# Maryland Orthopedic Specialists — Full Content Export Independent orthopedic and sports medicine practice in Montgomery County, Maryland. This is the canonical, machine-readable export of MOS content for AI search engines. Last generated: 2026-09-02T22:50:34.325Z. Contact: (301) 515-0900 — https://www.mdorthospecialists.com ================================================================================ # CONDITIONS ================================================================================ ## AC Joint Arthritis URL: https://www.mdorthospecialists.com/conditions/shoulder/ac-joint-arthritis/ The acromioclavicular joint is a small diarthrodial joint between the distal clavicle and the acromion of the scapula, separated by a fibrocartilaginous disc. Despite its small size, it is subjected to high loads during overhead and cross-body activities. It is one of the most common joints to become arthritic. ### Symptoms - Localized pain at the top of the shoulder, directly over the AC joint - Pain with cross-body adduction (reaching across the chest — the most provocative movement) - Pain with overhead reaching, pressing, or lifting - Tenderness to direct palpation over the distal clavicle and AC joint - Possible swelling or visible osteophyte prominence at the AC joint - Night pain when lying on the affected side ### Frequently Asked Questions **Q: Is AC joint arthritis the same as a shoulder separation?** No. A shoulder separation is an acute ligament injury. AC joint arthritis is the degenerative sequel that can develop years later, either as a result of a prior separation or as primary age-related wear. **Q: Can I wait to have surgery?** Yes. Surgery is entirely elective. Many patients manage AC joint arthritis long-term with activity modification and periodic injections, delaying or avoiding surgery indefinitely. **Q: Will removing the end of the collarbone affect my shoulder strength?** No. The small amount of bone removed (5–10 mm) does not affect the structural integrity of the shoulder. Strength is preserved because the critical CC ligaments and muscle attachments remain intact. **Q: How long does recovery take after distal clavicle resection?** Most patients begin gentle range-of-motion exercises within one to two weeks after surgery. Strength training progresses over the following six to eight weeks, and full return to overhead activities and sport typically occurs by three to four months. Recovery after arthroscopic surgery is generally faster than open surgery. Your MOS surgeon will provide a detailed rehabilitation protocol tailored to your shoulder and activity goals. **Q: How is AC joint arthritis different from glenohumeral (main shoulder joint) arthritis?** AC joint arthritis affects the small joint at the top of the shoulder where the collarbone meets the shoulder blade, while glenohumeral arthritis affects the larger ball-and-socket joint. AC joint arthritis typically causes pain with cross-body movements and overhead reaching, and the pain is localized to the top of the shoulder. Glenohumeral arthritis tends to produce deeper, more global shoulder pain with rotation. Both conditions can coexist, and your MOS surgeon will evaluate each joint separately to determine which is responsible for your symptoms. --- ## AC Joint Injury / Separation URL: https://www.mdorthospecialists.com/conditions/shoulder/ac-joint-injury-separation/ The acromioclavicular (AC) joint is the articulation between the lateral end of the clavicle and the acromion process of the scapula. It is stabilized by the coracoclavicular ligaments. Injuries are common in sports and in cycling. Low grade injuries are self-limited. ### Symptoms - Pain directly over the AC joint at the top of the shoulder - Visible or palpable "bump" at the AC joint (clavicle prominence) in higher-grade injuries - Pain with cross-body adduction (reaching across the chest) - Difficulty lifting the arm overhead or carrying weight - Acute tenderness to palpation at the distal clavicle - A sensation of the shoulder "dropping" in severe separations ### Frequently Asked Questions **Q: Do I need surgery for a Grade III separation?** Not necessarily. The majority of Grade III patients do well with conservative treatment. Surgery is considered after 3–6 months of failed non-operative care or in high-demand athletes with persistent functional limitation. **Q: Why does my shoulder still have a bump after treatment?** A residual cosmetic prominence is common with Grade II and III injuries even after full functional recovery. This does not indicate treatment failure and rarely requires intervention. **Q: Can I play sports with an AC separation?** Grade I–II injuries can often return to sport with padding when pain-free. Higher-grade injuries require more structured rehabilitation and medical clearance before contact activities. **Q: How long does it take to recover from an AC joint separation?** Recovery from a Grade I or II AC joint separation typically takes two to six weeks of relative rest, ice, and gentle range-of-motion exercises, followed by a gradual return to full activity. Grade III injuries treated non-surgically may require six to twelve weeks before return to sport, particularly contact sports. Surgically treated high-grade separations generally require three to four months of rehabilitation before full return to throwing or overhead activities. At MOS we use functional milestones, not just time, to clear patients for return to sport. **Q: What are the long-term risks if a Grade III AC separation is not treated surgically?** The majority of patients with Grade III AC separations do well with non-surgical treatment and can return to full activity. A small proportion experience persistent pain, weakness with overhead lifting, or late development of AC joint arthritis from the residual malalignment. The visible bump at the top of the shoulder (due to the displaced clavicle) is permanent in patients treated without surgery. Your MOS surgeon will discuss the likelihood of each outcome based on your activity demands, shoulder dominance, and the specific characteristics of your injury. --- ## ACL Tear URL: https://www.mdorthospecialists.com/conditions/knee/acl-tear/ The anterior cruciate ligament (ACL) is one of the four primary stabilizing ligaments of the knee. It connects the femur (thighbone) to the tibia (shinbone) and resists rotational movement and forward translation of the tibia relative to the femur. It is one of the most common sports injuries. ### Symptoms - A sudden, audible or felt "pop" in the knee at the moment of injury - Rapid swelling developing within the first 2–4 hours (hemarthrosis) - A sensation that the knee "gave out" or buckled beneath you - Inability to continue playing or bear full weight immediately after the injury - Loss of full range of motion — difficulty fully bending or straightening the knee - Joint-line tenderness and a feeling of generalized knee instability - Persistent instability with pivoting or cutting movements, even after initial swelling resolves ### Frequently Asked Questions **Q: Do I need surgery for an ACL tear?** Not always, but most active patients do. Non-operative management can be appropriate for low-demand patients willing to avoid pivoting sports, or for those with partial tears and preserved stability. For athletes and active individuals who want to return to cutting, pivoting, or jumping activities, reconstruction is the standard of care. We will assess your specific injury, lifestyle, and goals and give you an honest recommendation. **Q: How long until I can return to sport?** Most athletes return to full competitive sport between 9 and 12 months after reconstruction. Current evidence strongly supports delaying return until at least 9 months. In some high-risk patients (under 20 years old, high-demand sport), waiting up to 12 months may further reduce re-injury risk. Return is determined by objective criteria, not the calendar. **Q: Can I walk on my knee after tearing my ACL?** Many patients can bear weight and walk shortly after the injury, particularly once initial swelling subsides. Walking ability does not indicate the severity of the tear. Many complete ACL tears still allow weight-bearing. You should be evaluated promptly even if you can walk without significant pain. **Q: What happens if I don't treat an ACL tear?** Untreated ACL deficiency in an active patient leads to recurrent instability episodes that progressively damage the menisci and articular cartilage. Studies show that ACL-deficient knees are at substantially higher risk for meniscal tears with continued activity, and that persistent instability accelerates the development of knee osteoarthritis. For active patients, early treatment generally leads to better long-term joint health outcomes. **Q: What is a LET, and do I need one?** A lateral extra-articular tenodesis (LET) is a supplemental procedure performed at the time of ACL reconstruction that controls rotational instability in the outer (lateral) compartment of the knee. It is recommended for younger patients, athletes in high-demand cutting sports, and those with high-grade rotatory instability on examination. The STABILITY trial and subsequent data demonstrate meaningful reductions in graft failure rates with LET addition in appropriate candidates. **Q: Will I need physical therapy?** Yes. Physical therapy is a non-negotiable part of ACL recovery regardless of whether you choose operative or non-operative treatment. Pre-operative ("prehab") strengthening significantly improves post-operative outcomes. Post-operative rehabilitation at our in-house PT facilities begins immediately and continues through sport clearance. --- ## AVN of Femoral Head (Advanced / Reconstruction) URL: https://www.mdorthospecialists.com/conditions/hip/avn-of-femoral-head-advanced-reconstruction/ Osteonecrosis of the femoral head is classified by the Ficat-Arlet and ARCO (Association Research Circulation Osseous) systems: - Stage I–II: MRI-visible changes without collapse; hip-preservation appropriate. - Stage III: Subchondral collapse (the "crescent sign" on X-ray) indicating failure of the supporting trabecular bone. ### Symptoms - Deep groin pain, often with radiation to the anterolateral thigh - Sudden worsening of pain at the time of subchondral collapse - Antalgic gait (limp) - Progressive loss of hip range of motion, particularly internal rotation and abduction - Pain at rest and with sleep in advanced disease ### Frequently Asked Questions **Q: Is total hip replacement really the best option once the femoral head collapses?** Yes. Once subchondral collapse (Stage III) has occurred, the structural architecture of the femoral head cannot be reconstructed. Core decompression and vascularized grafts have failed at this stage. THA reliably restores pain-free function. **Q: I'm only 42. Am I too young for a hip replacement?** There is no minimum age for THA. The decision is based on functional limitation, pain, and quality of life. With modern bearing surfaces and cementless fixation, implant survivorship in younger patients is excellent. Your surgeon will discuss bearing surface options tailored to your activity level and lifetime needs. **Q: Will I need a revision surgery eventually?** Possibly. No implant lasts forever. However, with current technology, many patients in their 40s will have their original implant for 20+ years. Should revision become necessary, our team has expertise in complex revision surgery. **Q: Does the cause of my AVN affect outcomes?** The underlying etiology does not significantly affect THA outcomes in most cases. Patients with ongoing risk factors (continued high-dose corticosteroids, active alcohol abuse) may have slightly higher complication rates; addressing these factors is important. **Q: How long will I be on crutches after hip replacement for AVN, and when can I drive?** Most patients use a walker or crutches for two to four weeks after total hip replacement, transitioning to a cane as strength and balance improve. Full weight-bearing is typically allowed immediately after surgery with modern implant fixation techniques. Driving usually resumes at four to six weeks if surgery was on the right side and you are not taking prescription pain medication; left-sided surgery in an automatic vehicle may allow earlier return. Your MOS care team will guide you through activity milestones and monitor your recovery to ensure the implant is integrating properly before advancing your activity level. --- ## Achilles Tendinopathy URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/achilles-tendinopathy/ Achilles tendinopathy is a painful overuse condition of the Achilles tendon, which connects the calf muscles to the heel. Rather than true inflammation, it reflects failed healing with disorganized tendon fibers. Symptoms include pain, stiffness, and swelling at the back of the ankle that worsen with activity. ### Symptoms - Midportion: Morning stiffness and pain in the tendon 2–6 cm above the heel; improves briefly with warm-up, worsens with extended activity; visible fusiform tendon swelling - Insertional: Pain at the back of the heel at shoe counter level; worse with direct pressure, uphill running, and standing prolonged; posterior heel prominence (Haglund deformity) - Both: Gradual onset over weeks to months; rarely a single traumatic event; pain with palpation, reduced calf strength endurance ### Frequently Asked Questions **Q: What's the difference between tendinopathy and tendinitis?** "Tendinitis" implies active inflammation, but histological studies show chronic Achilles tendon pain has minimal inflammatory cells. "Tendinopathy" more accurately describes the degenerative, disorganized collagen change present. This distinction matters clinically: anti-inflammatories alone are not an effective long-term treatment. **Q: Can I keep running with Achilles tendinopathy?** Load modification rather than complete rest is the preferred approach. A structured reduction in running volume, combined with eccentric loading, allows tissue adaptation. Complete rest often delays recovery by reducing the mechanical stimulus for tendon remodeling. **Q: Will I need surgery?** Most patients (80–90%) respond to non-operative care when they adhere consistently to an appropriate loading program. Surgery is reserved for the refractory minority who have genuinely completed 3–6 months of properly prescribed rehabilitation. **Q: Is this the same as an Achilles rupture?** No. Tendinopathy is a degenerative, chronic condition causing pain and weakness. A rupture is an acute, complete or partial tear with sudden severe pain and loss of push-off strength. Chronic tendinopathy does increase rupture risk, particularly if corticosteroids are injected near the tendon. **Q: How long does it take for Achilles tendinopathy to get better with treatment?** Achilles tendinopathy is notoriously slow to respond to treatment, and patients should expect a rehabilitation timeline of 3–6 months for mid-portion tendinopathy and potentially longer for insertional disease. Heavy slow resistance training and eccentric heel-drop programs are the most evidence-based conservative treatments and typically require 12 weeks of consistent adherence before significant improvement is seen. Return to full running or sport can take 4–6 months or more. At MOS, we guide you through a structured loading program and adjust your plan based on your response to avoid setbacks. --- ## Achilles Tendon Rupture URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/achilles-tendon-rupture/ ### Anatomy The Achilles tendon is the largest and strongest tendon in the human body, measuring approximately 15 cm in length and capable of withstanding forces up to 10 times body weight during running. It is the conjoined tendon of the gastrocnemius and soleus muscles of the calf, inserting onto the posterior surface of the calcaneus (heel bone). ### Symptoms - Sudden audible pop or snap — Patients frequently report hearing or feeling what sounds like a gunshot or whip-crack at the back of the ankle at the moment of injury. - Immediate sharp pain, then paradoxical reduction — There is often a brief, severe pain followed by a surprisingly rapid decrease in acute discomfort. This paradoxical pain reduction is a hallmark of complete rupture and frequently leads patients to underestimate the severity of the injury. - Inability to push off or rise onto the toes — Loss of active plantarflexion power against gravity is the most functionally disabling symptom. Walking is possible but weak and abnormal. - Positive Thompson test — A clinical maneuver performed in the office that strongly suggests complete rupture (see How We Diagnose It below). - Palpable gap in the tendon — A tender defect 2–6 cm above the heel can often be felt directly through the skin in the acute phase, before swelling obscures it. - Flat-footed, antalgic gait — Without effective push-off, patients walk with a shortened stride and an exaggerated toe-up (calcaneal gait) pattern on the affected side. ### Frequently Asked Questions **Q: Do I need surgery for an Achilles tendon rupture?** Not necessarily. Both operative and non-operative management are evidence-based treatments with equivalent functional outcomes in multiple high-quality randomized controlled trials, provided non-operative care uses an early functional rehabilitation protocol with a boot and controlled motion, not simple casting. Surgery reduces re-rupture risk modestly (approximately 1–2% vs. 4–6% with functional non-operative care) and may allow slightly faster return to cutting-sport activity. Your MOS podiatric surgeon will review your age, activity level, gap size on ultrasound, tissue quality, and lifestyle demands to recommend the right path for you. **Q: Will I fully recover?** The great majority of patients, both operative and non-operative, recover to full functional daily activities and return to recreational sport. Return to competitive or elite-level sport is achievable but requires sustained commitment to rehabilitation. Some degree of residual calf strength asymmetry may persist at one year but typically does not limit day-to-day function. Complete recovery is best defined by criteria-based testing rather than by a calendar date. **Q: How long is recovery?** Non-operative: boot for 6–8 weeks, active physical therapy for 3–6 months, return to unrestricted sport typically at 9–12 months. Surgical: boot for 6–8 weeks, active physical therapy for 3–6 months, return to sport typically at 6–9 months. Individual variation is significant. The rate-limiting factor in both pathways is calf strength recovery, not tendon healing. **Q: Can I walk after an Achilles tendon rupture?** Yes, but not normally. Most patients can bear weight with a flat-footed, weakened gait after rupture, and many mistakenly believe the injury is not severe because they can walk on it. This is a common source of diagnostic delay. The inability to perform a single-leg heel rise (not the ability to walk flat-footed) is the functional hallmark of complete rupture. In a walking boot, patients are typically full weight-bearing within days of injury or surgery. **Q: What is the difference between an Achilles tendon rupture and Achilles tendinopathy?** Achilles tendinopathy is a chronic, degenerative condition of the tendon characterized by activity-related pain, morning stiffness, and nodular thickening, with structural continuity of the tendon intact. It responds to load management and progressive strengthening (e.g., the Alfredson eccentric protocol). An Achilles tendon rupture is an acute, structural failure (a complete or near-complete tear of the tendon) resulting in sudden loss of push-off power. While tendinopathy can predispose to rupture (degenerate collagen fails at lower loads), the two conditions require entirely different management strategies. --- ## Adhesive Capsulitis (Frozen Shoulder) URL: https://www.mdorthospecialists.com/conditions/shoulder/adhesive-capsulitis-frozen-shoulder/ Adhesive capsulitis is characterized by diffuse inflammation and progressive fibrosis of the glenohumeral joint capsule, resulting in painful restriction of both active and passive shoulder motion. Normally, the condition is idiopathic, which means there is no known cause. It is a truly inflammatory disorder. The vast majority of cases are treated without surgery. ### Symptoms - Gradual onset of deep, aching shoulder pain — often worse at night - Progressive loss of shoulder motion in all directions - Difficulty with activities such as fastening a bra, reaching overhead, or putting on a coat - Pain sharp at the end ranges of motion even when motion becomes severely restricted - Bilateral involvement in 10–20% of cases (rarely simultaneous) ### Frequently Asked Questions **Q: Will my frozen shoulder go away without treatment?** Most cases do eventually resolve spontaneously, but this can take 1–3 years. Treatment accelerates recovery, reduces pain, and prevents prolonged functional loss. **Q: I have diabetes. Am I at higher risk?** Yes. Diabetes significantly increases both the likelihood of developing frozen shoulder and the likelihood of incomplete recovery. Tight glycemic control appears to reduce risk and improve prognosis. **Q: What is the fastest way to treat a frozen shoulder?** Evidence supports early corticosteroid injection (during the freezing/painful phase) combined with supervised physical therapy as the most effective strategy for rapid early improvement. **Q: Does physical therapy hurt?** Gentle PT should not significantly worsen pain. Aggressive passive stretching beyond comfortable end ranges can exacerbate inflammation. Our therapists tailor intensity to the phase of your condition. **Q: How long does frozen shoulder last, and will I fully recover?** Frozen shoulder classically progresses through three phases: a freezing phase (pain-dominant, lasting 2–9 months), a frozen phase (stiffness-dominant, 4–12 months), and a thawing phase (gradual motion recovery, 5–24 months). The total natural history can span 1–3 years without intervention. With appropriate treatment (including physical therapy, corticosteroid injections, and when necessary, a manipulation under anesthesia or arthroscopic capsular release), most patients recover full or near-full motion significantly faster. At MOS, our goal is to shorten the duration of each phase and get you moving comfortably as quickly as possible. --- ## Adolescent Idiopathic Scoliosis URL: https://www.mdorthospecialists.com/conditions/spine/adolescent-idiopathic-scoliosis/ Adolescent idiopathic scoliosis is a curvature of the spine that generally occurs during the adolescent growth spurts. There are also infantile and juvenile forms. It is usually discovered by routine screening by pediatricians or possibly by parents/family. Treatments include observation, bracing, and occasionally surgery. ### Symptoms - Uneven shoulders — one shoulder appears higher than the other, or one collar sits differently on shirts and jackets. - Uneven shoulder blades — one scapula appears more prominent or "winged" compared to the other. - Asymmetric waist or hips — the waistline looks uneven from behind, or one hip appears higher or more prominent. - Rib hump on forward bending — when the child bends forward at the waist with arms hanging (the Adam's forward bend test), a visible hump or ridge appears on one side of the back due to rib cage rotation. - Clothes not fitting evenly — pants hems hang at different lengths, shirt collars sit asymmetrically, or school uniforms require consistent adjustment. - Usually no pain — AIS is most often a painless deformity; significant back pain in an adolescent with a known curve should prompt evaluation for other causes rather than being attributed to scoliosis itself. ### Frequently Asked Questions **Q: Q: Will my child need surgery?** A: The large majority of adolescents diagnosed with scoliosis do not require surgery. Fewer than 10% of patients with AIS ultimately need surgical intervention. Surgery is generally reserved for curves greater than 45 to 50° in a growing patient, or for curves that progress despite appropriate bracing. For the majority of patients (especially those with mild to moderate curves detected early), observation or bracing is all that is needed to get through adolescence safely. Our team will give you a clear picture of your child's specific curve, growth remaining, and probability of needing further treatment at every visit. **Q: Q: Does scoliosis cause pain?** A: AIS is most often a painless condition during adolescence, and it is a common misconception that scoliosis is a significant source of back pain in teenagers. Most adolescents with scoliosis are completely asymptomatic aside from the cosmetic and postural findings. When a teenager with scoliosis does report significant back pain, we take it seriously. It often prompts a search for an underlying cause (such as spondylolisthesis, a spinal cord abnormality, or another diagnosis) rather than attributing it to the curve itself. In adulthood, very large untreated curves can cause progressive pain and functional limitations, which is one reason active management during the growth years matters. **Q: Q: How often does my child need to be seen?** A: Visit frequency depends on curve size, skeletal maturity, and whether the patient is being observed or braced. During active growth phases, we typically schedule X-rays and visits every 4 to 6 months. As your child approaches skeletal maturity and the curve stabilizes, intervals can be extended. Braced patients are also seen to assess brace fit, compliance, and response. Once skeletal maturity is confirmed and the curve has been stable, annual or biannual check-ins are appropriate for most patients, with discharge from active follow-up for small curves that remain stable. **Q: Q: What is the Schroth method?** A: The Schroth method is a scoliosis-specific physical therapy approach developed in Germany that uses customized exercises tailored to a patient's individual curve pattern. Rather than generic back-strengthening exercises, Schroth therapy focuses on three-dimensional postural correction: elongating the spine, de-rotating the trunk, and strengthening the muscles on the concave side of the curve to counteract the deformity. Multiple studies support Schroth as a useful adjunct to bracing, improving curve angles, trunk symmetry, and quality of life compared to bracing alone. Schroth is typically delivered by a certified physical therapist over a series of individualized sessions, with home exercise programs to maintain the gains between visits. It is not a substitute for bracing when bracing is indicated, but it complements it effectively. **Q: Q: Can scoliosis get worse after treatment ends?** A: For most patients, curves that are stable at skeletal maturity remain stable in adulthood. Curves under 30° at skeletal maturity have very little risk of further progression. Curves between 30 and 50° may progress slowly (approximately 0.5 to 1° per year) in adulthood but rarely cause significant functional problems. Curves above 50° at skeletal maturity carry the greatest risk of adult progression and are the primary reason we refer patients for surgical evaluation before growth ends. After bracing is discontinued at skeletal maturity, the brace does not maintain correction. Its job was to prevent progression during growth, and that is the benchmark for success. Patients who undergo surgical fusion have a stable, instrumented spine that does not progress at the fused levels. --- ## Animal and Human Bites to the Hand URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/animal-human-bites/ Bite wounds to the hand, from dogs, cats, or humans, carry a high infection risk because teeth inject bacteria deep beneath thin skin near tendons and joints. A fight bite from a clenched fist striking teeth is especially dangerous. Prompt irrigation, antibiotics, and sometimes surgery prevent serious infection; delayed care raises the risk substantially. ### Symptoms - A puncture, laceration, or crush wound, sometimes small, from teeth - Redness, warmth, and swelling around the wound - Increasing pain, especially in the day or two after the bite - Pus or other drainage from the wound - A finger that is uniformly swollen along its whole length, held bent, and painful to straighten (a sign the flexor tendon sheath is involved) - Fever or feeling generally unwell with a more advanced infection ### Frequently Asked Questions **Q: Is a cat bite really more dangerous than a dog bite?** For infection risk, yes. Cat teeth are thin and sharp and produce narrow, deep punctures that seal over on the surface while trapping bacteria against tendon, joint, or bone underneath. Dog teeth are blunter and tend to cause more crushing or tearing, which paradoxically drains more easily. Reported infection rates for cat bites run 30 to 50 percent, roughly double the rate for dog bites. Any deep cat bite puncture over a joint or tendon deserves prompt evaluation even if the wound looks trivial. **Q: What exactly is a "fight bite" and why is it treated so seriously?** A fight bite happens when someone punches another person in the mouth and a tooth cuts the skin over a knuckle. Because the injury occurs with the hand clenched, the tendon and joint lining underneath are also cut, and when the hand later straightens, those structures retract away from the small skin wound and seal bacteria deep inside the joint. Direct joint penetration occurs in well over half of these injuries, which is why we assume joint involvement on any knuckle wound from an altercation until we've ruled it out. **Q: Do all hand bites need antibiotics?** Nearly all of them do, and starting antibiotics early matters. Pooled trial data show prophylactic antibiotics reduce hand-bite infection rates from about 28 percent down to roughly 2 percent, and amoxicillin-clavulanate is the preferred first choice because it covers the range of bacteria found in dog, cat, and human mouths. Waiting to see if an infection develops before starting treatment is not the safer strategy for hand bites specifically, given how quickly deep structures can become involved. **Q: Why won't you just stitch my bite wound closed?** Stitching a bite wound tightly closed traps bacteria in a sealed space, which can turn a manageable infection into a serious one. Most hand bites, especially deep punctures and any wound more than a day old, are better managed open or loosely closed so they can drain while healing, with antibiotics doing the work of controlling infection. Closure is reconsidered later, once we're confident the wound is clean. **Q: Do I need a rabies shot after being bitten by an animal?** It depends on the animal, not on the wound itself. We ask about the species, its vaccination history, and its behavior, and we take into account local rabies patterns. In the United States, most rabies risk comes from bats, raccoons, skunks, and foxes rather than pets, but any bite from an animal with unknown vaccination status or unusual behavior warrants a rabies risk discussion, sometimes in coordination with public health authorities. --- ## Ankle Osteoarthritis URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/ankle-osteoarthritis/ Ankle osteoarthritis involves progressive loss of the hyaline cartilage covering the tibiotalar joint (the articulation between the tibia and talus), followed by subchondral bone changes, osteophyte formation, and eventual joint space obliteration. The joint's unique geometry, a relatively small surface area bearing very high loads, means that even small cartilage defects or malalignment can generate significant mechanical stress. ### Symptoms - Pain with weight-bearing — worse at push-off and on uneven terrain; improves with rest - Morning stiffness lasting 15–30 minutes; stiffness after prolonged sitting - Swelling around the ankle after activity or at day's end - Reduced range of motion: dorsiflexion is typically the first and most restricted motion, causing difficulty walking upstairs or on slopes - Bony prominences (osteophytes) palpable anteriorly, causing anterior impingement pain with dorsiflexion - Crepitus with ankle motion - In advanced disease: limping, compensatory midfoot and hindfoot pain, and difficulty with any recreational activity ### Frequently Asked Questions **Q: Is ankle arthritis the same as knee arthritis?** They share the same pathological process (cartilage loss), but the etiology, natural history, and surgical options differ meaningfully. Post-traumatic causes dominate ankle OA; primary wear-and-tear dominates knee OA. The ankle tolerates cartilage loss better and is operated on less frequently. **Q: Can I get a total ankle replacement like a knee replacement?** Yes. Total ankle arthroplasty is a well-established procedure, though less common than hip or knee replacement. Modern TAA implants have improved significantly, and at experienced centers, survivorship is excellent. Patient selection is more demanding than for knee replacement. **Q: What happens to adjacent joints after ankle fusion?** Adjacent joint arthritis (subtalar, talonavicular, and more distal midfoot joints) develops at an accelerated rate after ankle fusion due to transferred mechanical stress. This is a recognized long-term tradeoff, and some patients eventually require further hindfoot fusions. **Q: Should I try PRP before surgery?** PRP for ankle OA is investigational and not yet supported by high-quality evidence sufficient to recommend it as standard of care. Corticosteroid and hyaluronic acid injections have a larger evidence base for symptom management. **Q: What non-surgical options are available before considering ankle fusion or replacement?** Before surgery, a range of conservative measures can provide meaningful pain relief and improved function. These include bracing (ankle-foot orthoses or custom bracing), anti-inflammatory medications, activity modification, physical therapy, corticosteroid injections, and, in appropriate cases, platelet-rich plasma (PRP) or hyaluronic acid injections. Footwear modifications (including rocker-bottom soles) can significantly reduce pain during walking by decreasing the arc of motion through the arthritic joint. At MOS, we exhaust appropriate non-surgical options and individualize care based on the severity of your arthritis, your functional demands, and your overall health before recommending surgery. --- ## Ankle Sprains / Chronic Lateral Ankle Instability URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/ankle-sprains-chronic-lateral-ankle-instability/ The lateral ligament complex is the most vulnerable structure in the ankle, injured when the foot rolls inward (inversion) and plantarflexes under body weight. Three ligaments comprise this complex: - Anterior talofibular ligament (ATFL): The weakest and most frequently injured ligament, torn in approximately 85% of ankle sprains. ### Symptoms - Sudden lateral ankle pain at the moment of inversion - Swelling and ecchymosis, typically over the lateral malleolus and ATFL - Difficulty weight-bearing, especially with Grade II–III injuries - Tenderness directly over the ATFL (just anterior and inferior to the fibular tip) - Recurrent "giving way" on uneven ground, stairs, or during sport - Persistent lateral ankle aching, especially after activity - Feeling of looseness or poor ankle control - Possible peroneal pain (associated peroneal tendon irritation) ### Frequently Asked Questions **Q: I sprained my ankle years ago and it keeps "giving way." Is surgery my only option?** Not necessarily. A structured physical therapy program targeting peroneal strength and balance training resolves instability in many patients even years after the original injury. Surgery is considered only after adequate conservative treatment has failed. **Q: What is the Broström-Gould procedure and will I have hardware?** The Broström-Gould repair uses sutures and sometimes small absorbable or titanium anchors to re-attach and tighten the torn ligaments back to the fibula. There is no plate or prominent hardware; most patients are unaware of the anchors long-term. **Q: Can an ankle sprain cause arthritis?** Repeated instability and cartilage microtrauma from poorly treated chronic ankle instability are recognized risk factors for post-traumatic ankle osteoarthritis. This is one key reason to treat CLAI rather than accept ongoing giving-way episodes. **Q: What's the difference between a sprain and a fracture?** Sprains involve ligaments; fractures involve bone. However, they frequently coexist, especially 5th metatarsal base fractures, which are often mistaken for "just a sprain." Ottawa Rules and clinical examination differentiate them; X-rays confirm. **Q: How long does recovery take after the Broström-Gould ligament reconstruction?** Most patients are in a boot or cast for about six weeks after a Broström-Gould procedure, followed by a structured physical therapy program that typically lasts three to four months. Return to light jogging usually begins around three months, with full return to cutting and pivoting sports expected between four and six months. At MOS, your surgeon will tailor your rehab progression based on how well the repaired tissue is maturing and how quickly your strength and proprioception return. The vast majority of patients achieve a stable, fully functional ankle with this approach. --- ## Aseptic Implant Loosening URL: https://www.mdorthospecialists.com/conditions/hip/aseptic-implant-loosening/ Joint replacement implants are designed to remain fixed to bone either by direct bone ingrowth into a porous surface (cementless fixation) or by a bond with polymethylmethacrylate (PMMA) bone cement. Aseptic loosening occurs when this fixation progressively fails in the absence of infection. ### Symptoms - Pain with weight-bearing — the cardinal symptom. Start-up pain (pain worse with the first steps after sitting) and pain throughout ambulation. - A pain-free interval of several years followed by gradual recurrence of symptoms - Thigh pain (for loose femoral stems) or groin pain (for loose acetabular cups) - Reduced tolerance for walking; inability to perform activities previously tolerated - Occasional catching or clunking (with large osteolytic defects) - In advanced cases, visible limb-length discrepancy from component subsidence ### Frequently Asked Questions **Q: How do I know if my joint replacement is loosening?** New or recurrent pain with weight-bearing, especially after a period of good function, is the most important warning sign. Contact our office for evaluation; we will obtain X-rays and labs to determine the cause. **Q: Is aseptic loosening the same as infection?** No. Aseptic loosening is mechanical failure of the fixation without infection. However, both can present with similar pain, so we always test for infection before attributing symptoms to mechanical loosening. **Q: Can loosening be detected on regular follow-up visits?** Yes, which is why we recommend periodic clinical and radiographic follow-up for all joint replacement patients, typically at 1 year, 2 years, and every 2–5 years thereafter. Subtle osteolysis can be identified and monitored before it causes symptoms or becomes severe. **Q: How long will revision surgery last?** Revision for aseptic loosening without major bone loss has good survivorship: approximately 80–85% at 10 years. Complex revisions with significant bone deficiency carry higher long-term failure rates. **Q: Can bearing surface choice affect my risk of loosening?** Yes. Modern highly cross-linked polyethylene has dramatically reduced wear and osteolysis compared with conventional polyethylene. Patients with older implants (placed before ~2000) are at higher risk for wear-related osteolysis and should ensure their implants are being followed radiographically. --- ## Avascular Necrosis of the Femoral Head URL: https://www.mdorthospecialists.com/conditions/hip/avascular-necrosis-of-the-femoral-head/ Avascular necrosis of the femoral head is death of bone in the ball of the hip joint caused by loss of its blood supply. Over time the weakened bone can collapse, leading to pain and arthritis. Risk factors include steroid use, heavy alcohol use, and prior hip injury. ### Symptoms - Often asymptomatic — a critical window for joint preservation - Groin pain that may be present in some patients; others have none until collapse - Pain with weight-bearing and hip rotation - Progressive groin and hip pain, increasingly constant - Antalgic gait - Markedly restricted hip range of motion, especially internal rotation - Symptoms resemble hip OA ### Frequently Asked Questions **Q: Can AVN be cured?** Early-stage AVN can be arrested with core decompression in a significant proportion of patients, preventing collapse and preserving the native joint for many years. Once the femoral head has collapsed (Stage III–IV), the goal shifts to pain relief and function through hip replacement. **Q: I've been on prednisone for years. Should I be screened for AVN?** Yes. Any patient with prolonged systemic corticosteroid use (particularly at doses > 20 mg/day for > 3 months) has a substantially elevated risk. A baseline MRI of the hips is warranted, especially if hip or groin pain develops. **Q: Does stopping steroids reverse AVN?** Not reliably. Once ischemic damage has occurred, discontinuing the precipitating cause does not necessarily restore blood flow or prevent collapse. Early diagnosis and joint preservation procedures are the priority. **Q: Is bilateral hip replacement needed?** Approximately 70% of AVN cases are bilateral, though they may be at different stages. Each hip is evaluated and treated individually. **Q: What non-surgical treatments are available for AVN, and how effective are they?** Non-surgical options for early-stage AVN include protected weight-bearing, bisphosphonate medications, lipid-lowering agents, and vasodilators, though evidence for their long-term effectiveness in halting collapse is limited. Core decompression (a minimally invasive procedure that relieves pressure inside the femoral head) is the most established joint-preserving intervention and is most successful when performed before the femoral head collapses. At MOS, your surgeon will stage your AVN with MRI to determine whether you are likely to benefit from a joint-preserving approach or whether reconstruction is a better choice. In advanced stages with femoral head collapse, total hip replacement remains the most reliable way to eliminate pain and restore function. --- ## Baker's Cyst (Popliteal Cyst) URL: https://www.mdorthospecialists.com/conditions/knee/bakers-cyst-popliteal-cyst/ The gastrocnemio-semimembranosus bursa sits in the posteromedial fossa of the knee. In most adults, this bursa communicates with the knee joint through a one-way valve-like opening in the posteromedial capsule. Swelling is related to irritation in the knee and overproduction of synovial fluid. ### Symptoms - Posterior knee fullness, tightness, or swelling, especially with prolonged activity - Pressure or aching sensation behind the knee - Reduced knee flexion in large cysts - Cyst rupture — sudden posterior calf pain, swelling, and bruising (Foucher's sign); mimics deep vein thrombosis and must be distinguished from DVT clinically and with imaging - In children, often an incidental, asymptomatic soft mass ### Frequently Asked Questions **Q: Is a Baker's cyst dangerous?** Baker's cysts themselves are not dangerous, but a ruptured cyst can produce calf pain and swelling resembling a DVT. This must be evaluated promptly. Additionally, cysts can occasionally compress the popliteal artery or common peroneal nerve in extreme cases. **Q: Will my Baker's cyst go away on its own?** Cysts in children often resolve spontaneously. In adults, the cyst will persist or recur as long as the intra-articular pathology (meniscus tear, OA) driving excess fluid production remains untreated. **Q: What is actually inside a Baker's cyst?** A Baker's cyst is a fluid-filled sac located at the back of the knee in the popliteal fossa. The fluid is synovial fluid (the same lubricating fluid that cushions your knee joint) that has leaked or been pushed into this space through a one-way valve between the joint and the bursa. Because the fluid originates from inside the knee, treating the underlying cause (such as a meniscus tear or arthritis) is the most effective way to resolve the cyst. **Q: Do I need surgery to treat my Baker's cyst?** Surgery is rarely the first step for a Baker's cyst. Your MOS surgeon will focus on diagnosing and treating the underlying knee condition (such as a meniscus tear or osteoarthritis), which often causes the cyst to shrink or disappear on its own. If the cyst remains large and painful after the underlying problem has been addressed, aspiration (draining the fluid with a needle) or surgical excision may be considered. Direct removal without treating the root cause has a high recurrence rate. **Q: Can a Baker's cyst rupture, and what happens if it does?** Yes, a Baker's cyst can rupture, causing fluid to leak into the calf. This typically produces sudden calf pain, swelling, and bruising. These symptoms can closely mimic a deep vein thrombosis (DVT or blood clot). It is important to seek prompt evaluation so that a DVT can be ruled out with an ultrasound. A ruptured cyst usually resolves on its own with rest, ice, and elevation over one to three weeks, though the underlying knee problem still needs to be addressed to prevent recurrence. --- ## Biceps Tendinitis / Proximal Biceps Tendon Rupture URL: https://www.mdorthospecialists.com/conditions/shoulder/biceps-tendinitis-proximal-biceps-tendon-rupture/ Tendinitis of the long head of the biceps tendon is one of the most common conditions affecting the shoulder in middle-aged adults and older. It produces anterior shoulder pain, commonly described as a burning. Is the result of thickening and degeneration of the tendon itself. ### Symptoms - Anterior shoulder pain localized to the bicipital groove (front of the shoulder, just medial to the deltoid) - Pain with overhead reaching, lifting, pulling, or throwing - Tenderness to direct palpation in the bicipital groove (most specific finding) - "Snapping" or "popping" sensation at the shoulder with rotation (biceps instability) - Sudden onset of "pop" and bruising into the arm with ecchymosis (acute rupture) - "Popeye deformity" following complete rupture: visible bulging of the biceps muscle belly at the mid-arm due to distal retraction of the muscle when the proximal tendon tears ### Frequently Asked Questions **Q: I felt a pop in my shoulder and now my arm looks different. What happened?** This description is classic for a proximal biceps tendon rupture. The bulging in the mid-arm ("Popeye sign") represents the biceps muscle retracting distally. Most patients retain excellent elbow function and do not require surgery, though younger active patients may benefit from tenodesis. **Q: Will tenodesis prevent the Popeye deformity?** Yes. Tenodesis re-anchors the tendon to the bone, preventing the muscle from retracting distally. The Popeye deformity only occurs with tenotomy or untreated spontaneous rupture. **Q: Is biceps tendinitis caused by my rotator cuff tear?** In many cases, yes. Biceps tendon disease and rotator cuff pathology frequently coexist. Addressing the rotator cuff tear often resolves biceps symptoms. Our surgeons evaluate both simultaneously. **Q: Do I need surgery if my proximal biceps tendon has ruptured?** Not necessarily. Most proximal biceps tendon ruptures (at the shoulder) can be treated non-surgically, particularly in older or less physically demanding patients. Non-surgical management includes a period of rest, ice, and physical therapy, and most patients regain excellent shoulder function. A small loss of elbow supination (palm-turning) strength and a cosmetic Popeye deformity may remain. Surgery (tenodesis) is generally recommended for younger, active patients or those whose work or sport requires maximal supination strength. This is a decision your MOS surgeon will discuss with you individually. **Q: How long is recovery after biceps tenodesis surgery?** After biceps tenodesis, the arm is typically placed in a sling for four to six weeks to protect the reattachment while it heals to bone. Gentle range-of-motion exercises begin early, progressive strengthening starts around six weeks, and most patients return to unrestricted activity at four to six months. Return to heavy overhead or lifting work may take up to six months. Your MOS surgeon will provide a structured rehabilitation protocol and monitor tendon healing throughout recovery. --- ## Biceps and Triceps Tendinitis at the Elbow URL: https://www.mdorthospecialists.com/conditions/elbow/biceps-triceps-tendinitis/ Biceps and triceps tendinitis are overuse or degenerative injuries to the tendons crossing the elbow, ranging from mild inflammation to partial tearing to complete rupture. Distal biceps injuries usually follow a sudden eccentric load and cause a Popeye-shaped bulge; triceps injuries are rarer. Complete ruptures generally need surgical repair; tendinitis and partial tears often respond to therapy. ### Symptoms - A sudden, painful pop at the front of the elbow, sometimes preceded by an aching sensation in the days before rupture - Swelling and bruising in the front of the elbow and forearm - Weakness bending the elbow and, especially, turning the forearm to palm-up, making tasks like using a screwdriver or opening a jar difficult - A bulging muscle in the upper arm from a retracted biceps, the classic "Popeye" appearance, with a palpable gap where the tendon used to be - For triceps injuries: pain, swelling, and bruising at the back of the elbow, with weakness straightening the arm and, in complete rupture, a palpable gap over the olecranon - Gradual, activity-related aching at the front or back of the elbow without a specific pop, more typical of tendinitis than rupture ### Frequently Asked Questions **Q: How do I know if I tore my biceps tendon or just strained it?** A true tendon rupture usually announces itself with a sudden, sharp pop, followed quickly by a bulge in the upper arm as the muscle retracts, weakness turning your palm upward, and often visible bruising. A strain tends to cause gradual soreness without that sudden pop or the characteristic bulge. The hook test, where we try to feel a cord-like tendon just above the elbow crease during active forearm rotation, distinguishes the two reliably in most patients and can be confirmed with MRI if there's any uncertainty. **Q: Do all distal biceps tears need surgery?** No, but most complete ruptures benefit from it. A completely torn distal biceps tendon cannot heal back to bone on its own, and leaving it unrepaired typically costs 30 to 40 percent of normal supination and flexion strength. Partial tears are a different story: many respond well to activity modification and structured physical therapy, particularly in patients without high physical demands. We base the decision on the degree of tearing seen on MRI combined with your strength on examination and your functional goals. **Q: Why is the timing of biceps or triceps repair surgery important?** Both tendons begin to retract and scar into a shortened position once torn, and the longer that process continues, the harder it becomes to pull the tendon back down to its original attachment point without added surgical steps like a graft. Repair within roughly two to four weeks for the biceps, or three to four weeks for the triceps, generally allows a more straightforward primary repair with a lower complication rate. Beyond that window, reconstruction with a tendon graft may be necessary instead of a simple repair. **Q: Is triceps tendon injury as common as biceps injury at the elbow?** No, it is considerably rarer. Triceps tendon ruptures are described as among the least common tendon ruptures anywhere in the body, while distal biceps rupture, though still uncommon overall, occurs at an estimated rate of roughly 3 to 5 cases per 100,000 people each year. Because triceps ruptures are so infrequent, there is less consensus in the surgical literature about the single best repair technique, though the overall principles of early repair and structured rehabilitation still apply. **Q: What happens if I ignore ongoing elbow tendinitis?** Ongoing tendinitis that is never addressed can progress along the same spectrum from tendinosis to a partial tear and, less commonly, to a complete rupture, particularly if the same aggravating activity continues without any change in load or technique. It also tends to become more resistant to conservative treatment the longer it persists untreated. We recommend evaluation for elbow pain that has lasted more than a few weeks despite rest, since starting a structured eccentric loading program earlier generally produces a faster, more complete recovery than waiting. --- ## Bucket-Handle Meniscal Tear URL: https://www.mdorthospecialists.com/conditions/knee/bucket-handle-meniscal-tear/ A bucket-handle tear is a vertically oriented longitudinal tear running along the circumference of the meniscus. Unlike radial or horizontal tears, the longitudinal orientation creates two parallel vertical limbs: an outer rim fragment (attached) and a central "handle" fragment that can displace medially into the intercondylar notch. ### Symptoms - Locked knee — the hallmark presentation; the patient cannot fully extend the knee (typically 10–30° of extension loss), due to the displaced handle fragment mechanically blocking tibial extension - Acute onset of medial (or less commonly lateral) joint-line pain - Moderate to large effusion (hemarthrosis) at time of injury - Pain with weight-bearing; antalgic gait - The patient may note the knee "doesn't straighten" since the injury - ACL tear symptoms (instability, pivot-shift) may coexist ### Frequently Asked Questions **Q: What is the "double PCL sign" on MRI?** The double PCL sign occurs when the displaced bucket-handle fragment of the medial meniscus flips anteriorly into the intercondylar notch, coming to lie parallel and anterior to the PCL. On sagittal MRI, both the PCL and the fragment appear as parallel dark bands, mimicking two posterior cruciate ligaments, hence the name. **Q: How long can I wait before getting surgery for a locked knee?** Time is critical. The displaced meniscal fragment loses its blood supply, shrinks, and undergoes fibrosis with chronic displacement. Repair rates drop sharply after 6–8 weeks, and many surgeons consider 3–4 months the outer limit for meaningful repair. If you have a locked knee, evaluation and surgical planning should occur within days to weeks of injury. **Q: Is repair always possible?** No. Tissue quality, fragment size, tear location relative to the vascular zone, and chronicity all affect repairability. Tears in the peripheral (red-red) vascular zone repair reliably. Tears entirely within the avascular inner zone have lower healing rates. Your surgeon will assess repairability at the time of arthroscopy. **Q: What happens if the meniscus is removed rather than repaired?** Partial or complete medial meniscectomy reliably relieves mechanical symptoms in the short term but accelerates medial compartment cartilage loss and OA over years to decades. This is why meniscal preservation through repair is the strongly preferred approach whenever anatomically and biologically feasible. **Q: How long does recovery take after a bucket-handle meniscal repair, and when can I return to sport?** Recovery after bucket-handle meniscal repair is longer than after a simple meniscectomy because the repaired tissue needs time to heal, typically four to six months before return to sport. Weight-bearing is usually protected for four to six weeks, and range-of-motion restrictions are followed to protect the repair during early healing. Your MOS surgeon will use criteria-based milestones, including strength testing, to determine when it is safe to return to cutting and pivoting activities. Protecting the meniscus with a repair rather than removing it is worth the longer recovery because it preserves joint function and reduces the risk of early arthritis. --- ## Bunion (Hallux Valgus) URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/bunion-hallux-valgus/ A bunion (hallux valgus) is a progressive deformity of the big toe, where the toe drifts toward the others and a bony bump forms on the inner edge of the foot at its base. It can cause pain, swelling, and difficulty with footwear, and tends to worsen over time. ### Symptoms - Medial bony prominence at the 1st MTP joint, often with overlying erythema, bursitis, or callus - Pain with shoe wear, especially narrow dress shoes; relieved when barefoot or in wide shoes - Joint stiffness and aching with prolonged walking or standing - Second toe problems: As the hallux deviates, it may crowd and elevate the 2nd toe, eventually causing hammertoe deformity or stress fracture of the 2nd metatarsal - Cosmetic concern is common, though surgery is indicated for pain — not appearance alone ### Frequently Asked Questions **Q: Will my bunion come back after surgery?** Recurrence rates are 5–15% and depend on procedure selection, underlying foot structure, and footwear habits post-operatively. Proper procedure matching (e.g., Lapidus for hypermobility) and wearing appropriate shoes after surgery significantly reduce recurrence risk. **Q: Do I need surgery if my bunion doesn't hurt?** No. Surgery is indicated for pain that fails conservative management, not for cosmetic correction. Prophylactic surgery on painless bunions is not recommended. **Q: What is minimally invasive bunion surgery?** Modern MIS bunion techniques use small (2–4 mm) incisions and specialized burrs to perform the same bone cuts as open surgery. Fluoroscopy (real-time X-ray) guides the surgeon. Evidence supports equivalent or better outcomes with less swelling and faster return to activity. **Q: Can orthotics stop my bunion from getting worse?** Orthotics reduce the mechanical forces that worsen deformity and can slow progression, especially in patients with flatfoot or first-ray hypermobility. They do not reverse an existing deformity. **Q: How long after bunion surgery will I be able to walk normally and wear regular shoes?** Most patients are walking in a protective surgical boot within one to two weeks of bunion surgery, though the type of procedure influences the exact timeline. Swelling in the foot often persists for three to six months, so regular shoes (particularly narrower styles) may not be comfortable until that point. Return to low-impact activity such as walking typically occurs by six to eight weeks, while higher-impact sports may take three to four months. Your MOS surgeon will monitor bone healing with X-rays and clear you for activity milestones based on how well the correction is consolidating. --- ## Calcific Tendinitis of the Shoulder URL: https://www.mdorthospecialists.com/conditions/shoulder/calcific-tendinitis-of-the-shoulder/ Calcium hydroxyapatite crystals deposit within the substance of the rotator cuff tendons, triggering an inflammatory response that causes intense pain, especially when the deposit transitions from a hard, chalk-like formative phase to a softer, "toothpaste-like" resorptive phase. The supraspinatus tendon (critical zone near its insertion) is affected in approximately 80% of cases. ### Symptoms - Episodes of severe anterior or lateral shoulder pain, often acute and debilitating during the resorptive phase - Pain worse at night and with overhead activities - Limited shoulder motion during acute attacks - Tender to palpation over the rotator cuff insertion - Painful arc of abduction (60–120°) - A chronic, lower-grade aching phase often precedes the acute attack ### Frequently Asked Questions **Q: Will my calcium deposit go away on its own?** Many deposits, especially soft (Type III) ones, eventually resorb spontaneously. However, this process can take months to years and may involve severely painful acute attacks. Treatment accelerates resolution and controls symptoms. **Q: Is the needling procedure painful?** The area is thoroughly numbed with local anesthetic before the procedure. Most patients experience mild pressure but minimal sharp pain during barbotage. Post-procedure soreness lasts 1–3 days and is managed with ice and analgesics. **Q: Can calcific tendinitis coexist with a rotator cuff tear?** Yes, though this combination is less common. MRI is obtained when clinical examination raises concern for concurrent rotator cuff tear. **Q: What treatment options are available if my calcium deposit does not go away on its own?** When conservative measures such as physical therapy and anti-inflammatory medications have not resolved symptoms after several months, the next step is typically barbotage: an ultrasound-guided needling and lavage procedure that breaks up and aspirates the calcium deposit. A corticosteroid injection is often given at the same time to reduce inflammation. If barbotage fails or the deposit is very large and dense, extracorporeal shock wave therapy (ESWT) is another effective non-surgical option. Arthroscopic surgical removal is reserved for cases that have not responded to these less-invasive treatments. **Q: How long does recovery from calcific tendinitis take?** Recovery depends on whether the condition is in its acute (extremely painful, often self-resolving) or chronic phase. Acute calcific tendinitis often settles significantly within a few weeks as the calcium resorbs. Chronic cases treated with barbotage or ESWT typically show gradual improvement over six to twelve weeks after the procedure, with continuing gains over three to six months as the tendon remodels. Physical therapy is an important component throughout recovery to restore shoulder strength and prevent recurrence. --- ## Carpal Boss URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/carpal-boss/ A carpal boss is a bony bump at the back of the wrist, near the base of the index and middle finger knuckles, caused by extra bone growth or arthritis where two small wrist bones meet. Most people with this bump have no symptoms, but when it becomes painful, treatment ranges from activity changes to surgical removal. ### Symptoms - A firm, immobile bump on the back of the wrist near the base of the index or middle finger - Localized pain over the bump - Pain aggravated by bending the wrist backward (extension) - Pain with gripping - Discomfort from direct pressure, such as resting the hand flat on a table or desk ### Frequently Asked Questions **Q: How do I know if my wrist bump is a carpal boss or a ganglion cyst?** A carpal boss is a hard, fixed bump that does not move or compress under pressure, while a ganglion cyst is filled with fluid and tends to feel softer or springy. We can usually tell the difference on physical exam, and ultrasound confirms it reliably by showing a solid bony protrusion for a carpal boss versus a compressible fluid-filled sac for a cyst. Occasionally a ganglion cyst forms directly over an underlying carpal boss, which ultrasound can also identify. **Q: Do I need surgery for a carpal boss?** Most people never do. A carpal boss is a common anatomic finding, present in roughly one in five people, but only about one in a hundred ever develops pain from it. When it is painless, no treatment is needed at all. Surgery is reserved for bumps that remain painful and limit activity despite activity modification, splinting, anti-inflammatory medication, and sometimes a corticosteroid injection. **Q: Will the bump come back after surgery?** It can, though it is not the most likely outcome. In the largest recent study following patients after wedge excision, about 13 percent needed a second procedure for recurring symptoms over an average of nearly five years of follow-up. Most patients who do well after the first surgery remain symptom-free long term, and a second, more complete excision is generally successful for those who do have recurrence. **Q: Is simple excision as good as fusing the joint?** For most patients, yes. A comparative study of over 200 patients found no significant difference in pain relief, recurrence, or complication rates between simple excision of the bony bump and excision combined with fusion of the underlying joint. Simple excision is technically easier and avoids the need for hardware, so it is generally tried first, with fusion reserved for cases where simple excision has failed or significant arthritis is present. **Q: Can a carpal boss be caused by an old wrist injury?