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Arthritis isn’t just a disease; it’s a complex disorder that comprises more than 100 distinct conditions and can affect people at any stage of life. Two of the most common forms are osteoarthritis and rheumatoid arthritis.

These two forms have very different causes, risk factors, and effects on the body, yet they often share a common symptom—persistent joint pain. The joint pain of arthritis can appear as hip pain, knee pain, hand pain, or wrist pain, as well as joint pain in other areas of the body. If you have joint pain, stiffness and/or swelling for more than two weeks, you may have arthritis. Make an appointment with your doctor.

Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.

The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. Instead, only two small incisions are made – one for the arthroscope and one for the surgical instruments. This reduces recovery time and may increase the rate of surgical success due to less trauma to the connective tissue. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring because of the smaller incisions. Irrigation fluid is used to distend the joint and make a surgical space. Sometimes this fluid leaks into the surrounding soft tissue causing extravasation and edema.

The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci.

Arthroscopy is used for joints of the knee, shoulder, elbow, wrist, ankle, and hip.

There are primarily two types of fractures: closed fractures and open fractures. In a closed fracture, even though the bone is broken, the skin is unharmed. In an open fracture, there is a deep injury that exposes the bone through the skin. A compound fracture carries the risk of infection due to the fragments of bone that stick out of the skin.

In most cases of open fracture, the broken bone is seen easily by the medical practitioner and an x-ray is usually performed. Sometimes a series of x-rays need to be taken from different angles to diagnose certain kinds of fractures such as a rib fracture. Also, an open fracture entails bleeding which needs to be kept under control. Doctors prescribe antibiotics to reduce the possibility of an infection.

Reduction of a fracture means restoring the broken bone back to its original position. The fundamental goal in treating fractures is to restore the broken bone to its original position, and then rendering it immobile. In case of a displacement, the bone should be restored to its original position with the help of cast or a splint. Once the bone is returned to its original position, it can then heal. Many times a surgeon may need to perform surgery for fracture reduction.

Hand surgery can be the result of many conditions. Listed are but a few:

Carpal Tunnel Syndrome
Trigger Finger
Ganglions

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome occurs when the median nerve which runs through the wrist to the hand becomes compressed. In the wrist, the median nerve (the major “communication line” between the brain and the hand) is routed through a small passage bound by the wrist bones (the carpals) and the tough ligament tissue connecting them. Nine tendons also pass through this crowded “carpal tunnel”. Because this structure is rigid, any influence that causes tissue swelling within the tunnel or reduces its size tends to compress and pinch the median nerve. If conservative efforts fail to control symptoms, an operation called a carpal tunnel release is indicated. In this relatively simple outpatient procedure, the surgeon carefully cuts the wrist ligament, releasing the pressure inside the carpal tunnel, usually providing almost instantaneous relief from arm and hand pain and tingling.

As the wound heals, new tissue will bridge the severed ligament in about six weeks, making the ligament long enough to create additional space inside the tunnel and prevent recurrence of symptoms in most cases.

The hand surgeon is specifically trained and experienced in diagnosing, treating and, when possible, preventing disorders of the hand and upper extremity. A hand surgeon will generally have available all effective methods of carpal tunnel evaluation and treatment.

Trigger Finger

Usually, snapping and clicking in the fingers relates to a condition we call trigger fingers or trigger thumbs. These clicks occur when one bends or straightens the fingers (or thumb). Occasionally, a digit will lock either fully bent or straightened. Why does this occur? Normally the tendons that bend the fingers pass through a tunnel that holds them attached to the finger bones. For some reason, the tendons form lumps that catch as they pass through the narrow passages of the tendon tunnel.

This condition usually occurs near the crease in the middle of the palm of the hand, and the patient feels pain in this area as well as over the top of the finger. Frequently, the clicking and locking becomes worse overnight, but as the patient uses the finger more and more during the day, the symptoms improve.

Treatment of these clicking fingers involves either cortisone injections or surgery. When cortisone is injected around the tendon, it can cause the lump in the tendon to become smaller, at least temporarily, which alleviates the symptoms.

