The pelvis is the sturdy ring structure located at the lower end of the trunk. The pelvic bones include the large triangular bone at the base of the spine (sacrum), the tailbone (coccyx), and the hip bones. The hip bones meet to form the hollow cup that serves as the socket for the hip joint, this is called the acetabulum.

Fractures of the pelvis and acetabulum are not very common. They generally occur as a result of a traumatic event such as a car collision or fall from a significant height. Because major nerves, blood vessels, and several organs pass through the pelvis, pelvic fractures may require urgent treatment. The care of patients with these injuries require a multidisciplinary approach. Doctors must address airway, breathing, and circulatory problems before addressing the fracture.

Symptoms

A fractured pelvis or acetabulum causes pain and an inability to bear weight. Sometimes there is also bruising, lacerations, hematomas, or swelling in the hip area.

Diagnosis and treatment

Your orthopedic surgeon will examine your pelvis, hips, and legs. He or she will test for stability by applying gentle compression. X-rays will be taken to determine how displaced the bones are.  A CT scan is also used to provide a more detailed image, it helps assess for asymmetry and rotation.

If the fracture is stable and the bones are not displaced, your doctor may recommend nonsurgical treatment. In order for displacement to occur, the pelvic ring has to be injured in at least two places. Crutches or a walker can be used to avoid bearing weight. Medication may be prescribed to relieve pain and avoid blood clots.

For unstable fractures, there are multiple fracture types and your surgeon will determine the best course of treatment. Your doctor may use external fixation to stabilize the pelvic region. This involves metal screws and pins being inserted into the bones and attached to a carbon fiber bar outside of the body to hold the bones in proper position until they heal. Internal fixation is a surgery where the displaced bone fragments are repositioned into their normal alignment. They are held together with screws or metal plates inside the body.

After hip surgery, your orthopedic surgeon will recommend you use crutches or a walker for a period of time to avoid bearing weight. Physical therapy is usually prescribed to regain flexibility, strength, and range of motion. Stable pelvic fractures tend to heal well. Unstable fractures may require multiple surgeries and may include other complications from additional injuries.

A fracture of the hip is a serious injury that refers to a break of the upper part of the femur, but it can also refer to a break of the pelvis.

Causes and risk factors

• The elderly are susceptible to fractures due to osteoporosis
• Forceful fall, collision, or blow
• Severe trauma

Treatment

Fractured hips are almost always treated with hip surgery. Surgical options may include metal pins, screws, plates, and rods, followed with splinting and physical rehabilitation.

Osteoarthritis is a gradual breakdown of cartilage in the joints. It is common in the hip because it bears the weight of the body. Resulting from wear and overuse, osteoarthritis of the hip can severely impact a person’s lifestyle. Symptoms include hip pain, tenderness, a grating sensation while walking, stiffness, and decreased range of motion.

Causes and risk factors

• Aging
• Wear and tear
• Traumatic injury
• Genetic predisposition
• Obesity

Treatment

Without treatment, osteoarthritis usually worsens. Most treatments focus on relieving symptoms, including rest, non-steroidal anti-inflammatory drugs (NSAID’s), physical therapy, and lifestyle changes. If the hip continues to deteriorate, total hip replacement surgery may be needed.

As people are living longer with active lifestyles, hip pain is becoming more common. One of the leading causes of hip pain is a tear of the labrum in the hip. The labrum lines the hip socket and provides a smooth surface for the head of the femur to glide within the socket. Labral tears can cause a locking or catching sensation in the joint during certain movements. They can cause hip pain and interfere with the joint’s normal range of motion. This condition is more common in athletes, especially those with repetitive hip rotation, such as hockey, soccer, football, and golf.

Causes and risk factors

• Physical activity, especially repetitive motions
• Sports injury
• Sudden twisting motion
• Trauma or diseases that injure the bone or cartilage of the hip joint

Symptoms

The symptoms of a labral tear vary, but the pain is most commonly felt deep in the groin. Many hip labral tears cause no signs or symptoms. Occasionally, however, you may experience one or more of the following:

• A locking, clicking, or catching sensation in your hip joint
• Pain in your hip or groin
• Stiffness or limited range of motion in your hip joint

Treatment

Non-surgical treatments for labral tears include activity modification, non-steroidal anti-inflammatory drugs (NSAID’s), corticosteroid injections, and physical therapy. Surgical repair or removal may be an option, depending on the severity of the tear. If conservative treatments don’t work, your orthopedic surgeon may recommend arthroscopic surgery, where a small camera and surgical tools are inserted via small incisions in your skin. Depending on the cause and extent of the tear, the surgeon may cut out and remove the torn piece of labrum or repair the torn tissue by sewing it back together.

