Frequently Asked Questions about Knee Pain

Frequently Asked Questions about Knee Pain

Article Featured on WebMD

Your knee hurts and you want to know why. Whether it’s an injury or arthritis, here are answers from an orthopedic surgeon who specializes in sports medicine and knee care.

Could my pain be from osteoarthritis?

Yes. Probably 95% of knee pain caused by arthritis is osteoarthritis, which is caused by “wear and tear” on the joints. Other types, like rheumatoid arthritis, are much less common causes of knee pain.

What kind of injuries can cause knee pain?

They’re usually twisting injuries to the knee: ACL, meniscus, or ligament injuries.

What’s the difference?

The main difference between arthritis and other kinds of knee pain is there’s no trauma associated with it. A person who tore their ACL or had a meniscus injury knows exactly when it happened. With arthritis, it’s more of a dull, aching pain. It gets worse as time goes on.

Will my pain go away on its own?

It depends. Arthritis pain tends to wax and wane over time. It may not completely go away, but sometimes it feels much better. Pain from an injury improves at first, but if you’re left with a sore joint, you may not be able to do certain activities.

When do I need to see a doctor?

Everyone has a different pain threshold. If you’ve an injury and your knee swells, you need to see your doctor. Even if the swelling goes away, you need to have your knee examined — you might have injured something inside the joint. If you have arthritis pain and the bad days outnumber the good, you should see your doctor.

How do I keep my knees healthy?

I think weight control is important. Flexibility helps as well. If you take part in a sport that requires a lot of physical exertion, like skiing or tennis or soccer, you need to get in shape.

Also, when you get tired, you need to stop. Look at the rate of knee injury: It goes up in the fourth quarter or final period of a game. Just a millisecond or two of delay of muscle function can cause injury. If the muscles that protect the ligament are tired, they don’t do a good job.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Osteoporosis Treatment: Can Medications can help Alleviate Symptoms?

Article Featured on Mayo Clinic

We all want our medicines to be as effective as possible, and that requires effort on our part. It may be necessary to avoid taking pills with certain foods or drinks, and to check that medications won’t interfere with each other.

And in some cases, it may be important to take a drug at a particular time of day. This approach, known as chronotherapy, is gaining attention as research suggests a relationship between when we take medications and how well they work.

If you’re undergoing osteoporosis treatment, you’re taking a step in the right direction for your bone health. But perhaps you have questions about your therapy. Is the medication you’re taking the best one for you? How long will you have to take it? Why does your doctor recommend a weekly pill when your friend takes a pill only once a month?

Which medications are commonly used for osteoporosis treatment?

Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:

  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Ibandronate (Boniva)
  • Zoledronic acid (Reclast)

Hormones, such as estrogen, can play a role in osteoporosis prevention and treatment. However, there has been some concern about potential side effects tied to the use of hormone therapy. Current recommendations say to use the lowest dose of hormones for the shortest period of time.

Still, women who have reasons — such as menopausal symptoms — to consider using hormones can weigh the benefit of improved bone health into their decision.

Some hormonelike medications also are approved for preventing and treating osteoporosis, such as raloxifene (Evista).

Denosumab (Prolia, Xgeva) is a newer medication shown to reduce the risk of osteoporotic fracture in women and men. Unrelated to bisphosphonates, denosumab might be used in people who can’t take a bisphosphonate, such as some people with reduced kidney function.

Teriparatide (Forteo) is typically reserved for men and postmenopausal women who have very low bone density, who have had fractures or whose osteoporosis is caused by steroid medication. Teriparatide has the potential to rebuild bone.

Abaloparatide (Tymlos) is the newest osteoporosis medication. Like teriparatide, it has the potential to rebuild bone. In a research trial comparing these two treatments, abaloparatide appeared to be as effective as teriparatide but was less likely to cause an excess of calcium.

How do most osteoporosis medications work?

With the exception of teriparatide, osteoporosis medications slow bone breakdown. Healthy bones continuously break down and rebuild.

As you age — especially after menopause — bones break down faster. Because bone rebuilding cannot keep pace, bones deteriorate and become weaker.

Osteoporosis medications basically put a brake on the process. These drugs effectively maintain bone density and decrease the risk of breaking a bone as a result of osteoporosis.

How do you know if you’re taking the right bisphosphonate?

Drugs in the bisphosphonate class are more alike than they are different. They all help maintain bone density. And, all bisphosphonates have been shown to reduce the chance of a fracture.

The decision to take one drug over another often is based on:

  • Preference
  • Convenience
  • Adherence to the dosing schedule
  • Cost, including whether or not the drug is a “preferred” option on your insurance company’s list of acceptable medications (formulary)

Your doctor might recommend a monthly dose of medication if it’s going to be better tolerated or better accepted. But if you’re likely to forget to take your medicine on a monthly schedule, you might do better taking medication once a week.

When might other osteoporosis medications be used?

Drugs such as denosumab, teriparatide and abaloparatide can be used by anyone with osteoporosis, but are more likely to be recommended for people with unique circumstances, including severe osteoporosis with very low bone density, multiple fractures, steroid use and young age.

These drugs, which are injected, might also be given to people who can’t tolerate an oral bisphosphonate. Intravenous (IV) forms of zoledronic acid and ibandronate also can be an option for people who can’t tolerate an oral bisphosphonate.

What are common side effects of bisphosphonate pills?

