FAQ Category: General

Methicillin-resistant Staphylococcus aureus, or MRSA, used to be only found in hospitals or clinics. It has, however, been spreading and is now in the community. As a result, people can develop an MRSA-caused infection outside of the hospital. Doctors differentiate between MRSA from inside the hospital and outside to help keep track of where the infection comes from and how it’s treated. MRSA in the community also affects a different population than from the hospital.

HA-MRSA (hospital-acqured MRSA) generally affects people who are already ill and/or have low resistance to developing infections. CA-MRSA (community-acquired MRSA), on the other hand, affects many healthy people who may have cut or scraped themselves and become contaminated that way.

Sometimes, people need bone to help heal a problem or to replace lost bone. This lost bone could be due to surgery (removing a tumor and part of bone), an accident, or deterioration of a bone. Grafting can be done with other materials, but over the years, doctors and researchers have learned that in many cases, bone from the patient him or herself is often the best material to use.

To get this bone, the usual place is in the pelvis, from an area called the iliac crest. The surgeon removes a bit of the bone that he or she needs and then places it in the destination site. The bone is then grafted, or attached, and the body begins to heal itself.

In the meantime, the iliac crest area will also have to be cared for so it may heal as well.

Whenever anything is placed inside your body, you react to it. Your body reads the new piece as an intruder and forms antibodies to try to get rid of it. In this case, if bone from a donor is used, the body could reject it, causing more problems in the long run.

However, if a surgeon uses bone from your own body, this isn’t a foreign substance and your body shouldn’t turn on it. Therefore, the body can concentrate on healing rather than fighting.

Fibromyalgia is a disease that is difficult to understand. Because there is no definite test for the illness, it may be hard for a doctor to pinpoint the cause of your symptoms. Unfortunately, for those with fibromyalgia, there also aren’t a specific set of symptoms that they can list and say “it’s fibromylagia.”

That being said, fibromyalgia is being recognized more often now and is receiving attention in the research community.

Platelet-rich plasma (PRP) is a fairly new treatment technique under consideration and study for the treatment of a wide range of medical problems including after plastic surgery and surgery on the mouth, jaw, and neck. It seems to promote bone graft healing and wound healing. The benefits of this treatment have brought it to the attention of others who have tried it for spinal fusions, bone fractures, and chronic conditions like tennis elbow. Platelet-rich plasma has also been used with positive results for patients with degenerative conditions such as osteoarthritis that result in joint damage from wear and tear.

Platelet-rich plasma refers to a sample of blood plasma that has more than the normal amount of platelets. To get this substance, a portion of the blood is removed from a patient and placed in a machine called a centrifuge. The centrifuge spins the blood fast enough to separate it into layers based on weight. Heavier parts (e.g., red blood cells) stay on the bottom. Platelets and white blood cells spin out just above the red blood cell layer. Lighter particles (plasma without platelets or blood cells) make up the top layer in the test tube.

The platelet-rich portion of the plasma is then injected into the damaged area (e.g., tendon, joint). This treatment technique isn’t entirely new — just new to the realm of sports medicine. It’s been used safely and effectively for 20 years in some parts of Europe for diabetic wound management, bone fractures that don’t heal on their own, chronic tendon injuries that also don’t heal, plantar fasciitis, and osteoarthritis.

Because platelets contain growth factors, the added number of platelets injected into the area help new blood vessels get started. With increased blood to an area, wounds heal faster and tendon/muscle recovery takes place in half the time. The introduction of growth factors in patients with cancer is a concern. Right now, until we know more about the effects of this treatment, anyone with an active tumor should not have this treatment. There’s no proof that platelet-rich plasma can stimulate cancer growth. But it hasn’t been ruled out either. Until more research is done, you would be advised to look for other ways to deal with your knee arthritis.

Taking anticonvulsant and some other types of medication used for the treatment of tuberculosis is a known risk factor for low vitamin D levels. It seems these drugs interrupt the metabolism of vitamin D before your body can use it. The result can be decreased intestinal calcium absorption and low bone mass density, which can lead to bone fractures.

