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General Definitions


Arthritis is a disease of the joint. A joint is where two bones meet. A limb moves when muscles pull a bone around its joint. To facilitate this motion, joints are naturally lined by a smooth surface called Cartilage.
Arthritis refers to damage to the smooth surfaces of a joint. It can be broken down into two general types-

  • Osteoarthritis,  a degenerative condition, commonly referred to as “wear-and-tear” arthritis. It getsmore common with aging, but can be triggered at young age following injury and certain conditions such as avascular necrosis and osteochondritis. People who say they have ‘arthritis’ usually mean osteoarthritis.
  • Inflammatory Arthritis on the other hand is a condition that destroys the joint in a specific pattern that starts with the surrounding tissues and creeps into the joint surface. The most common and best known subtype is Rheumatoid Arthritis. It can occur at any age and requires medical treatment by a rheumatologist. If the condition proves difficult to control medically, then surgery may be necessary.


Bursae are thin, slippery sacs located between bones, tendons and surrounding soft tissues. They minimize friction between the two. The bursa can become inflamed and swell with more fluid causing pain. This is termed Bursitis.


Tendinitis, tendonitis, and tendonopathy are two terms that are used interchangably. They refer to inflammation or irritation of tendons. Tendons are strong, cord-like structures that  connect muscles to bones. When the muscle contracts, it pulls on the tendon, which in return pulls the bone into motion. Tendons are frequently surrounded by slim sleeves of tissue called tendon sheaths. The inside of the sheaths are smooth and allow free gliding of the tendons. They also help prevent the tendons from snapping out of place while being pulled by the muscles.Technically, tendon substance is not affected by inflammation. So tendinitis theoretically does not exist. So tendon related pain is either due to degenerative changes of the tendon substance ‘tendonosis’, or inflammation of the surrounding tissues, such as the bursa ‘ ie bursitis’ or the sheath  (scientifically called tenovaginalitis, if you insist to know).


The term impingement describes the entrapment of a soft tissue structure, usually a tendon, between two solid structures, usually two bones. This is most commonly used in the shoulder: As the arm is raised, the space between the tip of the shoulder blade (the acromion) and rotator cuff narrows. This narrowing may  cause irritation and pain.


A fracture is a broken bone. When a bone breaks, it may crack but stay well aligned, or the pieces may shift (displaced and / or angulated fracture). If the force is extreme, the bone may shatter into more than two pieces. This is called a comminuted fracture.
If the break in the bone has been exposed to the outside, the fracture is called an “open” fracture. This type of fracture is particularly serious.
Most fractures occur due to an injury. Most of the time the injury is severe enough to break a healthy bone. Some times. however, a bone break after a trivial injury. This is termed an Insufficiency Fracture and may signal a high risk of future fractures. Other times a bone breaks without an obvious injury. This maybe related to overuse and is called a Stress Fracture.

Nonunion and Delayed Union

A nonunion is a fracture that fails to heal . A delayed union is a fracture that takes longer than usual to heal. The usual causes for nonunion and delayed union are either mechanical (too much motion) or biologic (less than optimal healing potential or blood supply). There are several factors that are known to increase the chance of a fracture not healing:

  • Use of tobacco or nicotine products: Smoking, chewing tobacco (rubbing snuff / spitting) , nicotine gum, or nicotine patches
  • Diabetes
  • Regular use of anti-inflammatory drugs such as aspirin, ibuprofen, and steroids.
  • Malnourishment
  • Infection
  • Limited local blood supply such as in scaphoid fractures.
  • Significant soft tissue damage and sever trauma, including open fractures

Avascular Necrosis

Avascular necrosis is a condition where blood supply to a segment of a bone, usually on the joint side, loses blood supply and dies. This may be related to injury, steroids, alcohol, or may just happen. One example is avascular necrosis of the scaphoid following a fracture.

Bone Graft

Bone grafts are pieces of bone that are ‘borrowed’ from a donor area in your body and used to fill a gap or augment bone healing where needed. Commonly used donor sites include the outer side of the pelvis (iliac crest), or the wrist. Bone graft can be obtained from the patients own bones or can be donated. A bone graft provides a lattice on which new bone may grow. Bone grafts also provide fresh bone cells and the naturally occurring chemicals the body needs for bone healing.Bone graft substitutes are not true bone but can be used to serve the same purpose when appropriate. Examples are calcium products. Vascularized bone grafts are those obtained together with their own blood supply most commonly locally from the same limb.

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