Patellar spur treatment: Bone spurs – Symptoms and causes
Orthopedic Surgery Disease：Patellofemoral Arthrosis | Treatment of disorder
Orthopedic Surgery Disease：Patellofemoral Arthrosis
Aching pain by bone deformation.
Fig. 1 Knee side view (Blue colored is cartilage)
There are two joints on knee, one is tibiofemoral joint (so called knee joint) consists with thighbone and Shinbone, and patellofemoral Joint consists with thighbone and patella. (Fig.1) There is cartilage on bone surface at contact point of patella and thighbone to reduce friction. When knee is bent stretched, patella moves smoothly up-down or left-right by cartilage. Patellofemoral Arthrosis is the status which aching pain is produced due to the inflammation developed at patellofemoral joint, cartilage is worn down, or bone is deformed.
Pain when step up/down stairs.
Symptoms are as follows.
- Aching pain on knee, enlargement or feeling of warmth
- Uncomfortable feeling or pain around patella when jogging or step up-down stairs.
- Uncomfortable feeling or pain around patella when standing up from chair.
- Caught on feeling at patella or making snap sound when knee is bent stretched.
Causes are advancing age and bone dislocation/subluxation.
There are mainly two causes.
Fig. 2 Side view of Patellofemoral JointThe one is the influence of advancing age or cartilage on bone surface is worn out due to continuous placement of burden on knee. Common among middle-aged female, and in most of this case, cartilage of tibiofemoral joint (knee joint) also worn out. The second one is bone dislocation or subluxation. If they are normal, patella is just slipped in the channel formed on thighbone and glide smoothly along the channel.
(Fig.2)
Dislocation of PatellaHowever, when patella comes off from channel (dislocation), or when it is about to come off (subluxation), cartilage is worn out by friction (Fig.3). When patella dislocation or subluxation is repeated, cartilage is damaged further, so that when it turns for the worse, it influences to bone itself. In this case, cartilage of patellofemoral joint (knee joint) will not commonly be influenced.
Dislocation of patella is developed, when muscle at front of thigh (quadriceps muscle) is strongly contracted at jump landing, when plate of knee receives severe impact externally by the accident, or when surrounding ligament (mainly inside) is loosened. It occurs with several reasons. In case where patella or thighbone shape is abnormal by nature and patella does not fit in the channel of patella, it becomes easy to be dislocated. Young female is said they are easy to develop the disease because joint is easy to lose by the influence of female hormone.
Confirm degree of deformation by X-ray photography.
Characteristics or position of pain on knee and movements of patella is observed by diagnosis. X-ray image photography, position of patella, shape of Patellofemoral joint (shape of channel), degree of deformation is confirmed. Remaining volume of cartilage by the size of joint channel is determined by the size of joint channel, and deformed degree is determined with how much unnecessary bones are formed. There may be a case where damaged cartilage position and its degree is confirmed by MRI.
Ease pain by drug therapy and/or physical therapy. When no effect, surgery is conducted.
Conservative treatment is while maintaining the complete rest of affected area, inflammation is blocked so that the relieve pain with drug therapy or physical therapy. When advanced age is the cause, knee surrounding muscle need to be trained and strengthen muscle or ligament then reducing labile of patella.
There is a case where attaching equipment so that it prevents patella dislocate to outside.
When no progress can be found in conservative treatment, there may be a case where surgery is conducted although it is rare case. For the case of dislocation due to the advanced age and cartilage of patella is worn out much in volume, there may be the case for artificial knee joint replacement is conducted. In this case, polyethylene cushion is replaced with worn out cartilage, as alternative method.
In case when patella dislocation is the cause of disease, depend on the shape or degree of symptoms, dislocation is prevented by shifting the position of tibia attachment part of patella to prevent from dislocation. Or, surgery is conducted for first to repair ligament at inside of patella so that preventing dislocation to outside.
Bone Spur in Knee: Causes, Symptoms, and Treatment
Some people can have a bone spur in the knee and not realize it because they have no symptoms, while others have pain so severe that it interrupts their regular movement.
To get a better understanding of the causes of bone spurs, symptoms of a bone spur in the knee, and how to treat it, read on.
Just what is a bone spur in the knee? Basically, it is a bony growth that can develop right on top of the actual existing bone, but it appears more often in the joints. These bony growths or bone spurs on the knee are smooth as opposed to jagged.
Medical experts believe that a knee bone spur is an extra bone that forms when the body tries to repair itself as it responds to some sort of damage. Bone spur in knee symptoms appear when there is bone on bone contact within a joint during movement. If you think this sounds unpleasant, brace yourself. A bone spur on the kneecap can be experienced for several years. In these situations, the symptoms tend to appear over time and can be really painful.
Bone spurs can grow on any part of the skeletal body; however, bone spur on the knee is rather common.
What Are the Causes, Risk Factors, and Symptoms of a Bone Spur in the Knee?
There is no one answer to the question of what causes bone spurs in the knee.
Each case of bone spur can be different but the list we provide here covers the most common causes. These causes are associated with a disease/condition that leads to cartilage degeneration or is a reaction to a bone injury.
Knee osteoarthritis: This is a form of arthritis that is caused by constant wear and tear of the knee joints. With excessive pressure, friction between the knee joints, as well as stretching of the joints, the cartilage in the bones can wear out. When the body attempts to repair itself, it can create bone spurs between the joints.
Knee injuries: A trauma or injury to the knee and specifically the cartilage tissue can cause bone spurs. There are crescent-shaped shock absorbers between the femur and the tibia that when damaged or torn, can cause bone spurs. This is what is often referred to as a meniscus injury.
Age: Data shows that knee pain bone spurs can be a result of natural wear and tear associated with aging.
In other words, the older we get, the more likely we are to experience a bone spur.
Other causes: Some people get a bone spur in the knee due to lack of physical activity, nutritional deficiencies, structural abnormalities during birth, or a build-up of calcium deposits in the body. Obesity has also been linked to bone spurs.
Along with advanced age, obesity, and an unhealthy diet, risk factors for bone spur in the knee include repetitive stress on the knee joint, as is the case for those who participate in high-impact sports, and those who have a family history of bone spurs. There is also some evidence to suggest that a person who has had past injuries, such as fractures and dysplasia, which is abnormal growth of a tissue or organ, are at higher risk.
As mentioned earlier, you may or may not have symptoms with a bone spur. Here’s what you can potentially experience with a bone spur on the knee.
- Severe pain in the knee
- Numbness, tingling, or weakness in the knee joint
- Decreased range of motion of the knee
- Knee stiffness
- Pain when bending or extending the knee
The symptoms outlined above can range from mild to severe depending on the degree of damage to the knee joint.
Complications of Bone Spur in Knee
Bone spurs can make a person feel downright miserable, but that’s not all. They can come with complications. Some people also experience permanent damage to the nerves in the knee, while others have to go through more than one treatment because surgery only brings relief temporarily and the bone spur grows back. With no treatment, bone spurs can cause severe pain and impact surrounding structures like tendons and nerves. In many cases, people with bone spurs in the knee have extreme pain when they walk.
How Is a Knee Bone Spur Diagnosed?
After reviewing your symptoms, a doctor will want to discuss any medical conditions or injuries you have experienced in diagnosing you with a bone spur. The next step will be to inspect the knee and leg for any signs of injury. Bending, extending, and rotating the knee will allow the doctor to determine your range of motion and level of pain.
Diagnostic imaging includes bone spurs in knee x-rays.
They can show bone abnormalities, including degeneration and fractures. Below is a list of other diagnostic tests.
- Magnetic resonance imaging (MRI): This can produce a 3D image of bones and soft tissue. It includes cartilage, muscle, and tendon damage in detail, as well as bone spurs.
- Computerized tomography (CT): A CT scan is a series of X-ray images from various angles that are then merged together to form a cross-sectional view of bones and soft tissues.
- Electromyography (EMG): The EMG shows electrical activity in the muscle during rest, as well as muscle contraction. This is usually performed if the doctor suspects muscle or nerve damage.
- Nerve conduction velocity (NCV): This shows the speed of electrical signals moving through the affected nerve. Slow speed can indicate nerve damage.
How to Treat a Knee Bone Spur
Knee bone spur treatment is not necessary if you aren’t experiencing any pain.
If you have mild to moderate pain, bone spur in the knee treatment can include attempts to relieve pain and stiffness in the joints. For instance, losing weight can help decrease the load on your knees and thus lower the pain.
