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Injuries, Symptoms & Treatments
General Orthopedics
Treatment for all orthopedic conditions
General orthopedics covers a wide range of conditions and treatments for patients, such as the diagnosis, treatment, rehabilitation and prevention of injuries and diseases affecting the bones, joints, ligaments, tendons and muscles within the body. Orthopedic conditions may be acute, such as fractures, sprains or strains; or chronic, such as arthritis, tendonitis and more, and may result in pain, stiffness, swelling, immobility and other troubling symptoms that tend to worsen over time.
Dr. Bellapianta treats a wide range of orthopedic conditions using conservative, alternative and surgical means depending on each patient's individual needs. Most of these general orthopedic problems do not require surgery. We offer injections for pain and inflammation, and at-home exercises that strengthen and condition your body. Each patient responds differently to treatment, so Dr. B monitors your progress closely to ensure that the prescribed treatment is effective. Many conditions require ongoing management in order to relieve symptoms and allow patients to function in their everyday lives.
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Diseases/Conditions of General Orthopedic Conditions
Overview
Arthritis is inflammation of one or more of the body's joints that causes pain and stiffness. Although arthritis is mainly an adult disease, some forms affect children.
There are many types of arthritis. They include osteoarthritis, inflammatory arthritis, post-traumatic arthritis, and septic (infectious) arthritis.
Arthritis may be caused by wear and tear on the articular cartilage through the natural aging process (osteoarthritis), or it may develop following an injury (post-traumatic arthritis). Inflammatory arthritis, such as rheumatoid arthritis or lupus arthritis, is the result of a systemic disease throughout the body.
Regardless of whether arthritis is caused by injury, normal wear and tear, or systemic disease, the affected joint becomes inflamed, causing swelling, pain, and stiffness. Inflammation is one of the body's normal reactions to injury or disease. In arthritic joints, however, inflammation may cause long-lasting or permanent disability when it destroys the joint's cartilge. There are 4 major categories of arthritis:
Osteoarthritis
The most common type of arthritis is osteoarthritis. Also known as "wear and tear" arthritis, osteoarthritis occurs when the cartilage that cushions and protects the ends of bones gradually wears away.
Osteoarthritis results from overuse, trauma, or the natural degeneration of cartilage that occurs with aging. There is a strong genetic component to osteoarthritis, but the genetics are complex and poorly understood. There is no single known osteoarthritis gene; the condition is likely due to a combination of many genes. Scientists call this type of genetics "multifactorial."
Osteoarthritis is often more painful in joints that bear weight, such as the knee, hip, and spine. However, joints that are used extensively in work or sports, or joints that have been damaged by injury may also show signs of osteoarthritis.
In many cases, bone growths called spurs develop at the edges of osteoarthritic joints. The bone can become harder (sclerosis). The joint becomes inflamed, causing pain and swelling. Continued use of the joint is painful.
Inflammatory Arthritis
As the name implies, inflammatory arthritis results from an excessive inflammatory response inside a joint. It often is the result of an overactive immune system (autoimmune arthritis) but can also be caused by certain diseases (such as Lyme disease) or by the buildup of crystals in the joint (such as gout or psudogout). The most common cause of inflammatory arthritis is rheumatoid arthritis.
Rheumatoid Arthritis
Rheumatoid arthritis is a chronic autoimmune disease that afects many parts of the body, but mainly the joints. The body's immune system, which normally protects the body, begins to produce substances that attack the body. In rheumatoid arthritis, the joint lining swells, invading surrounding tissues. Chemical substances are produced that attack and destroy the joint surface.
Rheumatoid arthritis may affect both large and small joints in the body and also the spine. Swelling, pain, and stiffness usually develop, even when the joint is not used. In some circumstances, juvenile arthritis may cause similar symptoms in children.
Psoriatic Arthritis
Psoriatic arthritis is associated with the skin disease psoriasis. While it may involve larger joints such as the knees it often presents with symptoms in smaller areas such as the distal joints at the tips of the fingers and toes.
Crystalline Arthropathy (gout or pseudogout)
Gouty arthritis develops as the result of uric acid buildup in the bloodstream. The uric acid forms crystals that cause acute inflammation in a joint. The big toe, ankle, knee, and elbow are the most common joints affected. A gout attack can be acutely painful and may look like an infection (septic arthritis). The inflamed joint becomes red and very sensitive to touch. Gout attacks are most often treated with medication rather than surgery. Long term, many patients develop soft tissue masses (tophi) over the affected joints.
