Knees, Shoulders Focus of Doc Chat

Old knee injuries, pinched nerves, ligament tears and more were the focus of an online chat June 28 that included more than a dozen questions from followers on the NorthBay Healthcare Facebook page.

The #OurDocTalk chat with orthopedic surgeon Jay Parkin, M.D., had been scheduled to last 30 minutes but easily stretched to 45 minutes, as Dr. Parkin took the time to explain the latest information on shoulder and knee injury diagnosis and treatment.

The discussion began with a question about a Baker’s cyst (a fluid-filled cyst that can develop behind the knee and cause pain). Dr. Parkin explain that often, the cysts don’t require treatment.

“Often times there are associated problems like a meniscal tear and the treatment is to fix the meniscus problem and the Baker’s cyst either resolves on its own or is asymptomatic,” he noted. “In cases where the Bakers cyst continues to be problematic it can be excised surgically. This is done through a 2-3 inch incision on the back of the knee.”

Knee pain caused by falls or sport injuries were the focus of several questions in chat.

“A direct blow to the knee may cause injury to the joint service of the knee cap,” he explained, adding that any twisting component to the fall injury could also mean injury to ligaments or the meniscus. “Initial treatment is anti-inflammatory medication, ice and limiting activities such as squatting and kneeling. If pain persists, X-ray or MRI may provide additional information. Meniscus tears, or fractures involving the joint surface may require surgery, but usually symptoms resolve with time.”

There were plenty of questions about shoulder pain, as well.

“A friend has pain in both shoulders radiating down shoulder blades and arms. Cannot lift 3lb weights above shoulders,” explained one Facebook follower.

“These symptoms sound more suspicious for a problem with the cervical spine. Pinched nerves in the neck can cause pain, numbness, tingling or weakness in the shoulders and arms,” Dr. Parkin replied. “Typical orthopedic problems I treat are usually related to the rotator cuff or shoulder joint. If your friend also has neck pain you should talk to your primary care physician who may recommend X-rays or MRI to evaluate the neck for problems such as a herniated disc or spinal stenosis. PT or medications may also be helpful.”

Here is an edited transcript of the chat:

Q.: Popliteal aka Baker's cyst. What can you tell me about treatment/outcomes?

Dr. Parkin: Baker's cysts are often asymptomatic and don't require any treatment in many cases. Often times there are associated problems like a meniscal tear and the treatment is to fix the meniscus problem and the Baker's cyst either resolves on its own or is asymptomatic. In cases where the Bakers cyst continues to be problematic it can be excised surgically. This is done through a 2-3 inch incision on the back of the knee. I've found most patients do well with surgery ie pain and limited flexion resolves, however, most patients I see with an MRI showing a Baker's cyst never require surgery for the cyst because there symptoms resolve with arthroscopic surgery for the intra-articular problem such as a meniscus tear.

Q.: Friend has pain in both shoulder radiating down shoulder blades and arms. Cannot lift 3lb weights above shoulders?

Dr. Parkin: These symptoms sound more suspicious for a problem with the cervical spine. Pinched nerves in the neck can cause pain, numbness, tingling, or weakness in the shoulders and arms. Typical orthopedic problems I treat are usually related to the rotator cuff or shoulder joint. I your friend also has neck pain you should talk to your primary care physician who may recommend xrays or MRI to evaluate the neck for problems such as a herniated disc or spinal stenosis. PT or medications may also be helpful.

Q.: I know someone with constant pain on the inner part of their knee. How do you know when it's time to see a doctor?

Dr. Parkin: If your pain is causing you to limit activities and has persisted for more than a week or two despite taking over the counter anti-inflammatory medication you should see for family doctor.

Q.: What is a " frozen shoulder "?

Dr. Parkin: Frozen shoulder is stiffness of the shoulder that isn't caused from other common shoulder problems ie rotator cuff tears, arthritis. It is sometimes associated with diabetes, but most often is idiopathic-bad luck. It often responds to stretching/PT, and rarely benefits from surgery unless another problem is contributing to the pain. .

Comment:  Dr. Parkin is the best!!!

Q.: Can sciatica cause lower leg pain and inflammation?

Dr. Parkin: Sciatica is a general term for pain due to nerve irritation in the lower back or buttock region. Often this can be due to spine problems such as a herniated disc or spurs pushing on a nerve. It is common to have pain, numbness , or tingling in a specific distribution that is associated with a specific nerve root. Anti-inflammatory medication like ibuprofen often helps but these symptoms often will resolve with patience, activity limitations, and medication. I would recommend an MRI if the symptoms are severe and have persisted more than a month or two.

Q.: Limited range of motion with shoulder when reaching behind and pain. Frozen shoulder? Rotator issue? Something else

Dr. Parkin: Could be either one. If painful more likely to be rotator cuff. Frozen shoulder is usually a diagnosis of exclusion.

Q.: Someone fell directly on their knees and since then has continued to have sharp pain in their left knee along with burning and tearing in their heels. Any suggestions?

Dr. Parkin: A direct blow to the knee can cause injury to the patellofemoral joint-the under surface of the knee cap. This usually causes pain localized to the front of the knee. Unlikely to be related to the heel pain. More common cause of heel pain is plantar fasciitis. Unsure why it would have started at the same time as the fall.

Q.: Thoughts on meniscus transplant?

Dr. Parkin: I consider this to be a last resort for patients under 50 with significant pain that can't be adequately treated with other measures. Knee replacement has much more reliable results but isn't a good option in younger patients.

Q.: What is the difference between pain of torn meniscus and bad ligament? Any treatment to help besides surgery?

Dr. Parkin: Ligament injuries are generally associated with a blow to the knee or a twisting injury. After the initial recovery the ligament usually doesn't cause ongoing pain. It will cause problems if it is loose which results in new episodes of pain or injury ie. returning to twisting sports with a torn ACL. A meniscal tear will cause continued pain if it is getting pinched which causes the tear to get larger.

Comment: This is one great, excellent doctor/surgeon!

Q.:  Avid skier with pain n aches in inner side of knee of where inner IT band located, X-rays show no broken bones, did RICE for several weeks w heavy pain n swelling subsided but unable to run w/o pain. Possible sprained knee? Longer time needed to recover? Can walk no problem and cycle for short period of time but aches n feels weak after too much activity.

Dr. Parkin: Common causes of medial knee pain include MCL strain or tear which is usually associated with an injury, meniscal tear which can occur without major injury, early arthritis, or tendonitis. If you had significant swelling or an injury that brought this on you are more likely to have a meniscus tear. If the symptoms persist more than a few weeks you should see you family doctor. May need MRI if history and exam are suspicious for meniscus tear.

Q.: A person falls on cement directly on their knee and twists it badly. The pains never stop and apparently separation has happened ... the inner part of their knee pains them much especially while trying to exercise. Can anything be done to fix it ?

Dr. Parkin:  A direct blow to the knee may have cause injury to the joint surface of the knee cap. If there was a twisting component to the fall injury to ligaments or the meniscus could also have occurred. Initial treatment is anti-inflammatory medication ie ibuprophen, limiting activities such as squatting and kneeling, ice. If pain persist X-ray or MRI may provide additional information. Meniscus tears, or fractures involving the joint surface may require surgery, but usually symptoms resolve with time.