Knee pain is a common complaint among skiers, and often knee pain in skiers is the result of an injury. The location and severity of the pain depends on the cause of the problem. Signs and symptoms that often accompany knee pain include redness, warmth, weakness, instability, swelling, stiffness, œlocking, and œpopping.

Be sure to notify your orthopedic specialist if you have knee pain accompanied with swelling, cannot fully extend of flex your knee, notice a deformity, have a fever, or if the knee œgives out.

Knee Injuries from Skiing

Because of the mechanics of the sport, knee injuries are quite common for skiers. These injuries can range from simple to complex, with 25% of all ski injuries affecting the knee.

MCL Injury – The most commonly injured knee structure is the medial collateral ligament (MCL). This is because of the type of stance and turn skiers use that places serious stress on the inside of the knee.

ACL Injury – The anterior cruciate ligament (ACL) is injured in more advanced skiers or from those who have a specific type of fall. ACL injuries are associated with sudden direction change with a twisting injury accentuated by the long lever arm of the ski.

Torn Meniscus – Another common skiing injury is a torn meniscus. The meniscus is a rubbery tough cartilage that acts a shock absorber for the joint. It is torn when you suddenly twist your knee with weight on it or from a direct contact blow during a fall.

Knee Bursitis – Certain knee injuries lead to inflammation of the bursae, the small sacs of fluid that cushion the knee joint. This condition is painful, especially with bending of the knee, and swelling is common.

Patellar Tendinitis – When one or more tendons are irritated and inflamed, patellar tendinitis develops. The tendons are the thick fibrous cords that attach bone to muscle. Skiers are prone to inflammation of this tendon that connects the quadriceps muscle on the front of the thigh to the tibia (shinbone).

Knee Dislocation – Pain from dislocation of the knee joint is rare and is a true emergency. The displacement of the leg stretches and tears the knee ligaments and may involove injuries to the arteries and/or nerves. This painful condition often produces an obvious knee deformity and requires immediate medical attention.

Kneecap (Patella) Dislocation – Dislocation of the patella is caused from direct trauma or forceful twisting of the knee. Obvious patella deformity occurs with this condition, and you should seek medical care immediately.

Runner’s Knee (Patellofemoral Pain)

Skiers put heavy stress on their knees that causes a condition called runner’s knee. This knee pain syndrome causes pain around the front aspect of the knee. The pain occurs with walking up or going down stairs, squatting, kneeling, or sitting.

Patellofemoral pain is caused by malalignment of the knee, partial dislocation, injury, flat feet, or tightness and weakness of the thigh muscles. Runner’s knee can be the result of soft tissue irritation in the front of the knee.

Treatment for Knee Pain

Treatment of your knee pain will depend on the particular problem that is causing the pain.

Basic First Aid for Knee Pain

Stop skiing and use the RICE formula:

Rest – Avoid putting weight on the painful knee.

Ice – Apply cold packs or ice wrapped in a towel for short intervals of time frequently.

Compression – Use an elastic bandage, like a simple knee sleeve with the kneecap cut out that fits snugly.

Elevation – Keep the knee raised up higher than your heart.

Nonsurgical Treatment

If you have knee pain, you should see an orthopedic specialist. The doctor may recommend physical therapy for you to learn reconditioning to regain full range of motion, power, strength, speed, and endurance. These exercises help the front thigh muscles (quads) and the back thigh muscles (hamstrings).

Another thing the doctor may recommend is a special brace to help protect and support the knee. Certain knee pain syndromes respond to injections of corticosteroids to reduce inflammation. The doctor may recommend a hyaluronic acid injection for joints that need extra lubrication.

Surgical Treatment

There are several surgical knee procedures for knee pain.

Arthroscopy – This is done when there is significant damage to the cartilage or meniscus. The orthopedic specialist uses a pencil-sized instrument (called an arthroscope) to look inside the knee joint to diagnose and repair your condition.

Realignment – This is done to reduce the pressure on the cartilage and supporting structures of the front aspect of the knee.

