There are lots of questions that come up from time to time. I thought it would be
helpful to bring some of them together for your enjoyment.
Are my bones really alive?
Certainly they are! Bones contain blood just like the heart, lungs, brain or any other
part of the body. With a fracture there is pain due to instability and due to bleeding.
When there is a break, both these conditions cause the nerves around the bone to let you
know there is a problem. Bones live! They need nutrition and oxygen like the rest of you.
When do I stop growing?
Growth stops when the bones stop getting longer. There is a special part of each bone
that is responsible for growth. The growth plate at the epiphysis looks a little like an
expansion joint in a sidewalk. This is where growth in long bones takes place. Injuries to
the growing area of bone can effect growth. This is what makes children’s fractures
special.
What causes bone pain?
When you injure the periosteal covering of the bone there is pain. Circulation changes
in the bone, called avascular necrosis, causes pain. Instability due to fracture, or
weakness of the bone structure also causes pain. There are many different causes for bone
pain.
How many bones are there in the human body?
There are a lot of them and it’s variable! Some people have more and some less
of the spinal segments. Some bones become fused together to make one larger bone (the
skull, pelvis, sacrum). There are many (sesamoid) bones that may be present in one person
and not in another.
There are: 1 skull, 1 jaw, 24 vertebrae, 1 pelvis, 1 scrum, 1 coccyx, 24 ribs, 1
sternum, 2 scapula, 2 collarbone, 2 humerus, 2 radius, 2 ulna, 16 carpal bones, 10
metacarpals, 14 finger phalanges, 2 femur, 2 tibia, 2 fibula, 2 talus, 12 tarsal bones, 10
metatarsals and 26 toe phalanges (by this count).
What’s the difference between a tendon and a ligament?
A tendon connects a muscle to a bone. A ligament connects two bones at a joint. An
ankle sprain is an injury to the ligaments that connect the bones of the ankle.
What is a knee cartilage?
The meniscus or knee cartilage is a pad between the bones of the knee. It acts like a
gasket, providing a seal and a cushion to forces across the knee joint. There are two
cartilages in each knee. Most people don’t think much about a knee cartilage until
they injure it. Then it hurts, swells and clicks until it’s repaired.
Do fractures in babies heal OK?
They heal very well indeed. Bones even tend to improve in shape as they grow. They get
slimmer and straighter. A crooked bone tends to become straight as a child grows taller.
This is called remodeling. Particularly at the ends of long bones, remodeling is an
important part of fracture treatment in children.
Do fractures in old people heal OK?
Yes! In the absence of disease, even people one hundred years old will heal up fine.
Poor circulation is a leading cause of slow healing, with instability, nutritional
problems and nerve problems also contributing to slower healing.
Why does my knee click when I kneel to scrub the floor?
A click in front of the knee with kneeling, squatting or stairs is usually related to
the kneecap. In adults the kneecap often is the site of injury and soreness related to
wear. Sometime this is called chondromalacia, meaning softening of the cartilage.
Sometimes it is called osteoarthritis, meaning wear of the cartilage. Patella pain is a
common reason to have a knee arthroscopy. For instance, the patella can be damaged from a
fall or an accident. Knee cap pain with kneeling can be helped. A click is the kind of
symptom treated with arthroscopy. You might try anti-inflammatory medications first.
I’m only 16 and my knee clicks. Why does it do that?
One cause is a tight band of tissue from the lining surface of the knee. This tight
band is called a plica. Removing a plica can relieve the click. Another cause of
painful click is side-to-side shifting of the knee cap. Called subluxation, this occurs
when the kneecap is loose in its track and want to jump out of place. There are many
procedures to realign the knee cap and to "float" the kneecap to relieve pain
and limit subluxation.
How do I know when it’s time for a new knee (total knee operation)?
A total knee is a great operation when your knee is pretty well worn out. Usually there
is substantial pain with walking and you have tried medication to little avail. Many
people note mild bowleg developing over time. Many people have lost some of the movement
of the knee. X-rays of the knee in standing position demonstrate the amount of
degeneration.
