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About Iliac Crest Pain (Pelvic Pain) Medical Treatment | Los AngelesThe pain is typically sharp, sudden, and differs in intensity. It can be experienced along the iliac crest. However, it can also spread all the way to the spine, along the sciatic nerve path, through the hip and all the way to the groin region.

It is crucial to identify the exact reason and location if the pain. This can enable the patient to be on the right track and speed for recovery.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

 

What can be done for Iliac Crest Pain?

Certain people go straight to the physician’s office at the first indication of pain. Yet others seek ways to treat their condition at home. There is no right approach here.

The patient can try and assess their general condition at home and decide whether they need professional help, or whether they want to try at-home treatment.

Some things that the patient can undertake are as follows:

Discontinue the pain-causing activity

While this may seem intuitive, there are many instances where people force themselves to endure the pain (like runners trying to finish a race). Doing so is not a good idea.

Rest

Resting will give the patient some time to assess their condition, and determine whether the intensity of the pain is increasing or reducing. In case it does not resolve on its own, patients should contact their doctor. This will also allow the body time to heal itself.

Icing

Icing the impacted area will settle the swelling down, reduce the inflammation, and relieve pain. The patient should ensure that they do not apply ice directly to the skin, and wrap it in a piece of cloth and then apply; nearly 15 minutes, around twice daily.

Stretching

Patients should approach stretching cautiously, depending on the reason for the pain. They should gently stretch the muscles of their core and leg and stop if they feel any pain before the condition worsens.

 

Best Iliac Crest Pain Exercises and Stretches – Iliopsoas Muscle

Iliac crest pain may occur due to issues with the Iliopsoas muscle. The video below offers more information on the muscle as well as the anatomy. It also features some good stretching exercises which can release the pain and tension:

Medical Treatment

The patient should contact their GP for help if the pain does not resolve after a couple of days, or it becomes worse. Some common medical treatments for iliac crest pain include:

  • injections to the affected region
  • anti-inflammatory medicines
  • physical therapy
  • electrical stimulation
  • range of motion exercises
  • surgery

If the pain is severe and sudden or persists for more than a few days, the patient should contact a doctor. Medical treatment options for this condition include:

  • lidocaine injection
  • physical therapy, particularly when the pain is caused by the iliotibial band
  • corticosteroid injection to decrease inflammation when other treatments have been unsuccessful
  • physical therapy can also address pain issues in the running gait

Board certified orthopedic surgeon Dr. Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

About Iliac Crest Pain (Pelvic Pain) Causes | Los AngelesIliac crest refers to the part at the top of the hip that lies close to the skin and forms the wing-shaped part of the pelvis on which a person will sometimes rest their hands.

Iliac crest pain may also spread to other parts of the body, including the groin, back, and abdomen. The area where the pain is felt depends on the underlying cause.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding communities.

 

Causes of Iliac Crest Pain

Weak Muscles

To support the joints and move properly, strong core muscles are necessary. Hip pain may occur if the lower back muscles or abdominal muscles are weak.

Trauma

The iliac crest can sustain damage during a trauma, such as a car crash or a fall. This can cause pain and tenderness in the hip region, and at times, in the lower back.

In case of a serious fall where a person lands on the front or upper portion of the iliac crest, it is known as a hip pointer.

Sacroiliac Joint Dysfunction

Lower back, groin, or abdomen may occur due to damage to or swelling in the sacroiliac joint.

This joint is in the pelvis and joins the iliac crest to the lower portion of the spine. It may sustain damage due to aging, arthritis, or exercise, such as jogging.

The pain often initiates in one side of the lower back and butt. It can extend up to the lower hip, upper thigh, or groin.

People may also experience tingling, numbness, or weakness in their leg. The symptoms may worsen when sleeping, sitting, or walking up and down stairs.

Ilium Apophysitis

An apophysis refers to a type of growth plate and the point on a bone where the muscles are connected. It is the region of the bone that the rest of the bone grows from. Therefore, it is the last area of the bone to completely harder. It is relatively soft in children and teens.

