Common Knee Injuries and Their Treatment

By William J. Bryan M.D.,

Common Knee Injuries and Their Treatment

Common Knee Injuries and Their Treatment

Knee injuries can occur at any given point in time, during a number of recreational activities or work-related projects. Knees are the biggest joints in the human body. Their lower and upper bones are separated by menisci. The femur (upper bone) is connected to the fibula and tibia (lower bones) through a network of muscles, tendons, and ligaments. The articular cartilage covers the surface of the bones featured by the knee joint, and that layer of cartilage serves an important purpose: it protects the bones from powerful impacts and also creates a smooth surface for optimal joint movement.

Identifying the Most Common Types of Knee Injuries 

Injuries can be listed among some of the most common health and well-being issues related to the poor functionality of a knee. Acute or sudden injuries are usually caused by powerful shocks (a direct blow), or abnormal, sudden movements, bending or falls. Acute injuries are usually accompanied with a plethora of common symptoms, including bruising and swelling. In some cases, the injury may damage blood vessels or nerves, making the knee or the entire leg change its color or feel weak or numb.

Fractures, ligament tears, sprains, strains, meniscus tears, kneecap dislocations, and knee joint dislocations are a few of the most common injuries that should compel patients to seek immediate medical care. All these medical problems can be linked to several causes. For instance, knee fractures are usually triggered by powerful forces. Someone could fracture his knee after falling on it, or after hitting an object with it by accident. Kneecap dislocation is a common type of injury that affects mostly women. As an end result of direct trauma, dislocation is preceded by a sudden change in trajectory when the leg is put down.

This misguided movement puts a lot of pressure on the kneecap, making it slip towards the outside of one’s knee. Furthermore, forceful twisting or too much pressure applied on the knee joint can be the culprit for a torn meniscus. Symptoms associated with this injury may include popping, inflammation and pain. At the same time, sudden twisting may cause a knee sprain. People can sprain a knee while running, jumping, or changing trajectory suddenly. Sprains are common injuries among athletes and people with active lifestyles.

Orthopedists Provide Accurate Diagnoses and an Effective Treatment Plans

The same cause can be linked to multiple knee injuries requiring different treatment plans; this is why patients should seek medical advice from a licensed and insured orthopedist before addressing their symptoms. Only a specialist could recommend the most adequate treatment plan, based on the type and extent of the patient’s injury. Conventional treatment for common knee injuries is usually comprised of a few key components, including first-aid measures, anti-inflammatory medication, bracing, rest, and physical therapy. When conventional treatment methods fail to provide the desirable results, or when the injury requires invasive treatment methods, doctors may advise their patients to undergo surgery.  Generally speaking, treatment plans vary a great deal depending on the severity, location, and type of injury, and a few particularities related to patients, including their medical history, lifestyle and age.

  Filed under: Education, Knee Injuries
  Comments: None

Middle Age Patients and Knee Arthroscopy

By William J. Bryan M.D.,

Middle Age Patients and Knee Arthroscopy

Middle Age Patients and Knee Arthroscopy

Is knee arthroscopy a viable option for people impacted by some of the most common knee problems? According to a recent study published by The New England Journal of Medicine, this type of surgical intervention doesn’t always yield the best results for middle-aged patients, and isn’t much more beneficial than fake operations or physical therapy when it comes to relieving knee pain or improving knee function. The study involved the participation of patients with a torn meniscus. At this point, according to the data provided by The New York Times, arthroscopic surgery done on the meniscus is a common procedure performed around 700,000 times on an annual basis in the U.S., totaling costs estimated at approximately $4 billion.

The Basics of Knee Arthroscopy 

During this procedure, small incisions are made to accommodate the small camera that the doctor uses to see inside the injured knee. Small tools are used to trim the torn surface, remove loose bone fragments, and smooth the edges. While the study conducted in Finland does not claim or prove that this type of surgery is always ineffective, it does indicate that knee arthroscopy should be seen as a viable option for younger patients, especially those who are dealing with accurate sports injuries. Nonetheless, in most causes tears are the result of wear and tear associated with the natural aging process; in this situation, researchers have reached the conclusion that surgery should be limited, given its reduced effectiveness.

