Knee Pain


 

KNEE PAIN AND INJURIES


The knee is the body’s largest joint.  It is a hinge joint and allows the leg to bend and flex in one direction only.  The knee should not rotate! It bears all of the body’s weight when standing, jumping or running and is prone to injuries and to osteoarthritis. It is a complex joint that is made up of ligaments, cartilage and bones.  


Three bones join at the knee. The tibia or shin bone, the thigh bone or femur and the patella also called the kneecap. The patella covers and protects the front of the knee joint. It is kept in place by the patellar ligament and the quadriceps tendon that extends from the front of the thigh. Within the knee are four ligaments, connective tissue that connects the bones, that keep the knee stable.  The Anterior Cruciate Ligament (ACL) prevents the knee from slipping forward and the Posterior Cruciate Ligament keeps the knee from sliding backwards. Collateral ligaments on either side of the knee prevent the knee from slipping sideways. The meniscus, a crescent shaped cartilage, in the knee acts as a cushion at the joint juncture of the bones. Knee ligaments, menisci and tendons are all at risk of injury.


At the Center for Integrated Pain Management customized treatment plans are designed to give patients optimal care and pain relief. Below is a list of knee conditions the Center treats.


  • ACL and PCL Ligament Injuries Meniscus Tear
  • LCL and MCL Ligament Injuries Knee Tendonitis
  • Knee Bursitis Muscle Spasms
  • IT Band Syndrome Knee Osteoarthritis


A diagnosis will be made once Dr. Kulick reviews your family history, competes a thorough physical examination and conducts an in-office ultrasound. If necessary,  Dr. Kulick may request that you obtain an MRI, a CT


Scan or additional X-rays in order to determine the diagnosis and treatment plan.


To learn more about the treatment of knee injuries please call us at 212-867-1777.


Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) Injuries


What are ACL and PCL Injuries?

The ACL and PCL stabilize the knee. They cross each other to form an X that allows the knee to flex and extend without

side-to-side movement. The ACL prevents the tibia or shinbone from sliding out in front of the femur or thighbone.  It runs diagonally across the center of the knee and also provides stability. These ligaments bear the brunt of many knee sports injuries.


The ACL may be sprained when it is slightly stretched but it will still maintain the stability of the knee.  An ACL tear, partial or complete, however, destabilizes the knee joint. An ACL tends to sustain a complete tear. An injury may be caused by suddenly stopping or changing direction while running, pivoting with your feet planted, colliding during sports, a traumatic fall landing on the knee, twisting the knee, or jumping incorrectly.  Often the meniscus is damaged as well.


The PCL is stronger than the ACL but remains at risk for a sprain, partial or a complete tear.  A PCL is more likely to suffer a partial tear and this does not completely destabilize the knee joint.  Injuries to the PCL can result from a blow to the knee, a fall, twisting the knee or even a misstep.


Seek Treatment for these Symptoms:

It is important to seek treatment immediately following an injury.  ACL and PCL injuries can lead to osteoarthritis and are frequently accompanied with meniscus tears or other knee injuries.


  • Popping sound in the knee at time of injury
  • Swelling
  • Severe knee pain
  • Difficulty walking
  • Instability or knee buckling


Next Steps

Consult the Center for a diagnosis and for treatment options. In addition to rest, ice, compression and elevation other options can provide pain relief.  These may include ultrasound-guided corticosteroid injections, anti-inflammatory medication for pain relief, ultrasound-guided injections of a hyaluronic injection acid such as Synvisc or Supartz to provide cushioning of the joint and physical therapy.  Other cutting edge treatments include ultrasound-guided injections of platelet rich plasma (PRP) to accelerate healthy tissue growth, ultrasound-guided stem cell injections and in some cases of a complete ACL or PCL rupture, surgery.


To learn more about the treatment and relief of ACL and PCL injuries please contact our office at 212-867-1777.



MCL and LCL Ligament Injuries


What are MCL and LCL injuries?


The medial or outside collateral ligament and the Lateral or inside collateral ligament control the side-to-side movement of the knee adding support and stability. The MCL connects the tibia or thighbone to the femur, or shinbone and keeps the knee from bending out, while the LCL connects the femur or thighbone to the fibula, a small bone in the lower leg and prevents the knee from bending inward. The MCL and LCL may be sprained or stretched and loosened.  They may also sustain complete tears as a result of a direct blow to either side of the knee. The MCL is more susceptible to injury.


Seek Treatment for these Symptoms:


  • Pain on either side of the knee
  • Knee instability or buckling
  • Swelling
  • Locking of the knee


Next Steps


Consult a Dr. Kulick for a diagnosis and for treatment possibilities. In addition to rest, ice, compression and elevation many additional options provide relief.  These may include ultrasound-guided corticosteroid injections, anti-inflammatory medication, ultrasound- guided injections of a hyaluronic injection acid such as Synvisc or Supartz to provide cushioning of the joint, and physical therapy.  Other cutting edge treatments include ultrasound-guided injections of platelet rich plasma (PRP) to accelerate healthy tissue growth or ultrasound-guided stem cell injections.


