Options for Orthopedic Surgery in Alabama

 

 
For lasting relief from chronic pain, choose the professionals at Alabama Orthopaedic Surgeons. We provide the highest-quality care to patients who seek relief from chronic pain associated with sports injuries, arthritis, fractures and other conditions.

When disabling conditions and acute trauma threaten to derail your health and well-being, it’s time to explore how orthopedic surgery can help you find relief from discomfort and assist in a return to your daily routine. Find out why so many Birmingham-area families place their trust in our team of orthopedic doctors and medical professionals, who are dedicated to providing exceptional care for all patients.

Our team of surgeons has a combined 60 years of experience in orthopedic medicine, and we pride ourselves in taking an individualized approach to addressing a wide range of conditions, including those listed in the categories below:

Neck, Back And Spine Injuries

Spine (Anatomy)
The spinal column is made up vertebrae, ligaments, muscles, connective tissues, nerves, and spinal segments that support the function, weight, and movement of the body. All of these elements work together to protect the spinal cord, which provides communication from the brain to the body. The spinal column can be divided into 5 different sections: the cervical spine, thoracic spine, lumbar spine, sacrum, and coccyx. Between each vertebra is an intervertebral disc, which acts as a shock absorber to protect the spine during activities that put a strong force on the spine, such as running, lifting weights, or jumping. In the back of the spine, pairs of vertebrae are joined together to form facet joints. Similar to a hip or shoulder joint, facet joints regulate motion such as bending forward, backward, and side to side.

Cervical Spine
The purpose of the cervical spine (c-spine) is to support the skull, enable a diverse range of motion for the head, and contain and protect the spinal cord. The cervical spine begins at the base of the skull and consists of seven vertebrae, eight pairs of cervical nerves, and muscles and ligaments to support the spine. The individual vertebrae are labeled C1-C7, with C1 being the vertebra at the top of the spine. Compared to other vertebrae that make up the spine, the c-spine vertebrae are considerably smaller and delicate.

Thoracic Spine
The most important role of the thoracic spine (t-spine) is to provide stability when holding the body upright and protecting vital organs in the chest. The t-spine consists of twelve vertebrae in the upper back that run from the base of the neck to the bottom of the rib cage. The rib cage is connected to each level of the t-spine—one rib is securely attached to each side of the vertebra. The ribs attached to the T1-T10 vertebrae curve around to meet at the front of the body and attach to the sternum. The T11 and T12 vertebrae in the lower back area do not attach to the sternum; however, they do provide protection for the kidneys.

Lumbar Spine
The lumbar vertebrae (L1-L5) are the most frequently injured vertebrae in the back because these vertebrae carry the weight of the body and are the subject of the stresses along the spine. The low back, or lumbar spine, begins directly below the cervical and thoracic vertebrae and directly above the sacrum.

When To See An Orthopaedic Surgeon
Injury to the spine can be caused by a fall or blow to the back, or by abnormal compression of the spinal cord. These conditions can often affect not only the back area but have resulting consequences in the arms, legs, and neck. Pain, numbness, or tingling in one or more limbs (arm or leg), limited range of motion due to pain, mild discomfort to severe pain in the back, legs, or buttocks, inability to balance, loss of fine motor skills coupled with neck pain, or shooting pain down the spine and leg should be examined by a physician.

Lumbar Strain
Pain in the lower back can be caused by muscular strain or injury as a result of awkward twisting or lifting. A lumbar strain is treated when examination and x-ray confirm that no injury to the spinal column has occurred.

Treatment and Recovery
Lumbar strain is usually able to be treated non-surgically with a combination of rest, physical therapy, and anti-inflammatory medication. Complete recovery is achieved in most cases within 2-8 weeks of injury.

Herniated Nucleus Pulposus
Abrupt pain in the lower back brought on by activity can be the result of a herniation. Often, as the back pain resolves, pain will begin in the buttock and run down the leg. Other symptoms can include pain and numbness, muscle weakness, bowel/bladder incontinence, and the inability to lift the straightened leg.

Treatment and Recovery
Non-surgical treatments for this condition include rest, anti-inflammatory medication, physical therapy, or steroids. Surgical treatment, if required, involves removing the affected portions of the disc. An orthopaedic surgeon will determine the best treatment option once a thorough examination has been conducted.

Internal Disc Disruption
A tear in one of the outer discs of the spine, also referred to as an annular tear, can be the result of an acute injury or part of a degenerative process. Pain is often found in the back and leg as a result of the associated inflammation.

Treatment and Recovery
Non-surgical treatments for this condition include rest, anti-inflammatory medication, physical therapy, or steroids. Surgical treatment, if required, usually involves fusing together the affected discs. An orthopaedic surgeon will determine the best treatment option once a thorough examination has been conducted.

Sacroiliac Joint Dysfunction
The pelvic joint, also known as the sacroiliac joint, can be injured as a result of abnormal motion within the joint. This causes inflammation and pain, typically in the pelvic joint region, but also radiating toward the hip and possibly the leg.

Treatment and Recovery
Due to the strong network of ligaments in this joint, the sacroiliac region is very stable with limited motion. As a result, non-surgical treatment is usually able to resolve the pain while the injury heals. Treatments can involve physical therapy, anti-inflammatory medications, steroids, or in rare cases, surgical joint fusion. An orthopaedic surgeon will determine the best treatment option once a thorough examination has been conducted.

Spinal Stenosis
A narrowing of the spine, known as spinal stenosis, causes pressure on the spinal cord or nerves. Depending on the nerves affected, the resulting pain or numbness may be felt in the legs, back, neck, shoulders or arms, and may even cause problems with coordination and bladder or bowel function. This condition is typically seen as a result of the aging process, but can also be caused by a degeneration disorder, or by a traumatic injury to the area.

Treatment and Recovery
Non-surgical treatments for this condition include rest, anti-inflammatory medication, physical therapy, or steroids. Surgical treatment, if required, usually involves the insertion of an implant to widen the affected area and relive pressure on the nerves. An orthopaedic surgeon will determine the best treatment option once a thorough examination has been conducted.

Scoliosis
The condition of scoliosis is characterized by a sideways “s-shaped” curve of the spine, which can sometimes be noticeable externally by uneven shoulders, waist, or hips. While most cases are mild, severe cases can be disabling and cause difficulty in the functioning of other areas of the body. Scoliosis most often occurs during puberty, during a time of rapid growth. Its exact cause is largely unknown.

