Patient Education Center
Here you will find answers to your questions about joint anatomy, the journey from injury to recovery, and what to expect every step of the way.
American Academy of Family Physicians Journal
Key feature: Joint, tendon and bursa injection techniques
This series of “office procedure” articles can be found for free online. They are perfect to reference when mastering how to perform injections. These articles contain peer-reviewed content and therefore have trustworthy information. The series includes injections of the
The technique section provides pictures and gives specific instructions for the injection approach.
Duke Orthopaedics: Wheeless’ Textbook of Orthopaedics
Key feature: Online orthopaedic textbook
There are not many free textbooks available, especially online. The Wheeless’ Textbook of Orthopaedics is written by Duke University physicians. The website details common orthopaedic conditions such as arthritis as well as surgical procedures. It also has a great physical exam section for each joint—ankle, elbow, hip, knee, shoulder and wrist. The physical exam section is great when referencing normal range of motion for each joint and includes specific exam tests: Lachman test, Anterior drawer, etc.
Key feature: ICD-9 and CPT coding
ICD-9 coding can be a challenge when first starting in medical practice. Most electronic health records already have all ICD-9 codes built into the system, which makes it easier. However, if you ever need a code, the website eORIF is a quick go-to. It has orthopaedic ICD-9 and CPT codes categorized by joints: shoulder, knee, hip, etc. In addition, this website is packed with orthopaedic information and relevant anatomy. The protocols are very helpful, such as the rotator cuff repair rehab protocol.
AO Surgery Medical App
Key feature: Surgical technique
AO Surgery is a free medical app created by AO Foundation, an organization of surgeons treating musculoskeletal conditions. AO Surgery Reference can also be accessed online as a Web page. This reference contains detailed information on surgical techniques, specifically for open reduction and internal fixation procedures for broken bones. You begin by choosing the fractured bone, and the app provides the possible surgical procedures and then walks you through the procedure by explaining positioning and approach.
Principles of Goniometry
Key feature: Joint range of motion
Goniometry is an objective measure to evaluate range of motion in various joints such as the shoulder or knee. It is used in an initial patient evaluation and to monitor progress after a surgical procedure. There is a lack of free goniometry references online. However, I did find Principles of Goniometry, which displays the normal degree of motion for all joints. The website displays the normal ranges in an easy-to-read table.
Injuries / Syndromes / Condition
Joints are the made up the connected ends of bones as well as ligaments, tendons, cartilage and synovial fluid:
Bones, specifically their articulated ends, make up the joint
Ligaments are short bands of tough fibrous connective tissue that function to connect one bone to another, forming the joint.
Tendons are made of elastic tissue and also play a key role in the functioning of joints. They connect muscle to bone.
Cartilage is a fibrous tissue that covers the bone surface and keeps the bones from rubbing directly against each other.
Synovial fluid lubricates joints so they can move freely.
So the next time you throw a ball with your kids, raise a glass for a toast or sit down for a long conversation with a friend, thank your joints. Healthy joints mean we can do all the activities we love, with freedom of movement and without pain. And that’s what this Patient Education Center is all about.
Knee Pain and Injuries
Understanding Your Knee – Knowing how your knee works is critical part of injury recovery and pain management.
Your knee is made up of two main bones, the thigh bone, or femur, and lower leg bone, or tibia. These bones are held together by four main ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (LCL) and medial collateral ligament (MCL). The meniscus is the rubbery cartilage that sits between these bones. When you step down, the meniscus acts as a shock absorber between the thigh bone, or femur, and the leg bone, or tibia. The bones come together to form a joint. It is at this joint that the bones move over one another to allow you to move about and move your body. At this joint the bones are lined with a hard substance called cartilage.
The patella is a disk shaped bone in the front of your knee. Your patella is attached to your tibia bone by a tendon called the patellar tendon. The kneecap also attaches to the quadriceps muscles which are the large muscles in the front of your thigh. The patellar tendon, quadriceps, and other soft tissue surround the patella in what we call a soft tissue envelope. Normally this soft tissue envelope is well balanced and strong allowing your knee to function without pain.
Normally your patella rides smoothly in a groove at the end of your thigh bone, or femur, when you bend and straighten your knee. The vastus medialis obliquus, or VMO, is important in maintaining this normal patellar movement and allowing balance of the soft tissue envelope around the patella. The movement of the patella in this groove at the end of the femur is called patellar tracking.
The largest joint in the body, the knee is also one of the easiest to injure. Knee problems can be caused by trauma, particularly from sports; physiologic issues like misalignment; degeneration from conditions like osteoarthritis; or just plain overuse. To learn about some of the most common knee injuries and conditions, view the videos, below.
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Elbow/Wrist Pain and Injuries
Understanding Your Elbow and Wrist – Knowing how your joints work is critical part of injury recovery and pain management.
The elbow joint is made up of the lower end of the upper arm bone, or humerus, and the upper ends of the two bones (the radius and the ulna) of the forearm. With your palm facing forward, the radius is on the outside of the forearm (on the thumb side) and the ulna is on the inside (or the ‘pinky’ side). At the place where they meet at the elbow joint, these bones are lined with a smooth type of cartilage which allows the bones to glide smoothly over one another during elbow motion.
The hand and wrist joint are made up of the following bone groups: the phalangeal bones of the fingers, the metacarpal bones of the hand, the carpal wrist bones, and the ends of each of the forearm bones which are called the radius and ulna.
The types of conditions most commonly affecting the elbow and wrist are overuse injuries. Tendonitis, which can occur in the elbow and wrist, is a frequent complaint. This condition can result from repetitive motion, like continually turning the wrist or hand gripping. Tendonitis is an inflammation of a tendon (connects muscle to bone) or bursa (a small, fluid-filled sac that acts as a cushion between bone and other moving parts).
The two most common types of tendonitis include: lateral epicondylitis (tennis elbow) which is an inflammation of the tendon on the side of the elbow away from the body; and medial epicondylitis (golfer’s elbow) which affects the side of the elbow that is toward the body. And, no surprise, these conditions occur more often as we get older.
Other types of injuries to the elbow and wrist include fractures, dislocations and arthritis.
Other non-surgical options to help manage pain and joint instability: cold therapy and rehabilitative exercises. Cold Therapy: Ranging from simple ice packs to motorized cold therapy (an insulated cooler with a pump and pads that deliver cold to specific joints), your doctor may suggest using cold therapy to reduce pain and swelling of an injured joint. All cold therapy, including ice, can be cold enough to damage your skin, so regardless of what kind of cold therapy you use, follow your doctor’s instructions.
Exercises for Joint Rehabilitation: Your doctor may recommend exercises to help enhance your recovery. This may include exercises for stretching to gradually increase range of motion, and strengthening to regain joint function.
Am J Sports Med. 1991 Sep-Oct;19(5):463-8. Spine injuries in gymnasts and swimmers. An epidemiologic investigation. Goldstein JD(1), Berger PE, Windler GE, …
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