Symptoms and Types of Ankle Arthritis | Orthopaedics

What is ankle arthritis?

Arthritis is a common term for a group of more than 100 diseases. The word “arthritis” means “inflammation of the joints.” Arthritis involves inflammation (swelling) in and around the joints. The inflammation can cause pain, stiffness, and swelling. Arthritis is an acute or chronic inflammation of the soft tissues of the joint and its surroundings.

In arthritis, progressive joint degeneration occurs and the soft “cushion” cartilage in the joints gradually disappears, causing the bones to wear down each other. The soft tissue in the joints also begins to wear out. Arthritis can be painful and eventually lead to limited mobility, loss of joint function, and joint deformities.

As you get older, your risk of developing arthritis will increase. Joint damage caused by this condition can cause swelling, pain, and physical changes in the feet and ankles.

Symptoms of ankle arthritis

 Symptoms of foot and ankle arthritis are usually:

  • Tenderness when touching the joint
  • Pain when you move it
  • Difficulty moving, walking, or putting weight on it.
  • Stiffness, warmth, or swelling of the joints
  • More pain and swelling when sitting or falling asleep after resting

Types of ankle arthritis

Arthritis is a common term for a group of more than 100 diseases. It can cause inflammation and swelling in the joints and surrounding soft tissues.

With many types of arthritis, your joints wear out over time. You will gradually lose the soft “cushion” cartilage within them. As a result, your bones rub against each other and wear out. The soft tissue in the joints also begins to wear out. After a while, the joint may not work or may not move as it should.

Several types of arthritis can cause pain in the feet and ankles, including:

Osteoarthritis, or “wear and tear” arthritis, is the most common type. Doctors also call it a degenerative joint disease or age-related arthritis. Osteoarthritis usually causes changes over many years. These are the most common foot and ankle joints:

  • The three joints of the heel bone, the inner midfoot bone, and the outer mid-foot bone.
  • The toe joint and foot bone.
  • The joint where the ankle and tibia meet.
  • Rheumatoid arthritis is one of the most serious forms. It is an autoimmune disease in which your immune system attacks the joint. It usually occurs in the same joint on both sides of your body.
  • Gout occurs when uric acid builds up in your diet. It is most common in the toe because it is the most distant part of the body from the heart.
  • Psoriatic arthritis can occur in one or more joints, including the ankles and toes. It can also cause an inflammation of the toes called dactylitis.
  • Post-traumatic arthritis occurs after an injury, especially after a dislocation or fracture. You may not notice problems for years.

Diagnosis of ankle arthritis

Doctors can often diagnose RA with a physical exam. They visually inspect the ankles for swelling or other signs and examine their range of motion.

Doctors primarily diagnose rheumatoid arthritis (RA)based on symptoms, but may also recommend other tests to get better details.

For example, doctors often recommend X-rays, ultrasounds, or sometimes MRIs to assess the extent and location of joint damage. This is higher when the doctor suspects RA in the ankle because the initial damage is more immediately apparent than in other areas.

Blood tests can help determine if antibodies in the blood indicate RA or have ruled out other conditions.

Treatment for ankle arthritis

Depending on your symptoms and the cause of your ankle arthritis, you may receive one or more of these treatments:

  • Steroids are injected into the joints
  • Anti-inflammatory drugs that help with inflammation
  • Analgesics
  • Supports pads or arch on your shoes
  • Cane or support braces
  • Shoe inserts that support the ankle and foot (orthotics)
  • Physical therapy
  • Custom footwear
  • Surgery for foot and ankle arthritis

Some people need at least one type of surgery to treat foot and ankle arthritis. Your doctor will prescribe the best treatment for you. Arthritis surgeries:

Fusion surgery: This is also known as arthrodesis. Fix the bones with rods, pins, screws, or plates. Once they heal, the bones stick together.

Joint replacement surgery: It is used mainly in severe cases. Your doctor will call it an arthroplasty. They remove damaged bone and cartilage and replace them with metal or plastic.

Home remedies for ankle arthritis

When you have arthritis in your foot or ankle, it is very important to wear comfortable shoes. Check out these details:

  • Shoes are shaped like your foot
  • Supportive shoes (for example, no slip-on shoes)
  • Rubber soles for cushioning
  • Flexibility
  • Proper fit; Ask the seller for help
  • Exercise helps keep your feet strong, straight, and painless. Good moves for your feet

Achilles stretch: Flatten with your palms against the wall. Take one step forward and one step back. Keep your heels on the ground and move forward. Pull the Achilles tendon on the back leg and calf. Hold for 10 seconds. Do this exercise three times on each side.

Big toe stretch: Put a thick rubber band around the big toe. Pull your muscles toward each other and the other leg. Hold this position for 5 seconds. Do it 10 times.

Pull the toe: Put a rubber band around the ball of each foot and extend your leg. Hold this position for 5 seconds and do the exercise 10 times.

Finger flexion: Remove the marbles with your foot.

Other home remedies for ankle arthritis

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. These can cause side effects such as stomach irritation, so consult your doctor before taking them.

