Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

A broken wrist is known as a wrist fracture and it may occur due to a variety of causes starting from undue pressure on the wrist which can result in an injury as well as debilitating conditions like arthritis, which makes the bones and joints prone to fractures. There are also non displaced breaks, which are stable kinds of fractures and in which, the wrist remains in its place. Let us find out more about the kinds of fractures and the procedures for treatment of the same.

Type of Fracture: The wrist is basically made up of eight small bones that connect the two long arm bones, which are known as the radius and ulna and create the forearm. The broken wrist can take place in any of these bones. A hand surgeon will generally take a look at this kind of fracture and determine whether it is displaced, stable or open. As discussed earlier, a wrist fracture can be of various types. While a non displaced wrist fracture is a more stable kind that does not really require much more than rest or medication, a displaced wrist fracture is a non stable kind where dislocation happens.

Other Factors: There are a variety of other factors that will be taken into consideration in order to repair this kind of a fracture. To begin with, the Orthopaedic specialist will consider your age and the kind of job, hobbies and other kinds of activities that you indulge in. Also, the doctor will try to ascertain whether or not you are in good health on an overall basis. The presence of other injuries will also be taken into account for this kind of an injury in there has been a bike or car accident that has caused the fracture.

Treatment: The method of treatment will vary as per the considerations listed above. A padded splint may be installed in order to align and support the bones and wrist respectively, so that there is ample relief from the acute pain as well. Further, an unstable fracture will require a cast as to support the entire forearm and give proper rest to the region so that the bone can grow back together and get aligned again. Surgery may also be required for very severe cases, and pins, screws, metals and plates may also be used depending on the exact location and type of fracture.

Recovery: Remember to move your fingers as much as you can so as to prevent them from getting stiff while they are held up in a splint or a cast.
Hand therapy will be helpful in gaining back motion and function of the wrist.

Wrist Fracture Procedure - Facts You Should Know About 

Also known as Median Nerve Compression, Carpal Tunnel Syndrome is characterized by a sensation of tingling and numbness in the hands or the arm caused due to a strained nerve of the wrist. This condition occurs due to stress which affects the functioning of the part of median nerve, situated along the wrist.

Various Causes of Carpal Tunnel Syndrome:
Constant movement of the hands in activities such as typing on the computer
Pregnancy
Arthritis

Various Symptoms of Carpal Tunnel Syndrome:
The symptoms of this syndrome start to show up when there is excessive pressure build up in the median nerve of the wrist. You may experience-

A sensation of numbness
A sensation akin to the pain experienced when needles are inserted into the skin
Pain (mostly at night)
The build- up of pressure can occur due to a number of reasons. They are-

Painful injury
Fracture
Tenosynovitis (a condition that affects the tendons along the sides of the thumb)
The compression of the nerve may develop anywhere, and not necessarily the wrist only.
Diagnosis of Carpal Tunnel Syndrome:
Doctors base their diagnosis of the condition on the symptoms and certain tests. These include-

Phalen s test (a test that is carried out to determine any pain or numbness in the fingers within one minute of this activity)
Wrist flexion/median nerve compression test
Tinel s test (a test that is used to diagnose irritated nerves)
Few nerve enlargements may be revealed by an ultrasound, X-Ray, MRI scan, CT scans etc. The doctor generally recommends any of the above tests to determine carpal tunnel syndrome.
Important measures that help treat the condition are

Getting ample rest
Educating yourself on the various symptoms
Knowing certain activities or movements that trigger symptoms
Attending physiotherapy sessions
Physiotherapy as an important form of treatment for Carpal tunnel syndrome
Extensibility of muscle as well as soft tissue
Strengthening the forearms and the ability to grip things and pinch too
Maintaining posture and performing hand agility exercises can improve the hand movement
Mobilization of the Carpal bone and stretching of the flexor retinaculum (a fibrous band near one s wrist) so as to widen the carpal tunnel
Gliding training for nerves/ tendons for unrestricted motion
Endurance training for strengthening the upper limb as well as the wrist

Carpal Tunnel Syndrome - Measures That Can Help Treat It!

Disc prolapse   or what is popularly known as a herniated disc   occurs when the soft, rubbery tissues of the spinal discs push through a crack in the tougher exterior casing. It usually results from wear and tear of the spinal discs over time.

Risk Factors-
The following factors may put you at risk of a disc prolapse  
  Genetics   You may have a tendency towards developing a disc prolapse
  Occupation   People who are engaged in physically demanding jobs are more likely to develop back pain
  Weight   Excessive body weight puts pressure on the discs in the lower back

Signs to Watch Out for-
Signs and symptoms of disc prolapsed may include the following  
  Pain in the legs, particularly in the calf, thigh, and buttocks
  Pain in the arms and shoulder that intensify when you sneeze, cough, or even move your spine into certain positions
  Tingling or numbness in the affected areas
  Muscle weakness
  Inability to hold an object

If the pain deteriorates i.e. if the pain shoots down from your back or neck to the extremities, consult a doctor immediately.