Treatment and Recovery
Most cases of scoliosis are mild, and regular examinations are conducted to monitor the growth of the bones to prevent further progression of the curve. In moderate cases, a brace may be worn until the bones stop growing to prevent further curvature. Severe cases typically worsen over time and can cause additional complications of the body’s functions. For this reason, surgical intervention may be recommended. The orthopaedic surgeon will need to conduct a thorough examination to determine the appropriate treatment.

Spinal Compression Fracture
Compression fractures of the spine occur when the normal spacing between the discs of the spine are compressed from the top to bottom. This occurs when pressure is placed on the vertebrae which exceeds its stability, and it collapses. Causes can include traumatic injury, but most often is caused by osteoporosis, or a condition causing the bone to thin and weaken. Because the nerves can become pinched by the pressure, pain is the most common symptom. It is also possible to notice a decrease in height or a curved ‘hump’ back.

Treatment and Recovery
Treatment for compression fractures normally involves preventing further complications by ensuring the bone is stable and able to support the body. Physical therapy and medication may be prescribed to control pain and help strengthen the back to prevent future injuries. In severe cases where a collapse of the spine is possible, surgery to restore and stabilize the spinal column may be the considered. Most fractures heal completely in 8-12 weeks, although preventative action is important to ensure the cause of the weakening does not continue to produce future compression fractures.

Spine (Disc Herniation)
When a disc herniates, it puts pressure on the nerve in the spinal canal, causing pain in one or more areas of the body. If a herniated disc in the c-spine presses on the nerve or nerve root, pain will develop down the arm into the shoulder or to the hand depending on the nerve involved. If a disc in the thoracic spine is herniated, pain in the chest wall (or sternum) and pain and numbness along the rib are common symptoms. In a herniated lumbar spine disc, symptoms can progress from a dull pain in the lower back to a severe, sharp pain.

Treatment and Recovery
The physician will examine the injured areas and determine the effect on movement and pain levels. An x-ray or MRI may is usually required to determine the extent and location of the damage. In many instances, satisfactory results can be achieved using rest, physical therapy, anti-inflammatory medications, nerve blocks, or physical therapy exercises. When conservative treatment fails to produce relief, a surgical procedure may be performed in order to correct the injury. While some spinal procedures can be performed outpatient, many require a short stay in the hospital. An orthopaedic surgeon will determine the best treatment option once a thorough examination has been conducted.

Shoulder Injuries

Shoulder (Anatomy)
The shoulder joint is comprised of the shoulder blade (scapula) and the head of the upper arm bone (the humerus). The humerus fits inside a depression in the scapula called the glenoid, allowing it to move freely in a wide range of motion. The surfaces of the humerus and glenoid are with cartilage which allows the shoulder joint to move without friction.

When to See an Orthopaedic Surgeon
If you experience pain or weakness when lifting your arm over your head or at night (especially while sleeping on the shoulder), following a fall or traumatic injury after which your shoulder immediately became extremely weak or tender, or a catching or ‘grating’ sensation when you rotate or raise your arm, you should make an appointment with an orthopaedic surgeon. In some cases, pain felt in the shoulder actually originates in the neck. A thorough examination will determine the type and extent of the injury, and an appropriate course of treatment will be recommended to you. You should also contact a physician if you continue to have pain or impaired use of your shoulder after non-surgical therapy.

Shoulder (Rotator Cuff Injury)(Shoulder Tendonitis)
The rotator cuff consists of four muscles and their tendons, which help to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. These combine to form a “cuff” over the upper end of the arm (head of the humerus).

An injury to this area of the shoulder may result in continuous pain, pain at night, tenderness to touch, and/or loss of shoulder mobility. Often, an injury to the rotator cuff is a result of aging, trauma, repetitive stress, or overexertion of a weakened shoulder. Individuals that participate in activities such as tennis, swimming, baseball, softball, football, and some manual labor jobs requiring similar overhead movements are at particular risk of injury. A healthy rotator cuff should allow the shoulder to have strength, flexibility, and stability; decreased ability in these areas should be examined by an orthopaedic surgeon.

Treatment and Recovery
In many cases, rotator cuff injuries or tendonitis may be effectively treated using non-surgical therapy. Treatments may include limiting use of the affected shoulder, use of a sling, anti-inflammatory medication, a steroid injection, or physical therapy as determined by the extent of injury and effectiveness over time of the treatment.

For surgical repairs, the type of surgery performed will depend on the size, shape, and location of the tear as determined by the orthopaedic surgeon. For those with active lifestyles or active use of the affected shoulder, surgery is commonly recommended to fully repair the tear, restore function to the shoulder, and decrease pain. Patients are generally able to return to normal activities within 3-6 months.

Shoulder (Shoulder Impingement)
Impingement is caused by pressure on the rotator cuff by the upper arm as it is raised, and can occur as a result of developing bone spurs and/or inflammation in the shoulder. Symptoms may begin with mild pain of the shoulder which can occur while at rest, while reaching or lifting, or in a radiating pattern from the front of the shoulder down the side of the arm. As the condition progresses, patients may experience pain at night, loss of strength and motion, and difficulty doing activities that require reaching or lifting up or down, or moving the arm behind the back.

Treatment and Recovery
An orthopaedic surgeon should examine the shoulder to determine the cause of the pain. Examination may include x-rays and range of motion tests to determine the extent and type of the injury. Non-surgical treatments may include limiting use of the affected shoulder, use of a sling, anti-inflammatory medication, a steroid injection, or physical therapy as determined by the extent of injury and effectiveness over time of the treatment.

Recovery typically takes two to four months to achieve complete relief of pain.

Shoulder (Shoulder Dislocations)
If the shoulder is wrenched upward and backward, as in a car accident, fall, or sports collision, it may become partially or completely dislocated from the socket. Symptoms include severe pain and an inability to move the affected shoulder. Often, the shoulder will appear slightly misshapen due to the underlying muscle and bone displacement, and may feel soft to the touch.

Treatment and Recovery
The shoulder should be examined by an orthopaedic surgeon to determine the extent of the injury. Examination may include x-rays so that the physician can determine the presence of the dislocation, and to look for any other injuries to the shoulder bones, ligaments, or blood vessels. Often, the injury is treated with a non-surgical repositioning or “reduction” procedure during which the physician reinserts the ball of the humerus into the shoulder joint socket. In severe cases, surgical reattachment of the torn ligaments is required to ensure joint stability.

Following dislocation and treatment, the shoulder will be immobilized for a period of up to six weeks. Most patients regain full use of the shoulder after 3-6 months, depending on the severity of the injury.

