Conditions & Treatments | Los Angeles

Patellafemoral Chondromalacia

Patellafemoral chondromalacia refers to the wearing out of the cartilage on the back of the patella (knee cap). Patients will often describe pain with squatting, kneeling, or walking down stairs. Treatment varies and includes medications, physical therapy, and injections.

Patella Dislocation / Subluxation

The knee cap, also known as the patella, can slip out of its groove and dislocate or subluxate. This is often due to trauma or a laxity of the ligaments that secure the patella in its groove. Patients will commonly report pain with climbing stairs or with lateral motion following a patellar dislocation. Treatment includes bracing, medications, and physical therapy. If the issue is recurring frequently, surgery may be necessary.

Osteoarthritis (OA) of the Knee

Osteoarthritis of the knee describes the loss of cartilage in the knee joint. Patients with osteoarthritis will experience sore and aching pain of the knees with stiffness and pain with sitting and walking. Treatment for osteoarthritis of the knee can include medications, physical therapy, injections, and joint replacement surgery.

Meniscus Injury

A meniscus injury describes when the cartilage pad in the knee joint is torn. The meniscus acts as a shock absorber in the knee and is injured during an episode of the knee twisting while the foot is planted. Symptoms of a meniscus tear include pain with squatting and twisting motions, or a catching and locking sensation in the knee. Treatment for a meniscus tear includes medication, physical therapy, and possibly surgery.

Medial Collateral Ligament (MCL) Sprain

The medial collateral ligament (MCL) is a knee stabilizing ligament that is on the inside aspect of the knee. This ligament is prone to injury when a patient experiences a traumatic hit to the outside aspect of the knee which forces the knee inward. Treatment for MCL tears involves medications, physical therapy, and bracing.

Total Knee Arthroplasty

In a total knee replacement, the damaged cartilage and bone will be removed from your knee joint. A new metal surface will be fixed with cement to the end of the femur (thigh bone) and also to the top of the tibia (shin bone) that make up the knee joint. The surgeon will make sure that the alignment and function of your knee is restored at this point. A plastic spacer is then connected to the tibial component, which recreates the native joint space. The third component of the knee replacement is the knee cap (patella). The back of the knee cap is also fitted with a plastic implant that acts to resurface the back of the knee cap, allowing for smoother flexion and extension of the knee.

Patellar Tendonitis

Patellar Tendonitis, also known as Jumper’s Knee, is an overuse condition of the knee that is a result of jumping or kicking sports. Patients with this condition will experience pain in the front of the knee below the knee cap. Treatment for patellar tendonitis includes medications, physical therapy, and cold therapy.

Medial Patellafemoral Ligament Reconstruction

This procedure is performed in two parts. Initially an arthroscopy of the knee is done to complete a lateral release. This involves releasing tight tissue on the outside of the knee that is pulling the knee cap out to the side and causing the knee cap to dislocate.

Baker’s Cyst

A Baker’s cyst, also known as a popliteal cyst, is a condition of the knee where the bursa sac in the back of the knee becomes inflamed and often fills with fluid. Treatment for a Baker’s cyst may include aspiration (removal of the fluid), medications, and possibly physical therapy.

Arthroscopic Meniscectomy

Arthroscopy of the knee with partial meniscectomy requires two small incisions in the front of the knee. Once the tear is visualized, the torn edges are shaved or bitten away using small instruments. This will leave a smooth edge of the meniscus so the patient can move the knee without any catching or locking sensation.

Anterior Cruciate Ligament Tear

The anterior cruciate ligament (ACL) is a stabilizing ligament for the knee. A tear of the ACL often results from a twisting or hyperextension episode of the knee. At the time of injury, an audible pop is commonly heard. Treatment for an ACL tear will include arthroscopic reconstruction of the ACL.

Arthroscopic Meniscus Repair

Arthroscopy of the knee with meniscus repair requires two small incisions in the front of the knee. Once the tear is visualized and deemed repairable, the edges of the torn meniscus are reattached to the body of the meniscus using surgical suture or tacks.

Trochanteric Bursitis

Trochanteric bursitis is inflammation of a fluid-filled sac on the side on the hip. This is often a result of a tight IT band. Patients will experience soreness and pain on the side of the hip, as well as difficulty with sleeping on their side. Treatment involves medications, physical therapy, injections, and sometimes requires surgery.

