Thank you for visiting our online medical library. This section of our web site currently contains brief summaries of scientific articles called abstracts plus definitions of words related to the field of orthopedics, a broad look at the different uses of anesthesia, detailed food and drug interaction information, and finally, important medical insurance overview. Simply click on the links below to read the information.
Clin Ortho, (367):50-60, October 1999
Cartier P, Sanouiller JL, Grelsamer RP, Clinique des Lilas, Paris, France
Abstract — Sixty knees in 54 patients were followed a minimum of 10 years after unicompartmental knee arthroplasty [partial knee resurfacing] surgery. Follow-up periods ranged from 10 to 18 years (average, 12 years). Two patients required arthroplasty surgery after the 10-year mark. Seven knees required revision prior to 10 years, and the 10- to 12-year survivorship for the entire cohort was 93%. Slight undercorrection of varus alignment and adequate polyethylene thickness of the tibial component appear to be important contributors to a successful outcome.
J Arthroplasty, 11(7):782-8, October 1996
Hasegawa Y, Ooishi Y, Shimizu T, Sugiura H, Takahashi S, Ito H, Iwata H Department of Orthopaedic Surgery, Nagoya University School of Medicine, Japan
Abstract —A total of 77 knees in 60 consecutive patients were operated on for medial gonarthrosis using a cemented porous coated anatomical unicompartmental knee arthroplasty [ partial knee resurfacing]. Their average age was 71.3 years; 11 were men and 49 women. Clinically, the results in 67 knees were rated as being good to excellent, with mean preoperative and postoperative flexion of 123 and 122 degrees, respectively. No deep infections or deep venous thrombosis occurred, but there was one dislocation of the femoral component. Overall clinical and radiographic results were satisfactory in 88% at 7.0 years’ follow-up. Kaplan-Meier survivorship analysis indicated that the failure rate of unicompartmental knee arthroplasty was 12% at average follow-up. In patients aged 70 years or more, unicompartmental knee arthroplasty [partial knee resurfacing] for medial gonarthrosis should be considered an excellent alternative to high tibial osteotomy.
Arch Orthop Trauma Surg, 117(4-5):183-7, 1998
Abstract — A retrospective review of medial compartment arthroplasty in 22 patients (22 knees) is reported. The operations were performed between 1973 and 1978. Eighty-six per cent were rated good or excellent using the knee rating system devised by the Hospital for Special Surgery, New York. Excellent or good results were achieved in six patients who had previously had a high tibial osteotomy. At the time of follow-up significant loosening had not occurred, although progression of patellofemoral disease was noted. This study supports the promising results reported for unicompartmental resurfacing arthroplasty in the elderly.
J Bone Joint Surg [Br], 66(5):682-4, November 1984
A 4.5-6-year follow-up study with a metal-backed tibial component.
Kozinn SC, Marx C, Scott RD, Brigham Women’s Hospital, Boston, Massachusetts.
Abstract — The results in the first 50 patients to receive an improved-design unicompartmental knee prosthesis [partial knee resurfacing] were reviewed after an average follow-up period of 5.5 years. The prosthesis is composed of a metal-backed polyethylene tibial component and a wide femoral surface replacement that are fixed to bone with acrylic cement. Forty-five patients with 55 unicompartmental knee arthroplasties were available for clinical study. Ninety-two percent of the knees were rated as having a good or excellent result, and 94% had lasting relief of pain. There have been no failures requiring revision. A radiographic review demonstrated that no tibial component was bordered by a complete radiolucent line. There was no subsidence or loosening of either the tibial or femoral components, and there was no instance of local osteolysis. These results, coupled with a 14-year follow-up experience with the original-design unicondylar prosthesis, encourages the authors to remain advocates of this procedure in selected patients with unicompartmental osteoarthritis.
J Arthroplasty 1989;4 Suppl:S1-10
Larsson SE, Larsson S, Lundkvist S Department of Orthopaedic Surgery, University Hospital, Linkoping, Sweden.
Abstract — A consecutive prospective series of 102 knees (90 patients) had unicompartmental knee arthroplasty [partial knee resurfacing] between 1973 and 1979 for gonarthrosis, Stages 2-4. Total clinical and roentgenographical evaluation was undertaken after 5-11 years (mean, 8.1 years) and included all 75 surviving patients. There were no early revisions but five late revisions; two due to loosening, one late infection, one instability, and one intractable pain. Complete loosening occurred in four patients (4%). Functional score (Hospital for Special Surgery method) averaged 77 points (preoperative, 43) with no tendency of deterioration with time. Loss of initially achieved alignment was generally associated with bone resorption around the tibial component. Minor arthritic changes of the non-operated compartment occurred in 4% of the cases.
