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Midwest Orthopaedics: Ask the Docs

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Hip Bursitis

Patient Question:
While playing softball last week I fell hard on my hip trying to make a play in the field. It didn't seem to hurt much then, but as time has passed I have experienced increasing pain at the point of my hip. Is this something that will go away on its own?
Dr. Charles Bush-Joseph:

It sounds like you are experiencing a hip bursitis or "trochanteric bursitis." This is an inflammation of the "bursa" located outside the greater trochanter (hip point). A bursa is a fluid filled sac, with a jelly-like feel that helps to protect/cushion the bones from overlying tissue. It also helps in reducing the friction that may be caused when your muscles glide over the hip bone. Hip injuries are not as common in softball as in contact sports such as football, but they do occur.

There are many causes that can create this inflammation of the bursa. A sudden fall or blunt trauma is one main cause. This could have happened when you fell on the field. Another important cause is repetitive stress or overuse of the hip. Although you may have aggravated your trochanter bursa when you fell, extended stress of the joint by continuing to play softball could have contributed to the inflammation.

Symptoms of trochanteric bursitis include a sharp pain at the point of your hip. Usually this pain starts out as a shooting pain, and as your body tries to cope with the inflamed bursa, the pain turns into an achy, throbbing feeling.

Treatment:

In most cases trochanteric bursitis can be treated with modified activity levels, taking an anti-inflammatory medication, and in severe cases using a walking cane or crutches. A sports medicine orthopaedic physician may recommend an injection of corticosteroids to help in relieving the pain caused by the inflammation.

If all of these initial treatments do not lead to the reduction of the inflamed bursa, the physician may recommend the removal of the hip bursa. This is usually only recommended in the most severe cases. The procedure is typically performed outpatient, and the patient can expect to be up and moving within a few days after the surgery.

For more information about Dr. Bush-Joseph and the sports medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.


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Overpronation, Flat Feet

Patient Question:
My 12 year old son is very active in competitive sports. Playing catcher in organized baseball, he has been experiencing both knee and hip pain. A pediatrician evaluated him and diagnosed tendonitis as a result of calcaneal valgus and pes planus. He prescribes MBA implants for both feet. Is this a good course of treatment or would you recommend an alternative?
Dr. Jeffrey Mjaanes:

The two conditions your son has-calcaneal valgus (overpronation) and pes planus (flat feet)-are very common but are uncommon causes of foot pain. Sometimes, however, overpronation and/or flat feet can be contributing factors to shin, knee, hip or back pain.

Treatment:

The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.

Since your 12 year old son is still growing, his arches may continue to form. Even if they don't, flat feet are usually not a problem (high arches usually are). If there is pain with flat feet, the treatment is pain relief by decreasing the abnormal pressure on the bones. This can be achieved with a simple over-the-counter orthotic or, if necessary, a custom-made orthotic. Motion-control shoes obtained at a running store may also help. In my opinion, surgery for these two common conditions is an absolute last resort.

For more information about Dr. Mjaanes and the sports medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.


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Dealing with Shin Splints

Patient Question:
For years I have been struggling with shin splints. When I wake up in the morning, my feet are extremely sore-even if I haven't been running. When I do attempt to run, I can't make it more than a quarter of a mile before the pain in my shins begins. I use custom made arch supports but they don't seem to be working. I also ice my shins after a run but that doesn't seem to help much, either. Is there any advice you can give me so that I can begin running again?
Dr. Johnny Lin:

The term "shin splints" is commonly used to describe pain in the front of the leg which occurs with increased levels of activity. The most common cause of this problem is inflammation at the attachment site of the muscles in the front of the leg. This can be the result of abnormal mechanics during running as well as overuse.

Treatment:

Treatment of shin splints revolves around a daily regimen of stretching for the ankle, hamstrings, AND hip (physical therapy). As you noted, if your foot is excessively flat or high arched, this can also contribute to abnormal mechanics. This can be treated with a corrective shoe insert; however the insert/arch support must be made appropriately to be effective. Finally, a training regimen implementing both impact (running) and non-impact exercises such as cycling, swimming, and the elliptical machine can also decrease the stresses on the leg while improving muscular endurance and cardiovascular fitness.

