Radiculopathy refers to a condition in which the spinal nerve roots are irritated or compressed. Many people refer to it as having a “pinched nerve.” Lumbar nerve impingement indicates that the nerve roots in the lower spine are involved, while cervical radiculopathy is associated with nerve roots in the neck. Nerve impingement is most often caused by a herniated disk or spinal stenosis.
The spinal vertebrae are separated by flexible disks of shock absorbing cartilage. These disks are made of a supple outer layer with a soft jelly-like core (nucleus). If a disk is compressed, so that part of it intrudes into the spinal canal but the outer layer has not been ruptured, it may be referred to as a “bulging” disk. This condition may or may not be painful and is extremely common.
Herniated disks are often referred to as “slipped” or “ruptured” disks. When a disk herniates, the tissue located in the center (nucleus) of the disk is forced outward. Although the disk does not actually “slip,” strong pressure on the disk may force a fragment of the nucleus to rupture the outer layer of the disk.
If the disk fragment does not interfere with the spinal nerves, the injury is usually not painful. If the disk fragment moves into the spinal canal and presses against one or more of the spinal nerves, it can cause nerve impingement and pain.
If the injured disk is in the low back, it may produce pain, numbness, or weakness in the lower back, leg, or foot. If the injured disk is in the neck, it may produce pain, numbness, or weakness in the shoulder, arm, or hand.
The Achilles tendon is the largest tendon in the body. It connects the muscles in the lower leg (calf) to the heel bone. With every movement of the foot, the Achilles tendon stretches and tightens. Because it is under so much stress, it can partially or completely tear (rupture) from excess force or overuse. Ruptures usually occur about two inches above where the tendon attaches to the heel bone.
An Achilles tendon rupture is most common in middle-aged “weekend warriors” who are not conditioned for athletics and who neglect to properly warm up and stretch prior to exercise. Ruptures frequently occur from sudden movements that stress the calf muscles, such as jumping or quick stops; from overstretching; from vigorous exercise after a long period of inactivity; or from untreated Achilles tendinitis/tendinosis (overuse).
Plantar fasciitis is the most common cause of heel pain. It is commonly referred to as a heel spur, although a heel spur, or bony growth on the heel bone, develops as a result of plantar fasciitis. The condition occurs when the long, flat ligament on the bottom of the foot (plantar fascia) stretches irregularly and develops small tears that cause the ligament to become inflamed. This inflammation is most often caused by walking with an abnormal inward twisting of the foot, called pronation. Over time, this slightly abnormal step may increase tension on the plantar fascia and cause it to become inflamed.
Lateral epicondylitis, commonly known as tennis elbow, is inflammation of the tendon that connects the muscles of the forearm, wrist, and hand to the upper arm at the elbow. The tendon on the bony outside (lateral) part of the elbow (the epicondyle) is most often irritated by overuse during physical activity.
Carpal tunnel syndrome is the term used to describe a specific group of symptoms (tingling, numbness, weakness, or pain) in the fingers or hand and occasionally in the lower arm and elbow. These symptoms occur when there is pressure on a nerve (median nerve) within the wrist (carpal tunnel). Carpal tunnel syndrome develops over time because of repetitive hand motions that damage muscle and bone in the wrist area.
A stress fracture is a microscopic crack in a bone that occurs from overuse. Muscles normally absorb the shock of physical activities, but when they become too fatigued to do so, they transfer the stress to the bones which results in a hairline-sized fracture.
Stress fractures usually develop in the weightbearing bones of the feet and lower legs, often after a rapid increase in the duration or intensity of exercise or from wearing improper or worn out athletic shoes.
The most common form of arthritis, osteoarthritis, can affect any joint in the body, but most often afflicts the knees, hips, and fingers. Most people will develop osteoarthritis from the normal wear and tear on the joints through the years. Joints contain cartilage, a rubbery material that cushions the ends of bones and facilitates movement. Over time, or if the joint has been injured, the cartilage wears away and the bones of the joint start rubbing together. As bones rub together, bone spurs may form and the joint becomes stiff after long periods of activity or inactivity.