The following are considered common treatments for bone spurs in the knee:
- Weight management: Talk to a doctor about what type of diet is best.
- Pain relievers: Over the counter anti-inflammatories and other pain relievers can reduce the agony and inflammation.
- Physical therapy: A qualified physical therapist can help you strengthen the muscles surrounding the knee. This will increase your range of motion, reduce stiffness, and possibly pain as well. If you are going to attempt bone spurs in knee exercises, you should consult with an expert first.
- Cortisone injections: These are injections that go directly into the knee joint and provide pain relief. Those who suffer from osteoarthritis are often candidates for cortisone injections.
The relief lasts anywhere from a few weeks to a few months. - Surgery: Bone spur knee surgery is usually considered when other treatments don’t seem to improve symptoms. Although the patient may not want to hear it, knee bone spur removal surgery may be the best option. Knee arthroscopy can remove bone spurs and is a less invasive type of surgical procedure. There are situations where a bone spur is only part of the problem and a partial or total joint replacement may be required.
- Natural options: Natural treatment for bone spurs in the knee include massage therapy, acupuncture and acupressure, as well as ice packs and heat therapy. Ice packs should be applied for about fifteen-minute stretches while heat can be applied for up to two hours, as long as it is not too hot.
The relief lasts anywhere from a few weeks to a few months.Prevention and Prognosis of Bone Spur in Knee
While in a lot of cases, bone spurs can’t be prevented, there are some ways you may be able to reduce your risk of developing them.
If you maintain a healthy weight by eating well and exercising regularly, if you limit repetitive stress on the knees, and if you wear proper safety equipment when engaging in sports, you will significantly reduce stress on the knee joints.
In most bone spur on knee cases, the prognosis is pretty good if treatment is applied within a reasonable amount of time. As we pointed out, there are situations where the bone spur will grow and become more painful, requiring surgery.
Thousands of Americans suffer from bone spurs every year. When someone experiences the kind of knee pain that makes it difficult to carry out normal day-to-day tasks, such as walking, it is time to seek medical attention. In the case of recurring bone spurs, you shouldn’t assume you’re an expert. Just because you might have been down this road before doesn’t mean that you can take matters into your own hands. For the best possible outcome, see a doctor as soon as possible.
Also read: 16 best exercises to overcome arthritic knee problems
Kneecap Pain Symptoms & Treatment
Pain in or around the patella (kneecap) affects people of all ages.
Strenuous activity can aggravate a painful kneecap, but sometimes pain and irritation arise without an obvious cause.
Our orthopedic and sports medicine experts will examine your painful knee and devise a treatment plan that can help you get back to walking, running or working in comfort.
Expert patella pain care
Patella pain can be complex. At Aurora Health Care, our orthopedic and sports medicine doctors can often resolve pain with physical therapy and conditioning. If you do need surgery, we’re well-versed in the most advanced minimally invasive techniques available.
No matter which type of treatment you need, we offer:
- Expert diagnosis: With more than 70 orthopedic and sports medicine surgeons on our staff, you’ll find experts in knee pain and patella pain. Our expertise means we can accurately identify the cause of the pain, whether it’s due to a knee injury or a related issue that’s affecting your knees – like a foot, ankle or hip problem.
- Coordinated care: As one of the state’s largest health care organizations, we offer everything you need in a single, integrated system. Our doctors and physical therapists work together as one team, sharing one electronic medical record. That means you’ll get timely updates on your test results and seamless communication about your care, no matter what kind of knee treatment you need.
- Advanced surgical expertise: If you need surgery to relieve the cause of knee pain, we offer advanced treatments including minimally invasive procedures. In fact, our knee replacement program has earned Joint Commission certification – meaning an independent, quality assurance organization has named our program among the best available. Learn more about our treatments for knee pain.
- Convenient locations: Our doctors and physical therapists are available at locations throughout eastern Wisconsin and northern Illinois, so it’s easy to get the knee care you need close to home or work. See our locations.
See our locations.What makes patella pain more likely?
Patella pain has several risk factors, including:
- Being female: Women are more likely than men to experience patella pain.
- Kneeling at work: Work that involves a lot of kneeling, like installing floors, can cause chondromalacia and patella pain.
- Doing sports that stress the knees: Sports that involve running, jumping and squatting – like basketball, soccer and weight training – make patella pain more likely.
- Increasing your training level: Working harder, longer or differently at sports can tax your knees and cause pain.
- Having prior knee surgery: If you’ve had anterior cruciate ligament (ACL) surgery using your own patellar tendon as a graft, you may have knee pain later. Learn more about ACL surgery.
Causes of patella pain
Patella pain occurs among active adults of any age.
It’s also common as people grow older. Different types of patella pain have different causes, which can include:
- Overuse: Walking, running, kneeling, jumping or squatting can stress your knee joint and cause irritation that leads to pain.
- Injury: A blow to the knee, including a fall, can cause patella pain.
- Chondromalacia patellae: Chondromalacia involves softened cartilage on the back of the kneecap. Normal cartilage protects the ends of bones from rubbing against each other. When cartilage softens, bone contact is more jarring, which causes pain.
- Tendonitis: When the patellar tendons or quadriceps tendons become inflamed, they may feel tender to the touch and cause tightening, swelling and knee pain. Learn more about tendonitis.
- Patellofemoral pain syndrome (PFS): Sometimes called runner’s knee, PFS causes pain behind the kneecap. This condition can develop when you abruptly start doing activities that strain the knee – for instance, if you start a rigorous workout routine that involves running, squatting and jumping. Women tend to get PFS more often than men do.
- Muscle imbalances: The muscles of the thigh, hip and knee work together to keep your kneecap aligned. When these muscles aren’t equally strong, they might pull your knee inward or outward, causing inflammation and pain.
Women tend to get PFS more often than men do.Signs of patella pain
You might experience patella pain as any of the following:
- Pain (usually a dull ache) in the kneecap
- Difficulty or pain when climbing up or down stairs
- Knee pain after sitting for a period of time
Sometimes, you’ll notice other signs of a patella problem. These symptoms may come along with knee pain:
- A knee that catches or gives way at times
- Creaking or grinding sounds (crepitus) in the knee
Is your hip and knee pain cause for concern?
Hip and knee pain doesn’t have to interfere with your life. Our hip and knee pain quiz evaluates your knees and hips, gauges the severity of any issues and gives you an idea what to do next based on your results.
Take the hip and knee pain quiz
Finding the cause of patella pain
To diagnose patella pain, our doctors will carefully examine your knee, ask when you first noticed pain and what you think caused it. They may also move your knee into different positions to understand where the pain is coming from.
To see problems inside the knee joint, our doctors might order X-rays (images of the bones), computed tomography (CT) scans or magnetic resonance imaging (MRI) scans. CT scans combine X-rays from different angles, while MRI scans use magnetic fields to form a picture of bones, muscles, ligaments and tendons.
Learn more about orthopedic diagnosis at Aurora.
Treating patella pain
Patella pain often resolves itself with rest, lower-impact activities, icing or anti-inflammatory medications.
If your pain does not improve with rest and medication, we’ll talk with you about possible treatments, including:
- Bracing or splinting: Braces or splints can help align the joint while an injury heals.
- Custom orthotics: Orthotics – special shoe inserts that stabilize the foot and knee – help relieve pain so you can stay active. Learn more about custom foot orthotics.
- Physical therapy: Physical therapy can help you strengthen the muscles that support the knee, which in turn can help relieve patella pain. Find out more about orthopedic physical therapy.
- Arthroscopic surgery: Using tiny surgical instruments, our surgeons can see inside your knee to tighten ligaments or remove loose cartilage – both of which can help with knee pain. Read about minimally invasive arthroscopic surgery.
- Realignment surgery: Realignment can correct the way the knee lines up with the thigh and shin, improving mobility and reducing pain.
Learn more about our treatments for knee pain.
Partial ruptures and bone pathology in Patellar Tendinopathy-ultrasound and surgical findings
Abstract
Surgical treatment of proximal patellar tendinopathy/Jumper´s knee is known to be difficult, and occasionally partial tendon ruptures complicates the treatment.
Objectives: To prospectively in a case series of patients operated for chronic painful patellar tendinopathy evaluate the incidence of partial ruptures, and the occurrence of patellar bone pathology in relation to the rupture site.