A second common cause of "shin splints" is excessive exercise-induced swelling of the leg. In this situation, there is abnormal pressure on the muscles and nerves in the leg resulting in pain. This is also referred to as "exertional compartment syndrome." It also responds to the treatment regimen outlined above. However, if this fails, than surgical expansion of the connective tissues surrounding the muscles of the leg can provide relief of symptoms.

For more information about Dr. Lin and the sports medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.


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A Pain in the Backside

Patient Question:
I'm a 48-year-old male. In my efforts to remain active, I play in a local fast-pitch softball league. Last week, I pulled a muscle high on the backside of my right leg while running to first base. I thought it might be a hamstring pull but it almost feels like it could be a glute injury. The pain is most noticeable at the point where the thigh and buttocks meet. Is this serious? Should I see a physician?
Dr. Trish Palmer:

You may be suffering from Ischiogluteal Bursitis, which is inflammation of the bursa that lies between the ischial tuberosity and the tendon of a hamstring muscle. Bursae are small fluid-filled sacs that lie between the bone and tendon and serve to reduce the amount of friction between the two surfaces. A bursa can become inflamed as an isolated injury, or injured in conjunction with hamstring inflammation and tendonitis.

Ischiogluteal Bursitis symptoms include pain and tenderness where the tendon meets the bone, pain when stretching and sitting, and pain when flexing the leg against resistance (running). The injury commonly occurs when an athlete attempts shorts bursts of speed (sprints). This could explain why you initially noticed the pain after a sprint to first base.

Treatment:

Treatment of Ischiogluteal Bursitis is not complicated but does require patience. Many athletes tweak the injury by pushing too hard and too soon to get back in the game. The first step in recovery is rest. Staying off of your feet will allow for the muscle to begin repairing itself. Along with rest, ice should be applied for 20 minutes every hour for approximately 48 hours after the injury. After the initial two days of treatment, a heat pad should replace the ice.

If the injury is more severe, you should visit an orthopaedic sports medicine physician. Depending on the severity of the injury, your physician may prescribe anti-inflammatory medication or a cortico-sterioid injection into the bursitis to reduce the swelling and pain. After you have sufficiently healed and are cleared by your orthopaedic specialist, physical therapy and stretching sessions will likely be prescribed. Strengthening exercises of the hamstrings and core muscles are used as preventative measures to decrease the chance of injury.

For more information about Dr. Palmer and the sports medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.


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Diagnosing the Severity of Ankle Sprains

Patient Question:
As a baseball coach, I've noticed that ankle injuries are somewhat common with my players. How can you tell the severity of a sprain? Also, can you offer any tips for healing and prevention of ankle sprains?
Dr. Johnny Lin:
There are three different levels of ankle sprain severity (Grade I to Grade III). These different injury grades require different treatment regimens and recovery times.
  • Grade I consists of mild swelling and tenderness with no loss of stability. You should be able to bear weight on the ankle with minimal pain. A Grade I ankle sprain is essentially a partially torn or stretched ligament.
  • A Grade II ankle sprain involves an incomplete tear of your ligament. Swelling and tenderness is pronounced, and you will have some loss of stability. Bearing weight on the ankle is difficult and painful.
  • Grade III is the most severe case of an ankle sprain and can sometimes lead to surgical repair. This stage is accompanied by severe swelling, complete loss of range of motion, and a total inability to bear weight. A Grade III sprain is essentially a complete tear of the ligament.
Treatment:

Be advised that nearly 40% of all ankle sprains can lead to chronic ankle problems if not properly cared for. Appropriate treatment begins with early application of PRICE (protection, rest, ice, compression, and elevation). If you exhibit symptoms of a Grade II or Grade III sprain, it's important to see an orthopaedic physician for a complete evaluation. Your physician will perform a thorough examination of the ankle to make sure that you do not have a fracture or severely torn ligament.

Once you have passed the initial injury phase, your physician will recommend that you rehab your ankle with muscle strengthening and range-of-motion exercises. These will allow you to safely get back in the game more quickly. It is important to remember that once you have sprained your ankle, strengthening exercises should never cease-even if you wear a brace. This can cause a reoccurrence of the injury, especially if you stop the exercises too early in your rehabilitation.

