Dr. Brown

Evaluation Procedures for Orthopedic Problems

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Adults – What are standard evaluation procedures?

Before a treatment or rehabilitation plan can be made, your orthopedist must first determine the reason for, and source of, your condition. This typically involves a complete physical exam and a review of your medical history profile, in addition to a description of your symptoms. Be sure to tell your healthcare providers of any other illnesses, injuries, or complaints that may be associated with the pain or condition. Also, tell him or her about any previous treatments or medicines prescribed. Initial tests may then follow.

Advanced evaluation procedures

If you need further evaluation you may have one of these tests:

  • X-ray. This test uses invisible electromagnetic energy beams to make images of tissues, bones, and organs onto film.
  • Arthrogram. This X-ray shows bone structures after an injection of a contrast fluid into a joint area. When the fluid leaks into an area that it does not belong, disease or injury may be considered, as a leak would provide evidence of a tear, opening, or blockage.
  • Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body. It can often determine damage or disease in a surrounding ligament or muscle.
  • Computed tomography scan (also called a CT or CAT scan). This test uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Electromyogram (EMG). This test evaluates nerve and muscle function.
  • Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs
  • Arthroscopy. This test is used to evaluate a joint. It uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen. It’s used to evaluate any degenerative or arthritic changes in the joint. It also detects bone diseases and tumors and may help determine the cause of bone pain and inflammation.
  • Myelogram. This test involves the injection of a dye or contrast material into the spinal canal. Next a specific X-ray study lets the healthcare provider evaluation of the spinal canal and nerve roots.
  • Radionuclide bone scan. This is a nuclear imaging technique. It uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
  • Blood tests. Other blood tests may be used to check for certain types of arthritis.

After the evaluative information is collected and reviewed, the orthopedist will discuss the treatment options with you to help you select the best treatment plan that promotes an active and functional life.

Children – What are standard evaluation procedures?

Children will be treated much like the adults are with a full physical exam and a detailed medical history. At this time, be sure to tell your child’s doctor of any other illnesses, injuries, or complaints that have been associated with the pain or condition, as well as any previous treatments or medicines prescribed. Some early tests may then be done, including:

  • Blood tests
  • X-rays.A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Advanced evaluation procedures

Children who need further evaluation may undergo 1 or more of the following:

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan).A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • EMG (electromyogram).A test used to evaluate nerve and muscle function.
  • Bone scan.A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone inflammation.
  • This is becoming a common test for evaluating musculoskeletal complaints.

After the evaluative information is collected and reviewed, your child’s orthopaedist will discuss with you all treatment options and help you select the best treatment plan to enable your child to live an active and functional life.

Blue Ridge Orthopaedic & Spine Center has two convenient office locations in Warrenton (540) 347.9220 & Gainesville (703) 743.2814 to serve all of your Orthopaedic needs.  Call us today to schedule an appointment.  Same day/next day appointments available.  For more information on all comprehensive services we offer, visit www.broava.com.

Courtesy: Krames Staywell

Online Medical Reviewer: Ogiela, Dennis, MD
Online Medical Reviewer: Banerjee, Rahul, MD 

Run away from Running injuries

bodies in motion

Race season is off to a fast start this Spring and regardless of your running experience, there are many chances for injuries. So, how do you avoid them? Well, there are a few ways and this article gives a few good tips for staying injury free.

Running is a great way to get in shape, but it can also lead to injuries. Knowing about common injuries and how to prevent them can keep you on track toward achieving your fitness goals.

Experts recommend the following strategies to prevent injuries:

Identify your running goals
You may choose to start running to improve your physique, lose weight, increase cardiovascular fitness, or socialize with friends. Whatever the reason, it’s a good idea to identify this goal when creating your exercise program. If you want to improve cardiovascular fitness, for instance, you should run at a quick pace to maximize your heart rate. If you’re running to lose weight or reduce body fat, it’s better to run at a slower rate for a longer time. Depending on your goal, your doctor or personal trainer may decide that a modest walking or jogging program is appropriate. Setting goals helps you follow a safe pace and keeps you from overexertion, which can result in injury.

Have a physical evaluation
Certain health problems may hamper your running performance and increase your risk for injury. Specifically, osteoporosis, arthritis, and other degenerative joint diseases can increase your injury risk. If you have any significant health issues, you should discuss these with your doctor before you start to run.

Warm up before your run and stretch after you run
Doing so can prevent some of the most common injuries. It’s most important to stretch muscles that move joints. These include the calf muscle, which moves the knee and ankle, and the hamstring, which moves the knee and hip. Walk or gently jog for 5 minutes. Cool down at the same pace for another 5 minutes at the end of your run.

