Category Archives: orthopedic bracing

What’s Worse: A Sprain, A Strain or a Fracture?

By  aenriquez  published  November 12, 2019

People often debate this ancillary medical question: Which is worse, breaking an ankle or spraining an ankle? For all of that, what’s the difference between the two?


To answer those questions, let’s review all the possibilities. From a medical point of view, the question “which is the worst” of two non-lethal injuries is the same as what injury limits functioning the most, which one hurts the most or which is the most disfiguring.


Furthermore, there are three types of medical designations for routine injuries of this type: Sprains, breaks, and strains. Here’s the difference between these three:




A strain is caused by sudden over-stretching, twisting or of a muscle or a tendon or both. A tendon is a fibrous band of tissue that connects a muscle to a bone.


Strains can be severe, causing intense pain, muscle spasms, inflammation, loss of strength and cramping. A strain can be either mild or severe with the worse cases involving tearing of either muscles or tendons, including tendons that detach from muscles or bones.


Strains commonly occur at the back of the hamstring muscle, which runs along the back of your thighs. A hamstring can be pulled by overstretching the leg, which might occur in running and then either accelerating quickly or jumping suddenly. Hamstrings are common to any sport where running is required.


Healing from a strained muscle or tendon


Healing from a strain can take up to six months or more. One of the problems with these types of injuries is that fully healing takes so long that re-injury is common.


The long and the short comes down to the time it takes to heal and the risk of re-injury




A sprain, technically, is an overstretching of ligaments, which connect two bones, often wrapping around two bones of a joint to hold the joint into place. As such, injuries to knees, ankles and other joints frequently are sprains, rather than strains.


A sprain can be very painful, causing the area to swell up and turn various shades of blue, black and yellow or red. The intensity of a sprain depends on the severity of the injury, which could involve rupturing a ligament or having it separate from the bone it is expected to support. Severe sprains might include dislocation of the joint.


Fractures or breaks


A broken bone can be very painful, but it is not always so. While a clear break is certainly painful, fractures can be very slight (often called a hairline fracture) and relatively small. There is usually some pain involved with a slight fracture, but the area could also experience numbness without much pain.




The severity of an injury is dependent on related factors. How much does it hurt? How much does treatment cost? How long does it take to heal? Is the injury likely to reoccur?


By several of these measurements sprains and strains could be said to be worse than breaks or fractures, if there is no surgery involved. Treatment of the fracture might be more expensive initially if a cast is required for stabilization, but severe sprains are also treated with stabilizing casts.


Here’s the breakdown. As far as pain, it is hard to conclude either of these is more painful than the other. A broken bone can be extremely painful at first, but a hamstring pull is often just as painful. A badly sprained ankle can also be painful. We have to consider this a virtual three-way tie.


The long and the short comes down to the time it takes to heal and the risk of re-injury. In this case, a sprain can take even longer to heal than a fracture or a broken bone and is far more likely to reoccur. A healed bone is almost as strong as one that never broke in the first place, whereas the soft tissue damage from a sprain or strain can persist for a long time, increasing the chances of re-injury.


How can you tell the difference?


Modern medical imaging (an X-ray or a CT Scan) is used to diagnose a sprain, strain or fracture, but you can make an educated guess when the injury occurs. Sprains and strains hurt primarily in an area of soft tissue, while bone pain (and swelling) occurs where the bone is the primary structure. Secondly, a broken bone or a fracture often results in numbness, where a sprain and/or strain do not.




Any sprain, strain, fracture or break should be seen by a doctor as soon as possible to prevent further injury. Let us help you return to an active lifestyle with minimum pain. Call FXRX Orthopaedics and Bracing in Phoenix, Az., at 480-449-FXRX.

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Common Golfing Injuries

By  aenriquez  published  November 8, 2019

The game of golf has a reputation for being slow, deliberately careful and so non-violent. But many injuries occur when playing golf. Generally, these are repetitive use injuries that occur by repeating the same motion over and over until wear and tear gradually result in some type of injury.


Here is a list of three common injuries that golfers sustain playing the grand old game and some reasons that they occur.


  • Rotator cuff tear
  • Golfer’s elbow
  • Hook of hamate fracture


Golfer’s elbow is not restricted to golfers and maybe more commonly known as tennis elbow

Rotator Cuff Tear


The rotator cuff is the name given to a group of muscles and tendons that support the shoulder, basically holding the joint into place. The reason this is necessary is that the socket of the shoulder joint is not an all-encompassing structure; it is a shallow dish-shaped bone that has evolved because the shoulder is given a wide range of motion. The knee or the elbow (and many other joints) bend in only one direction, while the shoulder is relatively freewheeling owing to the structure of the joint.


