Things You're Too Embarrassed to Ask a Doctor Season 1, Episode 10: Aches and Pains with Dr. Aravind Athiviraham
March 8, 2020
[MUSIC PLAYING] You are listening to Things You're Too Embarrassed to Ask a Doctor, a production of UChicago Medicine. Each week we'll feature one physician and ask them your most searched questions in their areas of expertise. For more information on our episodes, visit us at www.UChicagoMedicine.org/podcast. Have something you're too afraid to ask your doctor? Tweet us at TYTEPodcast. I'm your host Kat Carlton.
Hello, and welcome to the final episode of season one of our show. To round out the season, I thought we should have a little fun and invite on the Chicago Sky women's basketball team physician. His name is Aravind Athiviraham.
I'm an orthopedic sports medicine doctor. So what that means is usually, you know, treat athletes. Some examples of the injuries that I see are knee ligament injuries, cartilage or meniscus injuries, and, then, shoulder injuries, including shoulder instability or injuries to the rotator cuff are pretty common injuries I see.
This episode, instead of focusing solely on athletic injuries, I thought we could more generally discuss common ailments faced by pretty much anyone and everyone. I was particularly inspired to do this episode because over the last couple of years, I noticed my knees started clicking while I walk down the stairs of my office building. Now, I don't know how obvious this is, but I'm just rounding the corner toward turning 30, and this is something I really didn't expect to happen until I was much, much older.
But the more I've shared my experience with friends, the more common I realize this is than I had initially thought. And a lot of you are searching about knee clicking and popping online. So let's turn to the doctor for more. What causes knee clicking? And does it ever go away?
So that's a good question. So it's somewhat of a non-specific symptom because many things can cause clicking. One possibility is something called the meniscus tear, which is a shock absorber injury in the knee. And you know, it depends on what type of tear it is, in terms of if it'll persist, or if it can be treated with just, like, strengthening exercises around the knee.
Other things that can cause clicking include minor irregularities in the cartilage. Again, it would depend on, again, strengthening the knee and trying to get that better to hopefully improve. So again, nonspecific finding. But if it persists, and not getting better, and it's causing pain, then it's something that should be looked at.
At some point in our lives, a lot of us also experience arthritis. So, what causes it?
Typically, it's wear and tear phenomenon. And there might be some genetic contributions, as well as weight contributions as well. But overall, it's more of a wear and tear phenomenon that we see.
And next, can arthritis being cured?
I'm sure the person who discovers the cure for arthritis will win the Nobel Prize one day. And we have not discovered that yet. But there are a lot of options to manage it. And that's kind of what we try to do, is try to manage the symptoms. And usually we start off non-surgically. And when that fails, then we proceed to surgical options.
When I was doing research for these questions, something that kept coming up related to knee injections. Now, what are knee injections used for? And also, are they painful?
So again, knee injections are part of the non-operative treatment for arthritis of the knee. And the most common type is what's called a corticosteroid, or steroid shot in the knee. And the way I think of it, it's kind of like an anti-inflammatory. So part of the symptomology of arthritis revolves around some inflammation, which causes pain. And the cortisone shots are designed to try to alleviate inflammation and hopefully alleviate the pain.
It doesn't last forever. It doesn't work for everybody. So it's one of those things where you have to try it to see if it works or not. And it does tend to wear off in about three months or so. In terms of whether or not it's painful, it depends. I think if it's slightly more uncomfortable than a flu shot or a blood draw.
Let's move onto shoulders. A lot of questions around shoulder pain, shoulder sockets. And we'll start with shoulder pain. One question is, can shoulder pain be related to other issues such as heart and lung problems or even migraines?
Well, it's something that you really want to make sure that it's not a guess, So if a patient has, you know, chest pain that radiates to the shoulder, especially the left shoulder, I'd recommend they go immediately to the emergency room. Because sometimes a heart attack can present that way.
Similarly, a tension headache can present with some neck pain or stiffness that can radiate to the shoulder. But by and large, most patients I see with shoulder pain have pain mostly related with the shoulder itself. And in rare cases, related with neck pain.
So fortunately, we haven't seen patients that have had a heart issue or lung issues that have had shoulder pain. But something to definitely keep in mind if patient's had a history of either heart, lung problems.