Clin Orthop (232):174-81 July 1988
Abstract — In the past decade, two concepts have caused considerable controversy in orthopedic surgery of the knee. Some orthopedic centers contend that osteotomy of the tibia is the procedure of choice for unicompartmental gonarthrosis of the knee and resist the concept of unicompartmental arthroplasty. The other concept is that if unicompartmental arthroplasty [ partial knee resurfacing] is necessary, the entire joint should be replaced, since the uninvolved compartment may develop arthritis in the future. This concept is illogical and contrary to the basic orthopedic principle of preserving normal structures whenever possible. It is obvious that joint replacements may not last the life of the patient and the need for revision must be considered; therefore, the original procedure should preserve as much bone stock as possible. The purposes of this review of unicompartmental replacement are to resolve these questions with data on long-term results of unicompartmental arthroplasty [partial knee resurfacing] compared with data on high tibial osteotomy, to evaluate the cause of failures, and to improve future results. Eighty-seven consecutive unicompartmental arthroplasties [partial knee resurfacing] were performed between November 1972 and April 1976. There were 60 knees available for study, with a minimum ten-year (average, 11-year) follow-up period. The results were evaluated using the Hospital for Special Surgery rating system, with 30 excellent, eight good, four fair, and 18 poor results. Seventy percent of the patients had satisfactory results, and pain relief was accomplished in 86.6% of patients. Of the 21 failures, the majority was due to material or technical problems and improper selection of the patients.
Clinical Orthopaedics, January 1988(226):14-20
Murray D.W., Goodfelow J.W., O’Connor J.J. From the Nuffield Orthopedic Centre, Oxford, England
Abstract — Retrieval studies have shown that the use of fully congruent meniscal bearings reduces wear in knee replacements. We report the outcome of 143 knees with anteromedial osteoarthritis and normal anterior cruciate ligaments treated by unicompartmental arhroplasty [partial knee resurfacing] using fully congruous mobile polyethylene bearings. We reviewed 109 patients, mean time since operation was 7.6 years (maximum 13.8). We established the status of all but one knee. There had been five revision operations giving a cumulative prosthetic survival rate at ten years (33 knees at risk) of 98%. Considering the knee lost to follow-up as a failure, the ‘worst-case’ survival rate was 97%. No failures were due to polyethylene wear or aseptic loosening of the tibial component. One bearing which dislocated at four years was reduced by closed manipulation. The ten-year survival rate is the best of those reported for unicompartmental arthroplasty [partial knee resurfacing] and not significantly different from the best rates for total knee replacement.
The Journal of Bone and Joint Surgery (Br),1998:no 80-B, pag 983-9
John H Newman MD, Christopher E Ackroyd MD, Nilen A. Shah MD From the Avon Orthopedic Centre, Bristol, England
Abstract — We randomised 102 knees suitable for a unicompartmental replacement [partial knee resurfacing] to receive either a unicompartmental (UKR) or total knee replacement (TKR) after arthrotomy. Both groups were well matched with a predominance of females and a mean age of 69 years. Patients in the UKR group showed less perioperative morbidity, but regained knee movement more rapidly and were discharged from hospital sooner. At five years, two PKRs and one TKR had been revised; another TKR was radiologically loose. All other knees appeared to be clinically and radiologically sound. Pain relief was good in both groups but the number of knees able to flex >120′ was significantly higher in the PKR group (p < 0.001) and there were more excellent results in this group. Our findings have shown that PKR gives better results than TKR and that this superiority is maintained for at least five years.
The Journal of Bone and Joint Surgery (Br),1998 , no 80-B, pgs 862-5
AU: Owen B. Tabor, Jr, MD and Owen B. Tabor, MD
Abstract — From Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina Seventy-three consecutive unicompartmental knee arthroplasties (PKRs – [partial knee resurfacing] ) using a Marmor-style non-metal-backed cemented tibial component were perfomed from 1975 to 1990. Sixty-seven knees (58 patients) were evaluated with minimum 5 year follow-up (mean, 9.7 years; range 5-20 years). Knee rating and patient function were assessed using the updated Knee Society scoring system.Survivorship and functional outcome were not affected by body habitus, age, gender, or tibial component thickness. PKR’s offers long term relief of symptoms and excellent knee function in a high percentage of carefully selected patients with single compartiment gonarthrosis. KEY WORDS: unicompartmental knee arthroplasty , gonarthrosis, obesity, long-term follow-up.
