Typical Orthopaedic Diagnoses

• What is Impingement Syndrome?
  
  This used to be called Bursitis in the shoulder. There is a bursa on top of the rotator cuff and underneath the flat bone (acromion). When the rotator cuff is irritated, the body's natural reaction is to try and cushion it by filling the bursa with fluid. This in turn puts more pressure on the rotator cuff. When the rotator cuff gets more irritated it can scar or tear, leading to more pain, or more weakness.
   
• What is a Rotator Cuff Tear?
  
  This is a tearing of one or more tendons of the rotator cuff. It usually tears where it is attached on the arm. It can be caused by one major trauma, or over time in patients that have Impingement Syndrome (see definition above).
   
• What is an Anterior Cruciate Ligament Tear?
  
  The anterior cruciate ligament is one of four major ligaments that connect the femur (thigh bone) and tibia (shin bone) and keeps the tibia from moving too far forward relative to the femur. When you tear your ACL (anterior cruciate ligament) in your knee, it has to be reconstructed, not repaired. This is because there is not a very good blood supply to the center of the ligament, and simply stitching the tear is not adequate. The most common ways to tear the ACL is with hyperextending the knee, as when you catch the tip of ski and your knee bends the wrong way. In football, a helmet to the outside of the knee, a so called valgus injury, may result in the terrible triad: an ACL tear, a medial collateral ligament (MCL) tear – the ligament on the inside of the knee, and a tear of the medial meniscus – the cartilage cushion on the inside portion of the knee. The ACL can be tear w/ other mechanisms but these are the more common ways. The ACL is important in pivoting or cutting. That is why patients who tear their ACL can often perform straight ahead type activities like running or weightlifting but are unable to play football, basketball, or soccer.
   
• What is a Dislocated Shoulder?
  
  This is where the "ball" (humeral head) part of the joint comes out of the "socket" (glenoid) portion of the joint. The shoulder is a generally unstable joint. It is like a big ball sitting on a small flat saucer. This gives you the range of motion you have in your shoulder.
  
  By comparison, in the hip, the ball sits in the socket, but most people don't have the same range of motion in their hips as they do in their shoulders.
  
  There are two main static stabilizers in the shoulder. The labrum is a "rubbery" substance like a meniscus that goes around the socket and acts like a rubber stop. The capsule or joint lining is a sac that surrounds the joint. The dynamic stabilizer (which can strengthen or relax) is the rotator cuff. When you dislocate your shoulder, the structures that can be injured are the labrum, the capsule, the humeral head and/or the glenoid. In older patients, the rotator cuff may also be injured.
  
  The shoulder usually dislocates in the front, but can also come out the back, typically in patients with seizures.
   
• What is a Separated Shoulder?
  
  This involves the AC joint, which is between the collarbone (clavicle) and the flat part on the top of shoulder blade (acromion). When the ligaments in this joint tear, you then have a separated shoulder. It may first appear that the collarbone is pushing up, but actually the shoulder blade has dropped.
   
• What is Carpal Tunnel Syndrome?
  
  This is a big "tunnel" on the palm side of your wrist. There are eight tendons inside along with the median nerve. The median nerve supplies feeling to the thumb, the index finger, the middle finger and usually half of the ring finger. It also supplies the "power" to most of the muscles which move the thumb. When the tendons become irritated, they become swollen. This can occur, for example, when you are typing on a computer
  for a long period of time. Because the tunnel is a fixed size, when there is swelling, there is less room for the nerve and it becomes pinched. It is similar to your gaining five pounds and shrinking your jeans-either the inside has to get smaller or the outside has to get bigger.
  
  The way to make the inside smaller is to get rid of the irritation in the tendons and shrink the tendons back to their normal size. This can be done with rest, braces, medications and/or injections. If the nerve is pinched for long periods of time, then in addition to the pain, there can be tingling, numbness or even weakness. When the symptoms become more severe, your Doctor may have you get an EMG, which tests the function of the nerve. If there is too much pinching of the nerve or you have not gotten better, he or she may recommend a Carpel Tunnel Release (see below).
   

• What is "Trigger Finger"?
  
  Tendons that bend the knuckles of the finger start in the forearm. Because they are so long, they have arches or pulleys along the way to help pull them close to the bone. One of the arches, the A1 Pulley, is located where the finger connects to the palm. Because this is the area where there is a lot of movement of the tendon, there can be irritation. When the tendon gets irritated, it swells and rubs on the pulley. When the pulley gets irritated, it scars or shrinks (tightens). Because of this it "catches" and that is where term "trigger finger" comes from. The finger can even get stuck when the swollen portion moves past the pulley and can't pull back. Again, this is like gaining five pounds and shrinking your jeans. You now either have to make the inside smaller or the outside bigger.
  
  You can sometimes make the inside smaller with rest or an injection. If this doesn't work, you may require a trigger finger release (see below).

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