Know Your Bones

Treating Knee Osteoarthritis: Synvisc

In knees with osteoarthritis, the cartilage surface wears away and the joint fluid (called synovial fluid) breaks down and can’t help your knee move easily. Synvisc is designed to relieve pain and stiffness by lubricating and shock-absorbing between the worn surfaces.   Currently, it’s only used to treat arthritic knees, but research is promising for other joints like the hip, shoulder, ankle and thumb.

                

A. Cartilage wears away          D. Synvisc coats the knee joint
B. Bone spurs may develop
C. Joint fluid breaks down

There are other brands that make a treatment like this, but I have been using Synvisc for my patients for over 10 years.  Synvisc is only part of your treatment to relieve arthritic knee pain (weight management, low-impact exercise, medication, cortisone shots, bracing, surgery…).  I usually recommend it for patients who:

 

• …have pain that feels mostly like an aching, stiffness, or rubbing; not warm and swollen from inflammation.  In this case, a steroid injection could be more useful.
• …do not feel locking or instability from loose flaps of worn cartilage.  These knees need arthroscopic surgery first to clean out the joint; we’ll use Synvisc at 6 weeks postop.
• …are taking medication by mouth that usually helps, but the knee is getting really painful.
• ...had cortisone shots that don’t help for more than 6 months.

 

Insurance covers most of the cost of the office visit, injection and Synvisc, but every policy has different rules.  My staff will work with you and your insurance company to determine your out-of-pocket cost.

 

Synvisc is administered in 1 injection that contains about 1 teaspoon of a clear gel.  After you receive the shot, avoid strenuous activity for the next 24 hours or so (no heavy lifting or standing/walking for more than about 1 hour).  Apply an ice pack for 15 minutes every few hours.  Most patients schedule an afternoon or Friday appointment, and then go home and rest.

 

Synvisc is not a steroid.  It does not cure arthritis and is a way to buy time and preserve cartilage before knee replacement.  It doesn’t work for everyone.  Most patients don’t have total pain relief, but do notice less soreness and stiffness for 6-12 months or more.  Climbing stairs, walking long distances and getting up from a chair will be easier. The treatment can be repeated every 6 months if it has helped you.

Learn more at www.Synvisc.com and in Chapter 9 of my book KNOW YOUR BONES: Making Sense of Arthritis Medicine. 

 

Is your shoulder ready for surgery?

The most common reason patients come to my office is for shoulder pain.  Most of them aren't major league pitchers or electricians working overhead.  Instead, they spend most of their time behind the wheel or behind a desk, and don't realize they're slouching.  The muscles around their shoulder blades get weak, and they're prone to tendinitis and bursitis from bone spurs they never knew they had.

Watch the shoulder move in 3-D at About.com--the best illustration of the shoulder's structure and function I've seen so far! (It's worth waiting thru the 15 second commercial)

If your shoulders have started to hurt, be honest about how you've been treating them.  Start with sitting up straight and strengthening the muscles across your upper back. Use mild anti-inflammatory or pain medicines.  See your doctor for an exam and X-Ray, and maybe your pain will go away with a cortisone shot and/or physical therapy.

If you've done your best, but pain persists, the next step might be surgery to remove bone spurs and inflamed tissue, or to repair a tear in your rotator cuff:  click here for information from the AAOS. 

What is Carpal Tunnel Syndrome?

Do you have carpal tunnel?  Actually, you have 2.  The carpal tunnel is the normal anatomic structure of the wrist: an arch of bones covered with a ligament, through which pass the tendons that flex your fingers and an important nerve to the hand. 

Carpal tunnel SYNDROME is the problem, when swelling within this closed space presses on the nerve, causing numbness in your fingers.  See it all in 3-D at About.com (it's worth waiting thru the commercial--hey, someone's gotta pay for these great graphics!)

Cool your symptoms by respecting the way you use your hands:  takes breaks from repetitive tasks, manage your weight and chronic health problems (like diabetes), wear wrist splints at night to rest the tunnels. 

If the problem continues, surgery to release the ligament and decompress the tunnel is very successful.

What causes Tennis Elbow?

Tennis elbow is not just for tennis players anymore...most patients with pain on the outside of their elbow and top of their forearm turn wrenches or type for a living.  See how it works on a cool video at About.com

Bone health back in the news!

                                                  Thanks to the Time Warner affiliates throughout NY for rerunning our segment on osteoporosis prevention!  A number of patients and acquaintances have said, "I saw you on TV last week."  Nervous (afraid I was caught on hidden camera!), I wasn't sure why. 