Material and Methods: Fifty-seven consecutive patients (53 males and 4 females) with a mean age of 24 years (range 17-47), and a long duration (> 5 months) of pain symptoms from proximal patellar tendinopathy, were included. All had failed conservative management, including loading regimens. For pre-operative evaluation: clinical examination, US+DP examination, and the VISA-P score (function) was used. Per-operative evaluation: findings during arthroscopic treatment. In all patient ultrasound (US)+Doppler (DP) examination verified the diagnosis. All were treated with the US-guided arthroscopic shaving method, followed by a specific rehabilitation program.
Results: Before surgery, the mean VISA-P functional score was 32 (range 15-77).
In 23/57 tendons (40%) there was a partial rupture, and in all these 23 tendons there was prominent bone (spur, sharp edge) in close relation to the partial rupture. In 16/23 tendons with a partial rupture the pre-op US examination showed signs of a partial rupture together with prominent bone in the patellar tip, and in 7/23 only prominent bone was noticed. The preoperative VISA-P score for the 23 tendons with a partial rupture did not significantly differ from the VISA-P score in the tendons without a partial rupture.
Conclusions: In consecutive patients operated for patellar tendinopathy with the US-guided arthroscopic shaving procedure, partial ruptures were found in 40% of the tendons, and prominent bone was found in close relation to the rupture site. Prominent bone in the patellar tip found during the pre-operative US examination indicates a partial rupture in the tendon.
Introduction
Patellar tendinopathy is a relatively common overuse condition especially among athletes involved in leg explosive sports, and it is a condition known to be difficult to treat [1-3].
Conservative management focusing on different types of loading regimens is first line treatment [4,5]. In a sub-group of patients loading regimens are not enough to lower or cure the pain to allow for full training and sports activity, and these cases are treated surgically. The golden standard method for surgical treatment has been tenotomy and intra-tendinous revision of tendinopathic tissue, however, the results have been shown to be varying and the method is questioned [5]. A new surgical treatment method guided by ultrasound, ultrasound (US)+Doppler (DP)-guided arthroscopic shaving [6,7], has been shown to give good and stable clinical results in mid-term follow-ups [8].
In a sub-group of patients operated with the US+DP-guided arthroscopic shaving method, partial ruptures have been identified. This study aimed to evaluate the number of partial ruptures and their possible relationship with prominent bone (spurs, sharp edges) in the patellar tip, in consecutive operations performed by the same surgeon.
Material and Methods
Consecutive patients seeking help for chronic painful patellar tendinopathy between 2016 and 2018, were included. There were 57 patients, 53 males and 4 females (mean age 24 years, range 17-47) with a long duration (mean 16 months, range 5-48) of pain symptoms. All had failed traditional conservative management, including specific loading regimens. The patients were high level athletes, many were professionals, in different sports such as; Soccer (n=22), Gaelic football and Hurling (n=8), Rugby (n=5), Handboll (n=5), Alpine and Free Skiing (n=5), Ice hockey (n=4), Fitness (n=2), Gymnastics (n=1), Triatlon (n=1), Floorball (n=1), Basketball (n=1), Taekwondo (n=1), and Long distance running (n=1).
Previous conservative management included loading regimens (n=57), cortisone injection (n=10), PRP injection (n=11), high volume injection of local anaesthesia alone (n=3), sclerosing polidocanol injection (n=3).
All patients were clinically and with US+DP diagnosed to have patellar tendinopathy in the proximal part of the patellar tendon.
US+DP showed a thickened proximal patellar tendon with irregular structure mainly dorsal and central in the tendon, including hypo-echoic regions and high blood flow coming from the dorsal soft tissues and going into the tendon.
Surgical treatment
The surgical treatment [6,7] was performed in local anaesthesia.
The patients were in a supine position with straight knee and relaxed quadriceps. We used standard antero-medial and antero-lateral portals, and a pressure-controlled pump. No tourniquet was used. US was used per-operatively. A standard arthroscopical evaluation of the whole knee joint was performed. Then the patellar tendon insertion into the patella was identified, and a 4.5 mm full radius blade shaver was introduced. Simultaneous ultrasound examination (longitudinal and transversal views) guided the procedure. Careful shaving, aiming to destroy only the region with high blood flow and nerves adjacent to the tendinosis changes on the dorsal side of the tendon (separating the Hoffa fat pad from the patellar tendon), was done.
In cases with a bone spur or sharp edge on the patellar tip (Figure 1 and 2), careful removal with the shaver was performed. In such cases it was necessary to also remove some tendinosis tissue to reach the sharp bone, but emphasis was put on preserving tendon tissue. In cases with a partial tendon rupture (Figure 2) the rupture was debrided until fresh borders, using the shaver. The portals were sutured, and 20 ml of Chirocain was injected into the joint.
Figure 1. Grey scale ultrasound examination-longitudinal view. A sharp bone spur is seen in the patellar tip in a patient with a thickened proximal patellar tendon-proximal patellar tendinopathy
Figure 2. Grey scale ultrasound examination-longitudinal view. A sharp bone spur is seen in the patellar tip in a patient with a thickened proximal patellar tendon-proximal patellar tendinopathy
There was bandage from toes to above the knee.
After surgery the patients were resting overnight, allowed partial weight bearing, and seen for a follow-up visit the day after the operation. If the knee joint was swollen, evacuation was performed under strict sterile conditions. An ultrasound examination was done using sterile gel, and if everything looked fine rehabilitation according to a specific plan was started.
Below find the general guidelines for the rehabilitation program. There is sometimes need for an individual variation of the program.
Week 1-2: Full weight-bearing walking, ROM exercises and quadriceps contraction exercises. Light biking.
Week 3-4: Increased walking and biking. Introduction of closed chain strength training (low load and multiple repetitions).
Week 5-8: Heavier biking High resistance intervals) and strength training. No plyometric exercises until tolerate isometric, concentric and eccentric strength training.
Week 9-forward: Introduce more sport specific exercises.
If there is a partial tendon rupture the rehabilitation program is lengthened with 4 weeks. The program for week 1-2 is then used for 4 weeks.
Results
All patients had tenderness in the proximal patellar tendon and the mean VISA-P functional score was 32 (range 15-77) before surgery.
In 16/23 tendons with a partial rupture diagnosed during surgery the pre-op US examination showed signs of a partial tendon rupture together with prominent bone (spur, sharp edge) in the patellar tip.
In 7/23 tendons with a partial rupture diagnosed during surgery the pre-op US examination showed prominent bone in the patellar tip alone.
The pre-operative VISA-P score for the 23 tendons with a partial rupture did not significantly differ from the VISA-P score in the tendons without a partial rupture.
There were no complications in relation to the operations.
Discussion
In this observational study on consequtive patients operated for proximal patellar tendinopathy with the US-guided arthroscopic shaving procedure [6-9], we found partial ruptures in 23/57 (40%) tendons. In all cases with a partial rupture prominent bone from the patellar tip was found in close relation to the rupture site.
The number of partial tendon ruptures in patellar tendinopathy patients in this study is high compared to most other studies that have been reporting few, if any partial ruptures [5-8]. Karlsson, et al. [10] reported multiple partial patellar tendon ruptures, but in that study a partial rupture was defined based on ultrasound findings, where the findings of a hypo-echoic region in the tendon was interpreted as a partial tendon rupture. There was no verification during surgery. This is likely misleading because the ultrasound finding of a hypo-echoic region in a tendon represents only a fluid rich region, fluid not seldom covering under laying intact tendon tissue, such as in tendinopathy.
Consequently, in that material [10], the diagnosis partial rupture was not macroscopically verified, and unfortunately, there is no information about bone pathology in the patellar tip.
The relatively high numbers of partial ruptures in our material is likely not representative for the traditional patient with patellar tendinopathy. The reason for this is that the patients in our study represent so called “difficult cases”, and second opinion cases, sent for evaluation by this surgeon that is specialised on treatment of tendinopathy. Anyhow, it seems of importance to provide more knowledge about this condition that is well known to be difficult to treat. There seem to be a wide span of patients, from having only tendinopathy to having tendinopathy plus partial rupture and bone pathology.
In this material, ultrasound examination was a good method to find bone spurs and sharp bone edges in the patellar tip, and such bone findings were related to partial tendon ruptures.