Shoulder (Shoulder Instability)
Instability of the shoulder joint can occur when the structures surrounding the joint become loose and no longer fully maintain the ball within its socket. The shoulder may feel as if it is sliding or popping in and out of the joint and may be accompanied by pain, numbness, or weakness in the shoulder. Instability may be caused by congenital or developed defect of the joint, but is most commonly seen in patients with prior history of shoulder injury in which the supporting tendons were weakened and never fully recovered.

Treatment and Recovery
Non-surgical treatment may include physical therapy exercises in an attempt to strengthen the muscles surrounding the joint. However, the preferred method for long-term resolution is surgical repair in order to tighten the surrounding ligaments and stabilize the shoulder joint. An orthopaedic surgeon should examine the shoulder and determine the need for surgical treatment.

Shoulder (Acromioclavicular (AC) Separation)
The Acromioclavicular (AC) joint is where the collarbone (clavicle) connects with the highest point of the shoulder blade (acromion). Injury to the AC joint is commonly caused by a fall or sports collision resulting in impact directly to the shoulder, where the shoulder blade is forced down and away from the collarbone. In mild cases, the ligaments attached to the collarbone become torn away from the top of the shoulder blade, causing mild pain, swelling or discomfort. More severe injuries may be very painful and give the shoulder a deformed appearance due to the partial or complete separation of the ligaments and resulting displacement of the joint.

Treatment and Recovery
AC separations are seldom severe enough to require surgical repair, which your orthopaedic surgeon will evaluate during an office visit. Most injuries are able to be treated with the use of a sling or cold/hot packs applied to the shoulder. Rest and limited use of the shoulder will be required until the ligaments are healed.

Shoulder (Muscle Strain)
Muscle pain and stiffness between the shoulder blades is common when there is an overuse of the shoulder muscle, even for a relatively short period of time. Instances of carrying a heavy bag over one shoulder, typing on a keyboard that is too high, driving with the steering wheel in an awkward position, or general slouching can cause the muscles of the neck and shoulder to strain. Stress can also be a contributor to shoulder muscle pain.

Treatment and Recovery
Shoulder strains seldom require surgical intervention. Often, an orthopaedic surgeon will prescribe rest and/or a series of exercises aimed at strengthening and rehabilitating the shoulder muscles. Anti-inflammatory medications or cortisone injections may also be prescribed to manage pain and inflammation.

Shoulder (Biceps Tendon: Strain or Rupture)
The bicep muscle consists of two tendons that run from the shoulder to the elbow. Injuries to this area are commonly seen in active adults or athletes, often as a result of a specific event. Sharp pain is noticeable immediately in the front of the upper arm and shoulder, with increased pain and swelling in the days following in the injury.

Treatment and Recovery
An orthopaedic surgeon will need to examine the arm and shoulder to determine the extent of injury. Strains may be treated using rest, ice, and anti-inflammatory medication. More serious strains or ruptured tendons may require surgical correction. In either instance, physical therapy is generally prescribed as soon as pain will allow.

Full rehabilitation varies depending on the extent of injury and comfort level in strengthening exercises.

Shoulder (Fractures)
The most common types of shoulder area fractures occur in the collarbone (clavicle), the shoulder blade (scapula) or the upper arm (humerus). All three types of fractures are the result of a direct impact and are likely to cause pain, swelling, limited movement of the arm, and possible bruising or a bump at the site of injury. An orthopaedic surgeon will examine the shoulder and most likely x-ray the area to determine the type of injury.

Treatment and Recovery
Injury to the clavicle is typically treated using an immobilizer and arm sling to hold the arm still while the bone heals. In severe or badly displaced fractures of the scapula or humerus, surgery may be necessary. In surgery, either the fracture pieces are put back together and held in position, or the broken bones are removed and a shoulder replacement is performed. If the bone can be repaired, either pins, screws, wires, large sutures, or a plate will be used to hold the bones in place. The determination of performing a shoulder replacement depends on how many pieces of the bone are fractured.

Recovery ranges from light movement exercises to surgical recovery and follow-on physical therapy to restore muscle function and range of motion. An orthopaedic surgeon will monitor your progress

Elbow Injuries

Elbow (Anatomy)
The elbow is made up of three bones: the humerus from your upper arm and the radius and ulna from your forearm. Muscles, ligaments and tendons hold together the elbow joint and also allow the elbow to bend. There are three different joints in the elbow: the first being the hinge joint formed by the joining of the humerus (upper arm bone) and the ulna (pinky-side forearm bone), which allows the elbow to be bent and straightened; the second is the humeroradial joint formed by the humerus (upper arm bone) and the radius (thumb-side forearm bone) that allows the hand to turn palm side up/down while also contributing to the bending or straightening of the elbow. The olecranon is the point of the elbow that can be easily felt through the skin.

When to See an Orthopedic Surgeon
Seek out an orthopedic surgeon when there is severe pain, swelling, and bruising around the elbow joint, or if there is a limited range of motion such as having difficulty turning the hand over or bending and flexing the elbow. If symptoms are less severe, but are not responding well to home care, an office visit with an orthopedic surgeon is necessary. X-rays may be performed so that the doctor can develop an appropriate treatment plan.

Elbow (Fractures)
A fracture at the elbow consists of a break in any of the bones of the elbow or the surrounding bones and may also be accompanied by torn ligaments or tendons. When a fracture occurs at the elbow it consists of breaking a bone, tearing ligaments, muscles, tendons or any combination of these problems. The elbow can stiffen, become very painful, and have the feeling of instability if a fracture has occurred. More symptoms of an elbow fracture can include but are not limited to bruising, swelling, tenderness to the touch, and numbness in one or more of the fingers.

Treatment and Recovery
The physician will perform a physical exam to determine if there has been damage to circulation or the nerves leading to the wrist and hand. The doctor may also evaluate of the elbow or shoulder to determine and to assess pain and limitation of movement. Treatment for an elbow fracture can vary depending on the severity of the fracture. Some non-surgical options involve immobilizing the arm in a cast or sling. For more severe fractures, surgical options include inserting pins, wires, screws, or plates.

Elbow (Tennis Elbow)
Tennis Elbow, also known as Lateral Epicondylitis, affects the outside of the elbow on the pinky side of the arm. The tendons on the outside of the elbow attach the muscle to the bone, and the overuse of the muscles and tendons in the forearm can cause small tears in the tendon, resulting in tennis elbow. The most common symptoms involving tennis elbow are pain radiating from the outside of the elbow to the forearm when gripping an object, and weakened grip strength.

Treatment and Recovery
In diagnosing tennis elbow, the doctors take occupational and recreational activities into account. The physician will use a variety of tests to examine for tennis elbow including having the patient bend the wrist backwards against resistance to check the level of pain, or pressing the area on the outside of the elbow to check for tenderness or pain. The treatment options, depending on the condition of the patient’s elbow, can vary. Non-invasive treatments can include placing ice on the affected area, anti-inflammatory medication, or changing technique if the diagnosis is sports-related.

