Ligament Injuries to the Knee

Ligament Injuries to the Knee

What are knee ligaments?

There are 4 major ligaments in the knee. Ligaments are elastic bands of tissue that connect bones to each other and provide stability and strength to the joint. The 4 main ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include:

Anatomy of the knee
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  • Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).
  • Posterior cruciate ligament (PCL). The ligament, located in the back of the knee, that controls backward movement of the tibia (shin bone).
  • Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.
  • Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.

How are cruciate ligaments injured?

The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

The posterior cruciate ligament (PCL) is also a common ligament to become injured in the knee. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.

What are the symptoms of a cruciate ligament injury?

Often, a cruciate ligament injury does not cause pain. Instead, the person may hear a popping sound as the injury occurs, followed by the leg buckling when trying to stand on it, and swelling. However, each individual may experience symptoms differently.

The symptoms of a cruciate ligament injury may look like other conditions or medical problems. Always see your doctor for a diagnosis.

How are collateral ligaments injured?

The medial collateral ligament is injured more often than the lateral collateral ligament. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.

What are the symptoms of a collateral ligament injury?

Similar to cruciate ligament injuries, an injury to the collateral ligament causes the knee to pop and buckle, causing pain and swelling.

The symptoms of a collateral ligament injury may look like other conditions or medical problems. Always see your doctor for a diagnosis.

How is a knee ligament injury diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for a knee ligament injury may include:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film to rule out an injury to bone instead of, or in addition to, a ligament injury.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in bones and a surrounding ligament or muscle.
  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.

Treatment for knee ligament injuries

Treatment may include:

  • Medicaine such as ibuprofen
  • Muscle-strengthening exercises
  • Protective knee brace (for use during exercise)
  • Ice pack application (to reduce swelling)
  • Surgery
Bunion Surgery

Bunion Surgery

What is bunion surgery?

Bunion surgery is done to reduce the pain and correct the deformity caused by a bunion. A bunion (hallux valgus) is an enlargement of the bone or tissue around a joint at the base of the big toe or at the base of the little toe. This one is called a “bunionette” or “tailor’s bunion.” Bunions often form when the joint is stressed over a prolonged period. Most bunions form in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis. This often affects the big toe joint.

Before surgery is considered, your healthcare provider may recommend first wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas). He or she may also suggest using splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe and/or provide padding. For bunions caused by arthritis, medicines may help reduce pain and swelling.

If these treatments don’t help, your healthcare provider may suggest surgery. This often resolves the problem. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot.

Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot. Please see these procedures for more information.

The type of surgical procedure performed depends on the severity of the bunion, your age, general health, activity level, and the condition of the bones and connective tissue. Other factors may influence the choice of a procedure used:

  • Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone and realign the muscles, tendons, and ligaments surrounding the joint.
  • Moderate bunion. For a moderate bunion, the surgeon may cut the bone and shift it to its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned.
  • Severe bunion. For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments.
  • Arthritic bunion or big toe joint. If the joint is damaged beyond repair, as is often seen in arthritis, it may need to be fused. This allows the bones to heal together and eliminate movement and pain. Occasionally, joint replacement implants may be used in the reconstruction of the big toe joint.

Why might I need bunion surgery?

You may need bunion surgery if you have severe foot pain that happens even when walking or wearing flat, comfortable shoes. Surgery may also be needed when chronic big toe inflammation and swelling isn’t relieved with rest or medicines.

Other reasons for surgery include toe deformity, a drifting in of the big toe toward the small toe, and an inability to bend and straighten the big toe.

There may be other reasons for your healthcare provider to recommend bunion surgery.

What are the risks of bunion surgery?

As with any surgical procedure, complications can happen. Some possible complications may include:

  • Stiffness
  • Numbness
  • Swelling
  • Delayed healing
  • Infection

Other complications may include recurrence of the bunion, nerve damage, and continued pain. The surgery may also result in overcorrection of the problem, in which the big toe extends away from the other toes.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I prepare for bunion surgery?

