Why do doctors take so many X-rays?

March 11th — admin

The doctor I saw recently thought the pain in my groin area might be coming from a hip problem called impingement. But after three sets of X-rays and an MRI, it turns out the pain was coming from my lumbar spine. Was it really necessary to take so many X-rays?

X-rays are the key to making a diagnosis of hip impingement. With hip impingement, the head of the femur (thigh bone) bumps up against the lip or rim of the socket. A thin layer of cartilage called the labrum gets pinched in the process causing pain. This problem is often treated with surgery, so the imaging studies from all angles are essential.

There are three main ways X-rays can be taken. Each radiographic view offers a slightly different picture of the hip angle and shape. This information is important in diagnosing hip problems such as impingement.

The first is the anterior-posterior (AP) view. This is the view looking through the patient from the front to back. Second is the lateral view from the side. And third is the frog-leg lateral view.

In the frog-leg view, the patient lies on his or her back. The leg is flexed and abducted away from the body. The hip is externally rotated. The knee is bent so that the foot rests against the other leg. The frog-leg view has been shown to be a reliable way to diagnose hip impingement.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Twin boys have identical mishaped hips, but not identical problems!

March 6th — admin

We have twin boys who are both active in different sports. It turns out that they also both have a slightly misshaped hip. For one boy this has caused all kinds of hip problems, groin pain, and lost playing time on his soccer team. The other boy doesn’t seem affected at all. How come?

With impingement, the soft tissues around the joint get caught between the femur and the hip socket. There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.

Femoroacetabular impingement occurs when abnormal hip anatomy is aggravated by repetitive movements of the hip. There could be a slightly off center placement of the hip in the socket or a femoral head that isn’t perfectly round that is contributing to the problem. Or the hip socket may be too deep for the size of the femoral head or the rim of the hip socket is too prominent. Sometimes the angle of the femoral neck is bent or twisted just a tad from normal. There could be a separate piece of bone called the os acetabulum along the front rim of the hip socket. Any of these morphologic changes can lead to impingement.

The labrum, a fibrous rim of cartilage around the hip socket is the most likely area to get pinched. Add repetitive motion and you get repetitive pinching or compression until the labrum starts to fray and tear. No one knows for sure just yet why some athletes with this problem are affected while others seem not to notice a problem. With your sons, it could be there is just enough difference in the shape of one boy’s hip that he is spared the painful loss of motion and function. There could be differences in the degree of pinching that is going on or the tension of the soft tissues, muscles, and tendons around the joint.

Studies show that some high level athletes with abnormal hip joints never develop problems. Who does develop femoroacetabular impingement and how to predict if/when it should be treated are areas where further study is needed.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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My 14 year-old daughter has a hip impingement. What is normally done about this?

March 2nd — admin

Our 14-year-old daughter has developed an interest (and shown a great aptitude) for horseback riding. But a slight hip problem (called impingement) is limiting the amount of time she can be in the saddle and training. Her doctor has suggested surgery but wow! That seems pretty extreme. What is normally done about this problem?

Femoroacetabular impingement (FAI) of the hip joint can be a very painful condition — even while sitting in a saddle.

Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).

There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.Treatment may include surgery to restore normal hip motion but conservative (nonoperative) care with anti-inflammatories and physical therapy can be tried first. Some patients may also benefit from intra-articular injection with a numbing agent combined with an anti-inflammatory (steroid) medication.

A physical therapist will carry out an examination of joint motion; hip, trunk, and knee muscle strength; posture; alignment; and gait/movement analysis (looking at walking/movement patterns). A plan of care is designed for each patient based on his or her individual factors and characteristics.

Nonoperative care starts with activity modification (e.g., avoiding pivoting on the involved leg when getting on and off the horse, avoiding prolonged periods of inactivity or activity). This part of the program must be followed for at least six months (often longer). Improving biomechanical function of the hip involves strengthening appropriate muscles, restoring normal neuromuscular control, and addressing any postural issues. Tight muscles around the hip can contribute to pinching between the femoral head and acetabulum in certain positions.

