Meniscus tears – Diagnosis and Treatment

Medical Guides | 2014 Jul

A meniscus tear is one of the most common knee injuries experienced by active people. Sportsmen and women may experience this when violent movement actually causes a rip in the meniscus. The meniscus forms at each side of the knee and stabilizes the movement of the knee joint. Thus there are two menisci for each knee. If one of these is torn, movement of the knee can become abnormally painful.

As a patient gets older, meniscus tears may become more likely, since the meniscus becomes weaker. This is why older patients often have knee problems.

Diagnosis

The standard diagnosis is started when the general practitioner tests the knee for motion to determine where the problem exists. In minor cases, the pain may pass quickly though many cases require much more detailed diagnosis. This is first done by X-Ray which compares both knees, and if the results are not sufficiently detailed, an MRI scan will be performed to see more information. An orthopedic surgeon may be asked to look at the injury. This is all part of the normal diagnosis process.

Treatment

The treatment depends upon the severity of the injury. Cold packs may be applied to help bring down swelling or physical exercise may be supervised by a physiotherapist. The patient may be asked to elevate the leg, and to wear a knee brace. The more drastic the tear, the more the likelihood that the meniscus tears will need to be repaired by keyhole surgery, though meniscus removal or repair can add to the likelihood of arthritis at a later time.

Only the specialist will be able to determine the exact treatment needed in each individual case, although meniscus removal is avoided and is only used as a last measure if there are no other options. How efficient the repair will be depends largely upon where the tear is located.

Natural treatment

Protecting cartilage from damage has to be on everyone’s agenda. Cartilage throughout the body responds in the same way to aging and becomes fragile. However, there is scientific evidence that precautionary treatments with natural dietary supplements such as Regenerix Gold can help the regeneration of cartilage thus keeping it strong and able to withstand more shock. This may avoid meniscus tears because the fragility of the meniscus is automatically strengthened after continued treatment.

Treating Lower Leg Pain

Medical Guides | 2014 Jul

Lower leg pain has many causes. It could be as obvious as an injury, as common as cramp or as complex as damaged arteries.

Injuries such as shin splints, torn muscles and tendons or fractures and sprains can all cause tremendous pain. They have in common that they tend to be the result of over-use of the limbs or inadequate preparation for exercise and will, on the whole, heal with time.

Similarly, muscle cramp is something that affects most of us at one time or another. Caused by heat, dehydration or muscle fatigue, it is most common among older people and athletes who are not in top condition. Cramp is easily treated by stretching and massaging the muscles and applying heat to tight muscles or cold to those that are tender.

However, knee pain can be excruciating, not only in the knee itself, but also in the lower leg, making such simple tasks as walking almost impossible to pursue. Painful knee joints can lead to such things as the inability to walk comfortably on the affected side; deformity around the joint; pain at night or while resting; inability to bend the knee; swelling of the joint or calf area; infection.

However, lower leg pain is often due to problems with blood vessels:

Deep Vein Thrombosis                                                                                          

This is where a blood clot develops in a vein deep in the body, mostly in the lower leg or thigh. They are most likely to happen if you spend long periods of time inactive, smoke or take medicine that increases the risk of clots. If you suspect a blood clot, you must seek medical advice right away as pieces of blood clots can travel to lungs and other organs.

Varicose veins                                                                                                     

These are the purple or dark blue twisted veins seen near the surface of the skin and are usually caused by weak valves and vein walls. Apart from this visual indication, you are most likely to feel a dull ache, especially after standing for a while. Support stockings or trying to favour alternate legs while standing are highly beneficial.

Infection                                                                                                                         

A tender, red, warm and swollen area may indicate a skin or soft tissue infection. Soaking in a warm bath can help to soothe discomfort. If you develop a high temperature, your doctor may prescribe antibiotics.