Bisphosphonate pills aren’t absorbed well in the stomach. The main side effects of bisphosphonate pills are stomach upset and heartburn. Generic forms of these drugs may be more likely to cause these side effects.

To ease these potential side effects, take the medication with a tall glass of water on an empty stomach. Don’t lie down or bend over or eat for 30 to 60 minutes to avoid the medicine washing back up into the esophagus. When the recommended wait time is over, eat to neutralize the remaining medication.

Most people who follow these tips don’t have these side effects. But it’s possible to take the medicine correctly and still have stomach upset or heartburn.

Do intravenous bisphosphonates have advantages over the pill form?

Infused forms of bisphosphonates don’t cause stomach upset. And it may be easier for some women to schedule a quarterly or yearly infusion than to remember to take a weekly or monthly pill.

But, these drugs can cause mild flu-like symptoms in some people. You can lessen the effect by taking acetaminophen (Tylenol, others) before and after the infusion.

Two infusion medications — those that are injected directly into your vein — have been approved for osteoporosis treatment:

  • Ibandronate (Boniva), infused once every three months
  • Zoledronic acid (Reclast), infused once a year

Can bisphosphonates hurt your bones?

Long-term bisphosphonate therapy has been linked to a rare problem in which the upper thighbone cracks and may break. This injury, known as atypical femoral fracture, can cause pain in the thigh or groin that begins subtly and may gradually worsen.

Bisphosphonates can also cause osteonecrosis of the jaw, a rare condition in which a section of jawbone is slow to heal or fails to heal, typically after a tooth is pulled. This occurs more commonly in people with cancer that involves the bone — who take much larger doses of a bisphonate than typically are used for osteoporosis.

How long should you take a bisphosphonate for osteoporosis treatment?

There’s some uncertainty about how long to take bisphosphonates because of a lack of long-term studies. Bisphosphonates have been shown to be safe and effective for up to 10 years of treatment, depending on the medication.

However, even if you stop taking the medication, its positive effects can persist. That’s because after taking a bisphosphonate for a period of time, the medicine remains in your bone.

Because of this lingering effect, most experts believe it’s reasonable for people who are doing well during treatment — those who have not broken any bones and are maintaining bone density — to consider taking a holiday from their bisphosphonate after taking it for five years. But if you’re at very high risk of fractures or you have very low hipbone density, taking a break from your osteoporosis medication may not be a good idea.

What happens if you break a bone while taking an osteoporosis medication?

Osteoporosis medications lower the chance of fracture, but they don’t eliminate all risk of breaking a bone. If you have a fracture while on treatment, your doctor will reassess you to check for other problems that may have contributed to the broken bone.

Depending on the outcome of that assessment, you may be a candidate to switch to a more aggressive bone-building therapy such as teriparatide. Another option might be to switch to a newer type of osteoporosis drug called denosumab.

Can medication alone successfully treat osteoporosis?

Don’t rely entirely on medication as the only treatment for your osteoporosis. These practices also are important:

  • Exercise. Weight-bearing physical activity and exercises that improve balance and posture can strengthen bones and reduce the chance of a fracture. The more active and fit you are as you age, the less likely you are to fall and break a bone.
  • Good nutrition. Eat a healthy diet and make certain that you’re getting enough calcium and vitamin D.
  • Quit smoking. Smoking cigarettes speeds up bone loss.
  • Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy women, that means up to one drink a day.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Muscle Dysfunction in Head and Neck: Pain Causes, Osteopathic Options

Muscle Dysfunction in Head and Neck: Pain Causes, Osteopathic Options

Article Featured on PPP

OMT can play a pivotal role in mitigating degenerative changes in the posterior neck, treat acute and chronic head and neck pain, and combat modern ills, such as text-neck syndrome.

Neck pain is a common complaint that patients have when visiting a healthcare office. Its prevalence ranges from 15% to 50% and was the ninth leading cause of missed workdays according to the Global Burden of Disease (GBD) 2017. In addition, neck pain causes 20% of chronic headaches, and if these were included in the amount of missed work hours, neck pain would rank closer to second in the leading causes of missed workdays. It is essential for the healthcare community to address the issue of neck pain and headaches, especially for the working-age groups in which the burden of disease is heaviest.1-4

Further, while the burden of disease falls mainly on the working-age groups, GBD does not take into account the teenage and young adult population. The prevalence of neck pain in this group is likely to rise with the increase in cell phone and tablet use as duration of such use has been positively correlated with neck pain severity in college students.5 The flexed forward position strains the neck extensors and rhomboids, weakens the flexors, stiffens the chest muscles, and shifts the center of head gravity anteriorly.6 The compensatory positioning compromises the surrounding nerves and vasculature, which can cause headaches.

Due to the expected increase in neck pain and subsequent headaches in the younger population, this paper will focus on specifically the negative effects of prolonged cell phone and tablet use and how osteopathic manipulative treatment (OMT) can aid in the management of those effects.63

Mechanism of Injury

Portable Device Use and Improper Ergonomics

The use of portable electronic devices, which include mobile phones, laptops, and tablets, has become practically ubiquitous as the accessibility and practicality of these devices have increased. In 2018 alone, 1.56 billion phones were sold worldwide.7 As a result of this technological deluge, people are spending more time using their phones. In 2016, Statista reported that people in the United States spent, on average, 2 hours and 37 minutes per day on smartphones, with 1 hour and 40 minutes being spent on social media,and in Brazil, average use increased to almost 5 hours a day in 2017.9 However, excess phone use comes at an injurious cost.

