XRAY X-pectations

When you hurt your back (or ankle, or wrist) and head to the doctor, do you expect an x-ray? I find that many patients are surprised if I do not insist on an x-ray for an acute injury. Mind you, I certainly order plenty of x-rays when I believe that the results will change our management (is it a broken bone or a sprained ligament), or even if the results simply tell us what to expect about the time-frame for healing, such as a minor fracture in the foot or toe.

By the way, while we're on the subject, a SPRAIN happens to ligaments, the tissue that attaches bone to bone. A STRAIN occurs in muscles or tendons (tissue connecting muscles to bones.)

So back to XRAYs. XRAYS look at bones. They do not "see" cartilage, muscles, tendons or ligaments, though sometimes distance between bones suggests lack of cartilage. The vast majority of injuries that send patients to their doctors are not from broken bones, but strains and sprains and spasms of muscles and supporting tissue. As we try to limit both unnecessary radiation and expense, the world of medicine is taking a closer look at when interventions such as taking xrays are really needed to improve patient outcomes. Medical centers are developing guidelines for different injuries that help physicians determine when an xray is truly needed, such as the Ottowa rules for ankle injuries.

RICE: Rest, Ice, Compression and Elevation (plus a bit of pain-reliever/anti-inflammatory medicine such as ibuprofen) go a long way towards treating injuries. Your doctor can show you the best way to compression wrap an extremity, plus possibly prescribe muscle relaxants or stronger anti-inflammatory medicine. Perhaps most importantly, your doctor may prescribe PHYSICAL THERAPY- where you will learn strengthening, flexibility and stability for your injury to fully rehab.

BOTTOM LINE: XRAYS are helpful diagnostic tools for bone injury, but don't assume your treatment of an injury isn't complete without one!

Oh, My Aching Knees!

Do your knees ache and bother you? Have you seen your doctor yet, or are you holding off because you're afraid the only answer is surgery? Well, fear no more, and head in to your family doctor! The vast majority of knee pain that we see in primary care is not a blown-out knee with surgical needs, but more chronic use/overuse injuries and knee cap tracking issues.

Adolescents during growth spurts can develop pain just below the knees that comes and goes, and is worse with squatting, using stairs, or jumping-all these activities put strain on the site where the patellar tendon attaches, and can cause a condition called Osgood-Shlatter's lesion. The treatment here is REST, not surgery...though many sports-minded adolescents WISH the answer was a quick surgery!

Women of all ages (more than men, but not exclusively) are prone to a condition called chondromalacia, where the under surface of the knee cap begins to look like crab meat- all flaky and ragged, instead of polished and smooth. What are the symptoms? Pain in the front of your knee, especially after prolonged sitting, is the classic one, sometimes referred to as the "theatre sign". The noninvasive treatment for this is physical therapy and home exercises to build up the medial quads, such as straight leg lifts.

Of course there are numerous tendon strains, cysts, and inflammed bursas (the bags of fluid that cushion between the bones and ligaments.) Most of these respond to anti-inflammatory medicines and physical therapy, or possibly a simple drainage procedure done quickly in the office.

Finally, let's not forget the mature knee, that is aching and stiff from arthritis. Yes, surgeries can help, but they are not the only solution we have to offer! Again, physical therapy, anti-inflammatory pills, or different types of simple injections into the knee joint with either steroid or other therapies.

BOTTOM LINE: Don't suffer in silence (or whine loudly to your family and friends) if you have knee pain for fear the only answer is surgery- go see your family doctor, sports medicine doctor, or local orthopedic MD and find out your options!