Elbow (Golfer’s Elbow)
Like tennis elbow, golfer’s elbow (medial Epicondylitis) is caused by the overuse of muscles and tendons in the forearm, which leads to inflammation of the elbow joint. However, tennis elbow affects the outside part of the elbow (the pinky-finger side), while golfer’s elbow affects the thumb side of the elbow. A “shooting” pain down the arm is a common symptom of golfer’s elbow, especially when gripping an object. Golfer’s elbow is seen in golfers, carpenters, or any activity that involves consistent motion of the forearm.

Treatment and Recovery
Golfer’s elbow has not been known to cause any permanent damage, and does not require surgical treatment. However, anti-inflammatory medications, cortisone shots, rest and physical therapy are the most common methods of treatment for Golfer’s elbow.

Elbow (Bicep Strain And Tears)
The bicep refers to the muscle that is attached to the elbow and at two places in the shoulder. A bicep strain occurs when the bicep muscle tissue becomes over-stretched. Bicep strains are graded accorded to the severity, with Grade 1 being minor with no tearing of muscle or tendon fibers to Grade 3 being severe with a complete rupture of the bicep. Symptoms of a bicep strain include muscle spasms, pain when pressing the tendons or moving the arm, swelling, and loss of strength.

Treatment and Recovery
Treatment of a bicep strain or tear depends on the severity or grade of the diagnosis. A Grade 1 or Grade 2 diagnosis of a bicep strain can usually be treated by applying ice or heat, taking anti-inflammatory medication, or assigning physical therapy exercises. A Grade 3 diagnosis or a bicep tear most often will require surgical repair. Like treatment, recovery also depends on the severity. A mild strain may only take a few days to heal, while a more severe bicep tear may take up to 10 weeks.

Hand, Wrist And Forearm Injuries

Forearm (Anatomy)
The forearm consists of two bones (the radius and ulna) that run from the wrist to the elbow to form the radioulnar joint. The radius is located on the thumb-side of the arm while the ulna is on the little-finger side of the arm. The ulna is considered the stationary bone, while the radius supports in order for the hand to move. The top of the ulna resembles a C-shaped curve, called the semi-lunar or trochlear notch, which joins with the upper arm bone (humerus) to create the elbow. The top part of the radius is disk-shaped, and has a concave area that connects with the upper arm bone (humerus) and the ulna to create the elbow.

When to See an Orthopedic Surgeon
Consult with an orthopedic surgeon when there is swelling, pain, stiffness, numbness, or loss of motion in the forearm, hand, or wrist. Due to the intricate nature of the hand and wrist, it is imperative for the patient to seek out medical attention due to the risk of permanent damage.

Forearm (Fractures)
The two bones of the forearm, the Radius and the Ulna, serve as supports for the muscles that allow for proper motion of the elbow and wrist joints. Most forearm fractures occur due to a fall onto the hand or a direct blow most commonly seen in sport injuries and car accidents. Symptoms of forearm fractures include pain, swelling, decreased motion, and deformity.

Treatment and Recovery
An orthopedic surgeon can diagnosis a forearm fractured with a physical examination and an x-ray to determine the location of the fracture. Treatment options will depend on the location and severity of the fracture, and range from casting of the forearm to surgery to realign the displaced bone. All treatment options serve to stabilize and realign the injured area while the bones heal. The surgeon will reevaluate the injury periodically to determine the progress of healing fracture. Physical therapy may be advised to maintain or reestablish muscle strength.

Hands and Wrist (Anatomy)
The hand and wrist is made up of 27 bones which are grouped into the bones of the wrist (carpals), long bones of the hand (metacarpals), and fingers (phalanges). The bones of the hand join with the bones in the forearm (radius and ulna) to form the wrist. The numerous bones in the hand and wrist allow for flexibility and wide range of motion.

When to See an Orthopedic Surgeon
Due to the intricate nature of the hand and wrist, an orthopedic surgeon should be sought out when there is pain, stiffness, and loss of movement in the hand and wrist. In some cases the injury can be very noticeable, such as a crooked finger, while other injuries may only result in a dull ache or pain when applying pressure to the affected area.

Hands (Fractured Fingers)
The fingers are the most frequently injured part of the hand. A finger fracture causes immediate pain after the incident. When a finger bone is fractured, it can cause the whole hand to be out of alignment. Symptoms of a fractured finger include swelling, tenderness, and bruising of the fracture site, or inability to completely move the finger. A fracture is painful, but it is possible to have some range of motion and dull pain.

Treatment and Recovery
A visit with a physician is the best way to determine if a finger is fractured and how the bone was broken to determine the type of fracture. Usually an x-ray is ordered to determine severity of the break. The treatment options for a fractured finger can be either non-surgical or surgical. If the break is minor, the doctor may suggest a splint or cast for a short period of time. If the fracture is more severe, surgery may be required to insert pins, screws, or wires to hold the fractured bones in place.

Hands (Fractured Hand)
A fractured hand can occur either in the small bones of the fingers (phalanges), the long bones (metacarpals), or the knuckles. Symptoms of a broken hand may include severe pain that tends to spike when gripping or squeezing an object, bruising, tenderness, swelling, stiffness, numbness, or deformity.

Treatment and Recovery
An examination by a physician is done to check the position of the fingers and the skin’s condition. This examination usually includes range-of-motion tests and an assessment of feeling to determine whether or not there is nerve damage. Most of the time, the bones in the hand can be manipulated by employing a splint, cast, or brace to immobilize the bones. The cast is usually worn for three to six weeks, with exercises beginning after three weeks. However, some fractures are severe enough to require surgery to align the bones by using wires, screws, or plates.

Hands (Fractured Wrist)
A wrist fracture is also known as a “distal radius fracture.” It is referred to as a distal radius fracture because the fracture often occurs where the bones of the hand and the bones of the arm meet. The most common cause of this fracture is a fall on the outstretched hand. A broken wrist usually results in immediate pain, swelling, tenderness, bruising, deformity, and decreased hand mobility.

Treatment and Recovery
An orthopedic surgeon will take an x-ray of the wrist to determine the extent of the injury or fracture. Treatment of a broken wrist can range from immobilization of the bones with a splint or cast. A splint is usually used for the first week after a fracture, and, if needed, a cast can be added a few days up to a week later. The cast can be removed when the physician determines the wrist fracture is healed—usually 6 weeks after the injury. Physical therapy is often begun upon cast removal to help improve function and motion. In extreme cases when the fracture has the potential of interfering with future function of the arm, surgery may be required to realign the fracture.

