A sprain may occur to any joint. The ligaments connecting the bones in your joints are stretched beyond their tolerance, resulting in a partial or complete tear. In a partial sprain, some of the fibers of the ligament are torn, causing pain, swelling, and bruising. With a complete tear, the ligaments are completely severed and, along with the pain, swelling, and bruising, there is usually a loss of movement of the joint. Simple sprains are treated with ice, support bandages, and elevation. More severe sprains are immobilized with a splint or cast, while some require surgery to reconstruct the torn ligaments.

In a dislocation, the ends of the bones are forced from their normal positions. This can be the result of a severe sprain, in which the ligaments are so stretched or torn that the bones are allowed to move out of place, or it may be caused by an underlying disease such as rheumatoid arthritis. Joints previously dislocated may be weakened and subject to spontaneous dislocation. Dislocations are accompanied by severe pain and swelling. Often, the joint will be visibly misshapen. Once X-rays have confirmed a dislocation, your physician will return the bones to their proper position (called a reduction). He will then immobilize the joint with a sling or splint. If the problem is repeated dislocation, your physician may suggest surgery to tighten or repair the stretched or torn ligaments.

Fractures are categorized in several ways. In a nondisplaced fracture, the bone is simply cracked and the bones remain in alignment. In a displaced fracture, the bone is broken in two or more pieces, and the pieces move out of alignment. In a closed skin fracture, the bone is broken but does not protrude through the nearby soft tissues. When the bone does protrude from the skin, it is termed an open skin fracture. When a piece of bone is embedded into another piece of bone, it is called an impacted fracture. Pathological fractures are caused by an underlying disease such as osteoporosis. Green-stick fractures occur in children, whose young bones are more flexible and are more likely to bend and crack like a green twig.

If X-rays show the bone has been displaced, it must be set back in its proper position (reduction). Setting a bone without an operation is called closed reduction. If an operation is necessary, it is termed an open reduction. If a fracture extends into a joint, the physician may insert devices such as pins, plates, or screws to hold it in place. After the bone has been set, it must be immobilized. Preventing motion between the two ends of the bone lessens pain and facilitates healing. Immobilization may be obtained with casts, splints, or traction. Fingers or toes may simply be strapped to an adjacent digit, or may receive no immobilization at all. Ribs are held in place by the mass of chest muscles surrounding them. Once the bone has been set and immobilized, it is important to begin rehabilitation. This may consist simply of moving adjacent tissues to enhance blood flow. This facilitates healing and prevents blood clots. Movement also helps maintain muscle tone and reduce atrophy (wasting) of the muscles and bones that accompanies lengthy immobilization.

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Disorders such as osteoarthritis (the deterioration of cartilage in the joints) or rheumatoid arthritis (chronic inflammation of the joints) can, over time, cripple a hip or knee joint to the point that walking is a difficult, and painful process. In these cases, a surgical joint replacement (arthroplasty) is often the best treatment.

In osteoarthritis, the cartilage that forms a cushion between the bones of the joint deteriorates. Over time, the ends of the bones are affected, and painful spurs develop along the damaged bone. The primary area of attack in rheumatoid arthritis is the synovium, or sheath that forms a lining of the joints. This lining becomes inflamed and swollen. Tissue in the cartilage tends to grow or multiply rapidly, resulting in the erosion of surrounding tissues.

Arthroplasty is a re-forming of the joint. It usually involves replacing certain parts of the joint with plastic or metal components (replacement arthroplasty). In a hip arthroplasty, a metal ball and stem take the place of the upper part of your thighbone (femur), and a cup (usually plastic) is inserted in the pelvis. In a knee arthroplasty, any or all of the three bones in your knee joint are replaced. A tibial component fits on top of the shin bone, a femoral component fits on the bottom of the thighbone, and a patellar component covers the underside of your kneecap. In both procedures, the smooth-flowing and cushioning new parts replace the eroded, rough surfaces of the damaged joints. Recent developments include artificial joints covered with a material that allows natural bone tissue to grow into it over time.

