Arthritis in the knee and hip is a leading cause of pain and disability, particularly for older people. Doctors sometimes recommend replacement of the joints with prosthetic devices. They advise patients to drop some pounds before undergoing the surgical procedure.
Weight control can be challenging. The federal government recently announced new regulations, to take effect in late 2015, that might help people monitor their dietary habits. Calorie information will be required on food menus at restaurants, grocery stores, coffee shops and other establishments. The Food and Drug Administration’s new rules will even apply to movie theaters and vending machines, the Washington Post reported.
“Americans eat and drink about one-third of their calories away from home, and people today expect clear information about the products they consume,” said FDA Commissioner Margaret A. Hamburg. She explained that the new regulations will make it easier to make healthy choices.
The Post noted that, for years, advocates of “transparency” in food labeling have been urging government officials to enact such regulations.
“I consider this an enormous advance for public-health education and well worth the long wait,” Marion Nestle, a nutrition expert and professor at New York University, told the newspaper. “This is great news for public health and, hopefully, an incentive to restaurants to reformulate their offerings to be lower in calories.”
The calorie-listing requirement is a provision of the Affordable Care Act, the 2010 law also known as Obamacare. It took four years for the government to draft the rules, as consumer organizations pushed for stringent regulations and industry groups lobbied against any mandates.
The debate resulted in a plan to apply the calorie-posting requirement only to restaurant chains with 20 or more locations. Daily specials, seasonal foods and mixed drinks are among exempted items, according to the Post.
Pain resulting from arthritis in the knee and hip often can be treated without surgery. Many people relieve their discomfort and improve function in their joints by taking anti-inflammatory medication and receiving physical therapy. Exercises are designed to strengthen muscles and improve range of motion.
When such treatments fail to provide relief, full or partial replacement of a knee and hip may be needed to restore full function. In 2011, nearly a million people received knee and hip replacements in the United States. Also known as arthroplasty, it is one of the most common musculoskeletal surgical procedures, according to the American Academy of Orthopaedic Surgeons (AAOS).
Doctors generally advise obese or overweight patients to shed some pounds before having the operation. Excess weight increases the risks of surgery, and places too much stress on reconstructed joints, the AAOS explained.
Weeks or months before having surgery, it’s a good idea to engage in a weight-loss program featuring a nutritious diet rich in fruits and vegetables. Regular exercise and reduced alcohol consumption also are recommended.
If you are experiencing knee and hip pain due to arthritis, schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to learn about ways to relieve the discomfort and regain full use of your joints.

About 200,000 people suffer sports-related concussions in the United States annually. Some of them recover quickly, while others experience persistent problems and even brain dysfunction.
A recent study by Penn Medicine, published in the Journal of Neurotrauma, linked the severity of post-concussion symptoms to a brain-enriched protein called SNTF. Scientists confirmed previous evidence that patients with greater amounts of the protein are more likely to develop conditions like diffuse axonal injury and long-term cognitive dysfunction.
“We extended this biomarker research to the domain of professional sports to test its merit as an objective and rapid way to determine players’ severity of brain injury,” said lead author Robert Siman, PhD, research professor of neurosurgery at Penn. “This blood test may aid neurobiologically informed decisions on suitability for return to play following a sports-related concussion.”
The research involved 288 Swedish professional ice-hockey players, 28 of whom had sustained concussions during the 2012-13 season. The injury victims’ blood was analyzed daily to evaluate the degree to which their symptoms were subsiding. Eight of them no longer had symptoms a few days after their injuries. The other 20 players reported ongoing problems that kept them out of competition for at least six days.
The scientists discovered that those 20 study participants experienced increases in SNTF levels between one hour following their injuries and 144 hours later.
“These results show that SNTF has promise as a blood biomarker for sports-related concussion and beyond,” wrote Siman and senior author Douglas H. Smith, MD and director of Penn’s Center for Brain Injury and Repair.
Their report continued: “High blood levels of SNTF appear to identify acute brain damage that corresponds with persisting symptoms after concussion. These observations lend further support to the growing awareness that concussion is not trivial, since it can induce permanent brain damage in some individuals.”
Identifying concussion symptoms and initiating appropriate treatment is particularly crucial for children and teenagers who play sports. They usually take longer than adults to recover, according to the American Academy of Orthopaedic Surgeons (AAOS).
The injury hampers the brain’s ability to function and process information. It can affect balance, coordination, memory and speech. Athletes who have had one concussion are prone to suffering more such injuries. Recurring incidents can cause long-term disability.
Brain