The Journal of Arthroplasty, Vol 13, no 4, 1998
Rougraff BT, Heck DA, Gibson AE
Abstract — Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis 46202. An historical prospective study was performed to compare two surgical management alternatives in the treatment of patients with knee arthritis. There were 120 unicompartmental and 81 total knee arthroplasties in 98 and 66 patients, respectively. All living patients were available for follow-up observation, and survivorship data on all arthroplasties were obtained. The average follow-up interval was 78 months (range, eight-162 months) in the unicompartmental series and 68 months (range, two- 186 months) in the total group. Patients receiving the unicompartmental arthroplasty were treated with nonmetal-backed polyethylene tibial components. Prosthetic survivorship was 92% at ten years in the unicompartmental patient group. There were no statistically significant differences in aseptic loosening between these two patient groups. In appropriately selected patients unicompartmental arthroplasty was associated with better range of motion and ambulatory function than patients being treated with total knee replacement.
Clinical Orthopaedics, (367):50-60, October 1999
Scott RD, Santore RF
Abstract — Unicompartmental knee replacement [partial knee resurfacing] is an attractive concept that offers several potential advantages over bicompartmental or total replacement, including preservation of bone stock, of the anterior and posterior cruciate ligaments, of the patellofemoral joint, and of the normal opposite compartment. Of our first 100 consecutive knees that had unicompartmental arthroplasty [ partial knee resurfacing] for osteoarthritis and were followed for two to six years (average, three and one-half years), eighty-eight were medial and twelve were lateral replacements. The ages of the patients at the time of operation ranged from forty-six to eighty-five years, with an average age of seventy-one years. At follow-up, pain relief was good to excellent in 92 per cent of the knees. The average amount of flexion was 114 degrees (range, 90 to 140 degrees); one-half of the knees had at least 120 degrees of flexion. The average flexion contracture was 1 degree. There were no infections and no peroneal palsies. At the time of writing, three failures had required revision. Radiolucent lines at the bone-cement interface were present around 8 per cent of the femoral components and 27 per cent of the tibial components. Two femoral components subsided in obese patients. There was no tibial loosening in the series. The most common complications, pes anserinus bursitis, occurred in 12 per cent of the knees and was treated satisfactorily by injection of local anesthetics and steroids. Surgical technique must be precise to prevent subluxation of the tibia on the femur due to either improper positioning of the components or too tight a fit (too much pressure) between them.
J Bone Joint Surg [Am], 63(4):536-44, April 1981
Richard D Scott MD, Andrew G Cobb MB,BS,FRCS, Frederick G McQueary MD, Thomas S Thornhill MD
Abstract — From Brigham and Women’s Hospital, Boston, Massachusetts One hundred consecutive unicondylar knee arthroplasties [partial knee resurfacing] were reviewed after eight to 12 years of follow-up evaluation. Survivorship analysis revealed 90% survivorship of the prostheses at nine years, 85% at ten years, and 82% at 11 years. Sixty-four knees in 5l patients were studied clinically and roentgenographically at final follow-up study. Of these, 87% had no significant pain. The average knee flexion was 115 degrees. Anatomic knee alignment averaged 3 degrees of valgus for the knees with preoperative varus alignment and 8 degrees of valgus for knees with preoperative valgus alignment. Fifteen percent of these elderly patients (mean age, 80 years) used a cane outdoors, but only 8% because of their knee. Sixty percent had radiolucent lines at the tibial bone-cement interface, and these lines were incomplete in 96% of cases.
Clinical Orthopedics and Related Research, no 271, October 1991
Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC Department of Orthopaedic Surgery, University of Iowa College of Medicine, Iowa City 52242, USA.
Abstract — One hundred forty cemented unicompartmental knee replacements [partial knee resurfacing] were inserted in 103 patients between 1975 and 1982. Fifty-two patients were women and 51 were men. One hundred twenty-five were medial compartment knee replacements and 15 were lateral knee replacements. At minimum 15 year follow-up 34 patients with 48 knee replacements were living; only four patients with four knee replacements were lost to follow-up. Average preoperative and final follow-up Hospital for Special Surgery knee scores were 57 and 82 points, respectively for the knees of living patients. Average preoperative and final follow-up Knee Society clinical and Knee Society functional scores were 31 and 42, and 85 and 71 points, respectively. For all knees, 10.2% (14 knees) were revised [4.4% (six knees) for tibial loosening, 5.1% (seven knees) for disease progression, and .7% (one knee) for pain]. For patients living 15 years, 12.5% (six knees) were revised [2.1% (one knee) for tibial loosening, and 10.4% (five knees) for disease progression]. Revision for failure of fixation of these unicompartmental replacements was comparable with that reported for fixed bearing total knee replacement. Disease progression (46%; 62 of 136 knees) and tibial subsidence with wear (10.4%; 15 of 136 knees, five of which required revision) were the major long term problems in this group of patients.
