30. September 2016 08:47
Distal femur is the lower end of the thigh bone which lies just above the knee joint and resembles an inverted funnel. The end of the bone is lined by a thick slippery substance called cartilage which allows it to slide across other bones that constitute the joint. It also helps in movement of the distal femur when the knee is bent.
A crack or a break in this part of the bone is medically referred to as the Distal Femur Fracture of the Knee. In case the force causing the fracture is strong enough, it may also damage the kneecap. Such fractures are commonly observed in people aged above 50 years as their bones are relatively weaker. However, younger populace is at an equal risk although the causative factors may vary. The injury can be classified as follows:
- Closed Fracture- The skin is not ruptured
- Open Fracture- The skin is cut open during the injury and a part of the bone may stick out
- Comminuted Fracture- The injury causes the bone to shatter into multiple pieces
- Transverse Fracture- The crack or breakage occurs straight across the bone
These fractures may not only damage the femur but also affect the tendons and ligaments that surround it. The hamstring and the quadriceps muscles may tend to snap and shorten when the bone breaks.
- A fall from a height
- Vehicular accident
- Loss of bone strength and density as age increases
- Direct hit to the knee
- Sports injuries
- Severe pain
- Inability to stand or bear body weight
- The injured area may be tender when touched
- Visible deformity
- Change in gait as the leg may become crooked or shorter
- Clinical evaluation of the injured leg by an orthopedic doctor
- Evaluation of the mode of injury, patient’s medical records and the symptoms
- The blood supply to the nerves and their ability to feel sensations may be tested
- X-ray imaging, CT scan or MRI may be performed
- If the bone is in a relatively stable condition and does not involve multiple fracture, it may be treated by using a cast or plaster
- The doctor may attach a traction pin to the bone and tie weights with a pulley. This may help to hold the bone in place.
- Surgery may be required in case of an open fracture to avoid infection.
- The broken bone may be put in place using external fixator devices (screws and pins) which are fixed on a frame attached to the leg. Internal fixation may also be done by making surgical incisions. A metal rod may be inserted to keep the femur in place
- Severely damaged bone may need a bone graft which involves extraction of a piece of bone from the pelvis. Artificial bone fillers or allograft may be used in some cases
- Knee replacements may be recommended for elderly patients
- Physical therapy may be required in the post-operative phase to aid healing and restore flexibility as well as strength in the leg
For effective treatment of Distal Femur Fracture of the Knee and other injuries, visit OrthoTexas. To schedule an appointment with the orthopedic doctors in McKinney, TX, you can call at (972) 727 – 9995 or visit 7300 Eldorado Parkway, Suites 165/165A, McKinney, TX 75070.
27. September 2016 13:13
Dry needling is a treatment technique that is aimed at curing and reducing the severity of various neuromuscular disorders. It is performed by trained physical therapists and is based on the study and understanding of the neuroanatomy as well as musculoskeletal functioning. Also referred to as the Intramuscular Stimulation (IMS), the procedure may involve the use of either solid filiform needles or hollow-core hypodermic needles. The fact that these needles are used without any medicines or injections gives it the name Dry Needling.
Dry Needling: The Process
The needles are used to prick the skin above the myofascial trigger points that are believed to be the source of pain. If the needle prick results in a local twitch response (LTR) which refers to the involuntary spinal reflex action, it means that the therapist has identified the right trigger point. The twitching helps in deactivating the trigger point in the muscles and thus providing relief to the patient. The insertion of the needle also reduces muscle contraction as it cuts or pierces through numerous fibrous tissues of the stretched muscles. The needle piercing activates the immune system and stimulates it to send signals throughout the body.
The therapist inserts the needle for a few seconds and then removes it. The process is repeated a couple of times until the LTR ceases. The therapist presses the point of insertion once the needle is removed to prevent soreness and swelling.
Listed below are a few benefits of dry needling:
- It is very effective in restoring the normal functioning of the affected muscles
- It can be used to treat a variety of physical ailments such as Tennis Elbow, Fibromyalgia, Sciatica, Carpal Tunnel Syndrome, muscle spasms or strains, back pain etc.
- The therapy helps to eliminate biochemical dysfunctions
- The patient is better adapted at managing pain and other discomforting symptoms
- When used with other forms of physical therapy techniques, dry needling can significantly accelerate the rehabilitation process
- Range of motion can be greatly improved
- Dry needling not only helps in gaining therapeutic effects but also helps in locating the taut muscles (sore points) as well as diagnosing the underlying cause of the condition
- The needle insertion relaxes the muscles in the body
- Dry needling is a safe therapy as it involves fine and ‘one-time use’ sterile needles
- Patients who undergo this therapy feel more energized, are psychologically relaxed and experience holistic well-being. This therapy also improves appetite and the sleeping habits of the patients
- It improves blood flow to the muscles and prevents buildup of scar tissue
The physical therapists at OrthoTexas specialize in performing dry needling therapy to provide relief from pain. To schedule an appointment with the rehab specialists in Carrollton, TX, you can call at (972) 492 – 1334.
