Torn ACL vs. Torn Meniscus

Knee injuries in sports are incredibly common because the knees are weight-bearing joints.  Most sports require running and pivoting of the foot in order to change directions quickly.  This can unfortunately lead to various types of knee injuries.  I am always asked by patients and athletes the symptoms of knee injuries.  Two very common injuries that athletes are curious about are a torn ACL and a torn meniscus.  Both of these structures are very different and when injured, each have a unique presentation.

The ACL (Anterior Cruciate Ligament) is one of 4 important ligaments in the knee along with the PCL (Posterior Cruciate Ligament), MCL (Medial Collateral Ligament), and LCL (Lateral Collateral Ligament).  It is responsible for holding the knee in place while also providing flexibility.  The meniscus is cartilage that functions to cushion the inside of the knee.  Here is a picture for some clarity (Photo credit fpnotebook.com):

The classic presentation of an ACL tear is a buckling and hyperextension (bending back) of the knee with a pop.  The pop in the knee can either be heard or felt by the athlete.  Since the ACL has a very rich blood supply, it will bleed quickly and will lead to immediate swelling of the knee.  The athlete is generally not able to keep playing that day once the ACL tears.

The meniscus, on the other hand, tears due to a twisting type injury where the two bones rub against the meniscus and cause a tearing.  There is usually no pop in the knee.  The meniscus has a poor blood supply and so it will bleed much more slowly and athletes will usually report swelling later that evening, 4 to 5 hours later.  Many times an athlete is able to keep playing through the injury and it is only diagnosed a few days later.  

Over the next few days, the symptoms are also very different.  Those with an ACL may report that the knee feels unstable or feels like it will give out.  The swelling may resolve and they may actually even be able to play again since the knee feels better.  This may, of course, lead to further injury since the athlete is unaware of the underlying injury.  An individual with a meniscus tear will have symptoms of pain, locking, or catching of the knee. They may also feel pain with activity as the torn meniscus continues to grind in the knee joint.   

These are the basic signs and symptoms of an ACL tear vs. meniscus tear.  These injuries can also get very complicated based on location of tear, degree of tear, and multiple injuries at the same time.  As always, have your doctor evaluate your injury to avoid further damage!  

What is ALS?

Recently, the ALS Ice Bucket Challenge has taken the nation by storm due to social media.  It begins by an individual or a group pouring a bucket of ice on their head and then calling out 3 others to do the same.  They then hashtag it with #alsicebucketchallenge or #icebucketchallenge.  With this raised awareness, the ALS Association has received over 22 million dollars in donations.  The challenge is fun to watch as your favorite celebrities and athletes take part, along with your neighbor next door.  Everyone knows about the ice bucket challenge, but very few know about the disease itself.  Here is a brief rundown:

What is ALS?

ALS stands for Amyotrophic Lateral Sclerosis.  It is a disease that affects the motor neurons in our body.  Motor neurons control muscle function, whereas sensory neurons allow you to feel things.  In ALS, motor neurons slowly begin to die and patients begin to have muscle weakness and eventually loss of muscle function.

What are the symptoms of ALS?

The symptoms of ALS are not simple like the symptoms of a cold or flu.  Each person can have very different symptoms.  Some may have severe symptoms, other will start with very minor changes.  These can include, weakness in one limb, trouble swallowing or breathing, slurred speech, or twitching or cramping of muscles.  As the disease progresses, patients will have significant trouble breathing, chewing, swallowing, or speaking.  These symptoms are very broad and can be caused by various other diseases, making the diagnosis of ALS a very tough one early on.

Who gets ALS?

• Higher incidence in men by about 20%
• Most commonly found in ages 40 to 50
• Only about 5% report a family history.  Most cases are random.
• 5,600 people diagnosed annually with ALS in the United States
• Unclear who will get ALS and why.  Research studies are ongoing.

Is there a cure for ALS?

There is no cure for ALS.  There is a medication called riluzole which can help slow down the progression of ALS, but it is eventually a fatal disease.

How can you help?

Spreading the word is important, but donating to the cause at the same time is invaluable.  You can donate to the ALS Association at http://www.alsa.org/.  Your contributions will contribute to ALS research and hope to one day treat this debilitating disease.

