Advanced Orthopedics : Services : General and Trauma

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Arthritis

Definition

Arthritis is a disease that causes pain and inflammation in one or more joints, resulting in decreased mobility. It is one of the most prevalent and chronic health problems in the nation, affecting nearly one in five adults. There are over 100 types of arthritis but only two major categories: inflammatory and non-inflammatory.

Non-inflammatory

Non-inflammatory arthritis is a result of a degeneration of the cartilage in your joints, and commonly affects the foot, knee, hip, neck, back, shoulder, hand, thumb and finger areas. This arthritis group usually affects people over the age of 45. The most common type of non-inflammatory arthritis is osteoarthritis. In osteoarthritis, cartilage, the natural “shock absorber” between the bones, begins to deteriorate. As a result, the underlying bone hardens and cysts or bony spurs may form. Symptoms such as pain, stiffness, loss of joint motion, and swelling may occur. You may hear a cracking or crunching sound with joint movement, or there may be an apparent joint deformity. Osteoarthritis is also known as degenerative joint disease, degenerative arthritis, ostoearthrosis and hypertrophic arthritis.

Inflammatory

Inflammation occurs when the body’s white blood cells and chemicals fight off foreign substances such as bacteria and viruses. In inflammatory arthritis, the body’s immune system triggers an inflammatory response for no reason, and as a result causes damage to its own tissues. The most classic form of inflammatory arthritis is rheumatoid arthritis. This debilitating disease is systematic in nature, affecting the joints as well as the entire body — from lungs, to skin to blood vessels to eyes. It typically occurs earlier in life, often between the ages of 25 and 50. Other common forms of inflammatory arthritis are psoriatic arthritis, crystal induced arthritis, polymyalgia rheumatica and infectious arthritis.

Osteoarthritis

Definition

Osteoarthritis is a condition of somewhat unknown causes, but it is usually related to wear and tear of the articular cartilage in the larger, weight-bearing joints. Your joints consist of the slick articular cartilage that covers the bone; the synovial membrane, the soft tissue layer that secretes a lubricating fluid; and the joint capsule, a tough tissue shell that encases the joint. Osteoarthritis develops when the articular cartilage begins to flake and crack, causing the underlying bone to become thickened and distorted. This in turn causes the joint to become painful and restricted, and can lead to muscle loss due to infrequent use.

Symptoms

Symptoms of osteoarthritis vary greatly. Episodes of pain, swelling and stiffness may occur at intervals of months or even years. Or, the pain can become chronic, and hamper daily activities such as washing dishes, taking a walk or even sleeping comfortably. Sometimes the pain can transmit to other parts of your body. Swelling may be hardly noticeable or may cause the joint to become enlarged and knobby. As inflammation, stiffness and pain increase, the swelling can create a disfiguring appearance in the affected joints.

Diagnosis

Your physician will take your complete medical history, which will include asking you about the patterns of your pain and stiffness, past injuries or other existing conditions. Next, he will examine the joints, checking for mobility, pain and swelling. He may take X-rays for a clearer picture of the bones and joints. Blood tests may be ordered to help pinpoint the type of arthritis.

Treatment

There are a variety of treatments that, if used in conjunction with one another, can ease the pain and swelling of osteoarthritis. Your physician may prescribe aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), or he may give you a corticosteroid injection that may help alleviate pain and swelling for several months. Various physical therapy treatments, such as a hot or cold pack, strengthening exercises or ultrasound, can be helpful in treating osteoarthritis. Prevention and treatment options within your control include keeping your weight in check, following a healthy diet, and exercising regularly. If your pain isn’t relieved by medication, injections, diet or physical therapy, surgery to replace the joint may be necessary.

Rheumatoid Arthritis

Definition

Rheumatoid arthritis is a disease in which the joint lining becomes inflamed as part of the body’s immune system activity. This chronic condition occurs in joints on both sides of the body, which is what distinguishes it from other types of arthritis. It is one of the most serious and disabling types of arthritis, and affects mostly women. In addition to affecting the joints, rheumatoid arthritis may affect the skin, eyes, lungs, heart, blood, nerves or kidneys.

Symptoms

Common symptoms of arthritis include joint pain, swelling, redness and stiffness. Inflammatory arthritis such as rheumatoid arthritis causes stiffness with resting, especially in the morning, and affects joints on both sides of the body equally.

Diagnosis

Rheumatoid arthritis can be difficult to diagnose because its symptoms are common to many different diseases. Your physician will review your medical history, including any family history of arthritis. He will examine your joints for redness, warmth and tenderness and evaluate your ease of movement. He may order X-rays, which will provide an image of the bone, or noninvasive imaging tests such as magnetic resonance imaging (MRI) to show cartilage, muscles and ligaments.