In pseudogout, calcium pyrophosphate crystals depost in the joint and cause similar inflammation as the uric acid crystals of gout. Left untreated, the inflammation caused by these crystals may lead to breakdown of the cartilage of the joint.
Lyme Arthritis
Lyme arthritis can be one of the side effects of Lyme disease, a systemic infection caused by a tick bite. Lyme arthritis can present acutely as pain and swelling in early stages of the disease. Lyme disease is treated with antibiotics. Left untreated, Lyme disease can lead to chronic arthritis.
Spondylytic Arthritis
Spondylytic arthritis mostly affects the spine. The most common form is ankylosing spondylitis. It often presents as low back pain with initial changes seen at the sacroiliac joints in the pelvis. A doctor can confirm this diagnosis with a positive blood test, HLA-B27.
Lupus Arthritis
Lupus is an autoimmune disease that affects the blood and multiple organs, including the kidneys, skin, and heart. Lupus arthritis can be systemic and cause chronic pain in multiple joints.
Juvenile Arthritis
Juvenile arthritis is the most common type of arthritis in children. It is estimated that more than 250,000 children under the age of 16 in the United States are affected. There are several types of the disease and most are different from rheumatoid arthritis in adults.
The above is not an exhaustive list. There are many more less common causes of inflammatory arthritis.
Post-traumatic Arthritis
Post-traumatic arthritis results from an injury to the joint due to trauma. If a broken bone or fracture extends into a joint it will damage the smooth cartilage that covers the joint's surface. The surface becomes uneven and causes friction as the joint moves. Over time, the joint breaks down and becomes arthritic.
Septic Arthritis
Septic arthritis is an infection of the joint. Bacteria most often reach the joint through the bloodstream from an infection in another part of the body, such as the urinary tract. Infected joints are typically warm, red, and acutely tender. They are often swollen due to pus in the joint. An infected joint often needs surgical drainage in addition to antibiotic treatment.
Elbow (Olecranon) Bursitis
Elbow bursitis occurs in the olecranon bursa, a thin, fluid-filled sac that is located at the boney tip of the elbow (the olecranon). There are many bursae located throughout the body that act as cushions between bones and soft tissues, such as skin. They contain a small amount of lubricating fluid that allows the soft tissues to move freely over the underlying bone. Normally, the olecranon bursa is flat. If it becomes irritated or inflamed, more fluid will accumulate in the bursa and bursitis will develop.
Cause
Elbow bursitis can occur for a number of reasons.
Trauma. A hard blow to the tip of the elbow can cause the bursa to produce excess fluid and swell.
Prolonged pressure. Leaning on the tip of the elbow for long periods of time on hard surfaces, such as a tabletop, may cause the bursa to swell. Typically, this type of bursitis develops over several months.
People in certain occupations are especially vulnerable, particularly plumbers or heating and air conditioning technicians who have to crawl on their knees in tight spaces and lean on their elbows. Certain athletic activities may also prompt the development of olecranon bursitis, such as long holds of the plank position.
Infection. If an injury at the tip of the elbow breaks the skin, such as an insect bite, scrape, or puncture wound, bacteria may get inside the bursa sac and cause an infection. The infected bursa produces fluid, redness, swelling, and pain. If the infection goes untreated, the fluid may turn to pus.
Occasionally, the bursa sac may become infected without an obvious injury to the skin.
Medical conditions. Certain conditions, such as rheumatoid arthritis and gout, are associated with elbow bursitis.
Symptoms
Swelling. The first symptom of elbow bursitis is often swelling. The skin on the back of the elbow is loose, which means that a small amount of swelling may not be noticed right away.
Pain. As the swelling continues, the bursa begins to stretch, which causes pain. The pain often worsens with direct pressure on the elbow or with bending the elbow. The swelling may grow large enough to restrict elbow motion.
Redness and warm to the touch. If the bursa is infected, the skin becomes red and warm. If the infection is not treated right away, it may spread to other parts of the arm or move into the bloodstream. This can cause serious illness. Occasionally, an infected bursa will open spontaneously and drain pus.
Hip Bursitis
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
Bursitis is inflammation of the bursa. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis.
Another bursa — the iliopsoas bursa — is located on the inside (groin side) of the hip. When this bursa becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. This condition is not as common as trochanteric bursitis, but is treated in a similar manner.
Symptoms
The main symptom of trochanteric bursitis is pain at the point of the hip. The pain usually extends to the outside of the thigh area. In the early stages, the pain is usually described as sharp and intense. Later, the pain may become more of an ache and spread across a larger area of the hip.
