Conditions & Treatment

New York Sports Medicine Institute provides a wide range of highly specialized treatments to properly evaluate and treat sports related and chronic conditions affecting the shoulder, knee, hip, elbow, hand, wrist, foot and ankle. Sports injuries are often caused by trauma suffered during competition and repetitive or overuse wear and tear. Chronic conditions may include arthritis, age-related deterioration, or any number of factors related to use or associated health issues.

When surgery is required, NYSMI offers minimally invasive arthroscopic surgery for a number of conditions related to injury of shoulder, knee, hip, elbow, foot, ankle, hand and wrist. Our orthopedic surgeons are also highly regarded for providing hip, knee and shoulder total joint replacement.

Physical therapy is frequently prescribed for the treatment of sports injuries and chronic injuries that may not require orthopedic surgery. Physical therapy is also prescribed to ensure optimal healing and training following some orthopedic surgery procedures. For a number of patients, conducting physical therapy at the New York Sports Medicine Institute provides convenience and comfort – a visit to one location serves multiple needs and provides comprehensive care to keep you in the game.

Services Offered

To learn more about injuries, conditions and treatment, click below.

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Shoulder

Shoulder injuries are often the result of trauma, overuse or repetitive motion, whether sustained by sports injury or normal daily activity. A healthy shoulder is the most mobile of all joints in the body, but such mobility comes with the downside of being vulnerable and susceptible to injury. Shoulder injuries may result in limiting range of motion and pain or discomfort – affecting performance and ability. A number of shoulder injuries are sustained by landing on the elbow or outstretched hand, or by repetitive motion that places stress on the shoulder.

The shoulder consists of three bones − the humerus (upper arm bone), the clavicle (collarbone) and the scapula (shoulder blade) – along with ligaments that connect the bones to one another and tendons that connect bones to muscles. The shoulder also has three joints: the glenohumeral joint (the ball and socket joint), the acromioclavicular (A/C joint) and the scapulothoracic joint. Surrounding muscles support and stabilize each joint. At the tip of the shoulder is the deltoid muscle and underneath the deltoid is a network of four muscles known at the rotator cuff.

Much of the time, shoulder pain is attributed to instances of inflammation, instability, fracture or arthritis.

Common Shoulder Injuries and Conditions

Rotator Cuff Tear

According the American Academy of Orthopaedic Surgeons, rotator cuff problems are the most likely shoulder-related cause for people to visit with an orthopedic physician. The four muscles that make up the rotator cuff work to support the shoulder and it’s their healthy functioning that is required to be able to lift and rotate the arm. When one of these tendons is torn – perhaps from falling on an outstretched arm or lifting a heavy object with a jerking motion – range of motion is affected, and pain and discomfort are the likely results.

Shoulder Tendonitis and Bursitis

Similar to rotator cuff injuries, shoulder tendonitis and bursitis can also result from repetitive or stressful activity. This condition frequently causes pain and stiffness in an area of the shoulder joint that has inflammation.

If you consider the pressure placed on the shoulder when throwing a football, swinging a bat, serving a tennis ball or swimming, it’s not hard to imagine that these actions could stress the shoulder and lead to inflammation. When the rotator cuff tendon or the bicipital tendon becomes inflamed and irritated, this is referred to as rotator cuff tendinitis or bicipital tendonitis respectively.

Subacromial bursa is the name of the protective area between the shoulder and tendons. Inflammation in this area is referred to as subacromial bursitis. In addition to being sports and stress related, tendonitis and bursitis of the shoulder are also common results of the aging process, as tendons and muscles become less elastic and more rigid with age.

Arthritis

As an inflammation of the joint, arthritis causes stiffness and ache. The shoulder can be affected by osteoarthritis (damage to cartilage), rheumatoid arthritis (an autoimmune disease), or arthritis triggered by a rotator cuff tear. People with arthritis often notice that their joints can “predict” a rainfall; changes in humidity can trigger pain.

Shoulder Instability

Young people and athletes are among those commonly affected by shoulder instability − a condition that feels as though the shoulder is loose and may slip, or pop out of place. For an athlete, an unstable shoulder can be the result of muscles and ligaments being stretched beyond normal limits, perhaps due to extreme force on the shoulder while tackling, wrestling, pitching a baseball or serving a tennis ball.

When the ligaments holding the shoulder muscles to the bones tear in a manner that they can’t hold the joint together, the result is a dislocated shoulder. A dislocated shoulder can be extremely painful and requires immediate medical attention. A physician may treat a shoulder dislocation with an adjustment to put the shoulder back in place. However, a shoulder that repeatedly pops out of the socket is termed recurrent instability, requiring repair of the torn ligaments.

The shoulder can become dislocated in a number of ways – such as forward, backward or downward. A partial dislocation, also called subluxation, occurs when the humerus (the upper arm bone) becomes partially out of the glenoid (socket). In the case of a complete dislocation, the humerus is all the way out.