Treatment

There is no known cure for rheumatoid arthritis. The goal of treatment is to reduce joint inflammation and pain while maximizing joint function. Treatments are often a combination of methods including rest, joint strengthening exercises, heat and cold therapy, or hydrotherapy. Physical exercise is encouraged to reduce joint pain and stiffness as well as increase flexibility, muscle strength and endurance. Medications such as acetaminophen, ibuprofen and non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and swelling. In some cases, mobilizing the joint with a splint or brace can offer relief. Patients can also be educated as to the proper use of their joints to maintain flexibility and conserve joint energy.

Arthroscopy

Definition

Arthroscopy gets its name from the instrument used during the procedure – the arthroscope. The arthroscope is a thin, viewing instrument that allows your doctor to view the inside of a joint in your body, including the joint surfaces and surrounding soft tissue. Arthroscopy is commonly performed on the knee, shoulder, or ankle, but can also be used for the hip, elbow and wrist.

Why It’s Done

Arthroscopy is performed when a physician needs to evaluate and diagnose a joint problem when a physical exam or other diagnostic tests are inconclusive. In addition to a diagnosis, this procedure can be done to repair a joint problem, remove a loose or foreign object, monitor a disease or measure the effectiveness of treatment.

How It’s Done

Arthroscopic surgery is usually performed on an outpatient basis. If general anesthetic is used, you will be unconscious during the procedure and your vital signs monitored carefully. If a regional anesthesia is used, the area of your body where the procedure is being done will be numb, and you will be given a sedative to make you drowsy. After preparing the limb (blood flow may be temporarily restricted or the limb may be elevated), a small incision (.25 inches) will be made near your joint. Saline solution will be used to flush the joint space and allow better viewing, and the arthroscope will be inserted. Once it is in place, the physician will be able to view inside the joint via a video monitor attached to the arthroscope. If more surgery is required, additional small incisions may be made and other thin instruments inserted into the joint. After the surgery, the area is flushed with saline and drained. Local anesthetics or cortisone may be injected into the joint to reduce inflammation and pain. The incision(s) are closed with stitches or staples.

What to Expect After Surgery

If you were given a regional anesthetic for the procedure, your limb will be numb for several hours. You may experience soreness or mild discomfort after the procedure. You will be instructed to elevate the joint to reduce swelling, apply ice several times a day, and keep the bandages on the incisions clean and dry. Bruising around the incision and joint tenderness is normal and should disappear within one to two weeks. There may be bleeding, drainage or swelling at the site of the incision. Your physician will instruct you as to what to specifically expect from your surgery.

Fractures and Dislocations

Definition

A fracture is an injury that is caused when a strong force stresses the bone beyond its capacity, causing it to break or crack. Common causes of fractures include falls, car accidents, running, or something hitting the body. Some fractures can cause a bone to poke through the skin.

There are two main types of fractures, closed and open. In a closed fracture, the break does not result in the bone penetrating the skin. In an open fracture, the bone or bone fragments pierce the skin or a wound exposes the bone. This is also referred to as a compound fracture.

Types of fractures are also categorized by how serious the break is. A complete fracture goes across the bone, breaking it into two or more pieces. This is also known as a displaced fracture. An incomplete, or nondisplaced fracture occurs when the bone is not broken all the way across. This is commonly known as a “hairline” fracture.

A dislocation is caused when extreme pressure is put on a ligament (tissues that connect bones at a joint), causing the connected bones to separate. Dislocations are common contact sports injuries, and occur in the shoulder, hip, knee, elbow, ankle, finger, thumb or toes. In severe dislocations, the bone may come completely out of the socket.

Symptoms

Often it’s difficult to tell a fracture from a dislocation. Symptoms of both include pain in the injured area, swelling, difficulty moving or using the injured area and warmth, bruising or redness around the injury. If you suspect you have a fracture or a dislocation, seek medical attention at once. Moving a broken or dislocated bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone.

Treatment

Until medical treatment is available, the limb should be temporarily splinted or braced to restrict movement. Also, any open wounds should be covered by a clean cloth or bandage. Upon arrival at the physician’s office or hospital, an X-ray will be taken of the bone. In some dislocation cases, the physician may need to put the joint back into place. If there is a fracture, the physician may perform a “reduction”, which means restoring the parts of the broken bone to their original positions. You will be fitted with a splint or a cast to restrict movement of the limb, and given acetaminophen or ibuprofen for pain. Your physician may recommend R.I.C.E. treatments (Rest, Ice, Compression and Elevation).

The content provided on this page is to be used for information purposes only, and is not meant to be a substitute for professional examination, diagnosis or treatment. Please see your physician with any symptoms you may experience or questions you may have regarding a medical condition or procedure.