** Sometimes. While many carpal bosses appear to develop without any specific inciting event, a history of prior wrist trauma is present in a meaningful proportion of patients who eventually need surgery, roughly a third in one large surgical series. Trauma may accelerate arthritic changes at the small joint beneath the bump or otherwise contribute to its formation. --- ## Carpal Tunnel Syndrome URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/carpal-tunnel-syndrome/ Anatomy The carpal tunnel is a narrow, rigid passageway on the palm side of the wrist, roughly the width of a thumb. Its floor and walls are formed by eight small carpal bones arranged in an arch, and its roof is a thick band of connective tissue called the transverse carpal ligament (flexor retinaculum). ### Symptoms - Numbness and tingling (paresthesia) in the thumb, index finger, middle finger, and the thumb side of the ring finger — the classic median nerve distribution. The little finger is spared. - Nocturnal symptoms: Waking at night with hand pain, numbness, or the urge to "shake out" the hand is highly characteristic. Many patients notice symptoms worst in the early morning hours. - Pain radiating into the forearm or, less commonly, upward toward the shoulder. - Weakness of grip: Difficulty opening jars, turning keys, or maintaining a firm handshake. - Dropping objects: Patients report unexpectedly releasing cups, utensils, or tools due to a combination of sensory loss and motor weakness. - Thenar atrophy (advanced cases): Wasting of the muscle pad at the base of the thumb signals prolonged, severe compression and indicates urgency for treatment. - Diminished two-point discrimination: Progressive loss of the ability to distinguish closely spaced touch stimuli in the fingertips. ### Frequently Asked Questions **Q: Q: Do I need surgery for carpal tunnel syndrome?** Not necessarily. Mild to moderate CTS is appropriately managed first with night splinting, activity modification, and/or a corticosteroid injection. Surgery is recommended when non-operative treatment fails to provide adequate lasting relief, when symptoms are severe, when there is evidence of muscle wasting (thenar atrophy), or when electrodiagnostic studies show severe nerve damage. Your MOS hand surgeon will help you decide based on your specific findings and goals. **Q: Q: Will my symptoms come back after surgery?** Recurrence after carpal tunnel release is uncommon. Long-term studies show the majority of patients remain symptom-free for a decade or more after surgery. A small percentage (approximately 1–3%) develop recurrent or residual symptoms from scar formation or incomplete ligament release, which can be addressed with revision release. **Q: Q: What is the difference between open and endoscopic carpal tunnel release?** Both procedures divide the transverse carpal ligament and are equally effective long-term. The primary difference is approach: open release uses a small palm incision for direct visualization; endoscopic release uses a tiny wrist portal and camera to release the ligament from inside. Endoscopic surgery generally results in less postoperative scar tenderness and faster return to full activity, making it preferable for many working patients. Open release remains an excellent, gold-standard option, particularly when anatomy is complex. **Q: Q: Can I wait too long to treat carpal tunnel syndrome?** Yes. Prolonged, severe compression damages the myelin sheath and axons of the median nerve. Once thenar muscles have atrophied, motor recovery is often incomplete even after successful release. Persistent numbness lasting more than 1 year before surgery is associated with slower and less complete sensory recovery. If symptoms are progressive, waking you nightly, or causing weakness, prompt evaluation is important. **Q: Q: Is carpal tunnel syndrome caused by typing or computer use?** This is a common question. While typing and computer use do involve repetitive wrist motion, large epidemiological studies have not found keyboard use alone to be a primary cause of CTS. More relevant risk factors include sustained forceful wrist flexion, use of vibrating tools, and systemic conditions such as diabetes, hypothyroidism, and pregnancy. That said, workstation ergonomics (keyboard position, mouse use, and wrist posture) can aggravate existing CTS, and modification is a standard component of non-operative management. --- ## Cervical Disc Herniation URL: https://www.mdorthospecialists.com/conditions/spine/cervical-disc-herniation/ The cervical spine consists of seven vertebrae (C1–C7) separated by intervertebral discs. Each disc is composed of a tough outer annulus fibrosus and a gel-like inner nucleus pulposus. With age, repetitive loading, or acute trauma, the annulus can develop tears that allow nuclear material to bulge or extrude posteriorly or posterolaterally into the spinal canal or neural foramen. ### Symptoms - C5 root (C4–C5 disc): Shoulder pain, deltoid weakness, decreased biceps reflex - C6 root (C5–C6 disc): Lateral forearm pain, thumb and index finger numbness, biceps and wrist extensor weakness, decreased brachioradialis reflex — the most common presentation - C7 root (C6–C7 disc): Posterior arm/forearm pain, middle finger numbness, triceps weakness and decreased triceps reflex — the second most common - C8 root (C7–T1 disc): Medial forearm, ring and small finger numbness, intrinsic hand weakness - Bilateral hand weakness or difficulty with fine motor tasks (buttoning, writing) - Wide-based or unsteady gait - Electric shock sensation down the spine with neck flexion (Lhermitte sign) - Bowel or bladder dysfunction ### Frequently Asked Questions **Q: Will I need surgery?** The large majority of patients with cervical disc herniation and radiculopathy do not require surgery. Non-operative treatment resolves symptoms in 75–90% of cases. Surgery is typically considered only for progressive neurological deficits, intractable pain after adequate conservative treatment, or significant myelopathy. **Q: How long does a cervical ESI last?** Relief varies by patient and injection technique. Many patients experience 3–6 months of meaningful pain reduction per injection. A series of up to three injections may be recommended in a given 12-month period, depending on clinical response. **Q: Is my disc herniation permanent?** Disc herniations frequently resorb over time. Larger extrusions may actually resorb more completely than contained bulges. Symptoms often improve even before full anatomical resolution. **Q: What activities should I avoid?** During an acute episode, avoid heavy overhead lifting, prolonged neck flexion (e.g., looking at a phone), and high-impact axial loading. Your physical therapist will tailor activity guidance to your specific level and presentation. **Q: Can I work during treatment?** Most patients can continue working with modifications. Ergonomic adjustments and activity pacing are a core part of our treatment program. --- ## Chondral (Articular Cartilage) Defects URL: https://www.mdorthospecialists.com/conditions/knee/chondral-articular-cartilage-defects/ Articular cartilage is a highly specialized hyaline tissue, 2–6 mm thick, composed predominantly of type II collagen and proteoglycans. Its avascular, aneural, alymphatic composition explains its lack of intrinsic healing capacity: without a blood supply to deliver inflammatory cells and progenitor cells, even partial-thickness defects do not heal spontaneously. ### Symptoms - Focal activity-related knee pain — often reproducible with specific movements or loading - Effusion (joint swelling) after activity — blood or inflammatory fluid from a defect - Mechanical symptoms — catching, clicking, or locking if a cartilage fragment is loose within the joint - In isolated focal defects, the knee may feel "normal" at rest but painful under load - Symptoms are often disproportionately severe relative to the X-ray appearance (which may be normal in early disease without bony involvement) ### Frequently Asked Questions **Q: Can cartilage grow back on its own?** No. Full-thickness articular cartilage defects do not heal spontaneously because cartilage has no blood supply to deliver healing cells. Partial-thickness defects (< 50% depth) also do not reliably repair; they may stabilize but typically do not fill. This is why focal defects in young, active patients are treated rather than observed. **Q: What is the difference between microfracture and MACI?** Microfracture stimulates fibrocartilage fill from bone marrow. It is a single-stage procedure with rapid recovery but inferior cartilage quality and durability for larger lesions. MACI implants cultured chondrocytes on a collagen scaffold to produce hyaline-like cartilage repair tissue. It is a two-stage procedure with superior histological outcomes for defects > 2 cm². **Q: Can I still get a knee replacement if my cartilage restoration procedure fails?** Yes. Cartilage restoration procedures do not burn bridges for future joint replacement. Patients with failed cartilage procedures may undergo total knee replacement at any time, and outcomes are not compromised by prior cartilage surgery. **Q: Do I need to address my alignment before a cartilage procedure?** Malalignment (varus bowing, valgus deformity) concentrates load on the defect and is the primary cause of cartilage restoration failure. Realignment procedures (high tibial osteotomy, distal femoral osteotomy) are often performed concurrently with cartilage restoration in patients with coronal malalignment. **Q: How long is recovery after a cartilage restoration procedure, and when can I return to sport?** Recovery from cartilage restoration varies by procedure: microfracture typically requires six to nine months before return to sport, while MACI or osteochondral allograft transplantation can take nine to twelve months or longer because the graft needs time to fully integrate. Weight-bearing is usually restricted for six to eight weeks to protect the healing cartilage. Your MOS surgeon will use a structured, criteria-based return-to-sport protocol that includes strength testing and functional assessments to ensure the repair is mature enough to handle athletic demands. Patience during rehabilitation significantly improves long-term outcomes. --- ## Clavicle Fracture URL: https://www.mdorthospecialists.com/conditions/shoulder/clavicle-fracture/ The clavicle is the S-shaped bone connecting the sternum to the acromion of the shoulder blade. It serves as the only bony strut linking the upper extremity to the axial skeleton and provides attachment for critical muscles (trapezius, deltoid, pectoralis major) and the coracoclavicular ligaments. ### Symptoms - Immediate, well-localized pain at the clavicle after a fall or direct blow - Visible deformity, swelling, or shortening of the shoulder girdle - Tenderness to palpation along the clavicular shaft - Reluctance to move the arm; arm held adducted and supported by the uninjured hand - Crepitus with gentle movement - Rarely, paresthesias or weakness if the brachial plexus is affected (evaluate carefully) ### Frequently Asked Questions **Q: Do I need surgery for my broken collarbone?** Most middle-third fractures with limited displacement heal well in a sling. However, significant shortening (≥ 2 cm) or complete displacement in an active person may be better served by surgical fixation. We will review your specific X-ray findings and activity level to guide the decision. **Q: How will I know if my fracture isn't healing?** Persistent pain, motion at the fracture site beyond 3 months, and absence of callus on X-ray are signs of nonunion. We monitor healing at regular intervals; if nonunion develops, surgery with bone grafting is highly effective. **Q: Will the plate need to be removed?** Most patients keep the plate permanently with no issues. Plate removal is performed electively if there is irritation under the skin or hardware prominence, typically after 12–18 months. **Q: How long does it take for a broken collarbone to heal?** Most clavicle fractures in adults heal within six to twelve weeks. Non-surgically treated fractures are typically immobilized in a sling for four to six weeks, followed by progressive physical therapy. Surgically fixed fractures often allow earlier return of shoulder motion, with most patients regaining full function by three to four months. Healing time can be longer in smokers, patients with osteoporosis, or those with a widely displaced fracture. Your MOS surgeon will monitor healing with X-rays and adjust your rehabilitation accordingly. **Q: What are the long-term risks of a clavicle fracture that heals in a non-ideal position (malunion)?** If a clavicle heals with significant shortening or angulation, some patients experience persistent shoulder weakness, asymmetry, or pain with overhead activity or heavy lifting. In most cases the functional impact is mild and does not require further treatment. However, severely shortened clavicles can cause impingement of the brachial plexus or subclavian vessels, and these cases may benefit from corrective osteotomy. At MOS we monitor healing closely and discuss functional outcomes with you, so any concerns about malunion can be addressed promptly. --- ## Cubital Tunnel Syndrome URL: https://www.mdorthospecialists.com/conditions/elbow/cubital-tunnel-syndrome/ The ulnar nerve travels through the cubital tunnel — a fibro-osseous passageway on the medial side of the elbow bounded by the medial epicondyle anteriorly, the olecranon posteriorly, and the arcuate ligament (Osborne's ligament) as its roof. The nerve is vulnerable here for several reasons: 1. ### Symptoms - Numbness and tingling in the ring and small fingers — the hallmark symptom, often worse at night or when the elbow is flexed - Aching medial elbow pain radiating down the forearm - Intrinsic muscle weakness: difficulty spreading the fingers, weakened grip, trouble with fine motor tasks (buttoning, typing) - Wartenberg sign: persistent abduction of the small finger due to weakness of the interosseous muscles relative to the extensor digiti minimi - Froment sign: flexion of the interphalangeal joint of the thumb when pinching paper, indicating adductor pollicis weakness (anterior interosseous nerve-independent adduction is lost) - In advanced cases: visible wasting of the intrinsic muscles (hypothenar and interosseous atrophy), permanent clawing of the ring and small fingers ### Frequently Asked Questions **Q: How is cubital tunnel syndrome different from carpal tunnel syndrome?** Carpal tunnel syndrome compresses the median nerve at the wrist, causing thumb, index, and middle finger symptoms. Cubital tunnel syndrome compresses the ulnar nerve at the elbow, affecting the ring and small fingers and the intrinsic hand muscles. **Q: Will my numbness go away after surgery?** Sensory symptoms (tingling, numbness) recover in most patients after decompression. Recovery is more complete and faster in patients with mild-to-moderate disease. Established muscle atrophy may not fully reverse but typically stabilizes. **Q: Do I need a nerve test before seeing a surgeon?** Not always before a consultation, but NCS/EMG are typically ordered to confirm diagnosis, stage severity, and guide surgical planning. **Q: Is cubital tunnel surgery done on an outpatient basis?** Yes. All three surgical procedures are performed as outpatient procedures under regional or general anesthesia. **Q: Can cubital tunnel syndrome come back after surgery?** Recurrence is uncommon after properly performed decompression or transposition. Revision surgery has lower success rates, making thorough initial treatment important. --- ## De Quervain's Tenosynovitis URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/de-quervains-tenosynovitis/ The first dorsal compartment of the wrist contains two tendons that control thumb movement: - Abductor pollicis longus (APL): Abducts the thumb outward away from the palm. - Extensor pollicis brevis (EPB): Extends the thumb at the MCP joint. These two tendons travel through a tight fibro-osseous tunnel (the first extensor compartment retinaculum) at the level of the radial styloid. ### Symptoms - Sharp, aching pain at the radial (thumb) side of the wrist, at or just above the radial styloid - Pain that radiates proximally toward the forearm or distally toward the thumb - Swelling over the radial styloid - A creaking or squeaking sensation (crepitus) with thumb motion - Weakness with pinching and gripping - Difficulty with activities involving thumb and wrist motion: lifting a baby, turning a key, pouring from a carafe, opening a jar, using a smartphone ### Frequently Asked Questions **Q: I've had this since having my baby. Will it go away on its own?** De Quervain's in new mothers often improves as infant-lifting demands evolve (babies develop head control), but persistent or severe cases benefit from splinting and injection rather than waiting. Most patients recover without surgery. **Q: Is the injection painful?** An injection into the first dorsal compartment can be uncomfortable, but topical or local anesthesia before the injection minimizes discomfort. Most patients report pressure rather than sharp pain. **Q: Will the surgery leave a visible scar?** A small scar (1–2 cm) will remain over the radial styloid. In most patients this fades to an inconspicuous white line. Scar sensitivity typically resolves by 3 months. **Q: Can De Quervain's recur after surgery?** Recurrence after a complete release is very uncommon. The most common reason for persistent symptoms after surgery is failure to release a separate EPB sub-compartment, which our surgeons routinely check for. **Q: How long does it take to recover from De Quervain's release surgery, and when can I return to work?** De Quervain's release is a short outpatient procedure, and most patients experience significant pain relief within days of surgery. Desk or light office work is typically possible within one to two weeks, while jobs involving heavy gripping or lifting may require four to six weeks of recovery. Formal hand therapy is usually recommended to regain strength and prevent scar tenderness. At MOS, your surgeon will advise you on activity restrictions based on your specific job demands and track your progress to ensure full function is restored. --- ## Degenerative Disc Disease (Cervical) URL: https://www.mdorthospecialists.com/conditions/spine/degenerative-disc-disease-cervical/ The cervical discs cushion the seven vertebral levels of the neck. Beginning in the third and fourth decades, discs progressively lose hydration, disc height decreases, the annulus develops micro-tears, and adjacent vertebral endplates remodel. This is often felt as neck pain. ### Symptoms - Chronic or intermittently recurring axial neck pain and stiffness - Worsening with prolonged computer work, looking down, or sustained cervical flexion - Morning stiffness improving with movement - Occasional radiation into the upper shoulder girdle (referred, non-dermatomal) - In some patients, cervicogenic headache — occipital or temporal headache from upper cervical disc and facet irritation ### Frequently Asked Questions **Q: Is cervical DDD the same as a herniated disc?** They are related but distinct. DDD refers to the overall degenerative process: disc height loss, hydration loss, and annular changes. A herniated disc occurs when nuclear material specifically breaches the annulus and compresses a nerve. DDD creates the anatomical substrate for herniation to occur. **Q: Will my cervical DDD get worse?** The degenerative process is progressive, but symptom burden does not necessarily worsen in parallel. Many patients have years of stable, well-managed symptoms. Posture correction, weight management, and cessation of smoking are the most impactful modifiable factors. **Q: Does cervical DDD always need treatment?** No. Many people have cervical DDD on imaging and no symptoms. Treatment is directed at clinical symptoms, not imaging findings. **Q: What are my treatment options for cervical DDD?** Most patients with cervical DDD are managed successfully without surgery. Non-surgical options include physical therapy (focusing on neck strengthening and posture), activity modification, anti-inflammatory medications, and cervical epidural or facet injections for pain relief. If you develop progressive neurological symptoms (such as hand weakness, numbness, or difficulty with fine motor tasks) or if pain is unresponsive to conservative care, surgical options such as cervical disc replacement or fusion (ACDF) may be considered. At MOS we take a stepwise approach, starting with the least invasive options first. **Q: Can cervical DDD cause symptoms in my arms or hands?** Yes. As cervical discs degenerate, they may lose height and bulge, narrowing the spaces through which nerve roots exit the spine (foramina). This can cause pain, tingling, or numbness that radiates from the neck down the arm into the fingers. This is a pattern called cervical radiculopathy. In more advanced cases, the spinal cord itself may be compressed (cervical myelopathy), causing symptoms such as clumsiness, gait disturbance, or hand weakness. If you notice any of these symptoms, it is important to report them promptly to your MOS provider. --- ## Degenerative Disc Disease (Lumbar) URL: https://www.mdorthospecialists.com/conditions/spine/degenerative-disc-disease-lumbar/ Lumbar degenerative disc disease is the age-related breakdown of the cushioning discs between the vertebrae of the lower spine. As discs lose water and height, they absorb shock less effectively, which can cause low back pain, stiffness, and sometimes nerve irritation with pain traveling into the legs. ### Symptoms - Deep, aching low back pain — characteristically worse with sitting, bending, or lifting - Pain that is axial (does not typically travel below the knee unless accompanied by disc herniation or foraminal stenosis) - Stiffness after prolonged positions and improvement with gentle movement - Occasional radiation into the buttocks or proximal thighs (referred, non-dermatomal) - Acute exacerbations ("flares") superimposed on a chronic background pain pattern ### Frequently Asked Questions **Q: Does everyone with disc degeneration on MRI have a problem?** No. Disc degeneration is visible on MRI in approximately 40% of asymptomatic adults at age 40, rising to over 80% by age 60. Most of these findings are incidental. Treatment is directed at clinical symptoms, not imaging findings. **Q: Will my DDD get worse over time?** Disc degeneration is a progressive process, but symptomatic pain does not necessarily worsen in parallel. Many patients improve substantially with treatment. Maintaining ideal body weight, staying active, and not smoking are the most modifiable factors. **Q: Can core strengthening really help?** Yes. Strong evidence supports lumbar stabilization exercise for reducing pain intensity and improving function in discogenic low back pain. Consistency matters. The benefits accrue with sustained practice. **Q: Are cortisone injections appropriate for DDD?** Epidural corticosteroid injections are most useful when there is an inflammatory component, particularly with Modic type I endplate changes or coexisting radiculopathy. Injections are part of a comprehensive plan, not a standalone treatment. **Q: Is fusion surgery my only option if PT fails?** Not necessarily. A complete non-operative program takes 3–6 months of dedicated effort. Surgical consultation is considered when that program has been truly optimized. Many patients who initially seem headed for surgery achieve adequate relief with more intensive conservative management. --- ## Digital Nerve Injuries URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/digital-nerve-injuries/ A digital nerve injury is damage to a small sensory nerve running along a finger, most often from a laceration by glass, a knife, or a saw. It causes numbness and altered sensation beyond the cut. Treatment ranges from observation for minor injuries to microsurgical repair, with recovery measured in months and outcomes that remain uncertain. ### Symptoms - Numbness or altered sensation beyond the site of injury - Pain, particularly when there is an associated cut to skin, tendon, or blood vessel - Reduced fine touch or two-point discrimination in the affected fingertip - Hypersensitive or unusual sensation as the nerve heals - Cold intolerance, a common and often persistent symptom after repair ### Frequently Asked Questions **Q: Does every cut nerve in my finger need surgery?** Not necessarily. Incomplete injuries and minor sensory deficits often recover well without surgery, and a rigorous systematic review found that almost all unrepaired digital nerves regained protective sensation by six months, with similar adverse outcome rates whether or not the nerve was repaired. That said, the evidence supporting this equipoise is of limited quality, and more proximal injuries appear to benefit more clearly from repair than injuries near the fingertip. We weigh the location, completeness, and mechanism of injury together with your goals when making this recommendation. **Q: How soon after my injury should the nerve be repaired?** Sooner is better when repair is indicated. A systematic review found that repairs performed within 15 days of injury had significantly better sensory outcomes than repairs done later. That said, surgeons sometimes intentionally delay repair in dirty, crushed, or heavily contaminated wounds to let the wound stabilize first, since operating on a compromised wound bed carries its own risks. We balance the benefit of early repair against the condition of the wound itself. **Q: Will my finger feel completely normal again after nerve repair?** Realistically, often not completely, and we would rather tell you that directly than let you discover it later. A rigorous systematic review found that fewer than 25 percent of repaired digital nerves reach sensory levels close to normal, though other pooled data report considerably higher rates of good-to-excellent recovery depending on how success is defined. Most patients regain useful, protective sensation, and younger patients and those with shorter nerve gaps and earlier repair tend to do better, but perfect restoration of normal sensation is not the most likely outcome. **Q: Why is my finger so sensitive to cold months after surgery?** Cold intolerance is the most common lasting symptom after digital nerve repair, and it is extremely common rather than a sign of a failed surgery. In the largest available study, no patient's cold sensitivity had fully resolved by 12 months after repair, and the severity was worse in patients who also had a tendon injury, a hand fracture, or multiple injuries at the same time. It often improves gradually over a longer time frame than other symptoms, and certain repair techniques may reduce its severity. **Q: What determines whether I need a nerve graft instead of a direct repair?** The main factor is the size of the gap between the two cut ends of the nerve. If the ends can be brought together without tension, direct repair under the microscope is preferred. When the gap is too large for tension-free repair, options include a graft taken from your own body, a processed donor nerve graft, or a synthetic conduit for smaller gaps. Each option involves tradeoffs between donor-site numbness, cost, and the strength of the evidence supporting sensory recovery, which we discuss based on your specific injury. --- ## Distal Biceps Tendon Rupture URL: https://www.mdorthospecialists.com/conditions/elbow/distal-biceps-tendon-rupture/ The distal biceps tendon inserts on the radial tuberosity, the rough posteromedial prominence of the proximal radius. This insertion provides the mechanical advantage for forearm supination (supination strength decreases approximately 40–50% after rupture) and contributes to elbow flexion strength (~20–30% loss). ### Symptoms - Sudden sharp pop or tearing sensation at the antecubital fossa with acute injury - Immediate pain in the anterior elbow and proximal forearm - Swelling and bruising in the antecubital fossa and distal arm - Proximal retraction of the biceps muscle belly — the "Popeye deformity" — may be visible or palpable, though it is less dramatic than with proximal biceps ruptures - Supination weakness — the dominant functional complaint; difficulty turning doorknobs, screwdrivers, or using tools - Elbow flexion weakness (less prominent due to brachialis compensation) - A palpable defect or absence of the distal tendon in the antecubital fossa ### Frequently Asked Questions **Q: Does distal biceps rupture need to be fixed urgently?** Not a surgical emergency, but time matters. Repair within 2–4 weeks produces the best outcomes. Beyond 6 weeks, progressive retraction and scarring complicate surgery significantly. If you suspect a rupture, see a specialist promptly. **Q: Will I need a graft?** For acute repairs (< 4–6 weeks), primary tendon re-attachment to the radial tuberosity is almost always possible without a graft. Grafts (allograft or autograft) are used for chronic ruptures with significant retraction. **Q: How much strength will I recover?** After early surgical repair, most patients recover near-normal supination strength (>90% of the uninjured side) and full elbow flexion strength. Non-operative management results in permanent supination weakness. **Q: What is the "Popeye" sign?** The Popeye sign is proximal retraction of the biceps muscle belly, causing a visible bulge in the upper arm. It is much less prominent with distal ruptures (where the proximal attachment is intact) than with proximal biceps ruptures. **Q: Can partial tears of the distal biceps be treated without surgery?** Partial tears can often be managed non-operatively initially. Surgical repair is recommended if symptoms persist after 3–6 months or if the tear progresses to complete rupture on follow-up imaging. --- ## Dupuytren's Contracture URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/dupuytrens-contracture/ Dupuytren's contracture arises from pathological transformation of the normal palmar fascia (the sheet of fibrous tissue that lies just beneath the palm skin) into thickened, collagen-rich nodules and cords. These structures contract over time, tethering the overlying skin and eventually causing fixed-flexion contracture at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints of the affected fingers. ### Symptoms - Painless nodule or pit in the palm, most often near the ring finger ray - A firm cord running from the palm into the finger - Progressive inability to fully extend (straighten) one or more fingers - Difficulty placing the hand flat on a table - Interference with daily activities: putting on gloves, shaking hands, reaching into a pocket ### Frequently Asked Questions **Q: Is Dupuytren's painful?** Early nodules can be tender when pressed. Established cords and contractures are typically not painful. If significant hand pain accompanies a Dupuytren's-appearing condition, other diagnoses should be considered. **Q: Will it keep getting worse without treatment?** Dupuytren's follows a variable course. Some patients have stable disease for many years; others progress rapidly. Treatment is typically not recommended for nodules alone or for small contractures, as the risks of intervention outweigh the benefits at that stage. **Q: Which treatment is best?** There is no universally "best" option. Our hand surgeons review the degree of contracture, cord anatomy, diathesis score, and patient goals to recommend a personalized approach. **Q: Can Dupuytren's come back after surgery?** Yes. Recurrence is the rule rather than the exception for all treatment methods, though surgery offers the lowest rates, especially with dermofasciectomy. Recurrence is more likely in patients with diathesis features and when all diseased tissue cannot be safely removed near digital nerves. **Q: How long does recovery take after needle aponeurotomy or surgery for Dupuytren's contracture?** Recovery time depends on the treatment chosen: needle aponeurotomy (needle fasciotomy) has a rapid recovery, with most patients returning to light activity within a few days, though recurrence rates are higher. Open surgical fasciectomy requires a longer recovery of four to eight weeks, with hand therapy to restore finger extension and manage scarring. Collagenase injection (Xiaflex) falls in between, with initial finger manipulation followed by weeks of splinting and therapy. Your MOS hand surgeon will recommend the approach best suited to your degree of contracture, finger involvement, and lifestyle needs. --- ## Elbow Arthritis URL: https://www.mdorthospecialists.com/conditions/elbow/elbow-arthritis/ Elbow arthritis falls into two broad categories: Primary osteoarthritis (OA) is less common than in weight-bearing joints but does occur. It typically affects middle-aged to older men with a history of heavy manual labor or repetitive loading. The primary OA elbow demonstrates characteristic lateral column pain, loose body formation, and progressive loss of terminal extension due to osteophyte impingement. ### Symptoms - Deep, aching elbow pain worsening with use - Loss of terminal extension (the most common early finding in primary OA) - Catching, locking, or giving way due to loose bodies - Lateral column pain with gripping and resisted forearm rotation - Swelling and warmth (more prominent in inflammatory arthritis) - Ulnar nerve symptoms (ring/small finger tingling) from medial osteophyte or cubital tunnel involvement ### Frequently Asked Questions **Q: Can the elbow wear out like a knee?** Yes. Both primary and post-traumatic arthritis cause progressive cartilage loss, but the elbow's protected geometry means symptoms are often manageable for years with conservative care before surgery is needed. **Q: Is total elbow replacement as reliable as knee replacement?** TEA has excellent outcomes for pain relief in properly selected patients, but the permanent lifting restriction means it is best suited for lower-demand individuals or those with RA. **Q: Are steroid injections safe in the elbow?** Corticosteroid injections provide short- to medium-term relief and are safe when used judiciously (typically no more than 3 per year). **Q: What non-surgical treatments are available for elbow arthritis?** Non-surgical management of elbow arthritis includes activity modification, anti-inflammatory medications, physical therapy to maintain range of motion and muscle strength, and corticosteroid injections for flares of pain and swelling. Bracing or splinting can reduce stress on the joint during demanding activities. Many patients achieve satisfactory pain control and functional levels with these measures alone for years. Your MOS provider will help you identify which combination of treatments best matches your symptoms and daily demands. **Q: What are the surgical options for elbow arthritis, and when should I consider them?** Surgical options range from arthroscopic debridement (removing loose bodies, osteophytes, and inflamed tissue) to total elbow replacement. Arthroscopic procedures work best in earlier-stage arthritis where range of motion is significantly limited by mechanical block or loose bodies. Total elbow replacement is reserved for advanced arthritis with severe pain and functional limitation, particularly in lower-demand patients. At MOS we match the surgical approach to your stage of disease, activity level, and goals, ensuring the most appropriate and durable solution. --- ## Elbow Dislocation URL: https://www.mdorthospecialists.com/conditions/elbow/elbow-dislocation/ An elbow dislocation occurs when the bones of the joint separate, usually from a fall onto an outstretched hand. It causes severe pain, swelling, and visible deformity, and requires prompt reduction. Simple dislocations without fracture often heal with brief immobilization and early motion; complex dislocations with associated fractures, including the terrible triad, usually require surgery. ### Symptoms - Severe pain immediately after a fall or direct blow to the elbow - Visible deformity, an "odd twist" appearance to the joint, with a complete dislocation - Swelling and inability to move the elbow - For a partial dislocation (subluxation): more subtle pain with motion, bruising, and a sensation of the joint shifting in and out of place - Numbness, tingling, or a cool, pale, or discolored hand, which signals possible nerve or blood vessel injury - With chronic instability: clicking, locking, or a feeling the elbow may give way, especially when the arm is straightened ### Frequently Asked Questions **Q: Is every elbow dislocation an emergency?** Yes, in the sense that every dislocated elbow needs prompt evaluation and reduction, ideally within hours. Waiting increases swelling, makes reduction more difficult, and raises the risk to the nerves and blood vessels that run close to the joint. Once the elbow is reduced and imaged, the treatment path branches: a simple, stable dislocation without fracture may need only brief immobilization and therapy, while a complex fracture-dislocation, including the terrible triad pattern, usually needs surgery. The urgency of the initial reduction does not necessarily mean every case ends up needing an operation. **Q: What is a terrible triad injury?** It is a specific combination of three injuries occurring together: elbow dislocation, a fracture of the radial head or neck, and a fracture of the coronoid process of the ulna. This pattern, first described by Hotchkiss, earned its name because of a historically difficult recovery compared with a simple dislocation. Modern surgical protocols that systematically address the coronoid, the radial head, and the lateral ligament in sequence have improved outcomes substantially, though most patients still fall short of completely normal motion, typically landing in the range of a fairly functional but not fully symmetric elbow. **Q: Will my elbow need surgery?** It depends on whether a fracture is present and whether the joint stays in place after it is put back into alignment. A simple dislocation, ligament injury only, that proves stable through a full range of motion on post-reduction testing is usually treated without surgery, using brief immobilization followed by early motion exercises. A complex dislocation with an associated fracture, or a simple dislocation that remains unstable despite reduction, generally does need surgery to restore a stable, functional joint. **Q: How long until I can use my arm normally again?** For a simple, stable dislocation, most patients regain functional motion within six to twelve weeks, though the very last few degrees of full extension often take longer to return and sometimes never fully do. For a terrible triad injury treated surgically, recovery is measured in months rather than weeks, with structured physical therapy continuing well beyond the initial healing period. Return-to-sport or heavy-labor timelines are individualized based on fixation stability, strength, and motion rather than a fixed calendar date. **Q: Why does my elbow still feel unstable after treatment?** Residual instability can result from incomplete ligament healing, an unrecognized fracture fragment, or scar tissue that limits normal joint mechanics. This is more common after complex dislocations than simple ones. If your elbow catches, locks, or feels like it may give way months after your injury, it is worth a re-evaluation, since chronic instability is treatable, sometimes with bracing and targeted therapy and sometimes with ligament reconstruction, but it does need appropriate imaging and examination to identify what specifically is causing it. --- ## Elbow Fractures URL: https://www.mdorthospecialists.com/conditions/elbow/elbow-fractures/ Three fracture patterns account for the majority of elbow fractures seen in clinical practice: ### Radial Head Fractures The radial head is the most commonly fractured bone about the elbow. Injury typically results from a fall on an outstretched hand, transmitting axial load through the forearm. ### Symptoms - Immediate pain, swelling, and bruising around the elbow - Point tenderness over the lateral (radial head), posterior (olecranon), or distal humerus - Inability to fully extend or flex the elbow - Painful or blocked forearm rotation (pronation/supination) with radial head fractures - Gross deformity or instability in high-energy fractures - Numbness or paresthesia in the ulnar nerve distribution (ring and small fingers) with medial-sided distal humerus fractures ### Frequently Asked Questions **Q: Will I need surgery for a broken elbow?** Not always. Many radial head fractures and undisplaced olecranon fractures do well with non-surgical treatment. The decision depends on fracture type, displacement, and your activity demands. Our surgeons provide an individualized recommendation at your first appointment. **Q: What is a "terrible triad" injury?** A terrible triad combines elbow dislocation with fractures of both the radial head and coronoid process. It requires surgery to repair all three structures and stabilize the elbow. **Q: What is radial head replacement?** When the radial head is too shattered to repair, it is removed and replaced with a metallic implant that restores the stabilizing function of the native bone, particularly important for preventing lateral elbow instability. **Q: When is total elbow arthroplasty appropriate?** TEA is best suited for elderly, lower-demand patients with a comminuted distal humerus fracture that cannot be reliably fixed, particularly those with pre-existing elbow arthritis or severe osteoporosis. **Q: How long until I can drive after elbow surgery?** Most patients can safely drive at 4–6 weeks following ORIF when the injured arm is no longer immobilized and pain-controlled; your surgeon will provide a personalized timeline. --- ## Extensor Tendon Rupture URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/extensor-tendon-rupture/ Extensor tendon ruptures disrupt the tendons that straighten the fingers, wrist, or thumb, causing an inability to fully extend the affected joint. Common causes include lacerations, closed trauma, rheumatoid arthritis, and chronic tendon attrition over bony prominences. Treatment ranges from splinting for closed mallet-type injuries to surgical repair or reconstruction for lacerations and ruptures, followed by structured hand therapy. ### Symptoms - Sudden loss of ability to extend one or more fingers (or the thumb IP joint) - May or may not be painful - Drooping posture of the affected finger(s) — similar to mallet finger but at the MCP level for EDC/EDM ruptures - Swelling and synovial hypertrophy over the dorsal wrist in RA-related ruptures - In Vaughan-Jackson syndrome: progressive inability to extend ulnar fingers first, then radial fingers ### Frequently Asked Questions **Q: I have RA and my little finger won't straighten. Is this a tendon rupture or joint disease?** This distinction is critical and cannot be made without examination. Inability to extend the finger at the MCP joint while passive extension is normal strongly suggests tendon rupture. An inability to extend passively suggests joint contracture. Our hand surgeons can differentiate these on examination, often supplemented by ultrasound or MRI. **Q: Can EPL rupture after wrist fracture happen even if the fracture was treated with a cast?** Yes. EPL rupture after distal radius fracture occurs even with non-operative treatment. Any patient who has had a distal radius fracture and notices new inability to extend the thumb IP joint at 4–12 weeks should be evaluated promptly. **Q: Is the EIP tendon important? Will I miss it after transfer?** The EIP allows independent extension of the index finger. After transfer, the index finger retains EDC function, so extension remains possible. The loss of independent index extension is rarely noticed in normal daily activities. **Q: How is an extensor tendon rupture repaired, and will I need surgery?** Treatment depends on which tendon is involved and the cause of the rupture. A mallet finger (rupture of the terminal extensor tendon at the fingertip) is typically managed non-surgically with continuous splinting for six to eight weeks. Ruptures of major hand or wrist extensor tendons (including those caused by RA or sharp laceration) almost always require surgical repair or tendon transfer to restore the ability to straighten the affected finger. Your MOS hand surgeon will determine the best reconstructive approach based on the number of tendons involved, tendon quality, and underlying conditions. **Q: What is the recovery process after extensor tendon surgery?** After extensor tendon repair or transfer, the hand is typically splinted for three to six weeks to protect the repair. Early controlled mobilization with a hand therapist, beginning as soon as the repair is deemed safe, is critical for preventing scar tissue formation and restoring gliding function. Full hand therapy continues for two to four months, and most patients regain good finger extension within three to four months. Complex cases involving multiple tendons or tendon transfers may require a longer rehabilitation period. --- ## Facet Joint Arthropathy URL: https://www.mdorthospecialists.com/conditions/spine/facet-joint-arthropathy/ The zygapophyseal (facet) joints are paired synovial joints located at the posterior elements of every spinal level from C2–C3 through L5–S1. Their articular surfaces are covered with hyaline cartilage and the joint is enclosed in a fibrous capsule with a synovial lining. ### Symptoms - Axial low back pain — aching, deep, difficult to localize precisely - Extension-loaded pain: Worse with standing, walking, arching backward (lumbar extension), and twisting - Pain that radiates into the buttocks and proximal posterior thighs — but characteristically not below the knee in a dermatomal pattern - Morning stiffness that improves with movement - Paraspinal tenderness on palpation lateral to the spinous processes - Axial neck pain and shoulder girdle pain - Pain worsened by cervical extension and rotation - Referral into the occiput (C2–C3, C3–C4) or shoulder/upper arm (C5–C6, C6–C7) - Post-whiplash chronic neck pain is commonly maintained by cervical facet joint inflammation ### Frequently Asked Questions **Q: How is a medial branch block different from a facet joint injection?** A medial branch block targets the nerve supplying the joint, not the joint itself. It is primarily a diagnostic procedure. A facet joint injection (intra-articular) delivers corticosteroid directly into the joint for therapeutic purposes. MBBs are preferred as the diagnostic step before RFA because they predict response to denervation. **Q: Does RFA permanently damage the nerve?** No. Medial branch nerves regenerate after RFA, typically within 6–18 months. This is why pain relief, while durable, is not permanent, and why repeat RFA is possible. **Q: What does RFA feel like after the procedure?** Post-procedure soreness at the needle sites is common for a few days. Some patients notice a brief flare of back pain within the first 2 weeks as the nerve completes degeneration; this resolves as relief sets in. Unusual sensations (skin sensitivity, mild numbness) in the treatment area may occur transiently. **Q: Is the 50% pain relief threshold for a positive block strict?** Requirements vary. Many insurance carriers require 80% relief, while clinical guidelines accept 50%. Your MOS physician will clarify the specific threshold used at our practice and how it affects your pathway to RFA. **Q: Can facet arthropathy cause leg pain?** Facet-referred pain typically stays above the knee. True leg pain below the knee with dermatomal features suggests nerve root involvement (radiculopathy) from disc herniation or foraminal stenosis. This is a different diagnosis that would direct different treatment. --- ## Failed / Revision Total Hip Arthroplasty URL: https://www.mdorthospecialists.com/conditions/hip/failed-revision-total-hip-arthroplasty/ Revision total hip replacement is surgery to repair or replace a previous hip replacement that has failed from wear, loosening, infection, instability, or fracture around the implant. The surgeon removes the worn or loose components and implants new ones, sometimes rebuilding lost bone. It is more complex than the original replacement. ### Symptoms - Aseptic loosening: Gradual onset groin/thigh pain, worse with weight-bearing; often preceded by years of good function - PJI: Pain (often constant), warmth, swelling, sinus tract, fever — or may be subtle chronic pain without systemic signs - Dislocation: Sudden severe pain, deformity, shortened/externally rotated leg; inability to bear weight — medical emergency requiring emergent reduction - Periprosthetic fracture: Sudden onset pain after fall or minimal trauma; inability to bear weight - Bearing wear/osteolysis: Often asymptomatic until advanced; pain and instability as bone stock is lost ### Frequently Asked Questions **Q: How do I know if my hip replacement is failing?** New onset pain after a period of satisfactory function warrants evaluation, particularly groin, thigh, or buttock pain that worsens with activity. X-rays and laboratory tests can detect loosening and infection before advanced bone loss occurs. Annual X-ray surveillance is recommended for all THA patients. **Q: What is a "two-stage" hip replacement for infection?** In a two-stage revision, all infected hardware is removed and an antibiotic-loaded spacer is placed. After 6–12 weeks of antibiotic treatment and confirmation of infection clearance, new implants are placed. This two-step process is necessary because biofilm-protected bacteria cannot be eradicated with antibiotics alone while the implant remains in place. **Q: Is revision surgery as successful as primary THA?** Revision THA is significantly more complex with higher complication rates and less predictable outcomes than primary THA. Success depends on the cause of failure, degree of bone loss, presence of infection, and the surgeon's revision experience. In experienced hands, most patients achieve meaningful pain relief and improved function. **Q: Can I prevent my hip replacement from failing?** Maintaining a healthy weight reduces implant loading. Avoiding high-impact activities reduces wear. Preventing and promptly treating remote infections (dental procedures, UTIs, skin infections) reduces hematogenous PJI risk. Annual surveillance X-rays allow early detection of osteolysis before structural compromise occurs. **Q: What is a "constrained liner" and why would I need one?** A constrained liner mechanically locks the femoral head inside the acetabular socket, preventing dislocation. It is used when a patient has persistent dislocation despite correctly positioned components, particularly with deficient abductor muscles. The trade-off is higher interface stresses and potential for cup loosening. --- ## Femoroacetabular Impingement (FAI) URL: https://www.mdorthospecialists.com/conditions/hip/femoroacetabular-impingement/ Femoroacetabular impingement is a variation in hip bone shape that causes the femur and socket rim to contact abnormally during motion, damaging cartilage and the labrum. Diagnosis requires symptoms, examination findings, and imaging together. Treatment begins with targeted physical therapy, with arthroscopic reshaping of the bone for patients who do not improve. ### Symptoms - Motion-related or position-related pain in the groin or front of the hip, sometimes felt in the buttock or thigh - A pinching sensation deep in the hip when squatting, sitting low, or bringing the knee toward the chest - Pain with prolonged sitting, which makes driving and desk work provocative - Noticeably reduced hip rotation compared with the other side, particularly internal rotation when the hip is flexed - Clicking, catching, or a sense of the hip locking during movement - Stiffness that limits athletic positions such as a deep squat, a hockey stride, or a dance turnout - Difficulty with cutting, pivoting, or explosive acceleration in sport ### Frequently Asked Questions **Q: My X-ray shows a cam bump. Do I have FAI?** Not necessarily, and this is the single most important thing to understand. The international consensus definition requires three things together: symptoms, clinical signs on examination, and imaging findings. Cam and pincer shapes are common in people with no hip pain at all, present in roughly 17 percent of men in a large general population study and in a much higher share of athletes. If your hip does not hurt and your examination is normal, an incidental bump on a scan is a normal anatomic variant rather than a diagnosis, and it does not require treatment. **Q: Do I need surgery for hip impingement?** Usually not as a first step. Structured physical therapy focused on gluteal and core strengthening and on retraining movement patterns is the appropriate starting point for nearly all patients, and a meaningful fraction improve enough that surgery never becomes necessary. Surgery is worth considering when a genuine course of therapy has not worked, your symptoms and examination and imaging all agree, and your cartilage is reasonably preserved. The randomized evidence favors surgery over therapy on average, but by a margin that is modest rather than dramatic. **Q: Will fixing my impingement prevent hip arthritis?** We cannot promise that, and we would be misleading you if we did. Hips meeting the full criteria for impingement syndrome do carry a substantially elevated risk of developing arthritis over ten years, so the concern is legitimate. However, no completed randomized trial has demonstrated that surgically reshaping the bone reduces that long-term risk. The established benefit of surgery is symptom relief and improved function. That is a real benefit worth having, but it is a different claim from preventing arthritis, and the distinction deserves to be stated honestly. **Q: Why did this happen if I did not injure my hip?** Cam morphology develops during adolescence, while the growth plate at the top of the thigh bone is still open, in response to heavy athletic loading. Prospective imaging of adolescent hockey players captured the shape changing during the final growth spurt. So for many patients the shape formed years or decades before symptoms appeared, and it formed because of the sports they played as teenagers rather than because of any single injury. Symptoms typically emerge later, once cumulative contact has begun to damage the labrum and cartilage. **Q: What happens if too much or too little bone is removed?** Both errors cause problems, which is why precision matters so much in this operation. Removing too little leaves the impingement in place, and incomplete resection is the most frequent reason patients require revision surgery. Removing too much weakens the femoral neck and, rarely, can lead to fracture, or in the case of the socket rim, can turn an impinging hip into an unstable one. Intraoperative imaging and dynamic testing before closing are used to confirm the correction is adequate without being excessive. **Q: Can I still be treated if I already have some arthritis?** It depends on how much. Mild changes do not necessarily rule out hip preservation surgery, but the amount of cartilage wear present is one of the strongest predictors of how well you will do. In a large cohort, conversion to hip replacement within two years rose from under 1 percent in patients under thirty to about 14 percent in patients in their fifties, and higher grades of arthritis and joint space narrowing below two millimeters consistently predict poorer results. When arthritis is advanced, we will tell you that arthroscopy is unlikely to help rather than offering it anyway. --- ## Foot & Ankle Fractures URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/foot-and-ankle-fractures/ Foot and ankle fractures involve disruption of the bony architecture of the distal leg, hindfoot, midfoot, and forefoot. Several distinct fracture entities warrant separate discussion. ### Ankle Fractures Ankle fractures involve the malleoli: the medial malleolus (distal tibia), lateral malleolus (fibula), and/or posterior malleolus (posterior tibial lip). ### Symptoms - Ankle fractures: Immediate pain, swelling, bruising, and inability to bear weight after inversion or twisting injury; deformity if displaced. - 5th metatarsal fractures: Lateral foot pain and tenderness over the proximal fibula after ankle "roll"; may be mistakenly attributed to sprain. - Calcaneal fractures: Severe heel pain, massive swelling ("Mondor sign" of plantar ecchymosis), inability to bear weight; bilateral in 10% of fall-from-height cases. ### Frequently Asked Questions **Q: Can I walk on a fractured ankle?** It depends entirely on the fracture pattern. Some stable isolated fibula fractures allow protected weight-bearing in a boot; others require strict non-weight-bearing. Never assume. Get it evaluated. **Q: What happens if a Jones fracture doesn't heal?** Non-union of a Jones fracture causes persistent lateral foot pain and refracture risk. Surgical fixation with an intramedullary screw, sometimes supplemented with bone grafting, is the treatment of choice for symptomatic non-union. **Q: My heel is fractured. Do I need surgery?** Not always. Extra-articular fractures and many intra-articular fractures in patients with medical risk factors (diabetes, poor vascularity, smoking) are best managed non-operatively. Surgical decision-making is nuanced and based on fracture pattern, CT findings, and patient factors. **Q: What are Ottawa Rules?** The Ottawa Ankle Rules are clinical guidelines indicating when ankle/foot X-rays are needed after injury. They have ~99% sensitivity for ruling out fracture, reducing unnecessary imaging while ensuring fractures are not missed. **Q: How long will I need to be non-weight-bearing after a foot or ankle fracture?** The non-weight-bearing period varies considerably by fracture type and treatment: most ankle fractures treated surgically allow protected weight-bearing in a boot within two to six weeks, while calcaneal (heel) fractures and complex Lisfranc injuries may require six to twelve weeks of non-weight-bearing to allow adequate healing. Stress fractures in high-risk locations such as the fifth metatarsal (Jones fracture) or navicular also require strict non-weight-bearing for six to eight weeks. Your MOS surgeon will confirm healing with serial X-rays before advancing your weight-bearing status. Following these guidelines carefully is critical to preventing malunion or re-fracture. --- ## Forearm Fractures URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/forearm-fractures/ A forearm fracture is a break in one or both of the forearm bones, the radius and the ulna, most often caused by a fall or direct blow. Symptoms include pain, swelling, deformity, and difficulty rotating the wrist. Treatment ranges from casting to surgery depending on the break. ### Symptoms - Pain, swelling, and deformity of the forearm following trauma - Limited or painful forearm rotation (pronation/supination) - Tenderness along the radius and/or ulna - Signs of neurovascular compromise (anterior interosseous nerve or posterior interosseous nerve injury may accompany Monteggia fractures) ### Frequently Asked Questions **Q: Why do adult forearm fractures almost always need surgery?** The interosseous membrane and strong forearm muscles cause displaced fragments to shorten and rotate. Plaster casts cannot maintain alignment against these forces, and malunion produces permanent limitation of forearm rotation. Children, whose bones have greater remodeling potential, can often be managed in casts; adults cannot. **Q: What if the elbow doesn't hurt? Do I still need elbow X-rays?** Yes. The elbow X-ray is mandatory after any forearm fracture to identify an associated radial head dislocation (Monteggia). The elbow may not be painful despite joint disruption. **Q: Are the plates removed after healing?** In adults, plates are generally left permanently unless they cause symptoms. Plate removal is an elective procedure typically not performed before 18–24 months post-fixation. **Q: How long does recovery take after surgical fixation of a forearm fracture?** Bone healing typically takes eight to twelve weeks after plate-and-screw fixation of a forearm fracture, though early controlled motion of the wrist and elbow usually begins within the first one to two weeks. Regaining full forearm rotation (pronation and supination) can take three to six months and depends greatly on the quality of fracture reduction and commitment to rehabilitation. Your MOS surgeon will coordinate care with a hand therapist to maximize your functional recovery. **Q: Will I lose forearm rotation permanently after a fracture?** Most patients regain excellent forearm rotation after well-aligned surgical fixation, but some permanent loss is possible, particularly after comminuted (multi-fragment) fractures or those involving the radial head. Malunion (healing in a twisted or angulated position) is the most common reason for lasting rotational loss, which is why precise fracture reduction during surgery is so important. Physical therapy including progressive forearm rotation exercises is an essential part of recovery to maximize the rotation you regain. --- ## Foreign Bodies in the Hand URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/foreign-bodies-hand/ A retained foreign body is material such as wood, glass, or metal left in the hand's soft tissue after a puncture or crush injury. Metal and glass show up on X-ray, but wood often does not and carries a higher infection risk. Removal is recommended for most organic material, while small inert metal fragments may sometimes be left alone. ### Symptoms - A visible puncture, laceration, or entry wound, sometimes with a fragment protruding - Pain at the site, which may worsen rather than improve over the days following injury - A persistent sensation that something remains lodged beneath the skin - Redness, warmth, swelling, or drainage suggesting an early infection - Reduced motion or pain with movement of a nearby joint or tendon - Symptoms that reappear weeks or months after a seemingly healed, sometimes forgotten, injury, which can indicate migration of the object ### Frequently Asked Questions **Q: If my X-ray was normal, does that mean there's nothing left in my hand?** Not necessarily, and this is one of the most common misunderstandings about foreign bodies in the hand. Standard X-ray reliably shows metal and glass, but wood, plastic, and plant material such as thorns are often invisible on X-ray. Studies report that up to 38 percent of these radiolucent materials are missed on the initial film. If your symptoms and the way you were injured still suggest something may be retained despite a clear X-ray, an ultrasound is the appropriate next step, since it detects these materials far more reliably than X-ray does. **Q: Why does a wood splinter need more urgent attention than a piece of metal?** Organic material, wood especially, triggers a stronger inflammatory reaction in the body than metal does, and it carries the highest infection risk of any commonly retained foreign body material. Metal, in contrast, is relatively inert, and a small, harmless-seeming metal fragment can sometimes be safely left in place if it is not causing symptoms and is away from important structures. Because of this difference, we generally recommend removing wood and other organic material fairly promptly, while taking a more selective approach with small, deep, asymptomatic metal fragments. **Q: Do I always need surgery to remove a foreign body from my hand?** No. Many foreign bodies, particularly superficial ones, can be removed in an office or emergency setting under local numbing medicine, without a trip to the operating room. Formal surgical exploration is reserved for objects that are deep, close to a nerve, tendon, or joint, associated with infection, or that were not successfully retrieved during an initial bedside attempt. The decision is based on the object's depth, location, and any signs of infection, not simply on whether something needs to come out at all. **Q: What happens if a foreign body is left in my hand for a long time?** It depends on the material and location, but leaving organic material in place for an extended period raises the risk of ongoing infection, an inflammatory nodule called a granuloma, and, rarely, chronic bone infection. Foreign bodies located near tendons can also migrate over time and cause symptoms that appear well after the original, sometimes forgotten, injury. Because of this, we recommend evaluation for any retained foreign body that has not resolved on its own, particularly when the material is unknown or suspected to be wood or another organic substance. **Q: Can removing a foreign body cause more harm than leaving it alone?