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ACL vs. MCL Tears: What is the Difference?

Originally published on GilTepperMD.net

A tearing of one’s anterior cruciate ligament (ACL) or medial collateral ligament (MCL) can be incredibly debilitating, regardless of whether or not the patient is an athlete. These types of knee injuries can make everyday tasks much more difficult, and the recovery time can take several months. While these skeletal injuries are commonly associated with one another, and at times concurrent, they are actually quite different.

The ACL and MCL are just two of four total ligaments within the knee with the posterior cruciate ligament (PCL) and lateral collateral ligament (LCL) being the others. While knee injuries can damage any one of these ligaments, the ACL and MCL are the most commonly affected. The ACL is located in the middle of the knee joint that connects the femur to the tibia. It limits knee rotation and forward motion of the tibia. The MCL is a longer ligament that runs the length of the back of the knee joint, limiting sideways motion of the knee.

A tear of either of these ligaments is almost instantly recognizable, as many patients feel or hear a pop (more commonly in ACL tears), followed by swelling (caused by internal bleeding in the knee) and pain. Experiencing a locked knee or not being able to straighten it is another sign of a serious knee injury (meniscus tear). Following the sensation of a pop, your knee may also become unstable, making standing and walking difficult. Weakness upon trying to straighten the knee is another clear sign of a possible ACL or MCL tear.

ACL tears are typically caused by a sudden twist or dislocation of the knee. Stopping or changing directions suddenly while running puts a great amount of stress on this ligament, as does landing awkwardly from a jump. Twisting your foot after planting it can also twist the ACL itself. Even direct hits to the knee can damage the ACL enough to cause a partial or a complete tear.

MCL tears are usually caused by a widening of the ligament after contact, most often from sports. Patients will feel pain or tenderness in the inner part of the knee, as well as weakness or occasional locking. Tears of this ligament are classified as either grade 1, 2, or 3 tears. Grade 1 MCL injuries are when the ligament is overstretched, but not torn. Grade 2 injuries are partially torn MCLs, and Grade 3 injuries are complete tears.

If you feel you’ve sustained a knee injury that could be either of these types of ligamentous tears, assess your symptoms to determine which of the two it might be. As previously mentioned, ACL tears often come with a distinct popping noise unlike MCL tears. However, the symptoms experienced are very similar in both injuries (swelling, pain, and bruising). Check with your doctor immediately upon sustaining any type of knee injury to determine which is the optimal course for you.Initial period of ice, elevation and immobilization is wise. Early MEI is frequently needed to secure a definitive diagnosis and treatment plan.

Treating the two injuries differ greatly as well. MCLs tend to heal much more easily than ACLs, as their recovery process typically lasts roughly 8-9 weeks, and requires physical rehabilitation. ACL tears on the other hand, almost always requires surgical repair, and can take up to 9 months to fully heal.

For a torn MCL, it is recommended to ice the knee, bandage it, keep it elevated, and use crutches if possible. Combined with physical rehabilitation, the ligament should heal itself. Surgery may only be required if it is unable to do so. Because of the multiple ligaments within the ACL, surgery is usually required upon tearing it.

For athletes especially, understanding how to prevent these serious knee injuries is important. Consider wearing a knee brace during sports or physical activity, exercise the necessary muscles to strengthen your knee, and always avoid overexertion. As always, proper warm up before strenuous activities and regular conditioning is paramount to safe engagement with recreational activity. Stay toned!

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Work-Related Trauma and Acute Injuries

Originally published on GilTepperMD.com

 

Following up from my previous blog, today we will discuss some of the more common injuries sustained at work, how to treat them, and tips for prevention. Hundreds of thousands of accidents occur within the workplace every year, the severeness of which can vary greatly. Aside from knowing one’s legal rights and the ability to receive compensation, it is important to have these injuries treated physically in addition to legally. Below are some of the most common accidents that occur within the walls of a workplace.

Back Injuries

Injuries and pain in the back are the most common workplace grievances, with 5-10% of those documented becoming chronic among patients. Whether working in an office setting or a construction site outdoors, nearly every employee is exposed to the risk of back injury. Poor posture or prolonged sitting can lead to poor muscle development, pinched nerves, and damaged discs within the spine.

