Elbow Dislocations

The elbow becomes dislocated when the joint surfaces are separated. With a complete dislocation, the joint surfaces are separated completely. The joint surfaces are only partly separated with a partial dislocation, also called a subluxation. The elbow is a hinge joint as well as a ball-and-socket joint.

Injuries and dislocations to this structure can affect the normal range of motion. Elbow dislocations are either simple or complex. With simple dislocations, there is no major bone injury. With complex dislocations bones and ligaments are injured.

What causes an elbow dislocation?

The most common reason an elbow is dislocated is when a person falls onto an outstretched hand. There is considerable force sent to the elbow when the hand hits the ground. Most often there is a turning motion in this force and this can rotate and put the elbow out of its socket. Elbow dislocations often occur during car accidents, when the passenger reaches forward in an attempt to cushion the impact.

What are the symptoms of an elbow dislocation?

With a complete elbow dislocation, there is considerable pain and obvious deformity. With a partial dislocation, the joint appears fairly normal. However, there usually is pain and bruising on the inside or outside area where ligaments have been torn or stretched. If the ligaments never heal, partial dislocations can recur.

How is an elbow dislocation treated?

Elbow dislocations require immediate treatment and are emergency injuries. The goal of treatment is to return the joint to its normal alignment and restore function of the arm. The orthopedic specialist can realign the elbow joint using a reduction maneuver. Once the joint is reduced, an immobilizer is required for two to three weeks.

Physical therapy is often required to restore full range of motion. For complex dislocations, surgery is often required to restore bone alignment and repair ligaments. After the operation, the elbow will be protected with an external hinge device to prevent further dislocation.

Shoulder Dislocations

The shoulder is susceptible to dislocation because it can turn in many directions. A partial dislocation of the shoulder is also called a subluxation. This means the head of the upper arm bone is partially out of the socket. With a complete dislocation, the structure is all the way out of the socket.

What are the symptoms of a dislocated shoulder?

Most shoulder dislocations lead to swelling, bruising, numbness, and weakness. Many times, a dislocation results in torn ligaments or tendons or damaged nerves. It is possible for the shoulder to dislocate downward, forward, or backward.

What is the treatment for a dislocated shoulder?

Many times the shoulder can be reduced. This is where the surgeon places the ball of the upper arm bone back into the socket. After the reduction, the orthopedic specialist will immobilize the shoulder in a sling or device for a few weeks. Ice is recommended 3 to 4 times a day to reduce pain and swelling. Also, the doctor will prescribe rehabilitation exercises for you to help restore the shoulder’s range of motion and strengthen the muscles. If recurrent dislocations occur, surgery is sometimes necessary.

Hip Dislocations

The hip becomes dislocated when the head of the thighbone slips out of the socket in the hip bone. For around 90% of people, the thighbone is pushed out of position in a backwards direction. This is known as posterior dislocation. Rarely, the thighbone slips out of socket in a forward direction. This is called an anterior dislocation.

What causes hip dislocations?

The hip joint is formed of a ball-and-socket construction. The ball is the head of the thighbone (femur) and it fits into a cup-shaped socket in the pelvis. This joint has a great deal of stability and moves freely. The most common reason for a dislocated hip is motor vehicle accidents. Falls can also result in dislocated hips.

How is a dislocated hip treated?

With a dislocated hip, the orthopedic specialist must administer an anesthetic or sedative and then position the bones back into proper position. This is called a reduction and surgery is often required. The surgeon will make an incision over the hip region in order to reduce the hip.

It takes up to three months for a hip to heal once it has been dislocated. Many times it is necessary for the patient to be in traction for a short period of time. Special controlled exercises are prescribed to help the hip regain strength and function.

If you participate in physical fitness activities and sports, you are at risk for injuries to the soft tissues of your body. Damage to the tendons, ligaments, and muscles of the body can occur even during simple everyday activities. These types of injuries include sprains, strains, contusions, stress injuries, bursitis, and tendonitis. Soft tissue trauma is usually the result of a fall, a blow to the body, or a sudden twist. Many times injuries to the soft tissue of the body are obtained because of repeated overuse during athletic activities.

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Achilles Tendinits

Achilles tendinitis is a commonly occurring foot condition that leads to pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body, and it connects the calf muscles to the heel bone. This tendon is used for jumping and running.

There are two types of Achilles tendinitis: noninsertional and insertional types. With noninsertional Achilles tendinitis, the fibers in the middle portion of the tendon have started to break down and the tiny tears swell and thicken the tendon. This more commonly affects young, active individuals.

