Conditions

The ankle is a very narrow surface area supporting your body's weight. A minor injury or small amount of laxity can be very symptomatic. Ankle joints consist of the tibia and fibula (leg bones) and talus, a small bone between the leg bones, and the calcaneus (heel bone). A twisting injury can result in an ankle sprain or fracture if more severe.

• Ankle sprain describes an injury where the ligaments that stabilize the ankle joint are stretched or even torn in more severe cases. Mild cases can be treated with rest, ice, ACE bandage compression, and early motion. Moderately severe cases may need home or formal physical therapy to recondition and strengthen the ankle ligaments and muscles. The most severe and chronic cases may need surgery to anatomically stabilize the ankle joint.
• Talus osteochondral lesion (OCL) can result from a severe ankle sprain or fracture. The may cause persistent pain in the ankle after a recent ankle trauma. Talus OCL’s can sometimes be detected on X-ray or sometimes an MRI is required to detect subtle cases. Treatment may include a period of bracing or casting. If the injury does not improve, ankle scope surgery may be necessary to remove any loose bodies and possibly try and generate a new joint surface.
• Ankle arthritis is a degenerative process that occurs slowly over time. Sometimes a prior trauma can facilitate arthritis in the ankle, even after it has been treated with surgery or with immobilization. Arthritis can cause the joint space to decrease leaving you with less cushioning in the joint. Osteophyte (bone spurs) can form on some occasions. Treatment options include injections, therapy, bracing, and anti-inflammatory medications. Surgery is possible for more problematic cases and can include arthroscopy to debride any inflammation and shave down the bone spurs.
• Ankle tendinitis is inflammation of one or more of the muscle / tendon units that run down the leg and across the ankle. This is typically from an overuse injury. Symptoms may include pain worse with activity. Initial treatment is rest, anti-inflammatory medicine, bracing, ice-therapy and physical therapy. If the initial treatment fails an MRI may aid in ruling out a tendon tear and help guide surgical options such as tendon debridement or repair.
• Achilles tendon rupture is a traumatic and sudden tear in your heel cord. This often occurs during athletic activities. People often report the sensation of someone kicking them in the back of the ankle and hear a loud ‘pop’. Sedentary people may choose to treat this injury with a period of immobilization and therapy. Active patients may elect for operative repair to decrease the chance of recurrent rupture in the future.
• Achilles tendinitis / tendinosis is a repetitive or overuse injury that causes inflammation and swelling in the heel cord. Rest, anti-inflammatory medicines, ice, exercise and therapy may help mild cases. More severe and resistant cases may need a period of bracing and even surgery to remove the diseased tendon and repair the remaining Achilles tendon. In some cases, a bone spur on the heel may be involved and have to be removed.

Read more on foot & ankle conditions here.

A concussion is just not a bump or ding on the head. A sport-related concussion is a common injury that likely goes under-reported by pediatric, adolescent, and adult athletes for various reasons that need proper treatment whether mild or severe.

The Center for Disease Control and Prevention estimates 1.6 million to 3.8 million recreation and sports-related concussions in the U.S. yearly, although the true number is probably much higher. Football has the highest number of concussions and represents an estimated 8.9% of all high school athletic injuries.

Children and teens are more likely to get concussions and take longer to recover. There are some common physical, mental, and emotional symptoms a person may display following a concussion. Any of these could be a sign of traumatic brain injury:

• Confusion or feeling dazed
• Clumsiness
• Slurred speech
• Nausea or vomiting
• Headache
• Balance or dizziness problems
• Blurred vision
• Sensitivity to light or noise
• Sluggishness
• Ringing in ears
• Behavior or personality changes
• Concentration difficulties
• Memory loss

Umpqua Orthopedics clinic is excited to offer clinical concussion education, evaluation, and treatment. We provide comprehensive concussion management involving a thorough history, physical exam (including head, neck, neurological and cognitive function assessment), patient education, and treatment.

We also use neuropsychological (ImPact) testing as an objective measure of brain function and neuroimaging if necessary. Our focus is to educate athletes, trainers, coaches, and parents on preventing, recognizing, evaluating, and treating concussions. We hope to get you back on the field as quickly as is medically safe.

