Hip Pain on the Side: Greater Trochanteric Bursitis Explained

On December 19, 2024September 11, 2026 By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment

Lateral hip pain that lingers and gets in the way of ordinary activity comes up constantly in my practice. One of the usual culprits is greater trochanteric bursitis, or GTB. It frustrates patients, partly because it takes a while to get named correctly. It gets called arthritis. It gets called a back problem. Catching it early changes how the whole thing goes.

The greater trochanter is the bony bump on the outside of the hip, the one you can find with your fingers. Bursae sit around it, small fluid-filled sacs that keep bone, muscle, and tendon from grinding against each other. Inflame one and you get pain along the outer hip.

Symptoms

Patients describe an ache or a burn over the side of the hip. It can run down the outside of the thigh, though it rarely travels past the knee. Activity makes it worse: stairs, long walks, and lying on that side at night, which is the complaint that finally brings people in. The area is almost always tender to pressure. Some patients mention stiffness after sitting a while, or difficulty getting the hip moving again.

The symptom picture overlaps with lumbar radiculopathy and osteoarthritis, which is exactly why it’s so often mislabeled.

Diagnosis

History does most of the work. When did it start, what makes it worse, was there a fall, and did anything change recently in activity or training. That last question earns its keep more often than people expect.

Point tenderness directly over the greater trochanter is the classic finding. A positive Trendelenburg sign, which reflects gluteal weakness, points toward associated tendon involvement rather than isolated bursitis.

Imaging isn’t always needed. X-rays rule out arthritis. Ultrasound or MRI can show bursal inflammation or gluteal tendinopathy when the case isn’t behaving.

Treatment

Most patients get better with conservative care, and I want to be clear that conservative here doesn’t mean passive. Rest from whatever’s aggravating it, ice over the outer hip, and an NSAID like ibuprofen or naproxen for pain and swelling will settle the acute phase.

Physical therapy is the piece that actually changes the trajectory. Strengthening the gluteal muscles and improving hip stability relieves current symptoms and makes recurrence less likely. I’ve had patients who could barely sleep on their side due to the pain, and after a few weeks of targeted therapy, they were back to normal activities.

When conservative care runs out of road, a corticosteroid injection into the bursa can help, and ultrasound guidance improves accuracy enough to be worth asking for. Platelet-rich plasma and shockwave therapy are still being studied in resistant cases. Surgical bursectomy is rare and belongs to the severe cases that have failed everything else.

Prevention and Long-Term Outlook

Preventing recurrence means dealing with what caused it. Weight management reduces load through the hip. Footwear matters, particularly for anyone on their feet all day on hard floors. Regular hip strengthening and flexibility work keeps the area stable, and patients who avoid long stretches of unbroken sitting or standing tend to hold their gains.

Working Together

For colleagues: keep the differential wide on lateral hip pain, and get physical therapy involved early rather than after the third failed round of anti-inflammatories. A multidisciplinary approach is what produces durable outcomes here.

For patients: this hurts, it can drag on, and it’s genuinely treatable. Most people get their mobility back and return to normal routines.

Trigger Finger: What Is Stenosing Tenosynovitis Exactly?

On July 19, 2014September 29, 2026 By Dr. Scott RennieIn Orthopedic/Musculoskeletal1 Comment

In my urgent care years I often saw patients complaining that one of their fingers got stuck when they tried to bend or straighten it. They would describe how the finger locked in a bent position, and when they forced it straight, it popped painfully back into place instead of moving smoothly. This is what we call trigger finger. It’s a type of tenosynovitis, which means inflammation of a tendon and the protective sheath around it.

Tendons are the strong cords that connect the muscles in your hand to your finger bones. When the tendon or its sheath gets inflamed, movement becomes restricted. Most of the time this happens in the hand or wrist, though it can also occur in the ankle.

The causes vary. Repeated use of the hand with the same motion, like gripping tools or typing, is a common reason. Infection is another possibility, especially if bacteria spread into tissues under the skin.

Symptoms usually start with pain and stiffness, often worse in the morning. Many patients notice a popping or catching sensation when trying to straighten the finger. In some cases the finger locks completely in a bent position. A small, tender lump can sometimes be felt at the base of the affected finger on the palm side. Swelling is also possible, along with trouble gripping or holding objects. Trigger finger most often affects the thumb and middle fingers.

Diagnosis is usually made by physical exam, and most of the time testing isn’t needed. If there’s a history of trauma or concern for infection, your doctor may order x-rays, an ultrasound, or blood work to rule out other issues.

Treatment depends on the severity and the underlying cause. Rest and ice are often the first steps. A cold pack, or even a bag of frozen vegetables, applied to the swollen area for 15 minutes every few hours can help calm inflammation. Nonsteroidal medications like ibuprofen or naproxen may ease discomfort, though they don’t cure the condition.

For more persistent cases, a steroid injection directly into the tendon sheath can reduce swelling and improve movement. If infection is the culprit, antibiotics are required. Surgery is an option for severe or stubborn cases where conservative measures don’t help. Once the symptoms improve, gentle finger stretches can restore motion and prevent stiffness from returning.

What Is Olecranon Bursitis, Also Called Elbow Bursitis?

