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The hip joint is subject to many stresses and strains with activities of daily living, work tasks and sports related activities. Hip pain can result from injury to any of its structures, affecting all age groups. Your hips are strong when healthy but changes in the hip from disease, repetitive strain or injury can significantly affect your ability to function and can place abnormal stress on joints above and below the hip.
Childhood:
Perthes disease is a disease that affects hip joints in children most often between the ages of 3 and 11 where the blood supply to the top of the femur bone is temporarily disrupted. The bone gradually heals but may lead to problems later in life. Boys are more affected as than girls.
Teenage Girls and Young Women:
Snapping hip syndrome affects 5% of the population most commonly occurs between the ages of 15 and 40 in females. The cause is due to a labrum (cartilage tear) or from one of the hips tendons snapping over the bony structures of the hip. Stress fracture to the neck of the femur is also common in this age group.
Teenage Boys and Young Men:
Slipped capital femoral epiphysis(SCFE) occurs when the ball part of the hip joint slips away from the rest of the bone. This condition is occurs in males in the11-14 age group especially if the Perthes disease was missed in childhood. Hip pointer is bruise on the pelvis or hip bone caused by a direct blow or a bad fall. A pelvic avulsion fracture occurs when a tendon connected to the hip bone contracts so hard that it pulls off part of the bone.
Sports injuries:
Sports related hip pain is usually the result of a traumatic event as a fall or hard impact. Hip pain may also stem from a twisting injury or extensive repetitive overuse motion. Muscle strains and inflammation of the tendons of the hip and groin are subject to overuse injuries. Bursitis is inflammation from injury or infection of the bursae. Athletes who participate in ice hockey, soccer, football, and ballet are prone to labrum tears.
Active people:
Many hip conditions arise in active people ranging from muscular strains as groin and hamstring strains or a piriformis (small muscle at the back of the hip joint) strain. A number of nerves can become trapped as they pass through the hip and piriformis muscle and should be considered as a cause of hip pain. Muscle imbalances can occur result the bursae become irritated with a progression leading to the development of stress fractures to the hip joint.
Trauma:
Can affect every structure of the hip and may result in a ligament tear, a cartilage (labrum) tear, or a bone fracture, leading to swelling or bleeding in the hip joint. Most hip fractures in people with healthy bones are a result of a high-energy trauma such as car accidents, falling from a height or sports related injuries.
Referred pain:
Can be explained as pain experienced in the hip which originates in another location, possibly from knee joint damage or from injury to the low back. The Sacro-Iliac joint can also be a cause of hip pain. Referred pain can also be felt in the thigh, lower leg, ankle or foot. At times pins and needles or numbness may be felt in the affected leg or foot.
Hip Joint Inflammation:
Inflammatory arthritis occurs when a body’s immune system becomes overactive and attacks healthy tissue. Rheumatoid arthritis is one such condition that attacks and destroys the articular cartilage covering the bone, often affecting both joints. Many other inflammatory arthritic conditions can affect the hip joint that can cause a wide range of disabling symptoms and loss of functional ability often requiring a hip replacement.
Baby Boomers:
Osteo-arthritis of the hip joint is common hip condition associated with degeneration of the joint cartilage and changes to the underlying bone. Often a Hip Joint Replacement is needed to resolve pain and restore functional ability. Older people are at risk of a hip fracture, which often occurs from a fall or from thinning of the bones known as osteoporosis.
The elbow joint is relatively unstable due to the shape of the bones that form the joint. The unique movements possible at the elbow along with the high forces that it experiences predispose the elbow to significant injuries. Elbow pain can result from an injury to any of its structures, affecting all age groups.
Most elbow pain is caused by overuse injuries. These injuries happen when tendons muscles or ligaments of the elbow joint become damaged over time due to repetitive movement without adequate time to heal.
Childhood:
Elbow injuries are common in children who are active and participate in organized sports. Growth plate fractures, falling onto an outstretched hand and elbow dislocations are also common. “Little League Elbow” an overuse injury is the most common injury in youth baseball pitchers and throwers.
