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Orthopedics & Joint Replacement:
Clinical Conditions & Program
Offerings
Hip
Knee
Shoulder
Wrist, Elbow and Ankle
For more information or to schedule an appointment,
call the physicians of The Mercy Orthopedics and Joint Replacement
Division at 410-539-2227.
HipOsteoarthritis
Osteoarthritis is the destruction of the articular
cartilage or protective covering of the bone in the joint.
In some cases it
is the result of trauma or infection, but more often
there is no particular risk factor. Symptoms include a gradual
onset of pain in the buttock, groin or deep in the hip
joint over years. The pain is often present at rest but worsened with
activity. It is associated with a decrease in motion at
the
hip joint and often an obvious difference in leg length
is noticed. Treatment starts with anti-inflammatory use, weight
loss if indicated, activity modification and non-impact
exercise. The eventual treatment after failure of non-operative therapy
is total joint
replacement.
Rheumatoid Arthritis
Rheumatoid Arthritis is an auto-immune disease characterized
by overgrowth of the joint lining, or synovium, which leads
to destruction of the articular cartilage and bone of the joint.
Symptoms include
pain in the buttock, groin or deep in the hip joint, stiffness,
and limited motion of the hip. It is treated with multiple
oral medications and activity modifications. Severe cases require
joint
replacement.
Avascular Necrosis
When a portion of bone loses its blood supply the bone
dies, a condition known as avascular necrosis. The exact cause
is not known although there are risk factors such as long-term
steroid use,
sickle cell anemia and lupus. This abnormal bone, when located
in the head of the femur, can cause severe pain and loss
of motion. The condition can progressively worsen until there
is collapse
of the affected bone. Initial treatment includes anti-inflammatory
medications and limited weight bearing. Initial surgical
treatment
involves drilling of the bone to decompress the affected
area. More advanced cases are treated with bone graft to the
affected area, partial or total joint replacement.
Joint Replacement – Hip
Replacement Surgery
A number of conditions including osteoarthritis, rheumatoid
arthritis and avascular necrosis, can cause severe hip damage
and pain. If medications, changes in daily activities, and walking
aids do not relieve pain, a hip replacement may be recommended.
Hip replacement surgery relieves pain by replacing an artificial
joint where the diseased hip joint was previously. Prior
to hip replacement surgery an orthopedic evaluation will be conducted
and x-rays will be taken to assess the extent of the hip
damage. The final decision to undergo hip replacement surgery
should be made with your physician.
Anterior Approach Hip Replacement
Anterior approach hip replacement is a new, cutting-edge, minimally invasive hip replacement surgery. The surgery is initiated from the front of the hip rather than the side or back. This approach allows the surrounding muscles (typically detached from the pelvis or femur in a traditional hip replacement) to be left undisturbed, which can result in faster recovery, less pain, less tissue trauma, a smaller incision and less risk of dislocation. Click here for more information.
Knee
Meniscus Tears
The meniscus cartilage is a firm, rubbery textured tissue
in the knee which works as a shock absorber during high impact
activities. The meniscus can tear with a twisting motion such
as a sudden
change
in direction. It can also tear as part of the regular aging
process, known as a degenerative tear. Symptoms of a torn meniscus
can include
pain, swelling, locking of the knee in one position and a
sensation of instability. Some tears may heal on their own
but others need
treatment including rest, anti-inflammatory medications,
cortisone shots and arthroscopic surgery. Some meniscus tears,
usually acute
tears in younger patients, may be successfully repaired with
surgery and others, usually degenerative, require that the
torn piece of
meniscus tissue be surgically removed.
Ligament Tears (MCL, ACL)
The knee is stabilized by four ligaments-
the medial collateral, lateral collateral, anterior cruciate
and posterior cruciate. The
medial collateral ligament (MCL) and anterior cruciate ligament
(ACL) are the most commonly injured. The MCL is typically
injured by a hit to the knee from the side and is associated
with pain on the inside of the knee. It is almost always successfully
treated
with rest, anti-inflammatory medications and, in more severe
injuries, with a brace for several months.