Bursitis is inflammation of a bursa or bursae (more than one bursa), small fluid-filled sacs that cushion areas of friction around joints. Bursae contain synovial fluid that lubricates the joints. Bursitis typically occurs as a result of overuse during physical activities or infection of the synovial fluid. If a bursa becomes infected or irritated from repetitive stress, it will cause pain and limited movement. Bursitis is most common in the shoulder, knee, hip, elbow, or heel.
Teninitis is inflammation of a tendon, a band of tissue that connects muscle to bone. It is most commonly the result of overuse during physical activities. Repetitive motions can stretch and irritate the tendon, causing pain and swelling. Tendinitis occurs around joints such as the elbow, shoulder, wrist, ankle, or knee.
The medial and lateral menisci (plural of meniscus) of the knee are two crescent moon-shaped disks of tough tissue that lie between the ends of the upper leg bone and lower leg bone that form the knee joint. Meniscus tears commonly occur during sports when the knee is twisted while the foot is planted firmly on the ground. In people over the age of 40 whose menisci are worn down, a tar might occur with normal movement, minimal activity, or minor injury.
When muscles become inflamed, they can also spasm, or contract tightly, as a response to injury. While they are the body’s way of protecting itself from further injury, they often produce excruciating and often debilitating pain. Muscle spasms are common in the low back (lumbar) muscles.
There are four ligaments in the knee: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). The ACL and PCL stabilize front-to-back knee movements, while the MCL and LCL stabilize side-to-side movements.
The ACL can be sprained or torn if the knee is straightened beyond its normal limits (hyperextended), twisted, or bent side-to-side. A sprained or torn ACL is common in sports and usually results from a hard stop or aggressive twisting of the knee. The PCL is the least common ligament to be injured.
The MCL is injured when a force is exerted on the outside of the knee, pushing it inward, while the LCL is injured by a force exerted on the inside of the knee that pushes it outward. This type of hit is frequent in contact sports like football or hockey.
A torn knee ligament is usually accompanied by feeling or hearing a pop in the knee at the time of injury, severe pain and swelling, and joint instability.
Shin splints are an inflammation of the periosteum, a fibrous sheath that surrounds bone. In this case, the affected bone is the shin bone, or tibia. Shin splints are usually accompanied by pain and swelling in the front of the lower leg. Most frequent in runners, this overuse injury is caused by the repetitive stress of running on hard surfaces.
A shoulder dislocation (shoulder instability) occurs when the upper end of the arm bone pops out of the shoulder joint. This injury may be caused by a direct blow to the shoulder, a fall on an outstretched hand or arm, or an exaggerated overhead throwing motion.
A shoulder separation (acromioclavicular joint injury) occurs when the outer end of the collarbone separates from the end of the shoulder blade because of torn ligaments. This injury occurs most often from a blow to the shoulder or a fall on a shoulder or outstretched hand or arm.
Frozen shoulder (adhesive capsulitis) is a condition in which the tissues around the shoulder joint stiffen, scar tissue forms, and shoulder movements become difficult and painful. It can develop when you stop using the joint normally because of pain, other injury, or a chronic health condition, such as diabetes. Any shoulder problem can lead to frozen shoulder if you do not work to maintain its full range of motion.
Impingement syndrome is a common disorder of the shoulder that refers to an improper alignment of the bones and tissues in the upper arm. Inflammatory conditions such as tendinitis, bursitis, and arthritis are all closely related to impingement syndrome, as are tears to the rotator cuff tendons.
If the rotator cuff becomes inflamed from overuse or there is a bone deformity or spur on the end of the shoulder blade, then the space between the upper arm bone and tip of the shoulder blade is narrowed, causing the rotator cuff and its fluid-filled bursa to be squeezed or pinched. This impingement causes irritation and pain to the rotator cuff when the shoulder is raised.
The rotator cuff is a group of tendons and their related muscles that help keep the shoulder and upper arm bone securely placed in to the socket of the shoulder blade. The rotator cuff stabilizes the shoulder joint and helps you to raise and rotate your arms.
There are three stages of rotator cuff tears:
• A stage 1 tear is a partial tear less than 1 cm in size. It is accompanied by some pain following overhead arm movements, but range of motion is not limited.
• A stage 2 tear is a partial tear greater than 1 cm but less than 5 cm in length. Pain is common during and after overhead arm movements, as well as at night. It may be accompanied by a slight decrease in range of motion.