Arthroscopic Bursectomy

Arthroscopy with bursectomy usually involves one to two small incisions on the knee. The arthroscope is placed into the bursa along with a small shaving device. This device cleans out the bursa of any debris or inflamed tissue.

Snapping Hip – Internal

Internal snapping hip is a condition where a patient has a snapping sensation when the leg is brought from a flexed position to a straight leg position. The snapping can sometimes be painful and cause discomfort when a person is exercising. Treatment for internal snapping hip may include medications, physical therapy, and possibly arthroscopic surgery.

Arthroscopic ACL Reconstruction

Prior to ACL reconstruction surgery, a patient must have full range of motion of the knee. Therefore, it is common to be sent for a month of physical therapy prior to surgery in order to regain range of motion.

IT band snapping across greater trochanter of the hip

Snapping Hip – External

An external snapping hip is when the patient experiences a snapping sensation on the outside of the hip that is painful. This is often a result of a tight iliotibial band (IT band). Treatment for external snapping hip syndrome may include medications, physical therapy, and sometimes surgical intervention.

Total Hip Arthroplasty

In a total hip arthroplasty, the cartilage that lines the hip joint is a source of pain and is thus removed. The damaged ball of the hip joint is replaced with a metal ball that is attached to a metal stem, which is fitted in the femur. The socket of the hip (acetabulum) is replaced with a metal cup that has a plastic liner.

Osteoarthritis (OA) of the Hip

Osteoarthritis of the hip is the loss of cartilage in the hip joint. Patients with osteoarthritis will experience groin and buttock pain, stiffness in the hip, and pain with sitting and walking. Treatment for osteoarthritis of the hip can include medications, physical therapy, injections, and joint replacement surgery.

Proximal Hamstring Repair

During an open proximal hamstring repair, an approximately 3–5 cm incision is made at the crease of the buttock. Next the damaged hamstring tendon is located and any frayed or damaged tissue is removed. Once a clean edge of healthy tendon is achieved, it is secured using strong suture back to its insertion on the ischial tuberosity of the pelvis.

Labrum Tear

The labrum is cartilage in the hip which lines the outer lip of the hip socket (acetabulum). Damage to the labrum can occur as a result of trauma or from femoroacetabular impingement (FAI). Patients with a torn labrum will experience a deep pain in the groin area which is sore, aching, and sometimes sharp. Patients may also notice a decreased range of motion and pain with sitting. Treatment for a torn labrum includes conservative care as well as possibly arthroscopic surgery to repair the damaged labrum.

Arthroscopic Trochanteric Bursectomy

Through a small incision on the side of the thigh, a tiny shaver instrument is used to clean out the bursa. All of the inflamed, damaged, or frayed tissue is removed. This may be combined with an iliotibial band release, labral repair, and/or osteoplasty of femoral neck and acetabulum.

Iliotibial Band Syndrome

The iliotibial band, also known as IT band, is a thick band of tissue extending from the pelvis to the knee along the outside of the leg. With overuse activities such as running, this band can become inflamed and cause pain at the hip and the knee. Treatment for IT band syndrome includes medications, physical therapy, and possible injections and/or surgery if necessary.

Arthroscopic Partial Iliopsoas Tendon Release

The partial iliopsoas tendon release can be performed arthroscopically. Instead of releasing the tendon completely, which may lead to postoperative weakness, a partial tendon release is preferred. Using a heat device, the tendon is partially released and by doing this, the tendon is lengthened. This lengthening allows the tendon to glide over the hip joint and not snap any further.

Hamstring Tear / Rupture

The hamstring is a muscle in the back of the leg that is a source of many sports-related injuries. This muscle is often strained with a person exerts a lot of force on the leg as in running or sprinting. Patients can tear the hamstring tendon as well and will commonly report feeling a pop at the base of the buttock. Hamstring strains resolve over time; however, a ruptured hamstring will require surgical repair.