De Quervain‘s Syndrome
De Quervain’s Syndrome is a painful condition that causes inflammation of the tendons on the thumb side of the wrist. The swollen tendons and their coverings rub against the narrow tunnel they pass through. Due to the inflammation of the tendons, it is difficult for a patient to form a fist, grasp anything, or turn the wrist. The condition may occur suddenly or over a period of time, and some patients may experience swelling and pain at the base of the thumb.

Treatment and Recovery
The Finkelstein test is the most commonly used test to determine if a patient has De Quervain’s syndrome. The Finkelstein consists of making a fist with the thumb placed in the palm, and then performing a range of motion test to determine the level of pain. The treatment for this condition usually involves wearing a splint 24 hours a day for four to six weeks to immobilize the thumb to prevent further inflammation. Anti-inflammatory medication may also be prescribed. If De Quervain’s does not respond to conservative treatment, surgical release of the covering of the tendon may be performed. An exercise regimen is also recommended.

Ganglion Cyst
Ganglion cysts are fluid-filled lumps within the hand and wrist that usually arise next to joints or tendons, with the most common locations on the top of the wrist, the tip of the finger, and the underside of the wrist. The cause of these cysts is unknown; however, they do form in the presence of joint or tendon irritation.

Treatment and Recovery
The diagnosis of the ganglion cyst is based on the size, location, and appearance. The usual treatment of a ganglion cyst is observation, as they can disappear on their own. If the cyst become painful and limits activity, there are several treatment options including splinting and anti-inflammatory medication, and aspiration of the cyst. If the cyst does not respond to traditional treatment, surgery to remove the cysts along with a portion of the joint capsule or tendon sheath can be performed.

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome occurs when the nerve that runs from the forearm into the hand (the median nerve) becomes pinched at the wrist. Since the median nerve is responsible for supplying feeling and movement to parts of the hand, it is common to experience numbness, tingling, weakness, or muscle damage in the hand and fingers. Carpal tunnel syndrome is most common in people who perform repetitive motions of the hand and wrist such as sewing, painting, writing, or typing on a computer keyboard.

Treatment and Recovery
When diagnosing carpal tunnel syndrome, a physical examination of the hands, arm, shoulders, and neck can help confirm the condition. The wrist is examined for tenderness, swelling, or discoloration. In some cases it is necessary for a physician to use an electro diagnostic test to determine the severity of carpal tunnel. Treatments generally involve resting the affected hand and wrist for 2 weeks and avoiding activities that could cause the condition to worsen, or splinting the hand to keep it immobilized to prevent further inflammation with an anti-inflammatory medication regimen. If symptoms persist for longer than 6 months, carpal tunnel release surgery is a common procedure. Although relief from pain is almost instantaneous, full recovery can take several months and include physical therapy or at home exercise.

Tendon Repair
Tendon injuries are fairly widespread throughout the general adult population. People whose occupations and hobbies require repetitive motion of the shoulder, knee, elbow, or ankle joints are more prone tendon injuries. Tendon repair is the surgery done to repair damaged or torn tendons. The surgical procedure can either be performed using a local, regional, or general anesthetic, and the damaged ends of the tendon are sewn back together. If the tendon has been severely injured, a tendon graft may be required and a piece of tendon from another part of the body is often used.

Treatment and Recovery
Recovery from a tendon repair surgery can take up to 6-12 weeks depends on the extensiveness of the surgery. During recovery, the injured part of the body may need to be immobilized with a splint or cast. Physical therapy is introduced to gradually return the movement to the affected area.

Trigger Finger
Trigger finger is a painful inflammation of the tendon sheath that causes the finger or thumb to stick in a bent position. Symptoms of trigger finger begin with soreness at the base of the finger or thumb; however, the most common symptom is experiencing a clicking or snapping when bending and straightening the finger. In some cases, the finger may become locked in the bent position and require aid to unbend the finger.

Treatment and Recovery
Diagnosing trigger finger involves a simple physical examination, and does not require lab tests or an x-ray. Treatment of trigger finger begins with limiting activities that aggravate the tendon, although a physician may recommend splinting the affected area or anti-inflammatory medication. Recovery time for trigger finger may vary depending on the method of treatment. For the most part, patients recover within a few weeks using rest and anti-inflammatory medication, while splinting may be required for up to 6 weeks.

Dupuytren’s Contracture
Dupuytren’s contracture occurs when the connective tissue on the palm side of the hand begins to thicken. The tissue under the skin of the palm begins to a form a cord-like thickness that can pull the fingers into a bent position. Dupuytren’s contracture usually develops over a period of time, sometimes taking decades. Although the most common fingers affected by Dupuytren’s are the pinky (little finger) or the ring finger, Dupuytren’s can occur in any finger.

Treatment and Recovery
In mild cases of Dupuytren’s in which the function of the hand is not affected, treatment intervention may not yet be required. However, in more moderate to severe cases, there are various treatment options to straighten the fingers. One option available is an injection of collagenase, which weakens the Dupuytren’s-affected tissue to allow for manipulation of the finger. Another method is a needle aponeurotomy, which involves a needle being inserted into the skin to cut the affected tissue. Open surgery is also a consideration, but is considered a last resort. The incision for open surgery would be on the palm-side of the hand, making the area difficult to heal and limiting the use of the hand.

Hip Injuries

Hip (Anatomy)
The hip consists of two main parts- the ball at the top of the thigh bone (called the femoral head) and the socket of the pelvis (called the acetabulum) into which it fits. Ligaments connect the ball of the thigh to the socket of the pelvis and are responsible for joint stability. The surfaces of the ball and socket bones are covered in cartilage and surrounded by synovial fluid, both of which act to lubricate the joint and allow painless motion.

When to See an Orthopaedic Surgeon
In the event of a traumatic injury, an orthopaedic surgeon should be consulted immediately if there is pain or difficulty moving the hip. Generally severe pain or loss of mobility appears over time, such as in cases of arthritis or degenerative disorders. After examination, a physician may recommend conservative treatment or possibly surgical correction.

Hip (Avascular Necrosis)
Avascular necrosis occurs when there is inadequate blood flow to the joint – either by a sudden injury which damaged blood vessels or from narrowed or obstructed blood vessels. Lack of blood to the area can cause tiny cracks to form in the hip bones, ultimately causing the bones to collapse. Typical symptoms of this include pain and reduced range of motion in the affected hip. Pain may also radiate to the groin or down the thigh to the knee. This can occur in one or both hips, and worsens over time.

