Orthopedics is the medical specialty devoted to the diagnosis, treatment, rehabilitation and prevention of injuries and diseases of your body's musculoskeletal system. This complex system includes your bones, joints, ligaments, tendons, muscles and nerves and allows you to move, work and be active.

Once devoted to the care of children with spine and limb deformities, orthopedics now cares for patients of all ages, from newborns with clubfeet to young athletes requiring arthroscopic surgery to older people with arthritis. And anybody can break a bone.

Your orthopedist manages special problems of the many regions of the musculoskeletal system.

Your orthopedist is skilled in the

• Diagnosis of your injury or disorder
• Treatment with medication, exercise, surgery or other treatment plans
• Rehabilitation by recommending exercises or physical therapy to restore movement, strength and function
• Prevention with information and treatment plans to prevent injury or slow the progression of diseases.

While most orthopedists practice general orthopedics, some may specialize in treating the foot, hand, shoulder, spine, hip, knee, and others in pediatrics, trauma or sports medicine. Some orthopedists may specialize in several areas.

Your orthopedic surgeon is a medical doctor with extensive training in the proper diagnosis and treatment of injuries and diseases of the musculoskeletal system. Your orthopedist completed up to 14 years of formal education.

Our hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, and do many other activities. To do these tasks and activities, our hands require sensation and movement, such as joint motion, tendon gliding, and muscle contraction. When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.

• Carpal tunnel syndrome
• Tennis elbow
• Wrist pain
• Cuts on the fingers and hand
• Sports injuries to the hand and wrist
• Creating fingers from toes and other joints

Some hand surgeons treat only children, some treat only adults, and some treat both. Because many hand surgeons devote most of their time to examining, treating and studying the hand, they are specialists in hand care.

Hand surgeons often recommend non-surgical treatment options to assist you. Sometimes, they may refer you to a hand therapist for more treatment.

If you have pain in your fingers, hand, wrist or arm, or have other upper-extremity related concerns, you may want to consult a hand surgeon.

Our hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, and do many other activities. To do these tasks and activities, our hands require sensation and movement, such as joint motion, tendon gliding, and muscle contraction. When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible.

• Hand surgery is the field of medicine that deals with problems of the hand, wrist and forearm.
• Hand surgeons care for these problems without surgery, and they are specially trained to operate when necessary.
• Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems.
• Hand surgeons are orthopedic, plastic or general surgeons who have additional training in surgery of the hand.
• To become members of the American Society for Surgery of the Hand, hand surgeons must take a full year of additional training and must pass a rigorous certifying examination.

Osteoarthritis of the knee (OA Knee) is one of the five leading causes of disability among elderly men and women. The risk for disability from OA Knee is as great as that from cardiovascular disease. Here are some frequently asked questions about OA Knee.

OA Knee usually occurs in knees that have experienced trauma, infection or injury. A smooth, slippery, fibrous connective tissue called articular cartilage acts as a protective cushion between bones. Arthritis develops as the cartilage begins to deteriorate or is lost. As the articular cartilage is lost, the joint space between the bones narrows. This is an early symptom of OA Knee and is easily seen on X-rays.

As the disease progresses, the cartilage thins, becoming grooved and fragmented. The surrounding bones react by becoming thicker. They start to grow outward and form spurs. The synovium (a membrane that produces a thick fluid that helps nourish the cartilage and keep it slippery) becomes inflamed and thickened. It may produce extra fluid, often known as "water on the knee," that causes additional swelling.

Over a period of years, the joint slowly changes. In severe cases, when the articular cartilage is gone, the thickened bone ends rub against each other and wear away. This results in a deformity of the joint. Normal activity becomes painful and difficult.

Several factors may increase the risk of developing osteoarthritis of the knee.

