What happens when you fracture your ankle?

There are three bones that make up the ankle joint: the tibia, fibula and talus. A broken ankle, or fracture, occurs when one or more of these bones break. The joints and ligaments that make up the ankle can also be damaged when a fracture occurs. Common causes include impact during sports or car collision, tripping or falling, and rolling your ankle.

Symptoms

The symptoms of a fractured ankle are similar to an ankle sprain, so you should be evaluated by an orthopedic surgeon after an injury.

• Immediate pain
• Swelling and bruising
• Can’t bear weight on the injured foot

You may not require surgery if the ankle remains stable and the fracture is minor. If the fracture is out of place or your ankle is unstable, your orthopedic surgeon may need to do surgery. Watch this short video to see the surgical procedure used to correct a fracture of the fibula or tibia in the ankle joint.

Where is the ulnar collateral ligament?

On both sides of the elbow, thick ligaments hold the joint together. The ligament that connects the humerus and the ulna on the inside of the elbow is called the ulnar collateral ligament (UCL). Damage, inflammation, or a tear of the UCL is a common injury for baseball pitchers and other athletes who play throwing sports.

Causes and risk factors

This ligament is rarely stressed in daily activities, it is usually injured from overuse. Repeated overhead throwing can stretch or tear the UCL ligament.

Symptoms

• Pain on the inside of the elbow, especially when throwing
• A pop or tearing sensation at the time of injury
• Decreased throwing velocity
• Inability to straighten the elbow
• Numbness or tingling in ring and pinky finger

Diagnosis and treatment

Nonsurgical treatment of an ulnar collateral ligament injury includes rest, ice, non-steroidal anti-inflammatory medications, and physical therapy. If these treatments do not relieve symptoms, surgery may be necessary to reconstruct the UCL ligament. This procedure is commonly referred to as “Tommy John surgery”, named after the former major league pitcher who first had the surgery done in 1974.

What is Tennis Elbow?

Tennis elbow, or lateral epicondylitis, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Racket sports like tennis and pickleball tend to be a major cause for this injury and elbow pain, but any heavy use of the elbow with repetitive gripping and lifting can be a cause of this condition. It is a common work-related injury for plumbers, painters, carpenters, mechanics, and butchers. Generally, lateral epicondylitis develops gradually, but at times can occur acutely from an injury.

Causes

• Extended use in activity: Engaging in repetitive activities that involve the forearm muscles, such as gripping, twisting, or lifting, for an extended period can contribute to tennis elbow. These activities can strain the tendons in the elbow, leading to inflammation and pain.
• Wear and tear of overuse: Overuse of the forearm muscles without adequate rest and recovery can lead to wear and tear of the tendons, causing tennis elbow. This can occur in various occupations or recreational activities that involve repetitive motions, such as painting, plumbing, or playing musical instruments.
• Improper equipment in sports like tennis: In sports like tennis, using improper equipment or techniques can increase the risk of developing tennis elbow. For example, using a racquet with an ill-fitted grip size or playing with a technique that places excessive strain on the forearm muscles can contribute to the condition.

Risk factors

• History of rheumatoid arthritis: Rheumatoid arthritis is an autoimmune condition that causes inflammation and damage to joints, including the elbow. Individuals with a history of rheumatoid arthritis may be at an increased risk of developing tennis elbow.
• History of nerve disease: Certain nerve diseases or conditions can affect the function and health of the nerves in the forearm and elbow. These conditions may increase the likelihood of developing tennis elbow.
• Dominant arm primarily affected: Tennis elbow commonly affects the dominant arm, which is the arm predominantly used for activities and sports. The repetitive motions and overuse of the forearm muscles in the dominant arm can contribute to the development of tennis elbow.