Hip pain is typically associated with older adults, but everyone from young athletes to “weekend warriors” and even non-athletes can be at risk for developing this hip problem. Femoral-Acetabular Impingement (FAI) is caused when the hip bones do not form normally during the growing years. Abnormal rubbing at the hip joint causes damage to the cartilage and hip pain.

The hip is a ball and socket joint. The socket is formed by part of the pelvic bone (acetabulum), and the ball is formed by the femoral head at the top of the thighbone (femur). The surfaces of the ball and socket are covered by a slippery tissue called articular cartilage, which allows the joint to move without friction. The socket is lined with a strong fibrocartilage ring called the labrum that forms a gasket to create a tight seal and help provide stability to the joint.

Symptoms

• Pain in the groin or outer thigh
• Sharp pain when turning, twisting, or squatting
• The hip may also pop or catch
• Pain may increase during physical activity, or after periods of prolonged sitting or walking

Three types of FAI:

• Cam Impingement is caused when the femur’s head grows into a shape that is unevenly rounded and cannot rotate smoothly in the socket. Certain movements can cause the extra bone to catch against the edge of the socket, damaging the cartilage and labrum.
• Pincer Impingement is caused when extra bone grows along the socket’s rim, or when the socket is not angled properly, allowing the socket and femur to impact abnormally.
• In many cases, FAI is caused by a combination of cam and pincer types.

Diagnosis and treatment

Examination of the hip by an orthopedic hip specialist, x-rays, and sometimes an MRI are used to look for FAI deformity and labral tears. Treatment options can include changes in lifestyle that place less stress on the hip, physical therapy, or arthroscopic surgery. During this surgery, a small camera (called an arthroscope) is inserted into the joint and allows for a clear view of the hip ball and socket joint. This allows your orthopedics surgeon to look for the causes of your hip pain. The camera displays pictures onto a screen, and surgical instruments are guided into your hip to repair the joint.

Avascular Necrosis (AVN) occurs when a bone’s blood supply is disrupted. The bone cells die, and the dead bone weakens and may begin to fracture and collapse, leading to arthritis. It most commonly affects the head of the femur, but can also affect other bones in the body. Avascular necrosis causes hip pain and loss of mobility in the hip joint. Pain can be mild or severe, but usually develops gradually. Hip pain may be most noticeable during physical activity, but eventually the joint may hurt even when at rest.

Causes and risk factors

• Bone fracture
• Heavy alcohol use
• Joint dislocation
• Prolonged use of corticosteroids

Treatment

Although medications, exercises, and rest may slow the progression of the disease, avascular necrosis of the hip will typically need to be treated with surgery. Surgical options may include core decompression, bone reshaping, osteotomy, bone grafting or hip replacement.

Bursitis is a condition caused by inflammation of one or both of the fluid-filled cushioning sacs of the hip bone. The pain is initially sharp and intense and later becomes more of a dull ache and spreads across a larger area of the hip. The pain may become worse when walking, stair climbing, or after being seated for a prolonged period.

Causes and risk factors

• Overuse
• Hip injury
• Spine disease
• Leg length inequality
• Rheumatoid arthritis
• Previous surgery
• Bone spurs or calcium deposit

Treatment

Hip bursitis is usually treated without surgery. Many people experience relief with lifestyle changes such as:

• Activity modification
• Non-steroidal anti-inflammatory drugs (NSAID’s)
• Crutches/walking cane
• Physical therapy
• Steroid injection

Tendonitis of the wrist is a common condition that may occur due to repetitive use, overuse, or even from an acute injury. The most common type of wrist tendonitis involves the two tendons along the back and outside of your wrist, which help to lift your thumb, called DeQuervain’s Tendonitis.

Causes and risk factors

• Females are more susceptible than men
• Dominant hand
• New mothers
• Repetitive use
• Racquet/club sports

Symptoms

• Burning pain
• Sharp pain with use
• Swelling
• Occasional clicking/popping with use

Diagnosis and treatment

In most cases, the diagnosis can be made based on a physical exam and x-rays are often not needed. Treatment is tailored to each patient, depending on duration and severity of symptoms, as well as previous treatment. The following nonsurgical treatment options can be effective. Most cases resolve with nonsurgical treatment, but your doctor may discuss surgery with you if the following treatments do not provide relief.