Clinical Orthopaedics, (367):61-72 , October 1999
Anesthesia was once the most feared part of surgery. No more! Dramatic advances in monitoring blood pressure, pulse, respiration, blood oxygenation, and breath detection have enhanced the safety of all types of anesthesia. A modern anesthesia machine resembles the cockpit of a Boeing 747 Jumbo Jet.
The two most common types of anesthesia are general and regional.
General: Gas and drugs, including muscle relaxants, are usually given and the patient is completely asleep. The newest airway protection device used for some types of general anesthesia is called Laryngeal Mask Airway (LMA). These airway tubes are not inserted past the vocal cords in the throat, another plus for patient safety. Even the materials used in airway protection tubes have advanced safety features so that intubation is guaranteed to be in the right place. The safety of general anesthesia is parallel with safety of regional anesthesia.
Regional: Only part of the body is numb. It is common to also give some sedative so that the fear of being awake in the frightening environment of an operating room is eliminated. The most common types of regional anesthesia are spinal and epidural anesthesia.
Spinal anesthesia (sometimes called a nerve block) is now delivered with such miniature needles that once feared spinal headache is almost a relic of the past.
Epidural anesthesia is often suggested for hip and knee replacement surgery. A very small tube is introduced on top of the spine and left in place for pain controll after surgery.
For The Florida Knee and Orthopedic Center patients, pain control after surgery is now done with a local anesthetic delivered directly into the operative site. We are now involved in a multi-center clinical trial to promote this friendly pain control method to orthopedic surgeons around the world. Also used are relaxation and imagery techniques to help interfere with the perception of pain.
Abduct – To move away from the body.
Acromioclavicular Dislocation – Disruption of shoulder ligaments of the normal joint between the acromion and the clavicle.
Adduct – To move toward the body.
Anesthesia, local – Anesthesia confined to one part of the body.
Anesthetic, epidural – An anesthetic injected in the fluid-filled sac (the durra) around the spine, which partially numbs the abdomen and legs.
Ankle Sprain – Stretching and slight or partial tearing of one or more ligaments in the ankle.
Ankylosis – Fusion of bones across a joint.
Anterior – The front or forward facing direction. (Your mouth is on the anterior portion of your skull).
Antibiotic – A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill infectious germs.
Anti-inflammatory – something which decreases inflammation or swelling (e.g., ice, aspirin).
Anti-inflammatory Agent, non-steroidal – Anti-inflammatory agents that are not steroids.They have painkiller and fever reducing actions.
Anti-inflammatory Agent, steroidal – Agents capable of suppressing or counteracting the inflammatory process by acting on body mechanisms. They are used primarily in the treatment of chronic arthritic conditions and certain soft tissue disorders associated with pain and inflammation.
Arthralgia – Pain in a joint.
Arthritis – An inflammatory condition that affects joints (e.g., rheumatism or gout).
Arthrocentesis – A procedure where by a needle in introduced into a joint space for the purpose of removing joint fluid. This procedure can also be therapeutic if an anesthetic or corticosteroid medication is injected into the joint during the procedure.
Arthrodesis – The surgical immobilization of a joint (joint fusion).
Arthropathy – Any disease that affects joints.
Arthroplasty, replacement – Partial or total replacement of a joint with artificial components.
Arthroscopic knee repair – A fiber optic procedure, used in the surgical repair of any of several knee ligaments including the anterior cruciate ligament (ACL) or of the knee cartilages (meniscus).
Arthroscopy – Looking inside the joint with a small-lighted telescope.
Arthrotomy – A surgical incision into a joint.
Aseptic necrosis – Condition in which poor blood supply to an area of bone leads to bone death. Also called avascular necrosis and osteonecrosis.
Back pain, low – Symptoms in the low back can relate to the bony portion of the spine, to discs between the vertebrae, spinal cord and nerves, muscles of the low back, or even internal organs of the pelvis and abdomen. The low back, or lumbar area, functions in structural support, movement, and protection of certain body tissue.
Baker’s cyst – A cyst or pouch that occurs behind the knee, in the synovial lining of the knee. Synovial fluid escapes from the knee joint and into the cyst in people who suffer from degenerative and other joint disease. Aspiration of the cyst is therapeutic only temporarily since recurrence is common. Larger cysts can be removed surgically.