Prior to joint replacement surgery, you will undergo a series of routine tests which include blood tests, chest X-ray, and EKG. You will also be required to see your family doctor for a complete physical to ensure you are in optimum health before undergoing surgery. The operation itself may take up to 3 hours, depending on the joint and complexity involved. The total time spent in the hospital, assuming no complications, is generally four to seven days, depending on the joint, with hip surgery involving the longer recovery.

Physical therapy is one of the most important aspects of your recovery, and begins the day after surgery. Gentle exercises help strengthen the muscles around your new joint. Gradually, your physical therapist helps you to start walking, a few steps at a time, to promote healing. You will need the assistance of a walker or crutches for approximately four weeks for knee arthroplasty and five to six weeks for hip arthroplasty.

Total joint replacement is a safe, reliable surgical procedure that can relieve your pain and stiffness and return you to most of the activities you enjoy.

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Throughout history, casts have been used to immobilize injured bones during the healing process. Over the years, plaster of Paris became the preferred material for casts, although recently, synthetic materials such as plastic and fiberglass became popular as well.

For the application of a cast, the area is first covered with a soft material to protect the skin from irritation. Then, bandages saturated with plaster are wrapped around the injured area. The plaster dries in 5–10 minutes, but does not completely harden to the point of weight-bearing for 2–3 days. During this time, the cast should not be handled with the fingertips or rested on a flat or hard surface. The resulting dents or flattening can cause painful pressure points on the skin beneath the plaster. Instead, handle the cast in the palms of your hands, and rest it on pillows. Fiberglass casts harden completely in about 30 minutes, and they are able to bear weight at that time.

Casts should be kept dry at all times. Plaster, upon contact with water, becomes soft and weak, and although fiberglass casts are water resistant, a wet padding against your skin can cause problems. If you get either type of cast wet, contact your physician office for assistance.

Rest and elevation are important aspects of cast care. Although you may think of a bone or ligament injury as a “local” event, your entire body is taking part in the healing process. Rest allows your body to devote more energy to repairing the damage. Elevating the injured area above heart level facilitates excess fluid drainage, and reduces swelling and pain.

Exercise fingers and toes to prevent stiffness, and improve circulation. Do not wear rings on the fingers of a casted hand. If you experience itching, try sprinkling baby powder or cornstarch into the cast. Aiming a blow drier on the cool setting into the end of the cast may help. Never insert anything between the cast and your skin. This can be harmful and result in greater irritation.

Once the initial swelling has subsided, your cast should be fairly comfortable. Extreme pain or tightness; a constant rubbing sensation in one spot; and discolored, swollen, numb, or tingling fingers or toes are signs that something could be wrong. Elevate the cast and report any of these conditions to your physician office.

Injuries usually require more than one cast. As muscles shrink from lack of use, the cast becomes loose. Sometimes, as injuries heal, subsequent casts may be fitted to cover smaller areas. Often, X-rays are taken during these visits to detect any change in the position of the bones or tissues, and once again when the final cast is removed to verify proper and complete healing.

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Most foot problems are the result of ill-fitting shoes, improper foot care, and overuse and abuse of our feet. Proper self-care and, when indicated, prompt professional care are often all that are required to get us back on our feet.

Common Causes of Foot Pain and Their Treatments

Bunionette is like a bunion but occurs at the base of the smallest toe. Patients can usually choose between prescription shoes and surgery to remove the bony protrusion. Patients often choose surgery because it's safe, effective, and involves only a brief hospital stay. You'll leave with only a soft dressing, and should be back on your feet within a week.

Hammertoe may affect any toe (though most often, it is the second toe that is affected). The joints in the toe bend down and stiffen in that position. Hammertoes can be hereditary or can be caused by muscle and nerve damage such as may occur with diabetes. Painful corns, calluses, redness, and swelling often develop where the clawed toes rub against shoes. Self-care includes wearing shoes with a high toe box and cushioning pressure spots with adhesive pads. Your doctor may prescribe an orthotic appliance to position your toe properly and relieve the pressure and pain. Surgery may be necessary to flatten and straighten the affected toes by removing a piece of bone. A stiff wire keeps the bones in line while they heal. The wires are removed in the doctor's office after about a month.

