Arthroscopy

The anterior cruciate ligament (ACL)

Arthroscopy is surgery that is done using a tiny camera on the end of a tube to check for and treat joint problems.

See also:

Knee arthroscopy
Rotator cuff repair
Shoulder arthroscopy
Description
This procedure is typically done on the knee, hip, ankle, shoulder, elbow, or wrist.

Three different types of anesthesia (pain management) may be used for arthroscopy surgery:

General anesthesia. You will be unconscious and unable to feel pain.
Painkilling medicine. Your joint may be numbed, and you may be given medicines that relax you. You will stay awake.
Spinal anesthesia. This is also called regional anesthesia. The painkilling medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.
The area is cleaned and a pressure band (tourniquet) may be applied to restrict blood flow. The health care provider will then make a surgical cut into the joint. Sterile fluid is passed through the joint space to expand the joint and provide a better view.

Next, a tool called an arthroscope is inserted into the area. An arthroscope consists of a tiny tube, a lens, and a light source. It allows the surgeon to look for joint damage or disease.

Images of the inside of the joint are displayed on a monitor. One or two other surgical cuts may be needed so the doctor can use other instruments to remove bits of cartilage or bone, take a tissue biopsy, or perform other minor surgery. In addition, ligament repairs can be done using the arthroscope.

Why the Procedure is Performed
A number of different injuries and diseases may cause joint pain or problems.

Arthroscopy may be needed to:

Diagnose the cause of joint pain after an injury
Perform carpal tunnel surgery
Remove loose bone or cartilage fragments in the joint
Remove the lining of the joint. This lining is called the synovium, and it may become swollen or inflamed from arthritis.
Repair a torn ligament or tendon
Repair damaged cartilage or meniscus (the piece of cartilage that cushions the knee joint area)
Risks
The risks from surgery are:

Allergic reactions to medications
Breathing problems
Other risks from this surgery include:

Bleeding into the joint
Blood clot
Damage to the cartilage, meniscus, or ligaments in the knee
Infection in the joint
Injury to a blood vessel or nerve
Joint stiffness
Outlook (Prognosis)
After the procedure, the joint will probably be stiff and sore for a few days. Ice is commonly recommended after arthroscopy to help relieve swelling and pain.

You can resume gentle activities, such as walking, immediately. However, using the joint too much may cause swelling and pain, and may increase the chance of injury. Do not restart normal activity for several days or longer.

You may need to make arrangements for work and other responsibilities. Your doctor may also recommend physical therapy.

Depending on your diagnosis, you may have other resrictions or need to do certain exercises.

Before the Procedure
You will usually have an MRI scan of the joint done before surgery is planned.

Always tell yoru doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

You will be asked to stop taking drugs that make it harder for your blood to clot beginning 2 – 3 weeks before surgery. These drugs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Naprosyn, Aleve).

Ask your doctor which drugs you should still take on the day of your surgery.

You will usually be asked not to eat or drink anything for 6 – 12 hours before the procedure. Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

You must sign a consent form. Make arrangements for transportation from the hospital after the procedure.

Alternative Names
Arthroscopy – hip; Arthroscopy – wrist; Arthroscopy – ankle

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Joint pain

The anterior cruciate ligament (ACL)

Joint pain can affect one or more joints.

See also:

Arthritis (inflammation of joints)
Bursitis
Muscle pain
Considerations
Joint pain can be caused by many types of injuries or conditions. No matter what causes it, joint pain can be very bothersome.

Rheumatoid arthritis is an autoimmune disorder that causes stiffness and pain in the joints. Osteoarthritis involves growth of bone spurs and degeneration of cartilage at a joint. It is very common in adults older than 45 and can cause joint pain.

Joint pain may also be caused by bursitis (inflammation of the bursae). The bursae are fluid-filled sacs that cushion and pad bony prominences, allowing muscles and tendons to move freely over the bone.

Causes
Autoimmune diseases such as rheumatoid arthritis and lupus
Bursitis
Chondromalacia patellae
Gout (especially found in the big toe)
Infectious diseases, including
Epstein-Barr viral syndrome
Hepatitis
Influenza
Lyme disease
Measles (rubeola)
Mumps
Parvovirus
Rheumatic fever
Rubella (German measles)
Varicella (chickenpox)
Injury, including fracture
Osteoarthritis
Osteomyelitis
Septic arthritis
Tendinitis
Unusual exertion or overuse, including strains or sprains
Home Care
Follow prescribed therapy in treating the underlying cause.

