Which choices come before an operation?

What can you do at home?

For a few days, shorten the activity that brings the sharpest ache. Keep only motions that don't leave you more sore later or next morning.

For your knee, slowly straighten the leg while seated and without a weight. For a shoulder, slide the hand across a table without forcing the reach.

For an elbow, open and close the empty hand without squeezing hard. Stop any movement that causes sharp pain, new swelling, buckling or weakness.

A brace may make a daily task easier for a while. It won't repair a tear or replace an exam after a sudden injury.

When is more care worth discussing?

Get the joint examined when the ache keeps blocking normal life. The doctor checks the tender area, swelling, movement and strength.

Care may include medicine, a brace, physical therapy or an office procedure. A serious tear or other injury may still lead to surgery.

Ask which choice may help a task you can't do now. Name that task, such as climbing stairs, holding a cup or putting on a shirt.

Bring a record of medicines and earlier care. You'll get clearer answers when the examiner knows those details.

Write down the recommended choice and its reason. If that reason isn't clear, ask again before agreeing.

QC Kinetix offers natural pain treatments, meaning non-surgical blood-based shots that licensed clinic staff may discuss after examining the sore joint.

Sources

1. Tendinopathy is described in the Nature Reviews Disease Primers review as a complex, multifaceted tendon pathology - disorganised collagen fibres, increased microvasculature and sensory nerve ingrowth, dysregulated matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cell apoptosis - most commonly affecting the rotator cuff, the medial and lateral elbow epicondyles, the patellar tendon, the gluteal tendons and the Achilles. The authors state plainly that management consists of exercise and loading programmes, therapeutic modalities and surgery, and that their effectiveness 'remains ambiguous'.

   Millar NL, et al. — Tendinopathy.. Nat Rev Dis Primers, 2021. DOI: 10.1038/s41572-020-00234-1.

2. Across 41 randomised trials and 2,672 participants, corticosteroid injection reduced tendinopathy pain in the SHORT term but the effect reversed later. For lateral epicondylalgia, corticosteroid had a large short-term effect versus no intervention (SMD 1.44, 95% CI 1.17-1.71), but no intervention was FAVOURED at intermediate term (SMD -0.40, -0.67 to -0.14) and long term (-0.31, -0.61 to -0.01). Of 991 participants injected with corticosteroid in trials reporting adverse events, one (0.1%) had a tendon rupture. Platelet-rich plasma was not more efficacious than placebo for Achilles tendinopathy in the trials available at that time.

   Coombes BK, et al. — Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.. Lancet, 2010. DOI: 10.1016/S0140-6736(10)61160-9.

3. In 25 randomised trials covering 26,610 participants and 3,464 injuries, STRENGTH TRAINING reduced sports injuries to less than a third (RR 0.315, 95% CI 0.207-0.480) and proprioception training roughly halved them (RR 0.550, 0.347-0.869), while STRETCHING showed no protective effect at all (RR 0.963, 0.846-1.095). Overuse injuries specifically were nearly halved by exercise programmes (RR 0.527, 0.373-0.746).

   Lauersen JB, et al. — The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.. Br J Sports Med, 2014. DOI: 10.1136/bjsports-2013-092538.

4. The updated evidence-based ankle sprain guideline states that ligament damage severity is assessed most reliably by DELAYED physical examination 4-5 days after the injury; that after a short period of immobilisation the patient benefits most from tape or a brace combined with an exercise programme; that NSAIDs may reduce pain and swelling but are not without complications and MAY SUPPRESS THE NATURAL HEALING PROCESS; that supervised exercise-based programmes are preferred over passive modalities; that surgery should be reserved for cases not responding to comprehensive exercise-based treatment; and that ankle braces are efficacious for preventing recurrence.

   Vuurberg G, et al. — Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.. Br J Sports Med, 2018. DOI: 10.1136/bjsports-2017-098106.

5. The American Medical Society for Sports Medicine's position statement on regenerative medicine exists precisely because the field has 'produced widely varying opinions' and because regulators, clinicians, scientists, patient advocacy organisations and the media have raised concern about how these products are used. It sets out terminology, the basic science and clinical evidence for orthobiologics, regulatory considerations, and best practices for introducing them responsibly - describing the evidence as growing that CERTAIN products are safe and potentially efficacious, not as settled.

   Finnoff JT, et al. — American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine.. Clin J Sport Med, 2021. DOI: 10.1097/JSM.0000000000000973.

6. FDA states verbatim that stem cells, stromal vascular fraction, umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have not been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' Tendonitis and tennis elbow are named explicitly. No exosome product holds FDA approval at all, and the only stem cell products with FDA approval in the United States are blood-forming cells derived from umbilical cord blood, cleared only for disorders of blood production. FDA also states it has received reports of blindness, tumour formation and infections following treatment with unapproved products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

7. Thirty-nine men with patellar tendinopathy were randomised to peritendinous corticosteroid injection, eccentric decline squats or heavy slow resistance training for 12 weeks. All three improved at 12 weeks - but at the half-year follow-up the gains were MAINTAINED in the two exercise groups and had DETERIORATED in the corticosteroid group. Heavy slow resistance also produced elevated collagen network turnover and the highest treatment satisfaction at follow-up.

   Kongsgaard M, et al. — Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy.. Scand J Med Sci Sports, 2009. DOI: 10.1111/j.1600-0838.2009.00949.x.

8. The Cochrane review of injected corticosteroids for plantar heel pain pooled 39 studies and 2,492 adults. Against placebo or no treatment, steroid injection MAY produce a small short-term (under one month) reduction in heel pain (MD -6.38 on a 0-100 scale, 95% CI -11.13 to -1.64) - a confidence interval that only marginally includes the minimal clinically important difference of 8 - and made no difference at 1 to 6 months (MD -3.47, -8.43 to 1.48). Nearly all trials were at high risk of bias and most evidence was rated very low quality.

   David JA, et al. — Injected corticosteroids for treating plantar heel pain in adults.. Cochrane Database Syst Rev, 2017. DOI: 10.1002/14651858.CD009348.pub2.