The ACL is injured
with deceleration,
pivoting and hyperextension of the knee in such sports
as soccer,
basketball and skiing. Often the patient hears a pop and
has immediate swelling of the joint. The ACL is not capable
of healing and more
active individuals with a complete tear risk instability
and permanent damage to the knee joint if the injury is not
addressed. Some patients
do well with an aggressive rehabilitation program emphasizing
hamstring strength but many require reconstructive surgery
to regain knee
stability.
Patella Tendinitis
Patella tendinitis (inflammation of the patella tendon
insertion) is characterized by severe pain at the bottom of
the knee cap where
the patella tendon attaches to it. The pain is often worsened
by activity such as running or stair climbing. It is seen in
high level athletes such as marathon runners and soccer players
but even more so in poorly conditioned individuals who have
started an exercise program too vigorously. Treatment includes
rest, ice, anti-inflammatory medications, braces, and an aggressive
stretching
program. Cross-training to avoid overuse syndromes is also
emphasized.
Patello-Femoral Syndrome
When the patella or kneecap does not move fluidly
in the groove of the femur or thigh bone with flexion and extension
of the knee,
pain can result. This problem is commonly seen in runners
who will complain of pain along the outside of the knee cap,
grinding and
clicking. There are many causes of this problem, collectively
referred to as patello-femoral syndrome. Weak quadriceps muscles, “knock
knees” and poorly balanced training programs are only a few
of them. Treatment consists of rest, anti-inflammatory medications,
taping of the knee cap, bracing, and isolated strengthening
and stretching of certain muscles around the knee. In very
rare cases,
when the tilt of the knee cap affects its tracking or when
articular cartilage of the knee cap has been severely damaged,
surgery is
considered.
Osteoarthritis
Osteoarthritis is the destruction of
the articular cartilage or protective covering of the bone
in the joint. In some cases it
is the result of trauma or infection but more often there
is no particular risk factor. Symptoms include a gradual
onset of pain
in the knee over years (often worsened on stairs), decreased
motion, stiffness and a gradual increase in bowlegged or
"knock knee" stance.
Treatment starts with anti-inflammatory use, activity modification,
weight loss if indicated and non-impact exercise. Brace
use, corticosteroid injection, and joint protein injection
are all further
options.
Following failure of non-operative therapy partial or total
joint replacement is usually recommended.
Rheumatoid Arthritis
Rheumatoid Arthritis is an auto-immune disease
characterized by overgrowth of the joint lining, or synovium,
which leads to destruction
of the articular cartilage and bone of the joint. Symptoms
include pain, stiffness, swelling and limited motion of the
knee. It is
treated with multiple oral medications and corticosteroid
injections. Surgical treatment includes arthroscopic removal
of the joint lining
and, in more severe cases, joint replacement.
Avascular Necrosis
When a portion of bone loses its blood supply, the
bone dies, a condition known as avascular necrosis. The exact
cause is not
known although there are risk factors such as long-term steroid
use, sickle cell anemia and lupus. This abnormal bone, when
located in the femur or tibia of the knee joint, can cause
severe pain, swelling, and loss of motion. The condition can become
progressively
worse until there is a collapse of the affected bone. Initial
treatment
includes anti-inflammatory medications, a conditioning program,
bracing and activity modification. More severe cases require
surgery, which ranges from drilling the affected area to stimulate
a new
blood supply to joint surface replacement.
Joint Replacement – Knee
Replacement
Arthritis in the knee and certain knee injuries can
cause severe pain and hinder the performance of everyday activities
such as walking and climbing stairs. If medications, changes
in daily activities, and walking aids do not relieve pain,
a knee replacement may be recommended. Knee replacement surgery
relieves pain by resurfacing the knee’s damaged and worn
surfaces. Prior to knee replacement surgery an orthopedic
evaluation will be conducted and x-rays will be taken to
assess the extent
of the damage. The final decision to undergo knee replacement
surgery should be made with your physician.
Shoulder
AC Ligament Tears
A fall onto the shoulder can injure the joint between
the shoulder blade (acromion) and collarbone (clavicle). Symptoms
include pain,
swelling, and in worse cases, a prominent bump at the front
of the shoulder. Initial treatment includes rest, ice, anti-inflammatory
medication and a gradual return to full range of motion.
