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KNEE PAIN CAUSES/CONDITIONS

 

  1. Osteochondritis Dissecans

- Non-surgical treatment

A. Rest for 1-2 weeks

- - immobilization

- - minimal weight bearing

B. Modify activity level for 6-12 weeks.

1. Avoid rapid or high impact activity.

- - running

- - cutting

- - jumping

2. Consider low impact exercises

- - bicycling

- - swimming

C. Full activity

- - when no pain

- - normal exam

- - x-rays show healing

D. Isometric quadriceps exercises

E. Healing should occur over time

Surgical Treatments:

1. Arthrotomy or arthroscopic surgery

- - if fracture fragments are > 1 cm diameter

- - lateral femoral condyle

2. Patella Fracture

- Due to direct blow to the front of the knee.

A. Types

1. Stellate Fracture

- Due to direct blow to the knee 

2. Sleeve Fracture Fracture due to quad muscle contraction against a fixed lower leg.

B. Non surgical indications

1. non-displaced patellar fracture with intact articular surface

2. active knee extension against gravity intact.

3. minimal patella fracture fragment displacement

4. articular surface with minimal involvement.

C. Non –surgical treatments include: long leg cast or knee immobilizer

D. Surgical treatments include realignment of the bones with some combination of pins, screws or wires or a removal of portion of the patella.

1. Post-surgical complications can include.

- Infection

- non-healing of the fracture

- Failure of fixation

- Pain in the knee cap

- Arthritis.

3. BURSA

- Pes Anserine Bursitis

- Prepatellar Bursitis

- Treatment can include: medications, local ice, modify activities, injections

4. Cyst - Popliteal cyst

5. Iliotibial

- Iliotibial band syndrome (IT band)

- second most common cause of knee pain

- due to microtrauma to the area

- irritation of the distal iliotibial band

- excess friction at the lateral femoral condyle

- repetitive flexion and extension

- Non-surgical treatment can include

- rest, ice, compression and elevation

- cold therapy

- medications

- rest until pain subsides

- phonophoresis or iontophoresis

- injection

- orthotics

– adjust shoe for lateral wear

- Surgical treatment if conservative measures fail

6. Ligament

- Anterior cruciate ligament (ACL) tear

- contact sport related: foot planted in a fixed position or torque from a blow

- knee hyperextension injury

- Non-surgical treatments include: quad strengthening, bracing and activity modification

- Surgical treatments are available.

- complications of un-reapaired ACL

- meniscal injury

- osteoarthritis

- Treatment in children

1. Non-displaced Type I Avulsion Fracture

- long-leg cast immobilization for 4-6 weeks.

2. Displaced Type II to II Avulsion Fractures.

a. open reduction and internal fixation.

b. long-leg cast immobilization for 4-6 weeks

3. Intrasubstance tears

a. operative management – indicated for children near skeletal maturity.

b. non-operative management

1. indicated in young children.

2. perform operative reconstruction when mature.

- Collateral ligament tear (medial and lateral)

- medial tear is common

- lateral tear is uncommon

- Non-surgical treatment can include: rest, ice, elevation, compression, medications, local cold therapy, hinged knee brace, relative rest, rehab

- Surgical treatment is indicated for grade III tears or for other concurrent ligament injuries.

- Posterior cruciate ligament (PCL) tear

- uncommon injury

- direct trauma to the proximial tibia

- occurs when knee flexed decelerates quickly

- hyperflexion or fall on flexed knee

- Non-surgical treatments can include: immobilization, brace, quad strengthening exercise.

- Surgical treatments are rarely needed.

7. Meniscus - most common injury

- twisting injury to knee when weight bearing

- Non-surgical treatment can include: rest, ice, elevation, compression, medications, crutch walking, quad strengthening exercise, gentle knee ranges of motion exercises

- Surgical treatment is indicated if there is irreducible locking or failure of conservative management.

8. Patella - Chronic patella injury

- patellar tendonitis

- extensor mechanism dysfuction

- synovial plica inflammation

- Jumper’s knee

- tendonitis without rupture

- associated with jumping sports during growth spurts

- Treament can include: autologous blood injection to the patellar tendon

- DO NOT INJECT corticosteroid – risk of patellar tendon rupture

- Surgical treatment within 10 days of injury, immobilization following surgery and post- surgical physical medicine modalities.