Wear the correct shoes
Buying shoes at an athletic store, where a salesclerk can help you choose a shoe that fits your foot type, can help prevent injuries.

Common injuries
The following injuries are common among runners:
Achilles tendinitis
This injury is marked by dull or sharp pain along the back of the Achilles tendon, calf tightness, and early morning stiffness. Stretching can help prevent this injury. To treat it, rest, and stretch until the pain is gone.

Plantar fasciitis 
This injury is an inflammation of the plantar fascia, a thick, fibrous band of tissue in the bottom of the foot. Proper stretching can help prevent such an injury. Anti-inflammatory medication, stretching, and ice compresses help relieve pain.

Shin splints
This injury is caused by overuse or poor conditioning and worsened by running on hard surfaces. This injury causes pain on the inside of the shinbone. Shin splints are treated by complete rest and stretching until the pain is gone. You can relieve symptoms by stretching and using ice and anti-inflammatories. Once your symptoms have eased, you should make changes in the distance you run and your speed.

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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.

Beth Holloway, RN, M.Ed. and Kim Larson APRN, FNP © 2000-2015 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.

It’s NEVER a stupid question. Always ask.

 

40 Questions to Ask Your Surgeon Before Back Surgery

www.spine-health.com Stephanie Burke

Before you decide to have the surgery

1. What type of surgery are you recommending? Why?
2. What is the source of the pain that is being addressed? How do you know this?
Exploratory surgery is never done on the back.
3. Please explain the procedure in great detail.
The amount of information depends on your personal preferences. Some patients want to know everything, some not so much!
4. What are my non-surgical options?
5. What is the natural course of my condition if it is not surgically addressed?
6. What would you recommend if I was your friend, wife, sister, or daughter?
7. How long will the surgery take?
8. What are the side effects, potential risks, and potential complications?
9. Please explain the risks and how they relate to me personally.
For example, different risk factors like smoking, being overweight or having grade 3 spondylolisthesis, etc, will affect surgical outcomes.
10. What if, during my surgery, you encounter a different spine issue than you expected?
11. Do I need to donate my own blood? If yes, why?
For most types of back surgery, blood does not need to be donated ahead of time.
12. Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications?
13. Who else will assist you in the operation? What are their background and qualifications?
14. What are the long-term consequences of the proposed procedure?
For example, will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine? Questions about the surgeon
15. How many times have you done this procedure?
Generally, when it comes to surgery, “practice makes perfect,” so more experience is better. However, if the doctor is recommending something that is not often done, such as multi-level fusions, more experience would not necessarily be better.
16. Are you board eligible or board certified?
You can usually look on the wall and see a certificate.
17. Are you fellowship trained in spine surgery?
This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
18. If I want to get a second opinion, who would you recommend?
The recommendation should be someone not in the same practice.
19. Statistically, what is the success rate for this type of surgery? What is your personal success rate, and how many of this type of surgery have you done?
20. Can I talk to other patients who have had a similar procedure?
The patient will have to sign a HIPAA release form, but typically, happy patients want to share their success stories.

Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.

Questions about what to expect after the surgery

21. What kind of pain should I expect after the surgery and for how long?
22. How long is the hospital stay?
23. May a family member spend the night with me in the hospital?
24. How do you manage the pain in the hospital?
25. Which pain medications will I be sent home with? What are possible side effects of these prescriptions (e.g. constipation, drowsiness, etc.)?
26. Will you know before the surgery if I will need a back brace afterwards? If so, will I be fitted for one before the surgery?
27. Will I need any other medical equipment (like a walker) when I go home?
28. Who can I call if I have questions after the surgery? What is the process for communication?
29. How often will I see you after my surgery?
30. What symptoms would warrant a call to your office?
31. What symptoms would warrant immediate medical attention?
32. What limitations will I have after surgery and for how long?
33. How long should I wait to bathe?
34. How long will I be out of work? School?
35. What kind of help will I need when I return home?
36. When can I drive again?
37. When can I resume normal (light) household chores?
38. What expectations do you have for my recovery?
39. When is it safe to resume sexual relations?
40. How soon after the surgery can I start physical therapy?

One thing we pride ourselves on here at Blue Ridge Orthopaedic & Spine Center is our willingness to listen to you and answer all the questions you may have about a procedure. Back surgery is scary stuff and it’s not taken lightly, often it’s the last resort when treating the injury. Please do not hesitate to bring these, or any other questions to the table if
you are looking at having spine surgery. We welcome it.

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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.

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.