This is a great place to begin navigating through StoneClinic.com.  By finding the description that sounds most like your problem, you will be directed to the page that best fits your needs. 

 

"Doc, I twisted my knee and heard a pop.  My knee has swelled a little bit and is now hurting."

ANSWER: Twisting a knee, hearing a pop, and having knee swelling most commonly indicates a tear of important tissue inside of the knee.  This is usually the meniscus cartilage or the cruciate ligaments.  Twisting the knee, hearing a pop, and having swelling requires a careful physical examination, often a MRI, and the torn tissue is usually repairable. 

 

 "Doc, I twisted my knee, heard a pop, and now my knee gives way."

ANSWER: Most commonly represents a torn anterior cruciate ligament inside of the knee.  Though this sometimes can be a torn meniscus and the knee catches on the torn tissue and gives the feeling of giving way. 
 

"Doc, my knee crackles and pops when I bend and extend it, but it does not hurt or swell."

ANSWER:  Most commonly, this is either scar tissue or a rough area between the kneecap and the femur where the knee cap rubs.  Cracking and popping inside of the knee is very common, and usually does not need any treatment at all.  If the knee produces pain and swelling, then treatment can be performed; often non-operative treatment consisting of specific exercises and physical therapy helps.  Drinking glucosamine increases joint lubrication.  If these symptoms persist, a careful physical examination, x-rays, and a MRI are usually employed to make the diagnosis and sometimes damaged articular cartilage or scar tissue can be smoothed, removed or re-grown in order to diminish the pain with popping. 

 

"Doc, my knee catches when I walk, twist or bend."

ANSWER: Catching in the knee is mostly commonly either torn meniscus cartilage, scar tissue, or sometimes a loose body.  The diagnosis is confirmed by history and physical examination, x-ray, and MRI. 

"Doc, I have been told I have a torn meniscus cartilage.  What do I do?"

ANSWER: Meniscus cartilage is one of the key shock absorbers inside of the knee joint.  When torn, the meniscus usually does not heal.  Current thinking is to save as much of the meniscus cartilage as possible and therefore, when the cartilage is torn in a way that the surgeon is able to repair the tissue, repair should be undertaken.  If the cartilage is torn in an irreparable way, then the surgeon should carefully shape the meniscus in order to preserve as much of the remaining meniscus cartilage and to shape the cartilage to match the opposing femoral condyle so that there are no rough or sharp edges. Depending on what is called for, the meniscus can also be replaced or transplanted. Today, meniscus reconstruction is also an option through the Stone Clinic.

 

"How do I know if the meniscus can be repaired?"

ANSWER: Our criteria for meniscus repair depends on the quality of the tissue. This means that if the tissue appears healthy without degenerative, yellowing, or cracking in it then repairing it will lead to successful restoration of normal knee mechanics and shock absorption.  If, on the other hand, the tear is degenerative with yellowed, hardened tissue then repairing this tissue is often unsuccessful.  Much has been made about tears in the peripheral versus central aspect of the meniscus since the blood supply is better in the periphery.  However, we have often been successful at getting menisci to heal repairing even inner-margin tears if the tissue is really healthy and if a new blood supply can be stimulated to form.  We sometimes add growth factors, clots, and now investigating stem cell additivies to these types of repairs. 

"Doc, I have been told I need to have a knee replacement, but I would still like to play active sports….How to I avoid or delay artificial knee replacement?"

ANSWER: Artificial knee replacements are very successful procedures for older people who do not wish to play impact sports.  They can be successful for younger people who have severe arthritis or no other alternative are available.  However, new techniques developed at The Stone Clinic have proven that meniscus cartilage can be replaced in arthritic knees when it is missing and damaged articular cartilage can be re-grown in many areas of the knee joint.  The combination of meniscus cartilage replacement and articular cartilage re-growth is called a  biologic knee replacement rather than an artificial knee replacement.  Recent data in our 2 – 11 year study has demonstrated an 85% success rate documenting improved pain and function and survival of the meniscus allograft replacement in the arthritic knee.  An important component of this procedure is repairing the articular cartilage with a paste of articular cartilage and the patient’s own stem cells performed in a single step paste grafting procedure. 

 
"Doc, how do I know if I am a candidate for a biologic replacement?"

ANSWER: In-office visits with a careful history, examination, x-rays, and a MRI are the best way to determine which procedures are best for you.  However, if you live outside of San Francisco sending in an “outside consultation" can be arranged by contacting Lina at 415-563-3100.  Dr. Stone will ask for your x-rays, MRI (if you have one), any previous surgery or medical records pertaining to your knee, and history of your knee injury and symptoms. 

 
"Doc, my kneecap dislocated when playing sports.  Now what do I do?"