Benign – Something that does not metastize. Treatment or removal is curative.
Bennett’s fracture – A fracture-dislocation of the thumb.
Biopsy – Procedure that involves obtaining a tissue specimen for microscopic analysis to establish a precise diagnosis. Biopsies can be accomplished with a biopsy needle (passed through the skin into the organ in question) or by open surgical incision.
Bone banks – Centers for acquiring, characterizing, and storing bones or bone tissue for future use.
Bone cements – Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures.
Bone marrow – The soft, spongy tissue found in the center of most large bones that produces the cellular components of blood: white cells, red cells and platelets (haemopoiesis). It is also the most radiation sensitive tissue of the body.
Bone – The hard, calcified tissue of the skeleton of vertebrate animals.
Bulging disk – A condition that results in the abnormal protrusion (bulging, herniation of a vertebral disc from its normal position. The displaced disc may exert force on a nearby nerve root causing the typical neurological symptoms of radiating pain (to an extremity), numbness, tingling and weakness. Recurrent episodes of severe back pain are common.
Bursa – A bursa (burse, plural for bursa) is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.
Bursectomy – Surgical drainage and removal of an infected bursa.
Calcaneal spur – A heel spur. A bony growth off of the heel often resulting in recurrent pain.
Carpal tunnel release – An orthopedic surgical procedure, which relieves the pressure exerted on the median nerve within the carpal tunnel in the wrist. This surgery may be performed conventionally via a small incision or using a fiber optic scope (endoscopic carpal tunnel repair).
Carpal tunnel syndrome – A nerve disorder in the hand that causes pain and loss of feeling.
Cartilage – Connective tissue containing collagen type II and large amounts of proteoglycan, particularly chondroitin sulphate. Cartilage is more flexible and compressible than bone; it covers the articular surfaces (bone ends).
Cervical – Pertaining to the neck or to the neck of any organ or structure.
Cervical Spine – Neck area of the spine.
Chondromalacia – The progressive erosion of cartilage, common in the knee joint where it is known as chondromalacia patella.
Coccydynia – Pain in the coccyx (tailbone).
Collateral ligaments – A number of ligaments on either side of a joint having a hinge like movement. They occur at the elbow, knee, wrist, hands and feet.
Colles fracture – a common fracture of the wrist joint due to a fall on an outstretched hand. Colles fracture is also referred to as the silver fork deformity.
Compartment Syndrome – Build up of pressure in muscles, secondary to injury.
Compression fracture – A spinal fracture, more specifically, of a vertebral body. Compression fractions result in a loss of HEIGHT of the vertebral body on X-ray. May occur in any region of the spine. Commonly in post-menopausal women who are subject to osteoporosis.
Contracture – A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints or from disorders of the muscle fibers.
Contusion – A bruise, an injury of a part without a break in the skin.
Cramp – A painful, involuntary spasmodic contraction.
Cramp, writer’s – A dystonia (painful contracture) that affects the muscles of the hand and sometimes the forearm and only occurs during handwriting. Similar focal dystonias have also been called typist’s cramp, pianist’s cramp, musician’s cramp, and golfer’s cramp.
Cruciate – A cross or “X” shape. There are two cruciate ligaments in the human knee.
Cruciate (anterior) – One the most commonly injured ligaments which stabilizes the knee joint. The cruciate ligaments are cross-shaped within the knee joint. The posterior cruciate is deeper (more posterior) within the joint and not as commonly injured as the anterior cruciate.
Debridement – A term of French origin for the removal of dead, infected or foreign material from a wound.
Deep Venous Thrombosis – A blood clot that forms in a vein resulting in obstruction of venous flow. Most common in the lower extremities.
Degenerative Joint Disease – A form of arthritis that results in the destruction of the articular cartilage that line the joints. Seen predominately in the larger weight bearing joints of the hips, knees and spine, be seen in the small joints of the hands.
Disc – Material between spinal vertebrae that provide a cushion-like support against shock.
Dislocate – To put out of place, out of joint or out of position.
Dorsiflexion – To bend the toes toward the head.
Dupuytren’s Contracture – A painless thickening of the connective tissue in the palmar hand that can lead to difficulty extending the digits. Causes include hand trauma and genetic predisposition.
Ecchymosis – Internal bruising or bleeding which causes our skin to turn “black and blue.”
Edema – Swelling of tissues as a result of disease or injury.
Etiology – Cause of a disease.
Extend – To straighten.
Extension – The movement by which the two elements of any jointed part is drawn away from each other.
Femur – The largest bone in the body, extending from the hip to the knee (thigh bone).
