Transcription:
How to Treat Your Knee and Shoulder Pain

Melanie Cole (Host): Joint pain in your shoulders and knees is extremely common and can range from mildly irritating to absolutely debilitating. My guest today is Dr. Matthew Byington. He’s an orthopedic surgeon with Prairie Orthopedic. Welcome to the show, Dr. Byington. What are some of the most common causes of knee and shoulder injuries that you see?

Dr. Matthew Byington (Guest): Thanks for having me today. Yeah, so, today we’ll talk a little bit about joint pain, and specifically, knee and shoulders. We see this every day in our office, and some of the main reasons that people are presenting are due to – either it’s something due to a recent injury where they were lifting something and felt a rip or a tear in the shoulder and/or they were doing some type of an impact in exercise or some type of a lift – going from squatting to standing and felt a pop in their knee. Those are associated with – in the shoulder it would be a rotator cuff, soft tissue injury, and in the shoulder, specifically, there’s different structures such as the joint itself has cartilage. The cartilage is a protective cap over the end of the bone that is sort of like a set of brake pads in your car. When your brake pads wear out, you’re down to the rotors, and when your cartilage wears out, you’re down to the bone.

In the shoulder — and in the knee actually, too, when this cartilage gets injured, that can create little flaps or tears of cartilage that can cause quite a bit of discomfort and pain. Also, in the shoulder, you have the rotator cuff tendon. There are four different muscles and tendons that really help to stabilize the shoulder and help the shoulder function well, and if you injure the structure, your function is thrown off, as well. You have some pain as well. The question is often times did you tear the tendon or is there just an inflammation like a tendinitis-type of picture going on.

Tendinitis — and arthritis, which is where the cartilage wears away – those are some of the more common reasons we see shoulder pain. And in the knee, again, arthritis is a very common source of pain where the cartilage is injured and/or you have a chronic degenerative cartilage wearing away where arthritis flares up and causes discomfort.

As opposed to – there’s a structure in the knee called the meniscus. Meniscus tear or meniscus injury is one of the most common procedures that we take care of in orthopedic surgery. When people feel that pop, if they feel a click, catch, or giving away in that knee, it can oftentimes be that meniscus that is injured. We would be able to evaluate that in our clinic.

The younger population – so, some of the kids that are in high school, and college, and in their 20s playing high-level sports, their types of injuries are a little bit different. Most often times in the knee, that can be from a ligament injury like the anterior cruciate ligament injury or tear and in addition to the meniscus injury. And in the shoulder, the young athlete will oftentimes have an injury to what we call the labrum, which is a – again, the shoulder is a ball and socket, and the labrum is a tissue that – is a bumper of tissue that is circumferential around the socket of the joint. That gets injured with different mechanisms, oftentimes a subluxation or a little instability event of the shoulder depending on the sport and the mechanism. It really depends on the population as far as what is causing the pain, again, arthritis, bursitis, sprains, strains, and tendinitis. Those types of things are the main reasons we’re seeing patients for joint pain.

Melanie: Dr. Byington, let’s start with knee injuries first – might as well start from below and work our way up – and ACL injuries in soccer playing girls and athletes, as you mentioned, notwithstanding – the normal weekend warrior, maybe the runner, the walker, a woman in heels, whatever might be the cause of their knee injuries, what do you tell people to do? Is rice – if you sustain an acute injury at the beginning, is rice still what you use? Is that what you recommend? And do you also recommend bracing – if you’re someone who has arthritis or chronic knee pain, do you recommend bracing if you're going to go play tennis or go for a walk?

Dr. Byington: Yeah, good questions. I think most people have a good intuition about their injury. The first thing I like to tell patients is, “Listen to your body and let pain be your guide. If it hurts, back off. Don’t do things that hurt.” The old acronym of RICE -- Rest, ICE, Compression, Elevation – that definitely does have some value to it. It depends on the severity of the injury, the main point being if you feel like it’s a very severe injury, you want to go to the emergency room. That’s oftentimes people’s intuitions kicking in.

For most people’s injuries, or ailments, or discomfort, or pain, rest is going to definitely help and giving things time to heal. The acronym THAW – Time Heals All Wounds – is something that applies to most people every day of people’s aches and pains getting better as time goes on. The body has a great way of healing itself but how about when the time doesn’t help? If things are just not getting better, that’s when it’s important to go down your algorithm of your icing, and taking anti-inflammatories if you’re okay to take them medically. If you have a history of any ulcers or any kidney problems, then you really should be talking with your primary care doctor if you should be taking anti-inflammatories or not.