Frozen Shoulder

Also known as adhesive capsulitis, frozen shoulder begins with noticeable pain or discomfort that eventually fades, but is replaced by stiffness. As the Mayo Clinic notes, your chance of developing frozen shoulder increases “if you’re recovering from a medical condition or a procedure that affects the mobility of your arm,” including stroke, mastectomy or bone fracture.

Fractures

From auto accidents to sports related collisions and falls, shoulder fractures can cause severe ongoing pain and adversely affect the shoulder’s range of motion.

Treating shoulder pain

Fortunately, there’s no need to resign oneself to living with shoulder discomfort, be it chronic pain, stiffness, limited range of motion or impaired performance. The medical professionals at the New York Sports Medicine Institute have decades of experience in diagnosing and treating shoulder injuries and chronic conditions.

Whether you are a high-performing elite athlete or an individual suffering from age-related illness or injury, NYSMI’s highly specialized physicians will assist you in obtaining the optimal treatment plan.

Shoulder Injury Services

Among the shoulder injury services performed are:

Arthroscopic rotator cuff repair and labral repair surgery
Evaluation and treatment of fractures of the humerus and clavicle
Total joint replacement of the shoulder
Evaluation and treatment of a variety of shoulder conditions, including tendonitis, arthritis, rotator cuff tear, labral tear, frozen shoulder, impingement, calcium tendinopathy, dislocations and instability
Reverse total shoulder
Open shoulder instability surgery
Physical therapy of the shoulder

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Knee

The knee is a versatile and complicated set of twisting and turning bones, cartilage, ligament and fluid. This joint serves so many purposes – supporting weight through standing, pivoting, running and jumping – that it’s no surprise how many athletes and non-athletes alike are vulnerable to knee injuries and pain. Runners are one group of athletes that are particularly susceptible to injuries from excessive use.

The largest joint in the body, the knee is also one of the most easily injured. It is made up of the lower end of the femur (thighbone), which rotates on the upper end of the tibia (shinbone), and the patella (knee cap), which slides in a groove on the end of the femur. The knee also contains large ligaments, which help control motion by connecting bones and by bracing the joint against abnormal types of motion. Another important structure, the meniscus, is a wedge of soft cartilage between the femur and tibia that serves to cushion the knee and helps it absorb shock during motion.

Common Knee Injuries

Among athletes, knee ligament injuries are common. Sports injuries and even an awkward planting of the foot during a non-athletic activity can result in injuring one of the major ligaments in the knee. The knee is primarily stabilized by pairs of cruciate and collateral ligaments.

The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) cross one another on the inside of the knee. The medial collateral ligament (MCL) is also on the inside of the knee and the lateral collateral ligament (LCL) provides stability from the outside of the knee. Sports-related injuries frequently involve the ACL, MCL and PCL.

ACL Injury

For an athlete, an ACL injury is often caused by a quick change in direction, an abrupt change in speed or an awkward landing or pivot. For a football, baseball or soccer athlete, an ACL injury may be caused by the planting or sticking of a cleat in the field of play. A basketball or tennis player may injure the ACL by making a quick change of motion on the court.

Diagnosing ACL injuries may include the need of MRI to determine the severity of the injury. Ligament sprains are frequently described according to a three grades of injury. If the ACL is mildly damaged, but still able to support the knee joint, it’s considered a Grade 1 Sprain. A Grade 2 Sprain describes an ALC that is stretched to the point of being loose and a partial tear has been sustained. A complete tear of the ACL is considered a Grade 3 Sprain.

Treatment for ACL injuries is dependent upon the severity of the sprain and the activities required of the patient. Nonsurgical treatment may be recommended for a patient with a partial tear of the ACL, provided the ligament can provide substantial support for the knee. Nonsurgical treatment may include physical therapy and the use of a brace for certain activities.

Surgical treatment for ACL injuries often involve replacing the torn ACL with a graft of tendon taken from elsewhere in the patient’s body. Tendon taken from the patient’s own body is referred to as an autograft. Autograft for ACL replacement is often taken from the patellar tendon, hamstring tendon or quadriceps tendon. Rehabilitation following ACL surgery is crucial. The patient’s commitment to performing exercises and engaging in physical therapy plays an important role in the overall success of the surgical procedure.

MCL Injury

For athletes, MCL injuries are most frequently experienced in contact sports. A collision to the side of the knee during a football, baseball, basketball or soccer match may result in an injured MCL. Such force exerted to the outside of the knee can cause the MCL to stretch to the point of creating a tear. Some MCL tears are isolated and others are part of a complex injury that includes other ligaments, such as the ACL or the meniscus.

Because the MCL has a consistent blood supply, the ligament typically responds well to nonsurgical treatment. Nonsurgical treatment may include resting the knee and wearing a brace to limit side to side movement. Most often, surgery is not required for MCL injuries. When surgery is required, it is typically done through a small incision on the inside of the knee. If the ligament is torn where it attaches to the femur (the thighbone) or tibia (the shinbone), the orthopedic surgeon will re-attach it to the bone. If the tear is in the middle, the surgeon will sew it together.

