Meniscus: Surgery or physical therapy?Q. I’m a 55-year-old man with pain in my right knee. My doctor told me that I have arthritis and a tear in the cartilage (he called it the meniscus). Should I have surgery or physical therapy?
By: Joshua Wynne, Grand Forks Herald
Q. I’m a 55-year-old man with pain in my right knee. My doctor told me that I have arthritis and a tear in the cartilage (he called it the meniscus). Should I have surgery or physical therapy?
A. Arthritis associated with aging and joint wear and tear (called osteoarthritis) is common and typically affects the large joints like the knee and hip. It can cause pain and reduce exercise ability, and can be associated with mechanical complications, including joint clicking or locking.
Both arthroscopic surgery to trim the torn meniscus and physical therapy are quite effective in improving symptoms, reducing pain, and improving function over six to 12 months. A recently reported study comparing both treatments in 351 patients showed that they were equally effective.
Thus, either approach can be recommended. Maybe the best thing to try is an initial trial of physical therapy, with arthroscopy as the backup if the more conservative approach isn’t adequately effective. Either way, you are likely to have an improvement in your knee pain and exercise capacity.
Q. I keep having lower back spasms only when I’m lying down in bed, to the point that I can’t even get up sometimes. During the day, my back resumes to normal. Is this cause for concern or is this just part of aging? Would you recommend a massage therapist, chiropractor or physician?
A. As we have discussed before, back pain is a common problem many of us experience at some point in our life. It usually gets better over time, and we now know prolonged bed rest usually isn’t beneficial.
Most back pain is worse when standing or walking, but may be relieved by leaning forward or getting in certain positions. And most back pain is made better— not worse— with lying down. Such back pain may be associated with a more serious problem such as a tumor or growth, so I’d probably start with your physician or primary care provider asa first step in further evaluation.
Q. I understand that the United States has one of the lowest average life expectancies of the highly developed countries in the world, and much higher health care costs. What accounts for the reduced life span of Americans?
A. The life expectancy of an American male is almost four years less than in Switzerland, the world leader. But about two-thirds of the difference in males and twofifths in females is because of mortality under the age of 50, according to a recent study.
The major causes of under-50 mortality are injuries (including drug overdose); noninfectious diseases (often related to smoking, obesity, poor diet and sedentary lifestyle); complications related to pregnancy and delivery; and homicide. Conversely, the United States compares quite favorably with other highly developed countries in terms of elderly mortality, scoring in the top half in almost all age groups above the age of 75. In fact, we are second-best in the 95 to 99 age group.
Thus, our health care system actually performs pretty well in comparison with other countries, but much of our excess mortality can be traced to societal, behavioral, and environmental factors.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences and a professor of medicine. He is a cardiologist by training.
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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease.