Author: Nevada Orthopedic

Signs You May Be Suffering From Frozen Shoulder

The term frozen shoulder sounds quite serious, and in fact, this painful condition severely limits your range of motion. Also known as adhesive capsulitis, it can affect movements you take for granted like reaching upward or behind your back. These are signs you may be suffering from frozen shoulder.
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Do Rotator Cuff Tears Heal Themselves?

The rotator cuff in our shoulder is a part of our body we rarely think about. That is, until it begins to hurt. It is the group of tendons and muscles that surround our ball and socket shoulder joint. As we get older or have an injury, we can develop a tear or multiple tears in our rotator cuff, but do we always need surgery, or do rotator cuff tears heal themselves?

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Coronavirus Update

Please note that our clinic is now open to ALL patients, and elective surgeries have resumed. Nothing is more important to us than your health and safety. No patients with Coronavirus are being treated at Nevada Orthopedic.

To ensure maximum safety, we are preventing the spread of COVID-19 in any of our patient areas by:

  • Extensively cleaning exam rooms between patients.
  • Frequently disinfecting welcome areas.
  • Continuing to require staff, patients, and visitors to wear masks.
  • Enforcing social distancing.
  • Restricting the number of patients waiting in our lobby area and we have expanded our Northwest waiting room by using our outdoor space with a portable tent and swamp cooler.
  • Screening both patients and staff as needed.

As of this posting, no visitors are allowed. However, should you need an exception in the situation of a pediatric, elderly, or emergency surgery patient, we will allow ONE visitor. Please contact us for additional questions.

New Extended Hours for Our Fast-Track Clinic

Nevada Orthopedic & Spine Center’s Fast-Track Clinic is now open on Saturdays!

Nevada Orthopedic & Spine Center’s Fast-Track Clinic’s same-day visits are now available for extended hours. The clinic is open Monday thru Saturday from 10:00 AM – 7:00 PM.

View office details on the Fast-Track Clinic’s page here.

The clinic offers:

  • Call-Ahead or Walk-In Appointments
  • Short Wait Times
  • Most Insurances Accepted
  • Major Credit Cards Accepted
  • Care Credit

Parking and entrance are located on the West Side of the Parkway Medical Building.

Download the flyer for this announcement by clicking here.

Enchondroma

Dr Ronald Hillcock MD
Orthopedic Surgon
Adult Reconstruction and Orthopedic Oncology


Enchondroma (en-kon-DRO-ma) is a type of benign (noncancerous) tumor that begins in the cartilage found inside the bones. Enchondromas rarely cause pain or other symptoms, so most remain undiagnosed until x-rays are taken for an unrelated injury or condition.

In the majority of cases, enchondromas do not require treatment. In rare cases, however, multiple tumors may weaken the bone, causing it to fracture. When this occurs, surgery may be needed to remove the tumor and prevent additional fractures.

Description

Enchondromas can occur in anyone but are most common in patients between 10 and 20 years old. They are most often found in the small bones of the hand. In fact, enchondroma is the most common tumor in the hand. Enchondromas can also develop in the body’s long bones, such as the femur (thighbone), tibia (shinbone), and humerus (upper arm bone).

Enchondromas are most often solitary tumors. In rare cases, however, multiple tumors can appear as part of a condition such as Ollier’s disease or Maffucci’s syndrome.

Single enchondromas rarely become cancerous, though the chances are a little higher in patients with Ollier’s disease and Maffucci’s syndrome. When enchondromas do become cancerous, they usually become a type of malignant cartilage tumor called a chondrosarcoma.

Distinguishing between a noncancerous enchondroma and the very low-grade form of a cancerous tumor can be difficult, even for orthopedic tumor surgeons.

Cause

The exact cause of enchondromas is unknown. Some research indicates that they may result when cells turn into cartilage instead of bone.

It is not believed that the tumors are caused by radiation or chemical exposure or by any specific activity.

Symptoms

In most cases, enchondromas are not painful and do not cause any symptoms. However, if the tumors appear in the hands or feet, or if there are multiple lesions, the bone can weaken and become deformed. This can lead to pathologic bone fractures and enlargement of the affected fingers.

