Symptoms & Solutions: Meniscus Tears

Symptoms & Solutions: Meniscus Tears

Meniscus tears can occur when you twist or wrench your knee.  Learn more about these painful injuries and the various ways they can be treated.

What is the Meniscus?

The meniscus is the cartilage between the tibia (shin bone) and femur (thigh bone) in the knee.  There are two menisci in each knee.  They cushion the joint to prevent wear and tear to the upper and lower bones of the leg.

What Causes a Meniscus Tear?

A meniscus tear can happen to anyone, but because cartilage naturally wears down with age and use, the chances increase as you get older.  Making a sudden shift in direction or jumping during sports are some of the most common causes of meniscus tears.  Twisting or hyper-extending the knee during a stumble or fall can also tear the meniscus.  If the damage is severe, a loose piece of cartilage may lodge in the joint and cause the knee to seize up.

Symptoms of Meniscus Tears

Depending on the severity of a tear in the meniscus, you may feel only minor discomfort at first.  However, the symptoms and problems associated with the tear will increase over time.

Symptoms of a torn meniscus may include:

  • A sudden popping sound when the injury occurs
  • Pain in the knee joint
  • Inflammation of the knee
  • Difficulty straightening or bending the knee
  • Locking or “sticking” of the knee

Some people can “play through the pain” when the meniscus is torn, but over several hours or days, swelling and pain can increase dramatically.

Diagnosing a Meniscus Tear

If you have pain and swelling in your knee, see a doctor as soon as possible.  After a physical examination of the injury, he or she may order x-rays to determine whether any bones are broken.  An MRI scan will also be needed for a precise picture of the menisci and to determine the location of any tears.

Treating a Torn Meniscus

There are a variety of treatment options for meniscus tears, depending on the location and severity of the damage.  Your health, activity level, and age are also factors.

The outer ring of the meniscus, called the red zone, can heal successfully on its own if the tear is small.  This is because there is an abundant blood supply in this area.  In contrast, the inner part of the meniscus, known as the white zone, is more difficult to heal because there are fewer blood vessels.

Non-Surgical Treatments for Meniscus Tears

If the meniscus tear is minor and/or in the red zone, it may be possible to treat the injury without surgery.  As long as your knee isn’t locking up and the pain isn’t severe, you may be able to use topical treatment and physical therapy to aid in the healing process.  This could include:

  • Exercises and stretches recommended by your doctor
  • Limiting activities, including walking, whenever you feel pain
  • Walking on crutches for one to two weeks
  • Elevating your knee when resting
  • NSAIDs (non-steroidal anti-inflammatory drugs)
  • Icing the area periodically during the first two or three days after the injury or until the swelling is alleviated (your doctor can recommend a schedule for this)
  • Compression bandages around the joint to minimize swelling
  • Avoiding any sports or activities that involve impact, twisting, or extension of the knee joint

If these modalities don’t work, or if the tear is unstable or significant, you may need surgery.  For example, if your knee periodically locks up or freezes, surgery is warranted to repair the damage and remove any uneven or unstable edges of the meniscus.

Surgery for Meniscus Tears

If the damage to the meniscus is severe enough, surgery may be required.  This is more likely if the damage is in the white zone or if there is loose cartilage that has torn free.  The goal in any surgery for meniscus tears is to preserve as much of the menisci as possible.

Surgery for a torn meniscus is almost always effective.  In most cases, it is a relatively simple laparoscopic procedure that does not require overnight hospitalizationArthroscopic surgery is the most common approach and is usually an outpatient procedure performed under either general or spinal anesthesia.  In most cases, you can go home the same day.

There are a few different surgery options for repairing meniscus tears:

Arthroscopic Repair or Trimming

In this minimally invasive procedure, the surgeon makes two or three small cuts in the knee and inserts an arthroscope to inspect the damage.  Using dissolving sutures, the tear in the meniscus is repaired and any rough edges are smoothed.  In some cases, if the tear is along the edge of the meniscus, the affected area may be trimmed away rather than sutured.