Specific injuries to the back include muscle strains or sprains, and herniated discs. These affect over 1 million workers, which attributes to 20% of all workplace injuries and illnesses. Aside from effective employee training, the best way to prevent sustaining a back injury is to understand basic lifting, moving, and carrying procedures when working in an environment that requires all three. Back injuries can be extremely debilitating, and can even lead to weight gain and poor physical function due to loss of mobility.

Hernia

There are several types of hernias that one can endure, with some of the most common work-related being inguinal and hiatal. Inguinal hernias are when the intestines protrude through a weak spot or opening in the lower abdomen. Though it is more common in men than it is women, these can be caused by extremely heavy lifting, coughing, or old age, as the abdomen wall weakens over time. Hiatal hernias are when the stomach begins to extend up into the diaphragm. These typically come with age as well.

Hernias are generally easy to deal with in terms of pain, as a small bulge may appear around the affected area. Leaving it untreated does not necessarily increase one’s chances of worsening the injury, but depending on the severity of the symptoms, seeking treatment options would not be unwise. Should you feel “fullness” or pain upon lifting, consult a physician immediately. Surgery is sometimes required to treat these injuries. In less serious cases, the hernia can easily be pushed back into its proper position.

Arthritis

Arthritis is any rheumatic disease that affects joints, the surrounding tissue, and other connective tissue in the area. This is the most common disability in America, and can worsen within a workplace setting. Osteoarthritis specifically is more prevalent in workplaces, as this is associated with knee and/or hip pain. Outdoor professions like construction or agriculture typically put those at risk due to heavy lifting and constant movement in unnatural positions (kneeling or crawling).

Rheumatoid arthritis is a disorder defined as chronic inflammation in the joints of the hands and feet. Given the chronicfactor, this can make life difficult, especially within a workplace setting. Achy fingers or wrists can make typing challenging, as well as lifting anything at all. Work with a Rheumatologist to determine the best form of treatment for you, which can come in the form of medication, a change in diet, exercise, and physical therapy.

Early diagnosis is key in treating arthritis in order to prevent loss of mobility. Exercise and weight management programs are very helpful, but the consultation of a medical professional beforehand should never fall by the wayside.

Carpal Tunnel Syndrome

Associated with the peripheral nervous system, carpal tunnel is the compression of the median nerve around the wrist. This is very common in individuals who type on a computer on a daily basis, or work with their hands in general. Symptoms range from numbness, to weakness, to muscular atrophy. Carpal tunnel is more common in women, though nearly everyone is at risk. Some contributing factors to this condition include pregnancy, pre existing wrist injuries, arthritis, diabetes, and family history.

In terms of treatment, the first step is avoiding any activity that can worsen your condition. Wearing a wrist splint, therapeutic stretching, or medications have been found to work best, but surgeries are not uncommon in order to relieve more extreme cases.

Sciatica

Many lower back injuries can lead to this debilitating condition, which is caused by the compression of the sciatic nerve; a set of five paired nerves located in the lumbar spine. The entire nerve runs the length of the pelvis all the way down to the foot, passing through the buttocks and hip. Sciatica is caused by spinal disorders that compress the nerve like a herniated disc, lumbar spinal stenosis, tumors, or trauma to that area, of which many workplace incidents can contribute to.

Rotator Cuff Injury

The rotator cuff is a collection of muscles and tendons on the shoulder that connect your upper humerus to the joint, keeping it firmly in place. An injury sustained to the rotator cuff is often caused by consistent overhead movements like reaching or lifting objects. This is especially common in painters, athletes, or individuals in construction. The injuries themselves can range from minor inflammation to complete tears of the tissue.

Some symptoms to look out for include a deep ache within the shoulder, pain upon lifting either arm, and arm weakness in general. While this typically treated through rest, depending on the severity of the injury, leaving it motionless for too long can actually have adverse effects. Consult your physician immediately if you experience a sudden loss of mobility following an injury. This may be a complete rotator cuff tear.