• Heredity: There is some evidence that genetic mutations may make an individual more likely to develop OA.
• Weight: Weight increases pressure on joints such as the knee.
• Age: The ability of cartilage to heal itself decreases as people age.
• Gender: Women who are older than 50 years of age are more likely to develop OA Knee than men.
• Trauma: Previous injury to the knee, including sports injuries, can lead to OA Knee.
• Repetitive stress injuries: These are usually associated with certain occupations, particularly those that involve kneeling or squatting, walking more than two miles a day, or lifting at least 55 pounds regularly. In addition, occupations such as assembly line worker, computer keyboard operator, performing artist, shipyard or dock worker, miner and carpet or floor layer have shown higher incidence of OA Knee.
• High impact sports: Elite players in soccer, long-distance running and tennis have an increased risk of developing OA Knee.
• Other illnesses: Repeated episodes of gout or septic arthritis, metabolic disorders and some congenital conditions can also increase your risk of developing OA Knee.
• High impact sports: Elite players in soccer, long-distance running and tennis have an increased risk of developing OA Knee.
• Other risk factors are being investigated, including the impact of vitamins C and D, poor posture or bone alignment, poor aerobic fitness and muscle weakness.

OA Knee can be diagnosed in two ways: patient-reported symptoms such as pain or disability or actual physical signs, such as the changes in the joint seen on X-rays. In most cases, both pathology and patient-reported symptoms are present. An evaluation of OA Knee includes a complete history and physical examination. The examination should cover:

• The involved limb
• The spine
• The blood and nervous system
• The joints on either side of the knee, particularly the hip joint, which can also cause knee pain
• Posture
• Gait

Initial treatment is generally directed at pain management. OA Knee pain may have different causes, depending on the individual and the stage of the disease. Thus, treatment is tailored to the individual.

A wide range of treatment options is available. You and your doctor should decide together on the course of treatment that's right for you. In general, treatment options fall into five major groups:

• Health and behavior modifications, such as patient education, physical therapy, exercise, weight loss, and bracing
• Drug therapies, including simple pain relievers such as aspirin or nonsteroidal anti-inflammatory drugs, COX-2 specific inhibitors, opiates and stronger drugs for patients who do not respond to other drugs or treatments, and glucosamine and/or chondroitin sulfate
• Intra-articular treatments, including corticosteroid injections or injections of hyaluronic acid (viscosupplementation)
• Surgery, including arthroscopy, osteotomy, and arthroplasty (joint replacement)
• Experimental/alternative treatments such as acupuncture, magnetic pulse therapy, vitamin regimes and topical pain relievers

Your condition - osteoarthritis of the knee - has most likely caused you pain and limited your movement. For this reason your doctor has decided that you may benefit from a breakthrough treatment for osteoarthritis: Synvisc. By relieving your pain, Synvisc may help you get back the movement you thought you lost. Then you may once again be able to do the things you always did.

In a normal, healthy knee there is a fluid that acts as both a cushion and lubricant. In a knee with osteoarthritis, however, this fluid has lost some of these features. This can be one of the reasons you feel pain in your knee.

Synvisc is a viscous and elastic sterile mixture that is made up of hylan A fluid, hylan B gel,m and salt water. The two hylans are manufactured from hyaluronan (sodium hyaluronate) that comes from chicken combs. Hyaluronan is a natural chemical found in the body and is present in a particularly high amount in joint tissues and in the fluid that fills the joint. The body's own hyaluronan acts like a lubricant and a shock absorber in the joint, and is needed for the joint to operate properly. In osteoarthritis, ther may not be enough hyaluronan, and there may be a change in the quality of the hyaluronan in joint fluid and tissues.

Synvisc is used to relieve knee pain due to osteoarthritis. It is used for patients who do not get adequate relief from simploe painkillers or from exercise and physical therapy.

Two studies involving a total of 132 patients who were at least 40 years old and who had knee pain due to osteoarthritis were performed in Germany.l The patients were placed in one of two groups. One group was given an injection of Synvisc into one or both knee joints once a week for 3 weeks. The second group was given an injection of salt water once a week for 3 weeks. Joint pain and patients' and physicians' ideas of the success of treatment wewre measured for 12 weeks. Patients with osteoarthritic knee joint pain, who had not obtained pain relief with other medications,k experienced pain relief from the Synvisc injections into the knee joint. Patients who had been given Synvisc experienced more pain relief than patients who had received salt water. Some pain relief occurred within the first week after Synvisc treatment began. The most pain relief and the greatest amount of treatment success occurred 8 to 12 weeks after Synvisc treatment began.

A study in the United States evaluated 90 patients who were at least 40 years old and who had knee pain due to osteoarthritis. Patients improved after Synvisc treatments, but not significantly more than those who simply had a needle insertted into the knee to have fluid removed if any was present. This study was different from the German studies because the last comparison between Synvisc and control was only two weeks after the last Synvisc injection. It also differed 9in several other ways, including the length of time that patients had to stop taking medications before they could start treatment. This length of time was two weeks in the German studies and four weeks in the U.S. study.