Should this treatment fail, trigger finger release surgery, which enlarges the narrow part of the tunnel, is indicated. This allows the lump to pass freely back and forth through the narrow area, resulting in normal motion. Trigger finger release is highly successful in terms of “curing” this condition; in fact, many patients and hand surgeons prefer to proceed directly to surgery, since it is simple, safe, and more effective than cortisone injections. Once again, however, cortisone injections can be performed as an office procedure, while trigger finger release requires an operating room.

Ganglions

Ganglion is a Greek word meaning “a knot of tissue.” Ganglions were first described by Hippocrates and can be found emanating from any joint but are mostly seen in and around the wrist.

These lumps and bumps are not cancerous tumors at all and, in fact, have never been linked to cancer in any way. Rather, they are balloon-like sacs, which are filled with a jelly-like material. They are more frequently seen in women, and the reason for their occurrence is unknown.

One explanation is that they occur where there is a weak place in a joint capsule that develops a “blowout.” This area forms a balloon-like extension of a joint with a one-way valve from the joint. Joint fluid can then flow into the balloon through the one-way flap valve but cannot return to the joint. Therefore, the ganglion generally becomes larger and larger.

The relationship between ganglion formation and occupation and injury is not totally understood. Ganglions can also be seen in and around tendons. A common place where this occurs is the palm of the hand at the base of the finger.

Most hand surgeons allow patients to choose the treatment of their ganglion. Since we know that these are not cancerous lumps, one can feel comfortable leaving the ganglion alone as long as it is not bothersome. In olden times doctors recommended hitting a ganglion with a large book (usually the Bible as it was the largest book available) and thus rupturing the sac.

Nowadays, if the patient is bothered by pain or unsightly appearance, the hand surgeon can either aspirate (take the fluid out with a needle) or surgically remove the ganglion. Though surgery offers a better prognosis of a “cure”, it requires an operating room, while needle aspirations can be easily accomplished in the office. Regardless of the type of treatment, ganglions can recur even with satisfactory surgery. Hitting a ganglion with a large book is not recommended, since serious damage to bones and ligaments can occur.

There are several joint replacement procedures. The following are the most common. Doctors recommend joint replacement surgery when hip pain and loss of function become severe, and medicines and other treatments no longer relieve pain. Your doctor will use x-rays to look at the bones and cartilage in your hip to see whether they are damaged and to make sure that the pain isn’t coming from somewhere else. Total hip replacement may not be recommended for people who:

• Have poor general health and may not tolerate anesthetic and surgery well.
• Have an active infection or are at high risk for infection.
• Have osteoporosis (significant thinning of the bones).
• Are involved in heavy manual labor or physically demanding sports.
• Are severely overweight (replacement joints may be more likely to fail in people who are very overweight).

Our surgeons evaluate each person individually.

Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to be more active. Your doctor may recommend it if you have knee pain and medicine and other treatments are not helping you anymore.

When you have a total knee replacement, the surgeon removes damaged cartilage and bone from the surface of your knee joint and replaces them with a man-made surface of metal and plastic. In a partial knee replacement, the surgeon only replaces one part of your knee joint. The surgery can cause scarring, blood clots and, on rare occasions, infections. After a knee replacement, you will no longer be able to do certain activities, such as jogging and high-impact sports.

Many people know someone with an artificial knee or hip joint. Shoulder replacement is less common. But it is just as successful in relieving joint pain. Shoulder replacement surgery started in the United States in the 1950s. It was used as a treatment for severe shoulder fractures. Over the years, this surgery has come to be used for many other painful conditions of the shoulder. These include:

• Osteoarthritis (degenerative joint disease)
• Rheumatoid arthritis
• Post-traumatic arthritis
• Rotator cuff tear arthropathy (a combination of severe arthritis and a massive non-reparable rotator cuff tendon tear)
• Avascular necrosis (osteonecrosis)
• Failed previous shoulder replacement surgery

Rotator Cuff Tears

The rotator cuff is the network of four muscles and several tendons that form a covering around the top of the upper arm bone (humerus). These muscles form a cover around the head of the humerus. The rotator cuff holds the humerus in place in the shoulder joint and enables the arm to rotate.

Rotator cuff tears are a common cause of pain and disability among adults. Most tears occur in the supraspinatus muscle, but other parts of the cuff may be involved.