ORTHOPAEDIC INJURIES-PROBLEMS IN WOMEN

WOMEN are predisposed to developing certain musculo-skeletal problems in middle age. The differences in bones and joints of men and women help one understand women's increased susceptibility to certain injuries, knee, ankle and foot problems and stress fractures. This is not confined to athletes, even housewives and working women are prone to these problems.

Differences

There are both anatomic and physiological differences. There is more fat around the upper arm, buttocks and thighs gives women a more rounded appearance. When women undergo orthopaedic surgery, they require a slightly different protocol for pain management, physiotherapy and thromboembolic prophylaxis.

The extra padding around the arm, thighs and buttocks in women may lessen their chances of injury to the acromio-clavicular joint, clavicle, humerus after a sports-related fall. The female pelvis is wider than that of men. So the hip from which the thighbones descend is more widely set and there is a resultant outward muscular pull on the kneecap. The Q angle, formed by the direction of the pull of the quadriceps tendon and the patellar tendon, is more in women (17° against 5° in men.) Wide hips lead to an increased Q angle and can cause knock-knees, outward twisting of the shinbone and pronated feet.

The most common complaint in young and middle-aged women is anterior knee pain, which frequently arises from the under surface of the kneecap (patella) due to softening of the cartilage and wear and tear.

Common complaints

The main cause of this is misalignment due to the increased Q angle. It causes a more powerful component in the outer thigh muscle leading to a lateral vecot force on the kneecap. Thus the kneecap moves slightly out of joint.

Women's knees are more likely to dislocate outward. They can also be titled slightly outward thus predisposing to one-sided wear and tear. Pain in the knees can increase while climbing stairs or squatting. Some girls add to their problems by wearing high heels. The downward flexion gait increases the compressive force at the knee joint. Luckily, this pain can be banished after special exercises and only a small proportion require kneecap surgery.

Another knee problem that has been observed in sportswomen is a higher incidence of anterior cruciate ligament injuries. The exact reason for this is not yet clear. It may be partly due to the decreased size of the intercondylar notch at the lower end of the femur (thighbone), different biomechanical pattern of muscular activity and landing mechanism.

Women are more prone to developing bunions. This is more common in the West and may be due to improper footwear. Hallux valgus, a condition in which the big toe angles outwards excessively, is more common in girls. Callosities may develop on the inner side of the toe joint. Wearing high heels may lead to contracture of the Achilles tendon leading to tendon problems behind the heel and also pain under the heel. Women have lesser muscle mass than men due to hormonal differences.

Hormones

Female hormones also lead to ligamentous and tendon laxity. They also influence bone mass and density. Estrogen causes conservation of bone mass and osteoporosis results after menopause. Exercise-induced amenorrhea can lead to osteoporosis. Post-menopausal women develop stress fractures in their feet after prolonged and repetitive exercise and need to increase their intake of calcium. Women athletes can also develop stress fractures of the tibia.

Since cosmetics is an important factor in women, surgical incisions and wound closure techniques need to be planned well. Women tend to opt for minimally invasive arthroscopic techniques for shoulder and knee surgery.

Women also have a lesser pain threshold than men. After surgery, they require more painkillers. Persistent pain can lead to slow rehabilitation and calls for a more effective pain management.