On March 19, 2013September 11, 2026 By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment

A patient came in today complaining about a lump on her elbow and that is has been slightly painful for the last week. She is a student and spends many hours reading books and resting her elbow on a table while studying. This disorder called olecranon bursitis is a fairly common condition in which the bursa, which is a sac-like structure that protects the elbow from pressure injuries becomes inflamed. Bursas are found all over the body including the shoulders, elbows, knees, feet and hips. They contain a lubricating fluid that fills the sac and decreases the friction between ligaments, bones and tendons. Bursitis of the elbow can be caused from:

Prolonged pressure on a bursa (such as when leaning on the elbow while studying for long periods of time or resting the elbow on a car door during a long trip).
Repetitive motions that cause irritation (laying carpet is an example).
An injury or trauma
Medical conditions such as gout or rheumatoid arthritis or pseudogout
An infection within the bursa (called septic bursitis)

Usually a bursitis is not caused from an infection, but when there is redness and warmth to the skin there is a higher chance of infection. If the skin overlying the elbow becomes punctured or injured there is a higher chance of a septic elbow bursitis. How would I know if I have bursitis or some other type of problem causing the elbow pain? A medial provider who has experience with joint conditions will likely be able to diagnose the problem after examining you and hearing about your symptoms. If there is redness or increased warmth to the area in addition to the swelling, a medical provider might ask to use a syringe and needle to remove a sample of fluid from the bursa to test for infection. The fluid from the elbow can also be tested for crystals that can be caused by gout or pseudogout. If you have uric acid crystals in your elbow, the medial provider will help you lower your uric acid levels to prevent worsening symptoms and decrease the chances of crystals forming in other joints. For more information about gout, please see my blog article on that topic. Sometimes an x-ray, ultrasound or MRI is ordered if there is still some uncertainty about the cause of the elbow problem. What can I do for the bursitis? Treatment of elbow bursitis involved decreasing the pressure or motion that is causing the inflammation. If there is infection, treating with antibiotics is important. If the bursitis is not due to an infection however, then draining the fluid usually is not very helpful because the bursa will create more fluid and only enlarge again. In addition, there is a risk of introducing infection into the joint if a needle is put poked through the skin and into the bursa. If there was not an infection already present within the bursa or joint, there is a greater chance of introducing infection by attempting to withdraw the fluid. It is important to rest the joint and apply ice. We also usually prescribe an anti-inflammatory medication such as naproxen or ibuprofen. Sometimes heat or a steroid injection is also used to help decrease the inflammation. Heat can be applied to the elbow with a hot pack, a heating pad or hot water bottle. Ice can be applied using a frozen gel pack or a bag of frozen peas. I usually don’t recommend using either ice or heat for more than 20 minutes at a time and recommend caution so you don’t burn the skin. How can I prevent bursitis? Irritation to the small bursal sacs can be minimized by decreasing repetitive motions, using cushions or pads to reduce the pressure on joints and taking periodic short breaks from tasks that increase joint pressure. If you start having pain in a joint, this is a warning that there is too much stress and the activity should be modified or avoided. I hope that you have found this information useful. Wishing you the best of health,

Osteoporosis: How to Prevent It and How It’s Treated

On November 21, 2012September 11, 2026 By Dr. Scott RennieIn Orthopedic/Musculoskeletal2 Comments

Osteoporosis: A medical disorder that causes the bones to become weak, thin and fragile. Bones that are weaker are more likely to break (fracture). Women are more commonly affected by this disorder because after menopause lower levels of estrogen are produced by the body. Estrogen is a hormone that helps keep the bones strong. It is very important to detect low bone density (weak bones) because there are treatments available which can protect and actually help build up bone and prevent bone fractures in those people who are at the greatest risk. Why do we care? Bone fractures, especially in the hip cause a huge change in lifestyle and lead to decreased mobility, decreased ability for patients to care for themselves, and increased risk of death due to physical deconditioning, increased risk of infection (from surgery and also from decreased mobility respiratory illness). In fact, people who sustain a hip fracture are more likely to die than a person of the same age who does not experience this injury. About 20 percent of people who have a hip fracture die within a year of their injury. It is estimated that only one in four persons have a total recovery from a hip fracture. Most people spend from one to two weeks in the hospital after a hip fracture. The recovery period may be lengthy, and may include admission to a rehabilitation facility. People who previously were able to live independently will generally need help from home caregivers, family, or may require the services of a long-term care facility. Hip fractures can result in a loss of independence, reduced quality of life, and depression, especially in older people. Fractures that occur in the spine due to osteoporosis can lead to pain and cause changes in the curvature of the spine. We’ve all seen older folks who have difficulty walking due to having abnormal curvature of the spine and these patients often have osteoporotic fractures in the vertebra of the back. Risk factors for osteoporosis: 1) Sex – women are more likely to get osteoporosis than men 2) Age – risk of osteoporosis is higher with increasing age 3) Race – there is a higher risk of osteoporosis in people of white or Asian descent 4) Family history – you are at higher risk of osteoporosis if you have a parent or sibling with osteoporosis, especially if there is a family history of bone fracture 5) Body frame size – men or women who have a smaller body frame size are at higher risk because they have less bone mass to draw from as they age 6) Hormone levels – osteoporosis is more common in patients who have too much or too little of certain hormones (estrogen, testosterone, thyroid, parathyroid or adrenal hormones for example) 7) Low calcium in the diet – a lifelong lack of getting enough calcium increases the risk of developing bones that are thinner and more fragile. 8) Eating disorder – Patients with anorexia are at increased risk of osteoporosis due to decreased nutritional intake of calcium 9) Weight loss surgery – those patients who have surgery to help them lose weight are at higher risk of osteoporosis because of a reduction in the size of the stomach or a bypass of some of the intestines. This may decrease the absorption of calcium or vitamin d. 10) Certain medications – see below Prevention: Several important steps to maintaining proper bone formation and density can be done without the need of medication. These include proper diet, exercise and not smoking. A) Diet: Preventing the bones from thinning involves getting enough nutrients, especially calcium and vitamin D.