Increased screen time on portable electronic devices is not only correlated with depression, sleep interruption, and poor food choices, but also rising rates of neck pain, especially in adolescents and young adults.10,11 Neck pain, including dysfunction of C1 and altered mechanics of the cervical spine due to poor posture, can lead to headaches, which is one of the most common reasons for healthcare office visits as stated above.1

When studying 56 young adults’ texting techniques and posture while texting, Gustafsson et al, found differences in technique, posture, muscle activity, and kinematics between young adults with and without musculoskeletal symptoms.12 Young adults without musculoskeletal problems sat in positions with back and/or forearm support and held their head in a neutral position while texting. It was also determined that musculoskeletal symptoms did not cause the differences in technique and posture between the two groups, but rather the approach to texting may predispose an individual to having musculoskeletal symptoms. Although the connection between posture, neck pain, and phone use is well established as text-neck syndrome, only 21% of young adults are aware of measures to prevent it, and merely 8% know it exists.13

To combat neck pain, healthcare providers frequently recommend one or more of the following: muscle relaxants, non-steroidal anti-inflammatory medication, manual modes of therapy, physical therapy, transcutaneous electrical nerve stimulation (TENS), anesthetic blockades, botulinum toxin injections, radiofrequency thermoneurolysis, as well as more invasive surgical options such as joint fusion and nerve ablation.4 As reported in a previous PPM article, the PostureJac (SomatoCentric Systems, Inc.) may also be beneficial in improving dysfunction of the musculature that commonly causes neck pain.14,15 Another treatment modality shown to be effective in the management of neck pain is OMT.4

OMT for Neck Pain and Neck-Related Head Pain

Osteopathic manipulation treatment uses a detailed knowledge of anatomy and physiology to augment treatment of bones, muscles, nerves, visceral organs, and circulatory vessels including blood vessels and lymph vessels. In terms of neck pain, the nearby musculature, nervous, and/or vasculature systems are described below to demonstrate the key role they play in the development of pain in the head and neck.

The Posterior Neck Anatomy

The posterior neck is comprised of a superficial and deep layer of musculature. The superficial cervical muscles include the trapezius, splenius capitis, semispinalis, and levator scapulae. However, it is in the deep layer of the neck where other structures, such as vasculature and nerves, play a less obvious, but large, role. The deep muscles in this region, which is commonly the cause of cervicogenic headaches, are those that make up the suboccipital group: rectus capitis posterior major and minor, and the obliquus capitis superior and inferior.4 Directly overlying these muscles are the greater occipital nerves on either side. Irritation of this nerve causes pain along the posterior scalp and vertex of the head. Directly deep to the suboccipital triangle runs the vertebral artery/vein, deep cervical vein, and the suboccipital nerve, which innervate the deep cervical muscles.

When the suboccipital muscles are hypertonic, these nerves are compressed, further activating the muscles and creating a loop that sensitizes the muscle to pain. Inferior to the triangle is the third occipital nerve. This nerve courses down to the upper trapezius where it innervates the skin, and agitation causes pain in the caudad portion of the back of the neck. Therefore, if any of these muscles are hypertonic or if the tissue is tight, it can constrict the blood flow and impinge the nerves, causing cervicogenic headaches and pain.

General Facilitation

Deep cervical muscles that are dysfunctional can also cause restricted and/or altered motion at the related vertebral segment.16 The deep cervical muscles (rotatores brevis, interspinales, intertransversarii, and rectus capitis posterior minor) are short restrictor muscles that span across one or two vertebral segments.16 Because of their orientation and proprioceptive feedback, these muscles allow for balance of the spinal column and rapid response to segmental spinal cord facilitation. Facilitation involves the perpetuation of neurons (premotor neurons, motor neurons, or preganglionic sympathetic neurons in one or more segments of the spinal cord) in a state of partial or subthreshold excitation in which less afferent stimulation is required to trigger impulse discharge.17 In those with dysfunctional deep cervical muscles, pain may be produced even with minor insult. This facilitation leads to feedback that causes changes in the tissue and deep cervical musculature near the dysfunctional segment(s), which can be attributed to a change in hysteresis, ultimately creating a continuous and chronic loop of altered spinal mechanics.18

Hysteresis Changes

Hysteresis is defined as a characteristic of tissue texture. It describes the amount of recoil/response a tissue has after deformation. When the tissue is edematous and boggy, the recoil time will lag compared to normal, and in an opposite manner, fibrotic tissue will recoil faster than normal. Barnes et al, used a durometer that measured motoricity, mobility, frequency, and fixation in 240 participants to analyze the effects of OMT.19 Motoricity was defined by the overall dysfunction of a cervical vertebra; mobility corresponded to range of motion; frequency indicated the time it took to meet the end of range of motion; fixation measured resistance within tissues. Participants were divided into six groups (five different OMT modalities and one sham OMT group). Results showed significant changes in motoricity, fixation, and frequency for all OMT treatments but no change in the sham group from baseline, thus showing OMT having an appreciable effect on cervical tissue, which can improve the hysteresis of patients with neck pain.