Typically, the pain is worse at night, when lying on the affected hip, and when getting up from a chair after being seated for a while. It also may get worse with prolonged walking, stair climbing, or squatting.
Risk Factors
Hip bursitis can affect anyone, but is more common in women and middle-aged or elderly people. It is less common in younger people and in men.
The following risk factors have been associated with the development of hip bursitis.
Description
Simply defined, tendinitis is inflammation of a tendon. Inflammation is the body's natural response to injury or disease, and often causes swelling, pain, or irritation. Some types of tendinitus include:
Biceps Tendinitis
Biceps tendinitis is an inflammation or irritation of the upper biceps tendon. Also called the long head of the biceps tendon, this strong, cord-like structure connects the biceps muscle to the bone in the shoulder socket.
Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis. They can often be relieved with rest and medication. In severe cases, you may need surgery to repair the tendon.
Cause
In most cases, damage to the biceps tendon is due to a lifetime of normal activities. As we age, everyday wear and tear causes our tendons to slowly weaken. This degeneration can be worsened by overuse — repeating the same shoulder motions again and again.
Many jobs and routine chores can cause overuse damage. Sports — particularly those that require repetitive overhead motion, such as swimming, tennis, and baseball — can also put people at risk for biceps tendinitis.
Repetitive overhead motion may play a part in other shoulder problems that occur with biceps tendinitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.
Symptoms
Achilles Tendinitis
Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of your lower leg becomes irritated and inflamed.
The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, climb stairs, jump, and stand on your tip toes. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration.
Noninsertional Achilles Tendinitis
In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon have begun to break down with tiny tears (degenerate), swell, and thicken. Tendinitis of the middle portion of the tendon more commonly affects younger, active people.
Insertional Achilles Tendinitis
Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone.
In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis.
Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active. More often than not, however, it comes from years of overuse (long distance runners, sprinters).
Cause
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including:
Symptoms
Common symptoms of Achilles tendinitis include:
Sprains, Strains and Other Soft-Tissue Injuries
The most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury.
Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal.
Cause
Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries.
Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples include sprains, strains, and contusions.
Overuse injuries occur gradually over time when an athletic or other activity is repeated so often that areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.
Common Acute Soft-Tissue Injuries
Acute soft-tissue injuries vary in type and severity. When an acute injury occurs, initial treatment with the RICE protocol is usually very effective. RICE stands for Rest, Ice, Compression, and Elevation.
Sprains
A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connects the end of one bone with another. Ligaments stabilize and support the body's joints. For example, ligaments in the knee connect your thighbone (femur) with your shinbone (tibia), enabling you to walk.
The areas of the body that are most vulnerable to sprains are the ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can result from a sudden twist, and a wrist sprain can occur if you fall onto an outstretched hand.
Sprains are classified by severity:
While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains. Treatment for sprains begins with the RICE protocol and physical therapy. Moderate sprains often require a period of bracing (for example, a CAM walking boot can be worn to help support and immobilize a sprained ankle). The most severe sprains may require surgery to repair torn ligaments.
Strains
A strain is an injury to a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. Strains often occur in the back or leg (typically, the hamstring).
Similar to a sprain, a strain may be a simple stretch of your muscle or tendon, or it may involve a partial or complete tear of the muscle and tendon. Symptoms of a strain may include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.
Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for hamstring strains, as do sports that feature quick starts, such as hurdling, long jumping, and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping have a high incidence of hand sprains. Elbow strains frequently occur in racquet, throwing, and contact sports.
The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more severe tear.
Contusions (Bruises)
Contusions occur when a direct blow (or repeated blows) by a blunt object strikes part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface. Discoloration of the skin is caused by blood pooling around the injury.
Most contusions are mild and respond well to the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.
Common Overuse Soft-Tissue Injuries
Tendinitis
Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of small stresses that repeatedly aggravate the tendon. Symptoms typically include swelling and pain that worsens with activity.
Tiny tears in the Achilles tendon cause it to swell and thicken.
Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendinitis in their shoulders and elbows. Soccer and basketball players, runners, and aerobic dancers are prone to tendon inflammation in their knees and ankles.
Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause significant damage to the tendon, which may require surgery.
Bursitis
Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.
Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa to swell. Many people experience bursitis in association with tendinitis.
Bursitis can usually be relieved with changes in activity and anti-inflammatory medications, such as ibuprofen. If swelling and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually help relieve pain and swelling.