In the end, I wanted to post a very funny Charlie Sheen #alsicebucketchallenge and also one by the Ohio State Buckeyes football team.  Both are unique and entertaining.

Now it's your turn to take the challenge and make a donation!

Sunscreen and sun damage

This is a great video of how sun damage looks on the human skin and how sunscreen can help protect you.  If you need help figuring out what type of sunscreen to buy, check out my earlier post at How to buy sunscreen.  Feel free to ask any questions or comment below!

STD Tests

Sexually transmitted diseases, or STDs, are becoming increasingly common.  I often see patients who would like to be tested for "all STDs".  There are very different tests for the various STDs and it is important for patients to be aware of them.  This is a simple breakdown of the various types of tests we currently use for the most common diseases.

Gonorrhea and Chlamydia - Urine test for men, urine or vaginal swab for women.  Some women are able to have this during their PAP test but urine testing is available at all other times.

HIV - Blood test for screening.  If this test is positive, a test to confirm the disease is also done through blood testing.

Herpes - There are two types of testing for this.  The screening test is a blood test that tells you if you have ever been exposed to HSV (Herpes Simplex Virus), Type 1 or Type 2.  It used to be that one type of herpes was found in the mouth and the other was genital herpes. However, that has now changed and either strain can be found in either site.  Therefore, having a blood test to screen is not very useful because it will be positive even if you have ever had a cold sore.  It does not indicate the presence of an STD.

The better test for herpes is a viral culture.  This is when a patient has a fluid-filled blister that is popped open by the doctor and the fluid is sent for a culture to see which virus grows from it.  This is a definitive test and much better than the inconclusive blood test

HPV - Human Papilloma Virus has many strains that can lead to genital warts in men and women, or cervical cancer in women.  In women, HPV testing is done during a PAP test and can indicate which strain they are carrying.  For warts, there is no blood or genital test for men or women.

Hepatitis - Blood testing is possible for Hepatitis A, B, and C.

Syphilis - A blood test is used for screening.

Trichomonas - Much more commonly tested in women if they have vaginal discharge or itching. Testing is done by a vaginal swab in women and a urethral swab in men.

STD testing is very important in sexually active individuals and has become easier than ever before.  The topic may be somewhat taboo in the community and causes patients to withhold information from their health care provider.  It should be treated as any other disease and tested for as soon as possible to prevent person-to-person transmission.  See your doctor and get tested.  It could save your life or the life of someone else!

Cervical cancer screening and HPV guidelines

The American Cancer Society estimates that 12,360 women will be diagnosed with cervical cancer in 2014.  While rates of cervical cancer have declined over the years due to better screening measures, some women are not sure when they should begin the screening process.  Cervical cancer is caused by a virus known as Human Papilloma Virus or HPV.  The virus causes changes in the cells of the cervix and may lead to cancer.  Fortunately, a PAP smear is a basic test for women that can detect these changes early and lead to more effective treatment.  So when and how often do women need a PAP smear?

In 2013, ACOG (American College of Obstetricians and Gynecologists) released updated guidelines for cervical cancer screening as follows:

• Cervical cancer screening should start at age 21.  This is different than previous guidelines that recommended starting at age 18.
• Women aged 21-29 should have PAP smears ever 3 years.  This is different than yearly PAP smears which was recommended for a long time.  Women may still need annual screening if they have any cervical changes present.
• Women aged 30-65 should have a PAP smear and HPV testing every 5 years or a PAP every 3 years.
• Women should stop having PAP smears after the age of 65 if they have not had any moderate to severe cervical changes

Some exceptions to these guidelines do apply but in general, these are widely accepted to be the standard of care.  These recommendations are also consistent with those made by the US Preventive Services Task Force (USPSTF).

Cervical cancer is one type of cancer that can have a good outcome if proper screening practices are followed.  We know that it is caused by a type of virus and we have ways to detect the virus and treat the disease if it has led to biologic changes.  While many cases are detected in women without easy access to gynecological care, there are too many cases where patients have not followed up with their testing or are too hesitant to have a PAP smear.  Physicians, male and female alike, recognize the fact that women find a PAP smear uncomfortable and this is completely understandable.  However, if we do not take advantage of these great screening tools, we will lose to a disease that is preventable.  So please see your doctor and get tested!