Category Archives: blog

Swelling of the Knee

By  aenriquez  published  February 20, 2020

A common complaint among knee injuries is a condition frequently called water on the knee or sometimes, simply, swollen knee. A doctor might refer to this as an effusion of the knee, which indicates the movement of fluid.

There are many causes for water on the knee, and it will take an examination and possibly some laboratory analysis of the fluid to figure out the underlying cause of the effusion. The first noticeable symptoms, however, include a swollen, puffy, stiff knee. It is likely to be painful. In addition, the swollen area could be soft and pliable, moving the way a water balloon feels when you poke at it.

Causes

There are many possible causes for water on the knee. There could be an underlying disease present. Your knee could be swollen from acute trauma, such as a sports injury involving a collision or an over-stretching of a ligament. Over-use could be the problem. This implies long-term use of the knee, often in a repetitive fashion, that has worn down some of the joint’s cartilage. A bone could be fractured or broken. An infection could have set in. Various diseases could also result in water on the knee.

Common Diseases

The most common knee diseases include osteoarthritis, gout, pseudogout, blood or bone infections, tumors, cysts, or bursitis.

Risk Factors

There are risk factors involved in knee conditions, including age – the older we get, the more susceptible we get to many conditions – lifestyle, especially when involved in high-stress sports, and obesity. The more overweight you are, the more likely you are to injury your knees or have cartilage wear down over time.

Prevention

If you can avoid getting old, that would help. Unfortunately, no one has figured that out yet. However, you can strengthen your leg muscles to give more support to your knee when you need it. You can also try losing weight to take some stress off of your knees.

Diagnosis

Doctors will first interview the patient to see if there is an obvious lifestyle or family history factor to take into consideration. After this, the physician may order an X-ray, an ultra-sound or MRI imaging to be done to get a look at what is happening in your knee.

If imaging does not result in a firm diagnosis, the doctor may try a joint aspiration, also called an arthrocentesis procedure. This involves drawing some of the fluid out of the knee (with a syringe and a need), then sending the fluid to the laboratory to look, primarily, for the presence of bacteria, indicating an infection or crystals, indicating either gout or pseudogout.

Treatment

Treatment might begin with drawing fluid from the joint to reduce the stiffness and pain. In some cases, the fluid may not return, and the patient will not need further treatment. However, there’s a chance the fluid will return, as the cause of the fluid has not been addressed.


Treatment may also involve the use of antibiotics, pain, or anti-inflammatory medication or surgery. The surgery could include a minimally invasive arthroscopic procedure or a more complicated procedure. Knee replacement surgery is also a possibility, depending on the underlying condition and after serious discussions of alternative therapies.

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Sciatica Causes and Treatment

By  aenriquez  published  February 12, 2020

Sciatica is a condition marked by pressure put on the sciatic nerve, which runs from your lower back, through your buttocks to the back of each leg. It is often caused by a herniated disk, which is the term given to the movement of the cushioning tissue between each of your spinal vertebrae. When the disk slips out of place or tears (often called a ruptured disk), it can be very painful. Most often, this occurs in the lower back, the so-called lumbar region, where most of the weight of your torso and head, are supported.

On the other hand, there are other bodily systems in the same region, and one of these could also be the cause of sciatica. These include spasms of the piriformis muscle, which is deep within buttocks and connects the upper thigh to the lower spine. Another culprit involved in sciatic pain could be degenerative arthritis in the spine, sacrificing spine health, or spinal stenosis, which is a narrowing of sections of your spine, an occurrence associated with aging.

Other potential causes include what is called “fat wallet syndrome,” which refers to carrying around a bulky object in the back pocket of your pants. Over time, sitting in an uneven position can put pressure on your sciatic nerve.

Another temporary cause of sciatica is caused by pressure on the nerve of the growing uterus during pregnancy (and the weight of the growing baby). This usually resolves itself after delivery, but it can be quite painful and difficult during pregnancy when the weight of the infant is enough to worry about.

Sacroiliitis, an inflammation of the sacroiliac joint, which is the joint of the pelvis. An inflammation here could also put pressure on the sciatic nerve.