Although surgery is rarely necessary for bursitis, if the bursa becomes infected, an operation to drain the fluid from the bursa may be necessary. In addition, if the bursa remains infected or the bursitis returns after all nonsurgical treatments have been tried, your doctor may recommend removal of the bursa.
Removal (excision) of the bursa can be done using a standard incision (open procedure), or as an arthroscopic procedure with small incisions and miniature surgical instruments. Your doctor will talk with you about which procedure is appropriate for your situation.
Prevention
Injuries often occur when people suddenly increase the duration, intensity, or frequency of their activities. Many soft-tissue injuries can be prevented through proper conditioning and training. Other prevention tips include:
Fractures (Broken Bones)
A fracture is a broken bone, the same as a crack or a break. A bone may be completely fractured or partially fractured in any number of ways (crosswise, lengthwise, in multiple pieces).
Types of Fractures
Althouh bones are rigid, they do bend, or give, somewhat when an outside force is applied. However, if the force is too great, bones will break, just as a plastic ruler breaks when it is bent too far.
The severity of a fracture usually depends on the force that caused the break. If the bone's breaking point has been exceeded only slightly, the bone may crack rather than break all the way through. If the force is extreme, such as that caused by an automobile crash or gunshot, the bone may shatter.
If the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone, the fracture is called an open fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.
Common types of fractures include:
Cause
The most common causes of fractures are:
Symptoms
Many fractures are very painful and may prevent you from moving the injured area. Other common symptoms include:
Fibromyalgia
Fibromyalgia is a chronic, long-term illness. It causes all-over muscle pain, joint pain and fatigue. The pain may come and go. There’s no known cause, although certain factors such as stress and genetics may predispose someone toward the disease. Although there isn’t a cure, medications, lifestyle changes and other therapies offer relief.
Anyone can get fibromyalgia, including children. Women are twice as likely as men to have fibromyalgia. Symptoms often appear during middle age. Up to 20% of patients who suffer from other chronic disorders such as rheumatoid arthritis, lupus and sarcoidosis can also have fibromyalgia.
Causes
What causes fibromyalgia? Medical experts don’t know why some people develop fibromyalgia. It sometimes runs in families. Certain conditions or events may bring on symptoms, such as:
Symptoms
Widespread muscle pain and joint pain along with fatigue and poor sleep are the defining symptoms of fibromyalgia. The disease affects people differently. You may also experience:
Triggers of a fibromyalgia attack
Certain things can bring on fibromyalgia symptoms (a flare-up) especially those that increase the level of stress. These include:
Cervical Radiculopathy (Pinched Nerve)
Cervical radiculopathy, commonly called a "pinched nerve," occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This may cause pain that radiates into the shoulder and/or arm, as well as muscle weakness and numbness.
Cervical radiculopathy is often caused by "wear and tear" changes that occur in the spine as we age, such as arthritis. In younger people, it is most often caused by a sudden injury that results in a herniated disk. In some cases, however, there is no traumatic episode associated with the onset of symptoms.
In most cases, cervical radiculopathy responds well to conservative treatment that includes medication and physical therapy.
Cause
Cervical radiculopathy most often arises from degenerative changes that occur in the spine as we age or from an injury that causes a herniated, or bulging, intervertebral disk.
Degenerative changes. As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.
As the disks lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone—called bone spurs—around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also narrow the foramen—the small openings on each side of the spinal column where the nerve roots exit—and pinch the nerve root.
Degenerative changes in the disks are often called arthritis or spondylosis. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks and pinched nerves that do not cause painful symptoms. It is not known why some patients develop symptoms and others do not.
Herniated disk. A disk herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive nerve root, causing pain and weakness in the area the nerve supplies.
A herniated disk often occurs with lifting, pulling, bending, or twisting movements.
Symptoms
In most cases, the pain of cervical radiculopathy starts at the neck and travels down the arm in the area served by the damaged nerve. This pain is usually described as burning or sharp. Certain neck movements—like extending or straining the neck or turning the head—may increase the pain. Other symptoms include:
Alternative Methods to Help Manage Pain After Orthopaedic Surgery
After orthopaedic surgery, your doctors and nurses will make every effort to control your pain. While you should expect to feel some discomfort, advancements in pain control now make it easier for your doctor to manage and relieve pain.
Surgeons and their patients are increasingly using alternative methods, such as relaxation techniques and acupuncture, to supplement conventional medicine. A combined approach to pain management is often the best option because it allows the surgeon to tailor pain control methods to each individual patient.
