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.
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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.
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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.
Body
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
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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
Body
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.
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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.
Body
Skier’s Thumb is a common injury, especially in active individuals. Skier’s thumb, also known as “gamekeeper’s thumb” involves an injury to the ligament on the inside of your thumb – the ulnar collateral ligament (UCL) of the metacarpophalangeal joint. This injury can involve a sprain – in which case the ligament stretches or partially tears – or a complete tear leading to significant pain, weakness and instability of the thumb. The injury occurs most commonly from an acute traumatic event leading to hyperextension of the thumb.
Causes and risk factors
Trauma causing hyperextension of thumb
Commonly related to falls, especially while holding something in the hand such as a ski pole
Chronic instability may arise from repetitive injuries
Symptoms
Pain, swelling, bruising along the thumb
Weakness with pinching/gripping
Instability to the thumb
Diagnosis and treatment
In most cases, x-rays are obtained to ensure there is no fracture to the thumb. Most of the time, the diagnosis can then be made clinically based on your exam and symptoms. Occasionally, advanced imaging such as an MRI will be obtained to evaluate the extent of the tear and help determine treatment options.
Treatment depends on the extent of injury to the ligament. In most cases, UCL injuries are treated nonsurgically with immobilization, often by casting and then transitioning to a removable brace. In general, it may take up to three months to fully recover and return to normal activity after a sprain/partial tear of the ulnar collateral ligament. Complete tears may be treated surgically or nonsurgically depending on the pattern of tear and patient goals. Left untreated, complete tears can lead to chronic pain, weakness and instability of the thumb.
Body
A scaphoid fracture is a break in one of the small bones in the wrist. This small bone is one the carpal bones on the thumb side of the wrist. It is central to the mobility and stability in the wrist. This bone has a weak blood supply, so early, accurate diagnosis and treatment is important.
Causes and risk factors
Most often occurs by landing on an outstretched hand
Sport activities
Automobile accident
These fractures occur in people of all ages
Symptoms
Pain and swelling on the thumb side of the wrist
Severe pain when wrist or thumb is moved
Loss of motion in the area
Increased wrist pain after more than a day
Diagnosis and treatment
Your doctor will examine your wrist for any swelling, bruising, and loss of motion, as well as tenderness to the area. Generally an x-ray will be taken, although they are not always able to detect scaphoid fractures in the first few days, so at times additional imaging is required. Depending on the fracture location, pattern and displacement, your doctor will discuss treatment options with you. Many times scaphoid fractures can be treated non-operatively with prolonged casting, but often surgery is advised. Regardless of treatment, scaphoid fractures generally take several months to heal.
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Ganglion cysts are the most common form of lump or mass in the hand. Cysts can appear in many locations in the upper extremity but are most common around the wrist and at the end of the finger adjacent to the nail.
Causes and risk factors
Most common in younger people between the ages of 15-40
Women are more often affected
Common among gymnasts or athletes in sports that apply continuous pressure to the wrist
Cysts on the finger joint are often associated with arthritis
Symptoms
Visible lump, although some cysts remain hidden under the skin
Pain due to pressure on the joint
Large cysts can cause concern about appearance
Diagnosis and treatment
Ganglion cysts often don’t require surgery and may disappear or reduce in size with time. Initially treatment involves rest, bracing, activity modification and over the counter pain medication. Another non-operative treatment is called aspiration, where the skin around the cyst is anesthetized and the fluid inside is drained with a needle. If symptoms are not relieved by these methods, an orthopedic surgeon may offer a surgical procedure called excision.