The damage results from a sudden, high-impact force to the skull, which violently shakes the brain. Either a blow to the head, or an impact to another part of the body that makes the head snap, can cause a concussion. The injuries happen for a variety of reasons, but people who play sports are among those at the greatest risk. Football, ice hockey and soccer have some of the highest concussion rates.
The symptoms of this brain injury can be hard to recognize immediately following an accident. In some cases, the signs do not appear until days later. A concussion can result in physical, cognitive and emotional issues. According to the AAOS, the most common symptoms are drowsiness, headache, loss of consciousness, memory loss, irritability, confusion, balance problems, dizziness, difficulty speaking and communicating, depression, nausea and vomiting, and altered sleep patterns.
If you or your child suffers a concussion, an immediate evaluation by medical professionals is critical. The nationally renowned sports medicine staff at Orthopedic Surgery San Diego can assess your symptoms and recommend the best treatments.

Athletes know that good nutrition is necessary to gain the most benefits from exercise and protect the body from injury. However, recent sports medicine research indicates that taking supplements of vitamin C and E is less effective than getting the nutrients from food sources.
The New York Times reported that “antioxidant vitamin are enormously popular with people who exercise.” However, the newspaper noted in its “Well” blog, the supplements “might be counterproductive to certain types of exercise, including running and other endurance sports.”
Research by scientists at the Norwegian School of Sports Sciences, published in November in The Journal of Physiology, found that athletes who took vitamin C and E pills got bigger muscles, but gained less strength, than those in the control group.
“Aerobic exercise and strength training lead to the production of free radicals, molecules that in concentrated amounts can cause tissue damage,” the Times explained. “Antioxidants sop up and neutralize free radicals. So, the thinking goes, taking antioxidant should lessen some of the damage and soreness after exercise and allow people to train harder.”
To test the theory, researchers gave large doses of the vitamin to endurance athletes. The outcome was “a slightly smaller training response,” according to the Times. The volunteers had lower levels of the enzymes that encourage production of mitochondria in muscle cells, which creates cellular energy. Without sufficient amounts of that energy, a person cannot exercise as intensely or for as long.
The 32 participants in the Norwegian study were weight trainers, rather than endurance athletes like runners and cyclists. The activities involve different biochemical processes in the muscles. Half of the volunteers took vitamin C and E pills before and after their resistance training each day. The others consumed no supplements.
The experiment continued for 10 weeks, with weights being gradually increased. After five weeks, and at the end of the study, the scientists took muscle-tissue samples to measure muscle size and strength. They found that muscles had grown about the same for members of both groups.But those who took antioxidants gained less strength, and “had reduced levels of substances known to initiate protein synthesis,” the Times reported. The synthesis is crucial to the repair and strengthening of muscles after weight training.
As a result of their research, Dr. Goran Paulsen and his colleagues recommended that neither joggers nor weight trainers should take high dosages of the pills.
The scientists wrote: “Vitamin C and E supplementation interfered with the acute cellular response to heavy-load resistance exercise and demonstrated tentative long-term negative effects on adaptation to strength training.”
The findings do not mean that athletes should neglect their nutritional needs (Prednisone). Experts advise them to eat balanced diets featuring plenty of vegetables and fruits, as well as whole grains and protein. Substances these items contain (like thiamin, riboflavin and niacin) enable the body to convert food into energy. Athletes also need to replenish the potassium, iron and calcium that are lost during exercise.
Eating fish twice a week is recommended because omega-3 fatty acids regulate inflammation and stabilize blood sugar. Magnesium (found in leafy greens, nuts, beans and dark chocolate) strengthens muscles and regulates heart rhythm.
Nutrition is important for athletes because it determines how much they get out of exercise. Consuming vital nutrients also empowers the body to resist injury. To learn more, and to find out how you can improve the value of your workouts, schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego.