24. September 2016 09:30
The acromioclavicular (AC) joint is the point where the clavicle (collar bone) meets the acromion (shoulder blade). Injury to the ligaments that support this joint and connect these two bones is referred to as Acromioclavicular Joint Separation. The two main ligaments that may be affected are the acromioclavicular (AC) ligament and the coracoclavicular (CC) ligament.
The injury can range from mild to severe depending on the extent of damage to the ligament and bones. Mild injuries involve slight stretching of the ligaments whereas severe injuries witness complete tearing of one or both ligaments besides the separation of the two bones. Such injuries make the joint prone to Arthritis in the future.
Timely medical treatment can prevent chances of permanent shoulder deformity.
- A direct fall on an outstretched arm or hand
- Sudden trauma to the arm, elbow, shoulder or hand
- Sports injuries
- Pain in the upper part of the shoulder/collar bone which may get worse when the joint is moved
- Swelling and tenderness
- Loss of function and difficulty in raising the arm overhead
- A lump may form above the shoulder
- Some cases may have visible shoulder deformity
- Clinical evaluation of the injured shoulder through palpation and range of motion tests
- Evaluation of the mode of injury, symptoms reported by the patient and the medical history
- X-ray may be done and in some cases, the patient may be asked to hold a weight in the injured hand during the scan for better view of the injury
The treatment for AC joint separation may include:
- Resting the injured arm and avoiding any stress to it
- Applying ice packs at regular intervals may curb swelling and pain
- Keep the arm elevated above chest level
- Immobilization using a removable sling to provide support to the shoulder
- Soft compression may be used for relief
- Use of a shoulder brace
- Prescription of anti-inflammatory medications to relieve pain and discomfort
- Taping of the joint may be done for 2-3 weeks to improve stability
- Specific exercises may be done to improve strength, mobility and flexibility
- Surgical trimming of the collar bone to avoid it from getting in contact with the shoulder blade
- Surgical reconstruction of the damaged ligaments
The shoulder specialists at OrthoTexas provide effective treatment for Acromioclavicular Joint Separation and other orthopedic conditions. Patients in Denton, TX can call at (940) 382 – 1577 to schedule an appointment with the shoulder surgeons.
20. September 2016 08:21
Sesamoids are bones that are attached and supported by tendons. They remain embedded in the muscles and provide a smooth gliding surface for the tendons to move above them. Sesamoiditis is an orthopedic condition characterized by inflammation of the tendons near two small sized sesamoids located in the forefoot. These bones are about the size of a corn kernel and work to support the toes while weight bearing. Sesamoiditis is a type of Tendinitis and is most commonly seen in runners, baseball catchers as well as ballet dancers.
- Repeated movements that stress the foot such as dancing, hopping and running
- Presence of a high foot arch
- Sudden increase in the intensity of physical activity
- Bony feet that have less fatty layers are prone to Sesamoiditis
- Osteochondritis - Disrupted blood supply to the sesamoid bones may lead to their death and consequent deposition of calcium near these bones. This in turn leads to tendon inflammation
- Pain at the inner side of the ball of the foot
- Pain sets in gradually and increases if the activity is continued
- The big toe joint may feel tender when touched
- Clinical evaluation of the foot
- The doctor may move the foot in different directions to determine positions that increase the pain
- X-ray examination may reveal the position and status of the bones
- Bone scan may be required in some cases
- MRI test may also be conducted to diagnose bone infection
- The conservative methods of treatment for Sesamoiditis may include one or more of the following:
- The affected foot should be given sufficient rest and weight bearing should be avoided
- Use of shoe inserts and pads for added cushioning
- Immobilization of the big toe using taping techniques or removable straps
- Cryotherapy- Application of ice packs at regular interval may help to reduce pain and swelling
- Anti-inflammatory medicines may be prescribed by the orthopedic doctor
- Corticosteroids may be injected into the joint for immediate relief
- Wearing flat sole shoes may be helpful
- Surgical scraping of the infected tissues
- A part of the sesamoid bone or one of them may be surgically extracted
- A bone graft may be used in case of a fracture in any of the sesamoid bones
We, at OrthoTexas, provide complete diagnosis and treatment for Sesamoiditis. To schedule an appointment with our foot and ankle surgeons in Plano, you can call at (972) 985 – 1072 or visit 4031 West Plano Parkway, Suite 100, Plano, TX 75093.