• A stage 3 tear is a full tear greater than 5 cm in size. Stiffness, weakness, and pain occur during and after overhead arm movements and during sleep. There may be a slight to severe decrease in range of motion in the shoulder.
Degenerative disk disease is a general term applied to back pain that has lasted for more than three months. It is caused by degenerative changes in the intervertebral disks in the spine and can occur anywhere in the spine: low back (lumbar), mid-back (thoracic), or neck (cervical).
Under the age of 30, these disks are normally soft, and they act as cushions for the vertebrae. With age, the material in these lumbar disks becomes less flexible and the disks begin to erode, losing some of their height. As their thickness decreases, their ability to act as a cushion lessens. The less dense cushion now alters the position of the vertebrae and the ligaments that connect them. In some cases, the loss of density can even cause the vertebra to shift their positions. As the vertebrae shift and affect the other bones, the nerves can get caught or pinched and muscle spasms can occur.
Degenerative disk disease is primarily a result of the normal aging process, but it may also occur as a result of trauma, infection, or direct injury to the disk. Heredity and physical fitness may also play a part in the process.
Stenosis refers to a narrowing of the spinal canal, usually in the lower back (lumbar) region. This narrowing is often a result of the normal degenerative aging process. It occurs as the disks of cartilage that separate the spine’s vertebrae lose water and the space between the vertebrae become smaller, causing friction between the bones. The loss of water in the disks makes them less flexible and unable to act as shock absorbers in the spine. Daily wear and tear on the spine becomes more significant without these shock absorbers.
As the disks degenerate, vertebrae may shift, causing the spinal canal to narrow. In some cases, the nerves that travel through the spinal column to the legs become squeezed. This can cause back and leg pain, and even leg weakness. Arthritis and falls also contribute to the narrowing of the spinal canal, compressing the nerves and nerve roots and causing pain and discomfort.
In the low back, nerves join to form the sciatic nerve, which runs down into the leg and controls the leg muscles. Sciatica is a condition that may cause radiating pain, numbness, tingling, and/or muscle weakness in the leg but originates from nerve root impingement in the lower back. Nerve impingement is most often caused by a herniated disk or spinal stenosis.
A strain occurs when a muscle is stretched or torn. A sprain occurs when a ligament is stretched or torn.
Strains are often the result of overuse or improper use of a muscle, while sprains typically occur when a joint is subjected to excessive force or unnatural movements (e.g., sudden twists, turns, or stops). Sprains can be categorized by degree of severity:
• A first-degree sprain stretches the ligament but does not tear it. Symptoms include mild pain with normal movement.
• A second-degree sprain is characterized by a partially torn ligament, significant pain and swelling, restricted movement, and mild to moderate joint instability.
• In a third-degree sprain, the ligament is completely torn with mild to severe pain, swelling, and significant joint instability.
You will be taken to the recovery room and monitored for a period of time. After that you will be taken to a holding room (if in an outpatient surgery center) or to a patient room if you have been or are being admitted to the hospital.
If your operation was in a surgery center, a nurse will review post-operative home care instructions with you, as well as explain any special instructions provided by your surgeon regarding diet, rest, medications, when to follow up with your doctor, and how to use any durable medical equipment such as a sling or crutches your doctor may have ordered.
When you follow up with your doctor, he or she will discuss additional post-operative instructions such as rehabilitation, when stitches may be removed, when you can drive or return to work or school, how long you should use crutches or a sling, how long you should take pain medications, and more.
Your surgeon and anesthesiologist will determine what medications you should stop taking before surgery, when they should be stopped, and when you can resume taking them after surgery.
Most patients will not encounter problems after orthopaedic surgery. As with any surgery, however, there are potential risks, including: reaction to anesthesia, bleeding, infection, blood clots, nerve damage, lack of full range of motion, development of arthritis, scar formation, or re-injury of the joint or soft tissue.
The time you spend in the hospital or surgery center will vary depending upon the type of surgery performed, the type of anesthesia that was given, and your individual needs. If surgery is performed in an outpatient surgery center, most patients are discharged within one to three hours after surgery.