Calcium: Most experts agree that men and women who have not reached the age of menopause yet consume at least 1000 mg of calcium each day (combination of diet and supplements). Women who have already gone through menopause should consume at least 1200mg of calcium each day (combination of diet and supplements). Foods that have calcium include dairy milk, cottage cheese, yogurt, hard cheese, green vegetables (especially kale and broccoli). A way to calculate the amount of calcium from food is to multiply the number of servings of calcium rich foods by 300 mg. One serving size of dairy milk or yogurt is 8 oz. 1oz of hard cheese or 16 oz of cottage cheese is one serving size.
Vitamin D: Most experts also agree that men over age 70 and women who have gone through menopause consume at least 800 international units (IU) for vitamin D each day.
Alcohol: Drinking more than 3 drinks per day can increase the risk of fracture due to increased risk of falling and poor nutrition.

B) Exercise: We understand that our bones maintain their strength if we continue to use them. Patients who become immobile are at increased risk of bone fractures because their bones tend to become thinner with decreased use and activity. Patients who are more physically active are generally stronger and less prone to falling as well. Exercising 30 minutes or more three times per week or more is recommended to maintain bone strength. C) Smoking: Smoking cigarettes is known to speed bone loss. One study suggested that women who smoke one pack per day throughout adulthood have a 5-10% reduction in bone density by menopause. If you smoke, I suggest you get help with stopping to help prevent osteoporosis. We can reduce the risk of bone fractures by reducing falls. Several ways to reduce falls in older adults include: 1) Avoiding (as much as possible) medications that can cause dizziness 2) Provide adequate lighting to areas both inside and outside the home 3) Ensure there are no loose rugs or electrical cords that could lead to tripping or falling 4) Avoid walking in areas outside that are unfamiliar 5) Avoid slippery surfaces such as ice or wet/polished floors 6) Ensure good eye care by visiting an eye doctor regularly Screening for Osteoporosis: There are several different recommendations for when to start screening for osteoporosis. The U.S. Preventative Service Task Force (USPSTF) recommends screening women who are age 65 or older who has no increased risk of fracture as compared to a 65 yo women of Caucasian decent. If a woman has a previous bone fracture or an early family history of osteoporosis (especially a mother with an early bone fracture) or has thyroid disease or take medications that can increase the risk of thinning the bones, screening earlier is generally recommended. Assessment tools: There are several tools that have been developed by the WHO (World Health Organization) – (see FRAX) to help assess risk for osteoporotic fractures. These tools ask questions that relate to risk factors for osteoporosis and attempt to calculate a probability of hip fracture even without knowing exact measurements of bone density measured by special x-ray tests. DXA Bone Mineral Density Test: A bone density test uses special x-rays to determine how many grams of calcium and other bone minerals are packed into a bone segment. Bones that are commonly tested include the spine, hip and forearm. We do this test to identify patients who are at higher risk for bone fracture, as well as to monitor the progress of therapy for patients who are being treated. Bone density tests are not the same as bone scans. Bone scans usually require the patient to get an injection before the procedure and are used to detect bone fractures, bone cancer or bone infections. Medications that increase the risk of bone thinning: If you take any of these medications, ask your doctor about whether you should have your bone density tested: 1) Glucocorticoids such as prednisone or dexamethasone 2) Anti-Seizure medications such as Dilantin, Tegretol, Phenobarbital or Primadone 3) Heparin – medication to treat abnormal blood clotting 4) Acid reducing medications called proton pump inhibitors (PPIs) such as Prilosec may increase the risk of osteoporosis or fractures but more research is needed. Treatment for osteoporosis: The treatment really depends on the reason for the decrease in bone density. We might change the patient’s current medications to different medicines that are safer and have less risk for decreasing bone mineral density. Correcting a patient’s thyroid, parathyroid or testosterone imbalance may improve their bone density without the need for other medications. We usually try to ensure that they are getting adequate dietary intake of calcium and vitamin D and may due some lab tests to look for excessive loss of calcium in the urine. We might test the patient’s vitamin D levels along with the hormone levels mentioned above. If there has already been a hip or vertebral compression fracture we will also usually check a bone mineral density (DXA or DEXA) scan to confirm the level of osteoporosis. The DEXA scan gives us a numerical value that corresponds to the degree of osteopenia (low bone density) or osteoporosis (greater risk of fracture). A normal bone density is when the T-score (measured on the bone density test) is between 0 and 1 standard deviation below the mean. A normal T score may be reported as a T-score of +1 to -1. If the T score is -1 to -2.4 the patient is said to have osteopenia which means that they have a risk of developing osteoporosis if not treated. If the T score is -2.5 or less, the patient is diagnosed with osteoporosis. The lower the T score (higher the negative number), the greater the risk of fracture. Medical treatment of osteoporosis: 1) Calcium – at least 1200 mg of calcium/day but no more than 2000 mg/day. 2) Vitamin D – at least 800 international units/day – sometimes very high doses such as 50,000 IU/week may be prescribed if your levels are measured to be very low. 3) Bisphosphonates such as Fosamax , Actonel or Boniva are medications that slow the breakdown and removal of bone (bone resorption). These are taken first thing in the morning on an empty stomach with an 8oz glass for still water. There has been some concern about the use of bisphosphonates in people who require invasive dental work – it may lead to avascular necrosis or osteonecrosis. Most experts do not think that it is necessary for most people to stop bisphosphonates before invasive dental work (tooth extraction or implant) because the risk is very small for those people who take bisphosphonates for osteoporosis treatment or prevention. People who take a bisphosphonate as part of a treatment for cancer should consult their doctor before having invasive dental work however. There is some concern about atypical (stress) hip fractures associated with long-term use of bisphosphonates. Patients who have been taking them for more than 5 years may need re-evaluation to see if further continuation of the medication is recommended. 