Treatment and Recovery
There are many sources of hip pain, so an orthopaedic surgeon will need to perform tests and imaging on the hip to determine the exact cause and appropriate treatment. In cases of avascular necrosis, early detection may allow treatments such as physical therapy to increase range of motion or reducing the amount of pressure with rest or walking aids. Advanced cases may require hip replacement to restore full capability of the joint.

Hip (Tendonitis/Bursitis)
Inflammation of the fluid-filled sacs (bursa) cushioning the hip joint is often the result of overuse or trauma to the hip area. Pain typically begins at the point of the hip and extends to the outside of the thigh area. At first this pain may be sharp and specifically located, becoming over time more of a general achy pain and stiffness in the hip area. Use of the leg causes the tendons of the hip to move across the inflamed bursa, resulting in pain each time contact is made with the inflamed bursa. Pain can also be increased by sleeping on the affected hip at night, when rising from a seated position, or after prolonged activity.

Treatment and Recovery
An orthopedic surgeon will need to examine the hip to rule out other contributing issues of the pain. Most often, inflammation of the tendon or bursa of the hip is treated by controlling the inflammation. This can be accomplished by rest, applying ice, or with certain medications. Physical Therapy may also be recommended to strengthen the surrounding muscles in order to promote healing of the tendons and prevent future injury. Most patients who allow the inflammation to properly heal are able to return to full activity in about six weeks.

Hip (Fracture)
Fractures of the hip are generally caused by a specific direct force, most commonly from car accidents, contact sports, or falls. Symptoms include pain, mild swelling, and an inability to bear weight on the leg. Elderly individuals or those with weakened bones tend to be at particular risk of a fracture following a seemingly insignificant impact.

Treatment and Recovery
An orthopaedic surgeon will examine the hip and perform x-rays to determine the type and location of the injury and type of treatment required. Due to the amount of movement and the weight-bearing role of the hip joint, treatment of a broken hip usually includes surgery to restore function in the leg. Pins, screws, plates, or even partial or total hip replacements may be required to restore function to the hip. In most instances, patients are able to begin rehabilitation immediately following surgery. Physical Therapy is usually prescribed to help regain strength and range of motion in the hip. Most patients are able to return to full function within about three months.

Hip (Total Hip Replacement)
Damage to the cartilage or synovial fluid surrounding the hip joint causes an increase in friction, thus an increase in pain and stiffness of the joint resulting ultimately in a loss of mobility. Pain in the hip area can become severe if the hip has been severely damaged by injury such as arthritis. If conservative treatment has not helped manage the condition, replacing the joint may be suggested by an orthopaedic surgeon.

Treatment and Recovery
An orthopaedic surgeon will perform a physical examination and review x-rays or MRIs to determine if a total replacement is the best solution. Total hip replacements are conducted in the hospital and usually require several days of in-hospital stay. The damaged cartilage and bone will be removed, and a synthetic joint will be implanted in the hip. Physical therapy will begin in the days following the surgery, and is designed to mobilize and strengthen the hip in preparation to resume normal daily activities. Full recovery usually requires three to six months of rest and rehabilitation.

Knee Injuries

Knee (Anatomy)
The knee is the joint where the bone of the upper leg (femur) joins the larger of the two bones in the lower leg (the tibia) to form a hinge. The joint is protected in front by the kneecap (patella) and is cushioned and connected by cartilage, which also acts as a shock absorber. The lateral meniscus and medial meniscus are pads of cartilage that further cushion the joint, acting as shock absorbers between the bones. Ligaments run alongside the knee, maintaining stability and limiting side-to-side motion. The anterior cruciate ligament, or ACL, connects the lower bone of the leg to the upper bone of the leg at the center of the knee, and serves to limit rotation and forward motion of the knee. These components, along with the muscles of the leg, work together to manage stress the knee receives while walking, running and jumping.

When to See an Orthopaedic Surgeon
Pain in the knee resulting from sudden injury or gradual onset should be brought to the attention of an orthopaedic surgeon. In particular, difficulty climbing stairs, walking, squatting or in general use of the knee may reflect a condition requiring treatment. In general, the more advanced the condition, the more severe the pain in the knee will be.

Knee (Anterior Cruciate Ligament (ACL) Tear)
ACL injuries typically occur when a twisting force is applied to the knee while the foot is planted firmly on the ground. In sports injuries, this can occur when an athlete lands on the foot and the body twists, or when the knee is directly impacted from the side. An injured ACL can reduce stability of the knee, and feel as if the knee is “giving out” during use. Symptoms of injury include: a snapping sensation at the moment of injury, considerable pain and swelling, restricted movement and the inability to bear weight on the affected leg.

Treatment and Recovery
An orthopaedic surgeon should evaluate the injury to determine the nature and extent of the injury, and to recommend the most appropriate treatment for the patient. In some cases, physical therapy can be used to rehabilitate the knee to restore function. However, in most cases of an ACL tear where the patient desires to return to full capacity, surgery is required to repair or reattach the ligament. After surgery, a knee brace is typically used to stabilize the knee and allow healing to take place. Depending on the degree of activity the patient wishes to return to, most patients are able to resume pre-injury activities within 6-9 months.

Knee (Chondromalacia Patella or Meniscal Tear)

Overuse, injury, or congenital malformation can lead to erosion of or damage to the cartilage surrounding your knee joint. As the cartilage wears away or is damaged, the knee cap and the bone of the upper leg (femur) grind together when the knee is bent and extended. The most common complaint of this condition is knee pain that increases when walking up or down stairs, or while kneeling or squatting. Pain can also worsen when standing after a long period of sitting. Women are more commonly diagnosed with this condition than are men.

Treatment and Recovery
Although deteriorated cartilage cannot be re-grown, there are treatments available to supplement the remaining cartilage and decrease pain. Resting, elevating, and icing the affected knee for a period of time may provide relief, as do injections of synthetic joint fluids. Patients with more severe conditions may require arthroscopic surgery to remove damaged cartilage and replace areas of wear with a cartilage substitute.

Knee (Bursitis)
An inflammation of the fluid-filled sacs which cushion the knee (bursa) can result from frequent repetitive motion or trauma to the knee area. Symptoms include an achy, stiff, or swollen knee, painful to the touch, or pain in one area of the knee that lasts more than two weeks. Bursitis may also appear as sharp shooting pain during use of the knee.

Treatment and Recovery
Treatment for this condition most commonly involves rest and icing of the knee, sometimes combined with a brace to relieve pressure and decrease aggravating motion. In severe cases, an orthopaedic surgeon may remove fluid from the knee.