  • Creams that contain menthol or capsaicin, which can prevent nerves from sending pain signals
  • Keep the area warm or cold
  • Acupuncture
  • Glucosamine and chondroitin medications
  • Gentle exercises like yoga, tai chi
  • Massage

Medications: It is very important to reduce inflammation so that a person can limit the inflammation in their ankles and control their pain. The following medications can help with RA symptoms and reduce chronic joint damage:

  • Pain relievers to control uncomfortable symptoms
  • Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
  • Disease-correcting antirheumatic drugs (DMARDs)
  • biology

Maintaining inflammation can help restore mobility to the ankle and other joints. If RA causes permanent damage to the ankle joint, medications will not reverse it, but they will help with pain, prevent further damage, and improve quality of life.

Doctors can also use corticosteroid injections in the ankle to quickly reduce acute inflammation and prevent damage or pain. Because they can suppress the immune system, people should know that they are more likely to get an infection if they take DMARDs and biologics.

Surgery: People with advanced forms of RA or people who do not respond well enough to treatment may need surgery. The surgery doctors offer depends on the type of arthritis and the extent of the damage. Some surgeries involve massaging the bones of the ankle to prevent inflammation and pain.

Ankle replacement surgery may be an option to reduce pain and restore joint mobility in more severe cases if fusion is not effective.

Lifestyle Changes for Foot Arthritis: Some changes in your daily life can make you feel better and prevent your arthritis from getting worse. If a specific activity triggers inflammation, try to keep it to a minimum. Instead of high-impact exercises like jogging, do less spin like swimming or biking. Maintain a healthy weight to put more stress on your joints.


Achondroplasia – an Overview | Orthopaedics

What is achondroplasia?

Achondroplasia is the most common cause of bone growth disorder and dwarfism. Although this means “no cartilage formation,” there is a problem with the conversion of cartilage to bone during early development. The biggest effect of this is that the long bones of the arms and legs usually do not grow to the proper length, although there are also problems with the growth of the bones of the skull and face.

Achondroplasia does not affect intelligence, although the brain often expands as a result of the condition. Achondroplasia is a genetic (inherited) condition that causes abnormally short stature and is a common cause of short stature with fewer organs. The average height of an adult with achondroplasia is 131 cm (52 ​​inches or 4 feet 4 inches) in males and 124 cm (49 inches or 4 feet 1 inch) in females.

Although achondroplasia means “no cartilage formation”, the defect of achondroplasia is not in the formation of cartilage but in the conversion of bone, especially in long bones.

Achondroplasia facts

  • Achondroplasia is a genetic bone growth disorder.
  • Achondroplasia is the most common cause of dwarfism (asymmetric dwarfism of small limbs).
  • Achondroplasia is the least common cause of short stature.
  • A characteristic feature of a person with achondroplasia.
  • Intelligence is common in people with this disease.
  • Complications of this disease affect the brain and spinal cord.
  • Achondroplasia is inherited as a predominant trait, although 80% of cases are caused by new mutations (even the parents do not have achondroplasia).
  • It can be diagnosed before birth.

Symptoms of achondroplasia

People with achondroplasia usually have normal levels of intelligence. Its symptoms are physical, not mental. Each child can have different symptoms. Common symptoms can include:

At birth, children with this condition have:

  • Arms, legs, and little fingers
  • The upper arms and thighs are narrower than the forearms and lower legs.
  • Large head with a prominent forehead and flat nasal bridge
  • Congestion or poorly formed teeth

The curved spine (lordosis or “backward rolling”), which leads to kyphosis (hump), develops a small bump near the shoulders, which usually disappears after the child begins to walk.

Small vertebral canals (vertebral column or vertebrae) cause compression of the spinal cord in adolescence. A child with this disease can die suddenly during sleep or in infancy from compression of the upper end of the spine, which can interfere with breathing.

  • Legs are bent
  • Small and spacious flat feet
  • Extra space between the middle and ring fingers (also known as a trident hand)
  • Poor muscle tone and loose joints
  • Short periods of slow or stopped breathing (called apnea)
  • Frequent middle ear infections can lead to hearing loss
  • Delayed developmental milestones, such as walking (which can occur between 18 and 24 months of the year)
  • People with this disease have normal intelligence and life expectancy.

Children and adults with achondroplasia:

  • Have trouble bending their elbows
  • These have arrears
  • You experience recurring ear infections due to narrow canals in your ears.
  • Development of bent legs
  • Developing an abnormal curve in the spine called kyphosis or lordosis.
  • Developing a new or more severe spinal stenosis

The symptoms of this disease appear to be similar to those of other complications or medical conditions.

What causes achondroplasia?

During early fetal development, your skeleton becomes very cartilaginous. In general, most of the cartilage eventually turns into bone. However, if you have this disease, most of the cartilage does not turn into bone. It is caused by mutations in the FGFR3 gene.

The FGFR3 gene directs your body to make the protein necessary for the growth and maintenance of bones. Mutations in the FGFR3 gene make the protein overactive. It interferes with normal skeletal development.

Is achondroplasia inherited?

According to the National Human Genome Research Institute (NHGRI), in more than 80 per cent of cases, it is not inherited. These cases are caused by abnormal mutations in the FGFR3 gene.

