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Archive for October, 2012

The patella should rest between the femoral condyles (as pictured on the left).  In patellar tracking disorder, the quadriceps pulls the patella outside of the groove.

 

Patellofemoral pain is the leading cause of knee pain among athletes.  It is diagnosed by non-specific pain between the patella (knee-cap) and femur (thigh bone).  Patellofemoral pain is often referred to as “runner’s pain” because it can be caused by activities involving frequent contractions of the quadriceps muscles.  This does not mean that only runners can develop patellofemoral pain.  It can also be caused by osteoarthritis of the knee and by patellar tracking disorder.

Patellar tracking disorder occurs when the overall pull of the quadriceps is too lateral.  This draws the patella outside of the vertical groove between the femoral condyles (the two side-by-side balls at the end of the thigh-bone) when the knee bends and straightens.  This sideways slide leads to knee pain and worsens osteoarthritis by wearing down the cartilage behind the patella.

Patellar tracking disorder is frequently treated with knee braces designed to maintain the patella’s natural alignment.  It can also be treated with kinesiotape (the colorful tapes that olympians wore this past summer in London).  These treatments tend to be both simple and effective, so if you suffer from patellofemoral pain, consult your doctor to see if they might help you.



A recent article in a European journal confirms that type II diabetes is an independent risk factor for severe osteoarthritis.  We already know obesity can make osteoarthritis worse, and that obesity can lead to type II diabetes.  But we are only learning now that the metabolic effects of type II diabetes may lead directly to ostoearthritis.  More importantly, Dr. Schett, the author of the paper, claims that type II diabetes makes it harder to treat osteoarthritis.  Dr. Schett found that osteoarthritis patients with type II diabetes had dramatically reduced the benefits from arthroplastic surgery.

Diabetic patients with osteoarthritis of the knee had increased swelling in the joint space when compared to non-diabetic people of the same age and BMI.  This suggests that the systemic effects of diabetes make osteoarthritis worse by increasing the stress on the cartilage.  It would be like adding 50 pounds of extra pressure to a joint already supporting a body above its weight-class.

This is not all bad news.  In many ways, this simplifies the treatment of osteoarthritis in patients with type II diabetes.  It means that instead of treating two conditions at the same time, treating the diabetes may help with the osteoarthritis directly.  It also means that addressing unhealthy eating habits, a well-known cause of type II diabetes, could be the only treatment necessary.  Weight-losing lifestyle changes may be the only way to a healthy body.  Not just on the surface, but for your bones, joints, and cartilage as well.



Hyperextension helps to stabilize an unstable knee, but can cause pain and disability over time.

Knee instability occurs when the thigh and shin bones are held together too loosely.  It is usually caused by weak muscles and lax ligaments.  In many cases, the ligaments are loosened because of forces that occur when knee musculature is weak.  One common example is the relationship between weak knee extensors (the quadriceps) and hyperextension of the knee.

If the quadriceps are weak, the knee will have a tendency to buckle under body weight.  The body tries to reduce the risk of falling by forcefully hyperextending the knee.  This promotes knee stability, since the knee is very secure in full extension.  However, over a long period of time, this repeated and excessive extension stretches the ligaments and tendons along the back of the knee.  This allows the knee to hyperextend farther and farther over time until the hyperextension may be a more severe problem than the quadriceps weakness that it solved.

Hyperextension can lead to severe knee pain.  It causes stretch injuries to the back of the knee, and compression injuries the front.  The anterior compression can make osteoarthritis of the knee much worse.  It can speed up the breakdown of cartilage, and lead to inflammation and joint pain.

The most direct and least invasive treatment for instability of the knee is with a knee brace.  It can also be treated surgically, and many of the associated symptoms may be treated with drugs like non-steroidal anti-inflammatories like Tylenol.  If you suffer from knee pain caused by hyperextension and instability, talk to your doctor about bracing options that may be right for you.



 

The knee joint is the connection between two bones, the femur (thigh bone) and the tibia (shin bone).  The femur has two adjacent “condyles”, which are rounded portions that extend down to the tibia.  The tibia has two slightly cup-shaped sockets which meet the femoral condyles.

In healthy knee alignment, the femoral condyles rest evenly on the tibia, and apply nearly even pressure to both sides.  There are two types of knee deformities with asymmetrical force distributions: varus and valgus deformities.  A valgus (knock-kneed) deformity is where the knees are closer together than normal.  Valgus is more common than varus, and often occurs in overweight individuals.  A valgus deformity leaves a gap between the femur and the tibia on the lateral side, and increases pressure on the condyles on the medial side.  A varus deformity is where the knees are farther apart than normal.  Varus knees leave gaps between the femur and tibia on the medial side, and increase pressure on the lateral condyles.