Current recommendations for adults with vitamin D deficiency include: 1) eating a diet rich in calcium and vitamin D, 2) get adequate sunshine each day, and 3) supplement the diet with calcium and vitamin D with vitamin/calcium pills.

Repeated blood tests can be used to determine change in your blood level of vitamin D. The normal range is between 30 and 80 ng/mL. When blood levels dip down to 30 and below, it’s time to get serious about replenishing what your body needs. Your doctor can help you establish the best program for your age, health, and location.

Location is important because in the northern hemisphere, there are certain latitudes that just don’t get enough sun rays to build up vitamin D in the body. Some people may be advised to go to a tanning booth when their vitamin D levels remain low despite all efforts to correct this through diet and supplements.

But this should not be done by anyone without a physician’s supervision. The effects of tanning booths on vitamin D have not been fully investigated. If you have had skin cancer of any kind (but especially melanoma), or you have any risk factors for skin cancer, a tanning booth may not be recommended.

Decreased levels of vitamin D referred to as vitamin D deficiency have long been known to cause a condition called sarcopenia (muscle weakness and wasting). Older adults with poor intestinal absorption of calcium and low levels of vitamin D are at increased risk for falls because of the weakness. If they have decreased bone density from osteoporosis (brittle bones), the falls might result in bone fractures.

With the aging of America, these problems are on the rise. That’s why the effects of calcium and vitamin D have come back into focus and become big news all of a sudden. Vitamin D attaches to muscle cell receptors and helps increase the number of muscle cells and muscle fibers. That effect strengthens the muscles and improves muscle function.

Studies show that vitamin D alone is not enough. It has to be paired with calcium to get the positive bone and muscle benefit. Researchers are investigating the exact mechanism by which this all takes place. And it seems likely that there isn’t a one-dose-fits-all for everyone.

People metabolize vitamin D at different rates. There are many potential reasons for this including body weight, age, use of certain medications that inactivate vitamin D, and the presence of chronic diseases like cystic fibrosis and kidney disease, to name a few. You can expect to see more reports in the news as further information is gathered and tested.

Has this condition been diagnosed by a doctor or has your brother made his own diagnosis? Finding out what the problem really is would be the first step. Most people with an acute gout attack are in so much pain and discomfort, they seek medical help right away. Since the big toe is often affected, walking can become a real problem. In fact, when this condition was described by Hippocrates (the father of medicine), he referred to it as the unwalkable disease.

If an acute case of gout isn’t treated, the symptoms may gradually go away over a period of days to weeks. Early treatment is usually to reduce the painful inflammation and discomfort with standing and walking. Doctors often prescribe nonsteroidal antiinflammatory drugs (NSAIDs) as the first line of treatment.

For maximal benefit, the medications must be started within the first 12 to 24 hours of the attack. Each NSAID has its own effectiveness, so they aren’t all taken in the same dosage or same number of times each day. The physician prescribing the medication will let each patient know what drug to use and when and how to take it.

Your brother may not know that simple treatment with an oral medication can save him a lot of pain and discomfort. It may only require one visit to the doctor but it could be well-worth the time and effort.

Gout is a crystal-induced form of arthritis because of a problem with the breakdown of uric acid. Uric acid is a compound that forms when purine is metabolized (broken down) and passed out of the body through urine.

Purines are found in high concentration in meat and meat products, especially internal organs such as liver and kidney as well as some fish products. Plant based foods such as vegetables are generally low in purines but eating vegetables with purine content does not contribute to this problem. The rate of this form of arthritis is on the rise and it has been linked with obesity and metabolic syndrome. The increased intake of fructose-sweetened soft drinks has also been linked with an increased risk of gout but it doesn’t cause gout.

Food does account for about one-third of the body’s daily uric acid load. The rest comes from mechanisms within the body that produce this compound. When it is not passed out of the body through the kidneys and intestines, just the right conditions in the body result in the formation of uric acid crystals called tophus.

It’s these crystals that form in the joints causing attacks of joint pain, swelling, and even oozing of crystals from the affected joint. The big toe is a common target for crystal formation in gout, but the ear and elbow are also common sites for crystal formation. Without visible formation of crystals, doctors diagnose this problem by examining fluid taken from inflamed joints. The crystals are clearly seen when the fluid is observed under a special polarized light microscope.