Fixation – The act or operation of holding, suturing or fastening in a fixed position. The condition of being held in a fixed position.
Flex – To bend.
Fracture – A break or rupture in the bone.
Frozen Shoulder – This disorder results from any conditions that enforce prolonged immobility of the shoulder joint. There is marked restriction of range of motion. Physical therapy and corticosteroid injections may be helpful in some cases. Surgery will be required for more advanced cases.
Glenoid – The portion of the scapula (shoulder blade) that forms the cup segment of the shoulder joint.
Golfer’s Elbow – Inflammation of the tendons, which insert at the medical epicondyle(of the humerus) at the elbow. Symptoms include pain with forced flexion of the wrist joint.
Hallux Valgus – A swelling or deformity at the head of the proximal bone of the great toe (big toe).
Hemorrhage – To bleed.
Herniate – To protrude through an abnormal body opening (outside normal margins).
Hip Arthroplasty – Surgery to replace all or part of the hip joint with an artificial device that re-establishes normal hip joint motion. Indicated in cases of severe intratable degenerative arthritis.
Hip Fracture – A fracture of the hip commonly occurs in the neck of the femur (thigh bone). The elderly and those who suffer from osteoporosis are at greatest risk.
Hypercoaguable – State describing abnormally thick blood
Hypertrophy – Tissue or organ enlargement.
Knee Arthroplasty – Surgery involving the replacement of the knee joint with artificial components, which reestablishes normal joint function. Indicated in cases of knee fracture or degenerative arthritis (DJD) unresponsive to medical therapy.
Knee Sprain – Any injury to the different ligaments, which stabilize the knee joint. Knee sprains are characterized by knee pain, swelling and tenderness with range of motion. Completely torn ligaments may require surgical repair to reestablish knee joint stability.
Lateral – The outside portion of our body parts (away from). (Your ear is lateral to your nose.)
Ligament – Fibrous tissue that attaches bone to bone.
Magnetic Resonance Imaging (MRI) – A study of the soft tissues and structures inside the knee or other joint or body part. Imaging has greatly improved the ability of a physician to pinpoint a correct and accurate diagnosis
Malignant – Tending to become progressively worse and to result in death. Having the properties of multiplying, invasion and metastasis, said of tumors.
Medial – Toward the inside or center of the body. (Your big toe is medial to your small toe.)
Medial Collateral Sprain – MCL injuries are classified as grades I-III. Grade I injuries appear normal in an MRI (Magnetic Resonance Imaging), but there is subcutaneous tissue swelling (edema). Grade III injuries indicate a complete disruption of the ligament with associated soft tissue swelling (edema), and hemmhorrage.
Medical Collateral Ligament – A ligament connecting the thigh bone to the shin bone on the inner side of your knee.
Meniscus – A “C” shaped cartilage in the knee which provides a stabilization system for the knee and a measure of shock absorption.
Muscle – Body tissues which consist of cells that contract when lengthened or straightened
Myozitis – Inflammation of the muscle.
Nerve – One or more fibers or bundles of fibers which form a part of a system in the body that conveys impulses of sensation, motion, etc., between the spinal cord or brain and other body parts
Nerve Root – Where a group of nerves exit from the spinal canal.
Orthopedic (orthopaedic) – The branch of medicine, which studies, muscles, bones, and related soft tissues.
Ossification – The formation of bone, the transformation of fibrous tissue or of cartilage into a bony substance.
Osteoarthropathy – A condition that describes the broadening or thickening of the tips of the fingers (and toes). Often this finding on physical examination can be quite subtle and easily overlooked. Clubbing may be seen in a wide variety of cardiovascular conditions – most of them associated with a decrease in blood oxygen.
Osteophytes – Abnormal projections of bone.
Palpate – To touch, or feel.
Periostitis – Inflammation of the fibrous covering (outer layer) of a bone.
Physical Therapy – The treatment of disease or injury through physical or mechanical means including, but not limited to: ice, heat, massage, ultrasound and exercise.
Pivot – To turn.
Pronate – To turn, facing downward.
Radiate – That which travels. “The pain radiates from my neck to my elbow.”
Retinaculum – Connective tissue similar to a ligament, but more expansive – e.g. around the knee caps.
Rheumatoid Arthritis – Chronic inflammatory disease with destruction of joints. Considered by some to be an autoimmune disorder in which immune complexes formed in joints excite an inflammatory response towards own tissues.
Rotator Cuff – The group of muscles which comprise the shoulder.