Consequently, if there is bone pathology in the patellar tip on the pre-operative US examination, it seems that there is likely a partial tendon rupture. This is important information for the surgeon, that strengthens the indication to carefully explore the tendon especially in relation to the prominent bone. It can possibly be argued if it is of importance to find a partial rupture in a tendinopathic tendon? In our opinion, partial ruptures most often cause pain. We are performing these operations in local anaesthesia, and when we identify a partial rupture after having removed the fat tissue on the deep side [9], and occasionally some tendinopathic tissue on the deep side of the tendon, touching the tissue in the region for the partial rupture cause sharp pain. Then to continue, we need to add local anestesia in the region for the partial rupture. After adding local anaesthesia we can debride the partial rupture until fresh borders without causing pain. Altogether, this clearly indicate that the partial rupture is causing pain, and it seems appropriate to try to relief this pain by surgical revision using the shaver.
The background to partial tendon ruptures in this material is not clear. All patients had a gradual onset of pain, indicating that the partial ruptures were not caused by a sudden overloading of the tendon. Because we have no information about the existence of bone spurs or sharp edges in the patellar tip before the evolution of tendon pain, we cannot state that the tendinopathy and partial ruptures were caused by the sharp bone in the patellar tip. Interestingly, a long patellar tip has been suggested to be involved in patellar tendinopathy [11]. Also, theoretically the sharp bone in the patellar tip might be bone formation as a result of different loadings on the bony tendon insertion caused by the thickened patellar tendon? It was interesting to notice that in this material in 16/23 patients with a partial rupture treatment with intra-tendinous injections had been used. Injection into a tendon might damage the tendon, from the injected volume that cause increased intra-tendinous pressure, and possibly also from the substances injected.
The surgical procedure is performed with US-guidance, and after the traditional careful shaving aiming to destroy only the region with high blood flow and nerves adjacent to the tendinosis changes on the dorsal side of the tendon (separating the Hoffa fat pad from the patellar tendon), the patellar tip is inspected. If there is sharp bone it is carefully shaved away until smooth underlaying bone surface. Then if there is a partial rupture it is shaved out to normal borders. We haven´t had any complications with this procedure. Occasionally there is some hemarthrosis after surgery, and evacuation at the day 1 follow-up is sometimes needed for the patient to be able to comfortable start to load with full weight bearing walking. For patients having a partial tendon rupture, we use a careful rehabilitation allowing only ROM exercises, walking, and light biking, the first 4 weeks after surgery. Apart from the 4 weeks longer rehabilitation period, there is no difference in the rehabilitation program compared to patients treated for tendinopathy alone.
We have not seen any differences in the outcomes after surgery between patients having partial ruptures and bone prominences, and the patients having only tendinopathy changes.
It appears of importance to identify the patients that have a partial rupture and sharp bone in the patellar tip at an early stage, because there is likely a risk that a sharp bone spur in the patella can harm the tendon during certain loading situations. Even certain rehabilitation exercises might, potentially, harm the tendon. However, this needs to be evaluated in further studies.
In conclusion, partial tendon ruptures can be found together with tendinopathy in the proximal patellar tendon, and in this case series of consecutive patients operated for patellar tendinopathy with the US-guided arthroscopic shaving procedure, for all partial ruptures prominent bone was found in close relation to the rupture site. Prominent bone in the patellar tip found during the pre-operative US examination seem to indicate a partial rupture in the tendon.
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- Karlsson J, Kälebo P, Goksör LA, Thomée R, Swärd L (1992) Partial rupture of the patellar ligament. Am J Sports Med 20: 390-395. [Crossref]
- Lorbach O, Diamantopoulos A, Kammerer KP, Paessler H.H (2008) The influence of the lower patellar pole in the pathogenesis of chronic patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc16: 348–352.
J Bone Joint Surg Am 88: 1689-1698. [Crossref]Know about Your Knee | Knee Injury Ft Lauderdale
How is the knee joint structure?
The knee joint is one of the most complex joints in the body. It consists of bones, ligaments, and muscles. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, a soft cartilage between the femur and tibia, serves to cushion the knee and helps it absorb shock during motion.
The stability and strength of the knee joint is maintained by four ligaments: the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament.
When any of these structures are injured you may have knee pain and difficulty in walking. You may hear a popping or snapping sensation at the time of the injury or you may feel like your knee is giving way. You may also have swelling, limping, and inability to move the knee. If care is not taken during the initial phases of injury it may lead to joint damage that may end up destroying your knee.
What are the common causes of knee injury?
Common causes of knee injury are
- Fracture of femur (thigh bone), tibia and fibula (leg bones)
- Torn ligament (either anterior or posterior cruciate ligament)
- Rupture of blood vessels following a trauma that leads to accumulation of extra fluid or blood in the joint
- Dislocation of knee cap (patella)
- Torn quadriceps or hamstring muscles
- Patellar tendon tear
Arthritis is the most common cause of knee pain. Arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Osteoarthritis is also called as degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.
What is the diagnosis for knee pain?
For proper diagnosis and treatment plan, your doctor will ask about your symptoms and history of any injury and then perform a physical examination of your knee. Several tests are performed to evaluate the ligaments of the knee. Your doctor may also order other tests such as MRI, CT scan, and X-ray to help diagnose more complicated or severe injuries.
Know your options for knee pain treatment
Immediately following a knee injury and before being evaluated by a medical doctor, you should initiate the R.I.C.E. method of treatment:
- Rest: Rest the knee, as more damage could result from putting pressure on the injury.
- Ice: Ice packs applied to the injury will help diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
- Compression: Wrapping the knee with an elastic bandage or compression stocking can help to minimize the swelling and support your knee.
- Elevation: Elevating the knee above heart level will also help with swelling and pain.
Conservative Treatment Options
Initial treatment for arthritis is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and/or anti-inflammatory medications. With worsening symptoms, a cane or a brace may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted, and are no longer helpful, and the arthritis has become disabling, surgery may be recommended.
Total knee replacement
Total knee replacement is considered a treatment option if your knee pain cannot be managed any longer by conservative treatment. Total knee replacement is a surgical procedure in which the worn, damaged surfaces of the knee joint are removed and replaced with new artificial parts. If you find difficulty in performing simple activities such as walking or climbing stairs because of your severe arthritic knee pain, then total knee joint replacement may be considered. It is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Jumper’s Knee Treatment Salt Lake City | Knee Pain Murray
What is Jumper’s Knee?
Jumper’s knee, also known as patellar tendinitis, is inflammation of the patellar tendon that connects your kneecap (patella) to your shinbone. This tendon helps in the extension of the lower leg.
Causes of Jumper’s Knee
Jumper’s knee usually results from repetitive trauma or overuse, particularly from sports activities that involve jumping such as basketball or volleyball. Therefore, this condition is known as jumper’s knee. Rarely, this condition may also occur because of an acute injury to the tendon that has not healed properly.
Symptoms of Jumper’s Knee
Pain over the patellar tendon is the first symptom of jumper’s knee. You may also have pain during activities, especially jumping or kneeling. Rarely, swelling around the tendon may be seen.
Diagnosis of Jumper’s Knee
Your doctor will evaluate your condition based on your symptoms and physical examination. An X-ray of the knee may be ordered to ensure that there is no problem involving the bones or bone spur around the knee. An MRI scan can reveal degenerative changes in the patellar tendon.
Treatment Options for Jumper’s Knee
Conservative Treatment Options for Jumper’s Knee
Treatment options for jumper’s knee:
- Rest the injured knee and avoid activities such as running and jumping that worsen the condition.
- Non-steroidal anti-inflammatory medications (NSAIDs) may be prescribed to provide relief from pain and swelling associated with patellar tendinitis.
- Stretching before exercising is important to prevent the recurrence of patellar tendinitis. These exercises can also help strengthen the patellar tendon and nearby muscles such as the quadriceps, hamstrings and calf muscles.
- The application of ice to the affected area helps to control the inflammation and reduce the swelling.
- A knee support or strap (called an intrapatellar strap or a Chopat strap) can be worn to relieve pain by directing the force away from your tendon and into the strap.
- Iontophoresis involves the application of topical corticosteroid medication to the affected area with the help of a small device that uses an electric charge to deliver the medication through your skin.
- Corticosteroid injection may be administered directly into the sheath around the affected patellar tendon under the guidance of an ultrasound. This helps to relieve pain and perform strength exercises without any pain.