A rotator cuff tear can be debilitating, causing severe pain when you try to lift your arm, especially if you try to lift your arm above your head. That is where the problem begins. A rotator cuff tear, it follows, mostly afflicts people who work repetitively above their heads, such as painters, sheet-rock installers, or carpenters. It is also common among baseball players, tennis players and swimmers.




Once diagnosed, treatment usually starts with rest, putting ice or heat compresses on the shoulder and physical therapy designed to stretch the tendons and get them to relax. More involved treatment includes injections to help mitigate pain.


There are also a variety of surgical options for severe rotator cuff injuries, including arthroscopic tendon repair and open tendon repair, which is more invasive, requiring a longer surgical opening.


Golfer’s Elbow


Golfer’s elbow is not restricted to golfers and maybe more commonly known as tennis elbow. But it’s not restricted to just golfers and tennis players. It is associated with any activity that includes repeated striking of something by extending your forearm. As such, you can develop tennis elbow while roofing a house, as the many hammering motions can bring on this condition.


Golfer’s elbow is an affliction of a tendon but is mostly felt on the bony protrusion of your elbow or this area plus the upper portion of your forearm. While the injury is sustained by many relatively mild concussive strikes with the forearm (a golf ball or a tennis ball is not very heavy, after all), it can be very painful once you reach the threshold, and the injury develops.



Treatment of golfer’s elbow includes taking time off from golf for a while to allow the tendon to heal. Frequently, ice compacts are used to reduce pain.


A conveniently placed brace – a band – is often deployed. This is positioned just under the elbow, and it re-positions the tendon, so it no longer sustains impact when you use it. This can be very effective.


Also, physical therapy, pain management, and other techniques are used. Rarely does this condition require surgery to correct, in part because it becomes too painful to repeat the motion and forces people to stop the painful activity and to give the area time to heal.


Hook of Hamate Fracture


The hook of hamate is a bone. It is the carpal bone at the base of the pinky or little finger on the outside portion of your wrist. A fracture of this bone can be defined as a broken wrist.


The fracture can develop from a sudden trauma or from repeatedly striking an object, such as a golf ball, with the same motion over and over. The pain can come on suddenly and result in the inability to grip tightly to an object.




Once diagnosed with an X-ray or a CT Scan, a fractured wrist is often treated with a brace or a cast to restrict or stabilize movement. Pain management may also be required when the injury first occurs. Surgery is usually not needed.

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Rotator Cuff Surgery Includes Minimally Invasive Options

By  aenriquez  published  October 22, 2019

A rotator cuff tear is a common injury that occurs from either daily wear and tear of the shoulder or from a sudden trauma that occurs most often from a sports-related injury. The remedy for a rotator cuff tear is to rest the shoulder until it heals, although often surgery is required to repair the tendon or reattach it to the head of the humerus, which is the long bone of the upper arm.


The rotator cuff itself is a group of four muscles and tendons that allow for you to lift and rotate your arms. This group of muscles is complex, allowing for a wide range of motion for your arms, which is useful, of course, daily.

The three basic surgical options for rotator cuff repair are open shoulder repair, arthroscopic surgery, and mini-open surgery

Doctors assign two designations for rotator cuff tears. One is a partial tear, which refers to damage to a tendon. The second type is a complete tear. This refers to a tendon that has been torn free of the humerus bone and requires reattachment.




A rotator cuff tear can be painful, or it can be experienced as weakness in the shoulder with milder discomfort. The general symptoms are:


  • Difficulty raising an arm
  • Loss of motion in the shoulder
  • General weakness of the shoulder
  • Mild to severe pain
  • Pain that accompanies specific movement
  • An odd popping sound in your shoulder during movement




Minor rotator cuff tears can be managed with applications of heat or ice to provide pain relief or improved comfort. Also, non-steroidal anti-inflammatory drugs, such as ibuprofen, are recommended. Muscle relaxing and pain medications can also be used during the healing process.


Fortunately, if surgery is required, there have been advancements in techniques and equipment over the years that allow for minimally invasive surgery to repair rotator cuff tendons. Not only does this allow for outpatient surgery in many cases, it means quicker recovery times. It also means lower costs.


Your doctor will recommend a specific surgery depending on several factors. These include the amount of damage to the tendon, the medical history of the patient, and the doctor’s experiences with the various procedures. Other circumstantial factors could also influence this decision, such as the overall health of the patient or time constraints.


Three Surgical Options


The three basic surgical options for rotator cuff repair are open shoulder repair, arthroscopic surgery, and mini-open surgery.


