Can you please tell me about the injection for knee arthritis to replace your cartilage. What do you think of this treatment?

Hyaluronic acid is a natural component of cartilage and joint fluid. It helps to maintain the structure of the cartilage tissue and also serves as a lubricant in joints. Studies indicate it suppresses joint inflammation.

I am training for a marathon and I run about 20 – 30 miles every week.For the past month, I have developed pain in the mid – to distal portion of my shins.The pain is so bad at time that I have to stop running.Do I have shin splints ?

The pain you are experiencing in your lower legs could be the result of either a stress fracture, compartment syndrome, or shin splints(MTSS – , medial tibial stress syndrome).Stress fractures are very common among runners.Usually they occur in the proximal or distal thirds of the leg. Symptoms include localized point tenderness and pain, swelling, and increased warmth. Another cause of lower leg pain is tendinitis or inflammation of the outer soft tissue covering a bone called the periosteum(also known as shin splints or MTSS(medial tibial stress syndrome).Exercise – induced compartment syndrome is another condition that causes pain and soreness in the lower leg after running or jogging.Pressure builds in the compartments that contain different muscle groups during jogging causing pain.When one stops running, the pain subsides as the pressure increase dissipates.The pain usually subsides and the pressure dissipates when you stop running.Differentiating between stress fractures, MTSS, and exercise induced compartment syndrome can often be challenging.A good history including reviewing changes in training schedule, evaluating running surfaces and shoe wear is important.Observing the individual walk and run to spot excessive pronation( in -turning of the foot) can help to provide clues as to the source of symptoms.Lastly, studies including x – rays, bone scan, and MRI may be needed to confirm the diagnosis.

I have been concerned about a clicking noise on the in my knee. What is causing this?

Painful clicking in the knee can come from several sources.

• Plica which is a thickened area of knee joint capsule can be traumatized and enlarge to the point that it pops as it slides over the knee during knee flexion
• Iliotibial band is a wide tendon that crosses the outside of the knee. Pain and snapping in this tendon occurs predominately in runners and is usally related to running inclines or hills.
• Knee cap sliding out of place can occur when there is abnormal lower extremity alignment.
• Meniscus tears

Symptomatic clicking and snapping in the knee should be evaluated early as correction may prevent significant injury or damage from occurring.

I heard that there are various grafts that can be used when reconstructing the anterior cruciate ligament(ACL). Can you tell me the pros and cons of each of the graft choices.

Painful clicking in the knee can come from several sources.

• Plica which is a thickened area of knee joint capsule can be traumatized and enlarge to the point that it pops as it slides over the knee during knee flexion
• Iliotibial band is a wide tendon that crosses the outside of the knee. Pain and snapping in this tendon occurs predominately in runners and is usally related to running inclines or hills.
• Knee cap sliding out of place can occur when there is abnormal lower extremity alignment.
• Meniscus tears

Symptomatic clicking and snapping in the knee should be evaluated early as correction may prevent significant injury or damage from occurring.

I heard that there are various grafts that can be used when reconstructing the anterior cruciate ligament(ACL). Can you tell me the pros and cons of each of the graft choices.

There are two types of cartilage in the knee.The articular cartilage which is like the shiny white on the end of a chicken bone and the grisel in the joint which are the menisci. They are C – shaped wafers of cartilage that act as shock absorbers in the knee. The torn meniscus can be aggravated with any twisting motion of the knee. A meniscus tear can enlarge to a point where it will fold on itself and lock into position. Loose bone fragments can also cause the knee to lock.Meniscus tears that do not fit the criteria for repair(depends on location of the tear) are then arthroscopically trimmed to remove the torn segments of the tear to prevent further tearing and locking symptoms.

When are you too old to have your anterior cruciate ligament operated on? Can surgery be done if you are over 50 y/o?

The anterior cruciate ligament, or ACL, is an important stabilizing structure in your knee. (especially for cutting sports such as skiing and tennis). In the past, we were less aggressive in reconstructing the ACL in older patients Treatment included avoiding sports that cause the knee to buckle and utilizing a brace for athletic activity and physical therapy.A brace can offer some prevention against instability and buckling.