Knee Arthroscopy May Not Be Best for Middle-Aged Patients

All the volunteers participating in this study received incisions and aesthesis; however, while a group underwent surgery, the second one only benefitted from simulated procedures. Study participants were not told which group they were a part of. A year later, volunteers from both groups affirmed that their knees showed signs of improvement; moreover, the vast majority declared that they would actually repeat the experience, even if the procedure was stimulated. According to some orthopedics, the findings of this study suggest that arthroscopy isn’t always going to change people’s lives the best, especially when patients are middle-aged. At the same time, some specialists firmly believe that arthroscopic meniscectomy yields great results in appropriate patients; and are inclined to think that further research will help them come up with the most accurate definition of the “ideal patient”.

Many people who experience knee pain suffer from a meniscal tear. Nonetheless, doctors aren’t always able to guarantee that the tear is the sole cause of pain, and even if they could, they wouldn’t be able to promote surgery as a 100% foolproof method to address this symptom.

Surgery meant to eliminate meniscal pain in middle-aged people is not the best option at hand, especially if the patient isn’t reporting any kind of mechanical symptoms. Furthermore, a 2002 Texas study reveals that patients who underwent arthroscopy knee osteoarthritis did not show more significant signs of improvement than the ones who benefitted from sham surgery. A study conducted in Canada in 2008 reveals similar facts, indicating that people undergoing surgical interventions to treat knee arthritis didn’t feel better than the ones who opted for medication and physical therapy. These findings have convinced many surgeons to avoid performing surgery on middle-aged people who only suffer from knee arthritis.

In conclusion, according to the researches involved in the studies mentioned above, arthroscopic surgery done to treat osteoarthritis of the knee doesn’t provide any additional benefits when compared with optimized medical and physical therapy.

  Filed under: Knee Arthroscopy, Knee Replacement
  Comments: None

Shoulder Surgery Preparation

By William J. Bryan M.D.,

The shoulder joint is exceptionally vulnerable to being injured and obtaining arthritis. According to the American Academy of Orthopedic Surgeons, in 2006  approximately 7.5 million people reported shoulder having pain. When the traditional treatments do not work, or nor longer work, shoulder surgery may ensure that you regain strength and movement.

Before shoulder surgery, you will need to prepare for the procedure. Here is a guideline to help you experience the best surgical outcomes:

Learn What to Expect

Talk to your doctor about what you should expect to experience before, during, and after the surgery. Ask what the process is for hospital admittance, the type of anesthesia you will receive, and how long you will be in the hospital. Also, ask about the recovery period and pain management following surgery. Now is when you need to voice your concerns.

Assemble Medical and Personal Information

In the lead up to your surgery, you will be asked about medical history, insurance, and legal arrangements. There will be repetition in the questions, so it will make it easier for you and others if you create a thorough record of personal and medical information to help speed the process and ensure that you provide all the essential information, including:

Prepare Your Body For Surgery

Being in the best physical condition you can be prior to surgery will lower the chance of complications and speed recovery. Your doctor will be able to tell you what this entails for you, such as issues with smoking, diet, weight, alcohol, and exercises to do before and after surgery. Notify your doctor if you come down with a fever, cold or any other illness in the week before the surgery.

Plan For Your Release

Your recovery will take several weeks, but you can plan ahead to make your recovery time at home more comfortable and safe. Arrange to have someone drive you home and stay with you for several days after release. Consider what you will eat; either cook double and freeze half for a couple of weeks before surgery, or fill your freezer with ready-made, easy-to-heat meals. Place any items you need or use frequently at waist height on counters and sink areas, in the shower, near where you will spend most of your recovery, where you sit in the living room and by your bed. This will ensure you do not need to raise your arm higher than your surgeon has recommended. If you live alone, or have special needs, you may want to consider going to a rehabilitation facility following discharge for recovery and rehabilitation Screen Shot 2016-05-26 at 12.23.40 PM

Frequently Asked Questions about Shoulder Surgery

How long does the shoulder  replacement surgery take?

Shoulder replacements take about 1 hour of surgery time.

How long will I be in the hospital? 

Total and reverse total shoulder replacement patients spend 1 night in the hospital.

When can I use my shoulder? How long do I have to wear the sling? 

Following total shoulder and reverse total shoulder replacement your arm will be in a sling for comfort. You are allowed to remove your arm from the sling and move your arm and shoulder in basic motions. We are not operating on your elbow, wrist, hand, and fingers and you should move them to keep from getting stiff. You will be taught pendulum exercises to keep the shoulder supple and moving. You should not try to raise your elbow above your shoulder or put your operative arm behind your back but you may use your arm in front of you (much like “making a pizza”). You will be able to write, use a computer, brush your teeth, feed yourself but you will not be able to brush and wash your hair with the operative arm. You should NOT lift anything heavier than 2 pounds with your operative arm. Lifting restrictions will be removed as you progress through physical therapy. The sling is usually discontinued after 4-6 weeks.

