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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , , , . No Comments »

Does femoroacetabular impingement (FAI) surgery work? What are my chances for a successful FAI operation?

January 30th — admin

My question for you today is: does surgical treatment for femoroacetabular impingement (FAI) work? I’m facing the decision whether or not to have this surgery, and I want to know what my chances are for a successful operation.

We may find some helpful information to answer this question from a recent systematic review of studies done regarding surgery for femoroacetabular impingement (FAI). The statistical significance of any conclusions from a systematic review is worth noting. That’s because such a review combines the results of many smaller studies to give an overall view of the results of treatment like surgery for FAI of the hip.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.Most studies on this condition are case studies. That’s because no one surgeon sees 100s or 1000s of patients with this problem. Case studies are good because surgeons have to start somewhere when trying to see the effects of treatment. The problem with published case studies is that this is considered a low level of evidence. A surgeon wouldn’t want to treat any patient with methods considered “successful” based on low levels of evidence. Conducting a systematic review like this one allowed the authors to examine the data on 970 different patients (collected from 23 reports of case studies). Now surgeons can see what the latest findings are and evaluate their own practices based on what is statistically significant.One of the questions specifically addressed in this review is the very same one you raise. Does surgical treatment for femoroacetabular impingement (FAI) work? The answer to this question may depend on how “success” is defined.If pain relief is the measured outcome, we know that the majority of the 970 patients included did have relief of painful symptoms. A second outcome was improved function. That was also a benefit of surgical repair for femoroacetabular impingement (FAI). Levels of patient satisfaction as an outcome measure were not so high. For those patients whose pain didn’t improve and especially those patients who ended up having a hip replacement, reported patient satisfaction was low. In some studies, the rate of dissatisfaction and/or conversion to hip replacement was as high as 30 per cent.The obvious next question is: can we predict who will have a poor result? That’s a simple question that doesn’t have a simple answer yet. One risk factor for worse outcomes with femoroacetabular impingement surgery is advanced joint arthritis at the time of the diagnosis. But there are two problems with relying solely on this factor.First, not everyone with severe damage has a poor outcome with surgery. Just as many patients with severe damage had good outcomes as those who had a failed treatment. The reasons for those differences remain unknown and will require further study. Second, even with X-rays and MRIs, it isn’t always possible for the surgeon to know the full extent of the damage. Sometimes, it isn’t until getting inside the joint that the surgeon can see what’s really going on. These tests are still important and the results should be discussed with you by your surgeon when making the final decision about the best treatment choice for you.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , , . No Comments »

What is spontaneous ostenonecrosis and what causes it?

January 19th — admin

What is spontaneous ostenonecrosis and what causes it? My husband has been diagnosed with this problem in his left knee. We can’t figure it out.

You’re not alone in your questions. We know that osteonecrosis is the death of bone tissue. But spontaneous osteonecrosis (SON) is sudden, unexpected, and without known cause.

Some recent reports point to a possible increase in this condition in adults over age 60. At first doctors thought it was linked with arthroscopic surgery to remove a torn meniscus. But then five new cases were reported in patients who had meniscus degeneration but no surgery.

It appears that age-related wear and tear on the meniscus may be the start of the problem. But there are still many questions about what’s going on. For example, in one study of five patients, symptoms of knee pain were identified as medial meniscal degeneration.

At the time of the diagnosis, there were no changes in the bone seen on an MRI. The patients were all treated with physical therapy, exercise, and noninflammatory drugs. Two months later the symptoms increased. A second MRI showed osteonecrosis of the knee.

What happened in those two months between MRIs? Doctors just aren’t sure yet but further studies may offer some insight into SON.

Posted in Knees. Tags: , , , , , , , , , , , , . No Comments »

I’m 62 and have been having some pain inside my right knee. Is this just age, or should it be checked by a doctor?

January 17th — admin

I’m 62-years old and in reasonably good health. Lately I’ve been having some pain along the inside of my right knee. I’ve waited for it to go away. I’ve tried ibuprofen. It’s not getting worse but it’s not getting better. How do you know what’s just a sign of getting older and what should be checked out by a doctor?

Sometimes it’s impossible to tell the serious from the not-so-serious medical conditions. With aging come age-related changes in the body. With the knee, joint cartilage such as the meniscus starts to wear out. Early signs of arthritis start to set in.

But most experts agree that early intervention can make a big difference in many kinds of problems. Don’t wait to see your doctor. An X-ray may be all that’s needed. In some cases an MRI is best. If conservative care doesn’t improve your symptoms, then a second MRI may be needed.

Recently several studies have documented cases of spontaneous osteonecrosis in adults over age 60 who had some meniscus degeneration. Osteonecrosis is the death of bone. Spontaneous means it came on suddenly with no warning and no known cause. These are the kinds of problems you want to avoid by checking with your doctor sooner than 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.