In case the muscles are repeatedly pulled from the growth plate, say, during sports, it can become inflamed and irritated, or even be pulled off the bone. Once growth has finished, and the bone hardens fully, the condition will resolve itself.

Ilium apophysitis develops in children and teenagers. It occurs due to overuse and causes a dull pain at the front of the hip. At times, this area may be inflamed and is typically tender. The pain may worsen with activity.  

Iliolumbar Syndrome

Iliac crest pain syndrome, also called iliolumbar syndrome, develops when the iliolumbar ligament tears. This may occur due to repeated bending or twisting motions and actions. It may also occur due to trauma, such as a fall or car crash.

The common symptoms of this condition include persistent bouts of severe lower back pain that can spread to the groin and hip. The pain may worsen when a person twists or bends.

Board certified orthopedic surgeon Dr. Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

About Iliac Crest Pain (Pelvic Pain) | Los Angeles | Beverly HillsThe iliac crest forms the most prominent portion of the ilium, the largest of three bones that comprise the hip bone or bony pelvis.

It is the curved portion at the top of the hip that lies close to the skin and forms the wing-like part on the pelvis on which a person will sometimes rest their hands.

Iliac crest pain can also extend to other parts of the body, including the abdomen, back, and groin. The location of the pain depends on its cause.

The bony pelvis or hip bone provides stability, strength, and support to the organs and spine. It consists of three bones, namely the ilium, ischium, and pubis.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

 

Muscles Connected with Iliac Crest

Apart from dividing the abdomen and the pelvis, the iliac crest is connected to many vital muscles, such as:

  • Gluteus maximus of the hip itself
  • Latissimus dorsi or largest muscle in the back
  • Main abdominals

 

How does iliac crest pain feel?

Iliac crest pain usually causes difficulty in performing normal movements. The type of pain that patients experience can vary.

In addition, pain may be experienced in areas other than the hip, so as many nerves and muscles are joined to the pelvis.

The exact location of the pain will depend on its underlying cause. However, the most commonly experienced symptom is lower back pain.

The pain may extend down the leg, through the butt, and into the groin. It can also cause dull aches in the buttocks or back or sharp muscle spasms in some people. Others may feel pain when walking, which may be made worse by twisting or bending.

Inflammation and tenderness can also be indications of iliac crest issues, specifically if caused by trauma.

 

Iliolumbar Syndrome

Iliac crest pain syndrome, also called iliolumbar syndrome, develops when there is a tear in the iliolumbar ligament. This can occur due to repeated bending and twisting movements and actions. It may also occur due to trauma, such as a car crash or fall.

The common symptoms of iliolumbar syndrome include the persistent severe pain in the lower back that can extend to the groin and hip. This pain may worsen when a person twists or bends.

 

Piriformis Syndrome

Piriformis syndrome often occurs when muscles become too tight, usually due to wear and tear. This causes strain on the sciatic nerve. As a result, the pain spreads through the buttocks and hips.

This condition may develop due to exercising in worn gym shoes, causing pain in the pelvic area.

 

Gluteus Medius Pain

Pain near the iliac crest may occur due to a problem with the medius muscle. This may lead to reduced blood flow, range of movement, and flexibility as well as less nerve and muscle function.

 

Cancer of the Bone

In exceptional cases, iliac crest pain may occur due to cancer of the bone. But in most cases of iliac crest pain, the cause will be one of the above mentioned conditions.

Board certified orthopedic surgeon Dr. Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

Piriformis Syndrome - Treatment | Los Angeles | Beverly HillsThe piriformis muscle is located deep in the hip and extends in close proximity to the sciatic nerve. Upon becoming tight and/or swollen, it can lead to irritation of the sciatic nerve. This irritation causes sciatica-like pain, numbness, and tingling.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding communities.

 

Treatment Options

Various treatment options may be recommended by a medical care professional, depending on the severity of the sciatica-type pain that the patient is experiencing and other symptoms.