To learn more about the treatment and relief of MCL and LCL injuries please call our office at 212-867-1777.


Meniscus Tear


What is a Meniscus Tear?


One of the most common knee injuries is a meniscus tear.  The meniscus is the cartilage that cushions the knee joint and acts as a shock absorber at the junction of the shinbone and thighbone.  Meniscus tears can result from a sudden fall, twist or blow to the knee. Older men and women may also experience degenerative meniscus tears as cartilage weakens over time.


Seek Treatment for these Symptoms:


Symptoms may not appear until a few days following an injury. Many people are able to walk on the injured knee.


  • A popping sound when knee is injured
  • Swelling and stiffening of the knee
  • Locking or buckling of the knee
  • Difficulty walking


Next Steps


Consult the Center for a diagnosis and for treatment choices. In addition to rest, ice, compression and elevation other options should be considered.  These may include ultrasound-guided corticosteroid injections, anti-inflammatory medication and physical therapy. Other cutting edge treatments include ultrasound-guided injections of platelet rich plasma (PRP) to accelerate the growth of healthy tissue and ultrasound-guided stem cell injections to stimulate the growth of cartilage.


To learn more about the treatment and relief of meniscus tears please contact our office at 212-867-1777.




Knee Tendonitis


What is Knee Tendonitis?


Knee Tendonitis, also known as knee tendonitis or “jumper’s knee,” is an inflammation of the patellar tendon due to overuse. The patellar tendon attaches the patella or kneecap to the shinbone or tibia. It also works in conjunction with the thigh muscles to straighten the leg to allow you to kick, walk, jump and run. It is a common injury for runners as well as basketball and volleyball players.  Other causes include knee injuries, weak muscles or a structural imbalance when the patella does not fit directly into the groove of the femur or thighbone.


Seek Treatment for these Symptoms:


  • Knee pain or tenderness
  • Knee stiffness or weakness
  • Difficulty with bending, jumping or climbing up the stairs


Do not leave untreated as the condition may worsen and a tear may develop.


Next Steps

Consult the Center for a diagnosis and for treatment choices. In addition to rest, ice, compression and elevation other options may be considered. These may include ultrasound-guided corticosteroid injections, anti-inflammatory medication, ultrasound-guided injections of a hyaluronic injection acid such as Synvisc or Supartz to provide cushioning of the joint, ultrasound-guided tenotomy injections to remove damaged tissue followed by ultrasound-guided injections of plasma rich platelets (PRP) to accelerate healthy replacement tissue growth and physical therapy.  


To learn more about the treatment and relief of knee tendonitis injuries please contact our office at 212-867-1777.



Knee Bursitis


What is Knee Bursitis?


Knee bursitis is an inflammation of one or more knee bursae.  Bursae are fluid filled sacs that that cushion the large joints and reduce friction between the bones and soft tissue. The knee contains eleven bursae.  If the bursae become irritated they swell with additional fluid and cause knee pain. A knee injury, kneeling, overuse and rheumatoid arthritis may cause bursitis.


Seek Treatment for these Symptoms:


  • Knee pain or tenderness
  • Redness or swelling at the knee
  • Warmth to the touch at the knee


Do not leave untreated. Bacteria may enter the bursae and cause an infection.


Next Steps


Consult the Center for a diagnosis and for treatment choices. In addition to rest, ice, compression and elevation, other options should be considered.  These may include ultrasound-guided corticosteroid injections, ultrasound-guided prolotherapy injections, anti-inflammatory medication and physical therapy.


To learn more about the treatment and relief of Knee Bursitis please contact our office at 212-867-1777.



Muscle Spasms

 

What Are Muscle Spasms?

Muscle spasms are very common and can happen without warning. Perhaps you turn to reach for an item, twist to hit a ball, or even sleep in an awkward position. This suddenly triggers a muscle spasm in your knee and you cannot turn or move it without pain. Muscle spasms are the involuntary contraction or tensing of one or more muscles. They may occur in the knee, neck, wrist, forearm, hand, upper or lower back, and legs.  Muscle spasms may be caused by turning suddenly, heavy lifting, muscle overuse, weak muscles, nerve compression, spinal conditions such as degenerative disc disease or a herniated disc, and many sports injuries. Some sports including tennis, golf, football, weightlifting and basketball that require the constant twisting of the spine may lead to back spasms. Spasms may seem to appear out of thin air, however, typically small tears in the muscle may have developed over time. These tears may lead to swelling that compresses the nerves surrounding the muscle. This in turn sparks a muscle spasm that can cause pain, cramping or twitching.

Seek Treatment for these Symptoms:

  • Muscle pain that does not dissipate on its own
  • Constant muscle cramps
  • Difficulty walking or moving
  • Muscle appears hard or distorted

Next Steps

If the muscle spasm does not resolve by itself after a few days of rest, icing the area for short periods of 10 to 20 minutes every two hours or using a heated pad, and taking non-steroidal anti-inflammatory medication, then seek treatment. Consult the Center for a diagnosis and for options.  The spasm may be the result of an underlying condition that can be treated. Once identified, treatment options may include ultrasound-guided corticosteroid injections, trigger point therapy, ultrasound guided prolotherapy injections or anti-inflammatory or muscle relaxant medication. Ultrasound guided injections of platelet rich plasma (PRP), or stem cell therapy may be advised. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.