Symptoms

• Tenderness in the outer elbow: One of the main symptoms of tennis elbow is tenderness or pain located on the outside of the elbow. This tenderness is often localized to the bony prominence called the lateral epicondyle.
• Burning sensation in the elbow: Some individuals with tennis elbow may experience a burning sensation in the affected elbow. This sensation can be present at rest or during activities involving the forearm muscles.
• Pain and weakness when using the affected elbow: Tennis elbow can cause pain and weakness in the elbow, particularly when performing activities that involve gripping, lifting, or twisting motions. Everyday tasks like shaking hands, turning a doorknob, or gripping a tool can become painful and challenging.
• Pain with resistance: When pressure or resistance is applied to the wrist or forearm muscles, individuals with tennis elbow may experience increased pain. This can be observed when attempting to lift or carry objects or when performing activities that require forearm muscle contraction against resistance.
• Pain and weakness with gripping/lifting: Tennis elbow can make gripping and lifting objects difficult and painful. Even simple tasks like holding a coffee cup, lifting a book, or carrying groceries may elicit discomfort and weakness.

Diagnosis and treatment

Several factors are considered by the doctors when making the diagnosis, including history of related injury, use, and health. Tests such as x-ray may be utilized to rule out other possible causes for elbow pain, such as arthritis or a fracture. The majority of tennis elbow treatment is done without surgery.

Nonsurgical treatment options include:

• Short period of rest
• Keep your elbow moving to prevent stiffness
• Avoid aggravating activities such as lifting/forceful gripping
• Short term nonsteroidal anti-inflammatories (NSAIDs)
• Massage to painful area to increase blood flow and desensitize
• Stretching exercises to maintain flexibility of the elbow and wrist
• Topical anti-inflammatory/pain relief creams
• Compressive elbow wrap
• Wrist brace
• Acupuncture
• Physical therapy

The vast majority of cases will resolve with this type of treatment, but symptoms may last for 6 – 12 months or longer.

What is Golfer's Elbow?

Also known as medial epicondylitis, golfer’s elbow occurs when the tendons that attach the forearm muscles to the inside of the bone at the elbow become inflamed. Similar to tennis elbow, this inflammation occurs with repetitive motion and overuse.

Causes and risk factors

• Repetition of movement
• Overuse of the muscle
• Weakness of the area
• Hurried golf swing

Symptoms

• Tenderness
• Swelling
• Muscle spasm
• Muscle weakness
• Inflammation
• Cramping

Diagnosis and treatment

Most cases of golfer’s elbow can be treated without surgery with rest, ice, compression, and elevation. In addition, consider modifying your grip and/or the use of a larger grip, if your symptoms are stemming from a racquet sport or golf. If your symptoms do not respond after six to twelve months of nonsurgical golfer’s elbow treatments, your doctor may recommend surgery.

Nonsurgical treatment options include:

• Short period of rest
• Keep your elbow moving to prevent stiffness
• Avoid aggravating activities such as lifting/forceful gripping
• Short term nonsteroidal anti-inflammatories (NSAIDs)
• Massage to painful area to increase blood flow and desensitize
• Stretching exercises to maintain flexibility of the elbow and wrist
• Topical anti-inflammatory/pain relief creams
• Compressive elbow wrap
• Wrist brace
• Acupuncture
• Physical therapy

The vast majority of cases will resolve with this type of treatment, but symptoms may last for 6 – 12 months or longer.

The biceps muscle is the large muscle in the front of your arm that help to flex your elbow and rotate your forearm. The distal biceps tendon is the tendon that connects the biceps muscle to your forearm. This tendon is a common source of pain and injury. In most cases, pain in the distal biceps tendon is related to overuse and tendonitis. At times, however; the tendon may tear either partially or completely. Biceps tendonitis/tears are most common in men aged 30 – 60, but may occur at any age and either sex.

