Treatment Options for Knee Arthritis

Last month I attended a lecture titled, “State-of-the-art Treatment Options for Knee Arthritis” given by orthopedic surgeon, M. Mike Malek, MD at the Inova Fairfax Hospital. If you suffer from chronic knee pain or osteoarthritis of the knee, then this lecture provided pertinent information.

Dr. Malek first explained that this did not include rheumatoid arthritis which is a systemic disease. Osteoarthritis is a joint problem and a wear and tear problem. It is a degenerative problem that becomes arthritis. Part of osteoarthritis could be genetic and part of it is acquired. The knee is the least protected joint in the body and the most commonly injured.

As a wear and tear problem, the surfaces of the knee become pitted, eroded, uneven, and painful. This has to go on for 18 to 24 months before showing any changes on an x-ray.

Osteoarthritis symptoms include:

  • Pain
  • Loss of range of movement
    • Going up and down stairs
    • Unable to get off the toilet seat or couch
    • Night pain and stiffness
    • All day and night pain and stiffness

Causes include the following:

  • Excessive wear — weight is a major problem
  • Sport injury
  • Age
  • Obesity
  • Deformity — bow leggedness makes it worse
  • Work-related injury
  • Major trauma
  • Weak quadriceps
  • Lack of vitamin D

There is no laboratory test for osteoarthritis. There are 208 joints in the body and any joint can be affected, but the knee is the most common.

What are your treatment options?

  • Activity modification (One person said he’s a runner and he has knee problems. Dr. Malek said to find something else).
  • Physical therapy
  • Anti-inflammatories (NSAID) (Everything has side effects).
  • Cortisone injections
  • Visco supplementation (Joint fluid therapy — hyaluronic acid — something your knee produces).
    • There are five companies in the US that use rooster combs
    • Euflexxa is the only one that’s synthetic
  • PRP (protein-rich plasma)
    • Your own blood is taken and the Growth Factor is injected back
    • Athletes get on a regular basis
    • Makes healing faster
  • Bracing — customized about $1,200
  • Arthroscopy with or without HTO (High Tibial Osteotomy)
  • Arthroplasty — open surgery

With a knee replacement you will never have the full range of motion. Unicondylar knee replacement is a possibility for bowed legs. Only a part of the knee joint is replaced through a smaller incision than would normally be used for a total knee replacement.

The bottom line is your age, activity, use, and abuse of your knee will determine the length of how long your knee will last. However, you have a variety of treatment options for knee arthritis. Remember that nothing will last forever, not even knee replacement surgery. For more information, check out Dr. Malek’s Web site: http://kneesurgeryfairfax.com or http://kneeman.com.

See also a post I wrote last month about arthroscopic knee surgery.

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How to Ease Shoulder Pain

shoulder_rotation2Pain … ouch! Every decade seems to assure most of us that there’ll be more pain in some part of the body that we never felt before. One of the typical places is the shoulder where many muscles, tendons, and ligaments stabilize the joint. Years of activity as simple as reaching up for something or playing a musical instrument can lead to wear and tear on the joint and make the shoulder prone to injury. Falls or other accidents can also lead to injury.

You can keep your joints supple and strong by doing some exercises like the illustrations. However, if

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you are already feeling pain, you want to nurse that area and make sure you do not cause further injury and pain. Once the inflammation is down by using ice packs and perhaps over-the-counter medication, you can start exercising.

One exercise shown to the right is a deltoids stretch. You bring your arm across your body and press gently with the opposite arm either above or below the elbow. Hold for 30 seconds. For more information, check http:exrx.net.

http://familydoctor.org also offers some exercises below you can do. Having been through physical therapy myself, I know these were exercises that were recommended to me.

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Exercise 1

Exercise 1: Range of motion. Stand up and lean over so you’re facing the floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles, and then draw bigger ones. Repeat these exercises 5 to 10 times during the day. If you have pain, stop. You can try again later.

Exercise 2

Exercise 2

Exercise 2: Rotator cuff strengthening. Use a piece of rubber tubing for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With your hand that is closest to the door, bend your arm at a 90° angle and grab the loop of the tubing. Pull the band across your tummy. At first, do 1 set of 10 exercises. Try to increase the number of sets as your shoulder pain lessens. These exercises should be done every day.

Exercise 3

Exercise 3

Exercise 3: Upper extremity strengthening. As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your left arm at your side. With a weight in your left hand and your forearm across your tummy, raise your forearm. Keep your elbow near your side.

Topical pain relievers like creams and patches might also give some relief. They are widely used in other countries, but are less popular here. Topical analgesics might cause skin reactions, but pills affect the gut and blood.The one I use before I sleep is called Sunjing. For more information, click here.

Hopefully, this discussion of exercises and pain relievers will give you some relief if you are suffering from shoulder pain.

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