Clinical - Diseases
The word “Arthritis” literally means ‘inflammation of a joint’. Osteoarthritis is commonly referred to as “wear and tear” arthritis. It is progressive and is caused by a combination of factors including age, weight, previous injury, high-level sports, and occupational hazards. Normally, joint surfaces are covered in smooth cartilage that allows bones to glide past each other easily. Wearing away of this cartilage can eventually lead to bone rubbing on bone. This can result in additional loss of cartilage, formation of bone spurs, damage to bone, and soft tissue inflammation. Rheumatoid arthritis is an autoimmune process, causing the body to attack its own soft tissues and joints. It most commonly occurs in hands and feet, but can also cause problems in the neck, shoulder, and elbow. Several other conditions can cause arthritis, including psoriasis, gout, infection, and bleeding disorders. Your doctor can determine what type of arthritis you have through physical examination, xrays, and blood tests.
Osteoporosis is a condition in which there is enhanced bone fragility and an increased fracture risk. Risk factors including increasing age, female gender, family history, smoking, and low dietary calcium. Some medical conditions and medications may also increase the risk. Xrays are unable to distinguish osteoporosis until bone loss has reached approximately 30 percent. If your doctor is suspicious for osteoporosis, a DEXA scan may be ordered to measure bone density.
Clinical - General
A tendon is a fibrous connective tissue which attaches muscle to bone. A tendon moves the bone or structure. A ligament is a fibrous connective tissues which attaches bone to bone and usually functions to hold structures together and keep them stable. Cartilage is a hard substance that allows joints to move smoothly and protects against shocks to the body. It is found in joints, the rib cage, and between bones of the back. It protects places where bones rub against each other.
Cortisone is an anti-inflammatory medication. It is not a pain medication. It acts to calm the inflammation in a joint, in turn decreasing pain. Cortisone injections can start to provide relief within days and can last several weeks to months.
Arthroscopy is a procedure in which a fiberoptic camera is inserted into a joint through a small incision in order to visualize the joint surfaces and surrounding soft tissue. Accessory portals allow the introduction of additional instruments. Arthroscopy can be both diagnostic and therapeutic.
Clinical - Injuries
Stress fractures are microscopic fractures of bone resulting from repeated “stress”, usually from bearing your own weight. For example, stress fractures of the feet are related to long walking, running, or other athletic activities. Stress fractures can occur in other bones of the lower leg as well as upper extremities. This particular type of fracture is often too tiny to show up on a routine xray and generally requires an MRI or bone scan to make a diagnosis.
This type of bone fracture generally results from a fall where the vertebral column is compressed and then, under extreme pressure, cracks or breaks. This type of bone fracture may also be referred to as an impact fracture.
The labrum is cartilage that lines the glenoid, the socket portion of the joint, to help hold the ball in the socket and keep the bones from touching. This is commonly found as a result of recurrent shoulder injury or a shoulder dislocation.
There are two menisci in the knee – medial and lateral. They are cartilage that help give cushion to the knee or in other words, keep the bones from touching each other. A tear can occur acutely or can be chronic. The chronic tears come from arthritis. Acute tears usually occur from a twisting injury or a sudden change in direction.
The rotator cuff is made of a series of 4 tendons and muscles that provides stability to the glenohumeral joint (ball and socket) and also allows for lifting over the head and to the side. A tear can occur acutely with an injury or degeneratively (breaking down over time). Acutely it is usually seen after a fall or in someone who does a lot of repetitive overhead lifting.
The AC joint or acromioclavicular joint is formed by the distal end of the clavicle and the acromion. There are 5 types, I-V, with V being the worst. These generally result from a direct trauma to the area.
The ACL is a ligament that helps give stability to the knee, especially with activities such as running, cutting and jumping. This injury commonly occurs from a quick change in direction, landing from a jump, or a contact injury from getting hit on the side of the knee.
The MCL is a ligament on the medial side of the knee that give stabilization with valgus stress which is the knee bending inwards. There are 3 grades, I-III. Grade I is a mild strain, Grade II a partial tear, and Grade III a complete tear. These injuries most commonly occur with a direct blow to the lateral side of the knee. There is a high association of MCL injuries and ACL injuries.
Contrary to popular belief, a broken bone is no worse than a fracture. In fact, they both mean the same thing. While there are different classifications of fractures and broken bones, there is no difference between the two.
Clinical - Joint Replacement Surgery
There is no age limit for joint replacement. Your doctor is interested in your overall health, and may have you visit your primary care physician to determine if you are capable of tolerating anesthesia, surgery, and recovery. A mental understanding of the joint replacement process is also important so that you will know what to expect before and after surgery.
You should discuss the risks and benefits of joint replacement surgery with your doctor. Complications include but are not limited to infection, bleeding, nerve damage, broken bones when the implants are inserted, wearing out of the implants, need for additional surgery, continued pain, and blood clots. All of these risks are acknowledged and all necessary precautions are taken to decrease your risk.
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For patients under the age of 18, we need to know who is responsible for any patient balances.
A Physician Assistant (PA) is a unique health care provider who is licensed by the State Board of Medicine or certified by the State Board of Osteopathic Medical Examiners. The Boards approve physician assistants who are of good character and reputation, have graduated from a physician assistant training program certified by the Board, and have passed a national certifying examination by the Board.
A PA is neither a physician nor a physician trainee, e.g., resident, intern, or medical student. At the direction of a supervising physician and as his or her employee, the PA provides medical services and other tasks as allowed by law. The physician assistant augments the physician’s data gathering abilities in order to assist the supervising physician in reaching and instituting care plans for the physician’s patients.
Patients have the right to be seen by the physician instead of the PA. If this is your wish, please inform scheduling personnel. Please direct any questions, comments or concerns about physician assistants to the doctor.
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