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

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.

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

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.

I suspect that I may have a torn rotator cuff. What are the symptoms of a rotator cuff tear?

I suspect that I may have a torn rotator cuff. I dislocated my shoulder several years ago and I still have pain sometimes, especially if I’m trying to reach up for things. What are the symptoms of a rotator cuff tear?

Pain in your shoulder can be a few different things, including a torn rotator cuff. Only your doctor can tell you for sure if you do have tears in the tendons.

Signs and symptoms of a torn rotator cuff include:

Pain, particularly when you try to do every day activities such as putting your jacket or sweater on or reaching up

Aching or discomfort if you try to lie on the affected side to sleep

Difficulty reaching behind your back

Not being able to move your arm the full range that your shoulder should normally allow

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.

I’ll be getting my shoulder replaced. What should I expect?

I have to have my shoulder replaced. What can I expect?

Of course, the best thing to do is to discuss this with your own doctor, but there are some general things that you can expect.

 Your shoulder is made of a socket and ball, as well as muscles, tendons, and ligaments that hold it all together. The ball part in the replacement is generally made of metal. This is attached to your humerus either with a straight fit or with bone cement. This ball fits into the socket, which is called the glenoid component.

After the surgery, you will likely have to use a sling to keep the weight of your arm from pulling on the shoulder. A physiotherapist will show you how to strengthen your arm and shoulder and your doctor will tell you when you can stop using your sling. It is very important that you follow the instructions closely to increase the chance of a successful surgery.

 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.

Options for hang glider who crashed, tearing rotator cuff

I’m a certified hang gliding instructor with 20 years of experience. Even so I hit an updraft and crashed, tearing three of the tendons in my shoulder. I’ve had two surgeries to try and repair this massive tear. They didn’t work. Are there any other options left to me?

Repair of massive tears of the rotator cuff can be problematic. In some cases they are considered irreparable. Studies have been done trying different surgical methods of treatment for this problem. So far there hasn’t been a single type of surgery that works best.

For the most part the best approach seems to be cleaning up the damaged tendons. This is called debridement. Then the bone across the top of the shoulder (acromion) is removed. This is called an acromioplasty. If just the underside of the acromion is shaved, it’s called a subacromial decompression.

When any part of the rotator cuff is torn and can’t be repaired, an imbalance occurs at the shoulder. That’s why the rest of the rotator cuff can get impinged. Reducing or removing the acromion leaves room for the remaining tendons of the rotator cuff to slide and glide without getting pinched.

Other surgeries used to reconstruct massive rotator cuff tears include tendon transfers, fusion, and tendon grafting. No one method seems to have better results than the others.

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 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.

Rotator cuff tear result of trauma, aging

I’ve just been diagnosed with a rotator cuff tear but I’m not an athlete and I can’t remember any injury or trauma. How is this possible?

There are actually two ways to tear the rotator cuff. Trauma is the most common in the young, athletic population. Aging is more common in the over 50 crowd. Aging comes with its own wear and tear process in the shoulder.

The rotator cuff is a group of four tendons surrounding the shoulder. Over time and with use, it’s possible to wear a hole in the rotator cuff. Many people aren’t even aware it’s happening. It a lot like wearing a hole in the seat of your pants.

Weakness and then pain start to get our attention. It’s not until the person has trouble reaching behind to unfasten a bra or put on a coat that the problem is recognized.

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 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.

Time for total shoulder replacement? Not so fast!

I have arthritis in my left shoulder. It hurts constantly, but I can use it for most things. How can you tell when it’s time for a shoulder replacement?

The first place to start is with a medical exam. An orthopedic doctor is the specialist to see for this kind of problem. In some cases, medications and exercise may be all that’s needed. Muscle weakness can cause pain. A good rehab program can reduce pain, improve motion, and increase strength.

Sometimes, surgery to repair a torn tendon or muscle is advised. Many patients with shoulder pain have undiagnosed soft tissue damage. This could have happened years ago after a fall or other injury. A total joint replacement isn’t always the first answer to shoulder 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 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.

Medial, lateral, anterior, posterior – Where does your knee really hurt?

This booklet on knee anatomy should help you answer that question.

 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 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. For more information on this subject, visit www.zehrcenter.com

Does Shoulder Injury Require X-ray or MRI?

I started a weight-lifting program at home two weeks ago. When I increased to 20 pounds for shoulder movements, I felt a pop in my left shoulder. There was a twinge of pain at the time, and the next day I had extreme shoulder pain. I went to see the doctor, and she said I tore the supraspinatus tendon. There were no X-rays or other tests done. Shouldn’t I have X-rays or MRI?

X-rays have limited value in a case like this. Your doctor might have ordered an X-ray if she thought you could have fractured a bone. MRI (magnetic resonance imaging) is a useful test to identify damaged shoulder tendons. However, it is not always necessary to perform these studies. MRIs are very expensive, and most tendon tears can be accurately identified with a careful physical examination and history. An MRI is probably not necessary unless the doctor is considering surgery. If you do not get better after a program of physical therapy, the doctor may reconsider ordering an MRI. Getting a second opinion from another doctor may confirm the diagnosis at a lesser cost.

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 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. For more information on this subject, visit www.zehrcenter.com

What is a rotator cuff and how does it get torn?

I recently fell and hurt my shoulder. The doctor told me that I have a rotator cuff tear. What is the rotator cuff, and what part is usually torn?

 

There are four muscles that make up the rotator cuff. The tendons from each muscle encircle the top of the shoulder, much like the cuff of a sleeve goes around the entire wrist. The rotator cuff holds the humerus in the socket of the shoulder joint while still allowing it to turn, or rotate (hence the word “rotator”).

Usually only one or two tendons of the rotator cuff are torn. The tear commonly occurs close to where the tendon attaches to the bone. It is rare for all four tendons to be injured at the same time.

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 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. For more information on this subject, visit www.zehrcenter.com