Heritage Medical Park
8926 Woodyard Road, Suite 701
Clinton, MD 20735
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11325 Pembrooke Square, Suite 115
Waldorf, MD 20603
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6355 Walker Lane, Suite 501
Alexandria, VA 22310
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Market Place Medical Center
9455 Lorton Market Street, Suite 100
Lorton, VA 22079
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We are pleased to announce that effective April 1, 2014 the physicians of the Greater Metropolitan Orthopaedic Institute have joined MedStar Georgetown Orthopaedic Institute, which provides exceptional orthopaedic care across the Greater Washington region. In addition, our therapy practices have become part of the MedStar NRH Rehabilitation Network (MedStar NRH), one of the top rehabilitation providers in the country with more than 40 locations in D.C., Maryland and Northern Virginia. Together, we are committed to providing you with exceptional, personalized care.
The shoulder and the elbow are two of
most widely used joints in the human body.
All of this wear and tear causes many injuries
to the shoulder and elbow. Some of the most
common problems are:
The rotator cuff is actually made of four muscles that attach to the shoulder blade (scapula), and wrap around the front, back, and top of the shoulder. Together these muscles help guide the shoulder through many motions, and also lend stability to the joint. The ends of the rotator cuff muscles form tendons that attach to the arm bone (humerus).
Rotator cuff injuries are seen both in the young and old. Usually in younger patients, there is either a traumatic injury or the patient is demanding unusual use of his shoulder, as seen in professional athletes. As people age, the muscle and tendon tissue of the rotator cuff loses some elasticity and becomes more susceptible to tearing and is often injured while performing everyday activities. Therefore, this is an injury that tends not to discriminate by age.
The most common symptom of a rotator cuff injury is pain. It is often difficult for a patient to localize the pain to a specific area; rather, it is described as a generalized discomfort that is exacerbated with specific movements of the shoulder. Depending on the severity of the injury, there may also be a loss of range of motion.
Rotator cuff tears do not heal well with time, and therefore, only minor tears with minimal disruption to the patient’s life are left alone. In these cases, physical therapy and cortisone injections may help to relieve pain and strengthen the muscles around the joint. However, in more significant tears, surgery is often necessary. The surgical procedure usually involves both the use of an arthroscope, and a short incision to get access to the arm bone (humerus). The procedure allows the surgeon to insert strong sutures to repair the tear in the rotator cuff and reattach the mechanism to the arm bone.
Some period of immobilization of the shoulder joint is needed to protect the newly placed sutures from being disrupted. After one to two weeks, physical therapy begins. Initially, the therapy is gentle so as not to affect the repair. After four to six weeks, more active lifting with the arm begins. Several months after the operation, physical therapy will become more intense in an effort to strengthen the rotator cuff muscles. Complete recovery usually requires at least four to six months.[ Close ]
Frozen shoulder, or adhesive capsulitis, is a painful condition which results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury. The cause of this condition is unclear.
The symptoms are primarily pain and a very reduced range of motion in the joint. The range of motion is the same whether you are trying to move the shoulder under your own power or if someone else is trying to raise the arm for you. There comes a point in each direction of movement where the motion simply stops as if there is something blocking the movement. The shoulder usually hurts when movement reaches the limit of the range of motion, and can be quite painful at night.
Treatment of the frozen shoulder can be frustrating and slow. Most cases will eventually improve, but it may be a process that takes months. Initial treatment is directed at decreasing inflammation and increasing the range of motion of the shoulder with a stretching program. Anti-inflammatory medications may be prescribed. It is critical that a physical therapy program be started and continued to regain the loss of motion.
An injection of cortisone and long-acting anesthetic, similar to Novocain, may bring the inflammation under better control and allow the stretching program to be more effective. In some cases, injecting a long-acting anesthetic along with the cortisone right before a stretching session with the physical therapist can allow the therapist to break up the adhesions while the shoulder is numb from the anesthetic.
If progress is slow, your doctor may recommend a manipulation of the shoulder while you are under anesthesia. This procedure allows your doctor to stretch the shoulder joint capsule, and break up the scar tissue while you are asleep. In most cases, a manipulation of the shoulder will increase the motion in the shoulder joint faster than allowing nature to take its course. Alternatively, an arthroscope can be inserted into the joint to cut through adhesions. Open surgical release is rarely necessary.[ Close ]
The carpal tunnel is a passageway in the wrist formed by the eight carpal (wrist) bones, which make up the floor and sides of the tunnel, and the transverse carpal ligament, a strong ligament stretching across the roof of the tunnel. Your orthopaedic surgeon will further explain this anatomy to you, in order that you may understand your condition.
Inside the carpal tunnel are nine flexor tendons which flex (bend down) your fingers and thumb. Also running through the carpal tunnel is the median nerve, a cord about the size of a pencil containing thousands of nerve fibers supplying sensation (feeling) to your thumb, index and middle fingers, and half of the ring finger. The median nerve lies directly beneath the transverse carpal ligament and comes in contact with the ligament when bending or straightening the wrist or fingers. Carpal tunnel syndrome occurs when swelling in the tunnel compresses the median nerve.
Tingling, numbness and pain in the thumb, index and middle fingers are the most common symptoms of carpal tunnel syndrome. These symptoms are usually experienced at night, but also accompany prolonged gripping. Patients may also experience clumsiness when handling objects or weakeness in grip.