 Symptoms and Diagnosis

Pain in the lower back is the primary symptom of sciatica. However, the pain often shoots through the lower back, through the buttocks, and down one leg. The pain is often searing and intense and dependent on what position you hold yourself in. However, in various cases, even a changing position does not help, forcing you to sit in a chair or lie down to relieve pressure on the nerve.

A diagnosis of sciatica is relatively easy to make, but finding the cause of the discomfort is critical so doctors can choose how to treat the patient. Diagnosis is done by a thorough exam and interview by the doctor and by use of imaging, such as a CT scan or an MRI. These imaging techniques show bone structures and soft tissue, often revealing what is causing the pain.

Treatment

If you have a herniated disk, surgery might be required to relieve the issue; however, doctors most often recommend waiting on that decision, as 90 percent of sciatica incidents resolve themselves on their own.

Treatment might also involve pain medication, injections of anti-inflammatory steroids, acupuncture, physical therapy, massage, and diet. Being overweight can contribute to the problem.

When to seek help

Seek help anytime your child’s gait appears abnormal or if it is causing pain to the child. In Tempe, call FXRX Orthopaedics & Bracing at 480-449-3979 for an appointment.

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Is Your Toddler Toe-Walking?

By  aenriquez  published  February 5, 2020

When you see a toddler walking on his or her toes, you might assume it’s just a strange phase in the path towards learning how to walk. In this case, most of the time, you would be right!

Many toddlers learn to walk and feel comfortable up on the balls of their feet as they learn. It is considered a fairly common part of the learning to walk process, even if not all children do it. While it is most often normal, however, it can also be the symptom of various illnesses that should be addressed. (Normally, toddlers grow out of this habit and walk in the standard heel-toe pattern after a while.)

Some children walk on their toes for longer than the toddler stage, but this is because they’ve developed the habit of doing so. If you are worked about this, consult with a physician, and discuss the matter with them.

Risks

Toe-walking can be a symptom of several serious conditions. It could be the sign of cerebral palsy, muscular dystrophy, or autism spectrum disorder, according to the Mayo Clinic.

Toe-walking could also be a symptom of being born with a short Achilles tendon, which runs from the heel of the foot up the back of your lower leg. If the tendon is short, it can be difficult for the child to touch their heels to the floor.

Parents are advised to see a doctor if the toe-walking condition persists past the age of two (2). On the most basic level, toe-walking can increase a child’s risk of falling and sustaining injuries by falling.

Diagnosis

A diagnosis of toe-walking involves observation of the toddler. It also entails the use of an EMG, which is a very thin needle equipped with an electrode that is used to measure activities of the affected nerves or muscle. In this case, the EMG device is inserted into the muscle in the leg to measure nerve and muscle activity from a clinical point of view.

Other tests may also be ordered. The tests will likely include different examination options to determine if autism or cerebral palsy is the source of the problem.

Treatment

Treatment may not be necessary at all. The child may simply be learning how to walk and is stuck in the habit of walking on the balls of his or her feet. They will; normally outgrow this in time.

 However, a few other options may be recommended. These include:

— Physical therapy. This generally involves stretching and relaxing of the leg muscles. The child’s role is usually passive, while the therapist manually manipulates the muscles with movement for stretching and massage for relaxing.

— Leg braces or splints are sometimes recommended to train the child to walk in a heel-toe pattern.

— Casts are sometimes used as a form of leg brace. The casts promote normal walking and are replaced periodically as improvement is made, each cast guiding the child’s gait to the next level of success.

— Injections of onabotulinumtoxinA are recommended. This is injected into the calf muscles and can help return a gait to normal.

— Surgery might be recommended to lengthen a child ‘s Achilles tendons if one or both of them are too short to allow for heel-toe walking.

When to seek help

Seek help anytime your child’s gait appears abnormal or if it is causing pain to the child. In Tempe, call FXRX Orthopaedics & Bracing at 480-449-3979 for an appointment.

