Dr. Kenneth R. Brooks

No it does not. You are safe to continue if it makes your hands feel better and more mobile. Thank you for your question.

Pain without trauma or injury is generally not normal. If the fracture healed such that the bone is not shaped normally or has an abnormal prominence, then you may have a cause for pain. You should see an orthopedic surgeon for X-rays and clinical assessment.

Thank you for your question and be well.

You should see an orthopedic surgeon who specializes in Foot and Ankle problems to get the correct diagnosis, which will then lead you to the treatment that works best for you.

Go to the doctor ASAP for an exam and X-rays. Do not allow a possible dislocated shoulder to remain out of place. It will only get worse. Do not allow your mother to talk you out of going.

Who prescribed the medication? Have you voiced your concerns to that person?

The simple answer is: see a doctor who specializes in joint pain. I would recommend a visit with a Rheumatologist, Primary Care sports medicine specialist, or Orthopedic surgeon to discuss your joint pain.

First, she should consult with a spine surgeon to discuss neurologic symptoms and to establish care in case she needs surgery. If she has no neurologic symptoms (numbness, tingling, muscle weakness, bladder/bowel dysfunction, etc.), then physical therapy, anti-inflammatory and muscle relaxing medication, and possibly steroid injections compose a typical treatment plan.

Resumption of activity depends on resolution of symptoms.

More than likely the fracture has already healed. You should have had a follow X-ray to confirm healing. Some fractures in children may cause extra growth in the bone that was broken, so it is possible to have arms of two slightly different lengths.

Fractures that involve the growth plate of the bone may impact growth by stopping bone growth or causing abnormal bone growth.

You should consult with an orthopedic surgeon with experience in managing fractures in children if you have any additional questions.

Gout is one potential cause, especially if you eat a high protein diet and/or consume a lot of alcohol. However, trauma, injuries, obesity, and autoimmune disorders like rheumatoid arthritis need to be considered as well. A visit with your primary care doctor and then a rheumatologist is a good place to start.

Take care.

Thank you for your question.

I do not perform ankle arthroplasty, so I cannot comment on the recovery. My advice is to ask your surgeon for recommendations regarding resumption of specific activities, as each surgeon has his or her own protocols. I do allow my hip, knee, and shoulder arthroplasty patients to return to swimming after surgery once their incisions are completely healed. I am a strong advocate for the benefits of water based exercise.

Take care.

Thank you for your question, and I apologize for the delay in responding to you.

The grinding is described as "crepitus," and it is indicative of damage to the cartilage joint surface of the knee. Usually, the patella, or kneecap, is the part of the knee that has the damage. The cartilage is the smooth, gliding surface tissue that lines the ends of our bones in all the joints in the body. When the very slick, but delicate surface layer of the cartilage is damaged, the cartilage tissue starts to break down. As the process continues, the surface becomes rough, like a gravel road. We perceive this roughness as a grinding sensation that can be felt and/or heard.

Simply having crepitus does not mean you need to have your knees replaced. In fact, I also have crepitus in my knees, and I am really not bothered by it at all. The important point is pain-- is the grinding painful, or just a nuisance? If it is just a nuisance, nothing more than maintaining a healthy diet and exercise regimen is required to promote the health of your knees. If, however, the grinding is painful, then you should seek out a consultation with an orthopedic surgeon who specializes in knee problems. You can then discuss treatment options like medications, braces, physical therapy, and injections before embarking on knee replacement surgery.

Take care,
Kenneth Brooks, M.D.

Thank you for your question.

Your question is a little vague, so giving you a definitive answer is challenging. There are a wide variety of potential problems that could be the cause of your hip pain. It depends on what part of your hip hurts, what specific movements or motions make it hurt, whether it started after an injury, whether there are any associated symptoms like clicking or popping, what kinds of exercise or sports you have done throughout your life, etc.

At your age, some common hip problems include labral tears, impingement, IT band syndrome, muscle strains, SI joint dysfunction, athletic pubalgia, and even hernias or intraabdominal problems-- patients have come to me complaining of "hip" pain and have had some version of all of these.

My recommendations would be to make sure you have enough variety in your exercise program to prevent overuse injuries, and to seek out a consultation with an orthopedic surgeon who specializes in hip problems to discuss your pain.

Take care,
Kenneth Brooks, M.D.

Thank you for your question.

Your presentation is not very clear, so the answer to your question will not be clear. What you need is an assessment by an orthopedic surgeon specializing in knee problems. It sounds like your kneecap, or patella, is the source of the pain. However, if I were your doctor I would need some additional details in your history about what part of your knee hurts and whether there are any other associated symptoms. I would need to perform a detailed physical exam. I would also want to personally review your X-rays, and if they are normal then order an MRI to look at the soft tissue parts of the knee (cartilage, meniscus, ligaments, tendons, etc.).

Kenneth R. Brooks, M.D.

The decision to proceed with knee replacement is easy for some patients, but may not be so easy for others. As I so often tell my own patients in the office, I don't tell you when to have knee replacement, you tell me.

How does one know that it is time for knee replacement surgery? Here are some of the points of advice I give to my patients:

1. Does the pain occur every day?
2. Does the pain wake you up at night?
3. Does the pain keep you from the activities you need or want to do?
4. Do you have to limit your work activities due to your knee pain?
5. Do you find yourself declining to have experiences or do activities with friends and family because of your knee pain?
6. Do you find yourself saying "I can't" when asked to do active things or when you think about wanting to do active things?
7. Have you tried steroid (cortisone) injections and hyaluronic acid (rooster comb or
Gel) injections without relief or decreasing effectiveness?
8. Do you require pain medicine (NSAIDs or opioids) stronger than Tylenol on a daily basis?
9. Have you tried bracing (compression, correction of instability or bowing/knock knees) without relief?
10. Have you tried a supervised exercise or physical therapy program without relief?
11. If you are overweight, have you undergone weight loss without pain relief?
12. Do X-rays of you when you stand up show bone on bone (end stage) arthritis?

If you answer yes to all or most of these questions, then you are a candidate for knee replacement surgery. I recommend that you seek out a consultation with an orthopedic surgeon who is fellowship trained in or specializes in total joint replacement to discuss your options.

Thank you for your question.

Kenneth Brooks, M.D.

This is a very interesting and somewhat complicated question. There is neither a simple yes nor a simple no answer. There are a number of factors to consider when attempting to answer this question.

First is the person's activity level. The vast majority of people who want to participate or compete in cutting sports (soccer, basketball, football, baseball, tennis, etc.) need intact ACLs for knee stability and proprioception in making change of direction maneuvers. A very small proportion of the population has the neuromuscular development and coordination to make such maneuvers without the knee and limb control provided by an intact ACL.

Second is the instability in the knee. Some people who have no interest in participating in sports experience such a degree of instability in normal daily activities that they require ACL surgery to function. One of my professors experienced such a level of instability simply walking around his clinic that he underwent ACL surgery in his 40s just to be able to get through his work day.

The condition of the posterior horn of the medial meniscus is also a consideration. If the meniscus is intact, it acts as a secondary stabilizer against knee instability to the ACL and can act to provide stability when the ACL is absent. If a person has neither an ACL nor a medial meniscus, then the knee is usually very unstable and requires surgery.

Finally, one must consider the long term effects of ACL deficiency in the knee. Repeated episodes of pivot shifting or instability will damage the joint surface cartilage, leading to arthritis in the long term. ACL deficiency will put additional stress on the medial meniscus, leading potentially to meniscus tears and then cartilage damage and arthritis.

Thank you for your interesting question.

Kenneth R. Brooks, M.D.