17. September 2016 06:33
Kienböcks Disease, also known as Avascular Necrosis Of The Lunate, is a medical condition in which the blood supply to the lunate bone in the wrist joint is disrupted. The condition may also lead to the death of the bone. Lunate is an important bone that provides support and assists in the movement of the joint. Damage to this bone can cause pain, stiffness and if left untreated, may lead to the development of Arthritis.
- A fall on the wrist/outstretched hand can cause trauma to the joint and cease the blood flow
- The lunate is supplied blood by two arteries but in some people one of them may be missing. This may reduce the amount of blood that reaches the bone and thus damages it
- Disparity in length of the forearm bones- ulna and radius- may exert excessive pressure on the lunate bone
- Pain in the wrist
- Stiffness in the joint
- Inability to form a firm grip with the hand
- Loss of range of motion
- The middle portion of the wrist is tender when touched
- The hand cannot be moved upwards
- Analysis of the patient’s medical history, symptoms and injuries to the wrist
- The orthopedic doctor may examine the wrist and the movements that cause discomfort
- X-ray imaging may be done
- MRI scan may help to diagnose the severity of damage to the bone
- The disease may be managed through conservative methods of treatment in its initial stages.
- Anti-inflammatory medicines may be prescribed to relieve pain
- Immobilization of the joint using a cast or a splint for 2-3 weeks may relieve pressure from the wrist
- Surgical Revascularization- A piece of bone along with an attached blood vessel is removed from the other hand and attached to the damaged lunate bone. External fixator devices may be used to facilitate fusion and re-growth of the lunate
- Joint Leveling - If the wrist bones have difference in length, the doctor may use a bone graft to lengthen one of them or shorten the other by removing a part of it. Leveling may help to reduce pressure on the lunate bone and stop the progression of the disease
- Proximal Row Carpectomy - A surgical procedure in which the lunate is removed along with two adjoining bones. This may be recommended in case the lunate has broken or is severely damaged
- Bone Fusion - The lunate may be fused with one or more bones in the wrist joint for better support
For treatment of Kienböcks Disease, visit OrthoTexas. To schedule an appointment with the hand and wrist surgeons in Frisco, TX, you can call at (214) 618 – 5502.
13. September 2016 07:29
Pigmented Villonodular Synovitis (PVNS) is a medical condition which refers to the thickening of the synovial membrane. The membrane is a thin slippery layer of tissue that lines the cartilage and helps in lubrication as well as smooth movement of the joints. The condition causes the synovium to secrete extra fluids which eventually leads to swelling and hinders the movement of the joint. The overgrowth of the tissues forms a tumor but is not cancerous. PVNS may affect one or more joints of the body and is most commonly observed in knee, hip, elbow, ankle as well as shoulder. People in the age group of 30-40 years are more susceptible to the disorder.
Pigmented Villonodular Synovitis can be classified into two categories:
- Localized- The tendons are affected by the growth of the tumor but it is localized to just one point within the joint
- Diffused- The tumor spreads through the entire joint and may cause severe damage
PVNS is largely attributed to genetic anomalies and no other cause of this disease has been established so far.
- Swelling in the joint
- Catching or locking of the joint when moved
- The joint may feel unstable and weak
- Loss of motion or functionality
- The symptoms may occur periodically
- X-ray imaging to check if the condition has cause damage to the bone
- Clinical examination of the symptoms, affected joint and range of motion
- Evaluation of patient’s medical and family history
- MRI scan may help to assess if the condition is localized or diffused as well as the severity of the thickened synovium
- Aspiration- Drainage of the fluid from the joint for clinical testing
- The doctor may extract a part of tissue from the tumor for biopsy
Most cases of Pigmented Villonodular Synovitis require surgical treatment. The following procedures may be recommended:
- Arthroscopy- A camera guided, minimally invasive procedure to remove the tumor
- Open surgery- An incision is made in the joint and the membrane is removed to prevent any damage to the joint. The procedure is mainly recommended for patients with diffused PVNS
- Combined arthroscopic and open surgery- If majority of the tumor mass is located at the back of the joint, it is removed through open surgery while the remaining part at the front is extracted by arthroscopy.
- Total replacement of the joint may be required in severe cases. In this, the orthopedic surgeon removes the damaged part of the joint and replaces it with artificial implants.
OrthoTexas provides complete diagnosis and treatment for Pigmented Villonodular Synovitis and other medical conditions. To schedule an appointment with the orthopedic surgeons in Allen, TX, you can call at (972) 727 – 9995.
