If you’re experiencing knee pain, you may have a meniscal tear. Our orthopedic experts explain what causes this injury and what you can expect during your recovery.
The meniscus is a key cartilaginous structure in the knee joint. Pain and swelling in the medial, or inside, part of the knee can unfortunately be a sign of tearing, but your treatment options will look different depending on the type of tear, the cause, and the severity. Our guide explains meniscal injuries, and what you can expect when you visit your doctor.
WHAT IS THE MENISCUS?
The meniscus is the C-shaped, rubbery cartilage in the knee that acts as a shock absorber and stabilizer for the joint, distributing the body’s weight and providing a cushion between the femur and tibia bones. The medial meniscus is located on the inner knee, while the lateral meniscus is on the outside. Medial tears are more common, but the symptoms are the same for both injuries.
Meniscal injuries can be classified according to the “zone” of the meniscus that is affected. This allows the physician to determine the amount of blood flow available to aid in the healing process. The red zone is the outer third, which has blood vessels and is more easily repaired by the body. The red-white zone has fewer blood vessels and is less quick to heal. The inner third, the white zone, has poor blood flow and is therefore more difficult to repair.
Meniscal tears also come in a variety of shapes, which may influence the course of treatment. Common shapes include bucket-handle, flap, and radial tears, or complex combinations of the three. A tears is considered “complete” if a piece of tissue has become separated from the meniscus. Degenerative tears, which are generally caused by arthritis, are more typical of older patients. Traumatic tears are common among athletes, who often twist and turn the meniscus.
SYMPTOMS AND CAUSES OF MENISCAL TEARS
The first sign of a meniscal tear may be a “pop” in the joint, and you may continue to feel a popping or clicking sensation with movement. Although you may be able to walk on the knee at first, subsequent pain and swelling can worsen in the days that follow, especially if you continue to use the leg. For a severe tear, the knee may click, lose its full range of motion, or even give way. If a part of the meniscus comes loose, the knee can slip or even lock.
Athletes and young people are especially prone to this injury due to sports trauma or hyper-flexing the joint. A forced twist, especially when the foot is planted, may cause the meniscus to tear. Older people may experience meniscal pain due to arthritis or ordinary degenerative wear to the cartilage. In these cases the pain occurs due to gradual tearing over time, and may present with no trauma to the knee.
KNEE PAIN TREATMENT AND RECOVERY
The first course of action is to follow the rules of “RICE”: rest the knee, ice the area in 20-minute sessions, compress the area, and elevate the leg to reduce swelling. In some cases, the knee may heal with this conservative treatment, but we recommend consulting an orthopedic specialist to examine the joint and monitor your recovery. Your doctor may perform a McMurray test, which includes bending, straightening, and rotating the knee in order to determine if an MRI is necessary. Orthopedic specialists usually will not recommend surgery for older patients, but physical therapy may help you find relief within five weeks.
For younger patients, arthroscopic surgery may actually be a preferred option, as this will help preserve the cartilage and prevent early onset arthritis in the joint. This type of surgery requires only two pinhole incisions. In most cases, when the tear is in the white zone, the fragment is trimmed and the remainder smoothed. Tears in the red zone are usually repaired to retain the full benefits of a complete meniscus. Surgery is often completed in 30 minutes, followed by several days of walking with the assistance of a crutch, or possibly a brace. After a few days you can expect to return to most normal activities. Full recovery, and a return to strenuous activity, can be expected after a few weeks of physical therapy.
Non-invasive treatments should be your first line of defense against neck pain.
Workouts, sports, and even sitting at a desk all day can put strain on the neck, leading to pain and discomfort. While some conditions may require orthopedic surgery, non-invasive treatments often lead to better long-term outcomes, and should generally be the first line of defense against neck pain.
A qualified physical therapist can help you create an appropriate plan for chronic neck pain, which is defined as pain that lasts for more than a few weeks. With a physical therapy plan tailored to your needs, you can safely gain strength and flexibility, as well as lower your chance of developing a future neck injury.
If you’re suffering from neck pain and looking to find relief, your physical therapist might suggest some of the following exercises.