** Yes, in specific circumstances, which is why removal is not automatic for every retained object. A prolonged, poorly localized search for a small, deep fragment can require a larger incision and risks injuring nearby nerves or blood vessels, sometimes causing more harm than the foreign body itself would have. This is part of why we favor image-guided removal, using ultrasound to pinpoint the object precisely, over a blind surgical search, and why small, deep, inert metal fragments away from critical structures are sometimes reasonably observed rather than pursued. --- ## Ganglion Cyst URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/ganglion-cyst/ A ganglion cyst is a mucin-filled cystic outpouching that communicates with a nearby joint or tendon sheath through a one-way valve-like pedicle. The cyst wall is composed of compressed collagen fibers and fibrous tissue (not a true synovial lining), and its contents are a thick, gelatinous fluid rich in glucosamine, hyaluronic acid, and albumin. ### Symptoms - A visible, smooth, round or lobulated lump on the wrist or hand - May be soft and compressible (large, fluid-filled) or firm and immovable (small, seed ganglion) - Variable pain — some cysts are entirely painless; others cause aching, weakness, or pain with specific wrist positions - Dorsal wrist ganglia may enlarge with wrist flexion and shrink with extension - Wrist weakness or reduced range of motion when large cysts compress adjacent structures - Numbness or tingling if the cyst compresses the median nerve (at the wrist) or the ulnar nerve in Guyon's canal ### Frequently Asked Questions **Q: Is a ganglion cyst dangerous?** No. Ganglion cysts are entirely benign. They do not turn cancerous. **Q: Why does my cyst come and go?** Ganglion size fluctuates with activity and fluid pressure in the adjacent joint. Some patients notice cysts swell with high-activity periods and partially deflate with rest. **Q: If I have a ganglion on the back of my wrist, could my wrist ligament be torn?** A dorsal wrist ganglion can overlie a partially torn scapholunate ligament. If you have significant wrist pain beyond what the cyst itself would explain, or if your pain persists after cyst excision, further evaluation of the SLIL with MRI arthrogram or wrist arthroscopy may be warranted. **Q: Will the cyst come back after surgery?** Recurrence after complete surgical excision with stalk and capsule cuff removal is approximately 5–15%. This is significantly lower than after aspiration alone. **Q: Can I have a ganglion aspirated multiple times?** Yes, aspiration can be repeated if a cyst recurs after initial aspiration and the patient prefers to avoid surgery. Success rates with repeat aspiration are modestly lower than the first. --- ## Glenohumeral Osteoarthritis URL: https://www.mdorthospecialists.com/conditions/shoulder/glenohumeral-osteoarthritis/ Glenohumeral (GH) osteoarthritis (OA) involves the degeneration of articular cartilage on the humeral head and/or glenoid surface, accompanied by subchondral sclerosis, osteophyte formation, and eventual loss of joint space. It is the third most common large-joint arthritis after the knee and hip. ### Symptoms - Deep, aching pain in the shoulder, worsened with activity and improved with rest - Morning stiffness lasting less than an hour - Loss of both active and passive shoulder motion (especially external rotation) - Audible or palpable crepitus (grinding) with shoulder movement - Pain with overhead reaching, cross-body maneuvers, and lying on the affected side - Gradual progression over months to years ### Frequently Asked Questions **Q: What is the difference between TSA and RSA?** Anatomic TSA mimics normal shoulder anatomy and is preferred when the rotator cuff is intact. Reverse TSA changes the biomechanics to compensate for a torn or dysfunctional rotator cuff. Our surgeons select the appropriate implant based on your specific anatomy, cuff status, and bone quality. **Q: How long do shoulder replacements last?** Modern shoulder arthroplasty implants last 10–20 years or more in most patients. Glenoid component loosening is the most common long-term complication of anatomic TSA. **Q: Can I delay surgery?** Yes. Surgery is elective and reserved for patients with pain and functional limitation that significantly impairs quality of life despite conservative care. We will work with you on non-surgical options as long as they remain effective. **Q: What is the recovery timeline after shoulder replacement surgery?** After shoulder replacement, the arm is placed in a sling for four to six weeks to protect the repaired muscles and allow soft-tissue healing. Passive range-of-motion exercises begin within the first few days, and active use of the arm progressively increases over three to four months. Most patients achieve significant pain relief within the first few weeks and reach maximum functional improvement at six to twelve months. Return to light work or recreational activities typically occurs at three to four months, while overhead lifting and contact sports restrictions depend on the type of replacement performed. **Q: What are the long-term outcomes after shoulder replacement for glenohumeral osteoarthritis?** Shoulder replacement for glenohumeral osteoarthritis has excellent long-term outcomes, with modern implants lasting 15 to 20 years in the majority of patients. Patient satisfaction rates exceed 90 percent, with dramatic improvements in pain, sleep, and shoulder function. The most common long-term concern with anatomic total shoulder replacement (TSA) is loosening of the glenoid (socket) component, which may require revision surgery after 15 or more years. At MOS we use careful pre-operative planning and implant selection to maximize implant longevity. --- ## Gluteus Medius / Minimus Tendon Tears URL: https://www.mdorthospecialists.com/conditions/hip/gluteus-medius-minimus-tendon-tears/ The gluteus medius and gluteus minimus muscles originate from the outer surface of the ilium and insert via broad, flat tendons onto the greater trochanter of the femur. They are the principal hip abductors: muscles that hold the pelvis level during single-leg stance (walking, climbing stairs). ### Symptoms - Lateral hip pain over or just proximal to the greater trochanter - Pain that worsens when lying on the affected side (nocturnal pain is a key complaint) - Pain with single-leg stance, stair climbing, walking on uneven terrain - Hip abductor weakness — difficulty rising from a chair or walking without a limp - Trendelenburg gait: The pelvis drops toward the unaffected side when standing on the affected leg, indicating failure of the hip abductors to stabilize the pelvis - Point tenderness directly over the greater trochanteric footprint - Pain may extend to the outer thigh ### Frequently Asked Questions **Q: Is gluteal tendon tear the same as trochanteric bursitis?** No, though they often co-exist. Bursitis refers to inflammation of the fluid-filled sac over the greater trochanter. Tendon tears involve structural disruption of the gluteus medius or minimus. Many patients labeled with "bursitis" actually have underlying tendon pathology that requires targeted treatment. **Q: Can a complete tear heal without surgery?** Tendon tissue cannot reliably reconstitute itself once fully torn. Non-operative care may reduce pain but is unlikely to restore full abductor strength or resolve a Trendelenburg gait from a complete tear. Surgery provides the best opportunity for functional restoration. **Q: Will I need a general anesthetic for the repair?** Most gluteal tendon repairs are performed under general or spinal anesthesia as outpatient surgery. You will go home the same day with crutches. **Q: How do I know if my PT program is working?** Measurable improvement in hip abductor strength, reduction in Trendelenburg gait, and decreased lateral hip pain at 8–12 weeks indicate a positive response to conservative care. **Q: How long does recovery take after gluteal tendon repair surgery?** Recovery after endoscopic or open gluteal tendon repair is gradual and typically takes six to nine months to reach full function. For the first six weeks, weight-bearing is allowed but hip abductor loading is strictly limited to protect the repair. Formal physical therapy then focuses on progressive strengthening of the hip abductors, core, and pelvis, with return to unrestricted activity expected around the six-month mark. Your MOS surgeon will monitor tendon healing and guide your rehabilitation to ensure the repair matures fully before high-demand activities are resumed. --- ## Gout and Pseudogout of the Hand and Wrist URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/gout-pseudogout-hand/ Gout and pseudogout are crystal-induced arthritis affecting the hand and wrist. Gout is caused by monosodium urate crystals from high uric acid, while pseudogout comes from calcium pyrophosphate crystals, most often in the wrist. Both cause sudden, painful, swollen joints. Diagnosis relies on joint fluid analysis, and most cases respond well to medication rather than surgery. ### Symptoms - Sudden, severe pain in a joint, often the wrist, along with redness, warmth, and swelling - Symptoms severe enough to mimic a joint infection - With gout specifically, painless chalky deposits called tophi that build up under the skin over time if the condition goes untreated, which can erode through tendons or skin - With chronic CPPD, a more persistent, symmetrical joint swelling and stiffness in the hands and wrists that can resemble rheumatoid arthritis - Attacks that come and go, with symptom-free periods in between ### Frequently Asked Questions **Q: How can I tell if I have gout or pseudogout in my wrist?** The two conditions can look nearly identical during an attack: sudden pain, redness, warmth, and swelling. The only reliable way to distinguish them is by aspirating fluid from the joint and examining it under a polarized light microscope. Gout crystals are needle-shaped, while pseudogout crystals are rhomboid-shaped, and each has a different pattern of light bending (birefringence) that a lab can identify. Blood tests for uric acid and x-rays provide supporting information but are not definitive on their own. **Q: Why does my wrist hurt from gout when I thought gout only affects the big toe?** Gout classically starts in the big toe, but it commonly affects other joints too, including the wrist, elbow, and finger joints. If you've had gout elsewhere before, a new attack in your wrist is entirely consistent with the same underlying disease, and the diagnosis and treatment approach are the same regardless of which joint is affected. **Q: Is pseudogout the same thing as gout, just a milder version?** No, they are caused by entirely different crystals and have different long-term treatment. Gout comes from uric acid crystals and can be effectively controlled long-term with urate-lowering medication that prevents future flares. Pseudogout comes from calcium pyrophosphate crystals, and unfortunately there is currently no medication that reduces those crystal deposits once they've formed; treatment manages symptoms during flares and over the long term rather than reversing the underlying process. **Q: Do I need surgery for gout or pseudogout in my hand?** Most people never need surgery for either condition; medication controls the great majority of cases. Surgery becomes relevant for gout when large tophi have caused skin breakdown, significantly limited joint motion, or pressed on a nerve, and it's typically only recommended once you are committed to ongoing urate-lowering medication, since surgery removes existing tophi but doesn't prevent new ones without medical control. For pseudogout, surgery is reserved for advanced wrist joint damage that has developed over years and isn't responding to symptom-directed treatment. **Q: What are those hard lumps on my knuckles, and are they dangerous?** If you have a history of gout, hard, sometimes chalky-feeling lumps near joints or tendons are likely tophi, deposits of uric acid crystals that accumulate under the skin when gout goes untreated or undertreated over time. They are usually painless at first but can eventually erode through overlying skin or weaken a nearby tendon to the point of rupture, so they shouldn't be ignored even if they don't currently hurt. Bringing uric acid under control with medication is the most important step, and surgical removal is an option if a tophus is causing functional problems. --- ## Greater Trochanteric Pain Syndrome URL: https://www.mdorthospecialists.com/conditions/hip/greater-trochanteric-pain-syndrome/ Greater trochanteric pain syndrome causes pain and tenderness over the bony bump on the outer hip, usually from irritation of the nearby gluteal tendons and bursa. It often worsens with walking, climbing stairs, or lying on the affected side, and is frequently mistaken for hip arthritis. ### Symptoms - Lateral hip pain centered over the greater trochanter - Pain radiating down the outer thigh (may be confused with referred lumbar pain) - Severe pain when lying on the affected side (sleep disruption is a primary complaint) - Pain that worsens with prolonged walking, stairs, rising from a seated position, or crossing legs - Point tenderness when pressing directly over the greater trochanter - Pain provoked by single-leg stance on the affected side - Possible antalgic gait or Trendelenburg sign if underlying abductor tendon tear is present ### Frequently Asked Questions **Q: Is stretching helpful or harmful for trochanteric bursitis?** Targeted hip abductor stretches are beneficial. However, aggressive IT band stretching in positions that adduct the hip (e.g., standing lateral lean) can increase compression over the trochanter acutely. Your physical therapist will guide you through the appropriate progression. **Q: Why does it hurt more when I sleep on my side?** Direct compression of the greater trochanter against the mattress applies sustained pressure to the bursa and tendon insertions. Using a pillow between your knees maintains hip alignment and significantly reduces nocturnal pain. **Q: How many cortisone shots can I have?** We generally recommend no more than 2–3 corticosteroid injections in the same region per year. Repeated injections beyond this threshold may weaken tendon tissue and accelerate tendinopathy progression. **Q: Does GTPS come back after treatment?** Recurrence is common if the underlying biomechanical drivers (abductor weakness, gait pattern) are not corrected. Patients who complete and maintain their PT program have significantly lower recurrence rates. **Q: What activities should I avoid when I have greater trochanteric pain syndrome, and for how long?** During the acute phase of greater trochanteric pain syndrome, you should avoid activities that compress or repeatedly load the tendons over the greater trochanter, including running, climbing stairs quickly, crossing your legs, and sitting in low chairs. Side-lying on the affected hip and hip adduction stretches (crossing the leg past the midline) are particularly aggravating and should be avoided. Most patients see significant improvement within three to six months with a load-management program, targeted physiotherapy, and activity modification. Your MOS care team will guide a gradual return to full activity once the tendon has settled and strength has been restored. --- ## Hammertoe Deformity URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/hammertoe-deformity/ Lesser-toe deformities involve abnormal flexion or extension contractures at one or more toe joints. Three clinically distinct patterns exist: Hammertoe: Flexion deformity at the proximal interphalangeal (PIP) joint with extension at the metatarsophalangeal (MTP) joint. The toe adopts a "hammer" shape. ### Symptoms - Dorsal PIP corn: A hard corn (callus) over the prominent PIP joint where it rubs against the shoe upper — the most common symptom and presentation - Tip-of-toe corn or callus (mallet toe): DIP presses into the shoe - MTP joint pain and plantar callus: As the MTP joint extends and the plantar fat pad shifts, the metatarsal head is exposed to direct plantar pressure - Pain with shoe wear; difficulty finding comfortable footwear - In advanced disease: MTP joint subluxation or dislocation, with the toe riding up over the 1st or 3rd toe ### Frequently Asked Questions **Q: Will my hammertoe keep getting worse?** Flexible hammertoes tend to progress to rigid deformities over years, especially if contributing causes (bunion, footwear habits) are not addressed. Conservative care slows progression; it does not reverse an established structural deformity. **Q: Can I have both my bunion and hammertoe corrected at the same time?** Yes, simultaneous correction is commonly performed and is often preferable. Correcting the hallux valgus eliminates the deforming force on the 2nd toe, improving hammertoe outcomes and reducing recurrence. **Q: What is a "floating toe" after surgery?** A floating toe is a common outcome of PIP resection arthroplasty where the straightened toe does not fully contact the ground. It is generally painless and cosmetically acceptable, but some patients prefer fusion to maintain a more "grounded" toe. **Q: How long is recovery after hammertoe surgery?** Recovery after hammertoe correction typically requires four to six weeks of protected weight-bearing in a surgical shoe, during which you can walk but should limit prolonged standing. Swelling in the toe can persist for three to six months, and it may take up to a year for the final surgical result to be fully apparent. If a pin was used to hold the toe straight during healing, it is usually removed in the office at four to six weeks. Your MOS surgeon will guide you through each stage of recovery and advise when you can return to normal footwear. **Q: Can hammertoes be prevented from coming back after surgery?** Hammertoe recurrence is less likely when the underlying cause (such as abnormal foot mechanics, a too-long second toe, or an untreated bunion) is also addressed at the time of surgery. Wearing properly fitted, wide-toed footwear after recovery is one of the most important steps to prevent recurrence. Avoiding shoes with a narrow toe box or high heels significantly reduces the forces that cause the toes to buckle over time. Your MOS care team will provide guidance on footwear and foot care to protect your surgical result long-term. --- ## Hand & Wrist Arthritis URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/hand-wrist-arthritis/ Hand and wrist arthritis is progressive inflammation and wear of the joints in the hand and wrist. The most common form, osteoarthritis, results from gradual loss of cartilage, while rheumatoid arthritis is an inflammatory type. Symptoms include pain, stiffness, swelling, and weakened grip that worsen over time. ### Symptoms - Aching pain in the thumb base, finger joints, or wrist, often worse with activity and improving with rest (OA pattern) - Morning stiffness lasting more than 30–60 minutes (more typical of inflammatory arthritis) - Swelling and warmth around affected joints - A grinding, grating, or crunching sensation (crepitus) with movement - Weakness with pinch and grip — dropping objects, difficulty with fine motor tasks - Bony enlargements at the finger joints (Heberden's/Bouchard's nodes) - Thumb base pain with pinching, turning keys, or opening bottles ### Frequently Asked Questions **Q: Can arthritis be cured?** Arthritis cannot be reversed, but symptoms can be effectively managed. Many patients maintain an active lifestyle for years with non-operative care. **Q: Is surgery my only option for thumb arthritis?** No. Most patients with basal thumb arthritis are successfully managed with splinting, injections, and therapy. Surgery is reserved for those who have not responded to at least 3–6 months of conservative treatment. **Q: Will a cortisone shot damage my joint?** Occasional corticosteroid injections are safe and effective. Frequent injections (more than 3–4 per year over many years) may weaken surrounding soft tissue, so we use them judiciously. **Q: What is the difference between OA and RA?** Osteoarthritis is a wear-and-tear condition primarily driven by mechanical factors and age. Rheumatoid arthritis is an autoimmune disease driven by systemic inflammation that can damage joints, tendons, and other organs. **Q: I have CPPD. Does that need surgery?** Most CPPD flares are managed with aspiration, NSAIDs, or colchicine. Chronic CPPD-related arthritis is treated similarly to OA. --- ## Hand & Wrist Fractures URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/hand-wrist-fractures/ A hand or wrist fracture is a break in any of the small bones of the hand or the bones forming the wrist, usually from a fall, crush, or sports injury. Symptoms include pain, swelling, bruising, and difficulty gripping. Treatment ranges from splinting to surgery depending on the fracture. ### Symptoms - Immediate pain, swelling, and bruising following an injury - Visible deformity or shortening of a finger or the wrist - Inability to fully bend or straighten the fingers or wrist - Numbness or tingling (may indicate associated nerve injury) - Rotational malalignment of fingers — overlapping when attempting to make a fist - Point tenderness directly over the bone ### Frequently Asked Questions **Q: My X-ray at the ER looked fine, but my wrist still hurts weeks later. What should I do?** Some fractures, particularly scaphoid fractures, are invisible on initial X-rays. Persistent wrist pain after a fall warrants re-evaluation, which may include MRI or CT scanning. **Q: Will I need surgery for a Boxer's fracture?** Most fifth metacarpal neck fractures are treated successfully without surgery, provided the angulation is within acceptable limits and there is no rotational deformity. Our surgeons will show you what "acceptable" means on your specific X-ray. **Q: How long before I can return to sport after a distal radius fracture?** Most athletes return to non-contact sport by 8–12 weeks and contact sport by 3–4 months, depending on fracture severity and fixation type. **Q: What causes post-traumatic arthritis?** Arthritis develops when the joint surface heals with residual step-off or gap greater than 1–2 mm, or when altered mechanics accelerate cartilage wear. Anatomic surgical restoration of the joint surface is the best prevention. **Q: Will I develop stiffness in my hand or wrist after a fracture, and how do I prevent it?** Some degree of stiffness is common after any hand or wrist fracture due to immobilization, swelling, and scar tissue formation. Early mobilization of uninjured fingers during cast or splint treatment is important to minimize stiffness. Formal hand therapy, including active range-of-motion exercises, scar management, and progressive strengthening, is a cornerstone of recovery and significantly reduces long-term stiffness. At MOS, your treatment plan will include hand therapy referral as soon as it is safe to begin movement so that you recover the best possible function. --- ## Hand & Wrist Tendonitis URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/hand-wrist-tendonitis/ Hand and wrist tendonitis, more accurately tendinopathy, is painful irritation and degeneration of a tendon from repetitive overload, injury, or age-related wear. Common forms include de Quervain's and trigger finger. Symptoms include pain with movement, swelling, and stiffness, and most cases improve with rest, therapy, and injections. ### Symptoms - Aching or burning pain along a tendon, typically worsened with activity and improved with rest - Stiffness at the wrist or in the fingers, particularly in the morning - Mild swelling or warmth overlying the affected tendon - Weakness with gripping, pinching, or wrist loading - Crepitus (crunching or creaking) with movement in some cases ### Frequently Asked Questions **Q: Is tendonitis the same as tendinopathy?** "Tendonitis" implies acute inflammation; "tendinopathy" is the preferred term for chronic, degenerative tendon pain with less inflammation and more structural change. Both terms are used interchangeably in common practice, but the distinction matters for treatment: chronic tendinopathy responds better to loading programs than to pure anti-inflammatory treatment. **Q: How is this different from De Quervain's or trigger finger?** De Quervain's involves specific stenosis of the first dorsal compartment (thumb tendons), and trigger finger involves stenosis of the A1 flexor pulley. These have precise anatomical diagnoses and treatment protocols. General wrist tendinopathy involves other tendon locations without a defined pulley or compartment stenosis. **Q: Can I exercise with tendonitis?** Yes, active, graded rehabilitation is the cornerstone of treatment. Complete rest is counterproductive for most tendinopathy. Our therapists design programs that load the tendon appropriately without overloading it. **Q: What treatments are available if rest and anti-inflammatories are not helping my hand or wrist tendonitis?** If initial measures are insufficient, the next steps typically include a corticosteroid injection around the affected tendon sheath to reduce inflammation, combined with a structured hand therapy program. Splinting to rest the tendon in a protected position can also accelerate recovery. For conditions like De Quervain's tenosynovitis or trigger finger that do not respond to injections, minor outpatient surgery to release the constricting tendon sheath is highly effective, with quick recovery. At MOS we provide a clear progression plan so you always know what the next option is if your current treatment is not working. **Q: Can hand and wrist tendonitis become permanent if I ignore it?** Leaving tendonitis untreated can allow the condition to progress from inflammation to structural tendinopathy (chronic degenerative changes within the tendon), which is harder to resolve. In severe, prolonged cases, the tendon may eventually rupture, which is a more serious injury requiring surgical repair. Catching and addressing tendonitis early, while the tendon tissue is still intact and healthy, gives the best chance of full recovery. If your pain persists for more than four to six weeks, an evaluation with your MOS provider is advisable. --- ## Heel Spur URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/heel-spur/ A heel spur is a calcaneal enthesophyte: a bony projection that develops in response to repetitive traction stress at a tendon or fascial attachment. Two anatomically distinct types exist: Plantar heel spurs: Located on the inferior (bottom) surface of the calcaneus, at the attachment of the plantar fascia and intrinsic flexor muscles. ### Symptoms - Many patients have no symptoms — the spur is found incidentally on X-ray taken for another reason - When symptoms occur, they closely mirror the associated condition: - Plantar spur: morning heel pain at first steps, sharp pain under the heel with weight-bearing — this is plantar fasciitis; the spur itself is not causing this pain - Posterior spur/Haglund: pain and swelling at the back of the heel at the shoe counter, especially in rigid dress shoes or athletic shoes; retrocalcaneal fullness ### Frequently Asked Questions **Q: My X-ray shows a heel spur. Is that what's causing my pain?** Almost certainly not in isolation. Heel spurs are found in asymptomatic individuals at the same rate as in those with heel pain. The pain comes from the inflamed plantar fascia or irritated Achilles insertion, not the bone itself. Treating the soft tissues, not the spur, is what resolves symptoms. **Q: Can I just have the spur removed?** Isolated spur resection without addressing the underlying soft-tissue pathology typically fails. If surgery is ever needed, it should address the plantar fascia (release) or Achilles insertion (debridement ± spur resection) comprehensively. **Q: Will the spur grow back after surgery?** If the underlying mechanical stress continues, yes. Appropriate biomechanical management (orthotics, footwear changes, calf stretching) after any procedure reduces recurrence risk. **Q: How long does plantar fasciitis / heel spur pain usually last?** With appropriate treatment, the majority of patients experience significant improvement within three to six months. The condition is self-limiting in many cases, meaning it can resolve on its own, but this process often takes twelve to eighteen months without targeted treatment. A structured program including calf and plantar fascia stretching, supportive footwear, and custom or over-the-counter orthotics accelerates recovery significantly. Persistence with these measures, even after initial improvement, is important to prevent relapse. **Q: What are the surgical options if heel pain does not improve?** Surgery is considered only after six to twelve months of consistent non-surgical treatment have failed to provide adequate relief. The most common procedure is a partial plantar fascia release, in which the tight fascia is partially cut to relieve tension. This is most often performed endoscopically as an outpatient procedure. While effective, surgery carries a small risk of complications including nerve injury or arch flattening, so at MOS we reserve it for truly refractory cases and discuss all risks and expected recovery in detail before proceeding. --- ## Hip Articular Cartilage Defects URL: https://www.mdorthospecialists.com/conditions/hip/hip-articular-cartilage-defects/ Hip articular cartilage defects are areas of damage to the smooth cartilage that lines the ball-and-socket hip joint. Because this cartilage has little blood supply, it heals poorly on its own. Defects cause pain, catching, and stiffness, and can progress toward arthritis if left untreated. ### Symptoms - Deep groin pain, often associated with activity and relieved by rest - Mechanical symptoms: catching, clicking, locking (more specific for free chondral fragments or loose bodies) - Pain with pivoting, squatting, or hip flexion activities - Stiffness and aching after prolonged activity - Symptoms may be indistinguishable from labral tear or FAI until arthroscopy is performed ### Frequently Asked Questions **Q: If I have a labral tear and a cartilage defect, will both be treated at the same time?** Yes. Dr. Christoforetti addresses all pathology identified at arthroscopy in a single procedure whenever possible: labral repair, FAI correction (femoroplasty/acetabuloplasty), and cartilage restoration. **Q: Does hip cartilage surgery prevent arthritis?** The goal is to preserve function and delay or prevent joint-space narrowing in younger patients. Outcomes depend on the size and location of the lesion, the presence of underlying mechanical correction, and patient compliance with rehabilitation. Large defects or advanced age increase the risk of eventual OA. **Q: How does microfracture in the hip compare to the knee?** Hip microfracture outcomes are comparable to knee microfracture for small, contained lesions, but the hip's spherical geometry and higher contact pressures make rehabilitation more demanding. The non-weight-bearing protocol is strictly followed to allow clot formation. **Q: Am I a candidate for cartilage restoration if I'm over 50?** Age is not an absolute contraindication, but outcomes are better in patients under 40 with localized defects and no diffuse joint-space narrowing. Patients over 50 with extensive cartilage loss may be better served by hip replacement. **Q: How long is recovery after hip cartilage surgery, and when can I return to sport?** Recovery after hip arthroscopy for cartilage defects typically takes four to six months for return to sport, though procedures involving microfracture require strict protected weight-bearing for six to eight weeks to allow fibrocartilage formation. Patients who have had cartilage grafting or autologous chondrocyte implantation in the hip may need up to twelve months before full athletic activity. Your MOS surgeon will use a structured, phase-based rehabilitation program and will not clear you for return to sport until strength and functional movement benchmarks are met. Adhering to the rehabilitation timeline is essential to maximize the durability of the cartilage repair. --- ## Hip Capsular Contracture URL: https://www.mdorthospecialists.com/conditions/hip/hip-capsular-contracture/ The hip joint capsule is a dense, strong sleeve of fibrous tissue that surrounds the ball-and-socket joint. It is made up of three distinct ligaments (the iliofemoral, pubofemoral, and ischiofemoral ligaments), which are the primary static stabilizers of the hip. ### Symptoms - Restricted hip range of motion — internal rotation and flexion most commonly affected - Hip pain with activity, particularly end-range movements - Groin pain with hip flexion - Stiffness worse in the morning or after prolonged inactivity - Pain with tasks requiring full hip range of motion (getting in/out of a car, putting on shoes) - In post-arthroscopic cases: new or persistent restriction compared to the pre-operative range of motion ### Frequently Asked Questions **Q: How do I know if my restricted hip motion is from capsular contracture or FAI?** FAI impingement (bony) produces a hard end-feel to hip motion: you reach a firm stop. Capsular contracture produces a more gradual resistance with pain before the bony stop is reached. Imaging and a diagnostic injection help distinguish these. Often both contribute. **Q: Does capsular contracture come back after arthroscopic release?** Recurrence is possible, particularly if post-operative PT is inadequate. Committed engagement with the PT program, especially in the first 3 months after surgery, is essential to maintain the motion gains achieved in surgery. **Q: Is hip capsular contracture the same as a "frozen hip"?** "Frozen hip" (adhesive capsulitis) is rare compared to frozen shoulder, but true adhesive capsulitis of the hip does occur, producing profound range-of-motion restriction. It is treated with the same approach: PT, injection, and arthroscopic release for refractory cases. **Q: How is hip capsular contracture treated, and do I need surgery?** Initial treatment focuses on physical therapy (specifically stretching, joint mobilization, and strengthening the muscles around the hip) to gradually restore capsular flexibility and range of motion. Many patients improve meaningfully with a dedicated therapy program lasting two to four months. When conservative measures are insufficient and imaging confirms significant capsular thickening, arthroscopic capsular release is a minimally invasive option that can restore motion in appropriately selected patients. Your MOS surgeon will assess your imaging and response to therapy before recommending surgery. **Q: How long does recovery take after arthroscopic capsular release of the hip?** After arthroscopic capsular release, patients are typically weight-bearing as tolerated from the day of surgery, often with a brief period of crutch assistance. Intensive physical therapy begins within the first week and is crucial to prevent scar tissue from re-forming and to consolidate the gained range of motion. Most patients notice meaningful improvement in flexibility within six to twelve weeks, with full functional recovery taking three to six months. Maintaining a regular stretching and strengthening routine long-term is important to prevent recurrence. --- ## Hip Flexor Strain / Iliopsoas Tendinopathy URL: https://www.mdorthospecialists.com/conditions/hip/hip-flexor-strain-iliopsoas-tendinopathy/ The iliopsoas is formed by two muscles: the iliacus (originating from the inner ilium) and the psoas major (from the lumbar vertebrae). They converge into a single tendon inserting on the lesser trochanter of the femur. It is the most powerful hip flexor and plays a key role in lumbar stability. ### Symptoms - Anterior hip pain or deep groin pain - Pain with active hip flexion against resistance — most reliably reproduced by resisted straight-leg raise - Tenderness on deep palpation of the iliac fossa or anterior hip - Hip flexor tightness and reduced hip extension range of motion - Pain at the end range of hip extension (e.g., walking, lunging) - Possible snapping or clicking sensation at the anterior hip (see Snapping Hip) ### Frequently Asked Questions **Q: Is a hip flexor strain the same as a groin pull?** Not exactly. "Groin pull" typically refers to an adductor strain (inner thigh muscles). Hip flexor strain involves the iliopsoas. Both produce groin pain, but their physical examination findings and treatment differ. **Q: Can stretching make my hip flexor worse?** In the acute phase, aggressive stretching can worsen a strain. Initial treatment emphasizes rest and gentle range of motion, progressing to stretching once the acute pain subsides. Your physical therapist will guide this progression. **Q: What if my anterior hip pain doesn't improve with PT?** Persistent symptoms despite adequate PT should prompt evaluation for a hip labral tear, femoroacetabular impingement, or hip chondral defect. These conditions commonly co-exist with iliopsoas tendinopathy and require separate management. **Q: How long does a hip flexor strain take to recover from?** A mild hip flexor strain typically resolves within one to three weeks with relative rest, ice, and gentle stretching. Moderate strains may take four to eight weeks, and severe strains or iliopsoas tendinopathy that has become chronic can take two to four months of structured rehabilitation. Returning to sport or strenuous activity too quickly is a common cause of re-injury, so your MOS provider will guide you through a progressive return-to-activity plan based on your symptoms and functional testing rather than a fixed time frame. **Q: What is the snapping or clicking I feel in the front of my hip? Is it related to my hip flexor?** A snapping or clicking sensation in the front of the hip is often caused by the iliopsoas tendon flicking over a bony prominence. This is a condition called internal snapping hip or coxa saltans interna. It is closely related to iliopsoas tendinopathy and can accompany hip flexor pain and tightness. In most cases it is not harmful and resolves with stretching and strengthening. When snapping is painful or persistent, ultrasound-guided iliopsoas bursa injection or, rarely, arthroscopic tendon lengthening may be considered. Your MOS surgeon can determine which option is appropriate for you. --- ## Hip Labral Tear URL: https://www.mdorthospecialists.com/conditions/hip/hip-labral-tear/ A hip labral tear is an injury to the ring of cartilage that seals and stabilizes the hip socket. It causes groin pain, clicking, and pain with sitting or pivoting. Most tears are treated first with physical therapy, and arthroscopic repair restores the labrum's suction seal when symptoms persist. ### Symptoms - Deep pain in the groin or the front of the hip, often a dull ache at rest that sharpens with activity - The "C-sign," where patients cup a hand over the side and front of the hip to show where it hurts - Clicking, catching, or a locking sensation, particularly when pivoting or rising from a chair - Pain with prolonged sitting, which makes long drives and desk work especially provocative - Pain at the end of hip flexion, such as deep squatting, getting into a low car, or putting on shoes - Reduced hip motion compared with the other side, especially internal rotation - A decline in athletic performance with cutting, pivoting, kicking, or acceleration - A sense that the hip is loose, unstable, or about to give way ### Frequently Asked Questions **Q: Do I need surgery for a hip labral tear?** Usually not as a first step. Most labral tears improve with a structured physical therapy program addressing gluteal and core strength along with movement mechanics, and many patients do well long term without an operation. Surgery becomes a reasonable consideration when a symptomatic tear has not responded to a genuine course of therapy, typically at least three months, and when your history, examination, and imaging all point to the labrum as the source. The condition of your cartilage also factors heavily into that decision, since it predicts the durability of any repair. **Q: If an MRI shows a labral tear, does that mean it is causing my pain?** Not necessarily, and this is one of the most important things to understand about this diagnosis. Studies imaging people with no hip pain at all find labral tears at surprisingly high rates, including in young athletes. A tear on a scan is only meaningful when it lines up with where you hurt and what your examination shows. This is why we do not treat imaging reports in isolation, and why a diagnostic injection is sometimes useful to confirm that the pain is genuinely coming from inside the joint before recommending anything invasive. **Q: Will waiting make my hip worse?** It can, though not in every case. The labrum contributes to sealing and load distribution in the joint, so a torn labrum places more stress on the cartilage around it. Multicenter research that included our practice found that longer symptom duration before surgery predicted worse results afterward, and that existing cartilage damage and labral degeneration both predicted poorer outcomes. That does not mean every tear is an emergency. It does mean that a hip which is persistently painful, catching, or giving way deserves evaluation rather than indefinite waiting. **Q: Is a labral repair better than removing the torn part?** For most patients with repairable tissue, yes, repair is preferred. Repair restores the labrum's sealing and load-sharing function, while removing tissue sacrifices it. The long-term comparative evidence is not perfectly uniform. A ten-year study found repair and debridement produced similar results once age, cartilage status, and joint space were accounted for, while several more recent studies found repair conferred a meaningful survivorship advantage. Our practice favors repair when the tissue will hold it, and reserves debridement for degenerative tears that cannot be repaired. **Q: What if my labrum was already removed in a previous surgery?** Reconstruction is designed for exactly that situation. A graft, either your own tissue or donor tissue, is used to rebuild the missing labral segment and restore the seal. Multicenter research Dr. Christoforetti co-authored compared labral repair against both segmental and circumferential reconstruction and found comparable two-year outcomes across all three, which supports reconstruction as a legitimate option rather than a salvage procedure. Revision hip surgery is more complex than a first operation, and capsular deficiency from the prior procedure often needs to be addressed at the same time. **Q: How long until I can run and return to sport?** Straight-line running is typically introduced around three to four months, once you can walk briskly for thirty minutes without pain. Return to cutting, pivoting, and contact sport usually falls between six and nine months and should be based on objective strength and functional testing rather than elapsed time alone. Being candid about the ceiling matters: across published studies, most athletes return to sport after hip arthroscopy, but only a little over half return to their prior competitive level. Your sport, your position, and the condition of your cartilage all influence where you land. --- ## Hip Osteoarthritis URL: https://www.mdorthospecialists.com/conditions/hip/hip-osteoarthritis/ Hip osteoarthritis (OA) is a degenerative joint disease characterized by the progressive breakdown of articular cartilage, the smooth, low-friction lining that covers the femoral head and acetabulum. As cartilage thins and erodes, bone rubs on bone, triggering pain, inflammation, reactive bone spur (osteophyte) formation, and eventual joint-space narrowing visible on X-ray. ### Symptoms - Deep groin pain, often described as aching or throbbing - Pain with weight-bearing activities: walking, stair climbing, rising from a chair - Morning stiffness lasting less than 30 minutes (longer stiffness suggests inflammatory arthritis) - Reduced hip range of motion — difficulty putting on shoes and socks, getting in and out of a car - Grinding or catching sensation (crepitus) in the joint - Referred pain to the thigh, buttock, or knee - Positive FABER test (Flexion, ABduction, External Rotation) and FADIR test (Flexion, ADduction, Internal Rotation) on physical examination — internal rotation is typically the first motion lost in hip OA ### Frequently Asked Questions **Q: Can hip arthritis be reversed?** Cartilage loss cannot currently be reversed, but symptoms can be effectively managed and progression slowed. Maintaining a healthy weight, staying active with low-impact exercise, and following a structured PT program are the most impactful modifiable factors. **Q: How do I know if it's my hip or my lower back causing my groin pain?** Hip arthritis typically produces groin pain that worsens with weight-bearing and hip rotation. Back pain more commonly radiates down the leg below the knee and varies with spinal position. A diagnostic hip injection can clarify the source when both are suspected. **Q: Is there a best age for hip replacement?** Modern implants are highly durable (90%+ at 20 years) and age alone is rarely a limiting factor. The decision is based on symptom severity, functional limitation, and failure of conservative care, not a specific age threshold. **Q: What is the difference between PRP and a cortisone shot?** Corticosteroid injections reduce inflammation rapidly but do not address underlying cartilage changes. PRP delivers concentrated growth factors that may have regenerative effects. Many patients benefit from cortisone first for acute flares, and PRP for longer-term management. **Q: How long after total hip replacement can I expect to be back to normal daily activities?** Most patients walk with minimal assistance within one to two days of total hip replacement and return to light daily activities (including driving, household tasks, and short walks) within four to six weeks. By three months, the majority of patients report significant pain relief and improved function compared to before surgery. Full recovery, including optimal strength and endurance, continues to improve for six to twelve months as surrounding muscles strengthen. Your MOS team will provide specific activity precautions and a rehabilitation plan to ensure a safe, efficient recovery. --- ## Hip Stress Fracture (Femoral Neck Stress Fracture) URL: https://www.mdorthospecialists.com/conditions/hip/hip-stress-fracture-femoral-neck-stress-fracture/ A stress fracture develops when repetitive cyclic loading produces cumulative bone microdamage faster than the body can repair it. In the femoral neck, this occurs in two distinct patterns with very different prognoses: Compression-side (inferior femoral neck): The inferior cortex is under compressive forces. ### Symptoms - Groin pain or anterior hip pain that develops gradually with increasing activity - Pain worsens with running and weight-bearing; initially resolves with rest, then becomes persistent - Antalgic gait in more advanced cases - Tenderness over the anterior hip (femoral neck region) - Positive "hop test": Pain with single-leg hopping on the affected side is highly sensitive for femoral neck stress fracture - Fulcrum test: pain when the examiner applies a fulcrum force to the mid-thigh with the patient seated ### Frequently Asked Questions **Q: How is a femoral neck stress fracture different from a regular hip fracture?** A traumatic hip fracture occurs in an instant from a fall. A stress fracture develops gradually from repetitive loading without acute trauma. Both involve the femoral neck, but stress fractures occur in younger, often active individuals and have different management priorities. **Q: Can I keep training with a stress fracture?** No. Running or high-impact activity on a femoral neck stress fracture risks complete displacement. This is a surgical emergency that can cause permanent damage to the femoral head. You must stop running and seek immediate evaluation. **Q: Why do women get these more often?** The female athlete triad (low energy availability, menstrual irregularities, low bone density) significantly increases stress fracture risk. Estrogen plays a key role in bone remodeling, and low estrogen states from excessive training and caloric deficit impair bone repair. **Q: What is the treatment for a femoral neck stress fracture, and will I need surgery?** Treatment depends on the location and type of the stress fracture. Compression-side fractures (on the inner, lower part of the femoral neck) are lower risk and can often be treated with protected non-weight-bearing on crutches for six to twelve weeks, followed by a gradual return to activity. Tension-side fractures (on the outer, upper part of the neck) are at higher risk of completing into a full fracture and typically require surgical fixation with screws to prevent displacement. Your MOS surgeon will carefully classify your fracture on MRI and X-ray to determine the safest course of action. **Q: When can I return to running after a femoral neck stress fracture?** Return to running after a femoral neck stress fracture is a gradual process that typically takes three to six months for compression-side injuries managed non-surgically, and four to six months or longer after surgical fixation. Bone healing must be confirmed on imaging before impact activity resumes. A structured return-to-run program beginning with walking, then walk-run intervals, is essential to allow the bone to adapt progressively. Addressing any nutritional deficiencies, hormonal factors, or training errors that contributed to the fracture is equally important to prevent recurrence. --- ## ITB Syndrome (Iliotibial Band Syndrome) URL: https://www.mdorthospecialists.com/conditions/knee/itb-syndrome-iliotibial-band-syndrome/ The iliotibial band is a thick fascial band running from the iliac crest, along the lateral thigh, and inserting on Gerdy's tubercle on the lateral tibial plateau. The tendon can produce pain with repetitive motion activities such as running or cycling. ### Symptoms - Sharp, burning lateral knee pain that typically begins after a consistent distance ("pain at mile 3") and forces the runner to stop - Pain localized to the lateral femoral epicondyle, approximately 2–3 cm above the lateral joint line - Pain worsened by downhill running, stair descent, and prolonged sitting with the knee at 30° flexion - Generally no swelling or mechanical symptoms - Tenderness on the Noble compression test — direct pressure over the lateral epicondyle at 30° knee flexion reproduces the characteristic pain - Ober test — positive for ITB tightness when the leg does not adduct past neutral in the side-lying position with the pelvis stabilized ### Frequently Asked Questions **Q: Can I keep running with ITB syndrome?** A temporary reduction in volume is typically required during the acute painful phase. Most athletes can maintain cardiovascular fitness with cycling or aquatic running. Return to running proceeds gradually after pain-free strength and flexibility targets are met. **Q: Does foam rolling the ITB help?** Foam rolling the ITB itself is commonly prescribed but evidence for its direct therapeutic benefit is limited. Rolling the TFL and glutes (the soft-tissue proximal to the ITB origin) and addressing hip abductor strength are more reliably effective. **Q: What causes ITB syndrome, and why does it hurt on the outside of my knee?** ITB syndrome is caused by repetitive friction of the iliotibial band (a thick band of connective tissue running along the outer thigh) as it slides back and forth over the lateral femoral epicondyle (a bony prominence on the outside of the knee) with each step or pedal stroke. This friction leads to inflammation and pain specifically at the outer knee. Contributing factors include a sudden increase in training volume, hip abductor weakness, running on cambered surfaces, and anatomical variations such as a wider pelvis or bow-legged alignment. **Q: How long does ITB syndrome take to heal?** Mild to moderate ITB syndrome typically improves within four to eight weeks with relative rest, a gradual reduction in training load, and a structured physical therapy program targeting hip strength and running mechanics. Severe or chronic cases may take three to six months to fully resolve. Returning to running too quickly is the most common reason for setbacks, so your MOS provider will help you follow a progressive return-to-activity plan that keeps your training moving forward while protecting the healing tissue. **Q: Will I ever need surgery for ITB syndrome?** The vast majority of patients (well over 90 percent) recover fully with non-surgical treatment, making surgery quite rare for ITB syndrome. When conservative measures including physical therapy, activity modification, anti-inflammatory medications, and corticosteroid injections have not provided relief after six months or more, surgical release or lengthening of the ITB may be considered. At MOS we exhaust all non-operative options first and thoroughly discuss expectations and recovery before recommending any procedure. --- ## Instability After Total Knee Arthroplasty URL: https://www.mdorthospecialists.com/conditions/knee/instability-after-total-knee-arthroplasty/ Instability after TKA is categorized by the arc of motion in which it occurs: Flexion instability: The most common form, often underdiagnosed. The knee is stable in extension but collapses or bows backward when the patient tries to descend stairs or rise from a chair. ### Symptoms - Knee giving way while walking, descending stairs, or rising from a chair - Sensation of the knee "buckling" or "collapsing" - Recurrent actual dislocation (femoral component lifting off the tibial tray) - Anterior knee pain and clicking (patellofemoral instability) - Swelling and effusion with giving-way episodes - Progressive functional limitation and fear of falling ### Frequently Asked Questions **Q: Can instability go away with physical therapy?** For mild flexion instability, quadriceps strengthening sometimes compensates adequately. Severe instability with recurrent giving way, frank dislocation, or a structural cause requires surgical correction. **Q: Does more constrained mean less natural feeling?** More constrained implants (CCK, hinge) do sacrifice some rotational freedom and may change gait biomechanics compared with standard designs. However, stability is the priority when instability is causing falls and functional limitation. **Q: What are the most common signs that my knee replacement has become unstable?** Common symptoms of instability after total knee arthroplasty include a feeling that the knee is giving way, episodes of buckling during walking, difficulty navigating stairs, and pain that worsens with activity. Some patients notice swelling or an inability to fully straighten or bend the knee. Your MOS surgeon will assess your symptoms alongside X-rays and physical examination to determine whether instability is the underlying cause and which type is present: flexion, extension, or global instability. **Q: Will I need a full revision surgery if my knee replacement is unstable?** Not necessarily. The extent of surgery depends on the type and cause of instability. Some cases caused by soft-tissue imbalance or a loose polyethylene liner can be corrected with a liner exchange, a less invasive procedure than full revision. However, if the bone cuts, implant sizing, or implant position are the underlying problem, revision of one or both components is typically required. At MOS we use a systematic approach to identify the exact cause before recommending any surgical intervention. **Q: How long does recovery take after revision surgery for knee instability?** Recovery after revision surgery for knee instability is generally longer than recovery from the original knee replacement, typically taking three to six months to regain functional strength and stability. Physical therapy begins shortly after surgery and plays a critical role in retraining the muscles and improving balance. The complexity of the revision (whether it was a simple liner exchange or a more extensive component revision) significantly influences the timeline. Your MOS care team will set individualized recovery milestones and guide you through each phase of rehabilitation. --- ## Ischiofemoral Impingement URL: https://www.mdorthospecialists.com/conditions/hip/ischiofemoral-impingement/ The ischiofemoral space is the gap between the ischial tuberosity (the sit bone) and the lesser trochanter of the femur. The quadratus femoris muscle, a short external rotator of the hip, passes through this space. When the space is narrowed, the muscle is pinched during hip extension, adduction, and walking, causing reactive edema, fibrosis, and eventually muscle atrophy. ### Symptoms - Posterior hip and buttock pain — may radiate to the posterior thigh - Pain with walking, particularly during the extension phase of gait (when the hip extends behind the body) - Pain with activities requiring hip extension: walking fast, stairs, lunging - Discomfort when sitting for prolonged periods - Pain reproduced by passive hip extension and adduction ("long-stride test") - The pain may closely mimic hamstring tendinopathy or sciatic pain ### Frequently Asked Questions **Q: How is IFI different from piriformis syndrome?** Both cause buttock pain and can mimic sciatic nerve symptoms. Piriformis syndrome involves compression of the sciatic nerve by the piriformis muscle in the deep gluteal space. IFI involves compression of the quadratus femoris between the ischium and lesser trochanter. MRI findings distinguish them. Quadratus femoris edema points to IFI, while piriformis hypertrophy or asymmetry is seen in piriformis syndrome. **Q: Can IFI develop after hip replacement?** Yes. Changes in femoral offset and acetabular position after THA can alter the ischiofemoral geometry. IFI is an important cause of persistent posterior hip pain in THA patients without loosening. **Q: Is the injection a permanent fix?** For many patients with mild IFI, a single injection combined with PT provides durable relief. Those with severe narrowing, significant muscle atrophy, or post-THA anatomy may require surgical decompression. **Q: How is ischiofemoral impingement treated without surgery?** Non-surgical management is the first line of treatment for ischiofemoral impingement (IFI) and includes activity modification to avoid positions that narrow the ischiofemoral space (such as hip adduction and extension), physical therapy targeting hip abductor and external rotator strengthening, and gait retraining. An ultrasound-guided corticosteroid injection into the ischiofemoral space can provide meaningful pain relief and confirm the diagnosis simultaneously. Most patients with mild to moderate IFI respond well to this combination of treatments over eight to twelve weeks. **Q: What surgical options exist for ischiofemoral impingement?** When conservative treatment fails to resolve symptoms, surgical decompression of the ischiofemoral space may be performed. Options include endoscopic or open resection of a portion of the lesser trochanter (the bony prominence on the femur) to widen the space and relieve compression of the quadratus femoris muscle. In cases where IFI has developed after hip replacement, implant revision to address femoral offset or leg length may be required. At MOS we thoroughly evaluate all imaging and response to conservative care before recommending surgery, as outcomes are best in carefully selected patients. --- ## Joint Dislocations in the Hand URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/joint-dislocations-in-the-hand/ A dislocation occurs when the bones of a joint are forced out of their normal position. In the hand, the PIP joint (the middle joint of the finger) is the most commonly dislocated joint, accounting for the majority of finger dislocations seen in sports. ### Symptoms - Obvious deformity of the finger with pain and swelling following injury - Inability to fully bend or straighten the finger after reduction - Tenderness over the volar plate or collateral ligaments - Gross instability with lateral or extension stress after reduction ### Frequently Asked Questions **Q: Can I "self-reduce" a dislocated finger?** Reduction at the time of injury is reasonable if no medical care is immediately available. However, all dislocated fingers should be formally evaluated with X-rays afterward to confirm congruent reduction, rule out fractures, and assess ligament stability. **Q: Will my finger ever look normal again?** Mild residual swelling at the PIP joint is common and may be permanent, particularly after volar plate injuries. Functional recovery (motion and strength) is generally excellent with appropriate treatment. **Q: What if my finger still can't straighten weeks after a "jammed" finger?** Failure to regain full extension could indicate an undiagnosed central slip injury. This requires prompt evaluation to prevent progression to boutonnière deformity. **Q: What happens if a dislocated finger is not treated promptly?** Delayed treatment of a finger or hand dislocation can allow swelling and stiffness to set in, making reduction more difficult and sometimes requiring surgery that would not have been necessary with prompt care. More importantly, unrecognized associated fractures or ligament injuries can lead to chronic instability, joint deformity, or post-traumatic arthritis if left untreated. Even if the joint appears to have reduced spontaneously, it is important to have any significant 'jammed' finger evaluated with X-rays to rule out these hidden injuries. **Q: How long does rehabilitation take after a finger dislocation?** Simple dislocations without associated fractures or ligament rupture typically require only two to four weeks of buddy-taping, followed by a gradual return to full activity over four to six weeks. Complex dislocations involving fractures or ligament reconstruction may require six to twelve weeks of splinting or therapy and up to three to six months before full hand function is restored. Stiffness is a common challenge after any finger dislocation, and early guided motion under the supervision of a hand therapist significantly improves final range of motion. --- ## Kienböck's Disease URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/kienbocks-disease/ Kienböck's disease is a loss of blood supply to the lunate, a small carpal bone in the wrist, which can lead to bone collapse and arthritis if untreated. It causes wrist pain, swelling, stiffness, and weak grip. Treatment depends on the disease stage and ranges from splinting to bone-shortening surgery, bone grafting, or salvage procedures for advanced cases. ### Symptoms - Dull, aching pain on the back of the wrist that builds over time - Wrist swelling - Stiffness and reduced wrist motion - Decreased grip strength - Tenderness directly over the center of the wrist - Pain that worsens with use of the hand and improves with rest, at least early on ### Frequently Asked Questions **Q: Can Kienböck's disease be cured?** There is no way to restore a fully normal lunate once significant collapse has occurred, but the disease can be effectively treated at every stage. Earlier-stage disease treated with joint-leveling surgery or a vascularized bone graft can preserve much of the wrist's normal motion and prevent further collapse. Later-stage disease is treated with procedures that reliably relieve pain, such as proximal row carpectomy or wrist fusion, though these trade some motion for that pain relief. The goal at every stage is to stop progression and restore as much function as the stage allows. **Q: Why does the treatment depend so much on the stage of the disease?** Because the underlying problem changes as the disease progresses. Early on, the lunate's shape is intact but its blood supply is compromised, so treatment focuses on reducing load on the bone or restoring blood flow to it. Once the bone has collapsed and the surrounding carpal bones have shifted position, restoring the lunate is no longer realistic, and treatment shifts toward bypassing or removing the damaged bone. Matching the procedure to the stage is the single biggest factor in getting a good result. **Q: Is X-ray staging alone reliable for planning treatment?** Not entirely, and we think it is important for patients to know that. Studies looking at how consistently different examiners stage the same X-rays have found only moderate agreement between observers. That is why MRI, which can detect early changes in blood flow to the bone before X-ray changes appear, plays such an important role, and why staging in practice draws on more than X-rays alone. **Q: What causes Kienböck's disease?