To learn more about the treatment and relief of Muscle Spasms please call our office at 212-867-1777.



IT Band Syndrome


What is IT Band Syndrome?


Iliotibial Band Syndrome is a common overuse injury that causes pain on the outer side of the knee. The iliotibial band is a ligament, tissue that connects bone to bone, that runs from the pelvis, crosses the knee and attaches to the tibia or shinbone. When you bend or straighten the knee the IT band helps to stabilize the joint. As you flex and extend your knee the IT band glides over the  femoral epicondyle, a bony protuberance at the tip of the femur or thighbone, where it meets the knee. Typically, the bursa, fluid filled sacs at the joint, help the IT band to slide smoothly over this bulge. However, if the IT band is tight there may be friction as it passes over the epicondyle. Both the bursa and the IT band can become inflamed and cause knee pain. Runners, cyclists and weight lifters often suffer from IT Band Syndrome.


Seek Treatment for these Symptoms:


  • Sharp pain on the outer side of the knee especially with activity
  • Tenderness on the outside of the knee joint


Next Steps


Consult the Center for a diagnosis and for treatment choices. Rest, ice, elevating the knee and non-steroidal anti-inflammatory medications are initially recommended. If the symptoms do not subside, ultrasound guided corticosteroid injections or trigger point injections may also be suggested. other options????


To learn more about the treatment and relief of IT Band Syndrome please call our office at 212-867-1777.




Knee Osteoarthritis


What is Osteoarthritis?


Osteoarthritis afflicts millions of people and can curtail physical activities and disrupt daily routines. Know as the wear and tear disease, it causes the gradual weakening of the cartilage. Cartilage is connective tissue that protects the ends of the bones and allows the bones to glide smoothly in the joint. When cartilage deteriorates, bones rub against one another creating inflammation, stiffness and pain. Bone spurs, an overgrowth of the bone, often develop and intensify the pain. Aging and daily attrition accelerates the degeneration of the joint.


Osteoarthritis can occur in any joint – neck, shoulder, elbow, wrist, fingers, hips, spine, knees, ankles or toes.


Seek Treatment for these Symptoms:


  • Pain and tenderness in the knee
  • Loss of range of motion
  • Stiffness in the joint after a period of inactivity
  • Inability to participate in former activities
  • Difficulty bending the knee
  • Difficulty walking especially up or down the stairs


Next Steps


Seek a diagnosis and treatment choices. Dr. Kulick will design a customized treatment plan designed to alleviate the symptoms suffered.  Options include anti-inflammatory medication, ultrasound-guided corticosteroid injections, ultrasound-guided injections of a hyaluronic injection acid such as Synvisc and Supartz to help cushion the joint, ultrasound-guided prolotherapy injections and physical therapy.  Cutting edge therapy such as ultrasound-guided stem cell injections that may stimulate the growth of new cartilage.


To learn more about the treatment of Knee Osteoarthritis please contact our office at 212-867-1777.

Nerve Entrapment/Radculopathy


What Is Radiculopathy?

Radiculopathy is a group of conditions affecting one or more nerves in the spine. These nerves may become pinched or compressed, causing pain, numbness or tingling in the arms or legs. The sciatic nerve, the large nerve that runs down the lower back, hip, buttocks, and back of leg to the foot may be compressed in the lower back as a result of a herniated disc or other spinal damage.

Radiculopathy commonly occurs in the cervical spine (neck), the thoracic spine (mid back)or the lumbar spine (lower back).

Cervical, thoracic, and lumbar radiculopathy are often caused by herniated discs in the vertebrae (bones of the spine) and spinal stenosis, a narrowing of the hole in the vertebrae through which spinal nerves exit.  This places pressure on the nerves as they branch out from the spine. The compression may also be caused by an injury, overuse of muscles and tendons, poor posture, bone spurs, and arthritis.

Seek Treatment for these Symptoms:

  • Pain that radiates outward from the injured nerve
  • Numbness, tingling, burning sensation
  • Muscle weakness
  • Cervical radiculopathy affects the neck, upper back, shoulder, chest, arm,or hand.
  • Thoracic radiculopathy affects the chest, ribs, shoulders, mid back or stomach area
  • Lumbar radiculopathy causes sciatica which is an irritation of the large sciatic nerve located in the lower back.  This causes pain to radiate down the back of the leg to the calf or foot called sciatica
  • Pain may be aggravated by activities such as walking, climbing stairs or sitting

Next Steps

Consult the Center for a diagnosis and for treatment choices.  Depending on the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, ultrasound -guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve and ultrasound-guided nerve block injections will be recommended.


To learn more about cervical radiculopathy and its treatment please call our office at 212-867-1777.

Location
Alexander Kulick, MD
112 East 61st Street
Upper East Side

New York, NY 10065
Phone: 917-810-4139
Fax: (646) 585-0042
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917-810-4139