Conditions affecting the hand, fingers, and wrist are very common. Some of the more common orthopedic hand and wrist diseases include:

• Carpal Tunnel Syndrome - A nerve entrapment syndrome in which the thumb-side of the hand becomes painful, weak, clumsy, and develops a numbness or pins-and-needles sensation. Symptoms typically occur at night and are caused by various factors including repetitive use. Treatment starts with activity modification, splinting / bracing, injections, and possibly simple outpatient surgery. Umpqua Orthopedics offers both open carpal tunnel release surgery and a new technology of endoscopic carpal tunnel release.
• Trigger Finger – A condition in which the tunnel that houses the finger tendon gets inflamed and swollen. The swollen tunnel (tendon sheath) entraps the finger tendon. The entrapment causes triggering, which ranges in severity from clicking to a completely locked finger. Any finger or thumb can develop trigger finger. Treatment options typically include injections for milder cases or a minor office procedure to release the tendon for more severe or refractory cases.
• Cubital Tunnel Syndrome – Similar to carpal tunnel syndrome, this is also a nerve entrapment disease. The ulnar (funny bone) nerve on the inside of the elbow gets compressed and sometimes even dislocates from its location in the medial epicondylar groove. Symptoms are similar to carpal tunnel syndrome with weakness, clumsiness, numbness, and wasting or atrophy of the involved muscles in severe cases. Much like carpal tunnel, cubital tunnel syndrome, if milder, can be treated with bracing. Surgery may be necessary for more severe cases that do not respond to bracing. During surgery, the nerve is decompressed and occasionally rerouted to a more comfortable location along the elbow.
• Base of Thumb Arthritis – Any joint in the hand or fingers can develop arthritis. Initial treatments for this condition include over the counter anti-inflammatory medications (NSAIDs), orthotics, and sometimes hand therapy. If the arthritis becomes more severe, fusing the involved joint might alleviate the pain but may sacrifice joint motion. The joint at the base of the thumb is unique because the treatments are more diverse. An in-office steroid injection in the involved joint can provide relief. Ultrasound guidance can improve the injection accuracy. If injections fail, a procedure to remove the arthritic bone and stabilize the base of the thumb joint can be very effective for pain relief with minimal loss of strength.
• Wrist Arthritis – Wrist arthritis is most commonly associated with rheumatoid arthritis and can also occur with degenerative osteoarthritis. The wrist may become inflamed and swollen with excess joint fluid. Treatment options include NSAIDs, a brace, and a steroid injection.

Read more on hand & wrist conditions here.

The hip joint is a ball-and-socket joint. The femur, or thigh bone, has a spherical ball at that contacts the hip socket in the pelvis. Several muscles and tendons connect the spine and pelvis to the femur. Various conditions can occur with sports injuries, traumatic injuries, or wear-and-tear degenerative conditions.

• Greater Trochanteric Bursitis - Bursitis is inflammation of the bursa, the layer between the hip muscles and bone on the side of the hip. It can be associated with low back pain or hip arthritis or may occur spontaneously. Treatment such as anti-inflammatory medication (ibuprofen, naproxen), moist heat (hot shower or bath), stretching, and physical therapy can be helpful. We offer steroid injection into the bursa in the office and as an option if symptoms don't improve with medication or physical therapy.
• Sports Hernia - Athletes can strain their groin, causing pain on the front of the hip joint. It is strain of the muscles of the inner thigh. Treatments include a period of rest, stretching, and physical therapy. Read more about Sports Hernia Athletic Pubalgia.
• Hip Arthritis - Osteoarthritis is the most common of the arthritis conditions and is a degenerative arthritis. It can affect any joint in the body. In the hip joint, the cartilage on the surface of the socket and the ball of the hip becomes thinned and worn out. The hip joint can become swollen with excess joint fluid and the joint lining (synovium) can become inflamed. Anti-inflammatory medication can help. Glucosamine and chondroitin, over-the-counter supplements, are also an option. Exercise to maintain movement and mobility of the joint can also be helpful at the gym or under the guidance of a physical therapist. If the pain of the arthritis is so severe that it keeps you from doing your usual home or recreational activities, it may be time to consider joint replacement surgery. Joint replacement is where the degenerated cartilage is removed. Components made of metal, ceramic, and plastic are placed in the socket and thigh bone to reconstruct the hip joint. Umpqua Orthopedics offers both anterior and posterior approaches for joint replacement surgery.

Read more on hip conditions here.

Because of the geometry of the knee and its relation to your body's center of mass, the contact pressure within the knee joint can be four to five times the body weight in normal daily activity. For those overweight, even a relatively small weight loss can unload and protect the knee significantly.