Prevention comes in the form of carefully strengthening these muscles through exercise and stretching. In addition to shoulder workouts, strengthening the chest and back muscles are just as important for support around the shoulder blade.

Meniscus Tear

The meniscus is the cushioning disc located within the knee meant to keep the joint steady and balance your weight accordingly, of which there are two. A tear of this disc can be very crippling. Any sudden twisting or turning while the foot is planted can lead to this, which is not uncommon in sports or manual labor careers. The menisci weaken with age as well; another factor worth noting.

A minor tear may result in simply swelling and slight pain, which can be treated with rest and applied heat. A moderate tear will limit your mobility a little bit more, but walking is still possible. As a result of this, swelling will be more severe and stiffness is often felt as well. Be sure to be much more cautious in this case. A severe tear can cause the knee to catch, or lock, preventing you from straightening it due to pieces of the torn meniscus being able to move throughout the joint.

The location of the tear plays a large role in determining treatment. Tears on the outer edge of the meniscus are typically able to heal on their own thanks to a large blood supply. All that is needed in this case is a brace or resting period. Tears located on the inner part of the meniscus need much more assistance with healing because of less blood flow.

Surgical repair may be required in some cases, such as to remove torn pieces floating about. A total meniscectomy is required in very extreme cases, which is the removal of the entire meniscus, though this is generally avoided due to the increased risk of osteoarthritis.

Thank you for reading! Follow me on Twitter for more, and be sure to stay tuned for more pieces on orthopedics and spinal health.

When Spinal Surgery is Right for You (Pt. 3)

Now that we’ve come to part three of my spinal surgery blog series, we will cover even more spinal conditions, how they can be treated, and if surgery is necessary, specifically, those of the degenerative nature.

Degenerative spinal conditions often come with age, and can lead to chronic pain disruptive of one’s daily activities and lifestyle. Consider the constant weight and pressure applied to the spine and neck day in and day out. This, over a long period of time, can lead to loss of function. More specifically, discs begin to lose elasticity, ligaments start to calcify, and arthritic pain in general is increased.

Like with all conditions, medication and physical rehabilitation can provide more or less relief for certain individuals, but surgery may be required in more severe situations. Surgeries performed for degenerative disorders involve removing whatever part of the spine is causing the compression in order to relieve stress on the surrounding nerves, and thus, relieve pain. Some of those conditions include herniated discs, degenerated discs, and bone spurs.

  • herniated disc is when the inner material of said disc is exposed, compressing nearby spinal nerves. The surgical consideration to correct this includes removing the exposed material, or the entire disc.
  • Degenerative disc disease can occur in any motion segment /joint along the spine. When the cartilage lining the joints begins to wear out, those joints become irregular, much more stiff, and can begin to swell; another source of pressure being applied to the surrounding nerves. Surgery can range from complete removal/replacement of the joint causing the pain, to relieving the pressure in the nerves in order to relieve pain.
  • Bone spurs are the human body’s natural response to spinal column stresses. The bones attempt to straighten themselves out, which typically results in growths along the spine affecting nerve passages. Undergoing surgery for this requires removal of the spurs, or the entire joint depending on their severity.

If you or someone you know is affected by degenerative disc disease, herniated discs, arthritis, or bone spurs, consult your medical professional to discuss options before deciding on surgery. Regular rehabilitation can help in relieving pain, but minimally invasive surgery has been proven to be a safe, successful alternative.

Originally published on GilTepperMD.com

When Spinal Surgery is Right for You (Pt. 2)

Welcome back, friends. As discussed in my previous blog, spinal conditions and the types of surgeries that ensue can be complex. Exploring a number of other spinal issues, I thought covering the following would be appropriate.

At times, a stabilizing spinal reconstruction with disc replacement or fusion technique may be most suitable for return to action. There are several types of options here, one of the most common being spinal fusion surgery. This is done by a surgeon fusing two vertebrae together to form a single, stable cohesive unit that prevents movement, which is often the cause of pain.