It's last year's video, and our featured patient, Sharon, is fully healed.  No Fit to a T lecture series this year, but learn how to keep your bones strong at Fit to a T or Tone Your Bones!

Tone Your Bones

There's a fantastic, thorough tutorial about osteoporosis diagnosis and treatment called Tone Your Bones from the University of Alabama at Birmingham.

This friendly site walks you through the biology, testing, treatment and homework you'll do to protect your skeleton and prevent fractures.

Do you need a bone density test/DEXA scan?  Are you getting enough Vitamin D?  Do you have to take Fosamax?  What exercises should you be doing?

This site gives my patients all the information they need, in a way I could never deliver during an office visit!

Joint replacement is not the only answer!

You are invited to attend my presentation for the local chapter of the Arthritis Foundation on Osteoarthritis--Diagnosis, Treatment and New Directions on Thursday, March 22 from 7-8:30 PM at the Pittsford Community Library.

The theme of the talk will be more like "Osteoarthritis Reality Check for the Cranky Consumer."  You'll learn some basics about OA, but most of our time will be spent discussing the pros and cons of various treatments. 

Why are pills and exercise enough for some patients, but others need cortisone shots, Synvisc or surgery?  What can you expect from joint replacement, arthroscopy or fusion?  Why spend so much for a brace?  Is "minimally invasive surgery" all it's cracked up to be?  Have they invented the magic wand yet?

For more information, and to register, call 585-264-1468.  Refreshments will be served; 'Hope to see you there!

Synvisc--is it for you?

Synvisc® can be an effective treatment for your painful  knee. It puts lubrication back onto the worn surfaces of an arthritic joint. 

This treatment actually isn’t classified as a drug, but is considered a “device” because it’s not absorbed into the bloodstream, yet it changes the mechanical properties of the joint into which it is injected

Normal, healthy synovial fluid is viscous, or syrupy; it’s like the consistency of honey.  It nourishes, cushions and lubricates the cartilage that forms the joint’s load-bearing surfaces.

However, the synovial fluid in osteoarthritic joints loses viscosity and becomes more like water.  The whole purpose of Synvisc (or Hyalgan, or other brands called viscosupplementation) is to “supplement” the “viscosity” of your joints’ fluid, improving lubrication, relieving friction and pain.

Viscosupplementation won’t cure arthritis.  Although the advertisements for these treatments (like for so many other things) tout them as the miracle of the new millennium, there are definitely some shortcomings.

It doesn’t work for everyone.  In the best of circumstances, patients receiving these shots feel better for about a year.  Many patients don’t notice any improvement.  If it helps you for at least 6-9 months, then you could have another round of treatment.  The real benefit to viscosupplementation is that it might allow you to comfortably postpone the inevitable:  knee replacement surgery.

Find out more at In Step with Synvisc.  Upcoming posts will cover the pros and cons of shots for knee pain.

Getting back on the blog--Cortisone shots

Well, after 3 months of dormancy, it's time to get back to the blog.  I recently received an intelligent query from someone who had read my comments comparing cortisone shots to Synvisc at Bob's ACL Board. 

I forgot about the lengthy discussion on Bob's Board back in 10/05--click HERE to view my long-winded explanation to another reader about the limited, but important, role steroid injections play in the overall management of OA pain. 

There are a lot of fears and misconceptions out there about the shots, and arthritis treatments in general.  Hence, I wrote the book.    If you're reading this, you're looking for answers.   Buy the book, read it, and you've found them!

Stay tuned for the future of Know Your Bones, as I direct this blog and my orthopaedic practice toward "preventive maintenance".

Fit to a T at your Library

The T-Score is a measure of bone density, and it's an important number to know for your musculoskeletal health (just like you know your BP and cholesterol numbers).  "Fit to a T" is a bone health and osteoporosis education program, for men and women of all ages, especially those at risk for fractures. 

Join me with Drs. Susan Bukata and Edward Puzas for a series of talks at the Monroe County Library branches.  All presentations are FREE, on Thursday evenings, 7:00-8:30 PM:

• April 27th    Rochester Public Library (Main Downtown library)
• May 4th       Brighton Memorial Library
• May 11th       Pittsford Community Library
• May 18th      Chili Public Library
• May 25th      Penfield Public Library

Developed by the USBJD in partnership with the Public Library Association and the National Network of Libraries of Medicine!