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Is Spinal Stenosis a Serious Condition?

Is Spinal Stenosis a Serious ConditionSpinal stenosis is a condition where the bony vertebral canal that the spinal cord runs through narrows leading to compression of this structure. The result is pain and neurological issues such as numbness reduced reflexes and decreased muscle power at the level of spinal cord compression. Paralysis may occur if the stenosis is severe enough which makes this a very serious condition that needs to be managed adequately and appropriately. Spinal stenosis causes include the following pathologies and scenarios:

Congenital defects

  • The spinal canal develops a narrow structure.
  • There may be deformities of the vertebrae leading to canal stenosis.

Aging

  • The spinal ligaments can become thicker.
  • Intervertebral discs may bulge or herniate into the canal.
  • Bone spurs may form taking up space in the spinal canal.
  • Breakdown of facet joints leading to spinal column collapse.
  • Degenerative disc disease resulting in narrowing of the spaces in the spinal column.
  • Cyst formations on the facet joints resulting in compression of the thecal sac which is the spinal sac of nerves.
  • Osteoporosis (brittle bones) complicating into compression fractures of the vertebral bones.

Trauma

  • Patients with spinal stenosis caused by cervical spine myelopathy are at a higher risk of acute cord injury if they are involved in any accidents.
  • Injuries and accidents may result in dislocation of the spine or spinal canal or lead to burst fractures where fragments of bone may end up in the canal.

Arthritis

  • Osteoarthritis and less commonly rheumatoid arthritis results in narrowing of the canal due to persistent inflammation in or around the bony structure resulting in the formation of space-occupying canal lesions.

Management

Spinal stenosis treatment protocols involve conservative (non-surgical) and surgical therapies.

Conservative treatments may include:

  • Oral medications such as acetaminophen, non-steroidal anti-inflammatories, and narcotics.
  • Aerobic exercising to help to achieve or maintain overall satisfactory health.
  • Physical therapy to help perform and learn stretching and to strengthen exercises to build-up muscle mass to help support the back.
  • Weight loss in order to reduce pressure on the back and slow down the progression of the spinal stenosis.
  • Epidural steroid and/or anesthetic injections to help with pain relief.

Surgical interventions may include:

  • Lumbar decompressive laminectomy where the roof of bone overlying the narrowed spinal canal and surrounding thickened ligaments are removed to allow more space for the nerves and spinal cord to displace in. Around 70 to 90 percent of patients have good results after this procedure reporting decreased pain and neurological deficits.1
  • An interlaminar implant is placed in the area where the decompression was done to offer stability to the spine and to allow the nerves to freely run through the device without any compression of the tissue.
  • Patients with cervical myelopathy may have a discectomy and fusion performed where the intervertebral disc where spinal cord compression is located is removed from the cervical spine. The procedure can be done via access to the front or back of the neck.

What is Osteonecrosis?

Osteonecrosis is a condition that causes severe disability and pain. This condition occurs from overuse of corticosteroid agents or from drinking too much alcohol. Osteonecrosis can occur in any bone of the human body, but the bones most often affected are the hips, knees, and shoulders.

 

Osteonecrosis, often called aseptic necrosis or avascular necrosis, is the death of bone cells. The cells die due to decreased blood flow. Bone cell death leads to collapse of areas of the bone, which in turn, leads to osteoarthritis (called degenerative arthritis) of nearby joints. The bones and bone marrow of the body are made of health cells that require blood to stay healthy. When blood is restricted to the cells, the cells die, leading to osteonecrosis.

 

Incidence of Osteonecrosis

 

Osteonecrosis affects around 20,000 people each year in the United States. The condition can affect any age group, but most patients are between age 20 and 50 years old. A diagnosis of osteonecrosis does not alter life expectancy.

