KNEE PAIN
The knee is a hinge joint that connects the thigh bone (femur) to the lower leg bones (tibia and fibula) and the kneecap (patella). Like other joints in the body, the knee is made up of tendons and ligaments, as well as cartilage structures like menisci and bursae. The tendons and ligaments provide strength and stability and allow the knee to evenly carry the weight of the body, while the cartilage structures allow for smooth, fluid movements.
Causes of Knee Pain
Any of these structures can be damaged by injury, disease or other conditions that may result in knee pain. Knee pain is often a result of:
- Trauma
- Overuse
- Sudden turning movements
- Awkward landings from falls
- Infection
- Degeneration
Injury is one of the most common causes of knee pain and can sprain, strain or bruise any of the joint structures. Bones can fracture as a result of major trauma. Degenerative diseases like arthritis are also a common cause of knee pain, as they cause the cartilage between the bones to wear away. Bursitis is an inflammation of the bursae.
Because of the different structures involved, amount of use and wide range of diseases and injuries, knee pain can greatly vary. Pain may be severe and constant, or may be more of a dull ache that comes and goes. You may have difficulty walking or standing, experience stiffness or loss of motion. A fever can also be present if the pain is caused by an infection. Injury to the knee is likely to cause sudden, severe pain, while pain caused by disease may be more gradual and mild.
Knee pain is more likely to affect people who:
- Are overweight or obese
- Exert excessive use of the knee
- Play high-risk sports
- Are older
- Lack muscle strength and flexibility
Treatment Options
Many knee conditions can be treated with conservative home methods like rest, ice, compression and elevation.
Your doctor may also recommend other treatment options such as anti-inflammatory medications, physical therapy, corticosteroid injections, or braces.
Surgery may be necessary for more severe cases. Minimally invasive, arthroscopic procedures are available for most foot and knee conditions which helps minimize scars and recovery times. Surgery may remove, repair or replace damaged areas.
LUMBAR RADICULOPATHY (SCIATICA)
Lumbar radiculopathy is a disorder that is characterized by an irritation of the spinal nerve roots, which run from the lower back down each leg. Lumbar radiculopathy can be caused by many different factors, including a herniated or ruptured disc, bone spur, strenuous activity, an injury to the spine or osteoarthritis. Patients considered at the highest risk are older individuals and younger people who play contact sports or perform manual labor.
Lumbar radiculopathy is often referred to as sciatica since it commonly involves an inflammation of the sciatic nerve. The sciatic nerve is the longest nerve in the body, stretching from the spinal cord to the end of each leg. The condition usually develops gradually, as the nerve is compressed over time.
Causes of Lumbar Radiculopathy
Lumbar radiculopathy occurs when the spinal nerves have become irritated or compressed. Nerve compression may be caused by a variety of factors, including:
- Herniated or ruptured spinal discs
- Bone spurs, which occur when extra bone forms around a weakened herniated disc
- Degenerative disc disease, often resulting from the aging process
- Congenital defects
- Stress caused by repetitive or strenuous activities
- Traumatic injury or event, such as a sports injury or car accident
- Progressive conditions such as rheumatoid arthritis or osteoarthritis
- Diabetes
- Obesity
Symptoms of Lumbar Radiculopathy
Lumbar radiculopathy usually causes pain that radiates down the leg to the calf or foot. Abrupt movements may cause this sciatic pain to worsen. Other common symptoms of the condition include:
- Feelings of numbness throughout the legs
- Weakness in the legs
- Tingling or burning sensation in the legs
- Loss of reflexes
- Discomfort with sudden movements, such as standing up after a long period of sitting
- Incontinence
Diagnosis of Lumbar Radiculopathy
In order to diagnose lumbar radiculopathy, a medical history is taken and a physical examination performed. During the medical history portion, the doctor typically asks questions about the type and location of symptoms, as well as how long they have been present. The patient's muscle strength and reflexes will be tested for any abnormalities during the physical examination.
Imaging tests are usually conducted to obtain a clear picture of the lumbar region. X-rays are often conducted first, as they can be helpful in identifying the presence of trauma. MRI tests may be performed to evaluate the extent of the lumbar radiculopathy. For some patients, a CT myelogram may be used in place of an MRI. CT myelograms use X-rays and special dyes known as contrast material, to take pictures of the bones and the spinal canal. CT myelograms are commonly used for patients with pre-existing health problems such as diabetes, severe allergies or kidney disease as well as those with a pacemaker.
Treatment of Lumbar Radiculopathy
Conservative measures are usually the first options considered for treating lumbar radiculopathy. Physical therapy and exercises can help stabilize the spine, strengthen the muscles in the area and maximize flexibility to take some pressure off of the injured nerve roots. Medications, such as oral corticosteroids and non-steroidal anti-inflammatories, may also help by reducing pain and swelling. Epidural steroid injections are sometimes used to decrease swelling too, allowing for healing to take place and blocking pain signals.
However, if these treatments cannot provide the patient with relief or symptoms are worsening, surgery will often be required. There are several types of procedures performed to address lumbar radiculopathy. Extreme interbody fusion, or XLIF, is a minimally invasive spinal fusion procedure that is performed through the side of the body to treat spinal disorders and reduce long-term leg pain.
Lumbar laminectomy is a procedure that is designed to relieve pressure on the nerves branching off from the spinal cord by widening the spinal canal. During the procedure, a small section of bone that covers the back of the spinal cord, called the lamina, is removed in order to create space for the nerves. Another surgical option is lumbar spinal fusion, which involves the fusing of two or more vertebral segments of the spine together. This procedure can relieve pain, numbness, tingling and weakness and restore nerve function.