In patients with Ollier’s disease and Maffucci’s syndrome, bone deformities can be quite severe. If pain from other sources has been excluded, your doctor will carefully study the tumor to determine whether it could actually be a low-grade chondrosarcoma. Pain at night or at rest is more likely to indicate a malignant tumor. However, because pain is a common symptom of many conditions and injuries, your doctor will conduct a thorough evaluation.

Doctor Examination

Because they do not often cause symptoms, most enchondromas are found when routine x-rays are taken for another reason such as an injury or arthritis. When this occurs, your doctor will conduct an examination and order a number of tests to confirm that your tumor is actually an enchondroma—and not a more aggressive or cancerous tumor.

Physical Examination

During the exam, your doctor will take a complete medical history and ask about your symptoms. He or she will ask if your tumor is painful and when the pain occurs. There is greater concern if the pain occurs when you are at rest or at night and does not go away. Pain caused by activity is less worrisome.

In some cases, your doctor may give you an injection into the joint near the tumor. If the injection relieves your pain, it indicates that the enchondroma is not the cause.

Tests

X-rays. X-rays provide images of dense structures such as bone. On x-rays, enchondromas appear as small (less than 5 cm), lobe-shaped, darkened tumors in the middle of the bone. They usually contain white spots or calcification within. The white areas of the tumor show a pattern of rings and arcs that indicates the tumor contains cartilage.

x-ray of bone density

Other imaging studies. Your doctor may order a computerized tomography (CT) or magnetic resonance imaging (MRI) scan to help further evaluate your tumor. These scans give a more complete picture of the bone around the tumor. If the tumor has turned into a malignancy, the scans may show bone erosion, bone inflammation, or a mass growing outside the bone.

mri scan

In some cases, your doctor may order a bone scan. During this test, a very small amount of radioactive dye is injected into the body intravenously. Both benign and malignant tumors can cause an increased uptake of the radioactive material in the bone due to bone activity. Enchondromas are typically active on bone scans.

radioactive dye on thigh bone

Bone scan shows an uptake of radioactive dye near the end of the thigh bone.

Biopsy. A biopsy may be necessary to confirm the diagnosis of enchondroma. In a biopsy, a tissue sample of the tumor is taken and examined under a microscope.

A biopsy can be performed under local anesthesia with a needle or as a small open operation.

Grading. The grade, or aggressiveness, of the tumor is determined by imaging studies and how the tumor looks under a microscope.

Under the microscope, enchondromas have islands of cartilage that are easy to tell apart from the normal bone that surrounds them. Usually, cartilage is not found in the center of bones. Enchondromas in the hand and foot or in patients with Ollier’s disease or Maffucci’s syndrome may contain more odd-looking cartilage. It may be difficult to distinguish these tumors from low-grade chondrosarcomas.

Low-grade chondrosarcomas look more cellular than enchondromas under a microscope and there is less normal bone in the tumor. Because low-grade chondrosarcomas and enchondromas look similar, experienced surgeons, radiologists, and pathologists will work together to get the best interpretation of the tumor.

Characteristics of a more aggressive tumor or a malignant chondrosarcoma include:

  • Thickening of the bone’s outer cortex
  • Reactive bone growth on the outer surface of the bone
  • Destruction of the bone by the tumor
  • Soft-tissue mass
  • Large amounts of bone erosion
  • Bone erosion that is growing
  • Erosion surrounded by reactive bone

Treatment

Nonsurgical Treatment

If your tumor does not cause symptoms, your doctor may recommend observation and monitoring to see if it grows. During this time, you may need periodic x-rays or other tests. Most doctors think that tumors without symptoms do not need to be removed.

Surgical Treatment

Curettage

Curettage is the surgical procedure most commonly used to treat enchondromas. In curettage, the tumor is scraped out of the bone. Once enchondromas are removed, most will not return. If a tumor has caused your bone to fracture, your doctor will usually allow the fracture to heal before treating the tumor. The tumor will then be curetted out to prevent another fracture.