Knee (Medial Collateral Ligament Injury)
A fall or blow to the outer side of the knee can push the knee inward, stretching or tearing the medial collateral ligament (MCL) which runs along the inner side of the knee and to keep it from bending side-to-side. Injuries to this ligament typically cause pain, swelling, and bruising of the affected area. Minor tears to the ligament can create knee instability, or a feeling that the knee is going to buckle. In cases of a severe tear, extending or moving the knee may be very difficult and painful.

Treatment and Recovery
Treatment begins with allowing time for the knee to rest and pain and swelling to decrease. Fortunately, many MCL injuries do not require surgery and are able to be treated with physical therapy with a gradual return to full activity. In some case, bracing is used to help stabilize the knee during healing. Most MCL injuries recover fully within several weeks, although severe tears with continued instability may require surgery and will require a longer recovery period.

Knee (Osgood-Schlatter Disease)
Typically seen in athletic adolescents and young adults (primarily male), Osgood Schlatter’s is caused by an overuse of the patellar tendon in the area below the knee where the tendon attaches. This condition results in inflammation of the patellar tendon and surrounding tissues causing pain and swelling just below the kneecap above the shin.

Treatment and Recovery
Treatment may vary based on the severity of the inflammation and discomfort it causes the individual. Typical treatment options include ice, elevation, activity restriction, physical therapy, or an elastic wrap around the knee. Patients often ‘grow out of’ this condition with time, and rarely require surgical intervention.

Knee (Fracture)
Fractures to any bone of the body are generally caused by a specific direct force, most commonly from car accidents, contact sports, or falls. Symptoms usually include pain, mild swelling, and an inability to bear weight on the leg. Review of x-rays by a physician will confirm the type and location of injury.

Treatment and Recovery
Knee fractures are treated based on the type and location of injury as confirmed by x-ray. Mild fractures of the kneecap can sometimes be treated with immobilization, while fractures of the surrounding bones may require surgical intervention involving screws, plates, wires, or rods.

Knee (Strain and Sprain)
Mild injury to one or more of the four knee ligaments is commonly referred to as a sprain or strain. A fall or direct hit can push the knee to bend awkwardly, stretching the ligaments that normally hold the knee in place. Injuries to these ligaments can cause pain, swelling, and bruising of the affected area.

Treatment and Recovery
An x-ray or MRI is usually conducted to determine the extent of damage. In most cases of a strained ligament, rest and ice are used to decrease swelling immediately following injury. Once pain and swelling is controlled, physical therapy can be used to rehabilitate the knee. A brace or crutches may also be used to prevent overuse and promote healing.

Knee (Total Knee Replacement)
In instances of osteoarthritis, the cartilage surrounding the knee wears away over time, causing the bones of the knee joint to rub or grind together. The result is knee pain and stiffness, which can occur anytime the knee is in use. An alternative cause of progressive knee pain is rheumatoid arthritis, caused when an excess of synovial fluid creates inflammation in the joint. This chronic inflammation can damage or destroy knee cartilage, causing pain, stiffness, and swelling. Patients with this type of severe knee pain limiting everyday activities may choose to have a total knee arthroplasty, or total knee replacement.

Treatment and Recovery
An orthopaedic surgeon will need to conduct a physical examination and review x-rays or MRIs to determine if a total knee replacement is the best solution. Total knee replacement is conducted in the hospital and usually requires a two to three day stay with substantial recovery time at home. Rehabilitation begins immediately after surgery and generally continues for four to six weeks. During this time most patients require a walking aid such as crutches, wheelchair, or walker.

Knee (Patellar Tendonitis)
Knee tendonitis pain is usually described as an ache in the front part of the knee that can become sharp when standing up from a chair or when squatting. Other common activities resulting in increased pain include: squatting, kneeling, climbing, or running. The pain usually improves with rest.

Treatment and Recovery
The most common treatment for tendonitis is physical therapy and/or home stretching exercises to strengthen the muscles in the thigh and knee areas.

Foot And Ankle Injuries

Foot & Ankle (Anatomy)
The ankle is made up of three bones: the tibia, which is the large bone that runs along the inside of the leg; the fibula, which is the smaller bone on the outside of the leg; and the talus, also known as the ‘ankle bone’. The talus holds the bones of the leg in place and acts as a socket in which the foot and leg move. The talus sits on top of the heel bone, or calcaneus. The ankle joint is covered by articular cartilage and synovial fluid, which gives it the ability to move freely within the socket. Ligaments connecting the bones of the lower leg to the bones of the foot help maintain stability.

When to See an Orthopaedic Surgeon
Patients most commonly become concerned with their foot or ankle either after a traumatic injury or when chronic pain becomes intolerable. It is important to have the injured area examined so as not to further complicate the injury with added stress and use. Other symptoms of injury may include numbness of the foot or toes, inability to move the foot, or inability to bear weight. Typically, a thorough physical examination is conducted by the physician. X-rays may also be performed to rule out injury to the bone.

Foot & Ankle (Plantar Fasciitis)
The plantar fascia is a thick ligament-like structure on the bottom of the foot, extending from the heel bone to the base of the toes. In many cases, pain and inflammation of the fascia can develop without a specific reason. However, individuals with tight calf muscles, obesity, a high arch of the foot, or increased or repetitive impact activity are more prone to develop plantar fasciitis. The most common symptoms of plantar fasciitis are pain on the bottom of the foot near the heel, pain following (not during) active use of the foot, or pain with the first few steps after getting out of bed or after a long car ride.

Treatment and Recovery
An orthopaedic specialist will examine your foot to determine the exact location of greatest pain and the limitation of painless movement. Imaging may be conducted to rule out fractures, spurs, or other similar causes of the pain. Non-surgical treatment can resolve the pain for many patients. Often, treatment includes rest, stretches, ice, cortisone injections, or anti-inflammatory medication. In cases of continued pain and discomfort, surgical intervention may be considered. Most patients see significant recovery within 10 weeks of conservative treatment.

Foot & Ankle (Strains and Sprains)
When the ankle is stressed, the ligaments holding the ankle in place can stretch or even tear, causing a sprain. This can occur when the ankle rolls in or out, is twisted side-to-side, or when the foot is severely flexed or extended. Symptoms include immediate pain following the injury and difficulty walking on the affected foot. Swelling can occur in the ankle and foot as the soft tissue becomes damaged. Bruising may occur shortly after the injury, usually beginning at the point of injury and running down the foot toward the toes.