Patients suffering from spondylolisthesis are the best candidates for this surgery, as this is an unstable misalignment of two or more vertebrae that causes painful movement. Fusing said vertebrae with proper alignment, using rods and screws can prevent continued and progressively deteriorating pain. However, spinal fusion is not for everyone, and is not considered a long-term option. The joint can wear over time, leading to the familiar pain that was once cured. That said, I have been performing this surgery successfully since the early 90’s and have followed some pleased patients for nearly 20 years.

Motion sparing procedures have gained FDA approval recently and are increasing in popularity. Here choices include interspinous devices and artificial disc replacement (ADR). Spinal disc replacement or arthroplasty may serve in select patients as an appropriate choice for procedure. It combines a minimally invasive technique and motion sparing principles while decompressing the nerves and stabilizing the segment. As a principle FDA investigator on such artificial disc since 2003, I have performed this operation with remarkable and sustainable success over the years. I am pleased with the recent adoption and FDA approvals.

Laser spine surgery seems to be more of a dated technique now that minimally invasive surgery not including a laser has become a staple among hospitals across the world, and has been found to be much more effective. In the past, patients may have undergone this procedure due to spinal stenosis, herniated discs, or sciatica. However, the actual use of lasers was later discovered to be not much more effective than traditional methods, paving the way for minimally invasive surgery.

Coflex is another alternative to standard surgical practices that involves a stabilization procedure excluding rods and screws for patients suffering from spinal stenosis. Coflex’s signature device is a titanium implant that stabilizes the spine following surgical decompression, helping maintain your spine’s normal foraminal height and motion. This implant allows for much more flexibility compared to rods and screws, but is much stronger as well thanks to its titanium makeup. Additional benefits of this procedure include a much shorter recovery period, lasting relief for years to follow, minimal blood loss upon being surgically implanted, and more natural movement.

How to Help Those Struggling with Narcotic Addictions

America’s opioid epidemic continues to be a disconcerting issue faced by many who have gone through serious surgical procedures requiring pain medications during rehabilitation. It is shockingly easy for one to become addicted to painkillers like oxycodone, hydrocodone, or fentanyl following a major surgery. Weaning off these medications is much easier said than done and requires much support. For a family member or friend seeing their loved one experience this, can be extremely difficult at times.

Helping someone who is struggling with a narcotics addiction should be prioritized for the sake of that person’s health. The more time that passes, the harder it becomes, and the more resistant to help the individual may be. Frustration is entirely normal because of this, but putting their well-being ahead of yours is essential in helping them overcome this addiction.

A person struggling with an addiction to painkillers often thinks that their addiction is justified following a major surgical issue. They may feel as though the pain will return or they will not properly recover, despite progress already made. It is important to note however, that addiction is much different than dependence.

  • Addiction – Continued abuse of a substance despite bodily harm.
  • Dependence – The body has become dependent on the substance to function.

No matter the reason why your friend or family member may be abusing narcotics, your intervention is essential.

The first step in helping requires compassion. Show concern for the individual struggling with this addiction without coming off as judgemental. Addiction is a sickness not unlike any other chronic illnesses. That being said, the way you phrase your pleas for change are extremely important. Instead of demanding they seek help, tell them you are here for them and you’d like to offer assistance yourself.

You don’t have to approach this situation alone either. Consult a physician if you suspect a family member or loved one may be abusing opioids or narcotics of any kind. You can keep track of their prescriptions, making note of how much they are prescribed versus how much they may be taking.

As a safety precaution, always know the signs of an overdose. It’s a harsh reality that many people are afraid to face, but knowing what to do in an event of an overdose can spell the difference between life and death. Ask your physician for a prescription of naloxone to be safe; a medication designed to quickly reverse an opioid overdose.

For the entire blog and more, visit GilTepperMD.net!

When Spinal Surgery is Right for You (Pt. 1)

Enduring back pain and debilitating discomfort can be incapacitating for patients of all ages. If traditional forms of conservative treatment do not seem to be alleviating this suffering, spinal surgery may be the next appropriate step.

