LATEST POSTS
Posted May 18, 2012
A Pain That Won’t Quit
If osteoarthritis were a color, people with severe degeneration and bone-rubbing-against-bone pain might paint the disease as an incandescent, fiery red. In some cases the pain is so debilitating and unrelenting, it needs treatment by a health care professional.
For others, who have mild degeneration or intermittent or occasional discomfort, a pale pink palette might be more apt. They can often manage the disease themselves with rest and over-the-counter medications.
But what exactly is osteoarthritis?
It is a chronic degenerative joint disease that affects some 27 million Americans and results in approximately 632,000 joint replacements each year.
It is the leading cause of disability in the U.S, and it is expensive, not only in human terms, but in monetary ones as well. Osteoarthritis costs the U.S. economy nearly $128 billion dollars a year in medical care and indirect expenses. It is common to all races and backgrounds. Men, however, under age 55, are more likely to have it than women in the same age range, but, after age 55, women take the lead and are more commonly affected.
Osteoarthritis is a disease that mostly affects cartilage, the rubbery tissue that covers and protects the ends of bones in a joint and forms a cushioning space between them. When osteoarthritis is present, the cartilage loses its elasticity and is more easily damaged by injury or excessive use. Healthy cartilage allows bones to glide over each other and to absorb the shock of our movements. In OA, the top layer of cartilage has broken down and worn away, leaving a narrower or nonexistent space between the bones under the cartilage. The bones can then grind against one another, and that friction can cause pain, inflammation, swelling and, often times, loss of motion in the joint.
Additionally, as cartilage breaks down, changes occur in the underlying bone. Bony growths called spurs can develop along the bone surface at the margins of the joint which can also be sources of pain.
Adult cartilage has no blood supply, which makes regeneration virtually impossible. The changes are, therefore, irreversible.
“Osteoarthritis is very common,” says osteopathic physician Carina O’Neill, medical director of Massachusetts General Hospital’s Spaulding Rehabilitation Outpatient Center in Braintree. “If people live long enough, most will develop some form of osteoarthritis in at least one joint. It is a chronic condition and has no cure. The goal is to manage the symptoms.”
To read the full article: http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20120517/NEWS/120519848/-1/ENTERTAIN
Posted May 4, 2012
Knee pain, though common, can signal several ailments
Q: Is pain directly under my kneecap anything to be concerned about?
A: Knee pain is fairly common and can affect people of all ages. Your pain could be the result of an injury or could be a more serious medical condition.
Runner’s knee: Pain directly under the kneecap can be attributed to one of several conditions. Among the most common is chondromalacia, also known as runner’s knee.
It usually happens to people who participate in high-impact exercise, such as running, or sports that require a lot of stopping and starting. Chondromalacia is a softening or thinning of the cartilage under the kneecap.
Often, people with chondromalacia may feel a crunching sensation when placing their hand over the kneecap and bending the knee or when climbing down stairs.
To read the article in full: http://articles.chicagotribune.com/2012-04-25/health/sc-health-0418-knee-pain-20120425_1_knee-pain-chondromalacia-osteoarthritis
Posted October 26, 2011
How is the knee designed, and what is its function?
The knee is a joint that has three compartments. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third compartment called the patellofemoral joint. The thigh bone (femur) meets the large shinbone (tibia) forming the main knee joint.
The knee joint is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (cruciate ligaments). These ligaments provide stability and strength to the knee joint.
The meniscus is a thickened cartilage pad between the two joints formed by the femur and tibia. The meniscus acts as a smooth surface for motion and absorbs the load of the body above the knee when standing. The knee joint is surrounded by fluid-filled sacs called bursae, which serve as gliding surfaces that reduce friction of the tendons. Below the kneecap, there is a large tendon (patellar tendon) which attaches to the front of the tibia bone. There are large blood vessels passing through the area behind the knee (referred to as the popliteal space). The large muscles of the thigh move the knee. In the front of the thigh, the quadriceps muscles extend the knee joint. In the back of the thigh, the hamstring muscles flex the knee. The knee also rotates slightly under guidance of specific muscles of the thigh.
To read the article in full, Visit: http://www.medicinenet.com/knee_pain/article.htm
Posted October 17, 2011
Knee Pain: Is it arthritis, tendinitis, bursitis?
http://www.news-journalonline.com/columns/managing-pain/2011/10/17/is-it-arthritis-tendinitis-bursitis.html
Have you been told that you have arthritis because you experience knee pain? Is the pain on the side of your knee rather than within the knee joint? If so, you may actually have pes anserine bursitis or medial or lateral collateral tendinits.