  • Your healthcare provider will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your healthcare provider may perform a complete physical exam to make sure that you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
  • Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. It may be necessary for you to stop these medicines before the procedure.
  • If you are pregnant or suspect that you are pregnant, you should notify your healthcare provider.
  • You may be asked to fast for 8 hours before the procedure, generally after midnight.
  • You may receive a sedative before the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
  • Based on your medical condition, your healthcare provider may request other specific preparation.

What happens during bunion surgery?

Bunion surgery may be done on an outpatient basis or rarely as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider’s practices.

Most bunion surgery is performed under ankle block anesthesia, in which your foot is numb, but you are awake. Occasionally, general or spinal anesthesia is used.

Generally, bunion surgery follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. The skin over the bunion will be cleansed with an antiseptic solution.
  4. If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using intravenous medicine.
  5. The healthcare provider will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based upon the severity of the bunion.
  6. The healthcare provider will close the opening with stitches and apply a sterile bandage or dressing.

What happens after bunion surgery?

After your surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. The circulation and sensation of the foot will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

Your healthcare provider will give you specific instructions for caring for your foot at home during the first few weeks after surgery. You may be discharged from the hospital wearing a special surgical shoe or cast to protect your foot.

Once you are at home, you will need to rest and keep the foot elevated on 1 or 2 pillows to help reduce pain and swelling. Your healthcare provider may also recommend that you apply ice and limit walking. You may be advised to use a cane or walker following surgery.

It is important to keep the dressing clean and dry. You should cover the dressing with a plastic bag or plastic wrap and tape it with plastic tape when showering. An alternative is to take a sponge bath. The stitches will be removed during a follow-up visit, generally scheduled about two weeks after surgery.

Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines. Your healthcare provider may also prescribe antibiotics to help prevent infection following your surgery.

Notify your healthcare provider to report any of the following:

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
  • Redness, swelling, bleeding, or other drainage from the incision site
  • Increased pain around the incision site
  • Swelling in lower leg of the affected foot

Your healthcare provider will advise you as to your postoperative activities. Your foot may need continuous support from dressings or a brace for 6 to 8 weeks after surgery. You may need to refrain from driving for a week or more after surgery.

Exercises or physical therapy may be recommended to help the foot recover its strength and range of motion after surgery. High heels should be avoided for at least 6 months after surgery.

Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure
Carpal Tunnel Release

Carpal Tunnel Release

What is carpal tunnel release surgery?

Carpal tunnel release is a surgery used to treat and potentially heal the painful condition known as carpal tunnel syndrome. Doctors used to think that carpal tunnel syndrome was caused by an overuse injury or a repetitive motion performed by the wrist or hand, often at work. They now know that it’s most likely a congenital predisposition (something that runs in families) – some people simply have smaller carpal tunnels than others. Carpal tunnel syndrome can also be caused by injury, such as a sprain or fracture, or repetitive use of a vibrating tool. It’s also been linked to pregnancy, diabetes, thyroid disease, and rheumatoid arthritis.

The median nerve and tendons that allow your fingers to move pass through a narrow passageway in the wrist called the carpal tunnel. The carpal tunnel is formed by the wrist bones on the bottom and the transverse carpal ligament across the top (or inside) of the wrist. When this part of the body is injured or tight, swelling of the tissues within the tunnel can press on the median nerve. This causes numbness and tingling of the hand, pain, and loss of function if not treated. Symptoms usually start slowly, and may get worse over time. They tend to be worse on the thumb side of the hand.

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During a carpal tunnel release, a surgeon cuts through the ligament that is pressing down on the carpal tunnel. This makes more room for the median nerve and tendons passing through the tunnel, and usually improves pain and function.

Why might I need carpal tunnel surgery?

A diagnosis of carpal tunnel syndrome is about the only reason to have a carpal tunnel surgery. And even then, your doctor will likely want you to try nonsurgical treatments first. These may include over-the-counter pain medicines, physical therapy, changes to the equipment you use at work, wrist splints, or shots of steroids in the wrist to help relieve swelling and pain.

The reasons that a doctor would recommend a carpal tunnel release surgery may include:

  • The nonsurgical interventions for carpal tunnel syndrome don’t relieve the pain.
  • The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.
  • The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
  • The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.

What are the risks of carpal tunnel surgery?