1. SHOULDER AND HEAD ROLLS
These stretches are a good warm-up to start with before attempting other exercises. For a shoulder roll, keep your arms relaxed at your sides, and with your head upright, simply lift and roll your shoulders. Relax briefly between each roll. Do ten rolls forward, and ten back.
Before you try a head roll, stretch the neck. Make sure your shoulder blades are relaxed, and that your head is not tilted forward but sits directly over your neck. Start by dipping your chin slowly toward your chest, and hold for several breaths (if you are unable to dip your chin, or if it causes an increase in pain, stop and contact your doctor). Next, lift your head and lower your left ear toward your left shoulder, and hold. Repeat this movement on the right side, then do a similar stretch with your head tilted back.
After stretching your neck, you can roll your head slowly in sections, from tucked in front or tilted back toward each side, five times each. Avoid doing a full head roll, which can actually strain the neck.
2. SEATED NECK STRETCH
Deceptively simple, this exercise can even be performed at your desk. For a seated stretch, sit upright in your chair with your feet flat on the ground. Extend your right arm along your right side and place your left hand on the top of your head. Tilt your head to the left, applying pressure with your hand to gently intensify the stretch. Hold for 30 seconds, then repeat for the right side. You will feel this stretch in the levator scapula muscles in the sides of the neck.
3. WALL PUSH-UP
This exercise can help strengthen your shoulders and support your neck muscles, without causing as much stress as typical push-ups. Stand facing a wall, with two to three feet of space in front of you and your feet shoulder-width apart. Place your hands against the wall, just below shoulder level. Start with straight arms, and bend your elbows slowly to bring your body closer to the wall. Repeat this 10 times for one or two sets.
4. AQUATIC EXERCISES
While high-impact sports can be hard on the neck, low-impact sports like swimming, walking, or recumbent biking may help you avoid strain. If you have neck pain, many physical therapists recommend that you hit the pool for your aerobic exercises in order to increase blood flow to the neck.
While in the water, you can attempt neck flexibility stretches like the “clock” exercise. Repeat the following on both sides:
- Stand in a lunge position, with both arms at shoulder height. While the right foot and hand are forward at a 12 o’clock position, sweep the left hand back to 6 o’clock, following with the head and body. Repeat five times.
- Keep the left hand sweeping to 6 o’clock, while the head moves only to 9 o’clock, for five repetitions.
- For the last set of five, the head remains at 12 o’clock while the arm sweeps to 6 o’clock.
5. PRONE ROWS
This exercise strengthens the muscles that pull the shoulder blades together. You’ll want to lie facedown on a bed or similar surface, angled so that your face is in a corner, and you can dangle your arms off each side. Row upward, bending the elbows and squeezing the shoulder blades together without moving your head. Try about 20 repetitions for one or two sets. You can add light weights to this exercise if it is too easy.
EXERCISES TO AVOID
While adding these exercises to your routine, you should be careful to avoid workouts that may impede your progress. Don’t do sit-ups or crunches, as these can strain your neck vertebrae. In weightlifting, both the military press and lat pulldown put pressure on the vertebrae, and should be avoided.
The five exercises above can get you started on the road to recovery, although for best results, we recommend working with a physical therapist. If these exercises don’t relieve your pain, or cause pain that shoots into your shoulders or arms, contact a doctor as soon as possible. The orthopedic specialists at Comprehensive Orthopaedics can help you develop a personalized treatment plan and get back to the activities you love.
Here’s what you need to know about the painful but treatable condition called adhesive capsulitis, or frozen shoulder.
Frozen shoulder, or adhesive capsulitis, is an inflammation of the shoulder capsule. This band of connective tissue encases the shoulder joint, so as inflammation progresses, patients experience a restricted range of motion along with extreme stiffness.
While the medical community has not yet been able to pinpoint the exact cause of frozen shoulder, there are a number of conditions that can contribute to its development. These include diabetes, thyroid disorders, and past surgeries on the shoulder or chest.
SIGNS AND SYMPTOMS OF FROZEN SHOULDER
Patients suffering from frozen shoulder generally experience moderate to severe pain, inflammation, stiffness, and a limited range of motion in the shoulder.
