Category Archives: Areas of Expertise

The Hip

The hip, one of the body’s largest weight-bearing joints, supports the body both when it is still and when it is moving. It is designed to provide stability during standing and other weight-bearing activities, mobility for movement, and shock absorption for the torso and upper body.

The hip is a ball and socket joint. This type of joint allows movement and rotation in a variety of directions, including front-to-back, side-to-side, and left to right.

The hip is comprised of bones, cartilage, synovial membrane, ligaments, tendons and muscles that work together to keep the joint functioning correctly. A problem with any one of these parts can cause pain or hip function problems.

The hip joint consists of two primary bones: the thighbone, or femur, and the pelvis. The top or head of the thighbone is shaped like a ball. It fits tightly into a socket on the side of the pelvis. This cup-shaped depression in the pelvis is called the acetabulum.

The hip socket and the ball of the thighbone are covered in a layer of hard, smooth articular cartilage. The cartilage cushions the bones during weight-bearing activities and helps them move smoothly with little friction.

Synovial Membrane
The remaining surfaces of the hip joint are lined with a synovial membrane, a connective tissue that makes a small amount of synovial fluid to lubricate and eliminate almost all friction in the hip joint.

A complex system of connective tissue called ligaments attaches the thighbone to the pelvis. The ligaments provide stability to the joint during rest and movement.

There are three main ligaments in the hip joint.

  • At the front of the joint is the iliofemoral ligament, a Y-shaped ligament that attaches the pelvis to the thighbone. It is often considered the strongest ligament in the body.
  • The ligament that attaches across the front of the joint from the pubis bone of the pelvis to the thighbone is the pubofemoral ligament.
  • The back of the hip joint is reinforced by the ischiofemoral ligament that attaches from the back of the hip socket to the thighbone.

Muscles and Tendons
The muscles in the hip area both support and stabilize the joint and provide the power for the hip to move in multiple directions. Tendons connect muscles to bones. All muscles have tendons at the end where they meet the bone.

Flexing from the hip joint is made possible primarily by a muscle called iliopsoas. Extending from the hip joint is made possible by the gluteus maximus and the hamstrings muscles. There are quite a few other muscles in the hip area, also. They all work together to produce movement and reinforce the joint.

Foot and Ankle

The average person takes about 8,000 to 10,000 steps a day. In a lifetime, the average person has likely walked enough to go around the circumference of the world four times.

The foot and ankle is a complex mechanism. The foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles. The two most important functions of the foot are to bear weight and propel a person. The components of the ankle along with the muscles and tendons of the lower leg all work together to handle the stress the ankle has when a person walks, runs or jumps. A problem with any one of these parts can cause pain and difficulties with foot and ankle functions.

The ankle joint, called the tibiotalar joint, consists of three major bones: the tibia, fibular and talus. The tibia is the large shinbone; it forms the inside part of the ankle. The fibula is the smaller calf bone that forms the outside part of the ankle. The talus is the bone on the top of the foot that connects the ankle to the foot. This joint allows the foot to move up and down.

The subtalar joint is the primary joint of the hindfoot located just below the ankle joint. It consists of two major bones: the talus and calcaneus. The talus is the bone on the top of the foot, and the calcaneus is the heel bone. This joint allows the foot to move side to side.

The other foot joints include:

  • The talonavicular joint is where the talus connects to the naviculus, or the inner midfoot bone.
  • The calcaneocuboid joint is where the heel bone connects to the cuboid, or the outer midfoot bone.
  • The metarsocunieform joint is where one of the metatarsals, or forefoot bones, connects to the smaller midfoot bones.
  • The first metatarsophalangeal joint is where the first forefoot bone connects to the phalanx, or toe bone.

The ends of the bones are covered by articular cartilage. The hard, slick material helps reduce friction between the bones during movement.

The bones of the foot and ankle are joined to the other bones by short bands of tough fibrous connective tissue called ligaments. They give the joints strength and stability.

There are several major ligaments in the foot and ankle. Some of the more important ones include the following:

  • The anterior tibiofibular ligament connects the tibia to the fibula.
  • The lateral ligaments are three ligaments along the outside of the ankle that connect the fibula, talus and calcaneus. These are the ligaments most commonly injured in an ankle sprain.
  • The deltoid ligament, or the medial ligament, is a thick and strong ligament on the inside of the ankle. It attaches the tibia to the talus and calcaneus.

Muscles and Tendons
The muscles of the foot are either intrinsic or extrinsic muscles, and are responsible for causing movement and to provide stability during activities. The intrinsic muscles are located within the foot and cause movement of the toes. Extrinsic muscles are located outside the foot in the lower leg.

