Dr. Steven M. DeLuca

The definitive treatment for hip arthritis is total hip replacement. The hip arthritis is surgically cut out of the hip and replaced. Hip replacement is a very successful operation with 95% of patients reporting good or excellent results.

Go to see a local orthopedic surgeon. Do not go back to the ER. See your local orthopod.

I recommend a wrist extension brace (aka Carpal tunnel brace) at night for at least 6 weeks. This keeps the wrist in a neutral position while sleeping. When the wrist volar flexes (palmar flexion) while sleeping, there is tension on the ECRB (extensor carpi radialis brevis), which is the pain generating tendon involved in lateral epicondylitis (Tennis Elbow).

It is very possible that scoliosis is the cause of your "strange back shape." You should be evaluated by an orthopedic surgeon with full length spine X-rays to determine:

1. If you have scoliosis, and if so
2. How severe is it

The severity of the curve determines treatment.

Steven M. DeLuca, DO

There are two sides to the elbow: medial (inside) and lateral (outside). The most common cause of medial elbow pain is golfers elbow, which is inflammation at the muscle origins of the wrist flexors on the medial elbow. The most common cause of lateral elbow pain is tennis elbow, which is inflammation at the muscle origin of the wrist extensors on the lateral elbow. Less common causes of lateral elbow pain include inflammation of the elbow joint, arthritis of the elbow joint, and nerve entrapment in the proximal forearm. Less common causes of medial elbow pain include ligament instability and nerve entrapment called cubital tunnel syndrome. Regardless of etiology, rest, ice, heat, stretching, anti-inflammatory medications, and bracing can all be helpful. Proper ergonomic positioning of the hands, elbows, and wrists at work is also important to consider in your particular situation. If symptoms persist, evaluation by an orthopedic or sports medicine doctor is then indicated.

Steven M. DeLuca, DO

If the toenail is infected (an infected "ingrown toenail"), it is called a paronychia. This usually has to be drained. It's a procedure that should be done by a medical professional, most commonly by a podiatrist. After it is drained, there's usually about a 7- to 10-day course of oral antibiotics.

Steven M. DeLuca, DO

ACL tears are usually non-contact injuries, meaning the ACL can be torn without actually having another player or athlete involved. The mechanism of injury is usually a significant twisting type motion through the knee on a planted foot. Essentially, the lower leg twists one way and the upper leg twists the other way, leading to the tear. Many sports, including skateboarding, require this type of stress frequently across the knee leading to ACL tears in these athletes.

Steven M. DeLuca, DO

Orthotics and toe spacers are good places to start for most mild bunions. In general, bunions are more of a cosmetic deformity, meaning they look worse than they feel. Only if they start to cause pain or skin problems is surgery sometimes indicated.

Steven M. DeLuca, DO

There are many reasons for chronic back pain. It could be as benign as chronic muscle pain, but could always be something more serious. If the pain persists for more than six months, you should be seen by orthopedic surgeon for X-rays and a good physical exam. With that said, it's always good to start with core strengthening and stabilization exercises, a good stretching program of the hips and legs, good postural exercises, ice/heat and anti-inflammatories/Tylenol as needed. "Red Flags" requiring an urgent appointment with an orthopedic surgeon include night sweats, night pain, unexplained weight loss, radiating leg pain or numbness/tingling, loss of control of bowels or bladder and sudden inability to walk.

Steven M. DeLuca, DO

You are experiencing knee instability. If it's a painless giving way, it could be coming from something weakened inside the knee, such as a ligament, or weakness in the muscles around the knee, such as the quad or hamstrings. If it's a painful giving way, there could be something inside the knee getting caught causing a reflexive giving way, such as meniscus or cartilage damage/injury or a loose body moving around inside the knee. If it's painful, see an orthopedic specialist right away. If it's not painful, you could consider trying to strengthen the knee (quads/hamstrings). If you're still having instability despite strengthening, you will definitely need to see an orthopedic specialist.

Steven M. DeLuca, DO

There are multiple reasons for having back pain. The most common is overuse or a muscle strain. If rest, heat/ice, over-the-counter NSAIDs, stretching & strengthening exercises and time do not significantly reduce your symptoms, it may be reasonable to get your back checked by a physician. Sports medicine or orthopedic specialists with likely be the best to evaluate you as they can order and interpret an X-ray which would determine if you have spondylolysis.

Steven M. DeLuca, DO

"Cracking joints" (such as cracking your knuckles) is actually the release of gas (nitrous oxide) from the joint capsule as it is being stretched. It may also come from the snap or pop of a tendon or ligament around the joint. As long as its not painful and not associated with any other symptoms (instability, locking, catching), it's generally benign and nothing to worry about.