My aunt had a knee replacement, my cousin has a new hip. What other joints can be
fixed when they wear out?
There are specific techniques for each joint including the shoulder, elbow and small
joints of the hand and wrist. The knee and hip are most common but there is surgery for
the toes, ankle and other joint problems also.
Is it normal for my 2 year old to be so bowlegged?
Bowlegs are normal at age 2. By adolescence this will change to slight knock knee,
called valgus. Only for the most severe cases of bow legs would surgical correction be
required.
I twisted my knee and now it’s swollen, but I can walk on it. Do I have a
problem?
Yes. Swelling usually indicates a significant problem. Injuries like a torn cartilage
or arthritis can cause swelling. Swelling doesn’t tell you what the problem is, but
swelling is nature’s way of letting you know that a problem exists.
Are ankle sprains about the same?
Ankle sprains are divided not only by location but also by degree of injury. Mild
sprains (grade 1) do not involve substantial damage to the ligament and can be treated
with rapid mobilization. Medium (grade 2) sprains are more severe and are often casted.
Severe (grade 3) sprains can be unstable enough to require surgical repair.
Will a knee x-ray show a torn cartilage?
An MRI can show a torn cartilage. An x-ray can show fracture, deformities and other
bone and joint abnormalities.
My teenage says his leg hurts. Sometimes I think he limps. Should he be checked?
Yes! Teenagers may not know how to tell you exactly what the problem is. There are
conditions that are special problems only for the teen age group.
My fingers fall asleep at night. They get numb when I drive the car and often feel
numb in the morning when I wake up. I have to shake them or hold them up to get life back
into them. My friend had his carpal tunnel repaired. He says I have carpal tunnel also. Do
you agree?
The symptoms you describe certainly are typical of carpal tunnel. You should also check
with your medical doctor to rule out diabetes, thyroid trouble and vitamin deficiencies.
Alcohol or smoking can aggravate carpal tunnel. An electrical test can confirm the
presence of carpal tunnel, which then can be relieved by endoscopic surgery.
I had a neck injury when I hit my head in a motor vehicle accident. I also have
funny feeling in my hands. Is this carpal tunnel?
No! Probably not. You can have nerve pains and numbness from irritation or compressions
of nerves in the neck as well as in the wrist.
It’s not really my hands that go numb, it is the back of my head. It gets
tingly. What’s going on?
In this situation you are putting pressure on the nerves at the back of you head
(occipital nerves) It’s sort of like a "crazy bone effect" at the back of
your skull.
My back is sore after I shovel a lot. You would think at age 40 this wouldn’t
happen to me.
Back pain happens to the best of us. With rest, heat and anti-inflammatory medication,
in time most episodes will pass with full recovery. Orthopedic evaluation and management
are required when it interferes with normal life and work. A combination of light duty
work, physical therapy and medication will start most people back on track.
Not only does my back hurt, but pain also goes down my leg. When I sneeze it’s
terrible. What does this mean?
The leg pain that accompanies backache is called sciatica. This is a symptom of nerve
irritation coming from the back. There can be more than one cause and more than one
solution.
What tests are most useful to image the anatomy of the spine?
Different tests show different things. Regular x-rays give a good overall picture of
the spine and surrounding tissues. MRI images show the discs and nerves quite well. A
myelogram can show blockages in the spinal canal. Electrical tests can measure function of
individual nerves and indicate dysfunction due to arthritis or disc disease.
When does one look to surgery to cure back and leg pain?
Surgery is the best treatment for severe, longstanding back and leg pain that has not
responded to traditional rest, medication and exercise treatments. If you are not better
after 6-8 weeks of back trouble, it is time to do the test that are required and to have
it fixed.
I use my hands a lot at work. Sometimes they ache a lot up the forearm. What can I
do to get rid of the ache?
The first line of relief is to try rest and anti-inflammatory medication.
Which medicines do you recommend and are available to me?