Arthroscopic Meniscectomy

In a partial meniscectomy, the surgeon removes the damaged part of the meniscus and smooths the area to restore normal function to the knee.  In a total meniscectomy, the damaged meniscus is completely removed.  This is usually done only when the damage is so extensive that normal function cannot be restored through less extreme means.

Open Meniscus Surgery

In rare instances, a surgeon may need to expose the entire knee joint via a large incision.  This is done under general anesthesia and is usually reserved for significant damage or if there are loose fragments of cartilage that must be removed from the joint.  In most cases, the entire meniscus is removed.  The incision is then closed with sutures or staples.

What to Expect After Surgery

Meniscus repair and meniscectomy are low-risk surgeries with few complications.  The most common complications are joint stiffness, infection, or minor damage to nerves in the area.  Some surgeons may suggest wearing compression socks or bandages to minimize the chance of blood clots.

You may receive a local anesthetic injection before going home.  For the first few days after surgery, you will control the pain with prescription medication.  After three or four days, over-the-counter NSAIDs may be used to relieve pain and minimize swelling.

Recovering from Meniscus Surgery

Recovery depends on how severe your meniscus tear is, how well the surgery goes, your age, your general health, and how well you stick to the guidelines your doctor provides.  For most patients, it takes four to six weeks to fully recover from meniscus surgery.

You may need to wear a knee brace after surgery to protect the area while it is healing.  Physical therapy helps the recovery process and can minimize complications.  In the long-term, some patients may develop arthritis in the joint.  In the short-term, however, you should be able to return to all or most of your activities once you have completely recovered.

When Are Meniscus Tears Considered Fully Healed?

You should not return to your pre-treatment or pre-surgery activities without your doctor’s approval.  At the least, he or she will expect that:

  • You can walk, jog, jump, and move side-to-side without pain
  • You can straighten and bend your knee without pain
  • Your injured knee is as healthy as it was before treatment or surgery
  • There is no swelling in the area

Do You Have a Torn Meniscus?

If you have a knee injury, our orthopedic surgeons will evaluate you to determine how severe your injury is and whether you have a torn meniscus.  From there, you can discuss both surgical and non-surgical options to determine the best course of action.  Contact Arkansas Surgical Hospital at (877) 891-9322 to schedule an appointment.

Should I Get Foot Fusion Surgery?

Foot fusion surgery, also known as arthrodesis, is a surgical procedure that fuses two or more bones in the feet.

Fusion is the joining of two separate bones making up the damaged or painful joint.  This procedure is done when a painful area hasn’t responded well to treatments such as orthotics, pain medications, steroid injections, and physical therapy.

Several foot problems can be alleviated with foot fusion surgery.  It is most often used to minimize arthritis pain, but it can also treat flat feet, fractures, and excessive wear and tear to the joints of the foot.  The surgery brings relief by reducing pain, increasing stability, and improving the foot’s ability to bear weight.

Is Foot Fusion the Right Choice for You?

Only you and an orthopedic surgeon specializing in foot and ankle problems can determine whether foot fusion surgery is right for you.  In general, it is the last option in the orthopedic surgeon’s arsenal when a patient’s pain and limited mobility are no longer responding to less invasive measures.  You may be a good candidate for the procedure if your pain is constant, moderate to severe, and interferes with daily activities.

Some people worry that fusing joints in the foot will contribute to additional stiffness, but this is not usually the case.  Since the bones that are being fused already suffer from immobility, fusing them will not significantly change the stiffness.  Fusion will, however, dramatically reduce pain in the area and strengthen the joint so that it can function more effectively.

Who is A Good Candidate for Foot Fusion Surgery?

If you haven’t responded well to other treatment options and are suffering from chronic pain, or if your foot is becoming deformed, it’s time to look into foot fusion surgery.  However, not everyone is a good candidate for this surgery.  You need to be relatively healthy, have strong bones, and be willing to go through the extended healing and physical therapy program after surgery to achieve the desired result.