Arthroscopic Labral Repair with Osteoplasty of Femoral Neck and Acetabulum

The labrum is repaired using strong suture that is wrapped around the sagging or torn part of the labrum. By using surgical anchors, essentially small plastic pegs that hold the suture in place, the labrum can be resecured to its appropriate position on the rim of the acetabulum. These pegs do not contain metal and will break down and dissolve away over time. The suture will keep the labrum fixed to the rim of the acetabulum, and will help the labrum scar into position. It is common to use two or three of these anchors in a hip arthroscopy with labral repair.

Gluteus Medius Tear

The gluteus medius is a muscle that allows us to move our leg out to the side and away from the body. Patients can suffer a tear of this gluteus medius tendon resulting in buttock pain and weakness with lifting the leg to the side. Treatment varies for this injury, but is commonly resolved with medication and physical therapy.

Arthroscopic Iliotibial Band Release

Through a small arthroscopic incision, the IT band can be located on the outside of the thigh. In the procedure, a portion of the IT band is excised so that an opening is created over the greater trochanter. By removing this piece of the IT band, it will no longer get caught on the greater trochanter and thus the snapping sensation will no longer occur.

Flexor Tendonitis

Flexor tendonitis is a condition where the tendons in the front of the hip joint become inflamed and irritated. This is frequently the result of repetitive hip flexion such as with track athletes, gymnasts, and soccer players. Patients will experience soreness and occasional sharp pains in the front of the hip. Treatment for flexor tendonitis includes medications and physical therapy.

Arthroscopic Labral Reconstruction

A patient undergoing this procedure will have their labrum reconstructed with use of an allograft (cadaver tissue) or the patient’s own tissue (commonly iliotibial band is used). The reconstruction of a damaged or incomplete labrum is important to recreate the suction seal function of the labrum in the hip joint. This provides the patient with hip stability and resolves pain commonly associated with a labral tear.

Hip Dysplasia

Hip dysplasia is a condition where there is a lack of coverage of the hip socket over the ball of the hip. Patients with hip dysplasia will feel a sense of instability in the hip as if it is gliding in and out of place. Patients with this condition are at increased risk for labrum injuries in the hip. Treatment for this can include physical therapy, medications, and sometimes arthroscopic surgery.

Open Triceps Tendon Repair

A triceps tendon repair is an open procedure done through an approximately 5 cm incision on the back of the arm directly above the elbow. First, the ruptured or torn tendon is located by the surgeon. Once located, the end of the tendon is cleared of any damaged tissue so the tendon has a fresh edge. Then the end of the tendon is reattached down to the bone with strong suture known as Fiberwire.

Femoroacetabular Impingement (FAI)

Femoroacetabular Impingement (FAI) is a condition where the ball of the hip and the socket of the hip rub together and cause damage to the cartilage of the hip joint. Patients with FAI complain of soreness and aching with occasional sharp pains in the hip. Treatment for FAI varies greatly to include medications, physical therapy, and possibly arthroscopic surgery.

Open Medial Epicondylar Release

A medial epicondylar release is an open procedure, often performed through a 3–4 cm incision on the inside of the elbow. During the procedure, the tendon that attaches to the inside of the elbow is located and evaluated for any injury or damage. It is common to cut this tendon in order to remove damaged and inflamed tissue. The medial epicondyle is also debrided in order to remove any scar tissue or inflammatory tissue that has developed as a result of long term golfer’s elbow. Once this debridement is complete, the tendon is secured back to the medial epicondyle (on the inside of the elbow) with strong suture. This provides a clean, non-inflamed edge now connected to bone. This provides the tendon with more stability and less chance for reoccurrence when the patient resumes his/her activities. Following the procedure, the patient is placed in a soft cast to immobilize the wrist and not allow for wrist flexion. This is necessary initially so that there is not any force applied by the wrist on the repair.

Triceps Tendon Tear

The triceps tendon attaches the triceps muscles on the back of the arm to the elbow. Often a tear or rupture of this tendon occurs as a result of a fall on an outstretched hand or when sudden force is exerted on the elbow. Patients commonly report a pop or snapping sound at the time of injury. Depending on the extent of tearing, surgery to repair the tendon may be necessary.