A program of flexibility and stretching exercises won’t change the bony abnormalities present but can help lengthen the muscles and reduce contact and subsequent impingement. Anyone needing surgery will also benefit from physical therapy first to address muscle imbalances resulting in abnormal movement patterns that lead to femoral acetabular impingement.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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I have femoroacetabular impingement. If surgery doesn’t work, what next?

February 9th — admin

If surgery doesn’t work for my hip impingement, what next? The exact problem I have is called femoroacetabular impingement. I don’t exactly know what the surgeon will do — that will be decided when they get a good look inside there to see what’s going on. I forgot to ask this question when I was in the office for my preop.

Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).

There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. Current understanding of this hip deformity has resulted in surgery to correct the deformity.

The short-term goals are to relieve pain and improve function. The long-term goal is to prevent hip osteoarthritis.

As you have found out, the exact surgical procedure depends on the type of impingement and location and severity of deformity. The surgeon will also decide whether the procedure can be done arthroscopically or if an open incision will be needed.

Failure is not always defined the same by different surgeons. And patients may view the results differently than surgeons do. In some cases, continued pain after surgery is considered a failure. Others count osteoarthritis requiring a joint replacement as a “what next”? kind of failure. Some decisions depend on what type of complications might be present (e.g., infection, fracture, broken or bent screws, or loss of blood to the area).

Revision surgery may be needed to address whatever problem develops. With complete failure, conversion to a total hip replacement may be an option. Studies show that patients who already have severe arthritic changes at the time of surgery are the least likely to have a good result. Other pre-operative factors that could predict a poor result include older age and severe pain. Those findings suggest surgeons should give patients with these factors careful consideration before performing surgery to redesign the hip.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Our 16 year old son is getting hip surgery. What complications can we expect?

February 7th — admin

I’ve pretty much decided to agree to surgery for our 16-year-old son who has a hip impingement problem. We are convinced that this will help prevent arthritis later in life. What are the most likely complications from a surgery of this type?

FAI occurs in the hip joint. Hip pain, abnormal joint mechanics, and loss of hip function describe the three most difficult problems with femoroacetabular impingement (FAI). Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).

There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.Current understanding of this hip deformity has resulted in surgery to correct the deformity.

The short-term goals are to relieve pain and improve function. As you have found out, the long-term goal is to prevent hip osteoarthritis. Any surgery for any problem comes with the possibility of complications or problems. Surgery to repair a femoroacetabular impingement is no different. Some complications occur during the operation itself (e.g., bone fracture, reaction to the anesthesia). Others develop later during the postoperative period (e.g., infection, continued pain, blood clot formation).

It’s even possible to develop long-term complications. The bone may fail to heal, blood supply may become compromised, or hardware may break or back out of the bone. The whole procedure may fail to reduce pain and improve function. That means with repetitive load and use of the joint, cartilage destruction and joint degeneration may lead to osteoarthritis — the very thing you are trying to avoid.

It is good to be prepared for anything that might happen but expect good results. Ask your surgeon what he or she usually sees (if anything) with the particular surgery your son will have. Most complications are minor and easily corrected.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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My family has a history of hip problems. Is there value in having my hips X-rayed to see if they are okay?

February 3rd — admin

My family seems to have a history of hip problems. We don’t all have the same condition but quite a few have arthritis. Is there any value in going in and having X-rays taken to see if my hips are okay? I don’t have any pain but I’m getting up there in age.