Some people who are not good candidates for foot fusion surgery include:

  • Individuals with osteoporosis
  • Those with neurological problems that can interfere with healing
  • Individuals with autoimmune disorders that may prohibit recovery
  • Anyone suffering from an infection
  • Patients with narrowing of the arteries

It is best to discuss your options with an orthopedic surgeon who has had years of training and is familiar with all aspects of treatment from surgery to post-operative care.

What Happens During Foot Fusion Surgery?

Foot fusion surgery is done under general anesthesia.  There will also be an injection in the leg to numb the area and reduce post-operative pain.  For most procedures, the surgeon will make two incisions near the joints that will be fused.  Any damaged bone will be removed, and the ends will be smoothed down and joined using screws or plates that will stabilize the area and allow the bones to fuse together over time.  In some cases, additional bone may be needed for a successful fusion.  This bone can be harvested from another part of the body or obtained from a bone bank.

What to Expect After Foot Fusion Surgery

When you wake up from foot fusion surgery, your foot and leg will be in a cast up to your knee.  You won’t feel any pain because the area will be numb.  You will soon meet with a physical therapist to discuss how to walk without putting weight on your foot.  Once you are comfortable (usually a day or two after surgery, you will go home with instructions and pain medications.

Elevating your foot above your heart will minimize swelling and discomfort.  You should not move around unless you have to, and you should never put any weight on the affected leg.  You can take pain medications as prescribed by your surgeon.  Avoid anti-inflammatory medications such as ibuprofen and do not smoke during this phase of recovery, as either of these actions can slow the fusion or stop it altogether.

Walking Post-Surgery

Each individual is different, and some people can get back on their feet sooner than others.  This depends on how well you do in physical therapy, how complicated and extensive the surgery was, and how well the fusion is healing.

A general guideline may look like this:

  • 1-2 weeks: You will be walking on crutches in a plaster cast, placing no weight on your foot
  • 2-6 weeks: Your foot will be in a lighter cast, but you will still need to use crutches
  • 6 weeks – 3 months: Wearing a boot, you will be able to put some weight on your foot with or without crutches (depending on the surgeon’s and physical therapist’s recommendations)
  • 4 months: You should be able to bear your own weight in regular shoes

During this time, you will also work with a physical therapist to strengthen the foot and minimize swelling.  As your healing progresses and you begin walking, your physical therapist will help you learn how to walk properly and carry your weight effectively and safely.

Following Up with Your Surgeon

Most surgeons will have a specific schedule for follow-up visits so they can chart your progress and make sure there are no unexpected complications.  Most doctors will want to see you at two weeks, six weeks, twelve weeks, and six months after your surgery.  Your cast may be replaced by a boot at six weeks, and you should be able to transition to your own shoes by the third month following surgery.

Typical Results of Foot Fusion Surgery

The success rate of foot fusions is excellent, with most patients experiencing a complete or almost total reduction of pain by about three months.  After six months, you should be able to participate in sports.  You will continue to improve for up to a year with some minor swelling throughout the healing process.  You can control this with ice and elevation after strenuous activities or long periods of time on your feet.

Is it the Right Time for Foot Fusion Surgery?

If you’re suffering from nearly constant pain and all other options have failed, you may be a good candidate for foot fusion surgery.  This depends in part on your medical health, but there are other considerations as well.

Can you take time off to heal properly after the operation?  While you won’t be in the hospital for very long, you will have an extensive recovery period at home.  You will not be able to drive for at least three months, so you’ll need someone to take you on errands and to doctors’ appointments.  You will have to take time off work, which may be lengthy, depending on your career.  If you have a desk job, a month may be plenty of time; however, if you perform physical labor, you may have to be off work for as long as 16 weeks.

If you believe you’re a candidate for foot fusion surgery and are confident you can handle the operation and a potentially lengthy healing process, talk to one of the orthopedic surgeons at Arkansas Surgical Hospital.  You can schedule a consultation by calling (877) 891-9322.  We will be happy to answer all your questions and put you on the road to pain-free walking.