With insertional Achilles tendinitis, the lower portion of the heel where the tendon attaches to the heel bone is affected. This particular type can occur for any type of patient, active or inactive.

What are the symptoms of Achilles tendinitis?

Like most foot problems, the symptoms vary from person to person. These include:

• Pain along the tendon or the back of the heel that worsens with activity
• Pain and stiffness which is worse in the morning
• Severe pain the day after exercising
• Thickening of the tendon
• Swelling that is present all the time or worsens after activity
• Bone spurring

What causes Achilles tendinitis?

Achilles tendinitis is not the result of a specific injury; the problem results from repetitive stress on the tendon. Other factors that cause this syndrome include tight calf muscles and bone spurring.

How is Achilles tendinitis treated?

Nonsurgical treatment for Achilles tendinitis involves rest, ice therapy, NSAIDS, special exercises, physical therapy, and supportive shoes and orthotics. Surgical treatment may be necessary if conservative measures fail. Occasionally a gastrocnemius recession is performed, where the calf muscles are lengthened. Surgery typically involves debridement and repair of the affected tendon.

The aim of this procedure is to remove the damaged portion of the Achilles tendon. Occasionally a tendon transfer is required when a significant amount of damaged tendon is present. The unhealthy portion of the tendon is removed and reinforced with a graft to prevent the remaining tendon from rupturing with activity.

Adult Acquired Flatfoot Deformity (AAFD)

There are many different conditions that can lead to adult acquired flatfoot deformity. This syndrome results in a fallen arch with the foot pointed outward. For this condition, most people require orthotics and braces. For those who have no relief with these measures, surgery may be an option. Your orthopedic specialist will plan a treatment regimen for you based on what is causing your AAFD.

What are the symptoms of AAFD?

The symptoms of AAFD vary from patient to patient. They include:

• Pain that is worse with activity
• Pain along the course of the posterior tibial tendon which is on the inside of the foot and ankle
• Pressure or discomfort on the outside of the ankle bone
• Bony bumps on the top and inside of the foot that make wearing shoes difficult

What causes AAFD?

The most common cause of AAFD is damage to the posterior tibial tendon. This structure is one of the most important tendons of the leg. It extends from a muscle in the calf and travels down the inside of the lower leg to attach to the bones on the inside of the foot. This tendon functions to hold up the arch and support the foot with walking. Other things that can cause AAFD include arthritis, injury, and diabetes collapse (Charcot foot).

Who develops AAFD?

Women and people over age 40 are most likely to develop AAFD. Other risk factors are hypertension, obesity, and diabetes.

How is AAFD treated?

When orthotics and braces do not work, surgical treatment for AAFD may be necessary. The type of surgery will depend on the degree of dysfunction. With stage 1 dysfunction (pain along the posterior tibial tendon with no loss of arch), surgery involves debridement of the tendon and repair of longitudinal tears.

The operation for stage 2 dysfunction (pain along the posterior tibial tendon with associated fallen arch deformity) is more complex and involves realignment of the heel bone, a tendon transfer to support the arch, and often a spring ligament repair. When the deformity is due to arthritis, surgery to fuse the bones of the hindfoot (triple arthrodesis) is often required.

Plantar Fasciitis

If you are experiencing pain on the bottom of your heel, you may have plantar fasciitis. This condition occurs when the strong band of tissue that supports the foot arch becomes inflamed and irritated. The plantar fascia is a thin, long ligament that lies just beneath the skin on the bottom of the foot. This ligament connects to the heel in the front aspect of the foot to support the arch.

What are the symptoms of plantar fasciitis?

Common symptoms of plantar fasciitis include:

• Pain after the first few steps when arising in the morning or after a long rest period
• Pain on the bottom of the foot or heel area
• More intense pain after (not during) activity or exercise

What causes plantar fasciitis?

The plantar fascia absorbs the high strains and stresses placed on the feet. Sometimes, however, there is too much pressure and damage or tears to the tissues of the foot occurs. When this happens, the body’s natural response to injury is inflammation resulting in heel pain and stiffness of the plantar fascia.

How is plantar fasciitis treated?

Nonsurgical treatment of plantar fasciitis involves rest, ice therapy, NSAIDS, exercise (calf stretch and plantar fascia stretch), cortisone injections, supportive shoes and orthotics, night splints, and physical therapy. Your orthopedic specialist will recommend what is best for you. If all these measures fail, occasionally shockwave therapy is an option. Surgery is rarely