shoulder pain

Millions of Americans suffer from shoulder pain, due to injuries or other causes. When physical therapy and medication fail to relieve the discomfort and restore shoulder function, surgery is often recommended.
At Orthopedic Surgery San Diego, patients are evaluated to determine their best options. Types of shoulder operations include closed procedures and arthroscopic surgery.The shoulder consists of several joints, as well as tendons and muscles, that allow a variety of movements. The joint features three bones: the humerus, in the upper arm; the scapula, also known as the shoulder blade; and the clavicle, or collarbone. The humerus extends into the glenoid, a socket in the scapula. The muscles and tendons that hold the humerus in place make up the rotator cuff.
Some people feel pain only when they make certain movements, while others experience discomfort even while the shoulder is not being used. Sometimes, the joint heals and the pain goes away. In other cases, patients must obtain treatment to find relief.
The major reasons for shoulder pain are tendon inflammation due to bursitis or tendonitis, tendon tears (most common being the rotator cuff), instability, arthritis and broken bones (fractures). Less common causes include tumors, infections and nerve problems, according to the American Academy of Orthopaedic Surgeons.
Overuse of the shoulder, which occurs while playing sports or performing certain physical tasks, can lead to inflammation of the bursae (sacs of fluid that cushion the bones and tissues in joints). This condition is diagnosed as bursitis.
When the swelling is between the rotator cuff and the acromion (the top of the shoulder blade), it is classified as subacromial bursitis. This frequently afflicts people who also have rotator-cuff tendonitis, which results from long-term deterioration of a tendon.
Tendonitis is either acute, due to an injury from excessive throwing or other overhead activities; or chronic, a degenerative disease that gets worse with age. Most of the time, shoulder tendonitis occurs in one of the four rotator-cuff tendons or in a biceps tendon.
A tendon tear also can result from either an acute injury or degenerative effects. It can be a partial tear, or a severing of the tendon. A complete tear entails a tendon being pulled apart from a bone. Injuries to the rotator cuff and biceps tendons are most often responsible for tears.
When the acromion exerts too much pressure on underlying soft tissues while the arm is lifted away from the body, impingement (or rubbing) can occur. That can cause bursitis, tendonitis and even rotator-cuff tears.
Shoulder instability involves the head of the upper arm bone being forced out of the shoulder socket, because of injury or overuse. Such dislocations can be partial or complete. Some patients suffer multiple recurrences, as shoulder ligaments, tendons and muscles become loose and more vulnerable to instability. The more times it happens, the greater the odds of arthritis developing.
The most common type of shoulder arthritis, osteoarthritis, is characterized by pain, inflammation and stiffness that generally starts in middle age. The condition gradually worsens, due to wear and tear of the joint over the years. Athletes, as well as workers who repeatedly reach above their heads, are particularly susceptible to osteoarthritis.
Other kinds of shoulder arthritis result from rotator-cuff tears, infections and inflammation of the joint lining.
An injury can break the clavicle, humerus or scapula. For seniors, falling is the typical cause of a shoulder fracture. Younger people are more likely to be injured in a traffic accident or while playing sports. Patients with broken shouder bones experience severe pain, swelling and bruising.
Orthopedists employ a variety of diagnostic tests to identify the cause of shoulder pain. They usually advise patients to rest the joint, and reduce or alter activities. However, inactivity may lead to stiffness, pain and lost range of motion. Doctors typically recommend physical therapy, and prescribe anti-inflammatory medication.
In about 10 percent of cases, surgery is required to relieve symptoms and restore shoulder function. Operations often are performed arthroscopically, a minimally invasive technique that involves only small incisions. For shoulder reconstruction or replacement, open surgery is conducted.
If you are experiencing shoulder pain, it is necessary to pinpoint its cause to determine the appropriate and effective treatment. Schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to learn about ways to relieve the discomfort and regain full use of your shoulder.