Posted in Knees. Tags: , , , , , , , , , , , , , , . No Comments »

There was little concern about my hip pain until I mentioned it was always worse at night. Why?

January 10th — admin

No one seemed particularly concerned about my hip pain until I mentioned it was always worse at night. Then all of a sudden, I had a ticket to the MRI machine. They found a benign tumor (osteoid osteoma) in the upper portion of the femur. Why was this night pain the “hop to it” symptom?

Bone pain from osteoid osteomas usually occurs in young men between the ages of five and 24 (though it has been reported in older adults). Without knowing there’s a tumor present (and without a more dramatic presentation), it’s easy to think that the fellow is having growing pains. But pain at night that wakes the person up from a sound sleep is a red flag for cancer. Then the picture of a young person with bone pain at night suddenly becomes more compelling.Why does this type of pain develop? It turns out that cancer cells can signal the normal healthy tissue to form tiny blood vessels between the healthy tissue and the cancer. The process is called angiogenesis. The net effect is to siphon off blood to the tumor. This creates a loss of blood supply to the surrounding healthy tissue, a condition called ischemia. Without oxygen, the body sets up a pain response. Since most of this happens at night when the body is in a semi-state of hybernation, the symptoms don’t occur during the day.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , . No Comments »

I have a very painful buttock. I don’t recall any injuries. What could be causing this?

January 6th — admin

Ouchie — I don’t know how else to say this but I have one painful buttock. I can barely sit down and can’t put any weight on that side. It just seemed to come on all of a sudden. I don’t recall twisting wrong or doing anything sudden. What could be causing this?

Pain along the back of the hip or buttock can be a very complex and puzzling condition to figure out. Sometimes a muscle gets overworked and goes into spasm. There could be an alignment problem of the spinal joints in the lumbar spine causing your symptoms. There could even be a disc pressing on a nerve creating your symptoms.The best way to find out is to see a musculoskeletal specialist. This could be a sports medicine physician, orthopedic surgeon, or physical therapist. Give some thought to your symptoms because the physician or therapist will ask you many questions about where it hurts, how it feels, what makes it better or worse, how long it lasts, and so on. The answers to these questions are key to understanding what’s going on.Pain along the back of the hip is rarely coming from inside the joint. We know this from anatomy studies and understanding the nerve pathways that supply the joint and surrounding soft tissues. It is most likely coming from elsewhere — like the sacroiliac joint, low back, or knee. It could be from a muscle strain, hernia, bursitis, degenerative disc disease, fracture, or even from a hip dislocation. Rarely, buttock pain can be caused by more serious problems like infection or tumor.There are many clinical tests that can be done to sort out what anatomical structure is getting pinched, overworked, or is out of balance or alignment. Change in joint motion, areas of muscle weakness, muscle tightness, and even the way you stand and walk will provide the necessary clues to identify the underlying problem.Sometimes, X-rays or other imaging studies such as MRIs, CT scans, or ultrasound studies are needed. But most of the time, the problem clears up with conservative care and doesn’t require expensive or invasive tests. If your symptoms don’t improve or go away with a few days rest, warm baths, and stretching, then make an appointment for an evaluation. Early diagnosis and treatment preventing worsening of the problem often saves both the pocketbook and the buttock from further suffering.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , , , , , , , , , , , . No Comments »

Our son had knee pain. Doctors used an X-ray and an MRI. I thought they used bone scans. Why not?

November 30th — admin

Our son had knee pain every time he tried to run or work out. We finally took him to the doctor’s. An X-ray was negative but the MRI was positive for a stress fracture. I thought they used bone scans to find things like this. Why not?

Diagnosing stress fractures isn’t easy. As you know they don’t show up on X-rays in the early stages. This is called a false negative. In other words, the X-ray was read as normal when there really was a problem.

Bone scans have the opposite problem. They often indicate there is a problem when there isn’t one. This is called a false positive. False positives are more common with children and teenagers who are still growing or remodeling bone.

MRIs seem to offer the best results when looking for bone stress injuries. In a recent study of military trainees with exercise-induced knee pain, two separate radiologists read the patients’ MRIs. They did this without knowing the patient’s symptoms or history. They didn’t consult with each other. There was good agreement between the two physicians and an accurate result with the MRI.

MRIs can’t show the difference between bone bruises and bone stress injuries because bone marrow edema is present in both. In such cases the physician must rely on the history.

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.

Posted in Knees. Tags: , , , , , , , , , , , , , . No Comments »

I had a steroid injection for a chronic tendon problem. The pain is back. Should I have a second injection?

November 25th — admin

My doctor diagnosed me with a chronic tendon problem in the groin. After months of monkeying around with stretching and strengthening exercises, I finally had a steroid injection. It worked great — for about two months. Now the pain is back again. Should I have a second injection? There were a lot of warnings about too much steroid and how it could cause its own tendon damage.