  • 20 per cent of cases are inherited. The mutation follows the autosomal dominant inheritance pattern.
  • Only one parent will have to cross the faulty FGFR3 gene for a child to develop this disease.
  • If one of the parents has this condition, the child has a 50 per cent chance of developing it.

If both parents have this condition, the child:

  • 25 per cent chance of normal height
  • 50 per cent chance of having a defective gene that causes achondroplasia
  • There is a 25 per cent chance of inheriting two faulty genes, resulting in a malignant form of achondroplasia called homozygous achondroplasia.
  • Babies born with homozygous achondroplasia are usually born or die within a few months of birth.
  • If your family has a history of this disease, you may want to have genetic testing done before you get pregnant so that you can fully understand the risks to your future baby’s health.

Diagnosis of achondroplasia

The diagnosis of achondroplasia depends on the general physical symptoms, the symptoms of achondroplasia, which are evident at birth. X-rays, ultrasound, and other imaging techniques also look for characteristic features. With ultrasound, the diagnosis before birth is sometimes strongly suspected.

If there is a suspicion or increased risk of the disease (such as when the parents are affected by this disease), a molecular diagnosis of this disease is possible before birth. In families in which both parents have this disease, prenatal diagnosis is particularly useful, as the goal is to differentiate homozygous malignant achondroplasia (with two copies of the defective gene) from that of achondroplasia (with one copy of the achondroplasia gene). Prenatal diagnosis is made by examining cells obtained by chorionic villus sampling (CVS) or amniocentesis.

Treatment of achondroplasia

Currently, there is no way to prevent or treat achondroplasia, as most cases are caused by new, unexpected mutations. Growth hormone treatment does not significantly affect the height of a person with this disease. In specific cases, surgeries may be considered along the leg.

Although the cause of this disease is known, there is currently no known treatment for the underlying condition itself. Human growth hormone has been used to treat other types of dwarfism but has not proven beneficial for patients with this disease. Overall, most treatment involves the prevention and treatment of complications related to this disease.

It is important to recognize bone abnormalities, especially in the back, to prevent breathing difficulties, leg pain, or major dysfunctions. If the kyphosis (or hump) does not appear when a child begins to walk, it must be corrected surgically. Surgery can also help flex your legs. Ear infections need immediate treatment to avoid the risk of hearing loss. Dental problems must be treated by an orthodontist (a dentist who specializes in dental alignment).

Research on a family of genes called fibroblast growth factors has identified a gene that causes this disease. The goal is to understand how a faulty gene can cause the symptoms found in this disease, leading to better treatment. These genes have been linked to many other inherited skeletal disorders.

It cannot be cured. However, some adverse effects of the condition may require treatment:

  • Babies with a curve in the lower spine may need a back brace for about the first year of their life.
  • Effect of bowleg achondroplasia. Surgery can fix this.
  • The large opening under the skull is very narrow and may need to be surgically widened to avoid compression of the nerves, blood vessels, and spinal cord, resulting in shortness of breath (central apnea) and sudden death.
  • Middle ear infections are common and cause some degree of hearing loss, so they must be treated immediately with antibiotics.
  • Delays can aggravate back and joint problems, so patients should monitor their weight and seek the advice of their doctor to prevent obesity.
  • Patients can live normal and full lives, but due to the number of complications of their condition, it is important that they seek careful care from their parents and doctors who are familiar with the condition. Children with the condition need regular checkups with measurements to monitor their growth.

What type of specialist treats achondroplasia?

Paediatricians often guide paediatricians in treating a variety of problems, from orthopaedic surgeons to neurosurgeons.


Herniated Disc – What You Should Know? | Orthopaedics

What is a herniated disc?

A herniated disc is a common condition that is painful and debilitating and refers to a problem with the rubber pads (discs) that lie between the individual bones (vertebrae) that make up the spine. However, some people do not feel pain, especially if the disc is not pressing on any nerves.

A spinal disc has a soft, jelly-like nucleus, which is located in a hard, rubbery exterior (ring). Sometimes called a slipped disc or ruptured disc, a herniated disc forms when part of the nucleus is pushed outward by a tear in the annulus.

A herniated disc, which occurs anywhere in the spine, irritates a nearby nerve. Depending on where the herniated disc is located, it can lead to pain, numbness, or weakness in the arm or leg. Most people do not have symptoms of a herniated disc. Surgery is usually not required to alleviate the problem.

Symptoms of a herniated disc

Most herniated discs occur in the lower back, although they also occur in the neck. Signs and symptoms depend on where the disc is located and whether the disc is pressed against the nerve. They usually affect one side of the body.

  • Pain and numbness, usually on one side of the body
  • Pain that spreads to your arms or legs
  • It intensifies at night or with some movements
  • Worse after standing or sitting
  • Pain when running short distances
  • Unexplained muscle weakness
  • Tingling, pain, or burning sensation in the affected area
  • Arm or leg pain: If the herniated disc is in your lower back, you will usually experience more pain in your buttocks, thighs, and calves. You may also feel pain somewhere in your foot. If your herniated disc is in your neck, you will generally experience a lot of pain in your shoulder and arm. This pain can burn in your arm or leg when you cough, sneeze or position yourself. The pain is often described as sharp or burning.
  • Numbness or tingling: People with a herniated disc often have numbness or tingling in the part of the body affected by the affected nerve.
  • Weakness: The muscles that supply the affected nerves weaken. It affects your ability to make mistakes or to lift or hold objects.