Research shows that about eight per cent of the general population develops arthritis. This is probably an under estimate as it is based on X-rays and many people don’t have routine X-rays that reveal this diagnosis. In an effort to prevent arthritis, there are some experts who suggest routine screening for problems that might result in arthritis. But the cost of performing X-rays and/or MRIs on everyone may not be cost-effective.One condition that can lead to early degenerative changes is called femoroacetabular impingement (FAI). Perhaps one or more of your family members has had this diagnosed as the predisposing factor for their arthritis.Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.A recent study was done to see how many people in the general population have this problem. They took MRIs of the hips of 200 adult volunteers (ages 21 to 50) for a total of 400 hips. By examining the MRIs against other tests performed, they were able to see that 14 per cent of the people had femoroacetabular impingement and didn’t know it.In this study, they specifically looked at age, gender (male versus female), body-mass index (a measure of obesity), and ethnicity. These potential factors may put people at increased risk for impingement and then for going on to develop arthritis later.There were some significant findings from the measurements taken of each volunteer when compared with their MRI results. The elevated angle measured on X-ray (called the alpha angle) wasn’t diagnostic of femoroacetabular impingement by itself. (Though it was a predictor of hip pain and joint cartilage damage). When combined with restricted hip internal rotation, the alpha angle could be used to predict impingement. A positive impingement sign was a reliable indicator of a problem with the labrum (rim of cartilage around the hip socket).What this tells us is that your orthopedic physician can examine you and offer some direction as to whether or not an X-ray or MRI is even needed. If you are painfree and there are no clinical signs of impingement or arthritis, then it may be appropriate to just monitor your situation. This will avoid unnecessary costs and exposure to X-rays while still keeping an eye out for any signs of developing problems.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Early treatment of hip disorders can prevent later complications

January 18th — admin

Ever since I was a young teenager (maybe around 13 or 14), I’ve had a snapping hip problem. The general consensus at that time was to just ignore it. Now I’m in my late 30s and it is still bothering me. Should I see someone about this before another 20 years go by — or is it still considered a benign problem (don’t worry about it)?

It might depend on the cause of the problem. If you have a femoroacetabular impingement, then early osteoarthritis is possible, even probable. Just the slightest change in the morphology (shape and structure) of the hip joint can cause problems like this. Femoroacetabular impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket).

There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. The first type of femoroacetabular impingement (FAI) is called pincer impingement. This type occurs when the rim of the acetabulum (hip socket) sticks out farther than normal. There are several causes of this problem. There can be an overgrowth of cartilage forming the rim or even extra bone that forms in the area. Sometimes the hip socket is tilted backward slightly. In either case, every time the athlete flexes the hip, the rim that’s sticking out too far pinches the labrum against the neck of the femur. The labrum is a fibrous rim of cartilage around the socket to help give it some depth. It is a normal part of the hip biology.

The second type of femoroacetabular impingement is called CAM impingement. Normally, the head of the femur is a smooth, round shape. It is even all around so it can rotate inside the socket evenly. But any change in the shape can cause it to hit one point of the socket more than the others as the head of the femur moves inside the socket. The asymmetrical rotation of the pistol-shaped femoral head is called the cam effect. Anytime something repeatedly rubs against something unevenly, there is uneven wear, tear, and damage. In this case, when the hip is flexed or bent, the unevenly shaped femoral head doesn’t glide over the labrum as it should. Instead, it bumps up against the edge of the cartilage. Over time, the labrum gets worn down to the bone.

And finally, the third type of femoroacetabular impingement is a combination of the two just described (pincer and cam). Cam impingement is more common in males and brings on symptoms earlier than the pincer type. The combination of both types together causes problems sooner than if only one type was present. The best thing to do is see an orthopedic surgeon for an examination and diagnosis. It may be good to do this before any more time passes by. Early recognition and treatment of most hip disorders involving the soft tissue structures help prevent serious complications later.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Is it safe to try climbing walls after rotator cuff injury?

September 1st — admin

I have a buddy who wants me to try climbing walls at his gym. I’m really tempted but I had a rotator cuff injury several years ago. Is it safe for me to try this activity?

Arm injuries are common in sport climbing, especially injuries of the shoulder. The rotator cuff is a prime area for tendon damage and impingement (pinching) syndrome. Some of the stresses on the shoulders and arms depend on the angle and/or incline of the climbing wall. Ease with which handholds and footholds can be reached is another potential factor. Coordinated movements of the shoulder are needed for this sport.