Bony contact primarily occurs between the thigh and shin bones and also between the knee cap (patella) and femur. There are five main ligaments that stabilize the knee: the medial and lateral collateral ligaments (MCL and LCL), anterior and posterior cruciate ligaments (ACL and PCL), and the medial patellofemoral ligament (MPFL).

The bearing surface of the knee includes the articular cartilage, covering the bones in the areas where they meet, and the medial and lateral menisci, which are two separate c-shaped rings of cartilage that provide additional cushion between the femur and tibia at the periphery of the knee joint.

Active knee motion is required for normal walking and running. The primary muscles involved are the quadriceps, in the front of your thigh, which straighten or extend the knee and hamstrings in the back of your thigh, which bend (flex) the knee. The quadriceps are the most important.

Common Knee Conditions:

• Arthritis - Arthritis is loss of cartilage, the bearing surface of your joints. This causes pain, stiffness, swelling and deformity. Arthritis has multiple causes: such as normal “wear and tear,” injury, inflammatory disease and infection. Mild to moderate arthritis is typically managed conservatively. Severe arthritis (total loss of cartilage with “bone on bone” contact) is sometimes treated with Total Knee Replacement (TKA).
• TOTAL KNEE ARTHROPLASTY, which is also known as TKA, is very common and effective operation with over 700,000 performed annually in the U.S.A. The procedure involves resurfacing the ends of the femur and tibia with metal and placing a plastic (ultra-high molecular weight polyethylene) spacer in between. Hundreds of TKAs are performed annually by the surgeons at Umpqua Orthopedics. Modern protocols in cooperation with the New Strides total joint replacement program which we helped develop at Mercy Medical Center allow discharge from the hospital in an average of less than 2 days and rapid recovery.

Conservative management includes:

• RICE (Rest, Ice, Compression, Elevation): These are the first steps for an acute flare up of symptoms and are primarily for reducing inflammation. If the joint is painful, but not swollen or hot, sometimes heat feels better than ice.
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): There are many NSAIDs, some of the over the counter NSAIDs include: ibuprofen and naproxen. These drugs are pain medications and have anti-inflammatory actions as well. All NSAIDs can have side effects including upset stomach sometimes causing bleeding ulcers, decreased kidney function and even heart problems. Anyone who uses NSAIDs on a regular basis should be followed by their primary care physician.
• GLUCOSAMINE 500mg and CHONDROITIN 400mg: These are over the counter supplements which help many patients with their arthritis pain. They are NOT a pain medication. If tried, glucosamine 500mg and chondroitin 400mg should be taken twice daily for two months for an adequate trial. Continued if effective. Discontinued if not. Side effects and drug interactions are minimal.
• LOW IMPACT EXERCISE: For quad strengthening & weight loss, goal = Body Mass Index (BMI) <25
• STRAIGHT LEG RAISES: Lying on your back with one leg straight and opposite knee bent, hold your leg straight and lift your heel one foot off of the ground. Hold for 10 seconds, repeat 30 times on each leg daily.
• WALKING: Walk on smooth, level ground with supportive shoes.
• EXERCISE MACHINES: Elliptical machines, Exercise bike (with seat high and resistance low) or sliding type of machines like the NordicTrack.
• SWIMMING: (Probably the best) Use a straight kick, not a frog kick.
• ORTHOTICS:

1. SOFT BRACES – (neoprene) can help control joint swelling and enhance proprioception (your sense of joint position). This helps to protect your joint “subconsciously” especially on uneven surfaces.
2. HINGED BRACES – Most helpful for deformity or instability.

• INJECTIONS: Steroids (as a rule no more than 3) or hyaluronic acid (lubricant) injections can help for weeks, months or occasionally more than a year in some patients. PRP (Platelet Rich Plasma) injections for knee arthritis are also offered at Umpqua Orthopedics.