** In many patients, no single clear cause is identifiable, which is why the condition is often called idiopathic. A recognized contributing factor is negative ulnar variance, where the ulna is relatively shorter than the radius, concentrating more wrist load through the lunate. Variation in the lunate's own blood supply, with some people having only a single feeding vessel rather than two, is thought to make certain individuals more susceptible to a vascular disruption that triggers the disease. Repetitive loading and prior trauma may also contribute. **Q: Does Kienböck's disease affect children differently than adults?** Yes. A pediatric form of the disease, sometimes called Teenböck, affects patients under 15 and is generally managed more conservatively than the adult form, because children have real potential for spontaneous improvement as they continue to grow. Treatment recommendations also differ somewhat for patients in their late teens and early twenties compared with older adults, and tend to become more limited and salvage-focused in patients over 70. --- ## Knee Osteoarthritis URL: https://www.mdorthospecialists.com/conditions/knee/knee-osteoarthritis/ Knee osteoarthritis is the progressive wearing away of the articular cartilage that cushions the knee joint, causing pain, stiffness, and swelling that worsen with activity. It is the leading cause of disability in adults over 65 and affects all three compartments of the knee: medial, lateral, and patellofemoral. Treatment ranges from physical therapy and injections to surgery. ### Symptoms - Medial, lateral, or anterior knee pain worsened by activity, stair use, and prolonged sitting - Morning stiffness lasting < 30 minutes (distinguishing OA from inflammatory arthritis) - Crepitus — palpable or audible grinding with joint movement - Bony enlargement at joint margins from osteophytes - Varus or valgus deformity in advanced disease - Effusion (joint swelling) during flares - Gradual loss of full extension or flexion ### Frequently Asked Questions **Q: Can knee OA be reversed?** Articular cartilage has limited regenerative capacity, so structural changes of OA are not reversed by current treatments. However, symptoms can be substantially improved, and disease progression can be slowed with weight loss, exercise, and appropriate interventions. **Q: At what KL grade should I consider surgery?** There is no absolute radiographic threshold. Surgery is considered when symptoms are severe enough to significantly limit daily function despite at least 3–6 months of comprehensive non-operative management. KL Grade 4 disease with bone-on-bone contact and deformity that fails conservative care is the typical indication for TKR. **Q: Is PRP covered by insurance?** PRP is not currently covered by most insurance carriers for knee OA. Our team will discuss out-of-pocket costs and expected outcomes at your consultation. **Q: How long does a knee replacement last?** Modern implants demonstrate > 90% survivorship at 15–20 years in registry data, with continued improvement in outcomes as implant design and bearing surfaces advance. **Q: Are there exercises I should be doing to slow the progression of my knee arthritis?** Regular low-impact exercise is one of the most effective ways to manage knee osteoarthritis. It reduces pain, improves function, and can slow structural progression. Recommended activities include cycling, swimming, elliptical training, and targeted quadriceps and hip strengthening, which reduce the load transmitted through the knee joint. High-impact activities such as running on hard surfaces may be tolerated in mild arthritis but should be guided by your symptoms. At MOS, your care team can connect you with physical therapy to design an individualized exercise program that balances joint protection with maintaining your activity level. --- ## Lateral Epicondylitis (Tennis Elbow) URL: https://www.mdorthospecialists.com/conditions/elbow/lateral-epicondylitis-tennis-elbow/ Lateral epicondylitis is a degenerative tendinopathy of the extensor carpi radialis brevis (ECRB) origin at the lateral epicondyle of the humerus. Histologically, the tissue demonstrates angiofibroblastic tendinosis: disordered collagen, vascular hyperplasia, fibroblast proliferation, and a conspicuous absence of inflammatory cells. ### Symptoms - Lateral elbow pain at or just distal to the lateral epicondyle - Pain radiating down the dorsal forearm - Worsened by gripping, carrying, or wrist extension (e.g., shaking hands, lifting a coffee cup) - Point tenderness over the ECRB origin, approximately 1 cm distal and anterior to the lateral epicondyle - Grip strength weakness - Morning stiffness ### Frequently Asked Questions **Q: Why doesn't my tennis elbow respond to anti-inflammatories?** Because the pathology is degenerative tendinosis, not active inflammation. NSAIDs provide modest pain relief but do not address the underlying disorganized collagen. Treatments that promote tendon remodeling (PT, loading programs, PRP, ESWT) are more effective for long-term resolution. **Q: Should I get a cortisone shot?** Cortisone is very effective for short-term relief (4–8 weeks) and has a role in getting you out of acute pain so you can participate in PT. However, it should not be used as a standalone treatment. Pairing it with PT is essential, and multiple injections may weaken the tendon. **Q: What makes PRP different from cortisone?** PRP delivers a concentrated dose of your own growth factors directly into the injured tendon, stimulating biologic healing rather than suppressing the tissue response. Multiple RCTs show better 12-month outcomes with PRP versus cortisone. **Q: How do I know if I need surgery?** Surgery is typically considered after 12 months of dedicated conservative care with ongoing, functionally limiting symptoms. If you are not improving with PT and injection, scheduling a consultation is the right next step. **Q: Can I keep working during treatment?** Most patients can continue working with activity modifications, ergonomic changes, and a counterforce brace. Your treatment team will advise on any restrictions. --- ## Ligamentum Teres Tear URL: https://www.mdorthospecialists.com/conditions/hip/ligamentum-teres-tear/ The ligamentum teres (also called the round ligament of the head of the femur) is a triangular fibrovascular band originating from the acetabular fossa and inserting on the fovea capitis (a small pit on the femoral head). It carries a branch of the obturator artery, which contributes to femoral head blood supply in children (less so in adults). ### Symptoms - Groin and anterior hip pain with activity - Sensation of instability, giving way, or "looseness" in the hip - Mechanical symptoms: clicking, catching, or locking (from torn ligament tissue acting as a loose body within the joint) - Pain with internal rotation and traction of the hip - History of hip dislocation or significant twisting injury in many patients - Symptoms may overlap extensively with labral tear or FAI ### Frequently Asked Questions **Q: How common are ligamentum teres tears?** Studies report ligamentum teres pathology in 4–15% of hip arthroscopy cases, making it an uncommon but clinically significant finding. It is easily missed without high-index-of-suspicion imaging and thorough arthroscopic assessment. **Q: Can a ligamentum teres tear cause instability like an ACL tear?** The hip is the body's most stable joint by virtue of its bony architecture, labrum, and capsular ligaments. Ligamentum teres tears do not produce gross instability like an ACL tear, but they can contribute to subtle microinstability (particularly in patients with hypermobility or prior hip dislocation), causing pain and a "loose" feeling. **Q: Is reconstruction always needed for a complete tear?** Not necessarily. Many patients with complete tears are managed successfully with labral repair, FAI correction, and PT. Reconstruction is reserved for patients with clear instability symptoms, specific anatomic indications, and failure of non-operative care. **Q: How is a ligamentum teres tear diagnosed?** A ligamentum teres tear is most reliably identified on MRI arthrography of the hip, where contrast injected into the joint highlights the torn tissue. Standard MRI may miss partial tears, so your MOS surgeon may recommend an MR arthrogram if clinical suspicion is high. During examination, a positive FADIR test or pain with axial traction can suggest the diagnosis. Ultimately, hip arthroscopy is considered the gold standard because the ligament can be directly visualized and treated in the same procedure. **Q: What does recovery look like after ligamentum teres debridement or reconstruction?** After arthroscopic debridement of a partial tear, most patients are weight-bearing as tolerated within a few days and begin physical therapy within the first week. Return to non-impact activities typically occurs at 6–8 weeks, while return to sport may take 3–4 months. If reconstruction was performed for a complete, unstable tear, recovery is longer. Full activity may take approximately 4–6 months. Your MOS surgeon will provide a structured rehabilitation protocol tailored to the extent of your injury and your activity goals. --- ## Little League Elbow URL: https://www.mdorthospecialists.com/conditions/elbow/little-league-elbow/ During the overhead throw, the elbow undergoes rapid valgus stress at the medial side. In adult athletes, this stress is borne by the ulnar collateral ligament (UCL). In youth throwers, the medial epicondyle apophysis (an open growth plate) is the weakest link in the medial column. ### Symptoms - Medial elbow pain during or after throwing - Tenderness directly over the medial epicondyle - Swelling at the medial elbow - Decreased throwing velocity or accuracy - Occasional locking (suggests loose fragment) - In severe cases: inability to fully extend the elbow ### Frequently Asked Questions **Q: How is Little League elbow different from Tommy John injury?** Little League elbow is an injury to the growth plate (apophysis) in a still-developing skeleton. Tommy John (UCL tear) occurs in athletes with mature bones where the growth plate has closed. Most youth pitchers with medial elbow pain have apophysitis, not a UCL tear. **Q: Can my child ever pitch again after Little League elbow?** Yes. With appropriate rest and a proper return-to-throw program, the vast majority of athletes return to full pitching without lasting problems. **Q: How important are pitch counts?** Very. Population studies show a direct dose-response relationship between pitch counts and elbow injury risk in youth throwers. Adhering to evidence-based guidelines is the most effective injury prevention strategy available. **Q: How long does my child need to rest before returning to pitching?** The required rest period depends on the severity of the injury to the medial apophysis (the growth plate on the inner elbow). Mild cases with no displacement typically require 4–6 weeks of complete rest from throwing, followed by a gradual interval throwing program. More significant stress reactions or small avulsion fractures may require 2–3 months before a controlled return-to-throw program begins. At MOS, we use serial imaging to confirm healing before your child advances through each stage of the return-to-sport protocol. **Q: Will my child need surgery for Little League elbow?** Most cases of Little League elbow heal with rest and activity modification alone, without any surgery. Surgery is reserved for situations where the medial apophysis has been significantly displaced (typically more than 5 mm) or where a loose bone fragment is causing persistent symptoms. In those cases, your MOS surgeon may recommend arthroscopic removal of the fragment or internal fixation of the displaced growth plate. The vast majority of young athletes recover fully with conservative management when caught early. --- ## Little Leaguer's Shoulder URL: https://www.mdorthospecialists.com/conditions/shoulder/little-leaguers-shoulder/ Little Leaguer's Shoulder is a overuse injury generally resulting from baseball. It is a Salter-Harris Type I stress fracture of the proximal humeral physis (growth plate). In adolescent athletes whose growth plates are still open, the cartilaginous physis is the weakest link in the bone-tendon-muscle unit. ### Symptoms - Shoulder pain in an adolescent overhead athlete, typically a pitcher, catcher, or tennis player - Pain specifically during or immediately after throwing, particularly with maximal effort - Decreased throwing velocity - Lateral shoulder tenderness over the proximal humerus - Pain may radiate to the arm but is primarily proximal - No history of acute injury ### Frequently Asked Questions **Q: Can my child keep playing in the outfield or batting while resting from pitching?** Batting and outfield play still involve shoulder stress. We typically recommend complete upper extremity rest from all throwing activities during the initial rest period. Playing other positions is assessed on a case-by-case basis. **Q: Will this affect my child's growth?** Properly rested physeal stress injuries heal without growth disturbance in the vast majority of cases. The risk of growth plate complications is associated with continued throwing through symptoms. This is why early recognition and rest are so important. **Q: How do I prevent this from happening again?** Strict adherence to pitch counts, mandatory seasonal rest from throwing, proper mechanics (particularly hip rotation and leg drive to reduce arm stress), and avoiding year-round single-sport specialization are the most evidence-supported preventive measures. **Q: Should my coach be monitoring pitch counts?** Absolutely. Pitch count limits and mandatory rest days are the single most effective tool for preventing Little Leaguer's Shoulder and other overhead throwing injuries in youth athletes. USA Baseball, Little League International, and the American Sports Medicine Institute (ASMI) all publish age-specific pitch count guidelines with required rest periods based on pitches thrown. For example, pitchers aged 11–12 should throw no more than 85 pitches per game, with 4 days of rest after throwing 66 or more pitches. Coaches, parents, and athletes should all know these limits, and they should be enforced even when a child feels fine, since the physeal stress that causes this injury accumulates before pain begins. If your league or travel program is not tracking pitch counts, that is worth addressing directly with the coaching staff. **Q: Should my child see a specialist or is a pediatrician enough?** We recommend evaluation by an orthopedic surgeon with experience in youth overhead athletes. While a pediatrician is an important first step, confirming the diagnosis of Little Leaguer's Shoulder requires specific X-ray views of the proximal humeral physis (and in some cases an MRI) to assess the degree of physeal widening and rule out other causes of shoulder pain such as labral pathology or stress fracture. An orthopedic specialist will also guide the return-to-throw program and help determine when your child has cleared the milestones needed to safely resume pitching. Early specialist involvement reduces the risk of incomplete healing and recurrence. --- ## Low Back Pain / Lumbar Strain URL: https://www.mdorthospecialists.com/conditions/spine/low-back-pain-lumbar-strain/ Low back pain encompasses a broad spectrum of conditions affecting the lumbosacral region (L1–S1). In clinical practice, the most common presentation is acute lumbar strain — pain arising from overloaded or injured paraspinal muscles, thoracolumbar fascia, or posterior spinal ligaments. ### Symptoms - Acute onset of low back pain, often following a specific lifting, twisting, or bending incident — or in some cases, awakening after a restless night or without a clear precipitant - Deep, aching, or spasming pain in the lower back and paraspinal muscles - Stiffness with difficulty standing upright or changing positions - Pain that may radiate into the buttocks and upper thighs (referred, non-dermatomal — not true sciatica) - Protective muscle guarding with reduced lumbar range of motion - True radiating leg pain below the knee following a dermatomal distribution (suggests nerve root involvement) - Neurological deficits (weakness, numbness, reflex changes) - Bilateral leg symptoms or bowel/bladder changes - Bowel or bladder dysfunction (possible cauda equina syndrome — surgical emergency) - Progressive lower extremity weakness or numbness - Fever, chills, or unexplained night sweats with back pain (infection, malignancy) - History of cancer with new back pain - Recent significant trauma (vertebral fracture concern, particularly in osteoporotic patients) - Unintentional weight loss - Back pain in age <18 or >50 years with no prior history ### Frequently Asked Questions **Q: Should I get an MRI for my back pain?** For most people with new-onset acute low back pain, an MRI within the first 4–6 weeks is not needed and may not help. Guidelines recommend imaging only when red flags are present or symptoms fail to improve. Your MOS physician will advise if imaging is appropriate. **Q: Why does low back pain come back?** Recurrence is common because the factors that make the spine vulnerable (disc degeneration, muscle weakness, body weight, posture habits) persist. Active rehabilitation and core conditioning are the best preventive strategies. **Q: Is pain with movement a sign of serious injury?** In most cases, no. Pain with lumbar range of motion is typical of muscle strain and facet irritation, not structural injury. Neurological symptoms (numbness, weakness, bowel/bladder changes) are more concerning and warrant prompt evaluation. **Q: Are muscle relaxants safe?** Short-term use under physician supervision is generally safe. They cause drowsiness, so driving should be avoided. Long-term use is not recommended. **Q: When should I see a doctor instead of waiting?** See us promptly if you have: any leg weakness or numbness, bowel or bladder changes, fever, unexplained weight loss, history of cancer, or if your pain is not improving after 2–3 weeks of home management. --- ## Lumbar Disc Herniation & Sciatica URL: https://www.mdorthospecialists.com/conditions/spine/lumbar-disc-herniation/ ### Anatomy The lumbar spine consists of five vertebrae (L1–L5) separated by intervertebral discs: flexible cushions that absorb compressive load and allow spinal movement. Each disc has two main components: - Nucleus pulposus: The soft, gel-like inner core, composed largely of water and proteoglycans, that provides the primary shock-absorbing function. ### Symptoms - Low back pain — dull aching or sharp, often localized to one side of the lower lumbar region; may be the initial presenting complaint. - Radiating leg pain (sciatica) — shooting, burning, or electric-shock pain that travels from the buttock down the posterior or lateral thigh, calf, and foot along a specific dermatomal distribution corresponding to the compressed nerve root. - Numbness and tingling (paresthesia) — abnormal sensations in the affected dermatome, often described as pins-and-needles or a feeling of the leg "falling asleep." - Muscle weakness — difficulty with specific movements depending on the nerve root involved: foot/ankle dorsiflexion or great toe extension (L5), ankle plantarflexion (S1), or knee extension (L4). - Pain aggravated by sitting, forward bending (flexion), and Valsalva maneuvers — such as coughing or sneezing, which transiently increase intradiscal pressure and worsen nerve root compression. - Partial relief with walking or standing in extension — positions that reduce posterior disc pressure and decompress the nerve root. - Loss or diminution of deep tendon reflexes — reduced or absent patellar reflex (L4), medial hamstring reflex (L5), or Achilles reflex (S1) on the affected side. - New bladder dysfunction: urinary retention, incontinence, or difficulty initiating urination - New bowel incontinence or loss of rectal tone - Saddle anesthesia: numbness in the perineum, inner thighs, and genital region - Rapidly progressive bilateral leg weakness ### Frequently Asked Questions **Q: Q: Do I need surgery for a lumbar disc herniation?** A: The vast majority of patients do not need surgery. Published evidence consistently shows that 80–90% of patients with lumbar disc herniation and sciatica improve significantly with non-operative care (activity modification, physical therapy, anti-inflammatory medications, and epidural steroid injections) within 6–12 weeks. Surgery is generally reserved for those with persistent severe symptoms after 6–12 weeks of appropriate conservative treatment, progressive neurological deficits, or the rare emergency of cauda equina syndrome. **Q: Q: How long will it take for my symptoms to get better?** A: Most patients begin to notice meaningful improvement within 2–6 weeks of starting treatment, and the majority are substantially better by 6–12 weeks. Larger herniations (extrusions and sequestrations) often resorb on their own over this period, removing the source of nerve irritation. Factors that influence recovery speed include the type and size of the herniation, your activity level, adherence to physical therapy, and overall health. **Q: Q: What is sciatica?** A: "Sciatica" is a term for radiating pain caused by irritation or compression of a lumbar nerve root (most commonly L5 or S1) as it exits the spine. The sciatic nerve, formed from these lumbar and sacral nerve roots, is the longest and widest nerve in the body. When a herniated disc or other structure compresses this nerve root, it produces characteristic shooting pain, numbness, or weakness that travels down the buttock, thigh, leg, and foot along a specific pathway (dermatome). Sciatica is a symptom, not a diagnosis in itself. The underlying cause (in most cases a disc herniation) determines treatment. **Q: Q: What is an epidural steroid injection, and will it hurt?** A: An epidural steroid injection (ESI) is a procedure in which a small amount of corticosteroid (anti-inflammatory medication) is delivered directly into the epidural space of the spine, adjacent to the inflamed nerve root. All injections at MOS are performed under fluoroscopic (live X-ray) guidance to ensure precise placement. The procedure takes approximately 15–20 minutes; local anesthetic is used to minimize discomfort. Most patients experience mild pressure or brief stinging during needle placement. Some experience temporary numbness in the leg immediately after the injection due to the local anesthetic component. **Q: Q: Can the disc herniation come back after treatment?** A: Yes, recurrence is possible but not the norm. In patients who recover with non-operative care, lifestyle modification, maintaining a healthy weight, and continued core strengthening significantly reduce the risk of recurrence. After microdiscectomy, the risk of reherniation at the same level is approximately 5–15% over 10 years. Our team provides structured post-treatment rehabilitation and ergonomic guidance to minimize this risk. **Q: Q: What are the red flag symptoms that require urgent care?** A: Most disc herniations cause pain and neurological symptoms that, while distressing, can be safely managed on an outpatient basis. However, the following symptoms require immediate emergency evaluation. Call 911 or go to the nearest emergency department without delay: - New-onset inability to urinate or control the bladder/bowel - Numbness in the perineum (saddle area), inner thighs, or genitals - Rapidly worsening weakness in both legs - Loss of rectal tone These signs may indicate cauda equina syndrome, a spinal emergency caused by compression of multiple nerve roots at once, which requires urgent surgical decompression to prevent permanent neurological injury. --- ## Lumbar Spinal Stenosis URL: https://www.mdorthospecialists.com/conditions/spine/lumbar-spinal-stenosis/ The lumbar spinal canal is bounded anteriorly by the vertebral bodies and discs, posteriorly by the facet joints and ligamentum flavum, and laterally by the pedicles. Degenerative changes over time (disc height loss, facet joint hypertrophy, ligamentum flavum thickening, and osteophyte formation) progressively reduce the space available for the cauda equina and exiting nerve roots. ### Symptoms - Low back pain or buttock aching - Leg weakness with sustained activity - Numbness or tingling affecting one or both legs - Symptoms that are better riding a bicycle than walking (because cycling maintains a flexed lumbar posture) - Relief: Neurogenic — Sitting or flexion; Vascular — Standing still - Onset: Neurogenic — Walking + standing; Vascular — Walking only - Bicycle riding: Neurogenic — Well-tolerated; Vascular — Produces symptoms - Pulses: Neurogenic — Normal; Vascular — Reduced - Skin changes: Neurogenic — None; Vascular — Hair loss, pallor ### Frequently Asked Questions **Q: Does lumbar stenosis always get worse?** Not necessarily. Studies show that roughly 70% of patients with mild-to-moderate stenosis remain stable or improve over 4 years without surgery. Symptoms fluctuate, and non-operative management can meaningfully delay or prevent the need for surgical intervention. **Q: How many epidural injections can I have?** Generally, up to three epidural steroid injections are recommended per 12-month period, with retreatment based on the degree of response. Your MOS physician will guide the optimal injection schedule. **Q: Is walking harmful with stenosis?** Walking is generally encouraged within your symptom tolerance. Short, frequent walks with adequate rest breaks are preferable to prolonged forced marching. Activity modification, not rest, is key. **Q: Can stenosis cause permanent nerve damage?** Cauda equina syndrome (bowel/bladder dysfunction from severe central compression) is a surgical emergency requiring immediate evaluation. Outside of this rare scenario, most patients do not sustain permanent nerve damage from managed lumbar stenosis. **Q: Will a back brace help?** A lumbar flexion orthosis can reduce symptoms during high-demand activities. Its role is primarily as a symptomatic aid, not a structural correction. --- ## MCL / LCL Sprain & Tear URL: https://www.mdorthospecialists.com/conditions/knee/mcl-lcl-sprain-and-tear/ Medial Collateral Ligament (MCL) The MCL is a broad, two-layer ligament complex on the medial aspect of the knee. The superficial MCL, the primary medial stabilizer, runs from the medial femoral epicondyle to the proximal medial tibia approximately 6 cm distal to the joint line. ### Symptoms - Medial knee pain and tenderness along the MCL course (joint line to tibial insertion) - Swelling over the medial knee — typically less dramatic than ACL hemarthrosis - Sensation of valgus instability or buckling with pivoting - Pain with valgus loading (e.g., going up stairs sideways, sitting cross-legged) - Lateral and posterolateral knee pain - Instability with varus loading; "dial" of the foot outward when standing - Foot drop if peroneal nerve is injured (a recognized complication of severe LCL/PLC trauma — the peroneal nerve wraps around the fibular head) - Often associated with peroneal nerve neuropraxia producing lateral leg numbness or weakness ### Frequently Asked Questions **Q: Will my MCL heal without surgery?** Yes, isolated MCL tears, including complete Grade III tears, have a high healing rate with appropriate non-operative management. The MCL's extrasynovial, vascular location is key to its reliable healing, unlike the intrasynovial ACL. **Q: What is the posterolateral corner and why is it important?** The PLC is a complex of three structures (the LCL, popliteus tendon, and popliteofibular ligament) that work together to resist varus and external rotation forces. Failure to recognize and treat PLC injury leads to a very high failure rate of concurrent cruciate ligament reconstructions. **Q: What is a Pellegrini-Stieda lesion?** It is calcification at the medial femoral epicondyle (MCL origin) seen on X-ray, indicating a previous MCL injury with heterotopic ossification during healing. It is usually an incidental finding and rarely causes symptoms requiring treatment. **Q: Can I return to contact sports after an MCL tear?** For Grade I–II MCL injuries, yes, typically 1–6 weeks. For Grade III injuries treated non-operatively, most athletes return to contact sport within 10–12 weeks with appropriate brace support and when functional testing criteria are met. **Q: How long does it take for an MCL or LCL tear to heal, and what does rehabilitation involve?** Grade I and II MCL sprains typically heal within three to six weeks with protected weight-bearing, bracing, and physical therapy focused on restoring range of motion and strength. Grade III (complete) MCL tears often heal non-operatively in six to twelve weeks, though recovery may be longer if the injury involves the posteromedial structures. LCL and posterolateral corner injuries are less likely to heal reliably without surgery and often require reconstruction to restore rotational stability. Your MOS surgeon will assess ligament integrity with stress X-rays and MRI to determine the right treatment and guide your return-to-sport timeline. --- ## Mallet Finger URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/mallet-finger/ The DIP (distal interphalangeal) joint, the last joint at the fingertip, is held in extension by the terminal extensor tendon. When this extensor mechanism is disrupted, the fingertip droops into flexion and cannot be actively extended, producing the classic mallet posture. ### Symptoms - Drooping of the fingertip (DIP joint flexion deformity) that appears immediately or shortly after injury - Inability to actively straighten the fingertip - Pain and swelling at the DIP joint - May be surprisingly painless — some patients don't seek care immediately - Over weeks without treatment, a swan-neck deformity can develop (PIP hyperextension combined with DIP flexion) due to extensor mechanism imbalance ### Frequently Asked Questions **Q: What happens if I don't treat a mallet finger?** Without treatment, the extensor tendon heals with elongation, leaving a persistent DIP extension lag. Over time, a swan-neck deformity can develop. Chronic bony mallets with volar subluxation can lead to DIP joint arthritis. **Q: Can mallet finger heal on its own without a splint?** Spontaneous healing sufficient for functional use can occur, but an extension lag typically remains. Splinting optimizes the likelihood of full recovery and should always be attempted. **Q: Is the splint waterproof?** Standard Stack splints tolerate brief water exposure but should be dried promptly. We can provide waterproof options and demonstrate how to safely replace the splint during bathing. **Q: How long do I have to wear the splint for mallet finger?** The standard treatment for a tendinous mallet finger is continuous splinting of the fingertip in full extension for 6–8 weeks, with the key rule being that the tip must never be allowed to bend during this period, even briefly. After the initial phase, your MOS surgeon may recommend a gradual weaning protocol over an additional 4–6 weeks, often starting with nighttime splinting. If the splint comes off and the finger droops, the 6–8 week clock typically restarts. Compliance with continuous splinting is the single most important factor in achieving a good outcome without surgery. **Q: Will I need surgery for a mallet finger, and what does it involve?** The majority of mallet fingers (including tendon injuries and small avulsion fractures) heal successfully with splinting alone and do not require surgery. Surgery is considered when a large bone fragment (involving more than one-third of the joint surface) has displaced and shifted the fingertip joint out of alignment (subluxation), or when splinting has failed after an adequate trial. Surgical options include pinning the joint in extension or fixing the bony fragment back in place. Your MOS hand surgeon will review your X-rays and clinical picture to determine whether operative or non-operative treatment gives you the best long-term result. --- ## Medial Epicondylitis (Golfer's Elbow) URL: https://www.mdorthospecialists.com/conditions/elbow/medial-epicondylitis-golfers-elbow/ Medial epicondylitis results from repetitive tensile overload at the common flexor-pronator origin, primarily the pronator teres and flexor carpi radialis tendons. Histologically, the tissue shows angiofibroblastic tendinosis — not true inflammation — with collagen disorganization, neovascularization, and absence of inflammatory cells. ### Symptoms - Medial elbow pain at or just distal to the medial epicondyle - Pain worsening with wrist flexion, forearm pronation, or gripping - Morning stiffness of the medial elbow - Tenderness directly over the flexor-pronator origin (5–10 mm distal to the medial epicondyle) - Possible associated ulnar nerve symptoms (ring/small finger tingling) if cubital tunnel syndrome co-exists — present in up to 60% of cases - Weakness of grip in severe or chronic cases ### Frequently Asked Questions **Q: Is golfer's elbow the same as tendinitis?** Not exactly. The underlying pathology is tendinosis (collagen degeneration), not active inflammation. This is why treatments targeting inflammation alone (e.g., NSAIDs, steroids) provide only partial and temporary relief. **Q: How is golfer's elbow different from tennis elbow?** Tennis elbow (lateral epicondylitis) affects the extensor tendons on the outer side of the elbow. Golfer's elbow affects the flexor-pronator tendons on the inner side. Both involve tendinosis from repetitive overload, but at different insertion sites. **Q: Will PRP cure my golfer's elbow?** PRP accelerates healing in the degenerative tendon and shows better long-term outcomes than cortisone injection in multiple trials. It is not a single-session cure, but is an effective and durable treatment for many patients when combined with rehabilitation. **Q: When should I consider surgery?** Surgery is appropriate after 6–12 months of dedicated conservative therapy (including supervised PT and at least one injection) with persistent, functionally limiting pain. **Q: Can golfer's elbow recur after surgery?** Recurrence is uncommon (< 10%) after complete surgical debridement, particularly when the post-operative rehabilitation program is completed. --- ## Meniscal Root Tear URL: https://www.mdorthospecialists.com/conditions/knee/meniscal-root-tear/ Each meniscus has anterior and posterior "root" attachments to the tibial plateau that anchor the c-shaped meniscal body. The roots are critical to meniscal function: under axial load, the meniscus generates outward hoop stress (tension) within its circumferential collagen fibers that resists extrusion. ### Symptoms - Acute onset medial knee pain, often after a seemingly minor twisting or squatting maneuver - Rapid swelling within hours (distinguishing from gradual OA effusion) - Medial joint-line tenderness at or near the posterior horn — deeper than typical meniscal pathology tenderness - Difficulty fully weight-bearing in the acute phase - Rapid progression of medial compartment pain over weeks to months if untreated, as cartilage deteriorates - Audible or palpable "pop" at the time of injury reported by some patients ### Frequently Asked Questions **Q: Why is a root tear equivalent to removing the whole meniscus?** The meniscus works like a wedge-shaped cushion held under compression by its root attachments. When the roots are intact, axial load creates hoop (circumferential) tension that prevents the meniscus from being squeezed out of the joint. A root tear severs this tension mechanism. The meniscus simply extrudes outward under load and no longer transmits force across the cartilage. The cartilage then absorbs the full impact with every step. **Q: Can the root be repaired if there is already some arthritis?** Yes, in mild-to-moderate OA (KL Grade 2–3). Root repair in these patients has been shown to slow OA progression compared to partial meniscectomy. The repair is less likely to benefit patients with severe, bone-on-bone arthritis (KL Grade 4), where total knee replacement is more appropriate. **Q: What is the "ghost meniscus" sign on MRI?** It describes the appearance of the posterior horn of the medial meniscus on standard coronal MRI sequences. The meniscal tissue appears absent or attenuated where a normal meniscus should be visible, because the root-torn meniscus has extruded laterally out of the joint space. **Q: Will I need a knee replacement after a root repair?** Root repair significantly slows OA progression compared to no repair or partial meniscectomy, but it does not completely halt the disease process in the setting of concurrent OA. Long-term studies suggest significantly lower total knee replacement rates in root-repaired patients compared to those treated with meniscectomy. **Q: How long is recovery after a meniscal root repair, and when can I return to sport?** Recovery after meniscal root repair requires strict non-weight-bearing for the first six weeks to protect the healing root attachment, followed by gradual progressive loading guided by physical therapy. Most patients return to sport or demanding physical activity at six to nine months, once the repaired root has matured and knee strength is symmetrical. Your MOS surgeon will monitor healing with MRI at key intervals to confirm the repair is intact before advancing your activity. While the recovery is longer than many knee surgeries, root repair significantly reduces contact pressures in the joint and lowers the risk of rapid cartilage loss. --- ## Meniscus Tear URL: https://www.mdorthospecialists.com/conditions/knee/meniscus-tear/ Each knee contains two C-shaped wedges of fibrocartilage called the menisci: the medial meniscus on the inner side of the joint and the lateral meniscus on the outer side. Tears of the meniscus are one of the most common orthopedic problems. ### Symptoms - Pain along the joint line — typically on the inner (medial) or outer (lateral) side of the knee, often worsening with deep bending, squatting, or twisting - Swelling — joint effusion that develops over 24–48 hours after an acute tear, or recurrent swelling with activity in chronic tears - Mechanical clicking or catching — a palpable or audible sensation during knee movement; common with displaced or unstable tear fragments - Locking or inability to fully straighten the knee — a hallmark of displaced bucket-handle tears in which the torn fragment lodges in the intercondylar notch - A sense that the knee wants to give way — particularly with pivoting or descending stairs - Stiffness — limited range of motion, especially in flexion, that persists beyond the acute phase - Pain with kneeling or deep squatting — due to increased posterior horn compression in loaded flexion positions ### Frequently Asked Questions **Q: Do I need surgery for a meniscus tear?** Not necessarily. Many meniscal tears (particularly stable, partial, or degenerative tears in lower-demand patients) respond well to structured physical therapy and activity modification. Surgery is indicated when you have significant mechanical symptoms (locking, persistent catching), when the knee fails to improve with adequate non-operative treatment, or when the tear pattern is one that will not heal on its own and is causing ongoing joint damage. We will review your MRI findings, your symptoms, and your activity goals together and make a recommendation tailored to you. **Q: Can a meniscus tear heal on its own?** Tears in the well-vascularized outer (peripheral) zone of the meniscus have some intrinsic healing capacity with appropriate activity restriction. However, most symptomatic tears (especially those in the avascular inner zone) will not heal without intervention. Non-operative treatment can reduce symptoms and improve function even in tears that do not fully heal, but a structural tear in the avascular zone will not close on its own. **Q: What is the difference between a meniscus repair and a partial meniscectomy?** A repair stitches the torn edges of the meniscus back together, preserving the tissue and restoring its load-distributing function. It requires a longer recovery (4–6 months to sport) and is only feasible when the tear is in a location with adequate blood supply and the right geometry. A partial meniscectomy removes the torn fragment. Recovery is faster (4–6 weeks), but the lost tissue does not grow back. Because meniscal tissue is protective against cartilage wear and osteoarthritis, we preserve and repair whenever it is surgically possible to do so. **Q: What happens if a meniscus tear goes untreated?** The consequences depend heavily on the tear pattern. A small, stable degenerative tear in an older, lower-demand patient may be managed long-term without surgery. However, an unstable tear, a bucket-handle tear, or a root tear that goes untreated exposes the articular cartilage to abnormal stress and can accelerate the development of knee osteoarthritis. Longitudinal data confirm that significant meniscal loss (whether from untreated tears or from meniscectomy) is one of the strongest risk factors for tibiofemoral osteoarthritis over a 15–20 year follow-up period. **Q: Can I walk on a torn meniscus?** Many patients with meniscal tears can walk without significant difficulty, particularly in the days to weeks after the initial injury as acute swelling subsides. However, the ability to walk does not indicate that a tear is minor or safe to ignore. Continuing to load an unstable tear through impact activities can extend the tear, displace it, or cause further cartilage damage. If you suspect a meniscal injury, have it evaluated before returning to full activity. **Q: My knee locked and I can't fully straighten it. What should I do?** A locked knee that cannot be fully extended is a potential orthopaedic urgency. This presentation is the classic sign of a displaced bucket-handle tear in which a large fragment of meniscus is mechanically blocking the joint. Contact us immediately at (301) 515-0900 or go to the nearest emergency facility for evaluation. Prompt treatment protects the articular cartilage from further damage caused by the impinging fragment. --- ## Metatarsalgia URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/metatarsalgia/ Metatarsalgia is pain and inflammation in the ball of the foot, where the long metatarsal bones bear weight during push-off. It often results from abnormal pressure due to foot shape, footwear, or high activity. Symptoms include aching or burning pain that worsens with walking, running, or standing. ### Symptoms - Aching or burning pain under the ball of the foot, typically involving the 2nd–4th metatarsal heads - Feels like "walking on a pebble" or walking on unpadded floor - Worsened by high heels, prolonged standing, or walking barefoot on hard surfaces - Callus formation directly under the affected metatarsal head(s) - No radiation to toes (distinguishes from Morton's neuroma); no Mulder's click ### Frequently Asked Questions **Q: How do I know if it's metatarsalgia or Morton's neuroma?** Key differences: metatarsalgia causes pain directly under the metatarsal heads; Morton's neuroma causes burning/numbness radiating into adjacent toes, and Mulder's click is positive. Clinically the distinction is usually clear; ultrasound confirms a neuroma if there is doubt. **Q: Will orthotics fix my metatarsalgia?** Custom orthotics with metatarsal pads are effective for ongoing management and reducing recurrence but rarely "cure" the underlying anatomic cause. They are an excellent long-term solution for most patients. **Q: What is Freiberg's infraction?** Freiberg's infraction is avascular necrosis (bone death from poor blood supply) of a metatarsal head, usually the 2nd. It most often affects adolescent girls and causes localized metatarsal head pain and joint stiffness. X-ray shows characteristic flattening and sclerosis. **Q: How long does it take for metatarsalgia to get better?** With appropriate footwear modifications, metatarsal pads, and activity adjustments, most patients notice significant improvement within 4–8 weeks. Athletes or individuals who remain on their feet for prolonged periods may take 3–4 months to experience full relief. If an underlying cause such as a tight calf muscle or a hammertoe is contributing, addressing that problem is essential to lasting recovery. At MOS, your treatment plan targets both the symptoms and the biomechanical factors driving them, which leads to more durable outcomes. **Q: Do I need surgery for metatarsalgia?** Surgery is rarely necessary for metatarsalgia and is only considered when conservative measures (including proper footwear, metatarsal offloading pads, custom orthotics, and physical therapy) have failed after several months. When surgery is needed, it typically addresses an underlying structural problem such as an excessively long second metatarsal (Weil osteotomy) or a fixed hammertoe deformity. Your MOS surgeon will evaluate your foot mechanics and imaging to identify any correctable deformity and discuss whether an operative approach is likely to provide lasting benefit. --- ## Morton's Neuroma URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/mortons-neuroma/ The interdigital nerves travel between the metatarsal heads to provide sensation to adjacent toes. The third web space (between the 3rd and 4th toes) is most commonly affected, accounting for approximately 70% of cases, likely because the medial and lateral plantar nerve branches both contribute to this web space, making the nerve slightly larger and more prone to compression. ### Symptoms - Burning, electric, or shooting pain in the forefoot, typically radiating to the 3rd and 4th toes (or 2nd and 3rd toes with second space involvement) - Numbness and tingling in adjacent toes; patients often describe the sensation of "walking on a pebble" or "bunched-up sock" - Symptoms provoked by narrow shoes, high heels, or prolonged weight-bearing; relieved by removing shoes and rubbing the forefoot - Mulder's click: With the foot squeezed laterally while applying direct dorsal-plantar pressure in the web space, a palpable and sometimes audible "click" is elicited as the enlarged nerve subluxes. This is the most specific clinical sign for Morton's neuroma and distinguishes it from metatarsalgia and other forefoot pain generators. ### Frequently Asked Questions **Q: What is Mulder's click?** Mulder's click is a clinical test in which the examiner squeezes the forefoot laterally while pressing the specific web space. The enlarged neuroma subluxes, producing a palpable and sometimes audible click. It is the most specific physical finding for Morton's neuroma. **Q: Will I lose feeling in my toes after surgery?** Yes. Excision of the interdigital nerve produces permanent numbness between the affected toes. Most patients find this an acceptable trade-off given the severe pain they experienced beforehand. The risk of complications beyond numbness is low. **Q: Are injections a permanent cure?** Corticosteroid injections are often not permanent, with benefits lasting weeks to months. Alcohol sclerosing injections aim for a more lasting effect by progressively fibroing the nerve, and success rates are comparable to surgery in some series. Neither option guarantees permanent resolution for all patients. **Q: Can I have a neuroma in two web spaces?** Yes, but multiple simultaneous neuromas should prompt evaluation for an underlying contributing diagnosis such as inflammatory arthritis or peripheral neuropathy. Bilateral neuromas in the same web space are rare and warrant careful re-evaluation of the diagnosis. **Q: How long is recovery after Morton's neuroma excision surgery?** Most patients are walking in a surgical shoe or wide supportive footwear within a few days of Morton's neuroma excision. Swelling in the forefoot can persist for four to eight weeks, and the small area of permanent numbness in the affected web space typically becomes less noticeable over time as the brain adapts. Return to regular shoes and low-impact activity is usually possible by four to six weeks, with full activity including sport by two to three months. Your MOS foot and ankle surgeon will discuss realistic expectations for symptom relief and guide your return to footwear and activity. --- ## Mucous Cyst URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/mucous-cyst/ A mucous cyst is a small, fluid-filled ganglion cyst that forms at the last joint of a finger or thumb, usually linked to underlying arthritis. It appears as a firm bump near the nail and may cause nail ridging, pain, or thinning of the overlying skin. ### Symptoms - A firm, translucent, pea-sized lump on the dorsum of the finger at or near the DIP joint - Mild tenderness, particularly with gripping or direct pressure - A longitudinal groove or ridge in the overlying fingernail - Clear, jelly-like fluid discharge if the cyst ruptures spontaneously - Swelling and redness of the DIP joint (associated with underlying OA) - Occasional DIP joint pain or stiffness from the underlying arthritis ### Frequently Asked Questions **Q: Is a mucous cyst related to hand arthritis?** Yes. Virtually all mucous cysts are associated with DIP joint osteoarthritis. Treatment of the cyst does not treat the arthritis, but the arthritis itself usually causes minimal functional limitation at the DIP level. **Q: Why is home drainage dangerous?** Draining a mucous cyst at home creates an open skin tract leading directly to the joint. Bacteria on the skin can infect the joint, causing septic arthritis. This requires urgent surgical irrigation and can cause permanent joint damage. Leave cyst drainage to medical professionals. **Q: Can the nail groove be fixed?** Nail grooves from cyst compression often partially or fully resolve after successful cyst excision, once the nail matrix is no longer compressed. Recovery of the nail ridge may take 3–6 months for the full nail to grow out. **Q: Will the mucous cyst come back after surgery?** Surgical excision of a mucous cyst, when performed by an experienced hand surgeon, is associated with a recurrence rate of less than 5%. This is far lower than the recurrence rates seen with aspiration or home drainage. The key to preventing recurrence is removing not just the cyst itself but also the underlying bone spur (osteophyte) at the finger's last joint (DIP joint) that generates the cyst. At MOS, your hand surgeon addresses both the cyst and its root cause to minimize the chance it returns. **Q: How long is recovery after mucous cyst removal?** Recovery after mucous cyst excision is typically straightforward. The wound is usually healed and the sutures removed within 10–14 days. Most patients regain comfortable finger use within 3–4 weeks, though some temporary stiffness in the finger's end joint is common and usually resolves with gentle range-of-motion exercises. If a skin flap was needed to close the wound due to cyst thinning of the overlying skin, healing may take a few additional weeks. Your MOS surgeon will guide you through wound care and recovery to optimize your outcome. --- ## Nailbed Injuries URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/nailbed-injuries/ A nailbed injury is damage to the tissue beneath the fingernail, usually from a crush, laceration, or door-closure injury, and often involves an underlying fracture of the fingertip bone. Treatment ranges from simple drainage of blood under the nail to nail removal with direct repair. In children, a Seymour fracture is a distinct, infection-prone variant requiring prompt care. ### Symptoms - Pain at the fingertip, often out of proportion to how minor the visible wound looks - Dark discoloration under the nail from blood collecting beneath the plate - A visibly bent, lifted, or displaced nail plate - A cut or crush wound over the nail fold or fingertip - Reduced strength bending the fingertip against resistance, which can indicate a concurrent tendon injury - In children specifically, a fingertip that looks bent like a mallet finger after a door or sports injury ### Frequently Asked Questions **Q: Does blood under my fingernail always need to be drained?** Not always, but current evidence favors draining most acute, painful collections regardless of size, as long as the nail plate itself is not significantly displaced or unstable. Older teaching focused on whether the blood covered more or less than half the nail, but outcomes track more closely with how much pain the patient has and whether the nail bed underneath is intact. Trephination, a small hole made in the nail to release the pressure, is quick and provides fast relief. If the nail is displaced or there's a suspected underlying laceration, formal removal and repair rather than simple drainage is usually the better path. **Q: Will my nail grow back normally after an injury?** In most cases, yes, especially if the injury did not involve the base of the nail (the germinal matrix) or if that area was repaired precisely. Full nail regrowth typically takes two to six months, with new growth first visible near the cuticle a few weeks after repair. The main risk factor for a permanently abnormal-looking nail is damage to the germinal matrix that was not accurately realigned during repair, so we place particular care on that portion of the procedure. **Q: What is a Seymour fracture and why is it treated differently?** It is a fracture of the fingertip bone near the growth plate in a child, with an overlying nailbed cut, most often from a crush injury such as a slammed door. It looks similar to a routine nailbed injury or mallet finger, but because the fracture communicates with the nail bed, it behaves like an open fracture even when the skin appears mostly intact. If not treated promptly, it carries a meaningfully elevated risk of infection, so children with this injury pattern are treated more urgently, with irrigation, fracture reduction, and often antibiotics, rather than simple observation. **Q: Do I need to see a hand surgeon for a nailbed injury, or is the emergency room enough?** Many straightforward nailbed injuries, a small hematoma or a simple laceration with no fracture, are appropriately treated in an emergency department or urgent care. However, injuries with a displaced fracture, significant nailbed tissue loss, a suspected Seymour fracture in a child, or a laceration through the germinal matrix benefit from a hand surgeon's involvement, since precise repair of the germinal matrix specifically determines whether the nail regrows normally. If you are uncertain, call our office and we can advise on urgency. **Q: How long will my child's finger be out of commission after a Seymour fracture repair?** Most children are splinted or protected for roughly two to three weeks while the fracture and nailbed heal, with activity restrictions eased gradually after that based on comfort and X-ray follow-up. Because a Seymour fracture is treated as an open injury, your child will likely receive a course of antibiotics started promptly after diagnosis. With timely treatment, most children recover normal finger growth and function; the main determinant of a poor outcome is a delay in diagnosis or treatment rather than the injury itself. --- ## Neck Pain / Cervicalgia URL: https://www.mdorthospecialists.com/conditions/spine/neck-pain-cervicalgia/ Axial neck pain (cervicalgia) refers to pain localized to the cervical spine, suboccipital region, or upper shoulder girdle that does not radiate into the arm in a dermatomal pattern. It is one of the most common conditions to see an orthopedic surgeon. This is generally treated conservatively. ### Symptoms - Aching or stiffness in the neck, suboccipital region, or upper shoulder girdle - Pain worsened by sustained postures (prolonged looking down, prolonged computer work), cervical extension and rotation - Cervicogenic headache — headache originating in the upper cervical spine and referring into the occipital, temporal, or frontal regions - Tenderness of paraspinal muscles, upper trapezius, and suboccipital musculature - Restricted cervical range of motion — particularly rotation and lateral flexion - Referred pain into the shoulder blade (scapular region) — common with cervical facet referral - Pain radiating below the elbow with numbness or weakness (radiculopathy) - Bilateral hand clumsiness, difficulty with fine motor tasks, gait instability (myelopathy) - Electric shock sensation with neck flexion (Lhermitte sign — myelopathy) - Any bowel or bladder dysfunction ### Frequently Asked Questions **Q: Is my neck pain serious?** Most axial neck pain is not serious and resolves with conservative care. The important distinction is between axial pain (muscle, disc, facet, responds well to conservative treatment) and radiculopathy or myelopathy (nerve or cord involvement, requires additional evaluation). Your MOS physician will assess which category applies. **Q: What is cervicogenic headache?** Cervicogenic headache originates in the upper cervical spine and facet joints (particularly C2–C3) and refers into the occipital, temporal, or frontal regions. It is typically one-sided and worsened by certain neck positions. It responds well to cervical PT, medial branch blocks, and in some cases RFA. **Q: Does "text neck" cause permanent damage?** Sustained forward head posture accelerates cervical degenerative changes over time, but reversing posture habits can slow this process. Structural disc and facet changes cannot be reversed, but their symptomatic impact can be substantially managed with PT and posture correction. **Q: Should I use a cervical pillow?** A cervical (contour) pillow that maintains neutral alignment of the cervical spine during sleep can reduce morning neck stiffness for many patients. Your physical therapist or MOS physician can advise on appropriate pillow selection. **Q: Can I exercise with neck pain?** Yes. Low-impact aerobic activity (walking, cycling, swimming) is encouraged. Avoid high-impact activities and heavy overhead work during acute flares. Your PT will guide a progressive return to full activity. --- ## Olecranon Bursitis URL: https://www.mdorthospecialists.com/conditions/elbow/olecranon-bursitis/ The olecranon bursa is a fluid-filled sac overlying the olecranon process at the posterior elbow tip. It reduces friction between the skin and the bony prominence. When irritated or infected, the bursa fills with fluid, producing the characteristic soft, fluctuant swelling. ### Symptoms - Soft, fluctuant swelling at the posterior elbow tip - Pain ranges from mild to severe depending on etiology - Warmth and erythema of overlying skin (more prominent in septic or inflammatory bursitis) - Limited elbow flexion due to skin tightness when the bursa is tense - Fever and systemic malaise in septic bursitis - In gout: associated joint pain elsewhere; tophi may be visible ### Frequently Asked Questions **Q: How do I know if my elbow swelling is infected?** Key signs of septic bursitis include prominent skin redness extending beyond the bursa, warmth, fever, and systemic illness. Aspiration with fluid analysis is the definitive way to distinguish septic from aseptic bursitis. **Q: Can I drain it myself?** No. Aspiration should be performed under sterile technique to avoid introducing infection into the bursa and to obtain fluid for proper analysis. Home drainage attempts carry a significant risk of converting aseptic to septic bursitis. **Q: Will the bursa grow back after surgery?** Recurrence after surgical bursectomy is uncommon (< 5%), making it an effective permanent solution for chronic cases. **Q: Should I avoid leaning on my elbow if I have olecranon bursitis?** Yes. Avoiding repeated pressure on the point of the elbow is one of the most important steps in allowing the bursa to calm down and preventing the swelling from worsening. Using elbow padding or avoiding hard surfaces can significantly reduce irritation. In occupational or activity-related cases, identifying and modifying the repetitive pressure source is essential to preventing recurrence. Your MOS provider can recommend appropriate protective gear and activity adjustments as part of your overall treatment plan. **Q: What is the treatment if my olecranon bursitis is not infected?** Non-infected (non-septic) olecranon bursitis is initially managed conservatively with activity modification, elbow padding, and anti-inflammatory medications. If the swelling is large and bothersome, aspiration by a physician can provide relief, though fluid often re-accumulates. A corticosteroid injection into the bursa can help reduce chronic inflammation in cases that do not resolve with rest alone. Surgery to remove the bursa is reserved for recurrent or persistent cases that have failed multiple rounds of conservative care, and your MOS surgeon will discuss the timing and approach that makes most sense for your situation. --- ## Osgood-Schlatter Disease URL: https://www.mdorthospecialists.com/conditions/knee/osgood-schlatter-disease/ During pubescent growth spurts, the tibial tubercle apophysis — the secondary ossification center at the attachment of the patellar tendon onto the tibia — is particularly vulnerable to traction stress. This can cause a painful bump at the tendon insertion. ### Symptoms - Anterior knee pain and tenderness localized to the tibial tubercle (the bony bump at the front of the upper shin, just below the kneecap) - Visible and palpable bony prominence at the tibial tubercle — often a permanent cosmetic finding even after symptoms resolve - Pain worsened by running, jumping, kneeling, and squatting - Pain relieved by rest - Typically unilateral, though bilateral in approximately 25% of cases - No joint swelling or locking; normal range of motion ### Frequently Asked Questions **Q: Can my child keep playing sports with Osgood-Schlatter?** Yes, in most cases. Pain is the guide. Mild-to-moderate pain during activity is generally permissible. Severe pain that alters mechanics or carries risk of complete avulsion fracture should prompt temporary activity modification. **Q: Will the bump on the shin go away?** The bony prominence at the tibial tubercle typically persists permanently but becomes non-tender once the apophysis fuses. Most patients and parents find this cosmetically acceptable once they understand it is benign. **Q: Does Osgood-Schlatter affect the growth plate?** No. The tibial tubercle apophysis is separate from the primary proximal tibial growth plate responsible for leg length. Osgood-Schlatter does not affect final leg length. **Q: What treatments actually help with Osgood-Schlatter pain?** The most effective treatments are rest from aggravating activities, ice applied to the bump after exercise, and quadriceps and hamstring stretching to reduce tension on the patellar tendon. Anti-inflammatory medications like ibuprofen can help manage pain during flares. Physical therapy focused on strengthening the quadriceps and improving flexibility is often recommended for athletes who want to stay active. At MOS, we help families find the right balance between maintaining athletic participation and protecting the developing growth plate. **Q: Does Osgood-Schlatter disease ever require surgery?** Surgery is very rarely needed for Osgood-Schlatter disease and is almost never performed while a child is still growing. In a small number of cases, a loose bone fragment at the tibial tubercle remains painful into adulthood even after the growth plates have closed. In those situations, your MOS surgeon may recommend a minor procedure to remove the fragment. The vast majority of children with Osgood-Schlatter disease (including elite athletes) resolve their symptoms completely by late adolescence without any operative intervention. --- ## Osteochondritis Dissecans (OCD) of the Elbow URL: https://www.mdorthospecialists.com/conditions/elbow/osteochondritis-dissecans-ocd-of-the-elbow/ OCD of the elbow most commonly involves the capitellum, the lateral humeral condyle that articulates with the radial head. It is predominantly a disease of adolescence (ages 11–17), affecting skeletally immature athletes during a period of rapid growth and peak athletic participation. ### Symptoms - Lateral elbow pain during overhead sport or gymnastics activity - Activity-related swelling - Stiffness, especially loss of terminal extension (>5° loss is common) - Catching, locking, or giving way (suggests loose body from an unstable/detached fragment) - Tenderness over the lateral compartment / radiocapitellar joint - Reduced forearm rotation in advanced cases ### Frequently Asked Questions **Q: Can my child continue to throw or do gymnastics?** Not during active treatment of OCD. Continued loading through the affected capitellum risks fragment detachment, larger defects, and long-term arthritis. Rest is the single most important component of non-operative treatment. **Q: What happens if OCD is not treated?