Corns and calluses are caused by constant pressure on one or more toes, and are often brought on by shoes that squeeze the toes together. Self-care includes warm soaks and shoes with adequate toe room. In some cases, the corn can be caused by a bony protuberance on the adjacent toe, and will not improve with self-care. Doctor's care involves surgery to remove the protruberance. The corn or callus then disappears with time. The operation is done under local anesthetic and may require a hospital stay.

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Three common hand problems are tendinitis (swollen and inflamed tendons), lumps (such as cysts or tumors), and contractures (loss of some motion in a finger or thumb).

Tendinitis and tenosynovitis (inflammation of the synovium or sheath surrounding the tendons) are common causes of finger and hand pain. A common cause is overuse or repetitive motion such as occurs in some occupations like factory work or typing. Common signs are tenderness and pain; movement accompanied by a crackling sound; and difficulty in straightening a finger or thumb. Some types of tendinitis are trigger finger (in which a finger or thumb "locks" in a bent position and then suddenly "pops" or jerks in a sudden straightening motion), trigger thumb (similar to trigger finger but only affects the thumb; may be accompanied by a knot on the wrist near the thumb and pain accompanying a pinching or grasping motion), and carpal tunnel syndrome (numbness or tingling in thumb and fingers and/or pain in the wrist that "shoots" up the arm). There are also many tendons which cross the wrist joint. Tendinitis may affect any of these, and the symptoms experienced will depend on which tendon is involved. Treatment consists of antibiotics (if the cause is infection), rest (with or without some type of splinting for immobilization), and analgesics or anti-inflammatory drugs to reduce pain. If these measures fail, a corticosteroid injection may relieve the symptoms.

Surgery consists of cutting the tendon sheath to allow for greater space and reduce pressure on the tendon.

Cysts (fluid-filled lumps) are tumors (abnormal tissue growth) often caused by an injury and are rarely cancerous. A ganglionic cyst is usually found on the back of the wrist, but can also appear on the front of the wrist or the fingers. It is an accumulation of a jelly-like substance that has leaked from a joint or tendon sheath, and may or may not be accompanied by pain, especially when the wrist is extended or flexed. A ganglion is essentially harmless, but should always be examined by a physician to rule out any malignancy. If the ganglion is painful, your doctor may puncture it in several places and apply pressure to drain it. If it does not respond to drainage and remains painful, surgery to remove the ganglion may be necessary.

Contractures are usually inherited, but sometimes result from injury. A jammed finger is a sprained joint. As the pain and swelling of the sprain subside, scar tissue is formed and the finger heals in a bent position. Dupuytren's Contracture is a hardening of the lining of tissue under the skin of the palm of the hand. It isn't painful, but is usually progressive, causing an increasing degree of deformity as the person ages. It is most common in the ring and little fingers, but can affect any finger or the thumb. The cause is unknown, but is thought to be primarily hereditary. Treatment is usually not required. Surgery, if required, consists of removing the thickened bands of tissue to restore normal movement. Although surgery usually restores most or all of normal movement, the condition may recur.

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The ligaments in your knee provide support and flexibility for all that it does. The cartilage (meniscus) provides cushioning for all the pounding your knee receives. It is possible to damage ligaments and meniscus with everyday living–gardening, a fall, aging, wear and tear–so it is no wonder that the vigorous activity and physical punishment present in athletics result in so many knee injuries.

Two ligaments in your knee are more prone to injury than others. The anterior cruciate ligament (ACL), in the center of your knee, is commonly injured by a twist. The medial collateral ligament (MCL), on the inside of your knee, is most often hurt by a blow from the side, such as is common in football. Meniscal tears, like ACL tears, most often happen from twisting. It is not uncommon to experience damage to all three areas of the knee simultaneously.

When the ligaments that are responsible for bracing your knee are torn, either partially or completely, you may experience a “popping” sound, followed by a buckling of your knee.