How do I know if I've dislocated my shoulder or any other part of my body?
So hopefully-- you know, for most patients, dislocating the shoulder is a pretty painful experience so they'd know. But they usually feel like the ball of the socket will shift out of the socket. And usually it's in the front of the shoulder. And they'll feel a fullness in the front of the shoulder. It'll be difficult for the patient to move their shoulder.
Usually, this occurs in an athletic setting where there's an athletic trainer or a coach that's usually experienced reducing that shoulder. And there are methods to reduce the shoulder, especially if the athletic trainers are trained in those maneuvers. But usually it's a pretty painful experience and the patient would be able to pick it up. And hopefully it's able to be reduced right away. And if it's not, the patient will need to go to the emergency room to get it reduced back into the joint.
Hey, again. Another experience many of us have had at some point, probably within the last year, is bumping our elbow. You know exactly the kind of pain this causes. It's the kind that radiates all the way down your arm and through to your hand. Which leads me to our next question, why does my pinky finger hurt when I bump my elbow?
So the nerve that supplies the pinky finger is known as the ulnar nerve. And this crosses the inner aspect of the elbow. So when you bump the inner aspect of the elbow, you're irritating the ulnar nerve. And that shoots down to where the ulnar nerve distributes, which is the pinky finger.
Now, I don't know about you and what your exercise habits are, but personally, I hate running. And oftentimes when I run, I get ankle pain. What might it mean if my ankle hurts from running?
So, it depends on the region that is hurting. So, for example, we talked about the Achilles tendon earlier. And if it's in the region where the Achilles tendon is inserting, this can be due to Achilles tendinitis. Versus, if it's due to some subtle instability in ankle where it's because the ankle is inverting when the patient is running, this can be due to again laxity of certain ankle ligaments.
And the other cause could be inflammation of some tendons that surround the ankle joint as well. So, again, the treatment for this depends on what's causing it. So it could range from rest, to anti-inflammatories to strengthening the tendons around the ankle.
We talked a little bit about this already. But what's the difference between an ankle sprain, and a fracture, or a break?
OK, so the ankle sprain involves injury to ligaments. And there's different gradations of it in terms of how severe the injury is. But sprains in general relate to injury of ligaments. This is contrasted with, for example, a fracture or a break, which is essentially the same thing, which involves the bone.
So again, in relation to the ankle, an ankle sprain would be injury to the ankle ligaments. Versus an ankle fracture would be related with fracture to the bones around the ankle.
That's all the questions I have for today. Is there anything else you wanted to add, maybe to people who were unsure if they should be seeing their doctor for a pop, or an ache, or a pain?
I would just say, you know, it just depends on the nature and how it happened. So again, if a patient or an athlete comes down from a high contact injury, feels a pop and swelling in their knee, and is having trouble weight bearing, I think that's a pretty clear-cut need to be seen by a doctor.
Versus if they're just minor popping on occasion, something they've always had for the last 10 years, associated with no pain-- I think something they can tolerate with, I don't think that's as concerning. And if they can manage with self-directed exercise, I think that's certainly something that they could try beforehand.
So again, it depends on the acuity, whether or not they're associated with a lot of pain, if they're swelling or not. So it just depends on all of those things. But again, if you're not sure, it's always better to be seen by a provider. There's no downside on that.
Once again, I'm Kat Carlton. And you've been listening to Things You Are Too Embarrassed to Ask A Doctor. Music from today's episode is by Blue Dot Sessions.
For more information on our show or to submit your own question, visit www.UChicagoMedicine.org/podcast. Or tweet us at TYTEPodcast.
Description This episode, we speak with sports medicine doctor Aravind Athiviraham to chat about why knees click and pop, what happens when bumping your elbow radiates pain into the pinky finger, and more.
Subscribe to Things You're Too Embarrassed to Ask a Doctor:
Aravind Athiviraham, MD
A specialist in orthopaedic sports medicine, Aravind Athiviraham, MD, cares for patients with athletic and overuse injuries, including anterior or posterior cruciate ligament tears, meniscus or cartilage injury, patellar or shoulder instability and elbow ulnar collateral ligament tears. He is skilled in minimally invasive and arthroscopic procedures of the knee, shoulder and elbow.Learn more about Dr. Athiviraham