Shoulder care

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 

Is it a Bird or Shoulder Tendonitis?

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Shoulder tendonitis causes an inflammation of the rotator cuff and/or biceps tendon and is usually the outcome of a pinched tendon. Sports activities that require the arm to move over the head repetitively, such as baseball, weightlifting, racket sports, and particular swimming strokes often are the cause of shoulder tendonitis.
Do you have any of these symptoms?

• Pain or stiffness in the shoulder
• Unable to hold arm in particular positions

Pain relief strategies –

• Active rest
• Strengthening/rehabilitation exercises
• Anti-inflammatory medications such as Advil, Motrin or Aleve
• Anti-inflammatory steroid injections
• Surgery for extreme injuries
Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our Warrenton and Gainesville 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). Or visit www.broava.com to make an appointment. Same day/next day appointments available.

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.

Physical Therapy offers a non-drug alternative to Pain Management

NIH Says Current Treatment of Chronic Pain Has Created ‘Silent Epidemic;’ More Focus Needed on Non-Drug Approaches

News Now Staff – APTA

According to a report recently released by the National Institutes of Health (NIH), it’s time that treatment of chronic pain moves from a 1-pill-fits-all mindset to an evidence-based, individualized, multidisciplinary model that recognizes the value of non-pharmacological approaches, including physical therapy.

The report (.pdf) is the product of an NIH panel that looked at the current state of treatment for chronic pain, which is estimated to affect 100 Americans. In addition to looking into research on the issue, the panel convened a workshop that included more than 20 speakers. The results of the panel’s work were published earlier this week (.pdf), and featured in the online edition of Time magazine.

Much of the report is focused on the use—and possible overuse—of opioids as the “go-to” approach in almost all cases of chronic pain. In addition to contributing to patterns of drug abuse, the reliance on opioids may simply not be helping in all circumstances, according to the panel report.

“Together, the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’ of distress, disability, and danger to a large percentage of Americans,” authors write. “The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”

The answer to that question, the panel found, is no. Patients with chronic pain are typically “‘lumped’ into a single category, and treatment approaches have been generalized with little evidence to support this practice,” they write.

Because the manifestations and response to pain can be so varied, the report calls for a variety of treatment options that include physical therapy, which is specifically mentioned in the report. These non-pharmacological treatments can be very effective—the problem, as one speaker at the workshop noted, is that “lack of knowledge or limited availability of these non-pharmacological modalities and the ready availability of pharmacological options and associated reimbursement structure appear to steer clinicians toward the use of … opioids.”

An NIH press release on the report quotes panel chair David B. Reuben, MD, as saying that “clearly there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches.” The solution, he believes, is to ensure that “every patient’s individual needs are met by a patient-centered health care system.”

The panel report cites many barriers to the implementation of such a system, including lack of substantive evidence-based research, limited physician access to experts in other disciplines, and some insurance plans’ resistance to integrative treatment approaches. For now, authors write, the chronic pain landscape is one in which “large numbers of Americans are receiving suboptimal care.”

The release of the report comes at a time when the issue is receiving wider attention, thanks in part to Cake, and a new film starring Jennifer Aniston as a woman with chronic pain. Recently, the Washington Post addressed the issue in an article that called for a “blended approach” to chronic pain, including the use of physical therapy. That story followed up on a January 12 Washington Post article titled “8 ways to deal with chronic pain.” The article’s first recommendation: “embrace physical therapy.”

“The more you move, the better you feel,” reporter Rachel Noble Benner writes in the article. “Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain, and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain.”

The Physical Therapists at Blue Ridge Orthopaedic & Spine works exclusively in the treatments of Orthopaedic conditions and have experience working with patients who have chronic pain. In conjunction with your doctor and using evidence-based treatments, we create treatment plans to treat the patient as a whole, not just the injury, and to restore full functionality.

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center is Northern Virginia’s premier facility for diagnosing and treating back pain and spinal disorders. In addition to our regionally renowned Spine Center, our practice features Joint Replacement, Sports Medicine, Pain Management, Physical Therapy, Trauma Center, Shoulder Care, a Hand Center and a Foot and Ankle Center.

We are committed to treating not just injuries and physical ailments, but rather the whole person, by offering a wide range of specialty programs designed to support treatment. Specialty programs include Massage Therapy, Medical Nutrition and Aquatic Physical Therapy.

APTA has been at the forefront in helping the public understand how physical therapy can be a transformative agent in the treatment of chronic pain. The subject was featured in a Move Forward radio podcast, and the association offers a physical therapist’s guide to chronic pain syndromes. Additionally, the APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT’s role in chronic pain management was featured in the September issue of Motion magazine.

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