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Keeping Active and Pain Free.

Excess Fat: Effects on The Knees

When discussing issues with weight we often look at the effects that obesity has in relationship to cancer, heart disease, diabetes and high blood pressure, but excess weight has a major effect on joints as well. Extra body weight results in extra load on the joints which ultimately increases the stress and may accelerate the breakdown of the cartilage. For example every extra pound adds approximately 4 extra pounds of force placed on the knee joint with each step taken. An extra 5 pounds results in 20 extra pounds of force on the knee! With that extra force the chance of knee osteoarthritis increases by about 10%.

Good news is that weight loss can help to lower your chances of osteoarthritis. Studies have shown that 10% reduction in body weight of an obese elderly men decreases their chance of osteoarthritis by 21.5% and 33% in women. Stay active and maintain a balanced diet to help prevent osteoarthritis as well as other diseases!

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Dealing with Shin Splints

Shin splints, also known as medial tibial stress syndrome (MTSS), is defined by the American Academy of Orthopaedic Surgeons as “pain along the inner edge of the shinbone (tibia).”[1] Shin splints are usually caused by repeated trauma to the connective muscle tissue surrounding the tibia. They are a common injury affecting athletes who engage in running sports or other forms of physical activity, including running and jumping. They are characterized by general pain in the lower region of the leg between the knee and the ankle.

Symptoms: Shin splint pain is described as a recurring dull ache along the inner part of the lower two-thirds of the tibia.

Causes: While the exact cause is unknown, shin splints can be attributed to the overloading of the lower leg due to biomechanical irregularities resulting in an increase in stress exerted on the tibia. A sudden increase in intensity or frequency in activity level fatigues muscles too quickly to properly help absorb shock, forcing the tibia to absorb most of that shock. The pain associated with shin splints is caused from a disruption of Sharpey’s fibres that connect the medial soleus fascia through the periosteum of the tibia where it inserts into the bone.

Diagnosis: Shin splints can be diagnosed by a physician after taking a thorough history and performing a complete physical examination. The physical examination focuses on palpable, or gentle pressure, tenderness over a 4-6 inch section on the lower, inside shin area. Clinical history focuses on an individual’s previous history with shin splints. People who have previously had shin splints are more likely to have it again. Radiographies and three-phase bone scans are recommended to differentiate between shin splints and other causes of chronic leg pain. Bone scintigraphy and MRI scans can be used to differentiate between stress fractures and shin splints.

Treatment: Treatment for shin splints is not always successful because the exact cause of shin splints is still unknown.

Most Common Treatment:

  • Rest
  • Ice
  • Strengthen
  • Gradually returning to activity

Initial treatment for shin splints includes rest and ice. Rest and ice work to allow the tibia to recover from sudden, high levels of stress and reduce inflammation and pain levels. It is important to significantly reduce any pain or swelling before returning to activity. Strengthening exercises should be performed after pain has subsided, focusing on lower leg and hip muscles.Individuals should gradually return to activity, beginning with a short and low intensity level. Over multiple weeks, they can slowly work up to normal activity level. It is important to decrease activity level if any pain returns. Individuals should consider running on other surfaces besides asphalt, such as grass, to decrease the amount of force the lower leg must absorb.Orthoses and insoles help to offset biomechanical irregularities, like pronation, and help to support the arch of the foot. Less common forms of treatment for more severe cases of shin splints include extracorporeal shockwave therapy (ESWT) and surgery. Surgery is only performed in extreme cases where more conservative options have been tried for at least a year. However, surgery does not guarantee 100% recovery.

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Gamekeeper’s Thumb

Gamekeeper’s thumb (also known as skier’s thumb or UCL tear) is a type of injury to the ulnar collateral ligament (UCL) of the thumb. The UCL is torn at (or in some cases even avulsed from) its insertion site into the proximal phalanx of the thumb in the vast majority (approximately 90%) of cases. This condition is commonly observed among gamekeepers and Scottish fowl hunters, as well as athletes (such as volleyballers). It also occurs among ordinary people who sustain a fall onto an outstretched hand.

Symptoms and Signs: Symptoms of gamekeeper’s thumb are instability of the MCP joint of the thumb, accompanied by pain and weakness of the pinch grasp. The severity of the symptoms are related to the extent of the initial tear of the UCL, or how long the injury has been allowed to progress.Characteristic signs include pain, swelling, and ecchymosis around the thenar eminence, and especially over the MCP joint of the thumb. Physical examination demonstrates instability of the MCP joint of the thumb.The patient will often manifest a weakened ability to grasp objects or perform such tasks as tying shoes and tearing a piece of paper. Other complaints include intense pain experienced upon catching the thumb on an object, such as when reaching into a pants pocket.

Diagnosis: Gamekeeper’s thumb and skier’s thumb are two similar conditions, both of which involve insufficiency of the ulnar collateral ligament (UCL) of the thumb. The chief difference between these two conditions is that Skier’s thumb is generally considered to be an acute condition acquired after a fall or similar abduction injury to the metacarpophalangeal (MCP) joint of the thumb, whereas gamekeeper’s thumb typically refers to a chronic condition which has developed as a result of repeated episodes of lower-grade hyperabduction over a period of time. Gamekeeper’s thumb is more difficult to treat because the UCL has lengthened and become thinner as a result of repeated injury. It is moderately painful compared to similar injuries.

Treatment: When approaching this type of injury, the physician must first determine whether there is an incomplete rupture (or sprain) of the UCL, or a complete rupture. If the UCL is completely disrupted, the physician must then determine whether there is interposition of the adductor aponeurosis (Stener lesion), or simply a complete rupture of the UCL with anatomic or near-anatomic position. Radiographs are helpful in determining the possible presence of an avulsion fracture of the proximal phalanx insertion site of the ulnar collateral ligament. Stress examination, or one done under fluoroscopic guidance, can help determine the integrity of the ligament.Most gamekeeper’s thumb partial injuries are treated by simply immobilizing the joint in a thumb spica splint or a modified wrist splint and allowing the ligament to heal. However, near total or total tears of the UCL may require surgery to achieve a satisfactory repair, especially if accompanied by a Stener lesion.[3]

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