Once the problem has been diagnosed, treatment of the acute attack is with medications such as nonsteroidal antiinflammatories (NSAIDs). Chronic cases of gout are treated using a management model that involves lifestyle changes in diet, weight loss, and exercise. Eliminating foods and beverages high in fructose is one important strategy. Control (not cure) comes through the use of medications designed to reduce urate acid levels in the body.

Fibromyalgia is a medical term for a condition of aches and pains all over the body along with a laundry list of other symptoms. It can present very much like other problems such as Lyme disease, Epstein-Barr virus, multiple sclerosis, or arthritis. Without a blood test or other way to identify fibromyalgia, physicians rely on the patient’s history and clinical presentation to make the diagnosis.

The presence of chronic widespread body pain that lasts more than three months with specific tender points points to a diagnosis of fibromyalgia. The American College of Rheumatology (ACR) criteria includes 11 out of 18 points of pain as a positive test for fibromyalgia. These tender points are located in specific locations along the neck, chest, shoulders, back, hips, elbows, and knees.

Once the diagnosis has been made, then a management program of patient education, medications, physical therapy, and self-care is advised. There isn’t one magic pill patients can take to wipe away the pain, improve sleep, or restore energy. Instead, a wide range of medications are available that can act on the nervous system in a variety of ways. These include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SSNRIs), and anticonvulsants.

Finding the right drugs and the right mix or combination of those medications can take some time. And medication only offers small comfort in the big picture of things. Only about a third of the patients are helped and only about a third of their symptoms are improved by this means.

Many patients find nonpharmacologic treatment works best for them. This means they try to manage the pain, symptoms, and loss of function through the use of exercise, counseling, and alternative care such as hypnosis, acupuncture, or biofeedback/relaxation therapy. Clearly, all of the research so far confirms the need to treat this problem with a multidisciplinary approach. A multidisciplinary team of professionals includes doctors, nurses, physical therapists, psychologists, pharmacists, and other practitioners in the healing arts.

Patients must learn as much as they can both about this condition as well as about themselves and what works best for them. That’s easier said than done. Many times the pain and fatigue keep patients from getting the exercise they need. They become deconditioned and weak, which adds to their pain and loss of function.

In the ideal plan, the patient is really the manager who consults with these other experts to formulate the most effective plan. Reducing and managing symptoms, improving quality of life, and decreasing distress are reasonable goals. But the patient must understand that at the present time, there is no cure for fibromyalgia.

Your physician will help you get started and steer you in the right direction. Look for a support group in your area. Meeting with other people who have fibromyalgia can provide you with many helpful tips for managing and staying on top of the symptoms. You can get your life back but be patient with the process. It can take time and often requires some changes along the way — both in your thinking and in your lifestyle.

Fibromyalgia syndrome (FMS) is a chronic pain problem with widespread tender points and muscle pain throughout the body. Most patients with fibromyalgia also list many other symptoms that seem to be part of this condition. Those symptoms range from depression to fatigue to decreased sexual function and difficulty sleeping. Finding one medication to alleviate all of the many symptoms isn’t always possible.

Pharmacologic treatment (the use of medications to aid in managing the symptoms of this condition) offers what is referred to as the first-line treatment. Nonpharmacologic treatment such as exercise, counseling, strength training, and relaxation/biofeedback is usually an important adjunct (secondary or accompanying) treatment. Managing symptoms and improving function often requires a combination of medications and nondrug approaches. It can take a while to find the right blend or mix for each individual so be patient!

Your physician is the best one to advise you regarding which medication to try first. There are several different types of medications available for the treatment of fibromyalgia. The best evidence we have from research is that people with fibromyalgia have some type of dysregulation of the nervous system. Normal everyday ordinary sensory stimuli (touch, pressure, temperature, vibration) become enhanced, amplified, or altered by the nervous system until they are perceived as painful.

The various medications used in the treatment of fibromyalgia attempt to alter, bypass, or downgrade these sensory messages. They include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SSNRIs), and anticonvulsants. Finding the right drugs and the right mix or combination of those medications can take some time. Medication is the first-step. But only about a third of the patients are helped and only about a third of their symptoms are improved by this means. That’s why a whole-person management approach is advised.