It’s important to understand conservative spinal care for those who feel they may need surgery to see if these strategies relieve pain beforehand. These can include applying ice or heat, physical therapy, moderate exercise, or simply waiting. Non impact home exercise routines, stretching, rolling and core build up programs can be both helpful and prevent future bouts. Swimming breast stroke for 20-30 minutes daily builds up supporting spine muscles. Back pain can go away with time, but know signs of a serious case when waiting to seek the help of a medical professional. Should you experience a fever or decreased bowel/bladder control, consult a physician immediately.

Though spine surgery should be a last resort option for many people, back surgery of any kind can be extremely effective in relieving persistent pain. One common debilitating symptom is radiating pain. Sciatica is often a strong indicator of someone suffering from a damaged disc. This is an intense pain that can be felt in the lower back, buttocks, thighs, and legs. If you or someone you know experiences this sensation, traditional forms of rehabilitation are recommended before considering surgery. Up to 90 days in which a patient exercises and takes care of their back have been shown to alleviate this pain, but surgery can do so at a faster rate depending on the severity of one’s pain.

Microdiscectomy is a type of surgery for patients suffering from such damaged spinal disc, due to disc tear and deterioration over time with protrusion. This can cause the sides of the damaged disc to bulge outward and apply pressure to any surrounding nerves. In more extreme cases, the disc core can herniate and compress the more delicate interior of the spine. With the advent of improved magnification and illumination in surgery this can be performed in a non disruptive minimally invasive fashion. One can expect to return to an active routine much improved in a short time.

Spinal stenosis is common among older patients. This is when the area surrounding the spine is narrowed, leading to a higher risk of pain through protruding discs or ligaments. A few signs of this include leg pain upon standing up or walking short distances that is then relieved when sitting, pain leaning forward or backward, and sciatica. Spinal fusion or a laminectomy can help if physical therapy and medication fails to do so.

In my next blog, I will be covering a number of other spinal conditions and how to treat those as well.

Los Angeles Free Spine Care: Putting Philanthropy Back in Medicine

Modern day medicine and professionals in this industry understand the importance of compassion and altruism now more than ever. A patient’s well being is the ultimate goal of successful doctors, and achieving this is made easier when they are given the necessary tools, those being advancements in technology that benefit the less fortunate.

Bill and Melinda Gates started the organization known as Grand Challenges to identify the world’s biggest health problems, and fund the researchers dedicated to solving them. This program was designed to compensate for areas in which “capitalism fails to meet the needs of the poor.” Efforts like this are what define philanthropy, which is why my partners and I started the Los Angeles Free Spine Care program through Miracle Mile Medical Center.

This is a charitable foundation created for individuals throughout Greater Los Angeles who suffer from spinal conditions and complications, providing a range of treatments. These include both operative and non-operative orthopedic, spine, podiatric, general surgery, interventional pain management, and rehabilitation programs costing nothing to patients who are uninsured.

Los Angeles Free Spine receives referrals from the Saban clinic and the Venice family clinic, who manage all medical, social, and other associated needs of the patients. The spine institute focuses on the spinal surgical spinal issues only.

Myself and the other clinicians at LAFS work directly with the Saban Clinic, facilitating timely, efficient medical care for all of our patients. The moment someone steps into our facility, they are met with open arms and managed by a skilled physician to best optimize the medical and social benefits that come during and after treatment, no matter what they are suffering from. Conditions may include lumbar herniation, spinal stenosis, degenerative disc disease, or cervical myelopathy.

One such patient, Cesar Diolivera, said that he found enormous success through the LAFS program after undergoing surgery in 2012. “I had a lot of back pain,” he stated. “For about 4 years, I couldn’t stand up straight or walk more than half a block. The only relief I had was from lying down. My social life suffered. After surgery, I saw 100% improvement. I can walk 5-8 blocks without a problem, work for hours, socialize, and even go to the gym.”

Diolivera also noted that the scar following his surgery was very small. Minimally invasive surgery comes with a variety of benefits, including much less blood loss, lower chances of post-op infections or complications, and a faster recovery time; something we at LAFS pride ourselves on.

Incorporating philanthropy in the world of medicine does not require traveling across the globe to help those in underdeveloped countries. It starts with helping patients at home. At the Los Angeles Free Spine Care, our goal is to build a healthier city, one person at a time.