If you have osteoarthritis, there are several things you can do that do not involve Synvisc injections. These include the following:

Non-drug treatments

• avoiding activities that cause pain in your joints
• exercise
• physical therapy
• removal of excess fluid from the knee

Drug therapy

• pain killers such as acetaminophen and narcotics
• drugs that reduce inflammation, such as aspirin and other nonsteroidal anti-inflammatory agents (NSAIDs) such as ibuprofen and naproxen
• coricosteroids that are injected directly into the joint

• You should not take this product if you have had any previous allergic reaction to Synvisc or hyaluronan products
• You should not have an injection into the knee if you have a knee joint infection or skin diseases or infections around the injection site.

• Synvisc is only for injection into the knee, performed by a qualified physician.
• Consult your physician if you are allergic to products from birds such as feathers, eggs, and poultry
• After you receive the injection, you may need to avoid activities such as jogging, tennis, heavy lifting, or standing on you feet for a long time.
• The safety and effectiveness of repeat treatment cycles of Synvisc have not been established
• Synvisc has not been tested in pregnant women, or women who are nursing. You should tell yor doctor if you think you are pregnant, or if you are nursing a child.
• The safety and effectiveness of Synvisc have not been shown in children

Your doctor will give you your injection of Synvisc (15 mg/2 mL) into your knee once a week, for a total of three injections.

If you have any questions or would like to find out more about Synvisc, you may call Wyeth laboratories Inc., at 1-800-99-WYETH or fax (610) 964-5999. Synvisc is a registered trademark of Biomatrix, Inc. Synvisc is covered by U.S. patents.

Cosamin DS is a unique and patented supplement that contains high grade glucosamine HCI (500mg), chondroitin sulfate (400mg) and manganese ascorbate (5mg). When given together in correct proportions, these compounds work together to support the structure and function of articular cartilage.

Glucosamine is a small molecule that is normally made in the body by cartilage cells. In the cartilage, glucosamine acts as building blocks. Supplementing the diet with glucosamine is beneficial because it also stimulates cartilage cells and production in the articular cartilage.

Like glucosamine, chondrotin sulfate also occurs naturally in the body. It is a large molecule that is made is a series of reactions by the cartilage ccells. Chondroitin sulfate is normally the most abundant in the cartilage matrix, and it is responsible for binding with collagen so that the cartilage can be strong, slippery, and flexible. Supplementing the diet with condroitin sulfate is beneficial because it helps block the action of destructive enzymes in the joint.

The GluHCI and CS in Cosamin work together in a synergistic way to support joint cartilage. Taking the two compounds together is better than taking either alone, because they have different but complementary mechanisms of action. Glucosamine helps the body stimulate cartilage, while chondroitin sulfate decreases cartilage breakdown.

Yes. Cosamin DS has an excellent safety record, with no demonstrable toxicity and minimal incidence of mild, dose-dependent, reversible side effects such as intestinal gas. There are no known interactions with any drug or nutritional supplement, and no known contraindications.

Carefully designed animal studies have determined that Cosamin DS has no clinical effect on blood clotting. There is no indication that Cosamin DS has any interaction with coumadin or any other drug. However, many factors can influence blood clotting. We recommend that all individuals taking coumadin have their clotting times evaluated frequently when starting to use a nutritional supplement of a drug.

Yes. Although glucosamine and chondroitin sulfate are biochemically classed as carbohydrates (sugars), the body is not able to break them down into glucose, so these compounds do not raise blood sugar by providing an additional source of glucose. However, many factors can affect insulin secretion and blood glucose levels in diabetic patients, and we recommend that these individuals check their blood glucose levels frequently when initiating Cosamin DS or any new element into their regimen.

There is no cross-reactivity between sulfa drugs and Cosamin DS. Sulfa drugs are characterized by having a particular molecular structure and people who are allergic to sulfa drugs are probably reacting to this characteristic molecular structure. The compounds in Cosamin DS do not have similar molecular structures. An allergy to sulfa drugs should not be interpreted as an allergy to sulfur. Sulfur is an essential element that is present in many foods and occurs in every cell in the body.