 More Common Knee Conditions:

• Meniscal tear - The menisci (medial and lateral) are cushion cartilages which are fairly unique to the knee. They help distribute joint contact pressures over a larger are as you flex and extend your knee under load. Meniscal tears are very common. In young people, the menisci have a firm rubbery consistency and take a significant trauma (sports injury) to tear. As we age, the menisci become softer and can tear with minimal activity. Not all meniscal tears require surgery (especially degenerative tears). The orthopedic professionals at Umpqua Orthopedics are proficient in the diagnosis and non-surgical as well as operative treatment of meniscal injury.
• Ligament injury - Ligaments, the soft tissues that connect bone to bone, are quite important to normal knee function and stability. Ligament tears are also common knee injuries.
• Anterior cruciate ligament - The Anterior Cruciate Ligament is in the center of the knee joint and, because of its blood supply, cannot heal itself once torn. Fans of professional sports have often heard of the ACL as it is a common sports injury. Unfortunately, both younger and older school and recreational athletes as well as people at work or engaging in other cutting, twisting and turning activities commonly fall victim to this injury. Although ACL tear can be well managed with bracing and therapy in more sedentary and/or arthritic patients, most active patients are best treated with ACL reconstruction. The surgeons at Umpqua Orthopedics routinely perform this procedure with a variety of modern arthroscopic techniques.
• Posterior cruciate ligament - The Posterior Collateral Ligament is behind the ACL and has a better blood supply and is less commonly injured. Although commonly treated with bracing and physical therapy, PCL repairs that are more symptomatic than average or associated with multi-ligament knee injury are treated with surgical reconstruction. This service is provided at Umpqua Orthopedics.
• Medical collateral ligament - The Medial Collateral Ligament is on the inside (closer to the body mid-line) of the knee. It is an important structure and not uncommonly injured. This ligament has an excellent blood supply and frequently will heal with a period of protection using a hinged knee brace. MCL repair is most often done as part of reconstruction of multi-ligament knee injury. This service is provided at Umpqua Orthopedics.
• Lateral collateral ligament - The Lateral Collateral Ligament is on the outside (away from the body mid-line) of the knee. It is part of the postero-lateral complex. Injury and surgical reconstruction are usually associated with multi-ligament knee injury. This service is provided at Umpqua Orthopedics.
• Patellar instability - Patellar instability (abnormal side to side movement of the knee cap) is fairly common, especially in younger women. It can be multi-factorial. It can be the result of ligament tear, muscle weakness and bone deformity. If recurrent patellar instability fails to improve with bracing and physical therapy, surgical treatment may be an effective solution. This may include repair or reconstruction of the Medial Patello-Femoral Ligament (MPFL, the 5th knee ligament), lateral capsular release and/or extensor mechanism re-alignment. These non-operative and surgical services are provided at Umpqua Orthopedics.
• Fracture - Fractures (broken bones) around the knee are common and can involve the femur (thigh bone), tibia (shin bone), patella (knee cap) and fibula (the smaller bone in your lower leg). They are usually the result of trauma although other causes like tumors or metabolic abnormalities are seen. Unless the fractures are stable and non- or minimally displaced (cracks without separation of the pieces), they are often treated with surgery to correctly re-align and stabilize the pieces. Depending on the fracture, this can involve a variety of surgical techniques involving small to larger incisions and the use of various implants such as metal rods, plates, screws or wires and sometimes bone graft. The Orthopedic professionals at Umpqua Orthopedics frequently provide both non-surgical and operative treatment for fractures around the knee.
• Tendon tear - Tendons (which connect muscle to bone) which move the knee include the quadriceps and patellar tendons (the most important) as well as the hamstrings, gastrocnemius and popliteal tendons. Partial tears and chronic inflammation (tendonitis) are typically treated with a variety of conservative measures which include activity modification, RICE, NSAIDs, bracing and physical therapy. Full thickness tears, especially of the quadriceps or patellar tendons usually require surgical repair which is done by Umpqua Orthopedic surgeons.
• Cartilage or osteochondral injury - Cartilage injury or Osteochondral (involving the cartilage and bone immediately underneath) injury are distinct from arthritis in that they are both more localized and sudden in onset. However, both can lead to more generalized arthritis if they are not effectively treated. Repair of these lesions has been the subject of much orthopedic research for decades. This has led to numerous surgical procedures which can sometimes (but not always) effectively treat these problems. The surgeons at Umpqua Orthopedics are trained in these procedures provide them for patients who are appropriate candidates.

Read more on knee & leg conditions here.

The shoulder is the most mobile and complex joints in the body. Three bones form the shoulder: the clavicle (collar bone), scapula (shoulder blade), and humerus (upper arm bone). Four rotator cuff muscle / tendons and various ligaments and tendons stabilize and control the motion of the shoulder.

The ball-and-socket (glenohumeral) joint, acromioclavicular (collar bone), and scapulothoracic (shoulder blade to chest wall) joints are the three primary connections of the shoulder girdle.