Painful swelling usually ensues. Your knee will buckle easily or you may feel as if there is too much “play” in the joint. A meniscal tear produces a rough surface against which surrounding smooth surfaces must rub. The longer the torn tissue is there, the more damage results. Over time, if left untreated, meniscal tears can lead to painful arthritis.

Some knee injuries require open surgery to repair or remove the damaged tissue, but in most cases, your surgeon can fully diagnose and treat your knee injury with arthroscopy. The arthroscope is an instrument used to look directly into joints and consists of a tube, an optical system of magnifying lenses, and a fiber-optic light source. After an anesthetic is given (local, spinal—numbing from the waist down, or general), several small incisions are made in the knee and the arthroscope is inserted. The doctor can see inside the joint through the eyepiece or on a screen. A sterile fluid may be injected into the joint space to enlarge it and enhance visibility. Through the use of attachments, the surgeon can perform many types of surgery including removing or repairing damaged meniscal tissue, reconstructing an injured ACL, and smoothing or realigning the patella (kneecap).

Arthroscopy eliminates the long and painful recuperation period associated with open knee surgery. After the procedure, the incisions are stitched or taped, and the knee is bandaged. An ice pack is applied to reduce swelling and the leg is elevated for a short time. You may go home as early as two to three hours after arthroscopic surgery.

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The shoulder is the most movable joint in the body and, therefore, the most likely to develop problems. To understand shoulder complaints, we must first be acquainted with some of the shoulder’s many parts.

The shoulder is comprised of three bones (the clavicle—or collarbone, scapula—or shoulder blade, and acromion) held together with muscles, tendons, and ligaments. The acromion is at the top of the shoulder and is connected to the clavicle (collarbone) at the acromioclavicular joint (AC joint). The rotator cuff is a group of tendons that attach your upper arm to your shoulder. Between the acromion and the rotator cuff is a small fluid-filled sac called the bursa, which cushions the tendon from the bone.

Each time the arm is raised or held out from the body, the bursa and rotator cuff are squeezed. This can lead to inflammation of the bursa (bursitis) or rotator cuff (tendinitis). Sports and jobs that require repeated overhead reaching are main contributors to this condition. Excessive wear or a sudden trauma such as a fall can cause the rotator cuff to fray or tear completely. A torn rotator cuff, along with being painful, may cause a popping or grinding sound when you move your shoulder.

Diagnostic tools include X-rays, arthrogram (X-ray with dye injection), MRI, or CT scan. Your doctor may also suggest an arthroscopy to diagnose the exact cause of your pain. The arthroscope is an instrument used to look directly into joints and consists of a tube, an optical system of magnifying lenses, and a fiber-optic light source. After an anesthetic is given (usually general), several small incisions are made in the shoulder and the arthroscope is inserted. The doctor can see inside the joint through the eyepiece or on a screen. A sterile fluid may be injected into the joint space to enlarge it and enhance visibility. If your doctor finds torn or otherwise damaged tissues, he can repair them at this time using attachments and other instruments.

If the inflammation is due solely to overuse, your doctor will probably prescribe rest, cold and heat treatment, and anti-inflammatory medication. Sometimes, cortisone (a powerful anti-inflammatory) is injected directly into the inflamed area.

Other common shoulder injuries include sprains, separations, dislocations, and fractures. A fall may result in the AC ligaments tearing (sprain). A separation occurs when the acromion and clavicle separate completely. Anti-inflammatory medication and immobilization are usually enough to heal a sprain. Separations may require surgery with pins or screws to hold the clavicle in place. Dislocation occurs when the upper arm (humerus) is pulled out of the shoulder socket. This causes severe pain and complete loss of shoulder function. Your physician must reset and immobilize the joint. Once a joint has been dislocated, weakened ligaments make it prone to future dislocations. If it continues to dislocate, your doctor may recommend surgery to tighten and repair the ligaments. A heavy fall may result in a broken collarbone (clavicle). This injury is most common in children and doesn't result in any future weakening of the shoulder.

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