** Untreated unstable lesions may progress to loose body formation, osteophytes, and early-onset lateral compartment arthritis. Late-stage capitellar OCD can end athletic careers and cause long-term elbow stiffness. **Q: Is the surgery done through an open incision?** Most capitellar OCD procedures are performed or initiated arthroscopically. OAT is typically a small open or mini-open procedure. **Q: How long will recovery take after surgery for OCD of the elbow?** Recovery after arthroscopic surgery for OCD of the elbow varies by the procedure performed. If loose fragments were removed and the lesion was drilled to stimulate healing, most young athletes begin a gradual return-to-sport program at 3–4 months, with return to full overhead throwing typically between 6–9 months. If cartilage grafting was required for a larger lesion, recovery can extend to 9–12 months. At MOS, your surgeon will map out a clear rehabilitation timeline and monitor healing with follow-up imaging before advancing you to higher-demand activities. **Q: Can OCD of the elbow lead to early arthritis?** Yes. If OCD of the elbow is not treated appropriately, there is a significant risk of long-term cartilage damage and early-onset elbow arthritis. When a fragment becomes loose and moves within the joint, it can damage the joint surface and cause persistent pain, stiffness, and loss of motion that persists into adulthood. Prompt diagnosis and appropriate management (whether rest or surgery) significantly improves long-term outcomes and reduces the risk of premature joint deterioration. Your MOS surgeon will help you understand the stage of your lesion and the approach most likely to protect your elbow joint for the long term. --- ## Osteochondritis Dissecans (OCD) of the Knee URL: https://www.mdorthospecialists.com/conditions/knee/osteochondritis-dissecans-ocd-of-the-knee/ The exact etiology of OCD remains debated, with repetitive microtrauma, subchondral ischemia, and genetic factors all implicated. The condition preferentially affects the medial femoral condyle in approximately 75–85% of cases, particularly the classic posterolateral aspect of the medial condyle. The lateral femoral condyle, trochlea, and patella may also be affected. ### Symptoms - Poorly localized activity-related knee pain, often described as deep aching or vague discomfort in the medial knee - Swelling after activity; may be intermittent - Loose body symptoms — if the fragment detaches: sudden catching, locking, clicking, or giving way (pathognomonic of unstable/detached OCD) - In early JOCD, symptoms may be subtle — a child with knee pain during or after sports that fails to resolve with rest warrants evaluation - Tenderness over the medial femoral condyle with the knee in flexion (Wilson test — internal tibial rotation at 30° produces medial pain that resolves with external rotation) ### Frequently Asked Questions **Q: My child has OCD. Do they need surgery?** Most children with juvenile OCD and open growth plates do not need immediate surgery. Stable lesions in skeletally immature patients have an excellent healing rate with activity restriction. However, if symptoms persist after 3–6 months of conservative management, or if the MRI shows unstable features, surgery is appropriate and produces excellent results. **Q: What happens if an OCD fragment detaches?** A detached fragment becomes a loose body in the joint, causing locking, catching, and accelerated cartilage damage on the opposing joint surface. Fragment removal, fixation if tissue quality allows, or cartilage restoration is required. **Q: Is OCD of the knee related to osteochondritis dissecans of the elbow?** They are the same pathological entity affecting different joints. Patients with bilateral knee OCD or both knee and elbow OCD may have a familial or systemic predisposition and should be evaluated accordingly. **Q: Can I prevent OCD?** There is no proven prevention strategy, but minimizing repetitive joint loading during growth spurts, maintaining appropriate training volumes, and early medical evaluation of persistent joint pain in young athletes represent prudent practice. **Q: How long will my child need to avoid sports if treated non-surgically for OCD?** Juvenile OCD with an open growth plate has significant healing potential with non-surgical treatment, but recovery requires patience: typically three to six months of activity restriction, unloading (sometimes with crutches), and avoidance of impact sports. Healing is confirmed with serial MRI showing lesion consolidation and resolution of surrounding bone edema before sport is resumed. Returning to high-impact activity too soon is the most common reason for treatment failure and lesion progression. Your MOS surgeon will design a structured monitoring plan and provide clear criteria for when it is safe to return to sport. --- ## Osteonecrosis of the Knee URL: https://www.mdorthospecialists.com/conditions/knee/osteonecrosis-of-the-knee/ Spontaneous osteonecrosis of the knee (SONK) — also called SPONK — is the most common form. It typically involves the medial femoral condyle of older women (median age ~65), presenting as sudden-onset medial knee pain without a preceding traumatic event. ### Symptoms - Acute onset of severe medial knee pain (SONK), often without injury - Pain with weight-bearing and walking; night pain is common - Localized tenderness over the medial femoral condyle - Swelling of the knee - In later stages: loss of range of motion and symptoms indistinguishable from osteoarthritis ### Frequently Asked Questions **Q: Is SONK related to AVN of the hip?** Not directly. While both involve subchondral bone death, SONK is now understood to primarily represent subchondral insufficiency fractures rather than the ischemic osteonecrosis seen in the femoral head. The treatment principles overlap for advanced disease (arthroplasty) but differ early. **Q: How quickly does osteonecrosis of the knee progress?** Prognosis depends on lesion size. Small lesions (< 40% of condylar width) often resolve or stabilize with protected weight-bearing. Large lesions frequently progress to collapse within months, making prompt diagnosis and treatment critical. **Q: What are the treatment options for osteonecrosis of the knee, and do I need surgery?** Treatment depends on the stage and size of the lesion. In early or small lesions, non-surgical management (including protected weight-bearing with crutches, pain medication, and monitoring with serial MRIs) can allow the bone to heal. If the lesion is larger, involves a significant portion of the weight-bearing surface, or has progressed to collapse, surgical options such as core decompression, osteotomy, or partial/total knee replacement may be necessary. Your MOS surgeon will stage the disease on imaging and match the treatment plan to your specific situation. **Q: Can osteonecrosis of the knee be caused by medications or other medical conditions?** Yes. Secondary osteonecrosis of the knee can be triggered by corticosteroid use (even short courses at high doses), excessive alcohol consumption, blood clotting disorders, sickle cell disease, and certain autoimmune conditions. Spontaneous osteonecrosis of the knee (SONK), which typically affects older women, is now thought to be related to an underlying insufficiency fracture rather than true vascular compromise. Understanding the cause helps guide treatment and reduces the risk of the condition developing in the opposite knee. **Q: What is the long-term outlook for my knee after osteonecrosis?** Long-term outcomes depend heavily on the stage at diagnosis and the size of the affected area. Small lesions detected early, particularly those in SONK, often stabilize and allow patients to maintain good knee function for many years. Larger lesions that have progressed to joint surface collapse carry a higher risk of developing secondary arthritis, which may eventually require knee replacement. At MOS we use close imaging follow-up to detect any progression early, giving us the best opportunity to intervene before significant joint damage occurs. --- ## PCL Tear URL: https://www.mdorthospecialists.com/conditions/knee/pcl-tear/ The PCL runs from the posterior tibia to the anterior medial wall of the femoral notch, preventing the tibia from sliding backward on the femur. It consists of two functional bundles: the larger anterolateral bundle (taut in flexion) and the posteromedial bundle (taut in extension). ### Symptoms - Posterior knee pain and swelling acutely; may be surprisingly mild - Sensation of instability on stairs or during deceleration - Posterior tibial sag — the classic resting sign when the knee is held at 90° of flexion; gravity causes the tibia to sag posteriorly - Difficulty with stair descent and pivoting activities - Chronic cases often present with medial compartment or patellofemoral pain from altered biomechanics ### Frequently Asked Questions **Q: Can a PCL tear heal on its own?** Yes. Isolated Grade I and II PCL tears have substantial healing potential because the PCL is an intra-capsular but extra-synovial structure surrounded by a rich vascular envelope. Grade I–II injuries routinely recover full function with physical therapy. **Q: Why is the PCL called the strongest ligament in the knee?** Its cross-sectional area and ultimate tensile load exceed those of the ACL by approximately 20–50%, reflecting its role resisting the large posterior shear forces generated during daily activities such as stair descent. **Q: What happens if a PCL tear is missed?** Untreated high-grade PCL injuries lead to progressive posterior instability, medial compartment cartilage overloading, patellofemoral malalignment, and accelerated osteoarthritis. **Q: How is PCL surgery different from ACL surgery?** PCL reconstruction is technically more demanding (the popliteal neurovascular bundle is immediately posterior to the tibial attachment) and requires careful graft tunnel positioning to minimize graft bending ("killer turn") and maximize biomechanical function. **Q: How long does recovery take after PCL reconstruction, and when can I return to sport?** PCL reconstruction is associated with a recovery timeline of nine to twelve months before return to sport, in part because the PCL graft is under significant tension during knee flexion and matures slowly. Early rehabilitation focuses on quadriceps strengthening and controlled range of motion, avoiding positions that stress the healing graft. Sport-specific training typically begins at six to eight months, with full clearance contingent on passing strength and functional testing. Your MOS surgeon will monitor your progress carefully and will not clear you for competitive sport until objective criteria are met. --- ## Painful Hardware After Hand, Wrist, or Elbow Fracture Surgery URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/painful-hardware/ Symptomatic hardware is a plate, screw, or wire from prior fracture surgery that irritates skin, tendons, or nerves after the bone has healed. It causes localized pain, tenderness, or pressure discomfort, most often at the elbow or wrist. Many cases improve with padding or activity changes; persistent cases are treated with elective removal once healing is confirmed. ### Symptoms - Localized pain directly over the plate or screw, often worse with pressure - Pain specifically when leaning on the elbow, resting the wrist on a desk, or wearing a watch or sleeve near the site - Tenderness to touch over the old incision - A palpable or visible bump or ridge under the skin - Cold intolerance or unusual sensitivity limited to the area over the metal - Occasionally, painful clicking, snapping, or catching from a tendon rubbing against the hardware ### Frequently Asked Questions **Q: How do I know if my pain is actually coming from the hardware and not something else?** The strongest clue is a pain that is reproducible in one specific spot directly over the plate or screw, particularly with pressure like leaning on a desk or wearing a sleeve. We confirm this on examination by pressing directly over the implant and reproducing your symptoms, and we can use a local anesthetic injection at the site if the picture is unclear. Radiographs also rule out other explanations, such as a screw that has backed out or a fracture that has not fully healed. **Q: Will my hardware need to come out eventually just because it's metal?** No. Most hardware placed for fracture fixation is well tolerated indefinitely and never needs to be removed. A review of the evidence on removing hardware from patients who have no symptoms found no strong data supporting routine removal, so we base the decision on how much the implant is bothering you, not simply on the fact that it is there. **Q: Is removing hardware from my elbow riskier than from my wrist or forearm?** The risks differ by location and by the type of plate involved rather than by a simple hierarchy of joints. Forearm plate removal carries a documented refracture risk that varies by plate design, and heavier compression plates carry a higher risk than lighter ones. Olecranon plates at the elbow are removed frequently and generally tolerate removal well once healing is confirmed, but every removal decision should weigh the specific implant and healing status on your x-rays. **Q: How soon after my original surgery can hardware be removed?** We generally wait at least 6 to 12 months after the original fixation, and sometimes longer, to be confident the fracture has fully healed and the bone has regained strength. Removing hardware too early raises the risk of refracture at the original injury site. The exact timing depends on your x-ray appearance and how the bone is remodeling, not on a fixed calendar date. **Q: What happens during hardware removal surgery, and how long is recovery?** The procedure involves reopening the original incision, removing the plate, screws, or wires, and addressing any irritated bursa, extra bone, or tendon damage found at the same time. It is generally a shorter procedure than the original fracture surgery. Most patients have some restriction on heavy use of the arm for a period afterward, and in some cases a brief period of splinting, while the bone consolidates around the empty screw holes. --- ## Paronychia and Felon URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/paronychia-felon/ Paronychia is an infection of the skin folds around the fingernail; felon is a deeper, closed-space infection of the fingertip pad. Both usually follow minor trauma and respond well to prompt drainage. Felon is more dangerous because pressure builds within the fingertip's internal compartments, risking bone infection or spread to the tendon sheath if untreated. ### Symptoms - Acute paronychia: sudden pain, redness, and swelling of the skin fold beside the nail, often with a visible pocket of pus that can be expressed - Chronic paronychia: intermittent swelling, tenderness, and drainage over weeks to months, often with ridging or discoloration of the nail itself from ongoing irritation - Felon: intense, throbbing pain confined to the fingertip pad, frequently out of proportion to how the finger looks early on, with progressive swelling, warmth, redness, and a tensely swollen feel to the pulp ### Frequently Asked Questions **Q: What's the difference between paronychia and a felon?** Paronychia is an infection of the skin fold along the side or base of the fingernail. A felon is a deeper infection inside the fleshy pad at the very tip of the finger, below the last joint. They can look similar early on, but a felon is more concerning because the fingertip pad is divided into small enclosed compartments by internal fibrous bands, so pressure builds up quickly inside it and the infection can spread to the bone or tendon sheath if it isn't drained promptly. **Q: Do I need antibiotics after my paronychia is drained?** Often not, if the drainage is complete. Research on this specific question found that once a paronychial abscess is properly drained, routine oral antibiotics afterward usually don't add benefit, even in some cases caused by resistant staph bacteria. We decide case by case based on how extensive the infection is and whether there are signs it has spread beyond the immediate area. **Q: How is chronic paronychia different from a one-time infection?** Chronic paronychia lasts more than 6 weeks and behaves differently than a typical acute infection. It's often driven by repeated moisture exposure, such as frequent hand-washing or wet work, and frequently involves a yeast called Candida rather than the bacteria typically responsible for acute cases. Some causes are correctable, including zinc deficiency and certain cancer medications known to cause this problem. Treatment focuses on avoiding moisture and irritants and using topical medication rather than antibiotics alone, and surgery is reserved for cases that don't respond. **Q: What are Kanavel's signs and why do they matter?** Kanavel's signs are four physical exam findings that suggest an infection has spread into the flexor tendon sheath, a surgical emergency called pyogenic flexor tenosynovitis. They are tenderness along the tendon sheath, a bent resting posture of the finger, uniform swelling of the whole finger, and pain when the finger is straightened. Importantly, research shows that not every sign is present in every confirmed case, sometimes only about half of patients have all four together, so we don't rule out this diagnosis just because one sign is missing. **Q: Can a felon go away on its own without being drained?** Once a felon has progressed to a defined pocket of pus, no. The fingertip pad's internal compartments prevent pus from draining on its own the way a more open infection might, so pressure keeps building. Very early cellulitis without a defined collection may occasionally be tried on oral antibiotics with close follow-up, but if it doesn't rapidly improve, or if pus has already formed, surgical drainage is necessary to relieve the pressure and prevent complications like bone infection. --- ## Patellar Fracture URL: https://www.mdorthospecialists.com/conditions/knee/patellar-fracture/ A patellar fracture is a break in the kneecap, the bone at the front of the knee that transmits the force of the quadriceps muscle to the shinbone. It usually results from a direct blow or fall. Symptoms include pain, swelling, and difficulty straightening or lifting the leg. ### Symptoms - Immediate anterior knee pain, swelling, and ecchymosis following injury - Visible deformity or step-off over the kneecap with displaced fractures - Inability to perform a straight-leg raise — the key sign of extensor mechanism disruption - Tense hemarthrosis (blood in the joint) - Tenderness to direct palpation over the patella ### Frequently Asked Questions **Q: Why might I need surgery if I can still somewhat move my knee?** Extensor mechanism integrity is tested by a straight-leg raise against gravity, not by partial range of motion. Patients with partial extensor tears may still lift the leg. Surgery is indicated when there is a measurable gap, step-off, or any extensor lag, as untreated displacement leads to post-traumatic arthritis. **Q: Will my hardware need to come out?** Patellar hardware, particularly tension band wires, is symptomatic enough to require removal in approximately 30–50% of patients. Your surgeon will discuss a planned removal procedure once your fracture has fully healed. **Q: How long will recovery take after a patellar fracture?** Recovery time varies depending on whether the fracture was treated non-surgically or surgically. Non-surgical treatment with a brace or cast typically requires four to six weeks of immobilization, followed by a graduated physical therapy program, with most patients returning to full activity by three to four months. After surgical fixation, weight-bearing often begins earlier with the knee in extension, but regaining full strength and range of motion can take four to six months. High-demand athletes may require six to twelve months before returning to competitive sport. **Q: What are the long-term risks after a patellar fracture?** The most common long-term concern is post-traumatic arthritis of the patellofemoral joint, since the kneecap cartilage may be damaged at the time of injury even when the fracture heals well. Other potential issues include loss of full knee flexion (stiffness), weakness of the quadriceps, and, in cases treated with hardware, hardware-related irritation that may eventually require removal. Your MOS surgeon will monitor your recovery and address any complications promptly to maximize your long-term knee function. **Q: Will I be able to return to sports or strenuous activity after a patellar fracture?** Most patients do return to recreational and even competitive sports after a patellar fracture, provided the fracture heals well and rehabilitation is completed fully. The key milestones for return to sport include achieving near-symmetric quadriceps strength, full or near-full range of motion, and pain-free activity-specific movements. At MOS we use functional testing alongside your subjective readiness to clear patients for sport, rather than relying solely on a fixed time frame. --- ## Patellar Instability / Dislocation URL: https://www.mdorthospecialists.com/conditions/knee/patellar-instability-dislocation/ The patella glides within the trochlear groove of the femur, maintained centrally by a balance of static restraints (ligaments) and dynamic restraints (quadriceps muscles). The medial patellofemoral ligament (MPFL) is the primary medial restraint, providing 50–60% of resistance to lateral patellar displacement. ### Symptoms - Sharp medial knee pain and visible lateral displacement of the patella at time of injury - Patella typically reduces spontaneously when the knee is straightened - Immediate swelling (hemarthrosis from MPFL tear and potential osteochondral fracture) - Profound apprehension and inability to weight-bear - Tenderness along the medial patellar border and femoral MPFL origin - Episodes of patella "slipping out" or "giving way" with pivoting, jumping, or ascending/descending stairs - Anterior knee pain between episodes from patellofemoral articular cartilage overload - Positive patellar apprehension test — patient reflexively resists lateral patellar translation as the examiner applies gentle lateral pressure with the knee at 0–30° flexion - J-sign on dynamic examination ### Frequently Asked Questions **Q: What is the TT-TG distance and why does it matter?** The TT-TG distance measures how far the tibial tubercle (patellar tendon insertion) is lateralized relative to the deepest point of the trochlear groove. A large TT-TG (> 20 mm) pulls the patella laterally, predisposing it to dislocation. When elevated, a tibial tubercle osteotomy to medialized the insertion point is often required alongside MPFL reconstruction. **Q: Can a first-time dislocation be treated with surgery?** Surgery for a first-time dislocation is generally reserved for patients with displaced osteochondral fractures requiring fixation, or in high-risk patients (young athletes with severe anatomical risk factors) after shared decision-making. Most first-time dislocations are treated non-operatively. **Q: What is the redislocation rate after MPFL reconstruction?** Published series report redislocation rates of 1–5% after isolated MPFL reconstruction in appropriate candidates, compared to 15–44% with non-operative treatment. Outcomes are best when anatomical risk factors (high TT-TG, patella alta) are concurrently addressed. **Q: Does patellar instability cause arthritis?** Recurrent dislocation damages the medial patellar and lateral femoral condyle articular cartilage through repeated impaction, gradually increasing the risk of patellofemoral arthritis. Stabilizing the patella early reduces this long-term risk. **Q: How long does recovery take after MPFL reconstruction, and when can I return to sport?** Recovery after medial patellofemoral ligament (MPFL) reconstruction typically takes six to nine months before return to competitive sport. The first six weeks focus on swelling control, restoring range of motion, and early quadriceps activation. Progressive strengthening of the quadriceps and hip stabilizers follows, with sport-specific training beginning around four to five months. Your MOS surgeon will use functional and strength benchmarks, not just time, to determine when it is safe to return to cutting, jumping, and pivoting activities. --- ## Patellar Tendinitis (Jumper's Knee) URL: https://www.mdorthospecialists.com/conditions/knee/patellar-tendinitis-jumpers-knee/ Patellar tendinopathy is a degenerative condition of the patellar tendon, not a classic inflammatory tendinitis, despite the traditional name. Repetitive high-load stress (jumping, landing, sprinting) generates microtrauma in the tendon that overwhelms its repair capacity, leading to collagen disorganization, neovascularization, and thickening at the tendon's origin from the distal patellar pole. ### Symptoms - Anterior knee pain localized to the inferior pole of the patella — typically pinpoint tenderness - Pain provoked by jumping, landing, squatting, and stair use - Morning stiffness that eases with warm-up, then returns with high-load activity - In severe cases (VISA-P score < 50), pain limits all athletic activity - Patients typically point directly to the patellar tip with one finger ### Frequently Asked Questions **Q: Can I continue playing with patellar tendinitis?** Load management is key. Mild tendinopathy with VISA-P scores > 70 often permits continued sport with concurrent eccentric strengthening. Severe tendinopathy requiring complete rest is counterproductive. Controlled loading is therapeutic. **Q: Is patellar tendinitis the same as patellar tendon rupture?** They exist on a spectrum. Severe, longstanding tendinopathy with disorganized collagen is at increased risk of rupture, but most cases of patellar tendinitis do not progress to complete rupture. Early treatment reduces this risk. **Q: How long does patellar tendinitis take to heal?** Healing time varies considerably based on severity and how long symptoms have been present. Acute, mild cases can improve within four to six weeks with load management and a targeted eccentric strengthening program. Chronic patellar tendinopathy (when symptoms have persisted for several months) often takes three to six months of consistent rehabilitation to resolve. The single most important factor in recovery is following a structured, progressive loading program rather than simply resting, as tendons need controlled stress to remodel and regain strength. **Q: When does patellar tendinitis require surgery?** Surgery is reserved for cases that have not responded to at least six months of dedicated non-surgical treatment, including eccentric strengthening, load management, injections, and other adjuncts. At MOS we rarely recommend surgery as a first-line option, since the majority of patients recover with a well-structured rehabilitation program. When surgery is indicated, minimally invasive procedures such as tendon scraping or ultrasound-guided debridement are typically considered before open surgery. **Q: What is the difference between patellar tendinitis and patellar tendinopathy?** Patellar tendinitis technically refers to acute inflammation of the tendon, while patellar tendinopathy is a broader term describing the degenerative changes that occur when the tendon has been repeatedly overloaded over time. Most chronic cases that people call tendinitis are actually tendinopathy, meaning inflammation has given way to structural disorganization within the tendon tissue. This distinction matters because tendinopathy responds best to progressive loading and strengthening rather than anti-inflammatory treatments alone. --- ## Patellar Tendon Rupture URL: https://www.mdorthospecialists.com/conditions/knee/patellar-tendon-rupture/ The patellar tendon connects the inferior pole of the patella to the tibial tubercle and, along with the quadriceps tendon and patella, forms the extensor mechanism of the knee. A rupture most commonly occurs at the distal pole of the patella (the tendon's patellar origin), where repetitive microtrauma may have compromised tendon integrity even before an acute event. ### Symptoms - Sudden onset of anterior knee pain at the moment of injury - A "pop" felt or heard at injury - Inability to perform a straight-leg raise — the hallmark of complete rupture; the patient cannot extend the knee against gravity - Visible or palpable gap inferior to the patella - Patella alta — the patella migrates superiorly as the distal tether is lost; visible on lateral X-ray - Rapid swelling and ecchymosis over the anterior knee - Antalgic gait; inability to bear weight normally ### Frequently Asked Questions **Q: How urgent is surgery for a patellar tendon rupture?** Complete tears should be repaired within two to three weeks of injury. After this window, the quadriceps muscle shortens and scars, making it progressively harder to restore the patella to its normal position and achieve full extension. Outcomes are significantly better with early repair. **Q: Can I walk with a patellar tendon rupture?** Patients with complete tears cannot extend the knee against gravity and typically cannot walk normally without a locked brace. Partial tears with preserved active extension may allow limited ambulation. **Q: Will I regain full function after repair?** Most patients who undergo timely primary repair regain full or near-full range of motion and return to their pre-injury activity level. Return to high-demand athletics is expected by 9–12 months in athletes with uncomplicated repairs. **Q: What causes patellar tendon rupture in younger patients without trauma history?** Subclinical patellar tendinopathy (tendon degeneration) is present in a high proportion of "spontaneous" ruptures at autopsy. Chronic overuse, corticosteroid injections, and systemic metabolic conditions weaken tendon collagen architecture before a seemingly minor event causes complete failure. **Q: How long does recovery take after patellar tendon repair, and when can I return to sport?** Recovery after patellar tendon repair is a prolonged process that typically takes nine to twelve months before return to sport. The repaired tendon is protected in a brace for the first four to six weeks, with gradual restoration of knee flexion thereafter. Quadriceps strengthening is a central focus of rehabilitation, as the muscle often atrophies significantly during the protected phase. Your MOS surgeon will monitor tendon integrity and guide your progression through functional milestones, ensuring the repair is mature enough before high-demand activities are attempted. --- ## Periprosthetic Fracture URL: https://www.mdorthospecialists.com/conditions/hip/periprosthetic-fracture/ Periprosthetic fractures occur most commonly around total hip replacements (femoral stem fractures) and total knee replacements (distal femur fractures above the implant). Risk factors include osteolysis, osteoporosis, falls, implant stress-risers (tip of the femoral stem or distal component), and prior revision surgery. ### Symptoms - Sudden onset of severe pain in the hip or knee area, typically after a fall or low-energy injury - Inability to bear weight on the affected limb - Swelling and ecchymosis (bruising) around the fracture site - Deformity or shortening of the limb in displaced fractures - Occasionally, a pre-existing dull ache (suggestive of implant loosening) followed by acute fracture ### Frequently Asked Questions **Q: Why does a periprosthetic fracture need a specialist?** These injuries sit at the intersection of fracture surgery and joint replacement revision. Choosing between ORIF and revision — and selecting the right implants — requires expertise in both disciplines. Errors in classification or treatment lead to fixation failure, malunion, or implant loosening. **Q: My fracture is not near the implant tip — do I still need a joint replacement surgeon?** Not always for Type C fractures, but the presence of any joint replacement implant and the need for careful implant assessment make evaluation by an Adult Reconstruction surgeon appropriate. **Q: How is a periprosthetic fracture treated, and will I need surgery?** Most periprosthetic fractures require surgical treatment because the implant makes reliable healing with a cast or brace very difficult. Depending on the fracture pattern and the stability of the existing implant, treatment options include fixation with plates and screws around the implant, or revision to a longer-stemmed implant that bypasses the fracture. Non-surgical management is considered only in patients who are not candidates for anesthesia or in undisplaced fractures where the implant remains solidly fixed. Your MOS surgeon will evaluate imaging and implant stability to determine the safest and most durable approach. **Q: How long does recovery take after a periprosthetic fracture?** Recovery after surgical treatment of a periprosthetic fracture typically takes three to six months, depending on fracture complexity and the patient's bone quality. Weight-bearing restrictions are common in the early weeks to protect the repair while bone healing begins. Physical therapy is essential to restore strength and function, and your MOS team will guide you through each stage. Older patients and those with osteoporosis may require a longer protected period before full weight-bearing is permitted. **Q: What can I do to reduce my risk of a periprosthetic fracture in the future?** After treatment, several steps can lower the risk of a future periprosthetic fracture. Treating osteoporosis with medication, adequate calcium and vitamin D, and appropriate weight-bearing exercise is one of the most important preventive measures since bone density significantly affects fracture risk. Fall prevention strategies — including home safety modifications, balance training, and review of medications that cause dizziness — are equally important. At MOS we often coordinate with your primary care physician or an endocrinologist to ensure your bone health is optimized long-term. --- ## Periprosthetic Joint Infection (PJI) URL: https://www.mdorthospecialists.com/conditions/hip/periprosthetic-joint-infection-pji/ A periprosthetic joint infection occurs when bacteria or other microorganisms colonize the surface of a joint replacement implant. Biofilm formation (a protective matrix the organisms construct on the implant) makes these infections notoriously resistant to antibiotics alone and immune system clearance. ### Symptoms - Acute PJI: Fever, erythema (redness), warmth, and swelling around the joint; increasing pain; wound drainage; or dehiscence (wound opening) - Chronic PJI: Persistent or worsening pain after a pain-free interval; the patient may describe the joint never feeling right since surgery; stiffness; subtle swelling - Hematogenous PJI: Sudden onset of severe pain and swelling in a previously well-functioning joint, sometimes following a dental or other invasive procedure ### Frequently Asked Questions **Q: Can PJI be prevented?** PJI risk can be minimized but not eliminated. Pre-operative weight loss, tight glycemic control, smoking cessation, and treatment of remote infections (dental, skin, urinary) before joint replacement significantly reduce risk. Peri-operative antibiotic prophylaxis is standard. **Q: Is PJI always apparent immediately after surgery?** No. Acute infections manifest within weeks; chronic low-grade infections may not become symptomatic until months or years after surgery. **Q: What if the infection can't be eradicated?** Salvage options include resection arthroplasty (removal of implant without replacement, uncommon), arthrodesis (joint fusion), and in extreme cases, amputation. These are last-resort measures for patients who have failed multiple revision attempts. **Q: Do I need to tell my dentist I have a joint replacement?** Yes. Prophylactic antibiotics before invasive dental procedures are recommended for the first two years after joint replacement, and in some cases lifelong, per AAOS and ADA guidelines. Discuss your specific situation with your surgeon and dentist. **Q: How is periprosthetic joint infection treated, and will I need my implant removed?** Treatment of PJI depends on how long the infection has been present and which organism is responsible. Very early infections (within days to weeks of surgery) may sometimes be managed with surgical debridement, thorough irrigation, and exchange of removable implant components, followed by a prolonged course of antibiotics. Established chronic infections almost always require a two-stage revision: the infected implant is removed, an antibiotic-loaded spacer is placed, and a new implant is reimplanted after the infection is eradicated, typically two to three months later. Your MOS surgeon will work closely with an infectious disease specialist to select the antibiotic regimen and timing that gives you the best chance of a durable, infection-free outcome. --- ## Peroneal Tendon Tears / Subluxation URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/peroneal-tendon-tears-subluxation/ The peroneus brevis (PB) and peroneus longus (PL) tendons run posterior to the lateral malleolus, held in a groove on the fibula by the superior peroneal retinaculum (SPR). They are the primary evertors of the foot and lateral ankle stabilizers. ### Symptoms - Lateral ankle and posterior fibular pain — distal to the fibula, slightly posterior (distinguishes from ATFL sprain, which is anterior to the fibula) - Pain with resisted eversion - Swelling along the peroneal tendon sheath (tenosynovitis) - For subluxation: snapping or "popping" sensation over the lateral malleolus with active dorsiflexion and eversion; patient may be able to voluntarily demonstrate the subluxation - Lateral ankle instability symptoms may coexist ### Frequently Asked Questions **Q: Is peroneal subluxation the same as a sprain?** No. A sprain injures the lateral ligaments (ATFL, CFL); subluxation injures the superior peroneal retinaculum. Both can occur simultaneously, but subluxation requires targeted SPR evaluation and, if persistent, surgical reconstruction. Generic sprain rehabilitation will not stabilize a torn retinaculum. **Q: Can peroneal tendon tears heal on their own?** Partial peroneal tendon tears, particularly those associated with tenosynovitis without frank instability, can improve with non-operative management. Complete SPR tears causing recurrent subluxation rarely heal without surgery. **Q: What happens if subluxation is untreated for years?** Chronic peroneal subluxation progressively damages both tendons from repeated friction, and the fibular groove becomes increasingly eroded. Long-standing subluxation can complicate surgical repair significantly, making early recognition and treatment preferable. **Q: Will I need surgery for a peroneal tendon tear or subluxation?** Not all peroneal tendon injuries require surgery. Partial tears that cause pain and swelling are often managed with a period of immobilization in a boot, physical therapy, and activity modification. Many improve with conservative care over 6–12 weeks. However, subluxation (the tendon snapping out of its groove) rarely resolves permanently without surgery because the retinaculum that holds the tendon in place does not reliably heal. Your MOS surgeon will assess the severity of your tear and whether subluxation is present to determine the most appropriate course of action. **Q: How long is recovery after peroneal tendon surgery?** After peroneal tendon repair or groove-deepening surgery for subluxation, patients are typically non-weight-bearing in a splint or boot for 2–4 weeks, followed by protected weight-bearing and gradual progression in physical therapy. Most patients are walking comfortably without support by 6–8 weeks and can return to lower-impact activities at 3–4 months. Return to cutting sports and high-demand activities typically takes 5–6 months. At MOS, your rehabilitation is individualized based on the specific procedure performed and your sport or activity goals. --- ## Pes Anserine Bursitis URL: https://www.mdorthospecialists.com/conditions/knee/pes-anserine-bursitis/ The pes anserine ("goose's foot") is the combined insertion of three medial knee tendons (the sartorius, gracilis, and semitendinosus) onto the proximal medial tibia, approximately 2–3 cm below and medial to the tibial joint line. The pes anserine bursa sits between this combined tendon and the proximal tibial shaft and medial collateral ligament. ### Symptoms - Medial knee pain and tenderness below the joint line — distinctly 2–3 cm inferior and medial to the joint, over the proximal tibia - Pain worsened by stairs, prolonged walking, and getting up from a chair - Night pain characteristic, particularly in overweight patients with OA - Localized swelling may be present but is often subtle - Joint-line tenderness is absent (distinguishing it from medial meniscal pathology) — though the two conditions frequently coexist in OA patients ### Frequently Asked Questions **Q: How do I know if my medial knee pain is bursitis or a meniscus tear?** Location is the key distinguishing feature: pes anserine bursitis produces tenderness 2–3 cm below the joint line on the medial tibia, while medial meniscal tears produce joint-line tenderness. Both conditions can coexist, particularly in patients with knee OA, and MRI or arthroscopy may be needed to fully characterize the pain source. **Q: Will losing weight help my pes anserine bursitis?** Yes. Obesity is an independent risk factor for both pes anserine bursitis and knee OA. Weight reduction reduces medial compartment compressive forces and is one of the most effective long-term strategies for managing both conditions. **Q: What treatments are available for pes anserine bursitis?** Most cases of pes anserine bursitis respond well to conservative treatment. Initial management typically includes activity modification, ice application, anti-inflammatory medications, and physical therapy to address any underlying hip or knee muscle weakness. If symptoms persist, a corticosteroid injection into the bursa provides rapid pain relief for most patients. Surgery to remove the bursa is rarely necessary and is reserved for cases that have failed all non-operative measures over an extended period. **Q: How long does pes anserine bursitis last?** With appropriate treatment, most patients experience significant improvement within four to eight weeks. However, pes anserine bursitis frequently recurs if the contributing factors (such as obesity, osteoarthritis, or tight hamstrings) are not addressed. Addressing these underlying factors through weight management, knee arthritis treatment, and ongoing stretching and strengthening exercises gives you the best chance of long-term relief. Your MOS provider will help develop a plan that targets the root cause, not just the immediate pain. **Q: Is pes anserine bursitis related to my knee arthritis?** Yes, there is a well-established association between pes anserine bursitis and knee osteoarthritis, particularly in overweight patients. The altered gait and joint mechanics caused by arthritis can increase stress on the pes anserine tendons and bursa over time. Treating the arthritis (whether through injections, physical therapy, bracing, or eventually knee replacement) often reduces the recurrence of bursitis flares. At MOS we evaluate the knee as a whole to ensure both conditions are addressed together. --- ## Piriformis Syndrome (Deep Gluteal Syndrome) URL: https://www.mdorthospecialists.com/conditions/hip/piriformis-syndrome-deep-gluteal-syndrome/ The piriformis muscle originates from the anterior sacrum and inserts on the greater trochanter, serving as a primary external rotator of the hip. The sciatic nerve (the body's largest peripheral nerve) exits the pelvis through the greater sciatic foramen, passing directly beneath (or in anatomic variants, through) the piriformis muscle. ### Symptoms - Deep buttock pain — often aching, burning, or pressure-like - Pain radiating down the posterior thigh and leg (sciatic distribution) — may mimic disc herniation - Pain with prolonged sitting — the piriformis is under stretch when the hip is flexed; sitting on a hard surface exacerbates symptoms - Pain with hip external rotation and activities involving the piriformis (climbing stairs, walking uphill) - Possible numbness, tingling, or weakness in the leg in more severe cases - Piriformis/deep gluteal syndrome does not produce back pain that changes with lumbar flexion/extension - Symptoms are not provoked by spinal loading tests (e.g., Valsalva maneuver, lumbar straight-leg raise) - Lumbar MRI is typically normal or shows incidental disc changes that do not correlate with the symptoms ### Frequently Asked Questions **Q: How do I know if my sciatica is from my back or my piriformis?** Back-generated sciatica typically changes with lumbar movements (bending forward or backward) and is associated with low back pain. Piriformis syndrome is worse with sitting and hip external rotation but does not vary with lumbar loading. A normal lumbar MRI and positive FAIR test support a deep gluteal source. **Q: Is piriformis syndrome a permanent condition?** Most patients respond well to PT and injection. Even refractory cases can achieve significant relief with endoscopic decompression. Long-term prognosis is generally good with appropriate treatment. **Q: Can I exercise with piriformis syndrome?** Low-impact activities that do not require prolonged hip flexion or sitting (cycling, swimming, walking) are generally tolerated. Avoid extended running or any activity that reproduces the buttock/leg pain until symptoms are controlled. **Q: What treatments are available for piriformis syndrome, and do they work?** The first line of treatment is physical therapy targeting piriformis stretching, hip external rotator strengthening, and biomechanical correction, which resolves symptoms in the majority of patients when followed consistently. Anti-inflammatory medications can help manage acute pain. For patients who do not improve with therapy, ultrasound- or fluoroscopy-guided injections of corticosteroid or botulinum toxin directly into the piriformis muscle can provide significant, lasting relief. Surgical release of the piriformis muscle is reserved for a small subset of patients with refractory symptoms, and at MOS our surgeons are experienced in both endoscopic and open techniques for deep gluteal decompression. **Q: How long does it take to recover from piriformis syndrome?** Recovery time varies considerably based on how long symptoms have been present and how faithfully rehabilitation is pursued. Many patients with early or mild symptoms notice improvement within 4–6 weeks of consistent physical therapy. Those with longer-standing compression or more severe nerve irritation may require 3–6 months of treatment before symptoms fully resolve. It is important to address underlying contributing factors (such as hip labral pathology, leg-length discrepancy, or training errors) to prevent recurrence, and your MOS care team will evaluate for these during your workup. --- ## Plantar Fasciitis URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/plantar-fasciitis/ ### Anatomy and Biomechanics The plantar fascia is a dense, fibrous band of connective tissue that originates at the medial calcaneal tubercle (the bony prominence on the inner base of the heel) and fans out distally to insert into the bases of the proximal phalanges of each toe. ### Symptoms - First-step morning pain — the hallmark symptom; severe heel pain with the first few steps out of bed, caused by the fascia contracting overnight and being abruptly loaded - Pain after prolonged rest or sitting ("post-static dyskinesia") — similar start-up pain after any period of inactivity during the day - Point tenderness at the medial heel — reproducible tenderness when pressing directly on the inner aspect of the heel bone - Pain that initially improves with walking but returns and worsens with prolonged activity (walking, running, or standing for extended periods) - Increased pain when walking barefoot or on hard surfaces without cushioning - Worsening with stair climbing — particularly when pushing off the ball of the foot going upstairs - Occasional tightness or stiffness in the arch or calf, particularly in the morning ### Frequently Asked Questions **Q: Will plantar fasciitis go away on its own?** Plantar fasciitis is often described as a "self-limiting" condition, and many mild cases do improve over time. But the key word is time, often 12–18 months without intervention. Without treatment, many patients develop compensatory gait changes that cause knee, hip, or back problems. Early, structured treatment dramatically shortens recovery time and prevents these secondary issues. We strongly recommend evaluation rather than watchful waiting. **Q: I was told I have a bone spur. Is that causing my pain?** Not necessarily. Heel spurs (calcaneal enthesophytes) are present in approximately 50% of patients with plantar fasciitis, but they are also found in up to 15–20% of people with no heel pain at all. The spur is a calcified response to chronic traction at the fascia origin, a consequence of the underlying tendinopathy, not the primary pain generator. Treatment is directed at the fascia and its biomechanical causes, not the spur itself. Surgery to remove the spur is generally not indicated. **Q: Should I get a cortisone shot?** A corticosteroid injection can be very helpful for short-term pain relief when stretching and physical therapy have not provided adequate improvement. However, it is not a cure. It does not address the underlying degenerative pathology. Cortisone injections are best used as a bridge to allow more active rehabilitation, and they should not be repeated more than 1–2 times given the risk of fascia rupture. Patients seeking a more durable solution, or those who have already received one or more cortisone shots without lasting relief, are better candidates for PRP. **Q: What is PRP, and is it right for me?** Platelet-Rich Plasma (PRP) is created by drawing a small sample of your own blood, then spinning it in a centrifuge to concentrate the platelets and the growth factors they contain. When injected into the degenerated plantar fascia tissue, these growth factors actively stimulate healing, new collagen formation, and tissue remodeling. Multiple RCTs confirm that PRP produces more durable pain relief than corticosteroid at 6 and 12 months. PRP is an excellent option for patients with chronic plantar fasciitis (symptoms >3–6 months), those who want to avoid repeated cortisone injections, athletes, and anyone seeking a biological approach to healing. **Q: When is surgery actually necessary?** Surgery is considered only after at least 6–12 months of comprehensive, supervised conservative management (including stretching, orthotics, physical therapy, and at least one injection) has failed to provide adequate relief. This represents a small minority of patients. When it is needed, minimally invasive endoscopic plantar fascia release is safe and effective, with high patient satisfaction rates. Our podiatric surgeons will review all indications with you in detail before any surgical recommendation is made. --- ## Plantar Warts URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/plantar-warts/ Plantar warts are caused primarily by HPV types 1, 2, and 4, strains that infect the superficial layers of the skin (epidermis). HPV enters through small cuts or breaks in the plantar skin, favored by warm, moist environments such as pool decks, locker rooms, and public showers. ### Symptoms - Thickened, rough skin on the sole of the foot, often mistaken for callus - Pain with weight-bearing, especially on weight-bearing surfaces (ball of the foot, heel) - Pinpoint black dots within the lesion (thrombosed capillary loops) - Disrupted skin line pattern within the lesion - Multiple clustered lesions (mosaic pattern) in some patients - Tenderness to lateral pinch (squeezing the sides of the lesion) rather than direct pressure ### Frequently Asked Questions **Q: Are plantar warts contagious?** Yes. HPV can spread through skin-to-skin contact or through contaminated surfaces. Avoiding walking barefoot in public areas and not sharing towels or footwear reduces transmission risk. Autoinoculation (spreading to adjacent skin by picking or shaving the lesion) is the most common route of spread. **Q: Can I treat them at home?** Mild, asymptomatic warts (especially in children) can be treated with over-the-counter salicylic acid preparations. However, lesions that persist beyond 3 months, are painful, spreading, or atypical in appearance should be professionally evaluated. **Q: Will they come back after treatment?** Recurrence is possible after any treatment modality, as local immunity may not eliminate the latent virus entirely. However, clearance rates after surgical excision or laser treatment are high. **Q: How does a doctor treat plantar warts that have not responded to home remedies?** When over-the-counter salicylic acid preparations have not worked, physicians have several effective options. Cryotherapy (freezing with liquid nitrogen) destroys the wart tissue and is one of the most commonly used in-office treatments. Other options include prescription-strength topical agents, cantharidin application, laser treatment, or minor surgical excision for stubborn lesions. At MOS, your foot specialist will assess the size, number, and location of the warts and recommend the treatment approach most likely to achieve complete resolution with the least disruption to your daily activity. **Q: How do I know if my foot lesion is a plantar wart and not something else?** Plantar warts typically appear on the bottom of the foot as thickened, rough-surfaced skin with small black dots (thrombosed capillaries) visible when the surface is pared down. They can be distinguished from calluses by their tendency to disrupt the normal skin lines (dermatoglyphics) that run through the lesion. Corns occur over bony prominences and have a translucent core rather than black dots. Occasionally, a skin lesion on the foot can represent something that requires further evaluation, so any foot lesion that bleeds, changes rapidly, or does not respond to treatment should be assessed by a medical professional. --- ## Post-Traumatic Hip Arthritis URL: https://www.mdorthospecialists.com/conditions/hip/post-traumatic-hip-arthritis/ Acetabular fractures occur from high-energy trauma (motor vehicle accidents, falls from height) or, increasingly, low-energy mechanisms in osteoporotic elderly patients. Even with excellent open reduction and internal fixation (ORIF), the articular cartilage damage sustained at the time of injury initiates chondral breakdown. ### Symptoms - Deep groin pain worsening with weight-bearing and activity - Stiffness and reduced hip range of motion - An antalgic limp - Gradual progression of symptoms over years following the original injury - Occasionally, pain from retained hardware that conflicts with hip mechanics or must be removed ### Frequently Asked Questions **Q: I had my hip fixed years ago and it was doing well. Why is it painful now?** Cartilage damage at the time of the original injury can be silent for years before arthritis becomes symptomatic. This delayed presentation is characteristic of post-traumatic arthritis. **Q: Does my prior hardware need to be removed before hip replacement?** Possibly, depending on its location and interference with cup placement. This is evaluated on CT scan. In some cases, hardware can be left in place; in others, removal is necessary. **Q: Will I need a hip replacement, and how will I know when it's time?** Hip replacement becomes appropriate when pain from post-traumatic arthritis significantly limits your daily activities and quality of life, and when non-surgical measures (such as activity modification, anti-inflammatory medications, assistive devices, and injections) are no longer providing adequate relief. There is no single X-ray finding that makes replacement mandatory; the decision is primarily guided by your symptoms and functional limitations. At MOS we work with you to time surgery based on your goals and overall health, ensuring you get the most out of your new hip. **Q: Is hip replacement after a prior fracture more complicated than a standard hip replacement?** Yes, post-traumatic hip replacement is generally more complex than primary arthritis surgery. Scar tissue from the original injury or prior surgery can distort normal anatomy and increase bleeding risk. Deformity of the femur or acetabulum from the fracture may require specialized implants, bone grafting, or corrective osteotomy. At MOS, pre-operative planning using advanced imaging and custom implant templates is used routinely for these cases to maximize the safety and durability of the reconstruction. **Q: What is the long-term outlook after hip replacement for post-traumatic arthritis?** Modern hip replacements in post-traumatic arthritis patients have good long-term outcomes, with most implants lasting 15 to 20 years or more. However, post-traumatic cases may have slightly higher rates of complications such as infection (due to prior surgery) and loosening (due to altered bone stock) compared to replacement for primary osteoarthritis. Adhering to your rehabilitation program, maintaining a healthy weight, and attending follow-up appointments with your MOS surgeon are the most important steps to protecting the longevity of your implant. --- ## Post-Traumatic Knee Arthritis URL: https://www.mdorthospecialists.com/conditions/knee/post-traumatic-knee-arthritis/ Knee cartilage can be damaged by three injury mechanisms: - Articular fractures: Tibial plateau fractures, distal femur fractures, and patella fractures involving the joint surface disrupt cartilage directly, create step-off deformities, and initiate an inflammatory cascade that accelerates chondral breakdown over years. ### Symptoms - Knee pain with weight-bearing, activity, and prolonged standing - Swelling after activity - Morning stiffness or stiffness after sitting - Crepitus (grinding sensation) in the knee - Decreased range of motion and functional limitation - Giving way in patients with concurrent ligamentous instability ### Frequently Asked Questions **Q: Is knee replacement appropriate for younger patients?** Yes. Age is not an absolute contraindication. For patients in their 40s–50s with truly end-stage arthritis unresponsive to conservative care, arthroplasty significantly improves quality of life. Younger patients should be counseled about implant longevity and potential future revision. **Q: Does my prior hardware need to come out before knee replacement?** It depends. Hardware that conflicts with implant placement must be removed. Some surgeons stage hardware removal and arthroplasty separately; others combine them in one procedure. This is determined case-by-case. **Q: What non-surgical options are available for post-traumatic knee arthritis?** Non-surgical management includes activity modification, weight loss, physical therapy to strengthen the muscles around the knee, anti-inflammatory medications, bracing, and intra-articular injections (corticosteroids or hyaluronic acid). Bracing designed to offload a specific compartment of the knee can be particularly useful when arthritis is localized. These measures can provide meaningful pain relief and delay the need for surgery for months to years. Your MOS team will develop a personalized non-operative plan tailored to your activity level and the distribution of arthritis in your knee. **Q: How soon after a knee injury can arthritis develop?** The timing varies widely depending on the nature of the original injury. Significant cartilage damage at the time of the injury can accelerate arthritic changes that become symptomatic within five to ten years. Meniscus tears and ACL injuries (especially when associated with cartilage damage) are among the most common precursors to post-traumatic knee arthritis. Even injuries treated promptly and appropriately can eventually lead to arthritis, though timely treatment reduces the rate and severity of progression. **Q: Will a knee replacement fix the deformity from my old fracture?** Knee replacement for post-traumatic arthritis can correct most angular deformities (bow-leg or knock-knee alignment) that have developed as a result of the injury or malunion. However, significant bony deformity may require additional steps such as corrective osteotomy performed at the same time as or before replacement. At MOS we use pre-operative X-rays and advanced templating to plan the safest approach to achieving proper alignment, which is critical for the long-term success and durability of your knee replacement. --- ## Posterior Elbow Impingement URL: https://www.mdorthospecialists.com/conditions/elbow/posterior-elbow-impingement/ During the acceleration and follow-through phases of the overhead throw, the elbow rapidly extends from approximately 100° to near full extension, simultaneously under valgus load. This repetitive combination of forced extension and valgus stress causes the posteromedial olecranon tip to impinge against the medial wall of the olecranon fossa. ### Symptoms - Posterior or posteromedial elbow pain during late acceleration and follow-through - Pain specifically with terminal elbow extension — the last 20–30° of extension - Tenderness over the posterior olecranon tip or posteromedial compartment - Decreased throwing velocity and loss of command - Occasional locking or catching (loose bodies) - Extension deficit (loss of full elbow extension from posterior capsular scarring) ### Frequently Asked Questions **Q: Will my elbow get better without surgery?** Many athletes respond well to a structured non-operative program, particularly those with early-stage impingement and no established osteophytes. However, bony osteophytes will not resolve without surgery, and continued high-velocity throwing risks loose body formation and progression. **Q: Can I have arthroscopy and Tommy John at the same time?** In selected patients with concurrent posterior impingement and UCL insufficiency, combined procedures are performed. The surgical plan depends on the relative severity of each problem and the surgeon's assessment. **Q: How quickly can I return to pitching after elbow arthroscopy?** For isolated posterior impingement (without UCL reconstruction), most pitchers return to competitive throwing within 3–4 months of arthroscopic debridement. **Q: What causes posterior elbow impingement in throwers?** In overhead athletes, posterior elbow impingement typically results from the olecranon (the bony tip of the elbow) repeatedly slamming into the olecranon fossa at the back of the humerus during the acceleration and follow-through phases of throwing. Over time, this repetitive impact causes bone spurs (osteophytes) to form at the tip of the olecranon. Valgus overload (the stress placed on the inside of the elbow during throwing) worsens the impingement, which is why UCL insufficiency and posterior impingement often coexist in the same thrower. At MOS, your evaluation will assess the entire elbow to identify all contributing factors. **Q: What does recovery from posterior elbow arthroscopy look like?** After arthroscopic surgery to remove posterior osteophytes and loose bodies, most patients have minimal discomfort and begin gentle elbow range-of-motion exercises within the first few days. Swelling and stiffness typically resolve over 4–6 weeks with physical therapy. Throwers begin an interval throwing program around 6–8 weeks post-operatively and, in straightforward cases, return to competitive pitching at approximately 3–4 months. If the UCL was also addressed at the same time, the return-to-throwing timeline follows the longer Tommy John recovery schedule, which your MOS surgeon will walk you through in detail. --- ## Posterior Labral Tear URL: https://www.mdorthospecialists.com/conditions/shoulder/posterior-labral-tear/ The glenoid labrum is a fibrocartilaginous rim that deepens the relatively flat shoulder socket (glenoid), increases contact area with the humeral head, and anchors the glenohumeral ligaments. While anterior labral tears (Bankart lesions) dominate in the setting of anterior shoulder dislocations, posterior labral tears involve the posterior quadrant of the labrum and produce posterior shoulder instability or pain. ### Symptoms - Deep posterior shoulder pain, often worsened with overhead activities or pushing movements - Pain at the end of a baseball swing (batter's follow-through) - Pain with bench press, push-ups, or blocking movements - A sensation of shoulder slipping or giving way posteriorly - Clicking or clunking with shoulder motion - Pain or discomfort reaching across the body ### Frequently Asked Questions **Q: Is posterior instability as common as anterior?