Open Shoulder Surgery


Most often performed in a hospital setting, open shoulder surgery includes a surgical incision that allows the surgeon to view the shoulder muscles and tendons directly. This surgery most often requires the surgeon to detach the deltoid shoulder muscle to get a view of the damaged tendon. As such, this is the more invasive of the surgical options.


While performing open shoulder surgery, the surgeon will take advantage of the opportunity to also remove any bone spurs that may have formed on the underside of the acromion. This procedure is called an acromioplasty.


This option is chosen when the damage to the tendon is significant, including injuries in which the tendon has become detached from the bone. It is also the option chosen if a tendon replacement is required.


Arthroscopic Surgery


For arthroscopic surgery, the incision is tiny, just large enough to allow the surgeon to use very thin surgical equipment to repair a damaged tendon. Most often, there are two points of entry. At one point, the surgeon inserts a tiny camera into the shoulder, which will be used to guide the surgical procedure, which the doctor views on a monitor. The second entry point allows for the surgical equipment to be inserted into the area.


This is usually done on an outpatient basis at a medical clinic or the doctor’s office.


Mini-Open Surgery


This surgery includes a combination of open shoulder surgery and arthroscopic surgery. The incision is usually about 3-5 cm long. The advantage of mini-open surgery is that as much of the surgical work is done through arthroscopic equipment so that the deltoid muscle does not have to be detached. However, the incision does allow the doctor to directly view what he is doing for parts of the surgery.



Rehabilitation and Recovery


As with any surgery, there is a period of rest and recovery, which is followed by a rehabilitation period in which the patient begins to adapt to new limitations or to regain strength and flexibility on a gradual basis. During early recovery, pain medication may be prescribed, although any use of opioid pain medication must include a discussion with your doctor on the dangers of pain medication addiction.


See a doctor


Contact a doctor or visit the emergency room in your area quickly if you suspect a bone infection is occurring. With any of the symptoms above, have a doctor check you out to decide on the necessary course of action.


In Tempe, call FXRX Orthopaedics & Bracing at 480-449-3979 for an appointment.


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What Is A Torn Meniscus?

By  aenriquez  published  October 9, 2019

The meniscus is a C-shaped cartilage around the knee that separates the shinbone from the thighbone. Cartilage is a smooth tissue that helps keeps bone from rubbing against another bone. Bones rubbing neighboring bones leads to arthritis and other painful joint conditions.


A torn meniscus is a very common sports injury, as it is caused when someone twists on their knee with so much stress the cartilage is torn. It is commonly recognized by the popping sound it produces and the immediate pain that is the result.




A torn meniscus is quite painful and restricts movement of the knee anywhere from a bit to a major amount. Often it is difficult or impossible to straighten the knee with a torn meniscus. Other symptoms, while they may be self-explanatory, include:


  • Swelling and redness
  • Stabbing pain in the knee, especially during movement
  • Difficulty straightening the knee
  • Having difficulty moving the kneed to the extent it feels locked in place

Treatment of a torn meniscus usually starts with the basic approach of rest, ice and medication

Immediate treatment


Immediate treatment includes taking the weight off the afflicted knee, wrapping it to prevent movement and using crutches or a wheelchair if these are available. Seek medical treatment as soon as possible.




The diagnosis cannot be confirmed with an X-ray, because cartilage is not dense enough tissue to show up on X-rays. However, X-rays can rule out bone trauma and, therefore, could help narrow down the diagnosis.


Magnetic resonance imaging (MRI) can present an image of both hard (bone) tissue and soft (cartilage), which allows it to return images of your meniscus.


The third technique for diagnosing a torn meniscus is the use of an arthroscope, which is a small camera with a light that is inserted into your knee. While exploring the knee, doctors could also move ahead with surgical procedures to repair the meniscus or remove damaged tissue.




Treatment of a torn meniscus usually starts with the basic approach of rest, ice and medication. It often means taking a break from physical activities for a while.




Rest could entail the use of bandaging or braces to stabilize the knee while it heals. It may be wise to use crutches or a wheelchair to give the knee complete rest.




Ice is used to reduce swelling and help with the pain. Ice is best used for 15-30 minutes with the knee in an elevated position.




Over-the-counter, non-steroidal anti-inflammatory medication is often used. If the pain is severe, you can discuss with your physician use of more powerful medication.




Physical therapists can work wonders with cartilage damage. This is useful when you heal enough to begin activities again in a manner that does not re-injure the meniscus.




There are two strategies for surgery. Physicians first try to repair the meniscus. If this is not possible, surgeons will remove damaged tissue to allow the functioning cartilage to do its job unimpeded by irreparable tissue.


Seeking Help


A torn meniscus may require medical intervention to stabilize and repair the damage. In Tempe, call FXRX at 480-449-3979 to make an appointment with a specialist who has extensive experience with this injury.


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Bunions Aren’t Cute If You Have Them

By  aenriquez  published  September 11, 2019

A bunion sounds like something small and quaint – a bit like something extra someone in Victorian times would sneak into a picnic basket. Oh, you brought bunions! How delightful.


Bunions, however, are not particularly delightful. In fact, they are painful, bony protrusions that form at the base of the joint of your big toe or your little toe, where they are referred to as “tailor’s bunions,” or “bunionettes.” These also sound quaint, but are, in fact, painful.


A bunion is an abnormal growth that is fairly common. About 18 million women in the United States over 21 years of age (about 8 percent) have bunions, while about 4 million men suffer from the same condition. The difference between genders is explained due to the shoes men and women choose to wear. But the condition is the same and it can hurt.

The bunion shows as a swollen, usually red, inflamed looking bump protruding outward

A growth at the base of the outer toes has nowhere to go if not outward. The middle toes block the protrusion from going inward, so the growth goes outward. While doing so, it forms an exposed outer nub that will be the first thing your foot collides with when it bangs up against something. It is, in effect, an exposed, readily accessible growth that is even visible. It forms a bump at the base of the large or the small toe that then turns the toe inward. The affected toes then start to crowd the middle toes, overlapping them or pushing them inward.




The symptoms of a bunion include pain in the first joint of the largest or smallest toes (the first and fifth metatarsophalangeal joints). The bunion shows as a swollen, usually red, inflamed looking bump protruding outward.


The skin around the bunion tends to become calloused over time, so the skin is likely to be thickened around a bunion. In addition, bunions usually present a dull pain and are vulnerable to bumping. The toes may become misaligned and bunions can make it difficult to find proper footwear that is not painful to wear.


What causes bunions?


There are a variety of causes for bunions. Genetics can be a contributing factor. Poorly fitting shoes or foot injuries can also lead to bunions. Other causes include:


  • Flat feet
  • Poorly fitting shoes especially shoes that squeeze toes together
  • Congenital defects
  • Arthritis and other joint diseases that cause inflammation
  • Foot injuries
  • Occupational issues that require specialized footwear. Dancers are specifically prone to bunions.




Bunions and bunionettes will often retreat if the patient begins to wear the correct shoes, although orthopedic padding or shoe insteps could help the symptoms retreat even faster.


Padded socks can also be worn to protect the patient’s foot and help turn toes back to their proper alignment. Inflammation can be brought down with non-steroidal anti-inflammatory drugs. Heat is sometimes used to reduce swelling and alleviate pain.


In more serious cases, cortisone injections are used to reduce swelling and pain. Surgery is also a possibility for the most severe cases.


See a specialist


Bunions only sound cute. In reality, medical intervention is frequently required. See a specialist as soon as possible. Progressive conditions like bunions are best treated by starting a course of treatment as early as you can.


In Tempe, call FXRX Orthopaedics & Bracing at 480-449-3979 for an appointment.

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Sacral Fractures

By  aenriquez  published  April 25, 2019

The sacrum is formed by the fusion of 5 sacral vertebrae and articulates with 5th lumbar vertebra proximally and coccyx distally, and with ilia at sacroiliac joints bilaterally. It contains 4 foramina which transmit sacral nerves (L5-S5), which are responsible for the functions of anal sphincter tone / voluntary contracture, bulbocavernosus reflex and perianal sensation. As an osseous structure, sacrum transmits the load distributed by the first sacral segment through iliac wings to the acetabulum.

Sacral fractures are quite common, occurring in up to 45% of pelvic ring injuries related to high energy trauma (in young adults) or low energy falls (in elderly). They are often underdiagnosed and as a consequence, they are frequently mistreated and lead to serious complications such as neural damage (25% of all cases).

Transverse sacral fractures also have a high incidence of nerve dysfunction

The presence of a neurologic deficit is the most single most important factor in predicting the outcome. Untreated fractures with neurologic deficits lead to symptoms of lower extremity motor/sensory deficits and/or urinary/rectal/sexual dysfunction.

Sacral fractures are classified according to the Denis classification. Zone 1 fractures (50% of all) are lateral to the foramina and are least related to a nerve injury. Zone 2 fractures are through foramina, and based on whether they are stable or unstable, have an increased risk of nonunion, nerve damage and poor functional outcome. Fractures that are medial to foramina are associated with the highest rate of neurological deficit (60%), such as bowel, bladder, and sexual dysfunction. Transverse sacral fractures also have a high incidence of nerve dysfunction.  The u-type sacral fractures result from axial loading and represent spino-pelvic dissociation; these too have a high incidence of neurologic complications.

