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 »

Accurate diagnosis of hip pain can be elusive

July 28th — admin

I saw my primary care physician for hip pain that just won’t go away. Despite a huge amount of time testing me every which way, there’s no known cause for the problem. Should I insist on X-rays or an MRI?

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of the problem.

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 a bone bruise? After a car accident that dislocated my hip, I found out I also had a bone bruise around my knee.

May 6th — admin

What is a bone bruise? After a car accident that dislocated my hip, I found out I also had a bone bruise around my knee.

Pain around the knee after traumatic hip dislocation is often caused by a bone bruise. The force of the impact through the knee may cause tiny fractures. These occur just under the cartilage in the first layer of bone called subchondral bone.

Bone bruises can also occur as a result of falls, sports injuries, or a direct blow to the knee from people or objects. Bruises can be painful (mild to severe) and last from days to months. MRI shows swelling inside the bone marrow as a sign of a bone bruise. The injury usually heals on its own without treatment. Surgery may be needed if there’s a large fracture of any of the bones around the knee.

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 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.

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

My 72-year old mother,who has a history of alcohol abuse, fell and now has knee pain. Will an X-ray show anything if it’s not broken?

April 4th — admin

My 72-year old mother has a long history of alcohol use and now has osteoporosis. She’s been complaining of knee pain for the last two weeks. We think she fell on her knee but she won’t admit it. Would an X-ray show anything if it’s not broken?

In this age group with a history of alcohol use as described, an X-ray would certainly be a good place to start. If nothing unusual shows up, an MRI, CT scan, or even a bone scan may be needed.

Doctors are finding more and more cases of a condition called insufficiency fractures in this age group. Postmenopausal women seem to be at greatest risk, probably because of osteoporosis. The weakened bone just can’t stand up to normal, everyday stresses. Early diagnosis and treatment are important to avoid a full fracture.

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 »

Having gotten off a bus for 10 years, my mother’s hurt knee was diagnosed as an insufficiency fracture. Why was this time different?

March 25th — admin

My mother was getting off the bus when she had severe, sharp knee pain. The MRI showed a stress fracture. The doctors are calling it an insufficiency fracture. She’s gotten off that bus everyday for the last 10 years. Why was yesterday any different?

You didn’t say your mother’s age but age may be a factor. Older women are at increased risk for this problem. There’s an increased number of these fractures in women who are postmenopausal. Osteoporosis (decreased bone density) in this age group is another important factor.

Without its normal resiliency, the simplest, everyday stress can cause damage to the bone. Anyone who has arthritis is also at increased risk. Often, the osteoporosis added to any slight knee deformity can be enough to cause this problem.

Other factors include alcohol use, Crohn’s (intestinal) disease, and the use of steroids for arthritis. Low calcium absorption, vitamin D deficiency, and hormonal changes are also factors.

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 »

Is there any way to tell if a shoulder injury is minor, or if it may be a rotator cuff tear?

March 11th — admin

Is there any way to tell if you have just hurt your shoulder by pulling it or twisting it, or if it is something more serious like a torn rotator cuff?

The only way to be sure that your injury is a rotator cuff injury is to have it diagnosed by your doctor. To do this, you may have x-rays, an ultrasound or an MRI (magnetic resonance imaging) that allows the doctor to see the soft tissue and any damage.

Another test, called an arthrogram may be done. This is also an x-ray, but dye is injected into the shoulder first so that the joint can be seen more clearly.

  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 Shoulders. Tags: , , , , , , . No Comments »
« Older posts «
Newer posts » »