Chronic neck pain and facilitation of cervical vertebral segments not only cause hysteresis changes and decreased range of motion but also suboccipital muscle atrophy.20 In a study by Greenman, irreversible atrophic changes to the rectus capitis major and minor muscles were observed in participants with chronic head and neck pain as compared to controls.20 Magnetic resonance imaging demonstrated increased high signal intensity for suboccipital muscles in patients with chronic head and neck pain indicating increased fatty tissue in place of atrophied suboccipital skeletal muscle. The authors hypothesize that decreased proprioceptive afferent activity in the affected muscles may lead to increased facilitation, which is ultimately perceived as pain. OMT can play a pivotal role in mitigating these degenerative changes by preventing or treating long-term chronic head and neck pain.

In the Acute Setting

In addition to chronic pain, OMT effectively treats neck pain in the acute setting. McReynolds et al, studied the impact of OMT on patients with acute cervical pain of less than 3-week duration in an emergency room setting.21 Participants were enrolled in one of two treatment groups and were treated with either one 30-mg intramuscular ketorolac injection or OMT. To assess pain intensity, participants reported their level of pain before and after treatment using an 11-point scale. To assess perceived overall benefit of either treatment, they reported pain relief on a 5-point Likert scale. Within one hour of treatment, OMT provided perceived pain relief equal to that of a 30 mg intramuscular ketorolac injection.21 Additionally, those participants who were treated with OMT experienced a statistically significant reduction in pain intensity as compared to the ketorolac group.21 Therefore, OMT may be utilized to provide relief for neck pain, reduce facilitation of cervical vertebrae, and potentially prevent long-term chronic neck pain and suboccipital muscle atrophy.

Conclusion

Neck pain is prevalent in the working-age and young adult populations, which leads to missed workdays and decreased productivity.3 Additionally, this issue negatively impacts social interactions and relationships. People with neck discomfort feel more isolated due to perceived incomprehension of their pain from family and co-workers.21 Those with chronic pain report decreased participation both socially and at work due to fatigue, lower concentration, and psychological struggles due to pain.22

Therefore, the burden of neck pain extends beyond the cost of missed workdays. Healthcare providers seeing patients suffering from neck pain should support them with a proper work-up, that includes investigating and adjusting lifestyle habits, especially portable electronic device use. They should also recommend available resources, including osteopathic manipulative treatment as an option for musculoskeletal causes of neck pain.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Pelvic Pain Overview - Causes and Symptoms

Pelvic Pain Overview

By Celia Vimont Reviewed By Pamela Morrison Wiles, MS, DPT, BCB-PMD, IMTC

Pelvic pain is more common in women (an estimated 15%-20% of women in the United States are affected by it), but men can be impacted as well. It is estimated that pelvic pain affects between 2% to almost 10% of men. In males, pelvic pain is called chronic pelvic pain (CPP). It can begin with a bacterial prostate infection but once the infection goes away, the pelvic pain can remain and is related to pelvic floor muscle dysfunction (see below).

In some women, pelvic pain can be so severe that it interferes with activities such as work, exercising, or having intercourse. The pain can be constant or intermittent. In some people the pain is sharp and stabbing in a specific area, while in others it is a dull pain. It sometimes can radiate to the lower back, buttocks, or thighs. Some women only have pelvic pain during their menstrual periods.

Causes of Pelvic Pain

Common causes of pelvic pain include:

Endometriosis. The growth of uterine tissue outside the uterus can cause intense pelvic pain, painful menstruation, and sexual intercourse and contribute to infertility. According to the Endometriosis Foundation of America (EFA), the problem may affect as many as 10% of women during their reproductive years.

Interstitial cystitis/painful bladder syndrome. This condition causes bladder pain and a need to urinate frequently and immediately.

Vulvodynia. This condition involves pain or discomfort of the vulva (the parts of the female sex organs that are on the outside of the body).

Uterine fibroids. These are noncancerous tumors consisting of muscle cells and other tissues that grow within and around the wall of the uterus. They can cause heavy or painful periods, pain during intercourse, and lower back pain.

Pelvic floor disorders. There are two types: pelvic organ prolapsed and pelvic floor muscle dysfunction. In pelvic order prolapsed (POP), the bladder, uterus, cervix, or rectum can be falling down or sitting in a lower position, causing a pressure or pain sensation. Pelvic floor muscle dysfunction (PFMD) can be either overactive or underactive. Overactivity of the pelvic floor muscles causes pain, trigger points, shortening, and tension. Underactivity leads to incontinence, lack of support in the lower back and pelvis, and pelvic organ prolapse (drooping of any of the pelvic floor organs, including the bladder, uterus, vagina, small bowel, and rectum).

Irritable bowel syndrome. This digestive problem can cause pain, bloating, constipation, or diarrhea.

Adhesions. These are bands of tissue that form between internal tissues and organs. They can form due to surgery or infections, such as pelvic inflammatory disease or endometriosis.

Pelvic inflammatory disease (PID). PID is an infection of a woman’s reproductive organs. It can be a complication of some sexually transmitted diseases, such as chlamydia and gonorrhea. PID can cause pain in the lower abdomen, as well as fever, an unusual discharge with a bad odor from your vagina, pain and/or bleeding when you have sex, burning sensation when you urinate, or bleeding between periods.

Pregnancy and Childbirth. Approximately 50% to 75% of women have pregnancy-related pelvic pain, also known as pelvic girdle pain (PGP). The pain is disabling in 30% of women. An estimated 10% to 25% of these women will go on to develop chronic postpartum pelvic pain.

