Breaking the clavicle or “collarbone” occurs from a fall or direct blow to the area. Contact sports like football, rugby and ice hockey are common high risk sports. Falls while cycling, skiing and motor vehicle accidents are other common ways to fracture the clavicle. Immediately following the injury patients experience pain, swelling and limited use of the arm. X-rays are usually sufficient to make the diagnosis and initial treatment involves immobilization in a sling and use of ice and over the counter pain medications.
Treatment can be surgical or non- surgical. Non-surgical management simply lets the fracture heal in the position it is in and includes a period of immobilization. The immobilization period is typically 3-4 weeks until sufficient healing occurs so therapy can begin and pain is decreased. Non-surgical management has been the norm for a long time, however, surgical fixation or repair is gaining popularity for certain injuries.
Surgical repair can be accomplished with a variety of devices, but usually a plate and screws has some advantages. Repair can align very displaced fractures. When the fracture is very displaced and when fragments shorten or ride over each other patients who are active tend to complain of shoulder pain and sometimes weakness or dysfunction. This can be alleviated with surgical repair. In addition, fracture healing time is shortened with surgical repair and risk of fracture not healing is lessened by surgical fixation. Use of the upper extremity is allowed much sooner following surgical repair.
In summary, clavicle fractures can be managed with or without surgery. Treatment decision is made based on fracture type, displacement and shortening. Patients activity level, age and other risk factors are taken into consideration as well. Below is a short presentation on a clavicle fracture I treated utilizing sutures and a plate to restore the anatomy and fix the fracture anatomically.
Tennis elbow is a common problem for patients who play tennis or not. The #Tenex device offers a minimally invasive solution for patients not improving with typical treatments and those who do not want to wait any longer to return to activity. I combine this with PRP at time of the procedure.
Tears of the meniscus are a common source of knee pain. Tears can be due to sports injuries, slips and falls, car accidents and from degeneration. When a tear occurs from injury, pain is usually acute and sometimes the injury is associated with a pop and the development of swelling. The swelling could be immediate or occur over the next 24-48 hours. Pain is usually located at the joint line on the inside or outside of the knee. Degenerative type meniscal tears often occur gradually and got progressively worse but could have acute onset of pain as well. Associated signs and symptoms of a meniscal tear include pain at the joint line, swelling and sometimes locking or catching. In acute injuries, the meniscus can sometimes displace and cause locking or lack of motion of the knee.
Diagnosis of meniscal tear starts with a thorough history, physical exam and x-rays. X-rays are helpful to determine if there are any fractures with an acute injury, underlying arthritic changes and loose bodies within the joint. Underlying arthritis is frequently associated with degenerative meniscal tears. If x-rays are negative and clinical suspicion indicates a meniscal tear, an MRI may be ordered. Meniscal tears also occur frequently with ligament injuries to the knee, such as ACL tear. Special consideration should be given to meniscal tears associated with arthritic changes of the joint. In this particular situation, it is common to have a meniscal tear and arthritis at the same time. Current research indicates that in the majority of cases, pain comes from the underlying arthritis more so than the meniscal tear. It is common for your orthopedic surgeon to recommend nonsurgical management of a meniscal tear when there are significant arthritic changes present. There are certain indications and situations where more aggressive management of a meniscal tear would be warranted when they are underlying degenerative changes of the knee, a discussion with your surgeon will help determine which treatment method is most appropriate.
There are different types of tear patterns. They include vertical/longitudinal tears, radial tears (meniscal root variant), horizontal cleavage tears, complex tears, oblique tears, degenerative tears, and bucket-handle tears.
Treatment of meniscal tears depends on the level of symptoms, presence or absence of recurrence swelling, mechanical symptoms of catching and locking and the affective these on participation in sports or exercise. Treatment could include physical therapy, activity modification, anti-inflammatory medication and bracing. Treatment could also include injections, especially when there underlying arthritic changes. Surgical management is usually indicated for symptoms that are not responding to conservative treatment. Displaced bucket-handle tears causing locking or lack of motion usually require more urgent surgical intervention. The goal of treatment is to reduce pain, swelling and improve functional abilities and participation in exercise or sports. Below is a short video of a meniscal surgery I performed.
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Hello, this is my first attempt at blogging. My goal is to provide interesting(hopefully) and useful information about a variety of sports medicine injuries and orthopaedic conditions. The posts will be short, not overly technical and often have associated images and videos of work I have done or problems I have treated. I encourage anyone reading this to comment and ask questions, through a thoughtful exchange I can better understand what information my readers are looking for and what you get the most out of. These posts are not intended to diagnose, treat or give advice; rather to guide you about the injuries you may have and help you on your journey to recovery.
I have been a sports medicine orthopaedic surgeon for 20 years. I have cared for athletes of all levels, from the professional to the weekend warrior. I enjoy treating people of all ages and I welcome pediatric patients with sports injuries. My goal is to get you back on your field quickly, safely and confidently.