Partial Knee Replacement Surgery – This procedure is done when there is serious damage to the knee. The orthopedic specialist replaces the damaged portion with parts made of metal and plastic.

Total Knee Replacement – This surgery is done when the doctor must remove significant damaged bone and cartilage and replace it with an artificial joint.

Knee Pain Prevention

Keep weight normal – Maintaining a healthy weight is the best thing you can do to prevent knee pain and injury.

Get strong and stay limber – Weak muscles lead to knee injuries, so keep your quads and hamstrings strong. Balance and stability training allows the muscles of the knees to function properly. Also, avoid injury by stretching to increase flexibility.

Stay in shape – Prevent knee pain and injury by keeping yourself well-conditioned.

Use proper gear – Make sure your skiing shoes are good shock absorbers and of quality construction. Also, be sure your shoes fit properly.

Distal Radius Fracture

The radius is the larger of the two forearm bones. The end near the wrist is referred to the distal end, and the end close to the elbow is called the proximal end. Distal radius fractures are breaks in the radius bone close to the wrist. Most distal radius fractures occur when you fall onto an outstretched hand or from a car accident or other trauma. When the distal radius fractures, there will be instant pain, bruising, swelling, and limited range of wrist motion. Sometimes, the wrist will appear deformed or out of alignment.

To diagnose a distal radius fracture, I will need to take an X-ray of the wrist. An open fracture is where the bone breaks through the skin. If the fracture extends into the joint, it is called an intra-articular fracture. Fractures that do not go into the joint are extra-articular fractures.

Treatment of a distal radius fracture involves the immediate measure of stabilizing the arm and applying an ice pack. You do this to protect the injury from further insult and to decrease swelling and control pain. One nonsurgical option is casting done if the bone is in good position. I may find it necessary to straighten (or reduce) the bone to align it correctly. Surgery is necessary when the bone must be reduced through an incision. This is called an open reduction, and these procedures often require pins, plates, and/or screws to hold the bone pieces in place.

Scaphoid Fracture of the Wrist

The scaphoid bone is one of the many small bones of the wrist. It is located on the thumb side of the wrist where the bending occurs, just above the radius bone. When the scaphoid bone fractures, you will have pain, decreased wrist movement, bruising, swelling, and tenderness.

Most scaphoid fractures occur when you fall onto an outstretched hand. To diagnose a scaphoid fracture of the wrist, I will need to do X-rays to evaluate for displacement. Many times, however, a break in this area does not show up right away. If I suspect the scaphoid is fractured, I usually apply a wrist splint for a couple of weeks and have you come back for a repeat evaluation and possibly an MRI.

Treatment of a scaphoid fracture depends on the exact location of the break. Those that are near the thumb typically heal in a few weeks with protection. If the fracture is more complicated, I may apply a cast to the wrist and monitor the healing. Breaks of the middle area of the scaphoid are more difficult to heal due to limited blood supply.

I often recommend surgery for these types of scaphoid fractures. I make a small incision and insert metal implants to hold the bone in place while it heals. In rare incidences, a bone graft is necessary. Whether or not surgery is necessary, you may need to wear the cast or splint for as long as six months.

Elbow Fractures

The bony aspect of the elbow that extends from the ulna arm bone is called the olecranon. This prominence is located under the skin with little protection from the soft tissues or muscles. The elbow joint consists of three bones, and these allow it to bend and straighten like a hinge. The humerus is the upper arm bone, the radius is the thumb side lower arm bone, and the ulna is the pinky side lower arm bone. When the elbow is injured, either by breaking one of these bones or by tearing a ligament that connects one bone to another, it can be stiff, painful, and unstable.

Elbow fractures occur from a direct blow, such as being hit with a baseball bat, or indirectly from landing on an outstretched arm with the elbow locked out straight. Symptoms of a fracture of the elbow include sudden intense pain, swelling, bruising, inability to straighten the elbow, numbness in one or more fingers, pain with joint movement, and tenderness. In order to diagnose an elbow fracture, I must examine the injury and take an X-ray of the joint.