When can I take a shower?

Upon leaving the hospital there will be a clear bandage over the wound. This bandage is waterproof and you may shower immediately. This bandage should be removed by you in 3-5 days after going home. After removal of the bandage the wound should be left open to the air and only covered when you shower. You may take a shower after bandage removal as long as you cover the surgical site with plastic. We recommend Glad brand “Press and Seal,” as it provides excellent waterproofing for showering.

When do I return for my post-operative appointment? 

We prefer to see our total joint replacement patients about 2 weeks after surgery for their post-operative visit. The post-operative visit includes x-rays, wound assessment, and if necessary, staple removal.

How much help am I going to need after surgery?

Regardless of type of shoulder replacement, you will be up and walking immediately. You will be able to take care of basic activities by yourself. You will be much slower after surgery and you may need help with more complex tasks. We prefer that patients have someone at home all the time for the first few days after hospital discharge. Following the first few days, patients may be alone as long as they can reach others for assistance, if needed.

When can I drive after surgery? 

Total shoulder replacement patients may drive as soon as 2-3 weeks.

How much physical therapy will I need?

Everyone is different in their therapy protocol, but generally total and reverse shoulder replacement patients need 8-16 weeks of therapy. Total and reverse total shoulder replacement patients typically begin therapy at 1 month post-op.

How long will I need pain medication?Screen Shot 2016-05-26 at 12.27.21 PM

This is a very individual answer. Pain medication is necessary to participate in the therapy that is important to your overall healing and improvement. We ask that patients take pain medication only if they have pain and to try to discontinue use of narcotic medications within 4-6 weeks after surgery. Federal laws now require handwritten prescriptions for narcotic medications. These cannot be refilled by phone.

Do I have any life-long restrictions?

Total shoulder replacements were initially developed for pain relief. Today’s joint replacement patients are active individuals who want to return to an active lifestyle. The quality of the materials have dramatically improved and extended the lifespan of the replaced joint.

Do I have to do anything special when I go to the dentist?

We recommend that after shoulder replacement, all patients should take preventative antibiotics prior to any dental procedure for the remainder of their life. Furthermore, we ask that patients refrain from routine dental appointments in the first 3 months following joint replacement to reduce the risk of infection. If shoulder replacement is in your future, attending to dental issues is best done prior to surgery.

If you think you need shoulder surgery, call 713-766-0023 or visit to schedule an appointment with Orthopedic Surgeon, Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.

  Filed under: Knee Replacement, Surgery
  Comments: None

Knee Noises: Popping and Cracking

By William J. Bryan M.D.,

When you start to hear your knees pop and crack, it can be extremely concerning. Fortunately, popping and cracking sounds aren’t usually signs that something’s wrong.

According to Dr. David McAllister, “A lot of joints crack and the knees are a really common joint to crack,” he continued, “Most people have knees that crack when they squat down or go through the full arc of motion. We generally don’t worry about cracking or popping if it isn’t associated with pain or swelling.”

Are you curious to figure out why your healthy knees might be making noises? One of the main reasons is because as we age, the tissue that covers the bones, called cartilage, can develop uneven areas. When we squat or stand, sounds come from these rougher surfaces gliding across each other. Ligaments, the tissue that connects bones, tightens as you move and the joint lining moving over bones also creates its own melody!

Here are some more serious causes of knee popping and cracking:

Cartilage injury or wear a thick smooth layer of “articular cartilage” covers the bones of our knee. Injuries and certain diseases like Osteochondritis Dissecans (OCD) can cause defects or holes to occur in the cartilage layer.   If you have a cartilage defect then the surfaces of your knee are no longer smooth, and your knee is likely to pop, snap or grind.

Chondromalacia is often seen as an overuse injury in sports a condition where the cartilage on the undersurface of the patella (kneecap) deteriorates and softens. This condition is common among young, athletic individuals, but may also occur in older adults who have arthritis of the knee. Friction between the back of the kneecap and the underlying femur (thigh bone) can cause knee popping.

Meniscus Tears The two menisci are stuck between the end of the femur and top of the tibia.  They are C-shaped discs that help support the knee and protect the cartilage surfaces.  Because a meniscus is between the two bones, a torn meniscus with a loose flap can easily cause the knee to snap, pop or crack with turning, twisting and squatting.