4) Selective Estrogen Receptor Modulators (SERMs) produce estrogen-like effects on the bone. They include Evista and tamoxifen. In addition to osteoporosis treatment/prevention there is a decrease in the risk of breast cancer in women who are at high risk. These medications are not recommended for women who have not started menopause. 5) Calcitonin is a hormone produced by the thyroid gland that, together with parathyroid hormone, helps regulate calcium concentrations in the body. This may be administered via nasal spray or injection. Nasal administration is usually preferred due to ease of use and less chance of nausea and/or flushing. It’s not clear if calcitonin improves bone in places in the body other than the spine. 6) Parathyroid hormone (PTH) – (prescription preparation name Forteo) produced in the parathyroid glands(non-prescription form) stimulates bone resorption and new bone formation. Clinical trials suggest the PTH therapy is effective in both prevention and treatment of osteoporosis in post-menopausal women and men. It has been proven to reduce spine fracture risk more than any other treatment that we know about. It does, however require a daily injection and is expensive so it’s usually reserved for patients with severe hip or spine osteoporosis with a T score of less than -2.5 (higher number) and osteoporosis-related fracture. When taking Forteo, we often check a blood uric acid and calcium level at the start of the medication, after 6 weeks, 6 months later and then after 12 months of therapy. We generally do not use this medication in pediatric and young children whose bones are still growing or in patients with bone cancer, Paget’s disease of the bone and extreme caution is needed in patients who have a history of recent calcium kidney stones. 7) Prolia is a medication that helps improve bone mineral density and reduce fracture in postmenopausal women with osteoporosis. It is an injection under the skin once every 6 months. It’s usually well tolerated but can have side effects such as skin infections or eczema. It should not be given to patients who have a low blood calcium level. For more information, please check out the following resources: National Library of Medicine Osteoporosis and Related Bone Diseases National Resource Center National Osteoporosis Foundation National Women’s Health Resource Center (NWHRC) Osteoporosis Society of Canada The Hormone Foundation I hope that you have found this information useful. Wishing you the best of health,

Child Won’t Move Their Arm? It Could Be Nursemaid’s Elbow

On May 19, 2012September 11, 2026 By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment

Illustration of a toddler being pulled upward by the forearm with the elbow highlighted, the typical mechanism of radial head subluxation — Mechanism of nursemaid’s elbow (radial head subluxation). Illustration by Hariadhi, CC BY 4.0, via Wikimedia Commons.

A parent brought her young child in to see me today and told me that she was holding hands with her and then the child suddenly jerked her hand away and attempted to twirl around in a dance move. After the little girl yanked her arm away, she cried and didn’t want to move her left arm at all. This is a common scenario and classic story for what we call nursemaid’s elbow or radial head subluxation (RHS). Nursemaid’s elbow is the most common elbow injury in young children. It usually affects kids between one and four years of age. The left arm is more commonly affected than the right. Mechanism: With sudden traction of the child’s arm with the elbow extended, a portion of a ligament in the elbow slips over one of the elbow bones and gets trapped in this position. By 5 years old, this ligament becomes thicker and more resistant to being displaced. The typical story is that the wrist was pulled while the child’s palm was pointed down towards the ground. This is common when the parent or caregiver grabs the child’s arm to prevent them from falling or pulling away. It can also occur when the child is swung by the forearms during play. Falling onto the elbow, minor trauma, or twisting motion of the arm can also cause radial head subluxation. Younger children sometimes roll over in bed and this can somehow trap the forearm under the body and result in longitudinal traction. Symptoms: When the child comes in, I usually hear the story that she’s not using the affected arm. Treatment: Most of the time after explaining the procedure to the parents, we can treat the displaced ligament by relocating it by putting the child’s arm/elbow through a range of motion technique. No anesthesia or sedation is required, although the procedure is painful briefly. Complications/Recurrence: Nursemaid’s elbow can sometimes occur again if the child sustains another injury with the typical mechanism. There are no long term complications associated with nursemaid’s elbow. As previously mentioned, the annular ligament strengthens with age and therefore radial head subluxation rarely occurs after age five. The little girl who came into the clinic today is doing great. The procedure to fix her elbow took a few seconds and after a few minutes she was using her arm again and practicing her dance moves. I hope that you have found this information useful. Wishing you the best of health,