Pudendal Neuralgia.This condition affects the pudendal nerve, the main nerve of the perineum (the area between the testicles and anus of a man, and the vagina and anus of a woman). When this nerve suffers an injury, it can result in pudendal neuralgia. Othe rpossible causes are inflammation or an autoimmune illness, frequent infections, childbirth, surgery or tension on the nerve. The primary symptom is pain in the genitals or the anal-rectal area. The immense discomfort caused by pudendal neuralgia is usually worse when sitting and has been described as burning, knife-like or aching, stabbing, pinching and twisting. Some patients also report numbness. These symptoms are usually accompanied by urinary problems, bowel problems and sexual dysfunction. Sexual activity is extremely painful, or even impossible.

Some women have more than one cause of pelvic pain.

study published in the journal Human Reproduction in 2015 found that a high proportion of reproductive-age women may be experiencing pelvic pain that goes untreated. The study of more than 400 women who were scheduled to undergo surgery or imaging for such reasons as infertility, menstrual irregularities, tubal sterilization, or pelvic pain, found reports of pain were highest for women diagnosed with endometriosis. However, one-third of those without any pelvic condition also reported a high degree of ongoing pain or pain recurring during the menstrual cycle.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Knee Osteoarthritis: Overview

By Joseph J. Ruane, DO Article Featured on PPP

Osteoarthritis is the most common form of arthritis, and approximately 10 million people in America have osteoarthritis in the knees.

During your life, your knees go through a lot—these joints cushion your movements and help support your weight. Over time, this natural wear and tear process can lead to osteoarthritis (OA) in the knees. This is when the cartilage, which normally cushions your joints, wears away. The joints aren’t as protected as they should be then, and the bones in your knees can starts to rub on each other, leading to pain, stiffness, and swelling.

At the ends of bones, you have cartilage, which is a slippery tissue that helps bones glide over each other—it keeps the joints working smoothly. Additionally, cartilage works as a shock absorber for your movements.

If you develop osteoarthritis, the top layer of your cartilage around the joints starts to break down and erode. As it wears away, the bones can rub together, and bone-on-bone rubbing can cause pain, swelling, and less movement in your joint.

As more time passes, the joint affected by osteoarthritis may lose its normal shape. You also may develop bone spurs on the edges of the joint. You may have bits of bone and/or cartilage break off your joint; they then “float” in the joint space, and that can cause more damage and pain.

Knee Osteoarthritis Causes
Currently, researchers don’t understand the exact cause of knee osteoarthritis. Many factors can lead to the degeneration of the knee cartilage, including overuse and injury. But sometimes, knees can develop osteoarthritis without a clear cause.

Some factors that influence the development of osteoarthritis are:

  • Age:The older you are, the more likely it is that you will develop osteoarthritis. We put our joints through a lot of daily stress, and over the years, this can start to wear down the cartilage. Most people affected by osteoarthritis are older than 45.
  • Playing particular sports:Running, soccer, and tennis all put extra strain on the knee joint, and this can lead to the eventual development of osteoarthritis.
  • Repetitive stress:This is similar to playing certain sports—it’s all about the strain you put on your knees. Certain jobs that require a lot of lifting, squatting, or kneeling may make people more prone to osteoarthritis.
  • Weight:If you carry extra weight, this can put more strain on the knee joint, making it more likely to wear out.
  • Gender:In people older than 45, women are more likely than men to develop osteoarthritis.
  • Heredity:It is known that genetics plays a role in developing osteoarthritis. If someone in your family has or had osteoarthritis, you may be more at risk for developing it.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Carpal Tunnel Syndrome Overview

Article Featured on PPP

This common condition is caused by pressure on the nerve that runs through the wrist, causing pain and weakness in the hand and wrist.

Carpal tunnel syndrome is a painful, progressive condition that can cause tingling and numbness in your hand and wrist. It can also cause a sharp, piercing pain that shoots through your wrist and up your arm. Carpal tunnel syndrome is possibly the most common and treatable nerve disorder experienced today. It affects 4 to 10 million Americans, with middle-aged and older individuals, as well as females, more likely to develop the syndrome, according to the American College of Rheumatology.

The condition is caused by pressure on a nerve called the median nerve that runs from the forearm into the palm. The nerve runs through a small space in the wrist called the carpal tunnel.

The median nerve controls movement and feeling in the thumb and first three fingers (but not the little finger). Pressure on the median nerve can come from swelling, or anything that causes the carpal tunnel to become smaller. Some people are born with an increased risk because their carpal tunnels are smaller. This trait runs in families.

There are many risk factors for carpal tunnel syndrome, including:

  • Injury to the wrist that causes swelling. Bone dislocations and fractures can narrow the carpal tunnel and put pressure on the median nerve.
  • Assembly line work, such as manufacturing, sewing, cleaning, or meat, poultry or fish packing
  • Mechanical problems in the wrist joint
  • Repeated use of vibrating hand tools
  • Diabetes, which makes the nerves more susceptible to compression
  • Autoimmune diseases, such as rheumatoid arthritis and lupus. In an autoimmune disease, the body’s immune system abnormally attacks its own tissue. This causes widespread inflammation, which can affect the carpal tunnel.
  • Development of a cyst or tumor in the carpal tunnel

According to the Bureau of Labor Statistics, the 10 types of employment with the highest total number of carpal-tunnel-related events are:

  1. Cooks, institution and cafeteria
  2. Electrical power-line installers and repairers
  3. Painters, construction and maintenance
  4. Highway maintenance workers
  5. Welders, cutters, solderers, and brazers
  6. Bus and truck mechanics and diesel engine specialists
  7. Construction laborers
  8. Maids and housekeeping cleaners / Industrial machinery mechanics
  9. Laborers and freight, stock, and material movers, hand
  10. Automotive service technicians and mechanics

While many people associate carpal tunnel syndrome with computer use, the risk is much lower in computer users than in people whose work involves heavy labor.

