Knee Bursitis

Spring is right around the corner, and with the warmer weather, many of us will be getting back to our gardens or home improvement projects we postponed over the winter. After weeding in the garden, laying down new flooring, or performing any other activity for which you spend time on your knees, it can be normal to develop some soreness. This may, however, develop into increased pain, swelling, and inflammation. These symptoms are commonly caused by a condition called knee bursitis.

What is knee bursitis?

In our body there are hundreds of fluid-filled sacks called bursa. They live in between various parts of our body such as between tendons and bones, muscles and other muscles, or skin and the underlying structures, to name a few.

Bursae act as a slippery surface that allow for the many parts of our body to easily move against one another.

knee pain

One of the places you have bursae is around your knee. The two main bursae are the prepatellar bursa, which lives in front of the patella (the small mobile bone on the front of the knee), and the infrapatellar bursa, which lives in front of the patellar tendon (the thick tendon that runs from the patella to the main bone of the lower leg).

Who gets knee bursitis?

Bursitis can affect individuals of any age; however, as we age the skin overlying the knee slowly begins to thin. With this thinning there is less cushion for the underlying bursae. As such, older individuals are at greater risk for knee bursitis. Additionally, patients on chronic glucocorticoid therapy are also at greater risk for knee bursitis.

Signs of Knee Bursitis

Bursitis typically feels like pain and swelling in the knee, and you may also see some redness. When the bursa becomes inflamed, it can fill with more fluid, leading to swelling in front of the knee. When the knee is bent, this fluid filled bursa becomes compressed against the front of the knee (imagine pushing against a water balloon). This causes the bursa to stretch, leading to pain. This is why pain associated with knee bursitis typically worsens with bending of the knee and improves when the knee remains straight. If the bursitis is left untreated, the fluid filled sack has the potential to rupture. This could then lead to an infection of the surrounding skin.

Knee Bursitis Diagnosis

The diagnosis of knee bursitis can be made by an experienced clinician, who will ask you about your knee pain and examine the affected knee. Additionally, the provider will likely take a sample of the fluid in the bursa using a needle and send this for further analysis. The provider may also order blood tests and x-rays to rule out a more serious infection of the joint.

Here at the Orthopedic Specialists of Seattle, we have two experienced surgeons, Dr. Jonathan Franklin and Dr. Charlie Peterson, who have a wealth of knowledge and experience in diagnosing and managing knee bursitis. At our clinic, we also have the laboratory and imaging resources to properly work-up your knee pain.

How do I treat knee bursitis?

Once the diagnosis of knee bursitis is made, the goal of treatment is to relieve the immediate symptoms and prevent it from getting worse. This is achieved in several different ways including a knee brace, pain medications, or applying heat or ice, and your clinician will decide which is best for you. Ultimately, the swelling and tenderness will resolve somewhere between a few weeks to a few months, depending on your condition.

To prevent knee bursitis, it is a good idea to avoid spending too much time on your knees and take breaks often. Or, if you will be working on your knees, it can be helpful to wear knee pads or use a kneeling pad. Here at Orthopedic Specialists of Seattle, our goal is to help you return to your beloved activities as soon as possible and to prevent further episodes of pain.

Magnetic Resonance Imaging (MRI) – Accredited Facility

Seattle Orthopedic Center has been awarded a three-year term of accreditation in magnetic resonance imaging (MRI) as the result of a recent review by the American College of Radiology (ACR).

The ACR gold seal of accreditation represents the highest level of image quality and patient safety.  It is awarded only to facilities meeting ACR Practice Parameters and Technical Standards after a peer-review evaluation by board-certified physicians and medical physicists who are experts in the field. Image quality, personnel qualifications, adequacy of facility equipment, quality control procedures and quality assurance programs are assessed.

Broken Foot: Common Symptoms and Treatments

foot injuries

There are several medium and small bones that make up the three sections of the foot. The forefoot includes the slender bones that make up the 5 toes (phalanges) and the anterior portion of the arch of the foot (metatarsals).

The mid-foot is made up of more compact bones (navicular, cuboids, and cuneiforms) that make up the top of the arch of the foot. The hind-foot is made up of two bones, the talus that connects the foot to the lower leg and the calcaneus (the heel).

Foot injuries are common and can arise from a multitude of different mechanisms. Each of the bones of the foot are subject to fracture from externally applied forces. Fractures to the talus and calcaneus (hind foot) are typically caused by crushing forces, such as landing from a great height.

Fractures to the forefoot can be caused by crush, flexing, and twisting forces. In addition to trauma directly to the bone, there are ligaments and tendons attached to the bones of the foot. If enough force is applied to these ligaments and tendons, they can separate and take a small piece of bone with it.

In addition to fractures from a single traumatic blow, some fractures can result from repetitive impacts to a bone. This is called a stress fracture and commonly occurs in the metatarsals of the foot.

Common Symptoms

It can often be difficult to distinguish fractures from other types of injuries of the foot, such as sprains of the ligaments or bruises of the soft tissue. If a bone is fractured, there is typically pain localized to the fracture. There will also likely be soft tissue swelling around the affected area.

Treatment Options

To determine if there is a fracture radiology studies such as x-ray and CT may be necessary. Careful physical exam performed by an experienced surgeon can also help to elucidate whether or not a bone is fractured. Depending on the fracture type and location, there are multiple types of repair. These range from simple alignment and casting to surgical repair with hardware placement. Dr. Mark Reed of OSS is well versed in all of these repair techniques.

A New Treatment Option for Big Toe Arthritis?