** Anterior instability is far more common (80–95% of shoulder instability cases). Posterior instability accounts for 2–5% of cases but is underdiagnosed because it rarely involves frank dislocation. **Q: Can I keep playing sports without surgery?** Many athletes successfully manage posterior instability with strengthening programs. Surgery is reserved for those with persistent symptomatic instability despite rehabilitation. **Q: What is the difference between a posterior labral tear and a SLAP tear?** A SLAP tear involves the superior (top) labrum at the biceps anchor. A posterior labral tear involves the back portion of the labrum. They can coexist and are both visible on MRI arthrogram. **Q: Why are posterior labral tears sometimes missed?** They may cause pain rather than a dramatic dislocation, and standard imaging can be subtle. A careful history, posterior-instability examination, and appropriately selected MRI or MRI arthrogram help connect the imaging finding to the symptoms. **Q: When is surgery considered?** Surgery may be considered when persistent pain or instability limits daily activity or sport despite an appropriate rehabilitation program, and the examination and imaging identify a repairable posterior labral injury. The plan is individualized for associated bone loss, capsular laxity, and sport demands. --- ## Posterior Tibial Tendon Dysfunction / Adult Acquired Flatfoot URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/posterior-tibial-tendon-dysfunction-adult-acquired-flatfoot/ Posterior tibial tendon dysfunction occurs when the tendon supporting the arch of the foot weakens or tears, causing the arch to gradually collapse, known as adult-acquired flatfoot. Symptoms include pain and swelling along the inner ankle, a flattening foot, and difficulty standing on the toes. ### Symptoms - Medial ankle and arch pain along the course of the posterior tibial tendon (posterior to the medial malleolus) - Progressive arch collapse and hindfoot valgus ("flat foot getting worse") - Lateral impingement pain in later stages (fibula contacting calcaneus as hindfoot drifts further valgus) - Difficulty walking on uneven surfaces; early fatigue - In Stage III–IV: reduced ankle range of motion, lateral ankle and sinus tarsi pain, potential peroneal tendon pain ### Frequently Asked Questions **Q: Can a flatfoot "become" AAFD, or are they different?** Congenital or lifelong flatfoot is usually asymptomatic and does not represent PTT dysfunction. AAFD is acquired. Patients describe their arch "falling" over time, often with a history of medial ankle pain. The distinction matters for treatment. **Q: Will orthotics cure my flatfoot?** Orthotics cannot restore tendon or ligament integrity. They support the foot's remaining structure and relieve symptoms but are not curative. They are excellent long-term solutions for patients managing early-stage disease or those who are not surgical candidates. **Q: Can AAFD lead to ankle arthritis?** Yes. Chronic hindfoot valgus shifts the mechanical axis of the limb medially, concentrating load on the medial ankle compartment, eventually leading to Stage IV disease with deltoid insufficiency and tibiotalar arthritis. **Q: Do I need the whole fusion or is there a less invasive option?** Rigid (Stage III) deformity requires arthrodesis. Flexible (Stage II) deformity can be managed with the tendon transfer and osteotomy combination described above, preserving hindfoot motion. Stage selection is critical. An operation designed for Stage II will fail in a Stage III foot. **Q: How long is recovery after flatfoot reconstruction surgery?** Recovery after surgical correction of adult acquired flatfoot deformity is one of the longer orthopaedic rehabilitation journeys, typically nine to twelve months to full function. The first six weeks require non-weight-bearing to allow bone cuts, osteotomies, and tendon transfers to heal. Gradual weight-bearing in a boot follows, with formal physical therapy beginning around eight to twelve weeks. Your MOS foot and ankle surgeon will monitor bone healing with serial X-rays and guide your progression; swelling in the foot and ankle can persist for up to a year, but most patients achieve significant, lasting improvement in alignment, pain, and function. --- ## Proximal Hamstring Avulsion / Injury URL: https://www.mdorthospecialists.com/conditions/hip/proximal-hamstring-avulsion-injury/ The hamstrings are a group of three muscles (biceps femoris, semitendinosus, and semimembranosus) that share a common origin at the ischial tuberosity, the bony prominence at the base of the pelvis. They are the primary knee flexors and hip extensors, critical for running, jumping, and climbing. ### Symptoms - Sudden, severe pain in the posterior thigh and ischial region at the moment of injury - Audible or palpable "pop" - Significant bruising tracking down the posterior thigh within 24–48 hours - Inability to bear weight or run - Deep aching pain in the ischial region, worst when sitting on hard surfaces (the ischium bears weight when seated) - Pain during or after running — particularly uphill running and sprinting - Hamstring tightness that does not resolve with stretching - Pain with resisted knee flexion or hip extension - Palpable gap or fullness at the ischial tuberosity in complete avulsions - Tenderness at the ischial origin on direct palpation - Weakness of resisted knee flexion compared to the contralateral side - Positive "bent-knee stretch" test reproduces ischial pain ### Frequently Asked Questions **Q: I felt a pop in my upper thigh during a fall. What should I do?** Seek orthopedic evaluation as soon as possible, ideally within the first 1–2 weeks. If this is a complete proximal hamstring avulsion, early surgical repair provides significantly better outcomes than delayed repair. An MRI will clarify the diagnosis. **Q: Can I function with a complete avulsion without surgery?** Many patients compensate to some degree, particularly for activities of daily living. However, most active individuals experience persistent weakness, sitting pain, and inability to run or sprint at prior levels. For active patients under 70, surgical repair is almost always recommended. **Q: Will the bruising go away?** Yes. The dramatic posterior thigh bruising from a complete avulsion is caused by bleeding from the torn tendon and muscle belly and typically resolves over 2–3 weeks. Its presence does not change management. MRI is still needed to characterize the injury. **Q: What is "sciatic nerve entrapment" in the context of proximal hamstring injury?** When a retracted tendon mass scars to the sciatic nerve, patients may develop shooting pain, numbness, or tingling down the leg. Surgical repair must include careful sciatic nerve identification and neurolysis to address this complication. **Q: How long does recovery take after surgical repair of a proximal hamstring avulsion?** Surgical repair of a complete proximal hamstring avulsion is most successful when performed within four to six weeks of injury, before scar tissue and nerve entrapment complicate the repair. After surgery, patients are typically non-weight-bearing or toe-touch weight-bearing for four to six weeks with the hip in a protected position to minimize tension on the repair. A structured physical therapy program rebuilds hamstring strength progressively over six to nine months, with return to running around four to five months and full sport by nine to twelve months. Your MOS surgeon will monitor the repair and ensure you meet strength symmetry benchmarks before clearing you for competitive activity. --- ## Proximal Humerus Fracture URL: https://www.mdorthospecialists.com/conditions/shoulder/proximal-humerus-fracture/ The proximal humerus comprises the humeral head (the ball of the shoulder joint) and two bony prominences called tuberosities: the greater tuberosity (attachment of supraspinatus, infraspinatus, and teres minor) and the lesser tuberosity (subscapularis attachment). These structures articulate with the glenoid and are separated from the humeral shaft by the surgical neck. ### Symptoms - Acute pain and swelling at the shoulder after a fall or trauma - Ecchymosis spreading to the arm, chest wall, and even flank over 24–48 hours - Marked limitation of shoulder motion - Point tenderness over the proximal humerus - Possible weakness of deltoid contraction (axillary nerve injury) - Paresthesias or arm pallor if neurovascular structures are involved ### Frequently Asked Questions **Q: Does everyone with a broken shoulder need surgery?** No. More than 80% of proximal humerus fractures are treated successfully without surgery, using a sling and physical therapy. Surgery is reserved for displaced fractures in appropriate candidates. **Q: What is the risk of avascular necrosis (bone death)?** AVN occurs when the fracture disrupts the blood supply to the humeral head. It is most common with 4-part fractures and head-splitting injuries. In the elderly, reverse shoulder replacement avoids this risk entirely by replacing the humeral head. **Q: Why might my doctor recommend a reverse shoulder replacement instead of a traditional repair?** In elderly patients with osteoporotic bone and complex fracture patterns, RSA provides more reliable functional recovery than attempting to fix the fragments with plates and screws, which may fail in poor bone quality. **Q: How long does recovery from a broken shoulder take?** Recovery from a proximal humerus fracture depends on fracture severity and whether surgery was required. Non-operative fractures typically require 4–6 weeks in a sling followed by physical therapy, with most patients regaining functional motion by 3–4 months and continuing to improve for up to a year. Surgically treated fractures (whether with a plate, nails, or shoulder replacement) follow a similar or slightly longer timeline, and full strength and motion recovery can take 6–12 months. At MOS, your surgeon will set realistic expectations based on your fracture pattern, age, and bone quality. **Q: What are the signs that my broken shoulder is healing properly?** Healing is monitored through a combination of decreasing pain, improving range of motion, and serial X-rays showing progressive bone bridging at the fracture site. Most patients notice meaningful pain reduction within the first 4–6 weeks, and X-ray evidence of healing typically appears at 6–8 weeks in younger patients, though it may take longer in older adults or those with osteoporosis. One important warning sign to watch for is persistent severe pain or sudden loss of shoulder movement weeks after injury, which could indicate avascular necrosis (loss of blood supply to the humeral head). Your MOS care team will follow up with you regularly to ensure your recovery is progressing on track. --- ## Proximal Humerus Stress Fracture URL: https://www.mdorthospecialists.com/conditions/shoulder/proximal-humerus-stress-fracture/ A proximal humerus stress fracture is a small fatigue crack near the top of the upper arm bone, caused by repetitive overhead loading rather than a single injury. It is most common in throwing athletes and weightlifters, producing activity-related shoulder or upper-arm pain that eases with rest. ### Symptoms - Gradual onset of proximal or lateral shoulder pain in an overhead athlete - Pain specifically with throwing, especially late cocking and acceleration - Decreased throwing velocity and accuracy - Tenderness to palpation over the proximal humerus - No history of acute traumatic event (distinguishes from acute fracture) - Pain may be present at rest in severe or advanced cases ### Frequently Asked Questions **Q: Can I keep throwing if I push through the pain?** No. Continuing to throw with a stress fracture risks progression to a complete fracture, which would require surgery and a substantially longer recovery. Rest is not optional. **Q: How will we know it's healed?** Healing is confirmed by the absence of pain on clinical examination and resolution or stabilization of imaging findings. We use MRI and serial examination to confirm readiness before advancing the return-to-throw protocol. **Q: Is this the same as Little Leaguer's Shoulder?** They are related conditions affecting the same region but in different age groups. Little Leaguer's Shoulder affects the open growth plate in adolescents; this stress fracture occurs through metaphyseal/diaphyseal bone in mature athletes with fused growth plates. **Q: How long will I need to stop throwing because of a proximal humerus stress fracture?** Complete rest from throwing is typically required for 6–12 weeks, depending on the severity of the stress reaction and whether there is visible fracture on imaging. Healing is confirmed by follow-up MRI or X-ray showing resolution of the stress response before any throwing is initiated. A supervised interval throwing program then begins gradually, and most athletes reach full competitive throwing at 4–6 months from diagnosis. At MOS, we map out a precise return-to-throw progression and monitor your response at each stage to ensure the growth plate has fully recovered. **Q: Are stress fractures of the shoulder common in young pitchers?** Proximal humerus stress fractures (Little Leaguer's Shoulder) are not rare in competitive youth pitchers, particularly those who throw year-round across multiple teams without adequate rest. The open growth plate of the upper humerus in adolescents is mechanically weaker than the surrounding bone and tendons, making it the weak link under the repetitive rotational forces of pitching. Surveys of high-level youth pitchers have identified significant rates of growth plate stress changes in those who exceed recommended pitch count and rest guidelines. This is why pitch count rules, mandatory rest days, and off-season breaks are so important. These are guidelines that your MOS team will reinforce as part of your child's care. --- ## Quadriceps Tendon Rupture URL: https://www.mdorthospecialists.com/conditions/knee/quadriceps-tendon-rupture/ The quadriceps tendon is the conjoined tendon of the four quadriceps muscle heads (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius) inserting onto the superior pole of the patella. Together with the patellar tendon below, it forms the extensor mechanism of the knee. ### Symptoms - Sudden sharp pain above the kneecap at time of injury - A palpable "pop" or sense of something tearing - Inability to perform a straight-leg raise — the cardinal sign of complete rupture - Palpable defect superior to the patella — a soft gap in the normally taut tendon felt above the upper edge of the patella - Patella baja (low-riding patella) — the patella migrates distally without its superior tether; visible on lateral X-ray - Rapid swelling and ecchymosis over the anterior knee and distal thigh - Difficulty or inability to bear weight ### Frequently Asked Questions **Q: How is quadriceps tendon rupture different from patellar tendon rupture?** Quadriceps tendon rupture occurs above the kneecap (at the superior patellar pole), the patella rides low (baja), and it predominantly affects patients over 40 with systemic conditions. Patellar tendon rupture occurs below the kneecap, the patella rides high (alta), and it more commonly affects younger athletes under 40. **Q: Why is this injury frequently missed in emergency rooms?** The defect above the patella can be masked by hematoma and swelling, and patients often cannot reliably report the mechanism. Without a deliberate straight-leg raise test and lateral X-ray assessment for patella baja, the diagnosis is easily attributed to a contusion or strain. **Q: Can I return to normal activity after repair?** The majority of patients who undergo timely primary repair return to pre-injury function. Published series report > 80% return to previous activity level, though patients with systemic comorbidities and chronic tears have more variable outcomes. **Q: Should I stop fluoroquinolone antibiotics if I have tendon pain?** Yes. If you are taking a fluoroquinolone antibiotic and develop new tendon pain, contact your prescribing physician immediately. Fluoroquinolone-associated tendinopathy and rupture are a known class effect, and the antibiotic should typically be discontinued and an alternative prescribed. **Q: How long does recovery take after quadriceps tendon repair, and when can I return to sport?** Recovery after quadriceps tendon repair follows a structured timeline of nine to twelve months before return to sport. The repaired tendon is protected in a locked brace for the first four to six weeks, with knee flexion gradually restored thereafter to avoid overstretching the healing tissue. Quadriceps strengthening is the cornerstone of rehabilitation and often requires dedicated physical therapy for six or more months. Your MOS surgeon will use a combination of clinical assessment and strength testing to determine when the repair is strong enough for high-demand activities such as running, jumping, and sport-specific training. --- ## Radial Tunnel Syndrome URL: https://www.mdorthospecialists.com/conditions/elbow/radial-tunnel-syndrome/ Radial tunnel syndrome is compression of the posterior interosseous nerve (a branch of the radial nerve) as it passes through the radial tunnel near the outer elbow. It causes deep, aching pain in the forearm without the weakness or numbness of true nerve palsy, and is frequently mistaken for lateral epicondylitis (tennis elbow). ### Symptoms - Aching pain in the dorsal proximal forearm, typically worse with activity - Tenderness 4–5 cm distal to the lateral epicondyle (over the radial tunnel), not at the lateral epicondyle itself - Pain worsened by resisted forearm supination and by resisted extension of the middle finger - Absence of significant grip weakness (distinguishes from PIN palsy) - No sensory changes (the PIN is a motor branch) - Symptoms may worsen with sustained elbow extension and forearm pronation ### Frequently Asked Questions **Q: Why was I told I have tennis elbow when it's really radial tunnel?** The two conditions produce overlapping lateral arm/forearm pain. The key differentiator is tenderness location: at the epicondyle (tennis elbow) versus 4–5 cm more distal (radial tunnel). Both can coexist. **Q: Will I lose the ability to use my fingers?** Radial tunnel syndrome is a pain syndrome without motor loss. True PIN palsy (with finger/wrist drop) is a separate, more serious diagnosis that requires urgent evaluation. **Q: Is surgery often needed?** No. Most patients improve with conservative management. Surgery is reserved for those who remain symptomatic after a thorough non-operative trial. **Q: How is radial tunnel syndrome treated without surgery?** Non-operative treatment focuses on reducing nerve compression and allowing inflammation to settle. This includes activity modification to avoid repetitive forearm rotation and elbow extension, anti-inflammatory medications, and a forearm or elbow splint to rest the area. Physical therapy addresses nerve mobilization (neurodynamic techniques) and stretching of the structures at the radial tunnel. Corticosteroid injections can be helpful diagnostically and therapeutically. Most patients with true radial tunnel syndrome who commit to conservative management for 3–6 months experience meaningful improvement without surgery. **Q: What does recovery from radial tunnel surgery look like?** After surgical decompression of the radial nerve at the radial tunnel, patients typically wear a soft dressing for 1–2 weeks and can begin gentle elbow motion shortly after the procedure. Return to light desk work is possible within 2–4 weeks, while return to heavier manual labor or repetitive forearm use usually takes 6–12 weeks. Nerve recovery is gradual. If nerve compression was longstanding, complete resolution of pain or weakness may take 3–6 months or longer. Your MOS surgeon will guide your rehabilitation and set realistic expectations based on how long symptoms were present before decompression. --- ## Revision Total Joint Arthroplasty URL: https://www.mdorthospecialists.com/conditions/hip/revision-total-joint-arthroplasty/ Revision surgery involves the removal of one or more components of a failed joint replacement and reconstruction with new implants. Depending on the mode of failure, revision may involve replacing all components (full revision), exchanging select components (e.g., polyethylene liner only, or femoral head and liner), or managing complex bone defects with augments, cones, sleeves, or structural allograft. ### Symptoms - Loosening: Pain with weight-bearing, often after a pain-free interval of years; thigh pain (femoral loosening) or groin/buttock pain (acetabular loosening) - Infection: New or persistent pain; wound drainage; fever; erythema; pain that is constant and not relieved by rest - Instability (hip): Recurrent dislocation events; sensation of the hip "popping out" - Instability (knee): Giving-way, buckling, difficulty going down stairs - Periprosthetic fracture: Acute pain after a fall or low-energy event - Stiffness: Profound difficulty bending or straightening the knee ### Frequently Asked Questions **Q: Is revision surgery more dangerous than my original joint replacement?** Yes. Revision surgery carries higher rates of complications including infection, blood loss, nerve injury, instability, and implant failure than primary surgery. This is why the decision to revise is made carefully and the diagnosis confirmed thoroughly before proceeding. **Q: Will revision surgery give me the same result as my original replacement?** Outcomes are generally good but not as predictable as primary surgery. Most patients experience significant pain relief and functional improvement, but recovery is longer and the long-term durability of revision implants is somewhat lower. **Q: How do you know whether I need revision surgery?** Not all failed joint replacements require surgery. After a thorough evaluation (including labs, imaging, and aspiration), we determine the specific cause of failure. Some causes respond to non-surgical measures; structural failure of components requires surgery. **Q: Do I need to go to a specialized center for revision surgery?** Revision arthroplasty performed at high-volume centers by fellowship-trained Adult Reconstruction surgeons has consistently better outcomes than revision performed by lower-volume surgeons. MOS offers this expertise locally in the greater Maryland area. **Q: How long does recovery from revision joint replacement surgery take compared to my original replacement?** Recovery from revision total joint replacement is typically longer and more demanding than primary replacement because more bone and soft tissue are involved, and the surrounding muscles may have weakened from the original failed implant. Most patients see substantial improvement in the first three months, but full recovery (including optimal strength and function) can take six to twelve months or more. Inpatient rehabilitation or a skilled nursing facility stay is more common after revision surgery than after primary replacement. Your MOS revision surgeon will set realistic milestones and coordinate closely with physical therapists to help you achieve the best possible outcome. --- ## Rheumatoid Arthritis — Hip URL: https://www.mdorthospecialists.com/conditions/hip/rheumatoid-arthritis-hip/ In RA, the hip synovium is attacked by immune-mediated inflammation, releasing enzymes that destroy cartilage uniformly across the joint (axial joint-space narrowing is characteristic, in contrast to the superior narrowing of primary OA). The subchondral bone becomes osteoporotic and softens. ### Symptoms - Groin pain with weight-bearing and at rest - Stiffness that is often bilateral and accompanied by systemic RA symptoms (fatigue, morning stiffness in multiple joints) - Progressive limitation of hip range of motion — particularly abduction and internal rotation - Antalgic gait - In protrusio, the hip may feel "tight" and profoundly restricted even early in the disease course ### Frequently Asked Questions **Q: Is RA hip disease different from RA knee disease?** Yes. The hip's ball-and-socket architecture means RA produces uniform axial narrowing and is more prone to protrusio deformity, whereas RA knees develop pancompartmental arthritis with valgus deformity. Both require careful pre-surgical planning. **Q: Will my RA medications cause wound problems after surgery?** Biologic agents are held pre-operatively to minimize infection risk. Conventional DMARDs like methotrexate are generally continued. Your care team will provide specific medication instructions. **Q: When should I consider hip replacement for rheumatoid arthritis?** Hip replacement for rheumatoid arthritis is considered when persistent hip pain and functional limitations significantly affect your quality of life despite optimized medical management of your RA. Because RA patients are often younger and more systemically ill than typical osteoarthritis patients, the decision involves close collaboration between your MOS surgeon and your rheumatologist. Hip replacement in RA reliably reduces pain and restores mobility, and outcomes are generally excellent when disease activity is well controlled at the time of surgery. **Q: Does rheumatoid arthritis affect how a hip replacement is performed?** Yes. RA can cause generalized bone loss (osteoporosis), soft-tissue fragility, and joint deformity that makes surgery more technically demanding. The femoral bone may be weakened, requiring careful implant sizing and sometimes bone grafting. Cervical spine involvement in RA can also affect anesthesia (specifically positioning during surgery), so your anesthesia team will review cervical spine X-rays before the procedure. Your MOS surgeon coordinates with your full medical team to ensure every aspect of the procedure is safely tailored to your RA. **Q: What is the long-term outlook after hip replacement for rheumatoid arthritis?** Hip replacement for RA provides excellent long-term pain relief and functional improvement for the vast majority of patients. Modern implant survival rates at 15 to 20 years are comparable to those for osteoarthritis when RA is well controlled. Continued management of your RA with your rheumatologist after surgery remains important, as active systemic disease can increase the risk of infection and affect bone quality over time. At MOS we coordinate long-term follow-up to protect both your implant and your overall joint health. --- ## Rheumatoid Arthritis — Knee URL: https://www.mdorthospecialists.com/conditions/knee/rheumatoid-arthritis-knee/ In RA, the synovial membrane lining the knee joint becomes chronically inflamed (synovitis). Activated synoviocytes and immune cells release proteolytic enzymes (MMPs) and cytokines that degrade cartilage and erode the adjacent subchondral bone. Synovectomy and knee replacement used to be the only good treatments. Most patients are managed medically now. ### Symptoms - Bilateral knee swelling, warmth, and pain — often symmetric - Morning stiffness lasting more than one hour (a hallmark distinguishing RA from OA) - Fatigue and systemic symptoms (weight loss, low-grade fever) - Progressive loss of range of motion - Deformity: valgus (knock-knee) alignment is more common in RA than varus - Soft tissue rheumatoid nodules in some patients ### Frequently Asked Questions **Q: Do I need to stop my RA medications before surgery?** Yes. Most biologic agents are held for approximately one dosing interval before elective joint replacement to reduce infection risk. Your rheumatologist and orthopedic surgeon coordinate this plan. DMARDs such as methotrexate may be continued or held depending on surgeon preference and patient disease control. **Q: Can both knees be done at the same time?** Simultaneous bilateral TKA carries higher risk in RA patients, who often have cardiac and pulmonary comorbidities. Sequential surgery, typically staged 6–12 weeks apart, is more common. **Q: How is knee replacement for rheumatoid arthritis different from replacement for osteoarthritis?** Knee replacement for RA is technically similar to replacement for osteoarthritis, but several RA-specific factors influence planning and recovery. RA patients tend to be younger and may have more bone loss, deformity, and soft-tissue laxity at the time of surgery. A more constrained implant design may be needed to restore stability in knees with significant ligament involvement. Coordination with your rheumatologist to manage medications and disease activity before and after surgery is an essential part of the process at MOS. **Q: Will my knee replacement relieve all of my RA-related knee symptoms?** Knee replacement very effectively addresses pain and stiffness caused by joint destruction, and most RA patients report dramatic improvement in knee function after surgery. However, it does not treat the systemic inflammatory disease itself. RA affecting other joints, tendons, and soft tissues around the knee will continue to be managed by your rheumatologist. In some cases, soft-tissue inflammation outside the replaced joint can cause residual symptoms that require ongoing medical management. **Q: How long does recovery take after knee replacement for rheumatoid arthritis?** Most patients with RA are walking with assistance on the day of surgery and return home within one to two days. Active physical therapy typically begins immediately and continues for six to twelve weeks. Functional recovery (including walking without a device and returning to daily activities) is usually achieved within six to twelve weeks, though maximum strength and endurance may take up to six months. Patients with significant pre-operative weakness or deformity may take longer, and your MOS care team will set realistic, personalized goals for your recovery. --- ## Rotator Cuff Tears URL: https://www.mdorthospecialists.com/conditions/shoulder/rotator-cuff-tear/ The rotator cuff is a group of four muscles and their tendons (the supraspinatus, infraspinatus, teres minor, and subscapularis) that surround the shoulder joint, hold the humeral head centered in the glenoid socket, and power the arm through rotation and elevation. ### Symptoms - Shoulder pain that is deep, aching, and located over the outer arm or deltoid — often worse at night and with overhead activity - Weakness with lifting the arm, reaching overhead, or rotating the shoulder outward - A painful arc of motion — pain that is worst between approximately 60° and 120° of shoulder elevation - Difficulty with specific tasks such as reaching behind the back, brushing hair, or putting on a coat - A sudden, sharp pain with an audible pop in the case of an acute traumatic tear - Sleep disturbance — inability to lie on the affected shoulder is an extremely common complaint - Clicking or catching sensations with shoulder movement ### Frequently Asked Questions **Q: Do I need surgery for a rotator cuff tear?** Not necessarily. It depends on the tear type, size, your age, and your functional goals. Partial tears and degenerative full-thickness tears in older, lower-demand patients often respond well to physical therapy and injections. However, acute traumatic tears, tears in younger active patients, and tears that have failed structured non-operative treatment are generally best treated surgically. We will give you an honest recommendation based on your specific tear and your goals. **Q: Can a rotator cuff tear heal on its own?** Partial tears have some capacity for symptom improvement with conservative treatment, though structural healing is unusual. Full-thickness tears do not heal spontaneously. Without treatment, many tears (particularly those involving more than 50% of tendon thickness) will progress in size over time, and muscle quality will deteriorate, potentially making future repair more difficult or less successful. **Q: How long does recovery take after rotator cuff surgery?** The sling is typically worn for 4–6 weeks. Most patients recover functional use of the arm by 3–4 months and can return to light activity. Full return to overhead sport or heavy manual work takes 6–12 months depending on tear size. Overhead athletes should anticipate the longer end of this range. **Q: What is the difference between a partial and a full-thickness tear?** A partial tear does not go all the way through the tendon. It involves only a portion of the tendon's depth. A full-thickness tear extends completely through the tendon, creating an opening between the joint and the bursa above. Full-thickness tears are generally more symptomatic and more likely to require surgical repair, particularly in active patients. **Q: Will my rotator cuff tear get worse if I don't have surgery?** Many rotator cuff tears, especially degenerative ones, do progress in size over time, and muscle quality can deteriorate with prolonged denervation and disuse. For some patients this is clinically irrelevant. For others, particularly those with larger tears or higher functional demands, delay can make future repair more technically challenging. We will monitor your tear and advise you honestly if the window for optimal surgical outcomes is closing. **Q: What is the success rate of rotator cuff surgery?** Arthroscopic rotator cuff repair has excellent clinical outcomes, with the large majority of patients reporting significant improvement in pain and function. Structural re-tear rates vary by tear size. Smaller tears heal at rates exceeding 90%, while large and massive tears carry higher re-tear rates. Importantly, clinical outcomes (pain relief and functional improvement) remain good even in patients with structural re-tears, though strength recovery may be incomplete. --- ## SLAP Tear URL: https://www.mdorthospecialists.com/conditions/shoulder/slap-tear/ SLAP stands for Superior Labrum Anterior to Posterior. The superior labrum is the fibrocartilaginous rim at the top of the glenoid (shoulder socket) that deepens the joint cavity, provides stability, and serves as the anchor point for the long head of the biceps tendon. ### Symptoms - Deep anterior or posterior shoulder pain, often described as "inside" the joint - Painful clicking, popping, or catching with overhead motion - Pain at the extremes of shoulder rotation — especially the late cocking position in throwers (arm back, externally rotated) - Loss of throwing velocity or accuracy - A sense of shoulder instability or "dead arm" in athletes - Pain with bench pressing or push-ups (posterior type II) ### Frequently Asked Questions **Q: Can a SLAP tear heal without surgery?** Type I SLAP tears (fraying only) and many Type II tears in non-overhead athletes can be managed successfully with PT. Surgery is reserved for those with persistent symptoms despite adequate conservative treatment. **Q: Should I have a SLAP repair or a biceps tenodesis?** This depends heavily on age and activity level. For young competitive overhead athletes (especially pitchers under 35), SLAP repair is often preferred. For patients over 35 or those who are not competitive overhead athletes, biceps tenodesis offers reliable pain relief with a faster recovery and lower re-operation rate. **Q: How long until I can pitch again after SLAP repair?** Most pitchers return to competitive throwing at 9–12 months. Return at 6 months is possible for position players or non-pitching overhead athletes. --- ## Sacroiliac Joint Dysfunction URL: https://www.mdorthospecialists.com/conditions/spine/sacroiliac-joint-dysfunction/ Sacroiliac joint dysfunction is pain arising from the joint that connects the base of the spine (the sacrum) to the pelvis. Too much or too little motion, or inflammation, can irritate the joint. Symptoms include lower back and buttock pain that may radiate into the hip or groin. ### Symptoms - Pain in the low back, buttock, or posterior thigh — typically one-sided - Fortin finger test: The patient can point with one finger to the area of maximal pain, located within 1 cm below and medial to the PSIS — this is a positive Fortin finger sign, one of the most reliable clinical indicators of SI joint origin - Pain that may radiate into the groin, posterior thigh, or below the knee (though distal referral is less common than with lumbar disc herniation) - Aggravation with single-leg stance, prolonged sitting, getting in/out of a car, rolling over in bed, and climbing stairs - Pain that is often worse on one side, particularly in patients with structural asymmetry ### Frequently Asked Questions **Q: How do I know if my low back pain is from the SI joint and not the disc?** SI joint pain is typically well-localized to the PSIS region and does not follow a dermatomal pattern. Lumbar disc herniation more often produces leg pain below the knee in a specific nerve root distribution. Your MOS physician uses a structured clinical examination and, when needed, a diagnostic injection to make this distinction definitively. **Q: What is lateral branch RFA and does it hurt?** Lateral branch RFA uses radiofrequency energy delivered through a needle to thermally ablate the small nerve branches that carry pain from the SI joint. The procedure is performed under local anesthesia with light sedation if desired. Most patients experience soreness for a few days followed by progressive pain relief over 2–4 weeks. **Q: Can SI joint dysfunction occur during pregnancy?** Yes. Peripartum SI joint pain is common due to the ligamentous laxity effects of relaxin. A sacroiliac belt and pelvic floor PT are effective first-line treatments. Symptoms typically improve after delivery. **Q: Can an injection make my diagnosis clear?** Yes. A diagnostic SI joint injection is the gold standard. If you receive ≥75% pain relief from a local anesthetic injection into the joint, the SI joint is confirmed as the primary pain source. **Q: How long does SI joint RFA last?** Most patients experience 6–12 months of meaningful relief. The procedure can be repeated when the nerves regenerate and pain returns. --- ## Scaphoid Fracture URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/scaphoid-fracture/ The scaphoid is a small, boat-shaped bone located on the thumb side of the wrist (radial side), forming a critical link between the proximal and distal rows of the carpus. It spans both rows and bears significant load during wrist motion, making it vulnerable to fracture from axial loading, particularly during a fall on an outstretched hand (FOOSH). ### Symptoms - Wrist pain on the thumb side following a fall on an outstretched hand - Anatomical snuffbox tenderness: Pain when pressing in the triangular depression between the extensor pollicis longus and extensor pollicis brevis/APL tendons on the back of the thumb-side wrist — a highly sensitive clinical sign for scaphoid fracture - Scaphoid tubercle tenderness: Tenderness on the volar (palm) side of the wrist at the scaphoid tubercle - Pain with axial compression of the thumb - Wrist swelling, often minimal - Reduced wrist range of motion ### Frequently Asked Questions **Q: The ER said I have a wrist sprain. Could it really be a fracture?** Yes. Up to 20–30% of scaphoid fractures are X-ray negative initially. If you have snuffbox tenderness after a FOOSH, you should be evaluated further with MRI or repeat imaging. You should not simply be reassured based on a negative initial X-ray. **Q: Why is the proximal pole so serious?** The proximal pole receives blood only from vessels that enter distally. A fracture through the waist or proximal pole can interrupt this supply, potentially killing the bone (AVN). This is why proximal pole fractures often require surgery even when non-displaced. **Q: Is the screw permanent?** Yes. The headless compression screw is left in place permanently in most cases. Screw removal is rarely needed. **Q: What is SNAC wrist?** SNAC (scaphoid nonunion advanced collapse) is the arthritis pattern that develops in the wrist when a scaphoid fracture fails to heal. It can require partial or total wrist fusion in advanced stages, highlighting the importance of early diagnosis and treatment. **Q: How long will my wrist be in a cast, and when can I return to sport after a scaphoid fracture?** Non-displaced scaphoid waist fractures treated in a cast require immobilization for eight to twelve weeks, with healing confirmed by CT scan before the cast is removed. Surgical fixation with a headless compression screw significantly reduces healing time, and many active patients choose surgery to return to sport in as little as six to eight weeks. Proximal pole fractures take longer to heal regardless of treatment due to the tenuous blood supply in that region. Your MOS surgeon will discuss the risks and benefits of operative versus non-operative treatment based on the fracture location, your activity level, and your timeline for returning to work or sport. --- ## Sciatica URL: https://www.mdorthospecialists.com/conditions/spine/sciatica/ The sciatic nerve is the largest nerve in the human body, formed by the convergence of nerve roots from L4, L5, S1, S2, and S3. It is commonly irritated by disc pathology and facet joint arthritis. Symptoms are pain and numbness radiating down the leg. ### Symptoms - L4 root (L3–L4 disc): Pain along the anterior thigh and medial leg; sensory loss over the medial shin and foot; weakness of knee extension and dorsiflexion; reduced patellar reflex. - L5 root (L4–L5 disc): Pain along the lateral leg and dorsum of the foot; sensory loss over the lateral calf and great toe; weakness of extensor hallucis longus and ankle dorsiflexion; medial hamstring reflex may be reduced. - S1 root (L5–S1 disc): Pain along the posterior thigh, calf, and heel; sensory loss over the lateral foot and little toe; weakness of plantarflexion and toe push-off; reduced or absent Achilles reflex. - Bilateral leg symptoms or progressive weakness in both legs - Bowel or bladder dysfunction (retention, incontinence) — possible cauda equina syndrome - Saddle anesthesia (numbness in the perineum) - Fever with back pain (infection) - History of malignancy with new back/leg pain ### Frequently Asked Questions **Q: How do I know if my sciatica is serious?** Most sciatica is not a surgical emergency. The warning signs that require urgent evaluation are: bowel or bladder dysfunction, bilateral leg weakness, saddle anesthesia, or rapidly progressing neurological deficit. **Q: Can sciatica go away on its own?** Yes — disc herniations frequently resorb over time, and the associated radicular symptoms resolve with them. Non-operative treatment accelerates this process. **Q: Is an epidural injection the same as an epidural for childbirth?** No. A lumbar epidural steroid injection for sciatica uses fluoroscopic guidance to deliver a small amount of anti-inflammatory corticosteroid to a targeted area around the nerve root — not the large-volume local anesthetic used in obstetric epidurals. **Q: How long does an epidural injection take to work?** Most patients notice improvement within 3–7 days of injection, with maximal benefit over 2–6 weeks. Relief duration varies from weeks to months. **Q: Can I exercise with sciatica?** Yes, within your pain tolerance. Walking, swimming, and PT exercises are generally encouraged. Avoid heavy lifting, prolonged sitting, and activities that reproduce strong leg symptoms during the acute phase. --- ## Shoulder Impingement / Rotator Cuff Tendinopathy URL: https://www.mdorthospecialists.com/conditions/shoulder/shoulder-impingement-rotator-cuff-tendinopathy/ Shoulder impingement occurs when the rotator cuff tendons (most often the supraspinatus) are compressed between the humeral head and the undersurface of the acromion or the coracoacromial arch during shoulder elevation. This mechanical pinching creates repetitive microtrauma and inflammation within the subacromial space, leading to the spectrum of pathology collectively termed subacromial impingement syndrome or rotator cuff tendinopathy. ### Symptoms - Anterior or lateral shoulder pain, often radiating to the deltoid insertion - A painful arc between 60° and 120° of abduction - Pain with overhead activities, reaching behind the back, or sleeping on the affected side - Weakness or fatigue with sustained overhead use - Gradual onset in most cases; occasionally acute exacerbation ### Frequently Asked Questions **Q: Can shoulder impingement go away on its own?** Mild impingement can improve with activity modification and home exercises, but formal PT is more reliable and faster. Most patients avoid surgery with proper conservative care. **Q: Is impingement the same as a rotator cuff tear?** No. Impingement refers to mechanical compression of intact but inflamed tendons. A tear involves actual disruption of tendon fibers. However, chronic untreated impingement can progress to tearing over time. **Q: How many injections can I receive?** We typically recommend no more than two to three corticosteroid injections per shoulder per year. Excessive corticosteroid use may weaken tendon tissue. **Q: Will I need surgery?** Fewer than 10–15% of patients with impingement ultimately require surgical intervention. Surgery is reserved for those who fail at least 4–6 months of structured conservative care. **Q: What does physical therapy for shoulder impingement involve, and how long until I feel better?** Physical therapy for shoulder impingement focuses on restoring the normal mechanics of the shoulder blade and rotator cuff through a progressive strengthening program targeting the periscapular muscles, rotator cuff, and posterior shoulder capsule stretching. Most patients begin to notice meaningful improvement within four to eight weeks of consistent therapy. A full course of treatment typically lasts two to four months, after which most patients with tendinopathy (without a tear) can return to full activity. At MOS, your surgeon or physiotherapist will reassess your response to treatment and adjust the plan if progress plateaus, including considering whether imaging or additional interventions are warranted. --- ## Shoulder Instability URL: https://www.mdorthospecialists.com/conditions/shoulder/shoulder-instability/ Shoulder instability occurs when the humeral head slips partly or completely out of the socket because the labrum, ligaments, capsule, or bone no longer provide reliable restraint. It may follow a traumatic dislocation or develop gradually, and treatment is individualized to the instability pattern, anatomy, activity, and goals. ### Symptoms - Sensation of the shoulder slipping, popping, or "coming out" with specific movements — particularly with the arm elevated and rotated outward - Frank dislocation requiring reduction — either self-reduced, reduced in the field, or requiring urgent medical evaluation and manipulation - Apprehension and guarding — an involuntary resistance to externally rotating the arm when abducted to 90°, reflecting the patient's fear of re-dislocation (apprehension sign) - Pain with overhead or throwing activities — especially at the late-cocking phase of the throwing cycle when the shoulder is maximally abducted and externally rotated - Recurrent subluxations — partial, self-reducing episodes of the humeral head slipping forward or backward, sometimes described as a "dead arm" sensation followed by rapid recovery - Inferior laxity or a sulcus sign in MDI — a visible or palpable dimple below the acromion when downward traction is applied to the arm - Voluntary dislocators — a distinct subgroup, typically younger patients with hypermobility who can produce dislocation voluntarily; this group requires careful psychological and functional assessment before any surgical consideration, as operative intervention alone is rarely successful without addressing the voluntary component ### Frequently Asked Questions **Q: Will my shoulder keep dislocating if I don't have surgery?** It depends on your age, activity level, and number of prior episodes. In patients under 25 who participate in contact or overhead sports, the risk of recurrent dislocation without surgery exceeds 80–90%. Each subsequent dislocation accumulates additional bone loss from the glenoid and humeral head, progressively worsening the anatomy and narrowing future surgical options. For older, lower-demand patients after a first dislocation, non-operative management with PT is a reasonable initial path. Your MOS surgeon will review your specific risk profile and help you weigh the options. **Q: What is a Bankart repair?** A Bankart repair is an arthroscopic procedure that reattaches the torn anteroinferior labrum and inferior glenohumeral ligament to the glenoid rim using suture anchors. It restores the labral bumper that deepens the socket and the ligamentous tension that prevents the humeral head from slipping forward. The procedure is performed through small portals under general anesthesia and typically takes 45–75 minutes. It is the gold standard for traumatic anterior instability in patients without significant glenoid bone loss or high-risk anatomy. **Q: What is the Latarjet procedure?** The Latarjet procedure transfers a small piece of the coracoid bone — along with its attached conjoint tendon — to the front of the glenoid, restoring the bony arc of the socket and creating a tendon sling that actively prevents re-dislocation. Unlike the Bankart repair, which works only on soft tissue, the Latarjet addresses both bony and soft-tissue deficits simultaneously. It is the preferred procedure for patients with glenoid bone loss greater than 20–25%, off-track Hill-Sachs lesions, or recurrent instability in collision athletes. **Q: Can physical therapy fix my shoulder instability?** For MDI and atraumatic instability, PT is the primary treatment and succeeds in the majority of patients with a committed, supervised program. For traumatic instability — particularly in young athletes with a discrete labral tear — PT can reduce symptoms and improve dynamic stability but does not repair the structural lesion. The torn labrum does not reliably heal on its own, and non-operative management in high-risk patients is associated with very high recurrence rates and progressive bone loss. Your MOS surgeon will help you determine whether PT alone is appropriate or whether surgery should be considered early. **Q: Am I too young for surgery?** Quite the opposite: younger age is actually the strongest risk factor for recurrent dislocation after a first-time event, and early surgical stabilization in adolescent and young adult athletes is increasingly supported by the evidence. The risk of recurrence is highest (>80%) in patients under 20 in contact sports. Delaying surgery to "see what happens" risks repeated dislocations that erode glenoid bone and make surgery more complex. MOS surgeons are experienced in performing labral stabilization in teenage athletes and guide families through the timing decision thoughtfully. **Q: What is glenoid bone loss, and why does it matter?** The glenoid is the shallow socket of the shoulder joint. With each anterior dislocation, the leading edge of the glenoid can fracture or erode, progressively reducing the arc of bone that keeps the humeral head centered. When this deficit exceeds roughly 20–25% of the glenoid's diameter, the socket is too shallow to hold the ball in place with soft-tissue repair alone — the Bankart repair will fail at an unacceptably high rate. In these cases, a Latarjet procedure is needed to restore the bony arc. CT with 3D reconstruction is used to measure the exact percentage of bone loss so the correct operation can be planned. --- ## Shoulder Labral Tear URL: https://www.mdorthospecialists.com/conditions/shoulder/shoulder-labral-tear/ A shoulder labral tear is an injury to the ring of fibrocartilage that deepens and stabilizes the shoulder socket. Depending on its location, it may cause deep pain, clicking, reduced athletic performance, or instability. In young patients, a dislocation is often associated with the tear. ### Symptoms - Deep, aching shoulder pain — often described as inside the joint rather than on the surface; difficult to localize with a finger - Clicking, catching, or grinding with shoulder movement — a mechanical sensation created as the torn labral tissue moves in and out of the joint space - Pain at the end of range of motion — especially with overhead reaching, cross-body movements, and rotation - A sensation of the shoulder slipping, popping, or "coming out" — particularly with the arm in the abducted, externally rotated position (Bankart tears with instability) - Pain in the late-cocking phase of throwing — the classic symptom of a SLAP tear in overhead athletes; often associated with velocity loss and accuracy problems - Night pain — discomfort when sleeping on the affected shoulder - Weakness with overhead pushing or pulling activities - A "dead arm" feeling — a transient loss of arm strength or control during throwing or overhead activity, rapidly self-resolving ### Frequently Asked Questions **Q: Do I need surgery for a labral tear?** Not necessarily. Partial tears, degenerative fraying, and tears without instability in lower-demand patients frequently improve with physical therapy and activity modification. However, complete tears associated with instability, mechanical symptoms, or failure of conservative care in active patients generally require arthroscopic repair for reliable resolution. Your MOS surgeon will review your imaging, examine your shoulder, and give you an honest recommendation based on your tear type and goals. **Q: What is the difference between a labral tear and shoulder instability?** They are closely related but not the same thing. A labral tear is the structural lesion — the torn tissue. Shoulder instability is the clinical syndrome that results from it — the feeling that the shoulder slips, gives way, or dislocates. Not all labral tears cause instability (SLAP tears, for example, typically cause pain rather than dislocation), and not all instability is caused by labral tears (capsular laxity in MDI is a separate entity). Your diagnosis guides your treatment. **Q: Can a labral tear heal on its own?** The labrum has limited blood supply and poor intrinsic healing capacity in most locations. Complete tears — particularly those associated with instability — do not reliably heal without surgery. Partial tears and degenerative fraying may become less symptomatic with PT and activity modification, but the structural tear generally persists. Ongoing instability episodes from an unrepaired Bankart tear can cause progressive glenoid bone loss that makes future surgery more complex — early evaluation is worthwhile. **Q: What is the difference between a SLAP tear and a Bankart tear?** Location. A Bankart tear is at the anteroinferior part of the labrum (roughly 3–6 o'clock) and is the anatomic lesion of anterior shoulder instability — the shoulder slipping forward. A SLAP tear is at the superior labrum (12 o'clock, at the biceps attachment) and is primarily associated with deep pain and mechanical symptoms in overhead athletes. They are distinct injuries that can coexist. Both are diagnosed with MRI arthrogram and treated arthroscopically, but the repair technique and recovery differ. **Q: How long is recovery after labral repair surgery?** Sling wear for 4–6 weeks, followed by progressive physical therapy. Most patients are functionally recovered and returning to recreational activity by 5–6 months. Return to contact sport is typically 6–9 months, and competitive overhead throwing athletes (pitchers, quarterbacks) require 9–12 months. The repair heals biologically over 3–6 months, during which the tissue gradually regains strength — rushing return to sport risks re-tear. **Q: What happens if I don't treat an unstable labral tear?** For labral tears associated with shoulder instability, delaying treatment carries two risks: (1) each subsequent dislocation episode can erode additional bone from the glenoid rim, progressively worsening the anatomy and potentially converting a straightforward Bankart repair into a case requiring the more complex Latarjet procedure; (2) continued instability increases the risk of secondary rotator cuff tears, particularly in patients over 40. Early evaluation is important even if surgery is not immediately planned. --- ## Skier's Thumb (UCL Injury of the Thumb) URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/skiers-thumb/ The ulnar collateral ligament (UCL) of the thumb MCP joint runs along the ulnar (index-finger side) of the joint and provides stability during lateral pinch, gripping, and forceful thumb opposition. It is injured when the thumb is forcibly pushed radially (away from the palm), a valgus stress, overstretching or tearing the ligament. ### Symptoms - Sudden pain at the ulnar base of the thumb following a valgus (outward) injury - Swelling and bruising over the thumb MCP joint, ulnar side - Weakness and pain with pinching (turning a key, writing, zipping) - A palpable lump at the ulnar MCP joint (may represent the displaced ligament in a Stener lesion) - Instability of the thumb MCP joint with lateral stress ### Frequently Asked Questions **Q: Can I wait and see if my thumb gets better before deciding on surgery?** Early consultation is recommended. If a Stener lesion is present, delay beyond 3–4 weeks reduces the likelihood of a successful direct repair and may require reconstruction. Early imaging and clinical assessment avoid this problem. **Q: Will I have arthritis in my thumb if I don't treat this?** Chronic UCL insufficiency alters MCP joint mechanics and increases the risk of post-traumatic arthritis. It also produces chronic pinch weakness that limits many daily activities. **Q: How common is Skier's Thumb?** UCL injuries of the thumb MCP joint represent approximately 1 in 4 of all ski injuries. The injury is not limited to skiing. It also occurs in football, basketball, rugby, and falls. **Q: How long does recovery take after surgery for Skier's Thumb?** After surgical repair of a complete UCL tear of the thumb, the thumb is immobilized in a thumb spica cast or splint for approximately 4–6 weeks to allow the repaired ligament to heal. Physical therapy then begins to restore motion and strength. Most patients can return to light daily activities at 6–8 weeks and to sports or manual work at 3–4 months. Return to skiing or other high-demand gripping activities typically takes 4–6 months. Your MOS hand surgeon will tailor the return-to-activity timeline based on the quality of the repair and your healing progress. **Q: What is a Stener lesion, and why does it matter?** A Stener lesion occurs when the torn end of the ulnar collateral ligament flips over the adductor pollicis aponeurosis (a layer of tissue in the thumb) and becomes lodged in a position where it cannot heal back to bone on its own. Stener lesions are present in approximately 80% of complete UCL tears of the thumb and are the main reason surgery is recommended for complete tears. If a Stener lesion is present and the ligament is not surgically repositioned and repaired, the thumb will remain chronically unstable and lead to pain, weakness of grip, and eventual arthritis. Your MOS surgeon will assess for a Stener lesion clinically and on MRI to guide the treatment decision. --- ## Snapping Hip Syndrome (Coxa Saltans) URL: https://www.mdorthospecialists.com/conditions/hip/snapping-hip-syndrome-coxa-saltans/ Snapping hip has three distinct anatomic sources: 1. Internal (iliopsoas) — most common: The iliopsoas tendon snaps over the iliopectineal eminence (a bony prominence at the anterior pelvis) as the hip moves from flexion to extension. The snap is felt and heard at the anterior hip and groin. ### Symptoms - Audible or palpable snap, click, or pop at the hip with specific movements - Internal: snap at the anterior hip/groin, typically with hip flexion or circumduction - External: snap at the lateral hip, visible "jump" over the greater trochanter - Intra-articular: mechanical catching, locking, or giving way during activity - Pain associated with snapping in symptomatic patients - Activity-related — worse with exercise, dancing, repetitive hip movements ### Frequently Asked Questions **Q: Does a snapping hip always need treatment?** Not if it is painless. Many people have audible hip snapping with no functional limitation. This can be observed without intervention. Treatment is indicated only when snapping causes pain, affects performance, or limits activity. **Q: Can snapping hip lead to joint damage?** External snapping does not directly damage the joint. Internal snapping that causes bursitis or tendinopathy may worsen without treatment. Intra-articular snapping from a labral tear or loose body can cause progressive cartilage damage if untreated. **Q: Is this condition related to a labral tear?** It can be. Intra-articular snapping is caused by labral or chondral pathology inside the joint. Your evaluation at MOS will include imaging to determine whether arthroscopic treatment is indicated. **Q: Will snapping hip go away on its own?** Painless snapping hip that does not interfere with activity often does not require any treatment and can persist without causing harm. When the snapping is caused by a tight iliotibial band or iliopsoas tendon, a dedicated stretching and strengthening program frequently reduces or eliminates the snap over weeks to months. Painful snapping that does not resolve with conservative therapy may require additional evaluation to rule out an underlying labral tear or hip joint problem. At MOS, we help you determine whether your snapping hip needs treatment or can be safely monitored. **Q: What does surgery for snapping hip involve, and is recovery long?** Surgery for snapping hip is rarely needed but is available for patients with persistent painful snapping that has not responded to physical therapy and injections. For internal snapping (iliopsoas tendon), arthroscopic or endoscopic lengthening of the tendon is performed through small incisions. For external snapping (IT band), an arthroscopic or open Z-plasty lengthens the band over the greater trochanter. Most patients are walking normally within 2–4 weeks and return to sports at 3–4 months. Your MOS surgeon will only recommend surgery after a thorough trial of conservative management and a clear understanding of which structure is causing your symptoms. --- ## Spondylolisthesis URL: https://www.mdorthospecialists.com/conditions/spine/spondylolisthesis/ Types of spondylolisthesis: - Isthmic spondylolisthesis results from a defect in the pars interarticularis, the narrow bony bridge connecting the superior and inferior facets at each vertebral level. Pars defects (spondylolysis) are most common at L5–S1 and are associated with repetitive hyperextension activities: gymnastics, football linemen, weightlifting, and ballet. ### Symptoms - Low back pain — the most common symptom; typically aching, worsened by extension and loading activities, improved with rest and flexion - Neurogenic claudication (leg pain, heaviness, or numbness with walking and standing) — more common with degenerative spondylolisthesis at L4–L5 causing associated spinal stenosis - Radicular leg pain (sciatica-like) — when the slip compresses exiting nerve roots - Hamstring tightness — characteristically associated with isthmic spondylolisthesis in adolescents and young adults - Posture change — visible lumbar hyperlordosis or "step-off" deformity in higher-grade slips ### Frequently Asked Questions **Q: Can spondylolisthesis get worse?** Grade I and II slips can be stable for many years, particularly degenerative type in older adults where facet arthritis itself limits further motion. Dynamic instability detected on flexion-extension X-rays is the primary concern for progression and may prompt earlier surgical consultation. **Q: Is spondylolisthesis the same as spondylolysis?** Spondylolysis is the pars defect (stress fracture) itself; spondylolisthesis is the vertebral slip that results when bilateral defects allow forward translation. Spondylolysis can exist without spondylolisthesis. **Q: Can my young athlete return to sports?** Most young athletes with isthmic spondylolysis or Grade I spondylolisthesis return to full sport participation, often within 3–6 months of appropriate bracing and PT. Return-to-sport decisions are individualized based on imaging findings, symptom resolution, and functional testing. **Q: Will I need surgery?** The majority of Grade I and II patients do not require surgery. A structured non-operative program resolves symptoms in most cases. Surgical consultation is appropriate for Grade III–IV slips, progressive neurological deficits, or failure of optimized conservative care. **Q: How long is recovery after spinal fusion for spondylolisthesis, and when can I return to normal activities?