Bones & Joints

Use NSAIDs Cautiously

COX-2 inhibitors were developed to avoid the stomach problems that can occur with traditional NSAIDs. The COX-1 enzyme protects the stomach lining from corrosive effects of stomach acid, so it was thought that inhibiting just COX-2 would be easier on the stomach. But COX-2 also has a protective effect. The risk for stomach issues is about 50% lower with COX-2 inhibitors than with nonselectiveNSAIDs.

Don’t Ignore Ball-of-Foot Pain

The plantar plate is a fibrous structure underneath the foot that supports and stabilizes the joints between the toe bones and the bones of the foot. (These are the metatarsophalangeal joints [MPJ].) The plantar plate, which is made of collagen, consists of bands that provide attachments for ligaments that go to each toe and that go between toes. These keep toes straight (preventing them from drifting up) and also in alignment (preventing the toes from separating).

Should You Get a Partial Knee Replacement?

Osteoarthritis results from the deterioration of cartilage in joints. Cartilage is the tough material that covers the ends of bones, providing a smooth gliding surface. In the knee joint, where the thigh bone (femur) meets the shinbone (tibia), there are three places where bones make contact. One of them is on the inside (nearest the opposite knee, referred to as medial) and one is on the outside (farthest from the opposite knee, referred to as lateral). The kneecap (patella) is the third point of contact.

Children Get Arthritis Too

Juvenile arthritis can present in much the same way as adult-onset arthritis, with joint swelling, stiffness and soreness that's more pronounced in the morning or when children are active. In an active child, these symptoms can be hard to tease apart from the normal aches and pains of playing sports, which is why a thorough diagnosis with a complete health history is important. That's often followed by imaging scans, such as ultrasound or MRI, to give the doctor a closer look at the child's joints.

Ask The Doctors: October 2019

Corticosteroids are powerful anti-inflammatory medications. They suppress inflammation and pain, and they also suppress the immune system. If the immune system is weakened in any way, it can put you at increased risk for infections. A possible complication of any joint replacement surgery is infection. While this occurs only rarely, the risk is increased if the immune system is impaired. For this reason, people should wait to have joint replacement surgery after having a steroid injection until the immune system has had time to recover.

Ask The Doctors: September 2019

If not enough uric acid is excreted (a function of the kidneys) it can build up in the bloodstream and cause hyperuricemia. Some people, but not all, who have hyperuricemia will develop gout. In people with gout, uric acid leaves the bloodstream and travels to joints. The deposits of uric acid can intermittently form needle-shaped crystals, which set off an inflammatory response by the body. The result is a red, hot and swollen joint of a gout attack.

Download The Full September 2019 Issue PDF

Golf is an appealing sport for millions of Americans, including about 17 million people over age 50. Getting older doesnt diminish the desire to play, but it can present some new challenges.

Get Ready for Golf

"They can determine what parts of the body are problem areas before you play golf, and they will create an individualized conditioning program," says Dr. Burg, who is a certified TPI golf expert. Cleveland Clinic has several certified golf experts, and you can also find one in your area on the TPI website ( Golf assessments are not usually covered by health insurance unless you have a golf-related injury.

Can AI Fix Your Bad Back?

There also is a wealth of data in medical records and the research literature about the characteristics of individual patients and their experiences with different treatments. "When I'm in an exam room with a patient, it is difficult to reconcile the hundreds of data points in the records that influence how a patient will perceive their outcome and to render a truly informed decision for that patient," says Dr. Mroz. He believes the solution to this problem is artificial intelligence (AI).

Biceps Tendon Injury

There are two biceps tendons at the shoulder, called the long head and short head. "The long head of the tendon is deep in the shoulder, and it passes out of the shoulder joint into a little groove at the top of the humerus bone," explains Dr. Schickendantz. This lengthy pathway makes the long head of the biceps tendon more prone to injury than the short head.

Download The Full August 2019 Issue PDF

Joint replacement surgery is often recommended when osteoarthritis seriously limits the ability to function and can no longer be effectively managed with nonsurgical methods, such as exercise, physical therapy, pain medications and injections.

Ask The Doctors: August 2019

You should talk to your doctor to get an accurate diagnosis. If you know you have osteoporosis, be sure you are getting sufficient calcium (1,200 mg a day for women over age 50 and men over age 70 and 1,000 mg a day for men ages 51 to 70) and vitamin D (600 international units [IU] per day up to age 70 and 800 IU per day after age 70). A medication for low bone mass may be needed. Preventing osteoporosis from getting worse will help prevent further compression fractures. If you don't know whether you have osteoporosis and you haven't had a bone density test, see your doctor about getting one.