Hallux Rigidus

Big toe arthritis, also called 1st metatarsophalangeal (MTP) arthritis or hallux rigidus, is a common condition affecting the foot and ankle. It is the most common site for arthritis in the foot. Patients typically develop symptoms between age 30 and 60, and females are more commonly affected than men.

Presentation
Patients typically develop stiffness and decreased range of motion at the big toe, which affects walking, running, and other athletic activities. Some patients develop large bone spurs on the top of the foot, which can cause pain with shoe wear and discomfort when going up on the toes.

Causes
Sometimes trauma (a fracture or crush injury) can lead to this condition, but for most patients there is no specific inciting event. Some patients are more likely than others to develop big toe arthritis, either because of some anatomic abnormality or because of genetic predisposition.

Diagnosis
A clinical exam and x-rays can confirm the diagnosis. Generally, advanced imaging like MRI or CT scan is not required.

Treatment
Non-surgical options include anti-inflammatories, shoe wear modifications, and over-the-counter or custom inserts (orthotics). Physical therapy can be helpful to maintain range of motion. Occasionally cortisone injections into the joint can decrease inflammation for a period of time.

Surgery can be used to treat cases that fail non-operative treatment. Traditionally, a procedure called a cheilectomy can be used to remove bone spurs from the top of the big toe joint. This is recommended for mild to moderate cases of hallux rigidus. This is a joint-sparing procedure. Recovery involves walking in a surgical sandal for about 3-4 weeks after the surgery.

For moderate to severe arthritis, a fusion has until recently been the only proven surgical option. This is a joint-sacrificing procedure, in which the bones on either side of the joint are fused together with screws and possibly a plate.

This reliably addresses pain symptoms but eliminates all motion at the joint. Recovery involves a period of non- or heel- weight bearing followed by fully weight bearing in a surgical sandal for 8 weeks or more after the surgery.

Cartiva

A New Surgical Treatment Option

A new option is Cartiva, which can be an alternative to the aforementioned procedures. Cartiva is an organic polymer engineered to match the properties of human cartilage, which is what wears out as arthritis progresses. Your surgeon implants the polymer into the head of the 1st metatarsal, to act as a new joint surface. This is a joint-sparing procedure which retains, and in many cases increases, range of motion.

Recent literature shows greater than 90% patient satisfaction after 5 years of implantation. Recovery is similar to that of cheilectomy, and involves fully weight bearing in a surgical sandal for about 3-4 weeks after the surgery. If the procedure does not resolve pain, a fusion is still a surgical option for you.

Summary

Hallux rigidus is a common condition that involves pain, swelling, stiffness and decreased range of motion of the big toe. Diagnosis is often straightforward and involves a clinical examination and x-ray. Several non-operative treatments exist, including NSAIDs, shoe wear modifications, shoe inserts, and injections.

When non-operative treatment fails, surgery is an appropriate option. Cartiva may be an appropriate treatment option to avoid fusion of the big toe. Please see a qualified foot and ankle orthopedic surgeon if you believe you may be a candidate.

Mark Reed, MD is a fellowship-trained foot and ankle orthopedic surgeon who has undergone training on the Cartiva procedure and has incorporated it in his practice. Please contact OSS to schedule an appointment for an in-depth evaluation.

Shin Splints – What are They & How to Treat

Shin Splints

If you are a runner, you have likely experienced at some point that pulling pain along your lower legs. Most people report symptoms as a dull ache along the front part of the lower leg, pain along the inner part of the lower leg, pain on either side of the shin bone, muscle pain, or swelling of the lower leg.

In some rarer cases, people will also experience numbness and weakness of the feet. This is generally known as “shin splints”, or medial tibial stress syndrome (MTSS). Typically it coincides with exercise and may be associated with changes to training level, intensity, duration, running surface, or footwear. It is a common condition said to affect anywhere between four to thirty five percent of athletes.

shin splints

Medial Tibial Stress Syndrome

MTSS is an overuse injury that is most commonly caused by excessive pronation and repetitive impact activities. Pronation, or the way that the foot rolls inward upon impact with the ground, is the body’s natural mechanism for shock absorption. During this process, the lower leg, knee, and thigh also rotate internally.

In cases of excessive pronation however, the arch of the foot flattens and inward rotation of the foot is exaggerated. This increases stress on the muscles, tendons, and ligaments of the foot and lower leg, causing lower leg pain. With repetitive high impact activities such as running, the frequent strain will often cause inflammation and swelling about the lower leg, exacerbating the pain.

In most cases, MTSS is easily managed with rest, ice, and the use of nonsteroidal anti-inflammatory medications. Sports massage and calf stretching exercises may also be used to reduce tension in the muscles of the lower leg. Once the acute symptoms have resolved, it is important to identify and correct the triggers of MTSS.

Physical therapy is a wonderful option for those seeking professional assistance with learning proper stretching techniques, creating a proper training program focused on gradual conditioning, and addressing biomechanical issues. There are also many orthotists in the area who can create customized shoe inserts that help correct any alignment issues, such as over-pronation of the feet. It is generally treated non-surgically with great success.

While MTSS is a relatively benign condition, lower leg pain, swelling, numbness, and weakness can also indicate more serious conditions such as: stress fracture, exertional compartment syndrome, popliteal artery entrapment syndrome, various nerve entrapment syndromes, or gastrocnemius-soleus muscle strain. These can often be confused with MTSS given the similarities in their symptoms and cannot be identified without advanced imaging studies such as x-ray, CT, MRI, MRA, or Doppler ultrasound.

If you a runner with leg pain and have not responded to standard therapies, it is important to seek out a qualified foot and ankle orthopedic surgeon.