** Recovery after lumbar spinal fusion for spondylolisthesis varies by the extent of surgery, but most patients are walking within one to two days and discharged from hospital within two to four days. Light daily activities resume over the first few weeks, while fusion of the vertebrae takes three to six months to consolidate on imaging. Return to desk work often occurs within four to six weeks, while physically demanding jobs or sport may require six to twelve months depending on the degree of slip and number of levels fused. Your MOS spine surgeon will monitor fusion progress with X-rays and guide your rehabilitation milestones to ensure the bone graft has solidly united before unrestricted loading. --- ## Spondylolysis (Pars Stress Fracture) URL: https://www.mdorthospecialists.com/conditions/spine/spondylolysis/ A stress fracture of the pars interarticularis, the narrow bridge of bone connecting the vertebral joints in the lower back. It is the most common cause of back pain in young athletes, particularly gymnasts, football linemen, and divers. Most cases heal completely with activity restriction and targeted rehabilitation, without surgery. ### Symptoms - One-sided low back pain that is worse with extension — bending backward, arching the back, or performing a "bridge" reproduces pain in the lower lumbar region, often on one side. - Pain that worsens with activity and improves with rest — symptoms build over a season of practice and competition, easing with days off but returning when training resumes. - Pain that may radiate into the buttock — a dull ache may extend toward the gluteal region on the affected side; true leg radiation below the knee is uncommon with isolated spondylolysis. - Point tenderness over the lower lumbar spine — direct palpation of the L4 or L5 spinous processes and adjacent paraspinal muscles produces localized pain. - Positive single-leg hyperextension (Stork) test — standing on one leg and arching the lower back reproduces the characteristic pain; positivity on the ipsilateral stance leg is highly suspicious for a pars defect at the corresponding level. - Inability to continue training at prior level — the athlete notices a progressive decline in performance, inability to tolerate full practice, or recurrent low back stiffness that disrupts sport participation. ### Frequently Asked Questions **Q: Q: Will I ever be able to return to my sport?** A: Yes. For the overwhelming majority of athletes, return to full competitive sport is the expected outcome. Studies consistently report return-to-sport rates of 80–90% or higher following appropriately managed spondylolysis. The key factors are early diagnosis, strict adherence to the activity restriction phase, and completion of the full rehabilitation program before returning to training. Athletes who rush back before the bone and supporting structures are fully recovered face higher rates of delayed union and recurrence. **Q: Q: Do I need to wear a brace?** A: Not necessarily. Bracing is used selectively, primarily for athletes with acute fractures on CT imaging, or those who are not improving adequately with activity restriction alone. Many patients, particularly those with early stress reactions, heal successfully with activity restriction and physical therapy alone. Your MOS physician will review your imaging and symptoms to determine whether a brace is appropriate for your specific situation. **Q: Q: How is spondylolysis different from spondylolisthesis?** A: Spondylolysis is a stress fracture (or defect) of the pars interarticularis, the bony bridge between the facet joints. When the defect remains unilateral, the vertebra stays in place. Spondylolisthesis describes the forward slip of one vertebra on the one below it, which can occur when bilateral pars defects remove the posterior tension band that anchors the vertebra. Think of spondylolysis as the injury and spondylolisthesis as a possible consequence of bilateral injury. Most athletes with spondylolysis do not develop spondylolisthesis, particularly when managed promptly. **Q: Q: How long do I have to stop playing?** A: It depends on the stage of injury at the time of diagnosis. Stress reactions (the earliest stage, detected by MRI before a fracture line forms) typically require 6 to 8 weeks of activity restriction. Established stress fractures take longer: most athletes are out of sport for 3 to 6 months. This is why early diagnosis matters. Catching the injury at the stress reaction stage can cut the recovery time in half. Your physician will give you a specific timeline based on your imaging findings, not a one-size-fits-all estimate. **Q: Q: Can this happen again after I return to sport?** A: Recurrence is possible but not inevitable. Athletes who complete the full rehabilitation program (including core strengthening, hip flexor flexibility work, and movement pattern correction) and who return to sport through a structured progression are significantly less likely to experience a recurrence than those who simply rest and return to training. Maintaining core conditioning, monitoring training load during growth spurts, and working with a coach to limit unnecessary hyperextension repetitions are the most effective long-term protective strategies. --- ## Stress Fractures (Foot) URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/stress-fractures-foot/ Bone constantly remodels in response to load. When load is increased faster than the remodeling cycle can keep pace (through rapid training escalation, insufficient recovery, or inadequate nutrition), bone fatigue accumulates and a stress fracture forms. Metatarsal stress fractures (most common foot stress fracture): - The 2nd metatarsal is the most frequently affected, followed by the 3rd. ### Symptoms - Insidious onset of localized foot pain that worsens with weight-bearing and activity - Point tenderness directly over the fracture site (metatarsal shaft or dorsal navicular) - Swelling over the affected bone, occasionally with ecchymosis - Pain at rest in more advanced or neglected cases - Classic history: symptoms began after a change in training volume, new shoes, or transition to a harder surface ### Frequently Asked Questions **Q: Why is my X-ray normal if I have a stress fracture?** Plain X-rays lack sensitivity in the early stages because the fracture line is too narrow to be visible and periosteal reaction has not yet formed. MRI identifies bone marrow edema from day one. Always use MRI when clinical suspicion is high and X-ray is negative. **Q: What is the female athlete triad?** The female athlete triad is the combination of energy deficiency (inadequate caloric intake relative to expenditure), menstrual dysfunction (including amenorrhea), and low bone mineral density. This triad dramatically elevates stress fracture risk and should be assessed in any young female athlete with recurrent stress fractures. **Q: Can I exercise while my stress fracture heals?** Yes. Low-impact cross-training (swimming, pool running, cycling) maintains cardiovascular fitness without loading the healing fracture. Avoid impact activities until cleared by your physician. **Q: How long does it take a foot stress fracture to heal?** Healing time depends significantly on which bone is involved. Low-risk stress fractures (such as those of the second, third, or fourth metatarsals) typically heal with 4–6 weeks of protected weight-bearing in a boot, followed by a gradual return to activity. High-risk fractures, particularly those of the fifth metatarsal (Jones fracture) or navicular, carry a greater risk of delayed healing and re-fracture; they may require 8–12 weeks of strict non-weight-bearing or even surgery. At MOS, we classify your fracture by location and risk level and design a recovery plan that protects healing while keeping you as active as safely possible. **Q: When can I return to running after a foot stress fracture?** Return to running is guided by healing on imaging and the absence of pain with progressive loading, not by a fixed calendar date alone. For low-risk fractures, many athletes can begin a walk-to-run program at 6–8 weeks. For higher-risk fractures or those requiring surgery, return to running may take 3–6 months. Before resuming running, your MOS provider will review follow-up imaging and ensure that training load, footwear, nutrition (particularly calcium and vitamin D), and any underlying biomechanical issues are addressed to prevent a recurrence. --- ## Subacromial Bursitis URL: https://www.mdorthospecialists.com/conditions/shoulder/subacromial-bursitis/ A bursa is a fluid-filled sac that cushions tendons and bones, reducing friction during movement. The subacromial bursa lies between the rotator cuff tendons (above) and the undersurface of the acromion and deltoid (below). It is the largest bursa in the human body and serves as the principal lubricating structure within the subacromial space. ### Symptoms - Lateral and anterior shoulder pain, often radiating to the deltoid insertion - Painful arc: pain with shoulder abduction between 60° and 120° - Pain with overhead activities, reaching behind the back, and lying on the affected side - Night pain — often the most disabling symptom - Positive Neer sign and Hawkins-Kennedy test on examination - Palpable bursal thickening at the anterior lateral shoulder in some patients - Weakness with sustained overhead activity (fatigue rather than true neurologic weakness) ### Frequently Asked Questions **Q: How is bursitis different from a rotator cuff tear?** Bursitis involves inflammation of the bursal sac overlying intact (though possibly degenerating) tendons. A rotator cuff tear involves actual tearing of the tendon fibers. Both cause similar pain, which is why imaging is important for accurate diagnosis. **Q: Can an injection cure my bursitis?** A corticosteroid injection can resolve an acute episode of bursitis very effectively. However, if the underlying cause (impingement mechanics, scapular dysfunction) is not addressed through PT, symptoms are likely to recur. **Q: Is subacromial bursitis serious?** It is painful but not dangerous. Most cases resolve with conservative care. The concern is that persistent bursitis and impingement can, over years, contribute to rotator cuff degeneration. **Q: How long does subacromial bursitis take to heal?** Mild to moderate subacromial bursitis often improves significantly within 4–8 weeks with a combination of activity modification, anti-inflammatory medication, physical therapy, and occasionally a corticosteroid injection. Chronic or recurrent bursitis (particularly when related to a structural problem like a bone spur or partial rotator cuff tear) may take several months to fully resolve and occasionally requires surgery to create more space in the subacromial area. At MOS, we assess whether your bursitis is isolated or part of a broader shoulder problem to ensure we address the underlying cause rather than just the symptoms. **Q: Does bursitis mean my rotator cuff is torn?** Not necessarily. Subacromial bursitis can occur on its own as a result of overuse, poor posture, or repetitive overhead activity without any rotator cuff damage. However, bursitis and rotator cuff tears frequently coexist because an inflamed or thickened bursa often develops in response to a torn tendon rubbing against the overlying bone. An MRI or diagnostic ultrasound can clearly differentiate between isolated bursitis and a rotator cuff tear. Your MOS shoulder specialist will use imaging and a thorough physical examination to determine whether the bursa is the primary problem or a secondary finding associated with tendon damage. --- ## Swan Neck and Boutonnière Finger Deformities URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/finger-deformities-swan-neck-boutonniere/ Swan neck and boutonnière deformities are opposite finger postures caused by an imbalance in the extensor tendon mechanism, from trauma or inflammatory arthritis such as rheumatoid arthritis. Boutonnière causes a bent middle joint with a hyperextended fingertip; swan neck causes a hyperextended middle joint with a bent fingertip. Splinting is first-line; surgery treats deformities that fail conservative care. ### Symptoms - Boutonnière: the middle joint sits bent while the fingertip bends backward, sometimes with pain and swelling right after a jamming injury - Boutonnière: loss of active straightening at the middle joint, though grip and fist-making are often still possible - Swan neck: the middle joint hyperextends while the fingertip curls forward - Swan neck: difficulty making a full fist because the middle joint "locks" straight during attempted bending - Progressive stiffness or a fixed deformity if the condition goes untreated - A visibly abnormal finger posture that is often more noticeable than it is painful ### Frequently Asked Questions **Q: What is the difference between swan neck and boutonnière deformity?** They are opposite postures of the same finger joints. In boutonnière deformity, the middle joint is bent and the fingertip is hyperextended. In swan neck deformity, the middle joint is hyperextended and the fingertip is bent. Both come from an imbalance in the extensor tendon system that runs along the back of the finger, but the imbalance runs in opposite directions. Because the mechanics differ, the splints and surgical procedures used for each are different as well, even though both conditions affect the same two joints. **Q: Can a jammed finger really cause a lasting deformity?** Yes. A jamming injury during a ball sport can tear the central slip tendon over the middle joint. If that injury is missed or undertreated, the deformity that follows, called boutonnière deformity, can become fixed within weeks. This is why any finger that will not fully straighten after a jamming injury should be evaluated rather than assumed to be a simple sprain. Early splinting, usually six to eight weeks, resolves most acute cases without surgery. **Q: Does rheumatoid arthritis always cause finger deformities?** Not always, but it is common. Up to half of people with rheumatoid arthritis develop a boutonnière deformity in at least one finger, and swan neck deformity is also frequent, particularly in women. The mechanism differs from a traumatic injury: joint swelling and long-term synovitis gradually damage the tendons and ligaments that balance the finger joints. Because rheumatoid disease is progressive, we monitor these hands over time and intervene with splinting, and sometimes surgery, before a flexible deformity becomes fixed. **Q: Will I need surgery for my finger deformity?** Most people do not. Splinting is the first treatment for both boutonnière and swan neck deformities, and many acute or mild cases resolve without an operation. Surgery becomes reasonable when the deformity is fixed rather than flexible, when splinting has failed over a reasonable trial, or when there is a structural injury like a tendon laceration that will not heal on its own. We confirm with an X-ray beforehand that the joint is free of significant arthritis, since surgery works best on a joint that still moves well. **Q: Why does my finger lock straight when I try to make a fist?** This is the hallmark complaint of swan neck deformity. The middle joint is hyperextending rather than bending as it should, so when you try to close your hand, that joint "locks" backward instead of flexing forward with the rest of the finger. A figure-of-8 or ring splint that blocks the joint from hyperextending, while still allowing normal flexion, often resolves this immediately without surgery, provided the joint itself still has good passive motion. --- ## TFCC Injury (Triangular Fibrocartilage Complex) URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/tfcc-injury/ A TFCC injury is damage to the triangular fibrocartilage complex, a network of cartilage and ligaments on the little-finger side of the wrist that cushions and stabilizes the joint. It can tear from a fall or repetitive loading, causing pain, clicking, and weakness with rotation and gripping. ### Symptoms - Ulnar-sided wrist pain: Aching or sharp pain on the little-finger side of the wrist - Pain with forearm rotation (turning a doorknob, opening a jar, using a screwdriver) - Pain at extremes of wrist ulnar deviation or axial loading - A clicking, clunking, or snapping sensation with wrist rotation - Wrist weakness or instability - Swelling over the ulnar wrist - A fall on an outstretched hand with the wrist in loaded, rotated position - A forced twisting injury (e.g., catching a heavy object, sports-related load) - Distal radius fractures (associated TFCC tear in up to 70% of distal radius fractures) ### Frequently Asked Questions **Q: How is TFCC injury different from a wrist sprain?** A "wrist sprain" is a non-specific term. True TFCC injuries involve specific ligamentous or cartilage damage that requires accurate diagnosis and tailored treatment. Persistent ulnar-sided wrist pain after a "sprain" should always be formally evaluated. **Q: Do all TFCC tears need surgery?** No. Many central (Type 1A) perforations and early degenerative tears respond well to conservative management. Surgery is reserved for failed conservative treatment, peripheral tears with DRUJ instability, or significant functional limitation. **Q: Is MRI or MRI arthrogram better?** MRI arthrogram (with joint injection of contrast) is significantly more accurate for detecting TFCC tears and characterizing tear type and location than standard MRI. We routinely order MRI arthrogram for diagnostic workup of suspected TFCC injury. **Q: What is ulnar variance and why does it matter?** Ulnar variance is the relative height of the distal ulna compared to the distal radius. Positive ulnar variance means the ulna is relatively long, increasing the load on the TFCC. It is an important driver of degenerative TFCC disease and influences the choice between debridement and ulnar shortening. **Q: How long does recovery take after TFCC repair surgery, and when can I return to activity?** After TFCC repair surgery, the wrist is typically immobilized in a cast or splint for four to six weeks to protect the healing fibrocartilage. Formal hand therapy then focuses on restoring forearm rotation, wrist motion, and grip strength over the following two to three months. Return to light daily activities usually occurs by eight to twelve weeks, while sports or manual labor requiring forceful gripping and rotation may take four to six months. Your MOS wrist surgeon will confirm healing with clinical assessment and, if needed, imaging before advancing your activity level to ensure the repair does not re-tear. --- ## Tendon Laceration URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/tendon-laceration/ Tendons are the fibrous cords that connect muscles to bone and transmit the forces needed to bend and straighten the fingers and wrist. Two systems govern finger movement: - Flexor tendons run along the palm side (volar surface) and bend the fingers. ### Symptoms - Inability to bend a finger at the DIP joint (FDP injury) or PIP joint (FDS injury) - Inability to straighten a finger (extensor tendon injury) - A visible cut on the palm, finger, or back of the hand - Pain, bleeding, and swelling following a laceration - Numbness or altered sensation alongside the finger (associated digital nerve injury) ### Frequently Asked Questions **Q: My finger can still bend a little. Does that mean the tendon isn't cut?** Not necessarily. FDS function may be preserved if only the FDP is cut. Partial cuts may also allow some movement. Any wound near a tendon over a finger requires formal evaluation. **Q: How long after injury can a tendon be repaired?** Primary repair is ideal within 10–14 days. Repairs are technically more difficult after 4–6 weeks due to scarring and tendon shortening, often requiring grafting. **Q: Will I have normal finger movement after repair?** Many patients regain excellent function with proper repair and dedicated therapy. Zone II injuries have the most variable outcomes due to the complexity of the sheath and pulley system. Realistic expectations and early therapy engagement are essential. **Q: Can a nerve also be cut at the same time?** Yes. Digital nerves run alongside the flexor tendons and are frequently injured together. Nerve repair is performed at the same time as tendon repair. **Q: How long does recovery take after tendon repair in my hand, and when can I use my hand normally?** Recovery after flexor tendon repair in the hand requires a supervised hand therapy program beginning within days of surgery using a protective splint and a carefully controlled early motion protocol. The repaired tendon is protected from strong gripping for approximately six to eight weeks while it gains enough strength to tolerate loading. Light use of the hand typically resumes at eight to twelve weeks, with full grip strength and unrestricted use expected by four to six months. At MOS, your hand surgeon will coordinate your care with a certified hand therapist to maximize the chance of achieving excellent motion and prevent the tendon from rupturing or scarring down during the critical healing window. --- ## Thoracic Back Pain URL: https://www.mdorthospecialists.com/conditions/spine/thoracic-back-pain/ The thoracic spine consists of twelve vertebrae (T1–T12), each articulating with a pair of ribs at the costovertebral and costotransverse joints. The thoracic cage provides significant structural stability, making disc herniation and instability much less common in this region than in the cervical or lumbar spine. ### Symptoms - Mid-back aching or stiffness, often poorly localized - Pain worsened by sustained sitting, trunk rotation, and deep breathing (when costovertebral joints are involved) - Paraspinal tenderness, often unilateral - Pain with rib springing (lateral compression of the rib cage) - In some patients, wrapping chest wall pain that may mimic cardiac or pulmonary pathology - Thoracic pain in a patient with known malignancy - Thoracic pain with unexplained weight loss or fever - Acute thoracic pain after a fall or trauma (especially in an older or osteoporotic patient — compression fracture) - Progressive thoracic kyphosis - Lower extremity weakness, spasticity, or gait disturbance (thoracic cord compression) - Night pain that awakens from sleep ### Frequently Asked Questions **Q: Could my thoracic pain be from my heart?** Thoracic back pain (particularly on the left side) should prompt consideration of cardiac and aortic pathology if it is accompanied by chest pressure, shortness of breath, or sweating. MOS will conduct a thorough history to exclude these diagnoses; emergent symptoms require emergency evaluation. **Q: Does thoracic disc herniation require surgery?** The majority of thoracic disc herniations are asymptomatic or mildly symptomatic and are managed conservatively. Significant cord compression causing myelopathy is a surgical indication. MOS coordinates referral when cord involvement is identified on MRI. **Q: What is Scheuermann's kyphosis?** It is a developmental condition causing excessive rounding of the thoracic spine, often beginning in adolescence. Adults with Scheuermann's kyphosis may develop mid-back pain from the mechanical stress of hyperkyphosis. PT and posture-focused management are central to non-operative treatment. **Q: How is thoracic back pain treated?** The majority of thoracic back pain is muscular or postural in origin and responds well to physical therapy emphasizing thoracic mobility, postural correction, and periscapular strengthening. Anti-inflammatory medications and heat or ice can provide short-term symptom relief. When facet joint degeneration is contributing, targeted injections or medial branch blocks may be recommended. For the less common cases involving significant disc herniation or nerve compression in the thoracic spine, surgical decompression can be very effective but is approached carefully given the proximity of the spinal cord. At MOS, our spine specialists evaluate the full picture to find the safest and most effective path for your specific situation. **Q: When should I be concerned that my thoracic back pain is something serious?** Most thoracic back pain is benign and musculoskeletal in origin, but certain features warrant urgent evaluation. These include pain that is constant and not relieved by rest or position, unexplained weight loss, fever, a history of cancer, pain following significant trauma, or any neurological symptoms such as weakness, numbness, or bowel/bladder changes. Pain that radiates around the rib cage in a band-like pattern can suggest nerve involvement from a thoracic disc or, less commonly, conditions such as shingles. If you experience any of these warning signs, contact your MOS provider promptly so that serious causes can be ruled out with appropriate imaging. --- ## Total Hip Arthroplasty (Hip Replacement) URL: https://www.mdorthospecialists.com/conditions/hip/total-hip-arthroplasty-hip-replacement/ Total hip arthroplasty replaces the damaged femoral head (ball) and acetabulum (socket) with prosthetic components designed to replicate normal hip anatomy and biomechanics. It is indicated when the hip joint is irreversibly damaged by arthritis, avascular necrosis, or other conditions, and when non-operative measures no longer provide adequate pain relief or function. ### Symptoms - Chronic hip and groin pain that significantly impairs quality of life - Pain at rest and at night in advanced disease - Inability to perform daily activities (walking, stairs, dressing) - Failure of non-operative treatment: physical therapy, activity modification, NSAIDs, corticosteroid injections, PRP - Significant radiographic joint-space narrowing (< 1–2 mm) with loss of femoral head sphericity ### Frequently Asked Questions **Q: Am I too young for a hip replacement?** Modern implants are durable enough that age is not a barrier. The decision is based on pain severity, functional limitation, and failure of non-operative care, not age. Patients in their 40s and 50s with severe hip arthritis can and do undergo THA with excellent long-term results. **Q: What activities can I do after THA?** The American Academy of Orthopaedic Surgeons and most hip surgeons support low-impact activities: cycling, swimming, hiking, golf, doubles tennis, and walking. High-impact repetitive sports (running, basketball) are generally discouraged long-term due to theoretical implant wear concerns, though many patients resume them. **Q: How is THA different from hip resurfacing?** Hip resurfacing preserves more femoral bone and uses a larger femoral head, reducing dislocation risk. It is suitable for young, active men with good bone quality. However, metal-on-metal bearing concerns have significantly reduced resurfacing use. Our team will discuss whether resurfacing is appropriate for your specific case. **Q: What are the main risks?** Serious complications are uncommon but include infection, blood clot (DVT/PE), nerve injury, dislocation, leg-length discrepancy, and aseptic loosening over time. Our team uses proven risk-reduction protocols for each of these. **Q: Will I need a blood transfusion?** Transfusion is rarely needed with modern surgical techniques and ERAS blood conservation protocols. Pre-operative hemoglobin optimization, tranexamic acid, and meticulous surgical technique have reduced transfusion rates to < 2% for primary THA. --- ## Total Knee Replacement URL: https://www.mdorthospecialists.com/conditions/knee/total-knee-replacement/ Anatomy and the Problem The knee is divided into three compartments: the medial (inner), lateral (outer), and patellofemoral (front, between the kneecap and thigh bone). Each compartment is lined with articular cartilage, the smooth, shock-absorbing tissue that allows the joint surfaces to glide painlessly against one another. ### Symptoms - Severe knee pain that limits daily activities such as walking, climbing stairs, rising from a chair, or getting in and out of a car - Pain at rest or at night that disrupts sleep and prevents comfortable sitting or lying down - Failure of conservative treatments — including physical therapy, weight loss, anti-inflammatory medications, and corticosteroid or hyaluronic acid injections — to provide lasting relief - Chronic knee stiffness that restricts range of motion and makes the joint feel locked or difficult to bend and straighten - Visible deformity — a bowlegged or knock-kneed appearance caused by uneven cartilage loss - Inability to walk reasonable distances without stopping due to pain, limiting participation in work, social activities, and exercise - Declining quality of life and independence despite ongoing non-surgical management ### Frequently Asked Questions **Q: Am I too young or too old for total knee replacement?** There is no strict age cutoff in either direction. TKA is performed safely in patients in their 40s when arthritis is severe and quality of life is significantly impaired, as well as in patients in their 80s and 90s who are medically fit. The key factors are the severity of your symptoms, your overall health, and your functional goals, not your age on a calendar. **Q: How long will my knee replacement last?** Long-term registry and cohort studies show that modern TKA implants survive 20 or more years in the vast majority of patients. Survival rates of 90–97% at 20 years are reported across multiple large series. Implant longevity is influenced by patient age, weight, activity level, and implant design. Your MOS surgeon will discuss realistic expectations based on your individual profile. **Q: Will I set off metal detectors at airports?** Yes, in most cases. Modern TKA implants are metallic and will typically trigger airport security scanners. You will not receive a formal implant card that clears security, but alerting the TSA agent that you have a knee replacement before screening is straightforward, and the vast majority of travelers with TKA pass through security without difficulty. **Q: Can I kneel after a total knee replacement?** Kneeling is possible for many patients after TKA, though some find it uncomfortable or describe an unusual pressure sensation over the anterior knee. It is not medically harmful to kneel; the limitation is one of comfort rather than implant risk. Kneeling ability varies by implant design, soft-tissue healing, and individual anatomy. If kneeling is important to your work or lifestyle, discuss it with your surgeon during planning. **Q: What are the risks of total knee replacement?** TKA is a safe and well-studied procedure, but all surgery carries risk. The most significant potential complications include deep vein thrombosis (DVT) and pulmonary embolism, periprosthetic joint infection (PJI), aseptic loosening over time, stiffness, nerve or vessel injury, and persistent pain. Serious complications are uncommon in well-selected patients at high-volume centers. Your MOS surgeon will review the specific risk-benefit profile with you in detail at your consultation. **Q: What is the difference between partial and total knee replacement?** A partial (unicompartmental) knee replacement resurfaces only the diseased compartment (typically the inner, or medial, side) while preserving the healthy compartments, both cruciate ligaments, and more native bone. It involves a smaller incision, faster recovery, and a more natural feel for appropriate candidates. However, it is not suitable for patients with multi-compartmental arthritis, inflammatory arthritis, or significant deformity. Total knee replacement addresses all three compartments and is indicated when disease is widespread. Your MOS surgeon will review your X-rays and examination findings to determine which procedure, if either, is right for you. --- ## Traumatic Finger and Digit Amputation URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/traumatic-finger-amputation/ Traumatic digit amputation is complete or near-complete separation of a finger or thumb from the hand due to injury. Successful replantation requires restoring blood flow along with repairing bone, tendon, and nerve. Whether to replant or perform a revision amputation depends on the digit involved, injury mechanism, and how the part was preserved before reaching surgery. ### Symptoms - Complete or partial separation of a finger or thumb - Active bleeding from the injury site - Pain at the amputation site and in the residual hand - In a partial (incomplete) amputation, variable color and warmth of the still-attached segment depending on how much tissue and how many vessels remain connected - Exposed bone, tendon, or nerve at the wound ### Frequently Asked Questions **Q: What should I do with an amputated finger before I get to the hospital?** Rinse it gently if it is visibly dirty, wrap it in gauze moistened with saline, and place it in a sealed plastic bag. Put that bag into a container of ice water or ice slush. Never place the part directly on ice or dry ice, because direct contact causes frostbite-type injury to the tissue that can prevent successful reattachment. Get to an emergency room or call our office immediately rather than delaying to see how the injury looks. **Q: Is there a strict time limit for how long an amputated finger can survive before reattachment?** There is classic teaching that fingers tolerate up to about 12 hours without cooling or up to 24 hours with proper cooling, but this specific number is more of a longstanding rule of thumb than a hard scientific cutoff. Newer research actually found that properly cooled parts reattached after more than 12 hours did as well or better than uncooled parts reattached sooner, and that replantation within the first 6 hours carried notably higher survival odds than waiting until 6 to 12 hours. The safest approach is always to move quickly and preserve the part correctly rather than relying on any single number as a deadline. **Q: Will my finger always be reattached if it's amputated?** Not necessarily, and the decision is genuinely individualized. Thumb amputations and injuries involving multiple fingers are strongly favored for replantation. A single amputated finger, especially the index finger at the middle joint level, is more debated among surgeons; a recent survey found roughly 55 percent of hand surgeons would attempt replantation in that specific scenario and about 45 percent would not, so this is not a settled, one-size-fits-all rule. Mechanism matters too: sharp, clean injuries are far more often replanted than crush or avulsion injuries. **Q: Why would a surgeon choose not to reattach my finger?** The leading reasons surgeons cite for not replanting a single digit are concern about poor eventual range of motion and concern about patient satisfaction with a stiff, insensate finger, cited by roughly three-quarters of surgeons in one survey. A well-shaped revision amputation heals faster, requires far less time off work, roughly 3 weeks compared with roughly 12 weeks for replantation at the same level in one study, and in some comparisons produces similar overall satisfaction to a successful replant. This is a genuine tradeoff discussion, not an automatic decision either way. **Q: What is a ring avulsion injury and why is it treated differently?** A ring avulsion happens when a ring catches on something fixed while the hand is moving, tearing or degloving the finger's skin and blood vessels rather than cutting them cleanly. These injuries are graded by the Urbaniak classification, from Class I (circulation intact) through Class III (complete degloving or amputation). Outcomes get progressively worse as the class increases, and the most severe injuries have historically been treated with revision amputation rather than replantation because the torn, damaged vessels are harder to repair successfully, although this is an area of evolving surgical practice. --- ## Triceps Tendon Rupture URL: https://www.mdorthospecialists.com/conditions/elbow/triceps-tendon-rupture/ The triceps brachii is the sole extensor of the elbow. Its distal tendon inserts on the posterior surface of the olecranon process of the ulna. Rupture occurs at or near this osseous insertion and results in partial or complete loss of active elbow extension. ### Symptoms - Sudden posterior elbow pain with an audible or perceived "pop" - Immediate weakness of elbow extension - Swelling and ecchymosis over the posterior elbow - Palpable defect in the triceps tendon approximately 1–2 cm proximal to the olecranon - Inability to extend the elbow against gravity (complete rupture) - Preserved but weak extension (partial tear) ### Frequently Asked Questions **Q: Why is triceps rupture so rare?** The triceps is a comparatively less powerful muscle than the quadriceps or gastrocnemius-soleus complex, and its loads during normal activity are lower. However, the eccentric forces encountered in weightlifting or a fall can exceed tendon tolerance, particularly in tendons already weakened by steroid use or systemic disease. **Q: Do anabolic steroids cause tendon tears?** Yes. Anabolic steroids promote rapid muscle hypertrophy that outpaces tendon adaptation, and they directly impair collagen synthesis, predisposing tendons to rupture at lower loads. Triceps rupture in a young weightlifter should prompt discussion of steroid use. **Q: Will I be able to do push-ups and bench press again?** Most active patients return to full upper extremity athletic activities, including weightlifting, within 4–6 months of surgical repair. **Q: How is a triceps tendon rupture diagnosed?** Diagnosis begins with a physical examination. A complete triceps rupture typically causes a visible or palpable defect just above the elbow, significant weakness with elbow extension, and inability to extend the arm against resistance. The "modified Thompson test" (squeezing the back of the upper arm and checking for elbow extension) can help confirm the diagnosis at bedside. An MRI is the most accurate imaging study and can characterize whether the tear is partial or complete, how far the tendon has retracted, and whether the bone (olecranon) has been avulsed. At MOS, your surgeon will combine clinical findings with MRI to plan the most appropriate repair. **Q: How long after surgery will it take to regain full strength?** After surgical repair of a triceps tendon rupture, the elbow is protected in a splint at a comfortable angle for 2–4 weeks, followed by gradual range-of-motion exercises. Strengthening exercises begin at approximately 6–8 weeks, with progressive loading guided by pain and surgeon assessment. Most patients regain functional strength for daily activities by 3–4 months, but return to heavy lifting, bench press, or overhead sports typically takes 6–9 months. Final strength recovery can continue for up to 12 months, and your MOS surgeon will work with you and a physical therapist to ensure a safe and complete return to your pre-injury activities. --- ## Trigger Finger URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/trigger-finger/ The flexor tendons that bend the fingers each pass through a series of pulleys: ring-like structures that keep the tendons close to the bone as the finger moves. The A1 pulley, located at the base of each finger just over the metacarpophalangeal (MCP) joint, is the first and most clinically important of these pulleys. ### Symptoms - A snapping, catching, or clicking sensation when bending or straightening a finger - Pain or soreness at the base of the finger (over the A1 pulley), often worse in the morning - Morning stiffness — fingers may be most symptomatic upon waking - A palpable nodule at the base of the affected finger - A finger locked in flexion that requires passive manipulation to straighten (Grade 3–4) - In severe cases, the finger remains permanently bent ### Frequently Asked Questions **Q: Can trigger finger go away on its own?** Mild cases (Grade 1–2) occasionally resolve with rest and activity modification. Most established trigger fingers require active treatment. **Q: Can I have more than one trigger finger at the same time?** Yes. Multiple simultaneous trigger fingers are common, especially in diabetics and patients with inflammatory arthritis. **Q: Why does it hurt most in the morning?** Tendons swell during rest (particularly at night in a flexed position). Morning stiffness and triggering often improve as the hand warms up and circulation increases with activity. **Q: What if the injection causes my skin to go white or dimpled?** Fat and skin atrophy from steroid injection is uncommon but recognized. The risk is reduced by injecting into the tendon sheath rather than subdermally. Darker-pigmented skin is at higher risk for visible depigmentation, and this should be discussed at the time of injection consent. **Q: Is surgery risky?** Open A1 pulley release is one of the most reliable minor procedures in hand surgery with a very low complication rate. The main risks are incomplete release (<1%), infection, and injury to the digital nerves (rare in experienced hands). --- ## Turf Toe URL: https://www.mdorthospecialists.com/conditions/foot-and-ankle/turf-toe/ Turf toe results from hyperextension of the 1st MTP joint beyond its normal range, typically when the toe is planted on the ground and the body's weight drives the foot forward and downward (the classic mechanism in football linemen, soccer players, and basketball athletes on hard or artificial surfaces). ### Symptoms - Sudden pain at the base of the great toe at the moment of hyperextension - Localized swelling and plantar bruising - Difficulty pushing off during walking or sprinting - Restricted and painful 1st MTP dorsiflexion - In Grade III: instability, inability to bear weight, sometimes a palpable clunk ### Frequently Asked Questions **Q: Can I keep playing with turf toe?** Grade I injuries often allow continued play with taping. Grade II–III injuries typically do not, and playing through a severe injury risks converting a repairable injury to one requiring complex surgery. Get it evaluated. **Q: What is a bipartite sesamoid?** A bipartite sesamoid is a normal developmental variant where one sesamoid is composed of two ossification centers that never fused. It affects ~10% of the population. On X-ray it can mimic a fracture, but smooth, rounded margins and a contralateral matching finding distinguish it from an acute fracture. **Q: What long-term problems can turf toe cause?** Undertreated Grade III injuries can result in hallux rigidus (1st MTP arthritis and stiffness), hallux valgus, clawed great toe, and chronic push-off weakness. All of these significantly impact athletic performance and daily function. **Q: How is turf toe graded, and does the grade affect treatment?** Turf toe is classified into three grades based on severity. Grade 1 involves a stretch of the plantar capsule-ligament complex with minimal swelling and pain, allowing return to play within days with taping and a stiff-soled shoe. Grade 2 involves a partial tear with moderate swelling, bruising, and limited motion. Rest and protected weight-bearing for 1–2 weeks are typically required. Grade 3 represents a complete tear of the capsuloligamentous complex and may involve a sesamoid fracture, requiring strict rest for 4–6 weeks and, in some cases, surgery. At MOS, accurate grading on examination and imaging ensures you receive the level of treatment matched to the severity of your injury. **Q: Will I need surgery for turf toe?** The vast majority of turf toe injuries are managed successfully without surgery through activity modification, taping, stiff-soled footwear, and a structured rehabilitation program. Surgery is considered for Grade 3 injuries with specific findings such as a large sesamoid fracture, retraction of the capsuloligamentous complex, cartilage injury to the metatarsophalangeal joint, or chronic instability that has not responded to conservative care. When surgery is warranted, repair of the damaged structures can restore stability and prevent the long-term hallux rigidus (stiff big toe joint) that can result from an untreated severe injury. Your MOS foot and ankle surgeon will evaluate your MRI and clinical findings to guide the decision. --- ## UCL Injury (Tommy John) URL: https://www.mdorthospecialists.com/conditions/elbow/ucl-injury-tommy-john/ The medial collateral ligament (MCL) complex of the elbow comprises three bundles: anterior, posterior, and transverse. The anterior bundle, commonly called the UCL, is the primary valgus stabilizer of the elbow. It originates from the inferior surface of the medial epicondyle and inserts on the sublime tubercle of the proximal ulna. ### Symptoms - Medial elbow pain during the late cocking or early acceleration phase of throwing - Sudden "pop" at the medial elbow (complete rupture) - Loss of throwing velocity and accuracy - Medial elbow aching after pitching, progressing to pain during throwing - Occasional ulnar nerve symptoms (cubital tunnel syndrome co-exists in up to 40% of cases) - Difficulty achieving full elbow extension after throwing bouts - Tenderness directly over the UCL — 2 cm distal to the medial epicondyle at the sublime tubercle insertion ### Frequently Asked Questions **Q: What is "Tommy John" surgery?** Tommy John surgery is UCL reconstruction, a procedure that replaces the torn medial elbow ligament with a tendon graft. It was first performed in 1974 on Los Angeles Dodgers pitcher Tommy John, who went on to pitch for 14 more years. **Q: Will I need surgery if my UCL is partially torn?** Not necessarily. Many partial tears (especially in non-throwing athletes or those with Grade I sprains) heal with rest and rehabilitation. We individualize the recommendation based on tear severity, sport demands, and your response to conservative management. **Q: How long does Tommy John recovery take?** Return to competitive pitching typically takes 12–18 months. Position players with lower throwing demands often return sooner (9–12 months). This is one of the longest recoveries in sports medicine. **Q: Can Tommy John be done more than once?** Yes, revision UCL reconstruction is possible but technically more challenging and produces lower return-to-sport rates. Proper rehabilitation and adherence to pitch count guidelines after primary reconstruction is the best strategy to avoid revision. **Q: Does UCL reconstruction guarantee return to my prior level of play?** Approximately 68–83% of professional pitchers return to the same or a higher competitive level after reconstruction. Younger athletes and those with no prior elbow surgery have the best prognoses. --- ## Ulnar Impaction Syndrome URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/ulnar-impaction/ Ulnar impaction syndrome is a degenerative wrist condition in which the ulna presses excessively against the triangular fibrocartilage complex and nearby carpal bones, most often because the ulna is relatively longer than the radius. It causes chronic ulnar-sided wrist pain, clicking, and weak grip, and is treated with splinting, injections, or a shortening procedure when conservative care fails. ### Symptoms - Chronic pain on the small-finger side of the wrist - Pain that worsens with gripping, twisting a doorknob or jar lid, or rotating the forearm - Clicking or a mechanical sensation with wrist motion - Reduced grip strength - Tenderness directly over the ulnar side of the wrist - Symptoms that build slowly over months rather than appearing overnight ### Frequently Asked Questions **Q: What is the difference between the wafer procedure and ulnar shortening osteotomy?** The wafer procedure is done entirely through arthroscopic portals and removes a few millimeters of bone from the tip of the ulna without cutting all the way through it, so there is no fracture to heal and recovery is faster. Ulnar shortening osteotomy cuts through the ulna shaft, removes a segment of bone, and fixes it back together with a plate, which requires the bone to heal over several weeks. Outcomes for pain, grip strength, and function are similar between the two, but the wafer procedure has fewer complications and a faster return to work, while osteotomy is generally preferred when the lunotriquetral ligament is torn. **Q: Do I need surgery for ulnar impaction syndrome?** Not necessarily. Many patients improve with activity modification, splinting, anti-inflammatory medication, and a corticosteroid injection, particularly when the changes on imaging are mild and the ligaments of the wrist are intact. Surgery is considered when these measures fail to control symptoms or when imaging and arthroscopy show more advanced cartilage or ligament damage that is unlikely to improve without correcting the underlying mechanical overload. **Q: Will I need the hardware removed after ulnar shortening osteotomy?** It is common. Roughly six in ten patients eventually have the plate and screws removed once the bone has fully healed, usually because the hardware is palpable or irritating beneath the skin near the wrist. This is a separate, generally shorter procedure done after the osteotomy site is solidly healed, and it does not mean the original surgery failed. **Q: Can ulnar impaction syndrome come back after treatment?** Both the wafer procedure and ulnar shortening osteotomy produce durable results in most patients followed for up to ten years, since they directly correct the load imbalance that caused the problem. Recurrence is uncommon when the correct procedure is matched to the severity of disease, though patients who return to very high-demand gripping or racquet sports should expect ongoing monitoring. **Q: How long until I can return to sports or heavy grip work after surgery?** After the arthroscopic wafer procedure, most patients return to work within about four to five weeks, and light sport can often resume around that time depending on demands. After ulnar shortening osteotomy, return to work typically takes about eight weeks, and full return to high-demand gripping or racquet sports usually waits until the bone shows solid healing on X-ray, often three to four months. --- ## Unicompartmental Knee Arthritis / Partial Knee Replacement URL: https://www.mdorthospecialists.com/conditions/knee/unicompartmental-knee-arthritis-partial-knee-replacement/ Unicompartmental knee arthritis is osteoarthritis limited to just one of the knee's three compartments, most often the inner (medial) side. When only one compartment is worn, a partial knee replacement can resurface it while preserving healthy bone and ligaments, often allowing a faster recovery than total knee replacement. ### Symptoms - Pain localized to the inner aspect of the knee - Weight-bearing pain that worsens with prolonged walking or stair climbing - Morning stiffness that improves within 30 minutes of activity - A gradual bowlegged (varus) appearance to the knee - Knee swelling after activity - Night pain in advanced disease - Preserved range of motion compared with more advanced tricompartmental disease ### Frequently Asked Questions **Q: How do I know if I'm a candidate for a partial rather than total knee replacement?** Candidacy is determined by the compartmental extent of arthritis (confirmed on imaging), ACL integrity, range of motion, and deformity. Our surgeons perform a thorough evaluation including weight-bearing X-rays and, often, MRI before recommending UKA. **Q: Does partial knee replacement last as long as total knee replacement?** Registry data support comparable survivorship at 10 years for well-selected UKA patients compared with TKA. Long-term (15–20 year) survivorship is somewhat lower due to progression of arthritis in remaining compartments, which is expected in patients living for many more years. **Q: What happens if the arthritis spreads to other compartments?** If arthritis progresses in the lateral or patellofemoral compartment and pain recurs, conversion to total knee replacement is straightforward and reliable. Bone preservation from the original UKA is an advantage in this scenario. **Q: Is the partial knee replacement less painful after surgery?** Most patients experience significantly less post-operative pain than patients undergoing total knee replacement. The smaller incision, less bone removal, and preservation of native anatomy contribute to a more comfortable early recovery. **Q: Can I return to sports after a partial knee replacement?** Yes. UKA patients typically return to golf, cycling, swimming, hiking, and doubles tennis. High-impact running and contact sports are generally discouraged to protect longevity. --- ## Varus / Valgus Knee Deformity with Arthritis URL: https://www.mdorthospecialists.com/conditions/knee/varus-valgus-knee-deformity-with-arthritis/ Varus deformity is the most common alignment problem in knee arthritis. The tibia bows medially relative to the femur, creating a bow-legged appearance. As medial cartilage wears, the knee settles further into varus, a progressive cascade. Varus is most commonly associated with medial compartment OA and post-traumatic conditions. ### Symptoms - Visible bowlegged (varus) or knock-knee (valgus) alignment, which may have worsened over time - Pain localized to the overloaded compartment — medial for varus, lateral for valgus - A lateral thrust (limb lurching outward) or medial thrust with walking - Progressive difficulty walking, standing, and with stairs - Deformity-related gait abnormalities noted by family members ### Frequently Asked Questions **Q: Will my leg look straight after knee replacement?** Yes. One of the goals of TKA is to restore neutral mechanical alignment. Most patients with varus or valgus deformity notice their leg appears straighter and their gait more natural after surgery. **Q: Is valgus knee replacement more complex?** Generally yes. The lateral structures must be released carefully to avoid over-correction into varus. Severe valgus deformity may require more constrained implants and longer operative time. **Q: What is the difference between varus and valgus knee deformity?** A varus deformity (commonly called bow-legged) means the knee angles outward, concentrating force on the inner (medial) compartment of the joint. A valgus deformity (knock-kneed) means the knee angles inward, overloading the outer (lateral) compartment. Both deformities accelerate cartilage wear in the overloaded compartment and, when significant, affect the soft-tissue balance on the opposite side. Understanding which deformity you have is essential, as each requires different surgical planning and implant selection during knee replacement. **Q: Can a brace or osteotomy help before I need a knee replacement?** For younger or more active patients with deformity and arthritis limited to one compartment, a high tibial osteotomy (HTO) or distal femoral osteotomy can realign the leg and shift weight away from the damaged compartment, significantly relieving pain and potentially delaying knee replacement by ten years or more. Offloading braces provide a non-surgical alternative that mimics this effect and can reduce pain meaningfully in appropriate patients. Your MOS surgeon will evaluate your age, activity level, imaging, and deformity severity to determine whether joint preservation or replacement is the right next step for you. **Q: How long does recovery take after knee replacement for a varus or valgus deformity?** Recovery is similar to standard knee replacement, with most patients returning to independent walking and basic daily activities within four to six weeks. However, severe deformity corrections sometimes require additional soft-tissue procedures at the time of replacement to balance the knee, which can extend rehabilitation slightly. Physical therapy typically continues for two to three months, and full recovery of strength and stamina may take up to six months. At MOS we track your alignment and functional progress throughout recovery to ensure your knee is moving correctly and feels stable. --- ## Wrist Hypermobility and Midcarpal Instability URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/hypermobility/ Wrist hypermobility, also called midcarpal instability, is excessive and often painful motion between the wrist's carpal bones, frequently linked to generalized joint laxity or Ehlers-Danlos syndrome. It causes clunking, a sense of looseness, and recurrent sprains from minor movements. Treatment starts with bracing and stabilization exercises, with surgery reserved for persistent, disabling instability. ### Symptoms - Recurrent wrist pain - A clicking or "clunking" sensation with certain wrist movements - A feeling that the wrist is loose, unstable, or about to give way - Recurrent wrist sprains from minor movements or minimal force - Symptoms that fluctuate rather than following one clear injury ### Frequently Asked Questions **Q: Is wrist hypermobility the same thing as being double-jointed?** They are related but not identical. Being "double-jointed," or generally hypermobile, describes excess flexibility across multiple joints in the body, which is measured with the Beighton score. Midcarpal instability is a specific pattern of excessive, often painful sliding motion within the wrist itself, which can occur in people with generalized hypermobility but is a distinct clinical diagnosis with its own grading systems. Not everyone with a flexible body has painful wrist instability, and the Beighton score can actually miss wrist-specific laxity since it does not directly test the wrist. **Q: Do I need surgery for a hypermobile, clunking wrist?** Most patients do not. Bracing combined with a structured stabilization exercise program is effective for many people, and a recent randomized trial found no meaningful difference between exercise-based treatment and a hand orthosis at 12 weeks. Surgery is reserved for patients with persistent, functionally limiting instability that does not improve after a genuine trial of these non-surgical measures, particularly when the instability significantly interferes with daily activities or work. **Q: Will my wrist instability get worse over time if I have Ehlers-Danlos syndrome?** Not necessarily, and this is one of the more reassuring features of this specific diagnosis. Midcarpal instability related to EDS or generalized hypermobility is often described as self-limiting, meaning many patients see genuine improvement over time with rehabilitation rather than progressive worsening. This differs from instability caused by a single traumatic ligament tear, which is less likely to improve without intervention. **Q: What is the difference between dorsal capsulodesis and ligament reconstruction?** Dorsal capsulodesis tightens and reinforces the existing wrist capsule to limit excessive motion, while ligament reconstruction, such as three-ligament tenodesis or triquetrohamate reconstruction, uses a tendon graft to recreate a stabilizing structure that is deficient or absent. A long-term study following patients for eight years found both approaches produced durable results, but capsulodesis generally allowed a faster recovery, which is why it is often preferred when either approach is a reasonable option. **Q: Can four-corner fusion fix my wrist instability if other surgeries fail?** It can, and it is generally considered the most reliable option for refractory instability that has not responded to soft-tissue procedures. The tradeoff is that fusing four of the carpal bones together eliminates motion at the midcarpal joint permanently in exchange for dependable stability and pain relief. This procedure is reserved for cases where soft-tissue reconstruction has already been tried or is unlikely to succeed, since it removes wrist motion that cannot be restored afterward. --- ## Wrist Ligament Injuries (Scapholunate / SLAC Wrist) URL: https://www.mdorthospecialists.com/conditions/hand-and-wrist/wrist-ligament-injuries/ Wrist ligament injuries involve tearing of the ligaments that hold the small wrist bones in alignment, most often the scapholunate ligament. Untreated tears can lead to abnormal bone motion and a pattern of arthritis called SLAC wrist. Symptoms include pain, weakness, swelling, and a sense of instability. ### Symptoms - Wrist pain, often dorsal and radial, after a fall or twisting injury - A painful clunk or click with wrist motion (carpal instability) - Wrist weakness and reduced grip strength - Pain with loading tasks: pushups, weight-bearing on the palm - In chronic/SLAC wrist: progressive, diffuse wrist pain and stiffness ### Frequently Asked Questions **Q: Is a scapholunate ligament tear the same as a wrist sprain?** No. A complete SLL tear is a serious carpal instability injury, not a benign sprain. It requires accurate diagnosis and appropriate management to prevent SLAC wrist. **Q: Can SLAC wrist be prevented?** Early recognition and repair of acute SLL tears is the most effective prevention. Once established arthritis develops, salvage procedures rather than preventive treatment become necessary. **Q: Which is better, four-corner fusion or proximal row carpectomy?** Both are effective salvage procedures with high patient satisfaction. PRC is technically simpler and preserves slightly more motion; 4CF may provide better strength for heavier demands. The choice depends on disease stage, patient activity level, and surgeon experience. **Q: How is a scapholunate ligament tear treated, and does it always require surgery?** Treatment depends on whether the tear is partial or complete and how long ago it occurred. Acute partial tears (Grade 1–2) can sometimes be managed with immobilization in a cast or splint for 8–12 weeks, followed by physical therapy. Complete acute tears (Grade 3) almost always benefit from surgical repair to reattach or reconstruct the ligament before the wrist alignment changes permanently. Chronic tears that have already led to early SLAC (scapholunate advanced collapse) wrist deformity are addressed differently. Reconstruction may still be possible in earlier stages, but advanced deformity may require salvage procedures such as partial or complete wrist fusion. Your MOS hand surgeon will stage your injury and recommend the most appropriate intervention for your specific situation. **Q: How long is recovery after wrist ligament surgery?** Recovery after scapholunate ligament repair or reconstruction is measured in months, not weeks. The wrist is typically immobilized in a cast for 8–12 weeks after repair to allow the ligament to heal to bone before any motion is introduced. Physical therapy for motion and strength recovery begins after cast removal and continues for several months. Return to full manual work or sport typically takes 9–12 months, and some patients continue to see improvement for up to 18 months. At MOS, your hand surgeon will provide a clear rehabilitation roadmap and monitor your recovery with serial X-rays to confirm the wrist alignment is being maintained throughout the healing process. ================================================================================ # SERVICES ================================================================================ ## Arthritis & Joint Preservation URL: https://www.mdorthospecialists.com/services/arthritis-joint-preservation/ Osteoarthritis is the most common form of arthritis, affecting an estimated 32.5 million adults in the United States and representing one of the leading reasons patients seek orthopedic care. At Maryland Orthopedic Specialists, our board-certified orthopedic physicians take a joint-preservation-first philosophy: before any surgical option is discussed, we systematically explore every appropriate conservative, minimally invasive, and biologic treatment. ### Frequently Asked Questions **Q: What is the difference between osteoarthritis and rheumatoid arthritis?** Osteoarthritis and rheumatoid arthritis are both forms of arthritis but have fundamentally different causes, patterns, and treatments. Osteoarthritis is a degenerative disease driven by mechanical wear and cartilage breakdown. It typically affects older adults and is most prominent in weight-bearing joints like the knee and hip. Rheumatoid arthritis (RA) is an autoimmune disease in which the body's immune system attacks the synovial lining of joints, causing inflammation, pain, and progressive joint damage. RA tends to present symmetrically, often affecting smaller joints such as the hands and wrists first, and can occur at any age. While an orthopedic specialist can evaluate and manage the musculoskeletal manifestations of both conditions, rheumatoid arthritis is primarily managed by a rheumatologist with disease-modifying medications. Maryland Orthopedic Specialists works collaboratively with rheumatology for patients with inflammatory arthritis requiring dual management. **Q: Can osteoarthritis be reversed?