Today there are five medications that are useful and available without prescription:
- Aspirin (many brands)
- Acetamenophen (Tylenol, and other brands)
- Ibuprofen (Motrin, Advil, and other brands)
- Naproxyn (Naprosyn, Aleve)
- Ketoprofen (Orudis)
Is Aspirin any good?
Aspirin has been around the longest and has a proven record of safety and efficacy. It
is very effective and has been used extensively for rheumatoid arthritis. Aspirin is the
most cost-effective medicine in its class. I recommend aspirin for:
- Cartilage healing – 1 tablet twice a day
- Joint pains – 2 tablets every 4 hours as needed.
I avoid Aspirin in ulcer patients, or if there is sensitivity.
Is Tylenol better than Aspirin?
Tylenol (Acetaminophen) is a particularly useful drug for people with sensitive
stomachs, as it irritates the stomach the least. While sold for sore joints, there is
medical evidence that other medications may be more powerful for joint pain and swelling.
I recommend Acetaminophen for:
- Joint pain in ulcer patients, 2 tablets every 4 hours as needed in combination with
prescription narcotics (hydrocodone, codeine, and other brand names)
Should I use Ibuprofen?
Ibuprofen is a useful medication as long as it doesn’t bother the stomach. I
recommend Ibuprofen for:
- Joint pains in adults, 600 mg, 4 times a day for patients who have good results with
this medication
I avoid Ibuprofen in patients with stomach problems.
Is Naproxyn the one to use?
I find Naproxyn to be quite effective at reducing joint pain and swelling. I recommend
Naproxyn for patients where other medications have not been enough:
- Joint pain and swelling, 1 or 2 – 220 mg tablets, 2-3 times a day
- Severe joint pain and swelling, up to 500 mg, 2-3 times a day
I avoid Naproxyn in patients with stomach sensitivity.
How about Ketoprofen; is it any good?
Many doctors have used Ketoprofen and found it to be helpful. I have tended to use
other medication. I would recommend Ketoprofen if a particular patient found it worked
better for him or if other medications were not working well. I would avoid Ketoprofen in
patients with stomach sensitivity.
Osteoporosis
Can I take calcium to make my bones stronger?
Everyone needs adequate calcium and Vitamin D for healthy bones. Supplements are
appropriate for post-menopausal women. Treatment is appropriate for patients with
osteoporosis.
How much calcium supplement is right?
According the Medical Letter:
- Tums – 400 mg calcium, twice daily
- Os-Cal 500+D – 500 mg calcium, twice daily
- Citrical – 400 mg calcium, twice daily
- Citrical +D – 2-3 tablets daily
For treatment of osteoporosis, is there anything else?
For post-menopausal women hormone supplements have been the mainstay of osteoporosis
treatment for decades. The dose of Premarin is 0.625 mg daily. Often Medroxyprogesterone
is added to reduce the risk of endometrial carcinoma.
What strengthens bones the most?
Exercise has been shown to make bone stronger in young and old. Medium to strong
intensity exercise 45 minutes three times a week will do the trick. Even small amounts of
exercise can be helpful. The beneficial effect of exercise has been shown in astronauts,
children, women, military recruits and even people in nursing home. Strong minds and
strong bones go together.
Are there any newer treatments for osteoporosis?
In the past few years many new drugs have become available and other will be released
soon.
- Alendronate (Fosamax 10 mg once a day on an empty stomach) taken with
vitamin D and calcium has been shown to increase bone density and reduce fracture
frequency. One needs to take both calcium and Vitamin D as well.
- Calcitonin (Miacalcin 200 IU once a day, nasal spray) has been shown to
increase bone slightly and reduce fracture frequency. One needs to take both calcium and
Vitamin D as well.
- Fluoride (Slow Fluoride, 25 mg twice daily) has been associated with
increased formation of normal bone. It must also be taken with vitamin D and calcium.
- Raloxifene is a promising drug related to the hormone treatments.
Currently available only as part of a university study, Raloxifene may be released
soon.
Page Updated: 8/2002