PCL Injury

A PCL injury is often the result of strong force, such as a collision, to a knee in the bent position. Twisting or hyperextension of the knee is another way that a PCL injury may occur. Sustaining such an injury can present a patient with difficulty walking and the afflicted kneed may become unstable.

Diagnosing a PCL injury may be done by physical examination combined with an MRI to reveal more about the location and nature of injury. If the PCL is injured solely, without injury to other parts of the knee, nonsurgical treatment, including rest and icing may allow the PCL to heal on its own. A brace may also be used to help immobilize the knee and crutches may be required to limit pressure from weight applied to area. Physical therapy may be recommended as well, to help strengthen leg muscles that support the knee – a proven strategy for assisting the PCL healing process.

If surgery is required, a graft from another part of the body is likely to be used in replacing the torn PCL. Orthopedic surgeons can perform minimally invasive arthroscopic surgery to rebuild a PCL, allowing for quicker recovery process than traditional surgery. As with other post-operative procedures involving joints, the patient’s commitment to physical therapy and dedicated exercises is an important factor in the healing process.

Meniscus Tear

A meniscus tear is often referred to as torn knee cartilage. The meniscus is attached to knee ligaments and acts as a shock absorbing cushion for the knee. Over time, the meniscus may wear and become more susceptible to tearing. As a sports injury, a meniscus tear is most likely to occur during the action of pivoting, cutting, twisting, being tackled or abrupt deceleration.

In diagnosing a meniscus tear, a physician will perform physical tests that bend, straighten and rotate the knee. MRI may also be required to obtain images of the soft tissues within the knee. Treatment for a meniscus tear is dependent upon the nature and location of the tear, along with other factors, such as patient age and activity demands. Tears occurring within the outside part of the meniscus, where there is rich blood supply, have a strong chance of healing with nonsurgical treatment. Meniscus tears in the areas that lack such a supply of nutrient rich blood are more likely to require surgery. Minimally invasive arthroscopic surgery is typically the procedure performed for meniscus tears that require surgical treatment.

For a severely damaged meniscus, there is the option of meniscal transplant surgery. The primary purpose for meniscal transplant surgery is the replace the meniscus before damage is done to the articular cartilage that protects the knee. When articular cartilage is worn, it can damage the bones moving along the surface, causing pain and leading to a condition of osteoarthritis.

Mensical transplant surgery is performed using arthroscopic surgery, so the healing process is faster than traditional surgery. The transplant surgery uses healthy cartilage tissue from a human donor (a cadaver). Diligent work is done prior to surgery to screen for a donor that is a good match for the procedure. The donor tissue is called an allograft, which is the name for a graft taken from a human donor other than the patient. Patient eligibility for meniscal transplant is dependent on a number of factors, including patient age, overall health and health status of the knee joint being considered.

OCD of the Knee

Osteochondritis dissecans is a joint condition also referred to as OCD, and it is more common to occur in the knee than other joints. It most frequently affects young athletes who have sustained an injury. OCD of the knee is a condition where a piece of cartilage and a layer of the bone beneath it, typically of the femur (the thighbone) comes loose from the end of the bone. X-rays are frequently used to diagnose the condition. Treatment options vary, as the fracture may heal itself with rest, and physical therapy if required.

If nonsurgical treatment proves ineffective, arthroscopic surgery may be used to remove loose fragments or to reattach fragments to the bone. Another surgical procedure, depending on the nature of bone fractures, is to fill the defective area with cartilage containing bundles of collagen fibers known as fibrocartilage. Another option is to use the patient’s own bone marrow to help rebuild the damaged area, encouraging new tissue to grow in the space where a bone fragment is removed.

Articular Cartilage Injury

Articular cartilage is the tissue that covers the ends of bones, allowing bones to move over one another with limited friction. When damaged, either by injury or wear and tear, treatment is typically required, as this cartilage does not usually heal well once compromised. Many of the surgical procedures used to restore articular cartilage are done with minimally invasive arthroscopic surgery.

A variety of surgical options for cartilage restoration exist. One arthroscopic procedure is microfracture, where multiple holes are created in the joint surface, beneath the cartilage into the subchondral bone. The holes are created using a sharp tool called an awl. This procedure produces a new blood supply reaching the joint surface, delivering new cells that stimulate the growth of new cartilage. Drilling is another arthroscopic option, also aimed at stimulating the growth of healthy cartilage by way of penetrating the subchondral bone. Drilling is done with a small surgical drill or wire. Abrasion arthroplasty is another similar technique, but rather than using drill or wires, high speed burrs are used to simply remove the damaged cartilage and stimulate the healthy subchondral bone.

Autologous chondrocyte implantation (ACI) is a two-step procedure used to replace defective cartilage in the knee. ACI is done by extracting healthy cartilage tissue from a non-weight bearing part of the patient’s bone using arthroscopic surgery. The cells from the healthy cartilage are then cultured and increased over a three to five-week period. The second step of the ACI is to conduct an open surgery to implant the newly grown cells into the defective area of cartilage. Prior to implanting the new cells, the cartilage defect is treated with a layer of bone-lining tissue called periosteum, sewn over the area. The newly grown cells are implanted under the periosteal cover.