Types of Surgery for Shoulder Dislocation

A shoulder dislocation occurs when the ball of the shoulder joint is pulled or knocked out of its socket.  In some instances, the shoulder can be eased back into place, but the trauma to the joint can cause instability, pain, and recurring dislocations.  In these cases, shoulder surgery is recommended to stabilize the area and minimize the risk of repeated dislocations in the future.

There are several different surgical options for shoulder dislocation repair, depending on the severity and location of the injury within the shoulder.

Bankart Repair Surgery

If the dislocated shoulder moved toward the front of the body, the ring of cartilage surrounding the socket may have been torn out of the socket.  Bankart repair surgery corrects this by repairing the tear in the cartilage and reattaching it to the socket.  Depending on the severity of the damage, Bankart repair surgery can be done arthroscopically or through an open procedure.

Capsular Shift Surgery

If the shoulder has been dislocated multiple times, the ligaments holding the shoulder in place become hyper-extended and lose their ability to hold the joint in place.  Capsular shift surgery tightens the ligaments so they can once again hold the shoulder firmly in place.

Latarjet Surgery with Bone Grafting

This shoulder dislocation surgery is indicated when the bone on the edge of the shoulder socket has been damaged.  Bone from the shoulder blade is used as a graft to attach the tendon to the front edge of the shoulder socket.  Alternatively, bone from a bone bank or the patient’s pelvis can be used to stabilize the shoulder.

Remplissage Surgery

If the ball of the shoulder, or humeral head, has been severely damaged due to repeated shoulder dislocations, Hill-Sachs lesions may develop.  Remplissage surgery resurfaces these damaged areas by smoothing them out or filling them in.  The ball is then re-attached to the rotator cuff.  In some situations, Latarjet and Remplissage surgery are done in tandem to address multiple issues with a dislocated shoulder.

Total Shoulder Replacement Surgery

Multiple shoulder dislocations or instability due to repeated rotator cuff tears can lead to the need for a complete shoulder replacement.  This procedure replaces both the ball and socket of the shoulder with artificial parts that are then attached to the humerus, or upper arm bone, with a stem.

Total joint replacement is the most extreme surgery for shoulder dislocation.  It is usually only performed after other therapies have failed to bring relief for severe shoulder pain or loss of movement.

Determining Which Shoulder Surgery is Right for You

Any dislocated shoulder is a medical emergency.  The resulting pain and trauma to the joint—as well as potential complications—need to be addressed by a medical expert familiar with the various treatment options available.

It is important to remember that any shoulder surgery requires recovery time and physical therapy to re-establish range of motion and build strength.  Your surgeon will discuss the post-surgical treatment you will need to get back to the full use of your shoulder.

If you have suffered more than one dislocated shoulder or have chronic shoulder pain due to trauma to the shoulder joint, the orthopedic surgeons at Arkansas Surgical Hospital can evaluate your injury and determine the best shoulder surgery option for you.  Contact us today to schedule an appointment.

Arkansas Surgical Hospital Continues to Focus on the Safety of its Patients, Staff & Community

 
April 14, 2020 – A message from Brian Fowler, CEO of ASH speaking on behalf of the hospital on how we are meeting the healthcare needs of our patients and community.
 


 
April 5, 2020 – The physicians at Arkansas Surgical Hospital have been carefully evaluating each patient’s case to determine if their scheduled procedures can be safely postponed. Elective surgeries—procedures that can be postponed without causing harm to the patient—have been rescheduled or cancelled, while urgent surgeries are continuing.

“Urgent procedures are time-sensitive and can cause additional risk to the patient if delayed,” explained Brian Fowler, CEO of Arkansas Surgical Hospital. “These risks can include patient deficits, opioid addiction from continued use of medication to reduce pain, and emergency room visits during the COVID crisis. Our goal is to meet the needs of our community while addressing safety and care.”

The physicians at Arkansas Surgical Hospital use their clinical judgment and recommendations from the Centers for Medicare & Medicaid Services and the Arkansas Department of Health to determine whether to postpone or to continue with a procedure. The risk factors they must consider include intractable pain control issues, the possibility of permanent impairment with a lack of timely treatment, and the risk of injury from falling.

