Q1  What is the difference between x-rays, MRI, and CT scan?

Q2  Should I apply ice or heat to an injury?

Q3  What is physical therapy?

Q4  What is a tendon? ligament? cartilage?

Q5  What is a cortisone/corticosteroid injection?

Q6  What is an epidural?

Q7  What are NSAIDs and how do they work?

Q8  What is Arthroscopic Surgery?

Q9  What Causes Knee Problems?

Q10 How Are Knee Problems Diagnosed?

Q11 What Types of Problems Can Be Treated With Shoulder Arthroscopy?

Q12 What Causes a Stress Fracture?

A1 X-rays are a type of radiation, and when they pass through the body, dense objects such as bone block the radiation and appear white on the x-ray film, while less dense tissues appear gray and are difficult to see. X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors.

Organs and tissues within the body contain magnetic properties. MRI, or magnetic resonance imaging, combines a powerful magnet with radio waves (instead of x-rays) and a computer to manipulate these magnetic elements and create highly detailed images of structures in the body. Images are viewed as cross sections or “slices” of the body part being scanned. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone and joint problems.

A computed tomography (CT) scan (also known as CAT scan) is similar to an MRI in the detail and quality of image it produces, yet the CT scan is actually a sophisticated, powerful x-ray that takes 360-degree pictures of internal organs, the spine, and vertebrae. By combining x-rays and a computer, a CT scan, like an MRI, produces cross-sectional views of the body part being scanned. In many cases, a contrast dye is injected into the blood to make the structures more visible. CT scans show the bones of the spine much better than MRI, so they are more useful in diagnosing conditions affecting the vertebrae and other bones of the spine.

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A2 Ice should be used in the acute stage of an injury (within the first 24-48 hours), or whenever there is swelling. Ice helps to reduce inflammation by decreasing blood flow to the area in which cold is applied. Heat increases blood flow and may promote pain relief after swelling subsides. Heat may also be used to warm up muscles prior to exercise or physical therapy.
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A3 Physical therapy is the treatment of musculoskeletal and neurological injuries to promote a return to function and independent living. Physical therapy incorporates both exercise and functional training. Exercise restores motion and strength while functional training facilitates a return to daily activities, work, or sport.
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A4 A tendon is a band of tissue that connects muscle to bone. A ligament is an elastic band of tissue that connects bone to bone and provides stability to the joint. Cartilage is a soft, gel-like padding between bones that protects joints and facilitates movement.
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A5 Cortisone is a steroid that is produced naturally in the body. Synthetically-produced cortisone can also be injected into soft tissues and joints to help decrease inflammation. While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopaedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendinitis, and arthritis.
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A6 An epidural is a potent steroid injection that helps decrease the inflammation of compressed spinal nerves to relieve pain in the back, neck, arms or legs. Cortisone is injected directly into the spinal canal for pain relief from conditions such as herniated disks, spinal stenosis, or radiculopathy. Some patients may need only one injection, but it usually takes two or three injections, given two weeks apart, to provide significant pain relief.
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A7 Non-steroidal anti-inflammatory drugs (NSAIDs) are non-prescription, over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen sodium. They are popular treatments for muscular aches and pains, as well as arthritis.

NSAIDs not only relieve pain, but also help to decrease inflammation, prevent blood clots, and reduce fevers. They work by blocking the actions of the cyclooxygenase (COX) enzyme. There are two forms of the COX enzyme. COX-2 is produced when joints are injured or inflamed, which NSAIDS counteract. COX-1 protects the stomach lining from acids and digestive juices and helps the kidneys function properly. This is why side effects of NSAIDs may include nausea, upset stomach, ulcers, or improper kidney function.

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A8 Prior to 1970 most joint surgery required large incisions and a prolonged recovery.  Fortunately, arthroscopic surgery has completely changed the way joint injuries are treated.

With the aid of an arthroscope, the doctor can easily examine, diagnose, and treat joint problems which, in earlier years, may have been extremely difficult to even identify.

The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 to 5 mm. in diameter), but are designed to present a magnified picture.

The surgeon inserts the arthroscope into the joint through a tiny incision (about 1/4 of an inch) called a portal. Other portals are used for the insertion of surgical instruments. With small incision sites and direct access to most areas of the joint, the surgeon can diagnose and correct a wide variety of problems such as arthritis and ligament tears. Arthroscopy can also be used in conjunction with open procedures, such as an Anterior Cruciate Ligament (ACL) Reconstruction, as well as procedures dealing with the shoulder, elbow, wrist, and ankle.

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A9 There are two general kinds of knee problems: Traumatic and inflammatory.

Traumatic Knee Problems
Some knee problems result from a single injury, such as a direct blow or sudden force that shifts the knee beyond its normal range of movement. Other problems, such as osteoarthritis, result from years of wear and tear on the articular cartilage. 