In most cases of carpal tunnel syndrome, there is no single cause. Carpal tunnel syndrome is more likely in women than in men. This may be due to the smaller size of a woman’s carpal tunnel. Hormonal changes may also play a role. The condition usually develops in a person’s dominant hand.

In pregnant women, carpal tunnel syndrome may occur in both wrists. The syndrome usually goes away on its own after delivery, but symptoms can continue for 6 months or more.

In some people, carpal tunnel syndrome is a minor inconvenience, while in others, it becomes disabling. If a person’s carpal tunnel symptoms are mild and don’t last long, the condition often improves on its own. If a case is severe and untreated, the muscles at the base of the thumb may whither, and a person may permanently lose sensation.

Carpal tunnel treatment generally begins with a conservative approach, including rest, corticosteroid injections and splinting. Surgery may be recommended for people whose carpal tunnel syndrome does not improve with more conservative treatment.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Understanding Low Back Pain

Understanding Low Back Pain

By Lynne K. Schneider, PhD | Reviewed By Forest Tennant, MD, DrPH | Article Featured on Practical Pain Management

At some point in our lives, up to 90% of us will have low back pain, or pain in the lumbar (lower) spine. However, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM)1 assures us that in about 50% of these cases, the pain will resolve within 2 weeks, and in 80% of these cases, within 6 weeks.

However, one in five individuals will develop chronic back pain, which the National Institute for Neurological Disorders and Stroke (NINDS)2 defines as pain that lasts more than 12 weeks. It is difficult to determine which cases will become chronic, as chronic back pain isn’t necessarily related to the location, onset, or even the initial severity of the pain.

Most low back pain is caused by strains or sprains—people starting a new exercise routine, shoveling snow, or doing yard work. In general, overactivity back strains usually heal on their own, although you might need to use ice/heat packs and/or take over-the-counter anti-inflammatory medications.

Other important causes of back pain include osteoarthritis of the spine (or spondylosis), sciatica, and/or a herniated or bulging lumbar disc. Less frequently, notes the North American Spine Society (NASS),3 low back pain may be caused by something more serious, such as an infection, fracture, or cancer. Low back pain can also result from non-spinal causes, such as a kidney infection or stomach ulcer. In women, endometriosis, pregnancy, and fibromyalgia may cause low back pain.

How Do You Know If You Need To See A Doctor?

According to the American Association of Orthopedic Surgeons (AAOS),4 you will likely need medical attention if your back pain is accompanied by fever, chills, or if the pain doesn’t go away or worsens over a few weeks. Other indications of severe low back pain include weakness, numbness, or tingling in your arms, hands or in your groin or going down your leg, as well as swelling, or losing bowel or bladder control. You should also seek medical attention for low back pain that is severe enough to interfere with your ability to do your daily activities and/or preventing you from work.

NINDS, AANEM, and AAOS all mention things you can do to reduce your risk of low back pain, such as losing weight to put less stress and pressure on your back; learning correct exercise or weightlifting form (including shoveling and gardening); and doing exercises to help strengthen the surrounding low back muscles. While we can’t control the natural effects of aging that causes wear and tear on our spine, discs and ligaments, nor can we prevent accidents, injuries, or falls from happening, we can learn how to better deal with the stress on our backs and improving posture, both of which can help reduce the risk of low back pain. In addition, quitting smoking and removing inflammatory foods from your diet might also be beneficial. Making a few simple lifestyle changes can help reduce your risk for and help you deal with low back pain.

NINDS suggests that many cases of low back pain can be diagnosed by a physical examination and a review of your medical history. To help in the diagnostic process, you might think about what triggers your low back pain:

  • Does it get better or worse by rest or inactivity?
  • By prolonged sitting or standing?
  • By moving around?
  • By any specific movements?
  • Were you recently involved in an accident of some type?

Treatment*

Experts at Johns Hopkins Medicine5 suggest that once the cause of your back pain has been identified, your doctor might recommend rest, specific muscle strengthening exercises, diet and lifestyle changes, physical therapy, and OTC anti-inflammatory agents that may provide relief. The potential benefits of prescription drugs—muscle relaxants, anti-inflammatory drugs, and analgesics— need to be weighed against their side effects and risks. Opioid medications are never considered first-line therapy for low back pain.

Injection-based treatments, including epidural steroid injections, nerve blocks or nerve ablations, may be effective in lessening the pain in the short term, but do not address the underlying cause of the pain. The American Association of Neurological Surgeons (AANS)6 notes that surgery is often a last resort or used for people with serious complications such as loss of bladder or bowel functions, difficulty walking or standing, or progressive limitations due to the low back pain. A rehabilitation psychologist might recommend mindfulness, meditation, yoga or other relaxation strategies. Alternative treatments—acupuncture, biofeedback, transcutaneous electrical nerve stimulation (TENS), spinal manipulation/mobilization, and some laser therapies, may also be helpful with low back pain.

