Ankle sprains, a stretching or tearing of the ligaments that support the bones of the ankle, are one of the most common orthopaedic injuries. The sprain very often results from a sudden, inward rolling of the foot. Swelling of the damaged ligaments follows, and pain and stiffness can be considerable. Immediate care of a sprain should include ice and elevation of the affected limb. Ice applied for the first 24-48 hours after injury helps to decrease swelling. It is important to maintain ankle mobility during the healing process, and exercises can be recommended by the orthopaedic surgeon. Full recovery, depending on the severity of the sprain, takes time – requiring anywhere from two to twelve weeks.

2. My back hurts – will I need surgery?

Low back pain is one of the most common problems that brings patients to the orthopaedic office. The most frequent cause of low back pain is a pulled muscle. Muscles strain when they are stretched during contraction such as when a sudden twist or turn is done while lifting something. The result is pain, tenderness and a often a "knot" or spasm in the back muscle.

Fortunately, about 95 percent of back pain resolves in six weeks without intervention. Conservative measures like over the counter anti-inflammatories (Motrin, Advil) combined with heat and gentle stretching can often provide relief and facilitate healing of common low back pain. Physical therapy is often helpful. Pain that persists despite conservative treatment measures or that is accompanied by pain radiating to the leg, numbness, tingling or any changes in bladder or bowel habits should be evaluated by the orthopaedic surgeon.

3. What is a "slipped disc?"

Ruptured intervertebral discs, commonly known as "slipped discs" are often related to an episode of a sudden twisting movement while the back is flexed – such as when lifting. The bones of the back, called vertebrae, are cushioned by sponge-like intervertebral discs. The bones and discs are surrounded by a protective sheath called the annulus fibrosis . A ruptured disc occurs when the annulus fibrosus is torn by movements, like those described above, and the disc material is able to poke through the torn protective covering.

Symptoms of a ruptured disc include pain in the back and sometimes in the leg. Sciatica is a condition where the problem originates in the back, but the pain is perceived as a painful, burning sensation radiating down the buttock or leg. This problem occurs when spinal nerves, which also provide sensation to other parts of the body, are irritated or compressed by the bulging intervertebral disc.

4. My fractured leg was repaired with screws and plates – will I be stopped at airport security?

It is not uncommon for complicated fractures of the limbs to be repaired using stainless steel plates and screws to stabilize the bones for optimal healing. The hardware used can be removed at a later date, but it is sometimes left intact as are the metallic implants used in joint replacement surgery. If stopped at airport security, officials can simply use a handheld wanding device to scan the appropriate limb.

5. Is it normal for my stitches to itch and feel tight after surgery?

Sutures, commonly known as "stitches," are used to repair surgical incisions in a manner that maximizes healing and minimizes scarring. The time for post surgical suture removal varies, depending on the part of the body, the complexity of the incision and whether the area is subject to frequent stretching and stress from movement (such as a knee or elbow). As new skin tissue forms, the suture may start to feel tight and to become somewhat itchy. This is a normal part of wound healing. Any warmth, redness, drainage or tenderness at the incision site should be reported to the orthopaedic surgeon. Once the sutures are removed, small bandages called steri-strips may be applied to give the incision site continued support while it heals. The strips typically fall off in about a week, at which time, vitamin E-containing products, such a cocoa butter, can be applied in an effort to minimize scarring.

6. How can I prevent osteoporosis?

Osteoporosis is a condition that affects the bones as we mature. More prevalent in small, thin Caucasian women, osteoporosis is characterized by a decrease in the amount of bone that would be expected in a person of the same age and sex. Bone mass decreases slowly but steadily beginning around the age of 40. This process is accelerated with menopause. Osteoporotic bone is weaker and fractures more easily.

To prevent osteoporosis, a woman should supplement their diet with calcium ant vitamin D. Postmenopausal women require approximately 1,200 mg. per day of calcium, which can be obtained from dietary sources like dairy products or from supplementing with over-the-counter calcium tablets or calcium-containing antacids. Weight-bearing exercise, like walking, is also important in protecting the bones as it stimulates new bone growth. In addition, women over the age of 50 should have periodic bone density scans to look for early signs of osteoporosis or thinning of the bone. Individuals at risk for osteoporosis can be treated with various medications approved for prevention of bone loss.

