The Case of the Wandering Kneecap

Kneecap dislocation occurs when the patella, or kneecap, slides to the outside of the joint, thus stretching and possibly tearing the ligaments that hold it in place. The patella is probably the most commonly dislocated bone in the body, with kneecap dislocation occurring most often in teenage athletes and adult women.

Kneecap dislocations fall into two categories. Those involving an accident, such as a blow to or a twisting of the knee, are called traumatic dislocations. Atraumatic dislocations occur when the person is “loose-jointed” or the kneecap is misaligned (tilted or shifted), thus making the joint less stable.



Symptoms of a dislocated kneecap include

  • bleeding under the patella
  • bruising around the patella
  • swelling of the kneecap
  • tenderness along the edge of the patella
  • pain and clicking when the patella pops out of its groove and then moves back into place
  • actual dislocation of the patella when it moves out of the groove and gets stuck out there

Surgery is required when significant damage, such as muscle rupture, bone fracture or detachment of the ligaments, occurs or when kneecap injuries become recurrent. When recurrent injuries or serious damage are not involved, however, the patient usually engages in protective rehabilitation for three to five weeks to prevent the kneecap from moving laterally and relieve pain.

The second phase of kneecap rehabilitation, which should take anywhere from two to four months, involves rebuilding and strengthening the quadriceps muscle to prevent dislocation from happening again. We will be glad to design an individual rehabilitation program that will address your particular needs and get this complex joint functioning smoothly and strongly once more.


Straightening the Curves of Scoliosis

Scoliosis is a condition in which the spine is curved toward either the right or left side. Thus, the upper back seems to be rounded, the lower back appears to curve inward (swayback), and one shoulder and/or hip looks higher than the other.

About 80% of scoliosis cases occur in people 10 to 18 years of age, and the condition is far more common in girls. While most cases among both genders are mild and require no treatment, girls are more likely to progress significantly without treatment.

For a diagnosis of scoliosis to be made, a curve must measure 11º or more; a curve less than that is labeled spinal asymmetry and is unlikely to get much worse, although a pediatrician or an orthopedic surgeon can monitor it with visual inspections and x-rays to be sure it does not move in that direction.

The following procedures are commonly used to treat scoliosis:

  • A brace is the most common treatment for children who have scoliosis spine curvatures of 25º to 40º and who have not finished growing. The brace will not correct the curvature, but it will keep it from worsening.
  • Surgery is an option for more severe cases, in which the curves are 40º to 50º or more.
  • Spinal fusion, which joins vertebrae permanently, is effective but is not used for children whose bones are not fully grown because growth will no longer be possible in the fused area. Thus, fusion is often performed for older adolescents.
  • Metal implants and bone grafts are utilized to straighten the curve, although a zero-degree curvature is not possible.

Scoliosis does not usually cause back pain, but in severe, uncorrected cases, it can compromise overall health because there is less room in the chest cavity for the heart and lungs to function properly.

While physical therapy alone cannot cure scoliosis, exercise helps maintain good muscle tone and a healthier heart and lungs, and it may reduce discomfort. We will be glad to work with your physician to design an exercise program to augment the benefits of a brace or surgery in the treatment of this condition.

Why You Need Crutches After Meniscus Surgery

If only surgical treatment worked so perfectly that the patient would hop off the operating table, cured, with no painful recovery required. For knee surgery, that is not the case.

Today, most surgical procedures on the crescent-shaped, fibrous knee joint cartilage called the meniscus are performed with tiny incisions, cameras and instruments. Thus, the recovery timeframe is much shorter than for the once more common open-knee surgeries.

The meniscus, the knee’s shock absorber, is composed of rings of spongy cartilage located between the thigh bone (femur) and shin bone (tibia). When the meniscus is torn by injury and surgery is recommended, postsurgical measures frequently include the use of crutches. How long you use them will depend on several factors, including whether the meniscus tear was actually repaired or if, more simply, a piece of it was just removed (partial meniscectomy).

With a partial meniscectomy, crutches may be needed until you can walk without limping (usually five to seven days). With a proper rehabilitation program, you can usually expect to resume sports within four to six weeks after the surgery.

