Dr. Seal

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 

Neck Pain at Work?

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It’s  important to look at workplace ergonomics as part of treatment and prevention of neck pain.  Most often we forget.  This Spine Health article explains what you can do to reduce painful neck pain.

When sitting at a desk and looking straight ahead:

  • Eyes should point directly at the top third of your computer screen.
  • Forearms should be approximately parallel with the floor when typing.
  • Elbows should be at the side.
  • Feet should be flat on the floor with the thighs parallel with the floor.
  • If you stand or perform driving tasks, make sure that one side of the body is not constantly rotated more than the other side, and that there is as much symmetry in repetitive tasks as possible.

If you are experiencing neck pain, Blue Ridge Orthopaedic and Spine Center can help.  Our team of board certified/ fellowship trained physicians, as well as our physical therapy and rehabilitation department (including massage therapy) will diagnose your neck pain and develop a treatment plan that is right for you.

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.

Stiff Neck Causes and Symptoms

Stiff Neck Causes, Symptoms and Treatment
Richard A. Staehler, MD, www.spine-health.com

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.

Neck Strains and Sprains Video

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 Treatment

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.

Texters Beware!

Take note texters, your spine is suffering

You’re 18, ready to start college, play sports, make it big and prepare for spinal surgery. Wait, what? Spinal surgery? But I don’t have back pain or injury you say. Go ahead and blame that sometimes 60 degree angle of your neck is at while you are texting friends and family. Our bodies aren’t designed to keep that kind of stress on the neck and will eventually lead to degeneration.

“Your spine is at its happiest when your ears fall on the same plane as your shoulders, and your shoulder blades are retracted. Without these adjustments, you put added stress on your spine, Dr. Kenneth K. Hansraj, spinal & orthopaedic surgeon.

When you are texting, you are actually doing damage to yourself. Okay, once in a while isn’t going to hurt you, unless you’re driving at the same time, but consistent posture like this will do damage. It’s like carrying 60 pounds of extra weight on your spine. That’s a second grader on your back all the time! Nobody wants that. Normal usage would be about 700 – 1,400 hours of pressure and the worst offenders are looking at about 6,000 hours of that intense pressure on their spine per year. Here’s an idea of the pressure you put on yourself when you text and hold that position for a while.

Image Courtesy of http://www.thetimes.co.uk/

Image Courtesy of http://www.thetimes.co.uk/

Your resting pressure when you hold your head up straight is about the weight of your head, or 11 pounds. At 15 degrees tilted, it’s about 27 pounds, 30 degrees is about 40 pounds and by the time you hit a 45 degree angle, you are looking at 60 pounds of pressure on the spine.

That is a lot of pressure to be putting on your spine. However, it’s almost impossible to avoid today’s technologies so what do you do to help combat it?

Make an effort to limit the tilt. Okay, that can be easier said than done so here comes the Mom card. Do as your mom always told you and stand up straight. Good posture is so important on so many levels, don’t let it fall aside for a text. Keep your phone, or electronic device, away from waist level when looking at it to ease of off the pressure. “Look down with your eyes, no need to bend your head.” advises Hansraj

Here at Blue Ridge Orthopaedic & Spine Center, we offer complete comprehensive care for the whole family, including Physical Therapy, which is an invaluable resource to getting you back to your daily activities after an injury or surgery and will work with you to reverse the detrimental effects of repetitive daily activities like this.

 

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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.

Just what is Cartilage anyway?

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What Is Cartilage?

www.arthritis-health.com  –  Emmanuel Konstantakos, MD

Cartilage is a tremendously strong and flexible fibrous tissue that takes many forms and serves multiple purposes throughout the body. There are three types of cartilage: elastic cartilage, fibrocartilage, and hyaline cartilage.

Hyaline cartilage is the most common type of cartilage and can be found at the nose, windpipe, and most of the body’s joints. In essence, this cartilage can be thought of as the material that makes up the lubricant inside your joints. The word Hyaline is actually derived from the Greek word “Hyali” or “Γυαλί,” which means “Glass.” Under normal circumstances, a normal human joint is actually shiny and smooth similar to the inside of a glass.

In a joint, hyaline cartilage is referred to as articular cartilage because it covers bones’ surfaces where they articulate, or meet up with one another. This article focuses on articular cartilage.

Articular Cartilage
The thickness of articular cartilage varies from joint to joint. For example, cartilage at the wrist may be less than 1 mm thick 1 , while in some areas of the knee the cartilage may be as thick as 6 mm.2

Articular cartilage has two primary purposes:

  • Smooth movement. Extremely slippery, articular cartilage allows bones to glide over each other as a joint flexes and straightens.
  • Shock absorption. Articular cartilage acts as a shock absorber, cushioning bones against impacting each other during a weight-bearing activity, such as walking or jogging.

Articular cartilage also stores synovial fluid, a sticky, viscous fluid that lubricates and circulates nutrients to the joint. When the joint is at rest, the synovial fluid is stored in the articular cartilage much like water is stored in a sponge. When the joint bends or bears weight, the synovial fluid is squeezed out, helping to keep the joint lubricated and healthy.

Cartilage Damage
Despite its flexibility and strength, cartilage can be damaged. Problems can arise due to:

Injury
Wear-and-tear over time that can eventually lead to osteoarthritis
Diseases, such as rheumatoid arthritis or ankylosing spondylitis

Because it does not contain blood vessels, cartilage does not heal itself well. When cartilage has become thinned or damaged, a limited amount of new cartilage may be produced, but the new cartilage cells will grow in irregular, bumpy patterns. The result is that the bones may rub and grind against one another at the joint and this can be a source of pain.

Cartilage does not contain nerves, so damaged cartilage itself does not cause pain. However, the friction between bones and other resulting abnormalities in the joint can cause discomfort and pain as well as inflammation.

Gradual onset of stiffness, pain, and swelling in the joint can be a sign of osteoarthritis.

 

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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.

 

References:
1. Pollock J, O’Toole RV, Nowicki SD, Eglseder WA. Articular cartilage thickness at the distal radius: a cadaveric study. J Hand Surg Am. 2013 Aug;38(8):1477-81. doi: 10.1016/j.jhsa.2013.04.037. Epub 2013 Jun 28. PubMed PMID: 23810572.

2. Cohen ZA, McCarthy DM, Kwak SD, Legrand P, Fogarasi F, Ciaccio EJ, Ateshian GA. Knee cartilage topography, thickness, and contact areas from MRI: in-vitro calibration and in-vivo measurements. Osteoarthritis Cartilage. 1999 Jan;7(1):95-109. PubMed PMID: 10367018.