#treatment - Non-surgical
The practice of surgery has advanced greatly in recent years, and the diagnosis and treatment of conditions has become very technically advanced. Surgical techniques are being refined and improved upon all the time, with keyhole surgery and short stays in hospital now being the norm for many procedures.
However, regardless of the advances in the field of surgery and in the areas of infection control and risk management, although the general risks of undergoing surgery can be minimised there is still no such thing as entirely risk free surgery.
Prior to undergoing any kind of surgical procedure your surgeon will first focus with great care on taking a detailed history, performing a thorough clinical examination and potentially supplementing this with special investigations, such as X-rays, ultrasound scans or MRI scans, in order to reach a clear diagnosis. The definitive treatment of many conditions will inevitably involve a surgical solution, for example joint replacement for severely arthritic joints. However, for most conditions, surgery is kept as a last resort, and only undertaken when the potential benefits are felt to outweigh the potential risks, and when all other appropriate non-surgical (referred to as ‘conservative’) treatments have already been tried.
The various non-surgical treatments available are too many in number to list in full, and depend entirely on the actual condition diagnosed as well as the situation of any particular individual patient. However, the following list gives at least some general guidance on the kinds of non-surgical treatment that are available and which might potentially be appropriate for some conditions:-
Many orthopaedic conditions, particularly repetitive strain type conditions, respond best to simple rest and avoidance of aggravating activities. However, unfortunately, for many people rest and activity avoidance is not always a viable option.
There are many different types of painkiller available, and different painkillers may be best for different patients with different various conditions. The range of painkillers includes:
- Simple painkillers – such as Paracetamol
- Medium painkillers – such as Co-codamol, Co-proxamol or Co-dydramol
- Strong painkillers (based on morphine) – such as DF118, Tramadol or MST
- Anti-inflammatories – such as Voltarol/Diclofenac, Nurofen, Ibuprofen
- Drugs that focus specifically on nerve pain – such as amitriptyline, gabapentin or pregabalin
Each of these drugs can have potential side effects. Medium or strong painkillers can cause drowsiness or constipation. Anti-inflammatories can cause kidney problems, stomach irritation (gastritis) or even stomach ulcers, and can sometimes cause reactions in people with asthma. So, care must be taken to follow the advice that you are given with any prescription or the advice on the bottle.
There are many conditions that may respond well to a course of physiotherapy treatments. CLICK HERE for further information about physiotherapy.
Injections of various types can be particularly useful. Sometimes injections of local anaesthetic are given in clinic at various sites to see whether the injection gives pain relief, as a way of helping clarify a diagnosis.
There are also various injections that can be given as treatments:-
Steroids – steroid (also called cortisone) is a very powerful anti-inflammatory, and so can be very useful for treating conditions where there is inflammation. The steroid is normally mixed with a bit of local anaesthetic. The local anaesthetic works very quickly and gives rapid pain relief but also wears off quickly, after several hours. Steroid, however, can take 24 or even 48 hours to kick in and start working. For the first couple of days after a steroid injection the area may be uncomfortable, with a burning feeling, but this nearly always then disappears.
People are sometimes concerned about the possible side effects of a steroid injection, associating it with the concept of being ‘on steroids’. The significant potential side effects that are sometimes associated with steroid, such as water retention, thinning of the bones, problems with hormones and so on actually relate to patients being given very high doses of steroids or being put on long courses of steroid tablets, and this does NOT apply to being given a local steroid/cortisone injection, which is something that is given very frequently in association with sports injuries or repetitive strain injuries.
The conditions that may respond very well to steroid injections are:
- knee arthritis
- hip arthritis
- shoulder subacromial impingement
- shoulder supraspinatus tendonitis
- shoulder acromioclavicular joint arthritis
- some forms of tendonitis (especially if the tendon sheath is inflamed)
- plantar fasciitis in the heel
Hyaluronic Acid injections
Hylans are molecules that are found within the normal fluid within a joint. They are very long chain molecules, so when provided in a liquid form they are very viscous. There are some people who think that by injecting Synvisc into a knee you are ‘lubricating’ the joint – like changing the oil. There are others who believe that injecting hylans into a joint has a chemical/drug effect. Whatever the actual underlying processes might be, some people believe that injecting hyaluronic acid into a joint can provide symptomatic improvement in maybe 75% of patients, with decreased pain and increased mobility. Some patients may feel symptom improvement straight away after an injection, but in many it can take a few weeks before the full benefit is felt. The degree and length of symptom improvement does vary considerably between patients, but some people gain significant benefit for up to 12 months after an injection.
Some insurance companies will fund Synvisc injections but others won’t, and the injection can cost a fair amount of money. So, if you are covered my medical insurance then it is important that you do check with your insurer that your particular policy does cover this, otherwise you will end up having to cover the hospital bill for the injection yourself.
STOP PRESS — the latest advice from the American Academy of Orthopaedic Surgeons (the world’s largest orthopaedic organisation) is that there is insufficient evidence to support the use of HA injections in patients with arthritic knees, and hyaluronic acid is no longer recommended as part of the standard treatment algorithm for the management of knee arthritis.
To read more CLICK HERE