 

Cause of Osteonecrosis

 

Bone cells do not just die normally. There is usually a causative agent that leads to cell death. The most common causes for osteonecrosis are:

 

  • Severe injury or trauma – Leads to disruption of the bone’s blood supply.
  • Use of corticosteroid medications – When used in high doses for prolonged periods of time, these drugs cause bone cell death. Examples are methylprednisolone, cortisone, and prednisone.
  • Excessive alcohol consumption
  • Systemic lupus erythematosus
  • Decompression disease – Occurs with scuba diving.
  • Blood disorders – Includes antiphospholipid antibody syndrome, sickle cell anemia, and lupus anticoagulant.
  • HIV infection
  • Radiation therapy

 

Diagnosis of Osteonecrosis

 

A doctor will suspect osteonecrosis when a patient with risk factors reports feeling bone pain localized in a small area. Many patients with osteonecrosis report hip and groin pain. The pain associated with knee or hip osteonecrosis is often worse with walking or weight-bearing. After taking a detailed medical history, the doctor will conduct a physical examination. X-rays are taken of the painful region. Imaging scans used to make the diagnosis include bone scans and magnetic resonance imaging (MRI) tests.

 

Osteonecrosis Treatment

 

At present, there is no cure for osteonecrosis, but treatment does help control symptoms and prevent bone collapse. Options are:

 

  • Early treatment – Limiting weight-bearing on affected areas and taking pain medications are two conservative treatments for osteonecrosis. Patients with hip or knee osteonecrosis may need surgical procedures to prevent bone collapse and relieve pain.
  • Core decompression surgery – When osteonecrosis progresses, and pain worsens, the patient may benefit from a core decompression procedure. This involves removal of a piece of bone from the affected region. This is done to improve blood flow to the other bone regions.
  • Osteotomy – The surgeon may also perform an osteotomy. This involves removal of the dead bone and repositioning of the remaining bone to support the weight-bearing joint.
  • Joint replacement – When the bone of the joint collapses, a total joint replacement may be needed.
  • Bone grafting – This procedure involves taking a small piece of bone from the healthy leg and transplanting it to the place where the necrosis exists. Bone grafting allows for improved blood flow to the surrounding bone tissue.
  • Medications – While there are no established guidelines for preventive or curative medications, certain pharmaceuticals are used in osteonecrosis. Lipid lowering agents may prevent cell death. In addition, there is increasing evidence that anticoagulants may help. Bisphosphonates are used to treat low bone mass, and one study found that alendronate improved symptoms in patients with hip osteonecrosis. Finally, analgesics are used to control bone-related pain.

Resources

National Osteonecrosis Foundation (2014). Osteonecrosis. Retrieved from: http://nonf.org/nofbrochure/nonf-brochure.htm

Overview of Hip Strains and Treatment in Gilbert AZ

Hip Strains

A hip strain occurs when muscles that support the hip joint become stretched or torn. Strains can be mild, moderate, or severe, depending on the severity of the injury. A severe strain may limit hip mobility.

What structures are involved in a hip strain?

The large bones of the hip joint include the femur (thigh bone) and the pelvis, which serve as anchors for various muscles and soft tissue structures. Some muscles move across the buttocks and abdomen (gluteals and hip flexors), whereas others move down the thigh to the knee (quadriceps, canstockphoto28416938abductors, adductors, and hamstrings).

With a hip strain, tendons may also be injured. Tendons are fibrous, tough tissues that connect muscles to bones. Hip strains often occur near the area where the muscle joints the connective tissue to a tendon. The strain can be a simple stretch of a tendon or muscle, or it can involve a partial or complete tear of muscle fibers. Severe strains involve both muscle and tendon.

What complications are associated with a hip strain?

Once a muscle is injured, it is susceptible to reinjury. Repeated hip strains are associated with athletic pubalgia, which is also called sports hernia. This type of hernia is a tear or strain of soft tissue (ligament, tendon, or muscle) of the lower abdomen or groin region.

How common are hip strains?

In a recent study, researchers sought to determine if muscle strength and flexibility played a role in the incidence of hip flexor and adductor strains among National Hockey League (NHL) players. Among the 81 players, 8 had adductor strains and 4 had flexor strains.