Knee pain can result from an injury, like a ruptured ligament or torn cartilage; or a medical condition, such as arthritis or gout. The discomfort may progress to the point that it becomes difficult to walk and engage in other simple, everyday activities.
The best type of treatment or knee surgery depends upon the cause of the pain and the degree to which function is limited.  The staff at Orthopedic Surgery San Diego conducts a range of diagnostic tests to determine the most effective ways to relieve the symptoms.
Many patients find relief by taking anti-inflammatory medication and receiving physical therapy. For others, surgical repair of the knee is necessary to regain full function.
Left untreated, conditions like osteoarthritis can cause pain that increases with age. Joint damage and disability also may result from failing to address the problem.
Symptoms of a knee ailment include swelling and stiffness, redness and a knee that is warm to the touch, weakness or instability, popping or crunching noises, and inability to fully straighten the knee. Experts advise seeking the services of a doctor when putting weight on the knee becomes too painful, inflammation increases, the joint is hard to flex, the knee or leg looks deformed, or the knee “gives out”.
Some patients, especially athletes and those who regularly engage in other activities that put excessive strain on their knees, are vulnerable to injuries. Damage may be inflicted on the joint’s ligaments, tendons, bones, cartilage, or bursa (liquid-filled sacs that cushion the bones and soft tissues).Skiers and people who play soccer or basketball are prone to tears and other injuries of the anterior cruciate ligament (ACL). It is one of four ligaments that connect the shin bone to the thigh bone. Meniscus, a type of cartilage between the shine bone and thigh bone, can tear when the knee is twisted.
Knee injuries sometimes inflame the bursa, which leads to bursitis. Another common condition, tendonitis, entails irritation and swelling of one or more of the tendons that hold bones and muscles together. Patellar tendonitis, which happens to athletes whose sports require running or jumping, affects a tendon that extends from the thigh to the shin bone.
An injury or long-term deterioration sometimes causes a bone or cartilage fragment to chip away and float within the knee. These fragments are called “loose bodies,” which are often harmless. In some cases, they adversely affect knee movements and cause pain. A dislocated kneecap features the patella, a bone in the front of the knee, being forced out of its proper location.
Osteoarthritis results from cartilage wearing away over the years. Rheumatoid arthritis produces varying degrees of pain that may come and go. Gout, another type of arthritis that can affect the knee, results from a buildup of uric acid.
Other afflictions include pseudogout, caused by calcium-laden crystals forming in the knee; septic arthritis, which results from infections; and patellofemoral pain syndrome, which produces pain between the patella and thigh bone. Some patients suffer discomfort in the knees due to one leg being longer than the other, or having improperly aligned knees or flat feet.
Overweight and obese people are most at risk of sustaining injuries or developing conditions that cause knee pain. The more weight that the joint bears, the faster the cartilage deteriorates. It is important to get sufficient exercise, to maintain knee strength and flexibility. When muscles tighten or weaken, they fail to properly support the knees when strain is placed on them.
To pinpoint the cause of a patient’s knee pain, a doctor performs a physical examination and conducts a range of medical tests, such as X-rays, CT scans, ultrasounds and MRIs.
While the optimal treatment depends upon the type and severity of the problem, patients usually first try to relieve their symptoms with drugs and exercise therapy. In some cases, doctors prescribe arch supports or knee braces. Another approach is to inject into the knee corticosteroids, or a thick fluid that lubricates the joint.
Surgical options include minimally invasive arthroscopic methods, in which tiny tools and a fiber-optic camera are inserted into the knee through small incisions. Open surgery is necessary for partial or total knee replacements using prosthetic devices.  In these surgical endeavors, knee arthritis is eliminated when metal implants are used to perform a total knee arthroplasty.  This  surgery is performed by an orthopedic surgeon.
If you are experiencing knee pain, it is necessary to identify the cause to determine the appropriate treatment or surgery. Schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to learn about ways to relieve the discomfort and regain full use of your knee.