As with most surgeries, carpal tunnel release is not without its risks. Your wrist will be made numb and you may be given medicine to make you sleepy and not feel pain (called local anesthesia) for the procedure. In some cases general anesthesia is used, this when drugs are used to put you into a deep sleep during surgery. Anesthesia poses risks for some people. Other potential risks of a carpal tunnel release surgery include:

  • Bleeding
  • Infection
  • Injury to the median nerve or nerves that branch out from it
  • Injuries to nearby blood vessels
  • A sensitive scar

The recovery from carpal tunnel surgery takes time – anywhere from several weeks to several months. If the nerve has been compressed for a long period of time, recovery may take even longer. Recovery involves splinting your wrist and getting physical therapy to strengthen and heal the wrist and hand.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

How do I get ready for carpal tunnel surgery?

  • Tell your doctor about all medicines you are currently taking, including over-the-counter drugs, vitamins, herbs, and supplements. You will probably need to stop taking any medicines that make it harder for the blood to clot, such as ibuprofen, aspirin, or naproxen.
  • If you’re a smoker, try to quit before to the surgery. Smoking can delay healing.
  • You may need to get blood tests or an electrocardiogram (ECG) before surgery.
  • You will usually be asked not to eat or drink anything for 6 to 12 hours before the surgery.

Based on your medical condition, your doctor may request other specific preparations.

What happens during carpal tunnel surgery?

Carpal tunnel release is usually an outpatient procedure, which means that you can go home the same day as the surgery if all goes well. There are 2 types of carpal tunnel release surgery. The traditional method is the open release, in which the surgeon cuts open the wrist to do the surgery.

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The other method is endoscopic carpal tunnel release, in which a thin, flexible tube that contains a camera is put into the wrist through a tiny incision (cut). The camera guides the doctor as the surgery is done with thin tools put into the wrist through another small cut.

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In either case, here is the general sequence of events in a carpal tunnel release surgery:

  1. You will usually be asked to remove your clothing, or at least your shirt, and put on a hospital gown.
  2. Typically, local anesthetic is used for this procedure to numb the hand and wrist.
  3. In an open release surgery, the surgeon cuts about a 2-inch incision on the wrist. Then he or she uses common surgical instruments to cut the carpal ligament and enlarge the carpal tunnel.
  4. In an endoscopic carpal tunnel release, the doctor makes 2, half-inch incisions. One is on the wrist, and one is on the palm. Then he or she inserts a camera attached to a narrow tube into one incision. The camera guides your doctor as he or she inserts the instruments and cuts the carpal ligament through the other incision.
  5. The surgeon will stitch up the incision or incisions.
  6. Your hand and wrist will be placed in a splint or bandaged heavily to keep you from moving your wrist.

Once the surgery is done, you’ll be monitored for a short time, and then allowed to go home. Only in rare cases or complications is an overnight stay needed for a carpal tunnel release surgery.

What happens after carpal tunnel surgery?

Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.

You’ll probably have pain in your hand and wrist after surgery. It’s usually controlled with pain medicines taken by mouth. The surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.

Once the splint is removed, you will likely begin a physical therapy program. The physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.

The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your doctor will talk to you about activity restrictions you should follow after surgery.

Let your doctor know about any of the following:

  • Fever
  • Redness, swelling, bleeding, or other drainage from the incision
  • Increased pain around the incision

These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would  happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure
Dislocations

Dislocations

What is a dislocation?

A dislocation happens when extreme force is put on a ligament, allowing the ends of two connected bones to separate. Ligaments are flexible bands of fibrous tissue that connect various bones and cartilage.

Ligaments also bind the bones in a joint together. Stress on joint ligaments can lead to dislocation of the joint. The hip and shoulder joints, for example, are called “ball and socket” joints. Extreme force on the ligaments in these joints can cause the head of the bone (ball) to partially or completely come out of the socket.

Illustration of types of joints
Click Image to Enlarge

The most commonly dislocated joint is the shoulder.

Dislocations are uncommon in younger children because their growth plates (area of bone growth located in the ends of long bones) are weaker than the muscles or tendons. Instead, children are more prone to a fracture than a dislocation.

What are the symptoms of a dislocation?

