive treatment plan.
A dwarf is a person of short stature with an adult height under 4′ 10”. Dwarfism itself is not a disease. However, there is a greater risk of some health problems for people with dwarfism. With proper medical care, most people with dwarfism have active lives and traditional life spans.
More than 200 different conditions can cause dwarfism, but one type called achondroplasia, causes about 70 percent of dwarfism cases. Achondroplasia is a genetic condition that causes arms and legs to develop shorter in comparison to the head and trunk. This is a type of disproportionate dwarfism, where some parts of the body are small, and others are of average size or above-average size. Disorders causing disproportionate dwarfism inhibit the development of bones. Proportionate dwarfism describes a body that is proportionately small.
A number of disorders causing dwarfism can cause a variety of developmental problems and medical complications, so a number of specialists may be involved in diagnosing and treating health problems. Some team members could include a hormone disorder specialist; ear, nose and throat (ENT) specialist, orthopedics specialist; heart specialist; mental health provider; nervous system abnormalities specialist; and dental specialist.
The Tenet Florida Physician Specialists orthopaedics team may correct some dwarfism skeletal problems through procedures like altering growth plates, straightening bones, supporting the spine and limb lengthening.
Bones, cartilages, ligaments, muscles, tendons and fluid work together to make the elbow joint. With such a complex system, there are a number of ways to injure the area.
One common cause of elbow pain is tendonitis, which is an inflammation or injury to the tendons that attach muscle to bone. Tendinitis of the elbow is often a result of a sports injury or overuse in playing tennis or golf. Other causes of elbow pain include sprains, strains, fractures, dislocations, bursitis and arthritis.
Treatment depends on the cause. A physical exam, patient history, and imaging tests will all aid in diagnosis. Sometimes arthroscopy, a procedure that inserts a camera into the joint, is used to better visualize the area.
Mild injuries may be treated with rest, ice, compression or bracing, elevation, and pain management. More complicated injuries may use arthroscopy to make some repairs. Additional minimally invasive or open surgery might also be required. In most cases, physical therapy and rehabilitation will aid in healing, strengthening and regaining motion.
Foot deformities may occur as an isolated disorder or in combination with other syndromes and associated anomalies. The goal of foot deformity treatment is to correct the foot so that the patient has a functional, pain-free foot with good mobility and minimal calluses without a need for modified shoes. These issues will not resolve on their own.
Treatment should begin as soon as possible after birth and may continue for an extended period. Casting and bracing can fix and stabilize the area. If there is failure to achieve deformity correction by nonsurgical methods, or if residual deformities and recurrent deformities are unresponsive to nonsurgical measures, surgery may be needed. Surgical treatment is extensive and requires a combination of soft tissue release, joint manipulation, tendon lengthening, and temporary pinning. Foot deformity correction through surgery may require more than one operation over time.
After surgery, casting helps the bones and tendons heal properly. External pins may be removed about six weeks after surgery, and may be followed by additional casting and therapeutic footwear.
Developmental dysplasia of the hip (DDH) is a condition of the hip joint that is present at birth (a congenital condition) and occurs about once in every 1,000 births. With DDH, the “ball” of the hipbone moves partially or completely out of the hip socket.
Factors causing hip dysplasia are usually both genetic and environmental. Hip dysplasia is more common in females than males. The left hip is involved more frequently than the right due to intrauterine positioning. First-born babies are at higher risk since the uterus is smaller in a first pregnancy. Other risk factors may include a family history of developmental dysplasia of the hip or very flexible ligaments; position of the baby in the uterus, especially in breech presentations; and associations with other orthopedic problems.
Every baby may experience symptoms differently, but common symptoms include the leg appearing shorter on the side of the dislocated hip; the leg on the side of the dislocated hip may turn outward; the folds in the skin of the thigh or buttocks may appear uneven; and the space between the legs may look wider than normal.
Specific treatment varies by patient and may include non-surgical devices that help the hips and legs grow a certain way, casting and surgery.