A thorough approach to piriformis syndrome management may include a combination of the below mentioned non-surgical treatments:

  • Ice Packs and Ice Massage.
  • Ice and Heat Therapy for Piriformis Syndrome.
  • When the pain initiates, the patient may lie in a comfortable position on the stomach and apply an ice pack on the painful site for around 20 minutes. Repeat as necessary every two to four hours.

Combining a gentle massage with the ice may be more helpful. The patient should lie on their stomach and ask someone to massage the painful site with a large ice cube gently.

If the ice is placed on the skin directly (rather than using a cold pack), the application should be restricted to 8 to 10 minutes to prevent ice burn. If the pain increases after specific activities, it may be advisable to apply ice right after the activity.

 

Heat Therapy

Alternating cold with heat is also beneficial for some patients. If the patient uses a heat pad, they should lie on their stomach and apply the heating pad on the painful region for up to 20 minutes. Patients should be cautious to avoid sleeping on the heating pad as this can cause skin burns.

 

Medications for Sciatica Pain

As a majority of episodes of pain occur due to some type of swelling, non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen or ibuprofen, may help reduce inflammation in the impacted area.

 

Piriformis Injections

An injection may be part of the treatment for severe sciatica pain due to piriformis syndrome.

The doctor may inject a local anesthetic and corticosteroid directly into the piriformis muscle to help reduce the pain and spasm. The reason for administering an injection is often to reduce acute pain and allow progress in physical therapy.

 

Botox Injection

In case of a persistent piriformis spasm that is unresponsive to treatment with anesthetic/corticosteroid injections, an injection of botulinum toxin (for example, Botox), a muscle paralyzing agent, may be helpful. The objective of the injection is to enable the muscle to relax and help decrease pressure on the sciatic nerve.

 

Electrotherapy for Piriformis Syndrome

Electrical stimulation application to the buttock with a transcutaneous electrical nerve stimulation (TENS) unit or interferential current stimulator (IFC) can assist in blocking pain and reducing piriformis syndrome-related muscle spasms.

The piriformis muscle can be cut to alleviate symptoms in persistent cases. However, this is undertaken only in rare cases.

 

Piriformis Muscle Stretches

It is almost always necessary to stretch the piriformis muscle to relieve the pain along the sciatic nerve, and it can be performed in various positions.  

Many stretching exercises for the piriformis muscle, hamstring muscles, and hip extensor muscles may be done to help reduce the painful symptoms along the sciatic nerve and restore the patient’s range of movement.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

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Piriformis Syndrome - Cause | Los Angeles | West HollywoodThe piriformis is a muscle that lies behind the hip joint in the buttocks. The piriformis muscle is tiny in comparison to other muscles around the thigh and hip. This muscle helps in external rotation (turning out) of the hip joint.

The piriformis muscle and its tendon are closely related to the sciatic nerve (the largest nerve in the body), which provides the lower extremities with sensory and motor function.

The piriformis tendon and sciatic nerve cross one another behind the hip joint, within the deep buttock. Both of these structures are around one cm in diameter.

Piriformis syndrome is a condition that has been described as an irritation of the sciatic nerve from the piriformis muscle. It remains controversial whether or not this represents a distinctive diagnostic entity. However, it has been described multiple times in medical literature.  

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

 

Potential Causes

If an individual is diagnosed with piriformis syndrome, it is considered that piriformis tendon may be impinging the sciatic nerve, leading to nerve irritation.

It has not been proven, but the theory supported by many doctors is that when the piriformis muscle and its tendon are excessively tight, the sciatic nerve is compressed. This may reduce the blood supply to the nerve and irritate the nerve due to pressure.

A majority of individuals who suspect piriformis syndrome think that it develops due to anatomic variation of the muscle and tendon. In some people, it is believed that this relationship leads to irritation of the nerve causing sciatica symptoms.