Open Lateral Epicondylar Release

A lateral epicondylar release is an open procedure often performed through 3–4 cm incision on the outside of the elbow. During the procedure, the common extensor tendon is located and evaluated for any injury or damage. The tendon is split in order to remove damaged and inflamed tissue. The lateral epicondyle (bone) is also debrided in order to remove any scar tissue or inflammatory tissue that has developed as a result of long-term tennis elbow. Once this debridement is complete, the common extensor tendon is secured back to the lateral epicondyle (on the outside of the elbow) with strong suture. This provides a clean, non-inflamed edge now connected to bone, providing the tendon with more stability and less chance for recurrence when the patient resumes normal activities. Following the procedure, the patient is placed in a soft cast to immobilize the wrist and prevent any force applied by the wrist on the repair.

Medial Epicondylitis

Medial epicondylitis results from inflammation of the flexor tendons of the wrist. It is commonly referred to as “golfer’s elbow.” Patients will have pain with lifting, twisting of the wrist, or during a golf swing. Treatment involves physical therapy, medications, injections, and sometimes surgery.

Total Shoulder Arthroplasty

Total shoulder arthroplasty involves removing the damaged cartilage that lines the joint and replacing it with a metal implant. In this procedure, the ball of the shoulder is replaced with a metal ball and the socket of the shoulder is replaced with a metal socket and plastic liner. The implants used are made of titanium or cobalt chrome. They are sometimes cemented in place for additional stability.

Lateral Epicondylitis

Lateral epicondylitis results from inflammation of the extensor tendons of the wrist. Although most people with this condition do not play tennis, it is referred to frequently as “tennis elbow.” Patients will have pain with lifting, twisting of the wrist, or hitting a backhand in tennis. Treatment involves physical therapy, medications, injections, and sometimes surgery.

Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty involves removing the damaged cartilage that lines the joint and replacing it with a metal implant. In this procedure, the ball of the shoulder is replaced with a metal socket, and the socket of the shoulder is replaced with a metal ball. The implants used are made of titanium or cobalt chrome. They are often cemented in place for additional stability. Patients are often placed in a sling for comfort after surgery. With the reverse total shoulder, you will use accessory shoulder muscles such as the deltoid to raise your arm in the absence of the rotator cuff.

Biceps Tendon Rupture at Elbow

A ruptured biceps tendon describes when the tendon of the biceps muscle is pulled from its attachment at the shoulder or the elbow. This can happen as a result of lifting a heavy item or a jerking motion while your arm is flexed. Most commonly a patient will notice a deformity of the biceps muscle where there is an abnormal bulge in the arm.

Open Biceps Tendon Repair

Biceps tenodesis is an open procedure, meaning it requires either one or two incisions. Reattachment at the shoulder is done through an approximately half-inch incision on the inside of the arm close to the axilla. For reattachment at the elbow, a two-incision approach is utilized. At the elbow, the first incision is at the crease where the elbow bends. The second incision is on the back of the forearm. Regardless the number of incisions, the surgery is similar. First the ruptured tendon is located by the surgeon. Once located, the end of the tendon is cleared of any damaged tissue so the tendon has a fresh edge. Then the end of the tendon is reattached down to the bone with strong suture known as Fiberwire. If necessary, an additional screw or peg may be inserted for extra fixation of the tendon to bone.

Rotator Cuff Arthropathy

Rotator cuff arthropathy is a condition resulting from long-standing rotator cuff tears in the shoulder. Patients develop a severe loss of motion of the arm and weakness and will experience difficulty and pain with lifting, pushing, and pulling motions. There are both non-operative and surgical treatments for this condition.

Latarjet

Latarjet is an open procedure for the shoulder where the coracoid process of the shoulder is cut. The bone that is cut is then placed over the front of the shoulder joint and secured with a screw. This piece of bone now acts as a wall in the front of your shoulder that will stabilize the shoulder joint and prevent any instability or dislocation from occurring.

SLAP / Labrum Tear

The labrum is a pad of cartilage that lines the shoulder joint. Commonly, patients will injure the labrum as a result of repetitive motion such as throwing or swimming. A “SLAP” tear is a frequently used term to describe a tear that extends from the front of the back of the labrum. Treatment for labral tears involves medications, physical therapy, and possibly arthroscopic surgery.