However, some patients find it cumbersome and it does not entirely eliminate instability.Arthroscopic surgery can restore stability to your knee by reconstructing the anterior cruciate ligament. Age is a consideration, but a relatively minor factor in the decision – making process. If you are healthy, with few arthritic changes in your knee, and have a desire to continue sports but cannot because of your instability, surgery should be considered.

I was told that the pain in the front of my knee was ”Jumpers knee.” What is this?

“Jumpers knee” is inflammation of the patellar tendon at its insertion to the lower end of the knee cap(patella.) Also know as patella tendonitis, it results from excessive stress on the tendon at its insertion into the patella causing microtears of the tendon itself. These microtears result in an inflammatory response further weakening the tendon. Continued stress can result in further tearing, inflammation and breakdown of the tendon. Inciting factors usually include running.Factors implicated include training errors(most common), differerences in shoes and surfaces, and variations in anatomy.Non – operative treatment, effective 95 % of the time, includes anti – inflamatories, a patella protection rehabilitation program, a correction of training errors.Operative treatment, if necessary, requires surgical debridement of the degenerative tendon, stimulating a healing response.

What is Baker’s cyst? And what type of treatments is available for this case?

A baker’ s cyst is a symptom where the knee is filled with fluid.The first treatment would consist of knowing the nature of the injury, what is the cause of the swelling, then performing x rays and MRI is very important.The next step may be arthroscopy surgery where any problem inside the knee maybe fixed and repaired.

If a cartilage tear is present during the surgery it will be repaired, and the baker’ s cyst will heal on itself.If the cartilage tear is not present then excision of the baker’ s cyst will be successful.However, it may recur if it is related to arthritis.

What is a bone bruise?

Bone bruise is caused by an injury to the body that was not sever enough to cause a fracture instead it causes bleeding and swelling inside the bone. Such a bruise can not be seen through x rays, only through MRI.

What is Arthritis?

Arthritis is a destruction of a joint such as a knee or a hip.There are different types of arthritis: Osteoarthritis, Rheumatoid Arthritis, Psoriatic, Septic, and Gouty Arthritis.

What is a frozen shoulder?

Frozen shoulder refers to the medical term Adhesive Capsulitis. It is divided into two different forms, where in the first form,the cause is not known.However, in the second form the cause is usually predicted through an open heart surgery or an injury.This type can be treated by getting enough rest, performing some exercises to gain as much range of motion as possible. If none of the above treatments work then an arthroscopic shoulder surgery may be required.

What is shoulder impingement syndrome?

Shoulder impingement is a term used to describe pain that occurs with overhead movements as the rotator cuff and overlying bursal tissue get pinched between the shoulder blade and ball of the shoulder. There are several reasons why this happens.

Some people are born with a tight space for the rotator cuff tendon and bursal tissue to maneuver. The slightest bit of inflammation in this area will cause pinching of the rotator cuff tendon in this space. Some older individuals develop bony spurs over time, which decreases the space available for the cuff to move resulting in pinching of therotator cuff and bursa by the spur creating pain.

Injections into this space can alleviate the inflammation and increase the available space for the rotator cuff to move.Special X – ray views can view the bony spurs and see if a tight spaces id present. A magnetic resonance image study(MRI) is sometimes ordered if initial treatment is ineffective since it can determine how severe the rotator cuff tendon is being pinched off or if its torn. Arthroscopic surgery is utilized if injections, therapies and anti – inflammatories are ineffective.

What are rotator cuff tears?

The rotator cuff muscles and the tendons control the pivoting of the shoulder joint. The tear is caused when a hole arise in the rotator cuff from trauma or injury. It occurs more often in patients over age forty.Such patients will suffer from pain that elevate after performing overhead exercises and activities.Such pain may lead to limitation of motion and may lead to weaknesses. In addition to pain patients will suffer from shoulder weakness, tenderness and loss of motion

How is a rotator cuff treated?

Non operative care does not usually treat a rotator cuff that may be confirmed by x rays and MRI scans. Performing a surgery to repair the torn area would be performed to repair and reattach the torn area to the bone. Open repair surgery is always more recommended over arthroscopic repair.