7. What does a cortisone shot do?

Cortisone is a steroid medication used to treat various conditions in which inflammation causes swelling and pain. Since it is administered locally, there are often none of the systemic side effects associated with oral steroid use. After conservative therapy, like non-steroidal medications (Advil, etc.) have been attempted and failed, steroid injections are sometimes recommended for treatment of painful joints such as the knees. Injections are done in the office using sterile procedure, and patients generally have relief from symptoms in a few days. A frequent question concerns the number of injections that can be administered in a single joint. The general guideline is no more than three injections each year in the same site. Exceeding the recommended number of injections can result in damage to the surrounding tendon and compromise the integrity of the joints.

8. How long will I have to wear my cast?

There are many variables that govern how long a cast will be worn and whether or not the patient is permitted to bear weight on the leg. The purpose of casting is to immobilize the fractured bones in a manner that facilitates complete and well-aligned healing. On average, most casts are worn for six weeks. Certain fractures may require casting for longer or shorter periods. During that time, the patient may be rechecked with an x-ray to ensure that the alignment of the bones remains satisfactory. Depending on the severity and type of fracture, a "walking cast" may be applied. Other fractures require a non-weight bearing status to ensure optimal healing. Sometimes casts will be revised or shortened over the six-week healing process. It is extremely important to carefully follow your doctor's cast instructions for the best healing return.

9. What are the major risks of surgery?

The decision to surgically repair an orthopaedic problem is, like many decisions in medicine, is one of balancing the risks and benefits. The decision to recommend surgery is generally made when conservative treatment measures (rest, immobilization, medications, etc.) have failed or when a surgical repair is the only viable solution to the orthopaedic problem. Risks of surgery include infection, bleeding, numbness, stiffness, chronic pain , injury to the surrounding nerves or the need for further surgery. There may be other complications specific to each type of surgery, which your doctor will discuss with you. While these risks are typically low, they must be considered when making the decision to pursue a surgical remedy.

10. How is tennis elbow different from golfer's elbow?

Pain in the elbow is one of the most common orthopaedic complaints. The elbow becomes sore, and pain often radiates from the elbow down the forearm. Simple motions, such as picking up a container of milk, can result in discomfort. Activities like tennis and golf, where the forearm is used in repetitive, swinging motions, are well known to be a cause of pain.

"Golfer's elbow" or medial epicondylitis refers to pain over the inside of the elbow. "Tennis elbow," refers to pain on the lateral, or outside of the elbow. Many other activities that require repetitive lifting or twisting of the forearm, in addition to golf and tennis, can cause the same type of tendon inflammation. Treatment of tennis or golfer's elbow consists of resting and icing the affected area, anti-inflammatory drugs like Motrin or Aleve and sometimes the wearing of a supportive brace. If these conservative measures fail to provide relief, a cortisone injection in the elbow can often decrease the inflammation.

11. Why is my knee pain getting worse?

Erosion of the soft, smooth cartilage of the knee joint as a natural result of aging or from an inflammatory process like arthritis can result in significant pain as bone meets bone with each step taken. Early symptoms of arthritis in the knee can be treated with antinflammatory medications. The next line of therapy would be a corticosteroid injection. If those measures fail, another procedure called viscosupplemntation, where a lubricating injection is injected into the painful arthritic joint. The medication is given in a series of three injections a week apart.

If pain persists, a total joint replacement may be considered, depending on the patient's age and level of pain. Prosthetic knee joints last an average of 12-15 years. They can be replaced, but subsequent surgery becomes more difficult given scar tissue and increased age of the patient. In general, the longer a knee replacement can be delayed, the better to ensure that the prosthetic joint will last for the remaining lifespan.

12. Why do my heels hurt, particularly in the morning?

Stiffness or pain in the heel or bottom of the foot may be caused by a common condition known as plantar fasciitis. The plantar fascia is a thick, fibrous material on the bottom of the foot. It attaches to the heel bone and fans forward, allowing the foot to retain its arch. Where the fascia originates is a common site of pain and stiffness. Pain is typically worse with the first few steps out of bed in the morning and when rising from a sitting position.

Treatment for this common source of foot and heel pain includes antinflammatory therapy such as Motrin or Aleve. Home exercises to stretch the Achilles and and strengthen the forefoot will also help to alleviate the problem. Your orthopaedic surgeon may prescribe soft heel cups that can be worn in any shoes to redistribute and disperse the weight on the heel and bottom of the foot. In severe cases of plantar fasciitis which do not resolve with conservative therapy, a cortisone injection in the heel can often relieve pain.