• Activity modification
• Bracing/splinting
• Over the counter anti-inflammatory medications (ibuprofen, naproxen)
• Topical pain relief creams/gels
• Corticosteroid injections
• Prescription anti-inflammatory medications

Trigger finger occurs when the flexor tendon becomes irritated and begins to thicken, eventually creating nodules making it difficult for the joint to bend and straighten. When the tendon is lengthening, it becomes momentarily stuck then quickly pops out into extension.

Causes and risk factors

• Gender: Trigger finger is more common in women compared to men.
• Medical conditions: Certain medical conditions can increase the likelihood of developing trigger finger. These include:
  • Diabetes mellitus: Individuals with diabetes have an increased risk of developing trigger finger. The high blood sugar levels associated with diabetes can affect the tendons and contribute to inflammation.
  • Hypothyroidism: Hypothyroidism, a condition characterized by an underactive thyroid gland, can also be a risk factor for trigger finger.
  • Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation in the joints.
• Overuse and repetitive gripping: Overuse of the fingers or repetitive gripping actions can strain the tendons, leading to trigger finger. This is often seen in individuals who engage in occupations or activities that involve repetitive hand movements, such as gripping tools or playing certain musical instruments.
• Traumatic injuries: While less common than other causes, traumatic injuries to the fingers or hand can lead to trigger finger. In some cases, a direct blow or impact to the finger can damage the tendons or surrounding structures, causing inflammation and triggering the condition.

Symptoms

• Swelling: The affected finger or thumb may exhibit swelling due to inflammation in the tendon sheath.
• Tender lump in the hand: A small, tender nodule or lump may develop in the palm or finger where the tendon is affected.
• Popping and catching in the finger joints: Movement of the finger may result in a popping or catching sensation, often accompanied by a clicking sound.
• Pain when extending or bending the finger: Pain or discomfort is typically experienced when attempting to straighten or bend the affected finger.
• Stiffness in the fingers after prolonged inactivity, like sleeping: Upon waking up or after a period of rest, the affected finger or fingers may feel stiff and require some effort to regain full mobility.

Preventing trigger finger

Occupations, sports, and hobbies with repetitive gripping can be a cause of trigger finger. The best way to prevent trigger finger or trigger thumb is to take rest breaks, do gentle stretching and strengthening exercises of the wrist and fingers, and be sure to use the correct tools for the job.

Diagnosis and treatment

If symptoms are mild and generally pain free, your doctor may suggest resting the finger and/or placing it in a custom splint. Initial home treatment involves anti-inflammatory medications, massage, heat and working on range of motion of the digit. If symptoms persist, most commonly your doctor will recommend a steroid injection.

If the symptoms do not resolve, surgery may be an option to relieve pain and restore function. For most patients, this can be done in an office-based procedure room with the patient awake. This eliminates the need for anesthesiology and is less costly for the patient.

An orthopedic hand surgeon will numb the hand in the area of the trigger finger or thumb and then move the patient to a procedure room. The incision is made in the palm and is typically an inch long or less. The surgeon will remove the tissue that is causing the finger to catch or lock. After that, the patient will move the finger several times to ensure that the finger is gliding smoothly through the tunnel. The incision is closed with 2-3 stitches in the palm. A soft dressing is then applied and the patient can leave the office. Recovering from the trigger finger surgery includes range of motion exercises and normal activities of daily living. In 10-14 days the patient returns for a follow-up visit.

Nearly all patients get relief from the locking and catching symptoms after surgery. The recurrence rate for patients that have had surgery is very low.

Arthritis at the joint at the base of the thumb, or the carpalmetacarpal (CMC) joint is very common. When osteoarthritis occurs at this joint, the cartilage begins to wear down creating painful bone on bone friction.

Causes and risk factors

• Females are more susceptible than men
• Over 40 years of age
• Doing activities with repetitive stress
• Prior injury
• Obesity

Symptoms

• Sharp or burning pain when gripping or pinching
• Swelling, stiffness, and limited motion at base of thumb
• Lack of strength in grip and pinching activities
• Bone spurs/thickening around the base of the thumb

Diagnosis and treatment

Most people that have thumb arthritis will notice that their symptoms gradually worsen over time. In most cases, the diagnosis can be made based on a physical exam and x-rays. Treatment varies depending on each patient’s goals and symptoms. The following are nonsurgical treatment options:

• Activity modification
• Massage
• Over the counter NSAID’s (ibuprofen or naproxen)
• Anti-inflammatory herbs such as turmeric or ginger
• Topical pain relief creams/gels
• Occupational/physical therapy
• Corticosteroid injections
• Prescription anti-inflammatory medications

If these treatments are not working, surgery may provide pain relief and/or improved function.