Conditions
Conditions
Shoulder Conditions
The shoulder is one of the most complex and mobile joint of our body. Shoulder pain is very common and can have a negative impact if left unchecked on our daily work, activities of daily living, as well as sports activities.
Rotator Cuff Tears
Cuff tears - more common in the supraspinatus. Either traumatic or degenerative. If conservative treatment fails, the gold standard is repair with shoulder arthroscopy.
Dislocated Shoulder
A shoulder dislocation may lead to instability, especially in the young. Arthroscopy is indication from the 1st dislocation in ages less than 25, and from the 2nd dislocation in individuals older than 25.
Frozen Shoulder
Also known as adhesive capsulitis, more common in women 30-60 years - likely connection with diabetes and thyroid disease. Pain & stiffness are the common features of this disease. Shoulder arthroscopy is indicated if conservative treatment fails.
Shoulder arthritis
Osteoarthritis, cuff arthropathy, post-traumatic arthritis after a fractures. Cartilage wear and destruction of the joint surfaces. Early arthritis can be treated arthroscopically, whereas more advanced cases often need shoulder arthroplasty.
Calcific Tendonitis
Caused by calcific deposits forms in the cuff tendon insertion. Common and particularly painful. Night pain is a characteristic feature. Cause is unknown. Supraspinatus usually affected. Arthroscopy can give a solution is resistant cases.
Impingement Syndrome
Impingement syndrome is very common after the age of 30-40. Cuff tendons catch on the acromion on arm elevation, causing pain and inflammation. Arthroscopy helps in recalcitrant cases.
Rotator Cuff Tears
Typically supraspinatus tears, manifesting with pain and inability to raise arm
Shoulder arthritis
Cartilage damage and bone to bone contact
Dislocated Shoulder
Bankart lesion & shoulder instability, with risk of recurrence related to age
Calcific Tendonitis
Calcific deposits in the supraspinatus, with acute night pain
Frozen Shoulder
Inflammation of the shoulder capsule, pain and stiffness, especially in external rotation
Impingement Syndrome
Contact of cuff tendon with acromion, causing pain and inflammation
Conditions
Elbow Conditions
The elbow is a complex joint that is not immune to injuries, degeneration and wear. Most elbow problems are solved with conservative measures, but occasionally surgery is needed.
Tennis - Golfer's Elbow
Tennis & Golfer's Elbow are terms that refer to inflammation of the tendons that originate from the elbow and move the wrist. Treatment is almost always conservative, with surgery being reserved for the very tough cases.
Cubital tunnel syndrome
Cubital tunnel syndrome refers to the entrapment of the ulnar nerve at the elbow, resulting in numbness & tingling of the small and ring fingers. Treatment is typically surgical, with ulnar nerve decompression at the elbow +/- anterior transposition.
Distal Biceps Tendon Rupture
Distal biceps tendon tears are common. Mechanism of injury usually involves forced extension of the flexed elbow. Lack of the biceps results in reduced supination strength by >50%.
Elbow fractures
Olecranon fractures, radial head fractures, coronoid fractures, ligament tears, fracture-dislocations. These are complex injuries, that typically need surgery by an expert.
Tennis - Golfer's Elbow
Tennis elbow & Golfer's elbow. Inflammation of the muscles that originate from the elbow
Cubital tunnel syndrome
Entrapment of the ulnar nerve at the elbow. Tingling of the small and ring fingers
Distal biceps tendon tears
Forced extension of the bent elbow. Reduction of supination strength without surgery
Elbow fractures
Fractures of the olecranon, radial head, coronoid process, fracture-dislocations
Conditions
Knee Conditions
Knee pain is very common in all ages. It could be related to acute injury, overuse, or to an underlying pathology.
Locked Knee
That's a knee that suddenly cannot extend fully, typically after rotational stress or squatting. The common lesion is a meniscal tear (bucket handle tear). Treatment involves knee arthroscopy, and meniscal repair.
Meniscal Tears
Lateral & medial meniscus are essentially shock absorbers. A meniscal tear can be traumatic (age >40 years - rotational stress on the loaded knee) or degenerative (>40 years). Surgery involves knee arthroscopy with meniscectomy or meniscal repair.
ACL Tears
The typical mechanism of an ACL tear involves rotational stress on the loaded & flexed knee. In younger patients with greater functional demand, surgery with ACL reconstruction is warranted.
Patellar Tendon Rupture
Intense pain, with swelling and inability to weight-bear are classic signs of patellar tendon rupture. There is usually a palpable gap right under the patella. Treatment is surgical.
Quadriceps Tendon Rupture
Individuals with chronic conditions that compromise tendon vascularity are more susceptible to quadriceps rupture, ie rheumatoid arthritis or renal insufficiency. Treatment is surgical.
Locked Knee
Usually due to a bucket-handle tear, after a squat or rotational stress
Meniscal Tears
Τραυματική (<40 ετών), μετά από στροφική κάκωση, ή εκφυλιστική (>40 ετών). Αρθροσκοπική μηνισκεκτομή ή μηνισκοσυρραφή.