Transcutaneous Electrical Nerve Stimulation (TENS)
In transcutaneous electrical nerve stimulation (TENS) a special device transmits low-level electrical charges into the area of the body that is in pain.
A TENS system consists of a small, battery-powered machine connected by wires to a pair of electrodes. The two electrodes are connected to your skin near the source of pain or at a pressure point. A mild electrical current travels through your skin and along your nerve fibers which may cause a warm, tingling sensation. A typical TENS session lasts anywhere from 5 to 15 minutes.
Many studies have found that TENS is useful in easing pain after surgery, as well as pain related to injuries, such as fractures and sprains. TENS may also be helpful for some chronic pain conditions, particularly low back pain. TENS is generally considered safe. However, its routine use is not recommended.
There is also an acupuncture version of TENS in which the electrical impulses are sent through acupuncture needles instead of electrode pads. This form of TENS is called "electro-acupuncture" or percutaneous electrical nerve stimulation (PENS).
How TENS Works
There are several ways TENS is thought to relieve pain:
Gate Control Theory. In order for you to feel pain, the sensation must travel through a "gate" to get to the brain. Normally, the pain is allowed to flow freely through the gate because it (pain) is the only sensation trying to get through. However, if the gate becomes flooded with another type of sensation (in this case, an electric current), the gate will reach capacity and no longer have room for the underlying pain sensation to get through.
Release of Endogenous Opiates. Some scientists believe that TENS works by forcing certain nerve cells to release more of the body's natural pain killers called "endorphins." This causes you to feel less pain.
Central Inhibitory Effect. TENS may also work by changing the way your brain perceives pain.
When to Avoid TENS
TENS might not work as well if your pain is caused by mental or emotional problems. It also does not work as well if you suffer from drug addiction.
TENS should not be used if you have any of the following conditions:
Continuous Passive Motion
Continuous passive motion (CPM) is a technique in which your joint is moved constantly in a mechanical splint to prevent stiffness and increase range of motion. A CPM machine moves your joint for you without requiring you to exert any effort.
Medical evidence indicates that in many cases immobilization increases pain after surgery. As a result, early motion has been applied to many orthopaedic problems. CPM is thought to be most effective in the rehabilitation treatment of:
If you can already move — either actively or passively — without CPM, then using the device will not be beneficial. CPM is not a substitute for working with an experienced physical therapist who is trained to provide both active and passive motion exercises. If your doctor recommends CPM, you will also be monitored by a physical therapist.
The most important time to use a CPM device seems to be in the first 2 to 7 days after surgery, for about 4 to 6 hours every day.
Initially, CPM was only used in hospitals or outpatient physical therapy clinics, but today, CPM units can be purchased for use at home.
Acupuncture
When acupuncture is combined with traditional pain relief methods, it may be helpful for some types of chronic pain:
Acupuncture points tend to be areas of your skin that contain relatively large amounts of intersecting nerve endings that feed into your muscles or bones. Some scientists believe that these "acupoints" possess special electrical characteristics that can be manipulated using painless hair-thin needles.
A typical acupuncture procedure lasts for about 30 minutes. Treatments are used to relieve local pain and swelling, as well as to provide a more general feeling of relaxation due to the release of your body's natural painkillers, called endorphins.
Because each acupoint is responsible for producing effects in different areas of the body, it is important to be clear with your provider about the specific area and intensity of your pain. The acupuncturist can then target the correct acupoint.
Psychological Methods
Psychological methods can be effective as an additional treatment for pain control. These methods can reduce or eliminate the need for medication. Some of oldest and best documented psychological methods include:
In 18 medical research studies, medical hypnosis, guided imagery, or relaxation techniques were used to improve recovery after surgery. In 16 of the studies (4 were orthopaedic surgeries), researchers documented improvements in both the physical and emotional recoveries of the patients.
These results demonstrated that psychological methods are effective as an additional treatment for pain management, postsurgical recovery (physical and emotional), and orthopaedic rehabilitation.
These methods appear to have potential in orthopaedic surgery that could reduce pain, enhance treatment outcomes, and contain or even reduce medical costs.
Osteoarthritis
This is the most common form of arthritis. It can make your joints feel stiff and painful. It's a common condition that affects men and women. It most often affects older people.
Bursitis of the Shoulder
This is a swelling of a fluid-filled sac called the "subacromial bursa." It's in the shoulder, between a bony protrusion called the "acromion" and the rotator cuff.
