Monthly Archives: December 2014

When the excuse, I slept on it wrong, doesn’t work anymore.

Stiff Neck Causes, Symptoms and Treatment
Spine-Health.com – Richard A. Staehler, MD

A stiff neck is typically characterized by soreness and difficulty moving the neck, especially when trying to turn the head to the side. A stiff neck may also be accompanied by a headache, neck pain, shoulder pain and/or arm pain, and cause the individual to turn the entire body as opposed to the neck when trying to look sideways or backwards.

Symptoms typically last for a couple of days or a week and may prompt neck pain that ranges from mildly painful but annoying to extremely painful and limiting. While there are a few instances in which neck stiffness is a sign of a serious medical condition, most episodes of acute neck stiffness or pain heal quickly due to the durable and recuperative nature of the cervical spine.

Stiff Neck Causes and Symptoms
The most common causes of a stiff neck include, but are not limited to, the following:

Muscle Strain or Sprain
By far the most common cause of a stiff neck is a muscle sprain or muscle strain, particularly to the levator scapula muscle. Located at the back and side of the neck, the levator scapula muscle connects the cervical spine (the neck) with the shoulder. This muscle is controlled by the third and fourth cervical nerves (C3, C4).

The levator scapula muscle may be strained or sprained throughout the course of many common, everyday activities, such as:

  • Sleeping in a position that strains the neck muscles
  • Sports injuries that strain the neck
  • Any activity that involves repeatedly turning the head from side to side, such as swimming the front crawl stroke
  • Poor posture, such as slouching while viewing the computer monitor
  • Excessive stress, which can lead to tension in the neck
  • Holding the neck in an abnormal position for a long period, such as cradling a phone between the neck and shoulder.

Meningitis / Infection
A stiff neck, in conjunction with a high fever, headache, nausea or vomiting, sleepiness and other symptoms, may be indicative of meningitis, a bacterial inflection that causes the protective membranes of the brain and spinal cord to be inflamed. Other infections can also cause stiff neck symptoms, such as meningococcal disease, an infection in the cervical spine. Any time a stiff neck is accompanied by a fever, it is advisable to seek immediate medical attention to check for these possibilities.

Cervical Spine Disorders
Many problems in the cervical spine can lead to neck stiffness. The stiffness can be a reaction to the underlying disorder in the cervical spine. For example, a cervical herniated disc or cervical osteoarthritis can lead to neck stiffness, as the structures and nerve pathways in the cervical spine are all interconnected and a problem in any one area can lead to muscle spasm and/or muscle stiffness.

Stiff Neck Treatments
As a general rule, it is advisable to seek medical attention if the stiff neck symptoms do not subside after one week. Immediate medical attention is recommended if neck stiffness is noted after a traumatic injury, or if there are additional troublesome symptoms, such as a high fever.

In the vast majority of cases, a stiff neck may be treated within a few days.
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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814

 

What is Bone?

Anatomy of the Bone

What is bone?

Our bones create a strong framework for which we are built. It protects organs, creates our unique shape, and is a living part of us. Bone also serves as a storage site for minerals and provides the medium–marrow–for the development and storage of blood cells. They are as fragile as they are strong. We must take care of our bones as well as we take care of our whole bodies.

Bone is living tissue that makes up the body’s skeleton. There are three types of bone tissue, including the following:

Front view of a leg bone with cut section showing bone marrow.

  • Compact tissue. The harder, outer tissue of bones.
  • Cancellous tissue. The sponge-like tissue inside bones.
  • Subchondral tissue. The smooth tissue at the ends of bones, which is covered with another type of tissue called cartilage. Cartilage is the specialized, gristly connective tissue that is present in adults, and the tissue from which most bones develop in children.

The tough, thin outer membrane covering the bones is called the periosteum. Beneath the hard outer shell of the periosteum there are tunnels and canals through which blood and lymphatic vessels run to carry nourishment for the bone. Muscles, ligaments, and tendons may attach to the periosteum.

Bones are classified by their shape–as long, short, flat, and irregular. Primarily, they are referred to as long or short.

There are 206 bones in the human skeleton, not including teeth and sesamoid bones (small bones found within cartilage):

  • 80 axial bones. This includes the head, facial, hyoid, auditory, trunk, ribs, and sternum.
  • 126 appendicular bones. This includes arms, shoulders, wrists, hands, legs, hips, ankles, and feet.

What are the different types of bone cells?

The different types of bone cells include the following:

  • Osteoblast. Found within the bone, its function is to form new bone tissue.
  • Osteoclast. A very large cell formed in bone marrow, its function is to absorb and remove unwanted tissue.
  • Osteocyte. Found within the bone, its function is to help maintain bone as living tissue.
  • Hematopoietic. Found in bone marrow, its function is to produce red blood cells, white blood cells, and platelets.