The rotator cuff must function with just the right amount of muscle contraction and cocontraction. Cocontraction refers to muscles on the opposite sides of the joint contracting at the same time. Climbing techniques require a lot of body pull-up motions. The shoulder muscles must be strong enough to lift the entire body against gravity.

The best way to find out if your shoulder is stable enough for climbing activities is to have the muscles tested. Physical therapists offer isokinetic testing (e.g., Cybex system) to evaluate muscle strength under load. Any weakness or imbalance will be revealed with this type of testing. It’s possible a strength training program could prepare you for this vigorous sport.

One study comparing shoulder muscle strength of climbers versus nonclimbers found overall shoulder strength much greater among climbers. Shoulder extensors were twice as strong as the flexors. Training toward this ratio may help prepare you and protect you once you get started. Start with the easiest climbing walls first. Gradually increase the speed and level of difficulty based on the results of your muscle testing and endurance during the activity. If there is any question or doubt about your ability or preparation for this actvity, an evaluation with an orthopedic surgeon might be a good idea first before participating in this actvity.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What causes hip to squeak during sex?

August 2nd — admin

I’m a little embarrassed to ask this question. But have you ever heard of a hip replacement squeaking during sexual intercourse? I don’t notice it at any other time. It’s very annoying. What can be done about it?

You are not alone with this problem. In a recent survey of 149 patients with a THR, about one in 10 reported a squeaking hip. In that group, the sound was most noticeable when the patients were bending, walking, using the stairs, and during sexual activity.

There are many theories about what can cause this to happen. The best way to find out for sure is to remove the implant and take a look at what’s going on. But this isn’t always possible. The most common effect is seen as a broad stripe of wear on the femoral head. The wear pattern on implants removed and examined also show signs of impingement (pinching) of the femoral neck. The pinching occurs where the femoral neck meets the rim of the acetabulum (socket). Further testing with an electron microscope showed metal debris along the area of wear.

Rim impingement is probably the number one cause of hip squeaking. But there isn’t just one cause of impingement. Besides socket malposition, there could be a loss of fluid film lubricating the joint. Some patients have lax (loose) ligaments that can lead to impingement. There’s been some suggestion that an incomplete seal around the socket liner could cause squeaking.

Some studies have shown that thicker sockets don’t squeak but thin ones do. It’s possible that the thinner sockets deform when they are put in place. Incomplete positioning of the liner may be the problem there. Whatever the cause, there does not seem to be a way to stop it without removing the implant and revising the hip replacement. This may mean replacing part or all of the components. It’s important to match the socket with the right stem. The difference in resonance between the two parts can be enough to cause friction that creates vibration and then squeaking. Adding this variable to a patient with malpositioned components increases the risk of squeaking. Position and placement of the socket is important in preventing these wear patterns.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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I didn’t fall or hurt myself that I can remember. How can I find out what’s causing my pain?

April 21st — admin

How can I find out what’s causing my hip pain? I don’t notice it so much during the day but at night it aches like a son of a gun. I didn’t fall or hurt myself that I can remember. It just started bothering me all of a sudden.

There are many possible causes of hip pain. Often what patients call hip pain isn’t coming from the hip at all. Pain along the outside or back of the hip may not indicate a problem with the hip. True hip pain tends to cause pain along the inside of the leg near the groin.

There are many structures in and around the hip that can be causing painful symptoms. These include the joint itself, the rim of cartilage around the joint (called the labrum), the bursa, ligaments, muscles, and tendons.

Sometimes pain coming from the sacroiliac joint or low back can be referred to the hip. Most of the time, pain in the general region of the hip is caused by the soft tissue structures around the hip. There may be tightness, laxity, impingement, weakness, or poor alignment resulting in hip pain. Less often, fracture, infection, or tumor may be the source of symptoms.

A medical examination may be needed to find out exactly what’s causing your symptoms. Your doctor will take a history, perform some standard tests, and possibly order lab work to look for inflammation or infection.

Based on the results of these tests, further work-up may be advised. A set of standard X-rays may be needed. MRIs or CT scans are reserved for cases where further detail is required to make the diagnosis.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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