Biceps Tenodesis
This surgery repairs a biceps tendon in your shoulder. It fixes a tendon that is partially torn, or completely torn, from the bone.
Fibromyalgia
This chronic condition is believed to be a type of interference with the way your brain processes pain signals. It leaves you highly sensitive to pain.
Common Treatments of General Orthopedics
Medications
Over-the-counter medications can be used to control pain and inflammation. These medications, called non-steroidal anti-inflammatory drugs (NSAIDs), include aspirin, ibuprofen, and naproxen. Acetaminophen can also be effective in controlling pain.
Prescription medications also are available. A doctor will take account the type of condition/injury, its severity, and the patient's general physical health before prescribing a medication. Patients with stomach ulcers, asthma, kidney disease, or liver disease, for example, may not be able to safely take anti-inflammatory medications. For patients with inflammatory conditions, the doctor (typically a rheumatoligist) may prescribe medications that modify the body's immune response.
Diagnostic Imaging
Diagnostic imaging techniques help narrow the causes of an injury or illness and ensure that the diagnosis is accurate. These techniques include x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).
These imaging tools let your doctor "see" inside your body to get a "picture" of your bones, organs, muscles, tendons, nerves, and cartilage. This is a way the doctor can determine if there are any abnormalities.
X-rays
X-rays (radiographs) are the most common and widely available diagnostic imaging technique. Even if you also need more sophisticated tests, you will probably get an x-ray first.
The part of your body being pictured is positioned between the x-ray machine and photographic film or digital x-ray sensor. You have to hold still while the machine briefly sends electromagnetic waves (radiation) through your body, exposing the film to reflect your internal structure. The level of radiation exposure from x-rays is not harmful, but your doctor will take special precautions if you are pregnant.
Bones, calcifications, some tumors, and other dense matter appear white or light because they absorb the radiation. Less dense soft tissues and breaks in bone let radiation pass through, making these parts look darker on the x-ray film.
You will probably be x-rayed from several angles. If you have a fracture in one limb, your doctor may want a comparison x-ray of your uninjured limb. Your x-ray session will probably be finished in about 10 minutes. The images are ready quickly. They are either developed from the x-ray film or written to a CD to be viewed on a computer screen.
In some circumstances, a contrast material or dye may be injected into a joint while x-rays are taken. This procedure, which is called an "arthrogram," helps to outline soft tissue structures in the joint. It may also confirm needle placement in the joint when fluid is removed or medication is injected into the joint.
X-rays may not show as much detail as an image produced with more sophisticated techniques. They are, however, the most common imaging tool used to evaluate an orthpaedic problem and are available in our offices.
Computed Tomography (CT)
Computed tomography (CT) is an imaging tool that combines x-rays with computer technology to produce a more detailed, cross-sectional image of your body. A CT scan lets your doctor see the size, shape, and position of structures that are deep inside your body, such as organs, tissues, or tumors. Tell your doctor if you are pregnant before undergoing a CT scan.
You lie as motionless as possible on a table that slides into the center of the cylinder-like CT scanner. The process is painless. An x-ray tube slowly rotates around you, taking many pictures from all directions. A computer combines the images to produce a clear, two-dimensional view on a television screen.
You may need a CT scan if you have a problem with a small, bony structure or if you have severe trauma to the brain, spinal cord, chest, abdomen, or pelvis. Sometimes, you may be given a dye or contrast material to make certain parts of your body show up better.
A CT scan costs more and takes more time than a regular x-ray. It can be done in either a hospital setting or an outpatient imaging center.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) is another diagnostic imaging technique that produces cross-sectional images of your body. Unlike CT scans, MRI works without radiation. The MRI tool uses magnetic fields and a sophisticated computer to take high-resolution pictures of your bones and soft tissues. Tell your doctor if you have a pacemaker, implants, metal clips, or other metal objects in your body before you undergo an MRI scan.
You lie as motionless as possible on a table that slides into the tube-shaped MRI scanner. The MRI creates a magnetic field around you and then pulses radio waves to the area of your body to be pictured. The radio waves cause your tissues to resonate.
A computer records the rate at which your body's various parts (tendons, ligaments, nerves, etc.) give off these vibrations, and translates the data into a detailed, two-dimensional picture. You will not feel any pain while undergoing an MRI, but the machine may be noisy.
An MRI may be used to help diagnose torn knee ligaments and cartilage, torn rotator cuffs, herniated disks, osteonecrosis, bone tumors, and other problems. It may take from 30 to 60 minutes to do the study. Like a CT scan, an MRI scan may be done in a hospital or at an outpatient imaging center.
