Bone & Joint Injuries
Often caused by falls, trauma, or injury, bone and joint injuries can sometimes be serious enough to require surgery. A broken bone can occasionally puncture your skin, causing intense pain. If you suspect that you have a broken bone, you will need medical treatment right away. In serious cases, pins, screws, and plates are placed into the body to stabilize the bone and help it heal. Joints connect our bones, and joint injuries can often occur in the elbows and knees. To reduce your risk of joint injury, stay healthy. Staying at a healthy weight and keeping your muscles strong and fit reduces the wear and tear on your joints.
1 AnswerIontophoresis uses electrical currents to speed the delivery of medication to damaged tissue, or simply to reduce muscle spasms and related irritation. Patches similar to Band-Aids are placed on the skin, and a painless, low-level current is applied for about 10 to 15 minutes. You may feel warmth or tingling during the treatment.
1 AnswerHeat is a good way to reduce pain and stiffness in your joints and relieve muscle spasms. After an injury, wait a day or two for swelling to go down before using heat. You can use a heat pack applied directly to the joint, or warm your knees and hips in a hot tub or whirlpool or with a 15- to 20-minute soak in a regular bath. Therapists recommend a warm shower or bath before exercising to relax joints and muscles. Dress warmly afterward to prolong the benefit. Heating pads are convenient, but moist heat penetrates more deeply.
You can buy hot packs and heating pads, but a homemade hot pack works just as well. Heat a damp folded towel in a microwave oven (usually for about 10 to 60 seconds, depending on the oven and the towel's thickness) or in a conventional oven set at 300 degrees F (for about five to 10 minutes). Wrap it in a thin towel or cloth before applying to the injured area.
To relieve muscle spasms, a physical therapist may use diathermy (deep heat), a technique that uses electromagnetic waves to deliver heat beneath the skin and to relax muscles. Electromagnetic waves cannot be used on people with pacemakers.
1 AnswerAfter a knee injury, gentle pressure can reduce swelling and hasten recovery time. Wrap an injured joint in an elastic bandage, taking care that the wrap isn't so tight that the skin below the joint becomes cool or blue. Neoprene stretch knee supports provide compression and have a hole for the kneecap to prevent irritation.
1 AnswerAfter surgery for a meniscal tear, you'll return home on crutches for a few days. You can resume normal activities after about a week and start more demanding activities such as sports in about four to six weeks. Recovery and rehabilitation take longer after a meniscal transplant; during recovery, you'll need crutches for about three to four weeks and will need to wait three to four months to resume running and possibly five to six months before returning to other recreational activities. Rehabilitation includes exercises to improve the strength and flexibility of muscles surrounding the knee (hamstrings, quadriceps, and calf) and the range of motion of the joint.
After a meniscal tear, strengthening your quadriceps will help make up for lack of the knee's built-in shock absorber. Light exercise that does not put a lot of weight on the knee—such as swimming, riding a stationary bike, or using an elliptical machine—can help rebuild strength.
2 AnswersTo diagnose a meniscal tear, the doctor asks about pain and movement. Is your knee most comfortable slightly flexed? Is it hard to straighten your leg? As you sit, lie on your stomach, and lie on your back, the doctor maneuvers your legs to observe any pain, popping, or grinding in the meniscal area.
Magnetic resonance imaging (MRI) can reveal the presence of a torn meniscus, but it doesn't reveal whether a tear is new or whether it's the cause of your symptoms—yours may have been torn for years and never bothered you. Because MRI is expensive, the test is reserved for times when the diagnosis is in doubt or the results will influence treatment.
1 AnswerAmong the most frequently injured parts of the knee are the shock absorbers called menisci, which provide cushioning between the thighbone (femur) and shin bone (tibia). As you age, the menisci weaken and fray. Even such a simple motion as getting in and out of a squatting position or rising from a low chair can tear a meniscus. Magnetic resonance imaging (MRI) has revealed that damage to the meniscus is extremely common and often causes no pain. About 30% of people ages 30 to 40 have meniscal tears, and about 50% of people over age 50 have them but experience no pain.
In younger people, tearing a meniscus is usually caused by a strong, twisting force. This might occur as you round the bases in softball or pivot left to throw a basketball while your feet are facing right. Meniscus damage often accompanies a tear of the anterior cruciate ligament (ACL) in the front of the knee.
1 AnswerDuring surgery, the surgeon removes the old implant and damaged bone or joint tissue surrounding it. Depending on the amount and condition of the remaining bone tissue, you may need bone repairs or a bone graft to create a stable site for the new implant. Rehabilitation is similar to the initial replacement but takes longer after revision, and the outcome is often inferior. For example, your range of motion in the joint may be more restricted or your leg alignment less even, and even after healing you may need to use a cane to keep full weight off the joint.
Hopefully, with improved implant designs and newer materials such as cross-linked polyethylene, total joint replacements will last longer, making revision surgery less likely in the future.
1 AnswerLoosening, bone loss, being very active or overweight, and the wearing away of the artificial joint that typically occurs after 15 to 20 years can all necessitate revision joint replacement surgery. Knee and hip replacements typically last longer in older people, who tend to be less active than their younger counterparts, who put more wear and tear on a replacement joint. For knee or hip replacement surgery, there is a 1% failure rate per year (that means that revision surgery is needed within one year).
If your implant fails, surgery to replace it takes longer and may be more complicated than your original operation. There is also more risk involved. The in-hospital death rate for revision hip replacements is more than double that of first-time total hip replacements. Patients who have less pain and fewer additional medical conditions before revision surgery are more likely to experience better pain relief as a result of the surgery.
1 AnswerPrecautions against dislocating a new hip implant are quite limiting for about 12 weeks. It's important to follow them regardless of how well you feel, since a position can be risky without causing pain.
- Bend over as little as possible. Your hip should flex no more than 90 degrees, meaning you should not bend over farther than your waist. This rules out bending over to tie your shoes normally or pick up something you've dropped, and it also means you'll need a raised toilet seat and a chair or bed that is high enough that your knees don't rise above your hips when you sit.
- Be careful in bed. Lying down, you mustn't pull your knee toward your chest or reach down too far to get your covers.
- Rely on long-handled gadgets. Four devices can be helpful: a reacher to help you pull up pants or grab items that are out of safe range; a tool to pull on socks without bending over; a shoehorn to put on sturdy non-tying shoes; and a sponge to help you wash below your knees.
- Avoid movements that turn the operated leg in or out. Keep your feet pointed straight ahead when you sit and stand. Don't cross your legs, even at the ankle. Sleep on your back or on your side with your abduction pillow between your legs.
1 AnswerIn the weeks after a hip replacement, you'll need to take great care to keep from dislocating the implant before the surrounding tissues have healed enough to hold it in place. Even afterward, there is a chance of a painful dislocation—five out of every 100 implants dislocate after total hip replacement surgery. If your hip dislocates, your doctor gives you a sedative while he or she manipulates the implant ball back into the socket. A hip that dislocates more than once usually requires surgery to make the joint more stable.