Frequently asked questions
I have answered some questions which may commonly arise with regards to orthopaedic terms you may hear and also regarding why we do what we do.
What is meant by a 'Cartilage' injury of the knee '?
This is a term used loosely and you may quite commonly hear it. The actual cartilage is the layer of tissue which lines the surface of the bones inside the joint.This may get injured with trauma or may undergo wear and tear and degenerative changes as we age. This results in pain and symptoms, such as swelling and stiffness. However, when people refer to 'cartilage injuries' they are often referring to meniscal injuries/tears. The meniscus are two moon shaped structures in the joint which serves various functions. These can commonly get injured with trauma, sports injuries and can also undergo wear/tear changes as we age and with arthritis.
Meniscal problems may result in swelling, pain, stiffness and catching/locking sometimes.
Why is an MR scan sometimes needed in addition to an X ray?
An X ray is usually a primary investigation to look at the gross condition of the bone or the joint. Whilst it shows the bones in sufficient details, it does not show the soft tissues (i.e ligament, muscle, cartilage, tendons etc) in enough detail. Hence, the surgeon might often request an MR scan in addition to the prelimnary X ray to get more information to plan the appropriate treatment. It improves the accuracy of the diagnosis and also provides much needed detailed information. It is an investigation which is safe, with no radiation involved. There are however some instances where a MRI cannot be performed, like in case of patients who have had previous aneurysmal clips in the brain, metal foreign particles in the eye, pacemaker other loose metal items in the body.
Why are exercises and physiotherapy important after surgery, trauma or treatment?
The recovery from any injury or surgery depends a lot on the soft tissues around joints and bones regaining their integrity, flexibility and strength. The sooner and in a more controlled and predictable manner they recover, the better will be the rehabilitation and outcomes. This recovery of muscle strength and joint flexibility is provided in a controlled manner by the physiotherapist and the rehab doctor. The exercises are designed in a graded manner to gradually increase the flexibility and then strength. It is vital that the exercises are carried out in earnest to allow for best outcomes from surgery or recovery from an injury.
What is the immediate treatment for knee / shoulder injury?
Knee and shoulder injuries are fairly common. The usual presentation is pain in the affected joint, with sometimes difficulty in weight bearing or stressing through the joint, with bruising and swelling. There are a few things that can be done in the immediate situation to try and minimise the damage and aid recovery of the tissues. The easy way to remember the steps is to remember the acronym RICE - This stands for Rest, Ice, Compression, Elevation. This means rest the affected part to minimise further damage, apply ice indirectly (some ice cubes in a cloth or plastic bag held intermittently against the part), Compression with tubigrip or bandage to minimise swelling and elevation which means keeping the part elevated, ideally above the level of the heart to aid fluid return and prevent fluid accumulation around the part. Ofcourse, medical opinion should be sought if things do not settle down with this initial first-aid treatment.
Why are some fractures treated with plaster and some need surgery fixation?.
Fractures or broken bones happen when the forces going through the bone exceeds the bones capability to withstand it. This can be as a result of a single big force or repetitive smaller forces over time (Stress fracture). The aim of treating a broken bone is to restore the normal alignment between the broken parts and to stabilise and hold the position long enough to allow the body to heal it naturally. Now some fractures have a clean break and with parts not out of alignment, in which case just holding the position with a plaster cast will suffice. However, in more complex fractures with displacement of the parts or fractures involving joints, the normal anatomy will have to be restored with surgical intervention and the postion held with metal screws, plates, or fixators. The time taken for bones to heal depends on certain normal time ranges, which varies with the bone involved and also depends on various local and systemic factors such as age, other co-existent chronic diseases, smoking etc.
Dr Vinod Kumar Cochin
Sports surgeon cochin
Shoulder surgeon cochin