Treatment depends on the extent of the injury. Some fractures of the elbow only require a splint, sling, or cast and conservative measures, while others require surgical intervention. If the bones are out of place, or if there are pieces of bone cutting through the skin, surgery will be needed.

Generally, I make an incision over the back of the elbow and hold the bone pieces and other structures together with pins, wires, plates, screws, and/or sutures. Once the surgery is over, I apply a cast for a short period of time and restrict activity to allow for healing.

Shoulder injuries occur from athletic activities that involve repetitive, excessive, overhead motion, such as pitching baseball, tennis, swimming, and weightlifting. Injuries to the shoulder also happen from doing everyday activities, such as hanging curtains, washing walls, or lifting the laundry basket. The shoulder is a complex joint that connects with muscles and tendons to allow full range of motion of the arm.

The shoulder consists of the head of your upper arm bone (the humerus), your shoulder blade (the scapula), and your collarbone (the clavicle). The humerus fits into a round socket called the glenoid. The rotator cuff is a combination of tendons and muscles that keep your humerus in alignment.

The shoulder’s unique mobility leads to problems of impingement of the bony structures or the soft tissues as well as instability. With some shoulder injuries, you may only feel pain with movement of the joint. Others, however, result in pain at rest.

What are the types of shoulder injuries?

Most shoulder injuries fall into one of the four major categories: (1) tendon inflammation or tear; (2) instability; (3) arthritis; and (4) fracture.

Rotator Cuff Tears – The rotator cuff is one of the most significant structures of the shoulder. This component allows you to lift your arm and reach overhead. When your rotator cuff is injured, you will have loss of function of the shoulder.

Bursitis – A bursae is a small, fluid-filled sac that is located in the shoulder joint and other joints of the body. When the bursae is inflamed and swollen, there is loss of cushion between the bones and the overlying soft tissues that reduce the friction of the gliding motion. This condition is called bursitis, and it can cause the shoulder to have pain and loss of function.

Tendinitis – A tendon is a cordlike structure that connects muscle to bone. Tendinitis of the shoulder is the result of wearing down of the tendon from overuse. The acute form of tendinitis results from excessive throwing or other overhead activities during sporting activities or work. Chronic tendinitis is due to age, and there is degeneration of the tendon with this condition.

Tendon Tears – The tendon can split and tear from an acute injury or degenerative changes related to the aging process, long-term overuse and wear and tear, or from sudden trauma. Tendon tears can be partial or complete.

Impingement – Shoulder impingement is the result of the top of the shoulder blade putting pressure on the underlying soft tissues during arm lifting. The blade rubs on the bursa and rotator cuff causing limited movement and pain. If left untreated, severe impingement can result in rotator cuff tearing.

Instability – The shoulder is considered unstable when the head of the humerus is forced out of the socket. Instability occurs from sudden trauma or due to overuse of the joint. Dislocations can be partial (called subluxation), where the ball of the upper arm just partially comes out of socket. A complete dislocation is where the ball comes all of the way out of position. If the surrounding support structures are torn or loose, dislocations can occur repeatedly. Shoulder instability leads to increased risk of arthritis.

Arthritis – When there is wear and tear on a joint with inflammation, the joint is considered to have arthritis. Shoulder joint arthritis causes stiffness, decreased range of motion, crepitus, and pain. This type of injury is more common among older people.

Fracture – A fracture is a broken bone. Shoulder trauma can result in a fracture of the humerus, the clavicle, or the scapula, and this causes severe pain, bruising, and swelling of the shoulder.

What can I expect at the doctor’s examination?

If you have a shoulder injury, you should seek medical attention immediately. I will conduct a thorough evaluation in order to determine the cause of your shoulder pain and offer prompt treatment. During the physical examination, I inspect your shoulder for physical abnormalities, deformity, muscle weakness, tender areas, and swelling.