You may have a herniated disc without symptoms. You may not know you have it if it is not shown in the column image.

What causes a herniated disc?

As we age, the spinal discs gradually lose fluid volume. This process begins around age 30 and develops slowly over time. As discs dry, microscopic cracks or tears form on the outer surface, making them brittle, weak, and more prone to injury. The most common causes of a herniated disc are:

  • Wear: Discs dry out and are not as flexible as before.
  • Repetitive movements: Work, lifestyle, and certain sports activities that put pressure on the spine, especially the lower back, can further weaken an already vulnerable area.
  • Lifting incorrectly: Do not lift when bending at the waist. The proper lift is to lift with your legs and a straight back.
  • Injury: A high-impact injury can cause the disc to swell, tear, or break.
  • Ob requirement: Being overweight puts unnecessary pressure on your spine.
  • Genetics: People with disc degeneration often have certain genes. More research is needed to investigate the role of these genes; they may be the target of biological treatment in the future.
  • A slippery disc is formed when the smooth inner section of the intervertebral disc protrudes through the outer layer.
  • The human spine, or vertebrae, consists of 26 bones called vertebrae. The cushion-shaped rubber pads between each vertebra are called “discs.” These discs help support the vertebrae and act as shock absorbers.
  • Spinal discs have a soft, gelatinous centre and a hard outer surface.
  • Herniated disc forms when a soft inner part slides through cracks in the wall of the disc. It usually occurs in the lumbar area, but also the vertebrae of the neck.
  • Avoiding this “jelly” releases chemicals that irritate the nerves in the surrounding areas and cause significant pain. The enlarged disc puts pressure on the nerves and causes compression pain.

The cause of a leaking disc is usually regular wear and tear and heavy use as a result of repeated movements over time.

Risk factors for herniated disc

Herniated discs can occur at any age, but they are most common in men between the ages of 20 and 50.

Factors that increase the probability:

  • Weight: Being overweight puts extra pressure on your lower back.
  • Genetics: A person can have a reversal of herniated discs.
  • Occupation: People with physically demanding jobs or hobbies suffer from herniated discs such as pushing, pulling, or twisting. Any repetitive activity that distorts the spine can cause them.
  • Unsafe lifting technique: People should always use the strength of their legs, not their back when lifting heavy objects. Incorrect technique can lead to a herniated disc.
  • Frequent driving: Sitting for a long time and vibrations and movements of the car can damage the discs and the structure of the spine.
  • A sedentary lifestyle: Lack of exercise can lead to a herniated disc.
  • Smoking: Reduces the supply of oxygen to the discs and causes the shredding of tissues.

Herniated disc diagnosis

They can also check:

  • Your knee and ankle reactions.
  • Strength of your leg
  • How you walk on your heels and toes
  • Can you feel the light touching or vibrating?

If your doctor wants to rule out other sources of your pain or identify specific nerves that are exacerbated, they may perform more tests, including:

  • X-rays: Although a standard X-ray may not show if you have a herniated disc, it can show your doctor what your spine looks like and rule out whether your pain is caused by something like a fracture or tumor.
  • Myelogram: This test uses an X-ray to determine the colour and pressure in your cerebrospinal fluid.
  • Computed tomography: A computed tomography (or CT) scan takes several X-rays from different angles and combines them to create images of your spinal cord and the structures around it.
  • Magnetic resonance: MRI uses radio waves, magnetic fields, and computers to create detailed 3D images of the spine and surrounding areas. MRI scans can detect the location of a herniated disc, look inside it, and even determine which nerves are affected.
  • Electromyogram (EMG): Your doctor can use these tests to find out if any nerves are damaged or contracted. The EMG test uses a device to detect small numbers of electrical muscle cells when they are stimulated by nerves connected to them. The needle electrode placed on the muscle records its electrical activity and looks for what it shouldn’t be.
  • Nerve conduction studies (NCS) are often done in the same way as EMG: In this test, the nerves are stimulated with small electrical impulses by the electrode at one stage of the body, while the other electrodes detect impulses at a different time. The time it takes for electrical impulses to travel between the electrodes will tell your doctor if there is nerve damage.

Herniated disc treatment

Herniated discs can cause severe pain, but proper treatment can relieve symptoms. A person can largely resolve symptoms by avoiding pain-inducing movements and following the rules of exercise and pain relievers recommended by a doctor.

Treatment options include medications, treatment, and surgery.