For nonarthritis joint pain, both rest and exercise are important. Warm baths, massage, and stretching exercises should be used as frequently as possible.

Anti-inflammatory medications may help relieve pain and swelling. Consult your health care provider before giving aspirin or NSAIDs such as ibuprofen to children.

When to Contact a Medical Professional
Contact your health care provider if:

You have fever that is not associated with flu symptoms
You have lost 10 pounds or more without trying (unintended weight loss)
Your joint pain lasts for more than 3 days
You have severe, unexplained joint pain, particularly if you have other unexplained symptoms
What to Expect at Your Office Visit
Your health care provider will perform a physical exam and ask you about your medical history. The following questions may help identify the cause of your joint pain:

Which joint hurts? Is the pain on one side or both sides?
How long have you been having this pain? Have you had it before?
Did this pain begin suddenly and severely, or slowly and mildly?
Is the pain constant or does it come and go? Has the pain become more severe?
What started your pain?
Have you injured your joint?
Have you had an illness or fever?
Does resting the joint reduce the pain or make it worse?
Does moving the joint reduce the pain or make it worse?
Are certain positions comfortable? Does keeping the joint elevated help?
Do medications, massage, or applying heat reduce the pain?
What other symptoms do you have?
Is there any numbness?
Can you bend and straighten the joint? Does the joint feel stiff?
Are your joints stiff in the morning? If so, how long does the stiffness last?
What makes the stiffness better?
Tests that may be done include:

CBC or blood differential
Joint x-ray
Sedimentation rate, a measure of inflammation
Blood tests specific to various autoimmune disorders
Physical therapy for muscle and joint rehabilitation may be recommended. A procedure called arthrocentesis may be needed to remove fluid from the sore joint.

Joint x-ray

The anterior cruciate ligament (ACL)

This test is an x-ray of a knee, shoulder, hip, wrist, ankle, or other joint.

How the Test is Performed
The test is done in a hospital radiology department or in the health care provider’s office. The x-ray technologist will help you position the joint to be x-rayed on the table. Once in place, pictures are taken. The joint may be repositioned for different views.

How to Prepare for the Test
Inform the health care provider if you are pregnant. Remove all jewelry.

How the Test Will Feel
The x-ray is not uncomfortable, except possibly from positioning the area being x-rayed.

Why the Test is Performed
The x-ray is used to detect fractures, tumors, or degenerative conditions of the joint.

What Abnormal Results Mean
The x-ray may reveal arthritis, fractures, bone tumors, degenerative bone conditions, and osteomyelitis (inflammation of the bone caused by an infection).

The test may also be performed to investigate the following conditions:

Acute gouty arthritis (gout)
Adult still’s disease
Caplan syndrome
Chondromalacia patellae
Chronic gouty arthritis
Congenital dislocation of the hip
Fungal arthritis
Non-gonococcal (septic) bacterial arthritis
Osteoarthritis
Pseudogout
Psoriatic arthritis
Reiter syndrome
Rheumatoid arthritis
Runner’s knee
Tuberculous arthritis
Risks
There is low radiation exposure. X-rays are monitored and regulated to provide the smallest amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of the x-ray.

Alternative Names
X-ray – joint; Arthrography; Arthrogram

Perimenopause: Help for Haywire Hormones

Heart Disease

Perimenopause symptoms are different for every woman—get the relief you need with these customizable tips

1. Hot Flashes

Try This: If your heated moments are sporadic and mild, start off by wearing layered, natural-fiber clothing or using a fan. Spicy foods can trigger hot flashes, as can alcohol—so calculate the consequences of Mexican food and margaritas before you make dinner plans. Acupuncture may also provide relief: A March 2011 study found that this staple of Chinese medicine significantly lessens the severity of hot flashes. And many women swear by cooling pillows, which contain a liquid core that lowers your body temperature while you sleep. Try the Chillow ($40; soothsoft.com).

Then This: If your hot flashes are frequent and intense, talk to your health care provider about medical treatment. “The only FDA-approved treatment for hot flashes is hormone therapy,” says Dr. Pinkerton. If you have significant symptoms and no contraindications, your doctor should tailor a low-dose prescription of estrogen and progesterone if you have a uterus, estrogen alone if you’ve had a hysterectomy. Worried about possible health risks from HT? A new analysis of existing research found that women under 60 who use HT face no increase in mortality risk. For those who can’t or won’t take hormone therapy, there are non-FDA-approved therapies that can decrease the frequency or severity of the hot flashes.