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How The Knee Works

How The Knee Works

A healthy knee bends easily. The joint absorbs stress and glides smoothly. This allows you to walk, squat, and turn without pain. But when the knee is damaged, the joint may lose its ability to cushion stress. You may feel pain during movement. Sometimes a damaged knee joint will swell and hurt even when you are at rest.

A Healthy Knee

The knee is a hinge joint, formed where the thigh bone and shinbone meet. When the knee is healthy, the joint moves freely. This is because the joint is covered with slippery tissue and powered by large muscles.

  • Cartilage is a layer smooth, soft tissue. It covers the ends of the thigh bone and shinbone, and it lines the underside of the kneecap. Healthy cartilage absorbs stress and allows the knee to glide easily.
  • Ligaments are another type of soft tissue. They hold the bones of the joint together.
  • Muscles power the knee and leg for movement.
  • Tendons attach the muscles to the bones.
  • A Damaged Knee

    When one or more parts of the knee are damaged, joint movement suffers. Over time, cartilage starts to crack or wear away. Because cartilage cannot fully repair itself, the damage may keep increasing. At first, your knee may just be a little stiff. But as the bones of the joint begin rubbing together, you’re likely to feel pain.

    Osteoarthritis

    Years of normal use can cause cartilage to crack and wear away (osteoarthritis). As exposed bones rub together, they become rough and pitted. The joint grinds. Being overweight or having an alignment problem, such as knocked or bowed knees, puts extra force on the joint. This may speed up the damage.

    Inflammatory Arthritis

    A chronic disease, such as rheumatoid arthritis or gout, can cause swelling and heat (inflammation) in the joint lining. As the disease progresses, cartilage may be worn away and the joint may stiffen.

    Injury

    A bad fall or blow to the knee can injure the joint. If the injury does not heal properly, extra force may be placed on the joint. Over time, this can cause the cartilage to wear away (traumatic arthritis).

    Types of Disc Surgery

    Types of Disc Surgery

    Relieving the Pain

    Persistent pain in your low back or leg caused by spinal disc problems can be frustrating because it limits your ability to move and do the things you enjoy. Your disc problem may be corrected by a discectomy, the surgical removal of the portion of the disc that’s putting pressure on a nerve, causing pain. in your back or leg. Your surgeon may recommend a “classic” discectomy, a micros discectomy, or a percutaneous discectomy. The basic differences among these disc surgeries are the size of the incision, how your surgeon reaches your disc, and how much of the disc is removed. The “classic” discectomy and microdiscectomy require a hospital stay of a few days. Percutaneous discectomy is usually an out-patient surgery.

    “Classic” Discectomy

    To remove the disc material that is causing the pain, your surgeon first makes an incision in the midline of your back (over the bump you feel when you run your hand over your lower spine). Then, to see and reach the damaged disc, your surgeon removes some or all of the lamina. Next your surgeon removes the disc material that is pressing on a nerve.

    The incision is 2-3 inches long.

    Microdiscectomy

    Your surgeon may recommend a microdiscectomy to treat your disc problem. This surgery is much like the “classic” discectomy, except that your surgeon uses an operating microscope to magnify, highlight, and see the disc. A magnified view means that the incision, located in the midline of your back, is smaller than that of a “classic” discectomy, with less damage to surrounding tissue.

    The incision is about an inch long.

    Percutaneous Discectomy

    Is an outpatient procedure that uses x-ray pictures and a video screen as a guide for your surgeon to reach and fix the damaged disc. The incision, made in the small of your back, is about the size of a puncture wound. Because your surgeon can see the damaged disc on a video screen, it’s not necessary to remove bone to view and reach the disc. After surgery, a small bandage is placed over the incision.

    The incision is about 1/4 inch long, large enough to insert a small instrument.

    Disc material is removed with surgical instruments

    Suffering from Knee Pain? | Surgery Can Help

    Suffering from Knee Pain? | Surgery Can Help

    A Problem Knee

    You use your knee every time you take a step. Because of this, living with a worn or injured knee joint can be painful and frustrating. Even simple things, such as squatting to pick up the morning paper, may cause pain. But you don’t have to live this way. In many cases, an orthopaedic surgeon (a doctor who treats bone and joint problems) can replace the damaged knee joint. The surgery is safe and effective. For many people, having a total knee replacement means a return to pain-free movement. This booklet will help you learn what knee replacement means for you. It can also help answer many of your questions.

    Why did this happen?

    No matter what your age, a problem with the knee joint may keep you from activities you enjoy. Pain and stiffness may even limit the daily tasks you can do. Problems with the knee joint tend to build up over time. Your knee pain may be caused by any of the following:

  • A bad injury that did not heal properly
  • A chronic illness
  • Wear and tear from years of constant use
  • Surgery Can Help

    You may not have to live with knee pain for the rest of your life. Total knee replacement surgery almost always reduces joint pain. During this surgery, your damaged knee joint is replaced with an artificial joint (called a prosthesis). Surgery can’t make you young again, but it can bring real benefits.

    Benefits of Knee Replacement

    After a total knee replacement, you can look forward to moving more easily. Most people gain all of the benefits listed below. Knee replacement surgery almost always:

  • Stops or greatly reduces joint pain. Even the pain from surgery should go away within weeks.
  • Increases leg strength. Without knee pain, you’ll be able to use your legs more. This will build up your muscles.
  • Improves your quality of life by allowing you to do daily tasks and low-impact activities in greater comfort.
  • Provides years of easier movement. Most total knee replacements last for many years.
  • Arthroscopic Procedure

    Arthroscopic Procedure

    What is an arthroscope?