(PAD). Lower extremity peripheral arterial disease  

The leg artery lining can become narrowed and damaged the same as the heart. This reduces blood flow and can cause lower leg pain or cramping when walking, climbing stairs and other kinds of exercise as muscles aren’t getting enough blood. Resting will bring relief, but arteries that become severely narrowed or blocked, cause persistent pain, even when resting. Injuries may also fail to heal well. Left untreated, this condition can lead to gangrene (dead tissue). People most at risk include those with high cholesterol, high blood pressure, diabetes and smokers.

Lifestyle change will help to prevent this problem. Smokers should stop smoking; you should manage your weight and you should take some light exercise such as walking.

Other treatment may include medication to control cholesterol, diabetes, hypertension, to help with walking l and to prevent blood clots. Occasionally, surgery is required to improve blood flow to the area.

You may also find the use of supplements such as Regenerix Gold beneficial which may help to ease inflammation and pain. Studies show that patients who take supplements experience less pain and recover faster.

Why You Have Knee Pain – How to Live With It

Medical Guides | 2014 Jul

Painful knees can make life practically intolerable, significantly affecting your ability to move about, particularly the ability to climb stairs. Pain in the front of the knee is usually related to the patellofemoral joint. Climbing stairs increases compression at this joint, adding stress on cartilage and tendons.

What Causes Knee Pain When Climbing Stairs                                                                   

One cause of knee pain when climbing stairs may be knee bursitis, the inflammation of a bursa (a fluid-filled sac) which lies between muscles or tendons and bone and helps reduce friction during movement. Each knee has 11 bursae and, although any of these may become inflamed, the bursa over the knee cap and that on the inner side of the knee and below the knee joint, are most frequently affected. Bursitis may be caused by kneeling for long periods, knee trauma or bacterial infection of the bursae. Symptoms may be an area of the knee warm to touch or swollen; pain or tenderness when pressing on the affected area and frontal knee pain when climbing stairs.

Patellar tracking disorder also causes knee pain when climbing stairs. The kneecap is set in a thick tendon that is attached to your lower leg bone and should glide along a channel in the thigh bone as you bend and straighten your knee. Sometimes the kneecap shifts out of the channel which leads to patellar tracking disorder. This can be caused by muscle weakness on one side of the thigh muscles, meaning that the kneecap is pulled toward the stronger side.

Body structure may also contribute to knee pain when climbing stairs. The angle of pull on the quadriceps tendon is influenced by the alignment of the hips, thigh bone and lower leg bone. This alignment, known as the “Q-angle,” tends to be larger in women than men. A larger Q-angle can pull the kneecap outward so that it slides out of the channel when the knee is moved. Flat arches in feet can also cause the kneecap to track improperly. After a while, this may cause pain with normal activities such as climbing stairs. This pain will usually subside with rest.

Similarly, chondromalacia patellae causes knee pain when climbing stairs. This is the deterioration of cartilage on the underside of the kneecap. As with patellar tracking disorder, the kneecap is not tracking properly when bent, so it wears down as a car engine would if the gears were out of alignment. Chondromalacia patellae may be caused by osteoarthritis in older people. The symptoms include knee pain which worsens when climbing stairs; tenderness of the knee and a grinding sensation when it is straightened or extended.

 

Prevention Of Knee Pain When Climbing Stairs                                                                

The best way to prevent knee pain is to keep the muscles that support your knees strong and flexible. Start slowly. If walking causes knee pain, don’t try running; warm up before working out and then cool down afterwards. If engaging in high impact activities, only do them on alternate days; steer clear of running up and down stairs and full squats. Knee exercises to strengthen and stretch the muscles that support the knee are essential to prevent knee pain and injury. Also, reducing weight reduces stress on the knee.

 

You may also want to try a natural dietary supplement. These drug-free medications can give pain relief similar to other drugs, but without the possibly harmful side effects.  Supplements also aid the growth and repair of healthy tissue within the body and so help to prevent knee pain when climbing stairs.