Two other treatment options for treating Articular cartilage include osteochondral autograft transplantation and osteochrondral allograft transplantation. An osteochondral autograft transplant procedure takes a graft of healthy cartilage tissue from a non-weight bearing area of the patient’s bone, to be utilized in the area of defective cartilage. Because there is a limited amount of area within the patient’s bone to harvest osteochondral autograft, larger transplantation needs are done by way of allograft, where the tissue is taken from a cadaver donor.

Knee injuries may include:

Knee instability
Hearing a loud “pop” noise at time of injury
Experiencing acute pain inside of knee
Feeling like the knee is locking or slipping
Swelling, stiffness or tenderness in or around the joint

Arthritis of the Knee

Arthritis of the knee can be the result of sustained trauma or from disease (osteoarthritis and rheumatoid arthritis). In the case of osteoarthritis, the deterioration of joint cartilage causes bones to rub against one another. Arthritis of the knee commonly affects the elderly, overweight individuals and those suffering from pre-existing injury.

Treating Knee Pain

Minimally invasive arthroscopic ACL and PCL reconstruction surgery is a widely accepted treatment for ligament issues. This outpatient technique includes inserting a tiny set of optical fibers and lenses into the affected area. The pictures these lenses send back guides the orthopedic surgeon to fix or remove the problems causing the pain. Another arthroscopic procedure, meniscus repair, addresses the cartilage problems. Once again, the camera provides images to the surgeon, who then uses sutures to remove, repair or replace the affected cartilage, preventing the tear from widening and causing more pain.

New York Sports Medicine Institute’s orthopedic surgeons are adept at the diagnosis of knee injuries and developing an optimal plan of treatment. Patients benefit from the availability of onsite X-rays and onsite physical therapy.

Total Knee Replacement

The most common condition that leads to total knee replacement surgery is the degenerative joint disease known as osteoarthritis. Typically osteoarthritis affects middle-aged and older adults, though knee trauma and other factors can result in early onset of the disease.

Due to expert training and advancements in medical technology, NYSMI most frequently performs total knee replacement surgery with minimally invasive surgical techniques. As a result, patients experience faster recovery time and less pain compared to traditional surgery. The procedure involves removing damaged parts of bone and cartilage and replacing components of the knee with prosthesis. The artificial knee consists of three components: the tibial component (replacing the top of the shin bone), the femoral component (replacing the portion of thighbone), and the patellar component (replacing the bottom surface of the kneecap that rubs against the femur).

Following total knee replacement surgery, the patient will be instructed by physical therapists about the exercises required to assist the healing process.

Partial Knee Replacement

For some patients dealing with the effects of a degenerative disease such as osteoarthritis, a partial need replacement may be an alternative to total knee replacement. In a partial knee replacement procedure, only the damaged part of the knee cartilage is replaced with a prosthesis.

Partial knee replacement surgery may be appropriate for patients with medial, lateral or patellofemoral knee osteoarthritis. In such cases, the area of disease may be localized to the one area of damaged cartilage. Partial knee replacement can be advantageous in that the surgery preserves healthy tissue and bone in the knee, therefore recovery is can be significantly faster.

Expert Treatments Include

Arthroscopic ACL and PCL reconstruction surgery
Arthroscopic meniscus repair using sutures
Evaluation and treatment of knee conditions including: tendonitis, bursitis, arthritis, meniscus tears, dislocations, instability and sprains
Evaluation and treatment of fractures of the femur, patella, tibia and fibula
Total joint replacement surgery of the knee

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Elbow

Elbow pain can be the result of a condition that has developed over time, such as osteoarthritis or be caused by traumatic injury, such as a fall. The onset of osteoarthritis, a condition involving the degeneration of joint cartilage, is prevalent in people with a history of elbow injuries.

Elbow pain in athletes is often caused by injury or overuse. Overuse of the elbow creates agitation of the joint, such as astendinitis (commonly referred to as tendonitis) − popularly known as tennis elbow or golfer’s elbow.

Tennis Elbow

One need not play tennis in order to develop tennis elbow. In fact, this condition is actually more typical among carpenters, plumbers and chefs – people who do repetitive high-impact tasks with their arms. When overworked or incorrectly worked, the tendons in the elbow become swollen or strained. This causes the tendon to rub against a bony bump on the inside of the elbow, which leads to elbow pain. Sufferers may find it difficult to grasp a cup, turn a doorknob or shake hands because the weakened elbow isn’t helping to support the forearm and hands.

Rest and over-the-counter pain relievers may provide temporary alleviation of the symptoms, but if when elbow strain persists, it may be best to have an orthopedic physician assess the pain and proved treatment options.