 Carpal Tunnel Syndrome

Carpal tunnel syndrome of wrist is a condition that affects the hand and the arm of a person. It is a caused primarily by compression to the median nerve. The median nerve is a nerve that runs on the inner side of the wrist (palm side) through a tunnel that is surrounded by the carpals (bones that form the wrist) and ligaments. This nerve supplies all the fingers except the small finger and ring finger.

What are the Causes?

The pinching of median nerve can be caused by various factors like-

• Fracture of the wrist
• Inflammation or swelling in the wrist area
• Blood flow stoppage
• Diseases like diabetes and hypertension can cause this syndrome.
• During pregnancy when the fluid is retained within various body parts

You can be at an increased risk of developing this condition if:

• You indulge in activities that cause the over-extension of your wrist like in case of typing
• You overuse any vibrating tool or gadget for prolonged duration
• You are gripping the mouse or a keyboard in an improper way causing the wrist to get fatigued more often.
• You are a female because females have smaller space within the carpal tunnel thereby increasing the chances of compression.

How do I understand that I have it?

The usual symptoms that you might observe are-

• Tingling sensation– During the initial phase, you might just observe a tingling sensation in your thumb and first three fingers and extending towards the arm. This may progress to a condition when you find your arm going numb.
• Pain– Since there is median nerve compression; you may have pain in the areas that are supplied by the nerve. The pain may increase at night while you fall asleep.
• Weakness– This is quite dangerous and, at times, embarrassing. Things might just fall from your hand because you may lose the capacity to hold them tight as your grasp needs the coordination of all your fingers and your thumb which have become numb.

If you find these symptoms bothering you persistently, you need to go to your physician for medical assistance. Early diagnosis can prevent extensive and irreversible nerve damage.

What are the tests conducted by the doctor?

1. History– Firstly, your doctor will ask the details about your symptoms like the time when it started, the severity and questions alike.
2. Examination– Now your doctor will check your wrist and arm for any swelling or other deformity. He will also tap your wrist to check how you respond.
3. Xray– This may be required to rule out other factors of pain like fracture.
4. Electromyography– This test is conducted to check the electrical activity in muscles.
5. Nerve conduction test– This test is to check if the propagation of nerve impulses slow down inside the carpal tunnel or not.

What are the treatment options available?

Orthopedists try to treat this syndrome non-invasively. The usual non-surgical treatment modalities are-

• Wrist splint– This holds the wrist so that the nerve does not get compressed while you are asleep.
• NSAIDS– Ibuprofen is good for pain relief in the arm.
• Injectable corticosteroids– They provide instant relief when injected to the affected area as they relieve pain and reduce inflammation.

Surgically, it can be treated by incising the bands inside the carpal tunnel that put pressure on the nerve. This is done in severe cases only.

Simple preventive measures are-

• Avoid over exertion.
• Take breaks when you work on a computer or any other vibrating tool.
• Stretch your fingers and wrist in between work so that the nerve impingement is avoided.
• Do not sleep on your hand.

If you have been told that you have carpal tunnel syndrome or you would like to have your hand evaluated, contact our nationally renowned specialists at Orthopedic Surgery San Diego today for an appointment.