ANSWER: Kneecap dislocations from sports are usually a result of a tear of the medial patellofemoral ligament.  The patient is often tender along the medial side of the knee.  With careful physical examination, x-ray, and MRI can document the injury.  Many times this ligament can be repaired or reconstructed, returning the stability of the patella and virtually eliminating the recurrent dislocation.  Sometimes, there are significant boney abnormalities or alignment problems that need to be further addressed with physical therapy and rehabilitation for a speedy recovery from your injury.

 

 

 Ankle

 

 " I twisted my ankle. It swelled and now, feels unstable.  Now what?"

ANSWER: The most common injury when an ankle is twisted and has swelling, usually on the outside and front of the ankle, is a tear of the anterior talofibular ligament.  Many of these tears will heal on their own if the ankle is braced and a careful exercise program is undertaken.  Soft tissue massage and icing often help diminish the swelling and speed the healing.  When recurrent ankle swelling or instability occurs, then the ligament can be repaired through a small incision as an outpatient by a technique we developed and then a careful ankle rehabilitation program followed.  This has been very successful in eliminating ankle instability. 

 

"I have been told I have ankle arthritis and that I might need to have a fusion or an ankle replacement.  Is there any possibility for repair?"

ANSWER: Yes.  Articular cartilage repair in the ankle is performed at The Stone Clinic by performing a paste grafting technique to the areas of exposed bone or OCD lesions.  This, when combined with a careful rehabilitation program, can lead to restoration of ankle motion and diminishment of ankle pain with improved ankle function. 

 

"My foot arch collapses to the inside and I feel pain during running. "

ANSWER: Often arch problems can be improved by a careful exercise program and a custom-made soft orthotic.  We generally avoid hard orthotics for athletes as the impact on hard orthotics can sometimes produce knee and hip pain.  A careful physical examination and observation of the gait by our trained rehabilitation team can help make an accurate diagnosis.  We custom fit orthotics at the time of the visit.

 
 

 Shoulder
 

"My shoulder hurts, particularly when doing overhead activities and it wakes me up from sleep when I roll over on that side.  I think I remember falling on it, but I am not sure."

ANSWER: Very commonly, this is an injury to the rotator cuff muscles and tendons that elevate, rotate, and stabilize the arm.  The diagnosis can be made from careful physical examination and x-rays and confirmed by a MRI.  The treatment is exercise and rehabilitation if the rotator cuff is not torn.  If the cuff is torn all the way through, then in general repair of the rotator cuff is indicated and when successful can lead to a return of full function.  The repair is performed as an outpatient through an arthroscopic approach almost all of the time. 

"I fell on my shoulder and now I have bump. "

ANSWER: Often, this is an injury to the AC joint or the acromioclavicular joint.  Depending on how much of the bump and how unstable, the shoulder can receive various treatments.  If there is just a small bump and a small amount of instability, taping the shoulder can lead to better healing and significant pain relief.  The taping technique is performed by criss-crossing firm rehabilitation tape over the top of the clavicle. 

 

"Doc, I dislocated my shoulder.  Now what?"

ANSWER: An anterior dislocation of the shoulder is often a tear of the anterior inferior glenohumeral ligament, which is a key stabilizer for the shoulder.  In athletic people, we will often repair this ligament by an outpatient arthroscopic technique.  For people who dislocate their dominant arm and they are playing sports where they are at risk for dislocation repair of the ligament is especially important.  The diagnosis is made by a careful history, physical examination, x-rays, and confirmed by MRI.

 

"Doc, my shoulder hurts and I do not recall an injury.  It hurts with overhead activities.  It does not wake me from sleep.  What could it be?"

ANSWER: Most commonly, this is impingement syndrome or bursitis, where the bursa over along the rotator cuff has gotten inflamed and irritated.  This can often be treated by an anti-inflammatory and a careful exercise program.  Sometimes a cortisone shot can help by diminishing some inflammation. The diagnosis is made by careful physical examination and history.  If there is uncertainty about whether or not the cause is impingement versus a rotator cuff tear, a MRI will often confirm the diagnosis.  Sometimes impingement, if it fails to respond to conservative care, can be treated by arthroscopic debridement of the impinged tissue to remove the inflamed tissue and create more space for the rotator cuff.  Sometimes these symptoms are as a result of arthritis at the acromioclavicular joint.  This can usually be confirmed by physical examination and x-ray and treatment is often similar to the impingement findings treatment discussed above. 

 
"Doc, I lifted a heavy object, felt a pop, and all of a sudden my muscle in my arm looks like a Pop-Eye Muscle…."

ANSWER: This is usually a rupture of the biceps tendon.  Fortunately, this can often by either repaired or tacked back to the bone in order to restore the strength of the biceps.  A careful physical examination usually confirms this diagnosis.