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Restless Leg Syndrome

By  aenriquez  published  January 30, 2020

Restless leg syndrome is a condition that occurs in a person’s limbs, most frequently in the legs, that gives many sensations that contribute to the need – or the perceived need – to move your legs. The sensations are varied, running from a tingling sensation to a slight aching sensation that seems to demand leg movement, which, in fact, gives relief to the uncomfortable feeling in your legs – mostly in your joints. Restless leg syndrome (RLS) is also known as Willis-Ekbom disease (WED), and the condition can be debilitating. This is because, while the condition flares up mostly in the evening or night, it can interfere with sleep and, thus, create problems with concentration and fatigue. It can interfere with daily activities.

It can be mediated, if not cured, by making changes in your lifestyle or by the use of pharmaceutical medication. Although the underlying cause is not understood, it is thought that RLS/WED is connected to an imbalance of dopamine levels in the brain. This is because dopamine has a role to play in motor function.

While the restless sensation is the primary symptom for RLS/WED, finding relief from the discomfort by moving is also a marker of the condition. If movement does not alleviate the restless feelings at all, then you may have some other condition causing the joints to feel uncomfortable.

Further, the condition tends to worsen when you are at rest, which often means it occurs routinely at night. Some people have trouble falling asleep, as that is the time you rest your legs, and they could start twitching or kicking out indiscriminately, to calm down the uncomfortable feelings.

The sensations that trigger the twitching are hard to define. If you imagine the drawstring of a bow (in archery) becoming tenser as the string is drawn back, this is partly RLS/WED feels – like your leg is poised to kick out and feels relief in the release. The sensation is otherwise described as itching, aching, an electric kind of numbness, light throbbing, and awkward or creepy.

There are risk factors involved with RLS/WED. These include a potential iron deficiency, kidney failure, diabetes, certain brain injuries or spinal cord conditions and peripheral neuropathy, which is slight to severe nerve damage in the hands and feet, which can accompany diabetes and/or alcoholism.

Diagnosis

Tellingly, the clinical definition of RLS/WED comes from the International Classification of Sleep Disorders and the International Restless Legs Syndrome Study Group. Categorically, RLS/WED has such an association with times of rest that it is of special concern as a sleep disorder.

The diagnosis comes from the following symptoms:

The need to twitch, move, kick out your legs, prompted by an almost indiscernible feeling of discomfort, like a vague tension in your joints. The sensation can be very uncomfortable, but jerking the leg relieves the sensation. As such, the remedy and the symptom are the same: The symptom is twitching legs, and relief from the symptom of discomfort is to twitch your legs or kick them out.

Symptoms generally worsen in the evening. In addition, the symptoms cannot be explained by another underlying cause, such as some type of palsy or muscle disorder.

Medications

Ask your physician about medications designed to restore dopamine levels or balance in the brain. Various pain medications can be tried if the symptoms are severe. Muscle relaxants and sleep medications are also prescribed for this.

Lifestyle Options

There are various try-at-home options, including taking a warm bath, going for a walk, applying cold or warm compacts, avoiding caffeine, or getting a massage.

When to call a doctor?

Call a physician if any uncomfortable or unexplained symptoms persist or become acute. In Tempe, call FXRX Orthopaedics & Bracing at 480-449-3979.

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What is Physical Therapy?

By  aenriquez  published  January 21, 2020

Physical therapy involves the use of a variety of techniques designed to promote healing, reduce pain, or adjust behaviors and skillsets to adapt to a permanent condition that is affecting someone’s life.

Physical therapists deal with a lengthy variety of conditions that range from a sports injury to heart disease. They are the ground-level service providers for healing, conditioning, pain relief, and adaptation to unusual circumstances.

In so many words, your body is designed to heal from illnesses and injuries of all sorts. Your immune system fights off diseases and helps you recover from them. Your muscles and bones, when they are injured, are designed to recover, mending fractures and breaks and growing replacement tissue in many cases. A physical therapist has many techniques that accelerate the healing process. However, if a condition is permanent, like the loss of a limb or spinal cord paralysis, a physical therapist teaches ways to adjust to your disability so you can be as active and pain-free as possible.

You can view healing as one way your body reacts to pain; as such, healing is a process of returning function and to reduce pain. Since physical therapy can promote a speedier recovery, pain relief is an important goal in many physical therapy interventions.