Surgery for Jumper’s Knee
In rare cases, if there is persistent pain, surgery may be considered when other treatment options fail. Surgery involves the removal of severely damaged parts of your tendon and repair of any tears in the tendon.
Osgood-Schlatter Disease (for Parents) – Nemours KidsHealth
What Is Osgood-Schlatter Disease?
Osgood-Schlatter disease (OSD) is swelling and irritation of the growth plate at the top of the shinbone. A growth plate is a layer of
cartilagenear the end of a bone where most of the bone’s growth happens. It is weaker and more at risk for injury than the rest of the bone.
OSD goes away when a child stops growing and usually doesn’t cause lasting problems.
What Are the Signs & Symptoms of Osgood-Schlatter Disease?
OSD typically causes pain and swelling below the kneecap. The pain usually gets worse with running, jumping, going up stairs, and walking up hills. Severe pain may lead to limping. OSD can happen in one or both knees.
What Causes Osgood-Schlatter Disease?
Osgood-Schlatter disease happens during the growth spurt of puberty. During a child’s growth spurt, the bones, muscles, and tendons grow at different rates. In OSD, the tendon that connects the shinbone to the kneecap pulls on the growth plate at the top of the shinbone. Activities and sports cause this to happen over and over, which causes injury to the growth plate. This injury leads to the pain of OSD.
Who Gets Osgood-Schlatter Disease?
OSD usually happens in kids that are:
- in their growth spurt (usually around 9–14 years old)
- active in sports or activities that involve a lot of running or jumping
OSD is an overuse injury. This means it happens when a child does the same movements over and over again.
How Is Osgood-Schlatter Disease Diagnosed?
To diagnose Osgood-Schlatter disease, health care providers:
- ask about physical activities
- do an exam
Usually no testing is needed. Sometimes the health care provider orders an X-ray to check for other knee problems.
How Is Osgood-Schlatter Disease Treated?
Kids with Osgood-Schlatter disease need to limit activities that cause pain that makes it hard to do that activity. For example, it’s OK for a child who feels a little pain when running to keep running. But if running causes a limp, the child should stop and rest. When the pain is better (usually after a day or two), the child can try the activity again.
Sometimes health care providers recommend physical therapy (PT) to keep leg muscles strong and flexible while a child gets better. It doesn’t happen often, but some kids might need a total break from all sports and physical activities.
To help your child feel more comfortable while healing from OSD:
- Put ice or a cold pack on the knee every 1–2 hours for 15 minutes at a time. Put a thin towel between the ice and your child’s skin to protect it from the cold.
- If your health care provider says it’s OK, you can give ibuprofen (Advil, Motrin, or store brand) or acetaminophen (Tylenol or store brand). Follow the directions that come with the medicine for how much to give and how often to give it.
How Long Does Osgood-Schlatter Disease Last?
Osgood-Schlatter disease usually goes away when the bones stop growing. Typically, this is when a teen is between 14 and 18 years old.
Can Kids With Osgood-Schlatter Disease Still Do Sports?
Yes, kids with OSD can usually do their normal activities, including sports, as long as:
- The pain is not bad enough to interfere with the activity.
- The pain gets better within 1 day with rest.
For kids who play sports, it can help to:
- Wear shock-absorbing insoles in their sneakers and cleats.
- Put a heating pad or warm washcloth on the knee for 15 minutes before sports.
- Put ice on the knee for 15 minutes after the activity (with a towel between the ice and the skin).
- Wear protective kneepads, especially for wrestling, basketball, and volleyball.
- Stretch before and after sports.
Looking Ahead
Long-term effects of OSD usually aren’t serious. Some kids may have a painless bump below the knee that doesn’t go away. Very rarely, doctors will do surgery to remove a painful bump below the knee.
Some adults who had OSD as kids or teens have some pain with kneeling. If your child still has knee pain after the bones stop growing, see your health care provider. The provider can check for other causes of knee pain.
90,000 Heel spurs!
Shock wave therapy (SWT) in the practice of treating degenerative-
dystrophic diseases of the musculoskeletal system.
Currently, one of the most innovative methods of treating diseases of the musculoskeletal system is shock wave therapy. Diseases of the musculoskeletal system are widespread in various age groups, according to statistics, from 64 to 86% of the adult population suffer from this type of disease.Degenerative-dystrophic diseases of the musculoskeletal system are often accompanied by chronic pain that is difficult to treat, restricts a person’s functionality and worsens the quality of life. Diseases of the musculoskeletal system are also a social problem, as they cause disability and, with progression, disability of a person. Currently, there is a rejuvenation of the contingent of patients.
The shock wave therapy method was developed in Germany and Switzerland and has been used in medical practice since the 90s.
Indications for the procedure :
– plantar fasciitis (heel “spur”)
– Calcifying tendonitis of the shoulder joint
-radial / ulnar epicondylitis (“tennis elbow”, “golfer’s elbow”)
-therapy of trigger (pain) points
– trochanteric pain syndrome
– patellar head syndrome
– joint contractures (in the absence of metal structures)
– Anterior tibial syndrome.
The shock wave carries high therapeutically effective energy to the diseased tissues. In the tissues, the effect of cavitation occurs, accompanied by the destruction or over-irritation of nerve endings, the production of biologically active substances, the crushing of calcium deposits and ossificates, the activation of the function of macrophages, and increased blood circulation in the affected area. Thus, the shock wave energy accelerates healing, regeneration, has an analgesic effect, restores metabolism, and improves metabolism.The total number of impulses during one procedure is 2000 – 4000, the energy density of the shock wave is 0.05 – 0.28 mJ / mm2. The course of treatment is 3 – 5 procedures, carried out once a week.
The accumulated experience of treating arthrosis with the PIEZOWAVE apparatus confirmed the early effect after the first procedure, manifested by local anesthesia, a feeling of lightness, and a decrease in limitation of movements in the joint. In some patients, a return of pain is observed over the next 2 to 3 days, but of lesser intensity.After a course of treatment, the pain syndrome significantly decreases or disappears. At the same time, according to angulometry data, the volume of movements increases,
decreases
edema present.
In patients with chronic pain syndrome accompanying osteochondrosis of the cervicothoracic, lumbosacral spine, a positive effect is manifested in the course of treatment – a decrease in pain, an improvement in mobility in the spine, and an improvement in exercise tolerance.
Patients with plantar fasciitis (heel spur) after a course of shock wave therapy note a decrease in soreness, pain in the area of the sole and heel during exertion, an increase in painless walking distance.
There were no complications during shock – wave therapy. There was a satisfactory tolerance of the procedures by the patients; pain during the session did not require anesthesia.
Thus, the advantages of shock wave therapy are the rapid achievement of a therapeutic effect, safety, short duration of the procedure and the course of treatment, the possibility of outpatient treatment that does not disrupt the patient’s usual rhythm of life, which is important for working patients.In some cases, shock wave therapy is an alternative to surgical treatment.
Our clinic carries out treatment with the PIEZOWAVE apparatus of the RICARDWULF company and invites all patients who wish to receive treatment for degenerative-dystrophic diseases of the musculoskeletal system.
Information by phone:
(3952) 638-800, 638-802
We are open to all
90,000 Shock wave therapy (SWT) of the knee joint in Moscow at the Dikul clinic: prices, appointments
Shockwave therapy is a very effective method of treating various orthopedic conditions.UHT uses pulses of mechanical energy that propagate in the form of waves in the tissues. With shock wave therapy, the affected areas of the body are affected. For the first time, SWT was used in lithotripsy. Focused shock waves made it possible to break up kidney stones (without surgery). But since the 90s, SWT has been widely used to treat pain associated with various orthopedic conditions, including injuries of the knee joint. This joint is most often prone to various injuries and degenerative conditions.Knee shock wave therapy is one of the most effective, conservative methods of treating knee joint diseases.
Mechanism of Action
Extracorporeal Shockwave Therapy is a focused shockwave therapy that is applied externally. With this method of treatment, the energy of the waves is transmitted locally, to the diseased part of the body, where the main focus of pain manifestations is located. Immediately after exposure to shock waves, the blood flow in the tissues increases sharply in the affected area.