Studies on the use of steroid injections for groin tendon problems are not plentiful. Research shows that one to three steroid injections of soft tissues for acute and/or chronic inflammatory pain can be beneficial. More than that and the risk outweighs the benefit because steroids are known to break down collagen fibers that make up tendons and muscles.But if you obtained pain relief the first time and it lasted eight weeks, chances are a second injection might resolve the problem for you. Some of it may depend on your activity level and any anatomical or postural issues that might be contributing to the problem.Some additional testing might be helpful. MRIs with contrasting dye can offer useful information. If you are a competitive athlete (participating in your sport four or more days each week), your risk of recurrence is much higher. This is likely because your activity level is high enough to repeatedly cause microtrauma of the affected tendon(s). A positive MRI showing uptake of the dye into the damaged tendon is a predictive factor for symptom recurrence in competitive athletes.For recreational athletes (participating in any sports activity less than four times per week), the MRI findings are not as predictive. Some folks don’t have any sign of tendon pathology on the MRI but still get pain relief from the steroid injection. With a lower activity level and greater ability to rest between sports activity, recreational athletes seem to benefit from the injection regardless of the MRI results.

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.

Posted in Hips. Tags: , , , , , , , , , , , . No Comments »

Could groin pain curtail workouts for triathlete?

November 22nd — admin

I’ve been training for a triathlon for three months now. All of a sudden, I’ve pulled up lame with groin pain. Can I safely work through the pain? If I keep training, how do I modify my workouts?

There are different problems that can cause groin pain. Before making a decision about your training regimen, see a sports medicine specialist for an examination and diagnosis. If you have a simple tendon strain, the treatment approach is very different from a sports hernia or stress reaction (fracture).An X-ray can rule out (or confirm) the presence of any bone fractures. Stress reactions are not visible for six to weeks after the damage has been done, so there may be a lag time before this diagnosis can be made. Another imaging study that might offer some useful information is a contrast MRI. A dye is injected that is taken up by the tendon where it inserts into the bone. Damage to the tendon fibrils leave the soft tissue edges open so that the dye seeps into the area. Not all tendon problems show up on MRIs, so this test is not 100 per cent accurate.There are some simple clinical tests the physician can use to pinpoint the problem. Reproducing your pain by pressing on the adductor longus, the most common tendon involved in groin pain, is a sure sign that the problem is extra-articular. Extra-articular means the pain is coming from outside the hip joint. Two other tests are helpful: resisting movement of the adductor muscles and assuming a position that stretches the muscles. Pain with either of these tests helps confirm the adductor muscle as the most likely cause.Once the diagnosis has been made, then your physician can advise you as to the best treatment or management approach. This could involve a period of rest and avoidance of weight-bearing activities. Or it could mean a change in your training protocol. Depending on how far away the triathlon is, you may still be on target after rest and recovery. Continuing to repeatedly stress the area is usually not advised.

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.

Posted in Hips. Tags: , , , , , , , , , , , , , , . No Comments »

Is a labra tear with impingement diagnosis really that complicated?

November 8th — admin

I finally got a diagnosis for my hip pain: a labral tear with impingement. Seems like they did every imaginable test to figure it out. Is it really that complicated?

The hip is a fairly complex joint. Problems that often seem like they are in the hip really originate from the low back, sacroiliac joint, and even the knee. True hip pain usually occurs in the groin and front of the thigh. But even knowing the problem is in the hip doesn’t identify the true cause. It could be the soft tissues in and around the joint, the articular cartilage inside the joint, or the rim of cartilage around the rim of the hip socket called the labrum.When the labrum is tored, frayed, or damaged in some way, it can get pinched between the head of the femur and the acetabulum (hip socket). This pinching or impingement is what causes the groin pain, loss of hip motion, and sometimes grinding, catching, or locking sensation with certain hip motions. Labral tears can be especially difficult to diagnose because there are often other changes going on in the hip at the same time. The physician relies on a standard physical exam, history, and then special tests to sort it all out. Joint range-of-motion, strength, and a postural assessment provide helpful information. The patient’s report of what makes it better and what makes it worse is also very useful.There is also a pain test that can be done. The surgeon injects a numbing agent similar to novocaine into the hip joint. If the pain goes away, it’s an indiction that the source of the pain is coming from inside the joint. If the pain doesn’t go away, it could still be something around or just outside the joint.But X-rays and sometimes MRIs are often needed to confirm the presence of a torn labrum. And even then, it isn’t until the surgeon performs an arthroscopic exam that the true extent (and possibly cause) of the problem are uncovered.

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.

Posted in Hips. Tags: , , , , , , , , , . No Comments »
« Older posts «
»