The recognized reasons for piriformis syndrome are as follows:

  • Injury
  • Abnormal location or development of the piriformis muscle or sciatic nerve
  • Abnormal spine alignment, such as scoliosis
  • Leg-length discrepancy (when the length of the legs varies)
  • Extended periods of sitting, particularly if carrying a thick wallet in a pocket right behind the piriformis muscle
  • Before hip surgery
  • Unusually aggressive exercise
  • Foot problems, such as Morton’s neuroma

The cause cannot be determined in many cases.

 

Prevention

There is no reliable method to prevent the occurrence of piriformis syndrome.

The standard recommendations for individuals who have had this or other back issues include a heel-lift (in case the legs are of varying lengths, home exercises and stretching, not carrying a wallet in the back pocket, avoiding extended periods of sitting, and undergoing treatment for other contributory conditions, such as foot problems or spinal arthritis.

 

Prognosis

Timely diagnosis and treatment enable the prognosis to be quite good. But the condition may become long-lasting. A poor result may be likely in case of delayed diagnosis and treatment.

 

The Bottom Line

Piriformis syndrome may be the most commonly occurring cause of sciatic-type back pain that people have never heard of. On the other hand, it may be rare.

But no one is really certain. In case a person has persistent, unexplained buttock main that extends into the leg, they should stop carrying their wallet in their back pocket, try not to sit too much, and consult their physician.

They may have a disc condition or some other common back issue. However, it is possible that they may have piriformis syndrome and prompt diagnosis can make a difference.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

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Piriformis Syndrome – Symptoms | Los Angeles | Beverly HillsThe average patient with piriformis syndrome complains of “sciatica,” which is severe, sharp, radiating pain from the lower buttock or back extending down the leg and into the thigh, calf, and foot.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding communities.

 

Signs and Symptoms

The symptoms of piriformis syndrome may appear following disc herniation (“slipped disc”) or hip bursitis. However, a thorough examination by the doctor helps sort out the real cause as with piriformis syndrome the patient also experiences the following:

  • Challenging to sit or put weight on the posterior on one side
  • Muscle spasm of the piriformis muscle
  • Pain in the piriformis muscle during a rectal examination
  • Sciatica-type pain when the hip moves and rotates outward against resistance

Patients commonly report acute tenderness in the buttock and sciatica-like pain extending down the back of the thigh, calf, and foot. The symptoms of piriformis syndrome may include:

  • A dull ache in the butt
  • Pain extending down the back of the thigh, calf, and foot (sciatica)
  • Pain when walking up inclines or stairs
  • Increased pain after an extended period of sitting
  • Decreased range of motion of the hip joint

Piriformis syndrome symptoms usually worsen after prolonged periods of walking, sitting, or running, and may feel better upon lying down on the back.

 

Diagnosing Piriformis Syndrome

A review of the patient’s health history, a physical exam, and diagnostic tests help determine the presence of piriformis syndrome in a patient.

Piriformis syndrome diagnosis is made through a process of eliminating other possible conditions that may be the reason for the patient’s symptoms, such as sacroiliac joint dysfunction or a lumbar disc herniation.

 

Physical Examination

The physical examination involves an assessment of the hip and legs to check if movement causes an increase in lower extremity pain (sciatica pain) or low back pain.

In general, hip motion will recreate the pain. The examination will also eliminate or identify other potential causes of sciatica pain, such as testing for muscle strength or local tenderness.

 

Medical History

A health history includes a detailed review of the patient’s symptoms, such as how long they have been experiencing the symptoms, what activities or positions make the symptoms better or worse if they manifested slowly or following an injury, and what treatments have been tried.

This will also include an assessment of conditions that may be in the patient’s family, such as arthritis.

 

Diagnostic Tests

X-rays and other imaging tests for the spine cannot determine if the sciatic nerve is being compressed by the piriformis muscle. But diagnostic tests (MRI, X-rays, and nerve conduction tests) may be undertaken to rule out other conditions that can cause symptoms that are similar to piriformis syndrome.

To confirm if the piriformis muscle is the cause of the symptoms, an injection of anesthetic with or without steroids may help.