Screen Shot 2016-05-26 at 11.59.49 AM

Osteoarthritis is the degeneration or “thinning” of the cartilage that you have on the ends of your bones.  Normal cartilage is incredibly smooth.  As the arthritis progresses the cartilage will undergo changes that cause significant roughness to the surfaces of the knee.  Sometimes the cartilage can even peel off the bone leaving a defect or crater in the cartilage.  As the ends of your bones move on one another, any irregularity in the surface can cause snapping and popping within the knee

Tips to prevent knee injuries

If you are having knee pain, you may worry that exercising could cause more damage or pain, but the opposite is actually true. Here are some tips to maintain healthy knees while exercising:

  • Strengthening the muscles that support your knee, and keeping them flexible is the best way to prevent injuries. You should start exercising with weights or resistance bands to strengthen the knees.
  • Remember to warm up before and after you work out to keep your muscles warm. You should think of warming up as a primer. You should work on priming the joints, muscles, ligaments, tendons and stabilizing muscles for the areas that you will be working out.
  • When working out, start slow and use equipment appropriate to your size, strength, and ability. Avoid repeated movements that can cause injury. In daily routines or hobbies, look at activities in which you make repeated knee movements.
  • Avoid activities that put pressure on your knees such as deep knee bends or downhill running.
  • Wear shoes with good arch supports.
  • When playing contact sports, wear the right shoes that are made for the surface you are playing or running on, such as a track or tennis court.

If you have knee pain, you may need to see a specialist. Call 713-766-0023 or visit to schedule an appointment with Orthopedic Surgeon, Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.

  Filed under: Knee Replacement, Surgery
  Comments: None

The Importance of Bone Health

By William J. Bryan M.D.,

Bones play many roles in the body such as providing structure, protecting organs, anchoring muscles and storing calcium. Our bones also store minerals which help keep our bones strong, and release them into the body when we need them for other uses.

Why is bone health important?

Your bones are continuously changing; new bone is made and old bone is broken down. When you’re young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. Most people reach their peak bone mass around age 30. After that, bone remodeling continues, but you lose slightly more bone mass than you gain.

The likelihood of developing osteoporosis, a condition that causes bones to become weak and brittle, depends on how much bone mass you attain by the time you reach age 30 and how rapidly you lose it after that. The higher your peak bone mass, the more bone you have stored and the less likely you are to develop osteoporosis as you age. Screen Shot 2016-04-26 at 1.56.31 PM

What Affects Bone Health?

  • Age – Your bones thin and weaken as you age.
  • Hormones – An excess of thyroid hormone can cause bone loss.
  • Physical Activity – A sedentary life is associated with a higher risk of osteoporosis.
  • Calcium – A diet low in calcium can lead to diminished bone density, early bone loss and susceptibility to fracture.
  • Tobacco and Alcohol – Research suggests tobacco use contributes to weak bones. And more than two alcoholic drinks per day may impair the body’s ability to absorb calcium, increasing the risk of osteoporosis.
  • Gender – Women have less bone tissue than men. If a woman’s period is absent for long stretches of time prior to menopause, she can be at increased risk for osteoporosis – and menopause itself corresponds to dramatic bone loss as estrogen decreases. In men, lower testosterone can cause lower bone mass.
  • Genetics – If you’re of Caucasian or Asian descent, you’re at greatest risk for osteoporosis. Also at high risk are the extremely thin (body mass index of 19 or less) and those with a small body frame (having less bone mass to benefit from). A parent or sibling with osteoporosis or a history of fracture is a risk factor.
  • Eating Disorders – Sufferers of anorexia or bulimia are at risk for bone loss.
  • Surgical Procedures – Stomach surgery and weight-loss operations can impair your body’s ability to absorb calcium.
  • Digestive Disorders – Crohn’s, Celiac and Cushing’s diseases can adversely affect calcium absorption.

Take steps to prevent or slow bone loss!

Your diet should include ample calcium. 

You can find calcium in dairy products, almonds, broccoli, kale, sardines and soy products such as tofu. In addition, ask your doctor about your calcium supplement needs.