- Osgood Schlatter

- common in physically active children, ages 10-14.

- caused by repetitive traction of patellar tendon on tibial tubercle

- cartilage detachment from tibial tuberosity

- acute stress from recent increase in athletic activity or growth spurt

- Treatment can include: reduce physical activity, consider infrapatellar strap, immobilizer, quad strengthening, protect the area, medications. Avoid corticosteroid injections

- Surgical treatment may be indicated if there is persistent pain (rarely needed).

- Patellar Dislocation

- most common knee injury seen in children

- Treament can include reduction, bracing and taping, alter aggravating activities, physical medicine modalities, consider immobilization.

- Surgery may be indicated if there is not sufficient improvement after 6 months

- Patellofemoral Syndrome

- most common running injury

- causes can include: prepatellar bursitis, patellar tendonitis, meniscus tear, chondromalacia patellae, patella osteoarthritis, osteochondritis dissecans of the knee, Chondral fracture, patella instability, or synovial plica.

- Non-surgical treatments can include: rest, medications, ice, physical medicine modalities, shoe modifications, avoid factors that cause pain, patellar taping, bracing.

- Surgery may be indicated, if pain persists or there is failure of conservative management Diagnostic arthroscopy, lateral release or relocation

- Sinding

- Larsen-Johansson Disease

- - Inflammation of the inferior pole of the patella

- - ages 10-13

- - tenderness at the inferior pole of the patella

- - Non-surgical treatments can include: rest, analgesics, flexibility exercises, immobilization

- - usually resolves within 12 months and by skeletal maturity

9. Plica - Plica Syndrome

- more common in teenage athletes

- caused by blunt injury or twisting injury of the knee

- Non-surgical treatment can include: reducing the provocative activities, local cold therapy, steroid injection.

- Surgical treatment can be considered

10. Sesamoid

- Fabella Syndrome

- sesamoid bone in the lateral gastrocnemius

- more common in early teen years

- caused by friction of fabella on posterolateral femoral condyle

- Non-surgical treatments can include: rest, ice, elevation and compression, medications and heel lifts

- Surgery can be an option if conservative measures fail

 

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Posture and Neck Pain

Chronic neck pain is a miserable experience. Although some cases of neck pain are caused by an injury, many are simply due to poor posture. Poor posture stresses the muscles of the neck and can cause muscle spasms, stiffness and pain. Over time, the stresses of poor posture on the neck can cause degenerative diseases to develop in the discs and bones of the neck. Forward head A very commonly seen posture that puts a lot of strain on the neck is the forward head. The individual habitually thrusts the head forward, carrying it out in front of the shoulders. In this position, the weight of the head is constantly pulling on the spine and the shoulders. Sitting for hours hunched over a desk or a computer is a common cause of forward head. Many people with this habitual forward head carriage suffer from sore shoulders as well as a sore neck. Over time, the vertebrae at the base of the neck (C5 and C6) can develop painful degenerative conditions due to the constant weight of the head pulling on them in the forward head posture. Correct posture A correct posture is one that keeps the spine in alignment. Some people call it a neutral or balanced posture. One exercise to encourage a neutral posture is to focus on opening the chest wide as you try to squeeze your shoulder blades together. Once your chest is open, bring your head into alignment. Think of a string pulling up the top of your head and lengthening the neck. When you do this, your chin will tuck in and your head will naturally shift into proper alignment with your spine. Do the open chest/ string exercise multiple times a day. Other exercises to build better posture are head nods and chin tucks. To do a head nod, slowly nod your head slightly up and down without moving your neck. To do chin tucks, tip your nose down toward the ground and move the top of your head backwards. Repeat head nods and chin tucks several times a day. These exercises strengthen the muscles on the front of the neck. Individuals with habitual forward head posture usually have very weak muscles in the front of the neck. If you've worked hard at correcting your posture and you are still suffering from neck pain, why not give us a call?


Note: The information on this Web site is provided as general health guidelines and may not be applicable to your particular health condition. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. Remember: There is no adequate substitution for a personal consultation with your physician. Neither BPF Specialty Hospital, or any of their affiliates, nor any contributors shall have any liability for the content or any errors or omissions in the information provided by this Web site.