*Any treatment decision should be made after speaking with your spine or pain physician.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Caring for Someone Sick at Home

Caring for Someone Sick at Home

Protect yourself when caring for someone who is sick

Limit contact

COVID-19 spreads between people who are in close contact (within about 6 feet) through respiratory droplets, created when someone talks, coughs or sneezes.

  • The caregiver, when possible, should not be someone who is at higher risk for severe illness from COVID-19.
  • Use a separate bedroom and bathroom. If possible, have the person who is sick stay in their own “sick room” or area and away from others. If possible, have the person who is sick use a separate bathroom.
  • Shared space: If you have to share space, make sure the room has good air flow.
    • Open the window and turn on a fan (if possible) to increase air circulation.
    • Improving ventilation helps remove respiratory droplets from the air.
  • Avoid having visitors. Avoid having any unnecessary visitors, especially visits by people who are at higher risk for severe illness.

Eat in separate rooms or areas

  • Stay separated: The person who is sick should eat (or be fed) in their room, if possible.
  • Wash dishes and utensils using gloves and hot water: Handle any dishes, cups/glasses, or silverware used by the person who is sick with gloves. Wash them with soap and hot water or in a dishwasher.
  • Clean hands after taking off gloves or handling used items.

Avoid sharing personal items

  • Do not share: Do not share dishes, cups/glasses, silverware, towels, bedding, or electronics (like a cell phone) with the person who is sick.
When to wear a cloth face cover or gloves
  • Sick person:
    • The person who is sick should wear a cloth face covering when they are around other people at home and out (including before they enter a doctor’s office).
    • The cloth face covering helps prevent a person who is sick from spreading the virus to others. It keeps respiratory droplets contained and from reaching other people.
    • Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is not able to remove the covering without help.
  • Caregiver:
    • Wear gloves when you touch or have contact with the sick person’s blood, stool, or body fluids, such as saliva, mucus, vomit, and urine. Throw out gloves into a lined trash can and wash hands right away.
    • The caregiver should ask the sick person to put on a cloth face covering before entering the room.
    • The caregiver may also wear a cloth face covering when caring for a person who is sick.
      • To prevent getting sick, make sure you practice everyday preventive actions: clean hands often; avoid touching your eyes, nose, and mouth with unwashed hands; and frequently clean and disinfect surfaces.

Note: During the COVID-19 pandemic, medical grade facemasks are reserved for healthcare workers and some first responders. You may need to make a cloth face covering using a scarf or bandana. Learn more here.

Clean your hands often

  • Wash hands: Wash your hands often with soap and water for at least 20 seconds. Tell everyone in the home to do the same, especially after being near the person who is sick.
  • Hand sanitizer: If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
  • Hands off: Avoid touching your eyes, nose, and mouth with unwashed hands.

Wash and dry laundry

  • Do not shake dirty laundry.
  • Wear disposable gloves while handling dirty laundry.
  • Dirty laundry from a person who is sick can be washed with other people’s items.
  • Wash items according to the label instructions. Use the warmest water setting you can.
  • Remove gloves, and wash hands right away.
  • Dry laundry, on hot if possible, completely.
  • Wash hands after putting clothes in the dryer.
  • Clean and disinfect clothes hampers. Wash hands afterwards.

Use lined trash can

  • Place used disposable gloves and other contaminated items in a lined trash can.
  • Use gloves when removing garbage bags, and handling and disposing of trash. Wash hands afterwards.
  • Place all used disposable gloves, facemasks, and other contaminated items in a lined trash can.
  • If possible, dedicate a lined trash can for the person who is sick.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Is It Allergies or COVID-19? An Expert Helps You Tell the Difference

Is It Allergies or COVID-19? An Expert Helps You Tell the Difference

By Robert Preidt | Article Featured on WebMD

With allergy season and the coronavirus pandemic overlapping this spring, one allergist offers some advice on how to tell which one may be making you miserable.

“This spring allergy season has been especially challenging because of the pandemic of COVID-19, and a lot of my patients, and a lot of allergy sufferers, can have a hard time distinguishing between what is an allergy and what are symptoms of COVID-19,” said Dr. Rachna Shah, an allergist at Loyola Medicine in Maywood, Ill.

Typical symptoms of seasonal allergies include itchy eyes, itchy nose, sneezing, runny nose and post-nasal drip. Symptoms of COVID-19 include fever, cough, shortness of breath, fatigue, muscle aches, diarrhea and, sometimes, a sore throat.

Is it allergies or the flu?

“The big differentiating factor between allergies and COVID-19 are those itchy symptoms — itchy eyes, itchy nose and sneezing. If you are experiencing these, they are most likely due to environmental allergies and not COVID-19,” Shah said in a Loyola news release.

Many people with allergies also suffer from asthma.

“Asthma can also make you more susceptible to having more severe symptoms of COVID-19,” Shah said. “So, it is really important to have an up-to-date action plan for both your allergies and for your asthma.”

Shah noted that often, “when people are feeling well, they will become more lax about following their treatment plans.”

Patients must be “vigilant” in taking all medications as prescribed and having additional inhalers and refills, Shah urged.