By treating patients who are at risk of falling, developing blood clots, or undergoing nerve damage, the hospital hopes to prevent injuries that would otherwise mean a trip to the emergency room.

“Reducing the number of visits to the ER prevents unnecessary exposure to COVID-19, reduces the load on overworked ER and ICU staff, and limits the use of essential emergency resources,” said Fowler. “We are adhering to recommendations and have reached out to the Arkansas Department of Health to ensure that we are doing everything possible to protect our patients during this time.”

Arkansas Surgical Hospital is committed to a disciplined focus on safety and the care and comfort of our patients.

Do you know the symptoms of ankylosing spondylitis?

What is Ankylosing Spondylitis and How is it Treated?

Ankylosing spondylitis (AS), also known as Bechterew’s disease, is a type of arthritis primarily affecting the spine.  AS causes inflammation of the vertebrae, which leads to pain that often becomes chronic.  Learn more about this form of arthritis and how you can find relief.

What Does Ankylosing Spondylitis Do to the Body?

In severe cases, chronic inflammation leads bones to fuse along the spine.  This process, called ankylosis, leads to stiffening and immobility that may trigger inflammation and discomfort in the hips, shoulders, ribs, hands, and feet.  The hips are the most commonly affected area besides the spine.  There are also rare instances of AS affecting the eyes, lungs, and heart.

The pain of AS may be more or less severe in certain situations.  Because AS is an autoimmune disease, patients may experience flare-ups when the pain and stiffness intensify.

Symptoms of Ankylosing Spondylitis

Multiple symptoms could indicate you have ankylosing spondylitis.  If you have the symptoms listed below, consider seeing a doctor for a diagnosis and discussion of treatment options.

  • Lower back pain that is more severe in the morning or after you’ve been inactive
  • Difficulty walking
  • Reduced range of motion in the spine, including bending
  • Hunched posture
  • Chronic pain in affected joints, especially the hips
  • Chronic fatigue
  • Shortness of breath
  • Eye inflammation and pain

What Causes Ankylosing Spondylitis?

It’s not yet known what causes ankylosing spondylitis, but there are certain factors that put you more at risk.  For example, men are more likely to develop AS than women, and it usually develops in early adulthood or the teen years rather than later in life.

Individuals who have a specific gene called HLA-B27 are at a much higher risk for developing AS than those who don’t.  However, having this gene does not guarantee that a person will get AS.

Diagnosing Ankylosing Spondylitis

The primary feature of ankylosing spondylitis is inflammation of the sacroiliac joints at the base of the spine.  Diagnosis is done primarily through observation: physicians will first look for classic indications of this form of arthritis, including reduced range of motion, inflammation along the spine, inability to fully inflate the chest when breathing, and pain that is worse in the morning.

If AS is suspected, x-rays and blood tests will be ordered to confirm the diagnosis.  X-rays will reveal inflammation or any abnormal bone growth.  Blood tests may check for C-reactive proteins, anemia, or a lack of antinuclear antibodies, all of which may indicate AS.

Treating Ankylosing Spondylitis

Ankylosing spondylitis is a lifelong disease for which there is no cure.  However, there are several treatment options that can minimize inflammation and pain.

Medication

During the initial stages of ankylosing spondylitis, patients can take over-the-counter or prescription NSAIDs (non-steroidal anti-inflammatory drugs) to reduce swelling and minimize pain.  To augment NSAIDs, DMARDs (disease-modifying antirheumatic drugs) may also be prescribed.  These reduce the damage to joints and surrounding tissue caused by chronic inflammation.

In more severe cases of AS, corticosteroids are prescribed (usually when NSAIDs are no longer sufficient).  Steroids can be administered as shots into painful, inflamed joints to reduce swelling and give temporary pain relief.  For individuals with AS in the eyes, eye drops with steroids may be prescribed.  Short-term corticosteroid pills may also be prescribed for individuals who have a flare-up.  Unfortunately, steroids are not a long-term solution because they can cause damage to bones and tissues over time.