Ligament Construction of The Elbow

Baseball pitchers are among those athletes who most commonly suffer injuries to ligaments in the elbow as a result of stress occurring from repetitive motion and overuse. Collateral ligaments are the outer and inner ligaments that hold the elbow joint in place. The UCL is the ulnar collateral ligament that connects the inner side of the humerus bone to the inner side of the ulna bone. Because pitchers place extraordinary stress on the UCL, this is often where injury occurs.

Ulnar collateral ligament (UCL) reconstruction surgery is known to many as Tommy John surgery. Tommy John is a famous Major League Baseball pitcher who underwent a UCL procedure that used tendon from elsewhere in the body to successfully replace ulnar collateral ligament in the medial elbow. Following his famous surgery, Tommy John was able to continue his highly successful career as professional baseball pitcher.

The orthopedic surgeons at the New York Sports Medicine Institute are proficient at performing ligament construction of the elbow procedures for high performing athletes and weekend warriors alike.

Elbow Dislocation

Elbow dislocation refers to the condition of the joint surfaces becoming separated. Elbow dislocation can be a severe and painful injury to sustain, especially in the case of complete dislocation, where joint surfaces are completely separated. A partial dislocation, also referred to as a subluxation, is less severe. Elbow dislocation is frequently the result of trauma suffered to the elbow.

Elbow dislocation can also be described as simple or complex. Simple dislocation applies to cases without substantial bone injury, whereas complex dislocation consists of substantial injuries to bone and ligament. Depending on the severity of elbow dislocations, treatment can range from various non-surgical to surgical procedures.

Elbow instability from dislocation is a common injury that creates looseness in the elbow joint. Elbow instability caused by dislocation will often result in loose elbow that is prone to pop or catch, and to slip out of place. Chronic elbow instability is a condition that requires medical treatment for optimal healing.

Elbow Fractures

Elbow fractures are frequently the result of trauma to the region, whether the by direct contact or indirect force, such as landing awkwardly on an outstretched hand or arm. Olecranon fractures are common of injuries to the elbow caused by trauma. The olecranon is the pointy tip of the bent elbow – the lower part of the ulna bone. A direct blow to the olecranon can result in a painful elbow fracture.

In the case of an olecranon fracture where none of the bone fragments are “out of place,” the injury may be successfully treated non-surgically, by immobilizing the elbow and allowing the body to heal itself. In the case of an elbow fracture that is “displaced,” surgery is often required.

Other Elbow Conditions

Use, age and genetics can contribute to a number of medical disorders that affect the joint and surrounding bones. Bursitis, tendonitis or arthritis in the elbow – all conditions that one may initially be dismissed as simply a sports injury or “overdoing it” – can be treated and healed. Young athletes in high-impact activities like gymnastics and baseball (pitching) are prone to osteochondritis dissecans, which is a loss of blood supply to the cartilage of the elbow joint.

Repetitive motion and other stresses to the elbow can result in the formation of loose fragment of cartilage or bone referred to as loose bodies. Loose bodies in the elbow are relatively common for weightlifting athletes and those who perform occupations that include heavy manual labor. Loose bodies in the elbow may create pain and discomfort. In cases where the discomfort is significant, arthroscopic surgery is an option to remove loose bodies in the elbow.

Osteoarthritis of the elbow is a condition in which the joint cartilage is compromised, usually as related to age-related degeneration or the result of an elbow injury, such as a fracture. Osteoarthritis of the elbow can be diagnosed with X-rays. There are a number of non-surgical treatments for osteoarthritis of the elbow, including injections of corticosteroid or hyaluronic acid. Arthroscopic surgical solutions may also be warranted in certain cases.

About The Funny Bone

The ulnar nerve, which informs the brain of feelings tied to the fourth and fifth fingers, runs down the inside of the elbow. The ulnar nerve is behind the “funny bone” that tingles and stings when one hits the elbow the wrong way – but since the ulnar isn’t a bone at all, it will not fracture.

Severe elbow pain is most often treated with arthroscopic surgery, a minimally invasive procedure that cleans the elbow of loose cartilage, releases scar tissue, and contributes to the healing of rheumatoid arthritis.

Our orthopedic surgeons are specializes in modern upper extremity procedures, including orthopedic surgery to alleviate pain while fostering a long-term recovery for the affected joint.

Patients suffering from acute or chronic elbow pain should consult with a physician to evaluate the source of elbow pain. We provide onsite X-rays when required for proper diagnosis and onsite physical therapy to help patients heal from elbow pain and restore range of motion.

Common Elbow Treatments

Most common course of action for elbow pain or injury includes:

Evaluation and treatment of elbow conditions, such as : tennis elbow, bursitis, tendonitis, arthritis and stiff elbow
Arthroscopic surgery
PRP platelet-rich plasma (PRP) injections
Elbow arthroscopy and other minimally invasive approaches

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Hips

Just like other joints, like the knee or the elbow, the hip can suffer injury from trauma, overuse, lack of conditioning or a simple mishap. Hip pain is your first sign that something has gone wrong, but the source of that pain can vary.