Different causes of joint pain include (but are not limited to): arthritis, which covers about 100 different joint inflammation diseases the most common of which are osteoarthritis, rheumatoid arthritis, and juvenile arthritis; tendonitis, which is inflammation of a tendon which is the thick fibrous cord that attaches muscle to bone; sprains, which are an injury to a ligament; and bursitis, when the fluid-filled sacs around joints, called bursae, are irritated and inflamed.
Joint pain frequently responds to rest, ice, compression and elevation (RICE). Severe pain, visual misalignment, or inability to put pressure on the joint means it needs a doctor’s attention. Usually an imaging study, like an X-ray or MRI (magnetic resonance imaging), is needed to understand the scope of the problem. Sometimes other tests may be needed if the doctor suspects an underlying condition.
Treatments vary according to the cause of the joint pain. Over-the-counter anti-inflammatories are often enough to ease discomfort. Oral or injectable steroids may be used to reduce pain and inflammation as well. Physical therapy may be prescribed to strengthen surrounding tissues and increase flexibility. In some cases, surgery is needed.
The head of the upper arm bone fits in a shallow socket in the shoulder blade called the glenoid. A soft fibrous tissue rim called the labrum surrounds the socket to help stabilize the joint and serves as an attachment for ligaments. Injuries to the labrum can occur from acute trauma or repetitive shoulder motion. Throwing athletes or weightlifters can experience glenoid labrum tears as a result of repetitive shoulder motion.
The symptoms of a tear in the labrum include: pain, usually with overhead activities; catching, locking, popping, or grinding; occasional pain at rest; a sense of instability in the shoulder; decreased range of motion; and weakness. Patients may remember a specific incident or may note that the pain has gradually increased. A Palm Beach Health Network Physician Groups doctor will test range of motion, stability, and pain level. In addition, the doctor will request X-rays or other imaging.
Arthroscopy allows a doctor to insert a tiny camera through a small incision. The camera relays images to a monitor where the doctor can diagnose and sometimes repair damage. If the tear extends into the biceps tendon or if the tendon is detached, the shoulder will need a more complex surgery.
Post-operative rest and rehabilitation are important parts of recovery. There will also be a detailed physical therapy plan. Athletes can usually begin doing exercises about six weeks after surgery, but full healing takes three to four months.
Bones are connected to other bones by ligaments. They act like thick ropes that hold the bones together and provide stability. When a strong force stretches the ligaments beyond their ability to spring back, injury occurs. Injured ligaments are sprains that are graded on a severity scale of one to three. Grade one and two sprains may be treated with non-invasive approaches. Grade three sprains are considered complete tears and may need surgery.
Symptoms include pain, swelling and instability. Your Palm Beach Health Network Physician Groups doctor will make a full exam and take a medical history including sports or activities that may have caused the injury.
Diagnosing a ligament injury usually involves a doctor’s examination and x-rays or other imaging studies.
If the overall stability of the joint is intact, your doctor may recommend nonsurgical options. Rest, ice, bracing, and physical therapy may help those who have slight injuries or do not have an active lifestyle.
Surgery is needed for active patients and those with serious tears. Rebuilding the ligament with a tendon from the patient or a cadaver, followed by physical therapy and rehabilitation, will help get the patient back to normal.
Limb deformity can occur in the upper or lower extremities from congenital defects or during growth. Deformities may also arise from trauma, infection, tumors or medical conditions. Some of the conditions that can cause limb problems in a child or young adult also include: osteogenesis imperfecta, bow legs, knock knees, neurofibromatosis, arthritis, infections and tumors in the bone, and injuries involving the growth center of the bone. There may also be deformities of the soft tissues.
The symptoms of limb deformity vary. Sometimes it’s just a mild difference in the appearance of a leg or arm. Other times there is a major loss of function like a limp or diminished range of motion.
Diagnosis of limb deformity will include a thorough physical examination and medical history. Various tests may be ordered, from detailed imaging to blood and urine tests that screen for additional problems.