Young athletes, especially soccer players, sometimes suffer anterior cruciate tears. Children who sustain ACL tears requires special type of surgical attention,  because they are skeletally immature.Some teenagers and their parents are reluctant to choose surgery to reconstruct ACL tears, because they have heard there is a risk of damaging the growth plate in the proximal tibia (upper leg bone) or the distal femur (lower thigh bone).

However, according to a study published in November 2014 in the American Journal of Sports Medicine, pediatric ACL reconstruction can be done safely with the use of specialized techniques.

The researchers concluded that the surgery is “a safe option” for young patients. They wrote that the procedure produces “high functional and satisfaction results, without significant growth plate damage.”

The study was titled “Transphyseal Anterior Cruciate Ligament Reconstruction in Patients With Open Physes: 10-Year Follow-Up Study.” The authors were Calvo, Figueroa, Gili, Vaisman, Mococain, Espinosa, Leon and Arellano.

The researchers acknowledged that the procedure “is controversial, (though) current evidence supports the view that surgical techniques restore knee stability and prevent progressive articular damage.” They suggested that most previous studies of ACL reconstruction in teenagers were too small or short term to produce reliable findings.

Calvo et al wrote that they sought “to determine the long-term functional outcomes and secondary complications of transphyseal intra-articular ACL reconstruction with hamstring graft in skeletally immature patients.”

The study involved 27 people who were between 12 and 16 years old when they underwent the surgical procedure. The researchers assessed them 10-13 years following their operations.

Among the factors examined to determine clinical outcomes were the patients’ preoperative conditions, details of their surgeries, follow-up medical reports and scores on knee-function tests. The analysis also took into account the patients’ ability to return to playing sports, and whether they sustained ACL reconstruction failures.

“The anteroposterior knee laxity was assessed by arthrometry, and the presence of deformities and lower limb length discrepancies were evaluated by radiographs,” Calvo et al explained. “The presence of degenerative signs on anteroposterior and lateral knee radiographs at final follow-up was also evaluated.”

The researchers noted that there had been “significant differences” in the patients’ preoperative scores on several types of function tests. Two patients reported instability in their knees when they resumed playing sports. Three people experienced ruptures of the ACL graft.

Overall, the study confirmed that the surgery is safe for young patients. That is good news for those who have been unable to relieve their knee instability, and restore function, with physical therapy and other treatment. Athletes are particularly susceptible to ACL tears because of the strain their activities put on the ligament. In about half of the cases, there is also damage to other knee ligaments, the articular cartilage or the meniscus.

Injured ligaments, classified as “sprains,” are graded on a severity scale. A Grade 1 ACL sprain is the least severe, typically just an over-stretched ligament that does not impair normal knee function. A Grade 2 sprain involves a ligament stretched to the point that it is loose. This is sometimes called a “partial tear.”  A complete tear, when the ligament is severed and the joint is unstable, is a Grade 3 sprain.

According to the American Academy of Orthopaedic Surgeons, ACL injuries are typically caused by abrupt movements like rapidly changing direction or suddenly stopping. They also result from slowing down while running, landing wrong after jumping and colliding with another person.

Women tear their ACLs at a greater rate than men. Sports like soccer, football and basketball are especially hard on knee ligaments. Among the symptoms are a popping sound in the knee, the joint giving out, pain and inflammation, diminished range of motion and pain while walking. If you have been diagnosed with an anterior cruciate tear, learn more about your options. Schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego.