Teenage Girls and Young Women:
Most common injuries are related to overuse injuries in softball pitching are to the elbow and forearm due to the windmill action needed in pitching. Playing multiple games on consecutive days is often the cause. Pain from the forearm muscles is common in young girls when performing activities as cheerleading, gymnastics when performing weight bearing activities through the arm with a straight elbow
Teenage Boys and Young Men:
Tennis elbow is a condition affecting the outside of the elbow. Only 50% of the tennis population is affected. An overuse injury increasing with age. People in their 30’s and 40’s develop tennis elbow as a result of occupational tasks as laborers performing excessive gripping or wringing activities and musicians rather than sports activities. The condition is caused by repetitive and excessive use of the wrist. Golfers elbow, a less common elbow condition, affecting the inside of the elbow, men are more affected than women. Common causes are golf and frequently carrying a heavy bag or a case.
Sports injuries:
Ligament injuries are a common source of pain in the elbow. They are commonly under stress with overhead throwing as needed in baseball, javelin and throwing. Athletes commonly report a “pop” and bruising around the inside of the elbow. Inflammation of the triceps tendon is common in weightlifters and industrial workers who repetitively straighten the elbow against resistance. Javelin throwers are prone to repeatedly and forcefully extending the elbow producing pain.
Active people:
Many elbow conditions arise in active people ranging from muscular strains as inflammation of the biceps tendon. The ulna nerve can become trapped as it runs through the inside of the elbow providing numbness and tingling in the ring and little finger.
Trauma:
Trauma and injury to the elbow can damage the cartilage in the joint and can lead to an early arthritis. Inflammation of the bursa at the back of the elbow can occur with a history of trauma.
Referred pain:
Can be explained as pain experienced in the elbow which originates in another location, most commonly from the 5th and 6th bones of the cervical spine (neck). This can result in elbow pain, limited elbow mobility and mobility of the nerves around the elbow. Pins and needles are common around the elbow and forearm.
Elbow Joint Inflammation:
Inflammatory arthritis occurs when a body’s immune system becomes overactive and attacks healthy tissue. Rheumatoid arthritis is the most common causes of arthritis in the elbow, which leads to severe pain, swelling, elbow stiffness and deformity.
Baby Boomers:
Osteo-arthritis of the elbow affects the cartilage in the end of the bones. As degeneration progresses pain increases with limited movement of the elbow joint is common hip condition associated with degeneration of the joint cartilage and changes to the underlying bone. Elbow Joint Replacement, while not commonly seen, is needed to resolve pain and restore functional ability.
Both the wrist and hand is subject to many stresses and strains with activities of daily living, work tasks and sports related activities. Pain can result from injury to any of its structures, affecting all age groups. Your wrist and hands are strong when healthy but changes in the wrist and hand from injury can affect your ability to work, play sports or even dress or write. The most common wrist and hand injuries are sprains and fractures.
Childhood:
Wrist and hand fractures peak during childhood and the teenage years. Toddlers use their hand for investigation getting then caught in home doors resulting in crush injuries. The small finger and the thumb are the most common areas fractured. Wrist fractures are common due to highrisk sports as football or soccer or falling of a bike.
Teenage Girls and Young Women:
The ratio of male to female fractures in the wrist and hand is as high as 5:1. The participation of females in sports has decreased this ratio.
Teenage Boys and Young Men:
Hand and wrist fractures in teenagers peak between 11-16 years of age and is related to an involvement in fracture prone sports as skate boarding, ice hockey and trick biking. Males are more 5 times more likely to fracture their wrist and hand due to more aggressive and high- risk behaviors. The scaphoid bone of the wrist is commonly fractured, caused by a fall into an extended wrist.
Sports injuries:
Wrist and hand injuries are common in sports activities ranging from traumatic fractures as basketball related finger fractures to overuse injuries as wrist tendonitis in golf. Wrist sprains occur in basketball or rugby after a trip or fall causing tearing of ligaments. The Scaphoid is a bone in the wrist commonly injured in martial arts, gymnastics and football. Bennett’s fracture is a fracture of the thumb commonly seen in boxing.
Active people:
Many wrist and hand injuries occur in active people. Overuse injuries occur when too much stress is placed on a joint or other soft tissue. Carpal tunnel syndrome is caused by pressure on the medial nerve in the wrist producing tingling, numbness, pain and weakness of the fingers and hand. Tendonitis is inflammation in the tendon. Tendonosis is a series of common tears in a tendon resulting in pain, decreased strength and movement of the wrist, hand and fingers.
Trauma:
Can affect every structure of the hand and wrist and may result in a ligament tear, a cartilage tear, or a bone fracture, leading to swelling or bleeding in the joints. The type of fracture is related to the type of injury. A crush fracture is different to a fracture from a direct blow from hockey or lacrosse sticks.