Shoulder injuries such as dislocations can occur from traumatic events or overuse and may cause rotator cuff tendinitis. Many shoulder problems can overlap and be difficult to diagnose and treat. Consulting with an orthopedist specialized and experienced in shoulder disease is key to proper diagnosis and treatment.

Several surgeons at Umpqua Orthopedics have a special interest and vast experience with cutting-edge shoulder treatments. Common shoulder injuries include:

• Shoulder dislocations can cause chronic and recurrent instability, especially in younger people who play sports. The initial injury usually requires a visit to the ER or urgent care to be sedated so your shoulder can be manipulated back into the socket. Orthopedic treatment might include sling immobilization, therapy, and possibly surgery in some cases. The majority of people with recurrent shoulder instability can be stabilized with arthroscopic same-day-surgery; the rim of tissue around the socket is repaired and the lax shoulder joint lining is tightened.
• Acromioclavicular (AC) – Joint injuries usually occur by landing directly on the “point” of the shoulder. There are 6 grades of severity ranging from a sprain that just needs rest to a severely deformed injury that needs surgical correction. This can occur with or without a collar bone fracture. This injury typically causes pain on the top of the shoulder. The AC joint can also have an overuse injury such as synovitis (inflammation) or arthritis (wear and tear). This can be effectively treated with an injection of a steroid or in the more severe cases, with shoulder arthroscopy surgery.
• Bicep muscle tears – Many people are already familiar with the biceps muscle. It is sometimes traumatically torn at the elbow. What you may not realize is that the biceps originates in the shoulder and can tear or become inflamed with tendinitis. Tears of the biceps at the shoulder can be repaired if done in a timely fashion (6 weeks). If inflamed, treatment options include therapy, NSAIDs (ibuprofen, naproxen), injection, and for resistant cases, shoulder arthroscopy surgery.
• Rotator cuff problems are very common and several physicians at Umpqua Orthopedics have extensive experience in treating them all. The rotator cuff is a group of 4 muscle-tendons that start on the shoulder blade and insert on the humerus. This ‘cuff’ of tissue can be subject to ‘wear-and-tear’, inflammation, or even a tear. These problems can lead to pain, weakness, and shoulder dysfunction. Rotator cuff injuries are known for being especially noticeable at night (nocturnal pain). If the rotator cuff is inflamed or partially torn, or even fully torn in a low-demand person, therapy, injections, NSAIDs, or modifying your activity might be the initial treatment options. Impingement syndrome of the shoulder means there might be a bone spur irritating the rotator cuff tendon. Use of Orthobiologics is a very exciting new technique of treating various orthopedic injuries, including shoulder injury. One example is Platelet Rich Plasma (PRP) where a small amount of your blood is drawn and spun down in a centrifuge. The blood parts are separated and the parts known to encourage healing are injected into the diseased tendon or into the surgically repaired tendon. In a situation where the rotator cuff tendon is completely torn and symptoms persist, a surgery to repair the torn tendon might be necessary. Many techniques are available to repair the tendon, even large and massive tears can be repaired using arthroscopic techniques. Many people have been told that their rotator cuff tear is too old and cannot be repaired, however, a new technique (superior capsular reconstruction) uses cadaver tissue to replace and ‘patch’ the portion of the tendon that cannot be repaired has proven very successful.
• Shoulder arthritis a condition where the cartilage on the surface of the socket and the ball of the shoulder joint becomes thinned and worn out from age, wear and tear, chronic rotator cuff tendon tear or traumatic injury. The shoulder joint can become swollen with excess joint fluid, and the joint lining (synovium) can become inflamed causing pain. NSAIDs (anti-inflammatory medication) can help decrease the inflammation. Glucosamine and chondroitin, over the counter supplements, are also an option. Exercise to maintain movement and mobility of the joint can also be helpful, sometimes under the guidance of an occupational therapist. If the pain of the arthritis becomes so severe that it keeps you from doing your usual home activities or activities you do for fun, then it may be time to consider joint replacement surgery. Joint replacement is a procedure where the degenerated cartilage is removed. Components made of metal and plastic are placed in the shoulder socket (glenoid) and the arm bone (humerus), to reconstruct the shoulder joint. Umpqua orthopedic surgeons offer hemiarthroplasty (partial shoulder replacement), total shoulder arthroplasty, and reverse shoulder arthroplasty. Reverse shoulder arthroplasty is a unique way to replace the shoulder when the major tendons (rotator cuff) are torn and cannot be repaired.

Read more on shoulder & elbow conditions here.