 

De Quervain Tenosynovitis, The Causes And Treatments

Medical Guides | 2014 Jul

How is the doctor to treat de quervain tenosynovitis Singapore? Doctors here have been looking into the condition known as De Quervain’s Tenosynovitis as, linked to rheumatoid arhritis, it is 1 of the most common musculoskeletal problems affecting the general population and is likely to be experienced by most people at least once in their lifetime, women being six times more at risk, especially those in middle age. However, it is frequently seen in new mothers which is probably due to repetitive lifting and putting down of the baby. As with most tendon problems, this is most usually linked to activities which involve repetitious movements of the thumb and wrist, such as racquet sports, fly fishing, golf and infant care.

De Quervain’s Tenosynovitis is a condition caused by inflammation or irritation of the wrist tendons at the base of the thumb. This causes the area around the tendon to swell, making wrist and thumb movement painful.

Diagnosing De Quervain Tenosynovitis.

When people experience such pain, they should visit the doctor who will examine them and, making note of the pain, tenderness and swelling he observes will also include a Finkelstein test. This involves a fist made with the fingers over the thumb and, with de Quervain Tenosynovitis, will cause increased pain.

The doctor may also decide that X-rays are necessary to rule out other conditions, such as degenerative joint disease (which may coexist with de Quervain syndrome).

Treatments

How, then, is a doctor to treat de quervain tenosynovitis Singapore? Like most inflamed tendon problems, non-operative treatments are preferable and include wearing a splint to rest the thumb and wrist. Anti-inflammatory and painkilling medication is usually prescribed and the doctor may even prescribe a steroid injection into the tendon compartment to fight the inflammation. Corticosteroid cream may also help as it provides ultrasound through the skin and can reduce inflammation. Stretching the wrist may also help to relieve the symptoms and enhance recovery. These steps should relieve the pain caused by the irritation and swelling. In some cases, simply stopping the causal activities and allowing the muscle and tendon to rest may allow the symptoms to resolve on their own.

However, when the symptoms are severe or do not improve after a while, surgery may be necessary. This will open the compartment to make room for the inflamed tendons, thus breaking the cycle where the tight space causes more inflammation.

Preventing Recurrence of De Quervain Tenosynovitis

It is advisable for the patient to avoid the repetitive activities which may aggravate the pain, certainly until the condition has completely healed. With this in mind, it is a good idea to pay attention to workplace and home ergonomics and ensure that repetitive actions are not going to cause a repetition of the condition. Your doctor may also be able to advise you on exercises that will help to strengthen the area and improve flexibility.

Similarly, a healthy diet, possibly with the use of dietary supplements, is essential for a healthy body, particularly healthy tissue, tendons and muscles which means that the likelihood of injury may be reduced and recovery from injury is quicker. Wouldn’t visitors to the clinic prefer prevention to needing a doctor to treat de quervain tenosynovitis Singapore?

Artificial Disc Replacement

Degenerative disease of the spine is one of the leading causes of disability in the adult population. Most of these patients are treated non-surgically with analgesia, physiotherapy and injections. The majority will get better without surgery. However, a group of patients will
Cocktail Dresses
continue to experience pain. The chronic nature of spinal pain can be disabling and interferes with the ability to work and participate in regular daily activities. For these patients, surgical treatment becomes necessary.

Surgical treatment for degenerative spine disease has traditionally been spinal fusion. Unfortunately, there are a number of drawbacks to spinal fusion. Firstly, the bone may not be able to heal or fuse. The average success rate of fusion is approximately 80%. Failure of the bone to fuse may be associated with continued symptoms. Secondly, fusion will cause stiffness

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and decreased motion of the spine. Thirdly, spinal fusion will cause more stress to be transferred to adjacent levels. This increased stress at the adjacent level may cause further degeneration at the adjacent levels which may lead to additional spine surgery.
Artificial disc replacement is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial devices in the lumbar (lower) or cervical (upper) spine. The procedure is used to treat chronic, severe low back pain and cervical pain resulting from degenerative disc disease.