Two other medication options are muscle relaxants and opioids.  Muscle relaxants help with muscle spasms and stiffness triggered by joint inflammation.  Opioids are prescribed when pain is severe and hasn’t responded to NSAIDs or other medications.  Because opioids are highly addictive, they are only prescribed for short-term use and as a last resort.  Monitoring by a doctor is crucial for individuals taking opioids.

Exercise

Your doctor may recommend gentle exercises you can do at home to strengthen your muscles and improve mobility.  There are several kinds of activities that hey or she may suggest, including yoga, deep breathing techniques, and swimming.

Your doctor may also prescribe physical therapy.  Working with a physical therapist or a trainer can reduce your risk of injury.  These professionals can also guide you to learn proper exercise techniques and use heat, massage, stretching, and other treatments to reduce pain.

Topical Treatments

Heat can be applied to painful areas to soothe muscle tension and loosen stiff joints before exercising.  Ice packs may be helpful to reduce inflammation.  Talk to your doctor about which option is most effective for your situation.

If these less invasive treatments become ineffective in treating AS, surgery may be needed.

Ankylosing Spondylitis Surgery

While medication and physical therapy are preferred to treat mild to moderate ankylosing spondylitis, there are times when surgery is indicated.  If the pain is too severe for drugs, deforming of the joints has progressed, and quality of life has been impacted, surgical treatment may be necessary.

There are several kinds of surgery performed on individuals with AS, depending on which joints are affected.

Joint Replacement

Individuals with ankylosing spondylitis often sustain joint and tissue damage in areas other than the spine, particularly the hips.  Hip replacement is sometimes recommended for patients who have severe mobility issues due to hip problems.

Repair or replacement of shoulder and knee joints are also options for advanced AS patients.  Joint replacement is a complex but largely safe procedure in which damaged cartilage and bone are replaced with an artificial joint made of metal or plastic.

Spine Osteotomy

In some individuals with ankylosing spondylitis, the vertebrae in the neck become fused, causing a stooped posture.  The person may not be able to look upwards or stand up straight.  Osteotomy surgery cuts through and reshapes the bony overgrowth of the cervical vertebrae.

Spinal Instrumentation & Fusion

If the spinal column has become unstable or if ankylosing spondylitis has caused deformity of the vertebrae, spinal instrumentation and fusion may be needed.  In this procedure, the surgeon corrects any deformities and straightens the spine.  Instruments such as screws, rods, and wires are used to stabilize the area until new bone growth once again fuses the area in proper alignment.  While this procedure does limit movement somewhat, the spine will be straighter and more stable and the pain should be diminished dramatically.

Laminectomy

Ankylosing spondylitis can cause pressure on the nerves and spinal cord.  This often leads to loss of coordination, weakness, and a tingling feeling in the extremities.  A laminectomy is a type of decompression surgery that removes pressure on the spinal cord and nerves.

During the procedure, rods, bone grafts, and screws are used to stabilize the area.  A section of any damaged vertebrae is removed.  This section, called the lamina, is the flattened area of the bone’s arch that helps protect the spinal cord.  Once it has been removed, pressure on the spinal cord and nerves is relieved.  Surgeons may also carefully move some muscles aside to they will not continue to put pressure on the spine.  Laminectomy is a minimally invasive procedure done through a small incision and takes only a few hours.

Experts in Ankylosing Spondylitis Treatment Options

Our spine surgeons treat many patients with ankylosing spondylitis every year.  If you suspect you have AS, contact Arkansas Surgical Hospital at (877) 918-7020 to schedule an appointment.  We will offer various treatment options and help you determine what kind of treatment or surgery is best to help alleviate your AS symptoms.

Proper marathon training can prevent injury.

Preparing for the Little Rock Marathon

In the weeks leading up to the 2020 Little Rock Marathon, it’s more important than ever to practice a safe and effective exercise routine, get plenty of rest, and maintain a diet that will fuel your body without weighing it down.  With proper preparation, you’ll be able to minimize the chance of injury and use your training to your full potential on March 1st.

Read on for an overview of the marathon training process with advice from blogger Tia Stone, a 3-time winner of the Little Rock Marathon.

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