In severe
cases when pain is persistent, especially in a person who
performs heavy lifting, surgical reconstruction of the ligaments
is recommended.
Bursitis/Tendinitis
Bursitis/Tendonitis is a common
overuse injury in sports and general overhead activities. The
rotator cuff tendon and the bursa, the
fluid-filled sac which prevents friction with shoulder
motion, become inflamed and are irritated when they are
pinched between
the humeral head and the arch of bone above it with overhead
motion. Pain generally occurs at the tip of the shoulder and
into the deltoid
muscle when the arm is raised above the head and rotated
such as when throwing or shampooing hair. It can even be painful
when trying
to sleep on the affected shoulder. Treatment includes rest,
ice, anti-inflammatory medications and physical therapy. Occasionally,
a corticosteroid injection into the inflamed area is necessary.
If symptoms persist, surgery to increase the space available
for
the tendons is considered.
Frozen Shoulder
Occasionally after
untreated bursitis/tendinitis or immobilization of the
shoulder, adhesive capsulitis or a frozen shoulder may
occur. Symptoms include extremely limited motion and pain on
attempts at motion. Treatment includes anti-inflammatory medications,
a very aggressive therapy program and corticosteroid injections.
Manipulation of the shoulder joint under anesthesia and
release of capsule tissue arthroscopically are infrequently
necessary.
Osteoarthritis
Osteoarthritis is the destruction of the articular cartilage
or protective covering of the bone in the joint. In some cases
it is the result of trauma or infection but more often there
is no particular risk factor. This can occur in the ball and
socket joint
of the shoulder (the glenohumeral joint) and in the joint
between the collar bone and the shoulder blade (the AC joint).
Symptoms of glenohumeral arthritis include pain with all shoulder
motion
and limitation of motion. AC arthritis is characterized by
pain in the front of the shoulder when the arm is crossed over
the body. Treatment consists of anti-inflammatory medications, activity
modification,
and corticosteroid injections. Partial or total joint replacement
in glenohumeral arthritis is sometimes necessary to relieve
pain. Removal of the end of the clavicle is usually effective
in relieving
the pain of AC arthritis.
Wrist, Elbow and AnkleCarpal Tunnel
Repetitive wrist motion
can lead to inflammation and swelling of the flexor tendons
of the fingers at the wrist. This swelling
causes narrowing of carpal tunnel, the space in which these
tendons and the median nerve enter the hand, resulting in compression
of
the median nerve at the wrist. Symptoms include numbness
and tingling of the palmar surface of the thumb, index and
long finger with
associated pain and, in worse cases, atrophy of the thumb
muscles. Initial treatment includes rest, ice, modification
of risk factors
and anti-inflammatory medications. Splinting, physical therapy
and corticosteroid injections are also considered. If symptoms
persist, surgical repair is recommended.
Tennis Elbow
Tennis elbow (lateral epicondylitis) is inflammation of
the tendons that extend or bend back the wrist and fingers where they
attach
at the elbow causing pain at the outside of the elbow. Golfer’s
elbow (medial epicondylitis) is a similar condition involving
the tendons that flex the wrist and fingers causing pain
at the inside
of the elbow. They are both usually caused by repetitive
motion. Treatment includes rest, ice, bracing, stretching
and strengthening. Cortisone shots are sometimes necessary, and
surgery is rarely
required to relieve the symptoms.
Achilles Tendinitis
Achilles Tendinitis is an overuse syndrome usually caused by rapidly
increasing running mileage, adding hills to a workout, starting
up exercise too quickly after a lay-off and a sudden contraction
of the calf muscle. Symptoms include pain and swelling at the
Achilles tendon just above the heel bone. The pain often resolves
after warming up. Treatment includes rest, ice, antiinflammatory
medications, orthotics, a stretching program and choosing appropriate
shoes for your anatomy.
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Please call for an appointment.
Phone: 410-539-2227
Tollfree: 1-800-MD-Mercy (1-800-636-3729)
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