Bone Graft

After curettage, your doctor may fill the cavity with a bone graft to stabilize the bone. A bone graft is bone taken from a donor (allograft) or from another bone in your body (autograft). In some cases, another substance may be used to fill the cavity.

Some tumors may look like simple enchondromas on x-ray—but are painful. Treatment of these lesions can be controversial. Some doctors recommend surgical curettage. Others think that the tumors are not likely to be the cause of the pain in the area—so they recommend monitoring with regular x-rays.

Unfortunately, biopsies are not often helpful in these cases. Even for specialized bone pathologists, it can be difficult to differentiate between a benign enchondroma and a low-grade chondrosarcoma. In this setting, needle biopsies are not recommended.

More aggressive tumors with bone destruction or with a mass growing outside the bone are usually chondrosarcomas. These malignant tumors need to be removed in their entirety. The specific procedure used depends upon the grade of the tumor.

If you have concerns about a bone lesion please make an appointment in my clinic and I would be happy to provide an evaluation.


If you have concerns about a bone lesion please make an appointment in my clinic and I would be happy to provide an evaluation.

5 Common Shoulder Injuries From Weight Lifting

There are those who lift weights as part of their exercise routine, and then there are the serious weight lifters. The second group are certainly more rigorous and set goals well beyond their own body weight. Whichever group you fit in to, take some care and pay close attention to 5 common shoulder injuries from weight lifting.

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Chondromalacia patella

Chondromalacia patella (or patellae), also referred to as “runner’s knee” is a condition in which the cartilage cushioning the area under the patella (kneecap) begins to deteriorate and wear out. Due to this, the kneecap may start to rub against the femur (thigh bone) and cause discomfort or pain. This condition is often common among young athletes or sports people do to increased activity and action involving the knees. The condition can also occur in adults who are suffering from arthritis.

Chondromalacia patella can often occur due to misalignment of the knee or as a result of overuse, which can be seen it treated by a few days of rest. In the case of improper knee alignment, resting will not be enough and physiotherapy or surgery may be necessary to correct it.

Causes

Chondromalacia patella is most common in teenagers and young adult, usually affecting women more than it does men. It is
not fully known the reason why it occurs, but studies have indicated that when the patella (kneecap) rubs against the
femur (thigh bone) this can damage the cartilage underneath the patella, which is necessary for cushioning and reducing friction between the bones and joint. The main causes for this condition are usually:

Alignment problems with the knee or foot.

  • Overuse of the knee
  • Wear and tear as part of the aging process
  • Arthritis of the knee
  • Hypermobile joints
  • Imbalance of thigh muscles surrounding the knee

There are also certain risk factors, which increase the likelihood of having “runner’s knee” (chondromalacia patella), these include:

  • Age – growth spurts can often lead to imbalances between the bones and
    muscles
  • Flat feet – those with flat feet are more likely to have more pressure placed
    on the knee
  • Prior injury – previous injury to the knee region may increase the risk of
    runner’s knee
  • Gender – women are said to be more likely to develop this condition as
    they generally have less muscle mass than their male counterpart causing
    more lateral pressure on the patella.
  • High movement – participating in sports that require a high level of
    movement can increase the wear on the knees and joints increasing the
    risk of injury.

Symptoms

Individuals suffering from chondromalacia patella will often record similar symptoms to other conditions in the knee. The common symptoms being:

  • Pain and swelling around the kneecap
  • Clicking or grinding noise when bending or straightening the knee
  • Discomfort when walking up or down stairs
  • Discomfort when in a seated position for a long duration (it can be
    sometimes referred to as ‘theatre knee’ or ‘movie-goers knee’)

Diagnosis

A provisional diagnosis of chondromalacia patella is usually made after an examination by a doctor or qualified physiotherapist. It is usually an active diagnosis as it requires further follow ups, due to lack of access to the cartilage. If the initial signs show no proof of damage to the cartilage then the doctor is likely to view the injury as patellofemoral pain syndrome rather than runner’s knees.