Causes and risk factors

• Repetitive lifting/forearm rotation
• Overuse from work/sports
• Traumatic injury from the elbow forcefully extending against weight

Symptoms

• Pain, swelling, tenderness in the anterior forearm/elbow
• Weakness/pain with elbow flexion and/or forearm rotation
• In acute injuries, patient will often hear/feel a “pop” and develop significant bruising in along the elbow and forearm

Diagnosis and treatment

In many cases, the diagnosis is based on your history, symptoms, and exam. Plain radiographs (x-rays) may be obtained. If there is concern for a tear of the biceps, then an MRI of the elbow will often be ordered. Treatment depends on the extent of injury to the distal biceps tendon.  Tendonitis and partial tears are generally treated nonsurgically.

Nonsurgical treatment include rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDS), and physical therapy. Activity modification is key, including avoiding aggravating activities. Most patients with tendonitis and/or partial tearing of the biceps can expect recovery and return to normal activity with non-surgical treatment. If conservative treatment options do not relieve your pain, your orthopedic surgeon may discuss surgery.

A complete tear of your distal biceps tendon can be treated either surgically or nonsurgically.  Your orthopedic surgeon should discuss options and relative advantages and disadvantages of both treatment options. With nonsurgical treatment, most experience some loss of strength but overall good function. Surgical treatment can maximize strength and function. It entails reinserting the torn tendon to its normal attachment on one of your forearm bones.

Did you dislocate your elbow?

Elbow dislocation is an uncommon injury for most. The injury most often occurs during a fall with an outstretched arm/hand taking much of the force of the fall, sending that force through the arm to the elbow joint. There are several different types of dislocations, such as simple, complex, and severe, wherein blood vessels and nerves in the joint area may be damaged as well.

Causes and risk factors

• Loose ligaments
• Shallow grooved ulna bone
• Medical history
• Fall onto hand with outstretched arm

Symptoms

• Pain in the arm
• Deformed looking arm
• Awkward twist in the arm at elbow
• Bruising
• Swelling
• Numbness

Diagnosis and treatment

Depending on the severity of the dislocated elbow, this may at times be treated as an emergency and hospital attention may be needed. Simple dislocations can be treated by keeping the elbow immobile with a sling or a splint followed by physical therapy to aide in recovery. For more complex injuries surgery may be necessary – especially if elbow bone fractures and ligament repairs are needed as well.

What is cubital tunnel syndrome?

Cubital tunnel syndrome, or ulnar neuritis, is inflammation of the ulnar nerve in the arm that results in numbness or weakness in the hand. The ulnar nerve is more commonly knows as the “funny bone” and gives feeling to the little finger and half of the ring finger. It also controls most of the little muscles in the hand that help with fine movements and some of the bigger muscles in the forearm that help you make a strong grip. Left untreated, long term cubital tunnel syndrome can lead to severe weakness and disability in the hand.

Causes and risk factors

• Constant pressure on ulnar nerve at the elbow or wrist
• Extensive leaning on the elbow
• A surplus of fluid in the elbow
• Direct force on the inside of the elbow
• Arthritis of the elbow
• Past fracture or dislocation of elbow joint

Symptoms

• Tingling and numbness in fingers
• Ring and little finger “falling asleep”
• Lack of strength in grip and finger coordination

Diagnosis and treatment

If the nerve is compressed for a long time, irreversible muscle atrophy in the hand can occur. It’s important to see your doctor if elbow nerve pain symptoms are present for more than six weeks or are severe. The majority of treatments for ulnar nerve pain relief are nonsurgical such as anti-inflammatory medicines, splinting, or bracing the arm or nerve exercises to prevent stiffness. If symptoms do not subside, there are surgical treatments such as cubital tunnel release and ulnar nerve anterior transposition that an orthopedic doctor may discuss with you.

What is bursitis of the elbow?

Bursitis is an inflammation of the elbow, in the small sacs of fluid (bursae) that cushion and lubricate the areas between tendons and bones. Bursae are located throughout the body. In the elbow they cushion between the pointy bone at the back and the loose skin. Should this become irritated, additional fluid will fill up the bursa and create bursitis.