The recommended calcium levels for adults are as follows:

Adults 19 to 50: 1,000 mg/day

Men ages 51 to 70: 1,000 mg/day

Women 51 and older / men 71 and older: 1,200 mg per day

Ensure adequate intake of vitamin D

Getting adequate vitamin D from sunlight and diet alone is difficult, but you can include oily fish such as tuna and sardines, egg yolks, fortified milk and vitamin D supplements. The recommended vitamin D levels are as follows:

Adults 19 to 50: 400 to 1000 IUs per day of vitamin D per day

Ages 51 to 70: 800 to 2000 IUs per day

Stay physically active

Make weight-bearing exercises part of your regular routine. These activities include walking, jogging, tennis and climbing stairs. Engaging in them will help you build strong bones and slow bone loss.

Alcohol and smoking

Don’t smoke and don’t drink more than two alcoholic beverages per day.

Be aware of how medications affect you

If you’re taking a medication that can affect your bone health, talk to your doctor. He or she is able to monitor your bone density, and can recommend drugs to help prevent bone loss, if desired.

For women, estrogen therapy can help maintain bone density. But beware it can also increase the risk of blood clots, endometrial cancer and possibly, breast cancer.

If you are interested in meeting with an orthopedic surgeon Call 713-766-0023 or visit to schedule an appointment with Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.

  Filed under: Education
  Comments: None

Orthopedic Doctor Overview

By William J. Bryan M.D.,

Have you had an injury and been referred to an orthopedic doctor? Have you seen an orthopedic doctor before or are you wondering what exactly that doctor will do for you? Here is a brief overview of what your local orthopedic doctor is able to do for anyone that finds themselves in need.

Orthopedics is a type of medicine that is primarily focused on injuries to areas of the musculoskeletal system. The musculoskeletal system includes all the human bodies bones, joints, ligaments and tendons as well as muscles and nerves. This would also include the spine and joint injuries that occur as well as deformities. Orthopedics has many branches under the banner of the discipline of orthopedics. You can find surgeons, rheumatologists, physical therapist and even orthopedic pediatricians.

When you consider that over 28 million Americans develop some kind of musculoskeletal problem each year according to the Centers for Disease Control and Prevention (CDC), you can start to understand the importance of an orthopedic doctor being able to help you with diagnosis, treatment, prevention and rehabilitation. Most of these injuries range from being back and shoulder as well as knee pain, along with sprains, strains and overuse injuries.
Most of the time doctors in orthopedics will work in specialized practices and in the hospitals system. They treat broken bones, joint problems such as arthritis and other degenerative conditions like osteoporosis. You can find them treating athletes with sports injuries as well as infections, congenital conditions and also tumors in the bones. Orthopedics can be as minor as trScreen Shot 2016-04-26 at 1.41.57 PMeating a sprained ankle all the way through to performing a hip transplant.

If you have a joint or bone issue that you need advice and assistance with, you can easily see your orthopedic specialist to get a diagnosis and advice regarding pain management, treatment options and also recovery time.

If you don’t know when to consult an orthopedist, a good rule of thumb is to check in if you feel any continuous discomfort in your joints. This doesn’t mean stick it out with the pain for a year or so before making the appointment, though. If pain in a certain joint lasts over a month, you should contact an orthopedic doctor.

Orthopedic surgery is not always necessary. Many hold off on appointments because they fear that issues they may have will mean they’ll be forced into a procedure. This is not usually the case, many people see orthopedists for simple hand and wrist conditions, or for sports medicine. Health myths should not prevent you from making an appointment.

Another thing to note is that many orthopedic surgeons can help you with physical therapy for any joint pain (or refer you to another practice that can). Fixing these issues in joints can lead to a higher standard of living, and the benefits are immense! Physical therapy will help you improve the flexibility and movements of your joints, allowing you to use them more freely, without the pain.

If you are interested in meeting with an orthopedic surgeon Call 713-766-0023 or visit to schedule an appointment with Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.

  Filed under: Education, Knee Replacement, Surgery
  Comments: None

Knee Osteoarthritis

By William J. Bryan M.D.,

Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms. The disease may affect any joint in the body, but it is particularly common in the knee. Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people. Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active. The major types of arthritis that affect the knee are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis. Today, we will be focusing on Osteoarthritis.


Is a degenerative, “wear-and-tear” type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people, too. In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful bone spurs.


Osteoarthritis develops slowly and the pain it causes worsens over time. There are other symptoms, as well:

  • The joint may become stiff and swollen, making it difficult to bend and straighten the knee.
  • A knee joint affected by arthritis may be painful and inflamed.
  • Pain and swelling may be worse in the morning, or after sitting or resting.
  • Vigorous activity may cause pain to flare up.
  • Loose fragments of cartilage and other tissue can interfere with the smooth motion of joints. The knee may “lock” or “stick” during movement. It may creak, click, snap or make a grinding noise.
  • Pain may cause a feeling of weakness or buckling in the knee.
  • Many people with arthritis note increased joint pain with rainy weather.