Despite all the media hype around taking glucosamine and/or chondroitin, guidelines for the nonoperative treatment of knee osteoarthritis from the American Academy of Orthopaedic Surgeons (AAOS) do NOT support the use of these supplements. There simply isn’t enough evidence to show any clinical benefit of these supplements for individuals with active knee arthritis.

Some studies showed that taking a placebo (fake pill) was just as effective as taking the supplement. Other studies showed the glucosamine supplement was superior to taking a placebo. But stepping back and taking a look at the big picture from all the evidence available, the evidence doesn’t support the use of these products.

The best way to manage knee pain from osteoarthritis is with Tylenol or a nonsteroidal antiinflammatory drug such as ibuprofen. The risk of toxicity is low with these medications and they work better than a placebo. Antiinflammatories seem to be more effective than Tylenol but they have greater side effects such as gastrointestinal problems. If these medications are not sufficient to control pain, steroid injection into the joint might be of some short-term help. Steroid injections are not advised for long-term use.

Patient education, self-management techniques, physical therapy, and exercise are just a few ways this problem can be approached conservatively. The Arthritis Foundation is a good place to get up-to-date reliable information. Your medical doctor, specialist (e.g., rheumatologist if you have one), and/or physical therapist can help you keep track of what is the current scientific evidence to support (or refute) various current treatment approaches.

Your mother’s surgeon is right on with the orders to get her up and moving. Studies show that early ambulation after surgery for hip fracture can reduce complications and the costs associated with those complications. With this approach, more patients are able to go directly home from the hospital. More complications and longer hospitalizations increase the risk of discharge to a secondary unit such as a step-down/transition unit, extended care facility, or nursing home.

Although this information has been reported in the literature, immediate weight-bearing has not become a universally accepted and practiced treatment approach. A recent study from Italy showed that reduced numbers of physical therapists and nurses and the absence of physicians in the hospitals on weekends and holidays appear to make a difference in how patients progress after surgical stabilization of hip fractures. Patients who were operated on right before the weekend (e.g., on Friday) or before a holiday were more likely to experience a delay before getting up and going.

The authors suggest that if, as they showed in their study, the model of care for early in-hospital rehab of older adults with hip fractures can reduce the time of functional recovery, then results (especially long-term results) should be explored further. Data of this type may help move more hospitals toward a pattern of earlier recovery through immediate weight-bearing. If the center where your mother is currently hospitalized has already adopted an immediate weight-bearing protocol, then they should be creating staffing patterns to follow up on the program.

It’s possible your facility normally does have adequate staffing and you happened to hit it at a time when there were some specific staffing problems. You can always check with nursing to see if that’s the case. You may want to contact the administrative staff (probably on Monday) and let them know of your frustration. It may not help your mother’s immediate needs, but it could be the catalyst that helps bring about improved care for others who will face this same problem in the future.

People who suffer from chronic pain syndromes like fibromyalgia, irritable bowel syndrome, temporomandibular disease (jaw pain), or pelvic pain may have more in common than doctors once believed. Recent research has uncovered some new understanding about the way pain develops and is perceived by the affected individual that may link these conditions together.

Risk factors for fibromyalgia or any one of these other pain syndromes do include stress and trauma — physical or emotional trauma. That could be the result of a car accident, giving birth to a child, or as you suggested, being a victim of child abuse or domestic violence. Anyone who suffers from post-traumatic stress disorder (PTSD) is at risk for a problem like fibromyalgia. That includes survivors of war, terrorism, and torture.

But there are other risk factors as well. Women seem to be much more susceptible to this condition than men. That suggests a possible hormonal cause. Fibromyalgia does run in families, pointing to a possible inherited or genetic link. This hasn’t been proven yet but scientists are actively studying specific genes, receptors for pain and other neurotransmitters, and chemicals involved in stress responses. Other stressors have been identified as triggers including infections such as Epstein-Barr virus or Lyme disease, and thyroid disorders.