hand injuries

It is hard to imagine that something we use daily for our small children could possibly hurt them. While engineers work hard to ensure safety when it comes to products for young ones, there is always a chance of a product failure that can cause pediatric injuries.Graco, one of the most trustworthy names in baby products, has issued a recall on 4.7 million strollers manufactured by the company for those in the United States, Mexico, and Canada. Eleven finger injuries have been reported which include a finger laceration, four partial amputations of the fingertips, and six fingertip amputations. The cause of the hand injury is an external fold0lock hinge on the sides of the stroller that can pinch the child’s finger, hard enough that it can potentially cause amputation of the baby’s fingertips. The recall includes the following strollers by the Graco and Century brand: Aspen, Breeze, Capri, Cirrus, Glider, Kite, LiteRider, Sierra, Solara, Sterling, and Travelmate strollers manufactured between August 1, 2000, and September 25, 2014. The Consumer Product Safety Commission is urging those with one of these strollers to contact Graco. Free repair kits, which include hinge covers, will be available soon beginning December 2014. Fingertips are sensitive and have many nerve endings. A partial or whole fingertip amputation can damage skin, nerves, and possibly bone. Even though it is a small part of the finger, a missing piece can change how the hand works, and if not treated immediately, could likely result in deformity.If a finger or hand injuries occurs that results in amputation of the skin, the first course of action is elevate the hand and apply ice to keep the swelling down. Ice also reduces bleeding, and can help temporarily numb some of the pain. Cover the injury site in sterile gauze, and keep the hand as still as possible. If you are able to locate the amputated part, clean it with water, cover it with gauze, seal it in a bag, then put the bag in ice. Do not put the amputated piece directly in ice, it can potentially cause irreversible damage. Take the amputated part to the doctor with you. Treatment for a fingertip amputation depends on the amount of skin lost, how bad the injury is, and the wound’s angle. Small cuts, with no bone exposure may heal without surgery. If the wound is too large to heal on its own, a skin graft may be needed to cover the injured site. Injuries with the bone exposed could result in a shortening of the bone in order to cover the wound. Reconstructive flap surgery is also an option. Replantation of the amputated site is considered when the wound is very large. If you or a loved one is using one of the stroller listed above, immediately contact Graco Children’s Products at 800-345-4109 to get the hinge covers for the stroller. Even though injury risk is very low at 2.3 for every 1 million strollers, it’s never low enough for your family. Feel free to contact our pediatric sports medicine specialists at Orthopedic Surgery San Diego if you have any questions about your chil

For many people who suffer severe knee pain due to arthritis, medication and physical therapy are not enough. Knee replacement is sometimes necessary to relieve the discomfort and restore mobility.Surgeons conducted more than 600,000 knee arthroplasties (or knee replacements) in 2012, a dramatic increase from about 250,000 in 1999, Gretchen Reynolds reported in a New York Times “Well” blog.

However, she pointed out, recent research indicates that a large number of patients have their knee joints replaced with metal and plastic prosthetics before giving other treatments a sufficient chance to work.

Virginia Commonwealth University was the site of two studies that suggested knee replacement is advisable only in cases of advanced arthritis. The researchers said the surgery is appropriate for patients who have not only extreme pain, but also greatly limited physical ability. People at this stage can no longer climb stairs, rise from a chair or walk without assistance.Another conclusion of the research was that knee arthroplasty makes more sense for the elderly because the prosthetics typically wear out within about 20 years. Younger patients sometimes require additional knee replacements.

One of the studies involved assessing the medical records of nearly 200 people with arthritic knees who underwent knee arthroplasties. About a third of the patients suffered only minor arthritis, so they might not have been appropriate candidates for the surgery, Reynolds reported.

In the other study, the same researchers found that those with advanced, disabling arthritis enjoyed the best results from receiving knee replacements. Their knee pain subsided significantly, and they were able to regain a great deal of function.

Patients with less severe arthritis showed, on average, only about one-tenth as much improvement in knee function following surgery. “They had less room for improvement,” Daniel Riddle, a professor of physical therapy and orthopedic surgery who led the studies, told the Times.He recommended losing weight and working with a physical therapist, rather than resorting to knee-replacement surgery, unless all the cartilage in the knee has deteriorated.

Arthroplasty “is a safe and effective procedure to relieve pain, correct leg deformity and help you resume normal activities,” according to the American Academy of Orthopaedic Surgeons. The organization reported that, since the surgical method was developed in 1968, it has evolved to the point that “total knee replacement is one of the most successful procedures in all of medicine.”