  • Over-the-counter (OTC): Ibuprofen or naproxen-based medications can help with mild to moderate pain.
  • Medicines for nerve pain: Medicines that treat nerve pain include gabapentin, pregabalin, duloxetine, and amitriptyline.
  • Medications: If over-the-counter medications do not reduce discomfort, a doctor may prescribe a combination of codeine, oxycodone, and acetaminophen, or another type of medication. Side effects include nausea, vomiting, confusion, and constipation.
  • Cortisone injections: These are injected directly into the hernia area to help reduce inflammation and pain.
  • Epidural injections: A doctor injects steroids, sedatives, and anti-inflammatories into the epidural area around the spinal cord. Helps reduce pain and inflammation in and around the nerve roots of the spine.
  • Muscle relaxants: Help reduce muscle pain. Common side effects of dizziness and nausea.

Physical therapy

Physical therapists can help you find positions and exercises that reduce herniated disc pain.

Therapists may also recommend:

  • Treat with heat or ice
  • Ultrasound, which uses sound waves to stimulate the affected area and improve blood flow
  • Traction, which can reduce stress on the affected nerve.
  • To improve support, short-term braces for the neck or lower back.
  • Electrotherapy, because electrical impulses reduce pain in some people.


  • If symptoms do not improve with other treatments, cramps persist, or bladder control or movement deteriorates further, the treating physician may recommend surgery.
  • In most cases, the surgeon removes only the protruding part of the disc. This is an open discectomy.
  • The surgeon usually performs an open discectomy using a laparoscopic technique, opening a small hole in the front or back of the spine.
  • This technique eliminates the need to remove small parts of the vertebrae or move the spinal nerves and spinal cord to access the disc.

Artificial disc replacement

Surgeons in Europe have been performing disc replacement procedures since the 1980s, but they are not yet available in the United States.

There are two kinds. The first is to restore the entire disk. The second is the dismantling of the disc nucleus, which is just the soft nucleus of the disc called the nucleus.

Synthetic discs are made of metal, biopolymer, or both. A biopolymer is a material similar to plastic.

Complications of a herniated disc

Above your waist, your spine ends. Continuing down the spinal canal is a group of long nerve roots that resemble a horsetail (each equine).

In rare cases, a herniated disc can narrow the entire spinal canal, including all of the equine nerves. In rare cases, emergency surgery may be necessary to prevent permanent weakness or paralysis.

Seek emergency medical help if you have:

  • Exacerbating symptoms: Pain, numbness, or weakness can increase to the point of interfering with your daily activities.
  • Dysfunction of the bladder or bowel: Each equine syndrome can cause incontinence or difficulty urinating, even with a full bladder.
  • Saddle anaesthesia: This progressive loss of sensation affects the areas that touch the saddle: the inner thighs, the back of the legs, and the area around the rectum.

Prevention of a herniated disc

To help prevent a herniated disc, do the following:

  • Exercise: Strengthening the trunk muscles stabilizes and supports the spine.
  • Maintain good posture: This will reduce pressure on your spine and discs. Keep your back straight and aligned, especially when sitting for long periods of time. Lift heavy objects correctly, your legs, not your back, do a lot of work.
  • Keep a healthy weight: Excess weight puts more pressure on the spine and discs, making them more prone to herniation.
  • Give up smoking: Avoid using tobacco products.

Things to Know About a Torn Meniscus | Orthopaedics

What is a torn meniscus?

The torn meniscus is a piece of cartilage that provides a cushion between the femur (thigh bone) and the tibia (shin bone). There are two menisci in each knee joint.

A torn meniscus can be damaged or broken during activities that put pressure on or rotate the knee joint. Making a hard tackle on the soccer field or a sudden turn on the basketball court can result in a meniscus tear.

However, you don’t have to be an athlete to suffer a meniscus tear. Simply getting up too quickly from a squat can also cause a meniscus tear. According to Boston Children’s Hospital, more than 500,000 meniscus tears occur each year in the United States.

Liable on the severity of your injury, treatment options can vary from home remedies to outpatient surgery. You can help prevent this injury by doing exercises that strengthen your leg muscles and using proper techniques during contact activities or sports.

The 6 types of meniscus tears

  1. Intrasubstantial / Incomplete tear: An intrasubstance tear is a common finding on an MRI report. Seen in the upper left corner of the image, an intrasubstance tear generally appears normal at the time of surgery. These are often a sign of early degenerative changes in the meniscus tissue, but they are rarely the sign of a problem. Imperfect and transubstantial tears of the meniscus are stable injuries and usually do not require any surgical treatment. When people are in their 20s and 30s, intrasubstance changes in the meniscus tissue are most often seen on MRI.
  2. Radial tear: Radial meniscus tears, shown in the middle of the upper row in the image, are the most common type of meniscus tear. These tears are found within the avascular zone of the meniscus, where there is no blood supply. and therefore there is little healing ability of these tears. So, when these tears require surgical treatment, usually the only option is to trim the injured part of the meniscus.
  3. Horizontal tear: A horizontal tear is a tear that is usually amenable to meniscus overhaul. Observed in the higher right corner of the image, a horizontal tear runs through the circumferential fibres of the meniscus. Instead of removing the damaged part of the meniscus, a horizontal tear can be sewn. The key to determining the treatment of these tears is their location. If it is within the vascular portion of the meniscus (near the outer edge), then there is potential for healing and therefore repair. When more centrally located, these tears will not heal, even if repaired.
  4. Flap tear: A flap tear of the meniscus, shown in the lower right corner of the image, is an unusual pattern of the tear. In circumstances where the flap is causing symptoms of knee stiffness, usually, the meniscus flap can simply be removed without removing much tissue at all.
  5. Complex tear: A complex tear means that there is a combination of tear patterns. In the middle image in the bottom row, a complex tear often involves both radial and horizontal tear patterns. Complex tears are not normally treated with meniscus repair due to the complex nature of the tear. In some unusual circumstances, part of the torn meniscus can be removed, while other parts can be repaired.
  6. Bucket handle tear: A bucket handle tear is a big type of horizontal meniscus tear.10 These tears often cause the knee to muddle by causing the torn part of the meniscus to block the normal movement of the knee. Bucket handle tears often require more vital surgical treatment to allow the knee to begin to bend again.