This condition normally cycles through three progressive stages. These are:
- The “freezing” phase, where the patient experiences increasingly severe shoulder pain lasting from several weeks to nine months.
- The “frozen” phase, where pain in the shoulder decreases but stiffness lingers, lasting from four to nine months.
- The “thawing” phase, where pain continues to lessen and the range of motion in the shoulder slowly improves, lasting from five months to two years.
HOW TO PREVENT FROZEN SHOULDER
Frozen shoulder predominantly affects people in middle age, and it is possible to preemptively avoid this condition — especially if you’ve been diagnosed with any of the risk factors commonly associated with it, like diabetes or a thyroid disorder. The best possible prevention method is to steadily increase shoulder flexibility through stretching, including external rotation, forward flexion, and crossover arm motions.
HOW TO TREAT FROZEN SHOULDER
In many cases, conservative treatments can effectively ease shoulder pain and stiffness. These methods generally include a physical therapy regimen designed to restore shoulder motion and strengthen the surrounding muscles. Most patients will need to undergo a rehabilitation plan for approximately four to five months to ensure a complete recovery.
Sometimes, anti-inflammatories and corticosteroid injections are used to supplement physical therapy. If mobility issues continue, minimally invasive arthroscopic surgery can be utilized to break up and remove scar tissue that has built up in the shoulder, with full recovery occurring in as little as six weeks.
If you think you may be suffering from frozen shoulder, set up an appointment with an orthopedic specialist today. Backed by decades of experience in treating shoulder injuries, CompOrtho Specialists can work with you to develop a personalized recovery plan. Dr. Main and Dr. Gershtenson are top-rated orthopedic surgeons in Southeastern Wisconsin who specializes in the shoulder. Our team of specialists can help you through every step of your treatment, ensuring a quick and complete recovery.
Joint replacement surgery removes damaged parts of a joint and replaces them with man-made parts. The goal is to restore function and reduce pain and inflammation.
The most commonly replaced joints are the hip or knee. Less often, a shoulder, finger joint, ankle or elbow is replaced, the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases says.
The agency describes what to expect while preparing for and recovering from joint replacement surgery:
- You doctor probably will prescribe pain-relieving medication, both before and after the procedure.
- A growing number of patients are able to take advantage of out patient surgery centers where you can go home the very same day. If you are elderly or disabled, you may spend some time at an in-patient rehabilitation center before going home.
- Expect to use a walker or crutches for at least a few days.
- Physical therapy should begin soon after surgery, to help strengthen muscles around the new joint and help you regain motion in the joint.
- Pain and discomfort can be relieved with medication. Both should go away within a few weeks or months.
Spine and joint surgery patients aren’t taking advantage of common pain relievers like Tylenol or Motrin during their recovery, researchers say.
Instead, many are given opioids, such as oxycodone (OxyContin) or hydrocodone (Vicodin). These highly addictive narcotics are potentially deadly when abused. The United States is currently grappling with an ongoing opioid epidemic.
The new study also found that post-surgical patients improperly store and dispose of their unused opioid painkillers.
“It’s clear we need to empower patients to ask their physicians about non-opioid pain management options, as well as call on prescribers to be more thoughtful of their prescribing practices,” said study first author Dr. Mark Bicket. He’s an assistant professor of anesthesiology and critical care medicine at Johns Hopkins University in Baltimore.
Greater use of non-opioid painkillers means fewer opioids would need to be prescribed, making it less likely that they’d be lost, sold, taken by error or discovered by a child, Bicket said in a university news release.
The researchers found that six months after surgery, more than one-third of patients still had unused opioids at home. And more than 90 percent admitted that they weren’t stored safely.
Three-quarters or more said they had not received instructions on how to store or dispose of the opioids, the study authors noted.
The study included 140 patients, average age 56, who were surveyed two days, two weeks, one month and six months after surgery about their use of non-opioid painkillers. These drugs include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin and Advil, and acetaminophen (Tylenol).
Two days after surgery, 82 percent of patients were not using NSAIDs. Forty-four percent reported not using acetaminophen. Only 5 percent used both NSAIDs and acetaminophen.