Following a repair, you will typically use crutches for at least three weeks to allow the repaired tissue to become attached and to avoid retearing the meniscus. Maximal weight training is not allowed for two to three months, and a return to running and agility sports is permitted after three to four months if strength and motion have returned and there is no pain in the joint. Of course, your pre- and postoperative condition and the progress of your overall recovery will influence that timeframe.

In addition to using crutches, you may also engage in physical therapy to

  • strengthen your leg muscles
  • strengthen and regain full motion in your knee
  • return to a normal activity level

We will be happy to work with you and your surgeon to customize a physical therapy plan that will meet your goal of returning to work, home responsibilities and sports as quickly, comfortably and safely as possible.

Stroke: Every Second Counts

Strokes, or cerebral vascular accidents, exist in varying degrees of severity, depending upon which part of the brain is affected, how much of the brain is affected and the level of exercise the person performs. Other factors that affect stroke severity include advanced age, high blood pressure, diabetes, smoking, minimal variety in the types of food consumed, high cholesterol and migraine headaches.

There are two main types of stroke: a hemorrhagic stroke, which occurs when a blood vessel bursts, and an ischemic stroke, the result of a clogged blood vessel. A transient ischemic attack is referred to as a “mini-stroke” because the blood flow to the brain is briefly interrupted.

Because the care a stroke victim receives in the first few hours can significantly affect recovery, rapid recognition and transport to medical evaluation and treatment is vital. By recognizing the following signs and symptoms of a stroke, you can help clinicians give you the most effective treatment possible, as soon as possible.

  • sudden numbness or weakness of the face, arm or leg
  • sudden confusion, trouble speaking or understanding what has been said
  • difficulty seeing out of one or both eyes
  • trouble walking
  • dizziness
  • loss of balance or coordination
  • severe headache without a known cause

During the stroke recovery period, we can work with your physician to assess your unique presentation–that is, how much recovery you can achieve–and design a rehabilitation program tailored to your particular physical requirements. We can devise a recovery program to help improve your physical skills and suggest various lifestyle changes you can make to reduce the future risk of stroke.

Move Your Hips After Hip Arthroscopy

Arthroscopy, a procedure using a small fiber-optic camera device, has revolutionized hip joint surgery. Often recommended for athletes or those with degenerative arthritis, it is used to remove damaged tissue or splintered-off cartilage floating around the hip joint or to reattach structures within the hip.

A surgeon uses a small incision to insert a tiny camera into the hip, so that the damage around the joint is visible and whatever is causing pain and dysfunction in the patient can be fixed. In the past, an invasive procedure (and much larger incision) would have been necessary to treat many hip problems, but arthroscopy can achieve the same results with easier recovery time and less chance of complications.

Hip arthroscopy is an outpatient procedure, meaning that you will be sent home within hours after the surgery. Your physician may recommend using crutches, resting and applying ice packs for a short time to relieve pain and inflammation. Within a few weeks, you will feel well enough to incorporate some gentle movement of the hip into your recuperative routine. It is important to start a rehabilitation program as soon as possible, because research suggests that early movement speeds healing while lack of movement can lead to lasting problems. The rehabilitation sequence will be dictated by the specific tissues affected by the surgery.

Working with us, you can take advantage of what some experts have dubbed the “window of opportunity” after hip arthroscopy, when physical therapy makes the muscles around the joint stronger and before your body re-creates the corrosive fluids that caused your hip problems in the first place. Because your surgeon has just removed inflamed tissues and extra fluid that have affected the hip joint, you may find yourself pain-free for the first time in years. This is a perfect time to increase flexibility and function in the hip and strengthen the surrounding muscles, especially in the case of degenerative arthritis, whose symptoms may reappear in time.

On average, the rehabilitation process takes around six weeks, but the length and intensity of your postoperative rehabilitation will depend upon exactly what was accomplished–and why–through your surgery. Regardless, we can assist you to achieve your best chance of a full recovery after this revolutionary and effective type of joint surgery.

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