The knee joint, which links the thigh and shinbone, is stabilized by strong cords called tendons. Strategically placed to prevent the knee from moving side to side, the medial collateral tendon is located on the inner side of the knee to prevent it from collapsing inward, and the lateral collateral tendon, on the outer side, to prevent outward twisting. The pes anserine bursa, a sac-like, protective cushion, is located beneath the tendons on the inner side of the knee.
Medial collateral tendinits usually occurs as a result of trauma associated with falls such as skiing or football injuries. Lateral collateral tendinits happens less frequently and heals more easily because it is less vulnerable to injury due to its location on the outer side of the knee. When direct trauma, overuse or misuse occurs, not only can the tendons become injured but the bursa can also become inflamed and irritated, meaning bursitis.
Long-distance runners commonly develop pes anserine bursitis because of stress placed on the knees. Misalignment of the lower extremities due to osteoarthritis can stress knee tendons and bursas causing tendinits and bursitis.
The most common complaint with medial collateral tendinits and pes anserine bursitis is constant aching of the inner side of the knee with increased pain on rotation of the knee. Activity, especially flexion and external rotation of the knee, increases pain, while resting and heat relieves it. Often, patients wake up at night due to pain and are unable to kneel or walk down stairs. Physical examination may reveal tenderness along with pain upon flexion and rotation.
Treatments for these conditions are similar, but are obviously location specific: analgesics, nonsteroidal anti-inflammatory drugs, use of a knee brace to prevent reinjury, physical therapy and heat application. Local cortisone injections at the affected site (anserine bursa or medial or lateral collateral tendon) are crucial to decrease inflammation for a successful outcome.
As in many circumstances, other conditions can show similar symptoms that must be differentiated prior to beginning treatment. Knee pain can be caused by arthritis, tendinits, bursitis or meniscus tear. The coexistence of knee osteoarthritis and tendinits, bursitis or meniscus tear is quite common, particularly in the elderly, which makes diagnosis much more difficult.
Don’t just accept the answer that “You’re getting older and you have arthritis.” Know what the important differences are, and get the treatment you need and deserve.
Posted September 28, 2011
A Closer Look At Knee Problems
http://www.htrnews.com/article/20110927/MAN04/109270535/A-closer-look-knee-problems?odyssey=mod%7Cnewswell%7Ctext%7CFRONTPAGE%7Cs
Many people have problems with knee pain and feel forced to give up the activities they enjoy. Often, there are solutions to help keep them up to speed.
Here are a few commonly asked questions relating to knees and knee pain:
What makes your knee joint glide smoothly?
Articular cartilage is a complex living tissue that lines the bony surface of joints. Its function is to provide a low friction surface enabling the joint to withstand weight bearing through its range of motion. It acts like a thin shock absorber.
How is articular cartilage injured?
Articular cartilage injuries can occur as a result of either an injury or just wear and tear over the years.
Since it has no direct blood supply, articular cartilage has little or no capacity to repair itself. Occasionally, an articular cartilage fragment completely breaks loose from the underlying bone. This chip, called a loose body, may float in the joint, interfering with normal joint motion.
Degeneration of articular cartilage occurs with the progressive loss of normal cartilage structure and function. This initial loss begins with softening then progresses to fragmentation. As the loss of the articular cartilage lining continues, the underlying bone has no protection and begins to break down, leading to osteoarthritis.
What are signs of an articular cartilage defect or injury?
In many cases, you’ll experience knee swelling and vague pain. If a loose body is present, you might feel that your knee is “locking” or “catching.” You may also experience stiffness, decreased range of motion, joint pain and swelling.
How is this diagnosed?
Your orthopaedic surgeon will examine your knee looking for symptoms like decreased range of motion, pain along the joint line, swelling, fluid on the knee, abnormal alignment of the bones making up the joint and ligament or meniscal injury. Evaluation with an MRI or an arthroscopic procedure may be necessary.
When is surgery necessary?
When a joint is injured, the body releases enzymes that may further break down the already damaged articular cartilage.
Injuries that penetrate to the bone may heal, but the type of cartilage that is laid down is structurally unorganized and does not function as well as the original articular cartilage.
Treatment options include arthroscopic surgery using techniques to remove damaged cartilage and increase blood flow from the underlying bone. For smaller articular cartilage defects that are asymptomatic, surgery may not be required. For larger defects, it may be necessary to transplant cartilage from other areas of the knee or joint.