Inflammatory Knee Problems
Inflammation that occurs in certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus, can damage the knee.

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A10 Doctors use several methods to diagnose knee problems.

Medical history--The patient tells the doctor details about symptoms and about any injury, condition, or general health issues that might be related to the the problem.

Physical examination--The doctor manipulates and palpates the knee to assess motion, laxity, function and location of pain.  The patient may be asked to stand, walk or squat to help the doctor assess the knee's function.

Diagnostic tests--A variety of tests can be used to determine the nature of a knee problem.
  • X-Ray --An x-ray beam is passed through the knee to produce a two-dimensional picture of the bones.
  • MRI --Energy from a powerful magnet (rather than x-ray) stimulates knee tissue to produce signals that are detected by a scanner and analyzed by a computer. This creates a series of cross-sectional images of a specific part of the knee. An MRI is particularly useful for detecting meniscus, ligament, soft tissue damage or disease. Like a CAT scan, a computer is used to produce the images of the knee during an MRI.
  • Arthroscopy --The doctor manipulates a small, lighted optic tube (arthroscope) that has been inserted into the joint through a small incision in the knee. At this point, the entire joint is inspected. Direct visualization is sometimes necessary for an accurate diagnosis prior to any additional treatment.
  • CAT Scan --X-rays lasting a fraction of a second are passed through the knee at different angles, detected by a scanner, and analyzed by a computer. This produces a series of clear cross-sectional images ("slices") of the knee on a computer screen. CAT scan images show bone and soft tissue detail -- more clearly than conventional x rays. The computer can combine individual images to give a three-dimensional view of the knee.
  • Arthrogram --A small amount of dye is introduced into the joint prior to an x-ray or CT scan.  This results in better outlining and detail in the films.
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A11What types of problems can be treated with shoulder arthroscopy?
  1. Rotator Cuff Tear
  2. Acromioclavicular AC) Degenerative Joint Disease / Tear AC Meniscus
  3. Labral Tear
  4. Instability
  5. AC Sprain
  6. Impingement Syndrome
Rotator Cuff Tear: The rotator cuff is a group of muscles that allows specific movements of the shoulder. Injury to the rotator cuff can cause weakness, pain and loss of motion. Due to the fact that complete tears to the rotator cuff do not mend themselves, surgery may be indicated. Rotator cuff repair is the closure of the tear which usually includes re-attachment of the rotator cuff back to its insertion on the humeral head. Special arthroscopically inserted suture anchors facilitate the repair of the rotator cuff to the bone.

Acromioclavicular Degenerative Joint Disease / AC Meniscus Tear: Arthritis or damage to the meniscus cartilage in the AC joint causes pain. Pain mostly occurs with overhead motions and movements across the body. Arthroscopic surgery includes shaving a small portion off the distal clavicle to make room in the joint and to remove torn meniscus cartilage.

Labral Tear: Tear of the cartilage rim. The shoulder is a ball and socket joint the glenohumeral joint. The labrum is a cartilage rim that encircles the socket (glenoid) providing depth resulting in increased stability for the shoulder. A Labral tear may result from a single injury or chronic overuse. Repair of the torn labrum can be performed arthroscopically. This allows many athletes a safe and predictable return to sports.

Instability: Abnormal joint motion caused by trauma (dislocation/subluxation) or associated with generalized joint laxity. When increased laxity around the shoulder causes symptoms or recurrent dislocations, surgery may be recommended, to tighten the ligaments around the shoulder.

Acromioclavicular Sprain (Shoulder separation): Separation of the clavicle (collarbone) relative to the scapula (shoulder blade). These separations are graded I – VI. A small percentage of separations may require surgery to relocate the joint and repair the ligaments that have been torn during the injury. A simple shaving of the clavicle tip may eliminate pain.

Impingement Syndrome / Shoulder Bursitis: A painful process caused by inflammation of the rotator cuff and the bursa that lies above it. If anti-inflammatory medication, rest, therapeutic exercise and cortisone injections (possibly have failed) to relieve symptoms, surgery may be recommended. Arthroscopy increases the space available for the rotator cuff by shaving the acromion and removing inflamed bursa.
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A12 Stress fractures are microscopic fractures of bone resulting from repeated low level trauma which weakens the bone to the point of injury. Stress fractures of the feet -- which is where they occur most often -- are related to long walking, running or other athletic activities. However, stress fractures can occur in other bones of the lower leg as well as the upper extremities.
Unlike typical fractures, which involve bones snapping in two, stress fracture are microscopic cracks that are often too tiny to show up on a routine x-ray. MRI or bone scans are often needed to make the diagnosis.

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