In the majority of cases, chronic knee pain and disability are caused by osteoarthritis, rheumatoid arthritis or post-traumatic arthritis.

Osteoarthritis develops over time, as the knee joint sustains wear and tear, so it is typically experienced by people 50 years of age or older. They suffer knee pain because cartilage between the joint’s bones become soft and eventually deteriorate. That results in bones rubbing on bones, triggering pain and stiffness.The disease known as rheumatoid arthritis, which features inflammation of the synovial membrane that surrounds the joint, also destroys cartilage.

Post-traumatic arthritis occurs following knee injuries.

“Fractures of the bones surrounding the knee, or tears of the knee ligaments, may damage the articular cartilage over time, causing knee pain and limiting knee function,” the AAOS explained

.If you have knee pain or have been told you have knee arthritis, call to schedule an evaluation with our nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to review your options for relief.

Tilting the head to look down at a phone, while reading or sending text messages, may lead to fibromyalgia and other conditions that require physical therapy, manual therapy or treatment by an orthopedist.In some cases, patients benefit from egoscue, a type of bodywork that relieves neck pain and restores physical function. The technique entails a series of “low-motion” movements.

Research by Dr. Kenneth Hansraj, chief of spinal surgery at New York Spine Surgery & Rehabilitation Medicine, showed that looking down at a phone can add as much as 60 pounds of pressure to the spine. The amount of strain depends upon the angle at which the neck is bent, Time magazine reported.

Hansraj’s study, “Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head,” was published in Surgical Technology International.

The typical cell-phone owner spends two to four hours each day using the device, according to the research. Time noted that “over the course of a year, that adds up to 700 to 1,400 hours of excess stress on the cervical spine, or up to 5,000 hours for high school students.”  As a result, people’s posture becomes distorted into a hunched position, which causes neck pain and spinal wear and tear.

Hansraj acknowledged that it is “nearly impossible to avoid the technologies that cause these issues.” However, he pointed out that maintaining proper posture can help prevent pain from developing. He advised keeping the ears aligned with the shoulders while using a phone.When a person tilts the head forward, and droops the shoulders forward “into a rounded position,” the weight placed on the spine “dramatically increases,” the doctor said.

The introduction of Hansraj’s report noted that billions of people around the world use cell phones daily, and that most of them do so with poor posture. He explained that the purpose of his study was to “assess the forces incrementally seen by the cervical spine as the head is tilted forward,” and to help surgeons better understand “reconstruction of the neck.”

Hansraj created a model of the cervical spine, which he manipulated to determine how many pounds of pressure resulted from various movements.

“The weight seen by the spine dramatically increases when flexing the head forward at varying degrees,” he reported. “An adult head weighs 10 to 12 pounds in the neutral position. As the head tilts forward, the forces seen by the neck surge to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees and 60 pounds at 60 degrees. At 90 degrees, the model prediction was not reliable.”

The doctor concluded that “loss of the natural curve of the cervical spine leads to incrementally increased stresses about the cervical spine.” He pointed out that “these stresses may lead to early wear, tear, degeneration and possibly surgeries.”

Hansraj wrote: “Cervical spine surgeons need to pay attention to the alignment and therefore to the stresses about the spine when performing anterior discectomies and fusion along with arthroplasties.”

He added that “with advancing spinal surgical techniques, such as the motion-sparing total disc arthroplasty, attention to the final position of the neck becomes critical.” The report warned against “misalignment of a reconstructed segment.”

“As far as we are aware, and after a review of the National Library of Medicine publications, there is no other study available to assess the stresses about the neck when incrementally moving the head forward,” Hansraj wrote.

If you are experiencing neck pain, or have been diagnosed with a condition like fibromyalgia, schedule an appointment for an evaluation by the nationally renowned sports medicine surgeons at Orthopedic Surgery San Diego to find out how you can relieve your symptoms.