It is also necessary for me to assess your joint range of motion and strength. To properly evaluate your injury, I will take X-rays and possibly order a MRI, CT scan, and/or ultrasound. An arthroscopy is a surgical procedure where I look inside the joint with a tiny camera to evaluate the extent of the injury. This may be necessary for repair and diagnosis of certain shoulder injuries that are complex.

What is the treatment for shoulder injury?

The treatment of your shoulder injury depends on the type of injury. Some of the various options that I utilize include:

Activity Changes – Treatment typically involves alteration of your activities and rest so your shoulder can regain strength and flexibility.

Physical Therapy – Certain types of shoulder injuries require physical therapy. This treatment involves exercises and range of motion techniques that help you regain strength and motion of the shoulder joint.

Medications – I often prescribe certain medications to reduce inflammation and pain. Also, specific shoulder injuries require injections of anesthetics or steroids.

Surgery – While some shoulder injuries respond to conventional treatment modalities, others require surgical correction and intervention. Rotator cuff tears and recurring dislocations often require surgery. I also perform arthroscopic procedures to remove scar tissue and repair torn tissues for some shoulder injuries.

Plica syndrome of the knee occurs when synovial tissue bands become irritated from injury or overuse. Pieces of synovial plica are remnants from early fetal development. These plica are membranes that should normally diminish during the second trimester of fetal development. When the pouches do not combine to form a synovial cavity, the plica remain in the knee as bands of synovial tissue.

Plica syndrome of the knee is associated with chronic overuse, inflammatory conditions, and knee injury. The medial plica is one of the four plica that are found in the knee. This piece of the lower end of the kneecap runs sideways and attaches to the lower aspect of the thighbone.

How does a plica cause problems in the knee?

A plica that becomes irritated causes knee pain. This occurs as a result of repetitive motions, certain exercises, or from kneeling. Any activity that causes repetitive bending and straightening of the knee can cause knee plica syndrome, such as stair-climbing, running, or biking. When the knee is struck near the medial plica from a fall or car accident, knee plica syndrome can develop. These types of injuries cause the plica and the tissue around it to swell and become painful.

What are the signs and symptoms of plica syndrome?

The main symptom of plica syndrome is pain. There is frequently a snapping sensation along the inside aspect of the knee when it is bent. This is caused by the rubbing of the thickened plica over the edge of the thighbone where it enters the joint. The knee may also be tender to touch and swollen.

How is plica syndrome diagnosed?

The orthopedic specialist diagnoses plica syndrome during a physical examination or at an arthroscopic surgery procedure. X-rays, a CT scan, and/or a MRI may be done to rule out other problems. X-rays rule out fractures, and the MRI shows soft tissue injuries. The CT scan can detect a thickened plica in some cases. To confirm the diagnoses and treat the problem at the same time, the orthopedic specialist may perform an arthroscopy.

What is the treatment for plica syndrome?

Our orthopedic specialists treat plica syndrome by resting the knee joint and with anti-inflammatory medications. If these conventional measures do not ease the pain of the knee, the doctor may inject cortisone into the joint.

Cortisone is a powerful anti-inflammatory agent. For serious cases of plica syndrome, surgical removal of the plica may be necessary. This procedure is done with an arthroscope, using a small camera and tiny instruments to remove the inflamed tissue.

The area left once the plica is removed heals with minimal scarring. Plica resection is often needed. The goal of treatment is to reduce the inflammation and restore function.

What is involved with the rehabilitation process?

If your doctor treats you non-surgically, you should return to normal activity within 4 to 6 weeks. It may be necessary for you to see a physical therapist during this time to learn stretching and strengthening exercises.

Other therapies include friction massage, ultrasound, and ice applications, all done to decrease the inflammation associated with plica syndrome. If you have surgery, you will need physical therapy to help you regain strength and function.

A fracture is a broken bone. These types of injuries occur when there is physical force exerted on the bone. Broken bones are common during childhood. Also, as you age, your bones become more stiff and delicate and you are more susceptible to fractures. There are several types of fractures, but the main categories are displaced, non-displaced, open, and closed.

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