Arthroscopic Capsular Release

In order to resolve the stiffness associated with adhesive capsulitis, capsular release (cutting of the tissue that encompasses the joint) is performed to break up the inflamed scar tissue in the shoulder and allow the shoulder to move more freely. Depending on how stiff the shoulder is prior to surgery, a manipulation of the shoulder may be performed, which involves moving the shoulder around through all ranges of motion to help alleviate the stiffness in the shoulder.

Rotator Cuff Tear / Tendonitis

Rotator cuff tendonitis describes the inflammation of the rotator cuff muscles in the shoulder and is often caused by repetitive pushing, pulling, or heavy lifting activities. Tendonitis can lead to tears of the rotator cuff and a person may develop weakness in his/her arm because of the tear. Rotator cuff tear and tendonitis are treated with physical therapy, medications, and sometimes arthroscopic surgery.

Arthroscopic Subacromial Decompression

Shoulder arthroscopy with a subacromial decompression involves first, cleaning out the shoulder of any debris or inflamed tissue. Then, by using a small shaver device, the undersurface layer of the acromion is removed. The space below the acromium where the rotator cuff passes is thus made wider. By doing this, the rotator cuff can freely pass without rubbing on bone and becoming inflamed or impinged.

Osteoarthritis (OA) of the Shoulder

Osteoarthritis of the shoulder is the loss of cartilage that covers the ball and socket of the shoulder joint. Patients will experience stiffness, pain in the shoulder, upper arm, and neck and can often have trouble performing over head activities or lifting heavy items. Treatment for shoulder osteoarthritis includes physical therapy, medications, injections, and possibly surgery.

Arthroscopic Rotator Cuff Repair

Shoulder arthroscopy with rotator cuff repair involves first, cleaning out the shoulder of any debris or inflamed tissue. During this time, the surgeon will also remove any frayed or damaged tissue of the rotator cuff. Using multiple strong sutures the rotator cuff is secured back to its appropriate position on the ball of the shoulder joint (humeral head).

Shoulder Instability

Shoulder Instability is a condition that occurs as a result of recurrent shoulder subluxation or dislocation. Patients will comment that his/her shoulder feels like it is popping in and out of the socket. Treatment for shoulder instability is dependent on the age of the patient and the type of activity they participate in.

Arthroscopic Labral Repair

Shoulder arthroscopy with labral repair involves first, cleaning out the shoulder of any debris or inflamed tissue. During this time, the surgeon will also remove any frayed or damaged labral tissue. The torn piece of labrum is repaired using strong sutures to secure the labrum back to its appropriate position on the socket of the shoulder. This recreates the stability that the labrum provides for the shoulder joint and resolves the pain, clicking, and feeling of the shoulder “popping in and out” often associated with a labrum tear.

Rotator cuff being pinched with resulting inflammation

Shoulder Impingement

Shoulder impingement, also known as swimmer’s or thrower’s shoulder, occurs when the rotator cuff is pinched and becomes inflamed. Patients experience pain with overhead activity, reaching, pushing, or pulling motions, as well as pain at night. Impingement is often treated with conservative means including physical therapy and medications, etc.

Arthroscopic Distal Clavicle Excision

This procedure involves removing the end of the clavicle, which forms the AC joint. This will alleviate pain and loss of motion caused by impingement and arthritis. Your body will produce scar tissue where the bone is removed, and your pain will resolve since there is no longer bone rubbing on bone. This procedure is often performed with a subacromial decompression.

Biceps Tendonitis

Biceps tendonitis is an inflammation of the upper part of the biceps tendon. This is common in people who perform repetitive overhead activities or repetitive lifting. Pain is usually sharp and felt in the front of the shoulder. Treatment often includes medications, injections, and physical therapy.

Biceps Tendon Rupture at Shoulder

A ruptured biceps tendon describes when the long head of the biceps muscle is pulled from its attachment at the shoulder or the elbow. This can happen as a result of lifting a heavy item or a jerking motion while your arm is flexed. Most commonly a patient will notice a deformity of the biceps muscle where there is an abnormal bulge in the arm.

Adhesive Capsulitis

Adhesive Capsulitis is a condition that describes the loss of motion of the shoulder. Commonly referred to as “frozen shoulder,” patients with this condition experience a significant amount of shoulder stiffness, loss of motion, and pain. Treatment for frozen shoulder often includes medications, physical therapy, and sometimes surgical is necessary.