Magnetic Resonance Neurography: This type of magnetic resonance imaging (MRI) test checks for swelling in the nerves.

FAIR Test: The flexion, adduction, and internal rotation test flexes the hip in order to stretch the piriformis and impinge the sciatic nerve. It measures the time lapses in the sciatic nerve signals due to its impingement under the piriformis.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.
Dr. Tigran Garabekyan
 is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or 
call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

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What is piriformis syndrome? | Los Angeles | West HollywoodPiriformis syndrome refers to a neuromuscular disorder that occurs when the piriformis muscle compresses the sciatic nerve.

The piriformis muscle is a band-like and flat muscle that is located in the butt near the top of the hip joint. This muscle is crucial for lower body movement as it provides stability to the hip joint and lifts and rotates the thigh away from the body.

This allows a person to walk, shift their weight from one foot to another, and maintain balance. It is also vital to performing sports activities involving lifting and rotating the thighs. In fact, it is essential for almost every movement of the legs and hips.

The sciatic nerve is a long, thick nerve in the body. It extends alongside or goes through the piriformis muscle, extends down the back of the leg, and eventually branches off into smaller nerves that end in the feet. A spasm of the piriformis muscle may cause nerve compression.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

 

Pathophysiology

The piriformis muscle can compress or shorten the sciatic nerve underneath the muscle when it shortens or spasms because of trauma or overuse. In general, these types of conditions are known as nerve entrapment or as entrapment neuropathies.

The specific condition called piriformis syndrome involves sciatica symptoms that do not originate from spinal roots and/or spinal disc compression but occur due to the involvement of the overlying piriformis muscle.

In 17 percent of an assumed normal population, the sciatic nerve goes through the piriformis muscle, instead of passing beneath it. But in patients receiving surgery for suspected piriformis syndrome, such an anomaly was detected only 16.2 percent of the time. This creates doubt about the relevance of the anomaly as a contributing factor in piriformis syndrome.

According to some researchers, the relevance of this relationship in the etiology of the syndrome is not high. However, MRI findings indicate that hypertrophy (unusual largeness), as well as atrophy (unusually smallness) of the piriformis muscle, is related to the supposed condition.

Some theories hypothesize that individuals who exercise routinely by bicycling, running, and other forward moving activities may be more prone to developing piriformis syndrome if they do not perform strengthening exercises and lateral stretching.

But it is also likely that such individuals actually have small herniations in a spinal disc which compress the sciatic nerve and lead to a piriformis spasm secondarily.

There is scant evidence indicating a specific relationship between the strength or weakness of particular hip muscles and sciatic pain centered on the piriformis muscle. Additionally, this sports-related explanation is not useful in understanding the piriformis syndrome in people who are not particularly physically active (which is frequently the case).

A piriformis muscle spasm can result in the impingement of the sciatic nerve as well as the pudendal nerve. The pudendal nerve controls the muscles of the bladder and bowels. Pudendal nerve entrapment symptoms include numbness and tingling in the saddle areas and groin. It can also cause urinary and fecal incontinence.

Piriformis syndrome may also be related to direct injury to the piriformis muscle, such as from a knife wound or in a fall.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

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What is Osteonecrosis? | Los Angeles | West Hollywood | GlendaleOsteonecrosis, also known as avascular necrosis or aseptic necrosis, refers to the death of bone cells due to the reduced blood supply. This condition can cause pain and collapse of areas of bone. 

Bone collapse can further lead to degenerative arthritis (osteoarthritis) of the surrounding joints, most commonly the hips and knees. Osteonecrosis also affects the hands, shoulder, and feet albeit less often. In rare cases, osteonecrosis may develop in the jaw. This can lead to sores (ulcers) in gum tissue, pain, and exposed jaw bone.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

 

Key Facts

  • Similar to arthritis, osteonecrosis can also lead to severe pain and disability. The outcome may improve with early diagnosis and treatment.
  • Glucocorticoid (corticosteroid) or the consumption of excessive amounts of alcohol may lead to osteonecrosis.
  • Osteonecrosis can develop in nearly any bone of the body. But the sites that it most often affects are the hips, shoulders, and knees.
  • Osteonecrosis of the jaw involves a different cause and treatment in comparison to osteonecrosis found in other areas of the body.