Runners Condition – A condition where the kneecap (patella) rubs on the surface of the femur rather than following its normal tracking over the knee joint. This condition is due to stress or overuse (for example runners). Symptoms include knee pain, just under the kneecap after running, progressing to knee pain at rest. Treatment includes rest and stretching exercises for the quadriceps and hamstring muscles.
Strain – To wear out beyond a normal limit, often causing micro or tiny tears
Subluxation – To partially dislocate.
Supinate – To turn, facing upward. (When you collect change at the tollbooth, you supinate your palm.)
Surgery – The branch of medicine where physical deformity or disease is treated by an operative procedure.
Suture – Usually a synthetic based line that is minimally reactive in biological tissue. Commonly used are nylon, prolene and gut. Absorbable suture will dissolve over time (vicryl and chromic).
Syndrome – A set of symptoms that characterize a disorder or disease.
Synovial Membrane – A thin tissue that lines the capsule surrounding the joint.
Synovitis – Inflammation of a synovial membrane. It is usually painful, particularly on motion and is characterized by a fluctuating swelling due to effusion within a synovial sac
Tendinitis (tendonitis) – An inflammation (swelling) of the tendon.
Tendon – Fibrous tissue, which connects muscle to bone.
Tennis Elbow – Inflammation at the lateral epicondyle (bony process of the humerus) of the elbow and the tendons insertions. It has earned this name because of the common occurrence in tennis players (constant dorsiflexion of the wrist).
Varus – An abnormal position in which part of a limb is twisted inward, toward the midline, (opposite of valgus).
Vasculitis – Inflammation of the blood vessel walls.
Weight Bearing – Ability to tolerate carrying your weight on your feet while walking.
Some medicines interact directly with certain foods and beverages in the stomach. This interaction may make the medicines less effective or may cause dangerous side effects or other problems.
The following is a list of common prescription medicines that interact with food. Use the list to help you decide if your diet should be adjusted while you are taking the medicine.
If you have questions about your medicines, ask your doctor and/or pharmacist. Questions about any of the diets mentioned can be answered by a registered dietitian.
Take with food
Ceftin – Cardene – Biaxin – Keflex – Demadex – Augmentin – Ceclor – Ticlid
Take 15 minutes before food
Prilosec – Propulsid
Take on an empty stomach
(1 hour before or 2 hours after food)
Prevacid – Zithromax – Carafate – Ampicillin
May take with or without food
Effexor – Prozac (avoid alcohol) – Pamelor (limit caffeine)
Take with food – Avoid alcohol
Xanax – Zoloft – Paxil – Restoril – Desyrel – Buspar – Klonopin – Flagyl
Take with food – Avoid alcohol – Limit caffeine
Ativan – Valium – Elavil
Take on empty stomach – Avoid alcohol
Isordil – Monoket – Procanbid – Sorbitrate – Nitroglycerin – Pronestyl – Imdur – Quinidine Sulfate – Ismo
Axid – take with food. Avoid alcohol, limit caffeine, may need a bland diet.
Tagamet – take with food. Avoid alcohol, limit caffeine, may need a bland diet. Take iron supplement separately by 2 hours.
Zantac/Pepcid – may take with or without food. Avoid alcohol. limit caffeine, may need a bland diet.
Take the following on an empty stomach 1 hour before or 2 hours after food:
Floxin/Noroxin – take with 8 ounces of water. Drink plenty of fluids.
Tetracycline – do not take milk, dairy products, iron or calcium supplements, antacids or mineral supplements within 1 hour before or 2 hours after taking this medication. Take with 8 ounces of water.
Penicillin – avoid taking with citrus juices or carbonated beverages. For best results take with 8 ounces of water.
Take the following with food especially if stomach is easily upset:
Erythromycin – limit caffeine.
Cipro – limit caffeine and drink plenty of fluids. Take antacids, magnesium, iron, calcium or zinc supplements separate by 2 hours.
Septra/Bactrim – drink plenty of fluids. Avoid high doses of vitamin C.
(high blood pressure medication)
Take the following on an empty stomach:
Capoten – decrease sodium, decrease calorie diet may be recomended. Avoid salt substitutes that contain potassium, caution with potassium supplements. Take calcium or magnesium supplements separate by 2 hours. Maintain adequate fluid intake.
Procardia – take with decreased fat meal to prevent flushing. Do not take with orange, grapefruit or other citrus fruit juices. A low salt diet may be recommended. Do not take calcium supplement within 3 hours of taking this medication. Avoid alcohol.
Cardizem – a low sodium, low calorie diet may be recommended.