The four main types of anesthesia include general, regional, monitored, and local. The type of anesthesia you will receive is influenced by one or more of the following factors:
• The kind of surgery you are having
• Estimated length and site of the surgical procedure
• Your overall medical condition and health status
• Medications you currently take
• Your surgeon’s preference
With general anesthesia, you are completely asleep and unconscious with total loss of sensation.
In regional anesthesia, the anesthesiology provider injects you with an anesthetic to provide numbness or loss of pain or sensation to the area of the body requiring surgery. The injection is made near a cluster of nerves and is called a nerve block. The most common types are spinal, epidural, or peripheral. You may remain awake and alert or be sedated.
If you are sedated during regional anesthesia, then you receive monitored anesthesia care, also known as MAC sedation or twilight sleep. Monitored anesthesia care involves the administration of drugs to produce sedation and analgesia (insensibility to pain without loss of consciousness). In addition, your surgeon will administer local anesthesia to the operative site.
Local anesthesia is an injection that provides numbness to a small area and is used primarily for minor surgery. It is often administered by the surgeon and does not require the presence of an anesthesiology provider.
You will meet with your anesthesiologist prior to surgery and will have an opportunity to discuss your anesthesia options. Your anesthesiologist will inform you of the advantages, side effects, and possible complications of each. Depending upon the factors above, you may be able to participate in the decision-making and choose which method you prefer.
The length of surgery depends on the procedure being performed, the surgeon, and the method of surgery (e.g., minimally-invasive arthroscopy or a more invasive open incision). Arthroscopy may take anywhere from 45 minutes to a few hours.
Bathe or shower the morning of surgery but do not apply any makeup. Wear low heeled, comfortable shoes and loose, comfortable clothing such as t-shirts, button-down shirts, sweat pants or baggy shorts that will fit over bandages or dressings following surgery. Do not wear contact lenses or jewelry.
Arrive promptly at the time specified by the surgery scheduler. If you are having surgery at an outpatient surgery center, you will usually be asked to arrive one hour before your scheduled surgery. Times may differ if you will be admitted to the hospital prior to surgery. Most pre-operative blood, lab or paper work is preformed prior to the day of your surgery.
Someone from the surgery center or hospital will call you to discuss pre-operative instructions. They usually include the following:
• Do not eat or drink anything, including water, after midnight the day of your surgery. You may brush your teeth, taking care not to swallow any water.
• Follow your doctor’s orders regarding the taking of any medications the night before or the day of your surgery.
• Refrain from smoking after midnight the day of your surgery.
• Notify your surgeon if there is any change in your physical condition, such as a cold, fever or flu symptom.
• If there is a chance you are pregnant, please notify your surgeon immediately.
ACL reconstruction is a surgical procedure that repairs a torn anterior cruciate ligament (ACL), one of the four ligaments that help stabilize the knee. The ligament is reconstructed using a tendon that is passed through the inside of the knee joint and secured to the upper leg bone (femur) and one of the two lower leg bones (tibia).
The tendon used for reconstruction is called a graft and can come from different sources. It is usually taken from the patient’s own patella, hamstring, or quadriceps, or it can come from a cadaver. ACL reconstruction is most often performed through arthroscopic surgery.
Shoulder surgery for rotator cuff problems usually involves one or more of the following procedures: debridement, subacromial decompression, rotator cuff repair.
Debridement clears damaged tissue out of the shoulder joint.
Subacromial decompression involves shaving bone or removing spurs underneath the tip of the shoulder blade (acromion). This creates more room in the space between the end of the shoulder blade and the upper arm bone so that the rotator cuff tendon is not pinched and can glide smoothly.
If the rotator cuff tendon is torn, it is sewn together and reattached to the top of the upper arm bone.
On average, artificial joints have a lifespan of 10 to 20 years. If you are in your 40s or 50s when you have joint replacement surgery, especially if you are very active, you are likely to need another joint replacement surgery later in life.
Joint replacement surgery is performed to replace an arthritic or damaged joint with a new, artificial joint called a prosthesis. The knee and hip are the most commonly replaced joints, although shoulders, elbows and ankles can also be replaced.
Joints contain cartilage, a rubbery material that cushions the ends of bones and facilitates movement. Over time, or if the joint has been injured, the cartilage wears away and the bones of the joint start rubbing together. As bones rub together, bone spurs may form and the joint becomes stiff and painful. Most people have joint replacement surgery when they can no longer control the pain in their hip or knee with medication and other treatments, and the pain is significantly interfering with their lives.