It is impossible to list here all the conditions where a physical therapy strategy can be helpful. They help people learn to walk with a cane or braces; they help people relearn to walk; they help restore movement after a traumatic sports injury; they use a variety of massage techniques to promote deep healing and relaxation; they help women recover after giving birth, and they help people who aren’t injured learn how to do various activities in a safe manner to avoid or prevent an injury in the first place.

Many insurance policies allow people to go directly to a physical therapist – to make an appointment and start working with the PT. Other policies require patients to see a primary care doctor first so that they can make a proper referral to a physical therapist.

Perhaps the best scenario in this situation is to see a doctor in a clinic that already has a physical therapist (or more than one) on staff, so the referral is as good as done.

Goals

 A physical therapist’s goals are always to reduce pain, restore functionality, or prevent injury. Among the first steps in the process are for the physical therapist to measure your current functioning status and assess the level of pain you are suffering.

The physical therapist will then create a customized plan to address your issues. They will then walk you through the plan and teach it to you. Typically, a physical therapist will teach you stretching, relaxation, or exercising activities that you can do at home. They will then schedule a series of appointments with you to monitor your progress and teach new activities to move you to the next level of healing.

Appointments are also helpful for the physical therapist to conduct hands-on healing that is best done in the office, such as extensive massages or measuring your progress. As such, an appointment with a physical therapist often lasts much longer than the standard visit to a doctor’s office. The physical therapist is where the rubber meets the road, where the actual healing from many physical conditions begins. It can take some time for the magic to work. If you are committed to healing, a physical therapist can be a miracle worker.

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The New Epidemic: Sitting Down

By  aenriquez  published  January 17, 2020

There are several serious health risks that most adults already know. There’s are serious risks associated with obesity, smoking, addictions to many well-known substances (alcohol, illegal drugs, etc.) and exposure to various illnesses and carcinogenic substances. However, health officials are considering adding a new concern to our list of problematic behaviors: Prolonged sitting.

This brings health officials (and the general public) to weigh in on the following questions: How long do you have to sit each day for this to be deemed too long (or prolonged) and how dangerous is sitting?

These are reasonable questions and the answers fall mostly in the category of common sense. Many office workers, truck drivers, taxi drivers, telephone marketers and many others sit throughout their working day. Many others spend hours each day sitting and watching television or engaged in some activity on a computer. However, how long people sit and the risks associated with that can be put on a scale, rather than declaring a solid number. Certainly, sitting eight hours each day is concerning. However, if you sit eight hours each day, but those who use a bicycle to commute to their jobs or school and exercise daily and eat right will have less to worry about.

Without exercise, you could be in trouble. An analysis of several studies found that sitting eight hours per day with no exercise was the equivalent in terms of life expectancy as smoking or obesity. This makes sitting a national health concern.

There is a direct correlation between sitting and weight gain and a correlation between sitting and muscle loss. These factors are clear. By extension, then, there is a link between sitting and cardiovascular disease and diabetes. This certainly makes prolonged sitting a potential concern.

Further, it turns out that many people sit for longer – sometimes much longer – than eight hours a day. Many people sit at their jobs, sit down for lunch, sit in their car to commute and sit down to dinner and television in the evening. Ten or eleven hours a day of sitting is not uncommon.

There are also studies that show that sitting extended periods every day can bring on depression and anxiety. These studies show there is a difference in the quality of sitting. Those who sit and watch television tend to be more depressed and anxious than those who sit and read or study or somehow engage their minds with games or other diversions. 

What is the answer to this epidemic of sedentary lifestyles? The answer is within reach and it can be free and very portable. It’s called exercise.

You can exercise without joining a gym. You can walk, jog, take up a sport, or do calisthenics in your living room. You can do jumping jacks and sit-ups or push-ups with minimal space and no equipment at all. Of course, gyms are great options, too. 

Studies indicate that an hour to an hour and a half or moderate exercise – raising your heart rate for about half of this time – would counteract the effects of sitting eight hours each day.

In our modern society, it is certainly impossible for many people to avoid sitting for long periods of time. Work is work. School is school. Many activities are accomplished while sitting down. It’s unavoidable. 

If this defines your life, reach for the antidote: Move about, exercise, raise your heart rate a minimum of five times a week for at least 20 minutes to an hour. Get some fresh air – sweat a little. It will do you a world of good.

Help!