Right now, there’s no way to predict who might develop fibromyalgia. The best prevention is self-care including proper rest, good nutrition, and daily physical activity and exercise. With a history of abuse, it might be helpful to see a psychologist or licensed counselor to develop healthy stress management techniques.

Reducing risk factors that act as triggers for this condition may be helpful, but again, research is limited in this area. There’s no active proof that taking these steps will prevent fibromyalgia. But there’s plenty of evidence that a lifestyle of this type will enhance health and prevent many other chronic conditions. Either way, you’ll benefit!

Fibromyalgia is described as a neurohormonal mediated chronic pain syndrome. That simply means it is believed that the nervous system and the endocrine (hormone) system are somehow both involved in creating the pain signals that don’t seem to get turned off or even turned down.

But as a fibromyalgia sufferer yourself, you know the best way to describe it is pain everywhere. The muscles are stiff, sore, and tender. The joints ache. There are headaches, difficulty sleeping, numbness and tingling, and problems with bowel and bladder function. In fact, up to 50 or more other distressing symptoms have been reported in association with fibromyalgia.

So what causes this problem and is there a cure coming? Scientists agree that chronic pain of this type is centrally mediated meaning the problem isn’t coming from the muscles, joints, skin, or other soft tissues. It is originating within the systems.

Most likely it gets started in the central nervous system (brain and spinal cord) and then affects on all the peripheral tissues. Since most people with fibromyalgia experience pain with input or stimuli that isn’t usually painful, it is suspected that there’s a problem with pain or sensory processing, rather than some disease, inflammation, or impairment of the area that actually hurts (e.g., the back, the hips, the wrists).

New information is now available on chronic pain mechanisms because of advances in technology (e.g., functional imaging), genetics, and experimental pain testing. Although there is a link between brain function and somatic (body) illnesses like fibromyalgia, this condition is no longer considered a psychiatric (mental) illness like it was in the past.

Functional brain imaging shows areas of the brain that light up when pressure is applied to painful areas of the body. All indications are that once the central pain mechanisms get turned on, they wind up until there’s pain even when the stimulus (e.g., pressure, heat, cold, electrical impulses) is no longer there. This phenomenon is called sensory augmentation. There is some evidence that people with fibromyalgia have a decrease in their reactivity threshold. In other words, with a low threshold, it only takes a small amount of stimuli before the pain switch gets turned on.

We still don’t know why this happens. Many theories are being tested. It looks like the area of the brain that is in charge of sensory integration (taking in, processing, and making sense of all sensory stimuli) is hyperactive. Instead of properly processing the messages, it amplifies (turns up the volume) on them. Several studies using Single-Photon-Emission Computed Tomography (SPECT) have shown changes in the blood flow to certain areas of the brain. In some places of the brain, there was increased blood flow, while in other areas, the tests showed decreased blood flow. These altered patterns of blood circulation could be part of the problem.

MRIs of the brain have confirmed that patients with fibromyalgia process pain in the same areas of the brain as individuals without fibromyalgia. The difference is again with the amount of stimuli needed to activate those pain mechanisms. People with fibromyalgia have a narrow range of pain tolerance. And because women are affected much more often than men, it is suspected that the endocrine (hormone) system must be involved somehow.

Because there are so many variables and factors involved in chronic pain syndromes like fibromyalgia, treatment has evolved over time to become multidisciplinary. Besides medication and cognitive behavioral therapy, patients are also encouraged to stay active and exercise. Studies now show that exercise can be as helpful as medications for chronic pain conditions. Aerobic or cardiovascular training seems to be the most helpful. Low-impact activities like walking or biking, or even better, nonimpact exercise such as swimming are advised. Patients seem to do best when they progress slowly but gradually.

Our updated understanding has changed treatment approaches more toward this multidisciplinary model. Evidence supports finding the right combination of medications along with modifying thoughts and actions. Recent breakthroughs in understanding of pain, brain function, and the details of chemical and biologic responses in patients with fibromyalgia suggest better treatments are on the horizon — perhaps even a cure for or prevention of this painful condition. But right now, there still is no instant cure or pill that will prevent it.

