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I am double jointed. Does this mean I have more joints that other people?

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The term double jointed is a misnomer. The name implies that a person has twice the amount of joints as normal and thus their joints allow for greater movement outside of the normal range of motion for that joint. What this term actually refers to is that a person has greater mobility or flexibility of their actual joint and can move their joint beyond its normal end range without experiencing pain and discomfort. Hypermobile joints tend to be inherited. It occurs in about 10-25% of the general population. Most people don’t experience any symptoms and don’t need any intervention, but a small percentage of patients will have hypermobility syndrome where their unstable joints can lead to other conditions. Some may experience frequent sprains or tendinitis of their joints and activity modification and physical therapy may be recommended to strengthen and stabilize their joints. In some rare cases these joint issues may be related to a more serious underlying medical condition. In my practice I often see patients who experience subluxations or dislocations especially of their knee cap (patella) or their shoulder joint due to hypermobility. A subluxation is when the bones of a joint partially move out of place and then relocate back in on their own (known as a partial dislocation) versus an actual dislocation where the bones move completely out of the joint and stay out until relocated. These injuries may occur from a direct trauma to the joint like during sports or from a fall. I routinely see another subset of patients in my practice who have abnormal joint anatomy where the ends of their bones in their joint are abnormally shaped. These patients can not only have laxity in their joints, but also have anatomy that predisposes them to injury. These patients can experience a subluxation or dislocation event even without trauma such as from a sudden twist or movement of their joint. These patients require a thorough evaluation to determine what the best treatment is for them. It can range from pain medication and physical therapy to surgeries to stabilize the joint and prevent re-injury. Having hypermobile joints is not a problem for most people, but if pain and frequent injuries occur it is important to see an orthopedist who regularly deals with these issues. 

adminI am double jointed. Does this mean I have more joints that other people?
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My teammate had an ACL repair for a torn ACL, why is a different ACL surgery being recommended for me?

Over the years in my practice, this has become a familiar question—many patients come to my clinic wondering about their options for anterior cruciate ligament (ACL) surgery. These patients range from recreational athletes who sustained an ACL tear skiing, to the student athletes with an ACL tear from competing in high-level, pivot-heavy sports. My first response to my patients is that there is no one-size-fits-all approach to ACL surgery. Every case is unique. There are many factors that go into determining the right type of surgical or non-surgical solution for their ACL injury, including:

 

  • Location and type of tear:
    Most ACL tears occur in the middle or mid-substance of the ACL, and can be partial, meaning part of the ligament is torn, or complete, where the ligaments is torn in half. Less frequently we see an avulsion type ACL injury, where the ACL “peels off” from its attachment to the bone. These injuries are all ACL tears, but the treatments are not all the same.
  • Chronicity of the tear
    We want to know if this a recent ACL injury, or if the ACL injury of the knee occurred months to years ago, as this affects healing patterns.
  • Age & activity level
    The age, activity level, and future expectations of the patient are each critical factors in determining my approach to ACL surgery. Is the patient low demand, meaning their exercise comes from a bike ride on the weekends or yoga classes after work? Or, are they high demand, and a high level college athlete that plays cutting and pivoting sports?  
  • Surgical history
    I am looking to determine what prior knee surgery the patient has had on the injured knee, as well as the other knee and joints.
  • Imaging results
    These results help us see if there is a fracture or break in the bone where the ACL attaches, a tear in the meniscus (shock absorber), or damage to the cartilage (smooth glossy coating over the bones).

 

  1. Exam results
    This includes the evaluation in the office where we assess areas of pain and other stabilizing ligaments in your knee to see how stable your knee is. We also examine the anatomy of your knee to ensure alignment and mobility.  