The hip contains the body’s largest ball-and-socket joint, which means that this joint can bear an extraordinary amount of weight and pressure. When you move, a cushion of cartilage keeps the joint moving freely.

Hip Fractures and Tears

In athletes, hip pain can occur following some kind of hard contact. A common injury among football players, for instance, is called a hip pointer – a blow to the pelvis that causes hip pain. When a hip pointer occurs, the bone just under the waistline can be bruised. In more severe cases, a fracture may occur.

Long-distance runners, basketball players and ballet dancers – all of whom jump on hard surfaces – may suffer stress fractures of the hip. Women, who typically lose more bone mass to osteoporosis, are more prone to hip fractures than men. And for women age 65 and up, a hip fracture is a highly serious matter. According to a 2011 study by the Archives of Internal Medicine, women above age 65 who fracture a hip have double the mortality rate within a year’s time as women without hip fractures.

The labrum, a ring of soft tissue around the rim of the hip joint, is responsible for keeping the femur (thighbone) in place. When overstressed, the labrum can become injured. The resulting labral tear is characterized by a “catching” sensation along with some pain. Hockey players, golfers and soccer players – athletes participating in activities that involve fast pivoting around the hip – can be prone to labral tears.

Hip Conditions

The bones, tendons and cartilage of the hip can all be subject to such medical conditions as tendonitis, bursitis and arthritis. These conditions can lead to a breakdown of cartilage and an inflammation of the joint, causing hip pain and reduced range of motion. Age, physical conditioning, genetics and diet can all contribute to conditions that cause inflammation.

Hip Fractures and Tears

Hip Impingement (FAI)

When the hip’s ball-and-socket joint experience abnormal contact and damaging friction, this is a result of the condition known as hip impingement or femoroacetabular impingement (FAI). Often times the condition exists without being noticed, until discomfort persists in advanced stages. Athletes will often agitate the condition sooner than non-athletes due to enhanced joint movement within the context of sports.

There are different types of hip impingement – cam impingement is that caused by deformity of the ball at the top of the femur (the thigh bone) and pincer impingement is the condition associated with a deformity of the socket. Combined impingement indicates that cam and pincer impingement are both present. Hip impingement should be medically addressed since the results of wearing can lead to the onset of osteoarthritis.

Depending on the severity of hip impingement and other factors, non-surgical treatment options may include a modification of activities, physical therapy and anti-inflammatory medication. If surgery is required, minimally invasive arthroscopic hip surgery would most likely be the procedure of choice.

Snapping Hip

Snapping Hip is a condition that presents itself in a snapping sensation, sometimes accompanied by a popping sound, in the hip during various movements, such as walking, running, moving the leg in a swinging motion or even getting up from a chair. The sensation can range from a mild annoyance to a physical hindrance that affects athletic performance. The snapping may occur in a variety of areas where muscles and tendons move over bones within the hip.

The outside portion of the hip is the most common area of snapping hip. It is where the iliotibial band passes over the protruding part of the femur known as the greater trochanter. Excessive snapping hip can be especially problematic, as it can lead to hip bursitis – the thickening and inflammation of the bursa sac. Other areas of the hip that may lead to snapping hip syndrome include the front of the hip and the back of the hip. Additionally, damaged cartilage within the socket of the hip can become loose and cause the join to catch, thereby creating a snapping hip that can become painful and debilitating.

Physical therapy is a common non-surgical treatment for snapping hip. In more severe cases that require surgery, minimally invasive arthroscopic hip surgery is often a viable solution. Treatment of snapping hip is entirely dependent on the particular circumstances of the individual case diagnosed.

Arthritis of the Hip

Arthritis of the hip is a condition that involves a loss of cartilage between the head of the femur (thighbone) and the socket area of the pelvis where the femur fits into the joint (the acetabulum). The absence of cartilage, which is sometimes the result of age-related wear and tear, causes the bones to rub against one another, leading to inflammation (swelling) in the area. The inflammation can become painful and affect range of motion within the joint.

X-rays are often used to diagnose hip arthritis, as the loss of cartilage can be seen within the space between bones. Treatment for arthritis of the hip is dependent on a number of factors, including severity of the condition and age of the patient. Treatment options include changing activities to reduce stress, using a cane to shift weight away from the affected joint, pain relief and/or anti-inflammatory medication, prescribed exercises, weight loss and hip replacement surgery.

Hip Replacement

Hip replacement surgery has become a popular and highly successful option for the millions of Americans suffering from arthritis, including age-related osteoarthritis − the condition of cartilage worn away that results in bones rubbing against one another. Another degenerative hip disease that may require hip replacement is avascular necrosis of the hip, a condition where a loss of blood supply to the head of the femur (thighbone) causes death of the bone tissue. Hip fractures and other hip conditions, including some that appear in childhood, can lead to the need for hip replacement surgery.