Based on the results of the tests there are provided, different levels and of severity that can be experienced.

  • Grade 1 – softening of the cartilage around the knee
  • Grade 2 – softened cartilage alongside erosion of the tissue and an uneven surface
  • Grade 3 – increased deterioration with thinning of the cartilage
  • Grade 4 – bone exposure and significant deterioration of the cartilage tissue. In this event the bones are likely to be rubbing against each other and surgery may be required

If a diagnosis cannot be gathered from the initial physical examination by the doctor or it is unclear, then further tests may be carried out in certain situations. Tests that may be carried out include:

  • X-ray – this alongside standard blood tests can help in ruling out any
    underlying issues such as inflammation or arthritis
  • Arthroscopy – this is usually carried out to provide a direct look into the actual state of the cartilage. In this procedure, a small flexible camera is inserted into a keyhole through the knee
  • MRI scan – this provides a more detailed view of the knee and surrounding joints, it is usually the most flexible method of confirming chondromalacia patella.

Treatment

The initial mode of treatment for injuries such as chondromalacia patella after diagnosis is the application of the R.I.C.E principle (Rest, Ice, Compress, and Elevate). Although applying this in itself will not cure chondromalacia patella, it will help in reducing the discomfort, swelling or pain associated with the injury. It is essential to understand and correct the initial cause(s) of the injury and the treatment program that is recommended may be a mixture or one of the following:

  • Painkillers and anti-inflammatory medication – apart from the application of the RICE principle, the health professional may also recommend the use of NSAIDs and other anti-inflammatory medication which can aid in reducing the pain also.
  • Physiotherapy – exercises and a range of movement to strengthen the surrounding muscles and joints can help in the rehabilitation of the knee. Improving the lateral quadriceps structure leading to the knee can help in reducing pressure on the knee and cartilage and prevent further injury to the knee.
  • Patella taping – this treatment form can help to lessen the pain by preventing the rubbing together of the kneecap and the sore spot which causes the pain. The adhesive tapes are placed along either side of the affected knee, helping to guide and correct the movement of the patella. There are two main forms of patella taping techniques including the controlling technique for new injuries and the correct tracking technique for those looking to get back into sports activities. Knee supports specially designed for the patella can also help in relieving pain and pressure.
  • Surgery – this is usually not common for this kind of injury and only occurs when other treatment methods or rehabilitation have proved to be unsuccessful. The surgical procedure is usually simple and involves the use of an arthroscopy or keyhole surgery, whereby the damaged or deteriorated cartilage is either removed or shaved.

Prevention

To avoid a repeat of chondromalacia patella or to prevent it from occurring in the first instance, the following steps can be followed to prevent the likelihood:

  • Wearing the correct footwear can help to improve the arch of the feet, which is particularly useful for those with flat feet. As the pressure on the kneecap is reduced, it may help with the proper alignment of the kneecap.
  • Use of knee pads and patella supports, especially during repeated use can help reduce the likelihood of injury.
  • Performing regular strengthening exercises can help with muscle balance, especially for the hamstrings, quadriceps, adductors, and abductors.
  • Lowering body weight can reduce overall stress and pressure on the knees lowering the risk of chondromalacia patella. Reducing overall calorie intake and eating a balanced diet alongside regular exercising can help in keeping the knees and joints healthy in the long run.

If you are experiencing knee pain, chondromalacia may be the cause. Please make an appointment to be seen in my clinic and we can explore the issues and design a treatment plan for your unique needs.

Ronald Hillock MD
Fellow American Academy of Orthopedic Surgeons
Diplomat American Board of Orthopedic Surgery
Adult Reconstruction and Orthopedic Oncology

 

When to See a Specialist for Your Child’s Knee Pain

With the warm weather on its way, parents are likely to be faced with kids complaining of knee pain. They fall, overdo it playing sports, combined with bending, climbing and stretching the wrong way. Sometimes they may complain about it, and then never mention it again. But other times the pain becomes severe and doesn’t go away. It is important to know when to see a specialist for your child’s knee pain.

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