Ibuprofen and Advil are four pills three times a day. That’s twelve pills. That’s a lot of pills to take, as opposed to Aleve and naproxen. That’s just essentially two in the morning and two at night. It’s easier to take four pills a day, and you put that bottle of the Aleve next to your toothbrush, and when you brush your teeth in the morning and at night, you can take your Aleve for an initial injury. It’s just a good rule of thumb as opposed to it’s not as easy to be compliant taking all those pills for the Advil.

Compression and elevation – you really see that more applied for knee injuries. If your knee is really swollen, it really is important to try to keep that swelling down with ice and compression with possibly an ACE bandage and/or a knee sleeve. That’s a sign that you probably should see a physician regarding the injury because swelling is not normal and there could be different reasons for the swelling. Swelling also throws off your mechanics the way that your knee works or moves. If your knee is really swollen, you’re not going to walk normally and then your mechanics are off, and you can injure other tissues because of that.

Rest is definitely good, anti-inflammatories are good, and then one other thing we talk about is physical therapy as another avenue to get people better. When you have therapy — that’s usually prescribed to you by your physician, so that’s after you’ve been seen by the doctor. The question is when do you come in to see the doctor? If you’ve given it the proper time and done these things we’ve talked about and you’re still not getting better; you feel like things are either getting worse or plateaued and not getting better. At that point, it’s important to call up your doc and get in for an appointment to be seen, and again, use your intuition. If you think it’s a severe injury, you can call right away or go to the Emergency Room.

Melanie: Dr. Byington, how often – people hear for shoulders and knees about Cortisone shots, and how often are they – should they be getting these? How often are you willing to give them?

Dr. Byington: In general, we, as orthopedic surgeons, give Cortisone injections no more than four times per year in a joint. There’s been mixed literature about reasons why that is. The main point being is that you don’t want to put too much Cortisone or steroid in a joint where it can break down the tissues or the cartilage. But that, again – there is debate as far as whether that be every three months, or four times a year, or what it is, but that’s a good general rule of thumb how often we can do those injections. Those injections are really lower on the algorithm of treatment as far as what needs to be done to get people better. I like to use the anti-inflammatories, the rest, the physical therapy for getting people better. If that doesn’t work, usually we’re doing a diagnostic image like an MRI to see what’s going on and further investigate the injury. If a steroid injection is indicated, we will do that as well, and sometimes we’ll do that before the MRIs as well.

For shoulders and knees, it’s different. For knees, you’ll give Cortisone injections for arthritis and sometimes for small meniscus injuries, and sometimes some inflammatory type of conditions people have such as rheumatoid arthritis and gout – an example of that. In the shoulder, the injections are given more so for a tendinitis-type of a situation and/or arthritis. That’s when we will use the injections.

Melanie: Wrap it up for us, Dr. Byington, with your best advice for people and what you want them to know about hopefully preventing knee or shoulder injuries whether acute or chronic. What would you like them to know about the best ways to keep healthy knees and shoulders?

Dr. Byington: I think just mainly being active, getting out, and moving. It’s a difficult situation when somebody with bad knee arthritis is having their pain – and one of the treatments for that also is losing weight, and people can’t get out and lose weight because of their knee pain. Well, you can modify the way you do things. You can do some non-impact exercises, such as the elliptical and bike. You can also get in the pool and do some water aerobics or similar types of non-impact type of activities.

As far as treatment surgically for shoulder and knee injuries – usually, as physicians, our goal is to get people better. If surgery is part of that equation, great. We do a lot of knee and shoulder replacements for people with bad arthritis, and we do a lot of rotator cuff repairs and labrum repairs for people who have significant tears. That’s all done through a scope through two or three poke hole incisions. It’s really minimally invasive.

Medicine has really progressed well over the last couple of decades with arthroscopy and its advances. And then, in the knee, again, scoping is a very common procedure that we do for meniscus injuries, ACL reconstruction for ligament injuries. A lot of new literature and discussion on cartilage restoration procedures. We’re at the forefront of all of that, and we’ve got some great procedures that we’re doing to prevent knee replacements for smaller cartilage lesions to prevent somebody from having to have a knee replacement. But, at the same time, patients with knee replacements do so well and 95% patient satisfaction with knee and hip replacements because of how debilitating those arthritis conditions can be, and a joint replacement has been shown to be very effect for getting people better, more functional, and minimizing their pain.

Melanie: Thank you, so much, Dr. Byington, for being with us today. If you have joint pain or an injury, talk to your doctor. If you do not have a doctor, you can find one at bryanhealth.org/doctors, that’s bryanhealth.org/doctors. This is Bryan Health Radio. I’m Melanie Cole. Thanks for listening.