Bones & Joints

In The News: August 2019

An estimated 54.4 million adults in the United States have doctor-diagnosed arthritis, according to a study by the Centers for Disease Control and Prevention (CDC). The CDC analyzed data from the 2017 Behavioral Risk Factor Surveillance System, which is a telephone survey that included over 400,000 Americans. The study, published in MMWR (May 2019), found that about 23% of adults ages 18 and older have arthritis, with variation across the country, ranging from 15.7% in Washington, D.C. to 34.6% in West Virginia. Prevalence was generally highest in the Appalachian and Lower Mississippi Valley regions. Among adults with arthritis, about 31% reported severe joint pain and 34% said they were not physically active. People with severe joint pain were more likely to be physically inactive than those with moderate or no joint pain.

Robot-Assisted Joint Replacement

With robot-assisted joint replacement surgery, the surgeon can accommodate for each person's unique anatomy. "During knee replacement surgery, we place markers in the thigh bone and the shin bone and then we map out the ends of the bones," says Dr. Molloy. The computer detects the markers and overlays a map of the knee joint over a computed tomography (CT) image that was taken before the surgery. The surgeon can then very accurately position the components of the implant.

In The News: July 2019

The Food and Drug Administration (FDA) approved the drug romosozumab (Evenity) for osteoporosis in April 2019. Evenity joins two other anabolic agents (teriparatide [Forteo] and abaloparatide [Tymlos]), which treat the bone-thinning disease osteoporosis by stimulating bone formation. Evenity has a new mechanism of action. In head-to-head studies, Evenity increased bone mass more than Forteo. The anabolics differ from other osteoporosis drugs, which work by preventing bone from breaking down. (Bone undergoes a natural cycle of breaking down and building back up.) In one of the studies that led to the approval of Evenity, the drug lowered the risk for a spine fracture by 73 percent compared with placebo after one year. Evenity is approved for postmenopausal women with osteoporosis who are at high risk for a bone fracture. Evenity is given as a monthly injection for 12 months by a healthcare provider in a doctor's office.

Guide to Ankle Sprains

One reason to see a doctor if the symptoms of an ankle sprain persist is the possibility that something else is wrong. For example, the cartilage (the cushioning material covering the ends of bones in joints) in the ankle may be injured. "You can knock off a piece of cartilage when you have a sprain," says Dr. Berkowitz.

Helping Hands

Protecting joints is important to prevent injury and further harm. You want to reduce stress on the joints during daily activities to help relieve pain and inflammation while preserving the integrity of the joint, says Fetzer. She recommends the following:
- Respect pain. Dont work through the pain.
- Take frequent rest breaks. Balance rest with activity to let your body recover and rejuvenate.
- Organize your day. Spread out activities that might be difficult.
- Avoid painful positions, such as tight gripping or pinching.
- Use adaptive devices (see box).
- Use stronger joints for carrying objects.
- Carry objects with both hands, palms up.
- Instead of texting someone, callthem.

Keep Your Garden Green and Your Joints Pain-Free

Spending time in the garden is a great way to interact with nature. It can bring great satisfaction, but it can also be hard work. If gardening has become too difficult because of the aches and pains of arthritis or other musculoskeletal problems, you may think you have to abandon it. With a few modifications and adaptations you shouldn't have to.

Relief for Sciatica

The sciatic nerve, the largest and longest nerve in the body, originates in the low back. It goes through the buttocks, down the back of the thigh, and continues down to the foot. Sciatica is a group of symptoms (such as shooting pain, numbness and tingling) that occur when this nerve is compressed or irritated.

Ask The Doctors: July 2019

In general, side effects of corticosteroid injections, such as infection or bleeding, are rare. However, corticosteroids can increase blood sugar levels, which is a concern for people with diabetes. A study published in Sports Health (July 2017) reviewed results from 10 studies of people with diabetes who received steroid shots, mostly in the knee, shoulder, wrist or ankle. All of the studies showed there was an increase in blood sugar levels in the first few days after a steroid injection. Levels returned to normal within one to 10 days. People with type 1 diabetes and people with type 2 diabetes who use insulin had higher spikes in blood sugar than people with type 2 diabetes who didn't require insulin. There were no reports of serious adverse effects from the increased blood sugar levels.

Surgery for Hammertoes

The abnormal bending of the toes known as hammertoes is a common foot deformity, especially for women. The end of the toe bends down and the middle joint sticks up. Hammertoes mainly cause difficulty fitting into shoes and corns and calluses from pressure and rubbing. "These can generally be managed by accommodating for the deformity," says Georgeanne Botek, DPM, Head of Podiatry in the Department of Orthopaedic Surgery at Cleveland Clinic.

Download The Full June 2019 Issue PDF

When knee osteoarthritis worsens to a point where it can no longer be managed with nonsurgical measures, many people turn to joint replacement surgery. But there may be reasons to delay or avoid surgery. If thats the case, you arent necessarily out of luck. A genicular nerve block may help ease pain enough to get you back to functioning.

Ask The Doctors: June 2019

The number of osteoporosis drugs and the different ways they are taken can be confusing. There are pills, injections and infusions, taken weekly, monthly or at other intervals. Your doctor chooses the best drug based on a variety of factors. A small percentage of people who take bisphosphonates have gastrointestinal problems, such as nausea, stomach pain, constipation, diarrhea and gas. This may be one reason your doctor prescribed Prolia, which is given as an injection and is easier on the stomach.

Nerve Blocks for Knee Pain

Unlike with a corticosteroid shot, which is injected into the joint, the anesthetic that is injected for a nerve block stays outside the joint. "We want to target nerves before they dive into the knee," says Dr. Bolash. "If I wanted to cut off electricity to your house, I wouldn't go around to every lamp. I would cut it off before it gets into the house."