Q: Is surgery necessary for a broken collarbone?

A: Unless the fracture is severely displaced (out of alignment), involves nerve damage, or involves multiple fractures in the same extremity, surgery is rarely indicated. Generally a period of rest, with the affected arm in a sling is the recommended treatment. Anti-inflammatory medication may also be prescribed.

Q: I have tried all types of treatment for my tennis elbow - NSAIDs, cortisone injections, ultrasound therapy, and physical therapy - but continue to experience pain. Is surgery my only other option?

A: Today there are several other non invasive or minimally invasive options for chronic tennis elbow sufferers with symptoms nonresponsive to conservative treatment for six months or more. A relatively new, noninvasive shockwave therapy administered with an electrohydraulic device that utilizes "spark gap" technology - called the OssaTron - has proven effective in treating chronic tennis elbow. Depending on the severity of the condition and patient profile, arthroscopic elbow surgery is also an effective treatment option far less invasive than open surgery.

Q: My mom has osteoporosis and recently fell and broke her elbow. The doctor said she should replace her elbow with a new joint. Is this really necessary?

A: The bone density of those suffering from osteoporosis is extremely deficient and leaves bones vulnerable to breaks with even the mildest force. These bones are also difficult to repair, because it is hard to affix the commonly used fixation devices for fractures to these soft bones. An elbow joint replacement, known as arthroplasty, would be a viable solution in such situations.

Q: In overstress tendon conditions, do steroid injections become less helpful the more someone has?

A: As with many medications, the body begins to build a resistance and either requires higher doses or alternative solutions. With regard to steroid injections specifically, reports indicate that the benefit derived from injections steadily decreased with the number of injections.

Q: My grandmother had an elbow replacement and then got an infection in the joint and it had to be removed. The doctor says that too much of the joint is destroyed to do another joint replacement and is recommending arthrodesis. What is this procedure?

A: Arthrodesis is the process of fusing bones together - usually in the case of a failing joint with chronic instability and pain. It allows bones that make up the joint to grow together, or fuse, into one solid bone.

The goal of arthrodesis is to limit motion by obtaining bony consolidation of worn joint surfaces and eliminate the pain generated when articular surfaces lose their cartilage covering and bone is allowed to rub directly against bone.

New specialty plate and screw constructs are being introduced in both limited and total arthrodesis, which today are procedures indicated for trauma, carpal instability, avascular necrosis, tumor damage, septic and rheumatoid arthritis. Arthrodesis may also be used in the salvage of an unsuccessful wrist or elbow arthroplasty.