Dr. Travis Stork: Why does this hurt? That is the question we are answering for you today. Jamie has been in constant pain from quite some time, it's beginning to disrupt her daily life.
Jamie: Hey Doctors! I use to be really active, but lately my knee has been bothering me a lot and it's really keeping me from doing the sports that I really like to do. It's mostly an achy pain, but if I do certain movements like twist it, then it's a really sharp pain that's really unbearable. The pain in my knee has gotten in so bad that I really struggle when I walk up and down the stairs. Is there anything that I can do about it?
Dr. Travis Stork: Jamie recently went to see Dr. Stetson from Stetson Powell Orthopedic and Sports Medicine Clinic. She wanted to find out more about her knee pain. Welcome back first of all.
Dr. William Stetson: Thank you Travis.
Dr. Travis Stork: Welcome Jamie so first thing I want to let everybody at home know that you did X-rays and MRI to rule out ligamentous meniscus injury, right?
Dr. William Stetson: That's exactly what we did Travis. We did some standing X-rays because that's how Jamie lives her life and X-rays look fine there is no abnormal alignment, no signs of osteoarthritis. She had a long course of physical therapy which also didn't relieve the pain. So the next step is to try these series of injections to get her some pain relief and get her back to her regular activities.
Dr. Travis Stork: That's just cool skiing photo there. We've got to get you back on the water. So what we are going to do today is an injection of a material that may help improve her symptoms, because what you found is that she has got maybe some early osteoarthritis also known as condromalacia.
Dr. William Stetson: That's exactly it. Early osteoarthritis is called condromalacia and in young ladies in particular it's usually around the kneecap area. We saw that on the MRI. So the purpose of these injection is called Hyaluronic acid, it's almost like a lubricant and it nourishes the cartilage and that will help relieve the pain and get her back to those activities that she loves to do.
Dr. Travis Stork: Okay, so first thing is first you are going to inject a needle into her knee joint, and you are going to see if there is fluid you need to pull off, right?
Dr. William Stetson: Absolutely, we do that first. We of course numbed her up with Novocaine just like you get at the dentist and then we will try to take a little fluid off. If there is and no fluid, then we just change the syringe, we inject this ampoule of this little gel.
Dr. Travis Stork: You are ready Jamie?
Jamie: Sure, why not.
Dr. William Stetson: My assistant Suzy is going to help me. We have already marked the area we are going to put the Novocaine.
Dr. Travis Stork: And this is a relatively new treatment for a very frustrating condition,, because typically we think of osteoarthritis as wear and tear and it's a downhill course we haven't had many treatment options. This is really a new technology.
Dr. William Stetson: It really is Travis, because young ladies like this will oftentimes what they will do is they will just give up their activities and Jamie has been active in the past. She is just such a young lovely lady she wants to go back to those activities. But oftentimes unfortunately they say, it hurts, I don't want to do it anymore. But there are treatments and this is one of the treatments that we start with.
Dr. Travis Stork: And while you are doing the procedure I will probably ask you few questions. So you go ahead and do your job, and Jamie first thing is first you are going to get some numbing medicine.
Dr. William Stetson: That's exactly right. We always mark the area that we are going to put the Novocaine or Lidocaine just like you get at the dentist. And it's a very, very small needle so there is nothing to worry about. Again, we are highly trained medical professionals. I am just going to do it right here, don't try this at home. A little bit of stick Jamie just like that. And what we do we want to numb it up real good for her.
Basically, it doesn't hurt going into the skin, but getting into the knee capsule hurts more. People ask well my knee pain hurts on the inside, why are you ejecting it up above the kneecap? Well, if you can imagine the kneecap is like a capsule or a balloon, and what we do is we inject it into the spot that's the easiest place to get into.
So I can tell I am already into knee joint, I want to numb it up real good for you. We are almost done with that part. You will a little bit of bubble there, there we go. Now what we are going to do little bit of bigger needle, we are going to go in and we are going to see if we get a fluid off, one, two, three little bit of stick, okay, not so bad. Little bit.
Dr. Travis Stork: Are you okay Jamie?
Jamie: Yeah.
Dr. William Stetson: So I see I get no fluid out which is good. So when the knee is angry it produces fluid which is called water on the knee or an effusion. So Jamie hasn't had that so that's great we take this ampoule of this gel like substance and then what we do is we just inject it into the knee like that and we are all done.
Dr. Travis Stork: It's basically some WD 40 for the knee.
Dr. William Stetson: That's a good way to look at it. It's a lubricant in the articular cartilage, we get older, it's starts to wear down. So this is actually the lubricant for that articular cartilage.
Dr. Travis Stork: So Jamie will get one of these a week for how long?
Dr. William Stetson: We typically do it once a week for three weeks and then after that we gradually get her back to her activities, maybe restart a physical therapy program and get her back to doing all those activities that she loves to do.
Dr. Travis Stork: Well, we wish her the best of luck. We want to see you back on the ski soon.
Jamie: Thank you.
Dr. Travis Stork: Thank you so much doctor.
Dr. William Stetson: No problem, happy to do this job. Thanks!
Dr. Travis Stork: Thanks Suzy.
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