Causes of a torn meniscus

A forceful twist or sudden stop can cause the end of the femur to move toward the top of the tibia, pinching and potentially tearing the cartilage of the meniscus. This knee injury can also occur when squatting or kneeling deeply, especially when lifting a heavyweight. Meniscus tear injuries often occur during sports activities, especially contact sports such as soccer and hockey. Movements that require pivoting and stopping suddenly, in sports such as tennis, basketball, and golf, can also cause meniscus damage. Sports injury does not have to occur during a game, but it can also occur in practice, where the same movements lead to meniscus damage.

The risk of developing a torn meniscus increases with age because cartilage gradually begins to wear away, losing its blood supply and strength. Collective body weight also puts more pressure on the meniscus. Routine daily doings, such as walking and ascending stairs, increase the potential for wear and tear, degeneration, and tears. It is estimated that six out of 10 patients over the age of 65 have a degenerative meniscus tear. Many of these tears may never cause problems.

Because approximately of the cartilage fibres are unified with those of the ligaments that surround the knee, meniscal injuries can be associated with tears of the collateral and cruciate ligaments, depending on the mechanism of injury. While normal cartilage is shaped like a “C” or crescent, there is a variant shape that is oval or discoid. This meniscus is thicker and more prone to injury and tears.

Symptoms of a torn meniscus

When a meniscus tear occurs, you may hear a clicking sound around the knee joint. Later, you can experience:

  • Pain, especially when the area is touched
  • Swelling
  • Difficulty moving the knee or inability to move it through a full range of motion
  • The feeling that your knee is locking or trapping
  • The feeling that your knee is giving out or you can’t hold it

You may also experience a slipping or popping sensation, which is usually an indication that a piece of cartilage has come loose and is blocking the knee joint.

Contact your doctor if you experience any of these symptoms and they persist for more than a few days or occur after your knee is injured. Call your doctor right away if your knee locks up and you can’t bend it after straightening it.

Torn meniscus treatment

Treatment of meniscal tears depends on the size and location of the tear. Other issues that influence treatment include age, activity level, and related injuries. The outer part of the meniscus, often called the “red zone,” has a good blood supply and can sometimes heal on its own if the tear is small. In contrast, the inner two-thirds of the meniscus, known as the “white zone,” do not have a good blood supply. Tears in this region will not heal on their own, as this area lacks blood vessels to bring healing nutrients.

Fortunately, not all meniscal tears require surgery. If your knee does not lock, is stable, and symptoms resolve, non-surgical treatment may be sufficient. To speed up recovery, you can:

  • Rest your knee. Limit activities to include walking if your knee hurts. Use crutches to help relieve pain.
  • Apply ice to the knee to reduce pain and swelling. Do it for 15-20 minutes every 3-4 hours for 2-3 days or until the pain and swelling go away.
  • Compress your knee. Wear an elastic bandage or neoprene-type sleeve on your knee to control swelling.
  • Elevate your knee with a pillow under your heel when sitting or lying down.
  • Take anti-inflammatory medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil, Aleve, or Motrin, will help with pain and swelling. However, these medications can have side effects, such as an increased risk of bleeding and ulcers. They should only be used occasionally unless your doctor specifically indicates otherwise.
  • Use stretching and strengthening exercises to help reduce stress on your knee. Ask your doctor to commend a physical therapist for leadership.
  • Avoid impact activities like running and jumping.

However, these conservative treatments are not always enough. If a tear is large, unstable, or causes blocking symptoms, surgery may be required to repair or remove the unstable edges. The procedure is usually fairly straightforward, and you can often go home the same day. You may need a brace later to protect yourself if a repair is done.

For 85% to 90% of people who have surgery for a meniscus tear, the temporary results are good to outstanding. But in the long term, people who have a large meniscal injury that cannot be repaired may be at higher risk of developing knee arthritis.

Diagnosis of a torn meniscus

The diagnosis of a knee injury starts with history and physical examination. If there is an acute injury, the doctor will ask about the mechanism of that injury to help understand the stresses that were applied to the knee. With chronic knee discomfort, the initial injury may not be remembered, but many patients participating in sporting events or training can identify the specific time and details of the injury. Non-athletes may recall a deep turn or curve at work or doing housework.