The clinical diagnosis begins with taking a proper history – motor vehicle accident or fall from height are the most common causes of these fractures, but repetitive stress, insufficiency fracture in osteoporotic adults are also important predisposing factors. The most prominent symptom is peripelvic pain. The physical exam should include testing for pelvic ring stability by internally and externally rotating iliac wings, palpating for subcutaneous fluid mass indicative of lumbosacral fascial degloving, as well as performing a vaginal exam in women to rule-out open injury. A focused neurologic, vascular and rectal exams are also important to assess the degree of tissue damage.

Radiographs are required to diagnose a sacral fracture, although only 30% show sacral fractures. CT is by far the diagnostic study of choice for proper assessment of the fracture, while MRI is considered when neural compromise is suspected.

Nonoperative management includes progressive weight bearing with orthosis if needed, and can only be considered in patients with <1 cm displacement and no neurologic deficit, and in cases of insufficiency fractures. Surgical fixation (without decompression) should be considered if there is a displaced fracture >1 cm with associated soft tissue compromise and persistent pain after non-operative management, and also if there is displacement of fracture after non-operative management. Surgical fixation with decompression is the treatment of choice whenever there is evidence for neurologic injury.

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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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Implications Of An Untreated Stress Fracture

By  aenriquez  published  June 26, 2018

If you have pain in a bone that is unrelenting and associated with exercise or work then you might have suffered a stress fracture. These injuries seem innocent enough but can have significant implications if left alone and not looked at by a professional.

What is a stress fracture?

A fracture (as many of us will know) is a broken bone. A complete fracture splits the bone into two or more pieces whilst a partial fracture doesn’t. However, a stress fracture is a broken bone caused by repetitive and repeated compressive stresses to it. It can occur from a small number of high load repeated stresses and a high number of low load stresses (ie a marine with a heavy backpack running for a few miles versus a distance runner pounding the pavement for over 100 miles a week).

What happens if you leave it untreated?

This all depends on where the fracture is and whether it is in a high or low-risk site. In the worst case scenario, the stress fracture can develop into a full fracture causing displacement of the bone, nonunion (where the bone doesn’t heal properly) or fracture propagation (where the fracture becomes bigger and bigger). These complications are likely to occur at high-risk sites. High-risk sites for a stress fracture include:

  • Any stress fractures in the spine but particular the region of the lumbar spine known as the pars interarticularis
  • Hip and thigh fractures in the femoral head
  • Knee and leg fractures of the patella or the tibia
  • Ankle and foot fractures in the:
    • Medial malleolus
    • Talus
    • Tarsal navicular
    • Base of second metatarsal

A fracture (as many of us will know) is a broken bone

Some sites have a low risk of complication and these include:

  • Second and fourth metatarsal shafts (bones in the feet)
  • Posteromedial tibial shaft (part of the lower leg bone)
  • Proximal Humerus
  • Humeral shaft (arm)
  • Ribs
  • Sacrum (bottom of the spine)

How should it be managed?

If you or somebody you know suspects you might be suffering from a stress fracture then get in contact with a specialist orthopedic clinic immediately for evaluation. They will assess what the best treatment is, but the general principle is that the sooner treatment is given the better the outcome. They will decide between conservative and surgical treatment for the fracture. Usually conservative is chosen in low-risk fractures in those whose livelihood does not depend on getting better immediately. However, if an individual has a fracture in a high-risk site or their livelihood depends upon being active (ie a highly competitive athlete or a laborer on their feet all day) then it may be decided that surgery is the best option.

Conservative treatment usually consists of:

  • Pain control with medications
  • A splint that stops weight bearing on the fractured site
  • A reduction in activity until the fracture has healed
  • A slow and gradual increased in activities once the patient is pain-free
  • Exercises to help with rehab


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Benefits of Orthopedic Bracing

By  aenriquez  published  March 22, 2018

Braces and splints are useful for chronic and acute conditions alike. They can also be used for prevention of injury. There is much scientific evidence that supports the use of braces and splints.

Unloader Knee Brace

The unloader (valgus) knee brace is often used for pain reduction in people with osteoarthritis of the medial compartment of the knee. These braces are designed to apply an outside (external) force to reduce the load on the medial (central) knee compartment, which reduces pain. Improved joint proprioception also helps to relieve pain. In a study involving 120 patients with knee osteoarthritis and varus deformity, researchers found that the unloader knee brace helped relieve pain and improve functional status. The benefits of this brace were found to be greater than a hinged brace.

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