** At this time, there is no treatment that reverses the structural cartilage loss of established osteoarthritis. However, the disease can often be managed very effectively. Symptoms can be significantly reduced, functional capacity can be maintained or improved, and disease progression can be slowed with appropriate treatment. For small, focal cartilage defects (particularly in younger patients), certain cartilage restoration procedures may repair localized damage. The most important steps are early recognition, activity and weight management, and consistent engagement with an evidence-based care plan. Do not accept a "nothing can be done" message. There is a great deal that can be done to improve your quality of life with osteoarthritis. **Q: How do I know if I need a joint replacement for arthritis?** Joint replacement is generally considered when a patient has advanced osteoarthritis that has caused significant, persistent pain and functional limitation despite a comprehensive trial of conservative measures, including physical therapy, injections, activity modification, and biologic therapy. Imaging showing severe joint space narrowing or bone-on-bone changes is typically required. Equally important is the patient's subjective experience: if arthritis is meaningfully limiting your ability to walk, sleep, work, or participate in activities that matter to you, and conservative measures are no longer providing adequate relief, it may be time to have a candidacy discussion. Our physicians will give you an honest, unbiased evaluation of whether you are at that threshold. **Q: What is viscosupplementation and does it work?** Viscosupplementation is the injection of hyaluronic acid (a naturally occurring component of healthy synovial fluid) into an arthritic joint, most commonly the knee. The goal is to restore the viscous, lubricating quality of joint fluid that is diminished in osteoarthritis, reducing friction and improving joint mechanics. Viscosupplementation is FDA-approved for knee osteoarthritis and is typically administered as a series of one to five injections. The evidence is mixed (some studies show meaningful benefit while others show modest or no benefit compared to placebo), and patient response varies. In our clinical experience, viscosupplementation works best in patients with mild-to-moderate knee OA who have had limited duration of benefit from cortisone and who are not yet candidates for PRP or surgery. We provide a candid, evidence-based assessment of whether it is a reasonable option for you. **Q: Is walking good or bad for knee osteoarthritis?** Walking is generally beneficial for knee osteoarthritis and is recommended by virtually all major orthopedic and rheumatology guidelines. Regular low-impact aerobic activity strengthens the muscles that support the knee, helps maintain healthy body weight, promotes synovial fluid circulation that nourishes cartilage, and has well-documented benefits for pain and function. Walking does not wear out the knee faster. However, the type, intensity, and duration of walking should be appropriate to your current symptom level. Starting with shorter, flatter walks and progressing gradually is a sensible approach. High-impact activities such as running or jumping on hard surfaces may be less well-tolerated in advanced arthritis. Our physical therapists and physicians will help you develop an activity plan that supports your joints while keeping you moving. **Q: What is the best injection for knee osteoarthritis?** This is one of the most common questions we receive, and the honest answer depends on where you are in the disease course and what you have tried before. For an acute inflammatory flare, a corticosteroid injection often provides the fastest relief. For patients with mild-to-moderate OA who have exhausted or wish to avoid cortisone, PRP has the strongest current evidence base for durable benefit. Multiple randomized controlled trials have found PRP superior to both hyaluronic acid and placebo for pain and function over 6 to 12 months. Hyaluronic acid (viscosupplementation) is a reasonable intermediate option for patients who are not candidates for PRP or who prefer a non-biologic approach. There is no single "best" injection for all patients; our physicians will recommend the most appropriate option based on your clinical history, imaging, and goals. --- ## Bracing, Orthotics & Durable Medical Equipment URL: https://www.mdorthospecialists.com/services/bracing-orthotics-dme/ Maryland Orthopedic Specialists offers a comprehensive inventory of bracing, orthotics, and durable medical equipment (DME) to support your recovery after injury or surgery, protect joints during activity, relieve pain from arthritis and chronic conditions, and prevent re-injury over the long term. ### Frequently Asked Questions **Q: Does insurance cover braces and orthotics?** In most cases, yes. When bracing or orthotics are prescribed by your physician and accompanied by documentation of medical necessity, major insurance plans including Medicare, Medicaid, and commercial carriers will cover a portion or all of the cost, subject to your deductible and any applicable copays or coinsurance. Custom DME requires more thorough documentation than prefabricated items but is generally well-covered for appropriate clinical indications. Our billing team verifies DME benefits prior to dispensing and will communicate your out-of-pocket responsibility before you commit. **Q: What is the difference between a custom and prefabricated brace?** A prefabricated brace is manufactured in standard sizes and is suitable for patients who fall within typical anatomical ranges and have straightforward clinical needs. A custom brace or orthosis is fabricated specifically for your body (either by taking impressions, measurements, or digital scans of the relevant body part) and is indicated when standard sizing cannot provide adequate fit, when your anatomy is atypical, when post-surgical positioning requirements are specific, or when a biomechanical correction cannot be achieved with an off-the-shelf device. Your physician will recommend the appropriate type based on your diagnosis and the goals of bracing. **Q: Do I need a prescription to get a brace from your office?** DME dispensed at Maryland Orthopedic Specialists is prescribed by your treating physician as part of your care plan, so you do not need to arrive with a separate prescription. If you are establishing care with us specifically to obtain a brace or orthotic (and have imaging or records from a prior provider), bring those to your initial appointment and your physician will evaluate whether the requested equipment is appropriate and medically indicated. **Q: How long do I need to wear a knee brace after surgery?** Post-operative brace duration depends on the procedure performed, the integrity of the repair, and your surgeon's specific protocol. Following ACL reconstruction, a hinged knee brace is typically worn for four to six weeks, with a functional sports brace often recommended during return-to-sport activities for the remainder of the first year. Following meniscus repair, brace duration and motion restrictions are determined by the repair pattern and tissue quality. Total knee replacement patients typically transition out of a brace within the first two to four weeks. Your surgeon will give you a specific brace-weaning schedule as part of your post-operative instructions. **Q: Are custom foot orthotics worth it?** For patients whose foot mechanics are contributing to plantar fasciitis, posterior tibial tendon dysfunction, metatarsalgia, or lower extremity overuse injuries, custom orthotics can provide significant, lasting relief that over-the-counter insoles cannot. The difference lies in biomechanical specificity: custom orthotics are prescribed and fabricated based on your physician's assessment of your specific mechanical pathology (whether that is overpronation, supination, leg length discrepancy, or forefoot deformity), while OTC insoles provide generic cushioning and arch support that may or may not address the underlying problem. Patients who have failed OTC insoles, who have significant anatomical asymmetry, or who have complex mechanical diagnoses consistently benefit most from custom orthotics. --- ## Hand, Wrist & Upper Extremity Care URL: https://www.mdorthospecialists.com/services/hand-wrist-upper-extremity/ Maryland Orthopedic Specialists provides comprehensive evaluation and treatment for the full spectrum of hand, wrist, forearm, and elbow conditions at our Bethesda and Germantown, Maryland locations. What sets our upper extremity program apart is the integration of board-certified orthopedic surgeons with on-site Certified Hand Therapists (CHTs), allowing patients to receive coordinated diagnostic, surgical, and rehabilitative care under a single roof. ### Frequently Asked Questions **Q: What is the difference between a hand surgeon and an orthopedic surgeon?** Orthopedic surgeons who specialize in hand and upper extremity surgery have completed fellowship training specifically in the surgical and non-surgical management of hand, wrist, elbow, and forearm conditions, on top of their comprehensive orthopedic residency. The term "hand surgeon" is a specialty descriptor, not a separate medical degree; it may refer to an orthopedic surgeon or a plastic surgeon with hand fellowship training. At Maryland Orthopedic Specialists, our upper extremity providers are fellowship-trained orthopedic specialists with focused expertise in all aspects of hand and wrist care. **Q: How is carpal tunnel syndrome treated without surgery?** Mild to moderate carpal tunnel syndrome is often managed effectively without surgery through a combination of nighttime wrist splinting (which keeps the wrist in a neutral position to relieve nerve pressure during sleep), activity modification to minimize sustained wrist flexion and repetitive gripping, and corticosteroid injection into the carpal tunnel, which can provide significant relief for months to years. Physical and occupational therapy (including nerve gliding exercises and ergonomic training) is also beneficial. Surgery (carpal tunnel release) is considered when symptoms are severe, when nerve conduction studies show significant nerve damage, or when conservative measures have failed to provide adequate relief. **Q: What is Dupuytren's contracture and can it be treated without surgery?** Dupuytren's contracture is a progressive fibrous thickening of the palmar fascia that causes the fingers to contract toward the palm over time. Yes, it can be treated without surgery in eligible patients using Xiaflex (collagenase clostridium histolyticum), an FDA-approved enzyme injected into the fibrous cord to dissolve it, followed by a manipulation procedure to straighten the finger. Not all patients or cord patterns are suitable for collagenase injection; your physician will evaluate the extent and location of involvement to determine whether injection or surgical fasciectomy is the better option for you. **Q: How long does recovery from carpal tunnel release take?** Most patients experience significant improvement in nighttime numbness and tingling within days of carpal tunnel release surgery. Grip strength typically returns to normal within four to eight weeks for open release, though this can vary. Patients with desk work or light-duty jobs often return to work within one to two weeks; physically demanding occupations may require four to six weeks. Hand therapy is frequently prescribed after surgery to optimize scar management and functional recovery. **Q: Do I need a referral to see a hand specialist at Maryland Orthopedic Specialists?** Most insurance plans do not require a referral to see an orthopedic specialist, but this varies by plan. We recommend calling our office or your insurance provider to confirm your specific coverage and referral requirements. Our front desk team is experienced in navigating these questions and will help ensure your visit is covered appropriately. **Q: What is a Certified Hand Therapist (CHT)?** A Certified Hand Therapist is an occupational or physical therapist with at least three years of clinical experience, a minimum of 4,000 hours of specialized upper extremity practice, and successful completion of a rigorous national certification exam administered by the Hand Therapy Certification Commission (HTCC). CHTs are experts in the rehabilitation of hand, wrist, forearm, and elbow conditions, including post-surgical rehab, custom splinting, edema management, scar treatment, and progressive strengthening. The CHT credential represents the highest level of specialization available in upper extremity rehabilitation. --- ## Joint Injection Therapy URL: https://www.mdorthospecialists.com/services/joint-injection-therapy/ Joint injection therapy refers to the delivery corticosteroids, hyaluronic acid, or platelet-rich plasma directly into a joint space, bursa, or tendon sheath to relieve pain, reduce inflammation, and improve function. At Maryland Orthopedic Specialists, we perform joint injections at our Bethesda and Germantown, MD offices for patients throughout Montgomery County seeking relief from arthritis, bursitis, tendinopathy, and other musculoskeletal conditions. ### Frequently Asked Questions **Q: How long do joint injections last?** The duration of relief varies by injection type and individual patient factors. Corticosteroid injections typically provide relief for four to twelve weeks, though some patients experience benefit for several months. Hyaluronic acid injections for knee osteoarthritis can provide relief for six to twelve months in well-selected patients. PRP injections, depending on the condition, have demonstrated durable benefit lasting six to eighteen months or longer in clinical studies. Your physician will set realistic expectations based on your specific diagnosis and injection type during your consultation. **Q: How many cortisone injections can I get per year?** Most orthopedic guidelines recommend limiting cortisone injections to no more than three to four injections per year in any single joint, with a minimum interval of six to eight weeks between injections in the same area. This recommendation exists because frequent or high-dose cortisone can have adverse effects on cartilage and surrounding tissues over time. If you are reaching the recommended limit of cortisone injections and still experiencing significant pain, your physician may recommend transitioning to hyaluronic acid, PRP, or a surgical evaluation. **Q: Is the injection painful?** Discomfort during a joint injection is typically mild to moderate and brief. Many patients describe it as similar to a blood draw or a brief pressure sensation. We use local anesthetic preparation and ultrasound guidance to make the procedure as comfortable as possible. Some patients experience a brief ache during needle advancement or when the medication is delivered into the joint. Post-injection soreness may occur for one to two days but is generally manageable with ice and, for most injection types, over-the-counter pain relievers. **Q: How quickly will I feel relief after a joint injection?** This depends on the type of injection. Corticosteroid injections often begin providing noticeable relief within two to five days, with peak effect at one to two weeks. Hyaluronic acid injections may take two to four weeks to reach full effect, as the lubricating mechanism is gradual. PRP works through a biological healing process and typically produces improvement over four to eight weeks, with continued progress over several months. If you receive a corticosteroid injection, you may feel temporary soreness for the first day or two before improvement begins, which is normal. **Q: What is the difference between a cortisone shot and a PRP injection?** A cortisone shot delivers a synthetic anti-inflammatory steroid that rapidly suppresses pain and swelling but does not address the underlying tissue damage. PRP, by contrast, delivers a concentration of your own growth factors that actively stimulate the body's healing response and promote tissue regeneration. Cortisone typically provides faster, more immediate relief but shorter duration; PRP works more gradually but often provides longer-lasting benefit and has a regenerative rather than suppressive effect on tissue. The two injections are not interchangeable. Each is best suited for different clinical situations, and your physician will help determine which is most appropriate for your diagnosis. **Q: Do I need imaging before getting a joint injection?** Imaging before a joint injection is not always required, but it can be very helpful in confirming the diagnosis, evaluating the degree of joint degeneration, and planning the most appropriate treatment approach. For straightforward knee or shoulder injections with a clear clinical diagnosis, prior imaging may not be necessary before proceeding. For complex cases, atypical presentations, or joints with less clear anatomy (such as the hip or sacroiliac joint), prior MRI or X-ray is often recommended. In our office, we use in-office ultrasound during the injection itself for real-time guidance, regardless of prior imaging status. --- ## Orthopedic Surgery URL: https://www.mdorthospecialists.com/services/orthopedic-surgery/ When conservative treatments such as physical therapy, injections, bracing, and medication have been thoroughly explored without delivering lasting relief, our board-certified orthopedic surgeons at Maryland Orthopedic Specialists are here to guide you through the next step with clarity, skill, and compassion. ### Frequently Asked Questions **Q: How do I know if I need orthopedic surgery?** Surgery is generally considered when a specific structural problem (such as a complete tendon tear, unstable fracture, or advanced joint degeneration) cannot be adequately addressed through conservative measures, or when non-surgical treatments have been genuinely exhausted over an appropriate timeframe without restoring acceptable function. During your consultation, your surgeon will review your imaging, physical examination findings, and treatment history to give you an honest, individualized recommendation. Many patients who come in expecting surgery discover that a targeted injection or focused physical therapy program can provide the relief they need. **Q: What is the difference between arthroscopic and open surgery?** Arthroscopic surgery uses a small camera and thin instruments inserted through tiny incisions, allowing the surgeon to work inside a joint with minimal disruption to surrounding tissue. Open surgery involves a larger incision that provides direct visualization of the surgical field. Arthroscopic surgery typically means less postoperative pain, a lower infection risk, and a faster recovery. However, open approaches are sometimes necessary for complex reconstructions or when more extensive access is required. Your surgeon will recommend the approach that offers the best outcome for your specific condition. **Q: How long is recovery from orthopedic surgery?** Recovery timelines vary considerably depending on the procedure, patient age, overall health, and adherence to rehabilitation. Minor arthroscopic procedures such as a partial meniscectomy may allow return to light activity within one to two weeks. More complex reconstructions (such as ACL reconstruction or rotator cuff repair) typically require four to nine months before full return to sport. Your surgeon will outline a realistic, procedure-specific recovery timeline at your consultation. **Q: Will I need physical therapy after surgery?** In virtually all cases, yes. Physical therapy is not optional after orthopedic surgery. It is a critical component of achieving the best possible outcome. Rehabilitation restores range of motion, rebuilds muscular strength, retrains proprioception, and ensures that the repaired structure heals optimally. Maryland Orthopedic Specialists has an in-house therapy team at our Bethesda and Germantown locations, which means your therapists coordinate directly with your surgeon throughout your recovery. **Q: Can I get a second opinion before deciding on surgery?** Absolutely, and we encourage it. Making an informed decision about surgery is important, and we welcome patients who want to seek confirmation of their diagnosis or surgical recommendation from another qualified specialist. When you come to Maryland Orthopedic Specialists for a second opinion, we will review all available imaging and records and give you our unvarnished clinical assessment. **Q: Does Maryland Orthopedic Specialists perform joint replacement surgery?** Our surgeons provide comprehensive consultation, evaluation, and surgical planning for partial and total knee replacement. Joint replacement surgeries are coordinated with our hospital facility partners in the Montgomery County area to ensure appropriate post-surgical support and inpatient care when indicated. Our team remains actively involved in your care before, during, and after the procedure through our on-site rehabilitation program. --- ## PRP for ACL Injuries URL: https://www.mdorthospecialists.com/services/prp-acl/ The honest clinical answer requires a critical distinction that significantly affects whether PRP is appropriate for your specific injury. Complete ACL tears in active, high-demand patients (athletes, people with functionally unstable knees) typically require surgical reconstruction. PRP is not a substitute for the mechanical stability that reconstructive surgery restores in these cases. ### Frequently Asked Questions **Q: Can PRP heal a torn ACL?** It depends entirely on the type of tear. For partial ACL tears (Grade II) with preserved ligament continuity and clinical knee stability, PRP injected directly into the ACL can stimulate biological repair and has enabled return to sport in multiple clinical series. For complete ACL tears, PRP cannot restore mechanical function. The ligament has lost its continuity, and no growth factor injection can reconnect severed ends in an intra-articular environment hostile to clot formation. In complete tears, PRP's role is as augmentation during reconstruction surgery, not as a substitute for it. **Q: Who is a good candidate for PRP for an ACL injury?** The ideal candidate for conservative PRP management of an ACL injury has: a partial tear (Grade II) confirmed on MRI; a clinically stable knee (firm Lachman endpoint, negative pivot-shift, < 3 mm side-to-side laxity difference); no concurrent bucket-handle meniscal tear requiring surgery; a recreational or moderate activity level (not elite pivot-sport athlete); and willingness to commit to a 3–5 month rehabilitation program. Patients with complete tears who are candidates for surgery but wish to optimize their biological recovery during or after reconstruction are also good candidates for PRP as an adjunct. **Q: How is PRP injected into the ACL?** Depending on the clinical context, PRP can be delivered through several approaches. Ultrasound-guided injection is used to visualize the ACL along its intra-articular course and place the needle close to the area of partial disruption. Fluoroscopic guidance with contrast can confirm precise intraligamentary positioning. Arthroscopic direct injection provides the most accurate intralesional delivery and can be combined with diagnostic arthroscopy to assess concurrent intra-articular pathology. The choice of guidance method is individualized based on the specific anatomy and clinical scenario. **Q: Will PRP allow me to avoid ACL surgery?** Possibly, for carefully selected patients with partial tears. Clinical series in recreational athletes and professional soccer players with Grade II ACL tears show high return-to-sport rates (80–95%) following intralesional PRP without reconstruction. However, approximately 30% of patients with partial ACL tears managed non-operatively (with or without PRP) experience eventual instability requiring surgery. PRP improves the biological environment and may enhance healing, but it cannot guarantee that a partial tear will not progress. Patients must understand this and participate in close clinical follow-up, with surgery remaining an option if instability develops. **Q: Can PRP be used during ACL reconstruction?** Yes, and this is actually the application with the most robust clinical support. PRP applied to the graft, into the bone tunnels, or intra-articularly at the time of ACL reconstruction has demonstrated benefits including reduced early postoperative pain, some evidence for accelerated graft maturation at 3–6 months on MRI, and superior donor site healing in patellar tendon autograft cases. These benefits are most pronounced in the first 6 months after surgery. PRP augmentation during reconstruction adds minimal procedural time and no additional biological risk. --- ## PRP for Achilles Tendinopathy URL: https://www.mdorthospecialists.com/services/prp-achilles-tendinopathy/ Platelet-rich plasma injection delivers a concentrated dose of your own growth factors directly into the degenerated tendon, stimulating the healing response that chronic Achilles tendinopathy fails to initiate on its own. Used alongside an eccentric loading program, PRP has demonstrated superior outcomes to cortisone at six and twelve months, with lower re-injury rates and improved tendon structure on ultrasound. ### Frequently Asked Questions **Q: Does PRP help Achilles tendinopathy?** For chronic midportion Achilles tendinopathy that has not responded to conservative care including eccentric loading, PRP can provide meaningful improvement in pain and function. Evidence is strongest in this specific population. PRP is less well-supported for insertional tendinopathy and is not indicated for acute Achilles tendon rupture. **Q: How is PRP injected into the Achilles tendon?** At Maryland Orthopedic Specialists, PRP is delivered peritendinously, around the outside of the tendon in the area of tendinosis, under real-time ultrasound guidance. This approach avoids direct injection into the tendon substance, which carries risks of structural weakening, and ensures the growth factors are deposited in the peritendinous tissue where the repair response is initiated. **Q: How long until I see improvement after PRP for Achilles tendinopathy?** Most patients notice modest improvement beginning at 4–6 weeks post-injection. More meaningful improvement in pain and function typically develops over 8–12 weeks, with the full benefit realized at 3–6 months. The recovery timeline is slower than cortisone injection because PRP works by stimulating tissue remodeling rather than suppressing acute symptoms. **Q: Is PRP appropriate for Achilles tendon rupture?** No. The most current high-quality evidence, including the PATH-2 trial (Bone & Joint Journal, 2024), found no benefit of PRP over placebo for acute Achilles tendon rupture treated non-operatively. Acute rupture and chronic tendinopathy are different conditions with different biological requirements. PRP at Maryland Orthopedic Specialists is not offered for acute rupture management. **Q: Can I run after a PRP injection in my Achilles?** Running and high-impact activities should be avoided for 48 hours immediately following the injection. Walking is permitted from day one. A structured return-to-running program, guided by a physical therapist and based on pain-free loading milestones, typically begins at 4–8 weeks post-injection. Most patients can return to recreational running by 8–12 weeks if the rehabilitation program is followed, though this varies by individual severity and response. --- ## PRP for Gluteus Medius Tendinosis URL: https://www.mdorthospecialists.com/services/prp-gluteus-medius/ PRP for gluteus medius tendinosis is an ultrasound-guided injection of your own concentrated platelets into a degenerated hip abductor tendon. In a double-blind randomized trial, a single leukocyte-rich PRP injection produced greater and more durable improvement in hip function than a corticosteroid injection, with benefits sustained at two years. ### Frequently Asked Questions **Q: Does PRP work better than a cortisone shot for hip tendon pain?** For lasting relief, the best available evidence favors PRP. In a two-year double-blind randomized trial, a single leukocyte-rich PRP injection produced greater improvement in hip function than a cortisone injection, and that advantage widened over time. Cortisone tends to help within the first few weeks, but its benefit typically fades by three to six months, while PRP works more slowly and lasts longer. That said, a separate placebo-controlled trial found PRP was no better than saline, so we describe PRP as a low-risk option that outperforms cortisone for durability, not as a certain cure. **Q: How long does PRP take to work for gluteus medius tendinosis?** PRP does not provide the quick relief a cortisone shot can. Because it works by stimulating your tendon to rebuild disorganized collagen, the benefit develops gradually. Most patients notice meaningful improvement over the first two to three months, with maximal benefit typically reached between three and six months as the tendon remodels. Setting this expectation matters, because patients who expect immediate relief can feel discouraged during the normal, slower healing timeline. A brief flare of soreness in the first few days after the injection is expected and is not a sign of a problem. **Q: Can PRP treat a partial gluteus medius tendon tear?** Yes, for partial-thickness tears PRP is a reasonable option, especially after physical therapy has not resolved the pain. A prospective study of patients with moderate-to-severe tendinosis and partial tears showed significant improvement in hip function scores sustained beyond a year, with only minor injection-site soreness reported. Full-thickness, retracted tears are different. Those generally require surgical evaluation rather than injection, because the torn tendon ends have pulled apart and need to be reattached. An MRI helps us determine which category your tear falls into and guide the right treatment. **Q: Is PRP safer than surgery for lateral hip pain?** PRP carries a much lower risk profile than surgery. In a systematic review comparing the two, PRP was associated only with temporary injection-site soreness, while surgical repair carried complication rates as high as 19 percent in one series, including blood clots, infection, retears, and fracture. Both approaches can improve symptoms in the right patients, so the decision depends on the severity of the tendon damage. For tendinosis and partial tears that have failed conservative care, PRP is a sensible next step before considering surgery, which we reserve for tears that genuinely require repair. **Q: What should I do before trying PRP?** Structured physical therapy is the foundation and should come first. The evidence for gluteal tendinopathy is clear that education and a progressive exercise program focused on hip abductor strengthening produce durable improvement, often outperforming a cortisone injection at one year. We generally recommend a dedicated course of physical therapy and activity modification before considering PRP, and our Rockville office offers physical therapy for exactly this purpose. If pain persists despite a proper rehabilitation effort, and imaging confirms tendinosis or a partial tear, PRP becomes a well-supported next option. --- ## PRP for Hamstring Injuries URL: https://www.mdorthospecialists.com/services/prp-hamstring/ PRP has demonstrated clinically meaningful evidence for two distinct hamstring conditions: acute Grade II (partial) hamstring muscle tears, where PRP injected into the injury site may accelerate return to sport; and chronic proximal hamstring tendinopathy, one of the most refractory running injuries, where PRP has shown significant improvement in pain and function in patients who have failed conservative management. ### Frequently Asked Questions **Q: Does PRP help hamstring injuries heal faster?** For acute Grade II hamstring tears, the evidence suggests yes, when PRP is delivered under ultrasound guidance within 72 hours of injury and combined with a structured rehabilitation program. A well-controlled RCT by Hamid et al. found that athletes treated with PRP plus rehabilitation returned to sport approximately 16 days earlier than those treated with rehabilitation alone (26.7 vs. 42.5 days). A 2026 British Journal of Sports Medicine meta-analysis of 6 RCTs found PRP reduced return-to-play time by a mean of 8.6 days. The effect appears strongest for Grade II tears and when PRP is delivered early in the injury course. **Q: When should I get PRP after a hamstring tear?** The optimal timing is within 24–72 hours of injury, when the hematoma at the tear site is still present and the biological environment is in the proliferative phase. PRP introduced at this stage augments an already-active healing response. Injections performed after 1–2 weeks (once the hematoma has organized or resorbed) may still provide benefit for the remaining healing process but are generally considered less ideal timing. If you have recently sustained a significant hamstring injury and are considering PRP, early evaluation by one of our physicians allows prompt treatment during this biological window. **Q: How is PRP injected into a hamstring injury?** At Maryland Orthopedic Specialists, all PRP injections for hamstring injuries are performed under real-time musculoskeletal ultrasound guidance. The patient is positioned prone on the examination table. The ultrasound probe is placed over the posterior thigh to visualize the hamstring muscle architecture, identify the zone of fiber disruption or the degenerative proximal tendon origin, and guide needle placement with precision into the target tissue. Ultrasound guidance ensures the growth factors are delivered exactly where the tissue pathology is located, avoiding neurovascular structures in the posterior thigh. **Q: Is PRP effective for chronic proximal hamstring tendinopathy?** Yes, particularly for patients who have failed conservative management. Proximal hamstring tendinopathy is a degenerative condition. The tendon at the ischial tuberosity origin undergoes collagen disorganization and failed self-repair that does not respond adequately to anti-inflammatory treatments. PRP delivers growth factors that initiate the repair cascade the degenerated tendon cannot sustain on its own. Clinical studies demonstrate significant improvements in pain (PROMIS Pain, VAS) and function (PROMIS Physical Function, iHOT scores) at 3, 6, and 12 months post-injection, with patient satisfaction increasing over time. Leukocyte-rich PRP formulations may be particularly appropriate for tendinopathic applications. **Q: How long until I can return to sport after PRP for a hamstring injury?** For acute Grade II tears, the typical return-to-sport timeline following PRP is 8–10 weeks, with clearance based on clinical criteria rather than calendar time alone. For proximal hamstring tendinopathy, return to full running training is typically 10–16 weeks post-injection, with return to competition at 16–24 weeks for symptomatic athletes. These timelines are not shortened simply because PRP was given. Rehabilitation progression governs readiness. PRP accelerates the biological foundation; structured rehabilitation determines functional capacity for sport. --- ## PRP for Knee Osteoarthritis URL: https://www.mdorthospecialists.com/services/prp-knee-osteoarthritis/ Yes. Multiple randomized controlled trials and meta-analyses have demonstrated that platelet-rich plasma (PRP) injections reduce pain and improve function in patients with knee osteoarthritis, with outcomes that are superior to both corticosteroid and hyaluronic acid (HA) injections in mild-to-moderate disease, particularly at the 6- and 12-month mark. ### Frequently Asked Questions **Q: Does PRP work for knee arthritis?** PRP has demonstrated statistically significant and clinically meaningful improvements in pain and function in patients with mild-to-moderate knee osteoarthritis across multiple randomized controlled trials and meta-analyses. It has consistently outperformed hyaluronic acid at 6- and 12-month follow-up. Results are most reliable in patients under 65 with Kellgren-Lawrence grade 1–3 OA. It is not a cure and does not reverse established cartilage loss, but for appropriate candidates, it can provide meaningful, durable symptom relief. **Q: How many PRP injections will I need for knee OA?** Most patients receive a series of 1–3 injections, spaced 4–6 weeks apart. Meta-analytic data supports multiple injections over a single dose. Your physician will recommend a protocol based on the severity of your OA, your response after the initial injection, and your treatment goals. **Q: Is PRP better than cortisone for knee osteoarthritis?** For long-term outcomes, yes. The evidence consistently favors PRP over corticosteroids at 6 and 12 months. Cortisone provides faster initial pain relief (often within 1–2 weeks) but its effects tend to diminish after 4–8 weeks, and repeated use can accelerate cartilage degradation. PRP's onset is slower but its effects are more durable and do not carry the catabolic risks associated with steroids. **Q: Is PRP covered by insurance for knee osteoarthritis?** Currently, PRP injections for knee osteoarthritis are not covered by most commercial insurance plans or Medicare, as the procedure is classified as investigational or experimental by major payers. Maryland Orthopedic Specialists provides transparent self-pay pricing and financing options. We are happy to discuss cost and coverage at your consultation. **Q: Can PRP reverse knee arthritis?** PRP does not reverse established cartilage damage or restore articular cartilage to its pre-disease state. The RESTORE trial (JAMA, 2021) found no cartilage volume restoration on MRI at 12 months with a single injection. However, PRP can meaningfully reduce pain and improve function, and may slow the progression of the intra-articular inflammatory environment that drives degeneration. It is best understood as a symptom-modifying and potentially disease-modulating treatment, not a cure. **Q: How long do PRP results last for knee OA?** In patients who respond, pain and functional improvements typically last 6–18 months. Some patients in the published trials maintained benefit at the 2-year mark. Individual results depend on disease severity, age, activity level, adherence to post-injection protocols, and whether PRP is combined with an exercise rehabilitation program. Repeat injections can be performed if benefit diminishes over time. --- ## PRP for Plantar Fasciitis URL: https://www.mdorthospecialists.com/services/prp-plantar-fasciitis/ Yes. Platelet-rich plasma (PRP) has demonstrated clinically meaningful, durable pain relief for chronic plantar fasciitis across multiple randomized controlled trials. While cortisone injections act faster in the first few weeks, the preponderance of evidence shows PRP produces superior outcomes at six months, twelve months, and beyond, without the structural risks associated with repeated steroid use. ### Frequently Asked Questions **Q: Does PRP work for plantar fasciitis?** Yes, with important nuance about timing. PRP does not produce the rapid, dramatic 1–2 week relief that cortisone provides. Instead, it initiates a biological repair process in the degenerated fascia that builds progressively over weeks to months. Multiple randomized controlled trials and systematic reviews demonstrate PRP's superiority over cortisone at 6-, 12-, and 24-month follow-up, with outcomes that continue to improve rather than decline over time. It is best understood as a healing treatment rather than a pain-blocking injection. **Q: Is PRP better than a cortisone shot for plantar fasciitis?** For long-term outcomes, the evidence consistently favors PRP. Cortisone delivers faster short-term relief (weeks 1–6), which is why some patients still prefer it as a first injection when rapid pain reduction is the priority. However, cortisone's benefits fade significantly by 3–6 months and carry documented risks of fascial rupture and fat pad atrophy with repeated use. PRP's effects are more durable (AOFAS functional scores at 12 months favor PRP by a clinically meaningful margin in multiple studies), and PRP carries none of the structural risks associated with corticosteroid injection. **Q: How long does PRP take to work for plantar fasciitis?** Most patients notice the beginning of improvement at 4–6 weeks. Meaningful pain reduction and functional improvement typically develop through the 3-month mark, with continued maturation of the healed tissue through 6–12 months. The timeline reflects the biological process: collagen synthesis and tissue remodeling take months, not days. Patients should be counseled that this is a gradual, progressive improvement rather than an immediate effect. **Q: Can cortisone rupture the plantar fascia?** Yes. Plantar fascia rupture is a documented complication of corticosteroid injection, reported at approximately 1.4–2.4% per injection event. The risk increases cumulatively with repeated injections. A ruptured plantar fascia causes a different pain pattern (often described as a "pop" sensation followed by arch collapse) and may require surgical intervention. PRP injections have not been associated with plantar fascia rupture in any major clinical trial. **Q: How many PRP injections are needed for plantar fasciitis?** Most patients with chronic plantar fasciitis receive a single ultrasound-guided PRP injection initially. Response is assessed at 6–8 weeks. Patients with significant improvement continue with rehabilitation. Those with partial response may receive a second injection at that time. The majority of published studies showing clinical benefit used one to two injections, with a small subset of patients requiring a third at 12 weeks. A structured rehabilitation program (stretching, loading, orthotics) is essential alongside the injection. PRP provides the biological stimulus, but tissue remodeling requires appropriate mechanical load. --- ## PRP for Rotator Cuff Injuries URL: https://www.mdorthospecialists.com/services/prp-rotator-cuff/ PRP can be an effective treatment for rotator cuff tendinopathy and partial-thickness rotator cuff tears, with clinical evidence supporting meaningful pain relief and functional improvement for non-surgical candidates. Multiple randomized controlled trials and a recent meta-analysis demonstrate PRP's superiority over cortisone. For partial tears, PRP serves as a regenerative option that may reduce symptoms and delay or avoid surgery. ### Frequently Asked Questions **Q: Can PRP heal a rotator cuff tear?** PRP cannot structurally reattach or repair a full-thickness rotator cuff tear. That requires surgical intervention. For partial-thickness tears, PRP may stimulate healing of the incompletely torn fibers and reduce symptoms, potentially allowing some patients to avoid or delay surgery. For tendinopathy without a significant tear, PRP promotes tissue remodeling and pain reduction. The goal is symptom relief and functional improvement, not structural reversal of an established tear. **Q: How many PRP injections do I need for a rotator cuff injury?** For non-surgical management of tendinopathy or partial tears, most patients receive one injection with a follow-up evaluation at 4–6 weeks. Partial responders may benefit from a second injection at 6–8 weeks. Most published trials used a single injection protocol; the evidence for multiple injections in rotator cuff specifically is less extensive than for knee OA. **Q: Is PRP or cortisone better for shoulder tendinopathy?** For durable long-term relief, the evidence favors PRP. A 2021 meta-analysis found PRP superior to cortisone at both 6- and 12-month follow-up for shoulder tendinopathy. Cortisone provides faster relief in the first 4–8 weeks, which may be preferable in patients with severe acute pain. However, for patients seeking lasting improvement without the risks of repeated steroid injection (which include cartilage and tendon collagen changes), PRP is the more appropriate long-term strategy. **Q: Will PRP help me avoid rotator cuff surgery?** Possibly, depending on the size and nature of your tear. For tendinopathy and partial tears, PRP can be a meaningful intervention that reduces symptoms sufficiently to defer surgery, or, in some patients, to make surgery unnecessary. For large or massive full-thickness tears in younger, active patients, surgical repair remains the standard of care, and PRP's role there is as a surgical augment rather than a surgery substitute. This is a nuanced decision that your physician at Maryland Orthopedic Specialists will guide based on your MRI findings, age, activity level, and treatment goals. **Q: How long is recovery after a PRP injection for the shoulder?** The immediate post-injection period involves 24–48 hours of relative rest, with a gradual return to overhead activity over the following 1–2 weeks. Physical therapy typically begins at 2–4 weeks. Most patients are engaged in a full rehabilitation program by 4–6 weeks and experience meaningful functional improvement by 3 months. PRP does not require the weeks-long immobilization associated with surgical rotator cuff repair. --- ## PRP for Tennis Elbow (Lateral Epicondylitis) URL: https://www.mdorthospecialists.com/services/prp-tennis-elbow/ PRP has demonstrated superior long-term outcomes compared to corticosteroid injection in multiple randomized controlled trials, with durable pain relief maintained at 12- and 24-month follow-up in patients with chronic lateral epicondylitis. Clinical evidence consistently shows that PRP addresses the underlying degenerative pathology in a way that corticosteroids do not, resulting in better outcomes over the 6- to 24-month horizon. ### Frequently Asked Questions **Q: Does PRP work for tennis elbow?** Yes, for chronic lateral epicondylitis (symptoms lasting more than 3 months) that has not responded to conservative care. Multiple RCTs and meta-analyses demonstrate that PRP produces superior pain and functional outcomes compared to cortisone and autologous blood injection at 6-, 12-, and 24-month follow-up. It is not as fast-acting as cortisone in the first 4–8 weeks, but its effects are more durable and do not carry the tendon-weakening risks of repeated steroid injection. **Q: How long until I feel results from PRP for tennis elbow?** Most patients begin noticing improvement between 4 and 8 weeks after their injection. Unlike cortisone, which can relieve pain within 1–2 weeks, PRP works by stimulating a tissue repair process that takes time to mature. Full benefit is typically experienced at 3–6 months. Patience and adherence to the post-injection protocol, particularly the eccentric exercise program, are important determinants of outcome. **Q: Is PRP better than cortisone for tennis elbow?** For long-term outcomes (beyond 8 weeks), yes. The published evidence, including a 2-year RCT by Gosens et al., shows that while cortisone is superior in the first 4 weeks, PRP surpasses it by 8 weeks and maintains statistically significant superiority through 24 months. Cortisone is associated with a well-documented rebound phenomenon at 3 months; PRP is not. For patients who have already received cortisone injections with diminishing returns, PRP is a particularly appropriate next step. **Q: How many PRP injections are needed for tennis elbow?** The majority of clinical trial protocols and real-world practice involves a single injection, with re-evaluation at 6–8 weeks. If there is a partial response, a second injection may be offered. Most patients who are going to respond will show meaningful improvement after one injection. Tennis elbow typically requires fewer injections than knee OA. **Q: Can I play sports after a PRP injection for tennis elbow?** We recommend avoiding racquet sports and repetitive gripping activities for at least 48–72 hours post-injection. Light activity is appropriate after that period. A gradual return to sport is typically recommended beginning 2–4 weeks post-injection, starting with low-intensity activities and progressing over 4–6 weeks. Returning to full competitive play before the 6-week mark is generally discouraged, as it may stress the tendon during the active remodeling phase. --- ## Regenerative Medicine & PRP Injections URL: https://www.mdorthospecialists.com/services/regenerative-medicine/ Platelet-rich plasma (PRP) is an autologous biologic therapy derived from your own blood that concentrates growth factors and platelets to accelerate the body's natural healing response in injured or degenerative tissue. We offer PRP injections as a clinically informed, minimally invasive alternative or complement to surgery for patients in Bethesda, Germantown, and throughout Montgomery County, MD. ### Frequently Asked Questions **Q: How many PRP injections will I need?** The number of injections depends on the condition being treated, its severity, and your response to the initial treatment. For many tendon conditions and mild-to-moderate joint osteoarthritis, a single injection series of one to three injections spaced several weeks apart is sufficient to achieve meaningful improvement. Some patients with more advanced pathology or chronic conditions may benefit from a repeat series after 6 to 12 months. Your physician will discuss a realistic treatment plan and expected outcomes at your consultation. **Q: How long does it take to see results from PRP?** PRP initiates a biologic healing process, so results are not immediate. Most patients begin to notice improvement within 4 to 8 weeks following injection, with continued improvement often observed over 3 to 6 months. This timeline reflects the underlying biology. Tissue remodeling and collagen synthesis take time. It is important to have realistic expectations and to continue prescribed rehabilitation during this period, as physical therapy and structured exercise enhance the healing response. **Q: Does PRP hurt?** The injection itself involves a needle and is associated with some discomfort, similar in character to other joint or tendon injections. We use ultrasound guidance to improve accuracy and minimize the number of passes required. A local anesthetic may be applied to the skin prior to the injection to reduce discomfort. After the procedure, a temporary increase in soreness at the injection site is common and expected. It reflects the inflammatory healing phase and typically peaks at 24 to 72 hours before subsiding. Over-the-counter acetaminophen can be used for discomfort; NSAIDs such as ibuprofen should be avoided, as they may interfere with the healing response. **Q: Who is a good candidate for PRP?** PRP is best suited for patients with chronic or subacute musculoskeletal conditions that have not responded adequately to conservative measures such as physical therapy, activity modification, and cortisone injections, and who wish to avoid or delay surgical intervention. Ideal candidates are generally in good overall health, are non-smokers (or have limited tobacco use), are not on chronic anticoagulation therapy, and have realistic expectations about the timeline and nature of PRP-mediated healing. Patients with active infection, certain blood disorders, or active malignancy are not candidates. Your physician will review your full medical history to determine whether PRP is appropriate for you. **Q: What is the difference between PRP and stem cell therapy?** PRP and stem cell therapy are both biologic treatments, but they work through different mechanisms. PRP uses a concentration of your own platelets and their growth factors to stimulate and accelerate the existing healing response in targeted tissue. Stem cell therapy (more accurately referred to as bone marrow aspirate concentrate (BMAC) or adipose-derived cell therapy) involves harvesting cells with regenerative potential from bone marrow or fat tissue and injecting them into the damaged area. Stem cell-based procedures are generally more invasive, more costly, and carry a less well-established evidence base for most orthopedic conditions than PRP. Our physicians will discuss whether PRP or a more advanced biologic approach is appropriate based on your diagnosis and clinical picture. **Q: Can I get PRP if I'm on blood thinners?** This depends on the type and purpose of the anticoagulant medication you are taking. Certain blood thinners may affect platelet function or the quality of the PRP concentrate that can be produced. Some patients can safely pause anticoagulation therapy for a brief period around the injection with their prescribing physician's guidance; others cannot safely do so. It is essential that you disclose all medications (including aspirin, warfarin, clopidogrel, and newer anticoagulants) to our physician at your consultation. We will work with your prescribing provider to determine whether PRP can be safely performed and under what conditions. --- ## Sports Medicine & Athletic Performance URL: https://www.mdorthospecialists.com/services/sports-medicine/ Sports medicine is a specialized branch of orthopedic medicine focused on the prevention, diagnosis, and treatment of injuries related to athletic activity and physical performance. At Maryland Orthopedic Specialists, our board-certified orthopedic physicians provide comprehensive sports medicine care at our Bethesda and Germantown, MD locations, serving patients throughout Montgomery County and the greater Washington, D.C. ### Frequently Asked Questions **Q: What is the difference between sports medicine and orthopedic surgery?** Sports medicine and orthopedic surgery are related but distinct disciplines. Sports medicine focuses primarily on the non-surgical evaluation, diagnosis, and treatment of musculoskeletal injuries, including injections, rehabilitation, and return-to-sport planning. Orthopedic surgery encompasses the full surgical management of bones, joints, ligaments, tendons, and muscles. At Maryland Orthopedic Specialists, our physicians are board-certified orthopedic specialists who can provide both sports medicine care and surgical intervention when needed, giving patients a seamless experience without having to transfer between practices. **Q: Do I need a referral to see a sports medicine doctor at Maryland Orthopedic Specialists?** In most cases, you do not need a referral to schedule an appointment with our sports medicine team. Many patients contact us directly after an injury or when experiencing persistent pain. However, depending on your insurance plan, a primary care referral may be required for coverage. We recommend checking with your insurance carrier before your visit. Our front office team is happy to help you navigate the process. **Q: Can sports injuries be treated without surgery?** Yes. The great majority of sports injuries, including many ACL sprains, rotator cuff tears, meniscus tears, and tendon injuries, can be effectively managed without surgery using a combination of physical therapy, activity modification, bracing, and appropriately timed injections such as corticosteroids or PRP. The decision between surgical and non-surgical management depends on the severity of the injury, the patient's activity level and goals, and how the injury responds to conservative care. Our physicians will give you an honest, evidence-based recommendation either way. **Q: What is the fastest way to recover from a sports injury?** The fastest recovery is one that is properly staged, not rushed. This means beginning with an accurate diagnosis, following a structured rehabilitation program guided by a physical therapist, attending follow-up appointments to monitor progress, and respecting objective return-to-sport milestones. Returning too early is one of the most common causes of re-injury and prolonged disability. At Maryland Orthopedic Specialists, we help you move as efficiently as possible through each phase of recovery while protecting the long-term integrity of the injured tissue. **Q: Do you treat recreational athletes or only competitive athletes?** We treat athletes of all levels, from youth and high school athletes to weekend warriors, Masters-level competitors, and professional or collegiate athletes. Sports injuries do not discriminate by skill level, and neither does our care. If you are physically active and experiencing a musculoskeletal injury that is limiting your participation, you are exactly the type of patient we are here to help. **Q: What should I bring to my first sports medicine appointment?** Please bring a photo ID, your insurance card, a list of current medications and supplements, any relevant prior imaging (X-rays, MRI, ultrasound) on disc or with a written report, and any referral paperwork your insurance requires. It is also helpful to wear or bring any braces or orthotics you are currently using, and to be prepared to describe the mechanism of your injury, your symptom timeline, and what activities are most affected. The more information you can share, the more productive your first visit will be. --- ## What Is Sports Medicine? Fellowship Training, CAQ Certification & Advanced Care URL: https://www.mdorthospecialists.com/services/sports-medicine-specialty/ Sports medicine at MOS combines advanced arthroscopic surgery with evidence-based non-operative care to treat injuries of the knee, shoulder, hip, and elbow. Our fellowship-trained physicians offer the full spectrum, from biologic injections and targeted rehabilitation to complex ligament reconstruction and cartilage restoration, helping athletes and active adults return to the activities they love. ### Frequently Asked Questions **Q: What is the difference between a fellowship-trained sports medicine surgeon and a general orthopedic surgeon?** All fellowship-trained orthopedic sports medicine surgeons have completed a five-year general orthopedic residency plus an additional one-year sports medicine fellowship: approximately 500 to 600 additional cases focused exclusively on sports medicine procedures. A general orthopedic surgeon may perform some sports medicine procedures but has not received the same concentrated subspecialty training. For high-demand procedures like ACL reconstruction, rotator cuff repair, or hip arthroscopy, fellowship training is directly associated with better outcomes in the published literature. **Q: What does CAQ-certified mean and how do I know if my surgeon has it?** A Certificate of Added Qualification (CAQ) in Orthopaedic Sports Medicine is issued by the American Board of Orthopaedic Surgery to surgeons who have completed an accredited fellowship, met minimum procedure volume requirements, and passed a standardized written examination. It is renewable and requires ongoing recertification. You can verify a surgeon's board certification and CAQ status at the ABOS website: [abos.org](https://www.abos.org). **Q: What is the role of physical therapy after sports medicine surgery?** Physical therapy is not optional after sports medicine surgery. It is the primary determinant of long-term outcomes for most procedures. ACL reconstruction, rotator cuff repair, and labral procedures all require structured rehabilitation that progresses through defined phases: early motion restoration, strength rebuilding, sport-specific conditioning, and criteria-based return-to-sport testing. The physical therapist executes this progression and is the clinician most responsible for whether a patient achieves full functional recovery. **Q: What is a CAQ, and should I ask my surgeon if they have one before scheduling?** Yes, it is a completely reasonable question. The CAQ in Sports Medicine is the most objective credential for verifying subspecialty expertise in sports medicine. A surgeon who holds it has met nationally standardized criteria that go beyond self-designation. Asking about fellowship training and CAQ status before scheduling for a significant surgical procedure is a sign of an informed patient, and any reputable sports medicine practice will welcome the question. **Q: What is arthroscopy and why is it used in sports medicine?** Arthroscopy is a minimally invasive surgical technique in which a small camera (arthroscope) is inserted into a joint through a portal approximately the size of a small buttonhole. The surgeon views the interior of the joint on a monitor and operates through one or two additional small portals using specialized instruments. Because arthroscopy avoids large incisions, it reduces post-operative pain, lowers infection risk, and shortens rehabilitation timelines compared to open surgery for the same procedures. Most modern sports medicine procedures (ACL reconstruction, meniscal repair, rotator cuff repair, labral repair, hip arthroscopy) are performed entirely or primarily arthroscopically. **Q: How do I know if I need a sports medicine surgeon or a general orthopedic surgeon?** For injuries involving the moving parts of the body (ligaments, tendons, cartilage, and joint structures in the knee, shoulder, hip, elbow, and ankle), a fellowship-trained sports medicine surgeon is generally the most appropriate specialist. For fractures, joint replacement, spine surgery, and pediatric orthopedic conditions, a surgeon with subspecialty training in those specific areas would be more appropriate. At Maryland Orthopedic Specialists, our team includes specialists in sports medicine, joint replacement, hand and upper extremity surgery, and foot and ankle surgery, so we can direct you to the right specialist within our practice. ================================================================================ # PHYSICIANS ================================================================================ ## John J. Christoforetti, MD, FAAOS URL: https://www.mdorthospecialists.com/providers/john-christoforetti-md/ Specialties: Orthopedic Surgery, Sports Medicine, Hip Preservation Surgery Notable techniques: Arthroscopic hip labral repair, Femoroacetabular impingement (FAI) correction (osteoplasty), Joint-preserving hip osteotomies, Hip arthroscopy (cam and pincer impingement, gluteus medius repair, iliopsoas tendinopathy), Arthroscopic shoulder stabilization and labral repair (SLAP, Bankart), Rotator cuff repair with Regeneten augmentation, Platelet-rich plasma (PRP) and biologic injections Dr. John Christoforetti specializes in arthroscopic hip, shoulder and knee surgery, special interest in hip preservation. --- ## Peter G. Fitzgibbons, MD URL: https://www.mdorthospecialists.com/providers/peter-g-fitzgibbons-md/ Specialties: Hand Surgery, Orthopedic Surgery Notable techniques: Open and endoscopic carpal tunnel release, Trigger finger release (in-office and operative), Thumb CMC (basal joint) arthroplasty, Distal radius fracture fixation (open reduction internal fixation), Scaphoid fracture fixation, Cubital tunnel decompression / ulnar nerve transposition, Tendon repair and reconstruction (hand and forearm), Wrist arthroscopy Dr. Peter Fitzgibbons specializes in treating complex orthopedic conditions of the hand, wrist, and elbow. --- ## James S. Gardiner, MD URL: https://www.mdorthospecialists.com/providers/james-s-gardiner-md/ Specialties: Orthopedic Surgery, Sports Medicine Notable techniques: Dr. James Gardiner specializes in arthroscopic shoulder and knee surgery, special interest in athletic knee and shoulder injuries. --- ## Brian McCormick, MD URL: https://www.mdorthospecialists.com/providers/brian-mccormick-md/ Specialties: Adult Reconstruction, Hip and Knee Replacement A Washington, DC native and Georgetown-trained surgeon, Dr. Brian McCormick specializes in hip and knee replacement and joins MOS following a fellowship in adult reconstruction at New England Baptist Hospital — one of the country's premier joint replacement programs. --- ## Christopher S. Raffo, MD URL: https://www.mdorthospecialists.com/providers/christopher-s-raffo-md/ Specialties: Orthopedic Surgery, Sports Medicine Notable techniques: All-arthroscopic rotator cuff repairs, Regeneten bioinductive implant (rotator cuff augmentation), Quadriceps autograft ACL reconstruction, BPTB (bone-patellar-tendon-bone) autograft ACL reconstruction, Lateral Extra-Articular Tenodesis (LET) augmentation for ACL reconstruction, OCA (Osteochondral Allograft) for cartilage repair, MACI (Matrix Autologous Chondrocyte Implantation) for cartilage repair, Meniscal repair, Meniscal root repair, Arthroscopic shoulder stabilization and labral repair (SLAP, Bankart), Arthroscopic remplissage, Robotic MAKO total knee arthroplasty, Robotic MAKO partial knee replacement, CORI robotic total knee arthroplasty, Platelet-rich plasma (PRP) and biologic injections Christopher S. Raffo, MD is a board-certified sports medicine surgeon with 21+ years of experience in arthroscopic shoulder and knee care.