Physical Examination

During your appointment, your doctor will talk with you about your symptoms and medical history, conduct a physical examination, and possibly order diagnostic tests, such as x-rays or blood tests. During the physical examination, your doctor will look for:

  • Screen Shot 2016-03-25 at 3.39.20 AMJoint swelling, warmth, or redness
  • Tenderness about the knee
  • Range of passive (assisted) and active (self-directed) motion
  • Instability of the joint
  • Crepitus (a grating sensation inside the joint) with movement
  • Pain when weight is placed on the knee
  • Problems with your gait (the way you walk)
  • Any signs of injury to the muscles, tendons, and ligaments surrounding the knee
  • Involvement of other joints (an indication of rheumatoid arthritis)

Non-Drug Treatments

  • Exercise. A variety of exercises, such as strength training, aerobics, range of motion and tai chi, can help with both pain and physical function in knee Osteoarthritis. Water-based exercises may improve function in both knee and hip joints, but offer only minor benefits for pain.
  • Weight loss.Losing a moderate amount of weight can help reduce pain and disability by taking stress off of the knees.
  • Acupuncture. A form of traditional Chinese medicine involving the insertion of thin, sharp needles at specific points on the body, acupuncture has been used as a treatment for osteoarthritis pain.
  • Transcutaneous electrical nerve stimulation (TENS). A technique in which a weak electric current is administered through electrodes placed on the skin, TENS is believed to stop messages from pain receptors from reaching the brain.
  • Knee braces, sleeves, and other devices may be helpful for reducing pain and joint stiffness and improving function in knee Osteoarthritis, without causing any adverse side effects.
  • Canes and crutches.Using a cane may reduce pain and improve function in people with knee Osteoarthritis. However, while it takes the load off the knee, it can add more weight on to other affected joints, such as the hip.


  • Acetaminophen (Tylenol).
  •  Nonsteroidal anti-inflammatory drugs (NSAIDs) These medications (aspirin, ibuprofen, naproxen sodium)
  • Topical NSAIDs.
  • Corticosteroid injections.
  • Hyaluronic acid injections.
  • Your doctor can prescribe several other prescriptions.


  • Joint lavage is one option where a doctor flushes the joint with a sterile saline solution to wash out the contents (blood, fluid or loose debris) inside a joint space.
  • Arthroscopic debridement is the surgical removal of tissue fragments from the joint.
  • Osteotomy and joint-preserving surgery. For young, active people with knee osteoarthritis, osteotomy (a procedure in which bones are cut and realigned to improve joint alignment) may delay the need for joint replacement.
  • Unicompartmental knee replacement also called partial knee replacement is where the surgeon replaces the damaged portions of the knee with plastic and metal parts. This may offer the same improvement and function as total knee replacement but with less trauma and better range of motion.
  • Total knee replacement: In this procedure, the knee is replaced with an artificial joint. It requires a major surgery and hospitalization.

If you have knee pain, you may need to see a specialist. Call 713-766-0023 or visit to schedule an appointment with Orthopedic Surgeon, Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.

  Filed under: Education, Knee Replacement, Surgery
  Comments: None

Anterior Cruciate Ligament (ACL) Tears

By William J. Bryan M.D.,

The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of symptoms of their knee giving-out from under them.  

How does an ACL tear occur? 

An ACL tear is most often a sports-related injury. ACL tears can also occur during rough play, vehicle collisions, falls, and work-related injuries. Surprisingly, most sports-related ACL tears are “non-contact” injuries. This means that the injury occurs without the contact of another athlete, such as a tackle in football. Most often ACL tears occur when pivoting or landing from a jump.  

Signs of an ACL Tear 

The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear often have sustained an injury to the knee. They may have felt a “pop” in their knee, and the knee usually gives-out from under them.

ACL tears cause knee swelling and pain. On examination, your doctor can look for signs of instability of the knee. These special tests place stress on the ACL, and can detect a torn ligament. An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee.  Screen Shot 2016-03-25 at 3.26.33 AM

Is Surgery Necessary? 