Arthroscopic surgery is one of the most common orthopaedic procedures performed today. Through the use of small instruments and cameras, an orthoapedic surgeon can visualize, diagnose, and treat problems within the joints.
One or more small incisions are made around the joint to be viewed. The surgeon inserts an instrument called an arthoscope into the joint. The arthoscope contains a fiber optic light source and small television camera that allows the surgeon to view the joint on a television monitor and diagnose the problem, determine the extent of injury, and make any necessary repairs. Other instruments may be inserted to help view or repair the tissues inside the joint.
An orthopaedic surgeon is a medical doctor who has received up to 14 years of education in the diagnosis, treatment, rehabilitation, and prevention of injuries and diseases of the musculoskeletal system (bones and joints, muscles, ligaments, tendons, and cartilage).
Some orthopaedic surgeons practice general orthopaedics, while others specialize in treating certain body parts such as the foot and ankle, hand and wrist, spine, knee, shoulder, or hip. Some orthopaedists may also focus on a specific population such as pediatrics, trauma, or sports medicine.
Non-steroidal anti-inflammatory drugs (NSAIDs) are non-prescription, over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen sodium. They are popular treatments for muscular aches and pains, as well as arthritis.
NSAIDs not only relieve pain, but also help to decrease inflammation, prevent blood clots, and reduce fevers. They work by blocking the actions of the cyclooxygenase (COX) enzyme. There are two forms of the COX enzyme. COX-2 is produced when joints are injured or inflamed, which NSAIDS counteract. COX-1 protects the stomach lining from acids and digestive juices and helps the kidneys function properly. This is why side effects of NSAIDs may include nausea, upset stomach, ulcers, or improper kidney function.
An epidural is a potent steroid injection that helps decrease the inflammation of compressed spinal nerves to relieve pain in the back, neck, arms or legs. Cortisone is injected directly into the spinal canal for pain relief from conditions such as herniated disks, spinal stenosis, or radiculopathy. Some patients may need only one injection, but it usually takes two or three injections, given two weeks apart, to provide significant pain relief.
Cortisone is a steroid that is produced naturally in the body. Synthetically-produced cortisone can also be injected into soft tissues and joints to help decrease inflammation. While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopaedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendinitis, and arthritis.
A tendon is a band of tissue that connects muscle to bone. A ligament is an elastic band of tissue that connects bone to bone and provides stability to the joint. Cartilage is a soft, gel-like padding between bones that protects joints and facilitates movement.
Physical therapy is the treatment of musculoskeletal and neurological injuries to promote a return to function and independent living. Physical therapy incorporates both exercise and functional training. Exercise restores motion and strength while functional training facilitates a return to daily activities, work, or sport.
Ice should be used in the acute stage of an injury (within the first 24-48 hours), or whenever there is swelling. Ice helps to reduce inflammation by decreasing blood flow to the area in which cold is applied. Heat increases blood flow and may promote pain relief after swelling subsides. Heat may also be used to warm up muscles prior to exercise or physical therapy.
X-rays are a type of radiation, and when they pass through the body, dense objects such as bone block the radiation and appear white on the x-ray film, while less dense tissues appear gray and are difficult to see. X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors.
Organs and tissues within the body contain magnetic properties. MRI, or magnetic resonance imaging, combines a powerful magnet with radio waves (instead of x-rays) and a computer to manipulate these magnetic elements and create highly detailed images of structures in the body. Images are viewed as cross sections or “slices” of the body part being scanned. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone and joint problems.
A computed tomography (CT) scan (also known as CAT scan) is similar to an MRI in the detail and quality of image it produces, yet the CT scan is actually a sophisticated, powerful x-ray that takes 360-degree pictures of internal organs, the spine, and vertebrae. By combining x-rays and a computer, a CT scan, like an MRI, produces cross-sectional views of the body part being scanned. In many cases, a contrast dye is injected into the blood to make the structures more visible. CT scans show the bones of the spine much better than MRI, so they are more useful in diagnosing conditions affecting the vertebrae and other bones of the spine.