Most important therapeutic effects achieved with shock wave therapy:
- stimulation of regenerative processes in tissues
- stimulation of collagen synthesis
- Reduction of muscle tension
- destruction, with further dissolution, calcified fibroblasts
- pain reduction
- mechanical stimulation
- increase in local blood flow
- Increase in cellular activity – release of substance P, prostaglandin E2, NO, TGF β, VEGF and other inflammatory cytokines
- transient analgesic effect on afferent nerves
- destruction of calcifications (most often in tendons)
Indications for SWT of the knee joint
Shockwave therapy is most commonly used to treat the following conditions:
- Osgood-Schlatter disease,
- Jumper’s knee,
- medial stress tibia syndrome,
- Iliotibial Syndrome (Runner’s Knee),
- arthrosis of the knee joint
Jumper Knee
The quadriceps femoris is connected to the lower leg by a tendon called the patella.In the middle of the patellar tendon is the patella. With increased stress on the knee (when jumping, turning or suddenly changing the direction of movement), pain occurs in the knee joint, above and below the patella. The pain is associated with microscopic tears in the patellar tendons. Thus, the jumper’s knee begins to develop.
Tendon tears heal, but scar tissue forms instead of elastic collagen fibers. In such cases, the use of extracorporeal shock wave therapy gives a good result.Sound waves penetrate to a certain depth and cause tissue vibrations at a microscopic level. Normal healthy tissue reacts to this effect as a deep massage, while fragile, forming scar tissue cannot withstand the action of waves and is destroyed.
Osteoarthritis of the knee joint
Knee osteoarthritis is a condition in which cartilage degeneration and bone tissue remodeling occurs. In severe forms of arthrosis, the cartilage tissue disappears and the bones rub against each other.
Extracorporeal Shock Wave Therapy helps destroy old adhesive formations in the knee joint and triggers angiogenesis (proliferation of blood vessels). This process develops in the joint itself, as well as the muscles, tendons and ligaments surrounding the joint. The destruction of excess bone growths also occurs. As a result, after SWT procedures, mobility increases and pain decreases.
Iliotibial tract syndrome (runner’s knee)
The fascia lata of the thigh is located on the lateral surface of the thigh and connects to the iliac bone or the iliotibial ligament (tract).This ligament connects to the lower leg and helps the knee stabilize when the person lifts the opposite leg. This ligament acts like a knee brace. When the muscles attached to the IT tract tense due to the presence of trigger points or scar changes occur in the ligament, it begins to rub the outer part of the knee.
SWT for IT syndrome (runner’s knee) results in:
- Improving the flexibility of the bond
- Elimination of myofascial trigger points
- Improving knee mechanics
- Significant reduction in pain
Contraindications and precautions
- Use with caution in the area of the epiphyses
- Patients with hemophilia or who are on anticoagulant therapy are advised not to receive shock wave therapy, as complications such as bruising or bleeding are possible.
- Malignant neoplasms are a contraindication for shock wave therapy, since shock waves can accelerate the spread of malignant tissue.
- Metal implants should not be in the affected area.
- Infections in the affected area may lead to the spread of pathogenic flora.
- Endoprostheses of joints – treatment with the help of shock wave therapy has great risks.
No. 1 | Arthroscopic resection of hypertrophied folds | 20000.00 | |||
No. 2 | Arthroscopic meniscus resection | 20000.00 | |||
No. 3 | 9016 Arthroscopic removal of the telondromat 9017 | Diagnostic arthroscopy | 13000.00 | ||
No. 5 | Arthrotomy, revision of the knee joint, meniscectomy | 12000.00 | |||
No. 6 | Autobone removal to replace the defect | 4000.00 | |||
No. 7 | 9016 | 9016 9016 9016 9016 9016 | Reconstruction of the shoulder joint (acromioplasty) | 17000.00 | |
No. 9 | Reconstruction of the shoulder joint (rotator cuff) 9000 905 17000.00 | ||||
No. 10 | Reconstruction of the shoulder joint in case of habitual dislocation of the shoulder | 17000.00 | |||
No. 11 6 | No. 12 | Secondary treatment of wounds + replacement of the defect | 3000.00 | ||
No. 13 | Interlaminectomy, discectomy, spodils, Dalmins constructions 9 Dalmin300 | ||||
No. 14 | Excision of coarse scars, replacement with local tissues | 5000.00 | |||
No. 15 | Acute long tubules. Removal of sequestors. | 15000.00 | |||
No. 16 | Corrective osteotomy and resection, small volume. Removal of small sequestors | 8000.00 | |||
No. 17 | Volumetric vertebrological surgery | 30000.00 | |||
No. 18 | 9016 9016 | ||||
No. 19 | Surgery for incorrectly fused fractures with external fixation devices | 22000.00 | |||
No. 20 | Surgery for chronic nerve and tendon injuries | 16000.00 | |||
No. 21 | Operation with transverse flat feet (one foot) | 15000.00 | |||
No. 23 | Clicking finger operation 5000 | 00 | |||
No. 24 | Osteosynthesis of the femur | 22000.00 | |||
No. 25 | Osteosynthesis long tubulars | ||||
Osteosynthesis of long bones (shoulder) | 18000.00 | ||||
No. 27 | Osteosynthesis of the clavicle | 15000.00 | |||
No. 28 | Osteosynthesis of the bones of the forearm (both bones) | 20000.00 | |||
No. 29 | Osteosynthesis | ||||
No. 30 | Osteosynthesis of the bones of the tarsus (talus) | 15000.00 | |||
No. 31 | Osteosynthesis of the forearm00 | ||||
No. 32 | Osteosynthesis of the ankle | 15000.00 | |||
No. 33 | Osteosynthesis of the ankle 9000 | Osteosynthesis of the patella | 15000.00 | ||
No. 35 | Osteosynthesis of the metatarsal bone | 7000.00 | |||
No. 36 | Osteosynthesis according to Ilizarov (without the cost of the device), external fixation device | 15000.00 | |||
9164 No. 37 | |||||
No. 38 | Osteosynthesis of complex intra-compound fractures | 22000.00 | |||
No. 39 | Osteosynthesis of the phalanges of the fingers | 7000.00 | |||
No. 40 | 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 | PHO wounds with tendon suture | 7000.00 | ||
No. 42 | Transpedicular fixation | 30000.00 | |||
No. 43 | Removal of the ganglion (hygroma) of the hand | 5000.00 | |||
No. 44 | |||||
No. 45 | Removal of the popliteal fossa cyst (Baker’s cyst) | 7000.00 | |||
No. 46 | Removal of the ulnar bursa | 0 | |||
No. 47 | Removal of metal structures after osteosynthesis (femur) | 11000.00 | |||
No. 48 | |||||
No. 49 | Removal of metal structures after osteosynthesis (lower leg) | 8000.00 | |||
No. 50 | Removal of metal structures after osteosynthesis (hand) | 7000.00 | |||
No. 51 | |||||
No. 52 | Removal of metal structures after osteosynthesis (shoulder) | 8000.00 | |||
No. 53 | Removal of metal structures after osteosynthesis (forearm – 1 bone) | 7000.00 | |||
No. 54 | feet 7000.00 | ||||
No. 55 | Removal of the patellar bursa | 5000.00 | |||
No. 56 | Removal of subcutaneous wires after osteosynthesis | 5000.00 | |||
| No. 57 | 9016 9016 9016 No. 58 | Lengthening of bones with external osteosynthesis with external fixation devices | 20000.00 | ||
No. 59 | Elimination of joint blockage | 600.00 | |||
No. 60 | Tendon suture 9016 | ||||
No. 61 | Extract from medical records upon request | 800.00 | |||
No. 62 | Consultation on treatment correction | 600.00 | |||
No. 63 | Consultation with relatives 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 90.00 | No. 64 | Registration of documents for VTEK | 1500.00 | |
No. 65 | Registration of the spa card | 1500.00 | |||
No. 66 | Initial medical examination without appointment | 1500.00 | |||
No. 67 | 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 No. 68 | Re-admission of the patient | 800.00 | ||
Traumatology | |||||
No. 69 | 64 | ||||
No. 70 | Administration of the patient’s drug | 500.00 | |||
No. 71 | Intra-articular drug administration 9016 5006 90.00 72 | Reduction of dislocation of large joints | 3000.00 | ||
No. 73 | Reduction of dislocation of small joints | 1000.00 | |||
No. 74 | Reduction of dislocation of the middle joints | 2000.00 | |||
No. 75 | Opening 9016: gidaric ulcers (small digits) 1300.00 | ||||
No. 76 | Opening of abscesses (volumetric: phlegmon, paraproctitis – 1 area) | 3500.00 | |||
No. 77 | Opening of abscesses (medium: abscess, carbuncle – 1 area) | 1500.00 | |||
No. 78 | 1200.00 | ||||
No. 79 | Secondary treatment of wounds with delayed sutures | 2000.00 | |||
No. 80 | Extract from medical records on request | 800.00 | |||
No. 81 | Dismantling, removal of the external fixation apparatus and others. | 2500.00 | |||