Fat cells are also found within the bone marrow.

bone make up

Bone development and growth

Osteogenesis (bone tissue formation) occurs by two processes:

  • Intramembranous ossification involves the replacement of connective tissue membrane sheets with bone tissue and results in the formation of flat bones (e.g. skull, clavicle, mandible).
  • Endochondral ossification involves the replacement of a hyaline cartilage model with bone tissue (e.g. femur, tibia, humerus, radius).

Long bones continue to grow in length and width throughout childhood and adolescence. Increase in length is due to continued endochondral bone formation at each end of the long bones. Increase in circumference of the bone shaft is achieved by formation of new bone on the outer surface of the cortical bone.

Bone Modeling

Modeling is when bone resorption and bone formation occur on separate surfaces (i.e. formation and resorption are not coupled). An example of this process is during long bone increases in length and diameter. Bone modeling occurs during birth to adulthood and is responsible for gain in skeletal mass and changes in skeletal form.

Bone Remodeling

Remodeling is the replacement of old tissue by new bone tissue. This mainly occurs in the adult skeleton to maintain bone mass. This process involves the coupling of bone formation and bone resorption and consists of five phases:

  1. Activation: preosteoclasts are stimulated and differentiate under the influence of cytokines and growth factors into mature active osteoclasts
    2. Resorption: osteoclasts digest mineral matrix (old bone)
    3. Reversal: end of resorption
    4. Formation: osteoblasts synthesize new bone matrix
    5. Quiescence: osteoblasts become resting bone lining cells on the newly formed bone surface

We often overlook our bones when we talk about staying healthy and strong, but we can’t dismiss them and must work to keep them in great shape. The doctors and PA’s here at Blue Ridge Orthopaedic & Spine Center are at the top of their field when it comes to treating you and your orthopaedic concerns.

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We have on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

 
References:  http://www.iofbonehealth.org and The StayWell Company.

Sprains, Strains, Breaks: What’s the Difference?

If you’ve sprained your ankle, you know what severe pain is.

But maybe that “sprain” was a “strain” or possibly even a “break.”

The amount of pain in each case can be virtually equal, so oftentimes the only way to find out what you have is to see a doctor.

Just the facts
Here are some facts on musculoskeletal injuries:

  • Sprains are a stretch and/or tear of a ligament, the tissue connecting two bones. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the upper leg with the lower leg, enabling people to walk and run.
  • Strains are a twist, pull and/or tear of a muscle and/or tendon. Tendons are cords of tissue that connect muscles to bones.
  • Breaks are a fracture, splinter or complete break in bone, often caused by accidents, sports injuries or bone weakness.

Health care providers attend to millions of Americans with musculoskeletal injuries each year, according to the United States Bone and Joint Decade (USBJD). The USBJD says that about 18.4 million sprains and strains were treated in 2007. And about 16.2 million fractures were treated.

Sprains
A sprain is caused by trauma — a fall, twist, or blow to the body, for example — that applies stress to a joint and overstretches or even ruptures supporting ligaments.

In a mild sprain, a ligament is stretched, but the joint remains stable and is not loosened. A moderate sprain partially tears the ligament, causing the joint to be unstable. With a severe sprain, ligaments tear completely or separate from the bone. This loosening interferes with how the joint functions. You may feel a tear or pop in the joint. Although the intensity varies, all sprains commonly cause pain, swelling, bruising, and inflammation.

The ankle is the most commonly sprained joint. And a sprained ankle is more likely if you’ve had a previous sprain there. Repeated sprains can lead to ankle arthritis, a loose ankle or tendon injury.

Strains
Acute strains are caused by stretching or pulling a muscle or tendon. Chronic strains are the result of overuse of muscles and tendons, through prolonged, repetitive movement. Inadequate rest during intense training can cause a strain.

Typical symptoms of strain include pain, muscle spasm, muscle weakness, swelling, inflammation and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, resulting in serious injury. Some muscle function will be lost with a moderate strain, in which the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle or tendon is stretched or pulled, slightly.

These are some common strains:

  • Back strain. When the muscles that support the spine are twisted, pulled or torn. Athletes who engage in excessive jumping — during basketball or volleyball, for example — are vulnerable to this injury.
  • Hamstring muscle strain. A tear or stretch of a major muscle in the back of the thigh. The injury can sideline a person for up to 6 months. The likely cause is muscle strength imbalance between the hamstrings and the quadriceps, the muscles in the front of the thigh. Kicking a football, running or leaping to make a basket can pull a hamstring. Hamstring injuries tend to recur.

Breaks
Bone breaks, unlike sprains and strains, should always be looked at by a health care provider to ensure proper healing. Call your provider if the pain does not subside or if the bone appears to be deformed. Seek urgent medical care if you have numbness, weakness, or poor circulation in the injured limb.

Athletes are most susceptible
All sports and exercises, even walking, carry a risk of sprains. The areas of the body most at risk for a sprain depend on the specific activities involved. For example, basketball, volleyball, soccer and other jumping sports share a risk for foot, leg and ankle sprains.

Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for strains. So do sports that feature quick starts, such as hurdling, long jump and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping put participants at higher risk for hand strains. Elbow strains frequently occur in racquet, throwing and contact sports.

Treating injuries
A severe sprain or strain may require surgery or immobilization, followed by physical therapy. Mild sprains and strains may require rehabilitation exercises and a change in activity during recovery.

In all but mild cases, your health care provider should evaluate the injury and establish a treatment and rehabilitation plan.

Meanwhile, rest, ice, compression and elevation (called RICE) usually will help minimize damage caused by sprains and strains. You should start RICE immediately after the injury.

RICE relieves pain, limits swelling and speeds healing, and it is often the best treatment for soft-tissue injuries, such as sprains and strains. Here’s what to do:

  • Rest. The injured area should be moved as little as possible to allow healing to begin.
  • Ice. Apply it immediately to reduce inflammation, which causes more pain and slows healing. Cover the injured area with an ice pack wrapped in a towel for about 15 to 20 minutes, 3 to 4 times a day.
  • Compression. Using a pressure bandage helps to prevent or reduce swelling. Use an elastic bandage. Wrap the injured area without making it so tight that it will cut off the blood supply.
  • Elevation. Raise the injured area above the level of the heart. Prop up a leg or arm while resting it. You may need to lie down to get your leg above your heart level.

Do all 4 parts of the RICE treatment at the same time. If you suspect a more serious injury, such as a broken bone, call your health care provider immediately.

Prevention
No one is immune to sprains and strains, but here are some tips to help reduce your risk for injury:

  • Take part in a conditioning program to build muscle strength.
  • Do stretching exercises every day.
  • Always wear shoes that fit properly.
  • Nourish your muscles by eating a well-balanced diet.
  • Warm up before any sports activity, including practice, and use or wear protective equipment that’s right for that sport.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

 

Online Medical Reviewer: Finke, Amy, RN, BSN
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

 

 

When Bone Spurs Attack!

Written by John H. Schneider, MD
Spine-Health.com

Bone Spurs (Osteophytes) and Back Pain
Many patients are told that they have bone spurs in their back or neck, with the implication that the bone spurs are the cause of their back pain. However, bone spurs in and of themselves are simply an indication that there is degeneration of the spine; the presence of bone spurs does not necessarily mean that they are the actual cause of the patient’s back pain.

The term “bone spurs” is really a bit of a misnomer, as the word “spurs” implies that these bony growths are spurring or poking some part of the spinal anatomy and causing pain. However, contrary to this implication, bone spurs are in fact smooth structures that form over a prolonged period of time.

The medical term for bone spurs is osteophytes, and they represent an enlargement of the normal bony structure. Basically, osteophytes are a radiographic marker of spinal degeneration (aging), which means that they show up on X-rays or MRI scans and are by and large a normal finding as we age. Over the age of 60, bone spurs on the spine are actually quite common.


Bone Spurs and Spinal Anatomy
The human spine is made of thirty-two separate vertebral segments that are separated by intervertebral discs made of collagen and ligaments. These discs are shock absorbers and allow a limited degree of flexibility and motion at each spinal segment. The cumulative effect allows a full range of movement around the axis of the spine, especially the neck (cervical spine) and lower back (lumbar spine).

Motion between each segment is limited by the tough outer disc ligaments and the joints that move (articulate) at each spinal level (the facet joint). Under each joint, just behind the disc, is a pair of nerve roots that exit the spinal canal. The exiting hole (foramina) that surrounds the nerve (disc in front, joints above and below) is relatively small and has little room for anything besides the exiting nerve.

Normal life stressors, possibly compounded by traumatic injuries to the spinal architecture, cause degeneration in the discs and the joints of the spine. With factors such as age, injury, and poor posture, there is cumulative damage to the bone or joints of the spine. For example:

  1. As disc material slowly wears out, ligaments loosen and excess motion occurs at the joint
  2. The body naturally and necessarily thickens the ligaments that hold the bones together
  3. Over time, the thick ligaments tend to calcify, resulting in flecks of bone or bone spur formation
  4. As the central spinal canal and the foramina thicken their ligaments, compression of the nervous system causes clinical symptoms.

Degenerative changes to normal vital tissue begin in early adulthood, but usually this slow process does not present with nervous system compression until we are in our sixth or seventh decades. Factors that can accelerate the degenerative process and bone spur growth in the spine include:

  • Congenital or heredity
  • Nutrition
  • Life-style, including poor posture and poor ergonomics
  • Traumatic forces, especially sports related injuries and motor vehicle accidents.

As always, to help avoid or minimize back pain it is generally advisable to stay well conditioned (both in terms of aerobics and strength) and to maintain good posture throughout one’s life.

 

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office
radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

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