Elbow Pain: Several Common Causes and Treatment Options

On April 23, 2012September 11, 2026 By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment

Pain in the elbow is a common musculoskeletal complaint seen in the urgent care. It can happen as a result of sports injury or trauma or can be symptoms of underlying infection, gout or bursitis. Several causes are listed below: Elbow tendinopathy: This is usually called golf or tennis elbow and is caused when then tendon, or strong band of tissue that connects muscles to bones is injured or inflamed. The symptoms are pain, swelling and even weakness in the elbow. Olecranon bursitis: A “bursa” is a small fluid-filled sac that sits near a bone. Bursitis happens when the bursa gets irritated and swollen and can happen when a joint is moved over and over again in the same way over a short period of time. It may also happen if the elbow sits on a hard surface or stays in a position that presses on the bursa for a long time. Nerve entrapment: The ulnar, median and radial nerves course in close proximity to the elbow. Ulnar neuropathy is the most common compression neuropathy and it can cause sensory loss, pain and paresthesias over the ring and small fingers. Osteoarthritis: Degenerative processes of the elbow are rare because it is non-weight bearing. When present however osteoarthritis is usually related to prior fractures that involve the joint. If there is an elbow deformity, we often think about underlying inflammatory arthritis. Radial head fracture: Fracture of the radial head of the elbow most often occurs when the patient falls on an outstretched hand. The radial head and neck make up the proximal portion of the radius. Pain and swelling over the lateral elbow can be a sign of this type of fracture. Elbow dislocation: Posterior elbow dislocation is the most common dislocation in children younger than 10 years of age and the second most common in adults, after shoulder dislocation. Posterior elbow dislocations usually occur after a fall or a twisting injury to the elbow. Radial head subluxation (nursemaid’s elbow): This is a common elbow injury in young children typically between 1-4 years old. The mechanism of injury is sudden traction on the distal arm with the forearm pronated and the elbow extended. A portion of the annular ligament of the patient’s elbow slips over the head of the radius and slides into the radiohumeral joint where it becomes trapped and causes pain. The treatment is generally fairly easy by an experienced healthcare provider and the patient has immediate relief of pain when it is done properly. Gout: Usually characterized by the sudden onset of severe elbow pain often with redness, swelling and tenderness. There is no history of trauma. It is caused from the uric acid crystals that develop in the joint (usually a single joint) and is less common in the elbow than the big toe. Treatment of elbow pain: Identifying the cause of the patients elbow pain and treating that is the most efficient way to treat the patient’s pain. Treatment may involve manipulation of the joint, using a shoulder sling and ice, or medication such as anti-inflammatories, and pain relievers, and possibly antibiotics. I hope that you have found this information useful. Wishing you the best of health,

Shoulder Pain: Common Causes and Treatment Options

On April 22, 2012September 11, 2026 By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment

Illustration of the shoulder showing the supraspinatus tendon inflamed where it passes beneath the acromion — Rotator cuff impingement. Illustration by Injurymap, CC BY 4.0, via Wikimedia Commons.