Treatment and Recovery
An orthopaedic surgeon will examine the foot and ankle to determine the location of injury. Imaging may be performed to determine the extent and exact cause of pain in the affected area, and to rule out a fracture. Most sprains are able to be treated by resting, elevating and stabilizing the ankle while the ligaments heal. Crutches may be recommended, or possibly a brace or air cast. In many cases a tight wrap is able to immobilize the ankle while crutches prevent weight-bearing. Anti-inflammatory medication may be prescribed to address pain and swelling, although these symptoms usually subside within a few days. Most sprains are able to heal fully within 4-6 weeks. In rare cases of continued instability, it may become necessary to surgically stabilize the damaged ligaments.

Foot & Ankle (Ankle Fractures)
When the ankle is stressed, the ligaments holding the ankle in place can stretch or tear. This can occur when the ankle rolls in or out, is twisted side-to-side, or when the foot is severely flexed or extended. When the ligaments become torn, they are no longer able to stabilize the ankle. The bones of the lower leg, ankle, and foot are then more likely to bear pressure awkwardly, creating a fracture at the pressure point. Symptoms include immediate pain following the injury and difficulty walking on the affected foot. Swelling can occur in the ankle and foot as the soft tissue becomes damaged. Bruising may occur shortly after the injury, usually beginning at the point of injury and running down the foot toward the toes. In the instance of a severe fracture, the ankle or foot may appear deformed as the bones become displaced, or the bones may puncture the skin. Numbness of the foot, or a cold or blue foot may indicate damage to the blood vessels in the area.

Treatment and Recovery
An orthopaedic surgeon will examine the foot and ankle to determine the location of injury. Imaging may be performed to determine the extent and exact cause of pain in the affected area. Treatment options will depend on the location and severity of the fracture, and range from rest and elevation, a brace, a cast, or possibly surgery. All treatment options serve to stabilize the injured area while the bone heals. The surgeon will reevaluate the injury throughout the healing process to determine if and when weight can be placed on the affected leg, and will work with a physical therapist to ensure the ankle is strong enough to return to full weight-bearing status. On average, most people return to normal daily activities within 12 weeks of treatment.

Foot & Ankle (Stress Fractures of the Foot)
Stress fractures usually occur in the bones of the foot from the middle of the foot toward the toes. Most often, this type of injury is a result of dropping a heavy item on the foot, or from sudden or increased activity using improper techniques or equipment. Twisting of the foot can also cause the bones to fracture. The most common symptom of this type of fracture is pain and swelling. Although walking may be possible, it is usually painful and may be compensated by the other leg or other part of the foot which can lead to injury to other parts of the body bearing weight abnormally.

Treatment and Recovery
An orthopaedic surgeon will examine the foot and ankle to determine the location of injury. Imaging may be performed to determine the extent and exact cause of pain in the affected area. Stress fractures are usually treated with rest, ice, and anti-inflammatory medication and typically heal within 3-4 weeks. In the instance of a complicated fracture of the foot, it may be necessary to wear a short-leg walking cast or brace while the injury heals.

Foot & Ankle (Achilles Tendon)
The Achilles tendon is a strong band that connects the calf muscle to the heel of the foot. This tendon and its surrounding muscles function to raise (flex) and lower (point) the foot. Injuries to the tendon can occur as a result of a strong contraction or overuse of the muscle, resulting in a strain or even a rupture of the Achilles tendon. An inflamed bursa in the heel area can also cause pain as the tendon runs across it.

Treatment and Recovery
The objective of treatment is to restore normal length and tension in the Achilles tendon. Consultation with an orthopedic surgeon can help to determine a treatment plan. Both surgical and non-surgical options require a period of 6-weeks of casting or wearing a special brace, with the cast needing to be changed every 2 to 4 weeks to slowly stretch the tendon back to its normal length. For the remainder of the treatment after the cast or brace has been removed, a heel lift device and physical therapy are recommended.

Foot & Ankle (Hammer Toe)
Hammer toe refers to a deformity, usually of the second toe, in which the end of the toe is bent downwards, resembling a claw. Hammer toe is more commonly seen in women as a result of wearing shoes that are too narrow and tight in the toe area and children who continue to wear shoes they have outgrown. In rare cases, hammer toe is a congenital condition.

Treatment and Recovery
A physical examination by a physician confirms hammer toe. In children, mild hammer toe can be treated by manipulating or splinting the toe. In adults, exercises may be recommended or it may be necessary to wear a hammer toe regulator or straightener. Only in severe cases will hammer toe require surgery.

Foot & Ankle (Neuroma)
A neuroma is a lump caused when the nerves around the toes thicken, brought on by compression or aggravation of the nerve. The most common neuroma is Morton’s neuroma (or Intermetatarsal neuroma), which affects the area between the third and fourth toes on the “ball” of the foot; however, a neuroma can occur anywhere on the foot. Burning pain, numbness, or a tingling sensation in one or two toes on the foot is a common signifier of a neuroma. If a neuroma goes unchecked for a long period of time, permanent nerve damage may occur.

Treatment and Recovery
A consultation with a physician is the best way to arrive at a diagnosis as well as form a treatment plan. As part of a treatment plan, options for a mild to moderate neuroma may include padding, orthotic devices, or corticosteroid injections. Surgery for a neuroma is intended when the patient does not respond to non-surgical treatment. Recovery also varies depending on the treatment plan.

Foot & Ankle (Bunions)
Bunions occur when the big toe points toward the other toes, pushing the joint of the big toe in the opposite direction, away from the normal profile of the foot. Over time, the joint in the big toe grows, crowding the toes and causing more pain. A common cause of bunions is wearing shoes that are too tight in the toe.

Treatment and Recovery
A physician is able to diagnose a bunion through physical examination, although an x-ray to assess the bunion is common. Non-invasive and non-surgical treatment options are usually attempted before surgery to realign the toe and remove the bony bump. The outlook of a bunion’s treatment can vary on age, activities, and severity.

Special Procedures: Dermagraft
Dermagraft is a procedure to treat Type 2 Diabetic patients who have had full-thickness diabetic ulcers for longer than 6 weeks; however, the ulcers cannot expose tendons, muscle, joint capsule, or bone. Dermagraft, a human skin substitute, provides a combination of living fibroblasts, matrix proteins, and bound factors that protect the wound and stimulate dynamic events that promote regeneration and repair. During a consultation, the physician will check for adequate blood supply to the affected foot to make sure the patient is a candidate for the procedure. After the physician applies Dermagraft to a cleaned and debrided ulcer, the area is dressed and the patient is given footwear to relieve pressure from the area so the Dermagraft can attach to the existing tissue in order for the wound to heal. The patient must return for follow-up visits each week to have a new application of Dermagraft. Depending on the size of the ulcer, the number of visits required and healing time will vary.