ACL tears do not necessarily require surgery. There are several important factors to consider before undergoing ACL surgery. First, do you regularly perform activities that normally require a functional ACL? Second, do you experience knee instability? If you don’t do sports that require an ACL, and you don’t have an unstable knee, then you may not need ACL surgery.

There’s also a debate about how to treat a partial ACL tear. If the ACL is not completely torn, then ACL reconstruction surgery may not be necessary. Many patients with an ACL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist. 

Surgery for an ACL Tear 

The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament. There are several options for how to perform ACL surgery. The most significant choice is the type of graft used to reconstruct the torn ACL.  

Post-Surgical Rehab

Rehab is one of the most important, yet too often neglected, aspect of ACL reconstruction surgery. Rehab following ACL surgery focuses on restoring motion and strength, and improving the stability of the joint to prevent future injuries. 

If you are having issues with your ACL you may need to see a specialist. Call 713-766-0023 or visit to schedule an appointment with Orthopedic Surgeon, Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.

  Filed under: Education, Knee Replacement, Surgery
  Comments: None

Shoulder Pain Causes and Treatments

By William J. Bryan M.D.,

What most people call the shoulder are really several joints that combine with tendons and muscles to allow a wide range of motion in the arm, from scratching your back to throwing the perfect pitch. Mobility may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. The pain may be temporary or it may continue and require medical diagnosis and treatment. This article explains some of the common causes of shoulder pain, as well as some general treatment options.

Your shoulder is made up of three bones: your upshoulderper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

Causes of shoulder pain

Most shoulder problems fall into four major categories:

  • Tendon inflammation (bursitis or tendinitis) or tendon tear
  • Instability
  • Arthritis
  • Fracture (broken bone)

Other much less common causes of shoulder pain are tumors, infection, and nerve-related problems.


Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone. Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis. Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.


A tendon is a cord that connects muscle to bone. Most tendinitis is a result of a wearing down of the tendon that occurs slowly over time, much like the wearing process on the sole of a shoe that eventually splits from overuse.

Generally, tendinitis is one of two types:

  • Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
  • Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.

The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.

Tendon Tears

Splitting and tearing of tendons may result from acute injury or degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears may be partial or may completely split the tendon into two pieces. In most cases of complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are among the most common of these injuries.


Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.


Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket. Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body.


Shoulder pain can also result from arthritis. There are many types of arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as “wear and tear” arthritis. Symptoms, such as swelling, pain, and stiffness, typically begin during middle age. Osteoarthritis develops slowly and the pain it causes worsens over time. Osteoarthritis, may be related to sports or work injuries and chronic wear and tear. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining. Often people will avoid shoulder movements in an attempt to lessen arthritis pain. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion. shouldr2


Fractures are broken bones. Shoulder fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade). Shoulder fractures in older patients are often the result of a fall from standing height. In younger patients, shoulder fractures are often caused by a high energy injury, such as a motor vehicle accident or contact sports injury. Fractures often cause severe pain, swelling, and bruising about the shoulder.

Doctor’s Examination

In the case of an acute injury causing intense pain, seek medical care as soon as possible. If the pain is less severe, it may be safe to rest a few days to see if time will resolve the problem. If symptoms persist, see a doctor.

Your doctor will conduct a thorough evaluation in order to determine the cause of your shoulder pain and provide you with treatment options. The first step in the evaluation is a thorough medical history. Your doctor may ask how and when the pain started, whether it has occurred before and how it was treated, and other questions to help determine both your general health and the possible causes of your shoulder problem. A comprehensive examination will be required to find the causes of your shoulder pain. Your doctor will look for physical abnormalities, swelling, deformity or muscle weakness, and check for tender areas. He or she will observe your shoulder range of motion and strength.


Your doctor may order specific tests to help identify the cause of your pain and any other problems.

  • X-rays. These pictures will show any injuries to the bones that make up your shoulder joint.
  • Magnetic resonance imaging (MRI) and ultrasound. Thes imaging studies create better pictures of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your shoulder joint.
  • Computed tomography (CT) scan. This tool combines x-rays with computer technology to produce a very detailed view of the bones in the shoulder area.
  • Electrical studies. Your doctor may order a tests, such as the EMG (electromyogram), to evaluate nerve function.
  • Arthrogram. During this x-ray study, dye is injected into the shoulder to better show the joint and its surrounding muscles and tendons.
  • Arthroscopy. In this surgical procedure, your doctor looks inside the joint with a fiber-optic camera. Arthroscopy may show soft tissue injuries that are not apparent from the physical examination, x-rays, and other tests. In addition to helping find the cause of pain, arthroscopy may be used to correct the problem.