ACL tears
Rotational injury in the loaded & bent knee. Arthroscopic reconstruction
Quadriceps Tendon Rupture
Common in patients with underlying conditions. Treatment is surgical
Patellar Tendon Rupture
Pain, swelling & palpable gap. Surgical treatment
Conditions
Hand Conditions
54 of the 206 bones in our body are found in the hand and wrist.
Carpal tunnel syndrome
Entrapment syndrome of the median nerve in the wrist. Numbness & tingling of the thumb, index and middle finger. Night pain is common. Decompression at the wrist under local anaesthetic is the treatment of choice.
Thumb CMC Arthritis
Osteoarthritis on the base of the thumb, between the trapezium and the base of the 1st metacarpal. One of the commonest types of arthritis in the hand, often in professionals that do repetitive movements with their hands, such as hairdressers or dentists.
Trigger Finger
Also known as stenosing tenosynovitis. Finger is stuck in flexion and cannot be extended. Cause is thickening and inflammation of the A1 pulley.
Ganglion Cyst
A ganglion cyst usually originates from a joint or from a tendon sheath. It's essentially a small lump that shows up under the skin. Common in individuals 20-50 years of age, in the wrist or hand. Contains thick fluid of gel like consistency.
De Quervain's tenosynovitis
DeQuervain's tenosynovitis is essentially inflammation of the tendons of the thumb (APL, adductor pollicis longus & EPB, extensor pollicis brevis). Pain in the base of the thumb related with grasping objects.
Carpal tunnel syndrome
Entrapment of the median nerve at the wrist. Tingling of thumb, index and middle fingers
Trigger Finger
Stenosing tenosynovitis. Finger stuck in flexion. Thickened A1 pulley
Ganglion Cyst
Common wrist lump. Contains thick gel-like fluid
De Quervain's tenosynovitis
Inflammation of the tendons of the thumb (APL & EPB)
Thumb CMC Arthritis
Osteoarthritis of the base of the thumb, between 1st metacarpal and trapezium
Conditions
Fractures
Fractures may be treated conservatively or surgically, depending on location, personality of the fracture, etc.
Clavicle Fractures
Clavicle fractures are very common, for example after a fall from a bike. Most clavicle fracture are treated non-operatively. Indications for surgical treatment include significant displacement, comminution or shortening.
Ankle Fractures
Treatment for ankle fractures depending on the type and stability of the fracture. Stable fractures require observation with X-rays. Unstable fractures need surgical fixation.
Distal Radius Fractures
Most distal radius fractures can be reduced in an acceptable position and treated with a cast. Open fractures, intra-articular fractures and fractures that have subsequently lost reduction in the cast, typically need surgical fixation.
Olecranon Fractures
Olecranon fractures are typically significantly displaced and comminuted, so that surgical treatment with open reduction & internal fixation is warranted (tension band wiring, plate & screws, or suture fixation).
Proximal Humerus Fractures
Most proximal humerus fractures are relatively undisplaced and can be treated conservatively. Others need surgical treatment due to displacement, functional demands or conservative treatment failure.
Humeral Shaft Fractures
Traditionally, humeral shaft fractures are treated non- operatively. Surgery might be required in some cases (multiple concomitant injuries, open fractures, nerve palsy, nonunion).
Distal Humerus Fractures
Distal humerus fractures, are mostly treated surgically, with open reduction & internal fixation. In some cases (very distal fractures), arthroplasty is needed instead.
Scaphoid Fractures
Treatment of scaphoid fractures depends on many factors, such as degree of displacement, location (distal pole, waist, proximal pole), previous treatment failure (nonunion).
Complex Elbow Fractures
Most complex elbow fractures need surgery. These include radial head fractures, coronoid process fractures, olecranon fractures, fracture-dislocations, or a combination of the above.
Clavicle Fractures
Very common after a fall. Most commonly in the middle of the clavicle. Mostly conservative treatment
Distal Radius Fractures
Common fragility fracture > 60 years. Displaced or intra-articular fractures need surgery.
Ankle Fractures
Treatment varies depending on fracture stability
Scaphoid Fractures
Displacement, location (distal, proximal, waist), or prior treatment failure will dictate treatment.
Humeral Shaft Fractures
Traditionally treated non-operatively. Some may require surgery.
Complex Elbow Fractures
Radial head fractures, coronoid fractures, olecranon fractures, fracture-dislocations
Olecranon Fractures
Usually displaced and comminuted, requiring surgery.
Proximal Humerus Fractures
Most are relatively undisplayed and can be treated non-operatively
Distal Humerus Fractures
Most need surgery, with either fixation or arthroplasty
Symptoms
Location of pain, combined with other factors such as age, mechanism of injury, associated symptoms, as well as clinical findings, help us make a correct diagnosis and treat the specific underlying problem.
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Arthroscopic & Reconstructive Surgery - Orthopaedic Trauma - Sports Injuries - Microsurgery
Georgios Panagopoulos MD
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