Procedure Descriptions
ACL Reconstruction
Arthroscopic Surgery
Bone Spur Surgery
Bunionectomy
Carpal Tunnel Surgery
Ganglion Cyst Removal
Hammertoe Repair
Heel Surgery
Hernia Repair
Knee Arthroscopy (Knee Scope)
Pain Block
Pain Management Injection
Rotator Cuff Repair
Shoulder Arthroscopy (Shoulder Scope)
Shoulder Arthroscopy Decompression
Trigger Finger Surgery
Tennis Elbow Repair
Anterior Cruciate Ligament (ACL) Reconstruction
ACL reconstruction is surgery to replace the torn ligament with an autograft (tissue from the patient’s own body) or an allograft (tissue from a cadaver). The most common autografts use part of the patellar tendon (the tendon in the front of the knee) or use the hamstring tendons.
The procedure is usually performed by knee arthroscopy. The surgeon will replace the ACL. Additional small incisions are made around the knee to place the new ligament. The old ligament will be removed using a shaver or other instruments. Bone tunnels will be made to place the new ligament in the knee at the site of the old ACL. If the patient’s own tissue is to be used for the new ligament, a larger, "open" incision will be made to take the tissue. The new ligament is then fixed to the bone using screws or other devices to hold the ligament in place.
Arthroscopic Surgery is used to diagnose and treat many joint problems. This significant advance in joint care allows for rapid return to improved activity. Most commonly used in knees, shoulders, and ankles, the arthroscope can also be used for spine, hip, wrists, and elbows.
- Step 1 – Two small incisions are made around the joint area. Surgical instruments will be positioned in these incisions.
- Step 2 – A tube-like needle is inserted in one incision. Fluid is pumped through the tube and into the joint. This expands the joint, giving the surgeon a clear view and room to work. The tube will also be used as a drainage needle to regulate the amount of fluid in the joint during the procedure.
- Step 3 – The surgeon will insert the arthroscope through another incision. This instrument has a light and a small video camera that sends images to a TV monitor in the operating room.
- Step 4 – The surgeon can look for damaged tissue using video images from the arthroscope as a guide. If the surgeon sees an opportunity to treat a problem, a variety of small surgical instruments can be inserted through the third small incision.
- Step 5 – The surgeon may close the incisions with stitches or tape. Recovery from arthroscopy is faster than recovery from traditional open joint surgery.
Bone Spur Surgery involves the surgical removal or fusion of a piece of bone at a joint, most commonly from the spine, shoulders, hands, hips, knees, and feet. The two most common surgical procedures are called a Chilectomy (pronounced "K-eye-leck-toe-me") or an Arthrodesis (fusion).
The Chilectomy is a procedure done to remove the bone spurs. This often helps if the spurs are causing a block to the joint motion. However, if the joint cartilage is all worn off, a Chilectomy may not help the pain. The Arthrodesis, or fusion, is an excellent procedure at eliminating much of the pain, but it will cause the toe to be stiff at its base.
A bunion is a painful deformity of the bones and joint between the foot and the big toe. Long-term irritation caused by poorly fitting and/or high-heeled shoes, arthritis, or heredity causes the joint to thicken and enlarge. This causes the big toe to angle in toward and over the second toe, the foot bone (metatarsal) to angle out toward the other foot, and the skin to thicken
Surgical removal of a bunion is usually done while the patient is under general anesthesia and rarely requires a hospital stay. An incision is made along the bones of the big toe into the foot. The deformed joint and bones are repaired, and the bones are stabilized with a pin and/or cast.
Endoscopic carpal tunnel surgery involves a small incision over the palm of the hand through which a surgeon will insert a small tube with a light and camera. Using that tool they will cut the transverse carpal ligament to release pressure on the median nerve.
Some surgeons will remove tissue surrounding the nerve, especially if the tissue is swollen or irritated (as is often found in arthritis patients). The surgeon will then usually close the skin and subcutaneous tissues over only the carpal ligament, leaving the carpal tunnel uncovered. Other surgeons reattach the carpal ligament after lengthening it.
Ganglion cysts are fluid-filled masses that arise off of the joints or tendons of the hand and wrist. They typically arise from the back of the wrist, palm side of the wrist, or in the palm near where the fingers start. They are benign or non-cancerous lesions, which tend to arise in areas of weakness in the joint or tendon. Surgical excision done on an outpatient basis is the best way to avoid damage to other structures and to minimize the rate of recurrence.
Hammertoe is a bending of one or both joints of a toe. This deformity can put excessive pressure on the toe resulting in pain and discomfort.
Arthroplasty is the most common surgical procedure to correct hammertoe. In this procedure, the surgeon straightens the toe by removing a small section of the bone from the affected joint.
Arthrodesis is another surgical procedure to correct hammertoe and is usually reserved for the more advanced cases. In this procedure, the surgeon fuses a small joint in the toe to straighten it. A pin is typically used to hold the toe in position while the bone is healing.