Artificial disc replacement has been developed as an alternative to spine fusion. The introduction of the total disc replacement aims to relieve patient symptoms while preserving motion at the operative spinal level. The advantage of preserving motion is to minimize the stress at adjacent levels and thereby decrease the risk of degeneration of the adjacent segment.
Currently artificial disc replacement can be used for the lumbar or the cervical spine. Many different models have been developed. The majority consists of two metal plates Prom Dresses that have teeth to anchor the implant onto the bone of the vertebral bodies. Between the two plates is a metal core or a plastic core made up of polyethylene that allows for motion. Figure 1 shows a lumbar artificial disc replacement. Figure 2 shows a cervical artificial disc replacement.

Figure 1. Lumbar artificial disc

Figure 1. Lumbar artificial disc

Figure 2. Cervical artificial disc

Figure 2. Cervical artificial disc

 

 

 

 

 

 

 

 

 

 

The clinical diagnoses for lumbar artificial disc replacement include symptomatic degenerative disc disease and post-discectomy syndrome. Post-discectomy syndrome is persistent back pain following previous surgery to remove a

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herniated disc. For cervical artificial disc replacement, the diagnoses include cervical radiculopathy (where the nerve root is compressed) and cervical myelopathy (where the spinal cord is compressed).

The technique to insert an artificial disc (whether in the neck or low back) is routine and safe. For the cervical spine it involves going from the front of the neck. For the lumbar spine, it involves going through the abdomen. The procedure begins by removing the gelatinous disc between the vertebrae. Once the disc is removed, two metal plates are pressed into the bony endplates above and below the space now vacated by the disc. Metal spikes hold these plates in place on the bone. Eventually bone will grow over and around the metal plates. In between the metal plates is a metal or plastic core made of a polyethylene. Figure 3 shows the artificial disc placed in the spine.

Figure 3. Artificial disc placed in spine

Figure 3. Artificial disc placed in spine

Careful selection of patients for artificial disc replacement is critical. There are several conditions that may prevent patients from receiving a disc replacement. These include spondylolisthesis (the slipping of one vertebral body across a lower one), osteoporosis, vertebral body fracture, allergy to the materials in the device, spinal tumor, spinal infection, morbid obesity, significant changes of the facet joints (joints in the back portion of the spine), pregnancy, chronic steroid use or autoimmune problems. Also, total disc replacements are designed to be implanted from an anterior approach (through the abdomen for lumbar). Patients may be excluded from receiving an artificial disc if they previously had abdominal surgery or if the condition of the blood vessels in front of the spine increases the risk of significant injury during this type of spinal surgery.
In addition to the potential complications associated with general anesthesia, the complications associated with artificial disc replacement may include breakage of the metal plate, dislocation of the implant, infection, nerve injury and injury to blood vessels and urological structures. To help minimize complications associated with the implant itself, proper selection of patients and size of implant is very important. Also, artificial implants may fail over time due to wear of the materials and loosening of the implants.

Recovery from artificial disc replacement and care afterwards are much like that for other anterior approaches to the spine. In some cases, recovery is faster than for a traditional fusion surgery. There is less pain from the

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procedure and fewer complications in general. Another potential advantage of disc replacement is a more rapid

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return to activities than occurs after fusion surgery. Fusion patients have limited activities during the time required for the bone graft to grow into a solid mass. Because one of the goals of artificial discs is motion, patients are encouraged to return to motion early, although at a gradual progression. The length and type of activity restrictions following surgery are also much less with disc replacement.

Contributing Specialist:

(Spine Surgery)

Island Orthopaedic Consultants
Gleneagles Med Ctr,#02-16,
Tel:(65) 6474 5488, 6479 8998
Mt Elizabeth Med Ctr, #06-03,
Tel:(65) 6737 5683
Website: www.iog.com.sg

 

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