Fortunately for patients, hip replacement surgery is often performed with minimally invasive surgery. The procedure involves two small incisions that allow the orthopedic surgeons to access the socket and femur without the need to cut tendon and with minimal impact to soft tissue in the region. The ball and socket – the rounded head of the femur and receptacle area of the pelvis – are replaced with prosthetic devices. The minimally invasive procedure provides patients with significantly shorter time spent in hospital care and faster rehabilitation.

There are cases that due to their complexity of nature require traditional surgery for hip replacement. However, while traditional surgery requires longer hospital care and recuperation, like minimally invasive hip replacement surgery, outcomes are typically highly successful − enabling patients to move more freely without the pain experienced in the hip prior to hip replacement surgery.

Hip Injury Treatment

For patients of all ages and conditions, hip pain can spell the difference between normal activity and a less active lifestyle. Our board certified orthopedic surgeons have successfully treated hundreds of patients with hip injuries. The physicians at the New York Sports Medicine Institute work with patients to explore options that include physical therapy and minimally invasive procedures, such as arthroscopic surgery, to address hip injuries. Regardless of the treatment required, our patient-focused practice will determine a treatment program designed to mitigate the effects of hip pain and strengthen the joint to protect it from future damage.

Common hip injury treatment includes:

Evaluation and treatment of hip conditions, including tendonitis, bursitis, arthritis, labral tears and sprains
Evaluation and treatment of hip fractures
Total joint replacement surgery of the hip

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Foot & Ankle

With so many bones, ligaments, tendons and muscles in the foot and ankle region of the body, it should come as no surprise that there are many variations of injuries and painful conditions that can occur. Sports injuries of the foot and ankle are typically the result of trauma suffered during training regimen or in the act of competition.

Other common medical conditions affecting the foot and ankle include those associated with disease (such as arthritis), stress or overuse injuries, and deformities (such as hammer toes or bunions). Foot and ankle pain is often the result of sprains, strains, fractures and conditions.

Foot and Ankle Sprains

Sprains, which represent the stretching, tearing or rupturing of the ligaments that hold the ankle bones together, are one of the most common injuries. Active people are more highly susceptible to sprains. Running, pivoting, kicking, jumping − virtually any sport, from basketball to golf or tennis, can cause you to land in such a way as to cause a sprain within the foot or ankle. Everyday mishaps, like twisting an ankle or landing awkwardly off a curb or step, can also result in a sprain.

Foot and Ankle Strains

Strains, as opposed to sprains, represent damage to muscles and tendons, not ligaments. Foot and ankle strains are common among people who overdo their activity, fail to warm up properly, pull or stretch the foot, wear poorly fitting shoes, or consistently run on hard or uneven surfaces.

Fractures of the Foot and Ankle

Fractures of the ankle bone (the talus) can occur on either side of the ankle, or as a chip off the front part of the heel bone (the calcaneus). The symptoms of fractures are similar to those of sprains: foot and ankle pain, bruising, swelling or inability to bear weight. A fracture may also feel tender to the touch, and give the foot or ankle a deformed appearance.

Foot and Ankle Conditions

Painful medical conditions like arthritis and tendonitis can be triggered by past injuries to the foot or ankle. Arthritis in particular can form after a break or fracture of the joint, while tendonitis can arise from the constant strain on tendons associated with an over-pronated running style (landing on the outer rim of the foot). Some common foot and ankle conditions treated at the New York Sports Medicine Institute include: Achilles tendonitis, arthritis of the foot and ankle, ankle instability, peroneal tendonitis, bunions, corns and calluses, flat foot, hammer toe, Lisfranc injury, Morton’s neuroma and plantar Fasciitis,

Treating Foot and Ankle pain

Simple sprains and strains of the soft tissue can often be treated at home with RICE (rest, ice, compression, elevation). However, more serious or widespread problems require a physician’s examination. A bone chip or fracture, for example, can leave fragments in the joint that further compromise the ankle’s weight-bearing ability or the foot’s range of motion.

Arthroscopic procedures are frequently the most effective way to diagnose and treat pain and the “buckling” or “locking” sensation of a foot or ankle condition. This minimally invasive treatment employs video cameras to survey the inside of the injury, where the surgeon may then use delicate instruments to remove or repair chips, fractures or tears.

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Hand & Wrist

Some people may experience hand pain or wrist pain and draw an instant conclusion: carpal tunnel syndrome. Understandably so, as carpal tunnel syndrome has received so much attention in recent years and has indeed become a bit more popular due to increased computer use and other similar repetitive use tasks.

However, carpal tunnel syndrome is just one cause of hand or wrist pain. Depending on everything from genetics to sports activities and occupational tasks, a great many people find themselves susceptible to any number of the following common disorders affecting the hand or wrist:

Wrist Fractures

The bones of wrist consist of eight small bones located at the base of the hand (carpal bones) where they join the two large bones in the arm − the radius and the ulna. When a break is sustained in the area of the wrist, this is referred to as a wrist fracture. Wrist fractures are most frequently caused by falling on an outstretched arm, but a wrist fracture can also be the result of direct trauma to the wrist, such as being hit by a baseball or a collision with a football helmet. Individuals suffering from osteoporosis, a condition where bones become thinner and more fragile, wrist fractures can occur from an even lesser degree of force applied to the area.