 

What causes Osteonecrosis?

  • Serious injury (trauma) which leads to interruptions in the blood supply to a bone
  • Corticosteroid drugs (such as cortisone, prednisone, or methylprednisolone), especially when a high dose is used for an extended duration
  • Consumption of excessive amounts of alcohol
  • Systemic lupus erythematosus

Osteonecrosis affects between 10,000 and 20,000 Americans each year, and a majority of these patients are aged between 20 and 50 years. These patients usually have a history of serious injury, corticosteroid use, excess alcohol consumption or one of the other risk factors.

 

Treatment

Early treatment

In general, the treatment commences with pain meds and by limiting weight bearing, such as walking, on the impacted areas. For patients with osteonecrosis in small areas of the bone, this type of conservative treatment may be effective.

However, it is not a suitable treatment option for patients with knee or hip osteonecrosis who are experiencing worsening disease and collapse of bone. In such cases, the patient may require surgical intervention for pain relief and bone collapse prevention.

 

Surgery

Patients with worsening osteonecrosis may require a procedure known as core decompression. It eliminates a fragment (core) of bone from the impacted area aiming to enhance blood supply.

Patients facing an advanced stage of osteonecrosis may require a procedure called osteotomy. In this procedure, the surgeon will eliminate dead bone and re-position the remaining bone to allow the healthy bone to offer support to the weight-bearing joint surface.

If there has already been bone collapse at the joint, the patient will usually require total joint replacement (arthroplasty) of the knee or hip. This procedure should offer pain relief and improved function to the patient.

Bone grafting is another surgery for advanced osteonecrosis cases. In this procedure, the surgeon takes a tiny piece of the patient’s own healthy leg bone and transplants (grafts) it to the site of dead bone. Bone grafting enhances blood supply and support of the surrounding bone.

 

Medicine

For osteonecrosis management, there is no proven medical treatment. Certain studies indicate that short-term bisphosphonate treatment may slow, improve, or even prevent the collapse of bone in the knee and hip.

 

Treatment of Jaw Osteonecrosis

Conservative treatment can help improve most cases of osteonecrosis of the jaw. This treatment includes limited removal of dead tissue (debridement) and the use of medicated mouthwash and antibiotics.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

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Developmental Dysplasia of The Hip | Los Angeles | West HollywoodIn Developmental dysplasia of the hip (DDH), the “ball and socket” joint of the hip does not develop appropriately in babies and young children. Therefore, it is also known as congenital hip dislocation or hip dysplasia.

The hip joint connects the femur (thigh bone) to the pelvis. The top portion of the femur, or femoral head, is rounded like a ball and lies within the cup- shaped hip socket.

DDH refers to the condition in which the hip is too shallow, and the femoral head is not held firmly in position making the hip joint loose. The femur can even come out of the socket, or dislocate, in severe cases.

 

More Often in Females

While DDH can impact one or both hips, it occurs more commonly in the left hip. On top of this, it develops more frequently in girls and firstborn children. Nearly one or two in every 1,000 infants have DDH that requires treatment.

If left untreated, DDH may cause the following issues later in life:

  • Limp development
  • Hip pain, specifically in adolescence
  • Stiff and painful joints (Osteoarthritis)

The early diagnosis and treatment of this condition enable most children to develop in a normal manner and have a full range of motion in their hip.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding communities.

 

Diagnosing DDH

The infant’s hip will be evaluated as a routine part of the newborn physical exam within 72 hours of giving birth. When the baby is between six and eight weeks old, another hip exam will be performed.

 

Pavlik Harness

Infants who are diagnosed with DDH early on are typically treated with a fabric splint known as a “Pavlik harness.” This harness secures the baby’s hips as well as allows them to develop in a normal manner.