Referred pain:
Can be explained as pain experienced in the wrist or hand, which originate in another location, possibly from cervical spine (neck). In addition the various nerves of the arm can also be trapped and produce pain in the wrist and hand. At times pins and needles or numbness may be felt in the affected wrist or hand.
Wrist and hand Joint Inflammation:
Inflammatory arthritis occurs when a body’s immune system becomes overactive and attacks healthy tissue. Rheumatoid arthritis is one such condition that attacks and destroys the articular cartilage covering the bone, often affecting both wrist and hand. Many other inflammatory arthritic conditions can affect the wrist and hand joints that can cause a wide range of disabling symptoms and loss of functional ability.
Baby Boomers:
Arthritis means “inflamed joint” which can affect any of the 27 bones of the wrist, hand and fingers. The most common forms of arthritis in the hands and wrists are osteoarthritis (wear and tear form), arthritis that develops after an injury and rheumatoid arthritis the most severe form of arthritis. All forms cause the cause the wrist and hand to become stiff, swollen, pain and deformity. Most common areas affected are the base of the thumb, tip and middle joint of the finger. Arthritis affects 90% of patients over age 75. Colles fracture is a common fracture of the radius bone of the wrist in the elderly due to a fall in a patient with osteoporosis.
The shoulder is a very mobile flexible joint which is vulnerable to injury. Shoulder pain can result from injury to any part of the shoulder, affecting all age groups. Fortunately most shoulder pain will improve over time with the appropriate treatment.
Childhood:
Shoulder injuries are common in children especially those who are active and those who participate in sports. Traumatic injuries occur in the area of bone growth known as the “growth plate” (an area towards the end of a long bone where bone growth occurs) fractures caused by a fall onto an outstretched arm. Overuse injuries as “Little League Shoulder” is common in baseball players affecting the tendons and ligaments of a child’s shoulder.
Teenage Girls and Young Women:
Are more likely to develop shoulder instability. Instability can occur in the absence of trauma from weak muscles or stretchy ligaments. Instability can also occur from repeated overhead movements as in tennis, swimming and softball. The stress causes microscopic damage to the muscles, tendons and ligaments of the shoulder that do not have time to repair between bouts of exercise.
Teenage Boys and Young Men:
Shoulder pain is often caused by a traumatic event as a fall off a hover board or an awkward tackle resulting in a shoulder dislocation or a shoulder separation. Labrum tears are also seen in the pediatric athletes shoulder. Stress fractures can occur in overhead athlete as the young bones are still growing.
Sports injuries:
Shoulder fracture or dislocation, ligament tears, cartilage damage and tears of the labrum tears or articular cartilage. Overuse shoulder injuries cause microscopic in these structures. Sports injuries can require a surgical resolution followed by expert physical therapy.
Active people:
Many elbow conditions arise in active people ranging from muscular strains as inflammation of the biceps tendon. The ulna nerve can become trapped as it runs through the inside of the elbow providing numbness and tingling in the ring and little finger.
Trauma:
Can affect every structure of the shoulder and may result in a ligament tear, a cartilage tear, inflammation of the bursa, varying degrees of rotator cuff tear or a bone fracture of the bones of the upper am or collar bone, leading to swelling or bleeding in the shoulder joint.
Referred pain:
Can be explained as pain experienced in the shoulder, which originates in another location, possibly from cervical spine (neck). Referral of pain to the shoulder can also occur from internal organs as the heart, gall bladder and the liver.
Shoulder Joint Inflammation:
Rheumatoid arthritis is an example of shoulder joint inflammation, which limits shoulder movements resulting in significant disability. Other inflammatory conditions such as gout is more common in older adults. Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders.
Baby Boomers:
Osteo-arthritis of the shoulder joint is common as the cartilage covering the bone ends start to degenerate. Often the shoulder starts to click and lock with movement where a joint replacement is needed to resolve the pain and restore functional ability. If the rotator cuff muscles are damaged a reverse shoulder replacement is needed. Frozen shoulder is common in female baby boomers and those with diabetes or thyroid disease.
Foot and ankle disorders commonly give concern from young children to the elderly. Foot and ankle pain makes it harder to walk or carryout daily activities and can interfere with getting out of a chair, climbing stairs, walking, running, driving a car. Pain that leads to less mobility is accompanied by decreased strength and reduced functional ability.
There are two main challenges to the diagnosis and treatment of ankle and foot pain. To diagnoses both the problem and the cause. Treatment then must focus on both areas.