There is a true art to physical examination of the knee. By reviewing (looking), palpating (feeling), and applying specific diagnostic manoeuvres, the physician, trainer, or bodily therapist can often make the diagnosis of a torn meniscus.

The physical examination often includes palpating the joint for warmth and tender areas, assessing the stability of the ligaments, and testing the range of motion of the knee joint and the power of the quadriceps and hamstrings. Many tests have been described to evaluate the internal structures of the knee. The McMurray test, named after a British orthopaedic surgeon, has been used for over 100 years to make the clinical diagnosis of a torn meniscus. The healthcare professional flexes the knee and rotates the tibia while feeling the joint. The test is positive for a possible tear if a click is felt.

Magnetic timbre imaging (MRI) is the test of choice to settle the diagnosis of a torn meniscus. It is a non-invasive test that can visualize the internal structures of the knee, including cartilage and ligaments, the surface of the bones, and the muscles and tendons that surround the knee joint. An added benefit of MRI before surgery is that by knowing the anatomy, the orthopaedic surgeon can plan a possible knee surgery and discuss alternative treatments with the patient before the operation begins.

Plain X-rays cannot be used to identify meniscal tears, but they can be obliging in looking for bone changes, containing fractures, arthritis, and loose bone fragments within the joint. In older patients, X-rays of both knees can be taken while the patient is standing. This lets the joint spaces to be likened to assess the degree of cartilage wear. Cartilage takes up space within the joint, and if the joint space narrows, it may be an indicator that there is less cartilage present, probably due to degenerative disease. Plain X-rays can also uncover other causes of knee pain, such as arthritis and pseudogout.

Before the widespread use of MRI, knee arthroscopy was used to confirm the diagnosis of a torn meniscus. In arthroscopy, the orthopaedic surgeon supplements a small scope into the knee and looks directly at the structures inside the joint. The added benefit of arthroscopy is that the injury can be repaired at the same time using additional tools that are inserted into the joint. The downside to arthroscopy is that it is a surgical procedure with all the potential risks associated with surgery.

Risk factors for a torn meniscus

Performing activities that involve an aggressive twisting and turning of the knee puts you at risk for a meniscus tear. The risk is particularly high for athletes, especially those who participate in contact sports, such as soccer, or activities that involve pivoting, such as tennis or basketball. Wear and tear on your knees as you age increases the risk of a meniscus tear. So does obesity.

Complications of a torn meniscus

A torn meniscus can lead to a feeling of giving the knee, an inability to move it normally, or persistent pain in the knee. You may be more likely to develop osteoarthritis in your injured knee.

Prevention of torn meniscus

Meniscus tears are difficult to prevent as they are usually the result of an accident. But some precautions can reduce the risks of a knee injury. You should:

  • Keep your thigh muscles strong with regular exercises.
  • Warm-up with light activities before exercise.
  • Give your body time to rest between workouts.
  • Make sure your shoes have enough support and fit properly.
  • Stay flexible.
  • Never increase the intensity of your training sharply.

Tennis Elbow – Everything You Need To Know | Orthopaedics

What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is a painful elbow condition caused by overuse. It is not surprising that playing tennis or other racquet sports can cause this condition. However, various other sports and activities besides sports can also put you at risk.

Tennis elbow is an inflammation or, in some cases, a micro tear of the tendons that attach the muscles of the forearm on the outside of the elbow. The muscles and tendons of the forearm are damaged by overuse, repeating the same movements over and over. This chief to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary care physicians, physical therapists, and in some cases surgeons work together to provide the most effective care.

Causes of tennis elbow

The pain is concentrated on the outside of your arm, where your forearm meets your elbow.

It is related to the muscle and tendons in the forearm. Tendons connect your muscles to your bones. When you repeat certain arm movements, the tendons at the elbow end of a certain muscle, the extensor carpi radialis brevis (ECRB), can suffer small tears.

Tears can put pressure on the rest of the arm, making it painful to lift and grasp things. If left untreated, the pain can last for a long time.

Symptoms of tennis elbow

You may experience some of the following symptoms if you have tennis elbow:

  • Pain in the elbow that is mild at first but gradually worsens
  • Pain that spreads from the outside of the elbow to the forearm and wrist
  • A weak grip
  • Increased pain when trembling hands or squeezing an object
  • Pain when lifting somewhat, using tools, or opening jars

Tennis elbow treatment

  • Tennis elbow is a self-limiting disorder, which means that it will finally get better without treatment.
  • Though, it can often last for several weeks or months, because tendons heal slowly. In approximate cases, tennis elbow can persist for more than a year.
  • Several simple treatments can help relieve tennis elbow pain. The most important thing you can do is rest your injured arm and stop doing the activity that caused the problem (see below).
  • Holding a cold compress, such as a bag of frozen peas wrapped in a towel, against your elbow for a few minutes several times a day can help relieve pain.
  • Invasive treatments, such as surgery, will normally only be considered in severe and persistent cases of tennis elbow, where non-surgical approaches have not been real.