The baby will need to wear the harness at all times for several weeks. Only health professionals should remove this harness. During follow-up appointments, the medical professional may adjust the harness and discuss the baby’s progress with the parent(s).

 

Surgery

If the baby is older than six months, or if the Pavlik harness has been ineffective, they may require surgical intervention. Reduction is the most common surgical technique to treat this condition, and it involves the placement of the ball of the femur back inside the hip socket.  

This surgeon will perform reduction with the patient under general anesthesia. It may be done in the following ways:

  • Closed Reduction: The surgeon will place the ball in the socket without placing any significant incisions (cuts).
  • Open Reduction: In this procedure, the surgeon places an incision in the groin to enable them to place the ball in the socket.

The child will require a hip cast for a minimum of six weeks following surgery. The doctor will perform a hip examination with the child under general anesthesia again to ensure that it is healing properly.

 

A Possibility

Following this examination, the patient will likely need a cast for at least another six weeks to help the hip to stabilize completely. In some cases, the child may need osteotomy (bone surgery) as well during an open reduction, or later on, to correct any deformities of the bones.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

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What is a Hip Impingement? | Los Angeles | West Hollywood | GlendaleHip impingement, also called femoroacetabular impingement (FAI), causes the abnormal and wearing contact between the hip joint’s ball and socket. In this condition, there is increased friction during hip motions which may damage the joint.

Patients usually experience pain in the groin after sitting or walking for prolonged durations. Many athletes typically report pain in the groin during deep flexion or rotation of the hip. At times, there may be popping or clicking in the front of the hip.

The pain may also extend to the side of the thigh and in the rear. It is vital to exclude other reasons for pain in this area which may initiate in the abdomen or low back.

Hip impingement or femoroacetabular impingement treatment starts with nonsurgical, conservative approaches such as anti-inflammatory drugs, rest, activity modification, and physical therapy.

Patients may also experience relief with an anesthetic or steroid injection in the hip joint. When the patient requires surgery, arthroscopic hip surgery can usually effectively treat femoroacetabular impingement.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.

 

How is Impingement Diagnosed?

In the diagnosis of femoroacetabular impingement, medical imagery using x-ray and magnetic resonance imaging (MRI) is essential. An x-ray can display whether there is an excess of bone on the femoral neck or head, and on the acetabular rim. An MRI can help the doctor view fraying or tears of the labrum or cartilage.

 

Conservative (Nonsurgical) Treatment for Femoroacetabular Impingement

The treatment of femoroacetabular impingement should always initially focus on nonsurgical treatment.

A regimen of rest, modifying activities, physical therapy, and/or anti-inflammatory drugs can often resolve femoroacetabular impingement. These conservative treatments have been effective in the reduction of inflammation and pain in the joint.

In case the pain is persistent, it may sometimes be necessary to distinguish between the pain originating from the hip joint from pain initiating in the abdomen or lower back. Injecting the hip with a steroid and analgesic is a proven way to differentiate between the two types of pain.

 

Hip Arthroscopy in the Treatment of Femoroacetabular Impingement

Hip arthroscopy, also known as “hip scope,” is a minimally invasive surgery. Arthroscope use allows the surgeon to place two or three tiny incisions instead of a larger incision that they would need to place in the case of a more invasive “open” surgery.” They will use these tiny incisions (“portals”) to insert surgical tools into the joint.

On top of this, developments in arthroscope technology allow the flow of saline through the joint during the surgery offering the surgeon a clear view of the area. Fluoroscopy which is a portable x-ray apparatus also aids the surgery. It helps ensure that the surgical tools and arthroscope are inserted appropriately.

The surgeon will remove the damaged tissue and loose fragments within the joint. Sometimes, they may need to drill holes into patches of bare bone where there has been cartilage loss. This procedure is known as “microfracture,” and it prompts the development of new cartilage where it has been lost.

This is an outpatient procedure which allows the patient to undergo surgery in the morning and return home on the same day. The surgeon usually performs this procedure with the patient under local anesthesia.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

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