Childhood:
Incredible changes occur in muscles and bones of the ankle around puberty. The vulnerable phase occurs around 10 years of age in girls and 12 in boys. Rapid increase in the length of bones can increase the odds of a fracture.
Bones grow at a rate muscles cannot keep up with producing a phase of inflexibility leading to pain and inflammation. Sever’s disease affects the heel of the foot in the growth spurt phase. Growing pains as cramping and muscle aching can be present form months to years and are located in the calves and thighs. Juvenile arthritis, affecting the ankle joint is the most common arthritis in children.
In children most, toe, foot and ankle injuries occur during sports, play or falls. The risk of injury is greater if the child is a dancer, gymnast, soccer or basketball player.
Teenage Girls and Young Women:
Ankle injuries are common injuries in high school athletes. Sports that involve running and jumping, with the highest rates occurring in soccer, volleyball and track and field in female athletes. Female athletes have a higher rate of ankle injuries in practice than males.
Teenage Boys and Young Men:
For male athletes the most common sports for ankle injuries are football and basketball. Male athletes have a higher rate of ankle injuries during competition. In 85% of cases a ligament on the outside of the ankle is mostly affected. The most common cause of an ankle sprain during athletic activity is contact with another person causing the foot to twist inwards against the lower leg.
Sports injuries:
Ankle fracture, ligament tears, cartilage damage and cartilage tears. Overuse ankle injuries cause microscopic tears in these structures. Pain over the front of the shinbone can be caused by shin splints or in other instances a crack may develop in the shin bone known as a stress fracture, more common in female runners.
Active people:
Overuse injuries occur when too much stress is placed on the structures of the ankle and foot. Inflammation of a bursa causes swelling and tenderness at the back of the heel and ankle. Inflammation of the Achilles tendon (Achilles tendonitis) and Plantar Fasciitis is inflammation of the plantar fascia can occur producing severe pain when the foot/ heel contacts the floor.
Trauma:
Can affect every structure of the foot and ankle and may result in a ligament tear, a muscle tear, inflammation of the bursa, varying degrees of cartilage damage or a bone fracture. A bad sprain or fracture can cause damage to the cartilage of a joint and lead to arthritic changes on the foot or ankle.
Referred pain:
Can be explained as pain experienced in the foot and ankle, which originates in another location, possibly from the low back.
Ankle and Foot Joint Inflammation:
Rheumatoid arthritis is the most crippling form of arthritis and a cause of joint inflammation, often developing in both ankles and feet. Other inflammatory conditions, as gout, is diet related often affecting a single big toe, common in men.
Baby Boomers:
Osteo-arthritis of the foot and ankle joint is the most common arthritis form. It can occur suddenly by an injury or its onset may be gradual. The cartilage covering the bone ends start to degenerate producing intense pain. Breakdown of joint cartilage causes the bones of a joint to rub together causing joint stiffness, pain and loss of movement in the joints of the foot and ankle.
Osteoporosis is a decrease in bone density causing bones to become fragile and susceptible to fracture. More common in females and at times is seen in teenage female athletes.
The knee joint is subject to many stresses and strains with activities of daily living, work tasks and sports related activities. Knee pain can result from injury to any part of the knee, affecting all age groups.
Teenage Girls and Young Women:
Are more likely to develop knee cap problems such as knee cap dislocation and knee cap movement abnormalities as chondromalacia patellae.
Teenage Boys and Young Men:
Are more likely to have knee tendonitis (Jumpers Knee) or a condition known as Osgood-Schlatters disease where tendon overuse affects the bone just below the knee.
Sports injuries:
Kneecap fracture or dislocation, ligament tears, cartilage damage and tears of the meniscus tears or articular cartilage. Sports injuries can require a surgical resolution followed by expert physical therapy.
Active patients:
More likely to develop ligament sprains, muscle strains or overuse injuries from repeated use.
Trauma:
Can affect every structure of the knee and may result in a ligament tear, a cartilage tear, or a bone fracture, leading to swelling or bleeding in the knee joint.
Referred pain:
Can be explained as pain experienced in the knee which originates in another location, possibly from hip joint damage or from the low back.
Knee Joint Inflammation:
Rheumatoid arthritis is an example of joint inflammation, which may develop in patients of any age, other inflammatory conditions as gout is more likely in older adults.
Baby Boomers:
Osteo-arthritis of the knee joint is common. Often a Knee Joint Replacement is needed to resolve the pain and restore functional ability.
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