Author: Nevada Orthopedic

9 Possible Causes of Hand Pain That Won’t Go Away

Most days your hand and wrist hurt, and you have no idea why. Maybe you’ve gotten used to having the discomfort, and you keep popping anti-inflammatory meds. Since discovering the reason for the pain might reduce or eliminate it, here are 9 possible causes for that recurring pain!

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Signs That It Is Time For A Knee Replacement

If you hear that click and pop from your knee when you get up from a chair, it could be one of the signs that it is time for a knee replacement. If your activities are limited and the pain keeps you from enjoying life, it could be time to speak to Nevada Orthopedic & Spine Center about knee replacement surgery.

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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.

Common Spinal Issues From Sitting All Day At A Desk

Many of us have worked at a computer in an office for many years, and at the moment we may be working from home. Regardless of where you are working, there is no question sitting at a desk all day takes its toll on the spine. Learn how you can overcome the common spinal issues from sitting all day at a desk.

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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

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, call (702) 258-3773 to schedule an appointment at Nevada Orthopedic & Spine Center and we would be happy to provide an evaluation.

Dr Ronald Hillcock MD
Orthopedic Surgon
Adult Reconstruction and Orthopedic Oncology

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