What is the cause of hip strain?

A hip strain is an acute injury that occurs suddenly. Hip strain can be caused by:

  • Fall from a significant height.
  • Direct blow during contact sports.
  • Overuse, where tendon and/or muscle has become slowly weakened over time from repetitive movements.

What are the risk factors for hip strain?

Risk factors for a hip strain include:

  • Muscle tightness
  • Prior injury in the same area
  • Attempting to do too much too often and too quickly
  • Failure to warm up properly before exercising

What symptoms are associated with hip strain?

A hip strain causes significant tenderness and pain of the hip. Other symptoms are:

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  • Swelling
  • Muscle weakness
  • Increased pain with activity
  • Limited hip range of motion

How is hip strain diagnosed?

The doctor will ask you questions about your activities, what you were doing before the injury, and your symptoms. He will also conduct a physical examination to assess the muscles and bones. X-rays are used to assess bones and rule out stress fracture of the hip.

How is hip strain treated?

Most hip strains improve with simple measures. Medical treatment for hip strain is aimed at relieving pain and restoring strength and range of motion. Mild strains respond to the RICE protocol, which includes:

  • Rest – Avoiding any activity that puts weight on the hip for 4-7 days.
  • Ice – Using ice packs to the injured region for 20-minute intervals several times each day.
  • Compression – Use of an elastic bandage or compression shorts.
  • Elevation – Raising the leg up higher than the heart.

Other treatment options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These agents decrease swelling and relieve pain.
  • Heat therapy – Ice should be applied to the injury first. However, after 72 hours, heat therapy can help. This involves use of a heat pad, lying in the tanning bed, or soaking in a hot bath.
  • Physical therapy – If pain continues after 10-14 days, the doctor may recommend physical rehabilitation. The therapist provides an individualized exercise program that improves flexibility and strength.
  • Surgery – For severe injuries that involve torn muscle fibers, surgery is recommended. This involves suturing the torn soft tissue structure pieces back together.

What is involved in recovery?

For most cases, recovery only takes 10-14 days. For a severe hip strain, recovery could take 2-3 months. If your pain returns after resuming activity, you should discontinue activities and rest.

Orthopedic and Sports Performance Institute offers top treatment for the East Valley including Gilbert, Chandler, Mesa, Queen Creek and surrounding areas. This includes both nonoperative and operative treatments for all types of sports injuries such as hip strains, ligament injuries and tendonitis. Call us today for the best treatment options!

All about Hand Fractures – Info from a Gilbert AZ Hand Surgeon

Anatomy of the Hand

 

A number of bones join together to make up the human hand. These bones also form and act as the appendage’s supporting framework which attaches the muscles together at the wrists and shoulder and enables the fingers and arm to move.

A considerable amount of pressure directly to a bone is needed to break it, i.e. a hand fracture hand wrist carpal tunnel pain photooccurs due to direct force to the hand. What usually comes next, is pain, swelling, and a decrease in usage of the injured hand.

Kinds of Hand Fractures

While some fractures may be considered as simple, with bone pieces being perfectly aligned and stable, there are other kinds of fractures that are just the opposite, where bone fragments tend to shift or lose their place. There are also some fractures that happen in the main body of the bone, while there are others that only break the surface of the joint.

Comminuted Fractures: These are fractures where the bone is broken into many pieces and is often highly unstable.

Open Fracture: Also known as the compound fracture, it usually happens when a bone fragment tears through the skin. There is a level of risk associated with this type of fracture.

Signs and Symptoms of a Hand Fracture

If you have a hand fracture, you will experience;

  • Pain
  • Stiffness
  • Loss of movement

To help determine the exact plan of action to take in the case of a hand fracture, your orthopedic hand surgeon in Gilbert or Chandler will first undertake a medical evaluation and x-rays. A number of treatment options will be made available to you, depending on what type of fracture you are suffering from.