9. September 2016 09:10
Dupuytren’s Contracture is a physical disorder of the hands which restricts complete straightening of the fingers. The tissue layer beneath the skin may get thickened into clots which pulls the fingers towards the palm. The condition may have a severe effect on the day-to-day activities of the patient, such as lifting objects. Also, known as Viking’s Disease, it is most commonly observed in the ring and little finger. The disorder has a slow level of progression and often does not cause any serious problems.
- Hereditary factors
- Excessive alcohol consumption may be a potential cause
- Seizures may result in such abnormalities
- Smoking increases the risk of developing the condition
- Presence of thick lumps or nodules under the skin of the palm. When pressed, these lumps may feel tender but do not cause pain
- Difficulty in grasping objects
- Fingers may be flexed towards the palm
- Limited range of motion
- Irritation and burning sensation may occur, in case of inflammation of the tendons in the hand
- Clinical evaluation of the affected hand may reveal the presence of Dupuytren’s Contracture
- Palpation may be done to assess the thickened tissue cords beneath the palm
- The doctor may check the range of motion of the hand
- Specific devices may be used to measure the level of contracture
- Enzyme Therapy- Injecting some specific enzymes (collagenase) into the soft tissues of the hand may provide relief and improve motion as it dissolves the thickened cords
- Corticosteroids may be injected to arrest the progression of the disease
- Needle Aponeurotomy - a needle may be used to puncture the thickened tissue cords and manual manipulation may be done to straighten the fingers.
- Surgical correction of the tissues may be required if the condition progresses rapidly. In the procedure, the doctor may remove the lumps and perform skin grafting to close the wound.
- Post-surgery, the patient may be advised to keep the affected hand elevated to prevent swelling.
- Physical therapy may help to restore strength and flexibility of the hand and fingers.
The hand and wrist doctors at OrthoTexas offer comprehensive treatment for Dupuytren’s Contracture and other orthopedic conditions. To schedule an appointment, call at (972) 899-4679 or visit 4951 Long Prairie Rd, Suite 100, Flower Mound, TX 75028.
5. September 2016 10:04
Congenital Knee Dislocation (CDK) is a rare disorder that is present at the time of birth. It is a physical deformity which affects the alignment of the knee joint and may exist in isolation or could be a consequence of some musculoskeletal abnormality. It is characterized by a hyperextension of the knee, along with a possible misalignment or dislocation of the foot and hip joint as well. Congenital Knee Dislocation may promotes the chances of a breech birth and it is more common in girls.
- Family history or genetic factors
- Larsen Syndrome which refers to a faulty development of knee, hip or foot joints
- Neural Tube Defect- The spinal cord and meninges or the tissues covering it do not close and start protruding out of the baby’s back
- Abnormal fetal position in the womb
- Primary contracture of the quadriceps muscles
- Traumatic dislocation may also occur during parturition (vaginal birth)
- Underdevelopment or complete absence of the cruciate ligaments in the knee joint
- The child will be born with a clear knee recurvatum, i.e., backward bent knee
- Club Foot
- The child may also have an abnormal rib cage or chest cavity
- The hip joint may also be dislocated
- The knee cap is partially formed and may not be found during palpation
- A thorough clinical evaluation of the child’s limbs and adjacent parts may be done using palpation
- The flexibility and range of motion of the joint may be assessed
- An ultrasound test conducted during the gestation period may reveal the problem
- X-ray imaging to assess the severity of the deformity
- MRI scan may be recommended for children 3 years of age
In most cases, non-surgical treatment options are recommended for Congenital Knee Dislocation. Orthopedic doctors recommend that starting the treatment soon after birth enhances the chances of recovery. Treatment options may include:
- The hip and knee may be manipulated using external fixator to bring them back to their original position. These fixator devices may be used till the child attains the age of six months
- Use of splints on the affected part may be helpful
- Skin traction
- Percutaneous Quadriceps Recession- A minimally invasive surgical technique which aims at correcting the joint alignment
- Serial casting- Use of a fiberglass plaster to hold the deformed limb in correct position and stretch the tight muscle to control its flexion. A new cast may be fixed every week and the treatment is likely to continue for 3-6 weeks
- Surgical lengthening of the quadriceps or the tendons of the knee cap (patellar tendons) may be required at a later stage
- Leg brace may be worn to allow limited flexion of the knee
- Surgical repositioning of the displaced bones and reconstruction of supporting ligaments
- Strengthening the quadriceps muscles through physical therapy may be recommended
The knee doctors at OrthoTexas provide complete diagnosis and treatment for Congenital Knee Dislocation and other orthopedic conditions. Patients in Carrollton, TX can call at (972) 492 – 1334 to schedule an appointment.