Does shoulder replacement occur?

Yes, even though it is not so common. People who receive such a surgery require conservative care. It is taken place when the x rays shows presence of arthritis that is accompanied with pain. Sometimes only the ball requires replacement, while in other cases the ball and the socket need to be replaced to gain great results.

How successful are the shoulder replacement surgeries?

This type of surgery is very successful. It gets rid of arthritis and allows you to be pain free with regaining of full range of motion which will allow you to go back to your regular daily activities.Studies have shown that this type of surgery has longevity of 15 – 20 years.

Swelling developed in the back of my right elbow several months ago.It is only tender when pressure is applied to it. How do I reduce the swelling ?

Swelling in the back of the elbow occurs from a condition known as olecranon bursitis. The bursa is a tissue sac that pads or cushions the tip of your elbow or more specifically the olecranon. The olecranon is the pointed end of the bone in the back of your elbow.When the bursa becomes inflamed from Repeated trauma or friction inflames the bursa resulting in it being filled with fluid.Once the inciting factors are eliminated or reduced and anti – inflammatory medication started, the swelling will usually subside in a few weeks If persistent the fluid can be removed with a needle.

What is tennis elbow? Do treatments such as bracing, therapy, medications and injections work?

Tennis elbow, or lateral epicondylitis, is the term used to describe pain on the outside(lateral aspect) of the elbow.It is caused by repeated stress on a tendon that attaches to a bone in the elbow called the lateral epicondyle. The tendon initially becomes inflamed followed by tendon degeneration which causes swelling, weakness and loss of motion.

Most patients are helped with anti – inflamatories, bracing, and injections.Greater than 95 % of people respond to theses non – operative treatments.Surgery is reserved for those patient failing non – operative treatments. The surgery, when performed under the appropriate conditions, involves removing the degenerative tendon and is associated with a 95 % success rate in diminishing pain.

What is arthroscopic surgery?

Arthroscopy surgery involves the use of a small camera and fiberoptic equipment to look inside your ankle, shoulder, elbow, knee, or hip.The arthroscope is inserted into the joint via small incisions about a _ inch. The arthroscope allows us to work inside joints without performing big incisions decreasing post – operative pain and accelerating postoperative rehabilitation.

Can I shower after surgery?

You may shower 3 days after the operation.No soaking of the site under water in a bathtub, pool, or whirlpool.Place waterproof dressing over operative site when showering and do notlet water directly hit wound until healed.

When can I drive after surgery ?

You cannot drive until we give you permission to do so.Once given permission you should practice before getting on the roads.

When can I stop using the crutches/ sling?

We will tell you when to discontinue the sling or crutches.This depends on the type of your operation.

Do I use heat or ice after the operation?

After the operation, you should use ice packs intermittently on the site. Never put ice directly on the skin. Use ice for approximately 20 minutes 3 times per day.Ice helps with inflammation, swelling, and pain control.

When do I start physical therapy after surgery?

You will usually start physical therapy the day after the surgery.

How long will I stay in the hospital?

It depends on the procedure performed.For general knee, shoulder, elbow, and ankle arthroscopy surgery, stay one night.For rotator cuff repair and anterior cruciate ligament reconstruction, you will you stay for 2 nights.Prior to your surgery, we will give you more detailed information.

How long will surgery take?

It depends on the procedure performed. We will inform you of the approximate procedure time. Please remember that the operative time does not include anesthesia time and operating room setup time.

What is Regenerative Medicine?

Regenerative Medicine is a new and advancing scientific field focused on the repair and regeneration of damaged tissue utilizing stem cells.

How are adult stem cells used in surgical procedures?

Adult stem cells are used to treat patients with damaged tissues due to age or deterioration. During a procedure, stem cells are isolated from the patient, concentrated and delivered back to the site of injury to assist in the healing process.

Where do adult stem cells come from?

Adult stem cells are used to treat patients with damaged tissues due to age or deterioration. During a procedure, stem cells are isolated from the patient, concentrated and delivered back to the site of injury to assist in the healing process.

No, adult stem cells do not raise ethical questions as they are harvested from the patient’s body.