There are many non-surgical courses of treatment for carpal tunnel syndrome, such as splints or braces to immobilize and rest the wrist, activity modifications, oral anti-inflammatory medications, and steroid injections.
If non-surgical treatment is not successful or if treatment is sought too late, surgery may be required. This surgery involves enlarging the carpal tunnel, which in turn will relieve the swelling and pressure on the nerve. This is an outpatient procedure done under local anesthesia. In severe cases, even surgery may not reverse the effects of carpal tunnel syndrome. Carpal tunnel surgery is followed by hand therapy which varies per person, but usually lasts from 1 to 3 months.[ Close ]
Cubitus is Latin for elbow. The cubital tunnel is an anatomic passageway between the bony prominence of the inside of the elbow (medial epicondyle) and the tip of the elbow (olecranon process). Through this passageway travels the ulnar nerve as it crosses behind the elbow. To keep the nerve from displacing with motion of the elbow, the tunnel is completed by a covering of tissue called fascia. There are several other tunnels that the ulnar nerve passes through while traveling down the arm. Cubital tunnel syndrome occurs when there is compression or injury of the ulnar nerve in the cubital tunnel or in surrounding smaller tunnels.
The ulnar nerve provides sensation to the little finger and half of the ring finger. It also supplies several muscles in the forearm but most importantly it controls many of the small muscles in the hand responsible for coordinating finger motion and pinch. Patients with this condition commonly exhibit symptoms of intermittent numbness or tingling in the ring and little fingers of the affected extremity. These symptoms may occur with prolonged flexion of the elbow or resting against the elbow. There may be an associated aching discomfort along the inner forearm or elbow. If nerve damage persists, there is loss of sensation in the ring and little fingers. Eventually there is loss of pinch and grip strength.
In early stages of cubital tunnel syndrome, symptoms may be alleviated by avoiding activities requiring prolonged or repetitive elbow flexion or resting against the elbow. To prevent elbow flexion, particularly at night, it may be necessary to use a long-arm splint. An elbow pad worn during the day can be beneficial in protecting the cubital tunnel from direct pressure. At times, an oral anti-inflammatory is helpful in alleviating symptoms. When cubital tunnel syndrome is severe or fails to improve with conservative management, surgery may be indicated.[ Close ]
Thoracic outlet syndrome is a repetitive stress disorder that involves the shoulder and upper arm. The thoracic outlet is a triangular area through which nerves and blood vessels pass from the neck to the arm. The area is bordered by the collar bone, the first rib, and the anterior and middle scalene muscles. Thoracic outlet syndrome occurs when the nerves and blood vessels between the neck and shoulder are compressed. Activities such as pulling your shoulders back and down, sleeping with your arms above your head, carrying items such as a backpack or suitcase, or work that requires frequent overhead lifting may increase the risk of this syndrome.
Symptoms are similar to carpal tunnel syndrome: numbness in the fingers and hand, tingling in the arm as if it is "asleep", and pain that begins in the base of the neck and radiates into the arm or hand. Your orthopaedic surgeon must differentiate between the two conditions. Often with thoracic outlet syndrome, numbness and tingling may be in other parts of the upper extremity depending on which nerves are involved.
The mainstay of treatment is physical therapy. The goals are to modify postural habits, relieve muscle tension, improve alignment and increase nerve gliding. Rest, adjustments to how you perform daily activities, oral anti-inflammatory medications and steroid injections may be recommended. If non-surgical treatment is not successful or treatment is sought too late, surgery may be required. The two procedures available are release of the scalene muscles or excision of the first rib. Both procedures provide improvement in approximately 80% of properly selected patients, but over time 10% of the patients develop recurrent symptoms. The procedure is performed as an inpatient and generally requires several months for full recovery.[ Close ]
Injuries to the shoulder and elbow may occur in any age group: children, adolescents, adults, and the elderly. Like any injury involving a joint, the ramifications can be quite disabling. Both the shoulder and elbow react to trauma in ways that are difficult to manage. The extremes of stiffness and instability may commonly result, depending on the injury.
Given the demands that we place on our upper extremities, it is crucial that the shoulder and elbow retain as much function as possible following an injury. Although the hand may not have been involved, it can be made essentially useless if the shoulder or elbow fail to function properly. For this reason, it is important to seek medical attention as soon as possible after an injury to these joints to avoid unnecessary complications.[ Close ]
The elbow is an extremely temperamental joint. Under various circumstances, the elbow often becomes stiff and painful. Trauma, even mild trauma, is the most common reason for this problematic phenomenon. Even immobilizing the elbow for a short time in a cast or sling may cause significant stiffness. In special instances, bone can actually form around the elbow, and fuse it solid.
An elbow without motion renders the entire upper extremity useless. Specially trained physicians and therapists must work together with the patient in order to relieve pain and regain motion. Many hours of special equipment, exercises, stretching, and occasionally surgery are required to achieve those rehabilitative goals.[ Close ]
Greater Metropolitan Orthopaedics provides a
comprehensive approach to the care and treatment
of shoulders and elbows. If left untreated, any of
these ailments can prevent you from enjoying life
to the fullest.