Other procedures may be necessary in more severe cases, including skin wedging (the removal of wedges of skin), tendon/muscle rebalancing or lengthening, small tendon transfers, or relocation of surrounding joints.
Two common conditions that can cause pain to the bottom of the heel are plantar fasciitis and heel spur(s). Although there are many causes of heel pain in children and adults, most can be effectively treated without surgery. When chronic heel pain fails to respond to conservative treatment, surgical care may be warranted.
Plantar fasciitis is an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes. This tissue can become inflamed for many reasons, most commonly from irritation by placing too much stress (such as excess running and jumping) on the bottom of the foot.
Heel Spur(s) or heel spur syndrome are most often the result of stress on the muscles and fascia of the foot. This stress may form a spur on the bottom of the heel. While many spurs are painless others may produce chronic pain.
Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.
A hernia develops when the outer layers of the abdominal wall weaken (or have a defect), bulge, or tear. The hole in this outer layer allows the inner lining of the abdomen to protrude and form a sac.
Laparoscopic hernia surgery is usually performed under general anesthesia. A telescope attached to a camera is placed through a small opening under the belly button. Two more small cuts are made in the lower abdomen. The hernia defect is covered with a mesh and secured with stitches, staples, titanium tacks, or tissue glue.
Open repair surgery is the more traditional approach to Hernia treatment. Although there are many approaches, in a typical surgery the protruding tissue is returned to the abdominal cavity and the sac that has been formed is removed. The surgeon repairs the hole in the abdominal wall by sewing strong mesh surrounding muscle over the defect. Mesh may be used in place of sewing.
Knee Arthroscopy (Knee Scope)
A Knee arthroscopy is performed through small incisions in the skin using an arthroscope, a narrow telescope attached to a video camera. During the procedure, the surgeon also can insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues.
Compared with open surgery, which involves a larger incision, arthroscopy is less painful, carries less risk of infection, and enables a quicker recovery.
Lumbar Steroid Injections
Lumbar steroid injection is a procedure that can help relieve low back and leg pain by reducing swelling and irritation. An injection also can help your doctor diagnose the source of your pain.
Pain Block
For a Pain block, a local anesthetic is injected into a group of nerves, called a plexus or ganglion. These nerves cause pain in a specific organ or body region. If successful, another solution that numbs the nerves can then be injected.
Pain Management Injection
The most common type of pain management procedure is an Epidural steroid injection or Spinal epidural injection. Prior to an epidural steroid injection, the patient’s skin is cleaned with a sterilizing solution and a sterile drape is placed over the skin. Local anesthesia is injected into the skin to provide numbness at the injection site. The steroid injection consists of a local anesthetic and/or steroids. A small bandage may be placed over the injection site.
Rotator Cuff Repair
Rotator cuff repair is an arthroscopic procedure, in which the surgeon places an arthroscope in the space above the rotator cuff tendons. The surgeon can evaluate the area above the rotator cuff, clean out inflamed or damaged tissue, and remove a bone spur.
To repair a tear, the surgeon may perform the surgery with a larger, open incision, while other surgeons use the arthroscope and 1-3 additional small smaller incisions. The goal is to attach the tendon back to the bone where it became detached. The tendon is attached with sutures. Small rivets (called suture anchors) are often used to help attach the tendon to the bone. The suture anchors can be made of metal or plastic and do not need to be removed.
Shoulder Arthroscopy (Shoulder Scope)
Shoulder arthroscopy is a type of surgery to examine or repair the tissues inside or around your shoulder joint. Shoulder arthroscopy is performed through small incisions in the skin, using a narrow telescope (arthroscope) attached to a video camera. A nerve block may be used to numb the shoulder and arm to help reduce pain after surgery.
Shoulder Arthroscopy Decompression
Patients with impingement syndrome that is not cured with conservative treatments may consider a procedure called an Arthroscopic sub acromial decompression. This procedure removes the inflamed bursa and some bone from the irritated area around the rotator cuff tendons. By removing the tissue, more space is created for the tendons, helping inflammation subside.
Trigger Finger Surgery
Trigger finger is an inflammation of the tissue inside your finger or thumb. Tendons, the cordlike fibers that attach muscle to bone and allow you to bend the joints, become swollen. The synovial (a slick membrane that allows the tendons to move easily) also becomes swollen. This makes it difficult to straighten the finger or thumb. In surgery the surgeon opens and enlarges the sheath that surrounds the tendon to release the swollen tendon. This allows the finger to bend and straighten normally again.
Tennis Elbow Repair
Tennis elbow repair is a surgical procedure that involves removing diseased tendon tissue and reattaching normal tendon tissue to bone. It can be performed under regional or general anesthesia. Most commonly, the surgery is performed through a small incision over the bony prominence on the outside of the elbow. Recently, an arthroscopic surgery method has been developed.
After surgery, the elbow is placed in a small brace and the patient is sent home. After one week, the sutures and splint are removed. Next, exercises are started to stretch the elbow and restore range of motion. Light, gradual strengthening exercises are started two months after surgery. The doctor will tell you when you can return to athletic activity, approximately four months to six months after surgery.