These are just some of the factors that go into making the appropriate treatment choice to heal your ACL injury. While your friend, colleague or teammate may have had a different approach and experience with their ACL injury treatment, it doesn’t mean yours will be the same. Have a detailed discussion with your doctor about your options, and come up with a plan that works best for you.

adminMy teammate had an ACL repair for a torn ACL, why is a different ACL surgery being recommended for me?
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You Don’t Need to Run to Have Runner’s Knee

Beth Shubin Stein, MD, Associate Attending Orthopedic Surgeon

Sabrina Strickland, MD, Associate Attending Orthopedic Surgeon

HSS Patellofemoral Center

Do you feel pain in the front of your knees when going down stairs? Does knee pain interfere with your ability to walk, run, kneel, squat, or stand up comfortably? Has your knee ever “given out” on you? If you answered yes to any of these questions, you may be suffering from patellofemoral knee pain, arthritis, or instability. Anyone can suffer from these conditions, but they are more common in women than men.

Commonly known as “runner’s knee,” patellofemoral (“anterior knee”) pain can affect anyone. It can happen in people with improper alignment, where the kneecap does not slide smoothly in the groove or track of the femur (thighbone). This type of problem may run in families. Or it may result from injury to the knee (usually during adolescence or young adulthood).

Some people feel pain around or under the kneecap. Others feel instability and may experience a kneecap dislocation. Not everyone with patellofemoral problems needs surgery, but in some cases it is warranted to prevent more serious problems down the road. Here’s how to know what may lie ahead for you. (See a doctor to know for sure.)

If You Have Knee Pain

If you have knee pain without dislocation of the kneecap and a short course of modifying your activities does not resolve the discomfort, see a primary care sports medicine doctor or an orthopedic surgeon. You’ll likely have an x-ray of your knee to see how the kneecap is tracking in the groove of the femur. Physical therapy may help to strengthen the muscles around the knee that help keep the kneecap in place. If your pain persists despite physical therapy, you may need an MRI to look for cartilage damage under the kneecap.

If You Have Arthritis

If tests show there is cartilage damage under your kneecap (arthritis), you may continue physical therapy and/or receive injections to reduce inflammation and provide lubrication. Your doctor or physical therapist may advise you to change, reduce, or avoid certain activities that may aggravate your symptoms. Some patients with cartilage damage may have surgery with techniques that allow regrowth of the damaged cartilage or replace damaged bone with donor bone and cartilage. The surgeon may also correct any misalignments to prevent or minimize future cartilage damage. Patellofemoral cartilage surgery is typically reserved for younger patients (under age 35) or for older patients whose pain persists despite nonsurgical treatments. Some older patients may have partial knee replacement to create a new smoothly gliding joint.

If You Have Kneecap Instability

When the kneecap doesn’t track evenly in the groove of the thigh bone, it can slide out to the side (dislocate), causing your leg to give out under you. This instability is most common in adolescents and young adults, and it is also more common in females. But it can happen in anyone at any age with patellofemoral malalignment and trauma.

Doctors used to think that patients who had only one dislocation should always try nonsurgical treatment. However, much has been learned in the last five years indicating which patients with a first-time dislocation have the highest risk of recurrence. As a result, all patients who have a dislocation should see an orthopedic surgeon to determine if they are in that high-risk group and might benefit from early surgery.

If your kneecap dislocates a second time, you will need surgery to reduce the risk of arthritis from continued dislocations. During the procedure, the surgeon may rebuild the medial patellofemoral ligament — a “leash” that holds the kneecap in place, which often tears during dislocation and then heals in a stretched-out position. This can be done using your own or donor hamstring tissue; in some cases, you may require an additional bony surgery to fix problems with poor alignment. We are currently doing research to identify factors that increase the risk of a second dislocation among first-timers and potentially perform surgery earlier in those people to prevent subsequent dislocation.

If your kneecap has dislocated, it’s extremely important to have it checked out. Each time you experience a dislocation, there is likely to be damage to the cartilage that increases your risk of arthritis. See a sports medicine physician or orthopedic surgeon to find out what’s best for you.

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NBC Nightly News: Knee Replacement – Video

Dr. Shubin Stein is featured in a recent segment on NBC Nightly News entitled “New Study Questions Effectiveness of Knee Replacement Surgery”. In the segment, Dr. Shubin Stein explains types of patients and injuries that would be candidates for knee replacement.

Watch the segment »

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