Frequently Asked Questions

Below are the most commonly asked questions we receive from patients regarding the knee, hip and shoulder procedures we offer. The FAQ is segmented by procedure types. If you have a question that’s not answered here, click here to contact us for more information.

FAQs on Osteoarthritis of the Knees and Hips

What is Osteoarthritis?
Osteoarthritis, the most common form of arthritis, is also called degenerative joint disease or “wear and tear” arthritis. Almost everyone is affected by it to some extent as they grow older. It most frequently occurs in weight-bearing joints, mainly knees, hips and ankles. This form of arthritis slowly and gradually breaks down the cartilage that covers the ends of each bone in a joint.

Normally, cartilage acts as a shock absorber, providing a smooth surface between the bones. But with osteoarthritis, the smooth surface becomes rough and pitted. In advanced stages, it may wear away completely. Without their normal gliding surfaces, the bones grind against one another, causing inflammation, pain and restricted movement.

Bone spurs may form. In osteoarthritis of the knee, the shape of the bone and appearance of the leg may change over the years. Many people become bow-legged or knock-kneed. And in osteoarthritis of the hip, the affected leg may appear shorter.

What are the symptoms?
The number one symptom is pain. The pain is caused by irritation and pressure on nerve endings as well as muscle tension and fatigue. The pain can progress from mild soreness and aching with movement to severe pain, even when resting.

The second symptom is loss of easy movement, such as bending or rising normally. Morning stiffness is a problem for many people. This lack of mobility, in turn, often causes the muscles serving the knee or hip to weaken, and overall body coordination suffers.

How is it diagnosed?
A simple weight-bearing x-ray and examination by a skilled joint specialist will determine if you have osteoarthritis. Time-consuming and costly diagnostic procedures are not required.
What is the treatment?
There is no cure for arthritis, but the past decade has seen dramatic new ways to manage the pain, lack of mobility and fatigue that are among its most disabling symptoms. During the early and middle stages, a treatment program of medicines, cortisone shots, ice treatments, exercise, and physical therapy can be very effective in reducing symptoms and improving mobility.

Medicines – Coated aspirin helps relieve pain and has few side effects. Non-steroidal anti-inflammatory drugs (NSAIDS), such as Voltaren, Feldene, Naprosyn and Clinoril, are prescription drugs for pain and inflammation. Do not take aspirin if you are taking NSAIDS.

Cortisone Shots – Cortisone shots are given for inflammation. For many people, joint arthritis is often made symptom-joint arthritis is often made symptom-free for months or even years after cortisone shots. Four to six shots a year can be given without any dangerous side effects.

Ice Treatments – Ice packs on the knee (three times daily, 10-20 minutes at a time) are helpful for inflammation and temporary relief of pain and soreness. Heat applications in either the knee or hip make osteoarthritis worse.

Diet – There is no evidence that any specific foods will prevent or relieve arthritis symptoms. It’s important to keep thin, however, because excess weight aggravates arthritis by putting added pressure on the knee.

Exercise and Rest – Prolonged rest and days of inactivity will increase stiffness and make it harder to move around. Motion is lotion for arthritis! But keep in mind that excessive or improper exercise can overwork your arthritic joint and cause further damage. A balanced routine of rest and exercise is best.

FAQs on Sciatica (pain in the back of the leg)

What is Sciatica?
Sciatica is pain somewhere in the leg that originates in the back. Many people never even have any back pain and that is why it is sometimes hard to understand the diagnosis. The sciatic nerve emerges from the lower spine, goes down the leg and stimulates the muscles and skin of the thigh, leg and foot.
What causes it?
Injury or inflammation of the sciatic nerve can cause pain to travel down the leg from the thigh and into the foot and toes. Sciatica may be caused by a back injury, an irritation from arthritis of the spine, or from pressure on the nerve at various points along the nerve pathway.

Sciatica pain may also be caused by an abnormal bulging or protrusion of a disc in the lower back. The discs are jelly-like pads which act as elastic cushions to separate the vertebrae (spinal bones). The affected disc(s) may press on the spinal nerve root of the sciatic nerve. This condition is known as a herniated or “slipped” disc and the pain may be felt all along the lower back. ARTHRITIS in the back is the most common cause of sciatica. An enlargement on one of the joint processes, called an arthritic spur, irritates the nerve. It can also be caused by a slippage of two vertebrae bones which pinch the nerve.

Sciatica may arise when a muscle goes into a spasm, contracts abnormally and puts pressure on the nerve. Injury occurs as a result of weak back muscles, by prolonged or improper use of the back or as a result of being overweight.

What can ease the pain?
If you have low back pain or have reason to believe you have sciatica, apply a heating pad to the lower back to help reduce inflammation and swelling and decrease the pain. Use the heat for periods of 20 to 30 minutes, with at least a 30 minute interval between each application. Avoid sitting for any length of time, even for as little as 10 to 15 minutes. Sitting puts the weight of the body on the lower discs of the spine, which may aggravate disc problems related to sciatica.

You may be most comfortable when lying on your back or walking. A word of caution: these are temporary remedies and not a substitute for seeking immediate professional care. If you have sciatica, consult your doctor as soon as possible. Orthopedic doctors are educated and trained in the detection and treatment of problems affecting the joints. Many cases of sciatica lend themselves to correction through Epidural Steroid Injection (E.S.I.). Physical therapy also can be helpful.

What is epidural steroid injection?
It is a procedure in which a cortisone-like drug is injected on top of the spinal canal. The anti-inflammatory properties of the medication are intended to give long term, sometimes permanent relief of symptoms. The procedure is painless and the risk of complication is very low.
How is an ESI done?
E.S.I. is an outpatient procedure, really no more than an office visit. A small area in the lower back is numbed with a local anesthetic. A very small needle is then placed through the skin into the epidural space, an area adjacent to the affected nerves. The medications are painlessly injected through the needle and spread to the nerves. The procedure is performed by our doctors, who are skilled in this technique.
Will I need physical therapy after an ESI?
Your doctor may believe you can benefit from physical therapy after your ESI.

Physical therapy after an ESI injection is designed to strengthen the muscles of the lower back, abdomen, buttocks and legs, in order to promote good posture and enhance your treatment. Physical therapy treatment includes ultrasound, moist heat and massage.

The education portion of the program teaches you how to minimize recurrence of sciatica. Topics include exercises, medications and proper body mechanics. You will also learn which exercises you should avoid.