The most common wrist fracture is called a distal radius fracture. The radius is the arm bone that connects to the wrist near the thumb side of the hand, and the end of the radius that meets at the wrist is called the distal end, thus a fracture to this are of the bone is known as a distal radius fracture. A wrist fracture involving the other large bone in the arm is called a distal ulna fracture.

X-rays are typically required to properly diagnose wrist fractures. Treatment of wrist fractures may include use of a cast or splint to stabilize the area, allowing for the fracture to heal on its own. When necessary, minimally invasive use of an arthroscope is employed to diagnose complex wrist fractures. Arthroscopic wrist surgery may be warranted for fractures that result in small fragments of bone requiring removal; or fractured bones in need of alignment and stabilization to enable proper healing.

Tendonitis of the Wrist

Tendonitis of the wrist occurs when a series of small tears to the tendons result in inflammation. Individuals coping with tendonitis of the wrist may feel soreness or swelling in the wrist and find it more challenging to move fingers or grasp objects. Tendonitis of the wrist may also trigger pain in the fingers, but it’s a “referred” pain from the wrist. A popping “trigger finger” is evidence of a tendon problem.

Ganglion Cysts

Ganglion cysts are benign (non-cancerous) lumps that develop along the tendons or joints of the wrist or hand. This condition is more common among young women than other demographic groups; the cyst is well known in particular to female gymnasts, who apply hard stress to their wrists. With their soft, lumpy feel and the possibility of soreness or numbness when the cyst presses on a nerve, this can be a bothersome condition. In many cases, a healthy immune system will eventually take care of the cyst, but a particularly painful occurrence may require examination and treatment by an orthopedic physician.

Arthritis

Arthritis attacks the cartilage in joints, and the wrist can be a prime target, particularly if there is a history of fracture or other a bone there in the past. Hand and wrist pain is the key symptom, which can become more acute when the weather changes from sunny to rainy. An arthritic wrist can make a “cracking” noise as the cartilage deteriorates.

Carpal Tunnel Syndrome

Carpal tunnel syndrome has received much attention, yet it occurs less frequently than arthritis, tendonitis and conditions that cause hand pain or wrist pain. Carpel tunnel syndrome is an injury to the median nerve, which runs from the forearm to the palm of the hand. The carpal tunnel itself is a tight space that sits between the wrist bone and a band of fibrous tissue that normally supports the wrist joint. When pressure is put on the tissue, the resulting tingling, numbness and radiating hand and wrist pain can range from inconvenient, to incapacitating.

Finger Fractures

There are fourteen bones in the hand that make up the fingers called phalanges. There are three phalanges in each finger except for the thumb, which contains two. In the case of athletic injuries, finger fractures may be the result of trauma sustained by being “jammed” by a ball or landing awkwardly from a fall. Non-athletic finger fractures can result from fingers caught in a door or other such accidents.

X-rays may be necessary to diagnose finger fractures. Treatment is most often non-surgical, though severe cases may require surgery to implement screws, pins or wire to hold fractured bones together for optimal healing to occur.

Treatment for Wrist and Hand Injuries

Unlike injuries to the lower extremities, where an individual can still function more or less normally while staying off their feet, a condition of the hand or wrist can compromise every aspect of your daily life. Tasks such as driving a car or tying one’s shoes can become challenging or even “off-limits.”

Getting fast, effective relief from pain begins with a complete evaluation, followed by a course of treatment that may include minimally invasive arthroscopic surgery. During arthroscopic surgery, the orthopedic surgeon creates small incisions in the wrist or hand, inserts a miniature camera, called an arthroscope, to get a close look at the source of the problem. With the interior of the wrist or hand displayed on a monitor, the surgeon uses tiny instruments mounted on the arthroscope to remove or repair tissues, fractures and other disorders.

Most Common Orthopedic Treatment

Arthroscopic surgery
Evaluation and treatment of hand and wrist conditions, including: tendonitis, ganglion cyst, sprain, carpal tunnel syndrome, arthritis, tendon injuries and nerve injuries

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Radiology Services

At the New York Sports Medicine Institute, onsite digital X-ray and high-field extremity MRI technology (elbow, wrist, hand, knee, ankle and feet) provides convenience to patients and assists our medical staff in efficiently diagnosing musculoskeletal conditions. In addition to diagnostics, digital X-rays and extremity MRI are also periodically used by orthopedic surgeons to help evaluate the progress of treatment.

As with other medical personnel on staff at our orthopedic practice, the X-ray and MRI technicians are expertly trained to assist patients and physicians alike. The X-ray and MRI technicians have many years of experience − producing optimal images for reviewing the area of the body being evaluated. X-rays used for diagnostic imaging are produced using low-level radiation at a targeted spot. The process is painless, yet significantly beneficial for proper analysis and treatment.

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Injections

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Conditions & Treatment

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