Steven M. DeLuca, DO

The possibilities for wrist pain are numerous. When discussing wrist pain, it's important to localize the pain. Is it on the thumb side (radial), pinky side (ulnar) or in between? Pain can come from the ligaments (connects bone to bone), tendons (connects muscle to bone) or the bones themselves.

In general, wrist pain can be from:
Tendinitis - Inflammation of the tendons in and around the wrist area
Arthritis - Wearing away of the cartilage covering the bones of the wrist
Synovitis - Inflammation of the small joints in the wrist
Instability - Laxity in the ligaments that connect the bones in the wrist area
Kienbocks disease - osteonecrosis (bone death) of the lunate bone
TFCC Tear - tear of a stabilizing ligament on the ulnar side of the wrist

The next step for you should be a good exam & an X-ray of your wrist by an orthopedic or sports medicine doctor.

I hope this helps.

You need to find an adult deformity spine surgeon in your area to evaluate your son's. This doctor is sometimes an orthopedic surgeon and sometimes a neurosurgeon. Either is fine as long as they have extensive experience in treating adults with scoliosis. I would bring all of their medical records to that appointment with that surgeon. If you are near a city that has universities, they usually have these type of doctors working at their university hospitals.

Steven M. DeLuca, DO

Joint pain lasting longer then 8-12 weeks that is refractory to RICE (rest, ice, compression, elevation…including NSAIDs) may be suggestive of something more seriously injured then just a simple bruise, strain or sprain and should be evaluated by an orthopedic surgeon.

There are well established criteria for when a broken bone needs surgery, including the hand. In the hand: If there is malrotation that causes overlapping of the fingers with bending, surgery may be required. If the bones are displaced (usually shortened) or angulated severely enough, surgery may be required. If the fracture extends into the joint with articulate displacement or "step off," surgery may be required. Sometimes surgery in the hand is done with removable pinning of the bones through the skin (called perc pinning). Other times plates and screws are required. As always, consult your Orthopedic surgeon for specific indications for your particular injury.

Steven M. DeLuca, DO

The short answer is "yes," but it's not quite that simple. If the usual conservative treatments fail (rest, NSAIDs, PT, Epidural Steroid Injections) and surgery is indicated, there are basically 3 surgical options:

1. Open lumbar laminectomy (tradition surgical technique). This is most commonly performed.

2. Minimally invasive decompression (same surgery, but preserves more of the patient's normal anatomy-muscles, ligaments, tendons, bone). This is becoming more popular, but still less common than #1.

3. Laser assisted decompression (like #2, but a laser is used to "shrink" arthritic ligaments & disc material). By far the least commonly being performed and usually at special "laser spine centers." This technique may be associated with higher complications.

The most important thing is finding a surgeon with significant experience & good outcomes in whichever technique that particular surgeon performs.

Steven M. DeLuca, DO

This recovery from this type of surgery is dependent on what type of tumor is being removed and from what part of the spinal cord. I would strongly encourage you to fully discuss all risks of surgery with your neurosurgeon and the expected outcome including length of recovery. Only the operating surgeon can answer these questions for you.

Steven M. DeLuca, DO

In medicine, we refer to the possible causes of a condition as the differential diagnosis. The differential diagnosis for shoulder pain is a fairly long list. We can sometimes narrow the list based on location, age, history of injury, activity level and associated symptoms. For example, younger patients tend to have more post traumatic shoulder pain whereas older patients tend to have more degenerative conditions around the shoulder. Pain on the top of the shoulder can be associated with problems around the AC joint, whereas lateral shoulder pain is usually more rotator cuff-related. Anterior shoulder pain can be a labral/biceps problem or arthritis. Shoulder pain commonly radiates to the elbow, but usually does not reach the hand or wrist. Pain that radiates down the arm into the hand or wrist and is associated with numbness and tingling is usually a sign of a "pinched nerve" in the neck. There is some overlap with shoulder and neck pathology, so when being evaluated by your orthopedist, they should do a good neck and shoulder exam on you to help determine if it's coming from your neck, shoulder, or possibly both.

Steven M. DeLuca, DO

A corticosteroid injection (CSI) into the base of the thumb joint (basilar joint) is likely to provide significant but temporary relief of the arthritic pain in your thumb. The CSI may reduce pain and swelling for weeks to months but ultimately, the arthritis will progress.

Other non-surgical treatments include: ice or heat, oral & topical anti inflammatory medications, & splints or braces. Ultimately, if non-surgical treatments fail to provide adequate relief of symptoms, surgery is very successful at eliminating the pain in this joint, although a common result is mild residual weakness of pinch strength.

Steven M. DeLuca, DO