Osteoporosis means the bones are less dense than normal. They have less bone mass than they should. That makes them fragile and can put them at
risk for fragility fractures. A fragility fracture means the bone breaks without a traumatic event or unexpected force. Just the stress of movement and everyday activities causes the bone to break.

Medical doctors rely on evidence from scientific studies to help guide their treatment decisions. In order to avoid fragility fractures, your doctor will want to put you on some supplements that can help build up bone. They know that bone strength is directly linked to vitamin D levels. Fractures are more likely to occur in people with low vitamin D. Supplementation can improve bone density especially during fracture healing when new bone must be put down to heal the old.

Blood can be drawn and tested for vitamin D levels, parathyroid hormone, and calcium (all important ingredients for strong bones). These are called metabolic bone markers as they are an indication of bone health. Not enough vitamin D and/or calcium and too much parathyroid hormone can be treated in order to improve the quality of bone density. It usually takes between six and 12 weeks to see a change in bone mass as a result of treatment.

It’s a good question and one that may not have a single best answer. First, it should be noted that osteoporosis (brittle bones from loss of bone density) is a common problem in the elderly. Women usually start to lose bone density in their 50s and 60s after menopause.

Men lose bone mass, too, but it’s delayed by 10 years so occurs more in their late 60s and early 70s. The risk of bone fracture increases with any amount of osteoporosis but the more brittle the bone, the greater the risk. Inactivity and a sedentary lifestyle also leads to general deconditioning and loss of muscle mass called sarcopenia and muscle strength. Along with that comes a loss of flexibility and balance. Visual impairment, the use of multiple medications, and the presence of diabetes or other health problems head the list of additional risk factors for falls.

Once a fall happens, what determines which bones are broken? Body mass, direction of the fall, and reflexive reactions to right the body in an attempt to regain balance during the fall have something to do with it. The force of the landing and the angle of impact create vectors that help determine where the force is translated along the bone.

But a new finding might also help explain fracture locations. MRIs and arthroscopic exams of joint cartilage have shown that the biomechanical properties of joint cartilage might have something to do with it. It turns out that the cartilage in the hip weakens with age and is less resistant to stress compared to the ankle, for example.

The tensile stiffness of hip and knee articular cartilage also decreases with age much faster compared to the stiffness of the ankle. The thinner ankle cartilage just doesn’t seem to respond to the aging process in the same way hip or knee cartilage does. Scientists think that might help explain why people are more likely to develop arthritis in the knee compared to the ankle as well.

Chondrolysis is the medical term for rapid destruction of articular cartilage. That’s the cartilage that lines the joints and makes smooth motion possible. This is a rare condition that seems to develop following arthroscopic surgery. Eight to 12 months after the procedure, a rapid and complete loss of the articular cartilage affects both sides of the joint. The patient may not experience any symptoms at first but then pain and loss of motion develop. The symptoms advance quickly over a short period of time (four to six weeks).

No one is quite sure why chondrolysis develops in some people after arthroscopic procedures. It happens after all kinds of arthroscopic operations — not just for one type of problem. It happens in patients who have had thermal devices, suture anchors, and pain pumps put in the joint. But not everyone who have those implants develop chondrolysis, so there probably isn’t just one single reason for this rapid destruction of the joint cartilage.

Treatment centers around stimulating a healing response of the cartilage to save the joint, rather than remove and replace it. Joint sparing is the name given this approach. There are several ways to do this but it’s a challenge because the cartilage doe not have a good blood supply to promote healing and recovery. The first (and most commonly used) procedure is called debridement. The joint is shaved and smoothed down. Any debris or loose fragments of cartilage are removed. This helps restore smooth, pain free motion.

Microfracture is another method used to stimulate the cartilage to regrow. Tiny holes are drilled through the cartilage into the bone. This causes bleeding and signals a repair process to begin.

Other ways to restore damaged cartilage include autologous chondrocyte implantation (ACI) and osteochondral autologous transplant (OATS). In these procedures, cartilage is placed inside the lesion in hopes of restoring the normal structure and function of the original cartilage. ACI is a new way to help restore the structural makeup of the articular cartilage. Surgeons may recommend this procedure for active, younger patients (20 to 50 years old) when the bone under the lesion hasn’t been badly damaged, and when the size of the lesion is small (less than four centimeters in diameter).

