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.
Women who were regularly exposed to secondhand smoke as children might be at slightly increased risk of rheumatoid arthritis, a new study hints.
Rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks the lining of the joints. Researchers believe that a mix of genes and certain environmental factors conspire to cause the disease. And a number of studies have linked smoking to a heightened risk of RA.
The new study, published Aug. 14 in the journal Rheumatology, looked at whether childhood exposure to secondhand smoke might be a risk factor for RA, too.
The answer, researchers found, is “maybe.”
Among more than 71,000 French women followed for two decades, those exposed to secondhand smoke as kids were at somewhat higher risk of rheumatoid arthritis, versus other women. That was true of women who currently smoked, and those who’d never smoked.
But those differences were not quite significant in statistical terms. That means the association between secondhand smoke and RA risk could be a chance finding.
So while the results are “provocative,” further research is necessary, one U.S. expert said.
“It’s hard to definitively say from the data what role secondhand smoke exposure in childhood plays in RA development,” said Dr. Tamar Rubinstein, a pediatric rheumatologist at Children’s Hospital at Montefiore in New York City.
Rubinstein, who is also a member of the American College of Rheumatology, was not involved in the study.
She called the findings “interesting,” and noted that there is a “growing” body of research finding links between childhood health and environmental exposures and the risks of disease later in life.
Plus, Rubinstein said, it’s biologically plausible that secondhand smoke exposure in childhood could contribute to rheumatoid arthritis later in life.
As the study authors explain it, secondhand smoke may affect immune system development in a way that makes RA more likely to develop — particularly in kids who are genetically susceptible to the arthritic disease.
Future studies should look at whether the relationship between RA and childhood smoke exposure is stronger in people who carry RA-linked genes, according to lead researcher Dr. Marie-Christine Boutron-Ruault, from the Gustave Roussy Institute in Villejuif, France.
For now, the findings “highlight the importance of children — especially those with a family history of this form of arthritis — avoiding secondhand smoke,” Boutron-Ruault said in a news release from the journal.
The findings are based on 71,248 middle-aged women who were followed for over 20 years. During that time, 371 women were diagnosed with rheumatoid arthritis.
In line with past studies, smokers showed a higher RA risk. Women who had ever smoked, but had no childhood exposure to secondhand smoke, were 38 percent more likely to develop RA than lifelong nonsmokers.
The risk appeared somewhat higher among smokers who were regularly exposed to tobacco smoke as kids. They were 67 percent more likely to develop RA than nonsmokers were.
However, the difference between smokers who were or were not exposed to smoking as kids was not statistically significant.
There was a similar pattern among women who’d never smoked: If they were regularly exposed to smokers as children, their risk of RA was 43 percent higher.
But again, that finding was just shy of statistical significance. And only an association was seen, not a cause-and-effect link.
“That doesn’t mean that there isn’t an association in reality,” Rubinstein said. “But it suggests we need to study this further to better understand it.”
If you’re a weightlifter, don’t ignore an aching shoulder. Follow our tips to prevent and treat these three common conditions.
Experiencing shoulder pain while weightlifting? This might be a sign you need to take a step back and re-examine your form. Here are some ways to prevent your slight twinge from turning into a serious injury.
Weightlifter’s shoulder, or distal clavicular osteolysis, affects the collarbone where it meets the shoulder blade at a point known as the acromion. This joint is very flexible, and therefore one of the least stable in the body. Stress over time can lead to micro fractures on the end of the collarbone.
If you have weightlifter’s shoulder, you may experience:
Tenderness or sharp pain when you press on the area
Weakness or stiffness
Pain after exercising
Pain when you extend the arm across to the opposite side
Weightlifter’s shoulder can be avoided with good training practices. It is usually caused by overdoing shoulder extension exercises like bench presses, dips, or push-ups. When you work out, be sure not to use too much weight and give your muscles time to recover in between training sessions. Have a trainer check your form, and be careful not to push through when you’re experiencing pain. To build up your shoulder strength, try out the “Blackburn” exercise.
If you are suffering from weightlifter’s shoulder, the condition may respond to conservative treatment. Take a hiatus from lifting weights, ice the area, and take anti-inflammatory medications. Your doctor may suggest corticosteroid injections along with physical therapy. If surgery is needed, your doctor can perform a minimally invasive procedure using small incisions to remove about a centimeter of your collarbone, which will help eliminate pain and restore your range of motion.
Shoulder impingement affects the rotator cuff in the upper arm. Each time you raise your arm, you create less space between the tendons and the shoulder blade. Over time, the shoulder blade’s acromion may begin to irritate the rotator cuff or its bursa sac.
Motions that use the rotator cuff tendons increase the likelihood of impingement. This includes any sport with overhand motions or exercises that include lifting weights above the head. Many people don’t realize that the mild pain is a sign of impingement, and unfortunately don’t seek treatment until the pain has worsened.
You may have a shoulder impingement if you experience:
Swelling or tenderness
Pain whether you’re resting or exercising
Sharper pain when lifting or reaching
Weakness and loss of motion
Difficulty reaching behind your back
There are several ways that you can prevent this condition. If you’re just starting a training plan, add reps slowly and trade off between push and pull exercises to build both front and back muscles (i.e., for every pushup, do a row). Avoid overdoing exercises where the elbow is above the shoulder, like upright rows and shoulder presses, along with lateral raises and behind-the-neck pulldowns. For more stability, activate your lower trapezius muscles before pulldowns by bringing your shoulders down and together.
If you do experience shoulder impingement, we recommend temporarily replacing your weightlifting regimen with physical therapy. Your doctor may suggest cortisone injections as well. These conservative treatments are often sufficient, but if needed a doctor can perform surgery to remove or repair the damaged areas. This can prevent future injury to the tendons, especially if you have bone spurs.
ROTATOR CUFF TEAR
A rotator cuff tear affects the muscles and tendons that cover your upper arm bone, keep it in the ball-and-socket shoulder joint, and help you lift and rotate your arm. The stress of weightlifting can cause a tear as the tendon degenerates over time. Direct impact can cause damage as well — if you try to lift heavy weights with a jerking motion, you could tear the tendons.
You may have a torn rotator cuff if:
Your pain is worse when you raise your arm overhead
Pain makes it hard to sleep at night
You experience weakness and limited motion in your shoulder
You are unable to hold your arm at shoulder level without dropping it to your side
To prevent this injury, use lower resistance exercises with more repetitions to gradually strengthen the rotator cuff muscles. Balance these exercises with arm raises and external rotations to build up your deltoids — try the side-lying external rotation before your next workout. End your training session with cold compresses to reduce inflammation, and be sure to rest between gym days. Avoid sleeping on your sore side to help healing. The condition won’t go away on its own, but our expert orthopedists at Comprehensive Orthopaedics can diagnose your condition and get you started on the path to healing. Schedule an appointment with one of our orthopedic specialists today.