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Posterior Cruciate Ligament (PCL) Injuries

Updated April 6, 2020

What Is It?

The posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL) are two tough bands of fibrous tissue that connect the thighbone (femur) and the large bone of the lower leg (tibia) at the knee joint. Together, the ACL and PCL bridge the inside of the knee joint, forming an "X" pattern that stabilizes the knee against front-to-back and back-to-front forces. In particular, the PCL prevents the lower leg from slipping too far back in relation to the upper leg, especially when the knee is flexed (bent).

A PCL injury includes a stretch or tear of the ligament. The PCL most often is injured when the front of the knee hits the dashboard during an automobile accident. During sports activities, the PCL also can tear when an athlete falls forward and lands hard on a bent knee, which is common in football, basketball, soccer and especially rugby.

Arthritis Associated With Inflammatory Bowel Disease

Updated April 6, 2020

What Is It?

Inflammatory bowel disease (IBD) refers to two disorders — Crohn's disease and ulcerative colitis — marked by inflammation of the intestinal tract. They are thought to be autoimmune disorders in which the body's immune system mistakenly attacks the intestinal tract, and other parts of the body, although this is unproven.

Some people with inflammatory bowel disease have a type of arthritis that is similar to rheumatoid arthritis in some ways. However, there are some important differences.

Infectious Arthritis

Updated April 6, 2020

What Is It?

Infectious arthritis is joint pain, soreness, stiffness, and swelling caused by an infectious agent such as bacteria, viruses or fungi.

These infections can enter a joint various ways:

  • After spreading through the bloodstream from another part of the body, such as the lungs during pneumonia
  • Through a nearby wound
  • After surgery, an injection or trauma

Once the infection reaches the joint, it can cause symptoms of joint inflammation that is often accompanied by fever and chills. Depending on the type of infection, one or more joints may be affected.

Juvenile Arthritis

Updated April 6, 2020

What Is It?

Arthritis involves inflammation of the joints that causes pain and swelling. Although many people believe arthritis is a disease of old age, various forms of arthritis can affect just about anyone at any age. When arthritis occurs in children younger than age 16, it is called juvenile arthritis. According to the Arthritis Foundation, about 300,000 children in the United States have some form of the disease.

The most common forms of juvenile arthritis are:

  • Juvenile idiopathic arthritis (formerly called juvenile rheumatoid arthritis) – This is the most common form of juvenile arthritis. Juvenile idiopathic arthritis is thought to be an autoimmune disease, which means that, for unknown reasons, the body's immune system attacks some of its own tissue the same way it would react against a foreign invader such as a virus or bacteria. In juvenile idiopathic arthritis, the lining of the joint (called synovial membrane) becomes inflamed and enlarged, limiting movement and causing pain and tenderness. Enzymes released by the inflamed membranes cause further damage by eroding the bone and cartilage. This type of joint and bone damage can cause problems in a growing child. If the growth areas of the bones are affected, the bones may grow at different rates so that one bone may develop abnormally in shape or size. The result could be, for example, that one leg might be permanently shorter than the other.

There are several subcategories of juvenile idiopathic arthritis, including:

Oh, my aching jaw

Updated April 1, 2020

Diagnosing the underlying cause of jaw, mouth, and face pain is crucial to getting relief.

Sometimes, it's a dull painful ache on the side of your face. In other cases, you may feel a sharp pain accompanied by a popping or clicking noise when you chew. Or you may have a problem biting down.

While these various symptoms were once commonly grouped together under the umbrella of temporomandibular joint problems, casually abbreviated as TMJ, today we know that there are different underlying reasons for mouth, jaw, and face pain — what doctors call orofacial pain — and not all of them are caused by problems with the temporomandibular joint itself.

Doctors’ pain pill prescribing habits at odds with current guidelines

Updated April 1, 2020

Research we're watching

Doctors have been overprescribing opioids for chronic musculoskeletal pain, according to a December 2019 study in The Journal of Pain. Researchers looking at data from a survey conducted between 2007 and 2015 found that doctors more often prescribed pills, either non-opioid or opioid, rather than physical therapy, counseling, or other nondrug interventions — a practice that is directly at odds with what experts now recommend, including those in the CDC Guideline for Prescribing Opioids for Chronic Pain. At their first visit with the doctor, people were most often prescribed non-opioid painkillers (40.2%) or opioids (21.5%), followed by counseling, nonpharmacological treatments, and physical therapy. Study authors say this shows there is room for improvement through education. However, it's worth noting that the time period studied (2007 through 2015) preceded much of the recent work and advocacy aimed at reducing prescriptions of opioids.

Image: © robeo/Getty Images

Can alternative treatments help with painful fibroids?

Updated April 1, 2020

Ask the doctors

Q. I have uterine fibroids and am experiencing some pain and discomfort from them. Are there any alternative treatments that I can use to help manage my symptoms?

A. If you are experiencing anemia, severe pain, or difficulty with urinating that may be due to fibroids, it's important to seek the advice of a doctor. However, there are some pain management options other than medications or surgery that may help relieve symptoms related to fibroids. These strategies haven't been proven to relieve pain from fibroids, but The National Center for Complementary and Integrative Health, in a 2017 review of complementary approaches to chronic pain, found they have some promise in helping other types of chronic pain, specifically lower back pain. These include acupuncture, an alternative medicine treatment that uses small needles applied at specific sites on the body to relieve chronic pain; yoga, a type of low-impact exercise that includes a series of postures and breathing techniques; relaxation techniques, such as deep breathing and mindfulness (a practice that encourages staying focused on the present moment); tai chi, originally practiced as a form of self-defense, which incorporates slow, deliberate movements and deep breathing exercises; and massage performed by a massage therapist.

When is it time for a knee replacement?

Updated March 1, 2020

On call

Q. I have osteoarthritis. My right knee is especially painful and stiff. How do I know when the time is right for knee replacement surgery?

A. Timing is key. If you get the procedure too soon, you might not see enough improvement to make the surgery worth it. In addition, the younger you are when you have knee replacement surgery, the greater the chances it will not last and another surgery may be needed. But if you wait too long, you may subject yourself to unnecessary pain and disability.

Giving steroid injections a shot

Updated March 1, 2020

They can offer temporary pain relief, but are they right for you?

If you're battling with a flare-up of arthritis, bursitis, or tendinitis, you may find relief from an injection of cortisone (a type of steroid).

"People turn to injections when conservative treatments like over-the-counter and prescription pain medication or physical therapy no longer work, and their pain begins to interfere with quality of life," says Dr. Rob Shmerling, clinical chief of rheumatology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Don’t take back pain sitting down

Updated March 1, 2020

Some conditions can be aggravated by sitting, so after the initial pain subsides, aim to move more, not less.

Sitting down is supposed to be a way to relax after a long day on your feet. But for many women, sitting for any length of time is painful. It aggravates pain in the back instead of relieving it.

If this sounds like you, the problem could be one of several common conditions, says Dr. Steven J. Atlas, an associate professor of medicine at Harvard Medical School.

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