Avoid or modify activities

  • If you have a tennis elbow, you should stop doing activities that stress the affected muscles and tendons.
  • If you use your arms at work to perform physical tasks, such as lifting, you may need to avoid these activities pending your arm pain improves.
  • Alternatively, you can modify the way you perform these types of movements so that they don’t put pressure on your arm.
  • Talk to your employer about evading or modifying activities that could worsen your arm and make the pain worse.

Pain relievers and NSAIDs

  • Taking pain relievers, such as acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help dismiss mild pain and inflammation produced by tennis elbow.
  • In addition to tablets, NSAIDs are also available in the form of creams and gels (topical NSAIDs). They are applied directly to a specific area of ​​your body, such as the elbow and forearm.
  • Topical NSAIDs are often optional for musculoskeletal conditions, such as tennis elbow, rather than anti-inflammatory tablets. This is since they can reduce inflammation and pain without causing side effects such as biliousness and diarrhea.
  • Some NSAIDs are available without a prescription, while others are only available by prescription. Your GP or pharmacist will be able to recommend a suitable NSAID for you.


  • Your GP may refer you to a physical therapist if your tennis elbow causes additional severe or persistent pain. Physical therapists are healthcare professionals who use a variety of methods to restore movement to injured areas of the body.
  • Your physical therapist may use manual therapy techniques, such as massage and manipulation, to relieve pain and stiffness and to stimulate blood flow to your arm. They can also display the exercises you can do to keep your arm moveable and strengthen your forearm muscles.
  • Wearing an orthosis, such as a brace, bandage, support bandage, or splint, may also be recommended in the short term.

Steroid injections

  • Steroids are a type of medicine that contains artificial versions of the hormone cortisol and are sometimes used to treat particularly painful musculoskeletal problems.
  • Some people with tennis elbow may be offered steroid injections when other treatments have not worked.
  • The injection will be given directly to the painful area around the elbow. A local anaesthetic may be given first to numb the area and reduce pain.
  • Steroid injections are likely to only provide short-term relief, and their long-term effectiveness is poor. If they are helping you, they may offer you up to 3 injections in the same area, with at least 3-6 months between them.

Shock wave therapy

  • Shock wave therapy is a non-invasive treatment, in which high-energy shock waves pass through the skin to help relieve pain and promote movement in the affected area.
  • The number of meetings you will need will depend on the severity of your pain. You may be given a local anaesthetic to decrease any pain or discomfort during the procedure.
  • The National Institute for Excellence in Health and Care (NICE) states that shock wave therapy is safe, although it can cause minor side effects, such as bruising and redness of the skin in the area to be treated.
  • Research shows that shock wave therapy can help improve tennis elbow pain in some cases. However, it may not work in all cases and more research is needed.

PRP injections

  • Platelet Rich Plasma (PRP) is a newer treatment that a surgeon can offer in the hospital to treat tennis elbow.
  • PRP is blood plasma that contains concentrated platelets that your body uses to repair damaged tissue. PRP injections have been shown to speed up the healing process in some people, but their long-term effectiveness is not yet known.
  • The surgeon will take a sample of your blood and place it in a machine. This separates the healing platelets so they can be taken from the blood sample and injected into the affected joints. The procedure usually takes about 15 minutes.


Surgery may be recommended as a last resort treatment in cases where tennis elbow causes severe and persistent pain. The damaged part of the tendon will be removed to relieve painful symptoms.

Diagnosis of tennis elbow

There are several things your doctor will do to diagnose tennis elbow. First, they will review your medical history and lifestyle. Then, your elbow and arm will be examined for pain, swelling, and stiffness. They can also move their arm, elbow, wrist, and fingers. Your doctor may order an X-ray or MRI of your arm. These tests help ensure that you do not have a break or fracture.

Complications of tennis elbow

Complications of tennis elbow include:

  • Recurrence of the overuse injury.
  • Tendon rupture with repeated steroid injections.
  • Not improve with non-operative or operative treatment; These may be due to entrapment of a nerve in the forearm.

Risk factors for tennis elbow

Factors that can increase your risk for tennis elbow include:

  • Years: While tennis elbow affects people of all ages, it is most common in adults between the ages of 30 and 50.
  • Occupation: People who have jobs that involve repetitive wrist and arm movements are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers, and cooks.
  • Certain sports: Participation in racquet sports increases your risk of tennis elbow, especially if you use a poor hitting technique.

Prevention of tennis elbow

Stopping or reducing repetitive activities and resting your arm can help recovery. When rest is not possible, adjusting your arm movements can help relieve symptoms. For example, a person may try to keep the palms of the hands flat and the elbows bent when lifting.

Doing exercises designed for your tennis elbow help strengthen your forearm muscles and improve function. People whose jobs involve repetitive forearm movement should perform these exercises to prevent tennis elbow from returning.

Always consult a physician before attempting tennis elbow exercises. A doctor can make sure that the exercises do not affect any underlying conditions or injuries. If exercising the forearms seems to make tennis elbow symptoms worse, a person can try:

  • Resting the arm for longer
  • Wearing an ice pack on your arm to help reduce swelling
  • Taking over-the-counter medications, such as ibuprofen, to relieve pain and inflammation
  • Talk to a doctor or physical therapist to make sure they are doing the exercises correctly