Causes and risk factors

• Extended pressure on the tip of the elbow
• Trauma to the elbow, allowing extra fluid to fill the bursa
• Infection such as puncture or insect bite, allowing for bacteria to enter the bursa
• Medical conditions such as rheumatoid arthritis and gout

Symptoms

• Swelling
• Pain at the tip of elbow
• Paint with elbow movement
• Irritated skin at infection site

Diagnosis and treatment

Diagnosis and treatment are important with this condition, as with any damage to the elbow. If the bursitis is not related to an infection, nonsurgical treatments such as rest, ice, elbow pads, change of activity, and anti-inflammatory medicines can be effective. Occasionally, this can be treated with aspiration of the fluid and injection of a corticosteroid. If symptoms do not resolve, your doctor may discuss surgical treatment.

A traumatic brain injury (TBI) occurs when a blow to the head or penetrating head injury disrupts normal function of the brain. About 1.7 million cases of TBI occur every year, according to the American Association of Neurological Surgeons. A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. It is a serious condition that requires specialized medical expertise. Visit the St. Charles Center’s concussion center to learn more about our comprehensive program to assess, treat, and rehabilitate individuals who have had a concussion.

Symptoms

Symptoms vary greatly and may be mild, moderate, or severe. They may include the following:

• Vomiting
• Lethargy
• Headache
• Confusion
• Paralysis
• Loss of consciousness
• Dilated pupils
• Vision changes (blurred vision or seeing double, not able to tolerate bright light, loss of eye movement, blindness)
• Cerebrospinal fluid (CSF) (which may be clear or blood-tinged) coming out of the ears or nose
• Dizziness and balance problems
• Breathing problems
• Slow pulse
• Slow breathing rate, with an increase in blood pressure
• Ringing in the ears or changes in hearing
• Cognitive difficulties
• Inappropriate emotional responses
• Speech difficulties (slurred speech, inability to understand and/or articulate words)
• Difficulty swallowing
• Body numbness or tingling
• Droopy eyelid or facial weakness
• Loss of bowel control or bladder control

Treatment

Treatment option may involve emergency care to prevent further damage to your brain. If you had a penetrating head injury, you may need surgical procedures to correct damage to tissues and your skull, as well as medications to control fluid and prevent seizures. When a violent blow to the brain or concussion has occurred, patients will get a customized plan to return to activity and restore function.

Hydrocephalus is often described as water on the brain because it is derived from two words “hydro” meaning water, and “cephalus” referring to the head. It is a condition where excess cerebrospinal fluid (CSF) builds up within the fluid-containing cavities of the brain called ventricles. This fluid is necessary for brain function, but too much can increase pressure in the brain and damage brain tissue. Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older.

Causes and risk factors

Hydrocephalus is usually caused by a disruption of the drainage system for CSF. This colorless fluid is produced in the brain and carries nutrients to cells, absorbs shock, and regulates pressure. It normally flows through and around the brain and then down the spinal cord, where it is absorbed by the blood stream. When the drainage system does not work properly, the ventricles swell with excess fluid and this raises the pressure within the brain.

Symptoms

Symptoms very greatly, but some common symptoms include the following:

Infants/Toddlers:

• Abnormal enlargement of head
• Nausea/vomiting
• Downward deviation of an infant’s eyes
• Drowsiness
• Irritability

Adults:

• Headache
• Difficulty in waking up or staying awake
• Loss of coordination or balance
• Vision impairment
• Memory loss

Treatment

Treatment may involve implanting a device called a shunt. This allows the excess fluid to drain out of the skull and into another area such as the abdomen or heart, where it is absorbed in the body. Once inserted, the shunt usually stays in place for the duration of the patient’s life. Sometimes additional surgeries are required to revise the shunt system. This ongoing condition requires continued follow-up care, but any complications that arise can usually be dealt with successfully.