The following are the most common symptoms of a dislocation. However, each child may experience symptoms differently. Symptoms may include:

  • Pain in the injured area
  • Swelling in the injured area
  • Difficulty using or moving the injured area in a normal manner
  • Deformity of the dislocated area
  • Bruising or redness in the injured area
  • Numbness or weakness in the injured area

The symptoms of a dislocation may resemble other medical conditions. Always talk with your child’s healthcare provider for a diagnosis.

How is a dislocation diagnosed?

The healthcare provider makes the diagnosis with a physical exam. During the exam, the healthcare provider obtains a complete medical history of the child and asks how the injury happened.

Diagnostic procedures may help to evaluate the problem. Diagnostic procedures may include:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRI is only likely to be done if your healthcare provider is considering surgery.

Treatment for dislocation

Specific treatment for a dislocation will be discussed with you by your child’s healthcare provider based on:

  • Your child’s age, overall health, and medical history
  • The extent of the injury
  • The type of injury
  • Your child’s tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

All dislocations need immediate medical attention since fractures can also happen with dislocations and neglected dislocations can lead to serious problems.

Initial treatment of a dislocation includes R.I.C.E. (rest, ice, compression, and elevation). Dislocations may reduce spontaneously, meaning the bone ends may go back into place by themselves. However, for those dislocations that do not go back into place, your child’s healthcare provider will need to place the joint back into its proper position so it will heal. Your child will receive sedation to help him or her remain comfortable before the procedure. Sedation will also help the muscles around the dislocated joint relax, so the joint can be put back into place more easily.

Your child’s healthcare provider may recommend any of the following to help reduce the dislocation or promote healing afterwards:

  • Splint or cast, which immobilizes the dislocated area to promote alignment and healing. It protects the injured area from motion or use
  • Medicine (for pain control)
  • Traction is the application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the bone ends to help reduce the dislocation.
  • Surgery (especially for dislocations that happen again and again, or if a muscle, tendon, or ligament is badly torn)

Additional recommendations may include:

  • Activity restrictions (while the dislocation heals)
  • Crutches or wheelchair (to enable your child to move around during healing)
  • Physical therapy (to stretch and strengthen the injured muscles, ligaments, and tendons)

Long-term outlook after a dislocation

While dislocations are rare in younger children, they do happen more often among adolescents. It is important that the child stick to the activity restrictions and/or stretching and strengthening rehabilitation programs to prevent reinjury.

Joints Achy? New Study Says Don’t Blame Mother Nature

Joints Achy? New Study Says Don’t Blame Mother Nature

TUESDAY, Jan. 10, 2017 (HealthDay News) — You might want to think twice the next time you’re ready to blame the weather for your aches and pains, researchers say.

Some people swear that changes in humidity, temperature, air pressure and the like trigger back pain and arthritis. But a team at the George Institute for Global Health in Newtown, Australia said it found no evidence to support that theory.

“The belief that pain and inclement weather are linked dates back to Roman times. But our research suggests this belief may be based on the fact that people recall events that confirm their pre-existing views,” said Chris Maher, director of the institute’s musculoskeletal division.

The study included nearly 1,350 Australians with either lower back pain or osteoarthritis of the knee. The study participants’ pain flare-ups were compared with weather data.

There was no association between back pain/knee arthritis and temperature, humidity, air pressure, wind direction or precipitation, the investigators found.

“Human beings are very susceptible so it’s easy to see why we might only take note of pain on the days when it’s cold and rainy outside, but discount the days when they have symptoms but the weather is mild and sunny,” Maher explained in an institute news release.

Maher is also a professor of physiotherapy at the University of Sydney.

Back pain affects up to one-third of people worldwide at any one time. Nearly 10 percent of men and 18 percent of women over the age of 60 have osteoarthritis, the study authors said in background notes.

Manuela Ferreira, an associate professor of medicine who led the osteoarthritis research, said, “People who suffer from either of these conditions should not focus on the weather as it does not have an important influence on your symptoms and it is outside your control.

“What’s more important is to focus on things you can control in regards to managing pain and prevention,” he concluded.

Ferreira is a senior research fellow at the George Institute and the Institute of Bone and Joint Research at the University of Sydney.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on back pain.

SOURCE: George Institute for Global Health, news release, Jan. 10, 2017