Hydrocholorothiazide – diuretic potassium depleting. May need to decrease sodium, decrease calorie, increase potassium, increase magnesium. Avoid natural licorice. Limit alcohol. Caution with calcium supplements.
Triamterene – diuretic, potassium sparing. Avoid high potassium foods, potassium supplements, salts substitutes that contain potassium. A decreased sodium, decreased calorie diet may be recommended. Avoid natural licorice.
Calan (Verapamil/Isoptin) – decrease sodium, decrease calorie diet may be recommended. Limit caffeine. Caution with calcium and/or vitamin D supplements – hypercalcemia decreases effectiveness.
Take the following with food or on empty stomach:
Vasotec/Zestril/Accupril – avoid salt and salty foods. Avoid salt substitutes that contain potassium. Caution with potassium supplements. Avoid alcohol.
Atenolol/Metoprolol (Tenormin, Lopressor, Toprol XL) – a decreased sodium, decreased calorie diet may be recommended. Avoid natural licorice.
Hytrin/Cardura – a decreased sodium, decreased calorie diet may be recommended. Avoid natural licorice. Caution with alcohol.
These medications are prescribed to lower blood lipid (cholesterol) levels. A low cholesterol, low fat diet may be recommended. Avoid alcohol.
Pravachol – take on an empty stomach 1 hour before or 2 hours after foods.
Mevacor/Lopid – take with food.
Zocor/Lescol – may take with or without food.
Lanoxin – take this medication 1 hour before breakfast. Avoid high fiber foods such as bran, bran cereals or bran muffins for breakfast, but it is acceptable to eat high-fiber foods later in the day. Avoid natural licorice.
Miscellaneous Cardiac Medications
Quinidine (Quinaglute, Duraguin, Quinidex) – take this medication 1 hour before or 2 hours after food. Take with 8 ounces of water. Do not drink more than 1 or 2 glasses of citrus juice while on this medication. Caution with potassium supplements.
Take the following with food:
Lozol – a low sodium, low calorie, high potassium, high magnesium diet may be recommended. Avoid natural licorice. Limit alcohol.
Edecrin – a high potassium, high magnesium diet may be recommended. Liberal sodium diet for most patients. Limit alcohol.
Trental – a low cholesteral, low calorie diet may be recommended. Limit caffeine.
Bumex/Lasix/Hydrodiuril – a low salt, high potassium diet may be recommended. Avoid natural licorice and alcohol.
Theophylline – this medication will not work well if you eat more protein than usual. Try to eat the same protein foods each day. Avoid charcoal-broiled foods. Avoid caffeine. For Theo-24 only take with a high fat meal or snack.
Monoamine Oxidase Inhibitors (Parnate, Nardil, Marplan) – avoid foods high in tyramine. If you eat foods high in tyramine while on this medication it can cause nausea, vomiting, high blood pressure and headaches. Avoid alcohol and limit caffeine.
Oral Hypoglycemics (Diabinese, Glucotrol, Diabeta, Micronase) – take with food and avoid alcohol. Compliance with a diabetic diet is important.
Coumadin (anticoagulant) – avoid excessive amounts of foods that are high in vitamin K. Do not drink herbal teas or green teas while taking this medication. Because of the varied effects that food can have on this medication, maintain a well balanced diet with a consistent intake of vitamin K. Avoid alcohol.
Foods High In Tyramine
Aged cheese – Caffeine – Pickled Herring – Aged Meat – Chicken Liver – Raisins – Anchovies – Chocolate – Red Wine – Bananas – Cola Drinks – Salami – Beef Liver – Eggplant – Sausage – Beer – Figs – Sour Cream – Bologna – Mushrooms – Yeast Extract – Broad Beans – Pepperoni – Soy Sauce – Yogurt
Foods High In Potassium
Apricots – Cantelope – Honeydew – Prune Juice – Asparagus – Carrots – Milk – Pumpkin – Artichokes – Celery – Mushrooms – Raisins – Avocado – Chocolate – Oranges – Spinach – Bananas – Dates – Orange Juice – Squash – Bran Flakes – Dried Beans – Parsnips – Tomatoes – Broccoli – Dried Fruit – Potatoes – Tomato Juice – Brussel Sprouts – Figs – Prunes – V-8 Juice – Yams
Foods High In Vitamin K
Beef Liver – Green Tea – Brussel Sprouts – Cauliflower – Tomatoes – Soybeans/Soybean Oil – Green Leafy Vegetables
especially Broccoli, Cabbage, Kale, Lettuce & Turnips
Foods that Contain Caffeine
Coffee – Tea – Chocolate – Dark Sodas – Mountain Dew