For patients with osteoarthritis, non-surgical treatment consists of physical therapy, lifestyle modification (reducing activity), bracing and supportive devices, oral anti-inflammatory drugs or lubricant injections. Total joint replacement can provide relief for the symptoms of advanced osteoarthritis.
Posted September 21, 2011
Knee Pain Control – No Drugs – Doctor Used
http://www.prnewswire.com/news-releases/knee-pain-control—no-drugs—doctor-used-130218818.html
Dr. Melisa Estes, who is a pain specialist in Jupiter, Florida, sees many patients who suffer from chronic knee pain. She recently began incorporating a new technology into her treatment regimen.
Transcutaneous electrical nerve stimulation, also known as TENS, sends electrical stimulation to the source of patients’ knee pain. That stimulation inhibits pain signals from reaching the brain, and that reduces pain.
DJO Global of San Diego announced the launch of the Empi Active™ Knee System recently. It uses TENS to reduce knee pain.
“I like using it because it can help decrease the amount of pain medication that a patient may take,” said Dr. Estes.
Physicians are concerned about the addictive nature of pain medicine and its possible side effects. The most recent figures show over 250 million drug prescriptions for pain medications are written every year in the United States.
Dr. Abdallah Kabbara, who practices in the Cleveland, Ohio area, not only prescribes this new therapy, but he uses it himself to treat a knee injury from practicing martial arts with his children. “I am fascinated with simple stuff that works for the patient,” he said.
“I know from personal experience that the treatment works well on musculoskeletal strains. When I tell my patients that I was a patient and it helped me, it obviously builds confidence that it might work for them, too,” Dr. Kabbara added.
Posted August 27, 2011
Knee Pain; Explanation and Causes
If you’re a runner with knee pain, wait until you hear what might help. Here’s a hint…it’s connected to your hip bone.
The knee is a complex joint made of three bones: the lower end of the femur (thighbone), the upper end of the tibia (shinbone) and the patella (knee cap). The ends of the bones are covered in a layer of cartilage that protects the bones and provides lubrication. Four ligaments (tough bands of tissue) connect and hold the bones in place: the anterior cruciate ligament (ACL), posterior cruciate ligament, and two collateral ligaments.
The patella, located in the front of the knee, protects the joint. It is held in place by two tendons. The patellar tendon attaches the patella to the shin bone. The quadriceps tendon attaches the top of the knee cap to the thigh muscles. When the knee is bent or straightened, the underside of the kneecap glides over a V-shaped notch in the femur.
The American Academy of Orthopaedic Surgeons reports, in 2003, there were 19.4 million visits to physician’s offices for knee pain, making it the most common complaint seen by orthopedic surgeons. One of the most common causes of knee pain is patellofemoral pain syndrome (PFPS), also known as anterior knee pain, or runner’s knee. Researchers estimate 25 percent of physically active Americans have PFPS. Women are affected more often than men.
In PFPS, the kneecap doesn’t move properly over the end of the femur, causing wear on the cartilage. Eventually, when a section of cartilage softens and erodes, the bones rub together. The problem can occur if the kneecap is out of alignment, the muscles that hold the kneecap in place are unbalanced or the knees are stressed from excessive movement (like jumping and twisting).
The main symptom associated with PFPS is pain in the front of the knee. The pain is especially prevalent when climbing or descending stairs, getting up from a seated position or sitting with knees bent for an extended period. Tracy Dierks, Ph.D., Physical Therapy Researcher with IU School of Health and Rehabilitation Services in Indianapolis, IN, says runners with PFPS often complain of knee pain that starts sometime during the run and intensifies until they stop running.
To read the full article: http://www.wtvq.com/health/9382-knee-pain-hip-fix-
Posted August 8, 2011
Study Questions Combining Analgesics for Knee Pain
Combining ibuprofen and paracetamol at nonprescription doses conferred a modest improvement in pain relief in adults with knee pain/osteoarthritis. But this gain came at the expense of an increase in presumed gastrointestinal bleeding, results from a large randomized, controlled trial demonstrated.
The trial, published in the September 2011 edition of the Annals of Rheumatic Diseases, found that paracetamol 3 g/day may cause similar levels of blood loss as ibuprofen 1,200 mg/day, and that the combination of the two appears to be additive or even synergistic in terms of the number of individuals with a decrease in hemoglobin greater than 2 g/dL.