For more information about Dr. Lin and the sports medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.


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Frozen Shoulder

Patient Question:
I play in a recreational baseball league. Over the past few months my shoulder has really been bothering me. Oddly enough, I have been experiencing pain when I lift my non-throwing arm and my shoulder seems to be stiff. Have I torn something?
Dr. Gregory Nicholson:

Since the injury you're describing is to your non-throwing shoulder, the condition sounds like it could be Adhesive Capsulitis. Adhesive Capsulitis is also known as "frozen shoulder." Common symptoms of this injury include pain in your shoulder, decrease in your range of motion, and throbbing stiffness. This injury is more common (about 70% of cases) in women who are ages 40 to 60.

Adhesive Capsulitis, which can last from one to three years in extreme cases, progresses through three stages. The first stage is the "freezing" stage, beginning with a slow onset of pain that increases steadily for three to eight months. The second stage is the adhesive or "frozen" stage. Adhesive stages are typically less painful than the first stage, but the joint will remain very stiff for another four to six months. Finally, the third stage is called the recovery stage. During the recovery stage the shoulder becomes less painful and range of motion returns over a period of one to three months.

Treatment:

There is no immediate treatment that will cure Adhesive Capsulitis. Most doctors will tell you that this type of injury has to run its course. Due to this fact, primary treatment includes trying to manage the pain with ice, heat, and other methods to reduce muscle spasms and stiffening.

You should consult a licensed orthopaedic physician, who will likely prescribe a physical therapy program and stretching exercises to help reduce the effects of the stiffening stage. Many doctors will also prescribe medication to help alleviate the pain. The ultimate goal at this point is to diagnose the cause of the injury and take the necessary precautions to prevent it from happening again.

For more information about Dr. Nicholson and the sports medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.


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Treating Thumb Sprains

Patient Question:
This past week, while playing in my weekly baseball league, I injured my thumb while trying to catch a ground ball. My symptoms are bruising, tenderness, and swelling. I am assuming that I sprained my thumb. Do you think my self-diagnosis is correct? Do I risk further injury if I don't stop playing?
Dr. John J. Fernandez:

Your symptoms sound like you have experienced a typical thumb sprain. A thumb sprain occurs when the main ligament (ulnar collateral) that supports your thumb's grasp activities is torn. The ulnar collateral ligament helps your hand function properly, acting like a hinge to keep the thumb joint stable.

A sprained thumb is a common injury in baseball, basketball, football, and skiing (when you fall and extend your hand to catch yourself). Typical symptoms of a mild thumb sprain include the diminished ability to grasp items between your thumb and index finger, bruising, tenderness, and swelling. If you're symptoms are worse than these, it's a good idea to see an orthopaedic physician. Your physician can determine if your injury is severe (i.e., a broken thumb or hand) and help to ensure it will not cause long-term weakness, pain, and instability.

Treatment:

Treatment for a minor thumb sprain includes immobilizing the thumb joint with a bandage or cast while it heals. The splint may need to be worn for up to three or four weeks. After that, your orthopaedic physician will likely prescribe flexion and extension exercises. During this time your splint will be able to be removed, but it should be worn at all other times. These flexibility and strengthening exercises should continue for another two or three weeks, until the swelling and tenderness in the thumb have subsided.

In more serious cases where the ulnar collateral ligament of the thumb is completely torn, or your bone has fragmented away with the tear, surgery may be needed to correct the ligament and bone positioning. After surgery, a cast or a splint may be worn to protect the thumb ligament for up to six to eight weeks while the injury heals. Either way, I would not recommend that you compete this week. If indeed you sprained your thumb (or worse), playing with the injury too early can lead to a more severe injury.

For more information about Dr. Fernandez and the sports medicine physicians of Midwest Orthopaedics at Rush, call 877 MD BONES or visit them online at www.rushortho.com.


The information contained on this page is intended only for general public education, and is not intended to serve as a substitute for direct medical advice. This information should not replace necessary medical consultations with a qualified orthopaedic physician.