To minimize spring allergy symptoms, try to avoid allergens. For example, keep windows closed, and rinse off or change clothes after being outside.

Many of the current restrictions for preventing the spread of the coronavirus — such as staying at home — can also help minimize allergy and asthma symptoms this spring, according to Shah.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

New Mexico: State extends modified stay-home order

New Mexico: State extends modified stay-home order

Article Featured on NM Department of Health

New Mexico enters “Preparation Phase” for safe reopening

SANTA FE – New Mexico state leadership on Thursday announced the extension of the state’s emergency public health order through May 15 as the COVID-19 pandemic remains a grave risk to residents of all ages and in all communities across New Mexico.

As of Thursday, there were 3,411 reported positive cases in the state of New Mexico and 123 reported fatalities associated with the virus. The highly contagious virus continues to spread in communities statewide, with particular emphasis in the northwestern part of the state.

Despite continued spread, New Mexico as a state has begun to flatten the curve, purchasing much-needed time to ramp up our healthcare system. Because of that hard work, we are entering the “Preparation Phase” for gradual, safe reopenings. With that objective, the amended public health order relaxes several restrictions to begin relieving economic pressure.

In short, physical distancing must be maintained to assure the spread of the virus is stunted in every part of the state.

“These changes do not make our fight against the virus any easier; in fact, New Mexicans’ obligation to our social contract only deepens as we enter the next phase,” said Gov. Michelle Lujan Grisham. “The best defense against this virus, until there is a vaccine, is physical distance from other people. We know those who are infected do not always show symptoms, and we know the virus does not care about county lines; we must all be vigilant. The progress we have made is tenuous – and it is subject to change. But when we reach a place, as we have, where our collective actions have begun to flatten the statewide curve, we can begin to make productive, safe decisions about alleviating some of the awful social and economic pressure this virus has brought down on us all. Today we are willing and able to do that. As we move forward, and as we make more careful decisions about relaxations, the data about this virus and its spread in our state will be our guide; public health remains first and foremost priority.

“But let me be clear: The reopening of New Mexico depends upon New Mexicans. Going out and congregating will worsen the spread of this disease. It will lead to more illness and likely death. A cavalier attitude toward individual activity is a grave danger to our collective health. We cannot win this fight – we cannot prevent the illnesses and deaths of our neighbors all across the state – if we let our collective guard down. As a state, we have to prevent and manage the spread of this virus and provide for safe social and economic activity. Every day moving forward we will do both.”

To that end, the amended order, authorized by Health Secretary Kathy Kunkel and effective at 8 a.m. Friday, May 1, maintains the directive that New Mexicans remain at home except for outings essential to health, safety and welfare. The amended order similarly maintains that gatherings of more than five individuals are prohibited. Restaurants and dine-in outlets may provide only curbside and delivery service, as before. Grocers and other essential retail services must continue to operate at only 20 percent of their maximum capacity as determined by fire code.

The order allows for partial reopenings for business operations deemed non-essential to health, safety and welfare.

Non-essential retailers, beginning Friday, may provide curbside pickup and delivery services if permitted by their business license. Liquor licenses, for instance, do not allow for curbside or delivery service. Child care may now be extended to people operating non-essential businesses.

Additional changes include:​

  • State parks may reopen on a modified day-use-only basis, as staff is available. Camping and visitor centers are still closed. The Energy, Minerals and Natural Resources department will notify the public of the parks that will be open in the near future.
  • Federally licensed firearm retailers may open by appointment only as needed conduct background checks and to allow individuals to take possession of firearms ordered online.
  • Golf courses may open to golf only – no dine-in or retail service.
  • Pet services – including adoption, grooming, daycare and boarding – are permitted to operate.
  • Veterinarians are permitted to operate.

A separate public health order dated Thursday addresses New Mexico’s June 2 primary election by allowing polling locations to open with limits. The order says no more than four voters or 20 percent of capacity may be inside a polling place at a time; mobile voting units may have no more than two voters at a time.

A third public health order allows medical facilities to gradually resume non-essential but medically necessary procedures (including ambulatory and inpatient surgery) based on extensive guidelines from the Department of Health. The guidelines are designed to prevent a shortage of personal protective equipment and to safeguard the health of patients and healthcare workers.

At a remote news conference Thursday, the governor and state health officials outlined potential additional relaxations that could occur upon the expiration of the amended health order. These prospective relaxations — which will be evaluated by the governor’s Economy Recovery Council and supported by findings of Cabinet-led subcommittees on specific industries – are dependent upon increasingly positive trends in COVID-19 illness and transmission data as determined by the state’s “gating criteria.”

Those criteria include: A mitigated spread of the virus as reflected in the effective rate of transmission, to be measured by the state Medical Advisory Team; adequate and stable testing resources, to be measured by the Department of Health; effective contact-tracing plans and resources, to be measured by epidemiologists at the Department of Health; health care systems operating below staffed capacity for beds, ICU availability and ventilators, and sufficient personal protective equipment for health care workers and first responders, to be measured by the Department of Health and Medical Advisory Team.

Weekly modeling from the Medical Advisory Team will be regularly posted moving forward on the COVID-specific microsite, cv.nmhealth.org. Modeling data is available here: https://cvmodeling.nmhealth.org. That data along with slides from state officials’ remote news conferences are available here: https://cv.nmhealth.org/newsroom.

The modified public health order and other orders referenced herein are attached to this news release.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.