“These results need to be confirmed, along with their clinical relevance and identification of the site of gastrointestinal bleeding,” wrote the researchers, who were led by Dr. Michael Doherty of the Arthritis UK Pain Center at Nottingham (England) City Hospital. “If confirmed, this observation should lead to the reconsideration of current recommendations for oral analgesic use in osteoarthritis and in chronic pain in general, and to the consideration of strategies to reduce this side effect.”
To read the article in full: http://www.familypracticenews.com/news/more-top-news/single-view/study-questions-combining-analgesics-for-knee-pain/344aa288f6.html
Posted July 27, 2011
Tips to Prevent and Treat Knee Pain
http://abcnews.go.com/GMA/tips-prevent-treat-knee-pain/story?id=14017910
Knee pain can be caused by a variety of events, and many types of minor knee pain respond well to self-treatment. But if you’re experiencing minor knee pain, then unfortunately, several exercises you may be used to should be off limits during the time you have knee pain.
High impact sports (basketball, soccer) and strenuous jogging should be avoided until your knee pain improves.
Low impact exercises such as aquatic exercises (swimming, water walking) and regular walking are recommended.
Stretching can improve the flexibility of the knee. These include calf, hamstring, hip, and buttocks stretches.
It is key not to cause too much discomfort during these stretches in order to avoid stressing the knee further.
Certain leg lifts and hip abductor exercises can strengthen the knee.
BUT, call a doctor if you can’t bear weight on your knee, have significant swelling or are unable to fully extend and flex your knee. Your doctor can also give you more specific exercise recommendations.
Posted July 22, 2011
Four Common Injuries Runners Most Often Experience
http://heraldnews.suntimes.com/lifestyles/6148884-423/treating-the-4-common-injuries-runners-most-often-experience.html
Running has continued to increase in popularity in the United States over the past decade. The number of finishers of United States marathons cracked the half-million mark for the first time in 2010, according to Running USA.
There are many great benefits to running, such as improved cardiovascular health, decreased stress levels, and a great opportunity for competition. Running is relatively a low-cost sport to participate in, and many people can continue to run even at an older age.
Running may seem like a pretty straight-forward sport, but according to the American Academy of Physical Medicine & Rehabilitation, about 70 percent of all runners will be injured at one time during their running career. While many of these injuries may appear minor, they can get worse over time if not properly treated.
Types of injuries:
The four most common running injuries that occur are iliotibial band syndrome, patellofemoral syndrome, Achilles tendinitis and plantar fasciitis.
Iliotibial band syndrome is the most common cause of pain on the outside of the knee in runners. The iliotibial band is a band of connective tissue that stretches from the outside of the hip and inserts into the outside of the knee. A common cause of this condition is always running on the same side of the road.
Patellofemoral syndrome or sometimes referred to as “runner’s knee” is the most prevalent disorder involving the knee. It is characterized by pain in the front of the knee around the knee cap. Unfortunately the cause is unclear and can be due to improper biomechanics or alignment of the knee cap.
Achilles tendinitis is the acute inflammation of the Achilles tendon. This condition occurs more often in runners with a high arch, faster runners, or those runners who never stretch.
Plantar fasciitis in the inflammation of the tissue along the bottom of the foot. This condition often affects runners with a higher body mass index.
Causes, treatment:
The causes of these four injuries can be different for everyone. There are several common causes that will often contribute to these injuries.
Over-training, improper footwear, weakness or a previous injury, and improper biomechanics are all factors contributing to these injuries. Determining the cause of the injury is key to successful treatment and prevention.
Because of the nature of these injuries, there are several different treatments that can be applicable to all four injuries.
R.I.C.E. is an acronym that stands for rest, ice, compression and elevation. This is a good rule to follow after first being injured.
Gentle, slow stretching can also be helpful to alleviate tightness that may be contributing to an injury. Massage can be useful, too, for pain relief and increasing blood flow to the injured tissue to promote healing. Changing your training may help to alleviate some of your aches and pains as well, such as incorporating more rest or changing your shoe type or the type of running surface.
Strengthening exercises are a key component to not only treating your injury, but also preventing it from occurring again in the future. Various modalities can also help to speed the healing process. Some of these modalities include electrical stimulation, laser and ultrasound.
Physical therapy incorporates all of the above treatments and is a good idea for someone looking for a comprehensive treatment plan with results. The benefits of running far outweigh the risk of injury associated with the sport. The good news is that most running injuries are very treatable and rarely cause someone to completely stop running.
Find your local Orthopedic Surgeon
What is minimally-invasive surgery?