These deformities are fairly common and lead to asymmetrical degeneration of the cartilage in the knee.  This means that  an osteoarthritic knee in valgus would have extreme damage to the medial side of the knee, and milder effects on the lateral side.

A medial knee brace for osteoarthritis is a tested and reliable treatment for knee osteoarthritis.  It is especially effective on an individual with a mild valgus deformity, because they have increased stress on the medial compartment.



Doctor-Speak

October 13, 2012

My mother recently had her annual check-up.  She returned, horrified, with a list of words that her doctor had said regarding her mild knee pain.  He told her that:

“Your menisci appear to be intact, but I note mild ligamentous laxity in your MCL.  I also suspect degradation of the articular cartilage along the anterior aspect of your medial compartment.”

My terrified mother began planning her funeral.

In the spirit of her struggle, this post is designed to help you understand doctor-speak.  Their language does not need to be frightening.

For example:

Medial:  Towards the midline of the body.  Your big toe is medial to your pinky.

Lateral:  Away from the midline of the body.  Your arm is lateral to your torso.

Anterior:  Towards the front of the body.  Your nose is anterior to your ear.

Posterior:  Towards the back of the body.  Your heel is posterior to your toes.

Superior:  Towards the top of the body.  Your head is superior to your neck.

Inferior:  Towards the bottom of the body.  Your foot is inferior to your knee.

So next time your doctor uses these words, remember the directions that they describe.



OA and Knee Braces

October 10, 2012

 

Stride-OA-Knee-Brace

Knee pain is treated with many different braces, depending on the source of knee pain.  Osteoarthritis of the knee is a common diagnosis, and can occur in several variations.  One common type is called “unicompartmental osteoarthritis”.  This means that the osteoarthritis primarily effects one side of the knee (usually the side closer to the other leg).  If you have this type of knee osteoarthritis, then a medial knee brace for OA may be right for you.

A medial unloading knee brace supports the weight the would pass through the injured compartment.  It also redirects some of the remaining forces through the other compartment of the knee.  This reduces the stress on the osteoarthritis.  The medial knee brace for osteoarthritis can help without restricting motion at the knee.  In fact a recent study by the Steadman Philippon Research Institute found that a medial unloading knee brace can improve function and reduce the need for pain and anti-inflammatory medications.

If you have persistent pain on one side of your knee, then the medial OA knee brace may be right for you.  Braces make great solutions because they are mechanical, and not physiological solutions.  This means that the side effects are minimal, and adjustments can be made as necessary without the risk of systemic problems.



Total knee replacements are invasive surgeries that leave long scars accross the knee. They involve removing damaged bone and replacing it with a prosthetic.

Osteoarthritis of the knee is very common in people age 65 and older.  As the US population ages, more and more people are diagnosed with osteoarthritis.   Since it can produce extreme knee pain that worsens over time, many people are desperate for a miracle treatment.  While there are many medications, braces, and therapies for osteoarthritis of the knee, many people are turning to surgery for help.

According to a recent New York Times article, total knee replacement surgery rose more than 800 percent from 1979 to 2002.  With improving technology, this is  a wonderful treatment for many people.  But some people are not so lucky.  For as much as 30 percent of the population, knee pain is not reduced after surgery.  So almost 1 in 3 people may be undergoing knee surgery with no benefit.  Considering that all surgeries are potentially life-threatening, this is a terrifying statistic.

This does not mean that knee surgery is bad or ineffective, but it may not be right for everyone.  Before looking for a surgical solution, try non-invasive arthritic knee treatments first.  Why take the risk if you don’t have to?



Osteoarthritis of the knee often leads to knee pain.  Long-term inactivity can make the osteoarthritis and your quality of life much worse.  This means that short rests can increase knee pain.  In fact, sitting for a brief time can lead to joint stiffness.  That makes it harder to move your knee, and makes motion painful.

In most cases, joint stiffness is due to inflammation of the synovium (the fluid which helps to lubricate your knee).  More severe joint stiffness can be caused by shortening of tendons and ligaments in the knee, but this is often over longer periods of inactivity.  If the synovium is inflamed, the pain is intense at first, but decreases as the joint is used.  This means that avoiding activities because of joint stiffness you can limit your overall function.  However, while increasing activity should reduce stiffness, too much exercise can make the osteoarthritis worse.

Overall, persistent activity is the best way to reduce joint stiffness.  Avoiding painful activities can lead to shortening of tendons and ligaments.  This would make future activities much more difficult.

The best take away is:  Use it or lose it.