    The arthroscope is an instrument used to look directly into joints. This makes it useful for both diagnosis and treatment. The arthroscope contains magnifying lenses and coated glass fibers that beam an intense, cool light into the joint. A camera attached to the arthroscope allows your surgeon to see a clear image of most areas of your knee joint on a monitor. This procedure allows doctors to view the knee joint without making a large incision (cut) through the skin and other soft tissues. Arthroscopy is used to diagnose and treat a wide range of knee problems.

    The Arthroscopic Procedure

    Your surgeon must evaluate your knee to diagnose your problem. An evaluation may include a medical history, physical exam, and one or more diagnostic tests. To confirm the diagnosis, arthroscopy is often done. The arthroscopic procedure is usually an outpatient procedure, meaning patients don’t need to stay hospitalized overnight. At the beginning of the procedure, you will receive an anesthetic. It could be general anesthesia which will make you sleep or spinal anesthesia which will numb you from the waist down or just local anesthesia which will numb your knee.


    Illustration copyright 2000 by Nucleus Communications, Inc. All rights reserved. http://www.nucleusinc.com

    Sterile fluid is inserted through one portal to expand your knee joint. This makes it easier to see and work inside your joint. After inserting the arthroscope through another portal, your surgeon confirms the type and degree of knee damage. Whenever possible, your surgeon treats your knee during arthroscopy, using surgical instruments such as shavers or laser. This procedure results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to favorite activities.

    Risks and Complications

    As with similar surgeries, arthroscopy carries the risk of bleeding, infection, and stiffness, as well as recurring knee problems.

    Coming Back From Back Pain

    Coming Back From Back Pain

    Recovering from back pain and surgery is an ongoing process. How fast you recover depends on the type of surgery you had, your commitment to working closely with your physical therapist, and moving and exercising correctly, as recommended by your surgeon. It may take six months or longer before your back is completely healed.

    Physical Therapy

    After surgery, your surgeon may refer you to a physical therapist, who will teach you exercises to improve your strength and increase your mobility. The goal of physical therapy is to help you become active as soon as possible, using safe body movements that
    protect your back.

    Proper Movements

    Good body mechanics keep your spine well-aligned and reduce pain. But maintaining a safe, balanced position may require some changes in how you go about daily activities. For instance, you may need to learn different ways of sleeping, sitting, or lifting to avoid re-injuring your back.

    Exercise Regularly

    Your recovery plan may include back and stomach exercises, such as sit-ups, to
    strengthen muscles that help support your back. Done regularly, these exercises can help you build the strong, flexible muscles you need to protect your back.

    Follow-up Care

    You and your surgeon will continue to work together during your recovery. Before you leave the hospital, your surgeon may schedule follow-up visits with you, so that he or she can evaluate your progress, advise you about your activity level, and adjust any medications, if necessary. Sometimes your doctor may recommend follow-up tests to make sure you are
    healing properly.

    Rotator Cuff Injury | Restoring Your Shoulder Strength

    Rotator Cuff Injury | Restoring Your Shoulder Strength

    The rotator cuff is a powerful team of muscles and connecting tendons. These muscles and tendons attach your upper arm to your shoulder blade. Your rotator cuff helps you perform the following physical activities: reach, throw, push, pull and lift.

    Experiencing shoulder pain?

    Your shoulder might hurt because your rotator cuff tendons are swollen or damaged.

    This could be caused by many things which might include:

    • A fall on your shoulder.
    • Strained shoulder caused by doing too much reaching or lifting.
    • Twisted your shoulder during exercise.
    • Performing your regular chores at home could have triggered your pain.
    • Repetitive shoulder movement; maybe you threw one too many pitches.

    The older you get, the weaker your muscles and tendons become which means they are more easily injured. A rotator cuff injury can make everyday activities painful. What can you and your doctor do to stop the pain and get your shoulder back in shape? First your condition is evaluated. You and your doctor will then plan the best way to reduce your pain and heal your rotator cuff. Depending on your injury, your treatment may involve non-surgical care, surgical care, or both.

    How can you ease the pain?

    Care for your injury will most likely begin with non-surgical treatment ranging from simple rest to pain soothing injections your doctor will tell you how often you may need this treatments if the treatments relieve your pain you will be given an exercise program to restore your shoulders power if your pain just won’t quit you and your doctor may decide you need surgery.

    Rest
    Rest your shoulder by keeping it still. You may be giving a sling to support your arm. When sitting or lying down, try to keep a pillow between your arm and your side, because total inactivity can cause stiff joints and it would help to do some gentle stretching exercises.
    Cold and Heat
    Putting ice on your shoulder can help reduce inflammation and pain. Use a cold pack, a bag of frozen peas, or a towel filled with ice cubes for 15 to 20 minutes at a time. Alternating with heat and cold can also soothe your pain. Try warm showers, a hot pack or heating pad that uses moist heat.
    Medication
    To help relieve your pain and inflammation, your doctor may suggest that you take an oral anti-inflammatory medicine such as aspirin or ibuprofen. Your doctor will tell you how much you need.
    Electrical stimulation
    Electrical stimulation of muscles and nerves may decrease severe, constant pain and inflammation methods such as interferential nerve stimulation use electrical impulses to block the pain signals coming from your shoulder. Electrical impulses applied to your shoulder muscles and nerves can decrease the soreness and inflammation in your shoulder.
    Ultrasound
    These gentle sound waves warm the deep tissues in your shoulder. This improves blood flow and soothes sore muscles. To further reduce inflammation, cortisone cream can be worked into the muscles using ultrasound.
    Injections
    If your pain is severe, your doctor may inject cortisone near the inflamed area. This helps reduce the inflammation and pain. Anesthetics may also be used to control your pain.

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