One of the most common injuries that bring patients into the urgent care is related to the shoulder. The shoulder is an inherently unstable joint. The glenoid is shallow, allowing for a wide range of motion, with only a small portion of the humeral head articulating with the glenoid in any position. The anatomy of the shoulder allow for increased mobility, but also predispose the shoulder to increased risk of injury. There can be numerous causes for shoulder pain, some of which are presented here. Shoulder Impingement Syndrome: This occurs when the tendons of the rotator cuff and the subacromial bursa (a fluid-filled sac that separates the bones of the shoulder joint) are compressed between the bones of the shoulder. Doing work with the arms outstretched overhead can cause shoulder soreness but does not necessarily lead to impingement. Shoulder impingement is only diagnosed when symptoms continue and interfere with normal daily activity. Chronic impingement can lead to bursitis, rotator cuff tendinopathy, and if left untreated, thinning or tearing of the rotator cuff tendons. Separated Shoulder: A separated shoulder is a condition that causes shoulder pain and swelling. It happens when certain ligaments in the shoulder joint tear or get stretched too much. Ligaments are strong bands of tissue that connect bones to other bones. The shoulder joint is made up of 3 bones: The collar bone, the shoulder blade, and the upper arm bone. The most common cause of a separated shoulder are falling on the shoulder or getting hit in the shoulder. Biceps Tendonitis: Tendons are tough bands of tissue that connect muscles to bones. Repetitive activities and overuse can injur tendons leading to pain and impaired function. The biceps muscle is located in the front of the upper arms, and is used when lifting, bending the elbow, and reaching up over the head. The upper portion of the biceps muscle attaches to the front of the shoulder in two places and the lower portion attaches to the bone in the forearm. Lifting, pulling, reaching or throwing repeatedly can lead to biceps tendinopathy or even tears of the upper biceps tendon. Frozen Shoulder: The term used to describe a stuff shoulder joint that has temporarily lost the ability to move freely; most people with frozen shoulder have difficulty reaching overhead and reaching to the low back. The stiffening is the body’s natural response to inflammation that develops in or near the shoulder. Stiffening is a protective reflex that protects the shoulder from further injury. Rotator Cuff Injury: The rotator cuff is made up of 4 shoulder muscles and their tendons. One common injury is tendinopathy, and that is when people have a problem with 1 of their tendons. In most people with tendinopathy, the tendons are not inflamed or swollen. If they do get inflamed or swollen, doctors call it “tendonitis”. Another type of rotator cuff injury is a tear in a tendon. Tears can happen if a person falls on the shoulder or moves the shoulder too fast and with too much force. Tears can also happen as a tendon wears out over time. Shoulder Arthritis: Fortunately, arthritis of the shoulder progresses slowly and is an uncommon problem. In almost every case, the shoulder has been injured months or years earlier, leading to an abnormal wearing down of the cartilage. Shoulder Dislocation: Anterior dislocation of the shoulder is a painful condition that is usually caused by a blow to the abducted, externally rotated and extended arm (eg, blocking a basketball shot). Less commonly, a blow to the posterior humerus or fall on an outstretched arm can cause an anterior dislocation. Posterior shoulder dislocations are rare and are only about 2% of shoulder dislocations caused from a blow to the anterior portion of the shoulder. Shoulder pain treatments are tailored specifically towards the cause of the patient’s pain. Shoulder dislocations are usually treated by re-locating the shoulder joint after x-ray examination to rule out fracture of any of the bones of the shoulder. Dysfunction of the tendons or ligaments of the shoulder are often treated with physical therapy, anti-inflammatory and pain medications and sometimes surgery. Immobilization: Depending on the type of injury, a shoulder sling may be recommended to help reduce pain and help with healing. The patient should be careful not to remain in the sling for too long because the risks of frozen shoulder (ie. adhesive capsulitis) increase with shoulder immobilization. I hope that you have found this information useful. Wishing you the best of health,

Wrist Fracture or Colles Fracture: What Is a FOOSH Injury?

On April 1, 2012September 11, 2026 By Dr. Scott RennieIn Orthopedic/Musculoskeletal1 Comment

Fracture of the distal radius (arm) is one of the most common fractures. The majority of these fractures are in two distinct populations: youth who are involved in sports and sustain a relatively high-energy fall, and seniors with osteoporosis who fall with low energy. How the injury occurs: The most common mechanism is Falling On an Out-Stretched Hand (FOOSH), with extension of the wrist (backward bending). Indications for referral to surgeon: Most of the time distal radius fractures can be managed by your primary care physician. There are some circumstances however which require referral to a surgeon such as: 1) Open fractures – ie. Fractures with laceration of skin above the bone 2) Fractures where there is pressure building up in the soft tissues of the wrist due to ongoing bleeding 3) Fractures where the nerves of the hand/wrist are damaged 4) Other fractures that are unstable Treatment: We usually don’t put a cast on immediately after the injury because of the swelling, and risk of decreased blood flow due the injured area that can occur inside the cast. For non-displaced extra-articular fractures, we usually treat with a well-molded sugar tone, reverse sugar tong or double sugar tong splint. The elbow is usually flexed to 90 degrees and the arm is in a neutral position. The arm is kept in a splint for a few days following the injury and should do the following: 1) Elevate the arm 2) Apply ice to the fracture frequently (while keeping the splint dry) 3) Begin active range of motion to the shoulder and fingers 4) Use pain medication as needed Patients are seen 3-5 days after the injury to evaluate, remove the splint and assess neurovascular status. We often repeat x-rays at this time with the arm out of the splint. If the fracture still looks non or minimally displaced, the healthcare provider then applies a short arm cast. The cast will extend from the distal palmar crease to within 5cm of the antecubital fossa. The patient is by their healthcare provider every 2-3 weeks until the healing is complete. Patients should remain in the cast until there is evidence of radiographic healing or the fracture is non-tender and that is generally for 6 weeks. At this point, a wrist brace can be used instead of the cast. Complete healing can require 6-8 weeks. If there is initial displacement of the bones on x-ray, the splint is usually kept in place for 2-3 weeks, then changed to a short arm cast with immobilization for another 4-5 weeks. Healing of these displaced fractures usually takes 8-12 weeks. Possible complications: Injury to the medial nerve or compartment syndrome are the most important and early complications of a distal radius fracture. Acute Carpal Tunnel Syndrome (ACTS) is a nerve injury to the medial nerve that sometimes occurs with a traumatic fracture. Signs of compartment syndrome include increasing or constant severe pain or pain elicited by passive extension of the fingers. These symptoms usually start within 12-54 hours after the injury, so it is important for the patient to tell their physician if their pain is worsening during this time. Injury to other bones within the hand/wrist can accompany a distal radius fracture, but they are rare. They are suspected in patients with persistent wrist pain despite acceptable alignment. Return to work: Patients with more sedentary jobs may return to work immediately. Physical laborers may return to full duty of after they have regained near-normal wrist motion and strength. It is reasonable for participants in contact sports also to delay return to play until they have achieved near-normal motion and strength, and to wear a protective palmar splint during the first few weeks of play. Splint Care: a cast or splint will help protect the injured bone or tendons and reduce pain as you heal. It is important to take care of the splint to minimize risk of possible problems such as a skin infection. Splint care instructions: 1) Swelling is common and can make your splint feel tight initially. To reduce the swelling we recommend keeping the splint above the level of your heart for 24-48 hours. Resting the splint on pillows or having your arm or leg in a sling that keeps the extremity elevated is important. 2) Gently move your fingers or toes (where the splint is located) frequently. 3) Ice can help keep the swelling down. Apply ice or a frozen bag of vegetables to the injured area. Do not apply blue ice (mostly used for camping) directly to the skin because this can cause freezer burn. 4) Do not get the splint wet. Bathe with the splint covered in a plastic bag and tape the opening shut to prevent damaging it. Hang the splint outside of the bathtub if possible. 5) If the splint becomes wet, dry it with a hair dryer on the cool setting. Using a hot setting can burn the skin. 6) Keep the splint clean and avoid getting dirt or sand into it. Do not apply powder or lotion on or near the splint and cover the splint when eating. 7) Don’t place anything inside the splint, even for areas the itch. Sticking things inside the splint can injure the skin and lead to infection. Do not pull the padding out from inside the splint. When to seek help for your splint: 1) Your fingers or toes get cold or blue, hurt, get numb, tingle or throb – this may indicate the splint is too tight 2) There are sore areas or a foul odor from the splint 3) If the splint breaks or is damaged 4) If you develop severe pain in or near the splinted arm or leg 5) If the splint becomes soaking wet or does not dry with a hair dryer or vacuum. I hope that you have found this information useful. Wishing you the best of health,