Any sprain, fracture or break should be seen by a doctor as soon as possible to prevent further injury. Let us help you return to a normal, active lifestyle with minimum pain. Call FXRX Orthopaedics and Bracing in Phoenix, Az., at 480-499-FXRX.

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Treating Common Knee Injuries with PRP Therapy

By  david@ogrelogic.com  published  December 27, 2018

Meniscus tears are the most common knee injuries. These injuries can affect either the medial or lateral meniscus. Tears may occur because of a sudden, twisting motion resulting in –

  • pain
  • swelling
  • ‘catching’ or ‘locking’ sensation

If the physical examination by the orthopedic surgeon shows a torn meniscus, an MRI can be advised for confirmation.

Initially, meniscus tears are treated conservatively with rest, ice and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen, naproxen. It may be complemented with physical therapy for muscle strength and improved range of motion. Arthroscopic surgery may be recommended for severe cases.

However, now a highly effective, non-surgical intervention is available – PRP therapy. PRP or Platelet Rich Plasma therapy uses concentrated platelets from your own blood. With the help of ultrasound guidance, the injection is administered into the tear, allowing the tear to heal naturally. The injection is given under local anesthesia in an outpatient setting.

Other common knee injuries are –

  • ACL or Anterior Cruciate Ligament tear

This tear occurs as the result of a sudden stopping, sudden change in direction or hyperextension. This could be accompanied with a ‘popping’ sensation followed by deep pain, swelling, and instability.

  • PCL or Posterior Cruciate Ligament tear

The PCL can become inured due to a force to the anterior shin bone when the knee is flexed.

Both ACL and PCL tear can be treated with PRP therapy, stimulating the body’s natural healing mechanism.

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Wrist Splint for Fracture

By  aenriquez  published  December 18, 2018

The wrist is subject to fractures due to falling with outstretched or flexed hand. This can happen in a car, bike, skiing accident or with certain other sports activities. There are two bones in the forearm including the radius and ulna. The radius is on the thumb side. A fracture of the radius near the wrist is called a distal radius fracture.

 

Splinting is one choice for immobilizing the fracture and is commonly used for wrist fractures, reduced joint dislocations, sprains, soft tissue injury, and post-laceration repairs. Splints are mainly to immobilize and protect the injured wrist, aid in healing and decrease pain. Splints are primarily used for extremity injuries. Good anatomical fracture alignment is important.

 

There are a variety of splints used to treat fractures of the wrist and forearm. The splint used depends on the location of the fracture. These splints include:

  • Volar short arm splint
  • Dorsal short arm splint
  • Single sugar-tong
  • Long arm posterior
  • Double sugar-tong
  • Long arm

For immediate treatment, a splint may be applied to reduce pain and provide some comfort

There are two types of distal radius fractures called a Colles or Smith fracture. Determining the break depends on the angle at which the break occurs.

  • Colles fracture: results from a direct impact on the palm of the hand; a bump in the wrist results from the distal radius shifting toward the back of the hand.
  • Smith fracture is less common and can result from impact to the back of the wrist; a bump in the palm side of the wrist results when the distal radius shifts toward the back of the hand.

 

Wrist fracture symptoms include:

  • immediate pain when area is touched
  • bruising and swelling
  • deformity

 

Treatment for a distal radius fracture is dependent on several factors. For immediate treatment, a splint may be applied to reduce pain and provide some comfort. If the fracture is displaced it is put back into correct alignment under local anesthetic before application of the splint.  Additional factors influencing treatment are:

  • whether bones have shifted (displaced)
  • if there are multiple fractures presentation
  • involvement of the joint
  • ulnar fracture with injury to median nerve
  • whether it is the dominant hand
  • occupation and activity level

 

Once the fracture is in good position, a splint or cast is applied. The splint (or cast) will remain in place for approximately 6 weeks. A removable splint will be worn after that to allow physical therapy to regain proper wrist function and strength. X-rays may be taken at 3 weeks and 6 weeks to assess healing of fractures that were reduced or unstable.