Other Imaging Studies
Other orthopaedic imaging studies include ultrasound and bone scan (nuclear imaging).
Platelet-Rich Plasma (PRP)
During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries.
Many famous athletes — golfer Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.
What Is Platelet-rich Plasma (PRP)?
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets). The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors that are very important in the healing of injuries.
PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.
To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. These platelets are then injected into the injured site.
How Does PRP Work?
Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.
To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:
What Conditions are Treated with PRP? Is It Effective?
Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. Recent research has shown that certain tendon problems can have improved outcomes with PRP injections. Additionally, more and more literature is showing the significant effectiveness of PRP in the treatment of mild to moderate knee osteoarthritis. Factors that can influence the effectiveness of PRP treatment include:
Chronic Tendon Injuries
According to the research studies currently reported, PRP is effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.
The use of PRP for other chronic tendon injuries — such as chronic Achilles tendinitis or inflammation of the patellar tendon at the knee (jumper's knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.
Acute Ligament and Muscle Injuries
Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains.
Surgery
More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures. Recent research has been dedicated to the benefit of PRP in meniscus healing after meniscus repair; however, these studies are only in their infancy.
Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.
Knee Arthritis
More and more literature is showing the effectiveness of low-leukocyte PRP in treating low- to moderate-grade knee osteoarthritis. Some studies have shown that these results can last up to two years.
Fractures
PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.
Conclusion
Treatment with PRP could hold promise, however, current research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of certain chronic tendon injuries and low- to moderate-grade knee osteoarthritis, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions
Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.
If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers' compensation plans, provide even partial reimbursement.
Soft Tissue Injections
Soft tissue injections are shots into an area of the body that is not a bone or a joint. They may be used in areas such as a tendon, a muscle, or a bursa. (A bursa is a sac of fluid that cushions and lubricates areas where tendons, ligaments, skin, muscles, or bones rub against each other.) These injections are often used to treat problems such as inflamed tendons (tendinitis) and bursas (bursitis).
These shots may be used to put in one or more medicines. Examples are local anesthetics that can help with short-term pain relief or steroid medicines that can give longer-term relief. Steroids don't always relieve pain. And when they do, it can take a few days to work. But when they work, the pain relief can last for several days to a few months.
Physical Therapy
Orthopedic physical therapy can be life-changing. A skilled physical therapist (PT) can get you back on track with your daily activities after surgery, an injury, accident, or illness.
That’s because an orthopedic PT specializes in diagnosing and treating conditions that affect any part of your musculoskeletal system.
An orthopedic PT works to integrate all your other bodily systems — especially your neurological and cardiovascular systems — with your musculoskeletal system to treat your injury or condition appropriately.
In this article, we’ll take a closer look at what orthopedic physical therapy is, when you may need it, and the types of treatments it includes.
What’s orthopedic physical therapy?
Orthopedic physical therapy involves the care of your entire musculoskeletal system, which includes your:
A PT who specializes in orthopedics can evaluate your condition and diagnose the issue or condition you have. This will include:
Orthopedic physical therapy is provided in outpatient clinics, hospitals, skilled nursing facilities, sports facilities, and even in your home. The entry-level degree for a PT these days is a clinical doctorate. So when you go to work with a PT, you’re working with a doctor of physical therapy, who has completed three years of graduate school studies.
Rehabilitation after surgery
After you have surgery, orthopedic physical therapy may help reduce pain, normalize your walking, improve your range of motion, and prevent excessive scar tissue buildup. Additionally, it may also help you regain your balance, strength, and mobility. Patients often work with orthopedic PTs after surgeries such as:
Rehabilitation after acute injury
An acute injury is one that happens as a result of a single trauma to the body. If you sprain an ankle, tear your meniscus, or herniate a disc in your back, an orthopedic PT can help you:
Rehabilitation after chronic injury
A chronic injury is damage to your body that occurs over time, usually because your movement patterns have caused small, repetitive injuries to your tendons, bones, or joints. Examples of chronic injuries include:
An orthopedic PT can analyze your movement patterns to isolate the source of the injury. They can also help you manage symptoms like pain and swelling, and can educate you about how to move safely to avoid injuries in the future.
What types of treatments are used?
Orthopedic PTs use a wide range of therapeutic modalities, exercises, assistive devices, and patient education methods to help you. Depending on how your therapist uses these treatments, they may be:
Here are some examples of treatments that may be used with orthopedic physical therapy.