The gastrocnemius muscle, or main calf muscle, is an extrinsic muscle. It allows a person to point the foot and stand on tip-toe. The peroneal muscles are on the outside of the legs; they provide stability and allow the foot to turn out. Other muscles help a person extend the foot and toes.

Muscles have tendons, which connect muscles to bones. The larger Achilles tendon is critical. It attaches the calf muscle to the heel bone, and it is responsible for allowing a person to walk, run and jump. The posterior tibial tendon attaches one of the smaller muscles of the calf to the underside of the foot. This tendon supports the arch. The anterior tibial tendon allows the foot to be raised. The muscles of the toes also have tendons.

The Wrist

Carpal Tunnel Syndrome and The Wrist

A common source of hand numbness, weakness and pain, carpal tunnel syndrome is caused by increased pressure on the median nerve which enters the hand from the forearm through an area called the carpal tunnel.

What causes carpal tunnel syndrome?

Eight bones make up the wrist. These carpal bones form a “C” shaped ring covered by the transverse carpal ligament. The carpal ligament is part of the tissue that holds the wrist joint together. The ligament and bones form the narrow carpal tunnel through which the median nerve and the tendons that flex the fingers and thumbs pass. This carpal tunnel is only about as big around as thumb. If there is swelling in the carpal tunnel or something else takes up space, there is even less room and the medial nerve is likely to get pinched or pressured.

There are several possible reasons for developing carpal tunnel syndrome, including:

  • Repetitive strain or overuse: A combination of repetitive, forceful and awkward or stressed motions of hands and wrists, especially when done for prolonged periods without rest, may cause carpal tunnel problems. Using vibrating power tools and heavy assembly line work are two common causes of such injuries.
  • Physical characteristics: In some people, the carpal tunnel is smaller than in others. Also, some people have other mechanical problems in the wrist joint that cause pressure on the median nerve.
  • Certain diseases and conditions: Thyroid problems, diabetes, rheumatoid arthritis, fluid retention during pregnancy or menopause, a cyst or tumor in the canal, and other conditions make someone more susceptible to carpal tunnel syndrome.
  • Injury: Trauma or injury to the wrist, such as a sprain or fracture, can cause swelling in the carpal tunnel area.

What are the symptoms of carpal tunnel syndrome?

Symptoms usually begin gradually and can occur both at night while at rest and during the day with activity. The most common symptoms may include:

  • Pain, numbness or tingling in the palm of the hand, the palm side of the wrist and forearm, and the fingers (except the little finger).
  • A feeling of swollen fingers, though they may not look swollen.
  • A sense of weakness in the hand and a tendency to drop things.
  • Possible difficulty telling the difference between hot and cold to touch.

How is carpal tunnel syndrome treated?

The earlier treatment is started, the more effective it is for patients.

Non-surgical options

The first step for treating carpal tunnel syndrome is non-surgical care. In many cases, these treatments are successful. Treatments may include the following:

  • Rest and immobilization: The first treatment generally involves resting the affected hand and wrist by avoiding activities that may worsen symptoms. In many cases, an immobilizing wrist brace or splint is worn during activities that aggravate symptoms and/or at night to keep the wrist in a natural position during sleep.
  • Medication: Over-the-counter pain relievers and anti-inflammatory medications can lessen pain and swelling.
  • Activity alteration: Taking frequent breaks from repetitive activities and stretching before and after activities may help.
  • Injections: A corticosteroid injection may provide temporary relief.
  • Treating other conditions: If carpal tunnel syndrome is caused by an underlying physical problem, such as diabetes or water retention from pregnancy, treating the underlying condition will often relieve carpal tunnel symptoms.

Surgical options

Carpal tunnel release surgery is the most common surgical procedure. The surgery is done on an outpatient basis, so it does not normally require an overnight hospital stay.

Surgery is often required on both wrists, though both are not operated on at the same time. It may take several weeks to a few months after surgery for complete use of the wrist and hand to return.

The most common form of surgery is open release surgery. In this procedure, an incision of up to two inches long is made in the wrist and then the carpal ligament is cut to enlarge the carpal tunnel and release pressure on the median nerve.

The Elbow

The Elbow

The Elbow & Bursitis

Bursitis is a painful inflammation of a bursa, one of the many fluid-filled sacks that are found throughout the body between tendons, bones, ligaments, muscles or skin. The bursa helps reduce friction, especially in and around joints where there are risks of rubbing.

Bursitis can occur anywhere in the body where there is a risk of rubbing or pressure. It is especially likely to occur in the hip, knee, shoulder and elbow joint. Inflammation and the resulting pain generally happens when the stresses placed on a tissue are greater than what the tissues can handle.

Those most likely to develop bursitis are people who perform repetitive activities or tasks. It also can result from direct trauma to the joint, such as an ankle sprain.