Non-surgical intervention could include a program of physical therapy and bracing. Surgery may involve pinning, external or internal stabilization. Addressing limb deformity is often a long process that requires dedication from the patient and family.
The meniscus is a wedge-shaped piece of cartilage between the thighbone and shinbone. It has a tough, rubbery texture to help cushion the joint and keep it stable. Tears are classified by their shape and location. Common tears include longitudinal, parrot-beak, flap, bucket handle, and mixed/complex.
Sudden meniscal tears often happen during sports and may involve injuries to other ligaments and bones. Older people are more likely to have degenerative meniscal tears because of weakened cartilage.
Most people can still walk on an injured meniscus, but the joint will get progressively more painful and stiff. Other symptoms of meniscal tear are: swelling, catching or locking of the knee, the sensation of the knee “giving way,” and loss of range of motion.
A physical exam and patient history, including sports or activities that affect the knee, will help the doctor diagnose a meniscus tear. Imaging like an MRI or CT may also be ordered. A McMurray test, when the doctor manipulates the knee to check for a clicking sound, may help with diagnosis as well.
Some tears will heal on their own with rest and care. Others may need to be trimmed or repaired. Arthroscopic surgery allows the surgeon to insert a camera into a small incision in the knee. The surgeon can then visualize and repair the meniscus.
Bone fractures and orthopaedic trauma in children is all too common. Whether the cause is a sports related injury, an accident at home, or a car wreck, these injuries need special attention and rehabilitation in pediatric cases. Varying healing times and growth plate damage can cause long-term issues if they are not properly addressed.
Palm Beach Health Network Physician Groups offers evaluation and treatment of all musculoskeletal injuries of the limb and spine in children. Specialized diagnostics and imaging may be needed in addition to pediatric casting, bracing and prosthetics.
In many cases, families find our offices after the initial trauma is treated at an emergency room or outpatient center. Tenet doctors can provide a more thorough orthopedic assessment and provide a customized recovery and rehabilitation program.
The rotator cuff is a combination of four muscles that come together as tendons to form a covering around the head of the upper arm bone or humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate the arm.
When one or more of the rotator cuff tendons tears, the tendon no longer fully attaches to the head of the humerus, causing instability. Most rotator cuff tears are caused by the normal wear and tear that goes along with aging. Other risk factors include repetitive lifting or overhead activities.
A partial tear damages the soft tissue, but does not completely sever it. Complete tears split the soft tissue into two pieces. Acute tears occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.
The most common symptoms of a rotator cuff tear include pain at rest and at night, particularly if lying on the affected shoulder; pain lifting and lowering the arm; weakness when lifting or rotating the arm; or a crackling sensation when moving the shoulder in certain positions.
There are several treatment options for a rotator cuff tears, depending on age, activity level, general health, and the type of tear. In about half of patients, nonsurgical treatment (like physical therapy, pain management, and rest) relieves pain and improves function in the shoulder. After six months of continued pain, surgery may be required to reattach the tendon.
Shoulder injuries often involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching, and weightlifting. Injuries can also occur during everyday activities that require over-reaching.
The shoulder area is a complex combination of muscles, ligaments, and tendons, and bones. When shoulder tissues are overused or irritated, injury may occur. Some injuries are acute, like from a fall.
Orthopaedic surgeons group shoulder problems by either instability or impingement. Instability means one of the joint mechanisms is pushed out of normal positions. Impingement is when the shoulder muscles rub along the top part of the shoulder blade. (Rotator cuff injuries also affect the shoulder.)
Often, an orthopaedic surgeon will prescribe a series of exercises aimed at strengthening the shoulder muscles. Anti-inflammatory medication also may be prescribed to reduce pain and swelling.
MRIs and CTs may be needed to diagnose more serious shoulder injuries. Arthroscopy allows a tiny camera to be inserted into the area to view and possibly repair the joint. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the area.