Hot/cold therapy
Orthopedic PTs use both cryotherapy (cold therapy) and thermotherapy (heat therapy) to treat musculoskeletal pain and swelling.
In a 2015 studyTrusted Source involving 100 patients, both heat and ice helped prevent muscle damage, but cold used immediately after intense exercise was more effective at preventing muscle soreness.
Exercise therapy
Your therapist will create an exercise plan that will likely include strengthening, mobility, or balance-building exercises. It’s a good idea to practice the exercises with your therapist at first so you know you’re doing them correctly. Once you know how to do the exercises properly, you will be encouraged to do them at home on a regular basis to help boost your strength and mobility.
E-stim (TENS or NMES)
There is some evidenceTrusted Source that electrical stimulation has the ability to cut down on pain. When a PT uses this treatment modality, the therapist attaches an e-stim device to the injured area of your body.
There are two main types of e-stim devices. They include:
Traction
Traction takes the pressure off compressed or damaged joints. It can be conducted with a piece of equipment or with the therapist’s hands, and is considered helpful for people with:
Hydrotherapy
Your therapist may incorporate water therapy into your treatment plan. You may perform exercises in a pool or whirlpool as part of your rehabilitation.
This type of therapy can be especially helpful if you have joint issues or injuries because water provides gentle resistance. The buoyancy that water provides helps support you while you exercise, which reduces the impact you place on your joints.
Soft tissue manipulation
A soft tissue manipulation is a form of manual physical therapy in which the PT uses hands-on techniques on your muscles, ligaments, and fascia. This is done to break adhesions and to optimize your muscle function.
Although more research is needed to verify the specific effects of soft tissue manipulation, it is generally recommended as a way to reduce painTrusted Source and decrease muscle tension.
Joint mobilization
This technique involves a therapist moving your joint firmly and carefully in the desired direction. Like soft tissue manipulation, it is a manual technique.
Dry needling
In some states, PTs are permitted to use dry needling, a technique that’s similar to acupuncture.
With this technique, the therapist inserts a thin needle into a specifically targeted muscle with a trigger point — usually one that is the source of tension or pain.
Laser or light therapy
Orthopedic PTs may use low-level laserTrusted Source or light therapies to boost muscle performance, reduce muscle fatigue, and enable muscle repair after an injury.
Kinesiology taping
Kinesiology tape is an extremely flexible band of tape made of stretchy fabric. This therapeutic tape, which often comes in bright colors or snappy patterns, is applied to specific areas of the body. Although there is little research to support its effectiveness, anecdotal evidence suggests that kinesiology tape may help:
How can you get the best results from orthopedic physical therapy?
To get the most out of each physical therapy session, it’s important to:
Patient Guide to Safe Surgery
When we go for surgery we turn over our care to highly trained doctors, nurses, and hospital staff. However, we also know that patients who understand their treatment are going to get the most out of their hospital visit.
Talk to your caregivers, understand what is happening to you, and never be afraid to ask questions. Bring a friend or family member as your healthcare advocate. Ask new and unfamiliar caregivers to identify themselves and explain their role in your treatment. Be involved, and help to make your care go well.
Preoperative Consultation with Your Surgeon
When you visit your surgeon, use the following checklist to provide your surgeon and surgical team with necessary information about you and your orthopaedic problem.
Before Surgery
Bring to the hospital:
After Surgery
Pay attention to the health care you receive. If something does not seem right — such as the type of medication you are receiving-tell your doctor, nurse, or another healthcare professional.
Prevent falls.
Know your treatment plans.
At Discharge
You usually receive a lot of instructions just prior to leaving. The nurse will give you the highlights in writing, including a list of the medications you will need to take. It is hard to remember everything. As always, ask questions if you do not understand the instructions.
Conclusion
Research shows that patients who take part in decisions about their health care are more likely to have better outcomes. Ask questions, understand treatment, and follow instructions, and you will be on the road to recovery.
PRP Therapy
Platelet rich plasma therapy can help injured joints and other problems. It uses parts of your own blood to reduce pain and speed up healing.
Soft Tissue Injection: Shoulder
This outpatient injection procedure relieves pain in the shoulder caused by bursitis, or inflammation of the bursa.
Knee Stem Cell Therapy
If normal wear and tear has caused degeneration of your joint, stem cell therapy may help. It uses parts of your own blood to help repair knee damage. It may help you avoid surgery.
Physical Therapy
Physical therapy can help control your pain and help you recover from injury or disease. It can help you get better after surgery.
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