 

It is still important to be aware of potential complications that require additional monitoring. Complications from immobilization include:

  • joint stiffness
  • muscle atrophy
  • complex regional pain syndrome

 

The fractured extremity should be immediately evaluated if:

  • pain worsens or does not improve after medications
  • cast or splint becomes damaged, breaks, or gets wet
  • hands/fingers feel numb or cold
  • hands/fingers turn blue or white
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Femur Fracture Complications

By  aenriquez  published  December 14, 2018

The femur is the biggest and generally the strongest bone in the human body. Fractures take a long time to heal. Normal activities of daily living are impacted as it is the main bone used for walking and standing.  Depending on the type of fracture and potential complications the impact will last a lifetime.

There are several types of fractures. Each has its own characteristics. Each fracture is dependent on the force that breaks the femur.

Elderly people are subject to femoral breaks from falling due to weak bones

These types of fractures include:

  • stable fracture – pieces of bone line up
  • displaced fracture – bone is out of alignment
  • closed fracture – the skin remains intact
  • open fracture – bone punctures the skin

 

Fractures are classified by:

  • location – distal, medial, proximal
  • pattern – bone breaks in different directions (crosswise, lengthwise, in the middle)
  • skin and muscle damage

 

The most common femoral shaft fractures include:

  • transverse – straight horizontal break across the shaft
  • oblique – angled line across the shaft
  • spiral – spirals the bone shaft caused by a twisting force
  • open – bone or fragments stick through the skin; also known as a compound fracture; there is damage to tissues, tendons, and ligaments. High risk of complications.
  • comminuted – bone breaks into three or more pieces

 

Common symptoms noted with a femoral break include:

  • immediate severe pain
  • cannot bear weight
  • injured leg appears to be shorter and/or looks crooked

 

A femoral fracture is normally found in severe accidents such as an automobile accident. Elderly people are subject to femoral breaks from falling due to weak bones. Hip fractures are also common with the elderly.

 

Common complications from femur fractures are related to the following:

  • the bone must be set properly – there’s a chance injured leg may become shorter and can cause chronic hip and knee pain; poor alignment can be painful
  • peripheral injury – muscles, ligaments, and tissues can be damaged
  • surgical – infection or blood clots, common surgical risks
  • Compartment syndrome

 

 

On a special note: Compartment syndrome is caused when increased pressure inside a closed space, that compromises circulation and function of surrounding tissues. Temporary or permanent damage to muscles and nerves may result in temporary or permanent damage.

Compartment syndrome may be:

  • Acute – most often caused by trauma, generally more minor. Prompt diagnosis and urgent treatment are required.
  • Chronic – usually caused by exercise. Symptoms begin with recurrent pain and disability. These symptoms may subside when the cause (usually running) is stopped and returns when activity is resumed.

The bones have many blood vessels that help promote healing. With time, the body will regenerate and further promote healing. Practice caution to prevent a re-fracture.

A diet that contains bone-boosting foods like calcium and vitamin D helps with healing, as well as, using protective gear that can help prevent future fracture.

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What does your Knee Pain indicate?

By  david@ogrelogic.com  published  November 16, 2018

The Knee Joint

The knee is the largest bone joint in the body that allows you to run, walk, stand, sit, bend your legs, pivot, swivel and more. The knee joint consists of bones, cartilage, muscles, ligaments, and tendons, all working together. Three bones – the tibia (shinbone), the femur (thighbone) and the patella (kneecap) come together at the knee joint.

Knee Pain

Knee injuries are complicated because they can be the result of damage or injury to any of the several parts that make up the knee. It is also important to understand that the knee functions between two very mobile joints – the hip and the foot. Injury to the hip or foot can also affect the mobility of the knee.

With age, the strain on our knees increases and pain and discomfort become common complaints. However, the pain may also result from injury or an underlying condition, apart from aging. An experienced orthopedic doctor or surgeon can make an accurate diagnosis of the cause of knee pain and treat it.

Depending on its location, different problems can be responsible for knee pain.

  • Front of the knee – related to kneecap injury or damage
  • Inside or medial side of knee – related to medial meniscus tears, MCL injuries, and arthritis
  • Outside or lateral side of knee – often caused by lateral meniscus tears, LCL injuries, IT band tendonitis, and arthritis
  • Back of knee – due to the collection of fluid, also referred to as a Baker’s Cyst
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