No. 82 | Closed reduction of bone fragments under local anesthesia | 3000.00 | |||
No. 83 | Dry callus excision + sutures | 1000.00 | |||
No. 84 | 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9016 9000 No. 85 | Consultation with relatives on caring for the patient | 800.00 | ||
No. 86 | Correction of the external fixation apparatus (Ilizarova et al.) | 1000.00 | |||
No. 87 | Therapeutic, analgesic, novocaine blockade | 500.00 | |||
No. 89 | Plaster casts: large | 2000.00 | |||
No. 90 | .00 | ||||
No. 91 | Plaster casts: medium | 1000.00 | |||
No. 92 | 9016 9016 9016 and 9016 necroectomy 9016 and 15006 necroectomy and 15006 necroectomy 9000 | ||||
No. 93 | Operation for an ingrown nail | 1700.00 | |||
No. 94 | Operation with an ingrown nail (resection of the nail plate – 1 area) | 1000.00 | |||
No. 95 | |||||
No. 96 | Initial examination by an orthopedic traumatologist | 1200.00 | |||
No. 97 | Initial examination without preliminary appointment 150016300 | ||||
No. 98 | Small dressing, change of sticker | 400.00 | |||
No. 99 | 9016 9016 9016 wide 9016 | Medium dressing, removal of sutures | 500.00 | ||
No. 101 | Repeated examination by orthopedic traumatologist | 800.00 | |||
No. 102 | Puncture of the joint (diagnostic, removal of fluid) | 500.00 | |||
No. 103 | Puncture of the joint (diagnostic, removal of the subcutaneous) | ||||
No. 104 | Sacral (sacral) blockade | 1000.00 | |||
No. 105 | Removing the plaster cast | 4004 | |||
No. 106 | Removing the circular plaster cast | 1000.00 | |||
No. 107 | 9016 9016 9016 164 No. 108 | Removal of the ganglion (hygroma) of the hand | 2500.00 | ||
No. 109 | Removal of the ganglion (hygroma) of the foot | 2500.00 | |||
No. 110 | Tick removal | 300.00 | |||
No. 111 | Removal of superficial skin necrosis | Removal of superficial benign lesions (small) up to 1 cm | 1300.00 | ||
No. 113 | Removal of superficial benign lesions | ||||
No. 114 | Removal of superficial benign lesions (medium) up to 5 cm | 2000.00 | |||
No. 115 | |||||
No. 116 | Removal of pins protruding from the skin | 500.00 | |||
No. 117 | Surgical treatment of deep, extensive wounds. | 2500.00 | |||
No. 118 | Surgical treatment of superficial wounds | 1500.00 | |||
No. 119 | |||||
No. 120 | Cytological study | 240.00 | |||
PRP-therapy
PRP APPLICATION IN TRAUMATOLOGY
A dramatic increase in the number of professional sportsmen in recent years and amateur level.In this regard, there is a jump in morbidity and injury in the field of the musculoskeletal system of the competitors.
In our clinic, for the effective treatment of various kinds of injuries and exacerbations of chronic conditions of the musculoskeletal system, the PRP-therapy method is used with great success.
PRP-therapy (plated rich plasma – English: platelet-rich plasma) is a method of treating various types of diseases by injecting autologous platelet-rich plasma isolated from the patient’s whole blood.
The principle of action is based on the delivery of natural factors from alpha-granules of platelets to the pathological zone, which are involved in the recovery processes of the body, such as:
Epidermal growth factors (EGF)
Vascular endothelial growth factors (VEGF)
Platelet growth factors (PDGF)
Transforming growth factors beta (TGF-b) and fibroblast growth factors (FGF)
The PRP-therapy method is most effective when:
Exacerbation of degenerative-dystrophic diseases of the musculoskeletal system (arthrosis and arthritis of various joints, ostechondrosis of the spine, etc.))
shoulder-scapular periarthritis (damage to the rotator cuff, dry congestion of the long head of the biceps, impingement syndrome)
epicondylitis (tennis elbow, golfer’s elbow),
tendinitis, ligamentitis (inflammation of the Achilles tendon, inflammation of the patella’s own ligament).
Application:
arthrosis stage 2-3: gonarthrosis, coxarthrosis, omarthrosis, arthrosis of the acromioclavicular joint (therapy is most effective in the initial stages)
tendinitis, ligamentitis (inflammation of the Achilles tendon, inflammation of the patella’s own ligament)
impingement syndrome
fasciitis
arthritis
periarthritis
epicondylitis (tennis elbow, golfer’s elbow)
humeral-scapular periarthritis
subacromial syndrome
plantar fasciitis (heel spur)
Advantages:
Antibacterial effect
Reduction of pain syndrome
Reduction of the inflammatory process
Accelerated tissue regeneration
High efficiency of treatment
Security
Absence of harmful effects as when taking pharmaceutical preparations
Treatment results:
restoration of joint fluid;
Improving the nutrition of the articular cartilage and accelerating its recovery;
blood circulation is activated in the area of the affected joint;
decreases the pressure on the damaged articular areas of the bones and increases the distance between them;
the muscles surrounding the diseased joint are strengthened;
increases the mobility of the joint, a significant reduction in the period of rehabilitation after injuries, operations and prosthetics.
Features of the procedure in our clinic
The specialists of our clinic have been trained and have certificates that confirm the possibility of using PRP-therapy technology in traumatology and orthopedics.
The use of special tubes of the “hourglass” type, as well as adapted centrifuges, make it possible to obtain preparations of platelet-rich plasma in the shortest possible time (on average, the procedure takes no more than 20 minutes).The concentration of platelets in such samples, according to laboratory studies, can reach 2,000,000 activated platelets in 1 ml of the drug (for comparison, in whole blood this number averages 250,000 NOT activated in 1 ml).
Treatment of blood by the applied technique leads to the concentration of platelets 7-9 times, which leads to their activation – the release of growth factors from alpha-granules.
The obtained platelet layer is taken from a test tube and used as a medicinal preparation by injection into the affected segment of the musculoskeletal system.
The course of injections consists of 3-7 procedures with a frequency of once every 7-10 days, depending on the type of disease.
Shock wave therapy in Krasnodar
Shock wave therapy is a relatively new method of reflexology. It has been used since the 80s of the XX century. In the United States, shock wave therapy is classified as “non-invasive surgery,” because it can help solve problems that would normally require surgery.
Initially, UHT devices were created for crushing stones in the gallbladder and kidneys.The use of shock waves in the treatment and rehabilitation of the musculoskeletal system came into medical practice somewhat later.
Functional principle
When performing shock wave therapy procedures, energy is transferred to a specific area by means of a sound wave.
The wave data source is connected to the affected area using special silicone attachments. Depending on the settings of the shock wave therapy device, it is possible to act at different depths: in our practice, this is most often the range from 0.5 to 5 cm.
Soft tissues: muscles, skin, and subcutaneous fat layer are transparent enough for shock wave treatment. They transfer energy well and come into resonance with the induced wave. At the same time, bones and tendons have a higher density, and therefore are opaque for acoustic exposure.
The boundary formed by this difference is the zone of maximum release of shock wave energy. This area is under maximum impact, like a protective dam on the seashore, as it is subject to strong fluctuations of some types of tissue relative to others.
With correctly selected parameters (wavelength, intensity and duration of the induced effect), this effect has healing properties.
With the help of X-ray studies, it has been proven that shock wave therapy can not only stimulate the metabolism (thereby accelerating the process of tissue regeneration), but, under certain parameters, even destroy such bone-cartilaginous blockages as a heel spur. This result does not occur after the first procedure, and it is not significant in all patients, but in some cases the heel spur can be completely destroyed, thereby preventing the previously inevitable operation.
Indications for use of Shockwave therapy
In orthopedics, the classic indications for shock wave therapy (ESWT) are diseases associated with pathological changes in the tendon attachment sites, such as:
It is also possible to target the range of soft tissues with a depth of 0.5 to 5 centimeters, and due to the effect, increase blood flow, thereby stimulating treatment or removing edema.