Plantar Fasciitis Explained: A Real Pain in the Foot

On March 31, 2012September 11, 2026 By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment

One of the more common reasons that I see patients in the urgent care for is plantar fasciitis. It causes foot pain, mostly in adults. Patients are more prone to this kind of foot problem if they jump or stand for prolonged periods of time. These motions stretch the plantar fascia. Most people who have an episode of plantar fasciitis have no pain within one year. Causes: A strain in the ligaments in the fascia which is a thick, white pearly tissue with long fibers that starts at the heal bone and fans out along the under surface of the foot and extends to the toes. The plantar fascia provides support as the toes bear the weight of the body when the heal rises while walking. Symptoms: pain beneath the heel and sole of the foot. The pain is often worst when stepping out of bed early in the morning or getting up after being seated for a period of time. Risk factors: 1) Long distance running 2) Standing for long periods of time (grocery store cashiers for example) 3) Dancing 4) Repeated squatting or standing on the toes 5) Poor fitting shoes 6) Obesity Diagnosis: The diagnosis is usually made by a healthcare provider who takes the history of the patient and performs a physical examination. Treatment: Several treatment options are used to help with plantar fasciitis. They may include: 1) Rest – Limit jumping or standing for extended periods of time. A complete lack of physical activity is not recommended however 2) Ice – Putting ice on the area 4x/day for 20 minutes at a time may reduce pain 3) Exercise – Home exercises including calf-plantar stretches, foot and ankle circles, toe curls, and toe towels often help reduce pain. Careful attention not to overdo the stretches is important 4) Pain medication – Ibuprofen or Naproxen may be helpful to reduce the swelling and pain 5) Shoes with good arch support or metal shanks take the pressure off the plantar fascia and are one of the most important parts of treatment. 6) Steroid Injection – a steroid shot may be given in the foot to relieve pain but usually the effect wears off after a few weeks. There is also a risk of worsening the foot pain due to small crystals of the steroid forming in the plantar fascia 7) Casting – a short walking cast that has a rocker-shaped bottom decreases the flexibility of the sole of the foot and can provide relief from pain. 8) Surgery – this is rarely recommended for plantar fasciitis. If symptoms persist for at least 6-12 months and all other treatments have failed, it may be an option for some people I hope that you have found this information useful. Wishing you the best of health,

Cervicalgia – A Pain in the Neck

On March 30, 2012September 11, 2026 By Dr. Scott RennieIn Orthopedic/Musculoskeletal2 Comments

I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.