One month after surgery, only 6 percent of patients reported use of multiple non-opioid medications.
Also one month after their operation, nearly three-quarters of patients said they had unused opioids. Almost half of these said they had 20 or more unused pills, and 37 percent said they had more than 200 morphine milligram equivalents of opioids. Some experts say that, at this dosage, a patient who has never had narcotic painkillers would overdose.
The vast majority of the study patients reported unsafe storage of opioids a month after surgery and said they had not disposed of unused pills.
The study was published recently in the journal Anesthesia & Analgesia.
The American Academy of Family Physicians has more on pain control after surgery.
SOURCE: Johns Hopkins University, news release, April 30, 2018
Professional athletes’ speedy recoveries from injuries have nothing to do with superhuman abilities. Instead, it’s all about proper preparation and planning.
It’s no surprise that professional athletes tend to be in much better shape than those of us who don’t play sports for a living — but what might seem more puzzling is that they also seem to recover more rapidly from injuries. Think of D’Angelo Russell, the Brooklyn Nets’ star point guard. After suffering a knee injury in November, he underwent arthroscopic knee surgery and fully recovered in just over two months, returning to the court by the middle of January.
Such a speedy recovery isn’t evidence of superior physical fitness, however, so much as a clear strategy in the wake of an injury. Professional athletes have access to some of the best orthopedic specialist available — and these doctors, trainers, and therapists help them follow strict guidelines throughout the process of rehabilitation, ensuring that they can return to action as soon as possible.
While you might not have a dedicated team of doctors at your disposal, there are many steps you can take to enjoy a similarly quick recovery. ACL tears — a rupture of the anterior cruciate ligament, one of several ligaments that stabilize the knee — are a common injury affecting star basketball players and casual gym-goers alike. Here’s what you can learn from the professional athletes’ approach to ACL rehabilitation.
1. KEEP YOUR BODY HEALTHY
In order to help your body best respond to arthroscopic surgery, you need to stay healthy and hydrated. For at least a week before your surgery, be sure to drink plenty of water and eat a nutritious, wholesome diet rich in antioxidants, both of which can boost your body’s ability to heal.
2. STRETCH AND EXERCISE BEFORE SURGERY
Staying healthy requires more than just eating right, of course. Your preparation for surgery should include regular stretches and massages, which can strength the tissues surrounding the ACL and increase their flexibility. These measures ensure that the knee joint remains relaxed and enjoys proper circulation, both of which foster optimal surgical conditions.
3. DON’T BE AFRAID TO ASK QUESTIONS
Nobody expects an injury, so when these unfortunate events happen, you might not know what to expect. Athletes have a whole team on hand — ranging from surgeons to physical therapists — to guide them through the process, and while you might not have the same resources readily available, you should do your best to stay informed. Your doctor and surgeon are there to help you, so be sure to voice your concerns and ask any questions you may have.
4. FORMULATE AND WRITE DOWN THE RULES
When it comes to recovery, you can’t break the rules. A rehabilitation plan isn’t something you can come up with on the fly, so be sure to consult with your doctor, therapist, and surgeon to formulate a concrete plan centered around defined protocols and regular benchmarks to help you stay motivated and focused.
5. STAY STOCKED UP ON SUPPLIES
Proper recovery requires keeping plenty of tools on hand, such as ice packs and non-steroidal anti-inflammatories. You may struggle to get out of the house while you recover from the procedure, so ensure that you have an ample supply of everything you might need before you undergo surgery.
6. MAINTAIN A POSITIVE MOOD
As a minimally invasive procedure, arthroscopic surgery is designed to shorten recovery timelines, but you’ll still need to spend some time resting immediately after surgery. Since you won’t be able to participate in many of your daily activities, try to have some projects at the ready to keep you happy and occupied. Maintaining a positive mood will help boost your morale, and ultimately assist in recovery.
If you’re considering arthroscopic surgery for an ACL tear, CompOrtho is ready to help. Our team of specialists has decades of combined experience in treating knee injuries, providing every patient with the care and attention they need from the initial diagnosis to the final follow-up. Call us today to schedule a consultation!