Activity Changes

Treatment generally involves rest, altering your activities, and physical therapy to help you improve shoulder strength and flexibility. Common sense solutions such as avoiding overexertion or overdoing activities in which you normally do not participate can help to prevent shoulder pain.


Your doctor may prescribe medication to reduce inflammation and pain. If medication is prescribed to relieve pain, it should be taken only as directed. Your doctor may also recommend injections of numbing medicines or steroids to relieve pain.


Surgery may be required to resolve some shoulder problems; however, 90 percent of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise, and medication. Certain types of shoulder problems, such as recurring dislocations and some rotator cuff tears, may not benefit from exercise. In these cases, surgery may be recommended fairly early. Surgery can involve arthroscopy to remove scar tissue or repair torn tissues, or traditional, open procedures for larger reconstructions or shoulder replacement.

If you need help treating shoulder pain call 713-766-0023 or visit to make an appointment with Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.



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How to Prepare Yourself for Your Doctor’s Appointment 

By William J. Bryan M.D.,

For your next doctor’s visit, make sure you make the most out of your time as well as the doctors. Use these helpful suggestions to be prepared as much as possible.

Before your appointment

To be efficient make sure that the doctors office accepts your insurance. This is an important step to making sure that your insurance will help cover your medical costs. You can call or go online to your insurance website to see a directory of in-network care providers. If you are a new patient, make sure you bring your insurance card, state issued drivers license and complete the new patient paperwork prior to your appointment. If you have any requests that require paperwork, for example, you’re going on state disability, or you’re in need of a handicapped placard, let your provider know early in the visit. Lengthy paperwork often requires your input, too, so plan for enough time during the visit to fill in the vital information. Arriving 15 minutes ahead of your scheduled appointment time is recommended. doc appt

When making the appointment, either by phone or online, provide some details about your concern so that a proper appointment time can be scheduled. If it is your first visit to this particular physician or clinic, be ready to provide information about diseases that run in your family and describe your current and past health problems and treatments. Bring all medical records, test results, and immunization records. Additionally, rank your list and prioritize your concerns.

Taking these steps before your medical appointments will help you to make the most of your time with your doctor and their health care team. Make a list of the medications you have taken or currently take. Including the dosages and frequency of prescriptions. Don’t forget to include your over the counter medications as well.

Find a friend or family member to accompany you to your visit. A lot of information may be presented at the doctor’s visit, it may be helpful to have a friend or relative to help you write things down and share medical information.

During your appointment 

Share your symptoms and relevant health history. Your health is worth the time, repeat what the doctor has told you to be sure you understand and ask for clarification if necessary. Try to reach an understanding about your treatment plan. Asking questions about your diagnosis, treatments and medicines can improve the quality, safety, and effectiveness of your health care.

Here are some question suggestions to ask at your next visit. A curious patient is a healthy patient!

  • What do my blood pressure numbers mean?
  • What should my blood pressure be?
  • What should I know about the medicine you prescribed?
  • What are the side effects of this medication?
  • What should I do to prepare for my next visit?
  • How many patients like me have you treated?
  • What do you think is causing my problem?
  • Is there more than one condition (disease) that could be causing my problem?
  • What tests will you do to diagnose the problem and which of the conditions is present?
  • How good are the tests for diagnosing the problem and the conditions?
  • What is the likely course of this condition? What is the long-term outlook with and without treatment?
  • What are my treatment options? How effective is each treatment option? What are the benefits versus risks of each treatment option?
  • If my symptoms worsen, what should I do on my own? When should I contact you?
  • Are you aware of each of the medications that I am taking? Can they adversely interact with the medications you are prescribing for me?


Leaving your appointment

Find out when you should return and make the follow-up appointment then.  It may also be a good time to ask if you need to watch for certain warning signs, for your condition at what point if any, do you need to call in. Lastly, if you have received a new prescription, make sure you understand what it is for, the side effects and the dosing schedule. Your physician or nursing staff will be able to provide you with this information.

The goal 

You should leave your doctor’s office feeling like your concerns were heard and acknowledged. Together, you and your doctor should come up with a health care plan that feels right for your needs.

If you have shoulder or knee pain, you may need to see a specialist. Call 713-766-0023 or visit to schedule an appointment with Orthopedic Surgeon, Dr. William Bryan. He’s been in practice for over thirty-five years at the Texas Medical Center in Houston.



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