Treatment Options for Hand Fractures

In order to treat a fracture that isn’t displaced, a splint or cast is usually recommended. Your orthopedic hand specialist may also prescribe one to protect a fracture that has been set.

There are some fractures that need to be held in place with the help of wires or pins. This is known as a closed reduction and internal fixation, because no incision is made to carry out the procedure. On the other hand, some fractures require surgery known as open reduction.

Articular fractures or those that disrupt the joint surface require a precise setting of bone fragments to smoothly restore the joint.

In some cases, a bone graft might be necessary, especially when the bone is severely broken. In this procedure, your orthopedic surgeon will take bone fragments from another part of the body or from a cadaver and attach it to the area to be repaired, which provides stability to it. Depending on the case, substitutes for bone graft are also used at times, instead of taking it from the body part of the patient.

Once the fracture has been set and gains enough stability, your orthopedic surgeon will lead you through a range of motion exercises aimed at reducing stiffness and improving mobility with physical therapy.    

The top hand specialists in Gilbert, Chandler, Mesa and Queen Creek are at OSPI. All types of nonoperative and operative treatment are offered at Orthopedic and Sports Performance Institute for hand injuries. Most insurance is accepted. Call OSPI today at (480) 899-4333!

The Latest Advancements in Knee Replacement for Active Boomers

The majority of patients coming in for knee replacement surgery are in their 50s, according to Steven Haas who is heading the Knee Surgery and Attending Orthopedic Surgeon Department at the Hospital for Special Surgery based in New York City. If these statistics are compared with those of 20 years ago, there has been a rapid shift in demand for knee replacement surgery, especially for people in their 50s.

Why the sudden interest and growth of demand for the surgical procedure? The points responsible for this are new and innovative technologies that are being used now, especially in implant design and far more improved surgical techniques that are being used by orthopedic surgeons to meet with the growing demand for knee replacements. In addition, the growing number of baby boomers reaching older age has increased the numbers in need of the procedure.

The Latest in Knee Replacement Surgery

Only recently, the orthopedic community announced the arrival of the newest advancement for the surgery, i.e. a knee replacement implant that can last the patient as much as 30 years instead of the standard 10-15. Moreover, the implant has also been cleared by the FDA which means that those looking for ways to make their implants last longer, can opt for this.

VERILAST technology is used for making the implant that will make it possible for patients to possibly outgrow the implant, rather than the other way round. In addition to this, the implants are thought to be much more functional than the earlier versions, as is proved by a series of tests that researchers underwent before giving that verdict.

Adoption of Better Surgical Procedures and Techniques

Orthopedic surgeons have also changed their way of performing surgical procedures, by introducing techniques such as minimally invasive surgery, which helps in decreasing trauma to the patient, as much as possible, which in turn leads to a faster recovery.

Another development is the usage of small surgical instruments for performing the procedure, where the goal is to cut as little as possible, which will minimize the collateral damage and trauma that came with previous surgical procedures that were extremely invasive in nature.

Better Recovery Rate Due To Minimal Invasive Surgical Procedures

The entire point of such a surgery is not to make the cut big enough to fit the instruments, but rather, to use smaller instruments during the procedure that would best fit the cut made. This is the reason why, smaller incisions are used to get access to the knee area after providing local anesthetic to the patient.

One point in favor of the minimal invasive procedure is that, no need is felt to cut the quadriceps tendon or flip the kneecap upside down in order to gain access to the area, which was required in the case of previous surgical techniques. This has also improved the recovery rate far more significantly and at a much faster rate, than old surgical techniques, so now patients are up and about after only 6 weeks of having the procedure done as compared to 3 months.

OSPI offers expert knee replacement doctors in Gilbert, Chandler and Mesa AZ who specialize in the latest technologies including computer navigation, minimally invasive and even outpatient procedures. Call OSPI today to receive treatment with the top orthopedic doctors in the entire East Valley!

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