Patients frequently come into the Urgent Care clinic for problems related to neck pain. It can be caused by a number of different factors including ligament or muscle strain, arthritis or a “pinched nerve.” It is quite common, and in fact 10% of adults have neck pain at any one time. Most patients recover with conservative therapy regardless of the cause of the pain. Understanding neck pain is much easier if you have a good knowledge of the structural anatomy of the neck. Brief description of the anatomy is outlined below: 1) Cervical vertebrae: Seven small bones the make up the cervical spine of the neck 2) Spinal canal: The structure through which the spinal cord (nerves) flow which is made from the cervical vertebrae as well as the supporting ligaments and overlying neck muscles. 3) Cervical discs: Between the neck bones, these tiny shock absorbers cushion one bone from another. The inner part of the disc contains a gelatin-like material and when excessive pressure on the disc occurs, this gelatin-like material can protrude and cause what we call a “herniated disc.” Causes: There are several causes for neck pain, some of which are mentioned here: 1) Whiplash injury: A traumatic event that causes sudden forward/backward movement of the cervical spine. A motor vehicle accident is the most common cause. 2) Cervical strain: Injury to muscles of the neck that cause spasm of the neck and upper back muscles causes this type of pain. It can be a result of physical stresses of everyday life including poor sleep habits, muscle tension from psychological stress, or poor posture. 3) Diffuse skeletal hyperostosis: Also called (DISH) is when there are abnormal calcifications in the ligaments and tendons along the cervical spine. 4) Cervical spondylosis: Abnormal wear and tear causes gradual narrowing of the disk space and loss of normal bone structure which often leads to bone spurs. These spurs can increase the pressure on surroundings areas. 5) Cervical discogenic pain: The intervertebral discs of the neck function as shock absorbers that cushion the neck bones from one another. If there are structural changes in these discs, it can cause pain. 6) Cervical facet syndrome: Pain involving the facet joints is common in people who repeatedly extend the neck (tilt the head backwards). The facet joints are on the left and right of the vertebrae. 7) Cervical radiculopathy: When disk or neck pass pushes on or irritates a nerve root, this can cause pain, weakness or numbness/tingling of the neck and/or arm. 8) Cervical spondylotic myelopathy: This is narrowing of the spinal canal inside the bones of the neck, and is usually caused by either damage to the disks or degeneration from arthritis. Testing: In order to determine the cause of the pain, your healthcare provider will examine your neck and look at the movement or range of motion to the neck and observe posture of the neck and shoulders. In some cases there may be a radiological study such as an x-ray, MRI (magnetic resonance imaging) or CT scan (computed tomography) ordered. The need for on of these tests depends on the patient’s history and physical examination. Treatment: The individual treatment is tailored to the patient to help treat the underlying cause of pain. Some possible treatments may include: 1) Medications: Ibuprofen, naproxen or Tylenol may be prescribed. A muscle relaxant is sometimes added for a short course. Opioids are not a good answer for neck pain and I would not expect them to be part of the plan. 2) Heat: Can be helpful for decreasing the muscle spasm in the neck. Moist heat (from a shower, hot tub, or moist towel warmed in a microwave or with warm water) seems to work best 3) Ice: Can reduce the pain in many people. Ice is applied directly to the painful area. A bag of ice, frozen peas or a ice cubes in a plastic bag is often used, but avoid applying the blue ice that is used for coolers/camping to the skin as this can cause freezer burn. 4) Massage: By applying pressure on both sides of the neck and upper back, the neck muscles may be relaxed. This is usually most helpful if done by a professional massage therapist. 5) Stretching exercises: Do not attempt exercises without being evaluated by a healthcare provider as they can actually make the problem worse if performed incorrectly. Exercises can be performed to relieve stiffness and improve range of function. 6) Stress reduction: Neck tension can be increased due to emotional stress and can delay the recovery process. To help with stress reduction, breathing exercises, meditation, progressive muscle relaxation, biofeedback, prayer or self-hypnosis are helpful for some patients. 7) Posture: It’s important to avoid extreme ranges of motion or positions that cause constant tension. Avoid sitting in the same position for extended periods of time. Also avoid placing backpacks, over-the-shoulder purses, or children on the shoulders. Do not perform overhead work for prolonged periods of time. Hold your head up and keep shoulders back and down to maintain a good posture. Sleep with your neck in a neutral position by sleeping with a small pillow under the nape of your neck (while laying on your back). Carry heavy objects close to your body rather than with outstretched arms. Other treatments: 1) Osteopathic manipulative therapy (OMT)– physically manipulating the muscles, soft tissues and joints can help with neck pain 2) Trigger Point Injection: A local anesthetic such as lidocaine can be injected into an area of muscle spasm 3) Accupuncture: A needle placed into the proper body area by a healthcare professional who is trained in accupunture therapy can be helpful 4) Electrical stimulation: Transcutaneous electrical nerve stimulation (TENS) is a treatment that uses a mild electric current that is applied to the skin to decrease pain and increase mobility and strength. Some people have found TENS helpful. 5) Cervical traction: The use of weights to pull the spinal column into alignment have been helpful for some people in the short term, however clinical studies have shown no long term benefits. 6) Surgery: Surgery has a role in relieving symptoms related to a pinched nerve in some cases. Usually these patients have tried all prior treatment options before proceeding with surgery. To find an Osteopathic physician in your area, the American Osteopathic Association has a useful website: http://www.osteopathic.org/osteopathic-health/find-a-do/Pages/default.aspx I hope that you have found this information useful. Wishing you the best of health,

Dr. Scott Rennie

Category: Orthopedic/Musculoskeletal

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