In addition, the methods of shock wave therapy can be used in the healing of fractures and the treatment of pseudoarthrosis.
Major diseases affecting large joints, in which shock wave therapy is the main method of physiotherapy:
Shoulder:
periarthritis – supraspinatus tendon, subacromial bursa, tendon of the long head of the biceps of the shoulder.
Elbow joint:
tennis elbow (epicondylitis humeri radialis et ulnaris), traumatic and overload synovitis and tenosynovitis.
In the area of the pelvic ring bones:
ARS – syndrome, symphysitis.
Hip joint:
trochanteritis and inflammation of the bursa of the greater and lesser trochanter of the thigh.
Elbow:
epicondylitis, tenosynovitis, patellar enthesopathy (“jumper’s knee”, more often expressed in athletes and people actively involved in sports).
Stop:
plantar fasciitis, shock wave therapy of spurs and shock wave therapy of heel spurs, achillobursitis, enthesopathies of the tendons of the muscles of the foot.
Main useful characteristics of Shock-wave action:
- Removal of pain syndrome.
- Stimulation of the healing of degenerative – dystrophic diseases.
- Stimulation of blood circulation.
- Elimination of calcium deposits.
- Restoration of mobility of the affected area of the musculoskeletal system.
- Relief of the inflammatory process.
- Fusion of hard healing fractures, pseudoarthrosis.
Effectiveness of the shock wave therapy method
According to the latest research by Richard wolf, a manufacturer of shock wave therapy devices, the effectiveness of shock wave therapy in treatment and rehabilitation reaches 87%.
There are 4 or 5 variants of sound wave extraction using various physical effects in the world. In “Eurasia” we use a UHT device based on piezoelectric elements.
The membrane that creates a shock wave contains a piezoelectric layer that changes its size under the influence of an electrical discharge.This wave, due to the connection of the membrane and the body surface with the help of special silicone pads and an air-tight gel, is transmitted to the soft tissues with almost no loss of power.
Contraindications for shock wave therapy
The main contraindications to the use of shock wave therapy are:
- Pregnancy;
- The presence of a purulent or tumor process in the area of exposure;
- Blood clotting disorders;
- Cancer neoplasms in the affected area;
- This method is contraindicated in children.
- It is also an important fact that hormonal drugs should not be used during the treatment of shock wave therapy methods.
How does shock wave therapy work?
Today in the world there are 4-5 different methods of extraction of sound waves. At the Eurasia Medical Center, we use the Richard Wolf PiezoWave UHT device based on piezoelectric elements.
The membrane that creates a shock wave contains a piezoelectric layer that changes its size under the influence of an electrical discharge.This wave, due to the connection of the membrane with the body surface using special silicone pads and an airtight gel, is transmitted into the patient’s soft tissues with virtually no loss.
How is the procedure going?
Shock wave therapy can, to a certain extent, conditionally be compared with deep massage: in ancient times, in the East, the method of massage with the help of wooden hammers was used. In the system of Western medicine, a method similar in effect to the method of treatment did not previously exist.Shock wave therapy is a painful procedure. During it, the patient should experience pain.
In this regard, the membrane transmitting vibrations is not only a source of shock waves, but also a diagnostic sensor: if the patient experienced unpleasant sensations in some area of the shock wave exposure, it means that there is a problem at this point, and the impact on it with the help of a shock wave therapy will be effective.
If the membrane is attached to a healthy area, the patient will not experience any sensations and, accordingly, will not receive any therapeutic effect.
Using the settings, the pain level is brought to the level that the patient can endure during the entire procedure. In our practice, we try to set such a level of exposure so that the patient can easily endure discomfort without any side effects. The permissible number of procedures is from 3 to 7. The interval between sessions is from 3 to 7 days: more often it is impossible, less often it makes no sense. During treatment with shock wave therapy, hormonal drugs should not be used.
Why is UHT used at the Eurasia Medical Center?
At the Eurasia Medical Center, we use the Shock Wave Therapy method for the treatment of diseases and rehabilitation after injuries of the musculoskeletal system. The UVT devices we use are primarily intended for:
- Treatment of heel spurs;
- Treatment of the consequences of trauma;
- Treatment of various degenerative diseases (arthritis, arthrosis).
Clinic address:Krasnodar, st. Yana Poluyana, 55
90,000 Shock wave therapy in Izhevsk, UVT price for 1 session
Shock wave therapy (SWT). This is a method of exposure to regulated sound shock waves that are focused in a given area of the body, providing a precisely targeted therapeutic effect without damaging other body tissues.
Shockwave therapy is performed using a special device that generates sounds (acoustic waves) of a very low frequency (they cannot be heard).This acoustic wave in the area of application of the device spreads through the tissues of the body and stops its movement, reaching the bone.
Effect of shock wave therapy
This method of treating the musculoskeletal system has become widespread due to its simplicity and effectiveness, already during the procedure, patients will feel:
- rush of blood in the area of operation of the device;
- disappearance of pain;
- improvement of well-being.
Shock Wave Therapy Procedure
The procedure for carrying out shock wave therapy is very simple and absolutely painless. The patient is seated comfortably on the couch. The doctor covers those areas of the skin that will come into contact with the sensor of the UHT apparatus with a thin layer of a special gel. Then the doctor sets the individual settings of the device, which depend on each specific case and the pathology that will be treated. The sensor is pressed firmly against the skin and the process begins.The procedure lasts from 5 to 30 minutes. The break between sessions should be at least 4 days. A full course of treatment of the musculoskeletal system using shock wave therapy can range from 5 to 10 procedures. However, the duration and frequency of procedures are in direct proportion to the complexity of the pathology.
Indications for Shock Wave Therapy
1. Orthopedic and traumatological pathology.
Almost any pathology of the musculoskeletal system, including:
- Plantar fasciitis with and without a heel spur;
Physiotherapy in Noginsk at the medical diagnostic center Tomograd
Initial appointment with a physiotherapist – 750 rubles.
| Physiotherapy | Cost of procedure | Discount price / share |
|---|---|---|
| Shockwave therapy | RUB 1,500 | |
| Magnetotherapy course (5 procedures / 10 procedures) | 2000 rub. / 4000 rub. | 1900 p./ 3500 p. |
| Ultrasound therapy course (5 procedures / 10 procedures) | 2000 rub. / 4000 rub. | 1900 rub. / 3500 rub. |
| Phonophoresis (with medicine) course (5 procedures / 10 procedures) | RUB 2,500 / RUB 5,000 | 2400 rub. / 4500 rub. |
| Electrophoresis (with medicine) course (5 procedures / 10 procedures) | 2000 RUB/ 4000 p. | 1900 rub. / 3500 rub. |
| Electrical stimulation course (5 procedures / 10 procedures) | 2000 rub. / 4000 rub. | 1900 rub. / 3500 rub. |
| Galvanization course (5 procedures / 10 procedures) | RUB 1,500 / RUB 3,000 | RUB 1250 / RUB 2500 |
| Laser therapy | 600 RUB | |
| OKUF-therapy (1 procedure) | 200 RUB |
* This price offer is not an offer.
* The administration of the clinic takes all measures to timely update the price list posted on the website, however, in order to avoid possible misunderstandings, we advise you to clarify the cost of services at the reception or in the contact center by phone 8 (800) 500-87-33 (free call), 8 (495) 722-64-07
Physiotherapy – treatment with physical influences and procedures, for example, electric current, heat, laser, ultraviolet radiation or ultrasound.It is also used as an adjunct to treatment, improves blood supply, nutrition, helps to reduce swelling and pain, and much more.
Physiotherapy benefits:
- shortening the treatment time for many diseases;
- prevention of complications and relapses of the disease;
- no side effects typical of drug treatment;
- increasing the effectiveness of the use of medicines;
- Significant reduction in doses of prescribed drugs or complete rejection of them.
| Procedure | Indications for use | Therapeutic effect of the procedure |
|---|---|---|
| SHOCK WAVE THERAPY (SWT) |
|
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| LASER – THERAPY | ||
| MAGNET – THERAPY | ||
| PARAFFIN THERAPY |
| Resorption of infiltrates, muscle relaxation, pain relief, increased cellular metabolism, stimulation of sweat and sebaceous glands, improvement of blood and lymph circulation, an anti-inflammatory and compression effect. |
| PARAFFIN BOOTS |
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