ACI is done in two parts. First, a short surgery is scheduled to allow the surgeon to take a few normal, healthy chondrocytes and use them to grow more in a laboratory. At a later date, the patient returns for a second surgery, at which time the surgeon implants the newly grown cartilage into the lesion and covers it with a small flap of tissue. The cover holds the cells in place while they attach themselves to the surrounding cartilage and begin to heal.

With the second restorative procedure, OATS, a plug of cartilage and the first layer of (subchondral) bone are removed from normal, healthy cartilage and transferred to the site of the cartilage defect. This can be done all in one procedure and does not require two operations like the ACI.

An orthopedic surgeon can evaluate your problem and make the best recommendation for treatment based on the condition of the damaged cartilage, your age, activity level, and any other risk factors that might affect treatment. If you do not have an orthopedic surgeon of your own, see your primary care physician. He or she can recommend the best way to pursue management of this problem.

Reinjuries are common among high school athletes. None of the sports are immune to this problem. Football, volleyball, basketball, soccer, wrestling, baseball, and softball all come with an increased risk of sports injuries.

Sometimes it helps to see what’s happening in high school sports re: injuries and reinjuries reported across the U.S. A recent study from Ohio State University reported that recurrent injuries occur more often during competition than in practice. High school football has the highest rate of competition-based recurrent injuries. Volleyball has the lowest rate of competition-based recurrent injuries. Volleyball players are more likely to injure themselves during practice.

In sports played by both sexes (volleyball, soccer, basketball, softball, baseball), girls have more recurrent injuries playing soccer. Girls participating in soccer, softball, and basketball had the highest rate of recurrent concussions.

How does this information help you? It gives you some idea of what to watch for and when. Knowing that reinjuries occur more often during competition may change the way you coach the girls during practices and games. Keeping players from staying in the game is your job. Do it diligently and with an eye toward prevention for every team member, but especially your stronger players. It is tempting to keep your best player in more than is safe. Each win is important but the team may be adversely affected if a key player is out with a preventable injury for the season.

Make sure injured team members have sufficient recovery time before reentering practice and competitions. We still don’t have evidence-based guidelines for safely returning players to the game. But preliminary results suggest that completing the full rehab program may be more important than we thought. Players are eager to return to play and don’t always finish the last phase of rehab that fully prepares them for competition.

With concusions being a common injury in soccer, it’s important to make sure the player is fully recovered before returning to practice. Be aware that a second (or even third) concussion can lead to more severe symptoms and can even result in death. Recurrent concussions resulting in a life-threatening condition are called second-impact syndrome. Disability or death from second-impact syndrome is certainly a good reason to find ways to prevent sports injuries.

Sometimes videotaping practices and games gives some clues that might help your particular team members avoid injuries. Breaking down plays that result in injury can help isolate and identify risk factors that might be specific to a team member or the team as a whole. And, of course, proper protective gear must be worn at all times.

Symptoms of shoulder, elbow wrist, and/or hand pain and dysfunction from work-related repetitive tasks have been labeled as upper extremity musculoskeletal disorders (UEMS). According to the results of a recent study of UEMS, the recovery rate from these problems does depend on the site of the disorder.

Elbow pain and dysfunction have the best prognosis for recovery, whereas problems in more than one area are less likely to clear up (or take much longer to heal). Workers with multiple UEMS disorders like yourself are more likely to have persistent problems or recurrent symptoms compared with workers who have single-site involvement. Those with multiple UEMS have more pain that lasts longer.

Recovery rates for neck, shoulder, wrist, and hand fall somewhere between the results for elbow and the outcomes for multisite disorders. Older workers (defined in this study as over 30 years of age) were more likely to fall into the category of multiple UEMS compared with younger patients (under 30 years).

All of that sounds a bit negative but the information provides researchers with a spring board for action. Now they can look more closely at treatment and see which approach has the best results for single site and multiple site symptoms. And it will be possible to look at the results for each individual area (shoulder, neck, elbow, wrist, hand).