Acupuncture for Disc Prolapse-
Although there are certain non-surgical and surgical treatment methods, many healthcare professionals and doctors nowadays recommend acupuncture as an alternative cure.

Acupuncture is an ancient Chinese practice that believes that people possess  Chi  or an energy force. When the force is unbalanced or blocked, your body becomes susceptible to illness and pain. Traditional acupuncturists strive to free up these energy channels (known as meridians) by inserting needles into specific points in your body. It activates the release of endorphins in your blood, which acts as natural pain relievers and reduces pain.
The process involves inserting multiple needles, depending on your diagnosis. Most people do not feel pain when the needles are inserted. In fact, they feel relaxed or energized. The acupuncturist will leave the needles in for about 20-40 minutes   this may cause temporary soreness but do not pose serious complications.
Acupuncture can help relieve pain associated with bulging, herniated disc. If you are considering this option, you should visit a complementary and alternative medicine practitioner.

Disc Prolapse - Know How Acupunture Can Help!

The Anterior cruciate ligament (ACL) is an important ligament that gives stability to the knees. An injury to this ligament can result in a host of complications and discomfort. Children or adults who are into sports such as gymnastics, volleyball, tennis, basketball, soccer, football, often injure this ligament. As per various studies and surveys, ACL injury is more likely to affect female athletes as compared to their male counterparts.

Depending on the severity and extent of the damage, an Anterior Cruciate Ligament Injury may be ranked on a grade of 3.

Grade 1 sprains indicate a mild injury or stretching of the ligament, seldom affecting the stability of the knees.
Grade 2 sprains are indicative of a partial ligament tear (the ligament loosen up). The damage is still under control.
Grade 3 sprains are extensive and severe, indicating a complete ligament tear (the ligament often breaks in two pieces). With a complete ligament tear, the stability of the knee is also affected (the knee becomes highly unstable).
What causes Anterior Cruciate Ligament (ACL) Injury?
While a host of sports activities mentioned above increases the risk of the injury, a person may also suffer a partial or a complete anterior cruciate ligament tear under the following situations.

A jump down a ladder, a tree, or a wall. An incorrect jump or a landing may be equally responsible for the ligament tear.
A collision or a hit, especially on the knee (while playing football).
Slowing down suddenly while still in running motion. A person suddenly stopping or missing a step can also injure the ligament.
Symptoms associated with ACL injury

An excruciating pain (especially in the back and outside of the knee) is often seen in people with a complete ligament tear (the movement is yet not affected). However, within a few hours, there may a swelling around the knee, indicating the severity of the injury with internal bleeding within the knee joints.
There may be restricted knee movement. The knee also feels unstable, further limiting the movement.
Sometimes a pop in the knee can be heard just at the time of the ACL injury.
Prolonged ACL injury left unattended can result in a painful complication such as knee osteoarthritis.
Diagnosis
To diagnose the extent of the damage, the doctor may suggest

Physical examination, including a quick brief about the case history.
Imaging tests such as X-rays and MRI can go a long way to analyze the ligament injury.
In the case of extensive swelling of the knees, the doctor may carry out an arthroscopy to have a closer look inside of the knee.
An accurate and timely diagnosis is important to avoid the aggravation of the injury. In the case of swelling and knee pain, consult a doctor, and get yourself thoroughly examined.

Anterior Cruciate Ligament Injury- Causes, Symptoms, and Diagnosis

Causes and symptoms of knee pain

Knee pain is characterized by a feeling of pain in the knee joint caused by injury or overuse. The knee joint consists of small bone structures, the kneecap, supporting ligaments and cartilage of the knee. This joint bears the full weight of the body, which makes it very vulnerable to injury.

Causes of knee pain

Knee pain is usually caused by injuries to the knee such as exposure to a direct force on the knee, abnormal twisting of the knee or falling on your knees. Some causes of knee pain are -

Knee strains and sprains - Overworking the knee joints can damage the tissues of the knee joint resulting in knee sprains and strains

Osteoarthritis - it is condition where the protective cartilage around the kneecap is damaged, resulting in knee pain

Bursitis - Excessive movement of the knee or kneeling down for extended periods can irritate the bursa (a fluid sac below the skin above the knee joint) that causes swelling and pain, thereby giving rise to this condition

Gout - This condition is characterized by the accumulation of uric acid in crystal form around the knee joint, causing inflammation and pain

Tendon disorders - Tendons connect the muscles to the bones, and overworking the knee can cause the tendons around the knee to become sore and painful

Kneecap dislocation - Injuries may cause the kneecap to shift out of its position, this causes swelling and pain in the knee joint

Symptoms of knee pain

Severe knee pain can restrict movements such as walking or standing. The symptoms vary according to the extent of the damage suffered by the knee. Most common symptoms of knee pain are problems in climbing stairs, inability to extend the knees, limping and swelling of the knee joint. In some cases, knee pain may also cause fever.

Causes and Symptoms of Knee Pain

Don't wait any longer, manage your Clinical Physiotherapist online with a Lybrate doctor today

Consult for Clinical Physiotherapist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES